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THE
L O N D O N
MEDICAL AND SURGICAL
« > • j/v * •
JOURNAL;-
CONTAINING
REVIEWS OF ALL NEW WORKS, ORIGINAL COMMUNICATIONS, AND EXTRACTS FROM ALL THE MEDICAL PERIODICALS, DOMESTIC AND FOREIGN.
EDITED BY
V
MICHAEL RYAN, M. D.
A
%
Queer ere Verum. Horace.
VOL. VI.
FROM JANUARY TO JULY, 1831.
LONDON:
PUBLISHED BY RENSHAW AND RUSH,
356, STRAND, NEAR EXETER HALL.
1831.
fiUTHRIK,
i%m\ ,
LONDON t
15, SHOE LANE, FLEET STRKKt .
THE LONDON
MEDICAL AND SURGICAL JOURNAL.
No. 31. JANUARY 1, 1831. Vol. VI.
CRITICAL REVIEW.
I. — Dublin Hospital Reports and Communications in Medicine and Surgery „ Vol. V. 1830. — {continued. )
In accordance with our promise, we resume our analysis of the truly valuable clinical report of Drs. Graves and Stokes, which from its great length, and still greater im¬ portance, deserves the fullest notice and the most serious consideration. The remaining part is divided into two sec¬ tions ; 1, on Diseases of the Respiratory Organs ; 2, on Diseases of the Abdominal Viscera. It is difficult to speak of either in sufficient terms of praise, on account of the great ability evinced in the descriptions of disease, in the progno¬ sis, diagnosis, treatment and comments.' Suffice it to say, we have seldom perused a report so ably drawn up, and so ex¬ ceedingly interesting, both in a theoretical and practical point of view. Every page of it is replete with important informa¬ tion. It is therefore obvious that our notice of it must ne¬ cessarily be a lengthened one. Our authors commence their details of “Diseases of the Respiratory Organs” inthe follow¬ ing words : —
The most frequent diseases of the respiratory organs, which we have met with during the last year, were acute inflammations af¬ fecting either the pulmonary tissue, or the bronchial mucous mem¬ brane alone. Simple pleuritis, as far as our observations have gone, appears to be a very rare disease in Dublin. On this disease, how¬ ever, we shall presently offer some observations.
“ The plan of treatment which we have found of the greatest effi¬ cacy, in combating simple pneumonia, is the use of the lancet and the exhibition of the tartar emetic in full doses. As this latter forms a mode of treatment not yet extensively adopted in these countries, we shall put our experience of it on record.
“ The following is the common formula we have adopted. vol. vr. no. 31.
B
2
Critical Review.
Ik Tart, antimon. gr. vi. Aq. cinnamomi. Biv. Syrupi, mucila- ginis, a a Bh Tinctur. opii. acet. gs. xii. Of this half an ounce is given every hour, or oftener if necessary.
“ The cases in which this treatment is most applicable, are those where the disease is in the early stages, where it occurs in strong constitutions, and lastly, where there is absence of gastric symptoms. This is a point of great importance, and we shall refer to it presently.
“ It is during the existence of the first stage of the pneumonia, while the crepitating rale is heard most distinctly, and before the affected portion of the lung sounds dull on percussion, that we find the remedy to answer best : six grains are generally administered the first day, and the dose is increased by two or three grains daily, until fifteen grains are exhibited in the twenty-four hours. Beyond this dose we have never found it necessary to go ; but we have been able to persist in the exhibition of the remedy at this rate for many days, and with the best effects.
*• The cases in which we have found it necessary to continue this treatment longest, are those in which an acute pneumonia has super¬ vened on a chronic catarrh. In one case of this kind in which the pneumonia was double, one hundred and eighty grains of the tartar emetic were exhibited at the rate of twelve grains daily. In this case the tolerance of the remedy was completely established after the second or third day. Indeed, towards the termination of the disease, the patient’s appetite was excellent, although he was taking the rate mentioned. This we have often seen in other cases, a fact already observed by Lsennec.
“ We have very seldom observed abdominal irritation to follow the exhibition of the remedy, even where large quantities have been taken. In a few cases after the subsidence of the pulmonary disease, colicky pains occurred, but these almost constantly yielded to stuping, mild laxatives, and opiates. In one case, however, they were so se¬ vere as to require blood-letting ; the blood was cupped and buffed, and the patient recovered perfectly.” — p. 52.
The testimony of two such able physicians as Drs. Graves and Stokes, in favour of a plan of treatment as yet scarcely tried in these countries, must convince the most timid prac¬ titioner of its perfect safety and great value. Our authors combine the old and new plan of treatment, and thus differ from the continental writers who exclude the former, and solely rely upon the latter. Many eminent physicians have attested the efficacy of tartarized antimony in large doses in pneu¬ monia ; among whom were Lcennec, Dumangin, Hellis, Ra- sori, who revived it. Martinet, Dance, &c. and in this country Drs. Smith and Tweedie, of the London Fever Hospital. In our 4th vol. p. 147, will be found a memoir on the use of large doses of tartarized antimony, in acute articular rheu¬ matism, by M. Dance. In this report, we find the medicine was given in doses from four to eight grains, every hour or
The Dublin Hospital Reports.
3
every other hour, and continued from the period of eight days to two months. It produced great irritability of the di¬ gestive organs, cholera morbus, violent vomiting, tormina, colic, and upon the whole, was seldom borne in such large doses. We throw out these hints, lest some of our readers might be disposed to urge the remedy much further than the authors before us. The following interesting case, with its comments, shews the value of antimony, and also the differ¬ ence of opinion between our authors and Lsennec: —
“ Hepatization of the lung. Absence of many of the symptoms of
Pneumonia. Abdominal inflammation supervening during the use of
tartar emetic in large doses. Cure.
Steward Bowles, aged 17, of a strong habit. This patient was ad¬ mitted on the 1 7th of March, 1829. His illness commenced three weeks previously with chilliness, followed by anorexia, pains in the shoulders, and a stitch in the left breast. He had a trifling cough in the morning and evening, followed by yellow mucous expectoration.
“ On admission the pulse was full ; he had a slight cough, but no li- vidity of the face, and scarcely any acceleration of breathing : indeed from his external symptoms it was impossible to conclude that he had any serious affection of the lung.
“ On examination with the stethoscope, however, we detected a complete hepatization of the inferior lobe of the left lung. In the remaining portions of the chest, the respiration was puerile. He was bled generally and locally, and put on the use of six grains of the tar¬ tar emetic daily. The blood was not inflammatory, and next morn¬ ing all external symptoms of disease had wholly disappeared. He had no pain ; respirations sixteen in the minute ; the cough had ceased, and the pulse had become small and regular. The patient expressed himself perfectly well : there was, however, no change in the stethoscopic phenomena.
“ The tartar emetic was continued for four days in the doses of eight grains daily, which produced constant nausea. It was then omitted, on account of the supervention of violent vomiting, diarrhoea, and pain in the abdomen. These symptoms subsided under the use of a mix¬ ture of castor oil, mucilage, and opium ; the side was blistered. The sound, on percussion, became clearer, and there was some return of the natural respiratory murmur, anterior and latterly, but the bron¬ chial respiration posteriorly became much louder, and continued so for some time before its ultimate subsidence. No crepitus of resolu¬ tion was observed. In two days the abdominal symptoms returned with violence. Bleeding was had recourse to with relief ; the blood was now inflammatory. Resolution of the hepatization went on ra¬ pidly, and the patient speedily recovered. But in cases where from the commencement, symptoms of gastro- enteritis and pneumo&ia
4
Critical Review .
co-exist, we withhold the tartar emetic, as we have found that its ex¬ hibition under these circumstances is always improper. In the few cases which have resisted the remedy, wTe have found disease of the alimentary canal, particularly ulcerations of the small intestines. To¬ lerance in these cases is with difficulty established, and the remedy does not appear to have nearly the same influence on the disease. We cannot then subscribe to the opinion of Laennec, who believed, that the existence of gastro enteritis is not a contra-indication to the employment of the remedy. In such cases we rely upon general and local bleeding ; and frequently we have, by means of a free applica¬ tion of leeches to the belly, removed the gastric symptoms, and then commenced the use of the tartar emetic with safety.
‘ ‘ With respect to blood-letting in pneumonia we rely more on it as a means of combating the inflammation than Lsennec appears to have done. Except in cases of pneumonia combined with hypertro¬ phy of the heart, he considered bleeding more as a mode of prepar¬ ing the patient for the exhibition of tartar emetic, than as calculated directly to remove the disease. We consider, on the contrary, gene¬ ral and local bleeding to be of primary importance, while the tartar emetic is a very useful adjuvant. Thus, on any sudden exacerbation of the disease, we do not trust to increasing the dose of the remedy, but have at once recourse to general or local bleeding, as the case may be ; and we may here remark, that in the treatment of acute bronchitis and pneumonia, when occurring in the adult, local bleeding has been too little practised in this country.
“ In some cases we find that the first dose of the remedy makes the patient vomit freely, yet after a few more doses, the medicine is borne well. But in the greatest number of cases a state of slight nausea, without vomiting, is kept up, and continues for several days, and in¬ deed as long as the remedy is administered.
“ Sometimes we have found both vomiting and purging to follow at first, but to subside after twenty-four hours. Diaphoresis is a rare effect, and we have often witnessed cases where the patient was taking from ten to twelve grains of the medicine daily, without vomiting, purging, or sweating ; so that no effect could be observed, except a gradual reduction of the symptoms, and stethoscopic phenomena.
“ We generallyfind, in cases of simple pneumonia, when the disease is confined to the lower portion of one lung, that when we commence with the exhibition of six grains in the day, and increase this at the rate of a grain daily, we are able either to omit the remedy, or begin to dimi¬ nish it in the course of four or five days. W e seldom omit it suddenly, as more than once, a severe relapse has followed this practice.” — p. 56.
There are two other remedies of great value, in removingpneu- monic inflammation'in the opinion of our authors; tartar emetic and the combination of mercury with opium. In pure pneu¬ monia with inflammatory fever in full robust habits, the first remedy is to be preferred. In cases complicated with abdo¬ minal disease, low fever and great prostration of the powers
The Dublin Hospital Reports.
5
of life, the active use of calomel and opium, so as to affect the gums, followed by the use of polygala and other stimu¬ lants have succeeded in the most remarkable manner.
<f Where circumscribed hepatization of the lung has taken place previously to the patient’s being admitted into hospital, we have found the mercurial plan assisted by local bleeding, and the use of blisters, to be the means best calculated to remove the disease. Under this treatment we have seen extensive solidifications of the lung resolve with great rapidity. Indeed it appears that after the disease has passed the first stage, the tartar emetic loses much of its efficacy.” — p. 57.
“ In many cases of pneumonia, with great dyspnoea and lividity of countenance, we have observed great improvement in the general symptoms to follow venesection and the exhibition of tartar emetic ; but on the following day no improvement in the portion of lung, principally engaged, was discovered by the stethoscope. These were all cases of partial pneumonia, with general bronchitis, and the improvement wras owing to the beneficial influence of the reme¬ dies on the latter disease, while the patient, although greatly relieved, was still in considerable danger, a fact of which it is necessary to be aware in the treatment of pulmonary inflammation.
“ It is stated by Lasnnec, that in all cases of pneumonia the bronchial mucous membrane is necessarily engaged in the affected portion of the lung. We believe that this is generally true, but we have met with one remarkable exception to this law. A woman, aged thirty, was admitted labouring under the usual symptoms of acute pneumonia. The stethoscope indicated commencing hepati¬ zation of the inferior portion of the right lung ; notwithstanding very active treatment, she died on the seventh day of her illness. On dissection we found the lower lobe of the left lung nearly in a state of red hepatization, with effusion of lymph on the corres¬ ponding portion of the pleura. The bronchial mucous membrane in the whole of the left lung, and in the superior portion of the right, was inflamed, and the tubes filled with mucus, these parts of the lung being crepitating and free from engorgement, while in the hepa- tized portion the mucous membrane was perfectly white, and pre¬ sented no mark whatever of disease-” — p. 59.
In the case of Bowles it will be observed, that two inter¬ esting stethoscopic points appeared ; 1, the disappearance of the phenomena of hepatization without the occurrence of the crepitus of resolution ; and this our authors have fre¬ quently observed, especially when the solidification has been recent, but where it is chronic, they regard it as a rare phe¬ nomenon : 2, the increase of bronchial respiration is not an infallible sign of an extension of solidification. In this case it was a sign of diminution of disease.
6
Critical Review.
The next disease noticed is pleuritis, two cases of which were admitted into the clinical wards of Sir P. Dun’s hospi¬ tals, under the care of Dr. Osborne ; all the symptoms of effu¬ sion into the chest were present, and seemed to warrant the operation of paracentesis of the chest, had not the operation been contra-indicated by bronchial respiration, from which it was inferred, that there was adhesion between the costal and pulmonary pleuree. The appearances on dissection most sa¬ tisfactorily bore out the diagnosis.
“ A somewhat similar remark may be made with respect to the sonorous rale, as an indication of the existence of bronchial in¬ flammation. In several cases of the worst catarrhal fevers, when the patient was in a semi-comatose state, the skin covered with petechise, the face livid, but the respiration not much hurried ; nothing is often observable by the stethoscope when applied during ordinary respiration, except that the respiratory murmur is very feeble, or mixed with a very slight sonorous or mucous rale. On the patient, however, making a deep inspiration, an intensely loud sonorous rale becomes immediately audible, appearing to indicate that the smaller ramifications of the bronchial tubes were, in con¬ sequence of the inflammatory turgescence of their mucous lining, impermeable to air during ordinary respiration. Now we often observed, that when these patients began to convalesce, the sonor¬ ous rale was loudly audible during ordinary respiration, a circum¬ stance obviously owing to a decrease in the intensity of the inflam¬ mation.
“ A great number of cases of catarrhal fever, with and without typhoid symptoms, were admitted during this year. The cases which did best, were those where the fever was inflammatory, and in which blood-letting and tartar emetic were exhibited from the outset. Several of these patients recovered rapidly, without the disease passing into the second or more chronic stage in which the mucous rale becomes the pathognomonic sign. In others, after the use of these means for some time, they appeared to lose all efficacy ; the expectoration became copious, and an extensive mu¬ cous rale was generally audible. At this period the change from the antiphlogistic to the stimulating plan of treatment was often followed by a rapid cure. The decoction of seneka, with the ad¬ dition of carbonate of ammonia, camphorated tincture of opium, and some preparation of squill, was the remedy most commonly used, in addition to which the regimen of the patient was improved. But the mere fact of the disease having passed into the second stage does not appear in every case to warrant the propriety of the stimulating plan from the commencement of our treatment. We have observed some cases where bad effects followed this prac¬ tice, and have come to a conclusion, which appears to us to be of practical importance, that to render the stimulating plan of treat¬ ment decidedly successful, it will be frequently advisable to precede
The Dublin Hospital Reports.
7
it by the antiphlogistic, to prepare the patient for the exhibition of stimulants. The disease then yields rapidly, and this is another example of the pathological analogy of the disease of mucous membranes and of the skin.
“ The chloride of lime has been administered by us in a case of pectoral disease, with great fcetor of breath and expectoration, with remarkable benefit. The patient, in a fit of intoxication, lay naked on a stone floor for the whole of a night, and next morning had a severe pain in the side on which he lay, followed by other symptoms of an inflammatory alfection of the lungs. In the course of two days his breath and expectoration became foetid, and after some time he was admitted into our wards in a state of extreme debility, with hectic fever, cough, with foetid expectoration*, foetor of the breath, and hippocratic countenance.
“ It was determined to try the effect of the chloride of lime ; a pill containing three grains of the salt and one of opium, was ad¬ ministered three times a day, and in the course of three days the quantity was increased to twelve grains daily ; a small quantity of wine was also allowed.
<£ The most rapid and marked amendment followed this treat¬ ment : in a few days the foetor of breath and expectoration had disappeared ; no inconvenience whatever was experienced from the remedy ; we also directed the covering of the bed to be sprinkled with a solution of the salt ; the remedy was then omitted ; in two days the foetor returned, and fever began to appear ; but these symptoms again subsided with rapidity, on our resuming the em¬ ployment of the remedy. The patient was ultimately discharged, greatly improved in strength and flesh ; he, however, sometime afterwards relapsed, and died in the country.” — p. 64.
“ A very strong and uninterrupted adhesion extended from about two inches below the clavicle of the affected side, in a line passing through the middle of the mammary region, nearly to the bottom of the anterior part of the lung.
“ This adhesion, about two inches in breadth, was very firm and close, so as to form an intimate union between the pulmonary sub¬ stance and the anterior parietes of the chest, and extending nearly from the apex of the lung to its base. Along this line the pulmo¬ nary tissue formed a plate of compressed lung, about two inches in thickness, which, like a verticle partition, divided the pleural cavity into two chambers, each filled with sero-purulent matter, and sepa¬ rated by the lung extending from its root to its anterior adhesions.
<£ It is to be observed that these two cavities communicated to¬ wards the clavicle, where the adhesion was wanting, and were still further divided by other adhesions posteriorly, extending up¬ wards from the root of the lung to the superior lobe.
“ The lung forming these different partitions was red, com¬ pressed, and totally destitute of crepitus. The air cells were ren¬ dered impermeable by the pressure of the pleuritic effusion, but the bronchial tubes were not obliterated, and could easily be traced to within a line or two of the parietes of the chest.
8
Critical Review.
<{ We have stated that in no part of the affected side was there an absolute nullity of sound during respiration. This may be ac¬ counted for by the great extent and intimate connexion of the adhesion with the parietes of the chest, which not only made the bronchial respiration audible in the parts immediately over them, but by means of the ribs communicated the sound to parts even remote from the adhesion itself.
“ In both patients there was severe cough and puriform expecto¬ ration ; and the bronchial mucous membrane was accordingly found in an intense state of inflammation. In one of the patients, nature had attempted the evacuation of the fluid by means of ulcerations, which in several places had perforated the pleura and intercostal muscles, and formed sinuous passages into the sub-cutaneous cel¬ lular structure.” — p. 68.
The diagnosis in this case proves the great value of auscul¬ tation, and ought to convince the most sceptical of its utility. A curious fact is attested in the next paragraph, that in pleu¬ risy the superjacent integuments often become tender, swol¬ len and cedematous at the very commencement of the disease, in consequence of the inflammation spreading to .those parts ; and a similar occurrence has been often remarked in cases of hepatic abscess. It is thus that a careful examination of the integuments, sometimes reveals the suppuration of organs in the subjacent cavities.
In the employment of percussion, our reporters confirm the observations of others, that the patient experiences much more pain on the diseased than on the affected side ; this they observed in acute pleurisy and tubercular consumption. A curious fact, and one hitherto unobserved, is related, that in some cases in which percussion had been employed, after each stroke of the ends of the fingers, a number of little tu¬ mours appeared, answering exactly to the number and situa¬ tion of the points of the fingers, where they had struck the integuments of the chest. These having continued visible for a few moments, subsided, but could be again made to appear on repeating the percussion. In such cases the per¬ cussion produced a good deal of pain, and the tumours were most apparent in the subclavian region and over the great pectoral muscle. This appearance is ascribed to the con¬ traction of the muscular fibres in consequence of the irrita¬ tion of the blow. The following remarks on percussion are worthy of recollection, as they afford evidence, which proves the received opinion of the operation is liable to exception.
With reference to the value of percussion, we may remark, that the dulness of sound on percussion is by no means constantly proportioned to the extent of pulmonary disease. Thus in a patient
The Dublin Hospital Reports.
9
"who died of pneumonia, a great portion of both lungs was found inflamed, and the inferior lobes approached to hepatization, yet during life the sound on percussion had appeared to us clear, a circumstance explained by the remarkable fact, that the greater portion of the surface of the lungs had escaped disease.
“We have also observed several cases of phthisis, in which, during life, the chest sounded every where well, and yet upon dissection the lungs were found almost solid from general tubercular developement.” — p. 76.
The next disease described is one of a formidable nature, which has been very superficially noticed by writers in these countries, namely, laryngitis. A considerable number of cases in the chronic state were treated by our authors, some pro¬ duced by cold, many occurred in persons tainted with syphilis, and these were the most obstinate and distressing. In some there was spasm of the glottis, in others disease of the lungs. In the latter the stethoscopic phenomena were sin modified.
“ Thus, where the obstruction is so great as to cause the respi¬ ration to be long and painful, the expansion of the air cells is often quite inaudible. We recollect once examining a patient, labouring under laryngitis, in the Meath Hospital, in whom the obstruction was so great as to require the operation of tracheotomy. Previously to the operation, the chest sounded clear, but the respira tory murmur was extremely feeble, so that the stethoscopic pheno¬ mena closely resembled those of emphysema of the lungs. When, however, a free opening had been made in the trachea, the respira¬ tory murmur became at once puerile, and did not subside to the natural intensity for some hours.
“ A knowledge of this fact is of great practical importance in investigating the state of the lungs in persons labouring under chronic laryngitis, an inquiry which ought never to be omitted, on account of the frequent occurrence of tubercles in persons afflicted with this disease ; for it will appear presently that mercury, one of the most efficacious remedies in simple laryngitis, is inapplicable in these complicated cases. In fact, it is scarcely credible how far the existence of laryngeal obstruction tends to mask all the stethosco¬ pic phenomena, even in cases of extensive pulmonary disease. Thus we have seen several cases of phthisis, in which extensive excavations and numerous tubercles were found in the lungs on dissection, and yet during life no unequivocal evidence of this state of the lungs had been derived from the use of the stethoscope. The extreme weakness, and altered tone of the voice in this disease, deprives us of the assistance which the discovery of bronchophony or pectoriloquism wrould give in forming our diagnosis, and the protracted and gradual inspiration either prevents or renders very indistinct
V OL. vi. no. 31 .
gularly
c
10
Critical Review.
the valuable phenomena of crepitation, gargouillement, cavernous, bronchial, and peurile respiration ; under these circumstances, the general symptoms and percussion are our only guides, and we have already seen how uncertain both these are.” — p. 81.
We are informed that the chief diagnostic symptom in chro¬ nic laryngitis, is hoarseness increased by exertion of voice ; but this symptom may continue for years as we have repeatedly witnessed in persons, and perfect health. The treatment re¬ commended is of course extremely judicious.
“ The most efficacious treatment consists in enjoining silence, a point that cannot be too strongly insisted on ; next to this in value, is the frequent application of a few leeches to the region of the larynx ; we have also seen much benefit follow the exhibition of mercury, so as to affect the gums slightly. When we wish to employ counter -irritation, we prefer the tartar emetic ointment to the employment of blisters. It should never be forgotten that this disease is extremely liable to recur, to prevent which we have, in ad¬ dition to the usual means, recommended the habitual use of cold washing of the throat night and morning. In chronic laryngitis, the state of the fauces and pharynx should always be investigated, as in many cases, where no soreness of these parts is complained of, we have found, on inspection, that numerous small, irregular, and superficial excoriations, (if we may so term them) bounded by red lines, and of a greyish colour, occupied the upper portion of the pharynx; and we have strong reasons for thinking that the dis¬ ease of the laryngeal membrane is of a similar nature, and has been propagated from the pharynx, in the same way that acute laryngitis not unfrequently originates in pharyngeal inflammation.
“ The repeated application of a strong solution of the nitrate of silver, ten grains to the ounce, by means of a camel hair pencil, to the parts within our reach, proves very serviceable ; after a slight alterative course of mercury, the use of the compound decoction of sarsaparilla, and the general tonic plan of treatment, will be found most useful in such cases.
“ This complaint is much more obstinate and intractable, where it occurs in persons who have used large quantities of mercury for the cure of syphilis. In such broken down constitutions relapses are of frequent occurrence, and the disease very apt to terminate in ulceration of the cartilages. A nutritive diet, a seton in the neighbourhood of the affected part, the decoction of sarsaparilla, with the cautious use of corrosive sublimate or arsenic, the applica¬ tion of the nitrate of silver to the pharynx and rima glottidis, by means of lint moistened in the solution already recommended, and mercurial inhalations, have in some cases succeeded in removing the disease ; although the inflammation may have subsisted for a con¬ siderable time, the occasional application of leeches should not be nc , ,€d, particularly on any exacerbation of the complaint.
The Dublin Hospital Reports. 11
“ When a decided phthisical tendency accompanies chronic laryngitis, the case is generally hopeless.
“ The application of belladonna plaster, or of one made of Scotch snuff, as recommended by an American professor, to the region of the larynx during the spasmodic exacerbations, has been found by us of great utility. In many of our cases these attacks of spasms frequently supervened, producing terrible difficulty of breathing, which we have often found to yield with rapidity to the pediluvium, and the exhibition of an antispasmodic draught, consist¬ ing of the ammoniated tincture of valerian, ether, and opium. We cannot help suspecting that in chronic laryngitis, the operation of tracheotomy is sometimes unnecessarily performed, and that the imme¬ diately distressing symptoms would frequently yield to this prac¬ tice.’" — p. 84.
The last case mentioned is one of peculiar interest.
“ A man about forty years of age died of tubercular phthisis.
“ The oesophagus, after passing through the usual opening in the diaphragm, was found to re-enter the thorax by another very large opening in the tendinous portion towards the left side. The sto¬ mach occupied the inferior portion of the left thoracic cavity, its cardiac and pyloric extremities, both lying in the opening.
“ A considerable portion of the transverse arch of the colon was also included in the left side of the chest ; these viscera loosely, but permanently fixed by means of the serous membranes, all rested on the convex surface of the diaphragm, and pushed the heart and mediastinum towards the right side. The margin of the unnatural opening in the tendinous portion of the diaphragm was formed by a round tendinous cord about the thickness of a quill,, which addad greatly to its strength, and was evidently of very ancient formation. The lungs, small and tuberculated, did not exhibit any signs of compression, and was not adherent to the abdominal viscera. It may be easily conceived that the left pleural cavity was continuous with the cavity of the peritoneum, and both were lined by the one serous membrane.
“ This case is pregnant with interest ; we observe in the adult a new cause of displacement of the heart, and a new source of difficulty in stethoscopic ex amination ; for it is quite evident that auscultation applied to the left side of the thorax would have fur¬ nished very fallacious information, and the sounds heard would have varied according as the stomach and colon were full or empty, &c. The same observation applies also to percussion ; and the fact is, that during the life of this patient, those who examined his chest could not reconcile the phenomena afforded by auscultation or per¬ cussion with those of any known disease of the chest- The respi¬ ration was heard every where, except inferiorly and anteriorly on the left side, and here percussion gave a clearer sound than natural. No rale was audible in this part of the chest, but borborygmi and sounds resembling those produced by the motion of fluids in the intestines were observed.
12
Critical Review.
“ This man vomited frequently while under observation in the hospital ; now as the stomach was placed entirely out of the reach of being compressed by the contractions of the diaphragm, and as this contraction completely defended it from the influence of the abdominal muscles, it is clear that in this case vomiting must have occurred independently of compression, either of the diaphragm or abdominal muscles. This fact, worth a thousand experiments, completely decides the question, that vomiting may be produced by the action of the stomach itself, unassisted by any external com¬ pressing force, notwithstanding what Le Gallois and late physiolo¬ gists have said to the contrary.”- — p. 87.
The second part of this report on abdominal disease,, we shall notice in our bibliographical department.
Though it is our intention to notice all the papers in the valuable work before us, we are inclined to place two in¬ teresting and instructive reports of the different new obste¬ tric institutions of the Irish metropolis before our readers. The first is entitled., Report of the Wellesley Female Institution, by Samuel Cusack, M. B. the second, “ Re¬ port of the Coombe Lying-in Hospital, by Richard Reed Gregory, M. R. C. S. Dublin.” The pleasure and satisfaction which we have derived from the perusal of these documents, induce us to place them thus early before our readers. Another motive influences us to do so, and which is, that these are new and rival institutions, and though on a com¬ paratively small scale, when compared to the extensive Lying-in Hospital of Dublin, their usefulness* and the excellence of the practice pursued in them, are candidly sub¬ mitted to the profession, while the practice at present employed in the latter has not as yet been recorded. For the information of our readers in this section of the empire, on the European Continent, and in America, we deem it proper to make a few remarks on the support and manage¬ ment of the large obstetric hospital of Dublin. In doing so, wTe must premise, that we neither directly, nor indirectly, allude to its present medical officers. This institution is the largest in Europe, except that of Vienna ; it is a magnificent building, partly supported by an annual parliamentary grant, and by voluntary subscriptions. It affords relief to more than two thousand women annually. Its medical officers are, a master and two assistants, all physicians ; it has also its surgeons. The master is elected every seven years, and generally by interest ; talent and merit are not recommen¬ dations. He goes out every seven years, and his income is
The Dublin Hospital Reports .
13
estimated at about £.2,000 a-year. The, assistants pay £.250 each for their appointment, though of late years they have evinced much more talent and scientific attainments than some of their principals. Nothing can be worse than the farsical mode of election. Physicians have been appointed masters, whose abilities were the most slender — whose names were unknown beyond the precints of the Irish capital ; and who, in candid truth and justice, had no claim whatever to appointment. The consequence has been, that their lec¬ tures and principles were far below those of their contem¬ poraries. If proof were required of the truth of this state¬ ment, wre need only refer to the fact, that the perforator has been preferred to the forceps ; nay, that the forceps was condemned as a useless instrument. This will appear by the able and valuable defence of the latter by Dr. Beatty, a gentleman of great eminence, and a former assistant to the institution, whose opinions we shall insert in a subsequent article. Indeed, we can give our personal testimony in sup¬ port of our statement. Another serious defect in the insti¬ tution was, the great fee demanded of students for attend¬ ance ; namely, twenty guineas for extern, and thirty as intern pupils for six months. Without wishing to institute an invidious comparison between this and the new hospitals, which have given rise to these observations, we can fairly observe, that the defects of the former do not exist in the latter ; and moreover that the principles and practice incul¬ cated in the new institutions, more accord with the received views of the profession. In these remarks, we do not for¬ get the valuable papers of Drs. Beatty, Johnston, Breen, AFKeever, Douglas, Fergusson, and Kenedy ; but all these writers were assistants ; and what, let us enquire, has been done by the masters, since the time of Dr. Clarke ? Why is there not an annual report published ? Why are not the vast opportunities of this great establishment rendered sub¬ servient to the promotion of science ? The answer is suf¬ ficiently obvious ; because the masters are appointed without any proof of their qualifications, and because they must retire at the expiration of seven years, when they have acquired experience, which, instead of being useful to the interests of the poor, or of the students, is henceforth to be valuable to the affluent. Such being a fair sketch of this magnificent institution, we need scarcely observe, that it affords us great pleasure to witness the establishment of others, with infinitely more claim upon the notice of the profession and the public. Of the present medical officers of any of these hospitals we know nothing, except by their contri-
14
Critical Review.
butions to science, and to all we say, amicus Socrates, amicus Plato, sed magis arnica scientia.” Having1 premised thus much, we hasten to insert the details of the reports which led us into this exposition ; and have to observe, that these papers are highly creditable to their authors. The principles and practice maintained in them, are those of the most eminent obstetric writers. Dr. Cusack’s gra¬ phic and comprehensive report claims great attention, both from its extent, and the great variety of practical informa¬ tion with which it abounds. Mr. Gregory’s report contains some points of great interest. It is impossible to abridge the former, so that, we must give it in detail, as it attests very practical points of considerable importance. The only point in it which may be doubted, is the author’s reluctance in admitting the efficacy of the ergot of rye. He has not condemned it without a trial, and justly observes that its failure ought to be ascribed to the careless .and improper manner in which it is preserved by druggists. He should, however, have borne in mind, that as yet it has no place in the British pharmacopoeias ; and consequently that nine- tenths of medical practitioners, and nearly all its venders, are perfectly ignorant of its physical and chemical proper¬ ties, and of the best mode of preserving it. We have tried in numerous cases, and have never known it to fail when properly preserved ; we have no hesitation in declaring, from extensive personal observation, that we have never kn own it fail to produce its effects when properly preserved, when judiciously administered ; it certainly cannot perform impossibilities, and hence the outcry raised against it by many recent writers, who were so simple as to expect that it ought to effect delivery in cases of deformed pelvis. Besides it, in common with all medicines — can never be procured in a genuine form from the ordinary venders, whose calling is a trade, and not a profession.
Dr. Cusack proceeds as follows : —
“ The number of labour cases attended since the opening of the in* stitution up to the 31st of December, 1828, amounts to 398: of those cases three required instrumental aid for their completion ; one the forceps, two the perforator. Amongst the cases of preternatural labour, which amounted to twelve, there were four cases of presen¬ tation of the upper extremities, and eight of the breech and lower extremities.
“ The cases of presentation of the upper extremities (in all of which turning was performed,) had uniformly favourable terminations, as far as related to the mother. In two cases, however, the child was
The Dublin Hospital Reports.
15
not born alive ; in one the funis protruded with the arm ; in the other the mother had alternately borne dead and living children, and for some days previous to the accession of labour, had not felt any mo¬ tion of the child. > In three of those cases turning was performed with facility ; in the fourth, on introducing the hand, uterine action came on so violently, that it was considered expedient to withdraw the hand. On administering 120 drops of tincture of opium in di¬ vided doses, the operation was performed with facility.
“ The cases in which the inferior parts of the body presented were also favourable in their issue as far as the mother was concerned. The only cases in which the children were not saved, were those in which the head had been jammed in the pelvis by ill directed attempts at extraction previous to application for assistance from the dispen¬ sary. These , cases were almost entirely left to themselves, till the breech was expelled, when the usual attention was paid (when re¬ quired) to insure that the face of the child should be turned towards the sacrum of the mother, and after the extraction of the arms the chin was depressed by placing the finger in the mouth of the child in the usual manner, so as to give the head the direction of the axis of the pelvis, and to cause the biparietal, instead of the occipito-mental, to be the moving diameter. In one case, in which the foot rested against the perinceum, and the thighs were forced down so as to be impacted to a certain degree in the vagina ; the feet were extracted gently as far as the ankles, and the case was then left to the efforts of nature.
“ Two face cases were not interfered writh, and the labours, al¬ though tedious, terminated favourably both with mother and child.
“ In five cases the funis was protruded. In some of these cases the pulsation had ceased previous to application for assistance; in the others none of the means recommended in such cases for the preserva¬ tion of the child appeared admissible. Of six cases of puerperal con¬ vulsions, two occurred between the fifth and eighth month ; in one the fits were always induced by constipation of the bowels, and after this cause was removed, did not re-appear. One case occurred after parturition; the cause was similar to that of the preceding case. The patient recovered under the employment of venesection, and pur¬ gatives ; of the remaining cases of convulsions, all of which occurred during labour, one patient was delivered by turning, during which operation the fits were suspended, but recommenced after delivery, and carried the patient off. Another was delivered by the crotchet, wrho recovered from the convulsions, but subsequently died of perito¬ nitis. In another case (a first pregnancy) the convulsions appeared at the commencement of labour, the membranes were ruptured by the finger, twenty ounces of blood taken from the temporal artery, cold applied to the head, and injections and purgatives administered. The fits however continuing, the forceps were applied when the head was sufficiently low, and mother and child were both saved.
“ The convulsions appeared in one instance about twelve hours after the birth of the first twin, the woman having been improperly
16
Critical Review.
allowed to remain undelivered of the second all that time. The for¬ ceps were promptly applied, and the second child extracted without difficulty, but dead. In this case, instead of the patient being coma¬ tose between the fits, she exhibited all the symptoms of delirium fe- rox, the birth of the second child not seeming to have any effect on her condition, but after the extraction of the placenta she became per¬ fectly tranquil, and the fits did not again appear.
“ The opinion generally entertained as to the ineligibility of turn¬ ing for the relief of convulsions, might seem to be corroborated by the result of those cases; however, without at all entering into the dis¬ cussion of the comparative value of these different modes of delivery under such circumstances, it should be observed that the case in which turning wras employed had been allowed to proceed to such a length before assistance was sought for, that almost any kind of treat¬ ment appeared hopeless.
“ The author recently attended a case of convulsions with Dr. Ni¬ cholson. The patient was a short necked, full, plethoric female, about eight months pregnant with her first child. She was attacked with convulsionswhile dressing for dinner, and in the course of twrelve hours had eight fits of well marked violent convulsions : on examina¬ tion per vaginam, the os uteri was found dilated to about the size of a half crown, the head presenting, and membranes ruptured. By means of copious venesections, shaving the head, and cold applications, with the exhibition of calomel and scammonvby the mouth, and the use of enemata, first of soap and subsequently of turpentine, the convulsions were completely subdued, and the patient was delivered naturally of a dead child after an interval of thirty hours, during which she re¬ mained quite rational.
“ This case contrasted with one already related, where the con¬ vulsions had ceased on the delivery of the patient by the perforator, but in which fatal peritonitis supervened, would lead us to conclude, that artificial delivery ought to be limited, except when the pelvis is deformed, to those cases where the forceps can be used, and that turning, or the perforator, should be employed only in those cases where, from the condition of the parts, there appears no risk of ex¬ citing inflammation : indeed unless there be strong proof of the death of the child, or we have to deal with a narrow pelvis, it does not seem that under any circumstances is the use of the perforator justifiable. There can be no doubt that convulsions will often cease on artificial delivery being performed, even though in a rude violent manner, but the result in such cases usually is the death of the patient by peritonitis.
“ Though fully aware that bleeding in some cases is a most valuable and indispensable remedy, the author considers emptying the bowels of no less importance, and the use of applications to the head a powerful adjuvant : he is however of opinion, that there are cases in which the disease being the result of nervous irritability rather than of actual plethora, the too free abstraction of blood will only hurry the disease to a fatal termination.
“ The author was requested to examine a female who had died.
The Dublin Hospital Reports.
17
during labour, of convulsions, whom however he had not seen during life. The labour had made so great progress that the head of the child was on the level with the external parts of generation ; he examined the different cavities accurately, and found a tumour of a cartilaginous consistence as large as a hen’s egg, occupying the optic thalamus and the adjoining part of the brain of one side.
“ Hemorrhage occurred in six cases during labour, caused by the attachment of a small portion of the placenta over the os uteri, and in all it was arrested by the rupture of the membranes, either by the hand or by uterine action.
“ The cases in which it was found necessary to remove the pla¬ centa by the introduction of the hand, amount to fifteen : a large number, but which may be acccounted for by the circumstances of several applications at the dispensary for assistances of several, being made solely on account of the retention of the placenta, in consequence of previous mismanagement.
“ Five of these cases of retention were caused by the irregular or hour-glass contraction ; no difficulty was experienced in the re¬ moval of the placenta, except in one case, where, co-existent with > the stricture of the uterus, there was violent uterine action, and high excitement, both vascular and nervous existed ; previously to any attempt at extraction, venesection and the exhibition of opiates carried to the utmost extent, did not lessen in the slightest de¬ gree the difficulty of extraction, and the patient died in about ten days afterwards of venous inflammation.
“ In five cases hemorrhage occurred previous to the delivery of the placenta. Two of these cases were of hour- glass retention : in one sudden death took place about six hours after delivery, although the placenta had been removed without difficulty, and the patient appeared to have completely recovered from the loss of blood, which had not been at all extensive ; no hemorrhage oc¬ curred externally, nor on the post mortem examination did any appearance present itself sufficient to account for her death. The uterus had contracted well, and no coagula were found in its cavity.
“ A few hemorrhages occurring after the delivery of the placenta, were arrested by means of pressure over the uterus, by the applica¬ tion of cold, by quietude, and the access of air, &c. &c.
“ A considerable number of abdominal inflammations presented themselves ; at particular periods they were exceedingly prevalent ; at other times equally rare. The type of these inflammations varied with the periods of their appearance. In December and January,
1827, 1828, the peritoneum seemed to be the structure most deeply engaged, and the inflammation to be of a phlegmonous character. In March the disease assumed the low typhoid character. In May,
1828, several cases were met with in which the intestinal mucous membrane was the seat of disease : they were characterized by thirst.
VOL. vi. no. 31 .
JO
18
Critical Review .
redness of tongue, or white coating with florid papillae inter¬ spersed, intolerance of light, headach, and obscure abdominal tenderness.
“ Cases of abortion were exceedingly numerous. This accident is of frequent occurrence amongst the poor of the city, and one in general little minded ; the circumstances under which such cases ap¬ plied for relief were various. In some instances hemorrhage, in others retention of part of the ovum ; in others derangement of the general health consequent on abortion were the reasons for applica¬ tion. The hemorrhages in those cases were arrested by means of cold applications, rest, cool air, avoidance of any thing stimulating, &c. &c. ; excepting after the sixth month manual extraction of the placenta was not attempted, enemata, purgatives, friction of the ab= domen, and binding, being the means employed to promote its ex¬ pulsion. In a few cases of abortion, at an early period, plugging the vagina was found advantageous in arresting the hemorrhage.
“ The sequelae of abortion consisted of vaginal discharges, occa¬ sional hemorrhages, and general constitutional derangement; these affections were treated by improving the condition of the system, by the occasional use of purgatives combined with bitters, by attention to diet, air, exercise, &c. &c.
Amongst the most frequent of the diseases of females, were those connected with the functions of menstruation. In the treatment of these cases more attention was paid (with some exceptions) to the constitutional, than to the local symptoms, and what are considered specific or directly emmenagogue medicines were but rarely ex¬ hibited, and never found effectual. The catamenial derangements con¬ sisted in total suppression, in diminution, in excess, in irregularities attendant on their final cessation, and in distressing accompanying symptoms.
‘ £ These states were accompanied by two very opposite conditions of the system, and plethora. In the former, the object principally held in view was to improve, as much as possible, the general condi¬ tion of the system ; in the latter and less frequent condition, deple¬ tion, either topical or general, was employed.
“ Cancer of the uterus was frequently met with. In every in¬ stance, the disease was so extensive as to engage all the soft parts in the neighbourhood of the os uteri, evidently shewing that extirpation of the uterus was, at that period of the disease, totally in¬ applicable. In the only instance in which a post mortem examina¬ tion was permitted, the interior of the pelvis was so completely sur¬ rounded by scirrhous glands, that some difficulty was encountered in removing its contents.
“ Some instances occurred in which the os uteri was tumefied, ir¬ regular, and tender to the touch, accompanied by a muco-sanguineous discharge, by pain about the back and thighs, anasacra of the lower extremities, loss of appetite, debility, and sallowness of the counte¬ nance. They were treated with alterative doses of the pil. hydrar- gyri, followed by mild saline purgatives combined with bitters ;
The Dublin Hospital Deports. 19
strict attention was paid to their general and dietetic management, and in. every instance a perfect, though in some a gradual, recovery ensued.
“ The recovery of such patients should point out the necessity of sufficient investigation, before we condemn cases as malignant, that may be only obstinate or tedious, and thus submit patients to the hazard of a dangerous, and often an unsuccessful operation.
“ Two cases of polypus uteri occurred, in which the patients were reduced to a state of the most extreme debility ; the tumours were removed by the ligature, and the patients recovered perfectly. One polypus was of the hard, the other of the soft species ; the latter was exquisitely tender to the touch, a circumstance worthy of remark, and already noticed by Dr. Johnson in the Dub. Hos. Reports, who points out the error of adopting a diagnosis between polypus and in¬ version of the uterus, founded uj>on the tenderness of the uterus in the case of inversion.
“ In one case of polypus uteri, where the patient had been exceed¬ ingly debilitated, the pulsation of the large vessels about the neck was visible at a distance for some months, so that, on a superficial inspection, she might have been supposed to labour under disease of the heart.
** The uterine displacements were confined exclusively to prolap¬ sus uteri. Some cases of prolapsus vesicse aad vaginse were also met with. In one instance, a contracted state of the urethra giving rise to all the symptoms of diseased bladder, was cured by frequent introduc¬ tion of the bougie.
“ In several instances, in which females applied early, with all the premonitory symptoms of mammary abscess, the progress of that af¬ fection was completely arrested, by submitting the patient to the in¬ fluence of tartar emetic.
“ The remaining cases consisted principally of the diseases of pregnancy, of puerperal diseases, derangements of health connected with lactation, mammary abscesses, vaginal discharges, inflammations, tumours and abscesses about the vagina and external parts of genera¬ tion, abdominal tumours, &c. &c,
“ From the end of December 28, to October 29, the number of registered cases amounted to 303. Of these, six were cases of pre¬ sentation of the breech and lower extremities ; one of the superior extremity ; one case of face presentation was not interfered with, and the child was born alive. In two instances, the face was turnedtowards the pubis. In five cases twins were born. The perforator was em¬ ployed three times, and three females were delivered by the forceps. In one of these cases, the foetus was acephalous ; the labour had been rendered tedious by the large size of the body of the child.
“ The secale cornutum was employed in upwards of twelve cases, in six it produced no preceptible effect whatever ; the author is, how¬ ever, willing to believe that the ergot employed in those cases, though procured from respectable druggists, had lost its peculiar properties.
Critical Review.
20
“ In three instances, where it was employed in half drachm dosesr substance as well as infusion being administered, symptoms of an apo¬ plectic nature supervened, such as a diminution in frequency of the pulse amounting to from fifteen to thirty beats in a minute, stupor, epastaxis, &c. &c.
“ In a case of breech presentation, in a female who had borne se¬ veral children, ten grains of ergot, given in infusion, were adminis¬ tered ; she had not had any pains for the entire of the preceding night. Pains, however, came on so immediately after the adminstration of the ergot, as to leave no doubt on the author’s mind of its efficacy in that instance. Amongst other instances, a case was treated by Mr. Dash wood, an extremely intelligent pupil, where the placenta, after three hours’ retention, was expelled by uterine action consequent on the administration of the ergot, though in the two preceding deli¬ veries of the same patient the placenta was extracted by the hand.
“ The author cannot forbear relating two cases, where, in conse¬ quence of the total absence of pains, he had determined on making trial of the ergot ; in one instance, on returning to his patient after an hour’s absence, he found, that on her taking an aperient draught, which he had prescribed, though no purgative or griping effect had been produced, uterine action had come on so violently as to finish the delivery of the child and placenta before his arrival ; and in the other case, before he could procure the ergot, which he had to send for to some distance, such effective pains came on that he did not find it necessary to administer the remedy when it arrived.
“ In seven cases, the placenta was extracted by the hand ; in some of these the ergot had been previously tried, but ineffectually.
“ In four of these there was hemorrhage connected with the re¬ tention of the placenta. One of these cases terminated fatally, not¬ withstanding the hemorrhage had been completely arrested.
“ One case of polypus uteri was detected by examination per va- ginam. The tumour, which was not larger than a walnut, was con¬ nected to the interior of the cervix uteri by a long cord-like pedicle^ It was extracted by the fingers, and exhibited vessels running through its diminutive stalk. It was composed of a delicate membrane con¬ taining small vesicles, and a gelatinous substance, that could be drawn out by the finger to some distance.
“ Notwithstanding the small size of the tumour in this case, the irritation produced thereby was greater than the author had witnessed in any other instance of this disease.
“ One instance of severe puerperal inflammation of the joints oc¬ curred. In this case, in consequence of hemorrhage, the placenta was removed (without any violence) by the hand. The patient did not seem to suffer much from the loss of blood, and was in a favoura¬ ble condition till the seventh day, when, a} onrently in consequence of some irregularity, she was attacked with febrile symptoms, and in¬ flammation of the knee and ankle of one leg. The fever was of a mixed character, accompanied with much gastric derangement and acceleration of the pulse, without any increase of hardness. The
The Dublin Hospital Reports.
21
pain in the parts mentioned preceded the external symptoms of inflam¬ mation, but in a short time the joints affected became red and swollen. The calf of the affected leg participated in the tumefaction.
<f The pain was of so violent a nature as to deprive the patient completely of rest, and to require the use of large opiates.
“ The treatment consisted in the regulation of the patient’s • bowels, the administration of calomel, combined with opium and tartar emetic, till ptyalism was produced; frequent application of leeches, and in the intervals a saturnine lotion, was kept constantly applied, protected by a covering of oiled silk. In the progress of the disease a mixture of sulphate of quinine and the compound tincture of gentian was employed with apparently considerable benefit. The inflammation of the knee yielded rapidly to the treat¬ ment ; that of the ankle was of a more obstinate nature ; superficial abscesses formed over that joint. The patient, after some time, was sent to the country, and is now quite recovered. In no stage whatever of the disease were any symptoms of venous inflamma¬ tion discernible.
“ Two cases of hydatids of the uterus were treated ; both of the the individuals were married, and one had previously children, and experienced, with the exception of feeling the movements of the child, the usual symptoms of pregnancy. One patient had a con¬ stant discharge of a yellowish colour : the other was free from any vaginal discharge till a few days before the expulsion of the hy¬ datids, when there was a slight discharge of blood. In one instance the hydatids were expelled without much accompanying hemor¬ rhage ; in the other there was a considerable loss of blood. The patients were treated, after the expulsion of the hydatids, like puerperal patients ; one of them had a considerable quantity of milk in the breasts for a few days, and has since borne a living child. The hydatids expelled in one case amounted to upwards of a gallon ; they were of an elliptical elongated shape, connected toge¬ ther by delicate pedicles, and surrounded by a cyst, resembling the decidua.
“ One patient, affected with a malignant tumor of the os uteri, applied for relief at the dispensary. She was thirty-five years of age, had borne five children within the last fifteen years, and enjoyed good health till four months previously, when she became troubled with constant shooting pains in the back and loins, and the ordinary symptoms of malignant disease in this situation. Her general health too, was proportionately affected,
“ On examination per vaginam, a tumor, as large in circum¬ ference as a dollar, but much thicker, was found growing from the lower part of the cervix uteri. It was firm and elastic, and a portion of the cervix uteri could be felt above the tumor, apparently free from disease. After endeavouring as far as it was possible to im¬ prove the patient’s general health, a ligature was applied as high up¬ as the cervix uteri, by means of the common double canula.
22
Critical Review .
“ It may here be observed that the ligature employed on this, as well as on other occasions, was composed of catgut, or silk covered with silver wire, as sold at the music shops. Silk is con¬ ceived to be preferable to catgut, as the latter, when long exposed to moisture, sometimes becomes rotten.
“ The degree of firmness and elasticity, which a ligature of this description possesses, even when exposed to moisture, will be found to facilitate its application materially ; and even where there is an anticipation of difficulty in the application of the ligature from the size of the tumor, the author would suggest the trial of the com¬ mon canula, before having recourse to a more complicated ap¬ paratus.
“ In the progress of the case the ligature was tightened occa¬ sionally, but on the sixteenth day the cervix uteri, not being com¬ pletely divided, was drawn down, and cut through with a blunt pointed bistoury.
“ For upwards of a month the patient seemed to have recovered from the disease ; recently, however, ulceration has commenced at the place where the tumor was separated, and all the former dis¬ tressing symptoms have returned.
“ Though the result of this case was unfortunate, yet the case itself is important, as shewing how far the uterus will bear with impunity the application of the ligature, there being no threatening of peritoneal inflammation or retention of urine during the entire time that the ligature remained on the uterus ; and the case under consideration, as well as those cases in which the ligature has been applied on the inverted uterus, induces the author to question the soundness of the advice given by Doctor Gooch, regarding uterine tumors, in his recent work on diseases of females ; for while he agrees with him that including any portion of the uterus in the ligature, in cases of polypus, is worse than useless, he conceives that the advice given at page 307, regarding what are there termed fungous excrescences, is calculated to lead to most dangerous results, as it is only by the complete removal of that part of the uterus from which the tumor originates, that any reasonable expectation can be formed of its not again returning.
“ Should the author again meet with a similar case, he would prefer removing a portion of the uterus with the knife, to the ap¬ plication of the ligature.
“ The number of cases treated since October last, up to the present time, have, in proportion, considerably increased ; but, to avoid repetition, only a few of the more remarkable shall be here noticed. One instance of spontaneous evolution of the foetus oc¬ curred at the seventh month ; the child was situated in the manner usually met with, and born dead.
“ In one case of complete presentation of the placenta, turning was performed, the mother was saved, the child born dead. The most remarkable feature in this case, was the great advantage found
The Dublin Hospital Reports.
23
to arise from plugging the vagina ; the os uteri seeming, in the first instance, too rigid to allow of turning being performed with safety to the patient.
“ Two cases of hemorrhage after delivery, of an interesting nature, occurred. In one case, application was made for assistance nine hours after the birth of a first twin, in consequence of the retention of a second.
“ The patient, a healthy young woman, was much excited, apparently in consequence of having taken some spirits. Her face was much flushed, pulse 130, full and strong ; enemata and ape¬ rient medicines had been administered without any effect, and no uterine action existed. As the vascular excitement seemed the result of a temporary cause, it was not deemed necessary to have recourse to venesection ; and lest some untoward event should occur, it was deemed advisable to deliver the patient ; accordingly turning was performed, not without some difficulty, in consequence of the height in the uterus at which the child was placed. It however was born alive, and what was remarkable, very soon became a fine child, while the infant that was born naturally died in a few days,
<f Every means was taken to promote the safe expulsion of the placenta, which in about half an hour was expelled naturally, and the uterus became hard and well contracted. In a short time, however, most violent uterine hemorrhage came on ; cold was promptly applied to the region of the uterus, and pressure made over that viscus, by which means the hemorrhage soon ceased.
“ In this instance the patient did not become at all faint, nor was any internal stimulus employed except cold water, and the only effect produced by the loss of blood was the production of the pulse from 130 to 90, which also became proportionally soft ; a very desirable result. This was evidently a case of hemorrhage resulting from vascular excitement, and shews the necessity of preventing, by attention to temperature, diet, drinks, &c. during labour, so unfavourable a condition of the circulation.
“ The second case was one of quite an opposite nature, occurring in a weakly female who had borne several children, and each time had slight hemorrhage.
“ Lest a similar occurrence should take place on the present occasion, the management of her labour was intrusted to a person of some experience ; although however conducted most judiciously, the birth of the child was followed by immediate hemorrhage.
“ This was arrested by means of cold applications, and pressure on the uterus in the first instance ; as however it quickly recom¬ menced, the hand was introduced into the uterus, and the placenta, which was found lying detached in that cavity, was withdrawn ; the uterus contracted on the hand, and but a slight oozing of blood continued.
“ The quantity of blood lost in this case was not great, nor did the patient suffer complete syncope, yet for nine hours she lay as if
24
Critical Relieve.
•on the point of death; the face bloodless, extremities cold, pulse not to be felt at the wrist, and but faintly in the larger arteries.
“ The patient was watched through the day ; opium, brandy, and ammonia administered in small quantities ; she however re¬ jected every thing, and the first thing which she retained was a raw egg beaten up with a cup of tea.
“ It might here be asked, if this was not a case in which trans¬ fusion would not have been recommended by the advocates for that operation, and whether this operation might not have proved fatal in this, as it was in other similar instances.
“ While on the subject of hemorrhage, the author wishes to allude briefly to the subject of cold applications.
“ In the only instance of fatal hemorrhage which he witnessed, he found the patient’s bed, when he arrived at the house, com¬ pletely drenched with cold water, herself apparently as much sink¬ ing from the collapse produced by the slovenly application of cold, as from the loss of blood; so that he would caution his junior brethren from applying cold in such cases to any part, except the vicinity of the uterus, by arranging napkins so as to prevent the part of the bed on which the patient lies from l>eing wetted ; and when the heat of the extremities is below the natural standard, it is obvious that applying heat thereto, while cold is applied to the region of the uterus, will tend to equalize the general circulation. The author would wish to allude to the bad effects resulting from patients wiio are the subjects of hemorrhage, making any exertion in bed, especially if deviating from the horizontal position.
<£ It is unnecessary to enter into the details of the case just related, further than to state that the patients suffered for some months from a train of nervous symptoms, but is now quite reco¬ vered.
‘ ‘ One case of polypus uteri wus treated by ligature ; it came away the third day, and the patient is now quite well. At least a dozen cases of prolapsus uteri were relieved by the introduction of pessaries. The flat circular pessary was employed in preference to any ether.
“ Some of the cases of prolapsus uteri were of very long standing ; in no instance however was there anv difficultv in the reduction of
y y
the tumour, nor any unpleasant effects resulting from the restoration of the uterus to its natural situation.
“ One old woman who had a large prolapsus of the uterus for forty years, on a pessary being introduced for the first time last winter, expressed herself as being more comfortable, and in better health than she had been for a number of years. The daughter of this woman, who had both prolapsus of the uterus and of the rectum, was also relieved by the flat pessary.
“ At the time she applied at the dispensary she had a large tu¬ mour corresponding to the situation of the right kidney. Its forma¬ tion, which took place two years before, was preceded by shiverings, pain in the abdomen, & c. She appeared as if quite run dowm by hectic
The Dublin Hospital Reports.
23
hectic, having profuse diarrhoea, night sweats, &c. She passed in her urine, which in other respects was natural, immense quantities of pu¬ rulent matter. The uterus was supported by the pessary ; light nu¬ tritious diet was administered, and medicines given calculated to check the diarrhoea, merely with the expectation of alleviating symp¬ toms ; coutrary however to expectation, (the purulent matter still pas¬ sing with the urine,) the tumour gradually lessened, and at length totally disappeared, and she is now in the enjoyment of perfect health.”— p. 521.
Mr. Gregory gives a report of six hundred and ninety- one cases, presenting the following varieties of labour : —
“ Natural presentations, 645; Face, 2; Breech, 14; Feet, 7 ; Arm, 3; Shoulder, 1; Funis, 7; Twin cases, 12; Placenta, 0; — Total, 691.
III. — Medico- Chirurgical Transactions. Published by the Medieo-Chirurgical Society of London. 8vo. pp. *235. Two Plates. Yol. XVI. Part 1, 1830. — (continued.)
Three papers on aneurism are inserted in the work before us, and though they are not placed in succession, we shall notice them at the same time. They are as follow : —
I. — Case of aneurism of the external iliac artery , in which the femoral artery and aorta were tied. By J. James, Esq. Surgeon to the Devon County Hospital.
The patient was a man aged forty-four, of a spare habit, but not unhealthy, and was admitted into the hospital. May 7th, 1829. tie had had disease of the hip joint, and at the time of his admission, a supposed glandular tumour, which was discovered to be aneurism. In June it enlarged, and occupied the lower part of the abdomen. On the 2d of June, a ligature was applied about half an inch below Poupart’s ligament. In the evening the bulk of the tumour had decreased to about three quarters of an inch. On the 4th, some purulent matter was evacuated from the site of the ligature, and the tumour had decreased one inch. From this day the tumour began to increase, and on the 1 2th had equalled its original size, and pointed at its lower and outer part. On the 24th the integuments were tense, shining and painful, and the patient looked very ill. A consultation was held, at which it was determined to tie the aorta. The
Vol. VI. NO. 31.
E
26
Critical Review.
operation was performed at half-past three,, p. m, July 5th., in the presence of the medical officers of the hospital, and of many other medical gentlemen.
“ The man wras placed on the table with his shoulders slightly raised, the bowels having previously been thoroughly opened. I made the incision rather lower than in Sir A. Cooper’s case, begin¬ ning it an inch above the umbilicus, and continuing it two inches be¬ low. I scratched through the linea alba below the umbilicus, and then proceeded to open the peritoneum nearly to the same extent as the external wound. This first part of the operation was somewhat impeded by very copious bleeding from the vessels of the integu¬ ments.
“ As soon as the division of the parietes was effected, the viscera protruded, and the efforts of the poor fellow continuing strong, I soon found myself embarrassed with almost the whole of the bowels ; nearly all the colon, and a great part of the small intestines being pushed out, and presently quite distended with flatus, a circumstance frequently remarkable in the operation for strangulated hernia. I found the aorta without difficulty, pulsating strongly, but it was sur¬ rounded with dense cellular membrane, and a strong peritoneal cover¬ ing was likewise interposed between my nail and it.
I may remark that even in the dead subject, it is sometimes a dif¬ ficult matter to force the nail and finger between the aorta and the spine ; in this case, embarrassed as I was by the coils of intestine, in which my hand was buried, it was particularly so. I enlarged the wound, but it was of little service ; to have obtained suffici¬ ent room to push aside those inflated intestines would have required an incision of enormous extent ; and supposing this made, there would hardly have been a probability of retaining them completely within the abdomen by any mode of suture during the exertions which the patient might make, and which it would probably be im¬ possible to prevent.
“ I endeavoured cautiously to get the point of the aneurismal nee¬ dle through, and succeeded ; but when it reached the other side it broke at the handle, which in the one I had selected for its curve, was unfortunately of wood. I had little anticipated occasion for so much force. The broken part was so sharp that I was obliged to withdraw it, for fear of injuring the intestines. With some additional difficulty I got my finger, with Weiss’s instrument upon it, under the artery ; but even after this was effected, it was by no means easy, with the best assistance of my colleagues, to extricate the short needle bearing the ligature, so much did the intestines interfere with every kind of manipulation. When the ligature was underneath, I kept the intes¬ tines out of the way with the fingers of both my hands, and placed one of my thumbs on the vessel, whilst Mr. Luscombe drew it, first on my thumb, and then on the artery ; by this I prevented any thing from being included, a caution which Sir A Cooper has particularly dwelt upon. The ligature was then drawn tight, and the tumour
27
Medico-Chirur gical Transactions.
became flaccid ) a,t the same time the patient complained of deadness in the lower extremities. The ligature was cut close.
“ From the tension of the muscles and the inflated state of the in¬ testines, they were not easily returned, but when they had been re¬ placed, five needles were passed through the integuments, and the wound having been secured perfectly by the quill suture, large straps and a bandage were added, and the man was put to bed.” — p. 51.
Great prostration of the vital powers occurred during the operation., which was combatted with brandy and water, opium, & c. He experienced great pain in the lower extre¬ mities, especially on the aneurismal side ; there was no reduction of temperature until seven, p. m. when he ex¬ pired.
Autopsy. The tumour was considerably collapsed — there was no discoloration of its surface — the wound measured four inches. On opening the abdomen, a considerable quan¬ tity cf blood was found amongst the intestines, which was ascribed to the incision through the abdominal parietes, and also to the division of a small vessel in the mesentery. The intestines were distended with gas, and were uninjured. The ligature was firmly applied round the aorta, an inch below the duodenum, five lines below the inferior mesen¬ teric artery, and eleven above the bifurcation of the com¬ mon iliacs. A small vein, which ran along the aorta to the inferior mesenteric, w7as included in the ligature. The vena cava was uninjured. No operation could have been more dexterously performed. The cause of the failure of the first operation was, the division of the external iliac artery above PouparFs ligament, so that a free outlet had remained from the lower part of the sac, by means of the profunda. The operation, though unsuccessful, reflects great credit on Mr. James, as a scientific and practical surgeon.
II. — Case of Aneurism of the external iliac artery, in which a ligature was applied to the common iliac artery. By Philip Crampton, M.D. F.R.S. &c.
A soldier, aged thirty, of good general health, was ad¬ mitted into the Military Hospital, Phoenix Park, Dublin, July 8th, 1828, under the care of Mr. Crampton, surgeon- general. The patient complained of a pulsating tumour, which extended from about three inches below the umbi¬ licus, to the same distance below the crural arch, and w7as divided into twTo parts, in the line of Poupart’s ligament.
2S
Critical Review.
The upper portion presented the aneurismal thrill; the lower had no such character. There was a pulsating’ tumour, about the size of a small egg, in the right ham. There was great pain in the thigh and leg, loss of appetite, pulse 100, full and throbbing. He ascribed the complaint to a fall received in wrestling, nine months previously, but continued at his duty until the 20th of May. He was treated antiphlo- gistically, and was ordered digitalis. On the 18th of July, he was considered in a fit state for the operation, which was performed in the presence of Professors Colies, Macartney, and Wilmot, Mr. Stringer, the surgeon of the hospital. Dr. Ramsay, of Dundee, and other gentlemen. The de¬ tails of the operation are thus given by the distinguished operator : —
“ The' first incision commenced at the anterior extremity of the last false rib, proceeding directly downwards to the os ilium, it fol¬ lowed the line of the crista ilii, keeping a very little within its inner margin, until it terminated at the superior anterior spinous process of that bone, the incision was therefore chiefly curvilinear, the conca¬ vity looking towards- the navel. The- abdominal muscles were then divided to the extent of about an inch, close to the superior anterior spinous process, down to the peritoneum : into this wound, the fore finger of the left hand was introduced, and passed slowly and cau¬ tiously along the line of the crista ilii, separating the peritoneum touching the fore -part, and the fascia iliaca the hack part of the finger. A probe-pointed bistoury was now passed along the finger to its ex¬ tremity, and by raising the heel of the knife, while its point rested firmly on the end of the finger as on a fulcrum, the abdominal mus¬ cles were separated from their attachments to the crista ilii by a single stroke. By repeating this manoeuvre, the wound was prolonged until sufficient room was obtained to pass down the hand between the peri¬ toneum and the fasia iliaca. Detaching the very slight connections which these parts have with each other, I was able to raise up the pe¬ ritoneal sac with its contained intestines on the palm of my hand, from the psoas magnus and iliacus internus muscles, and thus obtain a distinct view of all the important parts beneath ; and assuredly a more striking view has seldom been presented to the eye of the sur¬ geon ; the parts were unobscured by a single drop of blood ; there lay the great iliac artery, nearly as large as my finger, beating awfully at the rate of .1 20 in a minute, its 3mllowish white coat contrasting strongly with the dark blue of the iliac vein which lay beside it, and seemed nearly double its size : the ureter in its course to the bladder lay like a white tape across the artery, but in the process of separat - ing the peritoneum, it was raised from it with that membrane to which it remained attached. The fulness of the Iliac Vein seemed to vary from time to time, now appearing to rise above the level of the artery, and now to subside belowr it. Rothing could be more easy
Medico-Chirurgical Transactions . 29
than to pass a ligature round an artery so situated. The fore finger of the left hand was passed under the artery, which with a little management was easily separated from the vein ; and on the finger, (which served as a guide,) a common e}'ed probe furnished with a li¬ gature of moistened catgut was passed under the vessel. A surgeon’s knot was made in the ligature, and the noose gradually closed, until Mr. Colles, who held his hand pressed upon the tumour, announced that c all pulsation had ceased !’ A second knot was then made, and one end of the ligature cut off short. On examining the vessel after it had been tied, it was found to be full, and throbbing above the li¬ gature, but empty and motionless below it. The external wound was united by three or four points of suture, and supported by long straps of adhesive plaster. The operation was completed in twTenty-two minutes ; the patient, who was a firm minded man, made no com¬ plaint during the operation, not even when the ligature was closed upon the artery. The tumour, immediately after the operation, was diminished nearly one-third, the diminution being confined to the ab¬ dominal portion; ten minutes after the operation, the pulse was 96; at 7 p. m. Mr. Stringer, finding the pulse full and bounding, took 20 ounces of blood from the arm; at 10 p. m. I found him tranquil, no pain, pulse 88, the limb, with the exception of the toes, warm : Saphena Vein full ; additional flannel was wrapped round the foot/’ — p. 56.
The following' day the toes were not so warm as those of the other foot ; castor oil, with an enema, was given, which produced no effect ; the former was repeated, with calomel and the enema terebinth, which opened the bowels. On the 21st, there was evident pulsation of the tumour, but no thrill. There was no pulsation in the femoral or popli¬ teal arteries. The temperature of the affected groin was 98°, of the hams 9 7°, of the ankles 94°, of the right great toe 87°, of the left and unaffected 87 — pulse 88. On the 22d, pulsation, accompanied by a slight thrill, and on the 24th, it was more distinct in the abdominal portion of the tumour. He was bled to syncope, had fever diet, and 20 m. of tine, digitalis every third hour. 25th. Pulsation more distinct, thrill very perceptible, no pulsation of the femoral artery, the ligature came away — blood cupped and buffed, v. s. ad. Bxij- 26th. On turning in bed, felt a severe pain in the thigh and knee, as if the latter was tearing off; the anterior part of the thigh was numb ; but in ten minutes the pain subsided. From the recurrence and strength of the pulsation, it was thought that an ordinary anastamosis could not produce it, and it was feared that the catgut ligature had been macerated and given away, a supposition too well founded. 28th. Much better — wound nearly healed. At six, p. m. while sitting in bed, violent haemorrhage
30
Critical Review.
issued from the wound, when he immediately expired. The body was examined next day, in the presence of the dis¬ tinguished professors who had witnessed the operation, and the following appearances were observed : —
“ The intestines being removed, the peritoneum raised, and the great abdominal vessels laid bare, the common iliac artery, at about three-fourths of an inch from the bifurcation of the aorta, was lost in an oblong tumour, about three fourths of an inch in diameter, and one and a half in length ; the tumour terminated upon, but did not com¬ municate with the, aneurismal sac. On cutting into the tumour, about half an ounce of greenish pus flowed from the wound and dis¬ covered the artery, which appeared somewhat contracted at one part, and its coats deeply indented, but not cut through, marking the place where the ligature had been applied. On blowing into the iliac ar¬ tery from above, bubbles of air escaped freely from the external wound from whence the blood had issued; water injected by a sy¬ ringe escaped by the same passage ; clearly establishing the impor¬ tant fact, that the ligature which was of cat-gut, had been dissolved by the heat and moisture of the wound, and thrown off, before the obstruction of the artery, or the coagulation of the blood in the aneu¬ rismal sac, had been completed. It further appeared that the dissolu¬ tion of the ligature had caused a small abscess to form in the place which it occupied. On slitting up the artery, the internal and mid¬ dle coats were found to be completely divided in the whole circum¬ ference of the vessel, and small portions of lymph adhered to its in¬ ternal surface. The popliteal aneurism wTas far advanced towards a cure ; the contents of the sac were quite solid, and the tumour was reduced to about the size of about a walnut; the artery, for six inches above the sac, was filled with a firm coagulum,” — p. 57.
The most important inferences to be drawn from this case, are, in the opinion of Mr. Crampton, —
<<r 1st. That the operation of tying the common iliac artery is not only feasible (when performed in the manner de¬ scribed in this paper) but is an exceedingly easy operation. The difficulties which Mr. Mott encountered, and which prolonged the operation to nearly an hour,’’ are clearly referable to the circumstance of his incision having been made too low. This, in the first place, brought him in contact with the aneurismal tumour, from which he was obliged, with great labour and considerable risk, to detach the peritoneum ; then he had the whole mass of the tumour between him and the artery, which he was to tie ; and lastly, he had the intestines pressing down upon him, and produc¬ ing such a complication of difficulties, as I believe, few men
but himself could have encountered with success. All these
w' ♦
31
Medico- Chirur gical Transactions .
difficulties, however, might have been avoided, by getting at the artery from behind and above the tumour ; in a word, by an incision which should begin where Mr. Mott’s ter¬ minated.
2d. The question has often been proposed, ee whether, under any possible circumstances, a surgeon could be justifiable in passing a ligature round the abdominal aorta ?” Without venturing to give a decided opinion upon this sub¬ ject, it may not be amiss to observe, that in several in¬ stances, aneurisms of the abdominal aorta have undergone a spontaneous cure, in consequence of the obliteration of the artery above and below the tumour.
I have given, in the second volume of the Dublin Hos¬ pital Reports, the history of a case of this kind, and the preparation illustrative of it is no w in the museum of Guy’s Hospital, deposited by Sir Astley Cooper, to whom I trans¬ mitted it in 1819. If such an operation should be deter¬ mined upon, I have no doubt that by a proceeding similar to that which 1 have described in this paper, a ligature could with great ease be passed round the abdominal aorta, without interfering wTith the cavity of the abdomen.”
It is greatly to be regretted that Mr. Crampton had not applied a silk ligature in the case before us, by which he might have succeeded in effecting a cure, or at ail events, a mitigation of the patient’s sufferings.
III. — An account of the dissection of the parts concerned in the aneurism, for the cure of which Dr. Stevens tied the internal iliac artery, at Santa Cruz, in 1812. Ry Mr. Richard Owen, Surgeon.
Much scepticism existed as to the fact that Dr. Stevens had really tied the internal iliac artery in the case above alluded to, and on his arrival in this country, in the spring of last year, he submitted the preparation to the inspec¬ tion of Sir Astley Cooper, Mr. Lawrence, and other emi¬ nent surgeons, who were all convinced upon the subject. He deposited the preparation in the museum of the Royal College of .Surgeons, the dissection of which was intrusted to Mr. Owen, and the details of that gentleman remove all doubt from the original statement of Dr. Stevens. It will be recollected, that Dr. Stevens considered the gluteal artery was aneurismal, but it appears from the account before us, the ischiatic wras the artery affected. The woman
32
Critical Review.
was cured of her disease, lived for ten years, and died of a pulmonary complaint.
We shall now pursue our analysis, in the order in which the papers appear in the volume under notice. The first paper is by Mr. James, and has been already described.
Th e second is by Mr. Barlow, of Blackburn, on the suc¬ cessful removal of a medullary sarcoma of nine years dura¬ tion, which occupied nearly the whole cheek, extended anteriorly from the inferior edge of the right orbit, hanging over the contour of the lower jaw, and laterally from the angle of the mouth to near the tragus of the ear, being remarkably prominent exteriorly. Idle integuments of the cheek presented a pale glossy aspect, and the surface of the tumour was covered with a net work of various veins. The vicinal glands did not sympathize with the disease. The operation consisted of an elliptical incision, which was followed by such profuse haemorrhage and profound syncope, that the patient (who was a female, aged 6G), seemed in the greatest danger. Several arteries were secured, and the patient was finally restored to health. Mr. Barlow adverts to a most important point in operative surgery, namely, the danger which arises in excision of tumours about the neck, from air passing into the divided veins, and destroying the patient. He details a case of this kind, which happened to himself thirty years ago, and refers to the cases narrated by Dupuytren, and Dr. Mott of New York. He shudders at the risk he has run in such operations, and inquires whe¬ ther compression or ligatures ought not be employed on the veins in the cases before us. No one can peruse this paper, without a conviction that the author is a truly scien¬ tific* and a cautious surgeon. The operation is highly creditable to his skill and dexterity, and proves him pos¬ sessed of a. degree of boldness which few practical sur¬ geons of the present day possess. If our position were disputed, we need only refer to his successful case of Caesa¬ rean operation, which has a high place in the annals of British surgery. His candour in acknowledging a fatal ope¬ ration, which happened to him so far back as thirty years, reflects the greatest credit upon him as an ardent lover of science, for few among our modern surgeons could be found who would volunteer a similar declaration. In fact, we sel¬ dom find our great operators of this capital refer to their cases of failure ; but their fortunate operations are as seldom left unrecorded.
[ 33 ]
IV. — Oases illustrative of the efficacy of various medicines , administered by inhalation in Pulmonary Consumption, in certain morbid states of the trachea , and bronchial tubes , attended with distressing cough , and in asthma . By Sir C. Scudamore, M. D, F.R.S. &c. &c. London, 1830.
We opened this volume with a confident anticipation, that St. John Long- had resolved to appeal to the ancient ordeal, of trial by battle, to be decided, however, by the pen, instead of the sword ; but that, not caring' to enter the lists in person (lest he should be flayed by the critics, with as little mercy as he has been accustomed to shew to his victims), he had selected for his champion the doughty knight, whose name and ap¬ pendages make so gorgeous an appearance in the Jtitle page; and that he had him equipped for the encounter with the de¬ fensive in armour of his illustrative cases.
But, alas! we were doomed to be disappointed. The age of chivalry is past; or, as Lord Byron would have said, “ there is no sprit now-a-days, unless it be the spirit of quackery and fanaticism.”
The Doctor hibernice. Sir Charles, seems to have made up his mind, that St. John, after receiving the crown of martyr¬ dom at the Old Bailey, to which he is justly entitled, will he duly canonized by his votaries as a matter of course, and there¬ fore that it would be well to secure him for his patron saint, and forthwith to erect a shrine in his own domicile, at which his disciples might celebrate his mysteries in their genuine spirit, when the law shall compel him to be absent in the body. And doubtless a very pretty trade it will prove, to collect St. John’s , instead of St. Peter’s pence, in Wimpole-street,so con¬ veniently near to the Temple in Harley street, where the saint’s own miracles were performed, indeed so fixed does the wor¬ thy knight’s resolution to assume the office of high priest ap¬ pear to be, that we would strenously advise St. John Long, should he yet again be spared to his agonized friends, expli¬ citly to disclaim all connection with any other house, except in consideration of value received.
To be serious, however, it is deeply to be deplored that a man like Sir C. Scudamore, whose former publications have shewn that he might at least have assumed a station of re¬ spectable mediocrity in medical literature, should have com¬ promised his character by the production of the pamphlet be¬ fore us ; the very highest air of which is but ad captandum vulgus ; literally to entrap the herd of titled and untitled pro¬ selytes of a detected impostor.
Vol. VI. NO. 31.
F
34
Critical Review.
As to the shallow pretence of performing a service to me¬ dical science and humanity, we would simply demand in what degree will science be benefited by the information, that Sir C. Scudamore is in possession of certain means of curing dis¬ ease, which he declines to impart to the profesion ? The plain fact is, that the work is of no use whatever to medical men, and was never intended for their perusal. We will cite some of the internal evidence which is afforded, in proof of this as¬ sertion.
In the first place. Sir Charles in his preface declines entering on the debatable question of originality, and in the very next sentence declares, “ When I commenced my investigation of the powers of iodine used in the way of inhalation, I had never heard a suggestion on the subject, and in regard to most of the other medicines, except chlorine, I am not aware that they have, up to the present moment, been employed in this way by any other individuals.' ” We would ask whether the name of Dr. Sanders, of Edinburgh, and his suggestion of the in¬ halation of the vapour of aether, in combination with muriatic acid, has never reached his ears.
The author subsequently alludes to the work of Dr. Murray, of Belfast, on the inhalation of iodine, and also to the me¬ moirs presented to the Royal Academy of medicine in Paris by M. Gannal on the use of chlorine, but as if for the express purpose of attracting attention to the mode in which he has attempted to conceal his disingenousness under the mask of candour, bespeaks of them only as recently published, whereas the memoirs were read in 1827, and Dr. Murray’s work issued rom the press in the following year.
The first case with which Sir Charles has favoured us came under his care in March, 1829, whence we infer that the em¬ ployment of iodine has been borrowed from Dr. Murray, and the glass apparatus from M. Gannal. Indeed, we expect if a second edition of Dr. Murray’s work should appear, that its author will repay the strictures on his practice of diffusing the vapour of iodine through the atmosphere of the apartments of the sick, by including Sir C. Scudamore and his glass bottle in the sarcasm, which he has already levelled against Dr. r Mudge and his tin tea pot.
The last and most convincing proof which we shall adduce that these cases are intended for the public, and not for the profession, is furnished by the author’s refusal to give a for¬ mula for his inhalation, lest those into whose hands it may fall should be tempted to employ it themselves to the manifest
Sir. C. Scudamore on the Cure of Consumption. 35
risk of their own injury, and the certain diminution of the profits of the inventor.
We repeat, therefore, that it is imposible to suppose that this work is published for any other purpose than that of sup¬ planting- Long, if he should be suffered to remain, or of succeed¬ ing- him if his career should be brought to a close ; and this in a certain degree it will certainly answer, in spite of ail the commentaries that criticism may offer. But we cannot help thinking that the ungracious task w^hich the author has impo¬ sed upon us might have been spared, together with the cost of publication to himself, and the annoyance of his readers, by the waste of valuable time consumed in perusing his cases, by the simple expedient of inserting an advertisement in the news¬ papers announcing, that Sir C. Scudamore, Knt. Doctor of Medicine, &c. &c. residing at 6, Wimpole Street, Caven¬ dish Square, can cure consumption with the greatest safety, and in half the time that Mr St. John Long can. Sir C. will not longer enjoy his new calling, as Mr. John Smith, Lec¬ turer on Anatomy and Surgery, has announced a similar work. O temporary o mores.
V, — Lectures on Anatomy , intersjjersed with practical remarks. ByBRANSBY B. Cooper, F.R.S. Surgeon of Guv’s Hospital, Lecturer on Anatomy, &c. &c : London, 1830. Two Plates, Royal 8vo. Vol. it. pp. 308. Highley.
A work of this description, comprising general and descrip¬ tive anatomy, physiology, and surgical remarks, has long been a desideratum in the medical literature of these coun¬ tries. General anatomy is in its infancy in our schools ; indeed, it forms no part of education in the greater number of them. Hence it is that the greater portion of students are perfectly unacquainted wdth this very important branch of science, without the knowledge of which they can never form a correct opinion on the lesions produced by disease. It affords us much satisfaction to observe, that examiners of the Royal College of Surgeons are now accustomed to test their candidates’ skill in this division of anatomical science, a plan long since adopted by their contemporaries in Dublin. It is really astonishing to think that the numer¬ ous class of medical practitioners in this section of the empire, should have been allowed for so long a period to enter on their professional duties without a knowledge of the intimate structure or tissue of the various parts of the body. It is a matter of no small surprize that this defect
36
Critical Review.
still exists in some of the large schools in this metropolis ; but we cannot wonder much at this, when we consider how lectureships are tilled up in these establishments. The time has arrived when the appointment of lecturers must depend on merit, and not on interest.
But to return to the work under notice.
The subject of this volume is the muscular system, which very properly follows that of the former, which was the osse¬ ous ; the next will contain, the anatomy, with physiolo¬ gical and surgical remarks of the interior parts of the body;” the fourth and last will he devoted to the brain, nerves, and organs of the senses.”
This production is not of a kind which we can illustrate by extracts ; but we can state with perfect confidence, it is evidently compiled by a gentleman of sound sense, practical experience, and a perfect knowledge of the subject, and who, besides his high professional acquirements, possesses, in no ordinary degree, the invaluable art of communicating the truths of science in a clear, simple, precise and popular manner. Another prominent recommendation to which we shall advert is, that the information it contains is of the newest kind, and that every part of the work has been care¬ fully adapted to the present improved state of medical science. It is dicidedly one of the most useful works which has yet been offered to the public, and when finished will be extremely popular with the profession. The plates are very clearly and beautifully executed. There is one defect which we hope to see obviated in a future edition, and that is, the exclusion of pathological anatomy. Had the talented author appended this very important branch of science, his work would be much more valuable, and he one of standard authority and reference with all classes of the profession. It differs from the productions of Dr. Cra- gie, Mr. Grainger, Bayle and Hollard’s, by comprising de¬ scriptive anatomy. Neither [does it contain such reference to the authorities as these which we have just named ; but there is a good excuse for this, when we recollect that the work consists of the author’s lectures, and every one knows how confusing it is to the minds of those commencing their studies in medicine, to have their memories loaded with the names of writers, whose opinions only are worthy of a place in their remembrance. Every opinion of standard authority is given, but the experienced and practical physician or sur¬ geon would wish to have more ample references.
[ 37 ]
VI —^Elements of Surgery . By Robert Liston, Follow of the Royal Colleges of Surgeons in London and Edin¬ burgh, Surgeon to the Royal Infirmary, Lecturer on Surgery, &c. : London, 18-31. Part I. 8vo. pp. 318; Longman and Co. and Adam Black, Edinburgh.
VII. — A System of Operative Surgery , containing a de¬ scription of the most approved plans of performing the different Operations in Surgery on the dead body , with remarks on their anatomy , and accompanied with prac¬ tical observations , being principally designed for the use of students in surgery . By William Hargrave, A. M. M. B. T. C. D., Member of the Royal College of Surgeons in Ireland, Lecturer on Anatomy, Physiology, and Operative Surgery, &c. : Dublin, 1831. l*2mo. pp. 533. Hodges and Smith.
Few really scientific members of our profession of the pre¬ sent day are satisfied, until they have contributed their share to the records of medicine ; and, in fact, there is none of the natural sciences which affords a greater scope for im¬ provement. After all that has been accomplished, the domain of medical science is as yet unexplored, and all that is known about it can be easily compressed into a narrow compass. So rapid has been the progress of our science, that our systematic and elementary works need constant revision. It appears from the prefaratory remarks of Mr. Liston, that the systems of Latta, B. Bell, and Allan, which were the text books of North Britain, are far behind the present state of surgical science, and therefore he has ventured to supply the deficiency, by reducing the heads of his lectures into a compendium or guide for those students who resort to Edinburgh. Mr. Liston is well known to the profession, as one of the best operative surgeons in these countries, and is eminently well qualified to arrange a compendium of his favorite science. He has executed his task, as might be expected, in a very able manner. His descriptions are simple, plain, concise, yet sufficiently co¬ pious, and his principles and practice such as every man of science has sanctioned.
The subjects of which he treats in the volume before us, are inflammation of the various tissues and its consequences, suppuration, mortification, erysipelas, furunculus, anthrax, inflammation of mucous, serous and synovial membranes, inflammation of bone, caries necrosis, fragilitas, and molli-
38
Critical Review,
ties ossium, rickets ; inflammation of arteries and veins, and other diseases of vessels ; tumours, wounds, ulcers, hos¬ pital gangrene, malignant pustule, ulcers of the genital organs, scalds and burns. It is evident that a work of this kind does not admit of analysis, of nothing more than an opinion of its merits. The grounds upon which this work founds its claims to approbation are, brevity, accuracy, perspicuity, and the practical details with which it abounds. It reflects great credit on the talents and industry of the author, and will add much to his well-earned reputation.
Mr. Hargrave’s object is to place before the student, the most approved plans of performing surgical operations, and to present to his view the relative anatomy of parts interested in operations, which has been almost excluded from elementary works of this description. All the prin¬ cipal operations that can be performed upon the dead sub¬ ject are described, such as the tying of arteries, amputa¬ tions, excision of joints, extirpation of different organs, laryngotomy, tracheotomy, cesophagotomy, lithotomy, ca- theterism, hernia, trephining, &c. The operations on the eye are omitted, as our author considers they ought to be studied in conjunction with ophthalmic surgery, or on the eyes of inferior animals in the closet. The anatomy of the different tissues implicated in each operation, is de¬ scribed with the most exact fidelity. The operations are graphically described, and the various standard works re¬ ferred to, and the latest improvements quoted. There is not a single work of authority which our author has not laid under contribution, and illustrated the tenets of each writer upon the dead body. The minute descriptions of general and relative anatomy, render this work the best companion to the surgical student.
In this very important point it is unrivalled, and surpasses every production of the kind hitherto published. In this it far excels Averill’s and the other manuals of operative sur¬ gery. It is a work well adapted to the dissecting room, and the best possible companion for the Dublin Dissector. It ought to be in the hands of every anatomical student and young surgeon, as it is an excellent guide to the dexterous performance of every surgical operation of importance. It is an accurate, well digested, well written work, evincing great research, discrimination, deliberation, extensive observa¬ tion, judgment and fidelity. It is a work of great utility, and cannot fail to be encouraged.
[ 39 ]
VIII.— Principles of Medicine . — By Archibald Bil¬ ling, M. D. Fellow of the Royal College of Pkysicans, Lec¬ turer on the Theory and Practice of Medicine, and on Clinical Medicine in, and Physician to, the London Hospi¬ tal, &c. &c. London 1831. 8vo. pp. 131. T. and G. Un¬ derwood.
The work of Dr. Billing is a lucid commentary upon the first principles of medicine, and comprises an interesting ac¬ count of the received doctrines of physiology and pathology. It seems to us to consist of introductory lectures on the sub¬ jects of which it treats, in which the author evinces a perfect knowledge of these branches of medical science. It has often struck us as with surprise, to notice some of our lecturers on the theory and practice of medicine in this metropolis, con¬ tent themselves with delivering an introductory lecture to the study of medicine, and then commence the practical part of their course with inflammation or fever. This perhaps arises from the super-excellence of the London teachers, who deem the study of the institutions of medicine a matter of no im¬ portance. This branch of medicine is taught however in all universities ; and is assigned to a distinct professor, and we may observe, embraces physiology, pathology, and therapeu¬ tics. Its first division is on life and health, its second, on the general doctrine of diseases, its third on the prevention and treatment of diseases. These subjects are scarcely touched on by any other professor, but the candidate for the surgical dip¬ loma, or licence from the Apothecaries’ company, is to be ushered into his career without the knowledge of the pulse and of those other important principles, without which he can never be a safe or successful practitioner. We speak ad¬ visedly when we declare, that not one in a hundred of those who qualify in London, for surgery and pharmacy under¬ stand the characters of the pulse, or ever heard a word about them during the course of their education. The truth is, the police of the medical profession in this section of the empire is in a most anomalous and absurd condition ; when a com¬ pany of druggists and a society of mere anatomists and sur¬ geons usurp the rights of the Universities and College of Physicians, in granting licences to practise medicine, and not pharmacy or surgery. There are no apothecaries or surgeons in this country, all pseudo-physicians, men who are not ex¬ amined as physicians, men who confine themselves to the study of descriptive anatomy, materia medica and surgery ; as
40
Critial Review.
to pathology , therapeutics, practice of medicine, clinical me¬ dicine or surgery , midwifery and diseases of women and chil¬ dren, chemistry or forensic medicine, they are seldom at¬ tended, forsooth as there is no examination upon such sub« jects, or only partially attended, to procure the certificates. As to the college of physicians which ought, and is in duty bound to take cognizance of medical education and the con¬ servation of the public health, it is too dignified, too im¬ portant, to notice such subordinate matters. The lethargy which the narrow laws of this body throw over the whole profession, has extended to the public, and exercises its bane¬ ful influence to the fullest extent, at the present period. If proof were required of the truth of this position, we need only refer to the career of Mr. St. John Long, and the myriads of his tribe who infest the metropolis. . Against complying with the claims of moral justice, the college alleges a thousand apologies ; all former arguments how'ever unsuited to the pre¬ sent state of opinion will be renewed, musty, fusty precedents, the products of three centuries back, produced; but all will not do, the interested veil of sophistry and monopoly is seen through, and those that run may read. It would be super¬ fluous to offer serious arguments in proof of the expediency of reform in the medical profession. The time has arrived when another hydra, the lawr, will be suited to the wishes of the public ; and medical abuses and defects will and must be speedily removed. It is monstrous strange that a society, whose meetings are attended by Dukes, Marquises, Earls, Arch¬ bishops, Judges, Legislators of both Houses of Parliament, all members of the Government, cannot procure the pow er of protecting and regulating the rights and interests of its mem¬ bers, and the interests of science and humanity. If the members, the elect, of this corporation, be silly enough to suppose, through their inordinate vanity, that they can precede and excel the members of rival, and in their opi¬ nion, subordinate institutions, and that the public will sane-' tion them, they suppose one of the most erroneous and absurd ideas that can be imagined. They have woven a web of delusion, which is exposed by daily observation and common sense, and which they inanely labour to prove cor¬ rect. We shall not prosecute this subject further at present, but dismiss it by observing, that the silence evinced by most of our contemporaries, on the absolute necessity of reform, is really inexcusable.
To return, however, to the work which has given rise
Mr. Swift’s Clinic Reports ,
49
14th. — Pulmonary affection relieved: bowels confined; to have opening medicine.
15th. — Complains of being still teased with cough; less weak¬ ness ; neuralgic pains diminished ; feels much better. R. G. am¬ moniac. assafoetide, 3j. a a pulv. ipecacuanhas, gr. x in pill x ij divid ... sumat, j. ter die.
17th. — Left hospital without permission. Neuralgic affection con¬ tinues, but is a little better.
V. — Enlargement of the Spleen, successfully treated by
Iodine.
James Laurent, aged thirty-eight, admitted on the 4th of August, with considerable enlargement of the spleen, extensive disease of the cervical and axillary glands, acute inflammation of both knees, and severe pains affecting the larger joints, inflammation of the periosteum, covering the middle part of the spine of the left tibia, a similar swel¬ ling situated on the right tibia, a little above the internal ankle, cedema of the . lower extremities, general wasting, and adynamia. About nine years ago, he had some disease of the liver, for which he took mercury, under the care of a physician, at Mullingar ; three years ago he was attacked again, with symptoms of enlargement of the liver, and used calomel and mercurial plasters, by the advice of Mr. Kirby, with considerable benefit. While under the influence of the mercury, he had gone abroad constantly. He was soon after attacked with pains in the knees and larger joints, and sometime afterwards was admitted as a patient into Sir P. Dunn’s hospital, with jaundice, and pain in the right hypochondrium. Here he was treated with leeches to the side, calomel again, to salivation and warm baths, by which the hepatic affection was relieved. About a year since, he was treated by a surgeon for the pains in the joints, with calomel, and mercurial friction to salivation, without any benefit.
At the time of his admission, the spleen was much enlarged, but not painful ; one of the lymphatic glands below the clavicle on the left side, and four in the cervical region of the right side suppurating, knees swollen and painful, particularly the right. He also complained of considerable tenderness of the ossa nasi. Hab. mist, colchici ^vij, magnesias usto oj ; sumat 3j ter die. 5j of the ung. hydrarg. fort, to be rubbed in every night over the region of the spleen.
9th. — Pains in the joints still continue ; right knee hot, tumid and painful ; complains of great soreness of the nose, and offensive dis¬ charge. Ordered to continue his medicines, to syringe the nostril with one part of supernitrate of mercury, and four of olive oil ; to be cupped on the knee.
11th. — Right knee relieved by the cupping ; complains now of the left, and of severe pains in the ankles; gets no sleep at night. 5iss
VOL. vr. no. 31.
G
50 Original Communications .
of tinct. opii to be added to his colchicum mixture, haust. anodyn. h. s.
15th. — No diminution of the spleen ; diarrhoea, with griping ; severe pains in the knees and ankles ; great prostration of strength. Haust olei ricini tinct. opii m. x. x — omit ung. hydrarg.
23d. — Pains as before ; diarrhoea still continues. Haust. rhei C. magnesia — repeat his medicines.
Sept. 2d. — Pain in the left knee increasing ; diarrhoea unchecked ; a blister to the abdomen, which succeeded in checking the diarrhoea almost immediately.
1 1th. — Has been placed under Dr. 1VP Dowel's care, who ordered to have the left knee, which was swelled and very painful, cupped to 5x, and his colchicum and anodyne repeated.
15th. — A portion of the ossa nasi exfoliated; pains still severe; glands of the neck still suppurating; spleen undiminished; slight return of diarrhoea ; diffused inflammation of the integuments and cellular substance, extending from the inflamed axillary glands to those above the clavicle. Cucurbit, cruent. genu sinistro.
17th. — Pain in the knee relieved by cupping ; other symptoms as before ; ordered to have a blister over the inflammatory tumour, near the clavicle, which is extending in the cellular substance ; lbj of the decoct, sarsaparilla daily — Extract cicutse, gr. ij. o. n. et m — to omit his other medicines.
20th. — Diarrhoea checked ; pains in the knees better ; sleeps badly ; to repeat his medicines as on the seventeenth, and to have an anodyne at night.
25th. — Feels stronger ; less pain in the joints ; discharge from the glands lessened ; to continue the decoct, sarsaparilla, and have ten drops of the tinct. iodinii, three times a day, half a drachm of the ung, hydriod. potassee, to be rubbed over the enlarged spleen every night. Haust. anodyn, h. s.
29th. — Improving ; less pain, but considerable stiffness in the knees and ankles ; a warm bath.
Oct. 7th'— Strength rapidly increasing; cervical glands nearly cicatrized ; spleen considerably diminished ; continue his medicines as on the twenty-fifth.
12th. — Continued improvement ; no pains in the joints; stiffness nearly gone ; moxa to be applied over the inflamed tumour, near the clavicle.
1 8th. — Going on well ; inflammation arrested by the moxa, tumour in the splenic region “ much lessened.”
VI. — Vesico-vaginal Fistula, successfully treated by actual
Cautery.
The patient, a young married woman, was delivered of her first child, about eighteen months ago, after a labour of eight days dura¬ tion. The consequence was, sloughing of the posterior part of the
Mr. Swift on Vesico-vaginal Fistula. 51
urethra and neck of the bladder, (the opening readily admitting the introduction of two fingers) with incontinence of urine in every posi¬ tion of the body. The ulcerated opening being considered too far back to admit of the application of a suture, the actual cautery was applied to it six times, by the aid of a speculum vaginae. From eight to twelve days were allowed to intervene between each application, and the pain which followed it, was speedily relieved by the warm bath. From this treatment she has derived considerable benefit. The incontinence of urine does not affect her while sitting, standing, or in the recumbent position, and she can retain it for a few minutes while walking about.
X. — Syphloid Gonorrhoea, a Papular eruption, Cure. — Peter Gaffney, aged twenty, was admitted on the seventeenth of September, with papular eruption, disease of the lymphatic glands of the neck, and an indolent tumour situated at the upper and inner part of the thigh. He stated, that he had a gonorrhoea about two years ago. The disease appeared five or six days after connexion, with discharge of a greenish yellow colour, and viscid consistence, accompanied by considerable ardor urinrn. Nearly at the same time, a bubo appeared in each groin, as was noticed by the gentleman to whom he applied for advice, in a few days after he first observed these symptoms. The discharge was removed in a fortnight by purgatives and balsam copaiba, and the buboes, by the application of a refrigerant lotion. He then returned again to drinking, from which he had observed a temporary abstinence, and in two months afterwards, one of the glands of the neck sup¬ purated. Similar inflammatory affections took place last Christmas, and a papular eruption came out, preceded by Severe pains in the joints and head, which were relieved as soon as the eruption was fully established. He had also, about the same time, a sore throat, which got well in a fortnight, by the use of a gargle. Three months before admission, he had been under the care of a surgeon, who gave him twenty-four mercurial pills, which slightly affected his mouth, with benefit to the eruption, but was obliged to discontinue the medicine, in consequence of its injurious effect on the cervical glands. The eruption occupies at present the trunk and upper extremities. Successive crops of papulae have appeared, which become filled with a small quantity of viscid purulent fluid ; this concretes, and forms scabs, which scale off, leaving behind blotches of a dark red colour ; after the disease has existed for some time, the papula, which, in the beginning, are distinct, have a tendency to become confluent ; several of them clustering together on the same inflamed base. He states, that he never had chancre, nor is there any trace of it discoverable, by the most careful examination.
He was ordered to take an ounce of the tartar emetic solution three times a day, an anodyne at night, and a warm bath every second night. Local applications to the affected glands, under this treatment, the pains were relieved, and the eruption quickly faded away, and the state of the lympjiatic glands improved ; he left hospital on the 29th of October. " ' ' * " " . ' • * “ ' • -
52
Original Communications .
VII. — Case of fatal Peritonitis in the last month of Utero~ gestation. By Samuel Malins, M.D. M.R.C.S.
At 5, p. m. on Wednesday, Nov. 24th, at the request of a messen¬ ger from Dr. Ryan, who had been hastily summoned in another di¬ rection, I visited Mrs. C., who was represented to be in labour, and otherwise seriously ill. I found on arriving, that Dr. R. had bled her from the arm, and directed the application of leeches, to be followed up by warm fomentations to the abdomen, and a dose of castor oil ; and on further inquiry it appeared, that she had been bled the preced¬ ing day by a general practitioner who had been in attendance, who had likewise applied leeches to the abdomen, and a blister to the chest, and from whom she had received some aperient powders. The com¬ mencement of her illness was dated from cold shiverings, with which she was seized on Saturday morning last, since when she had complained of pain in the abdomen and feverishness ; at present there was unceasing pain in the abdomen, and exquisite tenderness over the whole surface ; pulse very rapid and weak ; respiration hurried, anxious, and short ; constant thirst ; brown furred tongue, and fre¬ quent vomiting. (No evacuation from the rectum having taken place since Monday, a common aperient and emollient enema was ordered to be administered.) The expulsatory pains of labour had commenced this morning, according to the patient’s report, and had continued at progressively decreasing intervals ever since. Now they were of fre¬ quent recurrence, though of brief duration, and as she expressed her¬ self, were stopped, and suspended by the greater violence of the intestinal pain. It is right to mention that she was not at the full period of gestation, two or three weeks being wanting according to her computation. On examination per vaginam, the os uteri was felt dilated to the size of about half a crown, and through it the child’s head was distinguishable in its natural position at the brim of the pel¬ vis. The expulsatory pain regularly continuing, though checked each time, and abbreviated by the overpowering intensity of the general abdominal pain ; I continued with her several hours, and found that the dilatation of the mouth of the uterus was gradually though slowly increasing. About eight o’clock these expulsatory pains began to diminish in frequency, and in the course of an hour had entirely ceased. Shortly after nine, p. m. Dr. Ryan was able to repeat his visit, and then it was that a more circumstantial inquiry was made into the symptoms which had been present previous to our attendance having been desired. The vomited matter was now for the first time observed to assume a coffee coloured appearance, the frequency and feebleness of the pulse were increased, the anxiety and hurry of respira¬ tion (a prominent symptom during the whole progress of the disease, as far as we could learn) were more conspicuous ; cold and partial sweats supervened, the extremities began to lose their vital warmth, hiccup manifested itself, and the countenance began to present a hippocratic appearance. The bowels had been acted upon through
Dr.Malins on Fatal Per itonit is during Utero- gestation. 53
enema, without any mitigation of the pain. The patient when strictly interrogated (for she retained the most active use of her senses) confessed, that at the moment of commencement of her labour pains in the morning, she had felt “ something crack within her,” and at the same time experienced a severe shivering fit, an occurrence which the report of her nurse and attendants confirmed. The idea of rup¬ ture of the uterus having taken place, now suggested itself as a probability ; though it must be admitted there was little direct evi¬ dence, excepting the sensation of something having given way, the circumstance of the motions of the foetus not having been felt since the preceding day, ( the coffee coloured vomiting, and an anomalous vibratory jerking motion very manifest to the hand placed over the epigsatrium in support of the opinion, for the abdominal tumour pre¬ served its equable shape and tenseness, the head of the infant had not perceptibly receded from its position at the superior aperture of the pelvis, and there was no discharge of blood per vaginam. Still it was evident that the patient was sinking, and the grand question for consideration was, whether delivery should or should not be attempted. On the one hand, it was the moral duty of the attendants to preserve the life of the infant, if it could be done without risk to the mother ; while on the other, there was the great probability that the child was dead ; and that even were it living, the employment of manual or instrumental means of delivery, would prove a shock which the decreasing energies, and exhausted condition of her system would be inadequate to sustain. It was therefore decided not to interfere. At this time hot turpentine was directed to be applied to the abdomen, and cordial stimulant drinks to be given in such quantities, and at such intervals, as the almost incessant vomiting would permit. At one, a. jn. on Thursday, we visited her again. The application of the turpentine had thrown the patient into a delirious state, by the im¬ mense irritation that it excited, from which however, she was now recovered, and had resumed her former composure.
All the indications of the approach of a fatal termination were become more decided ; the pulse was tremulous and intermitting, the countenance perfectly hippocratic, the mouth encrusted with dark and foetid sordes, the tongue loaded with a thick brown fur, singultus was loud and frequent, the extremities were cold, the surface bedewed with a clammy sweat, &c. She lingered for several hours in this condition, till the supervention of low muttering delirium and con¬ vulsions ushered in the presence of death, which did not take place before 6, p. m.) In this state she remained the greater part of the day, her mind fully conscious and collected, but towards evening delirium and convulsions supervened, and put an end to the scene at 6, p. m. Permission to open the body was obtained on the following morning ; the inspection was confined to the abdomen, the parietes of which had already assumed a mottled discoloured ap¬ pearance, denoting the tendency to speedy decomposition, the uterus was found entire. The peritoneum as well where it lines the abdominal muscles, or where it is expanded over the uterus and
54
Original Communications .
reflected, around the large and sinall intestines, presented a dusky opaque appearance, with a congeries of injected vessels scattered in various parts of its surface, so that scarcely a square inch of its extent had a healthy colour or transparency ; these marks of inflamma¬ tion were more intense on the anterior surface of the womb, and the broad ligaments and ovaries were disorganized and in a state of gan¬ grene, being hard and lacerable with the greatest facility. A vast quantity of a muddy fluid was effused into the cavity of the abdomen, in which floated some flakes of coagulable lymph. The parietes of the uterus had a thickness of three quarters of an inch, and it is remarked en passant, that their structure bore no kind of resemblance to that of muscle. The liquor amnii was abundant, of a brown colour, but transparent ; the foetus, whose head had made some advance into the parieties of the pelvis cavity, was a fully developed male. Its cuticle presented a bluish aspect, and was readily separable from the subjacent surface ; the placenta was large, and of a soft spungy texture. The decidua, when stripped from the surface of the cavity, -showed this to be dark- coloured, turgid and highly vascular ; the cause of death was sufficiently evident — universal serous abdominal inflammation. The points of interest and doubt in this case are the occurrence of the sensation of disruption on Wednesday morning, the almost sudden cessation of the expulsatory pains on the same evening, and the peculiar oscillatory motion of the epigastriunn It may be conjectured fairly enough, that the fancied and apparent cracking or giving way,” depended on the last convulsive struggle of the foetus, but for the cessation of labour pains, and the sudden occasional movement of retraction felt in epigastrio, I am unable to assign any efficient reason, or to discern any determining cause.
With respect to the exciting cause of this most unusual and exten¬ sive inflammation, it did not appear, from the account we could obtain from the friends, that she had received any external injury, or been subjected to the action of any individual unnatural force. But her occupation as washer-woman and laundress, continually de¬ manded much mascular exertion, and frequent long- continued con¬ strained positions of the body ; after which she was accustomed to complain of irregular shooting pains in the abdominal region. Moreover, she had suffered about the third month of gestation from what was described as an attack of peritonitis, since which the abdominal uneasiness and soreness had been calm, when not induced by her forced and unnatural exertion, pretty constant. The age of this woman, it should have been noticed, was 33, and she had three children living. Her habit of body was delicate and weak ; and the digestive functions so decayed, that every solid meal taken throughout her gestation was rejected, in a greater or less period of time after its reception into the stomach, by the action of vomiting ; this was totally independent of the sympathetic effects of pregnancy in the stomach, which were present in a distinct but slight form, during the • first two or three months. Are we to suppose in this «ase, that -th£ -inflammatory process was proceeding during the whole
Dr.Malins on Fatal Peritonitis duringUtero-gestation. 55
interval between the first attack of peritonitis at the third month, and the sudden accession of the fatal attack on the Saturday pre¬ ceding her death, that it was originally set up at the first mentioned period, and was afterwards maintained by the series of rude disturb¬ ing motions, and the irregular violent pressure to which the uterus was obnoxious during the period of its progressive enlargement.
What other supposition will explain so readily the occasional pains and constant uneasiness, under which she indisputably laboured throughout ? Is there any thing in the nature of inflammation, any well ascertained and certainly defined phenomena belonging to its march and consequences, which forbid our entertaining the belief that it was present during this period, of from five to six months, working its latent and insiduous course, and accumulating its force and intensity for' the terrible display which it at last so suddenly manifested itself ?
Admitting the possibility of a latent or sub-acute inflammatory state of such duration, how was it that it did not display itself till the period we knew that it did ? Or rather why did it display itself then in preference to any other period ? for the knowledge of neither the patient herself, nor of her friends could supply us with any unusual circumstance to be adopted for, or tortured into an exciting cause.
Rejecting the possibility of inflammation existing so long without' evidences of its presence, by more than transitory abdominal pains, how, it may be asked, can they be better or differently ex¬ plained ? We had inflammation at the third month, pains and tender¬ ness are never absent up to the ninth month, we had then (without any evident or unusual exciting cause) other inflammation proving fatal in a short time. Here certainly was an inseparable claim, a linked continuity of morbid action.
38, Kirby Street, Hatton Garden.
December, 1830.
Note by the Editor. — Dr. Ryan was of opinion, on seeing this patient, that her disease was peritonitis, which he stated in the presence of the midwife, and several other persons, before his friend arrived.
There was intense pain on the slightest pressure, on every part of the abdominal parietes, and also increased heat of surface* The patient was bled from a large orifice to syncope, and the blood was neither cupped nor buffed ; on the preceding day it possessed both characters, when it was abstracted by a gentleman whom the husband had dismissed, though nothing could have been more judicious than his practice. He had blistered the chest, as there was a hard cough, and difficult respiration.
Rupture of the uterus wras suspected, for the reasons already stated ; and more especially, as every scientific obestetrician is aware that it' might happen in any of the last months of pregnancy, from mental emotion, (Percival, Underwood) from external injury, or preternatural labour, and without any evident cause. The usual appearance of
56
Original Communications .
the abdomen, and the natural presentation at the brim of the pelvis, in this case, disproved the possibility of its occurrence.
The grand question was, ought delivery to be effected or not? To determine this important question, it was necessary to consider every symptom of the case.
It will be recollected, that the peritonitis had preceded the sup¬ posed laceration, and must have been aggravated by the occurrence, had it actually taken place. The motion of the infant had ceased for some hours ; and under existing circumstances, there was the greatest probability that it was dead. As the uterine action had ceased, delivery could have been effected only by one or two opera¬ tions, both of which were unjustifiable, by forcible dilatation of the os uteri (in peritonitis) or by gastrotomy. The first operation is unsanctioned in all cases, until the womb is somewhat dilated ; an axiom held by obstetric writers, in all countries ; and still more ob¬ jectionable for the extraction of a dead infant. Again, was not gas¬ trotomy as objectionable, when the vital power was so prostrate, where abdominal inflammation existed, and where the patient might have died under the knife, though there was no positive evidence of uterine rupture, or of the life of the infant ? But suppose the infant was extracted, living or dead, setting aside the risk of the mother, of what benefit in her disease could delivery have been ?
Besides, it was reasonable and just to suppose, that the peritoneal coat of the uterus, and perhaps the organ itself were implicated in the disease ? — a supposition confirmed by the necrotomic appearances — had delivery been effected by turning, which in the humble but firm opinion of the writer, was unwarrantable in such a case, the patient’s disease could not have been benefitted in the slightest degree. First, the os uteri must be forcibly dilated, an unwarrantable proceeding in all cases ; 2d. the infant was to be extracted ; 3d. the placenta, a fatal proceeding, unless the uterus contracted, to stay haemorrhage ; 4thly, the decidua should inevitably be left behind, as there was no uterine action to effect its separation — a most undesirable circum¬ stance, in such a case as an additional source of irritation. Those acquainted with obstetric practice, will unanimously agree with this statement ; such being the views of Dr. Ryan, and of his talented and erudite friend. Dr. Malins, no operation was attempted ; and though few practitioners could have been more anxious for the pre¬ servation of parent and offspring, or either the unfavourable results afford a melancholy consolation in the positive proof of the validity of their opinions and practice.
The dissection proves that human endeavours were all useless.
It is right to explain, when the warm turpentine was applied ; it was for this reason, that it is highly valuable as a rubifacient — in cases so urgent as not to allow time for the effect of epispastics. It may be said, that the stethescope ought to have been applied to dis¬ cover whether or not the infant was living ; it was suggested by Dr. Malins : but the symptoms left little doubt of the death of the infant ; a conclusion also fully justified by the evidence afforded by
Dr. Bill mg' on First Principles of Medicine 41
to these observations, it affords us much pleasure to state, that Dr. Billing lias rendered the student of medicine an essential service, by this interesting and instructive volume. We strongly recommend, not only the perusal, but the study of it, to the student and young practitioner, and even to the ablest and most experienced, who will gain both information and knowledge from reading it. As a Compen¬ dium of the First Principles or Institutions of Medicine, it is well worthy of the attention of the profession. Should another edition of the work appear, of which wre enter¬ tain no doubt, we would suggest to the author the propriety of giving a table of contents, and dividing the pages into paragraphs, as at present their is no break or resting place from one cover to the other.
ORIGINAL COMMUNICATIONS.
I. — Case of Fractures of the Cranium, removal of depressed hones — recovery. — By Richard Tuthill, M.D. Assistant Surgeon to the 52d Regiment, Halifax, Nova Scotia.
Daniel Callaghan, set 23, a labourer, of a stout muscular habit, and sanguineous temperament, on the 9th of Septem¬ ber last, received a severe injury on the left side of the head, from a stone weighing 121bs. which was driven into the air by gunpowder, and fell from a considerable height. He was knocked down by the force of the blow, and was rendered senseless, in which state he lay for some time. Two distinct fractures were produced, one of the centre of the parietal bone close to the sagital suture, the other occupied a portion of thp anterior part of the parietal, and the adjoining part of the frontal bone; the former wras attended with considerable laceration of the $galp, that exposed the depressed portion of bone, which was partially buried under the inferior part of the parietal bone in such a manner, that it could not be removed without applying the trephine; the latter fracture was unac¬ companied with any laceration of the integument. Two portions of depressed bone were removed at about the dis-
VOL. VI. NO. 31.
K
42
Original Communications.
tance of half an inch from one another, and immediately af¬ terwards he was restored to his senses, and did not suffer the least deficiency of them afterwards. The hemiplegia of the op¬ posite side became evident after the sensibility was restored, and gradually subsided in the course of ten days; the upper extremity first recovered its functions, and then the lower one. Two bleedings, of 32 ounces each, were performed be¬ fore and a few hours after the operation. As no symptoms afterwards presented themselves, which required a repetition of the bleeding, the medical treatment consisted of purga¬ tives, diaphoretics and a low diet. The pulsation of the brain was very evident in this case. The wound healed by the first intention, the pulsation gradually decreased, he was perfectly restored to health and to his work, 21 days after the accident had happened.
II. — Fracture of the Cranium, fungus cerebri.
Jacob Faden, set 22, a native of Halifax, Nova Scotia, of a pretty stout muscular form and sanguineous temperament, on the evening of the 22nd July, received a blow upon the superior part of the left parietal bone, which produced laceration of the scalp, and such fracture and depression of the bone and laceration of the dura mater, as to occasion a small protrusion of brain. Stupor or coma came on imme¬ diately after the accident had happened, and continued until 24 hours after the operation was performed ; it then ceased, and did not return until a short time before his death. The operation was had recourse to as soon as possible after the wound was inflicted. When the circular portion of bone w as taken away, one or two small depressed portions were ele¬ vated, and several small pieces that were driven into the sub¬ stance of the brain wrere removed, the lacerated portions of the scalp were brought together by suture and adhesive plaster, and the patient was left quiet in bed. But soon after active cerebral inflammation came on, and was in a short time attended with such violent delirium, as to require the use of a straight jacket ; he was immediately bled to 24 ounces, the day after to 16, the third day to 12, and the fourth day to 12. Active purgatives were administered, followed up by diaphore¬ tics and opiates, and by these means the inflammatory action wras subdued, and his natural senses were restored. A short time after the operation had been performed, the brain put on a
Dr. Tuthill on Fracture of the Cranium . 43
morbid action,, and portions protruded, varying1 in size, which were removed by the scalpel and ligature ; between four to six ounces of the brain from first to last were removed, and notwithstanding so large a portion of so vital an organ hav¬ ing been cut away, it is singular to observe, that his senses and faculties were perfect to within a few hours of his death. He was doing so well as to sit up and walk about the last three weeks of his illness, without experiencing any inconve¬ nience ; his appetite improved, bowels were regular, and the strongest hopes were entertained of his recovery. But that unfavourable symptom, the profusion of brain, increased and was removed every day for a week, besides at other periods, without occasioning the least pain or any other bad symptom ; pressure was made by pledgets of lint, wetted in lime water, with a view of keeping down the morbid growth ; this gave rise to hemiplegia of the opposite side without the least im¬ pairment of the intellectual faculties, which continued three weeks, the period that the pressure was employed ; the mo¬ ment the pledgets were taken off, the functions of the oppo¬ site side wrere perfectly restored. On the 14th September, rigors took place, and became constant until the day of his death. On the 16th, the largest portion of brain, the size of a large hen’s egg, protruded, muttering delirium began in the evening, the day after the eyes were turned outwards and a little upwards, the pupils were irregularly dilated, he became insensible, incapable of even muttering or of making any ex¬ ertion, and on the 19th September, 56 days after the accident had happened, he died without making any struggle. The day after the upper part of the cranium was removed, the dura mater was found firmly attached to the circumference of the circular opening made by the trephine, and so united to the pericranium by vessels passing from one membrane to the other, that the edge of this opening presented a smooth hardened edge, of a cartilaginous nature, but of a preterna¬ tural red colour. The brain about the wound was in a per¬ fectly decomposed state, mixed with a portion of purulent matter. A. lage abscess, filled with matter, was found in the left middle lobe under the wound, which communicated with the ventricles and filled them with matter. The up¬ per surface of the tentorium, on the left side, was co¬ vered by a layer of purulent matter, which was found at the base of the cerebellum. No other morbid appearances Here discovered.
44
Original Communications.
III. — Case of C cesarean operation. — By John Stirling., Esq-
Halifax, Nova Scotia, communicated by Dr. Tuthill.
Sarah Munn, aged 42 years, of the height of four feet only* although the head, neck, and trunk, as low down as the os ilium, are of the size of those of a person of ordinary stature ; the lower part of the pelvis, upper and lower extremities, being so diminutive as to appear like those of a child of six or seven years, was married in the year 1822 ; in the month of July, 1823, she was taken in labour, and my assistance was re¬ quested. — On examination I found the pelvis distorted, and very much contracted ; the upper part of the sacrum pro¬ jected forward, so far as to overlap the symphysis pubis, the labour pains at this time were slight, and 1 could not find the os uteri. Under these circumstances I requested a consulta¬ tion, at which Messrs. Head, Hume, and Keegan, medical practitioners in this place, attended, and after due examina¬ tion, it was agreed that as the shortest diameter of the pel¬ vis seemed about two inches, an attempt to extract the foetus by embryulcia might succeed. The labour pains increased, the os uteri was gradually dilated, the membranes gave way, and the breech presented ; with great difficulty the feet were brought down, and at last the body was brought through ; but now finding it impossible to get the head into the pelvis, and also impracticable to pass the fingers through the vagina along the body, I was obliged to dislocate the upper cervical vertebrss and elongate the neck, so as to make room for my hand. I now introduced the perforator, and made two or three perforations into the skull, and after incessant efforts for six or seven hours, the head was at last extracted piece meal. In the progress of this effort, it w7as necessary to loose and remove separately each bone of the cranium, by means of the fingers in utero, and 1 was even obliged to separate the lower jaw and the spheniod bone from the bones of the face, before these last could be removed. The consequences of such violent and long continued efforts were severe inflam¬ matory fever, with sloughing of the soft parts in the pelvis, in which the bladder participated, and an opening about an inch in diameter remained, through which the urine continued af¬ terwards to pass into the vagina. She finally recovered, and again becoming pregnant, miscarried in the second month, in the year 1826.
In the month of Mav, 1828, she informed me that she was again pregnant, and I endeavoured to persuade her to permit
Mr. Stirling on Ccesarean Operation. 45
me to use mechanical means to produce abortion,, which she declined.
About three months afterwards, she had an attack of pneu¬ monia, which yielded to the usual mode of treatment, since which time she has enjoyed pretty good health, with the excep¬ tion of some febrile attacks occasioned by the pain and irritation produced by the urine passing into the vagina. On Satur¬ day evening, the 20th December, 1828, labour pains came on, at first slight, but they gradually increased. On Sunday after¬ noon, in consultation with Mr. Grigor, surgeon, found, on exa¬ mination that the os uteri was loose and soft, high up above the brim of the pelvis, and about one and half inches in diame¬ ter, the belly wTas pendulous, being projected wholly before the os pubis, pulse 90. On Monday, at two, p. m. the os uteri was nearly dilated, the membranes gave way, and the head was felt to present high above the brim of the pelvis ; after the rupture of the membranes, the pains diminished, and she became restless and thirsty, pulse about 104. The soft parts within the pelvis were highly irritable, and felt hot, and very much thickened, every attempt at examination, even by a single finger, occasioning excessive pain. — Under these cir¬ cumstances a full consultation of medical practitioners was called at seven o’clock, p. m. when it was the general opi¬ nion, that an attempt to extract the child by embryulcia would, from the thickened and irritable state of the soft parts, probably be fruitless, and if successful, must end in the de¬ struction of the mother, and as the patient herself expressed a resolution to submit to any risk rather than undergo the sufferings she formerly experienced, it was revolved (after explaining to her the great danger of the operation) to ex¬ tract the child by the Caesarian section.
At nine o’clock the same evening, the pains having nearly ceased, the operation was performed ; the bowels had been opened in the morning by a dose of castor oil, and at four, p. m. an enema was thrown up, which emptied the large intes¬ tines. The room was heated to about 90°, the patient placed on her back near the foot of the bed, and a broad swathe fixed loosely under her. Theoperation w;as commenced by an inci¬ sion, beginninga little below and to the left of the umbilicus, and extending in a line with the linea alba, about seven inches towards the pubis, this laid bare the tendinous sheath of the rectus ; a second incision exposed the peritoneum, which was also divided and the uterus appeared closely em¬ bracing the child. A small opening was now made into the uterus at the pubic end of the incision, and two fingers being introduced, the uterus was laid open by a blunt pointed bis-
46
Original Communications .
toury, the membranes ruptured, and a living female child with placenta removed without difficulty. Previous to the removal of the placenta, not more than half an ounce of blood was lost, and not more than six ounces in the whole. The uterus contracted strongly, and the wound in its sub¬ stance was now only about two inches in length. The small quantity of blood in the abdomen was removed by a soft sponge, a fold of the ilium, which protruded was carefully replaced, and the wound closed by five interrupted sutures through the skin and muscles, with long slips of adhesive plaster and a compress of lint, and the whole supported by the swathe pinned moderately firm around her.
She did not appear exhausted by the operation ; her pulse half an hour afterwards was 96, the child was strong and healthy, and still survives.
On being placed in bed, an anodyne draught was adminis¬ tered, and she remained quiet for half an hour, when she was seized with nausea, and vomited a part of the draught ; ano¬ ther was given, which she also rejected, after which she fell asleep, and remained in that state, with two or three short in¬ intervals, during the night. After the vomiting, her pulse was suddenly increased in frequency to 120, and during the night there was a discharge of a bloody appearance, from the lower part of the wound ; the discharge from the vagina in the or¬ dinary quantity.
Dec. 23. — 10, a. m. Abdomen soft, not tender on pressure, pulse 130, rather sharp, slight thirst, bled her to 10 oz. which produced some faintness, at 12, gave her a purgative enema. At 5, p. m. the enema not having produced any ef¬ fect, gave her 1 oz. of ol ricini, which unfortunately again in¬ duced vomiting and it was rejected. At 10, p. m. slight nausea, pulse 136, gave another enema, which produced one scanty evacuation.
Dec. 24 — 10, a. m. Has passed a restless night, and vomited frequently, there is some tumefaction of the ab¬ domen, no increase of pain, pulse 140, tongue clean andmoist, has some thirst, no evacuation from the bowels ; during the night there has been a considerable discharge of bloody sanies from the lower part of the wround, chiefly during the vomiting : ordered her calomel gr. iv. opii gr. i. to be repeated in four hours, with an enema — At 5, p. m. had slept about an hour, pulse 140,no evacuation frombowels, thirsty, belly tumid, discharge from the vagina has ceased, repeated the calomel and opium, with the enemata, the Vagina to be frequently washed with warm water by means of a syringe ; at 8, p. m. has not vomited since noon, pulse 140, thirsty, feels inclined
Mr. Stirling on Ccesarean Ojjeration,
47
to sleep, removed the swathe and compress, and applied fresh straps, found the integuments close and adherent, except a small space at the lower part, where there was a small co- agulum lying, which was removed. Belly tumid, without pain ; the uterus feels large, hard and painful on pressure ; repeated the calomel and opium, and ordered a purging enema to be repeated several times during the night, should no purging effect be produced.
Dec. 25 — 8, a. m. Was restless and vomited several times during the night, abdomen tumid, but soft and without pain, uterus can be felt hard and swelled through the integuments. Enemata produced two or three faecal evacuations, no lochial discharge, pulse 150, small and weak. She gradually sunk, and expired at three o’clock, p. m. being about 66 hours after the operation.
Examined the body next day. On removing the stitches and opening the wound, found three or four small coagula adhering firmly to various parts of the ilium, at which spots there were slight marks of inflammation. The peritoneum had also two very small specks slightly inflamed ; the uterus was large and hard, and from the wound in it, which was open, there oozed a dark thin sanies, its colour, particularly for some distance round the wound, was darker than natural, the bladder was small, but healthy, in it was a small circular opening about an inch and half from the sphincter, through which the urine had passed into the vagina.
Dimensions of the Pelvis.
Soft Parts removed.
In.
Short diameter from projection of
sacrum to the symph. pubis . 2. 1-1 2th
Long diameter of ditto .... 3^
Projection of sacrum to the point of
the os coccyx ...... 2^
From ischium to ischium . . . . 4|
From arch of the pubis to the re¬ motest part of the sacrum in the hol¬ low . * . . 2§
From superior spinous process of the ilium to the other ....... 8^-
Whole height of the body . . . 4ft. ^inch.
6th Oct. 1830, >
Halifax. J
Soft Parts not removed.
In.
3 6-8ths.
1 7
%
ol
^8
48
Original Communications.
IV. — Clinic Reports — Richmond Hospital , Dublin. — By John Swift,, Esq. — M.R. C.S. — Cubito- digital Neuralgia
— Excision of the ulnar nerve . — (continued.)
John Kearney, aged 70, of active habits, and enjoying good health, was admitted on the fourth of September, with neuralgic symptoms, principally affecting the ulnar nerve. He stated, that the pain com¬ menced in a circumscribed spot, on the palm situated immediately above the metacarpo-phalangeal articulations of the little and ring fingers, and runs along the ulnar nerve as high as the brachial plexus. Sometimes, but much less frequently, the pain runs in the course of superficial nervous arch of the palm, towards that branch of the median nerve, which supplies the outer side of the thumb, and then proceeds up the fore arm ; pain periodical, and brought on by trifling causes ; soreness felt on pressing the spines of the second and third cervical vertebrae, and over the roots of the brachial plexus. The principal uneasiness referred to the limited spot on the palm before mentioned.
These symptoms first appeared about seventeen years ago, after amputation of the fore finger of the affected hand. Moxa had been frequently applied to the palm without effect.
Sept. 6th. — Dr. M‘Dowel excised about an inch of the ulnar nerve, an incision two inches in length, was made through the integuments in the lower third of the fore arm, over the nerve, not parallel to its direction, but commencing above, close to its radial side, and termi¬ nating below, at the same distance from its ulnar, the aponeurotis was then divided; the flexor carpi ulnaris drawn inwards with a bent probe, and the nerve seen lying at the inner side of the artery, was raised with a tenaculum, and divided. The operator then, to satisfy himself, pricked the little finger on both sides, and the ulnar side of the ring finger, without being felt by the patient, but on touching the radial side of the latter, he complained of pain. The operation did not occupy two minutes, and there was no difficulty experienced in finding the nerve.
7th. — Has had no remission of pain since the operation ; it shoots from the affected spot on the palm, and from the thumb, in the course of the median nerve. Ordered, opii gr. iss. 8 vis. horis.
8th. — Pain continues undiminished ; a blister to be applied over the cervical vertebrae, which are tender on pressure. Habt. ext. cicutse, gr. ij. opii granum in pil, 6 tis. horis.
9th. — Slept better last night, and feels less pain.
11th. — Attacked on the preceding night with severe paroxysms of coughing, attended with difficult expectoration, perspiration, and tendency to syncope. Emplast. vesicat. thoraci. R. mist camph. ^vi, spirit, aether, oleosi yi. sumt. §j ter die.
12th. — Passed the night badly ; cough and weakness, as on the last night ; the blister had fallen off his chest. Hab. empl. vesciat inter scapulas — enema terebinth — fovr. pedes.
Dr. Malms on Fatal Peritonitis during Utero- gestation. 57
the dissection. It is important to state, that besides the morbid appearances already detailed, the peritoneal covering of the small intestines was inflamed, and all that portion of the uterus which was in contact with the brim of the pelvis, The substance of the organ was much redder than natural, and in many parts were of a dark brown colour, through which the finger passed with great facility. Both ovaries were much enlarged, brown, and softened, and readily lacerable. On making several incisions in the uterus, there was no evidence of phlebitis. The propriety and safety of incising the abdomen in peritonitis, are as yet undetermined.
The reasoning of Dr. Malins against the possibility of chronic peri¬ tonitis for so long a period as already mentioned, is exceedingly power¬ ful, and apparently conclusive. But according to the French patho¬ logy, it may be questioned. Our Gallic contemporaries maintain that “ sometimes the pain and alarming symptoms (of peritonitis) may cease on the third day, the disease continues and becomes chronic, or the disease may establish itself to continue indefinitely.” (Diet. Abrege Des. Sc. Med. 1825, T. X — p. 465.)
“ The more the subject is lymphatic, feeble, the more chronic peritonitis is obscure, less intense, especially at first, **** but it almost always ends by dropsy, after having continued one or many years;” Op. Cit. 468. It may become acute, and affect the brain, pleura, pericardium, stomach, intestinal canal, &c. and is most common to women, in whom it is especially observed after parturi¬ tion. Op. cit. It generally follows acute peritonitis, audits symptoms are as follow: — The abdomen is sensible on pressure, but not pained ; it is most so at night, or at irregular intervals, and without apparent cause. The patient complains of flying pains in the abdomen, on any slight exertion, on laughing, coughing, or riding in a carriage ; the digestion is capricious, or there is nausea, thirst, constipation or diarrhoea ; there is often cough, dyspnoea, especially on assuming the recumbent position. Op. Cit. 466. M. Andral has published cases, in which he thinks peritonitis has continued for forty days ; and these opinions induced Dr. Ryan to reply in the affirmative to a question put to him on a late occasion, at one of the Medical Societies — could peritonitis continue for a few days or weeks ? The great similarity between the symptoms of chronic peritonitis and these detailed in the case before us, is exceedingly remarkable ; and the great exertion made by the patient in the pregnant state, would favour this pathology. The reader will form his own opinion on the practice in the above case, and the critic will display his prowess ; to both the words of the poet are applicable ;
“ si quid novisti rectius istis
candidus imperti, si non, his utere mecum,”
VOL. IV. no. 31.
[ 58 ]
VIII. — Hydatid of Liver and Gall Bladder.
London Hospital. — Enlargement of the liver extending into the pelvis , hydatids, fistulous opening from the (rail bladder into the bronchia.
O
Sarah Manning, set 35, widow, had never borne children, was lately admitted into the London Hospital under the care of Dr. Billing ; had complained for three years of dry cough and pains in the right hypochondrium, without much disturbance of general health, until within two months, when the cough increased with pain ex¬ tending up into the chest ; at that time a tumour pointed and broke, half-way between the umbilicus and cartilages of the ribs in the right hypochondrium, and there is still a fistulous opening, from which a yellowish serous fluid escapes ; she is jaundiced, and ex¬ pectorates a large quantity of a frothy, thin, purulent looking matter ; she is perpetually harassed by cough producing retching, and con¬ stant rejection of her food ; there is mucous rale, and bronchial respiration in the inferior part of the right side ; she feels less oppres¬ sion of the chest, when the opening in the side discharges freely ; pulse moderate, tongue clean, skin soft, much emaciation ; there is a solid tumour in the situation of the liver extending down towards the pelvis.
The treatment consisted chiefly of mild tonics, and nourishment to support strength.
In a few days two or three membranous shreds (hydatids) the size of large grape skins, were discharged from the opening in the side, and she now mentioned that she had expectorated the same kind of substances. She gradually sunk from emaciation and exhaustion, without any urgent symptom.
Sectio cadaveris. — Upon opening the abdomen the liver occupied all the cavity down to the pelvis, into which it had thrust the intes¬ tines, (this appearance was increased in consequence of the waist of the woman having been unnaturally compressed by the tightness of her dress;) it was not much increased in bulk, but elongated; the lower part of it presented a hard tumour, very elastic, the size of a man’s fist, containing one hydatid about three inches in diameter, which had no young ones within it, but several granulations attached to the inner surface. The gall bladder formed another tumour stuffed with skins of dead hydatids, such as had been discharged through the opening in the abdomen, and a director was then passed upwards from the gall bladder in a fistulous channel, through the diaphragm, and through the lung into one of the larger bronchial tubes, which was wider than natural, thus forming a passage from the gall bladder to the trachea wide enough to admit the point of the little finger; the <?all duct into the duodenum was not obstructed. The other viscera were healthy.
Dec. 18th, 1830.
-•"I
[ 59 ]
IX. — Medico-legal questions , relating to Infanticide.
By M. Ryan, M.D.
Death of the foetus from voluntary causes.— The new¬ born infant may be the victim of external violence wilfully inflicted upon it, and it may also perish bjr the voluntary omission of that succour which is necessary to it in the first moments of its existence ; hence we distinguish infanticide by commission , and infanticide by omission.
Infanticide by omission may occur from exposure of the new-born infant to a temperature too cold or too warm, if it be deprived of nourishment or respirable air, and from umbilical haemorrhage, caused by disruption of the cord. It is difficult to determine what thermometrical degree of heat or cold would destroy life in these cases, but if we find the body of an infant naked, or nearly so, stretched on the ground, discoloured, the great internal vessels con¬ gested, and the external or superficial contracted, and almost empty, and with evidence that respiration has taken place, and at the same time there exists no trace of ex¬ ternal injury, there is every probability that death has been caused by cold.
The defect of nutriment is generally combined with aban¬ donment of the infant ; and to this cause we should attri¬ bute death, when atmospheric temperature is not sufficiently cold to be destructive, and when we find the alimentary canal dry and contracted.
The neglect of tying the umbilical cord will expose the infant to fatal haemorrhage ; but this is not always the case, and does not afford sufficient evidence of mortal haemor¬ rhage, as the large vessels should be empty, there should be paleness of the body, viscera and muscles, to prove that death has been caused by loss of blood from the cord. Again, death may take place from this cause, where it was impossible for the mother to afford the necessary aid to the new-born infant.
Thus in cases of placental presentation, the infant may be destroyed by haemorrhage, but there will be manifest signs in the woman under such circumstances ; she may be in a state of syncope from this occurrence, and be unable to save the infant from perishing. The foetus is often destroyed from separation of the placenta during pro¬ tracted labours ; in both of these cases the placenta will be attached to the umbilical cord. It has been said that the mother, during convulsions, may possibly rupture the
60
Original Communications .
cord, or that this may happen from the motion of the infant, or when the woman is delivered in the erect position, tiie foetus having fallen on the floor. In the last case, disruption may happen, but it appears very doubtful in either of the former.
It will be recollected that M. Klein has recorded one hundred and eighty-three cases of sudden labours, in many of which the cord was ruptured near the abdomen, and in twenty -one cases within the abdomen, yet there was no fatal umbilical haemorrhage.
It is also to be remembered that the infant’s head, in its passage through the external genitals, is so situated, that its face may be in contact with the liquor amnii or blood, and in this way may be deprived of air, or asphyxiated by impure air ; or the head may be expelled, respiration esta¬ blished, the labour cease, and strangulation be effected before delivery. This case is by no means unfrequent, every practical obstetrician has met with it, and should it happen in the first labour, it is evident, that from the igno¬ rance, pain, or syncope of the woman, the infant may be destroyed. It therefore appears evident that we must duly consider all these circumstances before we can safely con¬ clude there was criminal intention on the part of the mother.
Infanticide by commission , is indicated by contusions, wounds, luxations of the cervical vertebrae, fractures of the extremities, torrefaction or burning, and asphyxia.
Contusions and wounds. — The ordinary effect of contu¬ sions is ecchymosis, which will be more extensive, accord¬ ing to the situation in which it may be placed ; but great care must be taken not to confound this appearance with the cadaverous lividity. We should also be cautious to distinguish ecchymoses of the scalp, produced by parturi¬ tion, from those that result from violence. The former are generally superficial, and situated most commonly upon the vertex, occiput or parietal bones ; while those produced by violence are deep and brown, and in various situations, often on the temples. When caused by labour, the infant cannot have respired, and this will be discerned in the manner formerly mentioned. If considerable ecchymoses, contusions, or tumours exist upon an infant that has respired, there is just ground for the suspicion of criminal violence.
In some cases ecchymosis of the neck may be ascribed to pressure of the orifice of the womb, or of the vulva, or by twin¬ ing of the umbilical cord round the neck, and present the ap¬ pearance of strangulation ; under such circumstances, the
Dr. Ryan on Prolicide , Foeticide , Infanticide. 61
respiration may be impeded or prevented, the infant de¬ stroyed, the lungs evince the signs of respiration, and the case will be involved in great obscurity and difficulty. Other facts must exist to warrant a correct conclusion.
Luxations of the cervical vertehrce. — When death is produced by luxation of the cervical vertebrae, the ligaments of the vertebrae will be torn, the spinal marrow will be bruised or torn ; ecchymosis, and sanguineous infiltrations, will indicate that the injury has been inflicted during life, as these phenomena cannot exist after death. It is to be recollected, however, that such luxation may be the effect of injudicious attempts to extract the infant during labour ; and it is therefore necessary to ascertain if the parturition has been difficult, and whether any traction has been applied to the infant.
Fractures of the bones or wounds often depend upon parturition, or upon the violence offered by ignorant and bad practitioners ; it is therefore necessary to keep these facts in mind, in determining questions of infanticide from such injuries. • • ,
Torre faction, or burning, is a horrible method resorted to for the destruction of infants, a case which I grieve to indite, has occurred in this city within a few days. Here it will be necessary to examine all injured parts, and to apply the ordinary proofs, to ascertain if respiration had existed. In the case to which I have alluded, the coroner (an attorney) was of opinion that a verdict of manslaughter could not be received. The prisoner, a nursery maid, was acquitted !
Asphyxia. — A new bom infant may be asphyxiated by privation of respirable air, by mechanical obliteration of the air passages, by strangulation, by submersion, or by the action of the deleterious gas. The infant will be deprived of air by being placed in a chest, or under the pallet, &c. but as some minutes must elapse between its birth and death, the usual tests will decide that it has respired. Infants have been destioyed, whose nostrils and mouth were filled with linen, hay, earth, &c. to the prevention of respiration ; the presence of these substances will enable us to form a proper opinion. Infants have also been de¬ stroyed by pressure upon the mouth and nostrils, trachea and thorax, and by forcing the tongue into the fauces ; in all of which cases a few inspirations take place, and the pulmonary proof will be decisive.
In all these cases the rupture of the frcenum linguee, the
62
Original Communications .
ecchymoses of the neck, the marks of injuries upon the chest, and in the interior of the mouth, with the signs of cerebral congestion, afford very strong evidence against the accused.
The introduction of. fluids into the trachea or lungs, is another cause of suffocation ; the discovery of the nature of the fluid by chemical analysis, enables us to arrive at a positive decision against the accused. Submersion or drowning is a frequent mode of infanticide. The pulmonary evidence of respiration, and the similarity of the fluid found to that which surrounds the dead body, enable us to de¬ cide that death was caused by submersion. In such cases there is usually^ more or less fluid in the stomach. When death is produced by strangulation, there will be ecchy¬ moses on the neck and face, with cerebral congestion. The most frequent mode of infanticide, is the precipitation of the infant into the water closet or privy, which may be the effect of accident ; but the pulmonary docimacy will de¬ cide if the infant has respired. In the cases recorded by Klein, the majority of the women were primiparous. I have known a woman of low stature delivered of her first child by a single pain, and I have recorded similar instances in my work on obstetrics.
In all cases of infanticide, we must be certain that the woman has been recently^ delivered, and that this event coincides with the age of the infant. The signs of recent delivery have been already enumerated. It is right to men¬ tion that infanticide has been effected by the introduction of needles into the brain (Gui-Patin, Brendel, Belloc), and into the temples, internal canthus of the eye (Brendel), the neck, region of the heart (Fodere), and the abdomen. Infants have been destroyed by poisons, which have been applied by inhalation into the lungs, by commixture with food, absorption through the skin, and by enema. Those are to be discovered by the usual tests, which will be men¬ tioned hereafter.
Before concluding this subject, it is necessary to prove the validity of the statement, that the hydrostatic test is no longer considered conclusive. Some of our best jurists cling to it with a degree of tenacity, which, to speak in the mildest terms, is exceedingly remarkable. Drs. Beck and Gordon Smith think it decisive, with due precautions, and a reviewer in the Edinburgh Medical and Surgical Journal, in 1826, perhaps Dr. Duncan, thinks it affords 'presumptive evidence. The opinions of these talented and distinguished professors are of course entitled to respect and much con-
Dr. Ryan on Infanticide.
63
fidence ; but it is to be recollected, that the judges of the land will not receive the evidence afforded by this test. This is not the place to discuss the propriety of this con¬ clusion. Whether the recent modification of the law on the subject is a sufficient reason, lawyers only can determine. As the law now stands in this country, the questions to be decided in cases of infanticide are, has death been caused by violence, neglect, or ill-treatment ? The same evidence is required as in cases of homicide. The question of child murder is still, however, interesting ; for if the infant has been born alive, there is presumptive evidence against the accused ; and, secondly, the^ decision of the question will affect the disposition of property in cases of tenant by courtesy, as already mentioned. The law in this United Kingdom, Scotland excepted, and in almost all nations in Europe, is, that a child is born alive, when it evinces the slightest voluntary motion. A curious decision, made on this point by the court of Exchequer at Westminster, has been already recorded. According to the law of Scotland, the infant, must cry to prove its vitality. This is manifestly absurd, as asphyxiated infants have been resuscitated after an hour and a half, as I have often witnessed; and infants have been declared dead — the undertaker sent for, and every* preparation in progress for burial, though resuscitation was established after some hours.
In cases of still-born infants, I have more than once succeeded in establishing the action of the heart, and one or more inspirations, though complete respiration could not be established ; and in such cases, no physiologist can doubt the vitality of the infant.
Dr. Blundell and others have succeeded in resuscitating infants, extracted by gastro-hysterotomy, a quarter of an hour after the death of the mother ; and a case was recorded: in the Lancet, where the infant was pronounced by the medical attendant to be dead, it was placed as if dead, and on his visit next day, it was alive.
The unanswerable objection to the hydrostatic and other tests, is this, that when the infant breathes before delivery, which every practical obstetrician can attest, not one of them can prove it out-lived birth. Again, if we credit the records of medicine, we can have no doubt but that there may be intra uterine, vaginal and extra-uterine respiration before complete delivery. Dr. Beck and other jurists seem to doubt the reality of respiration in the first and second case ; but is it fair and reasonable to inquire what object could influence those who
64
Original Communications.
have narrated such cases ? Europeans and Americans are among the number.
Dr. Beck; who stands an ornament to his profession, and an honour to his country, employed all his argumentative powers against the probability of an infant, whose head was expelled, and who had respired, losing its life during delivery. His countryman. Dr. Hossack, has recorded a case in point. But suppose the accused do not allege uterine, vaginal, or extra-uterine, respiration, before a complete birth, are not the judges warranted to temper justice with mercy, and to give the prisoner the benefit of the reasonable doubt in such a case ? Most decidedly.
To return to the hydrostatic test, from which I have so far digressed ; I have to state in conclusion, that Drs. Duncan, Beck, and Gordon Smith, maintain it may afford presumptive evidence in infanticide.
But the following facts must be kept in recollection 1. the lungs of a still-born infant will sink in water, but float on the sixth, seventh, or eighth day, when putrefaction has commenced (Muyer in Schlegel), and so early as the third day in warm weather (Beck.)
It is universally known, that the body of a drowned person sinks at first, floats when putrefaction has gene¬ rated air, and rendered it lighter than water ; and sinks again, after the extrication of the air so generated. When the lungs of an infant are putrid, the air is near the surface, (W. Hunter, Jaeger), and can be readily squeezed out by pressure, when the lung will sink ; whereas, when respira¬ tion has taken place, no pressure will cause the lung to sink. (Marc, Beclard.) The lungs are the last organs in the body which undergo putrefaction (Camper, Mahon, Beck.) Marc is of opinion that the lungs which have respired, and are afterwards in a state of putrefaction, will always crepitate on incision, which never happens unless respiration has occurred ; secondly, on squeezing the putird lungs of a still-born infant, they will sink, whereas those of a child born alive, will float.
2. Squeezing the lungs after artificial respiration, will not cause them to sink ; in such cases, the lungs swam even with the heart attached, and also when cut into pieces, and care¬ fully compressed (Mendel, in Hufeland’s Journal der Prac- tischen Heilkunde, Aug. 1812 ; Bernt, Experimentorum Docematiam Pulmonum Hydrostaticam illustrantium cen- turia, Vienna, 1823 ; Merzdorff in Horn’s Archiv fur Me- dezinische, Erfahrung, 1823.)
[ 65 ]
BIBLIOGRAPHY.
1. The Introductory Lecture to a Course of Natural ‘Philosophy delivered in the Theatre of the Medical School, Brewer s-street , Golden-square, Nov. 3, 1830, by Edward Broyvjne, F.L.S. Surgeon to the Farringdon Dis¬ pensary.
In the distribution of the several subjects, which enter into the course of medical and scientific instruction delivered in this place, it has de¬ volved upon me, Gentlemen, to explain to you the principles of natu¬ ral philosophy, to point out the necessity of a knowledge of those, for the successful cultivation of some other departments of science ; and more especially to demonstrate the primary importance of this knowledge to the student of medicine and surgery.
It is not however to the youthful aspirant for the honours of the medical profession alone, that this science presents attractions, or of¬ fers more solid advantages ; indeed, while I regret that it should be so, I fear we must admit that the members of our profession generally are less familiar with this branch of philosophy, than many who pos¬ sess only that general knowledge of the sciences which constitutes in the present day, an essential part of the education of a gentleman.
The progress of intellectual improvement is marked at present, by a new and most important peculiarity — the diffusion of exist¬ ing knowledge amongst the mass of mankind. Can it be necessary that I' should adduce any proof of this ? Need I remind you of the nu¬ merous Literary and Scientific Institutions with which this- metropo¬ lis abounds ? Institutions for the most part yet in their infancy, some in their adolescence, but all promising a vigorous and perpetual manhood, of which the fabled existences of the heathen mythology, afford the only, but imaginary parallel. All intellectual prototypes of Hercules in the cradle. The attacks of the serpent, error and of preju¬ dice, are all which they have to repel, and these are fast expiring in their infant grasp, and unfolding those coils at their feet, which have so long encircled the human intellect and enfeebled its exer¬ tions.
I feel that I cannot impress this fact too forcibly on the minds of the junior portion of my medical hearers. They are no longer enter¬ ing a profession whose mysteries are sacred. They are no longer shielded from the criticism of their employers, by the magical influ¬ ence of a license from Apothecaries’ Hall, of a diploma from the Col¬ lege of Surgeons, or even by the more dignified distinction of an Un- versitv degree. Several cases have come to my knowledge, in which patients amongst the educated classes of society have detected, the want of physical and even of chemical knowledge in their medical
VOL. VI. no- 31.
K
66
Bibliography .
attendants. You will perceive therefore that ignorance of the sciences collateral to medicine is no longer safe . The hour is fast approach¬ ing, if indeed it has not already arrived, when the half educated man, will be unable to obtain even a subsistence amongst us.
The veil of the temple of knowledge, is rent in twain ! The arcana of nature are no longer communicated through the dark and doubtful medium of an oracle, but are accessible to all who will patiently and diligently investigate them. The source of the waters of know¬ ledge is discovered, and you are invited to drink at the fountain-head- The path which leads to it is that of experimental inquiry.
To point out this path to your footsteps, and to accompany you a short distance on your journey, is the task which I have undertaken to perform. To find you zealous and diligent in the pursuit of it, is the highest reward I can enjoy. You will have an opportunity in this place of becoming acquainted with the general principles of science, and with so much of its details as are already generally known ; but I charge you, my young friends, to reflect that the spirit of philosophy requires that you should repay the pains bestowed upon your educa¬ tion by eliciting future discoveries. You are not to rest satisfied with the information which you may obtain from others, but on the contrary you are bound to contribute, though it be but your mite, to the treasury of useful knowdedge. This the world will expect, this your profession has a right to demand from you ; for it affords you facili¬ ties for the cultivation of every branch of knowledge, which can be derived from no other source. A few words of explanation will suf¬ fice to convince you of this.
All the subjects on which the human mind can be employed, inde- pendantly of revelation, may be referred to two general heads. — Science or Philosophy and Natural History.
The first of these two fundamental divisions includes physics or natural phylosophy, chemistry, which is sometimes called experimen¬ tal philosophy, physiology, or the science which explains to us the laws of life, and metaphysics, or ontology, which embraces the consi¬ deration of the active and intellectual powers of the human mind.
Gentlemen, the course of your studies must include all these, or your medical education will be incomplete. Natural philosophy, che¬ mistry, and physiology, are separately taught in all the schools of medicine, except those established in this metropolis, where the omission of the first imposes on the teacher of chemistry, the neces¬ sity of rmiking a brief exposition of its principles, introductory to the proper subject of his course, and this omission is the more extraordi- nory, as Great Britain is the only country in which the possession of natural knowledge is implied in the very name of the physician. Such, however, is the fact.
In the cultivation of these branches of science, reference is neces¬ sarily made to measures of number and dimensions, and hence has arisen a secondary science, called mathematics of the science of quantity.
I am not aware that the philosophy of the human mind has yet
Mr. Browne's Lecture on Natural Philosophy. 67
been made a separate article of medical education, but the reference which must be made to the subject in the lectures on the practice of medicine under the head of insanity, and the influence of the mind upon the body, will convince you that it must not be altogether neglected.
There is one subject which is considered as belonging to the science of mind, to which I would call your attention more particu¬ larly, because the evidence on which it is supported is derived from every department of science and natural histosy — it is natural theology. The cells of the honey-comb are constructed upon strictly mathemati¬ cal principles, and who we may inquire instructed the bee to solve problems of maxima and minima. The proofs derived from the four fundamental departments of science are innumerable, and so clear that he who runs may read, hence the medical man has no excuse for being ignorant of them, and if, as I can scarcely conceive, there should be one who can resist the conviction they are calculated to bring home to the mind, it would be charitable to say of him “ quem Deus vult perdere, prius dementat.”
We come now to the consideration of natural history, this division of the objects of our study, refers to what have been termed the three kingdoms oi nature, the animal, the vegetable, and the mineral; per haps a more philosophical division would.be into the earth, of which minerals may be considered as detached portions, and its inhabitants endowed with animal or vegetable life.
To convince you of the necessity for making the study of natural history a branch of medical education, I need only remind you, that your therapeutical agents, the weapons with which you must encoun¬ ter disease, are supplied alike by each of its subdivisions.
It is not, however, as the members of a particular profession, exclu¬ sively, that you are interested in this subject, but as votaries of science in general ; natural history provides us with the individual examples by which the laws of natural philosophy, chemistry and life are severally illustrated; and on the other hand, what will be the extent of your knowledge of natural history without the aid of science? How can you cultivate an acquaintance with mineralogy, without reference to the physical properties, and chemical relations of minerals ? — how will you prosecute the study of botany or zoology, without some knowledge of the laws of vegetable and animal life ? You may indeed accumulate a long list of the names of stones, and plants, and animals, but this is all. The torch of science alone can guide you to the “ ultima thula” of your search.
It is manifest then that the two great departments of human know¬ ledge — natural history and science, are intimately connected and mu¬ tually dependent on each other. They are twin sisters, and like the interesting strangers, who have recently visited this country from the banks of the Ganges, they may not be separated without serious, per¬ haps fatal injury to both.
This mutual dependence of the several departments of knowledge on each other, gives to him who has taken a comprehensive view of
68
Bibliography.
the whole peculiar facilities for the cultivation of any particular branch ; and hence the medical philosopher derives the vantage ground on which he ought to stand. It is his privilege to exert the highest faculties of the mind, for the noblest of all sublunary pur¬ poses — the relief of disease — the mitigation of the pangs of death, while the very exercise of these privileges opens to him sources of the most sublime gratification in the indulgence of the best and kindliest feelings of his nature. To restore to his family and to his friends, one who has been the subject of a painful operation, or of a dangerous disease, is a pleasure peculiarly our own ; and even when this is denied us, to smooth the descent to the grave, by pointing to the brighter prospects beyond it, to soften the pillow of death, and to console the widow and the fatherless survivors in their affliction, are duties, which, however melancholy in their perform¬ ance, we may be grateful that we are permitted to share with the ministers of Him who made us — of Him whose only earthly occu¬ pation it was to heal the sick — to cleanse the leper — to give sight to the blind — and to say to the helpless cripple, Arise, take up thy bed and walk !
This hasty glance at the intimate connexion of the several de¬ partments of knowledge, is all that we can be permitted to take at present.
I must now proceed to point out the sources from which the study of natural philosophy derives its interest, and the practical application of its principles to purposes of utility, which invest it with importance.
To those who are desirous of cultivating an acquaintance with the sciences for their own sake, or as branches of general education, it will be sufficient to shew that the laws of physics govern every phenomenon of nature and art in which there is any sensible motion. Over the majority of natural phenomena, they preside alone. Thus they regulate the motion of the earth, the ebbing and flowing of the tides, and the elevation of the waters of the ocean, by the action of the sun’s rays, to form clouds, that impelled by the winds, in obedience to the same laws, are scattered over the face of the earth, again to descend upon it in refreshing showers, clothing it with verdure and invigorating it with life — or in the form of more violent rain of hail or snow, to take part in the warfare of the elements, and to mingle with the horrors of the storm. It is here that the principles of natural philosophy are developed in their most sublime supremacy — here, where the uneducated man sees nothing but confusion, the mental vision of the philosopher penetrates the obscurity at once, and perceives established order riding on the wings of the tempest, controuling its course, and wielding the lightning of heaven.
If we turn to contemplate the products of human ingenuity, we shall find that the civil and military engineer, the naval and terres¬ trial architect, the machinist and the manufacturer, the maker of wheel carriages, and of the implements of husbandry, and those
Mr. Browne’s Lecture on Natural Philosophy . 69
who are employed in the use of them, are all guided in the pursuit of their several occupations by the laws of natural philosophy. Lord Bacon has justly denominated it the root of the sciences, and of the arts, for it is by the study of its abstract principles in the closet, and the subsequent application of them to purposes of prac¬ tical utility that the arts have been brought to their present state of perfection. Sound theory is always in advance of practice, not only because it is necessary that men should first perceive the possibility of improvement before it can be carried into effect, but also because their first efforts have been too often attended with disappointment, even in those cases where the most brilliant success has ultimately crowned their exertions. In proof of this, we may select as ex¬ amples, the repeated unsuccessful applications of the power of steam, and the application of the Catenarian curve, once only a pleasing mathematical exercise to the construction of suspension bridges, connecting the summits of mountains with each other, or thrown across a broad and rapid river, as we see at Hammersmith, or project¬ ing into the bosom of the ocean, as in the chain pier at Brighton. I may mention these structures, because they will be familiar to most of my hearers ; and the last is celebrated for the disasters which attended its construction ; but it is now complete, and pro¬ mises to be as durable as it is elegant.
Surely such examples should prevent us from sinking into des¬ pondency with regard to any undertaking, whose progress is guided by the principles of science ; and hence we may indulge a reason¬ able hope, that the most magnificent project of our nation and of our age, the design of conveying an arched road way beneath the bed of a deep and rapid river, which has already proceeded to a considerable extent, in the case of the Thames Tunnel at Bother - hitlie, will yet, at no distant period, be carried to a triumphant termination, in despite of the untoward circumstances which have hitherto retarded its completion. For it is inconceivable that the people of England will allow it to be said, that a work of this national character, is capable of exciting more interest among foreigners, than among themselves, or that they will sit down tamely under the imputation that they want the hand or the heart to execute the achievements which their genius can conceive.
It is not only in modern times that the principles of physical science have conferred benefits on mankind, or immortality on those who have devoted their lives to the cultivation of them. The stupendous aqueducts of ancient Rome, have transmitted to us the memory of their founders, embalmed in the gratitude of their countrymen. Their very ruins excite our admiration, and forcibly recalling to the imagination the labours of the Titans, diminish our surprize that the fables which described them should have gained belief. Would you inquire how the want of these superb and costly structures is supplied in our own cities ? It is by the unobtrusive and economical, but far more effective arrangement of iron conduits, the material of which was known, to the Roman architects only as an useless stone
70
Bibliography.
or earth — if, indeed, it was known to them at all ; for it is now well ascertained that the building of the aqueducts was not resorted to by them from ignorance of the law, in obedience to which water seeks the Jevel of its source at whatever distance it may be led from it, as some have supposed, but merely from the want of more simple means of conducting it.
Over military affairs, too, this science held sway. Archimedes, the master mind of antiquity, defended his native town against the assaults of the Romans, entirely by the force of his mechanical genius. Such was the terror inspired by his engines, that the appearance of a beam with a rope attached to it, on the walls, was at all times sufficient to drive the assailants from their posts, until at length so strong a sense of security pervaded the minds of the beseiged, that on the celebration of a public festival, the ramparts were left undefended, the Romans entered the city, surprized and subdued the inhabitants, and slew the philosopher in his study, in opposition to the express commands of their general.
To this patriarch of science we are also indebted for the means of ascertaining the specific gravities of bodies, by weighing them when immersed in water, and comparing the weight of the water displaced with the absolute weight of the body given, when weighed in air. The idea appears to have struck him as he reclined on the liquid support of the bath, and it is reported that he was so transported with the feelings excited by his discovery, that he instantly sprung from the water, and rushed home unmindful of his nakedness, exclaiming, E vprjxa, E vpqxa, I have found it, I have found it. His mind was intent upon the numerous and important uses to which he foresaw it might be applied. Among more immediate, but minor circumstances, it enabled him to detect the fraud com¬ mitted by a goldsmith, who, having been furnished by Hiero, king of Syracuse, with a quantity of gold, for the purpose of making a crown, purloined a part of it, and replaced it with an equal quantity of silver.
The subject of specific gravities leads us directly to consider the connection of natural philosophy with chemistry. Chemical mani¬ pulation consists entirely of a series of physical operations. Such are the various processes by which masses are reduced to powder, and the mode of separating the coarser parts from those which are finer, by diffusing the whole through some fluid in which they are insoluble ; the coarse parts presently subside, and the supernatant liquid, in which the finer portion is still suspended, may be removed by the action of the syphon. The phenomena of evaporation, and the extent to which it may be modified, by the diminution or re¬ moval of the atmospheric pressure, which has been applied to a considerable extent in some manufacturing processes, as in the boiling of sugar, and in the preparation of the vegetable extracts em¬ ployed in pharmacy, are also examples of the fact. The chemical agencies of light, heat and electricity are not less numerous and im¬ portant. In the first the genius of Wollaston has provided the
Mr. Browne’s Lecture on Natural Philosophy . 71
pharmaceutical chemist, with the ready means of testing the purity of his essential oils by ascertaining their power of refracting the rays of light. The influence of the second is all but universal, and the last, in the hands of Davy, has almost erected chemistry into a new science.
I have already had occasion to mention, that in this metropolis the medical student derives the scanty knowledge of natural philosophy, which is accessible to him, for the preliminary explanations which the teacher of chemistry is obliged to enter upon, before the proper subject of his course can be made intelligible to his hearers. This cir¬ cumstance is a source of some inconvenience and obscurity. Students frequently confound physical with chemical phenomena, and few of them have a distinct idea of the mode in which a physical change contributes to the production of a chemidal combination ; for example, if alcohol be distilled with sulphuric acid, a compound called aether is produced, and the student having prepared this substance, is con¬ tent to say, that he has performed a chemical experiment, without once referring to the fact that the chemical combination of these bodies has been merely favoured by the state of minute subdivision on which they were presented to each other, while their elevation in the form of vapour, and their subsequent condensation in the receiver being mere changes of state, are strictly physical phenomena ; for if the resulting compound be distilled again, the same physical changes take place without at all affecting its chemical composition. I have se¬ lected this example on account of its simplicity, but there is scarcely an instance in which any chemical union or decomposition takes place without some concomitant physical phenomena ; and as such I conceive it to be essential to your perfect comprehension of any complicated ope¬ ration of this kind, that you should have clear ideas of the nature of the phenomena which they present, and be able to trace distinctly the several stages of their progress, I propose to direct your attention in a particular manner to the distinction between physical and chemical action in those processes which involve them both.
You will perceive that a knowledge of natural philosophy, is requi¬ site to enable you to understand the phenomena of chemistry. An acquaintance with both these sciences is necessary for the investiga¬ tion of the principles of physiology. Vital phenomena are the most complicated which science can present to us ; take the function of respiration for example, you will find that it embraces the phenomena of physics, chemistry and life. But although some of the vital func¬ tions require the aid of chemistry for their illustration, there are others in which phy sical and vital action only is concerned, as in the perform¬ ance of muscular motion, and some of which are referrible to natural philosophy alone. I would recommend the study of these to you, in the eloquent language of Dr. Arnott, as far more effective than any persuasion which I could employ. He describes the medical man as the engineer pre-eminently, and demands “ where shall we find to il¬ lustrate mechanics a system of levers and hinges, and moving parts, like the limbs of an animal body, where such an hydraulic apparatus as the heart and blood vessels, such a pneumatic apparatus as the
72
Bibliograjjhy .
breathing chest, such acoustic instruments as the ear and larynx, such an optical instrument as the eye, in a word such mechanical variety and perfection as in the whole of the visible anatomy.” We shall also have occasion to shew that the philosophy of imponderable substance is illustrated by the phenomena of animal heat, and by the functions of the brain and nerves. You will most of you be aware thet many physiologists have laboured to establish the identity of the electrical and nervous fluids, and that on the other hand it has been urged that we have not yet obtained sufficient evidence in support of this position, to enable us to decide on its validity. I am not disposed to go so far as those who have asserted that electricity and life are modifications of the same principle, but I do believe it to be the me¬ dium through which the unknown principle of life acts upon the ma¬ terial structures of the body, and I hope to be able to lay before you satisfactory evidence, derived from experiment, in support of the opinion.
If then the sciense of chemistry be based upon natural philosophy, it is equally evident that the superstructure of physiology is raised upon both. From this it follows that a previous knowledge of phy¬ sical principles affords great assistance, to the student in the investi¬ gation of the more complicated sciences ; with it indeed he seems to learn by intuition — the facts which are presented to his mind seem to arrange themselves in their natural order under the several heads to which they belong; whereas he who would study chemistry or phy¬ siology without such preparation, either fail to obtain clear ideas of the subject at all, or loses more time in attempting to unravel the confu¬ sion they are involved in than would have served to obtain a know¬ ledge of the whole body of physics, which it may be observed offers by far the greatest sum of knowledge, which a given amount of la¬ bour will suffice to accumulate.
It is obvious that the principles of natural philosophy can have no direct relation to the science of mind, but inasmuch as we are indebted to them for the instruments of our intellectual arts, such as writing, printing, drawing, painting, music and sculpture ; and for our mathema¬ tical and philosophical instruments, it cannot be denied, thatitikat least indirectly connected with this, as well as the other departments of science.
Hitherto we have considered the study of natural philosophy in its relations to the other departments of science, as part of an extended scheme of liberal education, such as a man of rank and fortune would wish to confer on his son, that his acquirements might be equal to his station in society. It only remains that I should point out the im¬ portance of its applications to the practice of medicine and surgery ; and here I may observe that it is by no means the least of the advan¬ tages which we derive from our profession, that it places us (in an in¬ tellectual point of view) on a level with the wealthy and the great. It has been asserted, however, that this study is not of primary import¬ ance to a medical man; but after what has been said of its connection with physiology, it can hardly be necessary, I imagine, to enter upon
Mr. Browne’s Lecture on Natural Philosophy . 73
a formal refutation of so palpable an error,. as far as regards the scien¬ tific information which is required of us. But I must remind you, that our profession is an art as well as a science, and that in the com¬ mon routine of private practice you will have daily occasion to avail yourself of the aid of physics. Are not all the instruments in the hands of the surgeon, or of the obstetrician, really mechanical tools ? If so, a certain degree of dexterity must be required for the manipu¬ lation of them, the acquisition of which should form part of a course of medical instruction ; to place this point fairly before you, let us compare it with some other mechanical occupation. If a carpenter takes an apprentice, the first lesson he teaches him is to handle the tools of his trade, whereas with us, I regret to say, that few of our in¬ struments are ever removed from their cases, except when they are to be employed for the performance of an operation on the living body. And what is the consequence of this neglect ? Those that can be per¬ formed with the scalpel, with which we become familar by dissection, are well and dexterously performed, but when any other instrument is required, alas! what a falling off is there. Let us take amputation, for instance. How often do we see the bone splintered just as its di¬ vision is completed, and the blame attributed to the awkward and in¬ efficient manner in which the assistant supported the limb, when it would be much more justly bestowed upon the surgeon for the awkward manner in which he held the saw. Mechanical manipula¬ tion is indeed of the utmost importance to the surgeon, and may be so easily acquired by some amusing work of carpentry, that it is folly or idleness to omit it. Again, I presume that no one will venture to deny that we should understand the construction of the instruments we are constantly using ; and we shall find upon inquiry, that they comprise all the simple machines or mechanical powers. These are the lever, the wheel and axle, the inclined plane, the wedge, the screw and the pulley. The punch for extracting the stumps of teeth, is as complete and simple a lever as a common crow bar ; and the tooth forceps, consist in fact of two levers, of which the rivet that connects them is the common fulcrum ; this instrument well illustrates the advantage of mechanical tools. In the first place, the tooth is seized by the iron jaws of the forceps, instead of between fingers, then it is grasped with the force of the whole hand, and lastly, this force is multiplied many times by the difference between the length of the claws and handles of the forceps. Wheel and axle find their representative in the tooth key, for it matters not whether the wheel be entire or reduced to a single spoke, its action is the same. The inclined plane supports our fractures, our cutting instruments are wedges, the tourniquet owes its power to the screw, and the pulley is employed by us for the reduction of dislocations. Can it be said then, that a knowledge of the principles upon which the usefulness of these various instruments is founded, is at best but of secondary importance to you ; or is there one amongst you who would be con¬ tent to use them without inquiry, merely because others have done so before you ? If there be such a person, I have yet another argument in reserve for him. The improvement of our instruments must be VOL. IV. no. 31,
L
74
Bibliography.
effected by ourselves, and we cannot expect to improve what we da not understand. Would you learn the extent of the benefits which may be conferred upon suffering humanity by this means ? I refer you to my esteemed colleague Mr. Costello, who has had the honour of introducing to the notice of the profession in this country, the mode of destroying calculi in the urinary bladder, which has long been adopted in France, and thus saving the patient from the horrors of li¬ thotomy, avowedly the most formidable operation in domestic surgery, which even Cheselden, whose mode of operating is yet unequalled, never undertook without reluctance, approaching, according to his own admission, to fear.
There is yet another point to which I would call the attention of my medical hearers ; it has been asserted by some persons desirous of underrating the value of scientific attainments, that they have a direct tendency to contract the feelings, and impair the affections of the heart. An anonymous satirist even goes so far as to suppose that if he were to fall into a river, the uneducated savage would instantly plunge in to his rescue, but that the scientific civilized man, viewing him merely in the light of a projectile, and calculating the depth of the water, the force and direction with which he impinged upon its surface, and the resistance of the fluid medium, would probably point out the precise spot in the mud at the bottom where his body might be found.
To the medical philosopher it is entrusted to refute this calumny, philanthropy is an essential part of his profession, and although 1 have dwelt upon this topic already, I cannot forbear to remind you that it is your business to console no less than to cure, and that the highest satisfaction your pursuits can afford, is derived from the ex¬ tent to which your feelings are interested in them.
In conclusion, I have only to allude to the arrangement which I propose to adopt in the ensuing lectures. The course will be divided into three parts. In the first part, we shall consider those subjects which are comprehended by the term mechanical philosophy ; in the second, we shall explain the philosophy of imponderable substance ; and in the third, we shall direct your attention to the sublime pheno¬ mena of physical astronomy. Each of these principal parts will be again subdivided into sections, at the end of each of which we shall enumerate all the applications of the subject to the practice of medicine and surgery of which it will admit, and then institute an examination, for the purpose of ascertaining that the explanations which have been given have been perfectly understood by the student.
SURGERY.
HOSPICE DE LA PITIE.
2. Cancer of the Nose — Extirpation. — G - , setat. 32, was ad¬
mitted in May last, with a carcinomatous affection of the nose ; the disease was of about two years’ standing, and seemed to extend over the cartilages of the nostrils and the septum, which had degene¬ rated into a large ulcerated tumour. After having watched the case for some time, M. Lisfranc, who was of opinion that it was a
Surgery.
75
case of superficial cancer, performed the following operation : — Two semi-elliptic incisions were made, by which the diseased part was circumscribed ; the skin, with the subjacent cellular tissue, which was found to be the principal seat of disease, was dissected off the surface of the cartilages, scraped with a bistoury, and then touched with the nitrate of silver, especially at those parts where the disease did not seem to have been entirely removed by the knife. After a few days, the eschar having come away, healthy granulation began to take place, and cicatrization was completed within a short time.
HOPITAL BEAUJON.
3. Fracture of the Neck of the Thigh-hone and of the Os Pubis. — - A young girl of robust constitution, but who had of late presented symptoms of mental derangement, threw herself, on the 7th of Oc¬ tober, from a window on the second floor. On being taken up, she was found to have a slight wound in the neck, and a violent contu¬ sion over the right hip. Twenty-five leeches were immediately ap¬ plied, and on the next morning she was brought into the hospital. There was much swelling and ecchymosis at the upper and external part of the hip ; the patient could not move the thigh, and complained of violent pain whenever it was raised ; the limb was not shortened or distorted in any direction, nor could any crepitation be heard on motion. The limb was placed on a double -inclined plane, and the patient ordered to be bled. During the following days delirium acceded, with tenderness of the abdomen and tympanitis, and sup¬ pression of the urine and fseces, and she died on the 14th of October. On examination, the muscles which cover the joint were found much contused and infiltrated with blood ; the articular cavity was filled with a thin reddish turbid fluid, and the neck of the thigh-bone, at about three lines from the shaft, was obliquely fractured. The frag¬ ments being in close contact with one another, accounts for the absence of distortion after the accident. The cellular tissue of the pelvic cavity round the bladder and rectum was infiltrated with a brownish matter, particularly at the right side, where the horizontal branch of the os pubis was found fractured at the distance of about a line from the spina pubis. The fragments were about three lines distant from each other ; the external fragment being drawn upwards and outwards. — Lane. Franc.
HOPITAL DE LA PITIE.
4. Lithotomy. — C - , aetat. 60, of a feeble constitution,, had,
during the last nine years, been labouring under symptoms of stone in the bladder. Being admitted at the hospital under the care of M. Velpeau, lithotrity had been tried, but without success ; the stone being very large, M. Velpeau was rather disposed to perform the high operation. M. Lisfranc, however, declared himself against it, and the lateral operation was accordingly decided upon, and performed on the 21st of October. After the incision in the bladder, the stone was easily grasped, but proved to be so large, that all attempts at
76
Bibliography .
extraction failed, and M. Velpeau was obliged to enlarge the wound, first in a lateral direction, and then by dividing the prostate. The forceps being now re-introduced, the stone was again seized, and at last, though not without violent efforts, extracted : it was of an oval form, two inches and a half in its large, and two inches in its small diameter. Contrary to what had been supposed from the previous examination with the sound, no other calculous was felt in the blad¬ der, which was large, but healthy. On the 28th of October the patient was going on favourably ; the hypogastric region was neither tense nor tender ; the urine still passed through the wound. — Ibid.
Midwifery.
Hotel Dieu.
5. Obliteration of the Vagina. — Angel. Andre, setat.22, was admitted on the 12th of August with violent colic pain, which she attributed to a stone in the bladder, but which, on examining the genitals, was found to be caused by the accumulation of menstrual blood in the uterus, in consequence of the vagina being obliterated. She had been quite well until about three months ago, when, in consequence of great excesses in drinking and debauchery, she was seized with violent inflammation of the genitals, which terminated in gangrene ; the extremity of the clitoris, the nymphse, and part of the large labia, went into mortification ; the vagina ulcerated, and, after the inflam¬ mation had subsided, was found to be completely obliterated. In other respects the girl was quite well, but at the time of the menses the blood accumulated, and caused a sensation of weight and sharp colic pain in the hypogastric region. At the next menstrual period, these symptoms returned with increased violence ; the colic pain, the attacks of which curiously enough always began at noon and ceased at about six o’clock in the evening, was very intense, and the patient experienced great difficulty in making water, and passing the stools. It was then only that she applied to a medical practitioner, who ad¬ vised her to go into the Hotel-Dieu, where the genitals were found to be in the following state : The large and small labia, as well as the extremity of the clitoris, were entirely wanting ; the orifice of the va¬ gina was very small, and terminated at about half an inch in a “ cul de sac at the left iliac region there was a large tumour, which could also be felt by the finger in the rectum ; it was of a globular form, moveable, and exhibited distinct fluctuation, and no doubt was entertained that it was the upper portion of the vagina distended with blood. On the 10th of August the following operation was performed by M. Duputryen : — a long trocar was passed into the contracted ori¬ fice of the vagina and plunged into the tumour, and the opening thus made was enlarged in several directions with a bistouri, carried along the canula of the trocar. A large quantity of dark, viscid, inodorous blood was thus evacuated, and the cavity having been washed out by the injection of warm water, a further examination of the parts was made. The parietes of the vagina were found to be adherent to one another for the space of about two inches, beyond which was a very considerable dilatation which had contained the menstrual fluid ; the os
Midwifery .
77
\iteri appeared to be closed. A tube of gum elastic was introduced into the vagina, and the patient went on well for a fortnight, when she was attacked with pneumonia, which proved fatal in about nine weeks. It is remarkable that the pain in the chest appeared to be re¬ lieved by the removal of the canula and increased by its re-introduc¬ tion. A similar case is related in a late number of the Lancette Francaise by M. Patrix; the patient had, after delivery, been affected with peritonitis and inflammation of the genitals, which terminated in gangrene : a great portion of the external genitals sloughed away, and the vagina became completely obliterated, al¬ though every thing was done to prevent it. By the continued use of lint tents, however, M. Patrix succeeded in reproducing the former canal ; the woman subsequently became pregnant and was safely de¬ livered.
In a case of congenital obliteration of the vagina, which was ad¬ mitted in 1829, M. Dupuytren evacuated, by the operation, more than three pints of viscous dark-coloured, but inodorous, blood; the patient was twenty-two years of age, and had, according to her state¬ ment, felt the first symptoms of menstrual congestion in her fourteenth year. She got perfectly well after the operation. The blood was submitted to chemical analysis by M. Thenard, who convinced him¬ self that it did not contain the least particle of fibrine or serum. — Lane. Franc .
MISCELLANIES.
6, MEETINGS OF THE MEDICO - BOTANICAL SOCIETY.
To the Medico Botanical Society.
On the effects of the severe cold of the last winter, upon two indi¬ genous medicinal plants, viz. Hyoscyamus Niger, and Leontodon Taraxacum, communicated by, Joseph Houlton, Esq. Read De¬ cember 14th, 1830.
The severe and protracted ccld of the last winter was very in¬ jurious to many of our more tender indigenous, biennial and perennial plants. The effect of the season upon two very important medicinal plants, the Hyosciamus Niger, and the Leontodon Ta¬ raxacum deserves notice; the plants of Hyosciamus in my gar¬ den, were all cut off by the frost, and but a very small quantity of the Mature herb was brought into the market ; forty -two shillings per hundred weight, was given by the wholesale trade in Covent Garden Market ; I understood from different persons connected with the trade, that it was not to be procured in sufficient quantity, to meet the demand of the profession at any price. The consequence has been, the substitution of the immature plant ; this I can state with confidence from my personal observation. When I had the honour to bring this plant before the notice of this Scientific Society, during the last session, I mentioned some facts which I considered important, and which I now beg leave to re¬ capitulate, because they are not all, as far as my reading extends, to be found in books. Contrary to what is stated in most modem
78
Miscellanies.
works on Botany and Materia Medica, Hyosciamus Niger I assert is a biennial plant, and is in a fit state for medical purposes in the second year only of its duration, when in flower, or according to the excellent general rule of the Royal College of Physicians “ post quam Hores expassi fuerint; et antequam semina maturescant — The leaves at this period differ very much from those of the first year, their season is generally from the beginning to the end of June, they are cauline, sessile, very clammy, and foetid, containing a large proportion of extractive matter. The leaves of the first year are plentifully brought to market in August and September ; they are radical, petiolated, having very little clamminess, or foetor, and containing considerably less extractive matter than those of the second year. The tincture from the mature leaves is a deep greenish brown and not clear ; the tincture from the first year’s leaf is much paler and clearer ; the difference in their relative strength is great.
The above observations may be very easily verified, their impor¬ tance must be obvious, when the value of the article of Materia Medica is considered, and the fact declared, that large quantities of the improper leaves are employed in this metropolis every year.
Leontodon Taraxacum suffered from the peculiarity of the sea¬ son in a curious manner. I have already stated to this Society and to the public, that the bruised roots of this plant in the month of August, yield by pressure, nearly a third of their weight of thick cream coloured fluid, and that early in they spring the afford a less proportion of their brown liquid. This year in the month of August, some roots which I had fresh dug up for me, contained but a very small quantity of juice, and that destitute of the more important sensible properties usually found in it at that season ; therefore the extract of the dandelion, prepared after my plan, cannot be obtained of this year’s manufacture. It may be proper to state, we must not depend too much upon the herb venders for these roots, as respects their proper season : for they are kept in sand with their herbaceous part removed ; if they remain long in this state, they will not answer to the description I have given of them to this Society.
Grove Place,
December, 1830.
LITERARY INTELLIGENCE.
6, The Medical Annual , containing a practical estimate of the the¬ rapeutic value of all the remedies, which have been introduced into the practice of medicine, within the last two years, an account of the proposed arrangements for a priced catalogue of drugs, &c., list of diseases, with references to the remedies that have been found most beneficial in their use or palliation, by Reece, & Co.
On the 1st of January, 1831, No. 1, of the Monthly Gazette, of Practical Medicine, containing a popular account of all the new dis¬ coveries in the art of preserving health, in curing diseases, and in promoting economy, an exposure of quackery, and every species of fraud.
Miscellanies.
79
BOOKS RECEIVED DURING THE MONTH.
1. The Works of William Cullen, M.D. Professor of the Practice of Physic in the University of Edinburgh : containing his Physiology, Nosology, and First Lines of the Practice of Physic : with numerous Extracts from his manuscript pa¬ pers, and from his treatise of the Materia Medica Edited by John Thomson, M.D. F.R.S. L. and E. Lecturer on the Practice of Physic, consulting Physician to the New Town Dispensary, and late Regius Professor of Military Surg3ry in the Uni¬ versity of Edinburgh. In 2 vols. 8vo. pp. 1420. T. and G. Underwood.
*** This is the most complete edition of Dr. Cullen’s works extant. It ought to have a place in the library of every medical man in the kingdom. His pathology of many disorders, which cannot be explained by morbid ana¬ tomy, has not yet been surpassed, nor even equalled.
2. A Supplement to the Pharmacopoeia, and Treatise on Pharmacology in ge¬ neral, including not only the drugs and preparations used by practitioners of medi¬ cine, but also most of those employed in the chemical arts ; together with a Collec¬ tion of the most useful Medical Formulae, Veterinary Drugs, Patent Medicines, and other Compounds ; an Explanation of the Contractions used by Physicians and Druggists ; and also a very copious Index, English and Latin, of the various Names by which the articles have been known at different periods ; being a complete Dis¬ pensatory and Book of Formulae for constant reference in medical and veterinary Practice, and Manual for retail Druggists. Fifth edition, considerably enlarged, including the new French Medicines, and Selections from Foreign Pharmacopoeias, and from the Formulae of British and Foreign Hospitals. By Samuel Frederick Gray, Lecturer on the Materia Medica, pharmaceutical Chemistry, and Botany. London. 1831. 8vo. pp. 576. Thomas and George Underwood.
*** Gray’s Supplement to the Pharmacopoeia has long kept its ground in despite of the many abortive attempts made to imitate and supersede it. This present edition is greatly improved and brought down to the present state of science. Its value is much enhanced by the introduction of nume¬ rous formulae and of the new medicines. It excels any Supplement to the Pharmacopoeias in our language ; and is a work we confidently recommend to all classes of our profession.
3. First Principles of Medicine. By Archibald Billing, M. D. Fellow of the Royal College of Physicians ; Lecturer on the Theory and Practice of Medicine ; and on Clinical Medicine ; and Physician to the London Hospital, &c. &e. London. 1831. pp. 131. Thomas and George Underwood.
*** This is an excellent commentary on the present state of science, and will be perused with advantage by students and junior practitioners.
4. Observations, Chemical and Practical, on the Dublin Pharmacopoeia, with a Translation annexed. By F. Barker, M D. Professor of Chemistry in Trinity College, Dublin ; Honorary Fellow of King’s and Queen’s Colleges of Physi¬ cians, &c. ; and William F. Montgomery, A.M.M.B. Professor of Midwifery in the King’s and Queen’s Colleges of Physicians in Ireland, and Member of the Royal Irish Academy, &c. Dublin. 1830. 8vo. pp. 721. Hodges and Smith, 21, College Green. 1830.
*** The work of Doctors Barker and Montgomery is one of the best Treatises on Pharmacology of modern times. It evinces great research, discrimi¬ nation, observation, and talent.
5. A System of Operative Surgery ; containing a description of the most approved plans of performing the different operations in Surgery on the Dead Body ; with remarks on their Anatomy, and accompanied with practical observations : being principally designed for the use of Students in Surgery. By Wm. Hargrave, A.M. M.B. T.C.D., Member of the Royal College of Surgeons in Ireland; Lec¬ turer on Anatomy, Physiology, and Operative Surgery, &c. &c. Dublin. 1831. 12mo. pp. 533. Hodges and Smith.
*** This work is executed in a masterly style, and supplies the place of AverilPs production, which in consequence of the premature death of the revered author, must have a new editor. Mr. Hargrave’s production is inestimable to the Student, and is the best companion we know of for the Dublin Dissector.
80
Miscellanies .
6. A new mode of ventilating Hospitals, Ships, Prisons, &c. &c. ; being an efficient method of destroying Contagion, and of preventing the spreading of infectious Diseases. By George Hawthorn, M.D. London. 1830. 12mo. pp. 84. Longman and Co.
7. The Dublin Hospital Reports and Communications in Medicine and Surgery. Vol. V. Dublin. 1830. 8vo. pp. 631. Eight Plates. Hodges and Smith. Reviewed in our former Numbers.
8. Observations on the Use of Instruments in cases of difficult and protracted Labour. By John Beatty, M.D., Licentiate of the King’s and Queen’s Colleges of Physicians in Ireland. Dublin. 1831. 8vo. pp. 23. J. M. Leckie.
*** Doctor Beatty’s object is to advocate the use of the forceps in all cases in preference to the perforator. He cites numerous eminent obstetricians in support of his opinion, with ’which no scientific mau can dissent. This essay reflects great credit on the eminent author as a man of sense, judgment, and science. We shall notice it more fully hereafter.
9. Reflections on the present state of the Profession of Pharmacy in Ireland. By M. Donovan, M.R. I A. Dublin. 1829. Svo. pp. 35.
*** Mr. Donovan is Governor of the Apothecaries’ Company in Dublin, and a gentleman well known to the votaries of science. In accordance with the universal spirit of improvement he advocates reform, which none but the monopolist will oppose. This little essay does him great credit. We shall notice it more fully hereafter.
10. Two Lectures on the Study of Anatomy and Physiology, delivered at the opening of the Medical Session, 1830, in the Medical School, Aldersgate Street. By James Quain, M.B., Lecturer on Anatomy and Physiology. London. 1830. 8vo. pp. 44. Simpkin and Marshall.
*** These Lectures abound with important information.
11. The London University Calendar for the Year 1831. London. 1831. 12mo. pp. 264. John Taylor.
*** The London University Calendar was much wanted, as there was no medium of acquiring information on the rules and courses of education pursued in that unequalled Institution but through pamphlets and detached statements, which were se eagerly sought for as to deprive the greatest part of the public of an opportunity of seeing them. We are happy to state, that this work is a. complete history of the University, and contains the fullest account of every point relative to it, and will be perused with infinite pleasure by every lover of science, and by every friend of civil and religious liberty. It is impossible to speak in too high terms of the execution and typography of this volume — -it is more like one of our beautiful Annuals than an ordinary book. In fine, it is a work that neither library nor respectable family should be without.
12. Illustrations of Mr. S. Cooper’s Surgical Dictionary, published monthly ; containing four Lithographic Plates, with Letter-press descriptions and References to the Text. London. 1830. Part IV.
A Third Edition of Sir Astley Cooper’s Lectures, by Mr. Castle, has just appeared, but has reached us too late for further notice.
ERRATA IN VOL. V.
Page 529, for “ embrysology,” read “embryology;” cochianosology,” read “ lochianosology “ cunes,” read “lacunes;” “ ovrager,” read “ ouvrages.” In article “ On Signs of Utero-gestation,” in our last, page 498, fourth line from bottom, ending “ affected with,” read on to twenty-two lines from the top of page 499, beginning “ this disease.”
All Communications and Works for Review are to be addressed to the care of Messrs. Underwood, 32, Fleet Street; or to the Editor, at his Residence, 61, Hatton Garden.
F
THE LONDON
MEDICAL AND SURGICAL JOURNAL.
«■ - >
No. 32. FEBRUARY 1, 1831. Vol. VI.
CRITICAL REVIEW.
I. — A Supplement to the Pharmacopoeia, and Treatise on
hmacology in general, including not only the drugs tfibtid preparations used by practitioners of medicine, but also most of those employed in the chemical arts ; to¬ gether with a Collection of the most usef ul Medical For¬ mulae, Veterinary Drugs, Patent Medicines, and other Compounds ; an Explanation of the Contractions used . by Physicians and druggists ; and also a very copious * Index, English and Latin , of the various Names by which the articles have been known at different periods ; being a complete Dispensatory and Look of Formulae ■ for constant reference in medical and veterinary Prac¬ tice, and Manual for retail Druggists. Fifth edition, considerably enlarged, including the new French Medi¬ cines, and Selections from Foreign Pharmacopoeias, and from the Formulae of British and Foreign Hospitals. By Samuel Frederick Gray, Lecturer on the Materia Mediea, Pharmaceutical Chemistry, and Botany. London, 1831, 8vo. pp. 576. Thomas and George Underwood.
t • * 1
II. — A new Supplement to the Pharmacopoeias of London, Edinburgh, Dublin, and Paris ; forming a complete Dis- pensatory and Conspectus ; including the new French Medicines and Poisons, with symptoms, treatment "and tests, as well as herbs , drugs , compounds , veterinary drugs, with the Fharmacopoeia of th e Ve terinary College, patent medicines , perfumery , paints, varnishes and simi¬ lar articles, kept in shojjs, with their compositions , imi¬ tations, adulterations’, and medicinal uses, .being a general book of formulae and recipes , for daily ref erence
Vol, vi. no. 32.
M
82
Critical Review.
in the laboratory and at the counter. By J. Rennie, A.M.A.L.S. Lecturer on Chemistry, Natural History, and Philosophy, &c. &c. London, 1829, 8vo. pp. 488. Bald¬ win and Craddock.
III. — Observations , Chemical and Practical , on the Dub - lin Pharmacopoeia, with a translation annexed. By F. Barker, M.D. Professor of Chemistry in Trinity College, Dublin; Honorary Fellow of King’s and Queens Col¬ leges of Physicians, &c. ; and William F. Montgomery, A.M.M.B. Professor of Midwifery, in the King’s and Queen’s Colleges of Physicians in Ireland, and Member of the Royal Irish Academy, &c. Dublin, 1830, 8vo. pp. 7*21. Hodges and Smith.
The subject of pharmacology has rapidly advanced within a few years, and principally through the admirable work of Dr. Paris ; but it is as yet in its infancy, and has much need of further cultivation and improvement. The dispensatories of professors Duncan and Thomson, the pharmacologia of Dr. Paris, and the work of Drs. Barker and Montgomery, with the supplement to the pharmacopoeias, by Dr. Spillan, and Gray’s Supplement, are our best works upon pharmaco¬ logy.
Pure coincidence has placed the works, whose titles are inserted at the head of these remarks, in juxta position, for though apparently synonymous, they are as dissimilar as possible. The first on our list has long retained its popula¬ rity with the profession ; and this we believe induced the publication of the second. These works, however, are widely different in arrangement, and in extent of information. Gray’s Supplement contains an immense mass of useful mat¬ ter unnoticed by its rival; it comprises an account of all productions of the vegetable, mineral and animal kingdoms employed in the practice of medicine, a large variety of ex¬ temporaneous prescriptions, which have been long approved of in practice, and which have been selected from the phar¬ macopoeias of foreign countries, and from formulae used in British and foreign hospitals. The present edition is con¬ siderably emended and improved, and is creditable to the industry, research and practical knowledge of its editor. The doses of medicines are accurately and faithfully given, which wre regret to state is not the case in the other produc¬ tion. Though Gray’s Supplement is a very heterogeneous production, a list of drugs, simples, nostrums, many of which
Gray’s Supplement to the Pharmacopoeia.
83
are useless, and long since banished from the pharmaco¬ poeias, yet the trade of newspaper puffing- is so very pro¬ fitable at the present period, and the gullibility of the public being ample as ever, it behoves those engaged in the prac¬ tice of medicine to have some work of reference, for inform¬ ing themselves of the composition of the innumerable nos¬ trums, so ardently employed by their patients. The best work for such reference is Gray s Supplement. It con¬ tains the- scientific names of all medicinal substances in our pharmacopoeias, and in use ; the English and officinal Latin names of all medicines, chemicals, &c. are given. The vegetable medicines are arranged according to Jussieu. In a word, it embraces every topic mentioned in its title page. A very copious English and Latin index is added, which af¬ fords a ready reference. It contains nearly 200 pages more than Mr. Rennie’s production. It is a work that ought to find a place in every medical library, and affords a fund of inter¬ esting information to the general reader. We can state with perfect confidence, that the effects of medicines are accu¬ rately described, and the doses correctly given, and, as a system of pharmacology, it will be wrorthy of attention. It has been revised and adapted to the present state of science, by a physician of great talent and extensive experience.
Mr Rennie, though not a medical practitioner, has under¬ taken the task of publishing a supplement to the pharmaco¬ poeias, and has spoken upon the effects of medicines, with as much confidence as if he was the president of the College of Physicians. He has even dissented from Dr. Paris on the effects of the superacetate of lead, and happens to be as wrong as he possibly could be. However well-informed he may be on the science of chemistry, we must candidly ob¬ serve he knows nothing of medicine. In proof of this asser¬ tion, we call the reader’s attention to the following statement, as to the doses of tartarized antimony, given from grs. ij. to oj.asan ordinary drink, or even 3i. diffused in oij. of water, p.28. This dangerous blundering will of course beputto the account of the printer, but such an excuse cannot be received; a mis¬ take so serious is unpardonable. We need scarcely observe that Rasori, Eorda, and Laennec, recommended the medicine very differently in inflammation of the lungs, as appears by our analysis of the report of Drs. Graves and Stokes in our last. Our anthor has made the following discoveries: — ei Prussic acid is a tonic and antispasmodic,” oxalic acid is refreshing and slightly diuretic, in doses of |||x. to tuxx. diluted with water, in which form I have myself often used it as a com¬ mon drink,” This we believe is the first time that a solid has
84
Critical Revieic.
been measured by the minim glass, and also the first time oxalic acid has been used internally as a common drink. Again, “ Agrimony is subaromatic. ”
Chlorine (aqua oxymariatica) is used in syphilis, typhus and scarletina not a word concerning its disinfecting pro¬ perties, or of its effects in hydrophobia, for which it is con¬ sidered a specific in Italy, (Brugnatelli, Valetta,) or in phthisis. “ Argenti nitras, is used from gr. ij. or 5j. into 5\j - of water, in fistulas, venereal sores, scrofulous, ulcers, &c.” Liquor opii. sedativus, is composed of tartaric acid and dregs of tine. opii. is a mild narcotic” (sedative.) It is generally supposed that this preparation is an acetous solution of opium, deprived of narcotine. It is far inferior to the old black drop, and must be given in a much larger dose than advised by its proprietor. We have found it so uncertain that we have ceased to employ it, and we know a gentleman who has exhibited 120 m. of it, to produce a sedative effect. Unusual effects of lytta, “ when it is used to vesicate, it some¬ times produces strangury, hmmaturia, and inflammation of the bladder and urethra, which ought to be treated with warm bathing, fomentations, and emollient drinks.” Those engaged in medical practice, scarcely ever observe effects requiring warm bathing or fomentations. Among the many good qualities of digitalis, it is prescribed ff in gonorrhoea.’ * Here is a discovery with a vengeance. Hydrargyri oxymu- rias is acrid, styptic, corrosive, stimulant alterative and an - tisiphilitic , and is used as a powerful remedy in sip hi l is and cutaneous disorders.” The dose of hydriodate of potas is stated, but no disease is mentioned. ee Liquor opii sedati¬ vus is imitated by mixing siss. of opium with Bvx. of pure water, and 5j. of pyroligneous acid; dose, six to ten drops or more. (Dr. Epps.)” Here we have the testimony of Dr. Epps, lecturer on chemistry and materia medica, in favour of the opinion which we expressed above, and in opposition to the assertion that tartaric acid is the menstruum of the sedative liquor.
Our author has given the following directions as to the employment of superacetate of lead : —
“ Internally it is a powerful, but unquestionably a ha¬ zardous astringent in protracted diarrhoea, and obstinate haemoptysis, and internal haemorrhage of the lungs, uterus, stomach, &c. In desperate cases it ought not to be omitted ; but notwithstanding the authority of Dr. Paris, I must enter a strong protest against its exhibition till every safer means has been unsuccessfully tried. When it is resolved to give
Rennie's Supplement to the Pharmacopoeias , 85
it, opium must be conjoined with it, (say gr, ss each of acetate of lead and opium in form of pill) to prevent spasm and paralysis. Care must also be taken not to give with it, nor after it, any acids, astringent infusions, sul- phates, none in short of the incompatible substances, unless it have been incautiously given in an overdose.” — p. 330.
Every practical physician can bear testimony in favour of the efficacy and safety of superacetate of lead in haemor¬ rhages from the lung’s, stomach, bowels, (dysentery) and uterus ; and thus Dr. Paris is amply supported by the pro¬ fession. Besides, Professor Thomson, of the London Uni¬ versity, has recently published the results of experiments on the medicine ; and states, that the danger consequent to its use, is to be ascribed to the conversion of the super¬ acetate into a carbonate. He therefore advises the use of dilute acetic acid, either in combination with the remedy, or immediately after it, and affirms that no bad effects can supervene. We have already recorded our opinion in favor of the extraordinary effects of superacetate of lead in the diseases already named, but more especially in dysentery and menorrhagia. We have commenced with small doses combined with opium, and urged them until ten grains of lead were administered. In obstinate cases of haemoptysis, we have used the remedy in combination writh distilled water, acetic acid, and tincture of opium, and urging it to a scruple daily without any injurious effects. Its value and safety, as an astringent, have been too often and so recently attested, that it is unnecessary to notice them further. But we cannot help thinking, that Mr. Rennie might have been less strenuous in his protest against Dr. Paris’s opinion. Our author, however, thinks otherwise, as he repeats his dissent from the same eminent pharmacologist, in describing potassee nitras. Dr. Paris surely mistakes, when he says it is an inconsiderable diuretic.” Indeed, Mr. Rennie is truly mistaken, as the remedy is seldom, if ever, used as a diu¬ retic, from its well-known inefficiency. <f Dr. Paris is mistaken, in mentioning lime amongst the incompatibles,” (with potas. sulphas.) at least, it is not so in its aqueous solution, though barytes is so.”
A few of the characters of the secale cornutum are de¬ tailed, and, it is said, on good authority — it promotes tardy parturition. The mode of exhibition is not mentioned ; but we are informed that 3j. boiled in a quart of water, to one pint, the half of which is given in divided doses during one day, as an emmenagogue. This dose is much too large.
86
Critical Review.
and might be productive of serious results ; the maximum dose being two drachms., even during parturition. In speak¬ ing of strychnine,, there is no mention made of the favor¬ able report of Dr. Bardsley, of Manchester. Had the author been a medical man, he would not have omitted the very valuable and highly important observations of that talented physician. We shall not proceed further, and dismiss the work by stating, that it contains many formi¬ dable errors. Whether these be typographical or not, we cannot determine ; but certain it is, that they may be pro¬ ductive of great injury, should the work fall into the hands of the uninitiated in our profession. The author must, or ought to be aware, that he who is not a medical prac¬ titioner, should be cautious in quoting Mr. Brande, the chemist, as a supporter of his own views on the operation of medicines, against such eminent and experienced phy¬ sicians as Professor Thomson and Dr. Paris. He cannot seriously suppose that the well-informed medical practi¬ tioner will agree with him in such a preposterous idea. We would remind him of the old adage, te ne sutor ultra cre- pidam.” We must also take leave to inform him, that his conspectus of prescriptions in medicine, surgery, and mid¬ wifery, to which he so often alludes in the work before us, is replete with errors ; in some parts we have observed the ^ for the 5, and in many parts the Latin quite barbarous. As the advocates of humanity and science we make these remarks, for we are ready to acknowledge both works contain much information, disfigured by gross errors.
We now come to a work of sterling value, and have to apologize to its authors for placing it in such bad company. We have already stated our reason for doing so. Drs. Bar- ker and Montgomery are very favourably known to the pro¬ fession by their valuable publications, and both eminently qualified to execute the task they have undertaken. The present conjoint production consists of two parts. The first, by Dr. Barker, consists of observations, chemically and practically, on that part of the last Dublin pharmacopoeia, 1826, devoted to the acids, alkalies, earths, alkaline, and earthy salts, sulphurous and metallic preparations. The second part, on the preparations, expressed oils, essential oils, distilled waters, preparations of ether, spirits, tinctures, medicated vinegars, wines and honies, confections and con¬ serves, syrups, inspissated juices, extracts, powders, pills, electuaries, ointments, plasters, extemporaneous prepara-
Barker and Montgomery on Pharmacopoeia . 87
tions, and miscellaneous ’'preparations, is consigned to Dr. Montgomery. Dr. Barker, , as an experienced physician, and Professor of Chemistry, in Trinity College, Dublin, is well qualified to perform the duty of commentator on the chemical part of the pharmacopoeia ; while Dr. Montgomery, also an experienced physician, and Professor of Midwifery, in the King’s and Queen’s College of Physicians in Dublin, is too favourably known to the profession to require an in¬ troduction from us. These are the men to write on phar¬ macology, and not mere chemists. But thanks to the Lon¬ don College of Physicians — all who please may assume the title and character of physician, and instruct the faculty, in this city of cities, in the science of therapeutics, while they deride the framers of the College pharmacopoeia, notwithstanding the order of the king and council in its favour made and obtained. Such is the respect shewn col¬ legiate dignity and royal authority in this age of intellect. It is said the Schoolmaster is abroad,” and it is ardently hoped, and a consummation devoutly to be wished,” he may, in the course of his perambulations, stumble upon our tottering medical corporations, and crumble them to the dust, for their outrageous insolence, and utter disregard to the wishes and wants of the great body of their ill-treated and indignant members. Viewing with heartfelt pleasure, the career of this potent personage in every other direction, and the mighty changes he is about to effect in all anti¬ quated and defective institutions, we are confident that those in question will very speedily be carried along with the universal progression of improvement. The hour has not yet expired, which is favourable for the exertion of liberal views, by those who ought to feel an interest and a pride in promoting good feeling in the profession ; but the ignoble spirit of monopoly and of abuse, renders them insensible to the loud calls of moral justice. They hesitate to lose their tawdery and puerile ascendancy ; but surely they cannot suppose their members are insensible to the superior position in which the faculty is placed in other nations. If we look to the history of the London College of Physicians, and especially to that part which relates to their pharmacopoeia, we find (and we indite it with sorrow, but with truth) they have ever been in the rear of the march of science. If our contemporaries had only spirit to speak the truth, and that openly, the medical rulers m England would cease to be behind all their contemporaries in other nations, and would occupy that superior position* which
88
Critical Review.
their country has proudly and honorably maintained for ages, in science, literature, and the arts. Enough ; we are grieved to be obliged to make these remarks, but they have been elicited by the lamentable fact, that the profession of medicine amongst us stands still, while in most other coun¬ tries it has been allowed to precede us.
The Dublin Pharmacopoeia is the latest which has been published in these countries, and, unlike those of London and Edinburgh, it has kept pace with science, and embraces many potent remedies omitted in the London code of 1824. It is still further enhanced by the very valuable observations of the commentators before us. They have added the most recent opinions of British and foreign writers, and also attested many facts by their personal testimony. We hasten to insert some extracts, to afford the reader strong evidence of the value of this publication, and of the able manner in which it has been executed.
“ Distilled Vinegar. — Take of wine-vinegar by measure, ten parts. • — Distil with a slow fire, by measure eight parts. In the distillation glass vessels should be employed, and the first portion which comes over, in quantity amounting to one part, rejected.
“ The specific gravity of this acid is to that of distilled water as 1005 to 1000.
“ Remarks. — The preparation here directed is that of acetic acid largely diluted with water.
“ Vinegar, a product of acetous fermentation in a vinous liquor, is an impure compound, containing, with acetic acid and water, also vegetable mucilage, gluten, sugar, extractive matter, often some malic and tartaric acids, and a minute portion of tartar, with a small quantity of alcohol and pyroacetic spirit. Microscopic insects are ge¬ nerally present in wine-vinegar.
“ To obtain the diluted acetic acid, detached from impurities, and to obviate the decomposition which vinegar when long kept, under¬ goes, is the object of the present process. Of the different ingredi¬ ents of vinegar, some are volatile, and rise when the fluid is heated to near 212°. The volatile ingredients are alcohol, pyroacetic spirit, acetic acid, and water. Of these the alcohol and pyroacetic spirit are the most volatile, and when vinegar is distilled, rise w'ith the first portions of vaporized compound. For this reason we are directed to reject the first portion, or of the whole fluid employed one tenth part, as this contains the alcohol and pyroacetic spirit. By proceeding with the distillation, and distilling seven parts more, we obtain a large proportion of the pure acetic acid united to water. The pro¬ cess is then to be stopped, lest the impurities should pass over and contaminate the distilled vinegar ; this will happen if the heat rises to the degree which occasions decomposition, in which case an em- pyreumatic flavour will be given to the product.
Barker and Montgomery on Pharmacopoeia.
89
“ A stronger vinegar is obtained from wine than from liquors merely saccharine, or produced by fermented malt ; for which reason the vinegar of wine is directed in this process. White wines are found to afford the strongest vinegar.
“ In the pharmacopoeia of 1807, six-tenth parts of the vinegar em¬ ployed were distilled over, the first tenth part being rejected; but ex¬ periment proved that on continuing the distillation, the diluted acetic acid which then came over was as strong as that which had preceded it, and equally free from empyreuma : it was therefore thought ad¬ visable to increase the proportional quantity to be distilled over, leav¬ ing a smaller residue in the retort, and rendeiing the process more productive.
“ In this process the use of glass vessels is directed, as the vine¬ gar would dissolve a portion of a metallic vessel if composed of the metals usually employed, lead, iron, or copper. Lead dissolved in the vinegar may he detected by the addition of water impregnated with sulphuretted hydrogen, and by a solution of sulphate of soda: the first of these re-agents producing a brownish coloured precipitate of sulphuret of lead; the second a white precipitate of sulphate of lead. Iron is ascertained to be present by a solution of prussiate of potash, which gives a blue tinge to the acid, or affords a blue preci¬ pitate. The presence of copper is indicated by a clean plate of iron immersed in the acid, a rose-coloured coating of copper appearing on the surface of the iron. Copper is also discovered by adding water of ammonia till the alkali predominates in the mixture, in which case an azure blue colour appears.
“ Properties and tests of its purity. — Distilled vinegar should have an agreeable acid smell and taste. It should form soluble salts with the alkalies and alkaline earths and with the oxide of lead ; but with protoxide of mercury, a salt of sparing solubility.
“ Vinegar is often adulterated by means of sulphuric acid. This may be detected by the addition of a baiytic salt, which will afford a precipitate insoluble in nitric or muriatic acid. This impurity is often present, as the preparer is allowed to mix one thousandth part of sul¬ phuric acid with the vinegar. Whether the sulphuric acid detected by the barytic salt exists in the vinegar in a disengaged state, or in combination with a fixed alkaline base, may be ascertained by eva¬ porating the vinegar to one-seventh or one-eighth of its original volume; dividing the residue into two portions, neutralizing one of these with pure carbonate of lime, separating the liquor from the un- dlssolved part of the mixture, and having ascertained whether the base of the salt contained in the dissolved part is potash or soda, de¬ compounding the solution by addition of a dissolved barytic salt, the precipitated sulphate when collected, dried, and weighed, making al¬ lowance for the sulphate of lime which is present, indicates the quan¬ tity of sulphate of potash or soda. The quantity of free sulphuric acid in the other portion, may be determined, by adding an aqueous solution of a salt of baryta sufficient to throw down the
Vol. VI. no. 32.
M
90
Critical Review.
whole of the sulphuric acid; the difference between the weight of this and of the former precipitate when dried, will give the quantity of disengaged sulphuric acid.
“ Muriatic acid is detected by adding nitrate of silver, which pro¬ duces a white precipitate assuming a pearl colour on exposure to light and dissolving in water of ammonia.
“ The presence of nitric acid may be ascertained by addition of a mixture of diluted sulphuric and muriatic acids, through which gold leaf has been diffused ; for if nitric acid is present, on applying heat the gold will be dissolved, the liquor will acquire an orange yellow tinge, and afford a purple precipitate with fresh prepared muriate of tin.
“ Sulphureous acid is sometimes present in distilled vinegar.
“ An impure vinegar of a brown colour and strong empyreumatic smell, is prepared by exposing wood to heat in large iron cylinders ; it is commonly named pyrolignous acid. From this a pure acetic acid, exceeding in strength the vinegar of commerce, is obtained. Different means are employed for this purpose. The following was practised with advantage. An acetate of lead was prepared with the impure acetic or pyrolignous acid, and the salt, purified by crystalli¬ zation and dissolved in water, was decompounded by a solution of sulphate of soda. The acetate of soda thus obtained in aqueous so¬ lution, and separated from the sulphate of lead was mixed with sul¬ phuric acid, and the diluted acetic acid obtained by distillation of the mixture in glass vessels.
‘ ‘ Specific gravity is an insufficient test of the strength of common vinegar, which varies in its specific gravity from 1010 to 1025. A part of this increased specific gravity, in common vinegar, is derived from mucilage and saline matter; on the other hand, the specific gra¬ vity of distilled vinegar is not unfrequently diminished by the pre¬ sence of that peculiar fluid named pyroacetic spirit, into which acetic acid, when united to a base, and exposed to heat is convertible. Py¬ roacetic spirit is known by these characters : it is of specific gravity 786, when rectified from dry muriate of lime; it boils at 138° of Far.; it is combustible, burning with a blue flame and a peculiar smell, and it unites in every proportion with water, alcohol, the fixed and volatile oils.
“ The specific gravity of both common and distilled vinegar may also be diminished by the presence of alcohol. Hence it is evident that specific gravity is not a rigidly accurate test of the strength of these acids. It has been ascertained that neither pyroacetic spirit nor alcohol are present in any sensible quantity in the distilled vinegar as obtained by the process of this pharmacopoeia. The most certain test of the strength of distilled vinegar is the quantity of carbonate of lime or dry carbonate of soda required to neutralize a known wreight of the acid, it being premised that 50 parts of real acetic acid neutralize 50 parts of carbonate of lime, and 54 parts of dry carbonate of soda.
“ 100 parts of distilled vinegar, of specific gravity 1005, require 5.2 parts of dry carbonate of soda for neutralization, and therefore con¬ tain 4.81 parts of real acetic acid.
Barker and Montgomery on Pharmacopoeia. 91
“ Uses. — Pharmaceutical. Distilled vinegar is employed in the preparation of several of the acetates ; of potassse acetas, sodse acetas, hydrargyri acetas, plumbi subacetatis liquor, and in the preparation of the compounds included in the class of aceta medicata; viz. aci- dum aceticum camphoratum, acetum colchici, acetum opii, acetum scillse.
“ — Medicinal. It is sometimes given internally as a refrigerant, and mixed with water may be used as a diluent drink in cases of in¬ flammatory fever; but for this purpose common vinegar is preferable, its flavour being more grateful than that of distilled vinegar. Acetic acid, either as distilled vinegar or in the more concentrated form, in¬ creases the solubility of acetate of lead in water, and may be added to solutions of this salt, to prevent the decomposition which arises in neutral acetate of lead from exposure to carbonic acid. Either dis¬ tilled or common vinegar is supposed to produce some anti-narcotic effect; on the contrary, Orfila found it to increase the activity of opium taken into the stomach ; this might be expected from the na¬ ture of those principles on which the powers of opium depend; their solubility and action being increased by union with the acetous acid.
“ In cases of diseased digestive and urinary organs, attended by a deposition of the phosphate of lime or of the ammoniaco-magnesian pyhosphate in the urine, diluted acetic acid is beneficial. In obstinate constipation, vinegar is administered with advantage as a glyster. It is also a useful fomentation in cases of burns or sprains. Its vapour is inhaled with benefit in putrid sore throat, and it has been pro¬ posed on obvious principles for removal of the dust of lime from the eyes.
“ Dose. — Of distilled vinegar, from one drachm to half an ounce.”
— p. 26.
All the acids are treated with the accuracy and fidelity apparent in this extract. After a description of the rationale of the formula, and changes effected in the formation of nitric acid, its medicinal properties are thus detailed : —
“ It is given internally as a tonic, and is supposed to have consi¬ derable efficacy in restraining the progress of syphilis. With this in¬ tention it was first given by Dr. Scott of Bombay, who found that its action on the human system resembled that of mercury, in producing soreness of the gums and salivation. That it is useful in restraining the progress of venereal ulceration, and restoring the strength, when broken down by the use of mercury, is certain, although it will not effect a radical cure of syphilis. In some liver diseases, as these appear in India, it is deemed benefical, and given much diluted with water, so as to form an acidulous drink, it was found useful by Dr. Duncan in the low typhous fevers that occasionally prevail in the su¬ burbs of Edinburgh.
“ Its fumes disengaged from nitre by strong sulphuric acid, are supposed efficacious in destroying the contagious effluvia of typhus or
92
Critical Review.
other febrile diseases. Dr. Carmichael Smith received from the British Parliament £.5000 for the introduction of this mode of disin¬ fection. It may be put in practice by passing into aflat earthen ves¬ sel, placed in hot sand, half an ounce of nitre reduced to powder, and pouring on this about half its weight of strong sulphuric acid or oil of vitriol; the nitrous fumes are immediately disengaged, and are not so offensive to the inmates of the dwelling as other vapours are, more especially those of chlorine. Dr. Duncan asserts, in his last valuable edition of the Edinburgh Dispensatory, that the above men¬ tioned quantities of nitre and sulphuric acid will fill with vapour a cube of ten feet; therefore by increasing, in proportion to the size of the room, the number of vessels containing the fumigating materials, the acid vapours may be completely diffused through every part of the open space of an apartment, but unless with particular care, the fumes can scarcely be brought into contact with clothes shut up in drawers or boxes, or with the interior of bedding, and to such arti¬ cles contagion is supposed, and with a high degree of probability to adhere. That the vapours of nitric acid, as some physicians have supposed, are altogether inefficacious, can scarcely be admitted when we bring to mind that infectious effluvia are probably, in composition, similar to other animal substances, and on these nitric acid has a powerful action, and completely alters their chemical qualities. But although we should concede to nitrous fumigation the power of di¬ minishing contagion, its superiority over ventilation and cleansing is by no means established, and it should not supersede the use of these preventives when practicable. Nitric acid has been used as an es- charotic, and proposed as a good application to the part bitten by a. rabid animal, with the intention of destroying the animal texture and altering the poison ; whether this practice should be preferred to ex¬ cision, experience alone can decide, for on its first application it may accelerate the absorption of the poison, and in this respect prove rather injurious than serviceable.” — p. 52.
The following remarks on prussic acid are highly im¬ portant : —
“ Prussic acid. — Take of cyanuret of mercuiy, an ounce, muriatic acid, by measure, seven drachms, water, by measure, eight ounces.
“ Distil into a refrigerated receiver, eight ounces by measure, to be kept in a well corked bottle, in a cool and dark place.
“ The specific gravity of this acid is to the specific gravity of distil¬ led water, as 998 to 1000.
“ Remarks. — In this process the cyanuret (or cyanide) of mer¬ cury is decompounded by the muriatic acid ; the hydrogen uniting with the cyanogen, and changing it into prussic acid which rises and passes over into the receiver ; the corrosive muriate or chloride of mercury remains in the retort, and as the residual liquor cools, de¬ posits its usual spicular crystals. The changes which take place in
93
Barker and Montomery on Pharmacopoeia.
K
this instance, and the atomic quantities transferred, are represented in the following scheme : —
Materials.
|
1 Mercury — |
200 |
2 Chlorine |
= 72 |
|
2 Cyanogen = |
52 |
2 Hydrogen |
= 2 |
|
1 Bicyanide of Mer¬ cury = |
2 Muriatic Acid 252 Products. |
= 74 |
|
|
2 Cyanogen = |
52 |
1 Mercury |
= 200 |
|
2 Hydrogen = |
2 |
2 Chlorine |
= 72 |
|
2 Prussic Acid Vapour = |
54 |
1 Bichloride of Mer¬ cury |
= 272 |
“ On reference to the tables of muriatic acid, it will be found that 74 parts of muriatic acid gas are contained in 229.8 parts of liquid muriatic acid, of specific gravity 1160; consequently 480 grs. or one ounce of cyarunet (bicyanide) of mercury, will require 437 grs. of the same liquid acid for complete decomposition, which is but a little less than the quantity directed in the pharmaceutical process ; the weight of 7 drs. by measure, of muriatic acid of specific gravity 1160, being 462.8 grs.
“ An experiment was made in which equal weights of cyanuret (bicyanide) of mercury and muriatic acid were employed. The prussic acid yielded by this process reddened litmus paper, and gave a precipitate with solution of nitrate of silver. The quantity of mu¬ riatic acid used in the latter case, is more than sufficient for the de¬ composition of the bicyanide of mercury. The quantity of liquid prussic acid, formed by the process of the pharmacopoeia as above given, amounted to about 7 oz. 5 drs. It had the specific gravity of 998 and was consequently much diluted with water, which, with an agent of such great activity, is an advantage, as its dose can be ap¬ portioned with more exactness than if the acid were stronger. By several other processes it may be obtained of much greater strength, but no advantage is thereby gained, as it cannot be administered in the concentrated state, but must in every case be diluted. The main object is to obtain the -whole of the hydrocyanic acid from the ma¬ terials, and of a certain fixed strength, whilst the dilution with water assists the exact regulation of the dose.
“ Tests of its purity. — The pure liquid acid is limpid and colour¬ less. It has a strong smell, which causes much irritation in the nos¬ trils, with a peculiar sensation extending downwards into the trachea ; and if inhaled incautiously, and in large quantity, producing giddi¬ ness or faintness. The latter effect is, however, more likely to arise from a strong acid than from the dilute acid of this pharmacopoeia. Its taste is peculiar, resembling that of bitter almonds or laurel leaves.
94
Critical Review.
The attempt to taste it should be made with great caution, as it is a most active poison.
“ The specific gravity of water is diminished by absorbing prussic acid vapour, in which respect this acid resembles ammonia. There¬ fore specific gravity affords an estimate of its strength; the less the specific gravity the stronger the liquid acid. But according to the experiments of Dr. Ure, specific gravity is not a rigorously exact criterion of the strength of liquid prussic acid. He states that liquid acid at specific gravity 996, contains about double the quantity of real acid which it does at specific gravity 998. Dr. Ure proposes as a more accurate mode than specific gravity, for determining the quan¬ tity of real prussic acid in water, the use of the red oxide of mercury prepared by nitric acid ; the nitric oxide of mercury of this pharma¬ copoeia. To apply this test, some of the oxide should be reduced to fine powder, dried with a moderate heat, and about forty or fifty grains of this powder carefully weighed : one hundred grains by mea¬ sure , of this acid, of specific gravity previously determined, passed into a glass tube, and the pulverized red oxide gradually added, which on agitation readily dissolves so long as any disengaged prussic acid is present; the difference in the weights of the residual red oxide and of that originally taken gives the weight of the portion dissolved by the prussic acid.
“ The real prussic acid, corresponding in quantity to the red oxide of mercury dissolved, is found by viewing the changes thus ; a bicya¬ nide of mercury is formed, as given in the preceding scheme ; two atoms of the oxygen contained in the peroxide of mercury, uniting with two atoms of hydrogen in the prussic acid to form water, and two atoms of cyanogen with one of mercury, to form bycianide of mer¬ cury. Hence it follows, that every 216 parts of peroxide of mercuiy indicate 54 parts of prussic acid vapour, or that the prussic acid is ex¬ actly l-4th of the weight of the peroxide of mercury, and therefore for every four parts of red oxide of mercury dissolved, one part of prussic acid existed in the liquor.
“ Dr. Ure observes that specific gravity is a criterion of greater nicety than can be conveniently used by the majority of practitioners, and he proposes to substitute for it the above application of peroxide of mercury. He has constructed a table, in which, as may be infer¬ red, the quantity of real prussic acid contained in the strong liquid acid of specific gravity 9570, was ascertained by means of the peroxide of mercury ; and with which strong acid, by addition of successive por¬ tions of water, mixtures of decreasing specific gravities, each contain¬ ing the known quantity of real prussic acid, were prepared.
“ The prussic acid of this pharmacopoeia should have the sensible qualities above described, and 100 parts of it by weight, should dis¬ solve a little less than 6.4 parts of red oxide of mercury, reduced to a fine powder; and therefore contain 1.6 of real prussic acid.
. “ An exact mode of detecting small quantities of prussic acid is of great importance, more especially when the acid has acted as a poison. In water it may be detected, according to Dr. Ure’s expe-
Barker and Montgomery on Pharmacopoeia, 95
riments, by making the liquid containing the prussic acid slightly al¬ kaline by potash, adding a few drops of a solution of the sulphate of copper, and then sufficient muriatic acid to re-dissolve the excess of oxide of copper. The liquid will appear more or less milky, accord¬ ing to the quantity of hydrocyanic (prussic) acid present. A quan¬ tity of this acid in water, not exceeding a 1 -20000th of the mixture, may be discovered by this test.
‘ ' Should the prussic acid be contaminated by muriatic acid, which will happen if too much of the latter acid was used in the process of preparing the prussic acid ; this can be ascertained by neutralizing the liquor with ammonia, and evaporating with a heat, at the end of the process not exceeding 212°. If muriatic acid was present, mu¬ riate of ammonia will remain.
“ Prussic acid may be purified from muriatic acid, by adding a small quantity of bicyanide of mercury, and re-distilling the mix¬ ture.
“ Uses. — Pharmaceutical. It is not applied to any pharmaceuti¬ cal use, according to this pharmacopoeia. In the Parisian codex me* dicamentarius, a syrup is directed to be prepared with prussic acid ; but it seems injudicious to multipply preparations of a medicine so active as prussic acid.
“ — Medicinal. — In the dilute state it is recommended as a re¬ medy in phthisis pulmonalis, and is reported to allay irritation and diminish the frequency of cough, but its curative efficacy in this disease is very doubtful. In simple dry cough, apparently connected with spasm, it is said to be beneficial, and accordingly it is found oc¬ casionally useful in spasmodic asthma. In hooping cough it also af¬ fords some relief. It has been reported to calm the irritability of the uterus even in cases of cancer, and to moderate the morbid acti¬ vity of the heart ; and it appears to have some specific action on mu¬ cous surfaces.
“ It may be useful here to advert to its poisonous qualities, for the purpose of reminding the prescriber of the great caution to be ob¬ served in the use of this remedy. When applied in its concentrated form to the tongue, fauces, eye, or even to the external surface, by spreading it over the skin, it acts as a most virulent poison ; and in the quantity of one or more drops, varying with the strength of the acid, vigour of the individual, and his previous habits in respect to its use, it causes immediate death. A single drop of a very strong acid passed into the throat of a strong dog has caused it to drop dead, and an animal is instantly killed by drawing a feather dipped in the strong liquid acid across the eye ball. Scarcely any irritability can be de¬ tected in the muscles of animals poisoned by prussic acid. A suffi¬ cient dose of the more diluted acid of this pharmacopoeia would also be destructive of human life ; the prescribe should immediately desist from its use when giddiness, vomiting, pain and sense of tightness at stomach, faintness, stupor, or sensations of weight at the top of the head comes on.
96
Critical Review.
“ As remedies for the effects of this poison, when the quantity swallowed is small, Orfila recommends that full vomiting should be excited by twelve grains of sulphate of zinc, dissolved in a glass of water, or by three or four grains of sulphate of copper ; then strong coffee, prepared by infusion for ten minutes, a quart of boil¬ ing water on eight ounces of coffee, and then straining : three or four table spoonsful of oil of turpentine mixed with the coffee, to be given at intervals of half an hour. If stupor and insensibility have come on, the immediate application of the stomach pump should be had recourse to.
“ Dose. — From two or three drops to half a drachm, by measure. The smaller dose to be commenced with, and gradually increased, a sufficient time being suffered to elapse between each dose.” — p. 63.
Dr. Barker gives an elaborate review of all the formulae for the preparation of tartarized antimony, and proves satisfactorily that the Dublin method is preferable to every other. His comments on this article occupy six pages, and are concluded by an account of its medical properties. He observes,
“ In a moderate dose it acts as a diaphoretic or sudorific ; in lar¬ ger dose as an emetic and sometimes as a purgative. The first effect is produced by this remedy, when given in doses below one-fourth of a grain ; the second when the dose amounts to one, two, and three grains. It has latterly been given, particularly in Italy and France, in very large doses, amounting to from thirty or sixty grains or more, dissolved in the merely sufficient quantity of water, restricting the patient from the use of all drink whilst under its operation. In these doses it is said to exert a sedative action, and to be a useful remedy in inflammatory cases. It is much to be wished that those who have given it in this manner, had stated the purity of the salt, determined by experiments similar to those above described as tests of its purity ; for if the salt employed was impure or adulterated, serious conse¬ quences might arise from the same application of a pure salt. The effects seem to vary much, according to the constitution of the pa¬ tient. Twenty grains, or a little more, in some instances acted as a poison, according to the testimony of Orfila. Dr. A. Duncan, of Edinburgh, has found it to act as a sedative, and with good effect, when given in doses of five grains where the powers of life were too feeble to admit of blood-letting. When taken in large quantity, and acting as a poison, it produces much vomiting and cramps in the stomach ; Orfila recommends copious draughts of water sweetened with sugar ; and if the pain should continue, a grain of opium re¬ peated two or three times, at intervals of a quarter of an hour. It is decompounded by infusion or decoction of bark ; and Orfila recom¬ mends this also as an antidote to its effects. Dr. Duncan tried with
Barker and Montgomery on Pharmacopoeia. 97
advantage a solution of sulphuret of potash for the same purpose. — Thus it appears, that in very small doses not exceeding one-fourth part of a grain, it acts as a diaphoretic, in doses of from one to four grains as an emetic, and in doses not exceeding five grains, but in general much below this quantity, its action is sedative ; but in these large doses it should be used with caution. To cause vomiting, the most effectual mode is to give it in half grain doses, repeated at intervals of ten minutes until vomiting is produced. As an emetic, it is fre¬ quently given with advantage at the commencement of febrile attacks ; as a diaphoretic also, it is given, oftentimes beneficially in such cases: as a sedative, it is considered useful in cases of pneumonia or bron¬ chitis. It is also sometimes used as an external application, and then it has the effect of producing a pustular eruption.” — p. 218.
The last extract which our space will allow us to make, is the following : —
“ Taken internally, acetate of lead acts as a sedative astringent; it is sometimes given in cases of hemorrhage from the lungs, and is much used in France for this purpose. In dysentery also it has been frequently prescribed, but the writer has often tried it in the advanced stages of this disease, with but little benefit; in these cases it is generally given combined with opium. It is said to have been em¬ ployed successfully in the treatment of epilepsy.
“ Although acetate of lead is poisonous when its use has been long continued, yet some peculiarity of constitution or unknown external circumstance is required to give it activity, for, large quantities have been accidentally swallowed without any bad effect. That it is poisonous, the production of saturnine colic from the use of wines containing salts of lead abundantly proves. Its poisonous nature is also established by experiments on lower animals. Orfila asserts, that dogs on whom its action in the solid form was tried, die in con¬ sequence of the corrosion it produces in the digestive canal, and that when taken in the liquid form, having remained in the stomach a time sufficient for absorption, its fatal effects depend more upon its action on the nervous system than on the inflammation it occasions.
“ Acetate of lead is a useful external application; made into a poultice with crumb of bread, its aqueous solution is often applied to moderate inflammatory action. It is also frequently used as a colly - rium. The decomposition which takes place in its solution in conse¬ quence of the absorption of carbonic acid from the atmosphere, may be prevented by the addition of a quantity of distilled vinegar suffi¬ cient to produce a slight excess of acid in the liquor.
“ Dose. — From half a grain to two grains.” — p. 304.
We have now enabled the reader to form his opinion upon the manner in which Dr. Barker has executed his task ; in our estimation he has done much credit to himself, as well as to the university to which he belongs. Like a true
VOL. VI. no. 32.
o
98
Critical Review.
votary of science, be has avoided all personality, and merely contented himself by defending the principles maintained in the pharmacopoeia, which he assisted in preparing.
He has displayed no special pleading, but a truly sci¬ entific view of every subject he has discussed. We part with him on terms of high respect, and congratulate him on the candour, research and ability he has evinced in treating of subjects so much disputed. He has contributed his por¬ tion to an exceedingly interesting work, and afforded ample proof of his sound practical knowledge as a physician, and his very great acquirements as a scientific and practical chemist. He is intimately acquainted with the most difficult chemical manipulations, and is quite conversant with the recent opinions on this branch of medical science. His fre¬ quent citations of the opinions of his venerable predeces¬ sor, Dr. Percival, will be exceedingly agreeable to his pro¬ fessional brethren in Ireland, as paying a just tribute to the profound knowledge, indefatigable industry, and genuine talents of that eminent individual. Dr. Good has also done him justice in his imperishable work ; and never was there a physician who had fairly arrived at the summit of his pro¬ fession, in a large city, more entitled to the esteem and veneration of his profession. He has long since retired from the practice of medicine, and is no longer sensible to praise or censure. We are not much in the habit of lauding the faculty, but we are ever ready to pay a just and well merited tribute of respect to the few who deserve it. We give to Caesar what belongs to Caesar. We have not the honour of Dr. Percival’s acquaintance — we speak of him as his estimable merits deserve. He was the Baillie of Dublin. We therefore return our best thanks to Dr. Barker, whose benevolence needs no eulogy from us, for his allusion to that universally respected individual.
We shall now exhibit specimens of the manner in which Dr. Montgomery has executed his part of the work, and, we think, convince our experienced readers that the pro¬ duction before us is well worthy of place among our best treatises on pharmacology. The latest improvements have been added, so that in fact this is the most recent work upon the subject. Had the commentators included the London and Edinburgh pharmacopoeias, then Dublin might boast of as good a dispensatory as any extant. The work, how¬ ever, in its present shape, is one of great utility to the pharmaceutists in Ireland, and will be referred to with ad¬ vantage by every man engaged in the practice of medicine
Barker and Montgomery on Pharmacopoeia. 99
in these countries. We strongly recommend it to every class of our readers. The following extracts will afford evidence in corroboration of our opinion : —
“ As the croton tiglium is now for the first time admitted into the list of the materia medica of this pharmacopoeia, it appears proper to notice here the expressed oil obtained from that plant, now much used, and known by the name of Croton oil.
“ Remarks. — The plant yielding the seed from which croton oil is obtained, is a native of the Molucca Islands,
“ The seeds which are contained in trilocular capsules, are about the size of a large coffee bean, and very much resemble in form the castor oil nut, and the plants belong to the same natural family. The seeds were formerly much used in medicine under various names ; they are the nucula cathartica of Geoffrey, by others they were called pinei nuclei Moluccani purgatorii, and still more fre¬ quently grana Molucca, or grana tiglia ; but they fell into disrepute, owing to their violently drastic effects, and were almost forgotten until attention was again directed to them by Dr. Ainslie, in his Materia Medica of Hindoostan. 100 parts of the kernels of the seeds, when bruised, yield 60 parts of acrid oil, and 40 of farina¬ ceous matter.
“ Qualities. — Croton oil is of a pale reddish brown colour. Its taste is hot and acrid ; it is soluble in ether and oil of turpentine. Alcohol takes up two parts out of three, and the solution possesses the active properties of the oil ; much of what is taken up by the alcohol is fixed oil. From the experiments of Dr. Nimmo, croton oil is composed of 45 parts, of an acrid purgative principle, and 55 of fixed oil resembling the oil of olives, and not possessed of any cathartic property.
“ Dr. Nimmo has also shewn that this acrid principle is resinous, and soluble in alcohol, sulphuric ether, volatile and fixed oils, and that ether and purified oil of turpentine dissolve the whole of the oil ; from the knowledge of which fact we are enabled, by digesting the kernels of the seeds in these menstrua, to obtain the oil in as genuine and apparently in a more uniform condition, than by the processes of torrefaction and expression practised in India.
“ M. Caventou obtained this oil by means of the action of alco¬ hol, at 100° Fahr. upon the kernels of the seeds reduced to a paste. He allowed it to macerate for 48 hours, and then filtered ; he then poured a second and a third quantity of alcohol upon the paste, which he afterwards submitted to strong pressure ; the alcoholic macerations were then placed in an alembic, and the alcohol drawn off by distillation. The oil which remained in the alembic was filtered through paper, and preserved in a stopper bottle.
“ MM. Vauquelin and Pelletier have made some experiments for the purpose of isolating the active principle of this oil, but without success. Dr. Paris thinks, that it bears a strong analogy to elatin
100
Critical Review.
and from the experiments of Caventou, it appears that it is not identical with the j atrophic acid, as was supposed.
“ Adulterations, and test of its purity. — From the high price at which croton oil is sold, it is frequently adulterated with the cheaper fixed oils. Dr. Nimmo has suggested the following means of de¬ tecting these adulterations.
“ Pour into a phial, the weight of which is known, 50 grains of the oil ; add alcohol which has been digested on olive oil ; agitate well, and having poured off the solution, add more alcohol of the same kind, until the dissolved portion is diffused in such a propor¬ tion of the alcohol, that each half drachm measure shall contain equal to one dose of the croton oil for an adult ; by placing the phial near a fire to evaporate what remains of the alcohol in the bottle, if the remainder be to that abstracted by the alcohol as 55 to 45, the oil is genuine. If it be adulterated with olive oil or any other, little soluble in alcohol, the residuum will be larger ; if with castor oil, it will be smaller than in the genuine oil, but it is evident, as remarked by Dr. Duncan, that this test will fail if it be adulterated with a mixture of olive and castor oils.
“ Medical properties and uses. — It is a powerful hydragogue pur¬ gative, and from the smallness of its dose, it can be given in cir¬ cumstances where other effectual medicines cannot be swallowed. As in cases of coma, apoplexy, mania, or convulsions. It has been found useful in delirium tremens, dropsy, and intestinal tympanites. It is usually given made into pills, with crumb of bread ; but the tinctura tiglii as proposed by Dr. Nimmo, seems a decidedly pre¬ ferable form for its administration ; every half drachm of which contains somewhat more than a drop of the oil ; the following is the formula which he recommends :
Tinct. tigilii 5ss.
Syrupi simplicis.
Mucilag. gum. Arab, a a 5ii-
Aquae distillatae 3ss. M — ft. haustus.
And in order to obviate the uneasy feelings likely to be produced in the mouth and throat, he advises, “ after swallowing a little milk to take the draught very quickly, and wash it down with repeated quantities of the same diluent.” A drop may be given on a lump of sugar : hut where there is no dislike to oil, one drop of croton oil with half an ounce of castor oil is a most effectual purge. Besides the effect produced on the alvine evacuations by this oil, the secre¬ tion of urine appears to be considerably increased.
“ In India it is used as an emmenagogue, and it is said with excellent effects, and as an external application in rheumatism.
“ Rubbed on the skin it sometimes produces its effects actively, and nurses who have been employed to rub it on the abdomen of patients, have been in several instances severely purged. Mr. Con- well states, that the odour of this oil, several times respired over a
Barker and Montgomery on Pharmacopoeia. 101
bottle containing sixteen ounces of it, was sufficient to purge a young girl ; while an adult having made the same experiment, suffered only from nausea.
“ The solution of this oil in oil of turpentine, is said by Dr. Thomson to produce a pustulous eruption when applied to the skin. Dr. Copland gave a combination of these two oils with great advantage in a case of tetanus.
“ Great care should be taken in the administration of this medi¬ cine, as an over dose will produce most dangerous hypercatharsis. Mr. Houlton mentions a case, in which three drops were given to a strong young man labouring under obstinate constipation ; it pro¬ duced evacuations in the course of fifteen minutes, and soon after¬ wards his sight failed him, and he became quite blind ; in four or five days he recovered the sight of one eye, the other was not restored for a fortnight from the time of taking the oil.
<£ In order to obviate the inconvenience arising from the variation in the size of drops, M. Caventou has proposed the use of a soap, prepared by triturating together two parts of the oil, and one part of liquid caustic soda of the French pharmacopoeia, without heat ; when the compound has acquired a sufficient consistency, it is poured into paste board moulds, after a few days, the soap is to be taken out in slices, and placed in a stopper bottle with a large mouth. This soap given in doses of two or three grains, diffused in water or in the form of pills, produced the same effect as the oil.
“ Dose. — From half a drop to two drops.” — p. 332.
Since the above was written. Dr. Short, of Ratcliffe Highway, has published an interesting essay on this remedy, which he found of great value in hepatitis, gastro- enteritis, tetanus, constipation, and hydrocephalus. For a review of his work, we refer to our last vol. (V.) p. 252.
“ Oil of turpentine. — Take of common turpentine, by weight, five pounds — water four pints.
“ Distil the oil from a copper alembic ; yellow resin will remain after the distillation.
“ Remarks. — In the list of materia medica prefixed to this phar¬ macopoeia, the pinus sylvestris is the species named as the source from which to obtain turpentine. In France, at Bordeaux, in the Landes, it is from the resin of the pinus maritima, that the volatile oil of turpentine is extracted, 250 parts of turpentine yielding from 50 to 60 of oil.
‘ ‘ Oil of turpentine differs from the other essential oils in being very sparingly soluble in alcohol, for although it dissolves in hot alcohol, it separates again in drops as the spirit cools. Whereas the turpen¬ tine whence it is obtained, dissolves with facility in that menstruum. It is limpid and colourless ; very light, volatile, and inflammable, and soluble in six parts of sulphuric ether. Its specific gravity is stated by Mr. Brande to be 8700, and by Dr. Paris to be only
102
Critical Review.
792°. If a stream of muriatic gas be passed through it, a resinous deposit is produced, resembling camphor in some of its qualities, but differing from it in not being soluble in weak nitric acid ; nor is it precipitated by water from its solution in strong nitric acid.
e< Oil of turpentine has a peculiarly strong and nauseous flavour, -which renders it intolerable to many as an internal medicine ; for the correction of this, either of these two methods mav be prac¬ tised ; agitate eight parts of the oil with one part of the strongest alcohol ; let them settle, and when a separation takes place, pour off the alcohol, repeat this three or four times, and the oil will become almost tasteless and without smell, and if evaporated will leave no residuum ; but it speedily returns to its original condition. The same effect may be more speedily produced by distilling it over quick lime, but it is to be doubted whether its medicinal efficacy is not thereby impaired.
“ The stimulating application known by the name of Whitehead’s Essence of Mustard, is composed of camphor and spirit, or oil of rosemary dissolved in oil of turpentine, with a little flour of mustard added to it.
“ Medical properties and uses. — It is stimulant, cathartic, diuretic, and anthelmintic ; extemallv it is an efficacious rubefacient. In doses of from half an ounce to two ounces it has been found to act almost as a specific in causing the expulsion of the tape worm. As a purgative it frequently succeeds when all others fail ; and is parti¬ cularly efficacious in the form of glyster. Its utility in epilepsy has been established upon numerous authorities. It is a popular remedy in rheumatism, and Dr. Cheyne, in his essay on gout, recommends it as a specific in sciatica; a commendation which, unfortunately, expe¬ rience has shewn it does not merit.
f‘ In gout in the stomach Dr. Mason Good speaks of it in very high terms, as being “ the best aperient, and at the same time stimu¬ lant medicine in such a case, for which the dose should be about six drachms swallowed un mixed/’ vol. ii. 687-8.
“ In puerperal fever its administration internally, and its applica¬ tion externally to the abdomen, has been found in many instances productive of the happiest results. From its effects in this disease, and in some others, oil of turpentine appears to have a specific influence in arresting inflammatory action, when administered in repeated doses; a very happy application of this power has been lately made by Mr. Hugh Carmichael of this city, in the treatment of iritis, by oil of tur¬ pentine, given in drachm doses three times a day.
“ In America, oil of turpentine in doses of a drachm every hour or two, has been successfully administered in cases of yellow fever, in which, says Dr. Chapman, it appears to be soothing in its effects, re¬ moving the sense of heat and irritation in the stomach, subduing the force of vascular action and general excitement, and inducing at once a state of more comfort and security.
“ It has been recommended by Mr. Colies, as an useful applica¬ tion to wounds received at the dissecting table.
Barker and Montgomery on P harmacopoeici.
103
“ Oil of turpentine is a valuable application to scalds or burns in tbeir recent state, and particularly in the form of liniment composed of it and linseed oil, or with ointment, of yellow resin, which latter combination constitutes the linimentum terebinthinse, which see.
“ Oil of turpentine has been used with success in the treatment of purpura hemorrhagica. See Edinburgh Medical Journal , vol. xviii. p. 540.
“ It has the singular property of communicating the odour of violets to the urine of those who take it, or who even expose them¬ selves for a short time to its effluvia.
“ Dr. Copland recommends the addition of tincture of capsicum to correct the nauseating effects which the oil frequently produces on the stomach. The ancients administered turpentine freely in coughs and various pulmonary affections.
f< Dose. — As a diuretic, ten drops to a drachm; as a purgative two drachms to an ounce, with the addition of an equal quantity of castor oil/’— p. 353.
“ Tincture digitalis. Medicinal properties and uses. — Itis diuretic and sedative ; as a diuretic, digitalis acts by diminishing arterial action, and so increasing that of the absorbents, by which means diuresis is promoted ; with this intention digitalis is given in ascites and other kinds of dropsy, particularly in hydrothorax, some of the most distress ¬ ing symptoms of which it palliates independently of its diuretic ef¬ fects. It is best administered in conjunction with other diuretics, as squill or nitrous spirit of ether, see page 373. If it purge or vomit, its diuretic effects are greatly impaired.
<f As a sedative it acts more directly than any remedy we are ac¬ quainted with, possessing great power in controlling the action of the heart and diminishing the impetus of the blood, on which account it is beneficially administered in aneurism and hemorrhages, particu¬ larly those from the lungs or uterus. Its effects in phthisis were much vaunted, but experience has not confirmed its utility in this complaint. The change made in the pulse by its use is very re¬ markable. Dr. Baildon informs us, that he reduced his own pulse from 110 to 40 by the use of digitalis, taken by gradually increased doses to the extent of six grains in the day. ITe late Dr. Halloran, of Cork, speaks very highly of its effects on persons afflicted with mania, for which he gave the tincture in doses of 60 to 120 drops three times a day; and the correctness of his observations have since been confirmed by the experience of others. In cases where there appears to be some organic affection of the heart or large vessels, the most decided benefit has resulted from its use.
“ The effects produced in some constitutions by the use of digi¬ talis are so remarkably violent, that its administration demands our utmost circumspection and attention to the state of the patient ; . and should there occur intermission of the pulse, vertigo, indistinct vision or nausea, with vomiting or purging, wTe should immediately discon¬ tinue the medicine, as its further administration under such ciroum-
104
Critical Review.
stances, will almost certainly give rise to a train of the most alarm¬ ing symptoms, terminating in death.
“ The effects of an overdose are best counteracted by the admi¬ nistration of cordials, as brandy and water with tincture of opium, or aromatic confection, mint tea, &c., and the application of a blister to the pit of the stomach.
“ Dose. — Ten drops cautiously increased to forty.” — p. 409.
“ Tinctur opii. Medical properties and uses. — Similar to those of crude opium. In small doses stimulant, in large ones power¬ fully narcotic and sedative, and anodyne both internally and exter¬ nally. This tincture is a most convenient and eligible form for the administration of opium, as it affords a means of apportioning the dose with great facility and certainty. It was long known and pre¬ scribed under the name of Thebaic tincture , because the ancients considered the opium brought from Thebes in Egypt as superior to any other. It was so named in the last edition of this pharmacopoeia.
“ Under certain forms of combination, opium becomes a most valuable auxiliary to many important medicines, by acting as a corri- gent of some of their qualities or effects ; and so rendering their action more complete. Thus, it will prevent mercurial alterative remedies from running off by the bowels, before they can produce their effect ; in combination with certain sudorifics, as antimonials and ipecacuan, it increases the sudorific effects, and will at the same time act as an anodyne. Combined with diuretics, as digitalis and squill, it corrects their tendency to cause vomiting and purging, which would in a great degree defeat their diuretic operation ; but it would far exceed the limits proposed in this work, to enter at length into a detailed account of the numerous effects ascribed to opium, or of the diseases in which it is administered or recommended; for as Dr. Paris ob¬ serves, “ in combination, the medical powers of opium are wonder¬ fully extended, so that there is scarcely a disease in which it may not, during some of its stages, be rendered useful.”
“ I shall therefore confine myself to a few observations on its most important effects and forms of administration ; and with respect to the latter subject, it appears as before stated, that the sedative power of opium depends on a peculiar substance contained in it called morphia , while the excitement and other disagreeable effects are caused by the principle which has been named narcotine ; hence it follows, that these preparations which contain the greatest quantity of the former with the smallest proportion of the latter, are to be preferred where the sedative effect is the object aim.ed at.
“ Thus, the acetum opii and vinum opii, which contain an acetic solution of morphia, its most active form, and the extractum opii aquosum, which contains only a very small proportion of narcotine and very little resin, produce their beneficial effects with compara¬ tively little of the general disturbance of the system, which so gene¬ rally follows the use of crude opium or common laudanum. The me¬ dicine known by the name of black drop, is also for the same reason
Barker and Montgomery on Pharmacopoeia. 105
an eligible form for administering opium. See acetum opii. Rous¬ seau’s drops are somewhat similar to the black drop.
“ With respect to its effects, and the proper circumstances under which it ought to be administered, it has been long regarded as a general rule, that “ its use is contra-indicated in all cases where inflammatory action prevails,” and this to a certain extent is true ; but the exceptions are very numerous, as it is found to produce the most beneficial effects in several highly acute and inflammatory dis¬ orders. Practitioners in the hotter regions of the earth, and espe¬ cially in India, have long been in the habit of giving opium freely in acute diseases, and even in tropical inflammation, after, or in com¬ pany with venesection, and generally in combination with calomel. “ The utility of this practice,” adds Dr. Johnson, “ has been long established in those climates, and is now making its way in this country, with some little variety in the modus.” — See Med. Chir. Review, June, 1824.
“ Dr. Armstrong, of London, enjoins this practice very strongly ; and in a paper which he published on the subject, he recommends the exhibition of opium in some most acute inflammatory affections, as acute inflammation of the peritoneal covering of the stomach, intestines, and uterus ; in such cases, after a copious venesection, he -administers three, four, or even five grains of good opium in the form of a soft pill. “ The effects,” he says, “ of opium thus administered, are to prevent a subsequent increase in the force or frequency of the heart’s action, and a return of the abdominal pain, while it induces a tendency to quiet sleep and a copious perspira¬ tion over the whole surface.” To the correctness of this statement, I can bear testimony from the decidedly beneficial result of such a mode of treatment, in some cases of puerperal peritonitis, which came under my observation ; and no remedy so effectually relieves the excruciating pain of acute rheumatism, which generally makes its attack at night, as a pill containing gr. iss. of opium, combined with gr. iss. of calomel, and gr. ^ of tartarized antimony. In swelled testicle, accompanied by a high degree of inflammation, the administration of a full dose of opium, after the application of leeches, is productive of the best effects.
“ In intermittent fever, opium, combined with brandy, and given during the cold stage, will often put an end to it ; or if given before its accession, will prevent it. The value of opium in the treatment of tetanus, is almost universally acknowledged, and in diabetes it is very generally regarded at present, as the most effectual remedy for alleviating the symptoms of that distressed and almost incurable disease. In the case related by Mr. Mooney, in the 5th vol of the Med. Chir. Trans, it reduced the quantity of urine passed in the day from twenty-five pints to seven ; but in both this disorder and teta¬ nus, in order to produce the good effects of opium, it must be given in quantities much exceeding the ordinary, even to the extent of twenty to thirty grains in the course of the twenty-four hours. Dr. Currie
Vol. vi. no. 32.
p
106
Critical Review.
gave five ouiices of the tincture in the course of the day in a case of tetanus.
“ After surgical operations a full opiate is generally given, and with good effect ; it soothes the pain, calms the patient’s feelings, induces sleep, and so tends to prevent the fever which so often comes on under such circumstances.
“ In dysentery and diarrhoea, after the exhibition of purgatives, opiates give great relief ; in the former disease by relieving the tor¬ mina and tenesmus, and in both restraining the excessive discharge.
“ The vomitings which sometimes so distress nervous persons or pregnant women, are often quieted by opiates better than by any other remedy: and cases have occurred where it produced this effect, applied by rags wet with laudanum over the region of the stomach.
“ In cholera and in pyrosis opium is a valuable remedy. It is also frequently introduced into the rectum, either in form of a suppository or as an enema.
“ As an external application in the form of liniment or otherwise, opium possesses considerable anodyne effects, particularly if combined with acetic acid. The following liniment is recommended as useful in convulsive or spasmodic affections : —
1^. Tincturae Opii 3 ss.
Olei Olivarum ^ i.
Vitelli Ovi. q. s. ut fiat linimentum.
“ The quarter of this to be rubbed on the thighs or legs twice or thrice a day.
“ Opium is often applied with good effect to the surface of sores, from which it is readily absorbed into the system ; Sir Astley Cooper mentions “ a case, in which a tetanic affection was produced in a child, whose leg had been amputated, and where the application of opium to the stump gave more immediate relief than I ever remember to have witnessed. It relieved the spasms, and, as I believe, saved the child;” and he adds, “ if opium, applied to the surface of sores, be absorbed into the system, it produces excessive costiveness, extreme pain in the head and torpor of the system, which is only to be re¬ moved by the frequent administration of active purgatives.’'*
“ The torpor of the intestines caused by opiates, in consequence of their paralyzing for a time their muscular fibres, may be best coun¬ teracted by aloetic purgatives, which have a directly contrary effect, that of increasing the peristatlic motions.
“ The administration of opium is frequently followed by clay co¬ loured stools, shewing that the biliary secretion into the intestines has been interrupted ; this may be best obviated by combining mer¬ curials, particularly calomel, with the opium, or giving them shortly afterwards, either alone or in combination with aloetics.
“ It is often productive of considerable benefit in threatened abor¬ tion, and in tedious labour where delivery is impeded by rigidity of the os uteri or other soft parts. Opium should never be given to in¬ fants if possible to avoid it, as it is apt to produce very untoward
Barker and Montgomery on Pharmacopoeia. 107
effects in them. Nor should it be given to mothers who are giving suck, at least without cautioning them not to suckle their child for some hours after. A case came to my knowledge a short time since, in which a woman, who was nursing her child, took twenty drops of laudanum to procure sleep, which had been disturbed for some nights by the pain of a sore breast ; the infant sucked a great deal during the night, and was so affected in consequence, that it remained for 'nearly twenty-four hours in a state of complete torpor almost resem¬ bling death, from which no effort could rouse it, though every means were used for the purpose. It however ultimately recovered.
Some of the oriental nations use opium habitually as a cordial sti¬ mulant, and as such, take it frequently in the day, to an amount which would appear almost incredible. Dr. Smith mentions, in the philo¬ sophical transactions, that being at Smyrna, he saw a man who took every day three drachms of opium, half in the morning and half after dinner, to prevent him from falling asleep ; this habit he continued for twenty-four years, and had begun with a grain ; but Dr. Smith says, that the consequence was premature old age. The Turks eat opium when going into battle, to excite them and rouse their courage, but this habitual use of opium completely blunts both the mental and corporeal faculties. I knew a person who every day took from thirty to sixty drops of laudanum to cheer him and prevent low spirits, which it did effectually ; but whenever accident prevented the habit from being indulged in, the consequence was a state of the most pitiable depression and misery of mind and body. Russel observes, that the effects of opium on those addicted to its use, are at first obstinate costiveness, succeeded by diarrhoea and flatulence, with loss of appe¬ tite and a sottish appearance ; the teeth decay, the memory fails, and the unhappy sufferer prematurely sinks into the grave.
“ Of crude opium, from half a grain, to a grain and a half, and from ten drops to sixty or more of the common tincture, are the quantities which may be considered as constituting a general dose for an adult; for children, particularly infants, the dose should be very small, not exceeding a drop or two ; but under particular circum¬ stances these doses may be greatly exceeded, as in some spasmodic affections, particularly tetanus, and in diabetes ; in cases attended by great bodily suffering, very large doses may be taken without any very sensible effect being experienced, but it sometimes happens that one-fourth of a grain will produce an effect in one person which ten times the quantity will not produce in another. I know a lady whom so small a dose as five drops of laudanum would throw into a state of delirium.
“ In case of an overdose being taken, a full emetic of the sulphate of zinc or copper, dissolved in a very small quantity of water, should be immediately given, and the stomach well evacuated by vomiting ; after this is accomplished, vinegar diluted, and other acidulous drinks, should be given ; drowsiness should be prevented by keeping the patient in motion, giving ammonia, brandy, or strong coffee ; or, by immersion in a tepid bath. Bleeding is sometimes necessary to
108
Critical Review.
relieve the vessels of the brain, and may be best performed in the jugular vein. When the overdose taken is a fluid preparation, the stomach pump affords an expeditious and certain means of withdraw¬ ing from the stomach its poisonous contents.
“ Dose. — Ten drops to sixty or more.” — p. 434.
“ Belladonna. Medical properties and uses . — Belladonna is power¬ fully narcotic, diaphoretic, and diuretic. It excites all the excretions, and has been found serviceable in neuralgia, used internally, and ap¬ plied externally in the form of a plaster. — See belladonna plaster .
“ MM. Schaeffer, Hufeland, and Wetzler, have declared it al¬ most a specific in hooping cough, and to its efficacy in this complaint Dr. A. T. Thomson also bears testimony. Wetzler succeeded in curing all his cases within twenty days from the time the patients began to use the belladonna ; the greater number were cured, from the eighth to the fifteenth day. In two cases in which I administered it for this complaint, it appeared to succeed completely, and removed the complaint from one child in a fortnight, and from the other in about three weeks. 1 used the extract dissolved in cinnamon water, and sweetened with syrup.
“ On the continent, belladonna was for a time much extolled as a preventive of hydrophobia ; but recent failures, in cases where it was fairly tried, have invalidated, if not annulled its claim to such a power.
“ It is also upheld by many, particularly of the continental physi¬ cians, as a preventive against the infection of scarlatina, during epi¬ demics of that disorder ; and its pretensions in this respect are sup¬ ported by so many respectable authorities, that we can hardly doubt of their being well grounded.
“ Dr. Berndt, of Custrin, who was the first to make a connected series of experiments on the subject, says that in the epidemics of scarlatina which prevailed throughout that city in 1818 and 1819, he used the belladonna as a preservative in children under fifteen years of age, who were freely and continually exposed to the contagion ; that out of 195 cases, only fourteen were infected; and that when he afterwards used a stronger preparation of the drug, every one escaped the disease. Koreff, professor at Berlin, affirms, from a very exten¬ sive experience and observation of sixteen years, that the most inti¬ mate intercourse may be kept up with patients affected with scarla¬ tina, provided the belladonna be taken in the proper doses for eight or nine days before exposure, and be continued till the period of desqua¬ mation; on this subject he has lately addressed to M. Laennec, in which, he says, “ it was not till I had received the authority of the cele¬ brated Soemmering, who informed me, that he obtained the most sa¬ tisfactory results with it when the disease raged epidemically, that I determined to employ it ; and he adds, “up to the present time, April 1824, neither season, nor locality, nor any other circumstance, has appeared to diminish the preservative effect of this plant.” In addition to these testimonies, maybe added that of Hufeland, who says in the Journal de Practischen Heilkunde, Nov. 1825, that “ it gives
109
Barker and Montgomery on Pharmacopoeia.
him great joy to be able to confirm, by the results of fresh experi¬ ence, the efficacy of belladonna as a preventive against scarlet fever ; and he adds, that having repeatedly used the medicine in his own practice, be has never seen it fail in a case where it had been pro¬ perly tried.” To these might be added, if necessary, the opinions of several others to the same effect.
“ The preparation employed was a solution of two or three grains of the extract in an ounce of cinnamon water ; of this two or three drops were given twice a day to children under a year old ; one drop more was added for every year above that. The principle on which it is given is, that diseases are to be combated by the exhibition of remedies which produce symptoms similar to those of the disease for which they are given, and on this principle belladonna was first sug¬ gested as a preventive of scarlatina in 1807, by Dr. Hahneman, of Leipsic.
“ Belladonna has been long used as an application to the eye pre¬ vious to performing the operation of cataract ; the extract is rubbed freely over the eye-lids and eye-brow, and in about an hour after¬ wards, if there be no adhesions of the iris to other parts, a full dila¬ tation of the pupil takes place, bringing the whole of the cataract dis¬ tinctly into view, and thereby materially facilitating the operation. Belladonna was also applied by the late Mr. John Cunningham Saunders, after the operation, with a view of preventing the iris from becoming adherent to the edges of the torn capsule. This practice is also adopted by.Dupuytren under similar circumstances. Mr. Saunders also strongly recommends a similar application to prevent obliteration of the pupil occurring as a consequence of inflammation of the iris. “Happily,” says he, “we are furnished in the extract of belladonna, with a perfect specific for this purpose.” — See his Treatise, page 63.
“ The action of this substance in such cases, appears to be limited to the radiated fibres of the iris. M. Segalas read a paper before the Royal Academy of Medicine in Paris, on the manner in which bella¬ donna acts when applied to the eye. Having placed on the eye of a young cat, a grain of the extract of belladonna, he saw the dilatation of the pupil begin fourteen minutes afterwards. Having in a second experiment placed a grain on the pleura of a cat, of the same age and the same height, the dilatation commenced in eight minutes. Lastly, in a third experiment, having injected a grain into the bronchial ves¬ sels, the dilatation appeared in two minutes after, that is to say, seven times quicker than after the direct application of the substance to the eye.
“ It would seem then, says M. Segalas, that the dilatation of .the pupil is quick in proportion as the belladonna is applied to a surface, possessing a greater or less degree of absorbing power ; from which it would result, that the belladonna only acts on the eye after being ab¬ sorbed and carried by the blood to this organ. It is to be regretted however, that his experiments were deficient in such a degree of ac¬ curacy as would warrant a very precise inference.
110
Critical Review.
“ Dupuytren, after a continued use of belladonna internally for the space of ten years, is perfectly convinced of its efficacy in long stand¬ ing cases of scrofulous ophthalmia.
“ In parturition, rendered lingering by rigidity of the os uteri, Chaussier recommends the application of the extract to the part, as tending to produce relaxation; and in a small pamphlet on the subject, he has published some cases in which it was successfully used. His formula is the following : —
Extracti Belladonna; drachmas duas Cerati Simplicis unciam. — Commisce.
“Dr. Conquest, of London, says he has seen decided benefit result from such a practice. I have never seen it tried for such a purpose. I was lately informed of a case of impaction of a calculus in the gall duct, in which instantaneous and complete relief was given by rubbing belladonna over the seat of the pain; it induced spasms in the face, which soon subsided ; the preparation used, was an infusion of a drachm of the powdered leaves diffused through an ounce of water. Dr. Paris informs us, that an ointment composed of equal parts of the powdered leaves and of lard “ rubbed over the penis prevents pria¬ pism, and relieves chordee more effectually than any application which has been proposed.”
“ Great caution is required in the administration of belladonna, as it is likely to bring on most distressing and alarming symptoms if in¬ judiciously or incautiously given, or when it is taken for a consider¬ able time, even in small doses, it is apt to induce a dryness and stricture of the fauces, pharynx, and oesophagus ; vertigo, dimness of vision and dilated pupil ; upon the occurrence of any of which symptoms its use should be discontinued for the time. The root of the plant produces somewhat similar effects, but of a milder character, and resembling intoxication ; this is alluded to by Shakspeare in his Macbeth ;
“ Or have we eaten of the insane root That takes the reason prisoner.”
*e When an overdose has been taken an active emetic of sulphate of zinc or copper, should be given, purgatives administered, and after¬ wards vinegar; the influence of belladonna on the stomach is so paralyzing that it is often impossible to excite vomiting ; in such cases, vinegar is recommended in the first instance, after which emetics are said to be more likely to produce their effect.
“ Dose. — One-fourth of a grain gradually increased to five grains.” — p. 484.
r .1
Time nor space will not permit us to make more extracts, but enough has been given to shew the value of the work.
[ 111 ]
IV. — A Treatise on Pathological Anatomy. — By G. An- dral, Professor to the Faculty of Medicine of Paris, &c. Translated from the French by Richard Townsend, A.B. M.D. M.R.I.A. and William West, A.M. M.D. M.R.I.A. Vol. II. 8vo. pp. 808 : Dublin, 1831. Hodges and Smith.
It affords us much pleasure to inform our readers that M. Andral’s Pathology is now to be had in the English lan¬ guage, and on terms almost as reasonable as the French edition. This work is the best extant, and is of course a standard authority. Its justly celebrated author has been placed whh unanimity at the head of the pathologists of the French school, and may be considered the chosen organ of that body. His qualifications cannot be better described than in the language of Dr. Townsend.
“ He has himself made, perhaps, a greater number of post mor¬ tem examinations than any other pathologist in Europe ; accordingly, his work is unrivalled in the number of original observations it con¬ tains, and I can assert from experience, having myself made within the last few years a very considerable number of dissections, that nothing can exceed the accuracy of his descriptions. But, M. An- dral has not confined himself to the irksome task of enumerating the various physical alterations that take place in our organs ; he has likewise endeavoured to investigate the origin of these alterations, to explain the mechanism of their formation, and to trace their mutual relation and order of succession. In his investigation of these important points, he has laboured to restrict the influence of inflammation within rational limits, and successfully combats the absurd doctrine, that every alteration of the living structure de¬ pends on an exaltation of its vital powers. He also examines the influence of these local alterations in the production of disease, and endeavours to point out how far the knowledge of these lesions may serve to aid us in determining its seat and nature, and to afford us certain data for the rational treatment of it. In short, he has attempted to combine pathology with morbid anatomy, and to de¬ duce from their combination such conclusions as may serve to fur¬ nish us with more correct ideas of the nature of disease, and more fixed and rational principles for its treatment. In pursuing this investigation, he does not allow his judgment to be warped by any favourite theory. He admits the influence of the solids in producing the phenomena of disease ; but he likewise accords considerable importance to the alterations of the fluids : he admits that local disease is capable of producing general or constitutional disturb¬ ance ; but he likewise maintains that those general agents, the blood and nervous influence, may be primarily affected, and that
112
Critical Review.
in this way general disease may precede the existence of any local affection. These few instances may serve to shew that the work is written in the purest spirit of eclecticism ; indeed it appears a con¬ stant object of M.Andral’s solicitude to reconcile the jarring interests of adverse doctrines, to select what is of real value from every theory, and thus to profit by them all, without wedding himself to any. The value of a treatise on morbid anatomy written on these principles, by an author so eminently qualified for the task, is too evident to require demonstration.” — Preface, p. ix.
He has evinced indefatigable industry in his investiga¬ tions, his research has been the most extensive, and his arrangement of the facts described by preceding writers, has been effected with fidelity. A standard work on morbid anatomy has long been a desideratum in the medical litera¬ ture of this country. During the last thirty years we have had the works of Baillie, Farre, Hooper, Abercrombie, Armstrong, Hodson, Hodgkin, Bright, Sir A. Cooper, Hooper, Craigie, and the Yademecum of Morbid Anatomy, with a host of essays in our periodicals, but no systematic treatise adapted to the present state of the science. This want is now supplied by the perfect production before us. It embraces every part of the subject, and is a work of infinite value to every class of medical practitioners. It is a source from which every medical man, when called to elucidate questions of judiciary medicine, can obtain cer¬ tain data on which they can form a correct opinion, in dis¬ criminating between the natural appearances of disease, and those produced by criminal means. Had it contained no other information, it would be a work of infinite value. But it is not confined to this alone, it embraces the principles of pathology, and the indications of treatment. We are happy to state that the translation is faithfully executed, and is highly creditable to Drs. Townsend and West. There is no scientific member of the profession in these countries who will not possess himself of this work, as the very best extant.
This volume is devoted to special pathological anatomy, and is arranged as follows: — digestive, circulatory, respira- toty, secretory apparatuses, apparatuses of generation and innervation. There is no morbid appearance observable in any of the tissues which constitute the organs in this cata¬ logue that is not minutely described. Many of the lesions enumerated have been discovered, though no symptoms indi¬ cated their existence during life. The accuracy of this statement is well attested by the following observations: —
113
[
M. Andral on Pathological Anatomy .
xi Of the alimentary canal in the healthy state. — There has been hitherto so little agreement on the subject of the natural appear¬ ance of the stomach and intestines, that I consider it indispensable to determine accurately what is the anatomical condition of the alimentary canal in the healthy state. Perhaps one circumstance which has long been an obstacle to the ascertainment of this point, is the great frequency of gastro-intestinal alterations. As there are very few subjects in which some of these are not met with, anatomists had become accustomed to consider them as belonging to the natural state of the parts ; and they seemed the more warranted in doing so, as, until very lately, the symptoms produced by these alterations were either totally unknown or ill understood. •
“ If we examine the internal surface of the stomach or intes¬ tines in a living animal, that is not struggling, and whose circula¬ tion is not disturbed, we find it of a red tint, somewhat deeper than that of the mucous membrane of the cheek in a healthy man. If we examine the same animal after death, we find that this red tint has disappeared, and that the surface is now uniformly pale, or, at most, very slightly rose coloured. In order that the experiment should afford these results, the animal must be deprived of life in such a manner as not to lose too much blood, on the one hand, as the natural paleness of the intestines would then be increased ; or to die in a state of asphyxia, on the other, as the mucous mem¬ brane would then be mechanically injected ; which, though not a morbid, would yet not be the natural state.
“ I think we may conclude from this experiment that after death, the mucous membrane of the stomach and intestines, tends to lose its colour like the skin.
“ There have been frequent opportunities of examining bodies in cases of accidental death, where the individual was apparently in the enjoyment of perfect health a few minutes previously. In most of these cases, also, the alimentary canal has been found free from any red tint.
“ Sometimes, however, different degrees of injection have been observed on the internal surface of the stomach or intestines, as well in animals supposed to be sound, that were sacrificed to phy¬ siological experiments, as in men in cases of accidental death. To this it may be answered in the first place, that if the alimentary canal has been found oftener without any redness, under the same circumstances, it is very probable that in the cases where the redness was observed, it arose from disease. But, besides the appearance of the parts that were found injected should have been described with more care and precision ; and a detailed account should have been given of the kind of death the animals suffered, and of the space of time that had elapsed between the accident and death in the other cases. •
*'* There are, in fact, certain circumstances under the influence of which the alimentary canal, though free from disease, may yet
VOL. VI. no. 32.
a
114
Critical Review.
present various degrees of red coloration in the dead body. Of these circumstances, some may have operated a certain period before death, others only during the last moments, and lastly, others either soon or at some length of time after the cessation of life.
“ Of the causes which operate before death, some are physiological and others pathological. Thus, it is an undoubted fact, that, during the process of chymification, the internal surface of the stomach acquires a considerable degree of redness ; as well as that the small intestine does the same wThile the separation of the chyle is taking place in it : any one may convince himself of the truth of these assertions by examining living animals. But, besides, it has been ascertained by observation, that this redness that is produced by digestion continues after death ; so that on opening the body of any individual that has died while chymification or chylification was going on within him, we shall find those portions of the alimentary canal in which the process had been taking place of an unusually high colour.
“ The pathological causes are all such as act by presenting some obstacle to the free return of the venous blood from the gastro-intes- tinal parietes to the right cavities of the heart. There happens then to the mucous membrane of the alimentary canal what happens to the skin in persons who die of asphyxia ; in such cases we observe the cutaneous surface long before death acquiring a constantly increasing colour from the venous blood ; now, what takes place in the skin must also take place in the intestine. We may assure ourselves directly of this by examining a coil of intestine in an animal who is slowly suffocating, when we shall find that, as the respiration becomes more difficult, the coil assumes a more intense and uniform red hue. Lastly, if, as Bcerhaave did long ago, we prevent by a ligature the circulation of the blood in the trunk of the vena portse, we shall observe the whole of the internal surface of the intestines assuming a fine red tinge, which is compared by Morgagni to the colour of cochineal ; and sometimes, even blood transudes through the parieties of the distended vessels, and fills the intestine. These facts being known, it is only drawing the conclusion from them to establish that, every time the blood cannot return freely from the capillaries of the intestinal mucous membrane to the venous trunks, that membrane will continue coloured after death. Hence arise the various shades it presents in cases of strangulated hernise, for instance, or of obstruc¬ tions of the liver, of tumours situated on the course of the principal divisions of the vena portse, of obliteration of the vein itself by old coagula, and lastly, of organic affections of the heart. If, however, there was but little blood in the body, wdiether through defect of sanguification, or in consequence of recent copious bleedings, a con¬ siderable obstacle to the venous circulation would produce a less in¬ tense coloration of the alimentary canal, than that which would arise from a slighter obstacle existing in a person whose vessels contained a great deal of blood a short time before death.
*■* The red coloration of the gastro- intestinal parieties in conse-
M. Andral on Pathological Anatomy. 115
r
quence of some mechanical obstacle to the venous circulation, pre¬ sents various degrees of intensity. In the lowest of these, the sub¬ mucous cellular tissue alone is coloured, but not in its capillary net¬ work ; it is traversed in various directions by bluish veins of pretty large calibre, which cease to be injected on arriving at the mucous membrane, while their other extremities are continuous with the mesenteric veins, which are themselves equally gorged with blood. In a higher degree of injection, depending quite as much on mecha¬ nical causes as the preceding, the mucous membrane itself begins to assume a tinge, and, according to the size, number, and relative situation of the injected vessels perceptible to the naked eye, it exhibits either simple branches separated by large colourless intervals, or ramifications of greater or less extent, produced by the injection of the smaller vessels, or, lastly, a redness considerable enough to produce a complete opacity of the parietes wherever it exists. According as these various shades of colouring are extended or circumscribed, the result will be either a diffused redness of the in¬ testine without any precise limits, or else streaks, stripes, patches or mere points. In fact, there is not one of these appearances that may not be produced by a simple injection from a hypersemia either mechanical or passive ; and he would be strangely mistaken who should imagine that the dotted redness, for instance, more necessarily announces an active hypersemia, than does the simple congestion of some of the submucous veins. In these different cases, on attentively examining the injected parts, we may perceive that the injected vessels are directly continuous with the great veins subjacent to the mucous membrane, just as these latter are continuous with the mesenteric.
“ If the obstacle to the return of the blood from the intestines to the heart is still more considerable, or if, what comes to the same thing, the obstacle not being increased, there is an increase of blood in the vessels, that fluid escapes from them, and becomes effused either into the submucous cellular tissue, where it forms ecchymoses, or into the cavity of the intestine itself, where it communicates a reddish tint to the bile, mucus or other matters, that happen to be contained in it. The facility with which a liquid or gaseous injection may be made to penetrate into the intestinal cavity when driven into the mesenteric veins from the trunks towards their branches, explains how, under the iufluence of a considerable congestion of the same veins, a part of the blood contained must have a tendency to escape into the interior of the alimentary canal.
“ Thus, on summing up all that we have learned both from simple physiological reasoning, experiments on animals, and the examination of dead bqdies, we are led to conclude that the gastro-intestinal mucous membrane may be indifferently white or red, without either of these colours necessarily indicating that the membrane had been in a morbid state ; it is either white or red, of various shades, according as there has existed before death some one of the conditions, mechanical, organic, or vital, which we have endeavoured to explain.
116
Critical Review.
Now, as those which produce the red coloration exist the most frequently, it follows that, in the dead body, we should more frequently find the alimentary canal injected than colourless. But that is not all ; after life has ceased, new causes arise which tend to produce new modifications in the colour of the intestines, and to in¬ ject some parts of it much more strongly than they were at the moment of death. The causes of redness produced after death, may be reduced to two principal ones ; one, the weight of the blood, and the other, its transudation through the parietes of its vessels.” — p. 14.
M. Andral adduces proofs from the experiments of MM. Trousseau and Rigot, that parts will be reddened in various positions, in which the law of gravitation will exert its greatest influence. This fact has been much dwelt on by medical jurists, in forming a diagnosis between cadaverous lividity and ecchymosis. Thus “ the coils of the small in¬ testines, which are more dependent than the rest — those, for instance, which are sometimes found sunk in the hollow of the pelvis, are also more strongly injected.” Our author further remarks —
“ It becomes a question whether this coloration from hypostasis can occur in the small intestine only ; it certainly can occur with more facility there than elsewhere, by reason of its disposition, and of that of the vessels distributed to it. I am, however, strongly inclined to think that, in certain cases, the redness observed on the great extremity of the stomach, and on its whole posterior surface in general, that being inferior in the subject,) results in like manner from this accumulation of blood by hypostasis. I am the more disposed to this opinion, from finding it mentioned in my notes that, in a case where a body had been laid upon the abdomen a short time after death, preparatorily to opening the spinal canal, and remained several hours in that position, the anterior part of the stomach was injected, and dotted with red, while the posterior part was pale. At the time, I imagined it to have been caused by gastritis ; but I should not be apt to think so now.
The redness of the intestinal parietes that is produced, wholly after death, by injection from hypostasis, the reality of which I have just now proved, presents various degrees or shades, like the redness from conjestion, either mechanical or passive, that had been previously under consideration. Thus, we may find the villi highly coloured, and even blood effused into the interior of the intestinal canal. This, however, very seldom happens, except in experiments on animals that are strangled, and kept in the vertical position for several hours after death. In such cases, in fact, every thing is most favourably disposed, for the blood’s being drawn in the greatest possible quantity to where it is attracted by the law of gravitation. Nothing similar has ever been observed in the horses killed by pithing, or by knock¬ ing on the head ; and, in the human subject, the determination of the
M. Andral on Pathological Anatomy.
117
blood towards the most dependent parts of the alimentary canal, most commonly produces in it only an injection more or less strong of the mucous membrane, or of the subjacent cellular tissue ; which may produce either a diffused tint, with an appearance of ramifications or circumscribed blushes in form of points, spots, streaks, &c.
“ Injection from hypostasis begins to take place immediately after death acquires its highest degree at the end of some hours, and ceases to be continued as soon as the blood having cooled, begins to coagu¬ late. Hence it follows, that in subjects whose temperature is long kept up, either naturally or artificially, and in which the blood con¬ tinues fluid, the injection of the intestines from hypostasis will be much more decided than under the 'opposite circumstances. It will also be more considerable, when after acute diseases, a great deal of blood still remains in the system ; and when, in consequence of a slow death, or of obstacles to the circulation, the intestinal veins were gorged with blood at the moment of the cessation of life.
“ As soon as a certain space of time has elapsed after death, a new cause of coloration begins to act ; as soon as putrefaction begins to seize upon the body, the blood contained in the vessels, both large and small, of the gastro-intestinal parietes, exudes through the membranes of those vessels, and is effused in variable quantities into the surrounding tissues, especially into the submucous cellular tissue. On this extravasation of the blood depend, for instance, the red spots almost always observed in the stomach along the veins of its great extremity, when the body is opened more than six and thirty or forty hours after death. These spots, thus assembled along the course of the vessels, are sometimes isolated, and sometimes grouped together and running into one another ; and in this manner mark the surface of the stomach with streaks and bands of various figures. If after having observed the stomach in this condition, we leave it, and examine it again at a later period, we find that the red¬ ness has increased, and that, moreover, it appears in a new form : it no longer exists solely along the vessels, but the whole surface of the stomach presents a tinge which has a constantly increasing ten¬ dency to become uniform ; and a period at last arrives, when all the membranes, having become soaked with blood, are equally red ; they may then have a tint almost similar to that which we observe on the internal surface of the arteries when stained by the contained blood. This kind of redness formed after death, cannot, however, proceed to such a high degree, unless in cases where a certain quantity of blood existed in the vessels of the stomach at the moment of death ; and as, from the effects of gravitation, that fluid accumulates towards the great extremity of the stomach in particular, it follows that it is there we should see the redness from transudation most strongly marked. It would be useless to attempt to fix precisely the period at which this transudation should commence : for, in order to do that, we should fix precisely the period at which putrefaction commences. Now, that period is very variable, as it depends, 1, on certain con¬ ditions relative to the body itself ; such as the kind of death, the
118
Critical Review.
nature of the disease that produced it, &c. ; and, 2. on certain external circumstances, especially on the thermometrical and hygro- metrical states of the place in which the body is. Accordingly, when, in summer time, we open bodies that have been kept, since death, in warm beds, and in rooms of a temperature at least as high as the external air, it is usual to find, so soon as after four and twenty hours, very evident marks of transudation in the alimentary canal ; in such cases, for instance, I have often found all the mem¬ branes of the great extremity of the stomach of a uniform red tinge. Under similar circumstances, the colouring matter of the blood may likewise transude, spread over the internal surface of the canal, and mix with the fluids contained. 1 have ascertained this to be the case in most of the bodies I had occasion to examine in the very warm summers of 1825 and 1826.” — p. 21.
The stomach may have its parietes discoloured by tran¬ sudation of blood from the spleen, which, upon the whole, is a rare occurrence. If we plunge a bladder filled with blood into different gases, the blood becomes singularly altered in its colour. It follows, that whenever similar gases are developed in the intestines, they must affect the blood similarly through the parietes of its vessels. It also appears that scraping the mucous membrane with the back of a scalpel, a redness sometimes follows, and extravasa¬ tion may even be produced. The effusion of bile into the stomach may be followed by imbibition, and a yellow tinge produced, which cannot be removed by ablution. Our author deduces the following inferences from this part of his investigations : —
“ To sum up ; the gastro -intestinal mucous membrane is not of one constant and invariable colour in the healthy state. It is per¬ fectly white only in a very small number of cases, which I have mentioned. Besides these it offers, without ceasing to be sound, different degrees of colouring depending; 1, on the passive hype- rsemia which has always a tendency to take place in the last mo¬ ments of life in the parts abounding in capillaries ; 2, on mecha¬ nical obstacles to the venous circulation formed at a longer or shorter period before death; 3, on the hypostatic accumulation of blood towards the dependent parts ; 4, on the transudation of the blood through its vessels ; 5 , on another kind of transudation which may take place, in some cases at least, through the capsule of the spleen ; 6, on the presence of different gases in the alimentary canal at the moment of death ; 7 , on the developement of other gases, at a longer or shorter period after death ; when putrefaction takes place ; 8, on the combination of the yellow matter of the bile with different parts of the gastro-intestinal mucous membrane ; 9, and lastly, on the accidental introduction into the alimentary canal of
M. Andrai on Pathological Anatomy.
119
different colouring principles that may stain its internal surface, and thus produce a colour more or less perfectly resembling the result of a morbid state. .
“ Of the colours produced by these different causes, some cannot be in any way confounded with that resulting from inflammation ; others differ from it only by characters which are often but feebly marked ; and, lastly, others, especially those mentioned under the heads 1 and 3, as also some varieties of those under the heads 2 and 4, exactly resemble the colour that would result in the alimentary canal from the irritation artificially produced in it by the introduction of a mineral acid sufficiently diluted with water to inject, without disorganizing, those portions of the tissues with which it comes in contact.
“ It is, besides, important to observe, that caeteris paribus, the colour of the gastro- intestinal mucous membrane presents some shades, according to, 1, the part examined; 2, the age; and, 3, whether the process of digestion was going on or not in the stomach or in the duodenum and jejunum at the moment of death. Thus, in those cases in which the mucous membrane is found colourless in the adult, we may observe, as M. Billard has shewn us, that it is whitish in the stomach, of an ashy white in the duodenum and jejunum, that the ashy shade diminishes towards the end of the ileum, and that, finally, in the great intestine, the mucous mem¬ brane resumes its dead white colour. With respect to age, we learn from the valuable researches of M. Billard, that the gastro-intestinal mucous membrane is rose coloured in the foetus and in the infant, and of a milky and satiny whiteness in young persons ; that, in the adult, it assumes a slight ashy shade, especially in the duodenum and commencement of the small intestine ; and lastly, that in old age this ashy shade becomes more decided and general, whilst the submucous veins, being dilated and filled with blood, lift up and impart a colour to the membrane covering them. At other times, however, in old persons who die in a decrepit and bloodless state, the mucous membrane is remarkable for its extreme paleness. I am even persuaded, that it is in old persons, and in very young children that had died of merasmus, that I have observed the internal surface of the alimentary canal in the most perfectly colourless state.” — p. 26.
A curious attempt is made to measure exactly the relative thickness of the different portions of the mucous membrane of the stomach and intestinal canal. This will vary accord¬ ing as the patient dies of acute disease, or of marasmus.
“ The consistence of the gastro-intestinal mucous membrane is in general directly in proportion to its thickness. It is much more considerable in the pyloric portion of the stomach than in its splenic portion ; in the colon, where the thickness of the mucous membrane is at its minimum, its consistence is also very slight. In the sto¬ mach, We may allow the mucous membrane to be of the natural
120
Critical Review.
thickness, when, on making an incision in it, taking care not to cut the subjacent tissues, especially the nervous, or more properly, the membranous coat, we can easily detach pretty considerable shreds of it with a forceps ; the shreds should be larger in the pyloric than in the splenic portion. In the duodenum its nature is such as not to admit of such considerable shreds being detached as in the stomach. In the rest of the intestines, the rectum excepted, the mucous membrane, even in its natural state, breaks and tears when¬ ever we attempt to detach any portion of it. In these various parts, however, the same physiological conditions which produce a varia¬ tion in the thickness of the membrane, such as the quantity of blood supplying it, and the general state of the nutritive powers, produce a variation in its consistence. Thus, at the same time that this membrane becomes thinner, it tends also to grow' softer, without the previous or present existence of any process of irritation.
** The mucous membrane of the alimentary canal may, after death, be modified in its consistence, as we have already seen it to be in its colour. This kind of softening has been observed prin¬ cipally in two cases ; 1 , long after death, when there were already signs of putrefaction in the body ; in 2, a very short period after death.
“ In the first of these cases the membrane loses its consistence but slowly. I have more than once found it not in the slightest degree softened in bodies of persons that had been from eight to ten days dead, in which the intestines were green and distended with gases, while there was exudation of blood into them, together with ecchymoses in the substance of their parietes, and in many parts, emphysema under the membrane. After the tenth day its con¬ sistence diminishes, and it then softens gradually ; from the fifteenth to the eighteenth day it becomes like pap, and from the twenty-fifth to the thirtieth it becomes quite undistinguishable.
“ This membrane, when exposed to the air, softens much more rapidly. M. Billard, after opening an intestinal canal, left it extended on a table for twelve days ; the temperature of the room was ten degrees above zero, and the son shone into it every day. The mucous membrane did not begin to soften until the sixth day, at which period putrefaction was already advanced ; on the tenth day it was of a pultaceous consistence ; and, on the eleventh, it was reduced to a very fetid greenish pulp.
On the contrary, this membrane, when removed from the influence of the atmosphere by being placed under water, softens but very slowdy. M. Billard, after leaving a portion of intestine for two months in the same water, and not till then, found its mucous mem¬ brane perceptibly softened, though it still retained a certain degree of consistence. It was not till three months had elapsed, that it was found to be so softened as to resemble merely a kind of very fetid purulent layer.
It follow's from these facts, that the post mortem softening of the gastro-intestinal mucous membrane does not occur until the putre-
M. And ral on Pathological Anatomy.
121
faction is pretty far advanced, and after the usual period of opening bodies in most cases. It would appear, then, that we should not con¬ sider the very evident softening of the mucous membrane of the stomach, that is sometimes observed at from twenty to four and twenty hours after death, to have taken place after that event. How¬ ever the solution of this question is embarrassed, if I may say so, by some cases in which the mucous membrane of the stomach has been found completely softened, in dogs killed in very good health, and opened shortly after death. Similar facts have been observed by M. Bretonneau. M. Trousseau, who gives an account of them in the Archives de Medecine, (tom. xii. p. 345) adopts an opinion of Hunter’s, who has numerous followers in England at the present day, and attributes this kind of softening to the solvent action of the juices secreted by the stomach. According to several English physicians, the softening might even extend to all the coats of the stomach, and produce a perforation of thatviscus after death. — p. 22.”
Our author next adduces all the facts in favour of Mr. Hunter’s theory, “ but he thinks they are neither suffi¬ ciently numerous nor circumstantially detailed, for us not to wait for new observations on the subject, to confirm or contradict the conclusion drawn from them.” — p. 35.
Much interesting information is given on the follicles of the alimentary canal. These are most manifest round the car¬ diac orifice of the stomach, and in the duodenum they are more developed in children. Thus in them we often find without any indication of intestinal affection, on the internal surface of the small and large intestines, small round bodies, of a white or greyish colour, and with a central orifice, the circumference of which is very often of a deep grey, which are nothing but follicles. Again, they are often congregated, often occupy an extent from one to three feet of small intestine. In the centre of each follicle, is often found a point of a blueish grey or black. As these exist without any indication of intestinal disease, our author is of opinion they do not constitute a morbid state in a child. They are often observed in persons labouring under diarr¬ hoea and adynamic (typhus) fever, especially near the end of the ileum ; but they are also found in bodies where there was intestinal disease. These follicles are also found in the bodies of dogs, sheep, and horses.
A great deal of stress has been laid on these enlarged follicles, by some writers on fever in this country ; and it appears, from the preceding testimony, without much rea¬ son. We have now afforded the reader an opportunity of forming his own opinion, on the value of Professor Andral’s
Vol. vi. no. 32.
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122
Critical Review.
Pathological Anatomy, and we think he will agree with 11s, in considering it a most valuable contribution to medical Science. It is a w?ork which stands a splendid monument of learning, industry, and talent, and has no equal in our annals of medical literature. This translation renders a valuable work accessible to every man engaged in the prac¬ tice of the healing art, and is executed with much ability and judgment. It is one of the most able and satisfactory works which modern times have produced.
Y. — Medico-Chirur gical Transactions, Vol. XVI. Part I.
London, 1830. Longman and Co. — (continued.)
In accordance with our promise we resume our analysis of the work before us. The third paper is entitled, A case cf ununited fracture of the thigh-bone, cured by the application of a silver wire between the fractured extremi¬ ties.” By Dr. Somme, of Antwerp ; communicated by J. H. Green, Esq. F.R.S. &c.
The patient was a healthy subject, between thirty and thirty-five years of age, and the fracture had remained ununited for five months. The operation was as follows: —
“ The patient being placed on his back and supported, I passed a long trocar and canula at first downwards on the inside of the upper fragment, and made it pierce the skin behind, and a little to the out¬ side' ; the trocar was then withdrawn, and a silver wrire passed through the canula, and out at the posterior opening. The canula was then withdrawn, and being replaced on the trocar, they were in¬ troduced again above on the outside of the lower fragment, and made to pass out the same opening behind. The trocar having been re¬ moved, the other end of the wii^ was passed through the canula, so that both ends wrere in contact behind, leaving a loop in front. I then made an incision in front, from one orifice to the other made by the trocar, and drawing the extremities of the wire through the wound, brought the loop between the fractured ends of the bone, and approximated the edges of the skin with sticking-plaster.”
The wire was drawn tighter at each dressing, so as to depress the loop more and more in the flesh. It was with¬ drawn in six weeks before it had divided the flesh, as the bone had completely united. The limb was kept in the fracture box six wreeks longer.
Medico-Chirur gical Transactions.
123
The fourth paper is, te An account of a concrete oil, existing as a constituent principle in healthy blood.” By Dr. B. G. Babington. Many physiologists have noticed oil in the blood, but generally it was considered a morbid pro¬ duction. Hewson, Traill, Christison, and Pretty, at the London Medical Society, last year, are those who have noticed it in this country. Dr. B. asserts that it is found in the healthy blood of man and animals, and may be sepa¬ rated in the manner following : —
‘ ‘ It may be procured by very gently agitating a quantity of serum
with a third part of ether, and separating and evaporating the
latter after four or five days, and when it has become of a yellow
colour. The oil thus obtained (which forms about. 3 of the serum
1000
of the blood), “ is of a deep yellow hue, is semi-solid, and melts at a temperature of 90° Fahr. The specific gravity is .918 From its so¬ lution in ether it crystallizes, by very slow evaporation, at a low tem¬ perature, in radiated tufts. It burns with a brilliant light, has a faint and peculiar odour, resembling that of a wet bladder, and in its general characters resembles other animal oils. It is uniform in co¬ lour, in general appearance, and in all its properties, from whatever kind of serum obtained.”
The fifth paper is on “ Phlegmasia Dolens.” By Wil¬ liam Lawrence, Esq. F.R.1S. &c. It was a case consequent to cancer uteri, in which the lower extremity was swollen, painful, the lower part of the leg and foot pitting on pres¬ sure. The pain was principally along the course of the iliac and femoral vessels ; the saphena presented a hardened and knotty feel, and great relief was afforded by the appli¬ cation of leeches along the course of the vessel.
The woman died suddenly from uterine haemorrhage, and the limb presented the following appearances : —
“ The cellular and adipose tissue round the lower part of the uterus and neighbouring portion of the vagina were thickened and in¬ durated, particularly on the right side. The hypogastric vein in¬ volved in this diseased mass, was closed in consequence of previous inflammation of its coats ; and the same change had occurred in the internal iliac, the common iliac, the external iliac, the femoral and profunda veins, as well as in the internal saphena, all of which were completely impervious. The affection terminated above at the in¬ junction of the common illiac vein with that of the opposite side, the latter vessel and the inferior cava being quite natural. The saphena was closed for a length of about four or five inches, beyond which it was natural. The profounda was cut through near the femoral vein, and the latter was divided as it passes the tendon of the triceps. The
124
Critical Review.
disease extended in both these vessels beyond the’ situations where they had been divided, but its inferior limits were not ascertained ; the right spermatic vein was closed in its lower half. The coats of the affected vessels and the surrounding cellular substance, were a little thickened, and their cavities were plugged by a closely adherent and tolerably firm substance of a light-brown colour. At some parts the vessels and their contents were of a dark livid hue.”
This w as clearly a case of eruritis, but not of phlegmasia dolens. The most eminent obstetric writers of this and other countries, affirm that the true phlegmasia dolens of puerperal women is scarcely ever fatal. We have cited a host of authorities in proof of this opinion, in an original article, on the real disease, in the fourth volume of this Journal, 18 SO.
The sixth paper is on Cf Swelling of the lower extremity, in a lad, aged seventeen, who died of this phthisis.” By Mr. Holberton. A second case is narrated of a woman, aged thirty-five, who died of phthisis. Here the swelling was much less, the limb was occasionally cold, and upon the whole, it bore not the slightest similitude to phlegmasia dolens. The author did not designate it such. The left
# o
common diac contained lymph, the same was observed at the union of the left internal iliac, with the former vein ; the remainder of the vessels wras healthy. The left external iliac was healthy, except at its lower portion, where it was com¬ pletely blocked up by coagulum, adherent at one part only. The coagulum was found to extend along the two upper thirds of the femoral vein.”
The seventh case is one of Stammering, successfully treated by the long continued use of cathartics. By Dr. Bostock. The defect of articulation came on suddenly, when the boy was three years old, and was much relieved by purgatives, which were indicated by his plethoric habit. Whenever the remedy was omitted, the defect increased, and again diminished by the use of medicine. A vegetable diet was also recommended. The complaint recurred at the twelfth year, when the boy was sent to a public school, and again removed by purgatives. He is now in his fifteenth year, and may now be said to be free from the complaint.
The eighth paper is on the pathology of Hooping Cough. By Dr. Alderson. The author states that the cause of death in hooping cough is hepatization of the lung, and that he has found great benefit from cupping glasses to the chest, which are preferable to leeches, which are too slowr in their operation. Calomel and James’s powder arc also useful.
Medico-Chirur gical Transactions.
125
He throws no new light on the subject, and even omits many recent opinions upon the pathology and treatment of the disease. Thus the continental writers consider that there is great danger of cerebral congestion in the disease, and pay close attention to the head, lest convulsions should supervene. Hence leeching the temples or nape of the neck is frequently resorted to, and also the application of counter- irritants to the chest.
The ninth paper is on the infrequency of Calculous Dis¬ eases in seafaring persons. By Mr. Hutchinson, and confirms the author’s former statement on the subject. He adds a second paper, on the frequency of Calculous Diseases in Scotland, and clearly shews that these are more frequent than in England. He says the proportion there is one in 80,000, and he only includes cases from the principal towns ; while in England, according to Dr. Yelloly’s account, it is one in 108,000. Mr. H. thinks this frequency of the dis¬ ease may be ascribed to the more sedentary habits of the Scottish people, and in some measure to the nature of the lower orders.
The tenth paper is entitled, (f Practical observations on the healthy and morbid conditions of Stumps.” By George Lanstaff, Esq. The author gives a graphic account of the healthy and morbid action in stumps, and illustrates his remarks by describing preparations in his own museum. There is nothing novel in his paper — nothing unknown to any scientific surgeon.
The eleventh paper is by Mr. Crampton, of Dublin, which, with the tenth, by Mr. Owen, we noticed in our last.
The twelfth paper is on Glanders in the human subject. By Dr. Elliotson. Two cases were admitted into St. Thomas’s Hospital, of typhoid fever, purulent discharge from the nostrils, abscess in different parts of the extremities, pustules on the alee nasi, which terminated in gangrene. Both patients died. Our talented author was at a loss to account for the cause of the disease, but suspected the absorption of some morbid poison.
In a few days after the death of his patient, he saw an ac¬ count of ee a fatal case of glanders in the human subject,” on the cover of the Medical Gazette, which at once led him to think he had discovered the cause of the disease for which he had been unable to account.
With that zeal for the interest for science which characterize that physician, he repaired to the residence of the father of
126
Critical Review .
one of his patients at Lambeth, and learned that the unfor¬ tunate youth had patted a glandered horse on the head, and was in the habit of wiping his eyes with the back of his hand, and for some time had been troubled with pimples upon the forehead and nose.
He also ascertained that his other patient had been infected by glanders. On speaking to Mr. Parrott, of Clapham, he learned the history of another case ; and, on applying to Mr. Coleman, at the Veterinary College, who did not believe in the possibility of contagion in such a case, he was referred to Mr. Traver’s Work on Constitutional Irritation, by Mr. Jewel. Dr. Elliotson, also obtained from Dr. Kind, of Finsbury Square, who is a native of Germany, an account of two si¬ milar cases, translated from Rust’s Magazine, of the Healing Art, and which are published.
The profession are deeply indebted to Dr. Elliotson, for elucidating this important subject, and this paper will add much to his well earned reputation.
ORIGINAL COMMUNICATIONS.
r ' . . '
I. — Medico-legal questions , relating to Infanticide.
By M. Ryan, M. D.
All authors are now agreed, that there is not any difference between natural and artificial respiration in the cases under notice, (Edinb. Med. and Surg. Journ. 1820. v. 26 — “ and the hydrostatic test can never prove positively that the child was still-born, but only that it had not breathed.” Op. Cit. p.389, ie at the same time, it will yield strong presumptive evidence.” Cf On the whole, then, it follows, from the pre¬ ceding statements, that when due precautions are observed, and when certain exceptions and corrections are made, the floating of the lungs afford at least stron g presumptive evidence that the child out-lived delivery.” — p. 374.
Dr. Beck arrives at the following conclusions on this point:
1. — That when the lungs float in water, it must be from one of these causes ; natural respiration, putrefaction, the artificial introduction of air.
2. — As the lungs may float from other causes beside respi¬ ration, their mere floating is no proof that the child was born alive.
3. — As whenever it is possible to discriminate between the floating of natural respiration and of that which is the result of other causes, it follows.
Dr. Ryan on Infanticide.
127
4. — That with due precautions, the floating of the lungs may be depended upon as a safe and certain test that the child has been born alive. The same distinguished jurist arrives at the following conclusions, on sinking of the lungs in water : —
1 . — That when the lungs sink in water, it must be from one or other of the following causes : the total want of respi¬ ration, feeble and imperfect respiration, some disease of the lungs, rendering them specifically heavier than water.
2. — As the lungs may sink from other causes than the absence of respiration, their mere sinking is no decisive proof of the child’s having been born dead.
3. — As, however, the sinking from the want of respiration, may easily be distinguished from that which is the result of other causes, it follows,
4. — That with due precautions, the sinking of the lungs is a safe test that the child was not born alive.
It is very evident, from the preceding statements, that a great degree of caution is necessary in every case, before a decision can be given with confidence ; and from the diffi¬ culties of the subject, a few practical rules may be laid down for the guidance of physicians and surgeons, when called on to give evidence in cases of infanticide.
The general appearance and condition of the body, should be carefully noted, as also the situation in which it had been found, all instruments which might be used criminally ; the size, wreight, and length of the infant, the proportion of different parts ; the degree of developement, the signs of putrefaction, desquamation of the cuticle, the appearance of the navel, and of eveny part of the body. We should examine whether there be contusions, ecchymoses, excoriations, and be careful not to confound them with cadaverous lividity : if any lesion is found, its precise situation and extent must be described. If wounds exist, their form, length, breadth, depth, must be accurately noted. The appearances of the head must be observed, and care taken not to confound those which are produced by parturition with those produced by external injury. We should ascertain, whether or not there be foreign bodies in the ears, nose, eyes and mouth, or marks of injury upon the neck, dislocation of the cervical vertebrae, whether the chest be arched or flattened, and when com¬ pressed, if a fluid escapes from the mouth or nose; whether the abdomen be soft or tense, if the umbilical cord be flaccid, dry, moist, detached, cut or lacerated, and its exact length, or if the navel be red, in a state of suppuration or cicatriza¬ tion; if the testicles have descended, and finally, whether there
128
Origin cu C ommtin ic at ions .
are dislocations or fractures of the superior or inferior ex¬ tremities.
Such are the principal points to be attended to, in the in¬ spection of the external condition of the body ; all appear¬ ances should be taken down in writing-, and the document carefully preserved, as the witness may produce it at atrial, or refresh his memory from it ; whereas he cannot use a copy in either case, especially in this country. The next part of our duty is to examine the external parts of the body, and here also the appearances are to be recorded.
Autopsy-Dissection. — Medical jurists are notagreed upon the method of dissection, in cases of infanticide. Drs. Beck and Smith think it most convenient to commence the dissec¬ tion with the mouth and cavities leading to the chest. MM. Chaussier, Renard, Briand and others, commence with the spinal canal, then proceed to open the head, thorax, mouth, pharynx, and passages to the chest and abdomen, and the abdomen. The former mode is more convenient, and I think the better. It is briefly as follows : —
The neck is to be placed on a block of wood, so as to render its anterior surface prominent. It is right to observe, whether the mouth be open or closed, if the tongue be pro¬ truded, or turned back into the fauces. An incision is then to be made from the lower lip to the upper extremity of the sternum ; and another along the lower edge of the inferior maxillary bone, the integuments are to be dissected back, and all marks of violence, ecchymoses, &c. noted. The lower jaw is now to be divided at its symphisis, the parts attached to its internal surface divided, the tongue should be depressed, when there will be a complete view of the mouth and pharynx. We should carefully observe whether there be any foreign body or sanguinolent appearance, and if the glottis and epi¬ glottis be natural, and if there be fluid in the larynx or tra¬ chea ; — the abdomen is next to be examined, an incision is to be made from the sternum to the spine of the ilium on each side, the flaps turned back, and the umbilical vessels observed and tied. We are next to observe the appearances of the abdominal viscera, and to note every thing unusual. We should ascertain if the umbilical vessels be empty, or contain coagulated blood, if cut or lacerated, if the ductus venosus be permeable or obliterated. The size of the liver should be noticed, its large vessels tied, and the organ be removed and weighed; but previous to its removal, the gall bladder is to be inspected, the colour of its bile noted, or whether it be entirely empty. The stomach should be removed, after its apertures having been tied, and its contents, if any, care-
Dr. Ryan on Infanticide.
129
Fully examined. We should further observe whether the in- terstinal canal contains meconium, fasces or other matter, or present any sign of disease ; and lastly, if the bladder be empty, or full of urine.
The cavity of the thorax may be opened in the ordinary manner, but on dissecting the integuments, every appearance of lesion is to be noted, and a minute examination instituted, in order to discover if the chest have been punctured. The cartilages of the ribs are to be divided with a scissors, in pre¬ ference to a scalpel. We should next examine the size and colour of the lungs ; if of a dull red or rosaceous, if these organs fill the thoracic cavities, and if the tendinous centre of the diaphragm be depressed. We are to take into account the size of the heart, the dimensions of its cavities, if they contain blood, the colour of its tissue, the degree of opening or closure of the foramen ovale and ductus arteriosus, the presence of fluid or coagulated blood; always recollecting that, the most dependent portion of the lungs, is engorged with blood andbrownish, and that the site of this engorgement will vary according to the position in which the body had lain while becoming cold, and that this appearance will be greatest in proportion as the patient has not lost blood. After having examined the oesophagus and trachea, and noted their appearances, the large vessels are to be tied, the lungs and heart removed, and the former subjected to the hydrostatic and other tests, in the manner hereafter mentioned. In examining the vertebral column or spine, an incision is to be made from the occiput to the sacrum, the integuments and muscles carefully removed, and the annular portion of the vertebrae divided with a strong scissors, which may be intro¬ duced under the fifth lumbar vertebrae. During this exami¬ nation, we must observe all lesions, ecchymoses, dislocations, fractures, wounds and punctures ; but we must not consider the congestion of the spinal veins or the presence of limpid, yellow or viscous serosity, the effect of violence ; as these are ordinary occurrences, and will be found in such situations as the posture of the body favours.
The best mode of opening the head, is to make an incision from root of the nose to the third or fourth cervical vertibra, and another from ear to ear, the integuments are to be dis¬ sected back, and all lesions carefully examined and noted, wounds, punctures, fractures, &c. A small opening is to be made with a scalpel, through the anterior fontanelle, and the sutures divided by a scissors, great care being taken not to wound the sinuses or larger vessels : the bones of the cranium
Vol. VI. no. 32.
s
130
Original Communications.
can be easily separated in this manner. We are now to ascer¬ tain if there be blood in the ventricles,, or on the base of the brain, to remove the cerebrum and cerebellum, and carefully dissect both.
The examination of all the organs having been completed, the inferences to be drawn will be evident, after a careful perusal of the statements made in the course of this work. But to render the information as complete as possible, it is necessary to describe the method of instituting the hydro¬ static test.
The water in which the lungs are to be placed, must not be too hot nor too cold, but of the temperature of the atmos¬ phere; it should contain no salt. If these precautions are observed, the lungs, with the heart, will float or sink in water ; if they float, it is proper to notice, whether upon or under the water ; if they sink, whether gradually or rapidly.
The lungs are to be taken out of the water, the large vessels tied, the heart separated, and the organs then weighed to ascertain the proportion they bear to the weight of the body. They are to be immersed again, then the lobes sepa¬ rately, and lastly, each to be cut in small pieces ; on incising it, we should note if there be crepitus, the tissue compact, or in a morbid condition. Should the fragments float, they are to be firmly squeezed in the hand, and again placed in the water. The inferences to be drawn from these experiments are the following, according to Dr. Beck. When there is nothing on the body of the infant to account for its death during delivery, the lungs untouched by putrefaction or artificial respiration, affording a crepitus on incision, floating entire or ip segments on the surface of the water, and if the segments float after firm pressure, then the evidence is irresistible that the infant was born alive, and enjoyed perfect respiration. If only the right lung, or its pieces float, the respiration has been less perfect. If some pieces only float, while the greater number sink, respiration has been still less complete. If neither the entire lungs nor any section of them float in water, the evidence is decisive that the child never respired.
It is right to mention, that Professor Bemt is of opinion that Ploucquet’s test affords decisive evidence in a few cases, and no more than presumptive evidence in the rest. It is scarcely necessary to remind the medical jurist, that he should ascertain if the woman has been recently delivered, and learn the whole history of her case. The signs of recent delivery have been already enumerated. He should inquire whether
131
Dr. Ryan on Infanticide.
the labour was sudden, in what position it took place, if the infant was born immediately after the rupture of the mem¬ branes, or how soon after ; if delivery took place without assistance, or what assistance was afforded ; if there was haemorrhage before, during, or after delivery; on what day and hour did labour commence, and did the birth take place ; if the woman was insensible before, during, or after delivery ; if the infant respired, if not, what attempts were made to re¬ suscitate it. All these questions should be put in a mild manner; the solemn duty of the medical jurist being to ascertain fact, and to take no interest in the prosecution or acquittal of the accused ; he should confine himself solely to the duties of his profession, and strenuously avoid putting, what lawyers call “ leading questions,” or intimidating the accused, or violating one of the best principles of our humane laws, by extorting a confession, or inducing a sus¬ pected female to criminate herself. His sole duty is to give the received opinion of his profession, regardless of conse¬ quences, but on all doubtful cases, leaning to the side of mercy.
In the foregoing dissertation I have only discussed the principal points which claim attention, in cases of infanticide ; as many more particulars will be found in the course of this work, more especially in the article on homicide, where the danger and mortality of wounds, contusions, and fractures, will be duly considered. Enough, however, has been said to warn the practitioner against committing errors, which have but too often led to the execution of innocent women : I might illustrate this assertion from the authority of Dr. W. Hunter, but his opinions are too well kiiown to require ex¬ pression in this place.
Medico-legal questions, relating to violation of
Women.
In a preceding article d have stated the law upon this subject, and it now remains to consider the questions which may be submitted to medical jurists for their decision. These are as follow : — 1, Are there certain signs of defloration ? 2, Can we distinguish between forcible violence against the consent of the accuser, and whether the signs of violence be not attri¬ butable to the introduction of other extraneous bodies into the external sexual organs ? 3, And whether a woman can be violated without her knowledge ? And 4, whether pregnancy can follow violation ?
132
O rig in a l Co mm uni cations .
1, Are there certain signs of defloration? To determine this question, we must decide whether there be certain signs of virginity. We have to refer to anatomical and obstetric works, for a description of the external genitals in a virginal state, to enable us to form a correct decision upon this ques¬ tion. The external genital organs are those connected with the subject, and these I have minutely described in my work on Midwifery: a brief description, however, is necessary in this place.
In virgins, the external labia are thick, firm, elastic, and internally of a vermillion or rosaceous colour, their edges in apposition, so as to close completely the orifice of the vulva. They are soft, pale, and separated in women accustomed to venereal enjoyment. But these characters are not to be de¬ pended on, as women of strong constitutions may have the signs of virginity ; and virgins the latter signs from leucor- rhoea, or fluor albus. In fact, no positive conclusion can be deduced from the state of external or internal labia. The same must be said of the froenum labiorum ; it may or may not be ruptured during coition, and every obstetrician of or¬ dinary experience, can attest its perfect condition during par¬ turition. Besides, it may be ruptured by falls, external inju¬ ries, or by the passage of solid morbid growths. The ori¬ fice of the vagina is usually narrow, but it may be relaxed by leucorrhoea, or may be larger in a virgin, than in a woman who has been violated. In some women it is particularly closed by the hymen, a membrane long held as the surest sign of virginity.
It is now universally known, that a great variety of causes, besides coition, may destroy this membrane, as sudden exertion of the lower extremities, leucorrhoea, masturbation, excoriation, confined menstrual fluid, and various morbid growths, both solid and fluid. It does not always exist even in infants, and does not entirely close the vagina at puberty, so that the introduction of the penis may be effected, if not disproportionate, (Teichmeyer,Brendel, Severin, Pineau, &c.) Indeed women have been in labour, and the hymen perfect. (Mauriceau, Ruysch, Pare, Meckel, Walter, Baudelocque , Smellie, Capuron, Nsegele, &c.) It is therefore no infallible sign of virginity, nor is its absence alone a positive proof of defloration. The carunculae mvrtiformes were long consi- dered as the remains of the hymen, but this is denied by Hamilton, Conquest, and Velpeau. They have been seen in infants and virgins, and are no proof of defloration, because, like the rugae of the vagina, they are only effaced by repeated
Dr. Ryan on Violation of Women .
133
coition. Dr. Beck admits, that many of the above signs are equivocal, but if taken in connexion with one and other, he thinks it cannot be possible that all mentioned in the chaste state, can be absent without a strong suspicion against the female. I cannot assent to this conclusion, as I think ex¬ perience has proved that all the physical signs of virginity are equivocal, and all may be absent from causes already enumerated, without room for a full grounded suspicion against the female. From my own experience and the result of my researches, I can arrive but at one conclusion, that there are no positive signs of virginity, and consequently these of defloration are extremely uncertain ; this, I find, is the opinion of the faculty of Lepsig, Metzer, and of Mor¬ gagni. The presence of the reputed signs of virginity afford no decisive proof of chastity, nor their absence no decisive proof of incontinence. If all the reputed signs described above exist, the female feels offended at the examination, or rather displays evidence of shame ; if her morals, age, and education have been good, then there are strong grounds for supposing her in possession of her chastity ; and if all the con¬ trary signs exist with a suspected reputation, and an equi¬ vocal virtue, then there is reason to pronounce a contrary opinion.
It is necessary to recollect the habit of body and age of the patient, as signs of virginity are most perfect between puberty and the twenty-fifth year, after which period they become more equivocal.
When defloration of any young female has recently taken place, the signs are very evident. The laceration of the hymen (if it exist), the presence of its remains covered with clotted blood, the contusions of the labia, majora, and minora, of the clitoris, and carunculee myrtiformes, the redness and tumefaction, or laceration of all the external genitals, leave no room to doubt. But almost all these marks will generally disappear in three or four days. They disappear almost instantaneously in chlorotic and leucorrheic females. (Briand, Manuel de Medicine Legale.)
Second question — Can we distinguish between defloration, the result of voluntary carnal commerce, or that which has been effected by violence, or by the introduction of a foreign body into the vagina ?
It is extremely difficult to determine this question in a po¬ sitive manner. Many medical jurists are of opinion, that contusions, lacerations, inflammation of the vulva, thighs, arms, breasts, and other parts of the body, prove that vio-
134 Original Communications.
lence had been used, and that the female did not consent. But- it is to be recollected that many women will not consent without some force, and also that injuries of the genital organs may follow a first congress, when the sexual organs are disproportionate.
Every person knows, says a French jurist, that at the epoch of puberty, young girls of an erotic temperament, employ foreign bodies for the gratification of their desires, and may cause laceration or contusion of the external genitals ; and who does not know that these excesses have brought on delirium, and who is ignorant of the deplorable effects of onanism. (Briand.) Again, women have injured the organs for the purpose of accusing an innocent man of rape. (Fodere.)
In all cases of defloration we must consider the age, strength, and state of mind of both parties. When this Crime is perpetrated on children of a tender age, the dispro¬ portion of the organs will be followed by the marks of injury already enumerated. On the other hand, a strong woman may accuse a delicate man, or boy, or one who is impotent. It is held by most jurists, that it is almost impossible ; at all events exceedingly doubtful that one man can violate an adult female. (Mahon, Farr, Fodere, Capuron, Beck, Briand, &c.) The exceptions to this rule are, when the female labours under insensibility from violence, syncope, or fainting, narcotics, intoxication, and, according to the fa¬ culty of Leipsic, when she is asleep.
It is indispensably necessary to examine the sexual organs of both parties. The man may be impotent from the causes already described ; the penis may have been destroyed by sloughing or cancer, &c., or the organ may be so small as to cause no pain on its introduction into the vagina. Zac- chias mentions a singular case of this last kind. The woman may labour under a variety of malformations which preclude the generative act. A speedy examination should be made in all cases, for the reasons stated in a preceding paragraph.
The state of mind of the woman must be kept in view, as an idiot at twenty or upwards can make less resistance than a girl of fourteen.
Venereal infection is a proof of violation, when it coincides with the time at which the crime is alledged to have been perpetrated, that is, if it appears from the third to the eighth day, and, above all, if the accused is affected with the dis¬ ease. Every well-informed practitioner is aware tha?t gonor¬ rhoea or syphilis cannot manifest itself immediately after
Dr. Ryan on Violation of Women.
135
congress* and therefore* if found on the female* it is a strong proof against her.
Every well-informed physician and surgeon is conversant with the purulent discharge of female children of scrofulous and delicate habits* from the period of dentition to the age of puberty ; such discharge is seen almost every day in dispen¬ sary and hospital practice among the poor. It is described by John Hunter* Hamilton* Astley Cooper* Dewees* Jewel, and the author himself, and is often mistaken by ignorant practitioners for gonorrhoea.
There is no fact better attested than this* that purulent discharge from the genital organs of both sexes* from the period of infancy upwards, may arise from causes purely physical* chemical, or specific. Venereal excess between two persons whose organs are healthy* may cause a dis¬ charge more or less intense in one or both ; but still the symptoms are not so violent as in gonorrhoea. Even children of both sexes are subject to genital discharge before and during dentition* from worms* or from local injury of the sexual organs, as in cases of defloration of female children. The last fact is one of great importance to those who are called on to give evidence before magistrates, or in courts of justice* in charges of rape. The accused may be free from gonorrhoea* and declare that if the child is infected it is not by him. The medical man should ascertain the lesions, and discriminate between purulent discharge the consequence of violence and inflammation* and that arising from infection. The history of the case will enable him to form a correct opinion in the majority of instances* and he ought to ascertain whether the child has not been subject to discharge previously to the supposed offence. In a case in which I was consulted, and which is recorded in the Lond. Med. and Surg. Jour. 1830* vol. v. the girl had laboured under purulent discharge five years before, and was then ten years old, and exceedingly delicate. On that occasion I afforded abundant evidence of the liability of female infants* and of girls to the age of puberty, to purulent discharge from the vagina. We know that equitation, injury on the peri¬ neum, calculus in the bladder* stricture of the urethra* hae¬ morrhoids* gout* rheumatism* certain cutaneous diseases, as herpes, impetigo, serpigo* lepra, &c.* the terebinthinate me¬ dicines* lytta* spices, diuretics, sexual intercourse during the catamenial or lochial evacuations, the introduction and long retention of a bougie in the urethra* irritation in different parts of the alimentary canal, constipation, certain aliments
136
Original Communications .
and medicines, as new beer, asparagus, &c. — in a word, dis¬ eases of organs which strong! 3' sympathize with the genito¬ urinary system ma3T cause simple gonorrhoea. Cases are recorded in which gastro-enteritis, diseases of the respirator}7 system, cor}7za, cynanche, pneumonia, and asthma, had ter¬ minated by a copious discharge from the urethra. It is admitted that there is a reciprocity of action between the mucous, serous, fibrous tissues, the digestive, respiratory systems, the urinary apparatus, and the urethra, and uterine system, and that none of these systems can be irritated or inflamed without affecting the urethra or uterine apparatus. So also the latter organs cannot be affected without impli¬ cating the former tissues in various degrees. Dr. Titley re¬ lates a case in which he supposed venereal gonorrhoea' existed for a period of three days, and for which he prescribed the usual remedies, but before the patient had taken the medi¬ cine, he was seized with a smart attack of gout, and in a few hours the urethral discharge had vanished.
Capuron was consulted in a supposed case of defloration, in which a purulent discharge escaped from the vagina ; the external genitals w ere ulcerated ; but that able physician ascribed it to the cause under notice, and the girl was soon restored to health. M. Biessy, of Lyons, relates a case in which all the surgeons of that town certified a child had been violated in consequence of the presence of a discharge. He denied it, which induced the Ma}7or to request five phy¬ sicians to examine the child separately, without knowing the application to each other, and the}7 all agreed that she onty laboured under a simple mucous discharge. (Manuel Me¬ dico-Legal, &c.)
The following case is related by the revered Dr. Perc-ival, in his admirable Ethics : —
Jane Hampson, aged four, was admitted an out-patient of the Manchester Infirmary, Feb. 11, 1791. The female organs wrere highly inflamed, sore, and painful; and it was stated b}7 the mother, that the child had been as well as usual, till the preceding dav, when she complained of pain in making water. This induced the mother to examine the parts affected, when she w?as surprised to find the appear¬ ances above described. The child had slept tw o or three nights in the same bed with a boy fourteen }*ears old, and had complained of being very much hurt by him during the night. Leeches and other external applications, together with appropriate internal remedies, were prescribed ; but the debility increased, and on the 20th of February the child
Dr. Ryan on Violation of Women.
137
died. The coroner’s inquest was taken ■ previous to which, the body was inspected, and the abdominal and thoracic vis¬ cera found free of disease. From these circumstances, Mr. Ward, the surgeon attending1 this case, was induced to give it as his opinion, that the child’s death was caused by ex¬ ternal violence ; and a verdict of murder was accordingly re¬ turned against the boy with whom she had slept. Not many weeks elapsed, however, before several similar cases occur¬ red, in which there was no reason to suspect that external violence had been offered, and some in which it was abso¬ lutely certain that no such injury could have taken place. A few of these patients died. Mr. Ward was now convinced that he was under a mistake in attributing the death of Jane Hampson to external violence, and informed the coroner of the reasons which induced this change of opinion. Ac¬ cordingly, when the boy was called to the bar at Lancaster, the judge informed the jury, that the evidence adduced was not sufficient to convict; and that it would give rise to much indelicate discussion, if they proceeded to the trial ; and that he hoped, therefore, they would acquit him, without calling witnesses. With this request the jury immediately complied. The disorder in these cases, says Dr. Percival, had been a typhus fever, accompanied with a mortification of the pudenda.”
Mr. Kinder Wood relates cases of a disease somewhat similar, in which there is fever for three days, inflammation of both labia, clitoris, nymphee and hymen, followed by sloughing and death. The mortality was ten in twelve, and the disease considered a peculiar kind of eruptive fever. (Med. Chir. Trans, vol. vii.)
I have already recorded a case of a delicate scrofulous girl, aged eleven years, who had purulent, or rather mucous discharge from the external genitals, and accused a young man of eighteen, whose genitals were developed in an ex¬ traordinary degree, of having violated her person. Two apothecaries swore the girl had been violated, a rape com¬ mitted, and gonorrhoea communicated. Dr. Gordon Smith, Mr. Whitmore, and myself, were of a different opinion. The froenum labiorum was perfect, the hymen absent, a dis¬ charge without any sign of inflammation the day after the alledged intercourse, and a small dark spot, observed by Dr. Smith only on the thigh. The examinations of the me¬ dical men were made at different times. The case was grievously mismanaged for the prisoner ; the only evidence in his favour was Dr. Smith’s, which was contrasted with that
VOL. VI. no. 32.
T
138
O rigin ul Communications’
of the two medical witnesses for the prosecution. The man was found guilty, and sentenced to six months imprisonment, and lectured by the chairman of the Middlesex sessions (Mr. Const) on his good fortune — that he was not hanged. The mother had informed Dr. Smith that her daughter had had the discharge since she was five years old. The medical witnesses for the prosecution declined examining the person of the prisoner, though those on his side had assured them he had no discharge from the urethra, nor had not had any for six months previously. The case was tried in November sessions, 1829. When the girl was examined at the trial, and asked why she did not tell the domestic who disturbed the parties during the alleged intercourse, she replied, “ she forgot it.” A girl of eleven years old, violated by an adult, forget it ! Cases like the present are unfortunately of too frequent occurrence, and are attested by Sir A. Cooper in the following impressive language: —
There is a circumstance which I am exceedingly anxious to dwell on, — I allude to a discharge from young females ; and I hope that there is not one here this evening but will be strongly impressed with the importance of the subject. Children from one year old, and even under, up to puberty, are frequently the subjects of a purulent discharge from the pudendum, chiefly originating beneath the preputium clito- ridis, the nymphse, orifice of the vagina, and the meatus urinarius, are iif an inflamed state, and pour out a discharge. The bed linen and rest of the clothes are marked by it. It now and then happens, to a nervous woman, to be alarmed at such an appearance, and she suspects her child of having acted in an improper manner ; and perhaps, not quite clear herself, she is more ready to suspect others, and says dear me, (if she confesses,) it is something like what I have had myself. She goes to a medical man, who may unfortunately not be aware of the nature of the complaint I am speaking of, and he says, f Good God ! your child has got a clap.’ (A laugh.) A mistake of this kind, gentlemen, is no laughing matter ; and, though I am glad to make you smile some¬ times, and like to join you in your smiles, I cannot do it on the present occasion, for it is too serious a matter. I can as¬ sure you a multitude of persons have been hanged by such a mistake. I will tell you exactly what takes place in such cases ; the mother goes home, and says to the child, f Who is it that has been playing with you ? who has taken you on his knee lately?1 The child innocently replies, ‘ No one, mother; nobody has, I declare to you.’ The mother then
Dr. Ryan on Violation of Women. 139
T» • < i ’ , j * , .
says, * Oh, don’t tell me such stories ; I will flog' you, if you do.’ And thus the child is driven to confess what never hap¬ pened, in order to save herself from being chastised : at last she says, ‘ Such a one has taken me on his lap.’ The person is questioned, and firmly denies it ; but the child, owing to the mother’s threats, persists in what she has said. The man is brought into a court of justice ; a surgeon, who is ignorant of the nature of the discharge I am now speaking about, gives his evidence ; and the man suffers for that which he never committed. The mother is persuaded, if there be a slight ulceration on the parts, that violence has been used, and a rape committed : she immediately says, f What a hor¬ rid villain must he be for forcing a child to such an unnatural crime, and communicating to her such a horrible disease ! I should be glad to see him hanged.’
“ If I were to tell you how often I have met with such cases, I should say that I have met with thirty in the course of my life. The last case I saw was in the city : a gentleman came to me, and asked me to see a child with him, wTho had a gonorrhoea on her. I went, and found that she had a free discharge from the preputium clitoridis. I said that there was nothing so common as this. There was considerable in¬ flammation, and it had even proceeded to ulceration, which I told him would soon give way to the use of the liquor calcis with calomel. f Do you tell me so V (he replied ;) why, suspicion has fallen on one of the servants ; but he will not confess. If he had appeared at the Old Bailey, I should have given my evidence against him ; for I was not aware of what you have just told me.’ I told him that, if the man had been hanged by his evidence, he would have deserved to be hanged too. /
“ I am anxious that this complaint should be known by every one present, and that the remarks which I have made should be circulated throughout the kingdom. When a child has this discharge, there is a heat of the parts, slight inflam¬ mation, and this sometimes increases, and goes on to ulcera¬ tion. This disease sometimes occurs in children at the time of cutting their teeth.” — Lectures on Surgery.
Dr. Dewees, the eminent professor of midwifery, in the University of Philadelphia, has also given an excellent ac¬ count of the morbid discharge under notice, in his Treatise on the Physical and Medical Treatment of Children, pp. 326, 435. He says, a We occasionally find that very young chil¬ dren have a discharge from within the labia of a thin acrid kind, or of a purulent appearance. When this occurs in very
140
Original Communications .
young subjects, it almost always proceeds from a neglect of cleanly attention to these parts, either by withholding a fre¬ quent use of lukewarm water, or permitting the child to re¬ main too long wet. * * * * Children, however, of a more advanced age, have also discharges of a purulent character, that seem to arise from a morbid action of the mucous membrane of the vagina or labia. This frequently shews itself about the fifth year, and may continue, if neglected, to almost any period. Parents, therefore, cannot be too much on the alert when this discharge is discovered on their children ; nor too early in the application of suitable reme¬ dies for its removal. It is in a great measure owing to this neglect, that fluor albus or whites become so common, and of such difficult management in adult age. If not inter¬ rupted in the beginning of its career, it is apt to continue until the period of puberty over the phenomena, of which it but too often creates an unfriendly influence.”
Orfila gives a table to enable medical jurists to discrimi¬ nate in all cases of stains on linen, wffiether by spermatic, leucorrhceal, gonorrhoeal, lochial, mucous and salival fluids. The evidence afforded by this table, is far from being posi¬ tive, and I therefore omit it.
Third question. — Can a woman be violated without her knowledge ? Decidedly she can, if under the influence of insensibility from violence, fainting, asphyxia, narcotics, or intoxication. I have recorded a case in which a female was impregnated during inebriation, and w as of course unconscious of it during1 the first seven months of uterogestation. She felt much offended, when I hinted my suspicions as to her being pregnant, but soon afterwards her paramour revealed the secret to me. Though it is difficult to suppose a woman can be violated during sleep, yet under some circumstances it seems to me very possible. A married woman who hasliad chil¬ dren, w hose sexual organs are dilated, may be violated dur^ ing sleep ; but a virgin could not be deflow'ered without her being awToke. Drs. Beck, Gordon Smith, Bartley, Fodere, and Capuron, doubt the possibility of a married w oman being violated during sleep.
Fourth question. — Can violation be follow ed by concep¬ tion? It has been long decided in the negative, as it was sup¬ posed that w omen who w ere influenced by the depressing pas¬ sions could not conceive, (Bartley and Farr.) Capuron, Fodere, Beck, Good, & c. agree with the majority of the profession,' that conception may happen, and is not accelerated or pre¬ vented by the volition of the sexes. This is the received
Dr. Ryan on Violation of Women. 141
and only rational opinion. How many women anxiously wish for children and have none, and vice versa. I have discussed this question very fully in my work on Midwifery. From the foregoing* observations, it is evident that medical science does not furnish positive proof of any of the questions discussed in this article, but merely probable and presump¬ tive evidence. I may observe in conclusion, that the proba¬ bilities are greatest when a child of 5, 7, 9, or 10, is the ac¬ cuser, after due consideration, of the sexual diseases of this period of life. Her age excludes all appearance of consent* as she cannot have desire, her organs being undeveloped, as stated in the section on disqualifications for marriage, nor is it likely any foreign body will be introduced. The base will be stronger attested by any other marks of* vio¬ lence. However, great caution is required in these cases, as depraved mothers have induced their children to make ac¬ cusations against innocent persons.
The only other medico-legal question connected with morals is sodomy. In these horrible cases it is said, there will be inflammation, excoriation, or syphilitic ulceration, di¬ latation of the sphincter, scirrhus of the rectum, haemorr¬ hoids. It is to be recollected that syphilitic excrescences are often seen on the perineum and about the anus, caused by disease from the genitals, where no suspicion can be enter¬ tained ; “ no man,” says Dr. Beck, ought to be condemned on medical proofs solely.” The physician should only deliver his opinion in favour or against ah accusation already prefer¬ red — Zacchias. The law on this subject has been already stated.
Medico-Legal Questions relating to attempts against
Health or Life. — Homicide by Contusions and Wounds.
Under this head we have to consider, 1, contusions, wounds, and homicide by them ; 2, homicide by asphyxia, strangulation, suffocation, submersion or drowning, asphyxia by non-respirable gases, or by deleterious gases ; 3, homi¬ cide by poisoning.
Of homicide by contusions and wounds .
In a former article I stated the law on this subject, and need only remind the reader, that by Lord Lansdowne’s Act, 9 Geo. 4, c. 31, contusions are classed with wounds, and under this statute we have to comprehend, ecchymoses, con-
142
Original Communications .
cussion or loss of power of organs, distortions, disloca¬ tions, fractures, bums, wounds of fire arms, and wounds in general.
Contusion is an injury, and sometimes a wound, inflicted by a hard, blunt instrument, without loss of substance, or wound of the skin, but with laceration of the cellular tissue and extravasation of blood, either diffused or congested, to a cellular extent : if the skin be divided, it is designated a contused wound.
Ecchymosis , or blackness, is an extravasation of blood by rupture of capillary vessels ; and hence it follows contu¬ sion, but it may exist as in cases of purpura haemorrhagica, scurvy, and other morbid conditions without the latter ; and we often see persons arise from sleep with numerous eechy- moses, which are sugillations, and called by the vulgar, “ dead men's pinches."
When ecchymosis is caused by injury, it generally ap¬ pears in a short time, or in a few hours, but sometimes not for days. The part appears red and bluish, then black or lead colour, violet and yellow, and is marked most in the centre. Its progress and duration will be modified by age and constitution.
It may be produced in deep-seated org’ans, as in the muscles of the thigh, &c. in the aponeuroses of the hands and feet, on the spinal marrow, whose membranes may be lacerated, without any blackness of the skin, or it may not appear before ten or fifteen days. Again, the viscera in the chest, abdomen and pelvis, may be ecchymosed from external injury, though the integuments are discoloured. It is easy to distinguish ecchymosis from lividity, consequent to acute or chronic exanthematous diseases, vesication, in¬ flammation or gangrene, bv recollecting the successive changes of colour, and the absence of all symptoms cha¬ racteristic of these maladies. It sometimes occurs, that intense vomiting causes rupture of minute vessels in the stomach, intestines, diaphragm and lungs ; and, on dissec¬ tion, we find black spots of various sizes, which are often mistaken for gangrene. In such cases these spots are soft, and easily detached, while the membranes that enclose the blood in a recent ecchymosis are firm. If we make a free incision through an ecchymosed part, we can readily wash out the effused blood, but ablution will not remove the changes effected by gangrene.
It too often happens that ecchymoses are confounded with cadaverous lividities, which are more or less extensive.
Dr. Ryan on Violation of Women.
143
of a brown, black, red or violet colour, forming rapidly after death, particularly on the back, thighs, sides, anterior surface of the body, upon those parts upon which the body has lain while it has been becoming cold. These also appear where pressure is made by the cloths, and from their resemblance to the injuries caused by flagellation with rods, are called by the French r ergetures. A more ap¬ propriate term is, cadaverous lividity or sugillation. These are frequently observed in the most dependent parts of the lungs and abdominal viscera. Professor Andral's remarks upon this subject are deeply interesting, and may be seen in the second volume of his Pathological Anatomy, trans¬ lated by Drs. Townsend and West. These sugillations will be modified by age, constitution, state of the weather, process to putrefaction, & c. They cannot be confounded
with ecc-hvmoses, as there is no effusion or infiltration of
•»
blood in the cellular tissue.
The term commotion or concussion , is the shaking of an organ bv a blow or fall, more or less remote, which causes inaction of an organ. Thus a blow or fall on the head, feet, knees, or body, causes concussion of the brain, which may be followed bv slight stunning. bv haemorrhage from the ears, nose, or eyes, or by immediate death. Concussion of the spine may or may not affect the brain, and if violent, will be followed by paralysis of all the parts, whose nerves arise below the site of the injury. Hence there may be para¬ lysis of the lower extremities of the rectum, bladder and generative organs. The organ likely to be affected next to the brain and spinal medulla is the liver, which may be followed by hepatitis, icterus, rupture, hcemorrhage, and death. Every scientific practitioner is aware that a violent blow upon the stomach, will suddenly extinguish life, by injury of the nerves and paralysis of the whole nervous sys¬ tem, and yet no mark of injury can be observed on dissec¬ tion. I have known a want of knowledge of this fact to be the cause of acquitting a man who killed his victim by a blow of a mason's hammer on the epigastrium. The medi¬ cal witness was ignorant of the danger of contusion on this part, and the judge reprimanded him very severely for not having opened the body. The practitioner was satisfied the blow was the cause of death, as the sufferer died almost immedately, but he was unable to account for the result to the court. Sir Astley Cooper mentioned a case in his lec¬ tures, where a man received a blow on the stomach from a friend, which caused instant death.
144
On ctisl il 0 crmmcL. me .1
LtOtcn on i* a seritns ixrnrj followed. fcj en^crg^neirt . which will not be dissipate! 'for w ecfcs or months. isecrd- in^ to the hah:: end eotstitclicn c: tie safert: Sonjetiioes ‘here is sheet ess of the joints . *omettne^ relaxation o: tie Lrmaeats. which is to be ascribed to a serofeon- or mietiv disc oeidim.
Z'. ;m bn ere generallr free front cat i e r the :rh tier
_ « _
mat he fcllowed Lt paialvsis ext arrettv :h:n the n tarr of a nerve.
F ~aerar i4. if simple ere not dao-zeroo*, bet if c-ompoaDd
Of commmpted, espeerkuiv it, or tear joists, ttev ere sextons
eel c::et fetal. I an greatlT ear: "x-t at the French arts ts
v- ho give a table to see = the terit-a et which fret tares will
be cosaolkleted. ns everv teee cf science neat be cotvii>:ed
c: the kaceiraCT cf at 7 fixed pc-rioa far consolidation whl
be completed so oxer or later according to the age, censtm-
titt aed state of health of tie patient.
For e rate tie, tte same eti of fracture ariil be Intel a
t~ettr hers n et iararr n thertv or forrr in et ahalt atl m • a ^ ^ fifty or six:: n at age! person or t*ernaps t it et e L a • e n
TTch-niomei tratmoaer nest a tree with ne it tonic a.
M. m — X ^
that e goaty, sartfaiocs, eareemas. or venereal: hat : mol- lities -tr irtgebtas cos: an. will modify tte period o: ossizea- tioo it framres, atd p-ove the fan it c ail txea periods. The venable remarks of the lastngnnaei eta era me e i¬ ther g: the Surgical Dictionary epet these paints anzlv at¬ test the tmh of this pesitioii.
Bum, present three degrees c: ntensetp . 1, There there is irrhaticL or sheet nearer, nan of the stir : where
there is Teseatien . 3. where teere is nstreennat-on c: the skit, tehne: nenbraze erntre deep-seated psart~.
It the first ael second case mere is Ltt e danger, aeless the it; a r v is ext nsire. or comp os pens endowed htV greet senshlhv ; it enteral both ere eared it e few lavs. It tee third case there is great laager, as tte degree of cot -na¬ tional britatkz is cotslierabde end often proves fatal to Tt atn end niiile aged persons, etl to those advanced in life hj profuse suppuration or gmgrene. Even these oases net
te mi tale ravooraolv. hat with tree: dettmitv.
« * — -• ^
dksj ear rx/undt. are severally latsrerotts her: here also we most be gmdni it our prognosis by the habit et 1 coa¬ st: t^titt g: the pati-ett. It tte w this of Hemet, S. Cooper,
Guthrie, Larrev Tt onset, Badna-all atd ah others —
« — -
we lean that the bravest net Lave lost their lives ct the fell cf battle, fcv prostration of the v.tai powers.
Dr. Ryan on Homicide by contusion and wounds. 145
who were only grazed by cannon and musket balls. In other cases, the bravest have lost their lives by haemorrhage, inflammation or gangrene, or have been disabled by atrophy of the injured limbs, or have recovered while a foreign body has been lodged for months and years in the brain and other parts of the body. Sometimes stiff joints are formed, or interminable fistulae, which may extend to re¬ mote parts. The judicious and scientific surgeon will be cautious in forming a prognosis in these cases.
From the preceding remarks, it must be obvious that an attempt to classify wounds into mortal and non-mortal, is use¬ less, and indeed impossible. I cannot therefore assent to the classification of Marc, Biessy and others, as I believe the constitution and habit of the sufferer will modify all external injuries to an illimitable extent. I am inclined to think that every well-informed surgeon will assent to my position, that wounds and external injuries will be more or less fatal ac¬ cording to the part or organ they occupy, and according to the constitution of the patient.
The majority of medical jurists agree, that penetrating wounds of the great cavities, or in other words, of the brain, heart, lungs, and digestive organs, are generally fatal.
Wounds of the head. In all these cases we should con¬ sider the degree of concussion, the site of the wound and the tissues which are injured. Wounds of the head are in¬ flicted with cutting or blunt instruments. If there is contu¬ sion of the occipito-frontal aponeurosis, there is danger of erysipelatous inflammation of the scalp and meninges of the brain, and of course the prognosis is very doubtful. The most unfavourable appearances have terminated favourably, as attested by Sir A. Cooper, and by myself in my work on Midwifery. If a cutting instrument penetrates obliquely to the cranium, union may take place (Boyer,) but there is much more probability of erysipelatous inflammation or of exfoliation of the cranium. Many of these penetrating wounds terminate favourably. If the wound penetrates the brain, there may be immediate death, or it may happen in a few days ; and in such cases the danger is exceedingly great.
Incised wounds of the scalp, if judiciously treated, usually terminate favourably. Perpendicular wounds of the scalp may terminate favourably and speedily by proper manage¬ ment, but penetrating oblique wounds are tedious, and often followed by exfoliation. If a wound penetrates the brain, there is danger of haemorrhage and inflammation ; and these
Vol. VI. no. 32.
u
146
Original Communications.
wounds are highly dangerous when a blunt instrument strikes the head perpendicularly ; a soft puffy tumour is produced^ which is resolved in five or six days by proper treatment, or concussion may cause death.
When the blow is inflicted obliquely, blood is extravasated in a sort of cavity, caused by the laceration of the cellular tissue, which is more tedious, and sometimes requires to be opened. In cases where the pericranium is detached, exfo¬ liation of the bone generally follows. I have known a case in which the integuments of the forehead were torn by a gun¬ shot wound ; they hung over the face, and were excised by an apothecary’s apprentice, who was amazed when I ex¬ plained to him the error he had committed, and the certainty of exfoliation taking place sooner or later, as the bone was denuded, and the lips of the wound so far distant, that it was impossible to approximate them. A piece of bone, the size of a crown, was thrown off by exfoliation three months afterwards. The countenance of the patient, an interesting young woman, was greatly deformed, and she became subject to epilepsy. The old surgeons considered wounds of the scalp and fractures of the skull highly dangerous for three weeks, and never declared the patient out of danger until after the lepse of that period. The rule is not a bad one, but the period of danger may be later and undefinable.
Fractures of the cranium must be produced by injury, ca¬ pable of causing concussion of the brain, and hence they are properly considered highly dangerous. A blow upon the crown of the head will cause fracture at the base of the cranium ; a blow upon the superior lateral part will cause fracture on the orbitar vault, and a blow upon the occiput may fracture the frontal bone. The danger of fractures and other injuries of the skull are so ably described in all recent works on surgery, that I need not dwell further upon them in this place.
Wounds of the Face. — Contusions and wounds of the eyebrows and lids are generally free from danger, though they may cause blindness. Penetrating wounds of the globe of the eye, of the optic nerve, and causing fracture of the orbitar plate, are dangerous, as the brain may become af¬ fected. In some habits all or any of these injuries may be followed by erysipelas of the scalp, and consequently be highly dangerous. Contusions of the globe of the eye may induce various disorganization of the complicated and deli¬ cate tissues of that organ, which, though indestructive to life, are generally destructive to vision, and therefore pro-
Dr. Ryan on Homicide by contusions and wounds. 147
ductive of great personal injury. Contusions and fractures of the nose are attended with little danger, and total ablation of the organ is no longer an irremediable deformity,, as ap¬ pears by Mr. Liston’s two successful operations for supply¬ ing its place from the integuments of the upper lip. (Edin¬ burgh Medical and Surgical Journal, Jan. 1831.)
Fracture of the anterior wall of the frontal sinus is not dangerous ; but not so of the posterior, from its contiguity to the brain. Slight fracture of the anterior wall of the max¬ illary sinus is not dangerous ; but, if produced by a violent contusion, as a gunshot, fistulous openings are apt to be produced, as also considerable deformity.
Fracture of the superior maxillary bone or zygomatic arch is not dangerous, unless in syphilitic or scrofulous ha¬ bits, when caries may occur. Luxations and fractures of the inferior maxillary bone are speedily cured, as also wounds of the cheeks and lips. Wounds of the tongue are easily remedied by suture ; but total ablation of the organ renders mastication, deglutition, taste and pronunciation, defective.
Wounds of the neck are highly dangerous, from the num¬ ber and importance of the vessels, nerves, and other organs situated in this part. Too many young surgeons are unmind¬ ful of the danger of injuries and wounds of the neck, as they consider these very slightly, when the carotids are undivided. It is to be recollected, however, that a blow of a blunt in¬ strument on the posterior surface of the neck will cause con¬ cussion of the spinal cord, fracture of the vertebrae, or dis¬ location of the odontoid process ; while a deep wound on the anterior surface of the neck may divide the phrenic nerve, and in an instant paralyse the diaphragm and muscles of in¬ spiration, or divide the pneumo-gastric or par vagum, and paralyse the stomach, impede respiration and the action of the heart. It seldom happens that the nerves on both sides on the neck are divided, and hence the wonderful escape from immediate death. If the trachea or oesophagus is fairly divided, the wound is considered mortal by medical jurists, as recovery seldom happens in such cas^s. When the inter¬ nal jugular vein or carotid artery is divided, death is inevi¬ table in a few minutes, unless ligatures are applied ; and it appears, from the testimony of Briand, that in nineteen such cases nine were saved by ligatures. The section of the prin¬ cipal nervous trunks, such as the great sympathetic and tenth pair, are mortal, by depriving organs essential to life, of a proper supply of nervous influence: the division of the recur¬ rent nerve will cause aphonia, and punctured wounds of any
148 Original Communications.
of the principal nerves will be followed by inflammation in all parts which they supply, and often by death. Lastly, the cutting’ instrument may pass between the cervical verte¬ brae and wound, or completely divide the spinal marrow.
Wounds of the chest. — Contusions and wounds of the chest may be followed by pleuritis, pneumonia, and various disorganizations of the lungs, pericardium and heart, and are therefore considered very serious injuries. Con¬ tusions on the female breast may ind le cancer ; on the ribs, caries or necrosis. When a penetrating cutting* instru¬ ment divides the mammary or intercostal arteries, there will be effusion of blood into the chest (haemathorax), which will produce death. Section of the axillary or sub¬ clavian arteries will be generally fatal, unless a ligature is speedily applied.
Luxation of the sternal extremity of the clavicle requires the immobility of the limb for twenty or thirty days, while that of the humoral extremity is followed by deformity.
Fractures of the ribs are generally unattended with dan¬ ger, but by wounding the pleura or lungs, may, of course, induce serious diseases of these parts. Fractures of the sternum, though very rare, may injure the subjacent organs ; those of the acromion, and coracoid process and neck of the scapula, are not dangerous, but may produce defective mo¬ tion of the arm or shoulder joint, or atrophy, or paralysis of the limb.
Fractures of the vertebrce , are usually complicated with concussion, or other injury of the spinal marrow, and con¬ sequently of paralysis of the inferior extremities, and of some parts of the abdominal viscera ; and these affections may occur after the lapse of months, when no trace of the former injury remains.
The prognosis of penetrating wounds of the thorax is uncertain, as there will be haemorrhage into the chest, and likewise the introduction of air, both of which will com¬ press the lung, induce inflammation, suppuration or indura¬ tion of some part of the organ. In general, wounds of the lungs, pericardium, heart, aorta, pulmonary vessels, venae cavae, vena azygos, and thoracic duct, are to be considered mortal.
Wounds of the abdomen. — Contusions on the abdomen will cause concussion or commotion of the subjacent vis¬ cera, or rupture, haemorrhage or death, though there may be no appearance of injury on the abdominal surface. The .muscles may lose their contractility, and hernia be pro-
Dr. Ryan on Homicide by contusions and wounds. 149
duced. Wounds of the abdominal parietes are highly dan¬ gerous, as they almost generally cause peritonitis ; and should any of the large vessels, aorta, cava, &c. be di¬ vided, immediate death must follow. Wounds of the ner¬ vous centres (solar plexus), which supply the abdominal viscera, will be followed by a mortal paralysis. Effusion of bile, blood, urine, food or faeces, is fatal, in consequence of inducing peritonitis, which cannot be cured. Hence wounds of the stomach, liver, intestines, spleen, kidneys, uterus, bladder, when distended, and thoracic duct, are generally fatal.
tVounds of the Organs of Generation. — Contusions and fractures of the pelvis are not dangerous, unless the latter are considerable, or unless some vessel of importance is wounded. Wounds of the spermatic arteries and veins of the male are necessarily fatal, as beyond the power of art ; but they rarely exist independently of other lesions equally unfavourable. Wounds of the scrotum are not dangerous, unless a large quantity of blood be effused into the tunica vaginalis ; those of the vesiculse seminales are not mortal, but are a cause of absolute sterility. Section of the penis is not dangerous, as haemorrhage can be easily arrested ; the wound cicatrises ; but there will be incomplete erection on the injured side of the organ. Total ablation of the penis will prove fatal, unless the arteries are secured. Contusions of the testicles may induce scirrhus, which will require cas¬ tration.
Lesions of the generative organs of women. — Contu¬ sions and wounds of the external genitals are not dangerous, unless inflicted during menstruation, when serious conse¬ quences may result. It is very evident that the uterus in the unimpregnated condition can scarcely be injured by external violence. In the gravid state, when it ascends above the pubes, it may be seriously injured by blows, falls, &c. in¬ ducing fatal inflammation or rupture of the organ, detach¬ ment of the placenta, and death of the foetus. If the organ be punctured, the wound must be considered fatal, if fol¬ lowed by inflammation or gangrene, to both the mother and the foetus. The organ may be inflamed and gangrenous, com¬ plicated with peritonitis and enteritis, in the last month of pregnancy, and without any external violence, or even any evident cause ; a case of which is narrated by Dr. Malins, of Liverpool, and myself, in the Lond. Med. and Surg. Jour. 1831, vol. vi. p. 52. In cases of prolapsus of the organ, its total removal has been effected by ignorant midwives ; and
150
Original Communications .
the fatal injuries inflicted by ignorant male obstetricians, by manual and instrumental operations in difficult parturitions, are unfortunately too notorious, of late, to require further comment.
Within the last year medical men in this country and in France, have been found guilty of manslaughter, and very justly, for the rashness and violence of their operations were more characteristic of illiterate savages, or of the darkest ages, than of men acquainted with the principles and prac¬ tice of obstetrics at the present period. Like all ignorant and bad practitioners, the delivery of the woman seemed their only object, and as to the consequences of contusions and lacerations of her organs and their fatal results, they were totally forgotten.
Lesions of the extremities. — Contusions, dislocations, fractures and wounds of the superior and inferior extremities are seldom fatal. The loss of a member or part of a mem¬ ber by external violence, accompanied with laceration, may destroy life by intensity of pain, prostration of the vital powers, by inflammation, profuse suppuration, gangrene, or sloughing. The divisions of the large vessels and nerves of the extremities, are mortal wounds, unless timely aid be af¬ forded. Here we must recollect the danger of comminuted fractures, especially in or near joints, wounds of joints, in¬ flammation, suppuration, hectic fever, constitutional irrita¬ tion, habit of body, &c.
* *
II — Mr. Searle on Cholera — Reclamation.
[We readily insert this reply to our Review of Mr. Searle’s work on Cholera : 1st. because it is written temperately and to the point ; 2dly, because it is on a subject of vast interest at present; and, 3dly, because we are anxious to convince its author, that we could have no object in animadverting upon his opinions, but the interests of science. In the discharge of our editorial duty, we speak of works as we find them, uninfluenced by name, station, partiality, favour, or self-in¬ terest ; ours is the cause of science and of truth, and no base, ignoble, motive will ever dissever us from our principles — no cringing, crouch¬ ing, gross adulation, or unmerited censure for us. We admit that a more accommodating line of conduct, and a closer eye to self-interest, would be more in accordance with the modern spirit of reviewing, and, perhaps, with worldly wisdom. It is our merit or demerit — which ever the reader may chuse to designate it — to prefer the principles we have adopted.
We have as yet no reason to be dissatisfied with our course. Authors, whose productions we have been obliged to censure, at first
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felt offended, then admitted the justice of our remarks, and finally became our friends. Even Mr. Searle has made one step in this march of reconciliation, when he partly admits the justice of our remarks. He must be well aware of the utter impossibility for an independent journalist to please authors and publishers. He must also acknowledge, that a medical man, whose duty it is to peruse all new and old publications of this and other countries, must be as competent to offer an opinion, more especially when it is that of the majority of the profession, and be as likely to arrive near the truth, as an author who broaches a new hypothesis. Such is the relative position of Mr. Searle and ourselves on the present occasion. However ingenious his views, and they are very much so, we cannot assent to them. Much more proof must be offered, before they can be received as legi¬ timate. At so advanced a period of our publication, we cannot de¬ vote further time to this subject at present ; but remain perfectly satisfied in referring our review and Mr. Searle's reclamation to the judgment of our readers. — Ed.]
To the Editor of the London Medical and Surgical Journal.
$ir, — Being on the Continent at the time your review of my work on the Cholera issued from the press, it escaped my notice, and it was by mere accident I came to a knowledge of the circumstance, a few days ago. This explanation, I trust, and your impartiality, will give me claim to a hearing on the subject, even at this distant period, it being in the September Journal when your review appeared.
With respect to the composition and style of the work, I am but too sensible that your strictures are but just. But far different do I consider your animadversions on the subject matter of the work, and your condemning in toto, all that I have advanced on the pathology of cholera and of fever, because I have presumed to differ with what may be the more generally received opinion, as to the primary operation of malaria on the system, in producing disease. My opinion being, that by inhalation, it is received into the circulation, in common with other serial fluids ; and thus, in common with many other poisonous agents of the sedative class, which I assume malaria to be, con¬ taminating the blood ; it primarily operates on the organic structure or functions going on in the capillary system ; and thence its influence on the brain and heart, in torpifying or arresting their functions, and •by consequence the secretive, and in short, all the functions of life. A position which, to my judgment, is quite as rational, and I main¬ tain too, as tenable (although you have thought proper to designate it unphilosophical) as the more prevalent opinion, that the primary operation of malaria and other poisonous agents, is upon the nerves and brain ; and by no means incompatible with the experiments of Messrs. Morgan and Addison, to which you have alluded.
That as you have commenced your review with the profession, that you will endeavour to detail faithfully my views, on the nature and treatment of this but too formidable disease, I beg leave to state.
152
Original Communications.
and appeal to the candour of any one, that your differing in opinion with me in the above instance, is not a justification of your condemn¬ ing me unheard, and injuring my publication in the opinion of the public, in the manner which you have done : and suppressing, in the following words, what has been acknowledged by all to whom I have shown the work, as exceedingly ingenious views, if not altogether a satisfactory explanation of the symptoms of cholera, and of fever also ; to which I have made it appear cholera is allied. “ Mr. Searle endeavours to explain the semeiology of the disease agreeably to his theory, but as his premises are untenable, it is unimportant to hear his conclusions.” Now, really this is a very hard sentence, to say the least of it ; and thus am I condemned to silence in all that I con¬ sider interesting in the work, or principally so ; and whatever my faults are, rendered most glaringly conspicuous. A mode of review¬ ing, upon which I shall make no comment, hoping this will be un¬ necessary ; and trusting, that my having pointed it out, will obtain for me the only reparation in your power, by allowing me to pre¬ sent to your readers, in your next journal, what are my views of this disease, and the real nature of the publication. When, if you have any objections to advance against my reasoning, I shall be happy to meet you in an open, candid discussion ; which, at this particular time, cannot be without interest, seeing that the disease, in its devastating course, has already extended to Russia, and may very possibly, at no distant period, make its appearance in this country. But, whether as an epidemic, it does so or not, is sporadic and endemic ; instances are already known to occur in this country, in proof of which, I need only instance the disease which occurred at Mr. Day’s school at Clap- ham, a year and a half ago, to justify me in the assertion, that the subject is meriting every attention which can be bestowed upon it.
Sincerely believing this to be the case, and confiding, Sir, in your sense of justice, I shall proceed to give as concise an analysis of the work as is consistent with the comprehension of the subject.
The work first presents the reader with a general description of the disease ; the nature of the attack, the progression of the symptoms, the state of the functions, the condition of the blood, and so forth. This is extracted principally from the Report of the Madras Medical Board, as being better testimony on this head than my own ; and the same obtains of the appearances noticed on post mortem examina¬ tion, which is the subject of the next chapter. This is followed by my own case, it having been by strictly attending to the progression of the symptoms in an attack of the disease in my own person, which led me more particularly to the views I have taken of the disease, as I have explained in my preface. At the same time, it was the circumstances attending this attack, which led me to the cause ; which I assume to be, some terrestrial exhalation of the nature is not identical with malaria, as the poultry about my house and premises at the time of attack, were dying in great numbers, of an analogous affection ; and this view is supported by numerous quotations, which are strikingly corroborative of the opinion. There is one, however.
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to which I should more particularly wish to draw the attention of my readers, as it almost amounts to demonstrative evidence ; this is the disease of precisely the same character which occurred at Mr. Day’s school at Clapham, which attacked twenty out of twenty-two boys, in the course of a morning, and of which number two died. This was unquestionably attributable, upon the evidence of Drs. Latham, Chambers and fepurgin, whose assistance was called in upon the occasion, to malaria, arising from the contents of a cesspool, which had a few days before been thrown upon the garden adjacent to the play-ground, to the effluvia of which the boys were fully exposed. That these, in conjunction with the several other instances adduced in the work, will, I think, leave no doubt on the mind of the reader, that malaria is the cause of this disease, as well as of fever, to which I have made it appear that cholera is nearly allied, observing, in the 47th page, “ The connection between the two diseases is very intimate, for the fact is undoubted, that fever has not unfrequently succeeded, or has been conjointly prevalent with cholera during its epidemic visitations, though, for a certainty, it has not been of usual or common occurrence.” And, in an after page, it is observed, “ In the primary actions of disease, the resemblance in all the essential characters that exist between cholera and fever is most striking, so much so, that it has been noticed by several practitioners in India, that the former appeared to them a protracted or continuance of the first or cold stage of the latter, which, in its essential character, I believe it to be ; the efficient cause or causes giving rise to the affection, operating with greater intensity or virulence, so depressing to the vital functions, that reaction of the system but seldom, or very partially takes place. Whereas in fever, the energies of the system not being equally depressed, excitement becomes developed to its pre¬ servation. In fine, the resemblance between cholera and the con¬ gestive typhus of Armstrong, is so strong in all the leading features of the two affections, that they present to my mind but one, or modi¬ fications of the same disease.”
The next question which arises, is, what is malaria ? This, we have replied to, by stating, that as it is the gaseous production of organized substances, in a state of decomposition, we may fairly infer that it is some compound of carbon, hydrogen and nitrogen, as these are the principal constituents of animal and vegetable substances ; and as such of the gases are known to be highly deleterious to animal life, and produce effects in common, there can be no difficulty in con¬ ceiving the thing, although endiometrical experiments have hitherto failed in determining the point ; and reasoning by analogy that it is so, from the effects induced upon animals by experimental exposure to such of the noxious gases, and to the appearances which have pre¬ sented themselves upon the dissection of the bodies of those who have died from exposure to memphitic exhalations.
We proceed next to observe, ** The next question presenting itself is, upon what parts or textures of the body are the primary operations ?of malaria exercised ? Now, as the skin and the lungs are the organ*
uoL-iv.. no. 3*2..
x
154
O r i o; in a l Commu nic at ion s .
more particularly exposed to its operation, indeed, we may say exclusively so, a doubt can hardly arise upon the subject, especially as regards the lungs; and little objection, I think, can be made against the operation of the same influence on the skin, the experiments of Jurine, Spallanzani and Abernethy, having unquestionably proved similarity of function ; the imbibition of oxygen, and the exhalation of carbonic acid gas, by the capillaries exposed to serial influence on both surfaces ; and the same is inferred, by the experiments before quoted ; the effects upon the system being the same from sulphuretted hydrogen, whether inhaled, or left sometime in contact with the sound skin. It remains then but to determine, whether this agency operates on the nerves and capillaries exposed to its influence, in arresting their function ; or, whether as a poisonous agent, it is imbibed and received into the circulation. The latter, I think, it will be acknowledged, the most reasonable conclusion, as it offers an explanation why diversity of effect, and variety in disease is induced, by variety or difference in the composition of the memphitic vapour or malaria ; and thus fever is the product in one case, and cholera in another. This view meets too with support, in the experiments with the noxious gases upon animals, which are found to exercise beyond the exclusion of oxygen, a positive noxious influence upon the system ; and this we find, differing somewhat in effect, according to the particular gas which is employed ; as is the case with the various other poisons, both of the animal and vegetable kingdoms ; effects which are presumed to take place in most instances, from the absorption of these substances and the blood’s contamination.”
“ Indeed, the office of the lungs would appear quite of a passive character, in relation to the changes effected on the blood by respira¬ tion ; the conversion of black into red blood, which is the simple effect on the one hand, of the exhalation of the ready formed carbonic acid gas, which the experiments of Mr. Brande proved it to contain, from the ramifications of the pulmonary artery distributed over the air-cells ; and on the other, of the imbibition of oxygen with the returning blood, by the pulmonary veins, which being connected by their trunks, with the left auricle of the heart, is thus absorbed by its dilitation ; hence it is, as was proved by the experiments of Professor Mayer, that absorption goes on from the lungs more energetically than from any other part of the system.”
“ We are borne out in these views of the respiratory function, by analogy with both Spallanzani’s and Abernethey’s experiments on the skin. The first was completely satisfied, that air in contact with the skin, is changed exactly in the same way as by respiration. When atmospheric air was employed, oxygen disappeared, and car¬ bonic acid was produced. He was of opinion, the oxygen employed had no share in the immediate production of the carbonic acid gas, because it was equally great, when the animal was exposed to gases containing no oxygen ; and he therefore concludes, that the carbonic gas was exhaled, and the oxygen absorbed ; and Mr. Abernethy’s experiments warrant the same conclusions.”
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“ That any appreciable direct influence, arising out of the inhala¬ tion of malaria, if it exercised any on the nerves of the part, the che¬ mical it would appear, living but secondarily subject to such influence, would be, on the mechanical function of respiration, and which were it thus to operate, would give rise to symptoms so characteristic, that they could not have escaped notice.”
“ That I believe we may safely conclude, that malaria is received into the system by absorption, and thence its influence is exerted ; though I may add, when very virulent it may simultaneously affect the capillary vessels exposed to its influence, whether cutaneous, or pulmonary, or both; but of this I shall speak hereafter.”
“ Assuming then, that the noxious influence of malaria is induced by the blood’s contamination, I shall, after a short digression I am constrained to make, in pursuance of the inquiry, trace its effects on the system in giving rise to the symptoms of the disease.”
“ It is an established fact in chemistry, that the decomposition of a compound, or the formation of a new one, is attended with an al¬ teration in the electrical capacities of the products. The change manifesting an increase or loss in this respect, it becoming either plus or minus, latent or evolved. Now as the process of acretion, assimi¬ lation and secretion, constituting the change or conversion of arterial into venous blood, at the termination of every arterial ramification throughout the system, is a chemical process ; this conversion is not only attended with an evolution of caloric, but it will not be unfair to add, with electricity also ; hence from the first, the body’s tem¬ perature, and its equal diffusion ; and from the second, its nervous, or electrical excitement or vitality. The latter or electrical evolution, which I believe to be in a ratio with the calorific and chemical change that has taken place, having its source in the capillary cir¬ culation, explains the reason why, vitalit}?- goes on in these vessels for a considerable time after the apparent death of an animal ; and the irritability of muscular fibre after the appearances more particu¬ larly denoting life have ceased. And it explains also the reason why the arteries after death are found empty, capillary circulation still continuing as long as the arterial trunks furnish blood for their ex¬ citement.”
“ Another argument that may be adduced, favouring this view of the body’s electrical generation, is the known fact, that a capillary tube is quite impervious to the passage as a fluid, but under the excitement of electricity, admits its passage freely ; now, as the capillary vessels of the accessorial system are so minute, that they are not discernible by the naked eye, but by a powerful glass, the free circulation of the blood is to be seen through them ; we are warranted in our analogy, in supposing them to be excited by the same means. As it has been proved by experiment, that it is no impulse of the heart, or action of the arteries, that carries on the circulation in these vessels ; as it still goes on long after the heart has been removed from the body. And further, it has been proved.
156 Original Communications
that the excitement of these vessels is not derived from the brain and nerves, bv removing both brain and spinal marrow.''
" That there can be little doubt of the origin of the nervous or electrical £nid of the body being in the way suggested. The electri¬ city thus generated- I am of opinion, is transmitted by the most per¬ fect conductors of the animal textures, the nerves, to their source, in the common acceptation of the word, and its receptacle, the brain and spinal marrow ; from whence it is again transmitted by tae nerves, at the pleasure of volition, in the several actions of muscular contrac¬ tions : excites the sensorium to tne various operations of the mind ; and tne organs of sense to their respective functions ; or is transmitted by the par vagnm to the gTcar secretive processes of the stimach and other organs to which these powers are transmitted : and hence, the intimate connection and remarkable sympathy existing uetween the head and stomach : and an explanation why mental emotions so immediately derange digestion, and the functions of the several organs to which these nerves are transmitted. For further particulars and arguments in illustration of these views, see the Essay in the Appendix/'
From the previous considerations, the following inferences are deduced : — That the noxious influence of malaria is induced by the blood s contamination, and operates in torp living or arresting: the chemical functions which take place in the general cap illaries of the system, by which there is a diminished evolution of caloric and electri¬ city, and in consequence, debility of all the functions. And it is probable, in the same way the venom of the serpent and the various other sedative poisons of both the animal and vegetable kingdoms induce these e meets : for it has been observed, by several persons, of cholera, “ that there appeared a sudden depression of every vital energy, and those who died had more the appearance of persons labouring under the bite or sting: of some poisonous reptile , or the e meets of some narcotic pcison than of disease.”
“ Another argument that may be adduced in favour of my views, is, the feet before adverted to, that in animals killed by exposure to the noxious gases, as well as in persons who have died by the like or mepnltic exhalations, there has not only been this blackness and fluidity of the blood noticed, but annihilation of the contractility of the muscular fibre : both of which are noticed by Dr. Davy, in the subjects of cholera ; the latter, however, if not so fully expressed, being fairly imp lied. Tne experiments of Sichattoo, on the respira¬ tory mnetion in animals may be adduced, as bearing: upon the subject, wno concludes his numerous experiments bv observing. — We con¬ clude tuen in general terms, and without attempting to determine how this takes place, teat the heart s action ceases, when the chemical pnenomenon of tne lungs are interrupted ; because the black blood which penetrates its muscular fibres, is not capable of keeping up their action. 5 And, the same he savs of the brain, and finally observes, “ The circulation of black blood carries to every part de¬ bility and death, the organ; ceasing to act, because they receive no
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red blood*” I have only to add, how well do the views I have taken of the capillary circulation, explain all this ; and render it, I am of opinion, apparent, that the primary operation of malaria, not only as a cause of cholera, but of fever also, is not upon the brain and spinal marrow, as it has been supposed, and asserted by Dr. Southwood Smith in his late work on fever, but are effects secondarily induced, as I have already partially, and shall more particularly explain here¬ after ; with the majority of symptoms in common to the two affec¬ tions, which I repeat, are but modifications of the same disease/’
“ If my views are correct as to the course and operation of that cause, the symptoms which ensue, are necessarily referable to the defective excitement of the heart and brain, or principally so, these being the two principal organs, and on which the functions of the others are dependent. The first I shall notice will be that of the heart, in a ratio with its defective power, in its twofold capacity of a forcing and sucking pump, which the experiments of Barry and Majendie warrant us in the conclusion that it possesses, will accumu¬ lation of blood take place in the veins, which accumulation or con¬ gestion will necessarily be to the greatest extent at those points of the circulation the most remote from the heart’s influence ; which obtains to by far the greatest extent in the mesenteric, gastric and splenic veins, forming the roots of the vena portae ; as the propelling action of the ventricle ceases in the arteries, and the sucking power of the auricle’s dilitation has to operate through the additional and protracted route of both the hepatic veins and vena portae. Hence, the distention of the mesenteric and gastric veins, and sense of pre¬ cordial oppression, the first symptom experienced by me, when I was the subject of the disease, as noticed in my case.”
Further, as it has been proved by the experiments of Home, Majendie and others, that these vessels in health absorb fluids from the stomach and bowels, and which it may be presumed, is effected by the heart's sucking agency, it is fair to suppose, the permeability of these vessels, which admit of absorption in health, under their present state of engorgement, and condition in which the sucking agency is withdrawn, or rendered comparatively nugatory, would admit of exudation ; and hence the sero-mucous or conjee water-like evacuations, either from the stomach or bowels or both ; but par¬ ticularly from the latter, as the natural exit of the contents of the former is through them. That sickness or vomiting, in the early stage, 1 think rather attributable to the stomach’s defective excite¬ ment, from diminished energy of the brain, as we see so often exemplified in cases of debility, on the patient’s removal from the recumbent to the erect position ; and particularly from the sudden loss of blood, the patient becoming giddy and sick from defective arterial distention and excitement of the brain. And this explains the giddiness and sense of weakness that so generally attends an attack of cholera, and has been so frequently complained of, as the first symptom the patient was sensible of or noticed.”
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Original Communications .
“ In a ratio with the defective excitement of the heart and brain, will be that of the glandular system ; hence, the diminution or sup¬ pression of the secretions of bile, urine, &c.
“ Inflammation and spasm come next to be considered ; and are as readily accounted for, by pursuing the same chain of reasoning, adding to the consideration, difference of temperament, idiosyncracy, state of the individual at the time of attack, a greater or less intensity of the cause and treatment pursued.
“ Thus, I would say, if the exudation from the mesenteric and gastric vessels do not take place, or is not equal to the relief of the distended veins, free egress of blood is not admitted from the capillar}7 arteries, and the consequence is, they become irritated by distention, and excited into inflammatory action. And hence the sense of burning heat, pain, extreme restlessness, and desire for cold water, and irritability of stomach : symptoms specifically denoting inflammation of the stomach and bowels.”
“ It is worthy of notice, that these organs being primary in the scale of animal existence, derive their nervous influence principally from the sympathetic : which originates in twigs given off by every collecting nerve, proceeding to the spine and brain, that they may be little influenced by causes operating on the latter ; hence it is, the stomach and bowels retain their irritability to the latest period of existence, even after the apparent vitality of ever}7 other organ has long ceased. And from which it may be inferred, that these organs would be proportionably more susceptible of inflammatory excitement than any others ; and hence it is in this disease, the leading features of which may be said to be the very reverse of inflammatory, that these organs have been found almost exclusively the seat of in¬ flam mation.”
Spasms come next to be considered ; they are for the most part of the clonic kind, or primarily so in all cases, dependent, I believe, on congestion in the spine, at the origin of the affected nerves ; and the tonic kind, to which the European is more frequently the subject, dependent on the same, but having developed a certain degree of in¬ flammation on the part.”
“ Having completed an explanation, which appears to me satis¬ factory, and the whole phenomena of the disease,* I have, in con¬ clusion of the subject, but to ask, are not those sudden and con¬ centrated attacks, which destroy the patient, without the develope- ment of the usual and more characteristic symptoms of the disease ; like a resistless apoplexy, resulting from the overwhelming congestion of the brain, annihilating its functions and all the powers ? * Mr-
Finlayson, observing, of some cases, which happened often in Bengal, that the operation of the morbific course was so violent as to destroy life in a few hours, without any other characteristic tokens of the disease, except the extreme prostration of strength. In these cases.
* For the symptoms not enumerated I must refer to the work.
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159
there was such congestion of blood in the brain, that it had the ap¬ pearance of being enveloped in a layer of dark coagulated blood, or by a diffuse and general ecchymosis, and in some cases, when it was cut into, large quantities of dark coagulated blood gushed from it, and from the theca of the spine. In the ordinary form of the disease, this appearance was wanting, the blood being principally collected in the abdominal viscera.’ And the Bombay Medical Board observes,
‘ That those who are most intimate with the disease, will be struck with the great similarity between it and the congestive typhus of Armstrong. And dissections they state, abundantly prove, that venous congestion constitutes the principal change that takes place during life.’
“ Having represented the connexion as most intimate between cholera and fever, it may be necessary that I say a few words on their distinctive characters. The former I have represented as a disease, marked by the subduction of power, or in which, symptoms of excite¬ ment are but seldom evinced, beyond what are resulting from topical inflammation ; whereas, the characteristics of fever in general, may be said to be the very reverse of this ; increased action and general excitement. The way in which this is brought about in the adynamic or typhoidal order, I believe to be somewhat analagous to that by which I have previously represented cold to have operated in the pro¬ duction of the synochal order. The depressing cause, being of less virulent character than in cholera, operating but to the extent of pro¬ ducing that degree of congestion which comparatively little interferes with the functions of the brain ; and but of resistance to the blood’s egress from the arteries, that distention in these trunks and excite¬ ment ensues. To which, we may add, that in proportion to the severity of the cause, and susceptibility and so forth, of the patient, will topical engorgements and inflammation be concomitant. Which inflammation will be seated in those parts, for reasons already enu¬ merated and assigned to them in cholera ; which being in the stomach and bowels more particularly, and the head, explains how both Clutterbuck and Broussais were individually led to the mistake of assigning to these organs the exclusive seat of fever.”
“ We have analogical illustration of this cause of excitement, in the operation of other sedative agents on the system ; opium may be mentioned, small doses producing primarily a certain degree of excite¬ ment ; whereas, a large one, induces an opposite effect, or at least the excitement is so transitory, that it cannot be calculated upon, and this is followed by overwhelming cerebral congestion.”
We have next divided the disease into three species, adding, how¬ ever, “ that the distinctions here made, although not without use, will not often be found so well defined in practice, as the species not only run into each other by insensible gradations, but are variously modified, by constitutional idiosyncrosy, temperament and habits of the patient ; and by numerous other circumstances of a local character ; for after all, they are but one and the same disease, modi-
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©
fxed by these circumstances, and a greater or less intensity of the morbific influence.”
“ We shall now present the reader with the symptoms of the most frequent form of the disease, our second species, or cholera congestion, as we have thought proper to denominate it in preference to spasmodica, as spasms are by no means uniformly present, whereas congestion, I believe, is always so.”
“ The patient is usually suddenly seized with giddiness, borbo- rygma and purging ; or the latter, with a sense of weakness, and symptoms of indigestion have been for some hours, or even days duration ; these are followed by vomiting, which with the evacuations from the bowels soon assume the conjee or barley water-like appear¬ ance, succeeded by great prostration of strength, tremor or twitching of the extremities — alias clonic spasm ; a sunken ghastly counte¬ nance, ringing noise in the ears, cold damp skin, feeble pulse, and prsecordial oppression. From the sense of preecordial oppression, heat sooner or later becomes developed, and the patient complains of inward burning, attended with great thirst and insatiable desire for cold water ; the irritability of the stomach is now usually increased, and there is extreme restlessness. The pulse becomes now sharp, frequent and wiry ; while the extremities are cold, and in general damp. With the developement of this partial excitement, tonic spasms or cramps usually set in, commencing in the feet and legs, and gradually increasing, or extended to the upper extremities, and occa¬ sionally involve the muscles, also of the belly and chest. The ex¬ hausting influence of these spasms, or sense of inward anguish, singly or conjointly, is soon succeeded by collapse. The stomach and bowels, which continued before irritable, now retain whatever is poured in them ; the spasms cease, the skin is livid, covered with cold sweat, and the fingers shrivilled ; the eyes are suffused with blood, or covered with a dense film, half open, inanimate, and countenance death-like ; coma and dyspnoea ensue, and life gradually leaves its frail tenement without a struggle.”
“ Nothing, perhaps, can be of more practicable consequence than to note accurately the various stag^ of acute diseases from their com¬ mencement to their termination ; for unless this be done, the disputes may be endless about the modes of treatment, which must corres¬ pond to the leading phenomena of each stage. This erudite and just observation of Dr. Armstrong is particularly applicable to the disease under consideration ; and it has been the want of its observance that has occasioned the discrepancies that at present prevail in practice. I shall therefore offer a few observations on this head. Each species is made up of an assemblage of the three following stages : — The first stage of torpor or oppression ; the second of general or partial excitement ; and the third of collapse.”
The second species or congestive, combining the whole. In the first instance oppression, bounded by the tonic spasms, or other symptom denoting the partial or topical excitement of the second
Mr. Searle on Cholera - - Reclamation.
161
stage ; which terminating in the least of collapse, is evinced by the spontaneous cessation of the vomiting, purging, and spasms ; accom¬ panied with the loss of pulse, coma, and profuse cold swTeat.”
“ The indications of treatment resulting from thus viewing the disease, are obvious — to remove the hist stage of oppression, which our explanation attributes, both to suppression of power and ve¬ nous congestion, by remedies both stimulant and evacuating ; then follows on its supervention, the moderating or removing the second of excitement, by remedies more part ieularly evacuating ; bearing in mind at the same time, the nature of the disease, that the powers of life may not be by the means employed in this, fatally subdued in the event of the third of collapse ensuing ; in which stage, the indi¬ cations are, to allay irritation, restrain every debilitating evacuation, to restore the natural secretions, and at the same time to husband and support the remaining feeble powers of existence.”
“ The laws of nature and of living matter being immutable, it is only to understand aright the operation of diseased action, and the same of our remedies, to enable us to lay down determinate rules of treatment.”
This calls upon me for the following observations, in reference to the indications of treatment, and to the modus operandi of our prin¬ cipal remedies : —
“ The immediate cause of the disease1, being, torpor of the ge¬ neral capillaries of the system, by which the chemical changes in the blood are hut imperfectly effected, and as a consequence of dimi¬ nished evolution of vital temperature and nervous energy that be¬ comes debility of all the functions — and hence the congestions and stage of oppression which ensue ; the primary indication of treat¬ ment is obviously the restoration of exciement to these vessels on which the whole phenomena of the disease depends. To accomplish which, stimulants are expressly indicated, and of chief among their number, might perhaps be mentioned, the inhalation of oxygen gas ; but as this is a remedy so seldom available, it is well that we have another that is always so, and whose ope ration, I believe to be, specific on these vessels ; this is mercury, for of this remedy I ex¬ pressed my opinion some years ago, to the following effect, which every day’s experience confirms me in the belief, is a most just one.’*
“ The effects of this remedy being so multifarious in the cure of disease, its operation must be very general on the system ; its pri¬ mary action, I believe to be on the capillary vessels, exciting them to increased action ; hence its renowned deobsturent powers, and its operation on the glandular system in increasing the various secretions. Its more obvious effect on the hepatic function, is probably owing to its primary direct influence on this organ, by its absorption from the stomach and bowels by the veins from these points forming the roots of the vena portarum. Its operation in exciting the capillary arte¬ ries, necessarily removes congestion from their venous terminations and obstruction from the exhalents ; hence its accredited action on
VOL. VI. no. 32.
Y
1(V2 Original Communications .
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>
the absorbents in removing the various exudations. Its power of increasing vascular action is further evinced by the febrile commotion it excites in the system, and the buffed blood under its influence ; effects, however, when they occur, that evince its contra-indication in practice.
“ In thus viewing its operation, its employment in cholera, would appear in various points of view, we might almost say, specific in the cure of this disease, and which I believe it to be, aided of course, by such remedies as circumstances require to further its action ; and in the removal of symptoms, as effects, arising out of the continuance of the disease. With the first of these intentions, both local and general, the more ordinary stimuli are indicated ; such as external heat and friction, aided by the recumbent posture ; and of internal administration, ammonia, warm spirit and water and the like. And with the second intention, stimulating saline clysters, with the view of increasing serous exudation, and by consequence, the removal of congestion from the mesentric and gastric vessels, as well as from the brain ; and thus aiding absorption of our remedies from the sto¬ mach and bowels. The experiments of Majendie having proved, that absorption from all the surfaces, went on in the inverse ratio with vascular distention ; and they may be resorted to with the further intention of tranquilizing the stomach. With the same intentions, added to some others, blood-letting becomes a remedy of great im¬ portance ; it would appear, by the removal of oppression from the capillary vessels, to afford direct aid in their excitement, or neces¬ sarily to increase the emulation through them, as verified in daily experience, the blood flowing in common phlebotomy, becoming after a certain loss, of a brighter colour ; which can only happen, from the removal of resistance from the veins, to its ingress from the arteries. It is hardly necessary to add, the more obvious indications for blood¬ letting in the second stage of the disease. It must, however, in the employment of this remedy be carefully borne in mind, that one of the essentials to the heart’s action, would appear to be a certain de¬ gree of distinction ; that in a disease like the present, after its ope¬ ration a certain period of time, from the congestions that ensue, there remains but little blood circulating through the heart ; hence the small weak pulse, which clearly prohibits its use, as I know by fatal experience. That it is an object with Europeans in general, I am of opinion, and the more robust among the nations of India, wherever there is no absolute prohibition to its employment, to practise it, at the earliest stage of the disease, whilst the pulse admits of it ; as it is a remedy judiciously resorted to, that general experience leaves most ample testimony in favor of ; and which is most obviously indi¬ cated with the intentions specified. But in saying thus much in its favor, I must add, my most solemn protest, not only against its indis¬ criminate employment, but in any one case, usque ad deliquium, which has been the advice of some, or to an extent bordering thereon. That to adopt it successfully, we should draw it from a small orifice.
Mr. Searle on Cholera. — Reclamation.
163
the patient being in the recumbent posture, at the same time with our finger on the pulse, that its effects may be carefully watched, carrying it to an extent limited alone, by the constitution of the patient on rising of the pulse under its loss ; or arresting it, should the pulse flag under the operation.”
“ As theory and successful practice both operate in my mind against what I believe to have been too common, the exhibition of opium in this disease ; this becomes next the subject of consideration, and the indications for its employment are pointed out. A detailed treatment follows : in support of which, numerous cases are recorded in the Appendix. Added to which, is an Essay on the Vital Tem¬ perature and Nervous Energy, in which, we have endeavoured to show the nature, source, and distribution of the latter ; and the con¬ nexion existing between the mind and the body.”
“ In submitting the above extracts, which may be considered a pretty fair outline of the work, I shall content myself ; leaving the merit of the publication to the attention and to the judgment of your readers. I have only to add, that I was constrained to its publication by a sincere and conscientious belief, that I could throw much light upon a benighted subject; having not only had a great deal of expe¬ rience in the treatment of the disease during twelve years, but from having also been the subject of its attack more than once during that time. And I may notice, recovered from it, which has not been the lot of many in the profession, nay, without arrogating any particular merit to myself, be allowed to have attained to a degree of experience, which others who have written before me on the subject, can lay no claim to.
“ With which observation I shall conclude,
“ Subscribing myself, Sir, your most obedient Servant,
“ Charles Searle.”
106, Great Russell-street, January 12th, 1831.
BIBLIOGRAPHY.
MIDWIFERY.
1 . On the follicular origin of some vaginal tumors. By George Oakley Heming, Esq. Member of the Royal College of Surgeons, London. — Sir Astley Cooper has, in a very interesting paper, shown that some encysted tumours consist in enlargement of cutaneous fol¬ licles; and in the course of his work upon hernia, that gentleman has described a similar tumour originating in enlargement of a mucous follicle, situated just below the meatus urinarius in women.
It has not, I believe, been hitherto conjectured that some of those tumours which are known occasionally to occupy the pelvis and ob¬ struct parturition, have a similar origin. This fact appears, however,
164
Bibliography .
to be distinctly established by cases which have fallen , under my ob¬ servation; and it is the more important, because it immediately sug¬ gests the propriety and safety of the treatment by free incision.
I have carefully examined the bodies of two women in whom I found tumours of this description projecting into the vagina; in one there were two of these tumours, in the other there was a single one as large as an egg. On a minute examination of their internal structure, it was evident that they consisted of obstructed lacunse, which had thereby become dilated into a cyst, and distended by a gelatinous fluid. I was enabled 1o trace distinctly in the smallest tumour a continuation of the mucous membrane of the vagina into the tumour, and a reflection of this membrane forming the lining to the latter. I can have no doubt that the tumour in Mrs. Hollings¬ worth, the particulars of which I am about to detail, was of the same nature. Mr. Vincent as .well as myself was convinced of this fact; and it is probable that the greater number of those tumours which obstruct parturition, and wdiich have been described by the authors who have written on this subject, weie of similar origin. If this be the case I think no one would doubt that when they existed in la¬ bour so as to obstruct the descent of the child, the best practice is to evacuate, and thereby diminish them by a very free opening.
This view of the subject is further confirmed, if that were neces¬ sary, by the history of the cases of this kind which are recorded. Perfect, Denman, Park, Merriman, Davis, and Drew, have each de¬ scribed cases in which tumours were found between the vagina and the rectum at the commencement of labour, which, from their bulk, afforded greater or less impediment to the passage of the child. Some of these tumours were proved by examination after death to have been diseased ovaries; others were concluded to have been ovaries, although sufficient proof of this fact was wanting. But in others the histories of the cases show that they cou’d not have been ovaries; but they leave the nature of the tumour in Cvmiplete obscurity.
Some which were not opened disappeared spontaneously after de¬ livery, leaving the practitioner to conjecture what they could have been. Others which were opened through *the vagina or through the rectum, discharged a bloody serum w ith membranous flakes, and became thereby collapsed; others, dui mg ?„n attempt to lift them above the brim of the pelvis, disappeai ed with a sensation of burst¬ ing; and one, an account of which is given by Dr. Drew in the first volume of the Edinburgh Medical and Surgical Journal, was extir¬ pated by an incision in the perinmum. In this doubtful state of our knowledge concerning the nature of tumours which are not of unfre¬ quent occurrence, which, when they* do occur, occasion so material an impediment in the process of parturi ion, and about the nature and treatment of which the minds of practitioners are so very unset¬ tled, it is important to establish the fact of the follicular origin, and safe treatment of some of them by incision.
Besides the proof of the first of these facts already given from dis¬ sections, I am enabled to add that of the second by a case which fell under my care some time ago.
Midwifery.
165
Mrs. Hollingsworth came to me in April 1822* with a tumour in the vagina, which a surgeon whom she had previously consulted told her was prolapsus uteri. I found an oval tumour situate between the vagina and the rectum , its attachments to either of these parts were so loose, that I could, by putting my finger beyond it, hook nearly the whole of it out of the vagina. It could not b q prolapsus, for the neck of the uterus could be felt above it in its natural situation ; and the same circumstance, together with the absence of the symptoms of pregnancy, proved that it could not be retroversion of the uterus. As the tumour, from its situation and bulk, was. very inconvenient,, the patient wished to have it removed ; but before doing it, I advised her to consult Mr. Vincent, who agreed with me in thinking that this might be done with safety. I therefore proceeded to perform the ope¬ ration. On cutting into the tumour, I found that it consisted of a cyst containing a considerable quantity of glairy fluid. This was eva¬ cuated, the cyst was left in its situation, and the patient was well in a few days. Three months elapsed, at the end of which time the pa¬ tient came to me again, stating that the tumour had returned ; that it was considerably larger than the first time she applied to me ; and that she wished 1 could remove it entirely. This I did by simply dissecting it out. The operation was attended with very considerable haemorrhage, which, however, was stopped by plugging the vagina with lint, and in three weeks she was quite well.
The great point is the diagnosis. This may be distinctly esta¬ blished by carefully tracing the origin of the tumour. The con¬ duct of the practitioner may then be both prompt and confident. A free incision at the period of parturition, and excision at any other time, will safely relieve or cure the patient. — Edin. Med. $ Sur „ J.
SURGERY.
2. Operation for restoring the Columna Nasi . By Robert Liston, F. R. C. Surgeon, one of the Surgeons to the Royal Infirmary, Lec¬ turer on Surgery, &c. — Case I. More than seven years ago 1 was consulted by Mr. M., then aged 16, on account of deformity occa¬ sioned by loss of the columna nasi, of the cartilaginous septum, and of part of the osseous septum, in consequence of external injury. At that time I proposed, as soon as the discharge had ceased, to furnish him with a new columna from the upper lip, and had several conver¬ sations with him and his friends on the subject. The proposal, how¬ ever, was not acceded to, and I lost sight of Mr. M. till the begin¬ ning of 1828. In July 1828, I performed the operation as originally planned. The patient’s head being held backwards, the under sur¬ face of the point of the nose was pared, so as to present a raw and concave surface; a bistoury was twice passed through the upper lip, close to the root of the original columna, and each time carried for¬ wards to the mouth in a straight direction, and with little sawing motion, so as to include a slip about a quarter of an inch in breadth. This slip, composed of skin, mucous membrane, and the interposed tissues, was then deprived of its prolabium, and elevated without
156
Bibliography .
twisting, so that its oral margin was placed in contact with the raw surface on the tip of the nose ; and in this position it was retained by a point of convoluted suture, a pin being passed obliquely through the point of the nose and the upper part of the new columna. The raw edges in the wound of the lip were brought into accurate apposition by two points of twisted suture, as in the operation for harelip.
The pins and ligatures were removed after a few days, and adhe¬ sion was found to be completed. The lip, which before was too full and dependent in the centre, had united with very little mark, and was materially improved in appearance. The union of the upper por¬ tion of the slip was also perfect ; and by supporting this part by a small round compress, and carefully plugging the nostrils, so as to distend the alse, the patient’s appearance was totally changed. The point of the nose could not fall downwards ; the alse were not shrunk and approximated to each other, but tense and natural ; and the cavity of the nostrils was not exposed, presenting the appearance of a dark and foul sore, but hid and protected by the firm and fleshy new columna. The patient, instead of being constrained by horrid de¬ formity to confine himself to his house and surrounding grounds, was able to mix in and enjoy society, without its being observed that any operation had been performed to improve his countenance. That part of the membrane of the mouth forming the outer surface of the new columna, remained reddish for some time, but by exposure gra¬ dually assumed the same colour, and apparently the same structure, as the surrounding skin.
Case II. — Anna Riley was admitted into the Royal Infirmay on the 10th of August 1828. There was very copious and foetid dis¬ charge from the nostrils; the triangular cartilage and columna nasi were completely destroyed ; and the inner surfaces of the alae exten¬ sively ulcerated. The point of the nose had become quite flat and depressed, from the loss of its natural support. The disease was of six months’ duration, and commenced without evident cause.
“ On the 7th of October, ulceration had ceased, and I formed a new columna, in the same manner as has been already described. The parts united by the first intention, and the operation succeeded perfectly.
“ On the 27th she was dismissed with her features greatly im¬ proved.
“ Case III. — Mary Anne Love, aged 11, was admitted about eighteen months ago, labouring under lupus. The alse of the nose, the upper part of the lip, and the inner surface of the nostrils pre¬ sented one continuous surface of angry ulceration. The columna nasi and part of the cartilaginous septum were destroyed, and the point of the nose was flattened and depressed. The discharge from the ulcer was acrid and highly offensive, and the countenance was very much disfigured.
The disease had existed for six months previously to her ad¬ mission ; and during that time various applications had been em¬ ployed with the view of checking the ulceration, but without effect.
Surgery .
167
** In the Infirmary means were taken to improve her general health, and the sore was touched occasionally with spirit of turpen¬ tine. Under this application the ulceration seemed to be arrested for some time, and the aspect of the sore began to improve ; but the benefit was temporary, and the liniment, having lost its influence over the irritable surface, was disused. A solution of the nitrate of silver was then employed, and that also, though at first beneficial, gradually became inefficacious. Solutions of the sulphates of zinc and of copper were afterwards had recourse to ; and by changing the above applications, according as each became inactive, the sore was brought into a healthy state, and the process of reparation com¬ menced. The topical remedy which all along proved of most ser¬ vice, and under the use of which the parts were ultimately brought to cicatrize, was the spirit of turpentine.
By the middle of last May, cicatrization was almost complete, and I prevailed on the patient to have her deformity removed by the formation of a new columna. The operation was performed in the same manner as in the preceding cases, and adhesion was completed in both the nose and lip in two or three days. The columna was supported by compress and bandage, and the alee were kept distended by dossils of lint.
Ulceration has not returned ; and the margins of alee, which were not quite healed previously to the operation, are covered with thin crusts, and apparently cicatrizing. The change in her appearance is very flattering, and promises to be still more so when oedema leaves the part.
Case IV. — In the summer of 1827, I performed the Indian opera¬ tion for restoration of the nose on Charles Thorne, and gave some account of his case in the 92d number of this Journal. I then stated that the operation had completely succeeded, except in the columnar part, and that I intended to repair that deficiency as soon as the patient would submit to farther procedure. To this, however, he was averse, and left this part of the country.
In August last he again presented himself, and was now anxious that the operation should be performed, as the point of the nose had necessarily fallen much down from want of mesial support. I made him a new columna (the third he had had) from the upper lip, hav¬ ing previously elevated the point of the nose as much as possible. The parts adhered quickly and firmly, and he left the Infirmary much pleased with the support and improved appearance which the new feature of his countenance had obtained .
Case V. — Mr. R. H. enjoyed good health till April 1827, when he had a smart attack of tertian ague, which yielded to the use of sulphate of quinine. In the following August, after severe mental exertion, he complained of pain in the head and general indisposition. He was advised to abandon professional pursuits for a season, and went to Brighton, where he was seized with violent pleurisy. Early in October he had another attack of tertian ague, with severe pain in the right side of the head. Aguish symptoms continued to harass
168
Bibliography.
him till December, after which he remained well till April 1828, when he was again affected with ague, pain of the head, debility, &c. and these symptoms returned in January following.
“ In July, 1829, he was sent to Leamington, and while there encrustations began to form in the nostrils, and on the separation of the crusts foetid discharge occurred. The discharge continued till the latter end of September, when he went to London. There his case was pronounced to be one of secondary syphilis, though the patient declared then, and declares still, that he never had pri¬ mary symptoms ; and, accordingly, he was ordered blue pill, sarsa¬ parilla, and eventually mercurial friction. His mouth soon became affected, and the salivation was very profuse. In October the bones of the nose and palate began to exfoliate, and the patient became much reduced. Early in November severe inflammation of the eye and of the side of the face supervened ; and Mr. H. was bled, purged, and starved. The inflammatory action was soon subdued, but was followed by a violent attack of diarrhoea, which brought the patient very low. From this time he regained strength gradually, and now he enjoys excellent health.
“ He applied to me in August last. The exfoliation has been extensive, and caused apparently by the abuse of mercury. In the posterior part of the palate there is a large deficiency, which the patient is obliged to supply by a metallic substitute ; and the lower part of the osseus septum is destroyed.
“ The cartilaginous septum and columna nasi were gone, and the nose lay quite flat on the face, with its wrinkled alee sunk on the floor of the nostrils, and its point adhering to the upper lip, where the root of the columna had formerly been.
“ The first thing to be done in this case was to prepare the parts for the columnar operation ; and accordingly, I divided the attach¬ ment between the point of the nose and the lip, removed the ruin¬ ous remains of the columna, and separated some adhesions within the nostril that had formed during the cicatrization, raised the apex of the nose, and distended carefully its alae. By these means even, the appearance of the patient was much altered, and he began to be satisfied with what had been done. He was persuaded, however, to get a more durable and elegant support for the parts than dossils of lint, and underwent the columnar operation on the 31st of August.
In this case, as in the others, union took place by the first intention ; and, I need scarcely add, that the result is very satis¬ factory. — Edinburgh Medical and Surgical Journal.
(Literary Intelligence, Books for Review, &c. in our next.)
All Conjmunications and Works for Review are to be addressed to the care of Messrs. Underwood* 32, Fleet Street; or to the Editor, at his Residence, 61, Hatton Garden. ,
THE LONDON
. - ■& y \ t . b. v v a,
MEDICAL AND SURGICAL JOURNAL.
No. 33.
MARCH 1, 1831.
Vol VI.
CRITICAL REVIEW.
I. — The Dublin Hospital Reports and Communications in * Medicine and Surgery. 1830, Vol. V. — ( continued .)
We resume, with much pleasure, our analysis of this very important work, every page of which is replete with valu¬ able information. We have noticed some of the papers in our preceding1 numbers, and now proceed to place the suc¬ ceeding ones before our readers. The paper which stands next in order is entitled, Practical Observations on certain Diseases of the Anus and Rectum.” By A. Colies, M. D. Professor of Surgery in the Royal College of Surgeons in Ireland.
This essay is one highly deserving of attention and study, as it is the production of a gentleman of the highest emi¬ nence, and the most extensive experience, both in private and in hospital practice, and especially as it controverts the general idea as to the frequency of stricture of the rectum. We are glad that a surgeon of such great celebrity as our author, has arrested the extravagance with which certain writers have of late referred every disease to stricture of the rectum. He also states that bougies seldom, if ever, cure the disease, and are used in numerous cases where no such disease has existed, and with fatal effects in some in¬ stances which had fallen under his own extensive observa¬ tion. His remarks are so important that we cannot but give them at length, as they cannot fail to render science and suffering humanity a great benefit.
“ Organic stricture of the rectum. — This disease spares neither sex nor rank ; it most frequently attacks those who are about the me¬ ridian of life ; sometimes, however, it afflicts children as early as the seventh or eighth year of their age. I have not met with any in¬ stance where it attacked a person at or beyond sixty years of age.
VOL. VI. no. 33.
z
170
Critical Review.
“ In some few cases the patient appears to be aware of the mo¬ ment of the first attack of this disease ; for he tells us, that without any previous illness the bowels at a certain period suddenly became costive ; that for the purpose of relieving them he took large and re¬ peated doses of physic for three, four, or five successive days ; that at length his bowels suddenly gave way and a very severe purging took place, which having continued for a day or two, was then succeeded by those symptoms which attend the disease when fully formed.
“ Many patients, however, cannot give any account of the first approach of this disease ; they merely state that they have been for many weeks, months, or years, subject to it ; that the symptoms from the commencement were pretty much the same as those they now labour under, but perhaps not quite so severe and urgent.
“ When organic stricture is fully formed (by questioning him,) we learn from the patient, that in the course of each day he has many and sudden calls to stool ; that at each of these he is obliged to strain very much, and that the straining, which is not followed by any severe pain, produces a discharge of not more than a table spoonful of mucus, which is sometimes streaked with blood, and very rarely mixed "with a small quantity of feces ; that these evacuations are generally attended with a copious discharge of wind, and that as soon as the evacuation has taken place, he feels free from pain or uneasi¬ ness : the remission however is of short duration, as he is soon again compelled to undergo the same unavailing distress. The number of these discharges are seldom less than from seven to twelve during each day and night ; they do not take place at regular intervals, but generally a considerable number occur in quick succession, and then are followed by a pretty long interval of ease. The greater number of these evacuatious are devoid of feces ; a feculent stool is passed perhaps once in two or three days ; the feces are then found passed in short pieces and of very reduced dimensions, not larger than a full- sized cathether, and in quantity not equal to what is passed in an ordinary evacuation by a person in health, yet after each feculent stool the patient feels much relieved.
‘ ‘ There is not the slightest prolapsus ani with any of these eva¬ cuations.
The bladder is in some cases slightly affected ; the patient then complains of a little difficulty or delay in passing his urine.
In some cases a fistulous opening forms in the nates or the peri- nseum, which will admit a probe to pass into the rectum ; it yields a moderate quantity of healthy pus. The fistula undergoes little or no change from the time of its first appearance, even until the death of the patient. In some cases, especially in females, I have known the number of these fistulous openings to amount to twelve or twenty. The majority of cases of stricture of the rectum, however, are unat¬ tended by fistufe.
Although this state of daily suffering proceeds with the most unvarying regularity, not only for weeks and months, but even for manY years, yet the constitution of the patient does not seem tosym-
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pathize- in the slightest degree for a long time ; not only do his colour and appearance proclaim the enjoyment of good general health, but even the most strict examination cannot discover in any of the functions the slightest deviation from health, except those above men¬ tioned.
“ After a lapse of time, however, which is very different in differ¬ ent cases, a peculiar paleness of countenance and wasting of flesh announce an inroad on the constitution ; those symptoms are soon followed by night-sweats, and now the patient complains of uneasi¬ ness about the sigmoid flexure of the colon, which soon extends along the left colon.
“ In this stage of the disease, it too frequently happens in females, that a communication is formed between the rectum and vagina, which causes the greater part of the entire of the faces to pass through the latter. In men, but more rarely, a similar communica¬ tion is established between the rectum and bladder.
“ As the disease draws towards a close, the patient begins to suf¬ fer much more serious distress from the state of the rectum, for in addition to the frequent unavailing efforts to discharge the bowels, he is troubled on the slightest exertion, such as coughing, sneezing, or voiding urine, with an involuntary discharge of a thin brownish fluid of a muco-purulent nature. After some time this peculiar discharge comes away in the morning, the moment the patient rises from his bed. In the last stage of the disease, this discharge comes away unceasingly without the consciousness of the patient, and the faeces will not pass unless in a perfectly liquid state.
“ This aggravation of local distress is accompanied by a corre¬ sponding decline in the general health ; his appetite fails, thirst be¬ comes very urgent, emaciation proceeds rapidly, hectic fever becomes fully formed, though more marked by profusenight sweats than by mid¬ day or evening exacerbations ; and now the patient, extenuated to the last degree, seems to be carried off as much by the exhausted state of his constitution as by the torments of the local disease.
“ Sometimes in the advanced state of this disease, the patient is seized with symptoms of peritoneal inflammation, wdiich puts a speedy termination to his sufferings, and he is suddenly carrried off. In such cases, on examination after death, we discover that the pro¬ cess of ulceration had opened the intestine immediately above the stricture, and that through this opening a portion of faeces had passed into the cavity of the abdomen.
“ In some very fewr patients, the hectic fever seemed to have been arrested by the warmth of summer weather, but only to run the remainder of its course with unusual precipitancy on the approach of winter.
“ Among a considerable number of patients afflicted with this disease, I have had an opportunity in two instances only, of meeting with it in its incipient state. In both of these, the patient complained of different symptoms of irritation of the rectum, frequent stools, dis¬ charges mixed w ith mucus, and certain feelings of uneasiness : on
172
Critical Review.
examination by the finger, a thickening and slight projection of the gut was felt at a small spot on one side ; this morbid alteration spread gradually round the entire of the canal, and extended along it only to a small distance ; hut until the morbid derangement of struc¬ ture had almost entirely performed the circle of the intestine, the patient did not exhibit those symptoms which I consider as the com¬ mon and inseparable attendants on stricture of the rectum. How¬ ever constant in their attendance, or unvarying in their course, may be the symptoms of this disease, yet will the surgeon desire to be confirmed in his opinion by manual examination. Proceeding to make this examination, we often observe at the orifice of the anus the following appearance, which is indeed almost always present when the disease is seated near to the external sphincter, namely, at each side of the anus a small projection, which on its external surface appears as a mere elongation and thickening of the skin, but in¬ ternally presents a moist surface, not exactly like the lining mem- brane of the gut, nor yet can we say that it is ulcerated ; these two projections lie close together below and divaricate above, presenting a resemblance to the mouth of an ewer. Whenever this external appearance exists, I feel almost certain of finding a stricture of the rectum before the finger is pushed as far as the second joint into the gut. In some cases, however, this external mark has not been present.
“ When the stricture is situated pretty high up, the portion of gut interposed between it and the anus is found to be in a perfectly healthy state ; but when the finger arrives at the stricture, it is arrested by the narrowness of the canal, which will barely admit the point of it ; if now a slight degree of force combined with a boring motion be employed, the finger may be pushed through the thickened and indurated part, and will then (as well as its benumbed condition permits it to feel) find that the gut just above the stricture is in a very healthy state. The extent of the stricture, however, is very variable ; sometimes it is little more than a mere ring, but at other times, it extends along the canal as high as the finger can reach.
“ I have not yet met with any instance in which the intestine was strictured, only by means of bands thrown across its canal ; such cases I presume must be very rare.
“ In a few instances the stricture has been seated so high in the gut that it could be barely touched with the point of the finger, until the patient was desired to “ force down,” and then a satisfac¬ tory examination of it could be made.
Cases of this disease examined after death, present all the coats of the intestine veiy much thickened, except the peritoneal tunic, which when closely inspected is found to retain its healthy structure and appearance ; the muscular, cellular, and mucous coats are much thickened, the latter is moreover hardened and raised into irregular ridges, or folds, but without any ulceration.” — p. 139.
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1 73
The diagnosis between this disease and those of the pelvic visera is graphically given. Cancer of the rectum possesses many of the symptoms of the affection under notice, but the leaden colour of the countenance and examination of the rectum, enable the surgeon to make a proper distinc¬ tion. In cancer, the same hard feel is often perceived, but if the examination is made after the lapse of some weeks, a certain portion of the hardened wall of the intestine will be found destroyed. In a rare form of scirrhus of the uterus and vagina, in which the latter passage is almost obliterated by the thickening of the parietes, a train of symptoms not unlike those before us is observed, but examination of the finger will remove all doubts ; the same test applies to en¬ larged prostate gland. Again, ulcer of the rectum may be detected, if low down, by expanding the anus, or by the finger, and a tumour in the pelvis can only press upon the canal laterally, and that the coats of the bowel are soft and healthy. Lastly, the calibre of the gut above the sphincter may be filled up with folds of the lining membrane, and in such cases the health is perfectly good. This fact is further attested by Mr. Houston in a subsequent paper, in which he describes four such folds, and illustrates them by well- executed engravings. We now arrive at the treatment of stricture of the rectum, which, for the gratification of those who cure it so effectually, we must insert. For ourselves, we can only observe, that the testimony of such an able and justly celebrated practitioner as our author, weighs more with us than ten times that of those who entertain the opposite opinion.
“ The treatment, by bougie, usually recommended in this dis¬ ease, appears to be well calculated to alleviate the sufferings of the patient. I feel confident, however, that a perfect cure of the organic stricture of the rectum has not been effected by any plan of treat¬ ment hitherto employed. I have paid great attention to the use of bougies, and yet I must candidly declare that hitherto I have not been so fortunate as to have effected a permanent cure in a single in¬ stance ; nor have I had the good fortune to meet with any patient whom I knew to have been afflicted with this disease, who had been cured by another surgeon. No man can he more ready to proclaim and boast of our control over diseases, and therefore I trust that this de¬ claration will be received by my brethren as it is intended, viz. that it will cause them to consider the history and nature of this intracta¬ ble disease, and to engage themselves earnestly in discovering some other plan of treatment which will gain the object of our anxious wishes.
174
Critical Review.
" I have not been contented with applying the bougie simply; I have often made it at the same time the means of conveying ^va- rious applications to the seat of disease. For this purpose I have employed bougies, with a deep groove running spirally their whole length, so that the ointment employed should not be rubbed off the instrument by the tightness of the anus and its sphincters.
“ I have nothing cheering to offer on the treatment of this disease; I have given the fullest and fairest trials to various internal medi¬ cines.’’ — p. 143.
Mercury., arsenic, hemlock and iron, were repeatedly urged to the fullest extent, without any benefit. Large quantities of mucilage, blue pill, with double the quantity of pulv. ipecac, c. have occasionally afforded a temporary alleviation. The puffing of certain members of the profes¬ sion on the frequency of the disease, and their infallibility in curing it, is rank empiricism, and highly disreputable to the dignity of true science. Dr. Colles next alludes to spasmodic stricture, which is so confidently described by modern authors, which the}7 so effectually cure by bougies. As his practice is the first in Dublin, and has been for many years, and probably more extensive than that of the whole writers on the subject before us, his opinion is entitled to confidence and respect. And here it is, gentle reader —
“ I must, however, frankly declare, that in the course of a pretty ex¬ tensive practice, the most extensive for the last twenty years, I have not been able to discover a single case of a disease corresponding to the de¬ scription of the spasmodic stricture of authors. I therefore feel a considerable share of scepticism on this point. Indeed I not only doubt the existence of any such disease, but I can recollect many cases in which this suspected condition of the rectum has yielded to the ordinary means for improving the state of the stomach and bowels, especially when combined with positive assurance to the patient that no such disease had existed : by this assurance alone we can sometimes remove all his anxiety and apprehension on this sub¬ ject.” — p. 145.
The symptoms which are stated by authors to indicate these diseases of spasmodic stricture, or of organic stricture seated beyond the reach of the finger, will, upon investigation, be found very falla¬ cious ; even supposing all those enumerated should be found combined in the same individual : — thus, we are told, that in such cases we arrive at a knowledge of the existence of these diseases by examina¬ tion with a soft bougie, by the very diminished diameter of the faeces and by the admixture of blood or mucus with the stools.
The soft bougie, however, may, and very generally will receive an impression irom the projecting ridge of the sacrum ; for it is by
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no means an easy matter to pass a rectum-bougie so that it shall not be arrested at this point, and consequently receive an impression from the projecting bone.
“ The diminished diameter of the faeces too, may be produced by any irritation in the rectum, which will cause it to act frequently, and with increased contraction ; this is often experienced even in per¬ fect health.
“ The admixture of mucus or blood with the faeces, is also fre¬ quently met with in other and very different affections of the bowels.
“ To prove the futility of these symptoms as a discriminating test, and the danger of being misled by them, I shall briefly state the out¬ lines of one case only.
“ Mr. - , aet. ann. 36, who had lived rather fully and freely,
applied to me six or seven years ago under the following circum¬ stances : — he said that he had been, for the last two years, affected with stricture of the rectum ; that in the preceding year he had an attack of dysentery, and that since that time he found the stricture worse ; the diameter of the faeces diminished, calls to stool more fre¬ quent, and seldom passing without an admixture of blood and puru¬ lent mucus : he was losing flesh rapidly, his appetite and rest were very indifferent, and his mind was miserable. Having examined the rectum by the finger, I expressed to him my hopes that he was not affected with such an intractable malady, by which I very nearly forfeited his confidence,; for he told me that he had applied to a very eminent physician in the north of England, and then to another in London, both of whom assured him of the existence of this disease ; and lastly, he had been under the care of the late Mr. White of Bath, who furnished him with the bougies he was then using, and immediately introducing one, he shewed me the mark which the stricture impressed on it. My most urgent remonstrances could at this time only obtain from him a promise that he would not use the bougie as frequently, or for as long a period as usual. By small doses of blue pill, combined with compound powder of ipecacuanha and an enema of olei oliv. cum subacet. litharg. liquor, the irritation of the bowels was mitigated in the course of eight or ten days. Availing myself of this favourable change, I again urged him to lay aside the bougie, and with some difficulty obtained a truce for ten days ; within this period it fortunately happened that he passed one con¬ sistent motion, in which the faeces were of a large diameter ; after this I had but little trouble in prevailing on my patient to lay aside altogether the use of the bougie. By persevering in the internal use of mild bitters and bark, and injecting every night an enema, con¬ sisting of ol. oliv. and unguent, supernitrat. hydrargyr. into the rec¬ tum, his disease was finally cured, and since that time his bowels, though sometimes deranged by ordinary complaints, have never suf¬ fered from a return of the former affection, and he has enjoyed very good health.
“ When we consider the irritable state of this patient’s bowels, the wasting of his flesh, and the wretchednes of his mind, we may, I
176
Critical Review.
think, reasonably believe that a further perseverance in the use of the bougie would have rendered his disease eventually fatal; yet here were present all those symptoms which are said to indicate stricture high up in the rectum ; the event has proved that no such disease did exist. And here let it be remembered, that serious mischief has occasionally been committed by rude attempts to dilate a supposed stricture at the top of the rectum or termination of the colon, for I have known two cases where peritoneal inflammation and death speedily ensued ; and I have heard, on the best authority , of two similar instances . ’ ’ — p . 149.
Our author considers spasmodic stricture of the sphincter ani a very rare disease. He met with only one case, which was pronounced stricture of the rectum, by an eminent provincial surgeon, another in Dublin, and a third in Lon¬ don. The patient had suffered from two to three months at a time, and then he enjoyed immunity from it for four months. By a minute examination, our author was satisfied it was only a spasmodic condition of the sphincter ; and to convince his patient that his fears were unfounded, he passed a wooden globe, three inches and a half in cir¬ cumference, mounted on a rod of whalebone, et ten inches up the sctotum, without having met with any obstruction.” Here is a salutary lesson for those worthy surgeons who would have tortured this unfortunate patient to the brink of the grave, had he had the misfortune to submit to their prac¬ tice. That stricture of the rectum occasionally occurs, every man of science will acknowledge, but that it is the fons et origo malorum, as certain interested individuals lead the public to believe, is a species of knavery which merits the indignant reprehension of every scientific practitioner-.
Dr. Colies next describes f,r vascular tumours of the rec¬ tum,” or, what are denominated “ haemorrhoidal excre¬ scences,” a term he deems objectionable. He describes their pathology in these words : —
I had an opportunity of examining the structure of these tumours in a patient who had died of another disease. On slitting up the rectum I saw three blood vessels, each as large as a crow- quill, running for some way down the intestine, and then dividing into a number of branches ; these vessels ramified very profusely, and each seemed by interweaving of its branches to form one of these tumours. The trunks and branches were covered only by the lining membrane of the intestine.”
With respect to the treatment, he prefers excision to liga¬ ture, as the latter may be followed by tetanus, and the haemorrhage from the former can be readily controlled. His
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mode of operating and suppressing haemorrhage is extremely judicious : — ■
“ The following mode of operating I have found to be uniformly and permanently successful, and it is considerably less severe than that generally recommended. The tumours having been made to protrude by means of a purgative injection, I direct my assistant to pass a hook or common tenaculum through one or two of the largest, while I seize another lengthwise with a polypus forceps, then drawing the tumour a little towards the axis of the gut, with a large pair of scissors passed behind the forceps, I cut off all that portion which is engaged between its blades. I then proceed in the same manner to remove those tumours which the assistant holds transfixed by the hook. By fastening and drawing out the tumour with the forceps, we much facilitate its removal by the scissors ; pro¬ ceeding in this way, I guard against these tumours being drawn up within the sphincter, as soon as the first had been removed. I do not think that any case will require the removal of more than three of these tumours, and not unfrequently the cure will be ensured by cutting off only two of them. When the operation is finished, the protruded parts generally lie within the sphincter ; should any part remain out, it must be completely pushed in with the finger. In order to guard against the danger of hsemorrhage, I take care not to prolong my incision higher on the bowel than what I conceive will, when replaced, lie within the sphincter ; for if wre cut the gut higher up, this part, when returned, may bleed freely, from not having any surface closely opposed to it. Besides, we know that by cutting higher up we are in danger of cutting the trunk of the vessel, instead of confining our incision to the tumour which is composed solely by the convolutions of its very minute branches.
“ I should be afraid to adopt Mr. Hey’s method of cutting away all the protruding tumours, together with the skin at the verge of the anus, lest the patient should afterwards occasion the distress which a too contracted state of this outlet must occasion ; for in one case, where for the purpose of extirpating warts, a ring of skin at the verge of the anus, had been cut away along with these excrescences, the condition of the patient was rendered truly miserable.”
He terminates his paper with an account of a <( peculiar kind of ulcer,” which he treats as follows : —
“ The remedy for this disease is, to introduce into the rectum a convex-edged scalpel, and make an incision through the entire length of the ulcer, continuing it through the sphincter and dividing the verge of the anus ; as soon as this wound has got into a state of sup¬ puration, we should dress it and the ulcer, with some stimulating ointment introduced on a dossil of lint. The case goes on without interruption, although it is rather tedious and slow of healing. I need hardly say, that the final cicatrization will be promoted by the occasional application of the nitrate of silver.”
VOL* IV. no. 33.
A A
178
Critical Review .
The succeeding paper is by Dr. Houston, entitled <e Ob* servations on the Mucous Membrane of the Rectum.” It is an excellent appendix to that we have just concluded. The author, who is demonstrator and curator of the Museum of the Dublin College of Surgeons, in preparing specimens of the pelvic viscera, which he has well delineated in an ano¬ ther work, discovered valvular folds in the rectum, which he supposes are destined to support the weight of the faeces, and thus preventing too much pressure on the sphincter. His pathological views are well worthy of attention, and the anatomical description is as minute as possible. We regret that our space prevents us from noticing’ his remarks in de¬ tail, but we must confine ourselves to those on the patho-
logy.
“ Considered in reference to disease, the valves or shelves thrown across the cavity of the intestine are fraught with still more import¬ ance. They may possibly become the most frequent seat of that morbid alteration of the inner membrane termed stricture. I have not, however, examined the subject with a view towards determining this question, but there are several facts which give probability to the conjecture. In the first place, this disease is generally confined at its commencement to a portion of the circumference of the gut; and, secondly, the seats of this occurrence correspond very much to the places where these valves are most frequently found, viz. near the orifice, about three inches up, or at the top of the rectum. There is still another more weighty reason why the surgeon should bear in mind the existence of these folds, that he may not mistake them for strictures in the gut, a mistake which, it is to be feared, has often happened to those who have reported such numerous cases of this disease, and which, by leading them to the frequent practice of bougies, may have brought on the very malady which their instru¬ ments were intended to remove/’
Our author and Mr. Crampton propose a spiral bougie in such cases.
The next paper is deeply instructive, as it shews how liable the most eminent and talented men are to mistake. The report is entitled A case of Aneurism of the Abdomi¬ nal Aorta, with dissection and observations,” by Thomas R. Beatty, M. D. &c. The patient was a gentleman aged 33, of a robust frame and temperate habits of life, who was subject to lumbago. He complained of pain in the back, as if it were between the bowels and spine. This was increased by making a false step or any irregular motion. The pain soon extended round the abdomen, and tympanites appeared. Drs. Cheyne, Graves, and Boisragon, of Cheltenham, and
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179
Author, employed numerous remedies, with only temporary relief ; Dr. Oolles was consulted, and also Mr. Fitzpatrick, of Woolwich. The patient was next under the care of Mr. Brodie, and finally he visited Paris, where he consulted M. Andral, in conjunction with Drs. Graves and Townsend, who happened to be there at the time. The father of French pathology pronounced the case “ neurose intestinale.” Dr. Wilson Philip was next consulted, and pronounced the case one of indigestion. The unhappy sufferer finally re¬ turned to Dublin, and placed himself under the care of Drs. Graves, Townsend and Beatty. He was now attacked with violent spasms of the back and side, which forced him to cry out, and leaping from his chair, he threw himself flat on his face in bed, which afforded him temporary relief. His daily dose of black drop at this time was from 150 to 200 drops, yet he was never drowsy, nor narcotised, and once he took 285 drops. A singular effect was produced by the opium, and this was retention of urine, which required catheterism. Death at length closed the scene, and the autopsy was as follows : —
“ The body was examined on the following day in the presence of Dr. Cheyne, Dr. Graves, Dr. Townsend, Dr. Wm. Beatty, Dr. Greene, Mr. Harris, and myself. On exposure, the emaciation ap¬ peared extreme. Before proceeding to the dissection, we wished to let some of the gentlemen present, who had not attended him, feel the enlarged liver, but we were much surprised to find that no tu¬ mour could be perceived ; this, though at the time inexplicable, was afterwards satisfactorily accounted for. The thorax was now opened and the right lung was found healthy, but in the left cavity of the pleura a large effusion of blood, partly coagulated, presented. The lung was compressed, and the inferior border appeared slightly car- nified, leaving the rest of the organ healthy. The incision being car * ried into the abdomen, disclosed the viscera contained in it, the ex¬ ternal appearance of which was natural, the longitudinal fibres of the large intestine were strongly developed, the stomach adhered to the diaphragm by a small band of membrane, and the liver, which dur¬ ing life had appeared so much enlarged, was found very little in¬ creased in size, and in structure quite healthy, but the outer convex sur¬ face was marked by deep indentations corresponding to the ribs, as if it had been subject to strong pressure against them. When the in¬ testines and liver were removed, a large firm tumour was discovered about the size of the head of a child a year old, lying upon the three last dorsal vertebrae, its transverse diameter being a little longer than the perpendicular, and extending with a curved outline to the kidney on both sides, having the aorta passing down before it, in a sort of groove on the anterior surface. The artery was cut across at the bifurcation, and slit up above the tumour, by which a round well
180
Critical Review.
defined hole, as large as a shilling, was exposed on its posterior surface* a little above the origin of the coeliac artery, communicating with the tumour, which thus proved to be an aneurism of the aorta. On exa¬ mination it was found that it was covered by the crura of the diaphragm, which were expanded and stretched tightly over its surface, forming an outer coat for it, on which many fila¬ ments of nerves were observed to run. In removing the tumour, an irregular opening was discovered at the upper and left part, through which the blood found in the thorax had escaped. The aneurismal sac was deficient at the back part, and its place was supplied by the three last dorsal vertebrje on which it lay. The bodies of these were deeply eroded, but the intervertebral cartilages remained sound and entire, forming prominent white rings between the destroyed verte¬ brae. At the left side of the eleventh dorsal vertebra, an opening large enough to admit the end of a finger was found, leading into the spinal canal. The heart was small ; there was concentric hypertro¬ phy of the right ventricle, the walls of which were thicker than those of the left. The stomach and intestines were slit open through their whole extent, and with the exception of partial softening of the mu¬ cous membrane, were quite healthy. The course of the symptoms in this case, although strange, and at the time inexplicable, can be ac¬ counted for by the position and growth of the tumour, and its influ¬ ence upon the parts with which it was connected. In the com¬ mencement, when it was yet small, it produced the dull fixed pain that was mistaken for rheumatism ; and this may be considered the first stage of the disease. As it advanced in size, it gave origin to the train of symptoms in which this case differs from any that I have found recorded ; I allude to the severe suffering of pain and spasm in the tract of the alimentary canal ; this, as far as I know, did not oc¬ cur in others, but in this it was so great, that for several months it formed the whole subject of complaint, and the attention wras directed entirely to these organs ; this can be satisfactorily explained by a reference to the situation of the tumour ; it was placed in the neigh¬ bourhood of the solar plexus, and the pressure exerted by it upon this great nervous centre, at once £>roduced irritation in the whole of the organs supplied by filaments from it, and caused the ‘ ‘ neurose intes- tinale” of Andral. The obscurity in the diagnosis was caused in a great measure by this class of symptoms, but from what I have observed on the situation of the disease, it will appear they were accidental, and therefore are not to be expected in similar cases, unless the tu¬ mour occupies the same position : this may be said to constitute the second stage. The third and last stage commenced when the tu¬ mour, having by its pressure destroyed the vertebrae, opened a com¬ munication with the spinal canal ; it is marked by the occurrence of the pain and spasms of the external muscles, and parts supplied by the spinal nerves indicative of irritation of the medulla spinalis.
“ It might be expected that the pulsation of so large a tumour would have been perceptible, and thus the nature of the disease have been developed. But it is evident it was not so in this case, else some
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181
of the many physicians who examined him must have discovered it. Andral, amongst others, made a most minute examination of the ab¬ domen ; his expression on the occasion was, <c il faut vous Men palper monsieur yet he detected no pulsation. In fact, the situation of the tumour entirely precluded the possibility of ascertaining its existence by the touch, firmly bound down to the spine by the crura of the diaphragm, and protected on the sides by the ribs, it lay secure from observation. A few days before death I perceived a pulsation in the epigastrium, which, on examining more closely, I found to be that of the artery, but I could discern nothing of tumour or diffused pulsa¬ tion, and as it is usual to be able to feel the beating of the aorta in these persons, I took no more notice of it. I regret much that we were not led to employ auscultation to the spine, as I think it very probable the disease would have been thus discovered, but as there was not the most remote suspicion of the existence of such a disease, the examination was not made. The chest was examined on two occasions, before death, by two most experienced and successful stethoscopists, Doctors Graves and Townsend, and no lesion was dis¬ covered. Auscultation affords a ready means for the diagnosis of aneurisms in the limbs, in those cases in which there is no percepti¬ ble pulsation. The “bruit de soufflet,” heard on applying the ste¬ thoscope, is very striking, and points out the nature of the disease ; and it is fair to suppose that this indication would have been af¬ forded had the instrument been used along the spine.
“ The intermissions seem to be the most inexplicable part of the case ; they formed part of the grounds upon which Andral and others founded the opinion, that the disease was in the nerves; but although so remarkable a circumstance, the case is not singular in this respect, for Scarpa relates one in which there was a complete suspension of suffering, at a period of four months from the commencement of the disease.” — p. 192.
Here we must conclude our analysis for the present, and however tedious it may appear to some of our junior readers, we believe all engaged in practice will be deeply interested in these highly instructive reports. The remainder of the vo¬ lume is equally important, and will appear in a future notice.
II. — Dublin Medical Transactions. 1830,
( continued.)
A paper, entitled Observations on the Use of Instru¬ ments in cases of difficult protracted Labour, by John Beatty, M. D. &c. &c. claims especial attention, from its great importance and value. It has often struck us with sur¬ prise and astonishment, that the Dublin and London obste¬ tricians should have been so extremely fond of performing
182
Critical Review.
craniotomy. The general and universally received axiom is, that the forceps or lever should be preferred to the perfora¬ tor. In Dublin the latter is generally preferred to the for¬ mer, and this has led Dr. Beatty, an able and eminent obste¬ trician, to oppose this unjustifiable practice. In justice to the profession in the Irish capital, we must state that it is chiefly among the older practitioners craniotomy is preferred, for it appears by the recent reports of Dr. Cusack and Mr. Gre¬ gory, which we have noticed, the practice is not sanctioned by the rising portion of the profession.
Few physicians are so well entitled to discuss this question as Dr. Beatty. He has been forty-two years in extensive practice, during the first five years of which he was assistant to the late much respected Dr. Clarke, in the great Lying'- in-hospital in that city. He informs us that he has delivered III women in private practice with the forceps or lever, never observing any unpleasant result.
“ None of the mothers died — none of them had their perinseum lacerated, nor any of those evils, which are set forth as the effects of the forceps ; and still more, all the children that we had any rea¬ son to think were alive at the commencement, were bom living, and none of the whole number had any injury or mark whatever inflicted by the instrument. From this extensive experience of the value of the forceps, I think I am justified in saying, that the opinions of the authors already quoted, are fully supported by the facts.” — p. 12.
And he cites the works of Lamotte, Deventer, Chamber¬ lin, Smellie, Chapman, Sir Fielding Ould, the first Professor Dease, Merriman, Dewees, Denman, Burns, Millot, May- grier, Lachapelle and Osborne, in favour of the forceps.
Indeed he might have quoted the best obstetricians of all countries in favour of the practice he advocates. We be¬ lieve the profession have been deceived by the sophistry and metaphysical reasoning of Dr. Osborne, in his defence of the perforator and embryotomy, opinions so ably and so justly criticised by Dewees ; and which are in direct opposition to those received throughout Europe at the present period. We confidently affirm, that the weight of authority is in fa¬ vour of the forceps or lever. If we examine the records of obstetric institutions, we find that the perforator is very rarely necessary, and yet a very large majority of modern practitioners are constantly detailing cases of craniotomy. We could narrate cases in which this operation has been un¬ necessarily performed, and even by lecturers on midwifery in this metropolis. The day is not far distant, when more scientific obstetricy will and must prevail, for at length
Dublin Medical Transactions.
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those who regulate medical education have enforced its study ; the salutary effects of which will be a powerful check to unnecessary and unjustifiable operations. The ris¬ ing’ race of obstetric practitioners will discover and expose the blunders of their contemporaries and seniors, and huma¬ nity will be the gainer. Having premised these few remarks, we hasten to introduce our author’s judicious observations to the notice of our readers ; he says —
“ In every case of midwifery, the chief object to he attained by the practitioner, should be the preservation of the lives of both mother and child entrusted to his care. The great majority of cases require no extraordinary assistance, and the duty of the accoucheur consists principally in watching the progress of the efforts which nature makes, and guarding against any unfavourable accident, or deviation from the ordinary course. Unfortunately, however, some few cases do occur, in which from particular circumstances, instru¬ mental aid is required, and while we may lament the necessity for such interference, it is our duty diligently to inquire into the merits of the means proposed to assist delivery, and to select those that we find most likely to effect the purpose already mentioned, that of preserving our patient and her offspring.
£< It is of importance that every man practising midwifery should avoid as much as possible the use of instruments in delivery ; for it is certain, that if he suffers his patience to be too readily exhausted, or yields too easily to the suggestions and alarm of the patient, or her friends, he will frequently be induced to promote delivery too soon, very much to the injury of the patient, and consequently to his own character. On the other hand, he has an important duty to perform in judging of the necessity, and the proper time for using instruments, and the kind suited to each particular case, for as much or more mischief may be done by delaying their use when absolutely required, as by having recourse to them too soon. In fact, in this, as in most other situations, the man who has patience to watch, judgment to discriminate, and firmness to act, will be the best qua¬ lified to perform the duties required of him.
“ Having endeavoured, during a long and actively employed life, to regulate my practice by such principles, I have formed the fol¬ lowing conclusions respecting the comparative value of the different instruments used, in long protracted or difficult labours. And I am induced to give a faithful account of my own experience, and of such means, as I have occasionally employed, because I have reason to know that my opinions on the subject, differ from those of some of the most eminent, and justly esteemed members of the profession in this city.
“ I do not propose to enter into a detail of the causes and nature of long protracted and difficult labours ; these are so fully treated of, and explained in all works on midwifery, that it would be use¬ less to repeat them at present ; but I may observe, that the cases in
184
Critical Review.
which mechanical assistance is required, may be comprised in two divisions ; 1st, Those where there is a disproportion between the head of the child, and the passage through which it must come ; and, 2dly, Those in which, although no mechanical impediment exists, the expulsive powers of the mother are not sufficient to accomplish the delivery.
“ Under the former 'will be found those caused by the deformity of the bony parietes of the pelvis, and by disease or rigidity of the soft parts, as well as unnatural size of the head of the foetus, face presentations and transverse position of the head. And under the latter, those in which delivery is delayed by general weakness of the patient, haemorrhage, frequent faintings, convulsions, great ex¬ haustion, fever, &c.
“ To assist delivery under such circumstances, two classes of in¬ struments have been devised ; 1st, Those by which extraction may be effected without injury to either mother or child ; 2dly, Those by wffiich the life of the latter must necessarily be sacrificed. I need scarcely remind the members of an enlightened and humane pro¬ fession, that the adoption of the latter alternative, is a step calling for the most serious consideration, and one that involves an awful and heavy responsibility. The value of human life is not to be estimated by the age, nor is there in the eye of the law, either human or divine, any distinction between that of the octogenarian and the child unborn.
It matters little, therefore, what the nature of the situation is, in which a fellow-being committed to our care is placed, whether it be a fever striking him in the prime of life, or a disease requiring the performance of a capital operation, or the perils attending his first entrance into the world, it is our bounden duty to employ such means as will best insure his safety.
“ Let it not be imagined that by these observations I would inculcate, that the well-being of the mother is to be overlooked in endeavouring to save the child ; far from it, the very nature of the sentiments points out the contrary ; but what I desire to maintain is, that the life of the child in utero, is as sacred as if it had breathed, and walked, and that its destruction can only be con¬ scientiously resorted to, when every other means by which it and its parent might be saved, have been fairly tried and found inefficient.” — p. 4.
Our author describes the usual mode of applying- the for¬ ceps, which need not be inserted here, and proves the safety of the operation. He next proceeds to show' how unneces¬ sarily the perforator is employed. Every man of eminence in this branch of practice could corroborate his statements. I he blunders made in obstetricy are little known to those who do not engage in this branch of medicine. The follow¬ ing remarks deserve serious reflection
Dublin Medical Transactions.
185
“ I have been called upon in several cases of protracted labour, some of them of first children, and in women advanced in life, to give sanction to deliver}’ with the perforator and crotchet, and have found the instruments ready prepared for the operation, when I have recommended a trial with the forceps, and fully succeeded in bring¬ ing into the world living children, with very little, if any trouble to myself, no risk to the mother, and no inj urv to the child ; this is well known by several most respectable practitioners in Dublin, who have been witnesses to the result.
“ When I contrast the feelings created at such a moment, in the operator, the patient, and her friends, with those experienced, when the body of a child (of whose previous life the mother had no doubt), is dragged mutilated into light, I confess that I cannot un¬ derstand why the latter should ever be adopted, without the fullest certainty of the impracticability of the former. What adds to the horror of the perforator is, that it is no uncommon circumstance to have a child bom alive and cry, whose head had been opened, and the brains partially destroyed. Doctor Burns says, “ by the rash and unwarrantable use of the crotchet, living children have been drawn through the pelvis with the skull open, and have survived, in this shocking state, for a day or two.” Deventer, Chamberlain, and others, give instances of women delivered by the crotchet of dead children, as “ they supposed, when to their great surprise, the miserable infants filled their ears with cries.” Mr. Dease states, “ that he has seen instances where the child has been miserably dragged alive into the world, with a great part of the brain eva¬ cuated.”
“ Similar instances have (I understand) occurred in this city, in one of which humanity prompted the accoucheur to plunge the child into a vessel of water, to put an end to its existence and cries.
“ I can never forget a scene of horror to which I was a witness in the year 1800. I was called upon to see a very young lady, in labour of her first child, who was under the care of one of the oldest and most eminent practitioners in this city, (since dead) ; her labour was most violent, which she bore with great impatience and noise. The head had been down on the perinseum (he said) several hours ; I proposed to give more time, and an opiate, not doubting the powers of nature, or to try the forceps, which he declined, on account of its being her first child, and the apprehension he enter¬ tained of her being exhausted ; and finally, he opened the head. The operation, as it always does, excited extraordinary uterine action, and before it was well concluded, or the brain evacuated, so as to lessen the bulk of the head, the child was propelled into the world alive and crying.
“ The old gentleman whose patient she was, was a person of very fine feelings, and the reader may imagine his sufferings on viewing the effect of a rash and ill-judged operation ; he declared no earthly consideration should ever induce him again to witness the applica¬ tion of the perforator,” — p. 15.
vol. vi. xo. 33.
B B
1 sc
C ncai R?r - ...
When convulsions supervene. Dr. Beat tv strongly insists upon the necessitv o: first trying the forceps, which, does not occupy so much nine as the perforator, and should the at¬ tempt fail, it is ease to have recourse to the latter. That this principle admits of practical application, the following ease testifies : —
In the year IS 14, a gentleman, residing eirhteen miles from Dublin, called cm me, to request I odd accompany him with all expedition to see his wife, who had been soddenlv seized with labour of her hrst child, attended with convulsions before he left heme.
~e reached his house in about hve henrs from the time he left it. I found the lady lying on the parlour floor, labouring' under severe convulsions, and quite insensible . in which state she had remained during her husband s absence. On examination- the head was found to he kw in the pelvis, and the os nteri dilated. Without re marring her I introduced the forcers, and in a few minutes succeeded in extra: ting a female child alive. The mother was now removed to bed : the convulsions cessed in a short time : her senses were restorec. ana me recovery was as speed- as if no untoward circum¬ stances had occurred. I may observe that the gentleman had no more children, and the child then bom is now alive, and heiress to his large estates . a consolation cf which he mast have been de¬ prived. had I rashly erotic red a destructive hnstmment. If I had experienced much difficulty in this case. I would have thought myself justiflanle . nay, called upon, to sacrifice the child T but cer¬ tainly net until I mew it w^s unavoidable : and I state it to show that in the worst cases, the render means may be resorted to with considerable prospect of success.” — p. 19.
Our author farther Informs us. that since 1504. he has used th- crotchet hut three times, daring which period the majority of his Ill forceps eases occurred, and he con¬ cludes with these impressive words —
In conclusion I win observe, that nothing short of the most imperative necessity can w-nrmnt the use of the destructive instru¬ ments, and no case can be considered as demanding them until every means ay which both mother and child roizht be saved have been pot onto recur::: : r. . and fairly tried. Let ns ask with Dewees, v a at is to be reared from a proper attlic&ticn o: the forceps ? Is moor r :*de of action snen as to do injury to either mother or child, v - v- directed : C ertaini- net. Then there is nothinn to he
a: q ten ended mom their structure, application., and mode of action, since they neitaer cut nor contuse mother cr child when well directed, i ney n aimer create unnecessary p ain, nar inordinately augment tnat which may o>e present ; but are tralv ealoulated. in hae mo. gunge c: Dr. Denman, tc supply the ins ‘am: i enow cr want of labour pmns. If tons be so, and it is admitted by Dr. Demnan
Dublin Medical Transactions.
187
himself, why should they be condemned, because in common with every thing we possess, they may be abused. I repeat it, the object of the practitioner should be to preserve both mother and offspring ; if, unfortunately, he should ultimately fail in this endeavour, he must then decide between the two, and sacrifice the child. To be driven to such an extremity, is one of the most painful situations in the practice of midwifery : it forces a man to perform an operation, differing in principle from every one in use among medical men. All others are done with a view to the ultimate benefit of the sufferer : this alone tends to his immediate destruction. Such a consideration, together with the heavy responsibility a man incurs, by becoming the voluntary destroyer of a human being, should, make us pause ere we lightly reject means, by which results so lamentable and awful might be avoided.” — p. 23.
We fully assent to the opinion so ably maintained in this paper, which is consonant with science, judgment and expe¬ rience. Every practitioner, with a spark of humanity in his breast, must shudder at the idea of destroying a fellow crea¬ ture, and we know no law, human or divine, which justifies such a proceeding.
In a subsequent paper. Dr. Beatty relates a case of (t Cancer Uteri,” attended by the usual symptoms, and presenting ex¬ tensive disease in the viscera and linings of the pelvis. He then relates a case of incipient cancer of the cervix, which was examined by two of the most eminent physicians in Ireland. Both were of opinion that the lady should live absque marito ; but our author has long observed that the disease in general occurs to those whose connubial inter¬ course had been interrupted at an early period of life. He therefore suggested that the lady should be restored to her conjugal rights, and that her disease might be arrested. The idea was new to his colleagues, but they readily acceded to the proposal. The result was the birth of a healthy child in less than a year. A perfect restoration of health followed, and has now continued for fourteen years.
That pregnancy may happen in incipient scirrhus uteri, is well known to ail obstetricians, but that the disease should be arrested in consequence of the proposed measure, is certainly a new and a singular observation.
Dr. Collins, the master of the Lying-in Hospital, Rutland Square, relates two cases of “ Laceration of the Uterus and Vagina,” which terminated favourably. The treatment con¬ sisted in purgation and repeated leeching the abdomen, warm baths and fomentations. About the end of the fourth.
188
Critical Review
or in the course of the fifth day, all abdominal tenderness was removed. Our author cautions the practitioner against allowing the child to escape into the cavity of the abdomen, and he recommends pressure to be made on the abdomen, to prevent the head from receding when the perforator is applied. He observes, that in some rare cases rupture occurs before the dilatation of the os uteri, and here the operation of gastrotomy is the only chance of success. No instance of this kind occurred during the mastership of Dr. Clarke. Though this recommendation is made by most obstetric writers, we very much doubt the propriety of acting upon it. In the majority of such cases, the child is dead, and in every case the vital powers of the woman are ex¬ tremely depressed immediately after the occurrence of the rupture This, perhaps, mainly depends upon the loss of blood consequent to such an accident, which may be so copious as to destroy life. It is to be recollected that the few instances in which gastrotomy was successfully performed, the vital powers were allowed to rally from one to eighteen hours after the rupture. Besides, the only other danger that can arise to the woman is the supervention of enteritis or peritonitis, neither of which can occur instantaneously, nor very speedily, when the vital powers are prostrate. It is therefore evident that time ought to be allowed the con¬ stitution to rally, that the operation ought not to be in¬ stantly performed after the rupture, as excision in such cases of prostration might extinguish life. Few surgeons would be willing to perform so serious an operation when the vital powers are prostrate in any considerable degree. A little sober reflection on these objections must convince the most sceptical of their validity. The fact is, writers in general have erred on this point ; for the facts on record are too few to warrant their conclusion.
The next paper is on the “ Value of Auscultation in Pul¬ monary Apoplexy,’' by Dr. J. C. Fergusson. The author very satisfactorily proves that the true nature of this dis¬ ease cannot be discovered by the symptoms, and that prac¬ titioners unacquainted with the stethoscope, will be in ge¬ neral deterred from employing depletion to the necessary extent, as it seems to be contra-indicated by the usual symp¬ toms. The value of auscultation is now so well established, that we need not continue our notice of this paper. We have only to state that Dr. Fergusson is an able stetho- scopist, as more fully appears in a subsequent paper.
Dublin Medical Transactions .
189
entitled “ Auscultation, the only unequivocal evidence of Pregnancy.”
Every man engaged in practice must admit that an infal¬ lible diagnosis of pregnancy, whether there be a foetus in utero, and whether it be living, would be highly important in forensic and private practice.
Our author thinks he has made this important discovery ; he says, “ I have had opportunities of testing the value of auscultation in such cases above one hundred times, and in every instance, with but one exception, I could detect either pulsation of the foetal heart, or placentary noise, generally both, after the patient had passed the fifth month of gesta¬ tion, and in many, and indeed in the majority, before that period.” He makes the examination when the patient is placed in a chair, and no part of the dress removed. He, however, prefers the horizontal posture. The only error of which he is aware, and into which we are liable to fall in making this examination, is where the pulsation of the iliac arteries are accompanied by a bruit de soufflet.” But this noise will be heard at both sides in the groin, whereas the noise of the placenta is heard over a space of some extent, perhaps three or four inches square. The foetal heart may be heard in almost every region of the abdomen, though it, and that of the placenta, may be heard in the same side, or even in the same spot, yet generally they are to be met with in the opposite sides, in the iliac regions. The double pulsation of the heart is usually felt in one spot, it may vary, and is double that of the mother. He detected the two sounds in a foetal heart, not larger than a hazel nut. Drs. Corrigan and Hunt were present at the examination. He then relates cases of concealed preg¬ nancy, which he detected, and which will be found in a late original article on forensic medicine in this Journal. Our readers are aware of the objections made to the infallibility of auscultation, by Dr. Nagle, in the Lancet.
Dr. Law describes cases of “ Putrefactive Disorganization of Lungs.” He commences with a description of the re¬ ceived opinions on gangrenous inflammation, and then de¬ tails his cases. He says that the disease may exist for a year ; that the lung will be reduced to a blackish, softened substance, not unlike the broken, dissolved condition of the spleen after protracted ague. The autopsies of his cases warrant his conclusions.
190
Critical Review.
The first patient was a lad, aged nineteen, who was ad¬ mitted into Sir P. Dunn’s Hospital, labouring under severe haemoptysis, with foetid breath. The usual remedies were tried with success ; the haemorrhage was arrested, but he finally sunk.
Autopsy . — The right lung adhered to the ribs, was studded with tubercles, and its parenchyma in a sloughy state. The left lung was similarly affected, but not to so great an ex¬ tent. Three similar cases are detailed. The author denies the reality of dyspeptic phthisis, and asserts, that had Dr. Philip employed the stethoscope, he would not have broached such a doctrine. He also cites a case, which dis¬ proves the curability of phthisis, by the suppuration of the glands in the neck, as attested by the same author ; and states that mercury will rapidly excite the softening of pul¬ monary tubercles.
He relates two cases of hsematemesis, in which the gas¬ trointestinal mucous membrane was blanched, but the liver tuberculated, and quotes the authority of Frank in support of this pathology. He has also observed that when young females are affected with this disease, whose catamenia are irregular, an uneasy sensation is experienced in the spleen, which he thinks may arise from the organ disgorging itself of its contents. This is a further proof of Mr. Dobson’s theory, and illustrates the pathology of the pain in the left side, which is so troublesome in such cases, and which has lately been so much noticed by writers on neuralgia and hysteria. These papers are highly creditable to the attain¬ ments and judgment of the author.
Dr. Collins relates an interesting case of Extra-uterine Foetation.” A tumour was felt between the vagina and rectum, which Dr. Labatt considered enlarged uterus, and Dr. Colles fungus haematodes of the organ. The os uteri was examined, but no trace of membranes could be found. After much pain in the lower part of the abdomen and pelvis, the woman sunk. On dissection, the pelvic cavity was found filled with blood — the tumour contained a foetus of about two months, the sac had burst, the intestines were infiamed, and both Fallopian tubes were impervious — not a vestige of them remained in the uterus. The author thinks the foetus must have been formed without the uterus. This case favours the doctrine of seminal absorption from the vagina, as stated by Gartner and others.
Dublin Medical Trans auctions.
191
The next paper is on “ Hydrophobia,” by Dr. Purdon. It contains nothing worthy of attraction.
A case entitled Anomalous Labour,” is related by Dr. Fergusson. It was a footling or pedal presentation, which proceeded favourably until the base of the skull presented. Here unusual difficulty was experienced, which was found to arise from the presence of the head of a second infant, occupying the pelvic cavity. The first infant, which was partly expelled, was alive, and remained so for a consider¬ able time, but the head of the second was first expelled, accompanied by that of the first. The first infant was dead, the second living. Our author intended to have perforated the vertex of the second infant, but fortunately he had no instruments, and was refused the loan of them by some humane practitioners. It was his intention to save the life of the infant that was partly expelled, but nature decreed otherwise, and preserved that of the other. The author refers to three cases somewhat analogous, but differing widely in their peculiar circumstances, which are recorded in the Med. Chir. Trans, v. 12. We may observe that such cases are noticed in almost all the French works on ob- stetricy.
Dr. Harty describes two cases of Polypus of the Heart,” one of which was witnessed by Dr. Colies, the other by Mr. Crampton, the Surgeon-General. The latter is now in the museum of Dr. Montgomery. Our author details the symptoms of both his patients with great minute¬ ness, but we think no diagnosis could be formed from them. He, however, predicted the existence of the disease before the second autopsy took place. He refers to the opinions of the numerous writers on cardiac affections, and shewrs these are not against the possibility of the occurrence of the disease.
III. — Oulines of Physiology , with an Appendix, contain¬ ing Heads of Lectures on Pathology and Therapeu¬ tics. — By William P. Alison, M.D. F. R. S.E. Professor of the Institutes of Medicine, in the University of Edin¬ burgh. Edinburgh 1831, 8vo. pp. 452. William Black¬ wood.
The author deems it necessary to apologize for the publi¬ cation of a work on physiology, which contains no new
192
Critical Review.
facts, after the appearance of productions of such value on the subject, as the System of Dr. Bostock, the Outlines of Mr. Mayo, the Translation of Blumenbach’s Physiology by Dr. Elliotson, and of Magendie by Dr. Milligan.
t
“ My apology is, that it appears to be important for a teacher of any branch of science to follow the arrangement which seems to his own mind the most satisfactory ; and important likewise for the stu¬ dents attending any course of scientific lectures, to have in their hands a text-book arranged on the same plan, and containing the same views. The following pages have been written, therefore, for the sake of the medical students of this school. My objects in writ¬ ing them have been, first, to state the facts which appear to be ascer¬ tained, and the inferences which appear to be fairly deducible from these, in regard to the functions of the living human body ; and secondly, to arrange these facts, as far as possible, in the order in which the functions, as existing in the living body, in the adult state, are dependent on one another.
“ I entertain a hope, that some of those, already conversant with the science, who may look into the following pages, may approve of the attempt to give a more systematic form to the subject than has been usual in most recent publications ; while I am aware that others do not think the science sufficiently advanced to be taught with good effect on such a plan ; and may not approve of the views, as to the connexion of the nervous system with other parts of the animal frame', and particularly with the functions of organic life, which are here stated, and which appear to me to justify the present arrangement.
rt In justification of such views on these subjects as may appear to some erroneous or premature, I can only say, that they seem to me the most legitimate inferences from the facts that are known, and to involve less of hypothesis than those to which they are opposed ; and that, in manyr of the medical writings of the present day, I think there is a want, not so much of facts in Physiology, as of principles by which these facts ought to be connected, and by which the recol¬ lection and useful application of them may be best secured.
I have thought it right to enlarge, in these outlines, not on the subjects which occupy the largest portions of the lectures, but on those where, without such assistance from a text-book, the state¬ ments made in lectures may be the most easily misapprehended ; and on this account, I fear that some of the subjects here discussed may be thought more abstruse than I should have wished them to appear.
By the publication of these outlines, I expect to be able to abridge considerably the time occupied in the first division of the Lectures on the Institutes of Medicine in this University ; and, for the conveni¬ ence of students, I have added an appendix, containing the Heads of the Lectures on Pathology and Therapeutics. These I hope to be able to enlarge, at a future time, into another volume, similar to the present.” — Preface, p. 10.
Dr. Alison on Physiology.
193
The work consists of seventeen sections, arranged as follow : 1. Preliminary observations. — II. Of the laws of vital con¬ tractions. — III. Of the circulation. — IV. Of the composition and properties of the blood. — V. Of nutrition, exhalation, and secretion in general. — YI. Of absorption. — VII. Of the properties of the textures and secretions formed from the blood in the living body, as bone, cartilage, tendinous and fibrous substances, serous and mucous membrane, glands and secretions, substance of the lungs, skin, muscular and nervous substance.— VIII. Of the animal functions in gene¬ ral.— IX. Of respiration. — X. Of animal heat. — XI. Of digestion. — XII. Of the external sense, common sensation, smell and taste, sight, hearing. — XIII. Of the mental facul¬ ties. — XIV Of voluntary and instinctive motion. — XV. Of the physical effects of emotions and sensations. — XVI. Of sleep. — XVII. Of generation; and XVIII. Of the peculiari¬ ties of age, sex and temperament. The appendix contains Heads of Lectures. Part I. On Pathology. Part II. On Therapeutics.
The author commences with an inquiry on the pheno¬ mena of life, which he treats in an able, concise, and simple manner, as appears by the following extract :t—
In treating of physiology, we first consider the living human body when fully formed, in the adult state, and in the full enjoyment of health ; and endeavour to deliver the history and explanation, so far as is yet possible, of all that takes place in it, different from what takes place in the dead body. Afterwards we explain the manner, in which the body gradually attains to the state of perfection in which we first considered it.
“ In order to have a distinct understanding of the kind and degree of explanation of which facts in physiology admit, and to avoid the misapprehensions and controversies which have obscured the first principles of the science, it is necessary to attend to the following considerations.
“ The word life, as commonly used, does not denote an indivi¬ dual fact, nor a simple idea, and cannot, therefore, be defined. It is applied to a certain assemblage and succession of phenomena, which are seen in a great variety of the objects that surround us, and dis¬ tinguish them from the other objects of our senses. When these phenomena are examined throughout the whole of nature, it is found that the most general and characteristic of them is, the continued ap¬ propriation and assimilation of surrounding matter, which we call nutrition ; a process which maintains a certain definite structure called organization , — which originates in all cases that can be satis¬ factorily observed by generation, — and terminates by death.
vol. vi. no. 33;
c c
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Critical Review „
“ Having given this general description of what are called living bodies, we next observe, that many of the phenomena exhibited by these bodies have been found to be not only inexplicable by, but manifestly inconsistent with, the mechanical and chemical laws that regulate the changes, and have been inferred from the observation of other departments of nature. In so far as we can ascertain this to he the case, we say that these phenomena are effects of the vital principle, or of vitality, and that is our definition of these terms; They are the general expression for those of the changes occurring in living bodies, which we judge to be peculiar to them ; and stand in the very same relation to the science of physiology, as the terms chemical affinity, electricity, gravitation, to other departments of physical science.
“ Thus defined, the notion of vitality is not only admissible in physiology, but is that which entitles it to the name of a separate science. Those physiologists, accordingly, who object to the sub¬ stantive term, vitality, or principle of life, are obliged to use the adjective vital, which conveys the very same idea.
“ This notion of vitality, extending to all classes of organized beings, has no connexion whatever with the notion of mind, as distinguished from matter. The latter is the characteristic mark of the animal creation only ; and requires the admission into the physiology of animals, of a class of facts, and a kind of evidence, that have no place in any other physical sciences. Neither does any opinion, or con¬ jecture, that can be formed concerning the essential nature of vitality, affect the conclusions in natural theology, which are drawn from physiological facts ; because these conclusions do not rest on the mode in which vitality is thought to be communicated to living beings, but simply on the observed adaptation of means to ends, in the economy of living beings.
“ As the phenomena of life are seen only in bodies more or less organized, it has been conjectured that they depend merely on orga¬ nization ; but when we inquire how organization has been effected, we find that it implies in every instance, where we can observe it, the previous existence of vitality ; and therefore must be regarded as one of its effects, not as its cause.
“ On the other hand, the supposition entertained by others, of a material substance, such as an ethereal or subtile fluid, superadded to organization during life, and producing the phenomena of life, is both unsupported by evidence, and useless in the explanation of facts.
Setting aside both these hypotheses, we hold that all physio¬ logical inquiries are intended only to ascertain the conditions, under which the various phenomena of life take place, and naturally termi¬ nate in a reference to certain laws of vitality, or ultimate facts in this department of nature ; just as the investigation and explanation of phenomena in the inanimate world terminate in a reference to cer¬ tain laws of motion, of gravitation, of chemical affinity, &e. Of such first principles in science we can give no other account, than that they depend on the will of the Author of Nature ; but the deter-
Dr. Alison on Physiology.
195
mination of such first principles is the main object, and the applica¬ tions of them constitute the details, of all sciences; and every science is thus mainly conversant with principles peculiar to itself.
“ In this, as in other sciences, these general laws of nature can only be ascertained analytically, i. e. by the slow process of observa¬ tion and comparison of individual facts ; but when they have been ascertained, even partially, in this way, the information acquired is more quickly and easily communicated to others, by stating some of these principles in the outset, with short and simple illustrations, and then tracing the facts which constitute the details of the science syn¬ thetically, as originating, in part at least, from the operation of the laws first laid down, and then related to each other as physical causes and effects. The science of physiology appears sufficiently advanced to be taught on this plan. The physical causes, or conditions requi¬ site for the performance of each of the functions, will thus appear, in part at least, from the subjects discussed immediately before it, and its final causes or uses, from those discussed immediately after- it; and several advantages seem to arise from this arrangement, particularly in a course addressed to students, who have already acquired a considerable knowledge of physiology in the course of their anatomical studies ; but have not been accustomed to regard the functions of the living body systematically, or as connected with a perfect whole.
“ The explanation of many of the phenomena of living animals is still very imperfect : but enough has been done to shew, that the principal laws regulating these phenomena must be ranked under three heads ; I . Those of vital contractions, by which the visible movements of living animals are chiefly effected ; 2. Those of vital affinities, by which the chemical changes peculiar to living animals are determined, and their physical structure maintained ; 3„ Those of nervous actions, by which the physical changes in living animals are placed in connexion with mental phenomena, and subjected to the control of mental acts.
“ Of these, the vital affinities are perhaps the most general and the most fundamental ; but they are the least understood, and, in the higher animals at least, their exercise is dependent on internal vital contractions ; and the laws of these contractions are, therefore, properly to be considered first.
“ The most important division of the phenomena of living animals is into the departments of organic and animal life, as distinguished by Bichat ; i. e. into those which do not imply the intervention or con¬ sciousness of the mind, and those in which some act of the mind is essentially concerned ; and the former are obviously subservient to the latter. This distinction will always be kept in view, but cannot be strictly observed ; the more complex functions (such as respira¬ tion and digestion) comprehending phenomena which come under both heads.
“ The most general of the laws which regulate the economy of animals appear to extend throughout the whole range of creation ;
196
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and all the vital functions, as occurring in man, may be illustrated by the corresponding functions, at least in the different divisions of the vertebrated animals.” — p. 6.
We have now afforded the reader a fair specimen of the manner in which the work is executed, and we think he will agree with us in opinion, that it is very favourable to the high reputation of the author. Instead of spreading out the subject to a great length, he has condensed the principles of physiology into a simple concise form, and thus afforded the student and young practitioner an excellent text book. The style is good, the information complete, and the work rendered at a moderate expense. It is a work of great inte¬ rest and utility, and cannot fail to have a place in every me¬ dical library. We hope soon to have the pleasure of no¬ ticing the promised volume on pathology and therapeutics, and we know few so well qualified to execute the task as Dr. Alison.
IV — A Manual of Surgery , founded ujjon the principles and practice , lately taught by Sir Astley Cooper , Bart. fyc. and Joseph H. Green , Professor of Surgery , in the King's College, fyc. Third edition considerably en¬ larged, containing many additional notes from the writ¬ ings of other distinguished surgeons. Edited by Thomas Castle, F. L. S. of the Queen’s College, Oxford, &c. London 1831. 12mo. p.p. 515. E. Cox.
This wTork is published with the express permission of Sir A. Cooper and Mr. Green, and is a compendium of the lec¬ tures on surgery, delivered by these eminent teachers. Mr. Castle has compressed the opinions of lecturers, and added some important extracts from the best surgical works. We think he should have distinguished his annotations from the text, as most readers would prefer a line of demarcation. The work is an excellent manual for students and younger surgeons ; it has rapidly passed through three editions, a fact which affords the best proof of the degree of estimation in which it is held by the profession. It is one of the best text books extant, and ought to be in the hands of surgical students. It has a large sale, and it wrell deserves it.
[ 197 ]
V. — Two Lectures on the Study of Anatomy and Physio - logy, delivered in the Medical School , Alders gate-street. By Jones Quain, M. B. Lecturer on Anatomy and Physi- olog-y. London, 1830. 8vo.pp.44. Two plates. Simp- kin and Marshall.
These lectures bear strong evidence in favour of the talents and attainments of the author. He displays the most inti¬ mate acquaintance with the sciences of anatomy and physi¬ ology, and his descriptions elevate the mind to the most sublime conceptions of the beneficence of the Author of nature. A spirit of religion, as well as philosophy, breathes through every page, which reflect great credit on the author and the man. We select a passage to show the truth of our position, and which must convince even the sceptical that the most enlightened part of our profession is not, and cannot be, affected with the poison of infidelity.
“ The personal I is confessed a permanently being ; every indi¬ vidual acts as if he were one and identical ; and such he is invari¬ ably considered by others, notwithstanding the admitted fact, that the material components of his body are subject to a perpetual mutation; for, over this ceaseless cycle of change presides that power, which altogether suspends the ordinary play of affinities in the first moments of foetal existence, modifies and controls them during the succeeding stages of life, and allows them to come into action, only when it is withdrawn at death. “ I had rather,” says Bacon, “ believe all the fables of the Legend, the Talmud, and the Koran, than that this universal frame is without a mind. When the mind of man looketh to second causes scattered, it may some¬ times rest on them, and go no farther ; but when it beholdeth the chain of them confederate and linked together, it must needs flee to Providence and to Deity.” How strangely then do those men * argue, who contend that all the phenomena of living beings, and all the functions which they perform, are results — the necessary results of their organization ; and that their structure is produced by an aggregation of particles, according to the laws of chemical attraction. We have seen, however, that such is not the rule of their formation ; so far from it, they are formed by a process the very reverse of this ; which is a conclusive evidence that there is some other power at work, besides that of attraction. But, were we, for a moment, to admit that the form and structure of organized bodies are determined by attraction, then we could have no grounds for expecting to find evidence of design or forethought in their con¬ formation. This at once prompts us to enquire, (and surely it is an interesting subject of enquiry) whether they do not exhibit incon-
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testable evidence of both, in whatever point of view we examine their habits and capabilities, or investigate their structure.
“ It is a favourite opinion with many that all our knowledge is derived from the senses ; as well might it be said that all arts and manufactures are derived from the doors and windows of the houses, into which the raw materials are brought to be subjected to the skill and dexterity of the workmen. Again, as our senses exist before we have acquired any experience, we have sufficient grounds for questioning another assertion, which is frequently put forth, namely, that all knowledge comes from experience. There is a sort of knowledge which is prior to experience, and acts quicker than reason, and which exhibits itself for the most part in prompting measures for self preservation. Thus young animals seek the breast from which their nutriment is derived ; and, in after life, the dif¬ ferent tribes of living beings select different sorts of substances for their food ; some feed on herbs, and every part of their conforma¬ tion marks them to be fitted and intended for digesting that kind of food. Others live on animal substances, and as we saw yesterday, when examining the structure of carnivorous animals, the confor¬ mation of their teeth, jaws, stomach, limbs, adapt them for the habits that have been impressed on them. Some become torpid during winter, and choose places of security whilst in that state ; others, as the swallow, enjoy a perpetual summer, by migrating from one country to another, and their conformation enables them to fulfil their destination. The bee and the wasp lay up stores for win¬ ter, and, strange to say, the comb which the bee builds is always placed vertically, that of the wasp, horizontally. Moreover, the cells are all constructed on strictly geometrical principles ; for each of them is a hexagon, terminated by a pyramidal base. In the execution of their work they give a practical solution of a very difficult problem. “ A quantity of wax being given to form out of it, similar and equal cells of a determinate capacity, but at the same time so arranged, collectively, as to occupy the smallest possible space, whilst each individual cell possesses the largest possible area in proportion to the quantity of matter employed.” If they were cylindrical, vacant spaces must exist between each three contiguous cells : if they were square or triangular, they would require more material, and be altogether unsuited to the form of the bee’s body.
Is it from instruction — is it from their senses — is it from expe¬ rience, that these creatures execute their work with the precision and method of the most accomplished artist ? No one, I believe, would answer in the affirmative ; each group of living tilings has its special aptitudes, its peculiar habits.
Dente lupus, cornu, taurus petit ; unde nisi intus
Monstratum ?
Their habits and their aptitudes are stamped upon them at the first moment of their being, and constitute them so many agents fashioned for the execution of a purpose, — so many means devised
Mr. Quain on the Study of Anatomy
199
for the attainment of an end; as such, every one of them bears upon it the impress of design and contrivance. Observe some of these groups attentively, note the peculiarities which characterise them, and then pass on to an investigation of their internal struc¬ ture and conformation, you will not fail to find abundant evidence of their perfect adaptation to their different spheres of action — their various modes of life.” — p. 36.
VI. — The Life of Sir Humphry Davy, Bart. L. D.D. late President of the Royal Society , fyc. fyc. By John Ayr¬ ton Paris, M. D. Cantab. F. R.S. &c. Fellow of the Royal College of Physicians. 4to. London. Colburn and Bentley, 1831.
Of all the philosophers who have contributed by their ge¬ nius and labours to exalt the scientific character of the mo¬ dern world, no one deserves better than Sir H. Davy, that his life and actions should be attentively considered. The peculiarity which entitles the biography of Davy to this dis¬ tinction consists in the important circumstance that even his most surprising discoveries were attained not by any fortu¬ nate accident, not by chance medley in the laboratory — but by a deliberate and well adjusted process of reasoning— which operated among some of the mysteries of nature as successfully as the faculty of intuition itself. The more then we reflect on this fact, which so forcibly puts into con¬ trast the career of Davy with that of Galvani and other dis¬ coverers, the more we shall be convinced of the utility of handing down to posterity such examples as the former, for assuredly no man can peruse the annals of such a progress as Davy’s, without feeling all his noblest impulses, — all his propensities to industry, invigorated and quickened. — Viewed then through the medium of such a description as is given to us by a writer like Dr. Paris, one who, from his avo¬ cations, is enabled so well to appreciate them, the labours of Davy become not only a valuable record of important events with regard to the past, but also a history very much calculated to “ teach by its example” with respect to the future.
The subject of this memoir was born in Penzance, on the 17th December, 1778. His parents were respectable, although Davy himself was the sole founder of his own fortune.
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Critical Review.
After receiving a good education, he was bound apprentice to a surgeon-apothecary named Borlase, in his native town. The youth however displayed so strong an attachment for chemical inquiries, as to justify the fear at a very early pe¬ riod of his life, that he would do but little at the profession in which he had been initiated. Dr. Paris gives many plea¬ sant anecdotes illustrating the fondness of Davy for his favourite employment, and showing the natural energy and ingenuity of his mind. To some influential persons with whom he became acquainted during his apprenticeship, but especially to the patronage of Mr. Thomas Giddy and Mr. Gregory Watt, he owed those recommendations which gained him some public notice, and finally secured him the situation of assistant in the Pneumatic Institution of Dr. Beddoes, at Bristol. Before this event, Davy, by several beautiful compositions in verse, proved himself to be pos¬ sessed of a fine imagination, and of a forcible and elegant vocabulary. Whilst in the capacity of assistant at Bristol, young Davy performed some of his most dangerous experi¬ ments. Those on the respirability of nitrous oxide, are some of the most memorable acts of temerity which a love of science has ever succeeded in impelling any of her suitors to commit. Having found that this gas served as a stimulus when inhaled, the philosopher was resolved to try its effect in increasing or modifying the intoxicating power of wine. He, for this purpose, swallowed a bottle of wine in a few minutes, which soon produced on one so very abstemious as Davy always was, complete drunkenness.
“ While I was drinking,” he says in one of his letters, “ I per¬ ceived a sense of fulness in the head and throbbing of the arteries, not unlike that produced in the first stage of nitrous oxide excite¬ ment ; after I had finished the bottle this excitement increased, the objects around me became dazzling, the powers of distinct articulation was lost, and I was unable to stand steadily. At this moment, the sen¬ sations were rather pleasurable than otherwise ; the sense of fulness in the head however soon ' increased, so as to become painful, and in less than an hour I sunk into a state of insensibility. In this situa¬ tion I must have remained for two hours, or two hours and a half. I was awakened by head ache and painful nausea. My bodily and mental debility was excessive, and the pulse feeble and quick.”
These experiments were followed by one still more hazard¬ ous, and indeed scarcely justifiable, to ascertain the possibi¬ lity of respiring carburretted hydrogen gas . Upon this subject Dr. Paris has the following observations: —
Dr. Paris’s Life of Sir Humphry Davy.
201
“ The scientific and medical world are alike indebted to Davy for this daring experiment, (breathing carburetted hydrogen gas), and, if the precaution it suggests be properly attended to, it may become the means of preserving human life. The experiment is also valu¬ able, as affording support to philosophical views with which the author was probably unacquainted. In the first place, it may be necessary to apprise some of my readers, that the hydro carbonate here spoken of, differs very little from the gas now so generally used to illuminate our streets and houses. We have just seen how deadly are its qualities, and that, even in a state of extreme dilution, it will affect our sensations. The question, then, naturally suggests itself, how far this gas can be safely introduced into the interior of our apartments ? Did we not possess any direct evidence upon the sub¬ ject, the answer would be sufficiently obvious, since it is impossible so to conduct its combustion, that a portion shall not escape unburnt. Such is the theory ; but what is our experience on the subject ? That pains in the head, nausea, and distressing langour have been often experienced in our theatres and saloons by persons inhaling the unburnt gas ; that the atmosphere of a room, although spacious and empty, will, if lighted with gas, convey a sense or oppression to our organs of respiration, as if we were inhaling an air contami¬ nated with the breath of an hundred persons. In the next place, Davy’s experiment is important, inasmuch as it proves, that in cases of asphyxia, or suspended animation, there exists a period of danger after the respiration has been restored, and the circulation re¬ established, at which death may take place, when we are least prepared to expect it. Bichat has shown that, when dark coloured blood (venous) is injected into the vessels of the brain, by means of a syringe connected with the carotid artery, the functions of the brain become disturbed, and in a short time entirely cease. The effect is precisely similar, whether the dark coloured blood be transmitted to the brain by the syringe of the experimentalist, or by the heart itself. Thus, to the case of asphyxia, the dark coloured blood which has been propelled through the vessels during the sus¬ pension, or imperfect performance, of respiration, acts like a narcotic poison on the brain ; and no sooner, therefore, does it extend its malign influence on that organ, than deleterious effects are produced, and the animal, after apparent recovery, falls into a state of stupor, the pupils of his eyes become dilated, the respiration laborious, the muscles of the body convulsed, and it speedily dies — poisoned by its own blood. In the experiment which has given origin to these reflections, (adds Dr. Paris), Davy distinctly states, that after hav¬ ing recovered from the primary effects of the carburetted hydrogen gas, and taking a walk with his friend, he was again seized with giddiness, attended with nausea and loss of sensation. The imper¬ fectly oxygenized or dark coloured blood had evidently affected the brain, and his life, at this period, was probably in greater jeopardy than in any other stage of the experiment.
VOL. VI. no, 33.
D D
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Critical Review.
Sir H. Davy had already acquired a considerable degree of celebrity as a chemist, when the establishment of the Royal Institution in London opened a field of employment, to which it was likely that the ambition of the rising philo¬ sopher would direct him. Davy’s abilities were well appre¬ ciated by Count Rumford, the director of the new Institu¬ tion, so that no difficulty stood in the way of his engagement, except what arose, strangely enough, from the prejudice which the first appearance of the young chemist produced in the mind of the Count. The following anecdote, perhaps as forcibly as any description could do, serves as a criterion of the rustic state of Davy’s personal address at this time. — Dining one day amongst a large and select company, he ventured to differ with Fuseli upon Milton’s poetry, which the latter affected to love with enthusiasm ; Davy observed that there were passages in the works of that great poet which he at least could not understand — Very likely. Sir,” replied the artist, with an unfeeling' arrogance quite charac¬ teristic of him — “ Very likely. Sir, but I am sure that it is not Milton’s fault.” Davy had been but a short time lecturing at the Royal Institution, when he became a general favourite. By his abilities and address he made chemistry a fashion, or rather a rage , so that Albetnarle-street was as much fre¬ quented by the countesses of bon ton as Fop’s Alley in the Opera Flouse is this moment by the dandies. It is stated by our author that a lady, now of some celebrity in literature, sent Davy a poem, full of compliments, and accompanied by a pretty pendant suited for a watch, wffiich she requested he would wear at the next lecture. He was welcomed in the highest circles, and became, even in the most exclusive coteries of the West end, a lion of no minor interest and value. Nevertheless he pursued, with redoubled exertions, his favourite employments.
In 1806-7, Davy favoured the world with an account of his Electro-Chemical Theory, which from its importance merits a few words : — Volta proved that electricity was developed when certain metals were placed in contact with each other. Such, for example, as copper and zinc; the demonstration ol this fact is, that these metals, when separated after con¬ tact and insulated, are found oppositely electrified. The conclusion which Sir Humphry drew from his experiments was, that one of the metals became positively electrified, and the other negatively electrified. But this power of disturbing the equilibrium of electricity resident in bodies, was not pos¬ sessed by metals alone, for Davy showed by experiment, that
Dr. Paris’s Life of Sir Humphry Davy. 203
alkaline earths may be deprived of their electricity by the contact of metals, nay even, that acids may undergo the same change by the contact of alkalies, both being in the dry state. Sir Humphry even went farther than this, and main¬ tained, that when the atoms (those who are acquainted with Dalton’s theory will understand us) of two different bodies are in contact, one of the atoms renders up its electricitv to the other ; wherefore, by reason of the positive electricity of the one atom, and the negatively electrified state of the other, both atoms cohere, and unless there be adequate counteracting causes, they wrill remain together, forming an entirely new compound. The whole phenomena of chemical affinity or attraction are accounted for, therefore, according to Davy’s theory, by the opposite states of electrical excite¬ ment in which the concurring particles are respectively found. The essence of the theory of Davy then is, that all com¬ pounds consist of elements which are oppositely electrified ; and he necessarily inferred that if these elements, which were thus held in combination, could be placed in the same elec¬ tric condition, the bond of union would be forthwith broken, and the particles would retire from one another. The truth of this theory was demonstrated on a cup of water. This liquid, it is well known, is a compound of oxygen and hydrogen; in other words, it is constituted by the union of two elements, each in an opposite state of electricity. Davy showed, that if water be exposed to the power of atoms, which have a greater attraction for its separate constituents than is the attraction that keeps those constituents in union, then the elements are separated ; and this is the whole theory of the decomposition of substances by means of galvanism. By the aid of such an agent, Davy was able to show that several simple ingredients entered into the formation of what hitherto had been deemed in itself simple. He, for the first time, de¬ composed alkalies and earths, and astonished the world by producing the metal potassium . As connected with this theory, although the subject is not noticed until a much later stage of his work, by Dr. Paris, we must mention Sir Humphry’s plan for protecting the copper sheathings of ships’ bottoms from oxidation by sea water.
Upon an elaborate investigation of the phenomenon of the destruction of these sheathings, it was inferred that the corrosion occurred in this way : — The atmospheric air is constantly dissolved in water ; the oxygen, which is a part of this air, is taken up by the copper ; the oxide of copper formed by this junction, takes up the muriatic acid which was in
204
Critical .Review.
. f .
combination with soda and magnesia in the sea water* and thus the formation of submuriate of the oxide of copper is constantly going on. In plainer phrase* the copper is under¬ going a permanent process of decay. Now Davy argued* that if the copper did not oxidize* it would have entered into no combination with the muriatic acid* and consequently* that by forbidding the union of the oxygen and copper, he would afford to the latter the fullest protection. How was this to be done ? He reverted to his original theory of the union of two different bodies* and referring the combination of oxygen and copper to the fact, that their contact had created the disturbance of the electrical equilibrium (the copper becoming positively and the oxygen negatively elec¬ trified)* he concluded that to render the copper negative, or in fact* to reduce them both to the same electric condition* no union would take place* and consequently none of the effects resulting from that union.
The practical experiment dictated by this reasoning proved triumphantly successful. A piece of zinc was placed in contact with the copper* it drew off a sufficient portion of the electricity of the latter, and thus what Davy ascer¬ tained to be the source of union between them* namely* the opposite state of their electricity being changed, the oxygen and the copper no longer coalesced* and the latter remained perfectly free from corrosion. Mr. Babbage* in his able work on the Decline of Science,* says that Laplace con¬ sidered this as Davy’s greatest discovery. We are ourselves of the same opinion* inasmuch as the result was an induction which could have been foreseen only by the most delicate and accurate application of the principles of reasoning. The remedy was but too successful, for in such a perfect state did it keep the surface of the copper sheathing, that an evil of an opposite kind was induced; marine animals and vegetables* which before could not live in contact with the submuriate of the oxide of copper* now clung in such abundance to it, that in order to get rid of an inconvenience so much greater than the corrosion of the copper* the remedy was abandoned. But though the plan was found to be unfortunately imprac¬ ticable for the reasons stated* the genius and intelligence of the inventor merit all the applause which a successful inven¬ tion should receive. That which he promised he performed*
* Reflections on the Decline of Science, &c, by Charles Bab¬ bage, Svo.
Dr. Paris’s Life of Sir Humphry Davy. 205
and his method was invalidated not by any inefficiency of its own, but on account of a misfortune which was only contin¬ gent on the very perfection of its succcess.
In the midst of all his cares,, Davy proved himself an enthusiastic fisherman. To relieve the seriousness of our narrative, we shall give an account of his sporting cos¬ tume —
“ His whole suit consisted of green cloth, the coat having sun¬ dry pockets for holding the necessary tackle : his boots were made of caoutchouc, and for the convenience of wading through the water, reached above the knees. His hat, originally intended for a coal- heaver, had been purchased from the manufacturer in its raw state, and died green by some pigment of his own composition ; it was, more¬ over, studded with every variety of artificial fly which he could re¬ quire for diversion. Thus equipped, he thought, from the colour of his dress, that he was more likely to elude the observation of the fish. He ‘ looked not like an inhabitant of the earth, and yet was on’t; ’ nor can I find any object in the regions of invention with which I could justly compare him, except, perhaps, with one of those grotes¬ que personages who, in the farce of the Critic, attend father Thames on the stage as his two banks.
“ I shall take this opportunity of stating, that his shooting attire was equally whimsical : if, as an angler, he adopted a dress for con¬ cealing his person, as a sportsman in woods and plantations, it was his object to devise means for exposing it ; for he always entertained a singular dread lest he might be accidentally shot upon those occa¬ sions. When upon a visit to Mr. Dillwyn, [of Swansea, he accom¬ panied his friend on a shooting excursion, in a broad- brimmed hat, the whole of which, with the exception of the brim, was covered with scarlet cloth. ”
The latter statement is curious., particularly when con¬ sidered in reference to what we must call a superstition of Davy’s, we mean a horror which he always showed to any person crossing his knife and fork at dinner in his presence. It is said that when De Humboldt innocently adjusted the implements of dinner in this way, Davy manifested the most serious displeasure. Such are the strange contradictions that unite, even in the characters of the most intellectual men; he who was ready to expose his life in the inhalation of de¬ leterious gases, and approached in a rash moment, as near as ever a healthy being did to the precincts of death, he was constantly afraid of being shot in his sporting excursions, and became horror struck at the sight of a crossed knife at the table where he sat !
The next great discovery which we have to notice, and indeed that by which he is most extensively known, and by
20G
Critical Review.
which he will be longest remembered, is his invention of the safety lamp. Here again we have a magnificent result from his powers of induction. This invention is well known, and to those who wish to be well acquainted with its origin, progress, its principles and nature, we recommend an atten¬ tive perusal of the elaborate and accurate account of the history of this lamp by Dr. Paris. We cannot however refuse ourselves the pleasure of inserting from the work the following recapitulation : —
“ He commenced with ascertaining the degree of combustibility of the fire damp, and the limits in which the proportions of atmos¬ pheric air and carburetted hydrogen can be combined, so as to afford an explosive mixture. He was then led to examine the effects of the admixture of azote and carbonic acid gas ; and the result of those experiments furnished him with the basis of his first plan of security. His next step was to enquire, whether explosions of gas would pass through tubes ; and on finding that this did not happen if the tubes were of certain lengths and diameters, he proceeded to examine the limits of such conditions, and by shortening the tubes, diminishing their diameters, and multiplying their number, he at length arrived at the conclusion, that a simple tissue of .wire-gauze afforded all the means of perfect security ; and he constructed a lamp, which has been truly declared to be as marvellous in its operation as the storied lamp of Aladdin, realizing its fabled powers of conducting in safety through ‘ fiends of combustion/ to the hidden treasures of the earth. We behold a power which in its effects, seemed to emulate the vio¬ lence of the volcano and the earthquake, at once restrained by an almost invisible and impalpable barrier of net- work. We behold, as it were, the daemon of fire taken captive by science, and minister¬ ing to the convenience of the miner, while harmlessly fluttering in an iron cage. And yet, wonderful as the phenomenon may appear, his experiments and reasons have demonstrated, that the interruption of flame by solid tissues permeable to light and air, depends upon no recondite or mysterious cause, but simply upon their cooling powers, which must always be proportional to the smallness of the mesh, and the mass of metal. When it is remembered that the security thus conferred upon the labouring community is not merely the privilege of the age in which the discovery was effected, but must be extended to future times, and continue to preserve human life as long as coal is dug from our mines, can there be found in the whole compass of art or science, an invention more useful and glorious ?”
The blot on Davy’s character was his conduct in France, in the company of the French philosophers. In his inter¬ course with them, he showed the most extraordinary con¬ tempt of the common courtesies of life — and that too, whilst the Savans made even sacrifices in order to show their esteem
Dr. Paris’s Life of Sir Humphry Davy.
20 7
for Davy. Dr. Paris is very candid on these points, and endeavours to excuse his hero with infiniteJy more good nature however in our opinion, than success. The following’ laughable anecdotes will appear almost incredible, when we remember that Davy was a man of so much imagination as to be able to gain reputation as a poet, and that he always showed a genuine relish for beauty, wherever it was visible in the works of art, as well as of nature.
“ He was conducted to the Louvre by Mr. Underwood. The Eng¬ lish- philosopher walked with a rapid step along the gallery, and, to the great astonishment and mortification of his friend and Cicerone , did not direct his attention to a single painting ; the only exclamation of surprise that escaped him was — “ What an extraordinary collection of fine frames !”
“ On arriving opposite to Raphael’s picture of the Transfiguration, Mr. Underwood could no longer suppress his surprise, and in a tone of enthusiasm he directed the attention of the philosopher to that most sublime production of art, and the chef-d’oeuvre of the collection. Davy’s reply was as laconic as it was chilling — “ Indeed, I am glad I have seen it and then hurried forward, as if he were desirous of escaping from any critical remark upon its excellenciess
“ They afterwards descended to a view of the statues in the lower apartments : here Davy displayed the same frigid indifference towards the higher works of art. A spectator of the scene might have well imagined that some mighty spell was in operation, by which the order of nature had been reversed : — while the marble glowed with more than human passion, the living man was colder than stone ! The apathy, the total want of feeling he betrayed on having his attention directed to the Apollo Belvidere, the Laocoon, and the Venus de Medicis, was as inexplicable as it was provoking ; but an exclama¬ tion of the most vivid surprise escaped him at the sight of an Anti- nous, treated in the Egyptian style, and sculptured in alabaster. 1 Gracious powers,’ said he, ‘ what a beautiful stalactyte !’ ”
“ What a strange, what a discordant anomaly in the construction of the human mind do these anecdotes unfold ! We have here pre¬ sented to us a philosopher, who, with the glowing fancy of a poet, is insensible to the divine beauties of the sister arts ! Let the meta¬ physician, if he can, unravel the mystery, — the biographer has only to observe, that the Muses could never have danced in chorus at his birth.”
Sir Humphry Davy spent the last years of his life chiefly on the continent. He married a Mrs. Apreece, by whom he had no issue ; but who brought him a fortune that enabled Davy to be indifferent to the pecuniary results of his great discoveries. This circumstance however does not detract from the noble liberality with which he communicated the
208
Critical Review.
produce of his labours to the world — and for the most splendid of which the philosopher never received any state reward or acknowledgment beyond the sterile dignity of a patent of baronetcy. In giving an account of his death, Dr. Paris relates,
“ In addition to his will, he left a paper of directions, which have been religiously observed by his widow. He desires, for instance, that the interest arising from a hundred pounds stock may be annu¬ ally paid to the master of the Penzance Grammar School, on condi¬ tion that the boys may have a holiday on his birth-day. There is something singularly interesting in this favourable recollection of his native town, and of the associations of his early youth. It adds one more example to show that, whatever may have been our destinies, and however fortune may have changed our conditions, where the heart remains uncorrupted, we shall, as the world closes upon us, fix our imaginations upon the simplicities of our youth, and be cheered and warmed by the remembrance of early pleasures, hallowed by feelings of regard for the memory of those who have long since slept in the grave. . v
“ With that restlessness which characterises the disease under which Sir Humphry Davy suffered, he became extremely desirous of quitting Rome, and of establishing himself at Geneva. His friends were naturally anxious to gratify every wish ; and Lady Davy there¬ fore preceded him on the journey, in order that she might prepare for his comfortable reception at that place. Apartments were accord¬ ingly in readiness for him at L’ Hotel de la Couronne, in the Rue du Rhone ; and at three o’clock on the 28th of May, having slept the preceding evening at Chambery, he arrived at Geneva, accompanied by his brother, Mr. Tobin, and his servant.
“ At four o’clock he dined, ate heartily, was unusually cheerful, and joked with the waiter about the cookery of the fish, which he appeared particularly to admire ; and he desired that, as long as he remained at the hotel, he might be daily supplied with every possi¬ ble variety that the lake afforded. He drank tea at eleven, and hav¬ ing directed that the feather bed should be removed, retired to rest at twelve.
His servant, who slept in a bed parallel to his own, in the same alcove, was, however, very shortly called to attend him, and he desired that his brother might be summoned. I am informed that, on Dr. Davy’s entering the room, he said, * I am dying,’ or words to that effect ; ‘ and when it is all over, I desire that no disturbance of any kind may be made in the house ; lock the door, and let every one retire quietly to his apartment.’ He expired at a quarter before three o’clock without a struggle.”
We conclude by reminding’ our readers that we have not in this review affected to give any thing like a consistent account of the life and labours of Sir H. Davy. Our ambi-
Dr. Paris’s Life of Sir Humphy Davy. 209
tion was limited to the mere duty of presenting* to the pro¬ fession, such samples from the pages of Dr. Paris,, as would fairly represent the manner in which the whole composition is executed : and if we succeed in inducing any of cur readers to desire a better acquaintance with the able and well written work from which we have made our extracts, our aim and our wishes will be alike answered*
ORIGINAL COMMUNICATIONS.
I. — Mr. Mitchell on Disease of the Hip-joint.
To the Editor of the London Medical and Surgical Journal.
Sir, — I have enclosed a very protracted case, which I have detailed briefly. If you find it worthy of insertion, please to give it a place in your valuable Journal, and you will oblige
Your most obedient servant,
Charles Mitchell, Surgeon.
J. B. eet. 38, a painter, of a scrofulous habit, had, twenty years ago, rigors, much constitutional disturbance, and pain of the right hip-joint : an abscess formed, the contents escaped, and the cavity contracted. The shiverings recurred shortly afterwards, followed by fresh collections and con¬ sequent discharges of matter, sometimes scanty, and in other instances profuse.
January, 1829, he had a slight attack of fever, attended by head-ache, thirst, aching of the limbs, dull countenance, quick breathing, hot skin, quick pulse, sickness, loss of appetite, white tongue, and urine high coloured. These, however, rapidly subsided, under the use of an emetic, followed by salines and occasional purgatives. He had another febrile attack in April (but symptomatic), with the subsequent formation and evacuation of matter. During the febrile attack the hip was inflamed ; two caustic issues were applied, fluctuation soon became apparent, cataplasms were applied, the sympathetic fever increased, the secretions lessened, diarrhoea ensued — he became exceedingly debili¬ tated. The diarrhoea resisted rhubarb, combined with chalk and opium, but was restrained by opiate enemata.
VOL. VI. NO. 33.
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Original Communications .
The general health improved amazingly ; bark, diluted sulphuric acid, porter, nutritious diet, soon effected rapid amendment.
The secretion became more puriform from a thin acrid sanies, and the pain and inflammatory nature of the abscess subsided.
April, 1830, had an attack of pneumonia, which was sub¬ dued, by a strict adherence to antiphlogistic regimen. The irritation and discharge of the hip became again aggravated ; a clyster was applied, ultimately a moxa, but they rather increased than alleviated the irritative action ; several ulce¬ rated openings formed immediately opposite, in the neigh¬ bourhood of the trochanter major, the discharge became pro¬ fuse, the pain settled in the knee ; by his own desire a blister was applied to each side, which certainly afforded him con¬ siderable relief, aided by repeated doses of the pulv. ipecac, c. ; he continued much in this state during the months of July, August and September. In October, the hectic be¬ came more permanently established ; colliquative sweats ensued, followed by roughness and dryness of the skin ; a renewal of the diarrhoea, which became of a most incessant and irritating nature. The pulse became small, frequent, and weak, finally wiry, — the voice failed, the masculine fea¬ tures shrunk and disappeared — the countenance pourtrayed a most afflicting and aggravating gloom, the stomach lost its retentive powrer, the eye acquired a pearly appearance, the skin became of a yellow' hue, ultimately shrivelled and contracted — the non-naturals wrere almost annihilated ; to¬ ward the middle of November, the fatal catastrophe hap¬ pened ; thus terminated a deplorable and irremediable course of suffering, which extinguished the miserable afflictions of this poor victim’s ill-fated career.
It of course became necessary, in order to alleviate the harassing nature of these symptoms to administer opiates freely.
Sectio cadaveris. — Upon laying open the chest, the lungs were found tuberculated; adhesion to a considerable extent had taken place. The centre of some of the tuber¬ cles contained small quantities of purulent matter. The lower extremity of the left lung wras inflated, forming a bag larger than an ordinary clenched hand, which Dr. Parr assigned to absorption, in consequence of having viewed it repeatedly in other parts not at all connected with the respiratory action ; but it appeared more plausible, judging from the lax and strumous habit, that it arose, in the first
Mr. Mitchell on Disease of the Hip-joint. 211
instance, from rupture of one of the cells, and that at each inspiration, the quantity collected was imperfectly expelled ; hence from the compressible and dilatable nature of the reti¬ cular substance, we had the gradual evolution of the cavity. If we were to reason from analogy, the imperfect expulsion of air in some obstinate and fatal cases of asthma, and the consequent enlargement of the cells, form a most convinc¬ ing proof of its rectitude. Vessels extended through the empty cavity unsupported.
The liver was pale and granular.
Through the course of the colon, one half of its villous tunic was absorbed, which rendered it extensively ulcerated, in some places deep, but for the most part superficial ; its calibre was considerably contracted, some of the smaller vessels were injected, forming red streaks, but by no means numerous. The discoloured skin surrounding the four large ulcerated openings, on the upper and outer part of the thigh, was tense. Upon introducing the finger into the largest opening, which was three inches long, and seven in dia¬ meter, numerous elastic spiculse of bone were adherent, and moveable with the muscular substance to which they were attached. They were more distinctly exposed upon dividing the skin, arranged in the form of laminae, which adhered through the medium of tough fibrous substance ; the ossific parts of which had been absorbed. The mus¬ cles were exceedingly pale.
In dividing the gluteal muscles inserted into the tro¬ chanter major, half an ounce of dark coloured matter issued forth. The trochanter was enlarged, softened and perforated. The capsular ligament was entire. The head of the os femoris encircling the lig. teres, was ulcerated, as much as would admit an ordinary sized hazle nut. Two inches from their insertion, the gluteus med and minim were altered in their structure, having become of a fatty, fibrous consistence.
There were some places in the cervix of a dark appear¬ ance; there was likewise a dark fissure extending from the cervix to the centre of the head of the bone, the perichon- drial covering of which was denuded, although it had a shining lustre. At the outer and lower side of the trochanter major, there was a depression, with elevated and irregular margins. The periosteum at the edges of these had a cor¬ roded appearance, leaving little doubt from whence the- sequestra had proceeded.
Lamb’s Conduit Street,
Feb. 18, 1831.
212
Original Communications .
[This case possesses many interesting features,, and shows the dangerous effects of hip-joint disease and of scrofula upon the constitution. We are much obliged to Mr. Mitchell for its narration. — Ed.]
II. — Mr. Searle on Cholera.
To the Editor of the London Medical and Surgical Journal.
Sir, — The ready compliance, on your part, with my request, by the insertion of my reclamation, claims not only my ack¬ nowledgment, but a walling assent to the principles which you state to actuate you in your editorial duties — the cause of science and truth, uninfluenced by name, station, partiality, favour, or self-interest — a line of conduct much to be la¬ mented, but little in accordance with the modern spirit of reviewing. Difference in opinion, when expressed in becoming language, is what no one can object to, and par¬ ticularly when it bears reference to a new hypothesis, which you are pleased to consider mine. Expressing, at the same time, your sense of the exceedingly ingeniousness of my views ; a circumstance which encourages me to hope, that I have not made altogether a wrong estimate in supposing' the work to have some little claim to the attention of the pro¬ fession.
I have only to add, that in your insertion of my reclama¬ tion, I am sorry to have to notice some typographical errors, but as fewr readers would be at the trouble of correcting them, it would be of little avail to point them out.
I am. Sir,
Your most obedient servant,
Charles Searle.
Great Russell-street, February 7th.
[Mr. Searle must remember, that his manuscript was not the most distinct, and that it bore marks of hasty composition. It was printed exactly as sent us, as we considered he might, complain had we made some verbal changes which seemed to us to be necessary.
Mr. Searle on Cholera.
213
We agree with him, that the spirit of modern reviewing is very far from what it should be, but the evil will be removed by the good sense of the profession. We believe Mr. Searle to be influenced by no other motive than the wish to eluci¬ date an obscure and difficult point in etiology ; and if he has not convinced the whole profession of the soundness of his views, he must, not be surprized. His work evinces con¬ siderable research, much original and ingenious thought, and many valuable practical precepts. It deserves a place in the libraries of those whose future destiny may place them in our East Indian possessions. — Ed.]
III. — Case of Chronic , Peritonitis, without much pain — delivery — death . By John Rees, Esq.
- Warren, eet 28, a married woman, of a slightly
florid complexion, middle stature, and of regular habits. She had a living child, about three years ago, her labour was natural. She has always enjoyed very good health. Her husband (a butcher,) left her about six months ago ; this circumstance did not appear to have greatly affected her mind. The person that she had lodged with for the last fortnight told me, that she always appeared in good spirits ; yet (added she) her husband, i think, is always uppermost in her mind.”
On Saturday, January 29, the liquor amnii was discharged without being attended with any labour pains, and on Mon¬ day evening, January 31st, uterine action came on. The labour proved of a very lingering nature, slight bearing down pains occurring occasionally, which would continue tolerably regular for a few minutes; and during the interval of the pains she w7ould complain very much of aching pains about the lower part of the abdomen and small of the back.
At 8 o’clock on Tuesday morning, the os uteri had be¬ come dilated to about the size of the mouth of a wine glass, it was soft and yielding, and the parts were abundantly lubri¬ cated with mucus. She had now given her 3fs. of the secal. cornut. in decoction, with no other effect than that of in¬ creasing the aching pains in the back and abdomen. The labour went on in the same lingering way during all Tuesday. She took in the evening of the secal. cornut. in decoction in two doses, with the same effects as attended
214
Original Communications .
©
the dose in the morning'. By about 8 o’clock on Tuesday evening*, the head had advanced as far as nearly to bear on the perineum. Uterine action having been for some time quite suspended, the patient being now (10, p. m.) very rest¬ less and much exhausted, and the pulse being frequent, small and weak ; the forceps were applied, and the foetus was extracted in a short time and with tolerable ease, al¬ though the child (which was dead) was a very large one. The catheter was introduced, to relieve the bladder, twice during the labour.
The uterus being in this torpid state, the hand was intro¬ duced into its cavity with the intention of exciting uterine action, for the expulsion of the placenta. This course of proceeding had the wished for effect and the attending loss of blood was very trivial.
February 2nd. A. m. Has been very restless all night, says she feels very weak, face is flushed, feels very sore about the parts ; there is pain in the lower part of the abdo¬ men increased on pressure ; tongue white, pulse small, weak and about 120. Bladder and bowels have not been eva¬ cuated. T. Hyos. 5ij. spr. sether, nit. 5iss. m. eamph. Bviij. m. cap. cocb. ij. amp. ter. hora.
Ten, p. m. Did not get the mixture till six o’clock. Has not made water, no evacuation from the bowels, says she is very sore. Pulse 140, very intermitting, ordered to apply warm fomentations to the hypogastrium and external geni¬ tals.
3rd. Was called up at 5 this morning, J found her greatly troubled with hiccup, much exhausted. Pulse very feeble, very intermitting and about 143. There has been no evacuation from the bladder or bowels.
She had brandy given her immediately, which was re¬ peated till the pulse got tolerably regular, and stronger. I drew off by the catheter about iss. of high coloured urine, and ordered her an enema of gruel every quarter of an hour till the bowels should be acted upon, and after alvine evacua¬ tion to take the following draught, L. opii. sedat. mxii. mis. camp. Siss. iq. ft. haustus.
Seven, p. m. Has had four glysters without the desired effect, she is very restless, tongue brownish, hiccup less distres¬ sing, pulse 140 and regular. Bladder was relieved by the catheter. Ordered to have two glysters Bss. of ol. ricini in each, one immediately and the other in an hour if necessary ; and should the bowels not be opened, to take 3ss. of ol. ricini and another half in three hours if necessary.
Mr. Rees on Chronic Peritonitis.
215
4th, a. m. Has had the glysters, and has taken the ol. riein. without giving rise to alvine evacuations. Has been very restless all night, say she is weaker. Abdomen is painful on pressure, pulse 140, regular. Has vomited some black adhesive fluid. Urine was drawn by the catheter.
R. ol. crot. m. iss. in pil. 2 c. ext. gent. capt. i. stat. et aliam post duas horas si opus sit.
Nine, p. m. She omitted the pill; Mr. Jewel ordered her a glyster, which gave her one stool, highly offensive and of a black colour ; has not been much troubled with hiccup to¬ day ; has again vomited some black fluid ; has been dosing this evening. Pulse 120, regular and tolerably strong, can take only a little tea ; has been observed this evening, to turn up frequently the white of her eyes.
5th, a. m. Has been speechless and insensible since three o’clock this morning. There have been involuntary evacu¬ ations from the bowels, which were highly offensive. Tongue brown, pulse intermitting and very weak. She lin¬ gered in this manner till 6 o’clock on Sunday morning the 6th, when death closed the tragic scene.
Sect, cadav. 6th horis post mortem.
The body appeared to be that of a person who had en¬ joyed good health, but had been cut short by some acute disease. The muscles were firm, the abdomen was not unusually large.
All the thoracic viscera were perfectly natural. The head was not opened. Abdomen — The omentum was highly in¬ flamed, being of a brownish red colour, and at several parts it was adherent to the anterior surface of the uterus. The small intestines in the neighbourhood of the womb were greatly inflamed, and several parts of them adhered to the fundus uteri. The peritoneum lining the lower parts of the abdominal muscles, was in a state of high inflammation, and there was ulceration of some portions of it. The inferior part of the uterus had contracted strong and extensive adhe¬ sions to the adjacent parts. On the right side of the uterus and anterior to the coecum was observed a kind of a sac, which appeared to be bounded externally by the peritoneal coat of the uterus, and internally by the uterine parietes. The anterior of this sac, which contained gas, also black and highly offensive matter, communicated by an opening (sufficiently large to admit the passage of the thumb,) with the cavity of the uterus. The fundus uteri was in a natural state excepting its peritoneal coat, which was highly vascular, but more so on the anterior than posterior pari. The ante-
216
Original Communications.
rior part of the uterus was in a gangrenous state. There was a white muddy fluid in the peritoneal cavity. The descend¬ ing colon, and ccecum presented marks of great inflammation.
February 8th, 1831.
[This was clearly a. case of chronic peritonitis, in which the symptoms were obscure, and in many points bear a close resemblance to that narrated by Dr. Malins in our January number. We are much obliged to Mr. Rees for the history of this case, as it strongly attests the views we took of that just alluded to. We earnestly hope that the details of both cases may attract the attention of practical obstetricians to a subject of such vast importance. We have only to observe in conclusion, that the unwearied attention bestowed by Mr. Rees, affords no slender proof of that anxiety which charac¬ terises the majority of our profession. — Ed.]
IV. — Popular Summary of Vaccination. By John
Marshall, Esq.
Mr. Editor,
The publication of the history, perhaps, of the following experi¬ ments upon the cow, although unsuccessful, yet, in conjunction with some other collateral relation concerning vaccination, &c. may become somewhat interesting to your numerous readers, through the medium of your excellent and widely circulated Medical and Surgical Journal, which will be gratefully acknowledged by your obedient and obliged servant,
John Marshall,
53, Jermyn Street, Jan. 22, 1831.
TO THE READER.
The principal object of the present essay, is to promote the views already promulgated in my former publication, relative to the prac¬ tice and causes of failure of vaccination ; and, I trust my extended practice has enabled me to elicit some further information upon the important subject of security. In drawing up my statement, I have carefully avoided all technical expressions, as it is my anxious wish to give as general a currency as possible, to opinions which must carry comfort and satisfaction into the bosom of every family.
Mr. Marshall on Vaccination.
21 7
The cow-pox, though harmless, no doubt requires the most careful manipulation, in order to secure ulterior protection ; but there is the satisfaction of knowing that there does not exist any difficulty in comprehending the sources of failure. Although it may be remarked that the operation of cow-pox has been simplified beyond the bound¬ ary of safety, for it is deeply to be regretted that numerous cases have unfortunately from time to time, and recently occurred, of small-pox, after vaccination, among families of the highest rank, as well as of middle classes of society. But these instances are attri¬ butable to various causes, but above all to the palpable error of a solitary vesicle , which has been far too generally adopted ever since its promulgation. In short, its prophylactic power is only to be obtained, by forming, in all cases, a plurality of vesicles ; this principle is founded upon irrefragable facts, and it is strongly re¬ commended to be adopted in the first, second, and either annual or every repetition of the process.
Some baseless theories are yet upheld against vaccination’s durable hold upon the human frame, which have arisen from mere defi¬ ciency of information ; such doctrines are wholly untenable, they are neither to be supported by reasoning, nor countenanced by facts. In this country, and, I believe, in most others, as yet, there is nei¬ ther decadency nor deficiency in the pristine power of vaccine lymph, nor is such an event likely to happen, since man is to all intents as well capable of ensuring its successive production as the cow.
It may be observed, that some remarks on this subject are similar to those which I have already published, but I may be allowed to repeat them, since further experience has brought to light additional evidence in their support.
Some experiments are recorded wherein I have inoculated the cow with both distinct and confluent small-pox matter, in its most viru¬ lent state, with the hope of ascertaining whether such a source gave rise to cow-pox, by the accidental application of the disease on the hands of the milkers to the nipple of the animal. The unsuccessful result of these trials is fully exemplified. It may, however, be here remarked, that facts implicitly recorded in every branch of science are pithy things, which in all instances ought to present the shield of protection against unwelcome reproach. If this experiment, at all events upon the cow, in more able hands, can eventually be found to succeed in England, I shall not only be most readily open to conviction, but even highly delighted and richly gratified. It is therefore surmised that the trial could be accomplished upon a larger scale, with far greater facility, among the herds of liberal graziers of our dairy counties, than the fastidious herdsmen of London. This hint is given with a sincere wish that it may be the means of stimulating some gentlemen of the faculty, residing in the country, who may have perchance perused this friendly challenge, since they
VOL. VI. no. 33.
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21S
Original Communications .
must be fully aware of the state of doubt in which the question is left, which evidently forms a physiological desideratum.
By way of concluding this address, I embrace this opportunity of recording a singular, and perhaps novel reality, which has been lately made to me by an all-talented physician. That all persons of both sexes, who are freely pitted with the small-pox, generally pos¬ sess, e consequential a pallid complexion (with the occasional excep¬ tion of free livers). This extraordinary phenomenon is ascribable to severe inflammation, which vents its force upon the features pending the disease, and by thus obliterating the faciei cutaneous colouring vessels. .Such an alteration, however, of the countenance but rarely occurs when small-pox succeeds non-eflicient vaccination.
The merits of vaccine have been simply elucidated by practical documents throughout my studies, and wholly divested of theoretical reasoning.
SECTION I.
The origin of Cow-pox considered. — Description of the genuine vaccine purple Scab upon the teats of the Cow. — Intelligence from Egypt , France , Scotland and England, relative to inoculating the Cow with Small-pox matter . — Eleven quadrupeds vaccinated at Utrecht, and similar operations upon Cows in the British empire .
It is readily admitted that in all branches of scientific inquiry, the labours of an experimentalist, whether for or against the subject of pursuit, may, peradventure, contribute to aid the cause, since nega¬ tive are equal to positive proofs, and may be the means of stimulat¬ ing others towards lending their aid, by either establishing or con¬ futing the theorem.
I have undertaken the task of inoculating three cows with the most active small-pox virus, on the back of their udders, with nu¬ merous punctures, thereby with the hope of establishing the momen¬ tous question respecting such a cause being the rightful origin of the genuine disease of cow-pox. From this affection, peculiar to the cow, has sprung one of the highest benefits to mankind, by its lead¬ ing to, and forming the source through the medium of the milker, of the discovery and practice of vaccination. This opinion, ever since its rise and promulgation, has been unremittingly entertained by celebrated philosophers, both at home and abroad ; namely, that its origin is ascribable to small-pox matter conveyed to the cow ; wThile many others have maintained with equal ardour, that the grease of the horse was its true base. But after all these cogent arguments, I am more than ever inclined to think that the disease will ultimately resolve itself into one which is naturally incidental to, or the sole offspring of the cow. Moreover, should this opinion
Mr. Marshall on Vaccination.
219
be found to be hereafter established, it goes far to corroborate the doctrine I have premised in the first section of my publication, a Popular Summary of Vaccination, with the causes of failure, &c. wherein these words occur, which may perhaps eventually be proved to be prophetically correct, that “ the disease, however, of the cow, is probably sui generis, and is propagated alone in that animal.”
So recently as on the 13th instant of November, 1830, for the first time in my life, I had the opportunity of witnessing, among a very numerous herd of cows kept at Knightsbridge, the remaining vaccine scabs of the genuine cow-pox, on the various nipples of four of the animals. This visit was made as soon as reported, with the hope of obtaining a specimen of recent vaccine virus, but the vesi¬ cles on the teats were all perfectly dried up by the termination of the active symptoms of the disease ; and all the necessary precau¬ tions were adopted by the herdsman, bearing the name of Dexter, to check its further progress, together with the immense trouble it occasioned among his milkers, during the indispensable operation of emptying the udders. On inquiry, 1 learned that the re¬ spective vesicles had been each surrounded with the circumam¬ bient inflammation, which fully proved that the genuine cow-pox had prevailed. The scabs were so remarkable in shape and appear¬ ance, that they are deemed worthy of describing. The colour re¬ sembled a mulberry about two-thirds ripe, of a deep reddish purple, edges jagged, of irregular shapes, and varying in size, the largest about an inch and a quarter in length, approaching indefinitely the figure of a triangle, placed carelessly topsyturvy, and here and there touching each other by its angular apex. A very fine cow, which had suffered the most, had large and very white teats, which ground, so suddenly contrasted with the zig-zag purple edge of the vaccine crust, formed a very grotesque appearance, which forcibly struck me at the moment to be very unlike any thing else that could possibly be effected by either grease or small- pox matter.
The intelligence collated from Egypt, France and Scotland, about to be described, seems highly plausible, by supporting both the theory and practice of such an origin, but nevertheless I am as yet free to confess, since candour is my object, prompted by the rules of experience, that I am disposed to doubt the fact of obtaining, by so eligible a mode, a supply at command of recent vaccine lymph in the climate of England. Previously to entering upon the detail of my own trials upon the cow, it seems incumbent upon me to lay before the public the several documents just alluded to, which, if they are still capable of realization, would no doubt afford a cause of delightful gratification to the enlightened world, to find that cow-pox is neither more nor less than a mitigated small-pox. I may, however, be permitted to premise, that pending the foreign experiments upon the animal, that in each cas'i they might possibly have been simultaneously affected by the accidental visitation of the genuine cow-pox ; and if such a casualty can be admitted, it might, perchance, have led to an inference grounded on fallacious prin-
220
Or igin al Com m un icat io ns.
ciples. It is painfully conjectured, that occasionally in medical works and others, theoretical cases are published, which have been figured in the study, free from truth and experience, but reprehensibly de¬ signed for betraying the unsuspicious. Such measures stint the advancement of science by fading the growth of its fruit.
In the year 1829, at one of the evening meetings so generously given to the faculty and literary members of learned institutions, by the Royal College of Physicians, under the patronage of its learned President, Sir Henry Halford, Bart, and the rest of its enlightened Fellows, a very interesting and elegantly written paper on vaccination, was read from the rostrum by the Registrar, Dr. Machmichael. By the liberal permission of the President, I have not only been honoured by the loan of this classical document, but also permitted to cull the following partial extract, which is closely allied to the subject : —
“ But a letter from India, with the perusal of which I was favoured yesterday, contains the following remarkable statement, which seems to me deserving the greatest attention : —
“ It appears that from the vaccine matter having lately failed in Egypt, in a great many instances, medical gentlemen were led to institute certain experiments, by which it has been discovered, that by inoculating a cow' with small-pox matter from the human body, fine active vaccine virus is produced. At the time the letter was written, there was a Greek child at Mocha that had been success¬ fully vaccinated with matter direct from the cow, produced as above mentioned ; and the virus taken from its pustules had acted with the best effect on several other children at Suez, where former attempts had failed.”
“ Now if this shall be found upon further trial to be really true, it will prove one of the most important facts connected with this interesting subject, for henceforth we need no longer fear that we may be deprived of the means of combating the small-pox, since that baneful contagion will furnish its own antidote.”
A question may fairly be asked, what cause can have given rise to the paradox, that vaccine lymph “ has lately failed in Egypt in a great many instances,” while in England, and all other countries, we are as yet strangers to such a phenomenon.
The concluding paragraph of the learned author contains, from such a document, the most appropriate inductions that could be drawn ; which, peradventure, it is hoped, may yet be found capable of con¬ firmation. It must, therefore, be strikingly evident that the subject may still require the attentive investigation of English physiologists, and that the truth of this doctrine is worthy to be put to the test of further experimental trials, and more especially since the dis¬ ease in the cow has ever been considered by experienced graziers as of rare occurrence.
Another parallel extract, equally interesting, and apparently fully confirming the foregoing quotation of the transmutation of variola into vaccina, bred through the medium of the constitution of the
Mi*. Marshall on Vaccination.
221
cleanly cow, is also extracted from the London Literary Gazette, dated March 20, 1830.
“ M. Robert, a physician at the Marseilles Lazaretto, has made a number of experiments, from which he concludes that the vaccine eruption had no other origin than the accidental transmission of the variolus virus of man to the nipple of the cow, and its consequent mitigation. He thinks that this discovery will diminish the number of opponents of vaccination ; as it will shew that the vaccine virus does not proceed from any impure and disgusting animal malady, but is simply a mild and local small-pox.
In consequence of the seemingly faithful relation of the antece¬ dent foreign experiments in two quarters (but since the discovery of Australia, what is now called by the literati, two-fifths) of the globe, Asia and Europe, they each demand our respect, which, in the opinion of many, may yield an impression of truthful conviction. A practical query may possibly arise, however, by the trial failing here and succeeding there, that warmer climates are probably more congenial towards aiding the full characteristic developement of the inoculated small-pox upon the system of the cow. It is universally admitted, from time immemorial, that warmth greatly increases the morbid effects of variolus miasmata, as proved by the immortal Sydenham. Suffice it to say, that since this is the truth, the im¬ portant subject under contemplation becomes a pathological problem, that still merits solution by further inquiry. Hence I have resolved again to repeat the experiment upon the cow during the prevalence of the hot weather, usually occurring in the vernal months, other reasons may be also assigned for choosing this period of the year ; namely, the animal is then deemed by all experienced graziers to be in the highest state of health, and more generally attacked by genuine cow-pox, which opinion is confirmed by Jenner, in con¬ junction with many other authors.
Again, Dr. Paterson has done me the honour to communicate orally the following additional and highly interesting intelligence, which is intimately connected with this point of discussion : —
About thirty years ago. Dr. P. while practising medicine at Ayr, in the West of Scotland, having, for the first time, introduced vac¬ cine inoculation into that part of the kingdom, he was impressed with an idea, that cow-pox originated from small-pox matter being commu¬ nicated to the nipples of cows by the milkers ; under this impression. Dr. P. inoculated nine milch cows on the lower part of the udder, in two different stables, with matter taken from a case of confluent small¬ pox. In a few days pimples had been produced on each of the animals, with one exception, which pimples continued to increase and form matter, with which this gentleman was very desirous to inoculate chil¬ dren, in order to discover what disease might follow. But this was unfortunately prevented by the impossibility of inducing any parent to allow their children to be inoculated with such matter.
Surely the large proportion of successful inoculation, in the ratio of eight to one, affords a striking, and even an encouraging stimulus
222
Origin al C om mu ni cat ions.
towards reiterating the scientific attempt of confirming this im¬ portant question, by further experimental search. And again, I repeat, that thus encouraged by the sanction of Dr. P. on whose integrity and veracity the utmost confidential reliance is placed, to reiterate the experiment.
The following extract on vaccination may also prove additionally interesting to the physiologist, by exemplifying the effects pro¬ duced by vaccinating eleven quadrupeds, widely differing in zoolo¬ gical classification. Many of these trials being original and de¬ scribed in a strain of truth and simplicity, they are worthy of com¬ municating. But more especially since the information has been conveyed to this country by so highly a respectable source, the Lon¬ don Literary Gazette, July 4, 1829. These cases prove that even the mild lymph of cow-pox, is fully capable of producing its vesicle in all these animals, with only one exception, namely, the rabbit. Many of the facts recorded and seemingly established, are truly remarkable, which may be said to afford some very scientific and curious points, worthy the consideration of the pathologist : —
“ M. Numan, a veterinary surgeon at Utrecht, has recently made several experiments with the vaccine matter, upon the following ani¬ mals — the cow, bull, horse, ass, camel, sheep, pig, ape, dog, and the rabbit. He states as the result of these, that the vaccine virus taken from man, reproduces the original effect when applied to the cow and the bull ; but that the action of the virus so applied to these ani¬ mals, is only for a single time ; on the horse and the ass it produces pustules, and when applied from them to the cow, its action is more intense than that of the primitive virus. The camel receives it easily by inoculation ; but when taken again from the camel and applied to the cow, it produces little effect. Applied however from that animal to the goat, it is quite efficacious ; but both the goat and camel are susceptible of its effects only once. The sheep does not yield readily to its influence ; and the virus from this animal has no effect upon any other. On the ape, the effect is nearly the same as upon man. The pig may be vaccinated, but the virus cannot be subsequently propagated. The dog is more difficult than the sheep, and the rabbit is quite inaccessible to the influence of the vaccine matter.
It is rather whimsical, that the effect of vaccine virus upon the ape comes the nearest to man.
So many principal animals recorded in the list of M. Numan, namely, the cow, bull, camel, and goat, that are subject only a single time to the vaccine disease, and first and foremost the cow, is readily granted; because, in England, this particular subject has been long known as an established fact in our dairy counties. For whenever it has been retaken by the animal, further proofs of its capability of resisting its former virulence has been invariably confirmed, first by the harmlessness of the vesicle, and secondly, its rapidly dying away ; thereby strictly resembling a case of re-vaccination in man, who has already derived full protection from a former operation. This re-
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223
markable circumstance, I think, if memory does not mislead, is re¬ corded in the works of Jenner. M. Numan is entitled to the thanks of the public, for prosecuting the experiments with so much ability and zeal. The successful management so largely diversified from one animal to another, must have occasioned considerable toil and difficulty. By succeeding also with vaccine lymph, which being comparatively less virulent than small-pox matter, it is fair in jus¬ tice to infer, that each operation must have required in its manipu¬ lation a high degree of experience and intelligence, and proves that he is a truly expert and zealous vaccinator. But nevertheless it re¬ mains to be a subject of doubt whether these animals would have been, either collectively or individually, alike susceptible of small¬ pox matter by inoculation.
It is likewise a well-authenticated fact, that in England, the vac¬ cine lymph derived from the vesicle in the human subject has been from time to time inserted into the udders of heifers, and milch cows, by surgeons in London and its vicinity, as well as in several parts of the British empire. The vaccine vesicle, thus produced in the animal was found by following up vaccination, to give back to man a genuine and unalloyed specimen of the vaccine disease, in all its wonted bearings.
With the exception of Dr. Paterson’s experimental cases, thirty years ago, of small-pox inoculation upon the cow before mentioned, it appears that the only similar trial, perhaps, which has ever been since attempted, and recorded in this country, was performed in the year 1829, by W. Sewell, Esq. assistant professor to the Royal Ve¬ terinary College. I am permitted also by this scientific gentleman, to state, that the variolous matter was freely inserted by inoculation into the teats and udder of a fine healthy milch cow, two calves, two lambs, and a couple of rabbits. But I greatly regret to be com¬ pelled to state that his praiseworthy intentions, of realizing this re¬ markably interesting phenomenon, entirely failed in these seven animals. Such negative proofs go far, as yet to confirm my own unsuccessful efforts, and casts a sombrous shadow over the ray of future hope.
It excites however my surprise that this influential subject for ex¬ perimental investigation, so apparently and originally connected with the question of the disease in the cow, and its valuable power, so auspiciously ordained for the relief of mankind, should have re¬ mained in a comparative state of relinquishment among the nu¬ merous scientific, members of the faculty, during an epoch so pre¬ eminently distinguished by the rapid advancement of scientific dis¬ coveries. I deeply regret that this important object has devolved upon myself, because in abler hands it would have been adorned with superior physiological illustration, which would have caused a more forcible claim to public attention.
224
Original Communications ,
SECTION II.
A general Detail of Experiments tried upon three Cows by
Small~pox Inoculation .
After surmounting numerous impediments and anxious delays, aris¬ ing from objections made to the proposition of trying the experiment upon the property of herdsmen, both within and without the metro¬ polis, at length however, I am enabled to announce a series of trials, which, although successless, may probably be deemed somewhat in¬ teresting, inasmuch as they may become useful to others, who may be induced to perform the like.
On September, the 16th, 1830, I obtained a supply of small-pox matter, of the distinct type in its most active state, on the eighth day from a young man of good stamina. On the same day, in a cow- pasture at Kilburn, the variolous matter was introduced by inocula¬ tion into the udder, between the legs, of a healthy milch cow, five years old, which period is deemed by farmers the prime, in full milk, and which had calved about six weeks; sixteen punctures were made with armed lancets and needles, from which resulted twelve red spots or blotches, — :they all became distinctly visible on the second day ; on the fourth, they were each progressing, and accompanied with a circumambient ring of inflammation ; on the fifth, increasing simultaneously in size ; but on the sixth day, they all suddenly dried up, and degenerated into a brown coloured scab, corresponding with the relative dimensions of the rose coloured spots ; three were ovi¬ form and the rest circular, and each about a quarter of an inch in diameter.
A question may possibly arise, how came it that matter was not taken from such a numerous sprinkling of what has been styled blotches, before they resolved themselves into a crust ? Because there was not the smallest approach made in either, towards the for¬ mation of matter ; and thus decidedly differing from either small¬ pox pustule or vaccine vesicle, when obtained by inoculation upon the human subject. In fact, they were all, strictly speaking, neither more nor less than simply a red blotch, without the slightest eleva¬ tion or distention of the epidermis beyond the cutis vera, although the lump projected above the surface in the form of a plano-convex lens. Hence they were unworthy to b.e called by the name of either pock, pustule, vesicle, or pimple. A slight areola oftentimes ac¬ companies a blotch upon the human skin, and this momenclature is more significantly adapted to the appearance on the udder than any other can express in the vocabulary of our language.
The sudden stoppage of the vesicles was at the time, for want of experience, attributed to the probability of the animal having pre¬ viously undergone the genuine cow-pox.
Before commencing inoculation, the cow was secured by a rope round its horns, and fastened to a gate post ; the hind legs were
Mr. Marshall on Vaccination.
s 225
also bound by a rope above the tarsus or hock ; this mode of precaution is called hobble, by herdsmen ; but in restive animals two ropes are necessary, one as before, and the other round the pastern or fetlock, which is technically named double-hobbling. Milkers rarely keep the hobble-straps, which are used in operations by vete¬ rinary surgeons to guard against accident. It will presently be made to appear that the hobble straps, being thongs of leather, had better be used than inferior tackle. Since the temper of animals, especially that of cows, is known greatly to vary, and the effects even of this slight operation cannot be prejudged ; it is therefore more prudent, in every instance, to be protected from danger.
The udder had been recently milked, which renders it far more manageable than while in a state of spherical distention.
On the score of humanity the nipples were purposely avoided, by preventing the sufferings of the animal, and the risk of injuring the pustule, during the frequent repetitions of milking ; and in an¬ ticipation of checking the supposed liability of the unpleasant con¬ sequence of extending the disease by the hands of the milker to the rest of the herd.
But further trials have been made upon two more cows, which moreover shew the precariousness awaiting the means of pursuit. These animals were selected from a numerous herd, being the healthiest and finest among them ; one yielded daily eleven quarts of milk, and the other nearly as much. On Saturday, November the 6th, 1830, they were each inoculated, by well armed lancets and needles, with confluent small-pox matter, taken from a lad on the seventh day of eruption. In the first cow fifteen punctures were made upon the hinder part of the udder, with every possible delibe • ration and cautious manipulation, but no proofs of effect of any sort or kind was ever afterwards perceptible. The other animal became so extremely restive and viciously inclined, that she broke her ropes, and remained for a time almost ungovernable ; the herds¬ man, milkmen, and self, were compelled to run by a speedy retreat, to escape her long and powerful strides ; under such untoward cir¬ cumstances, only two inoculations could be effected. These, how¬ ever, took an effect by exhibiting, on the second and third day, two red circular blotches, which dried up, and partly disappeared on the fourth day, when only a dry cuticular scale distinguished the spots.
It may be remarked that these experiments seem to involve in considerable doubt the questionable hope of ulterior success. The most active variolus virus of the distinct and confluent type has been freely employed, and the effect has fallen far short of realizing the project, which appears thus far to be consigned to mere theore¬ tical speculation, unaided by useful facts. Suffice it to say, that these failures are truly appalling, and serve to stagger hope and faith.
The cow, however, is capable throughout the seasons of equally displaying all the phenomena of the progressive changes of the vesi¬ cle by vaccination as perfectly as her genuine cow-pox, while the highly virulent small-pox matter, only exciting a temporary spot of
VOL. VI. no. 33.
G G
226
Original Communications .
inflammation, goes far to prove that her constitution seems to pos¬ sess an innate power of resisting its specific action.
SECTION III.
Hereditary Cases of Secondary Small-pox , #c.
It is much to be lamented that the small-pox has raged epidemi¬ cally with great severity throughout London, and its vicinity, also in divers parts of the country, during the last two years, but at the present period, although the depth of winter, it has become more rife than ever ; this fact is corroborated by the teeming instances of small-pox, after undue vaccination, not being followed up among the rising generation ; then may a further diffusion of my endea¬ vours be effected by repelling the prevailing evil. About thirty cases have been reported from various parts of the British empire, of the variolous miasmata having recurred to those who had had it before, either naturally or by inoculation. About eighteen years ago, my attention was drawn, by my late revered friend Col. B. to an hereditary and secondary case of small-pox, which had been exemplified in father and son. The singular anecdote connected with the history of these cases is worthy of record. The father, during infancy, caught the small-pox naturally, and his face was in consequence ever afterwards severely pitted. In early manhood, on the morning fixed for the solemnization of this gentleman’s mar¬ riage ; as bridegroom, however, he was prevented meeting his bride at the altar, by a severe attack during the night of the eruptive fever of secondary small-pox ; who, when slowly recovered, from a hair breadth escape of the confluent type, the marriage was happily consummated. The son and heir of this gentleman, while an infant, had been inoculated, and his face, like his father’s, bore ample testimony of its severity ; who, when arrived at the age of manhood, during a visit to London, he again imbibed the small-pox. I saw him repeatedly, while alarmingly ill and blind with confluent variola, of which attack, however, he also slowly recovered.
Such hereditary cases of small-pox, appear to me to have been but rarely noticed by medical authors, but left to be communicated by tradition. Upon inquiry, however, among many of my profes¬ sional colleagues, I have been enabled to glean some further intel¬ ligence, orally, upon this curious deviation from the general laws of nature, which, by surpassing the instinctive faculty of man, bids defiance to pathological explanation. A whole family of an English baronet, have been long known to be liable to secondary and here¬ ditary attacks of small-pox ; from motives of delicacy the name is suppressed, which wras imparted to me by a friend who has long attended the family. Some other gentlemen of the faculty, whom I have long known, have also met with similar instances in the course of practice.
Mr. Marshall on Vaccination.
227
In all such cases, it would be unreasonable to expect entire pro¬ tection from vaccination, yet it is highly consolatory to find, that even in such cases of constitutional peculiarity, whenever small- pox does recur after genuine vaccination, that the antecedent operation is frequently found to controul its threatening danger, by preventing the accession of the secondary fever. Hence, although this pheno¬ menon, in the opinion of the inexperienced reader, may appear para¬ doxical, yet it is a well known fact to the faculty, that small-pox, by recurring, even after the lapse of a large portion of life, is more severe in its secondary visit, as exemplified by the foregoing cases, and oftentimes fatal.
These comments may contribute towards confirming the compa¬ rative merits of the vaccine disease, and also that it is in every instance, and on every account infinitely more prudent and wise to vaccinate than to inoculate. If, however, doubts of security con¬ tinue to exist in the mind of the timid, from either hereditary or casual causes of failure, the patient had better be annually re¬ vaccinated, until its effects are capable of banishing the alarming impression of casual small-pox.
It ought to be universally known that vaccine lymph is specifically free from the contamination of the seeds of all other diseases ; and also that it remains identically the same in our own and many other climates, both in force and efficacy, after the long periodical test of thirty-one years. This circumstance admits of comparison by a new light. The rising generation who are now entering into the cares of the world, having been vaccinated, I have a right to suppose in early infancy, full twenty years ;'go, were consequently vaccinated when the lymph was proportionably new ; therefore it brings to conviction that one of the principal causes of failure is infinitely more attributable to a solitary vesicle than to decadency.
SECTION IV.
Some further Remarks derived from ocular Observation , which go far to enforce the necessity of forming a plurality of Vaccine
Vesicles.
Several opportunities have recently occurred, by tracing and ob¬ taining a more enlarged insight into the public and private practice of vaccination. To fearlessly expose the reasons of failure, founded on the principles of experience, truth and candour, has been my object, yet wholly divested of feelings, either of rancour or scur¬ rility, but merely with a view of upholding this striking object of humanity. It grieves me, therefore, to be constrained to announce the following facts, which, impelled by public duty, ought not to be repressed, as a general salvo re-vaccination in all doubtful cases has already been strongly recommended. By so doing, I am well aware that my professional colleagues, by being called upon to
228
Orig in al Commu n ication s .
reiterate vaccination in numerous instances, to correct the omissions of others, have had no feasible reason to complain. On this point of practice, I have also appealed to the warm affections and lively sympathy so unremittingly pourtrayed by all intelligent parents, in every family, towards the health and welfare of their offspring. Lest, however, these prefatory remarks may be deemed either tedious or superfluous, I shall now proceed forthwith to illustrate this topical subject of contention ; which, though far from personal reflection, it has been, alas, too general. These practical hints are therefore given with the hope of more certainly insuring the pro¬ phylactic power of vaccination.
During the last eighteen months, at various periods of life, from childhood to manhood, among the high and wealthy classes, as well as the middle and lower ranks of society, who had been vaccinated, in town and country, I have detected a very insufficient mode of vaccinating, by carefully examining both arms previously to repeat¬ ing the operation ; when only a solitary scar, very rarely two, and three never as yet found ; while many others, not having a ves¬ tige left, by escaping the power of naked vision, and even when assisted by the help of a double convex lens. But what is more remarkable, the cases of one cicatrix far outnumbered the average of the rest ; the consequence, however, that followed was still worse, because among those a larger proportion were found unpro¬ tected ! But my astonishment of such a discovery was cautiously suppressed, because many had been thus Vaccinated by gentlemen of high professional rank, to use a vulgarism, “ at the top of the tree,” many of whom have long ceased to exist, and others who are now in full practice ! It is a well known axiom, that the fear of overdoing this disease by a plurality of vesicles, is groundless. The praiseworthy example of triplet vesicles in each arm, is coeval with the commencement of the practice in the year 1799, in this metropolis, which highly prudential mode has been ever since, down to the present era, faithfully observed and encouraged by all the patronized vaccine institutions of this vast emporium. This prece¬ dent, it is fervently hoped, has been generally adopted throughout the British empire, in all the charitable establishments which adorn the state ; and should it also be further proved that the faculty else¬ where have been equally regardless of this valuable precept, it is never too late to mend ; the mind of the enlightened is readily open to the conviction of error.
During the epoch of variolous inoculation, from the fickleness of the matter, more especially in adults, by its venom producing reci¬ procally either confluent or distinct small-pox, a single pustule was deemed sufficient. But on account of the perfect harmlessness and comparative definite effects of vaccine virus, it possesses a diminished degree of force, and if so, it consequently requires a freer admini¬ stration for the purpose of effecting future protection ; and also by thus creating a wider expansion of surface for absorption, the system necessarily becomes more efficiently saturated.
Mr. Marshall on Vaccination.
229
The following trite remarks, if faithfully and universally adopted, will go far to insure a signal success to the cause. The vaccine lymph, obtained from a well- conditioned vesicle, if timely and freely employed, affords lasting protection. These emphatic data, pointed out by italics, may be said to comprehend the pith and marrow of the practice of vaccination.
Solely with a view of corroborating the laws and practical effects of vaccination, I may be permitted to give a summary view, free, it is hoped, of the unwelcome stigma of either vanity or boasting, which is founded on the basis of honour and ingenuousness. Among the thousands recorded in my public and private list, not a single case of subsequent small-pox has ever as yet occurred to my know¬ ledge. Numbers of whom, at various periods of life, have been since severely and repeatedly exposed to the contagion of variolous miasmata. The following additional statement contributes to con¬ firm the foregoing inference, namely, from the willingness of my public patients, assisted by the ignorant, to impugn the practice of vaccination. Three instances at lengthened intervals have hap¬ pened, wherein the children have been brought to me at six, eight, and fifteen months after genuine vaccination, with the eruption of varicella or chicken-pox, and each of these cases were unjustly denominated small-pox, two of which had been so misjudged by chemists ; these, however, were fortunately confronted and contra¬ dicted by the accidental presence of Mr. Stone, in one instance, and Mr. Tupper in the other.
But it fully appears that all impediments to the advancement of vaccination are rapidly subsiding, by its vast extension throughout the habitable world.
Hence from the foregoing arguments, it may perhaps be made evident that this innocent disease, while under the guidance of genuine principles of practical management, offers the feasible prospect of protection. It therefore constitutes a source of happi¬ ness to man, by defending him from the loathsome ravages and perils of small-pox ; its enfeebling inroad upon the human constitu¬ tion too frequently occurs, which lurks throughout the destined period of mortal existence. Whereas the faculty are strangers to any malady which can possibly be imputable to the gifted powers of vaccine, which fortuitously shields and nurtures the blessings of health, strength and beauty.
SECTION V.
Some original Events , illustrating the History of Inoculation and Vaccination , by those who were unconnected with the Medical Art ; namely, Mr. Benjamin Jesty, and two illustrious personages. Lady Mary Wortley Montague, and Viscountess Strangford.
With a view of informing the reader, who has not seen my former pubUcation on the practical causes of failure of vaccination, and to
230
Original Communications .
elucidate one important branch of this section, it appears to be somewhat expedient to give a succinct sketch of my fourth sec¬ tion, and more especially since its contents are original, by having never appeared before (it is surmised) in any other regular work of vaccination. The intelligence was chiefly obtained at the dinner table of the late Dr. George Pearson, who honoured me with an invitation expressly to meet at his hospital board Farmer Jesty, and the medical staff, who at that early period belonged to the Original Vaccine-Pox Institution.
A farmer, bearing the name of Benjamin Jesty, determined to try the effects of vaccine inoculation on himself, his wife and two sons, who accordingly armed the needle from the vesicle on the teat of a cow, and operated on the back of the hand near the knuckle of the fore finger, which left a cicatrix. This experiment took place in 1774, at least thirty years before Dr. Jenner. In 1804, Mr. Jesty and one of his sons came to London, at the request of the Board. On being asked why he did not persevere in his plan of inoculation, he replied, “ That he was so laughed at and ridiculed by the inha¬ bitants of the village, for introducing a bestial disease into his family, that he gave it up, and thought no more about it ; notwith¬ standing, however, he rejoiced to find that it was taken up by the faculty.” A question was asked (which I have since remembered) what induced him to make the trial ? “ By having known, through¬ out his life, that all the milkmaids who had taken the disease from the cow, never afterwards caught the small-pox,” In order, how¬ ever, to ascertain whether they were secure after the lapse of thirty years, Jesty and his son were re- vaccinated. The operation I seve¬ rally witnessed, which was followed by premature irregular pimples, attended by itching, which died off in a few days. Farmer Jesty was then in his seventieth year, who, on being asked how often the disease prevailed among cows, replied, to our mutual surprize, “ That it was by no means a common or frequent occurrence ; he had only seen the complaint three times during his life, and that it happened about once in two or three and twenty years, or thereaway.”
It may be here remarked as somewhat surprising, by the acknow¬ ledged freedom with which the story got wind among the tittle- tattle scandle of the village gossips, aided by the satirical weapons of peevish old maids, that some juvenile medical spark residing in the purlieus, did not embrace the fit opportunity of crowning him¬ self by taking a hint, and snatching the laurel from the brow of Jesty.
A hundred years ago, Lady Mary Wortley Montague was Am¬ bassadress to the Sublime Ottoman Port of Constantinople, by whose elegant epistolary correspondence, a vast improvement in the treatment of small-pox was introduced to Old England, by mitigat¬ ing the deadly attributes of natural variolous by inoculation, which is fully described, in vol. ii. fifth edition, 1805, of her Ladyship’s works. For the amusing intelligence of the reader, a compendious abstract follows. By the pressure of modern works, and the lapse of
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231
a century, this subject may have been partly forgotten by the public* but never by the faculty.
“ A propos of distempers, I am going to tell you a thing that will make you wish yourself here. The small-pox, so fatal and general amongst us, is here entirely harmless, by the invention of ingrafting , which is the term they give it. There is a set of old women, who make it their business to perform the operation every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox ; they make parties for this purpose, and when they are met, the old women come with a nutshell full of the matter of the best sort of small-pox, and ask what vein you please to have opened. She immediately rips open that you offer to her with a large needle (which gives no more pain than a common scratch), and puts into the vein as much matter as can lie upon the head of the needle, and after that binds up the wound with a hollow bit of shell, and in this manner opens four or five veins. The Grecians have commonly the superstition of opening one in the middle of the forehead, one in each arm, and one on the breast, to mark the sign of the cross ; but this has a very ill effect, all these wounds leaving little scars, and is not done by those that are not superstitious, who choose to have them in the legs, or that part of the arm which is concealed. The children or young patients play together all the rest of the day, and are in perfect health to the eighth. Every year thousands undergo this operation, and the French ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries. You may believe I am well satisfied of the safety of this experiment, since I intend to try it on my dear little son.”
It appears, however, by other travellers, who have stated that the part principally selected for inoculation by the Turks, is between the thumb and finger.
Another authentic . memorial, outvieing the former in value, affords an eligible subject for concluding this section. The com¬ munication, however, far exceeding in extent of utility, yet serves to elucidate a parallel line of association, by each acting in return or correspondence to the other. This memorable reciprocation, at all events of superior advantage to man, richly merits our admiration, and becomes an honour to England,
The vaccine disease was propagated in the following manner, from our native shores into the Turkish dominion, which completely absorbed the untoward impediments in the medical art, which had been hitherto fostered by the superstitious doctrines of the Koran. By the powerful influence of this regal example, many other coun¬ tries rapidly adopted vaccination, situate in the eastern climates ; namely, Egypt, Arabia, Syria, and Abyssinia. This reminds me of the anecdote told of Louis the Fourteenth, who banished, in one day, the mistaken objections made by his subjects against the
232 Original Communications .
t
potatoe, by wearing at court a blossom of the plant in his button holes, as a bouquet.
Vaccination was primarily communicated to the juvenile princes of the august Mahometan family, of the grand monarch of the Turkish empire, residing in the sumptuous Seraglio of Constanti¬ nople, through the medium of one of the illustrious offsprings of our Lady Ambassadress, Viscountess Strangford.
This striking coincidence of mutual benefits imparted from Con¬ stantinople to London, and vice versa, by two lady ambassadresses of exalted rank and talent, must be for ever hailed as a remarkable reality by the inhabitants of both nations, which will live for ages in the annals of history and natural philosophy.
SECTION VI.
The highly important Subject of the Decadency of Vaccination , together with Cow-pox Lymph, separately considered.
The chief aim here intended is to uphold the aspect of good faith and simplicity, but above all the cause of humanity, assisted by practice.
An almost uninterrupted succession of opinions are yet prevailing among the faculty and public, with regard to the durable power of cow-pox. This subject appears to demand further investigation. Some there are who tenaciously cling to an opinion that vaccina¬ tion looses its protective property upon the human constitution after a conjectural number of years, varying despotically from five, seven, to fifteen years ; such a line of demarcation, however, I have never as yet been able to discover ; and probably this tact in reality may puzzle the acumen of the most profound pathologist ; but never¬ theless this prophetical doctrine is supported by many with a degree of sang-froid which is somewhat surprising. Again, others are of opinion that decadency, or failure of vaccine lymph, is owing to its gradually wearing out. But this principle is also equally untenable, because the various evolutions of the vaccine vesicle in England progresses unalterably, as it did originally. I am unable to discover any ostensible reason for adopting such theories. These important heads are proposed to be separately elucidated by practical data ; but it is first deemed necessary to give a cursory history of small-pox virus upon the human frame. The change from a better to a worse state of small-pox miasmata, has never as yet been heard of among the annals either of ancient or modern authors, it remains un¬ changed by the hand of time. It has been, however, at all times subject to the influence of the floating temperature of climate, the changes of relative seasons either increasing or diminishing its
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233
malignity, the mode of treatment, and by a peculiarity of con¬ stitution varying in families.
But whether it has been either mild or virulent, the same lasting effect remains, with the exception of those ungovernable attacks of secondary cases.
The weighty question of vaccine lymph possessing a prophylactic force, constitutes the sheet-anchor of the merits of this national discovery, and throughout its career, this point of view has invited my untired labours of research ; cow-pox appears, by manifold results, to require a considerable degree of circumspection in its administration, which is the only means of securing its action.
By way of exemplification, a few hints may go far to strengthen the position, by tritely alluding to my former statement. Numerous mothers, who had been early vaccinated, have been tested in after life from the cow-pox vesicle of their sucking babes, with exemplary proof of protection. Milkmaids, after imbibing the matter of genuine cow-pox from the animal, become for ever invulnerable to small-pox. Numbers of men and women among the humble classes of society, who have long surpassed the adult age, by the test of re- vaccination, have been found protected. Such proofs go far to upset the opinion of decadency of vaccine upon the constitution of man.
The second division of this subject remains to be explained ; the fading of vaccine lymph, still in use throughout the British empire, appears to rest upon a false foundation ; the discrepancy of small¬ pox virus might as well be granted with equally physical truth. It appears, however, by some foreign reports from Egypt and Bengal, that the fervid heat during the torrid zone has impaired its efficacy ; while on the contrary, by intelligence received from the English faculty practising in our West India Islands, it has not suffered an iota in diminution ; — thus the western report presents a flat contradiction to the eastern. The European inhabitants residing at the presidency of Calcutta, prefer the cooler months of Novem¬ ber, December, and January, for vaccinating during' the prevalence of the north-east monsoon.
If the opinion upon the declining state of vaccine lymph at home, after the lapse of thirty-one years, becomes an admissible fact, by such reasoning, those patients, it would be fair to suppose, who were vaccinated with its infant tymph, ought to have evinced a more forcible or lasting effect, and the scale of decadency must have been governed by the revolving of time. But it is useless to defend such misconceived notions ; the decading property of the vaccine lymph has been rejected by the highest authorities at home, by patronised institutions on the continent of Europe. After eight years trial of the identical source of lymph. Dr. Jenner prognos¬ ticated this encouraging doctrine, which has been strongly defended by numerous authors. But another all-powerful defence of the non-decadency of cow-pox lymph remains to be quoted, which sus¬ tains the argument down to the present epoch, by positive illustra-
VOL. vi, no. 33. h H
234
Original C ommunicati ons .
tion. I performed the operation during the summer of 1830, upon the ncevus maternus, or mark of the mother, situate in the arm of a child, which was wholly obliterated by the united combination of nu¬ merous vaccine vesicles. This subject alone brings home to convic¬ tion that the pristine force of the lymph remains in statu quo. This merciful result has been also recently testified by surgeons of acknow- ledgjd rank and talent.
The sequel, however, of such defalcation is easily accounted for ; the alarming attacks of small-pox after vaccination, are primarily attributable to a parsimonious vesicle, by wounding the same when at its height of perfection, to administer its ripening c ontents to others ; also employing it after the by-gone period of activity and perfection, or by some untoward accident arising by either rubbing, scratching, or crushing by pressure.
These circumstances, by occurring in a vesicle, are not unfre- quently so slight or trivial, that they evade detection even among a group of six or more ; if it happens to be solitary, it beguiles the sur¬ geon and patient. The antecedent adverse chances comprise the fundamental causes of failure, and exonerate the genuine lymph from blame. It is therefore hoped to be made to appear that the balance of justice springs high in its favour.
SECTION VII.
The discovery of Vaccination derived from Milkmaids, and whether Cow-pox is also attributable to the same class of peasantry.
It is universally admitted, that mankind is wholly indebted to the discovery of cow-pox by English milkers resisting small-pox con¬ tagion, after imbibing the genuine disease from the nipples of the cow.
The blithsome milkmaid rising in the morn, beholds with awe Aurora’s purple eastern beams, who tramps in verdant lawns and pastures wild, bedecked with
Rosy cheek and sparkling eye,
Beauty, health, and symmetry.
But it becomes a questionable subject, to understand whether or no the disease in the teats of tire animal has likewise originated by their hands and fingers being infected by small-pox pustules during the operation of milking. An apparent solution of this intellectual difficulty is not satisfactorily to be met with in any author ; it appears at all events, for want of due deliberation, to have been by many too hastily adopted ; an attempt will, therefore, be made to refute this notion, by practical observation, assisted by the laws of pathology. Would it not be repugnant to the feelings of philanthropy, even for a moment to conceive that a poor humble individual, sorely afflicted by a loathsome eruption of pustules extending all over the body to the
Mr. Marshall on Vaccination.
235
fingers’ ends, accompanied by fever, debility and blindness, to be con¬ veyed in such a plight to a pasture field to perform the functions of her calling ? Such a sight would accord with the tragical scenes of Melpomene. Reduced by disease, the patient requires recumbent rest, medicine, and nourishing diet to recruit her stamina, long after the drying-up of the pock and separation of its scab. These remarks prove the needful absence of the patient from the cow, and may per¬ haps suffice to carry conviction home to the breast of the sceptic. Many slighter cases of natural small-pox may readily be quoted to strengthen opposition to this groundless doctrine, e. g. frequently the disease in various constitutions is mild, and accompanied by a slight sprinkling of pustules, which are chiefly confined to the face, with but few or none either upon the body or hands. But modified speci¬ mens, among milkers and others, have been more frequently effected by inoculation, whereby the venom is often confined to a few pocks either within or hard by the scope of the surrounding inflammation of the original pustule obtained by the lancet, with pain in the arm- pits and transient fever, while the patient is announced to be safely protected. By the general adoption, however, of vaccination through¬ out our country, this speculation must speedily fall to the ground. The cases which occurred last November, 1830, among cows at Knightsbridge, could not be ascribed by the herdsman, Dexter, to small-pox prevailing among his numerous helpmates. Has ever an authenticated case been heard of from any dairy county, wherein the animal became affected by variolous matter by the hands of the milker? Dr. Jenner, it is well known, practised many years in the dairy county of Gloucestershire, who never adduced such an instance ; so far to the contrary, I have already proved at length, that his judg¬ ment was diametrically opposed to this origin.
This subject, after all, may be said to rest upon a fanciful basis, which by analagous experiments upon the cow, I am prompted to reject as a phantom. Suffice it to remark, that a plausible tale fre¬ quently involves matter of fact into a mist of obscurity. The late Dr. Hawes, pending the meetings of the debating society, held in the theatre of Guy’s Hospital, who whenever a student indulged too largely in theory, he used to call him to order by this appropriate address that, “ a drachm of practice is worth a pound of theory.”
[For Mr. Marshall’s Cases of N atvus Maternus, we refer our rea- dear to our Number for July last.]
A COROLLARY.
It may be here observed, by way of corollary, that the small-pox has been ascribed by ancient authors, to owe its origin to a disease in the hoof of the camel ; a theory, however, during the lapse of some thousand years, a period sunk into oblivion by the revolving darkness of ages, has never as yet been proved experimentally upon the human
236
Original Communications .
being ! At present, therefore, it strikes the author, that the cause of cow-pox is inveiled in a somewhat similar perplexing mystery. It appears also to have been equally impracticable to produce any decided affection upon the cow, by the grease of the horse. It may be asked, while the cow is always amenable to mild cow-pox by vaccination, all the year round, how is it that she is at any time capable of resisting the effects by inoculation of virulent variola.
Here follows a trite metaphorical illustration, in three alternate sentences ; of natural small-pox, inoculated small-pox, and vacci¬ nation.
Man, in a state of nature, forded the river, and thousands of his fellow creatures wertf drowned.
The savage, impelled by instinctive reflection, constructed a raft and boat, by which fewer companions were lost.
As civilization advanced, however, the skilful architect designed a bridge, where all pass over in safety !
53, Jermyn Street , February , 1831.
V. — Judiciary Examination of Wounds.
By M. Ryan, M. D.
According to the law of this country, the surgeon must describe the length, depth and situation of wounds, also state whether they be mortal or not. He is to examine the orga¬ nic state of the wound, and ascertain whether it be in a healthy or morbid condition. Thus a slight blow may cause rupture of a vomica or an aneurism, strangulation or gan¬ grene in a hernia, or rupture of a varicose vein in the leg. A person who inflicts a wound or contusion in such cases can¬ not be responsible, as he did not foresee the danger, and the injury he inflicts is independent of his will. We must exa¬ mine the state of the constitution and habit of body , as wounds are greatly aggravated, when the patient is of a weak, enfeebled constitution, or is labouring under a chronic disease, or is of scrofulous, venereal or cancerous habit. We must bear in mind the personal conduct of the patient, as his refusal to submit to proper treatment or a necessary operation, his removing* bandages, his inattention to regimen, his use of aliment or ardent liquors, interdicted by his con¬ dition, may render a wound not necessarily mortal, highly dangerous or fatal. The conduct of the attendants must be observed, as their opposition to the proper treatment.
Dr. Ryan on Judiciary Examination of Wounds 23 7
their excitement of strong* emotions in the sufferer, may cause death. W e should also remember the state of the weather, or insalubrity of situation, as an atmosphere too warm or cold, or that charged with putrid emanations, or that of hos¬ pitals, may render a wound mortal. The occasional occur¬ rence of hospital gangrene, and epidemic erysipelas, such as has been lately present in the London Hospitals, and well known to scientific surgeons, may of course render a wound not dangerous, after infliction, ultimately fatal. Lastly, we should consider whether the treatment had been scientific. Here we must be exceedingly cautious in giving an opinion, and always recollect that the greatest diversity of opinion, both as to the nature and treatment of, by far the greatest number of diseases exists, and that the authority of eminent men may be quoted on both sides of the question. On the other hand, when gross ignorance is displayed and fatal injury follows, such conduct richly deserves exposure. This rule was laid down by Dr. Percival, and ought to be fol¬ lowed. It would, however, be an ungracious task to volun¬ teer an opinion on the practice of a respectable contempo¬ rary, even for the promotion of the ends of justice. But no honorable practitioner would violate the etiquette and fra¬ ternal feeling which have invariably characterised the pro¬ fession, by exposing or censuring the practice of another from private pique or jealousy, and for no public advantage. Every man who does so, will be despised by the profession, and indeed by the sensible and thinking part of the public. He violates the golden rule of ethics, <f do unto others as you would they should do unto fyou.” All medical prac¬ titioners, like their fellow mortals in all stations, are fallible; whoever is without this imperfection, may throw the first stone. Every man engaged in practice meets with bad and fatal cases, and may make mistakes, but it would be unjust and unwarrantable in a brother practitioner to expose him to public censure, unless the interests of humanity and science demanded it. As the law now stands, the president of the College of Physicians or College of Surgeons is as liable to be criminally indicted for unsuccessful practice as the veriest empiric in this land of empirics ; such was the opinion lately laid down by Judges Park and Garrow, at the Old Bailey, in Long’s case ; but they went further and declared no man, regular or irregular, can be subject to a criminal information. Lord Coke held a felony for an irre¬ gular person to undertake a cure and allowed to die. Sir Matthew Hale thinks this an error, and Judge Blackstone
238 Original Communications .
sides with the former ; Mr. Justice Bayley holds it man¬ slaughter— -Will cock on the laws relating to the medical profession, p. 2 27. Such is the discord among the judges upon this point ; but common sense and justice are in favour of the profession and against empirics. From the preced¬ ing statements it is evident, that one medical man should be cautious in condemning the practice of another, unless under the circumstances mentioned.
The rules to be followed in making an autopsic examina¬ tion for juridical purposes have been in a great measure de¬ scribed in the article infanticide. Other points are to be kept in view, as the posture of the body, whether it be naked or covered, if it be in contact with any hard sub¬ stance, if it be so situated that putrefaction may be retarded or promoted; how it is situated relative to surrounding objects, and particularly with respect to weapons of all de¬ scriptions. Every part of the body is to be examined, and all marks of violence carefully noted, when a weapon is found in the hand of the deceased, if this really produced death, or was so placed by a homicide. We should com¬ pare its dimensions with those of wounds, and consider the state in which the body has been found, and before removing it, ascertain the site, direction and extent of lesions, and finally, to avoid confounding the derangements which may be caused by removal with those produced by former violence. We should also notice whether the instruments have pierced, cut, or contused any part, and if deceased could have made resistance. It is also necessary to note the apparent age, muscularity, condition of the body, whether full or ema¬ ciated, the colour and quantity of hair, and in a word, every feature which can prove identity. It is right to observe the dress, all* papers, money and other matters found about the person of the deceased.
Having accomplished these things, the body may be re¬ moved, washed, and every mark of injury, contusion, ecchy- mosis, wound, fracture, dislocation, carefully examined, and we must take care not to confound cadaverous lividity with ecchymoses. If the body is that of a female, we must ex¬ amine the mammae, abdomen and reproductive organs, in order to ascertain signs of recent or former delivery.
After all these considerations on the external state of the body, we are next to examine all the outlets, observe all fluids contained in them, and sometimes analyse the latter.
The body may be examined in the manner laid down when describing the examination for infanticide, or as recommended
Dr. Ryan on Judiciary Examination of Wounds. 239
in the recent manuals of practical anatomy. The most minute examination of all internal organs should be made,, and all marks of disease carefully noted.
A question has arisen, whether an autopsic examination ought to be made when putrefaction has set in ; and it has been decided in the affirmative. Orfila was charged to ex¬ amine a body, which had been buried twenty-nine days ; the external surface was generally in a state of putrefaction, and exhaled an insupportable odour, which required the use of disinfecting agents ; but the digestive organs, liver and spleen, pancreas, bladder, heart and lungs, were unaffected by decomposition, and traces of poison were found in the stomach and bowels. A case was lately recorded in one of the French journals, where poison was discovered fourteen years after the interment of the body.
The brown, green or blackish colour of the skin should not prevent the examination of the body, and the fetid odour and all danger arising from effluvia, will be obviated by a free use of the chlorate of lime, in the proportion of six ounces to fifteen pints of water. Orfila strongly advises this solution when exhumation is to be effected, and says some pints of it are to be poured on the earth, when the labourers approach near the coffin, and also when the latter is un¬ covered before raising it from the grave. The labourers should apply a handkerchief, dipped in vinegar, to the lips and nostrils, as in some cases instant death has been pro¬ duced by opening a grave.
It is indispensably necessary to open the head, chest and abdomen in all cases ; to state all morbid appearances as concisely and as intelligibly as possible, avoiding technical- ties whenever we can, and observing generally that all parts were healthy, with the exceptions which may be found. The object of a coroner’s inquest in these countries is to ascertain the cause of death, and not to hear a tedious and unintelli¬ gible detail of the natural appearances of every tissue in the human body. The questions are the morbid appearances observed sufficient to account for death, and were they pro¬ duced by natural disease or by violence ? I shall consider all the bearings of this position in my remarks on the man¬ ner of giving medical evidence.
When the body is mutilated externally, we should examine all the cavities, especially the intestinal canal, as cases are recorded in which poison was detected under such circum¬ stances.
Can we distinguish wounds inflicted before and alter death 1
■ •
240 Original Communications.
O
In describing* wounds, I have endeavoured to point out the diagnosis between ecchymoses and cadaverous lividity — a point of the greatest importance.
When a wound is inflamed, in a state of suppuration or cicatrization, it must have been produced before death.
If it is inflicted in the last moments of life, its edges are more or less retracted and tumid, it is covered with a clot of blood, there is a sanguineous infiltration in the cellular tissue.
When a w ound is made some hours after death, its lips are retracted as if inflicted during life, but its lips are pale, not tumified, without any trace of blood ; the cellular tissue is not infiltrated, unless a large vein has been divided.
But when a wound is made immediately after death, it is impossible to draw a distinction ; it will possess all the characters of a wound inflicted in the last moments of life Much stress has been laid on the presence of blood stains upon clothes, and deadly weapons found upon or near the deceased, or in the possession of the accused, but we must be fully convinced of their existence, before we give a posi¬ tive opinion. Evidence upon this point has too often proved fatal to innocent persons. When such stains are sworn to, the prisoner usually ascribes them to the blood of animals, or to effusion of blood from the nose, an accidental wound or an ulcer; but other facts generally disprove his assertions.
Can we distinguish by dissection whether death is the effect of homicide or suicide ? A careful examination of the situation of a wround, may perhaps enable us to determine this question in the affirmative. If, for example, a fatal, incised, or punctured wound, exists on the back of the head or chest, if the hand or hands of the deceased are also w ounded, it is evident resistance had been made, and murder generally proved, though there may be some exceptions. In general a suicide inflicts wounds on the anterior surfaces of the face, chest, and abdomen, and almost always in an oblique direction from right to left: those made by an assassin are from left to right; but though this difference is conclusive with some jurists, I think it far from being* posi¬ tive or satisfactory.
Fodere is of opinion that the expression of the physi¬ ognomy of the suicide is more tranquil than that of the victim of homicide ; but this distinction is far too nice to be de¬ pended upon.
Before we arrive at a final conclusion, w^e must consider the age, physical and moral constitution, the season and constitution of the atmosphere, &c. In general, suicide is
Dr. Ryan on Judiciary Examination of Wounds. 241
very rarely committed before puberty, generally from the age of 20 to 50, and rarely after this period. It is said that persons of a sanguine temperament commit suicide in an instant of passion, and the melancholic after long delibera¬ tion. It is proved by late writers, that this dreadful act is not so much influenced by climate as was formerly imagined, and that it is as common in Paris as in London. The human frailties and passions are to be found in all nations ; and hence we observe, that the hope to serve a country, parent or friend, the respect for religion, for the laws, the belief in a certain religion, political dogmata, philosophical princi¬ ples, prejudices, usages, pain, moral or physicial, chagrin, weariness of life, impotence, delirium of passions, acute diseases and mania, are the motives and causes of suicide in all civilized countries.
Reflection has convinced me that the moral as well as the physical defects of the human family throughout the face of the globe, are not so very dissimilar, as national jealousy had at one time determined.
Dr. Powell, who was secretary to commissioners for licensing lunatic asylums, published an account of the num¬ ber of lunatics from 1775 to 1809 inclusive, in which he concluded the malady was on the increase in this country. This conclusion is disputed by Dr. Good, who says, “ cal¬ culating with Dr. Powell, that the number of lunatic pau¬ pers, and those received into public hospitals, which, under the act of parliament, are not cognizable by the commis¬ sioners, together with those neglected to be returned, com¬ pared with the returns entered into the commissioners’ books, bear the proportion of three to two, which is pro¬ bably far above the mark, still the aggregate number of insane persons for the year 1800, contrasted with the gene¬ ral census for the same year, will only hold a ratio of about 1 to 7300 ; while if we take, with Dr. Burrows, the propor¬ tion of suicides committed in foreign capitals as a test of the extent to which insanity is prevalent in the same towns, which is nevertheless a loose mode of reckoning, though it is not easy to obtain a better, we have reason to conclude, that insanity is comparatively far less fre¬ quent among ourselves, than in most parts of the continent: the suicides of Paris, Berlin, and Copenhagen, as drawn from tables collected by Dr. Burrows for this purpose, being, in proportion to the relative population of London, as 5 to 2 for the first, 5 to 3 for the second, and 3 to 1 for the third.”
VOL. vi. no. 33.
i i
\
242
Original Communications,
Sir Andrew Halliday maintains, that the number of the insane in England has been tripled during the last twenty years. — Letter to Lord Robert Seymour , 1829.
i . 'i-
BIBLIOGRAPHY.
MEDICINE,
1. Phthisis in its last stage , terminating favourably. — I was requested to see a post-boy, who had been long ill with cough, and had emaciated considerably ; I found him, as I thought, in a hopeless state of pulmonary phthisis. He was a victim to the dark catalogue of ills which characterize the last stage of that complaint. His emaciation was extreme. He had, alternately, colliquative diarrhoea and profuse sweating. The mouth was aphthous ; the cough har¬ assing, and the expectoration profuse. The ankles were oedema- tous, and the countenance pale and cadaverous. The breathing quick and laborious. The disease had come on insidiously . I re¬ garded it as a lost case, and so spoke of it to the friends, ordering merely a mixture of chalk and laudanum to restrain the diarrhoea ; and after visiting him a few times, abandoned him to his fate. To my no small surprize, the man recovered by continuing the chalk mixture, and has resumed his station as a post-boy, which employ¬ ment he has continued for the last three years : but there is mani¬ festly still existing great mischief in the lungs. His breathing is short, and he is never without a cough ; moreover, his appearance is cadaverous, and gives proof that he is still a prey to some disor¬ ganizing process in the important viscera of the chest. Notwith¬ standing all this, he has so far recovered as to be able to follow his avocation, and is exposed to all the hardships which attend the life of a post-boy.
What shall we say, then, of this case ? Is chalk mixture a cure for pulmonary consumption in its last stage ? Dr. Hastings. — Mid¬ land Med. and Surg. Rep. Feb.
2. Impotence and Sterility. Dr. Harrison has published an essay on the powerful influence of the spinal nerves over the sexual organs, and through them upon the general state of the body, which was added to an appendix to the Monthly Gazette of Practical Medicine- The author relates some curious cases of spinal disease which pro¬ duced impotence and sterility, which finally gave way to his plan of treating the original disease. We believe there are few practition¬ ers in this country so successful in the treatment of spinal curvature as Dr. Harrison, and we have in an original editorial observation, on impotence and sterility published in this Journal, adduced ample
Medicine .
243
evidence of the possibility of these affections depending on the causes under consideration.
We are sorry to observe a gross and personal attack, in the last Monthly Gazette of Practical Medicine made by Dr. Fosbroke of Cheltenham, on a highly respectable and regularly educated surgeon of this city*— Mr. Darwin. Granting every merit to the writer for his unbounded zeal in attacking empiricism, of which few more highly approve than ourselves, we would recommend him to be a little more cautious in naming individuals in future. We might expa¬ tiate further on this topic, but we shall decline to do so. Neither shall we remiiid the parties of an old adage, which will naturally suggest itself, if not to them, to every other practitioner who views their position.
3. Proposed Nottingham Dispensary .■ — We have been favoured with a well written historical sketch of the Medical Charities of Not¬ tingham, by Mr. Thomas Jewett, surgeon of that town, where, among the fullest particulars of these Institutions, we find to our utter asto¬ nishment “ the exclusion of the medical faculty from the committee of the proposed dispensary.” This piece of imbecility and pre¬ sumption on the part of the governors, naturally aroused the profes¬ sion to assert its dignities, and led to several meetings of the whole faculty, which were conducted in that decorous manner, characteristic of our profession. A remonstrance was unanimously adopted against the nominal cause of exclusion, “ it was not desirable to place medi¬ cal gentlemen on the committee from the danger of exciting profes¬ sional jealousy and of giving undue influence to individuals, who might afterwards wish to become medical officers of the charity.” It clearly appears to us, from the evidence before us, that the exclu¬ sion of the physicians and surgeons was a preconcerted plan on the part of the governors, and that they were perfectly justified in re¬ monstrating and resenting the indignity offered to them. We are truly surprised that the governors should be so blind to the interests of the intended institution, as to exclude those best qualified to afford information on the best manner of managing it. They might have looked to their Hospital, Lunatic Asylum and other Institutions, for the benefits conferred by the medical committees ; and if they still doubted, they might have inquired how is this affair managed in the metropolis. They would then have learned that there is not a Dis¬ pensary in London, that has not its medical committee, a body to which the general committee looks with the greatest respect for in¬ formation as to the best mode of conducting the institution. We should have doubted the possibility of the occurrence of such &T piece of absurdity, had we not been convinced of the fact, that Dr. Mars- den, the senior physician of Nottingham, and twenty six other medi¬ cal gentlemen had signed the remonstrance. As soon as the sage governors had their eyes opened by the medical meetings, they struck their colours, and expressed themselves, ready, willing and “ happy to receive them (the medical practitioners) into their body.”
244 Bibliography.
These worthies ought to be henceforth designated, “ The Wise Men of Nottingham.”
PRACTICE OF MEDICINE.
4. State of Medicine in Turkey. — “This gentleman was bom at Zagori, a district not far from Ioanina, famous throughout the Levant for its breed of itinerant quacks. The male population consists solely of M.D.'s; Zagoriot and doctor being synonymes ; and indeed, the medical profession becomes, in their hands, so lucrative, as en¬ tirely to supersede the necessity of any other. An idea of their wealth may be formed from their houses, which are well built, spacious, and the best furnished in Turkey. When at home, they live like gentlemen at large. It may not prove uninteresting to those who wish to ascertain the state of medicine in Turkey, to hear some particulars relative to the education and qualifications requisite to obtain a degree at this singular university. The first thing taught to the young men is the professional language ; a dissonant jargon composed purposely to carry on their business, hold consultations, &c. without being understood by any being in existence but them¬ selves. They are then taught reading sufficiently to decipher the pages of their i<rT£o<To(pi, or manuscript, containing a selection of deceptive formulae, for all possible diseases incident to human nature. When a candidate has given before the elders proofs of his profici¬ ency in these attainments, they declare him to be dignus entrare in docto nostro corpore ; and he then prepares to leave Zagori. The Zagoriots generally travel about Turkey in small bands, composed of six or eight different individuals, each of whom has a separate part to perform, like strolling players. One is the signor dottore. He never enters a town but mounted on a gaudy- caparisoned horse, dressed in long robes, with a round hat and neckcloth; never opening his mouth but ex cathedra, his movements are performed with due professional gravity, and he is at all times attended by his satellities. One is the apothecary ; the second the dragoman ; for it is the doctor’s privi¬ lege not to comprehend a syllable of any other language but the Za¬ goriot : a third is the herald, who, endued with a surprising volubi¬ lity of tongue, announces through the streets and in the public squares, the arrival of the incomparable doctor ; enumerates the wonderful cures he has performed ; and entreats the people to avail themselves of this providential opportunity : for, not only does he possess secrets for the cure of actual diseases, but of insuring against their future attacks. He possesses the happy talent too of ingravi- dating the barren, and leaves it to their choice to have male or female, &c. &c. He is skilled in the performance of operations for the stone, cataracts, hernia, dislocations, &c. Two others, who pass under the denomination of servants, employ their time in going from house to house in quest of patients ; and as, from their menial employment, they are thought to be disinterested, credit is the more easily given to their word. Thus they journey from town to town, hardly ever
Practice of Medicine .
245
remaining more than a fortnight in any place. After a tour of five or six years, they return for a while to their families, and divide in equal shares the gains of their charlatanism. On a second journey, they all change parts, in order to escape detection. The dottore yields his dignity to the servant, and does the same offices to him as he was wont to receive; the dragoman becomes herald, the herald apothecary, &c." — Literary Gaz.
SURGERY.
5. — Case of Fungus Hcematodes of the Thigh, cured by Amputation. By William M ‘Do wall. Surgeon, Kirkcudbright. — William Carson is a lad of about 23 years of age, in the village of Twynholm, near Kirkcudbright. He had about nine years ago been seized with a swelling and inflammation a little above the right knee joint, upon the inside of the thigh, accompanied with fever and swelling all over the thigh, and an abscess formed, which, as described to me, had broke of itself, and discharged a great quantity of matter from three different openings above the knee. It continued to discharge matter occasion¬ ally till about the end of September 1829, when I was called to see him. The thigh was then swelled from the knee to near the groin. The tumour was found soft, and had the appearance of fluctuation bqt not very distinct, like a deep-seated abscess. I called two days afterwards and opened the tumour, with an abscess lancet, but no matter came out ; thinking that I was not deep enough to reach the matter, I opened it more deeply with a scalpel, but nothing appeared except a white fatty substance and a little discharge of blood from the cut. From that opening of the integuments, a large fungous white tumour began next day to advance, and every day it gradually shot out larger and larger. I enlarged the opening of the integuments of the thigh to see what size the tumour would grow to. It continued to enlarge till it measured about twenty inches the one way over the top, and nineteen inches the other way, and the circumference at the base measured about twenty-five inches. It had much the appear¬ ance of a large melon, and blood began to ooze from it, as if pressed from a sponge. There was no way of stopping the bleeding, but by fine tow or lint applied dry over the surface ; upon the top it began to mortify, and emitted a very foetid smell. The lad was anxious to have this tumour removed. For this purpose, he was taken out of bed, and placed upon a table, and when the tumour was cut into, its substance appeared to be soft and pulpy like brain. It was removed down to the bone of the thigh, and was found to penetrate under the integuments and betwixt the muscles ; I was obliged in a great measure to push it out with my fingers, for, on account of its soft¬ ness, it would not separate well from the muscles by cutting.
There was a great loss of blood in the removing of the tumour, which took much longer time than I had anticipated. The lad was nearly an hour under the operation ; and from these causes, when the wound was dressed he fainted away, and I was much alarmed for his
246
Bibliography,
recovery from the faint ; but by cordials and applying heat to his feet he gradually recovered. The sac and wound seemed to get clean, and began to fill up with new granulations. The matter got better ; his appetite and strength seemed to recruit for about two or three weeks ; and we were hopeful that the wound would have healed, but the appearances did not continne long. Five fungus tumours began to advance out of the sac of the wound. Every day they enlarged, and they at length assumed heads as big as the largest apples, and indeed appeared very like a cluster of apples upon a tree. When this se¬ cond fungus growth was advancing, a sharp point of bone was felt by the finger just over the head of the fibula. It had separated from the inside of the thigh bone, and had passed into the situation just mentioned, where it was cut out with difficulty. As soon as it was removed, a large fungus tumour just of the same appearance with the others began to advance. That fungus bled profusely ; and when the lad moved his limb, or upon the tumours being dressed, I observed the blood oozing out of the top of them all, like water pressed from a sponge. He went on in this way for several weeks ; and from pain and loss of blood he was reduced to the last state of human distress and misery. His pulse was upwards of 125, his face pale, and his appetite nearly lost, and he was affected with diarrhoea. It was now about ten weeks from the time I had first seen him, and it was suggested that the only chance he could have of recovery was by the amputation of the limb. To this, although he had previously objected, he now readily submitted ; and on the 10th December, 1829, after consulting with James Watson, Esq. surgeon in Gatehouse, I performed the operation by amputating the limb above the diseased part. The lad stood it well, and there was not above half a cupful of blood lost in the operation. The place where the patient lay was a poor cottage, which being badly lighted, and the day being dark, we were obliged to use candles in taking up the vessels — this caused the operation to occupy a few minutes longer. It is unnecessary to relate the different steps of the opera¬ tion, but the limb was taken off very high up, about four inches below the trochanter major. The pulse came down, and the general health improved every day after the limb was taken off, and in about a month the stump was quite healed, and the poor lad had quite recovered his strength. I may mention, that I met him on the road upon the 10th day of April, 1830.
After the limb was removed, it was dissected and examined, when it was found that the piece of bone measuring five inches in length, which was cut out near the head of the fibula, had been detached from the femur, and had left the cavity of that bone open to the marrow. From this opening the fungus hmmatodes had proceeded. The whole of the muscles near the knee joint were turned into cellular substances and had lost their action, and there was very little motion of the joint. The cavity of the joint seemed to be
Surgery.
2 47
sound, but the thigh bone above the knee on the inside where the piece of bone had exfoliated was in a curious state a long way up.
MATERIA MEDICA.
6. Dr. Reece has published a Medical Annual for 1831, con¬ taining an account of the latest discoveries and improvements in me¬ dicine of real practical utility, in which the author has executed his task in a concise yet comprehensive manner. He has added a selec¬ tion of prescriptions of established efficacy, a catalogue of diseases and their treatment, with a list of drugs, their doses and numerous auxiliaries to medicine. This work contains much valuable and recent information, and will be perused with great advantage by the general as well as the junior medical reader.
MIDWIFERY.
By Mr. J. Greening , Surgeon, Worcester.
7. I was requested to call upon Mrs. O. aged 35 years, of a spare habit. She complained of acute pains over the lumbar region, which were increased upon taking a deep inspiration, or from over exertion. The bowels were regular ; she had not menstruated for the last five or six months ; she believes herself to be pregnant ; the palpitation of her heart is so strong, as to be visible ; the carotid arteries are quickly pulsating. She had been troubled with this complaint for several years, and had taken the opinion of the best informed medical men in this part of the country, whose opinion was, that she should be occasionally bled. At times, she seemed to have lost the use of her arms ; but, upon grasping any thing firmly, she was relieved. The pulse is regular and full ; she is troubled with leucorrhcea. Fiat venae sectio ad Sxvi. Low diet.
28th. — The blood is buffed. She is better.
29th. — I saw her again about half-past nine, p. m. She had been with a person whom I delivered the day before, the best part of the day. After her return home, she was seized with acute pains in her bowels, coming on at intervals, like labour pains 2 There is no dis¬ charge. Yy tinct. opii nfxx. mist, camph. 5iss- m. ft. Haust. statim sumend. Eleven o’clock. The pains still continue.
30th. — 1 o’clock, a. m. — A foetus was expelled at the sixth month. The placenta was thrown off by the efforts of the uterus. The child was so small and feeble, that I requested the nurse to put it by, for I thought it could not possibly live. I am confident it would go into a quart jug.
July 1st. — She had a very restless night; she is thirsty; her bowels are' costive. Sumat ol. ricini, §ss. Milk is secreted in her breasts. The discharge continues. The pulse is hard and frequent, not so full. The child is alive, and takes gruel,
9 o’clock. — The oil has operated ; she is restless ; the pulse is soft, and 80 in a minute ; the skin is dry ; there is much pain over
248
Bibliography.
the lower part of the belly and right iliac region ; pressure gives pain. Ap. hirad. xii. part, affectse. Liq. ammon. acet. §iss. Pot nitrat. 5i. Liq. antimon. tart. 5iss. Aq. menth. §iv. ss. m. Sumat. coch. mag. iii. 4tis. horis.
2d. — She is much better.
3d.— -She had occasional pains in the night. The pulse is 75 ; the tongue is clean ; the skin moist. Capt. ol. ricini. ^ss. statim. The child takes the breasts.
4th. — She is sitting up, and complains of nothing but weakness. The child improves.
31st. — Up to the present time they are both well. I again questioned her respecting the time when she last menstruated, and she assured me she had not since January.
April 30, 1830. — She engaged me to attend her again in her lying- in, which she expected to take place at the latter end of July of the present year.
June 13tH. — I was sent for from Malvern, about three o’clock, p. m. She had been in labour for some hours. She was delivered at five o’clock. The labour was natural. The child was betwixt the seventh and eighth months, and very feeble. Brandy was administered to it, and the warm bath used. This child was much larger than the last, but the nails were wanting.
14th.-—' The child is living, and the mother is doing well.
The foregoing cases do not abound with much novelty ; still it seems worth while to note the occurrence of two children born at so early a period of pregnancy, and both of them thiiving and doing well. Dionis, Portal, Chapman, and other authors of a more recent date, who have written upon midwifery, have given numerous cases; but I do not remember any of them describing a case in any respect like these.' — Midland Med. Rep. Feb.
MEDTCAL JURISPRUDENCE.
8. Trial of St. John Long, for Manslaughter. Before Baron Bayley,
Justice Bosanquet and Baron Bolland. Old Bailey, February 19.
The indictment against the prisoner charged him “ with having, on the 6th October, 1830, committed an assault upon Mrs. Colin Campbell Lloyd, the wife of Edward Lloyd, and on divers other days between that and the 12th of same month, by administering certain noxious unwholesome vapours and a certain inflammatory, corrosive, and dangerous liquid which was applied to the chest and breast of deceased, by washing, sponging and rubbing, whereby •she -received and procured one mortal sore and ulcer, of sixteen inches in length, nine inches in width, and two inches in depth ; in consequence whereof she lingered to the 8th of November follow¬ ing, when she died.”
The deceased was forty- eight years of age, and had no complaint except globus hystericus. The husband had first seen the pri-
Medical Jurisprudence .
249
soner at the inquest of Miss Cashin in August, and deemed it right to have his advice. It appeared that the deceased inhaled, and was rubbed on the 6th of October, and on the 8th her breast was sloughing and in excruciating pain, and the prisoner said “ that every thing was well and going on just as he wished.” He even proposed to repeat the external application, which deceased refused. Mr. Campbell was now called in, as also Mr. Vance, both of whom considered the patient in great danger, and she ultimately expired. Such is a condensed view of the facts stated in the opening speech for the prosecution.
Captain Lloyd substantiated this evidence, and stated, that on the 3d of October his wife had applied a blister about the size of half-a-crown to her throat, as was her usual practice, and this was nearly healed on the 6th. She called on the prisoner on the 7tli, 8th, 9th and 10th, and then complained of a violent burning across her chest, there was great redness, darker in the centre than at any other part ; she also complained of great shivering and cold ; the edges round the spot became white and puffed up, there was a whitish thick discharge from the centre ; these symptoms increased when the redness stopped ; there were blisters on the skin ; wherever the discharge had gone the skin was irritated, in the end wherever the discharge had gone, the part mortified. Thirst, restlessness, vomiting and feverishness were urgent. At this time the prisoner said there was no danger, as these appearances were generally the case in the first instance. During this state of things, a cabbage leaf was applied by the advice of the prisoner, but it having pro¬ cured no relief, deceased threw it aside, and applied a simple blister and dressing. The prisoner applied a towel to absorb the moisture ; or, as he said, to rub it out. He said greasy plasters were injurious, and old linen the best. He was dismissed; Mr. Campbell called in, as also Mr. Vance and Mr. Brodie. The pri¬ soner sent a strange person to see Mrs. Lloyd, but he was refused, and referred to the medical gentlemen in attendance.
Mr. Campbell described the deceased as suffering great pain from an extensive wound covering the whole anterior part of the chest, the skin was destroyed and lay separated in folds on the chest, the cellular membrane under the skin was partly destroyed, and there was a considerable discharge from the whole wound, which extended from nearly one armpit to the other, above the throat, to the bottom of the chest ; the skin was nearly off both breasts ; the centre of the wound was darker in colour than the other parts, cabbage leaves were applied, which witness removed, and substituted spermaceti ointment. When Mr. Vance came, he approved of the treatment, and advised some calamine powder with poultices. The patient had saline aperients, quinine and mineral acids. Mortification commenced about a week after witness’s attendance. The wound on the breast was the cause of death ; it
VOL. VI. no. 33.
K K
250
Medical Jurispru deuce .
was not necessary to produce it for the disease in the throat or for any disease. On cross-examination, Mr. C. admitted the known injurious effects produced by blisters, had apprized the sister of deceased of her danger, did not recommend a consultation, as the family were satisfied with his ability.
On re-examination, witness said, though he apprehended danger, he believed he understood the treatment perfectly, and after the body was examined, he saw no reason to think he was mistaken ; the injury was not similar to that produced by common blisters. The simple dressing was calculated to reduce inflammation ; rubbing would have increased, and would not in any way have benefitted the. treatment.
Mr. Vance corroborated the testimony of last witness; was called on 21st October, when Mr. Lloyd described the patient as suffering from extreme soreness in her mouth and throat, and attributed it to the inhalations of Mr. Long ; there was a sloughing ulcer on the chest, the wound was 17 or 18 inches long, and 10 or 12 broad, the dead parts were separating from the living ; the friends were apprized of the certainty of her death : the mortification was the cause of death. No man of common skill or prudence would have produced such a wound in two or three days ; such practice is the greatest proof of rashness and ignorance. Mr. CampbelFs account in court of his treatment, corresponded with his statement to me.
Mr. Brodie confirmed the evidence of the last two witnesses ; he never, in the whole course of his practice, knew such inflammation as in the case of Mrs. Lloyd, produced by any external application, prescribed by a medical man.
Mr, Richard Franklin, a surgeon, agreed with the former witnesses. This was the case for the prosecution.
It was contended on behalf of the prisoner, that there was no felony committed, that both regular or irregular practitioners were placed in the same situation in the eye of the law, and that there was no case to go to the jury.
Mr. Baron Bayley held, that any man presuming to meddle with what he did not understand, unacquainted with principles, ventur¬ ing to prescribe for the sick, incurred a heavy responsibility, and indisputably, in some cases, was guilty of manslaughter. Thus, if a man were to say laudanum is an exceedingly good medicine, no one could question his assertion ; but were he to administer a tea- cupful of laudanum, was there any man in his senses would say that such a person was not guilty of manslaughter? Surely then, the person who would so deal with that valuable medicine, a deadly poison, for it was the one or the other, according to the quantities in which it was administered, would in the eyes of all men, be guilty of a most criminal act, and would be pronounced by cverv lawyer, to have committed the offence of manslaughter. The same obser¬ vation applied with equal force to any misapplication of any medi¬ cine, when the party misapplying it, had neglected previously to
Medical Jurisprudence
251
make himself acquainted with its properties. The consent of the patient in the present case, did not prevent it to be an offence against criminal law.
The prisoner was then called on for his defence ; the principal points of which were the following : that when he ceased to attend Mrs. Lloyd, there was no mortification ; the flesh was red and healthy, and no injury appeared for eight days afterwards. He knew nothing of any blister ; how could the medical men state the cause of death, without the examination of the head and spine, the case was riot his hut Mr. Campbell’s ; and the only remedy employed to cure mortification was spermaceti plaster. He could show by the testimony of hundreds of witnesses, that his process of inhaling, is attended with the most complete success ; he prescribed for the deceased on tfle Sunday, and she was taken out of his hands on the Tuesday, and then her death attributed to him. Could it be supposed that he, wTho had cured so many hundreds, should all at once be deprived of his skill, and should be accused, when having prescribed but once, not only of a total failure, but of a felonious intention ? Mr. Campbell followed a particular line of practice, evidently absurd and insufficient, and why should he be responsible for the act of another ? He could produce gentlemen of known learning and character, who would prove he had sufficient knowledge to prescribe as he had done ; he had cured consumption, liver complaint, diseases of the hip-joint, small-pox, insanity, and a number of other maladies, and he never lost a patient, except those who had been previously in the hands of regular practitioners. This proceeding originated with the physicians and surgeons of this Metropolis, though he had spent more money on his education than any ten physicians in that court. He reminded the jury, that he stood there upon the same terms as the President of the College of Physicians ; he could produce hundreds in that court, whom he had saved from the jaws of death.
An immense number of highly respectable witnesses bore testi¬ mony in the strongest and most unqualified terms to the assiduity, skill and humanity of the prisoner, in the practice of the healing art, and to the high character which he bore amongst those who had been placed under his care, and to the extraordinary success which had uniformly attended him.
Mr. Baron Bayley summed up the evidence in the most luminous manner, and told the jury, if they were satisfied that the prisoner acted with a felonious intention, they must find him guilty. But, on the other hand, they were to remember, that persons with the best intentions, might be sometimes mistaken as to the effects of the remedy they might administer; and God forbid that felony should be imputed in all cases where ill success took place ; the chief question for the jury was, whether or not the prisoner had in the present case, acted with due caution, and been previously aware of the nature and effects of the substance he was applying,
252
Medical Jurisprudence .
\
and also whether he had shown sufficient skill and knowledge to estimate the effects of such a remedy upon the individual constitu¬ tion of Mrs. Lloyd ; if they thought that he had betrayed gross ignorance, gross rashness, or want of thought, they must find him guilty. It was clear enough, that subsequently to the application of the remedy, he was not guilty of any negligence ; but the question was, whether in the first instance, he was rash, ignorant and unskil¬ ful. The learned judge then gave an historical account of the evi¬ dence, and told the jury, that if they should be of opinion that the death of the deceased took place from the wound, they must give the verdict against the prisoner, but they must be fully satisfied that the death arose from that alone. If, however, they entertained any doubt about it, then they would give the benefit of that doubt to the prisoner ; they should also consider, whether the remedy applied was of an improper nature to administer, for if it were not, then the prisoner could not be charged with any bad intent ; if they were of opinion that the prisoner was rash in making the applica¬ tion, then he had been guilty of a felonious act ; the two points, therefore, he begged to remind them of were, had the death of Mrs. Lloyd proceeded from the wound, and was the application that caused that wound of a felonious nature.
The learned judge then commented upon the evidence of the prisoner, and said it afforded him an excellent character for skill, general care and humanity ; the jury must be satisfied as to what was the exact state of the wound when taken under the care of Mr. Campbell, and how it had been in the early stages of the tran¬ saction ; if, on due consideration of all these circumstances, the jury had a perfect conviction produced in their minds that there was a want of care and improper rashness in using the application in question, and that the use of that was the cause of Mrs. Lloyd’s death, then the prisoner was liable to be found guilty, and ought to be found guilty ; but if they did not feel that full conviction, then the prisoner was entitled to that doubt, on the points that he had already brought before their notice.
The jury retired for an hour, and then returned a verdict of • — not guilty.
A more extraordinary verdict than this was never returned in a court of justice. A clearer case of manslaughter, according to the law laid down by the learned judge, could not be recorded. It was stated by the judge, that if the prisoner were considered guilty of rashness, he must be found guilty ; and if the wound caused death, a like verdict must be returned. It was proved by all the medical witnesses, that the man who would produce such a horrible wound as that described, afforded the best proof of rashness and ignorance, and this evidence was unimpeached and unimpeachable. This would be the evidence of all the Faculties of Medicine in existence. The deceased lost her life by the infliction of the injury or by the treatment pursued ; the medical witnesses proved the
Medical Jurisprudence.
253
latter to be judicious, and therefore she lost her life by the injury. As to the defence made by the prisoner himself, it was all assertion ; and the medical part of it the grossest nonsense ever uttered. The very words, terms and phrases used by this rash and audacious quack, prove his utter ignorance of the slightest acquaintance with medical science.
Who ever heard of spermaceti plasters, of rubbing a suppurating or sloughing ulcer with a towel ; of curing incurable diseases ?
The presumption and impudence of this man is unequalled in the annals of empircism. It was no wonder he should influence a common jury by such a tissue of plausibility and nonsense, who decided in this instance directly contrary to the charge delivered them ; they have rendered the State a service in allowing him to resume his vocation ; but had he been a poor, illiterate, half starved mechanic, he w *uld have found little sympathy. There must have been a few thick headed persons on this jury, and we most strongly advise them to have some of Mr. Long's innocent liniment applied to their scalps as early as possible, lest at a fu¬ ture sessions they perchance might again be called upon, of course, to lend their lucid minds to the consideration of another death, accidentally caused by his remedies, not manslaughter. If Mr. Long have a spark of humanity in his composition, let him peruse some work upon local and constitutional irritation, and open his eyes to the dangerous and fatal practice he employs indiscrimi¬ nately and extensively in all ages, constitutions, habits and tem¬ peraments.
Had he been aware of the danger of slight local irritation in certain habits of body, and how speedily it will destroy life, he would shudder at the rashness and presumption with which he applies his external remedies. We are firmly convinced in our own minds, indeed as much so as we are of our existence, that both Miss Cashin and Mrs. Lloyd lost their lives by his remedies ; • and any candid, honest and scientific member of our profession, must arrive at this conclusion. If Mr. Long pursued a practice, not indiscriminate, not dangerous to human life, we should never waste aline about him. We should consign him, with his innumerable brethren in this metropolis, to silent contempt. We should not blame him to gull the public, “ nine tenths of which are fools," and his supporters chiefly of this class ; for if lords, ladies and gentlemen choose to stultify themselves, they cannot be prevented. But when we see a man cause a painful ulcer of the magnitude in Mrs. Lloyd’s case, and persist in declaring it safe and as he wished, and what was usual, no punishment could be too great for such a fell destroyer of society ; for upon his own showing he must be guilty of sacrificing human life to an extent little imagined by the public. Can any scientific practitioner deny this fact ?
If 1000 patients were subjected to the same injury as Mrs* Lloyd, we would ask how many could recover? Perhaps not five*
254
Medical Jurisprudence.
not even one. Well might Mr. Vance and Mr. Brodie condemn the desperate practice of producing such a formidable and fatal injury. Mr. Long, like all pretenders to physic, entertains a most erroneous and absurd idea, that he can cure all diseases by one remedy. He of course can form no idea of the difference of tissue, of structure or of functions of different organs, nor no notion of the fact, that when a part becomes disorganized, or its natural struc¬ ture destroyed by disease, such an organ can never be restored to its natural condition. In the last stage of consumption one or both lungs may be disorganized in part by tubercles, by purulent mat¬ ter or the various other morbid changes, known to the educated practitioner ; and it would be as sensible of Mr. Long to assert he could substitute a new lung for a diseased one, as to say he can cure consumption. So also with regard to all other organs. We throw out these observations as we know they will meet his eye, otherwise we should apologise to our readers, for stating facts so well known, but we hope humanity may be the gainer.
MISCELLANIES.
9. Asbestos — In a communication recently made to the French Academy by M. Aldini, with reference to his fire-proof dresses, he states that some experiments, which have been made at Milan, seem to shew that garments, composed of asbestos, will supersede the necessity of metallic dresses. A manufactory for asbestos cloth has already been established at Valleline ; and a paper maker has it in contemptation to employ it instead of cotton or linen in the fabrica¬ tion of paper intended for theatrical scenery. Asbestos may be easily imported from Corsica, where it is found in great plenty, and of excellent quality. It exists also in several other countries of Europe, in which no use is at present made of it. — Literary Gaz.
10. King’s College. — We have at various times reported progress in what concerns this interesting Institution, and have now to add to the several appointments mentioned on preceding occasions, those of N. W. Senior, Esq. to the chair of political economy ; J. J. Park, Esq. English law and jurisprudence ; the Rev. Henry Moseley, natural and experimental philosophy; Joseph Lowe, Esq. lecture¬ ship of commerce ; the Rev. J. R. Major, A. M. head master of the High School, attached to the upper department.
11. We are glad to learn that the typhus fever, which has for some time past been raging with great violence at Warwick Bridge, is now considerably abated. The greatest exertions have been used by the Messrs. Dixon to arrest the progress of this dangerous dis¬ order ; and to these, added to the skilful treatment of the patients recommended by Dr. Barnes, may in a great measure be attributed the decidedly favourable turn 'which it has already taken. Printed regulations and directions, drawn up by Dr. Barnes, in which clean¬ liness, ventilation, fumigation, and immediate separation of the sick from the healthy, were insisted upon, have been strictly enforced
Miscellanies.
255
among the operatives ; and the more effectually to carry them into effect, a temporary hospital, to which all access was shut out, excepts by permission, was erected, and a person appointed to fumigate and whitewash the houses, and to see the regulations attended to. Owing to these excellent precautions, the fatality of the fever has been comparatively trifling. There have been a few deaths among persons in different occupations in life ; but it is worthy of remark that not one person in Messrs. Dixon’s cotton-works has died, although upwards of one hundred cases of this fever have occurred, — a circumstance which speaks loudly in favour of the preventive and remedial system adopted in that establishment.
12. Extraordinary Productiveness. — In the month of September, there were sown, in a garden near Silberberg, in Silesia, 287 grains of wheat. At the ensuing harvest, they actually produced 117,644 grains, fully and perfectly matured ! There were two ears, amongst the rest, one of which contained 1055, and the other 1077 perfect grains. The longest halm measured six feet two inches in length, inclusive of the ear, and some of the leaves were two feet and more in length.
13. Paracentesis cranii. — Dr. Conquest has performed this opera¬ tion in seven cases of chronic hydrocephalus, in four of which a complete cure has been effected. We trust a full detail of these important cases will be speedily laid before the profession.
BOTANY.
14. Guaco. — At a late meeting of the Medico-Botanical Society, a paper on guaco, by Mr. Hermann, was read ; in which numerous facts in proof of the efficacy of this plant as an antidote for the bites of serpents were adduced. Dr. Sigmond informed the meeting, that Mr. Tegart had the plant in full perfection in his garden. It was also stated by the noble and scientific president, Earl Stanhope, that the Society will furnish any practitioner with this remedy by apply¬ ing to the secretaries. Dr. Sigmond, 24, Dover Street, and H. Gibbs, Esq. 47, Half-moon Street. We communicate this information, as Dr. Whiting observed, that the remedy seemed to procure some beneficial effects in a case of hydrophobia.
The anniversary address of the noble President was delivered on Wednesday, the 2d ultimo, at eight o’clock in the evening, and was numerously attended by some of the most eminent physicians and other scientific characters. Sir H. Halford addressed the meet¬ ing, and eulogized the able address of the noble President, and moved that it be printed for distribution among the members of the Society. It affords us much pleasure to observe the progress of this Society, as it is the only one in this metropolis devoted to investigation of therapeutics. The next meeting of the Society will take place on the Pth instant, and we are happy to state that all medical students are allowed admission to the discussions and lectures on materia medica, botany, toxicology and chemistry, by application to one of the secretaries.
256
Miscellanies.
BOOKS RECEIVED DURING THE MONTH.
1. Outlines of Physiology, with, an Appendix, containing Heads of Lectures on Pathology and Therapeutics. By William Pulteney Alison, M. D. F.R.S. E. Pro¬ fessor of the Institutes of Medicine in the University of Edinburgh. Edinburgh. 1831. 8vo. pf). 152. Blackwood.
2. A Manual of Analytical Chemistry. By Henry Rose, Professor of Chemistry at Berlin. Translated from the German, by John Griffin. London. 1831. 8vo. pp. 454. Tegg.
3 Physiology of the Foetus, Liver, and Spleen. By George Calvert Holland, M. D. Lecturer on Physiology, and Joint Lecturer of the Practice of Physic in the Sheffield Medical Institution. London. 1331. 8vo. pp. 229. Longman and Co.
4. The Effects of the principal Arts, Trades and Professions, and of civic states and habits of living, on Health and Longevity ; with a particular reference to the trades and manufactures of Leeds ; and suggestions for the removal of many of the agents which produce disease, and shorten the duration of life. By C. Turner Thackrah. London. 1831. 8vo. pp. 126. Longman and Co.
5. Appendix to the Second Edition of a Series of Observations on Strictures, &c. &c. By R. A. Stafford, Esq.
6. Arteriology of the Human Body. By Borremans ; revised, and adapted to the English Nomenclature, by T. King, Professor of Anatomy and Surgery. London. 1830. 8vo. pp. 15. Feuillet, Dumus and Co.
7. Medical Zoology ; or Illustrations and Descriptions of the Animals and Minerals employed in Medicine, and of the Preparations derived from them ; com¬ prising their generic and specific characters ; English, provincial and foreign appellations; a copious list of Synonymes; natural history; physical, chemical and medical properties and uses ; including also a popular and scientific account of animal, mineral, atmospheric and gaseous Poisons ; with figures coloured from Nature, intended to serve as a continuation or supplement to the Author’s, and other works on Medical Botany,” and Materia Medica. By John Stephenson, M.D. F. R. S. London, 1831i Published monthly by Wilson.
8. A few Observations on the Subject of Medicinal Composition, with a view to the establishment of an improved form of Aperient Pill, for domestic purposes ; addressed to dyspeptic Invalids, Amateurs in the Practice of Medicine, and the con¬ sumers of popular Pills, styled “ Antibilious and recommended to ' the attention of country clergymen and benevolent ladies, who interest themselves in the welfare of their poor and afflicted neighbours ; to which are added, some remarks upon the St. John Long’s principles of Practice ; the whole accompanied by numerous expla¬ natory notes. London. 1830. 8vo. pp. 32. Miller.
9. The Companion to Post Mortem Examinations ; illustrated by six plates. London. 1831. 8vo. pp. 24. Rose. White, &c.
10. Illustrations of Mr. S. Cooper’s Surgical Dictionary, published monthly, containing four lithographic plates, with letter-press descriptions, and references to the text. London. 1830. Longman and Co.
11. The Nottingham Dispensary; its necessity, origin, objects and history; historical and statistical inquiries into the Nottingham General Hospital, St. Mary’s Medical Establishment, and other provisions for the sick poor of Nottingham ; their resources, expenses, supporters, privileg.es and government ; the nature and extent of their assistance, and other useful information ; a correct narrative of the proceedings relating to the proposed Dispensary ; full particulars of the exclusion of the Medical Faculty from its Committee; correspondence; the meetings and resolutions of the Medical Profession ; and other proceedings arising from that measure; opinions and comments, &c. &c. ; the whole drawn up from authentic sources. By Thomas Jowett, Surgeon. Nottingham. 1831. 8vo. pp. 42. Bennett &c.
12. A Letter to John Bull, on the Dissection of his Body. By Gracchus. 1829. 8vo. pp. 19. London. Eccles, &c.
All Communications and Works for Review are to be addressed to the care of Messrs. Underwood, 32, Fleet Street; or to the Editor, at his Residence, 61, Hatton Garden.
THE LONDON
MEDICAL AND SURGICAL JOURNAL.
No. 34. APRIL 1, 1831. Vol. VI.
CRITICAL REVIEW.
1. — * Change of Air, or the Pursuit of Health ; an Autum¬ nal Excursion through France, Switzerland and Italy, in the year 1829. By James Johnson,, M.D. Physician Extraordinary to the King. London, 1830. 8vo. pp. 294. G. Underwood and S. Highley.
It is long since we passed an evening so pleasantly, as in the perusal of this very amusing and instructive volume. Every page of it reminds us of the “ Sentimental Journey,” and in referring to that imperishable production for the list of travellers, we could find none so applicable to the able author before us as that of Yorick — namely, the Sentimental Traveller. Like its prototype, this work, is so spirited, so sentimental, so full of sound moral reflection, so correct and so impartial, that we scarcely know where to look for its equal. It may be said to contain all the information relating to the countries named in the title, which can be inte- resting to the whole circle of travellers, — whether simple, idle, inquisitive, lying, proud, vain, splenetic, and we may add philosophical. It is a classical and philosophical tour, in which the characteristic features of every district are sketched with fidelity and effect ; and allusion is made to every remarkable person or event, connected with the locality described. In addition to extensive reading and research, the author has travelled over many countries in collecting his materials. The work is full of entertainment for all who love history, topography, the description of beautiful scenery, the traditionary legends of country, and the antiquarian accounts of the remains of historical monu¬ ments. To travellers and invalids it is an amusing’, instruc¬ tive and invaluable companion. It is impossible to dip into any part of it, without having the attention rivetted, and
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the fancy pleased. Of this production we need only say, it is worthy of the accomplished author. It is written with elegance, accuracy, and an impartial spirit of philosophy, and will add to his high literary and professional reputation. Had he wsitten but this volume, he would have ranked among the best topographical writers of the day, for his descriptions cc of men, manners and countries,” are seldom equalled, and scarcely surpassed.
In justification of these remarks, we must place a few specimens of the work before our readers, though there is little medical matter to be laid under contribution. The following extract is partly of the latter description : —
“ Moral Effects. If abstraction from the cares and anxieties of life, from the perplexities of business, and, in short, from the opera¬ tion of those conflicting passions which harrass the mind and wear the body, he possible under any circumstances, it is likely to be so on such a journey as this, for which previous arrangements are made, and where a constant accession of new and interesting objects is presented to the eye and understanding, that powerfully arrests the attention and absorbs other feelings, leaving little time for reflec¬ tions on the past, or gloomy anticipations of the future. To this may he added, the hope of returning health, increased, as it generally will be, by the daily acquisition of that invaluable blessing, as we proceed.
“ One of the first perceptible consequences of this state of things is a greater degree of serenity or evenness of temper, than was pre¬ viously possessed. There is something in the daily intercourse with strangers, on the road, and at the table-d’hote, which checks irri¬ tability of temper. We are not long enough in each other’s society to get into argumentation, or those collisions of sentiment which a more familiar acquaintance produces, and too often raises into alter¬ cations, and even irascibility, where the mind and body are pre¬ viously irritable. These short periods of intercourse are the honey¬ moons of society, where only good humour and politeness prevail. We change our company before we are intimate enough to contra¬ dict each other, and thus excite warm blood. Besides the conversa¬ tion generally turns on scenes and subjects with which we are pleased and interested on the road — while political and religious dis¬ cussions are studiously avoided by all travellers, as if by a tacit but universal compact. One of the best remedies, then, for irritability of temper, is a tour of this kind. A few hundred pounds would be wrell expended, annually, by many of our rich countrymen, in applying this pleasant remedy to the mind, when soured and unhinged by the struggles after wealth, rank, or power ! •
“ I have already pourtrayed the influence of bad health, and especi¬ ally of disordered states of the digestive organs, in producing depression of spirits, or mental despondency, far worse to bear than corporeal
Dr. Johnson on Change of Air .
259
pain. • For the removal of this kind of melancholy, there is no other moral or physical remedy of half so much efficacy as a tour conducted on the plan which I have pointed out. It strikes directly at the root of the evil, (as I shall presently shew, when speaking of the physical effects of travelling,) by removing the causes on which this sombre and irritable state of mind depends. It is true that, in some cases of confirmed hypochondriacism, no earthly amusement, no change of scene, no mental impressions or excitement, no exercise of the body, can cheer the gloom that spreads itself over every object presented to the eye or the imagination ! With them, change of place is only variety of woe — ccelum non animum mutant. Yet, from two or three instances wdiich have come within my knowledge, of the most inve¬ terate, and apparently indomitable hypochondriacism being miti¬ gated by travelling, (though the mode of conducting the journey was far from good) I have little doubt that many cases of this kind, which ultimately end in insanity, or at least in monomania, might be greatly ameliorated, if not completely cured, by a system of exercise con¬ ducted on the foregoing plan, and urged into operation by powerful persuasion, or even by force, if necessary. The change for the bet¬ ter, in such cases, is not perceptible at the beginning of the tour ; but when the functions of the body have once begun to feel the salu¬ tary influence of the journey, the mind soon participates, and the gloom is gradually, though slowly dispelled. Where the mental despondency is clearly dependent on disorder of the digestive organs, and has not yet induced any permanent disease of the brain, an almost certain cure will be found in a journey of this kind, for both classes of complaints. It is hardly necessary to observe that benefi¬ cial effects, to a greater or less extent, will be experienced in other sombre and triste conditions of the soul, resulting from moral causes, as sorrow, grief, disappointment, crosses in love, &c. by a tour con¬ ducted in such a manner as strongly to exercise the body, and cheer¬ fully excite the mind.
“ In a former part of the work has been shewn the powerful influ¬ ence of moral causes in deranging the functions of the body through the medium of the intellectual functions. The same functions may be made the medium of a salutary influence. In the greater number of nervous and hypochondriacal complaints, the attention of the indi¬ vidual is kept so steadily fixed on his own morbid feelings as to require strong and unusual impressions to divert it from that point. The monotony of domestic scenes and circircumstances is quite inadequate to this object; and arguments not only fail, but abso¬ lutely increase the malady, by exciting irritation in the mind of the sufferer, who thinks his counsellors are either unfeeling or incre¬ dulous towards his complaints. In such cases, the majestic scenery of Switzerland, the romantic and beautiful views in Italy and the Rhingau, or the keen mountain air of the Highlands of Scotland or Wales, combined with the novelty, variety, and succession of man¬ ners and customs of the countries through which he passes, abstract, the attention of the dyspeptic and hypochondriacal traveller (if an
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- thing can) from the hourly habit of dwelling on, if not exaggerating, his own real or imaginary sensations, and thus help to break the chain of morbid association by which he is bound to the never-ending detail of his own sufferings. This is a paramount object in the treat¬ ment of these melancholy complaints : and I am convinced that a journey of this kind, in which mental excitement and bodily exercise are skilfully combined, would not only render many a miserable life comparatively happy, but prevent many a hypochondriac and dyspep¬ tic from lifting his hand against his own existence. It would unquestionably preserve many an individual from mental derange¬ ment.
“ This principle was well understood long before medicine was established as a science. At the extremities of Egypt were two tem¬ ples dedicated to Saturn, and to these the melancholics or hypochon¬ driacs of ancient days were sent in great numbers. There the priests worked on the body as well as the mind by the pretended influence of supernatural, and the real influence of medicinal agents. The con¬ sequence was, that miracles, or at least miraculous cures were daily performed. The Romans sent their invalids to Egypt for change of scene ; and Hippocrates has distinctly recommended those afflicted with chronic diseases, to change the air and soil' — ‘ In morbis longis solum mutare. ? It would be going out of my province to speak of the benefits of travelling in any other moral point of view than that which is connected with the restoration of health : I shall, therefore, proceed to a consideration of the effects of this combination of men¬ tal and corporeal exercise on our bodily functions.
“ Physical Effects. — The first beneficial influence of travelling is perceptible in the state of our corporeal feelings. If they were pre¬ viously in a state of morbid acuteness, as they generally are in ill health, they are rendered less sensible. The eye, which was before annoyed by a strong light, soon becomes capable of bearing it with¬ out inconvenience; and so of hearing, and the other senses. In short, morbid sensibility of the nervous system generally is obtunded, or reduced. This is brought about by more regular and free expo¬ sure to all atmospheric impressions and changes than before, and that under a condition of body, from exercise, which renders these impressions quite harmless. Of this we see the most striking exam¬ ples in those who travel among the Alps. Delicate females and sen¬ sitive invalids, who, at home, were highly susceptible of every change of temperature and other states of the atmosphere, will undergo extreme vicissitudes among the mountains, with little incon¬ venience. I will offer an example or two in illustration. In the month of August, 1823, the heat was excessive at Geneva and all the way along the defiles of the mountains, till we got to Chamouni, where we were, at once, among ice and snow, with a fall of 40 or more degrees of the thermometer, experienced in the course of a few hours, between mid-day at Salenche, and evening at the foot of the Glaciers in Chamouni. There were upwards of fifty travellers here, many of whom were females and invalids ; yet none suffered
Dr. Johnson on Change of Air.
26!
inconvenience from this rapid atmospheric transition. This was still more remarkable in the journey from Martigny to the great St. Bernard. On our way up, through the deep valleys, we had the thermometer at 92o of reflected heat for three hours. I never felt it much hotter in the East Indies. At nine o’clock that night, while wandering about the Hospice of the St. Bernard, the thermo¬ meter fell to six degrees below the freezing point, and we were half frozen in the cheerless apartments of the monastery. There were upwards of forty travellers there — some of them in very delicate health ; and yet not a single cold was caught, nor any diminution of the usual symptoms of a good appetite for breakfast next morning.
*e This was like a change from Calcutta to Melville Island in one short day ! So much for the ability to bear heat and cold by journeying among the Alps. Let us see how hygrometrical and barometrical changes are borne. A very large concourse of travellers started at day-break from the village of Chamouni to ascend the Montanvert and Mer de Glace. The morning was beautiful; but, before we got two -thirds up the Montanvert, a tremendous storm of wind and rain came on us, without a quarter of an hour’s notice, and we were drenched to the skin in a very few minutes. Some of the party cer¬ tainly turned tail ; and one Hypochondriac nearly threw me over a precipiece, while rushing past me in his precipitate retreat to the village. The majority, however, persevered, and reached the Cha¬ let, dripping wet, with the thermometer below the freezing point. There was no possibility of warming or drying ourselves here ; and, therefore, many of us proceeded on to the Mer de Glace, and then wandered on the ice till our clothes were dried by the natural heat of our bodies. The next morning’s muster for the passage over the Col de Balme shewed no damage from the Montanvert expedition. Even the Hypochondriac above-mentioned regained his courage over a bottle of Champagne in the evening at the comfortable ‘ Union,’ and mounted his mule next morning to cross the Col de Balme. This day’s journey shewed, in a most striking manner, the acquisi¬ tion of strength which travelling confers on the invalid. The ascent to the summit of this mountain pass is extremely fatiguing ; but the labour -is compensated by one of the sublimest views from its highest ridge, which the eye of man ever beheld. The valley of Chamouni lies behind, with Mont Blanc and surrounding mountains apparently within a stone’s throw, the cold of the Glaciers producing a most bracing effect on the whole frame. In front, the valley of the Rhone, flanked on each side by snow- clad Alps, which, at first, are taken for ranges of white clouds, presents one of the most magnificent views in Switzerland, or in the world. The sublime and the beautiful are here protended before the eye, in every direction, and in endless, variety, so that the traveller lingers on this elevated mountain pass lost in amazement at the enchanting scenery by which he is sur¬ rounded on every point of the compass. The descent on the Mar¬ tigny side, was the hardest day’s labour I ever endured in my life — yet there w7ere three or four invalids with us, whose lives were
262
i Critical lie view.
scarcely worth a year’s purchase when they left England, and who went through this laborious, and somewhat hazardous descent, slid- ing, tumbling and rolling over rocks and through mud, without the slightest ultimate injury. When we got to the goat-herds’ sheds in the valley below, the heat was tropical, and we all threw ourselves on the ground and slept soundly for two hours — rising refreshed to pur¬ sue our journey.
“ Now these and many other facts which I could adduce, offer incontestible proof how much the morbid susceptibility to transitions from heat to cold — from drought to drenchings — is reduced by tra¬ velling. The vicissitudes and exertions which I have described would lay up half the effeminate invalids of London, and kill, or almost frighten to death, many of those who cannot expose themselves to a breath of cold or damp air, without coughs or rheumatisms, in this country.
“ The next effect of travelling which I shall notice, is its influ¬ ence on the organs of digestion. This is so decided and obvious, that I shall not dwell on the subject. The appetite is not only in¬ creased ; but the powers of digestion and assimilation are greatly augmented. A man may eat and drink things while travelling, which would make him quite ill in ordinary life.
“ These unequivocally good effects of travelling on the digestive organs, account satisfactorily for the various other beneficial influ¬ ences on the constitution at large. Hence dyspepsia, and the thou¬ sand wretched sensations and nervous affections thereon dependent, vanish before persevering exercise in travelling, and new life is im¬ parted to the whole system, mental and corporeal. In short I am quite positive that the most inveterate dyspepsia (where no organic disease has taken place) would be completely removed, with all its multiform sympathetic torments, by a journey of two or three thou¬ sand miles through Switzerland, Germany, or any other country, conducted on the principle of combining active with passive exercise in the open air, in such proportions as would suit the individual con¬ stitution and the previous habits of life.
“ There is but one other effect of travelling to which I shall allude, before I close this section ; but I think it is a very important one — if not the most important of all. It is the influence which constant change of air exerts on the blood itself. Every one knows the benefits which are derived from change of air, in many diseases, when that change is only from one part to another, a few miles sepa¬ rated. Nay, it is proved, beyond all possibility of doubt, that the change from what is considered a good, to what is thought a bad air, is often attended with marked good effects. Hence it is very rea¬ sonable to conclude, that the mere change of one kind of air for another has an exhilarating or salutary effect on the animal eco¬ nomy. It is true, that we have no instruments to ascertain in what consists this difference of one air from another, since the com¬ position of the atmosphere appears to be nearly the same on all points of earth and ocean. But we know, from observation, that there are
Dr. Johnson on Change of Air,
263
great differences in air, as far as its effects on the human frame arc concerned. Hence it would appear that the individual, confined to one particular air, be it ever so pure, languishes at length, and is bettered by a change. This idea is supported by analogy. The stomach, if confined to one species of food, however wholesome, will in time, languish and fail to derive that nutriment from it, which it would do, if the species of food were occasionally changed. The ruddy complexion then of travellers, and of those who are constantly moving from place to place, as stage-coachmen, for example, does not, I think, solely depend on the mere action of the open air on the face, but also on the influence which change of air exerts on the blood itself in the lungs. I conceive, then, that what Boerhaave says of exercise, may he safely applied to change of air. ‘ Eo magis et densum, et purpureum sanguinem esse, quo validius homo se exer- cuerit motu, musculorum.’ It is to this constant change of air, as well as to the constant exercise of the muscles, that I attribute the superiority of the plan of travelling which I have proposed, over that which is usually adopted — where health is the entire object. On this account, I would recommend some of my fair country-women, (who have leisure as well as means) to improve the languid states of their circulation, and the delicacy, or, more correctly speaking, the pallor of their complexions, by a system of exercise in the open air, that may give colour to their cheeks, firmness to their muscles, tone to their nerves, and energy to their minds.” — p. 30.
Another section of the work, f<r on the medicinal effects of Italian climate on consumption,” is deeply interesting' to the medical practitioner. The author satisfactorily proves, that the supposed advantages of residence in warm climates for the cure of phthisis, have been very much over-rated. This is also the opinion of Dr. Clark and others. He insti¬ tutes a comparison between this and warmer climates, shews the superiority of our own, and, in other words, expresses the sentiments of Sterne, “ where, then, my dear country¬ men, are you going ?” He observes —
“ The sum total of our knowledge, then, on this important point, appears to stand thus : — I. In delicate health, without any proof of organic changes in the lungs — in what is called a “ tendency to pulmonary affection,” a journey to Italy, and a winter’s residence there (under strict caution), offer probabilities of an amelioration of health : — IL In cases where there is a suspicion or certainty of tubercles in the lungs, not softened down or attended with purulent expectoration, an Italian climate may do some good, and may do much harm, the chances being pretty nearly balanced : — III. Where tuberculous matter appears in the expectoration, and where the stethoscope indicates that a considerable portion of the lungs is unfitted for respiration, a southern climate is more likely to accele-
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rate than retard the fatal event — and takes away the few chances that remain of final recovery.
“ If this be a correct estimate (it is at least an honest one) of the influence of an Italian climate on constitutions disposed to, or affected by pulmonary consumption, it shews that medical men incur a fearful responsibility in proposing to the parents and friends of invalids, a measure which is fraught with danger, involved in uncertainty, and too often attended by the most destructive sacri¬ fices of the feelings, as well of the finances of the parties concerned.
“ Those who have not witnessed lingering illness and death-bed scenes in distant climes, can form no just conception of the tide of mournful emotions which daily rushes over the mind of the dying stranger in a foreign land. Death is deprived of more than half his terrors by the sympathy of friends, and the consciousness that our ashes shall be deposited in the land that gave us birth, near those whom, in life, we cherished, loved, or revered ! This may be a prejudice — perhaps even a weakness ; yet it is natural — it is instinc¬ tive — and the instincts of nature can seldom be entirely repulsed, even by the most philosophic minds.
Expellas naturum furca tamen usque recurrit.”
“ But the sigh of sorrow, perhaps of regret, is not always buried in the grave of the sufferer, on these occasions. The companion, who counts the tedious hours of protracted disease, and closes the eyes of the departed friend in a foreign country, undergoes a terrible ordeal, always harrassing to the feelings, and not seldom hazardous to life ; while the surviving relatives, at home, are subject to the painful anxiety of suspense— -sometimes to the poignant stings of remorse, for having suffered the victim of an irremediable malady to expire on a foreign shore !
“ Heaven forbid, that on such a momentous question as this, involving the lives of my fellow creatures, I should throw the weight of a feather in the scale against the preservation, or even the prolongation of human existence ; but I have lived too long, and seen too much, not to know the errors of discrimination and the fallacies of hope, that send pulmonary invalids from the gloomy skies, but comfortable abodes of England, to lands where comfort is unknown, even by name, and whose atmospheres cannot work miracles, whatever their saints may do. The balance, indeed, between permanent benefit and blighted expectation, or even actual injury, is so nearly poised, that a breath may turn the scale. — That breath is as often one of error as of judgment. The conse¬ quences are obvious.
“ But there is a large class of complaints which resemble con¬ sumption, and which, I have no doubt, contribute much to the repu¬ tation of southern climates, for the cure of that terrible scourge. These are bronchial affections, viz. — chronic inflammation or irrita¬ tion of the mucous membrane of the lungs. The journey to Rome, or to Pisa, and the mild air of the winter in those places, with care
V
Dr. Johnson on Change of Air. 265
to avoid sudden transitions, often cure or greatly relieve these com¬ plaints, and the individuals are said to be saved from tubercular consumption. The greatest care — sometimes considerable power of diagnosis, is required to discriminate the bronchial from the tuber¬ cular affection — and yet, upon this discrimination, often hangs the fate of the patient, or, at all events, the propriety of migrating to a southern clime. The science of auscultation, now so ardently cul¬ tivated, will prevent much injudicious advice being given by the profession, and much serious injury being sustained by invalids.
“ It is also probable, that in some cases where there is a very partial or circumscribed tuberculation of the lungs, (the rest of the apparatus being unaffected) a winter’s residence in Rome, Pisa, or Nice, might be beneficial. This is the opinion, at least, of Dr. Clark ; but here the greatest care is to be taken, in examination with the stethoscope, to ascertain that the expectoration comes from a very small excavation, the lungs being elsewhere in a sound state.
“ There are several other infirmities, for the cure or mitigation of which, the climate of Italy is recommended. One of these is chronic rheumatism, and we have the testimony of Dr. Clark and others, that benefit is often derived, in this complaint, from a resi¬ dence of some duration at Rome or Nice. This is probably the case ; since the cold winds of Italy are dry, and the hot winds are moist — circumstances rather favourable to rheumatism. But it should be remembered that rheumatism is very closely allied to neuralgia, and produced, not seldom, by the same cause — malaria. We shall probably therefore be no greater gainers by depositing rheumatism in the eternal city, and bringing back tic douloureux, or some other malarious disease in its stead. Whatever advantage, then, the rheumatic invalid may derive from the climate of Rome or Nice, during the winter, one position may be safely laid down, that he should avoid those seasons and those places where malaria obtains, in other words, that he should quit Italy in summer.”— p. 271.
A curious fact is mentioned with respect to a susceptibility to nervous and spasmodic complaints among the residents of Rome, which is ascribed by many writers to luxurious habits, and by our author to the filth of the eternal city, which, he says, is the dirtiest in Europe, except Lisbon. Both ladies and effeminate gentlemen often faint, on perceiving the odour of the most pleasant flavour. If compelled to answer the cause of this, I would say that it is the habituation to stink of the Roman streets, which prevents the sensibilities of the olfactory nerves, renders them unac¬ customed to decent smells, and throws them into convul¬ sions on contact with a perfume.” In disorders of the digestive organs, comprising indigestion, bilious, stomach
VOL. vi. no. 34.
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affections, our author thinks a journey to Italy of advantage, buthe will neither assert confidently, nor peremptorily deny, whether a permanent residence be beneficial.
Such are some of the medical opinions of this work, from which few well-informed physicians can dissent. The other parts of the. volume are not fit for our pages, but we most strongly recommend the work to all classes of our readers. It is one of the most interesting productions which modern times have produced.
II. — The Effects of the Principal Arts, Trades and Pro¬ fessions, and of Civic States and Habits of Living , on Health and Longevity . By C. Turner Thackrah : Lon¬ don, 1831. Longman and Co. Leeds, Baines and Co.
This is an exceedingly instructive essay, containing much valuable information on hygiene, a branch of medicine totally neglected in this country. It is the production of a man intimately acquainted with the medical sciences, and is the only work in our language upon the subject. In other countries, the influence of arts, trades and professions, and of civic states, and habits of living, on health and longe¬ vity have been duly considered ; but thanks to the antiquated rules of our universities and medical colleges, a matter of such vast importance has been excluded from the educa¬ tion of the cultivators and practitioners of medicine in this part of the world. We trust the day is not distant, w:hen reform will and must be effected in our profession — when the vile absurdities of three centuries’ date, will be con¬ signed to well-merited oblivion. We have repeatedly ex¬ posed the imperfect state of medical police in this empire, and thereby excited the ire of our medical corporations ; but we console ourselves with the idea, that one and all of them deserve exposure, as well as the indignation of every inde¬ pendent and zealous friend to science. The day of mono¬ poly and insolent tyranny is gone by, and no longer shall the few lord it over the many. The voice of the many will, shall, and must prevail — the whole body of our pro¬ fession will arouse from that lethargy into which they have been thrown by the sordid and corrupt imbeciles whom the law has placed over them, and whose base and iniquitous career draws fast to a termination. The insolent treatment
Mr. Thackrah on Health and Longevity . 267
and arrogant manners of all our medical corporations, destroy a friendly intercourse or close connexion between their respective members, parties who live by wrong, and fatten upon the vitals of their profession. We turn from such preposterous conduct with disgust, to the pleasing duty of placing the inestimable value of our science to mankind before our readers. The talented and erudite author, after describing man in his several relations, as the most interesting subject for examination and reflection, observes —
“ If we turn our view from man to his works, we see the wilder¬ ness converted into towns and cities, roads cut through mountains, bridges carried over rivers and even arms of the sea, ships which traverse the globe, lakes converted into corn fields, forests made into pasture, and barren rocks covered with timber ; in a word, we see the face of the world changed by human will and human power.
“ If we look immediate^ at home, we observe the wonders which science and art have effected. We see large buildings, manufactures of almost every kind, and substances so changed, reformed and combined, that nature could scarcely know her own productions. We admire the inventions of science, alike in their minuteness and their size, their accuracy, and their extent of opera¬ tion. We see wool converted into cloth, in establishments so numerous and extensive as almost to supply the civilized world : we see the slight blue -flowered product of the field formed, in the same mill, into the thread which passes- through the eye of the needle, and into the canvass which bears our ships to every region of the globe : we see rough and massive minerals drawn from the bowels of the earth, converted, on the one hand, into instruments which surpass in power the united strength of the largest animals, and on the other hand, formed into the finest and most delicate pieces of mechanism.
“ These, and works like these, are assuredly wonderful. But while we admire, let us examine. What are the effects of these surprising works — effects, I mean physical and moral ? I say no¬ thing of the wealth they produce or have produced, for wealth is good or evil according to its application. I refer to the health of fifty thousand persons, who spend their lives in the manufactories of Leeds and its neighbourhood, or in allied and dependent occupa¬ tions. I ask, if these fifty thousand persons enjoy that vigour of body which is ever a direct good, and without which all other advantages are comparatively worthless ? I ask, if the duration of life is as great here as in the agricultural districts ?
“ To the first inquiry, the mere appearance of our population affords a reply. Take indifferently twenty well-fed husbandmen, and compare them with twenty manufacturers, who have equal means of support, and the superiority of the agricultural peasants in
268
Critical Review.
health, vigour and size will be obvious. Medical men, moreover* have daily proof of the ill effects on the human constitution, which our employments produce. They find a number, a variety, and a complexity of diseases, which are little known in country practice, and which, though not directly fatal, greatly reduce the powers of life.” — p. 3.
Our author satisfactorily demonstrates the destruction of 150 persons annually in Leeds,, from the injurious effects of manufactures, the crowded state of population, and consequent bad habits of life. He argues that the impaired health, the lingering ailments, the premature decay, mental and corporeal, of nine-tenths of the survi¬ vors, cannot be a subject of indifference. “ Assuredly/’ says he, an examination into the state of our manufac¬ tures has long been demanded, alike by humanity and by science.” This position cannot be disputed, but the cul¬ tivation of public medicine is scarcely tolerated, and certainly not fostered in this section of the empire, except¬ ing the novercal protection of that wise and enlightened body, the worshipful Company of Apothecaries. The medi¬ cal student never hears a word upon the subject during his education, and he is expected to illumine judges and juries on all points relating to public and legal medicine. What, an absurdity ! He is about as well qualified to perform this task, as he is to enlighten the judge upon thel common and ever changeable statute law of the country. Such is the condition of nine-tenths of the profession, and if proof were demanded in support of this conclusion, we have merely to refer to the public press for the amplest evidence. No day passes without presenting us with the humiliating evidence of some practitioner stultifying himself in courts of justice — the most eminent as well as the most insigni¬ ficant.
In further illustration of this argument, we may add, that our author reminds us “ his subject is new, and that scarcely any thing has been published even on the employ¬ ments common to England at large.”
For the convenience of the inquiry, our author divides the inhabitants of Leeds into four great classes: 1, operatives; 2, dealers; 3, master manufacturers and merchants ; 4, pro¬ fessional men. He commences with the operatives, who approach nearest to the perfection of the physical state. They are men of active habits, and whose employments are chiefly in the open air.
Mr. Thackrah on Health and Longevity .
*269
“ Butchers stand at the head of this division. They are much in the open air, and take strong exercise. Most of the masters ride on horseback to the neighbouring markets, and often traverse the sur¬ rounding country to buy cattle. They are well known to ride fast, and to take often long journies. Drovers of cattle for the butchers, though their action is generally less violent, have great distances to travel. They walk twenty, thirty, or forty miles a day. Butchers, and the slaughter-men, their wives, and their errand boys, almost all eat fresh-cooked meat, at least twice a day. They are plump and rosy. They are generally also cheerful and good-natured. Neither does their bloody occupation, nor their beef eating, render them savage, as some theorists pretend, and even as the English law presumes. They are not subject to such anxieties as the fluctua¬ tions of other trades produce ; for meat is always in request ; and butchers live comfortably in times as well of general distress as of general prosperity. They are subject to few ailments, and these the result of plethora.
“ The atmosphere of the slaughterhouse, though sufficiently disgusting to the nose, does not appear to be at all injurious to health. The mere odours of animal substances, whether fresh or putrid, are not apparently hurtful ; indeed, they seem to be often decidedly useful. Consumption is remarkably rare among the men employed in the slaughterhouse. If we see a phthisical youth in the fraternity, we shall generally find that his parents, aware of an hereditary disposition to consumption, brought him up to the busi¬ ness with the hope of averting this formidable malady. The atmos¬ phere of the slaughterhouse, imbued with a foreign admixture, is moreover less susceptible of those natural changes, which produce epidemics. From this circumstance, conjoined with their diet and habits of life, butchers are less subject than other trades to cholera and dysentery. To the same favourable combination, we attribute their comparative exemption from diseases, considered as infectious or contagious. Of five hundred and twenty patients taken to the House of Recovery in this town, during the last year, only one was a butcher, and his was a case not of typhus, but of simple fever.
“ Notwithstanding the favorable circumstances in which butchers are placed, longevity is not greater in them, than in the generality of employments. I suspect it is even shorter than among most other men, who spend as much time in the open air. Butchers in fact live too highly, not too highly for temporary health, but too highly for long life.” — p. 9.
Cattle and horse dealers lead an active life in the open air, and would be healthy were it not for the habit of drink¬ ing. They are liable to diseases of the stomach and liver. Our author thinks cart drivers, labourers in husbandry, sand leaders and road makers, would be healthy had their wages been higher. They are subject to disorders of the diges¬ tive organs, and suffer greatly from epidemics. Brickmakers
270
Critical Review.
have full muscular exercise in the open air, and though half naked, and with their bare feet in the puddle all day, are not more liable to catarrh, pneumonia and rheumatism, than men who work under cover and are dry. Persons of great age are found at this employ.
“ Chaise drivers, postilions, stage coachmen, and guards of coaches, with an equal advantage of fresh air, are differently situated in reference to exercise. Postilions, of course, have great and continued exertion ; but the kind is objectionable. Their posi¬ tion on the saddle is bad, and they use the arms unequally ; hence curvature of the spine. They are moreover said by Morgagni to be particularly subject to aneurism of the aorta. The drivers of chaise and hackney coaches have more moderate and equal exercise ; but their position subjects them to popliteal aneurism. They, as well as postilions, suffer from irregular living, and the habit of frequent potation. They are subject to disorders of the head and the stomach. Still worse is the state of stage coachmen and guards. With an equal or greater degree of intemperance, they have less muscular exercise to counteract its effects. In addition to morning sickness, and other affections, indicating gastric disease, they have venous congestion of the abdomen ; then of the head ; finally apoplexy and palsy.
“ The atmospheric vicissitudes to which all drivers are exposed, are thought to produce rheumatism and inflammation of the lungs. I conceive, however, that these diseases would rarely occur to abstemious men. It is intemperance which gives the susceptibility to such maladies ; and it is intemperance which produces much greater, the fatal affections which we have just mentioned. I scarcely need add, that the whole class is short-lived. They generally die before they reach the age of fifty. Among all the Leeds men, we could find only three individuals who are old, and two of these have the character of great temperance.
" Gentlemen’s coachmen often suffer from excess of nourish¬ ment ; they eat more than they work. Having often to wait for their masters, to use Dr. Good’s phrase, “ They fill up their time, by filling up their stomach.” They also take ale too frequently: And from these united causes, they become plethoric, have the venous systems congested, and the secretions consequently impeded. The fault of these men, though much less than the dram drinking practised by their brethren of the stage, certainly tends to the pro¬ duction of gout and serious affections of the brain.” — p. 12.
Coach builders, carpenters, joiners, wheelwrights, mill¬ wrights, coopers, ropemakers and paviors, are generally healthy when they are temperate.
Our author adverts to the unnatural state of the air of Leeds, which he considers deteriorated by on excess of car¬ bonic acid, and says “ our skins and linen prove an abundant
Mr. Thackrah on Health and Longevity .
271
admixture of charcoal itself.” Ammoniacal and other va¬ pours from manufactories, sewers and places of refuse, add to the general impurity. This state of the atmosphere affects, in a greater or less degree, all the inhabitants. He thinks that not ten per cent, of the inhabitants are in full health — the complexion is pallid, and the tongue shews that digestion is disordered and imperfect. Alas! what must be the fate Of the residents of the modern Babylon, on whom the advice of the medical poet is lost: —
Fly the rank city, shun its turbid, air.
Breathe not the chaos of eternal smoke And volatile corruption, from the dead.
The dying, sick’ning, and the living, world Exhal’d, to sully heavens transparent dome With dim mortality.
However true this picture may be, it is now universally admitted, that the progress of phthisis is much less in smoky towns than in purer air of the country. Still it must be granted that the impure atmosphere of crowded streets with imperfect ventilation, is highly injurious to health and longevity. This fact is well illustrated by the pale and emaciated countenance of the sedentary mechanic, which proves the presence of formidable encroachments upon health. The truth of this position is amply attested by daily observation. It is not air, which has reeked back from a million lungs inquinated by rank exhalations from “ all obscene, corrupt, offensive things,” that can be bene¬ ficial to health. Of the persons employed in a confined and impure atmosphere, tailors are placed first.
“ Sitting all day in a confined atmosphere, and often in a room too crowded, with the legs crossed and the spine bowed, they can¬ not have respiration, circulation, or digestion well performed. The employment, we must admit, produces few acute diseases. But disorders of the stomach and bowels are general, and often obsti¬ nate. Pulmonary consumption is also frequent. Some of the men state their liability to pains of the chest ; but the majority make no complaint. It is nevertheless apparent,- even from observing only the expression of countenance, the complexion, and the gait, that the functions of the stomach and heart are greatly impaired, even in those who consider themselves well. We see no plump and rosy tailors ; none of fine form and strong muscle. The spine is gene¬ rally curved.” — p. 16.
Not one of the workmen employed in Leeds attained the age of sixty. The evils attendant on the employment, are
272
Critical Review.
in many cases greatly aggravated by bad habits, as these people who are physically depressed, often seek comfort from ale and ardent spirits. Our valued correspondent, Mr. Dobson, informed the author of the following facts: —
“ Shultz and Co. tailors, of London, employ three hundred and thirty-four men. Of these six are above sixty years of age ; four¬ teen about fifty ; and the greater number of the remainder about forty. Three men of the above six above sixty have curvature of the spine. They are so subject to anal fistula that they have a 4 Fistula club,’ Their most common affections are dyspepsia, diarrhoea, and dull headache, with giddiness, especially during sum¬ mer. They attribute their complaints to two causes ; one of which is, the posture, the body bent for thirteen hours a day ; the other, the heat of the shop. I examined the temperature of the rooms on Monday, the 7th June, 1830. It was 98°, while in the open air the thermometer stood at 76°. On Tuesday it was 108°, and in the open air 84°. Tailors are the most intemperate set of men in Lon¬ don. A large proportion died annually of phthisis.” — p. 17.
To correct these evils, the author suggests a plan which might be easily adopted.
“ The position of the tailor might be amended. He now sits cross-legged on a board ; because in the ordinary sitting posture he could not hold a heavy piece of cloth high enough for his eyes to direct his needle. Let a hole be made in the board of the circum¬ ference of his body, and let his seat be placed below it. The eyes and the hands will then be sufficiently near his work ; his spine will not be unnaturally bent, and his chest and abdomen will be free. I am aware that old workmen will be unwilling to regard this or similar suggestions ; for every man is formed to his habits. If how¬ ever masters and medical men would urge an alteration, and if especially boys apprenticed to the trade were taught to work in the posture recommended, tailors would assuredly become much more healthy. The practice of drinking might also be easily reduced, if masters discharged from their employ every man who absented him¬ self a day without proper cause.” — p. 18.
The evils which affect milliners, dress makers and straw bonnet makers, arise from crowded apartments, and improper length of time in which these persons are employed. They are often employed from six in the morning until twelve at night. The bent posture in which they sit injures the diges¬ tive, circulatory and respiratory organs. Hence fresh look¬ ing country girls soon become pale and thin. The constant direction of the eyes to minute organs produces ophthalmia or amaurosis. The respiration is affected very much by the sulphurous gas evolved in the process of stoving straw
Mr. Thackrah on Health and Longevity. 273
bonnets. It induces cough, and finally pulmonic disease. This gas might be absorbed, in a great measure, by plac¬ ing water in a shallow dish, or prevented by having the operation performed in a small out building. The other remedies for the evils attendant on these trades, are ventila¬ tion, reduction of the hours of work, and exercise in the open air. The great cause of ill health of dressmakers is the lowness of their wages, which oblige them to work in excess. They are subject to pain in the left side, constipa¬ tion, dyspepsia, irregular menstruation, and probably from neuralgia, arising from slight curvature of the spine, or at least from the unnatural position of that column.
<f Weavers have a confined atmosphere, and, though the limbs are fully exercised, the trunk is kept comparatively fixed, and the chest is not expanded. This stooping however, is somewhat diminished by the mode of casting the shuttle with a string, instead of the hand. W hen weaving is carried on at home, the rooms are often small and ill ventilated ; and among the Irish we find a sad want of cleanliness. Fever is rather frequent among weavers, but other acute diseases are rare : the men, however, seldom enjoy health. Digestion is imperfect, asthma and other affections of the chest are common. They complain of the smell from the oil-lamps. This no doubt annoys the lungs, but their reduction of health is attri¬ butable chiefly to the confinement. The susceptibility of fever may arise from the frequent defect of proper nourishment. The weavers of stuffs have low wages, and are often out of employ. There are more old men in the occupation of weaving than in most others.”- —
p. 21.
Our author describes the injurious effects of all trades, but we must confine ourselves to the most common.
“ Shoemakers, it is well known, are placed in a very bad pos¬ ture — a posture second only to that of tailors. The abdominal viscera, and especially the stomach and liver, are compressed. Lads put to this employ, often suffer so much from headache and general indisposition that they are obliged to leave it ; and men who have been able to bear it for years, lose appetite and strength. Digestion and circulation are so much impaired, that the countenance would mark a shoemaker almost as well as a tailor. We suppose that, from the reduction of perspiration and other evacuations, in this and similar employments, the blood is impure, and consequently the complexion darkened. The secretion of bile is generally unhealthy, and bowel complaints are frequent. The capacity of the lungs in the individual examined we found to average six and one-third, and the circumference of the chest thirty-five inches. In the few shoe¬ makers who live to old age, there is often a remarkable hollow at the base of the breast bone, occasioned by the pressure of the last.
VOL. vi. no. 34.
N N
274
Critical Review.
Are shoemakers subject to popliteal aneurism? Morgagni asserts this ; hut I am not aware that a similar observation is now made. Much as posture injures shoemakers, bad habits injure more. Work¬ ing late on Saturday night, they often lie in bed all Sunday morn¬ ing, lounge in listlessness all the afternoon, drink all Monday, are sick and taking physic on Tuesday, and return to work on Wednes¬ day. Surely the interference of the masters might prevent half the disease and wretchedness for which the shoemaker is remarkable. Exercise in the open air is urgently required for the relief of this as well as other employments, which we have yet to examine ; but to prevent repetition I shall make some general remarks on this sub¬ ject at the close of the paper.
“ Curriers and leather-dressers are subjected to no injurious agent, except the bent posture in the process of “ shaving.” This affects the head. The smell of the leather produces no disagreeable effect. The men are generally very healthy, and a considerable proportion live to old age.
“ Saddlers are obliged to lean forwards, and are confined to this position. Hence they are subject to headache and indigestion.
“ Printers are kept in a confined atmosphere, and generally want exercise. Pressmen, however, have good and varied labour. Com¬ positors are often subjected to injury from the types. These, a compound of lead and antimony, emit, when heated, a fume which affects respiration, and are said also to produce partial palsy of the hands. Among the printers, however, of whom we have inquired, care is generally taken to avoid composing till the types are cold, and thus no injury is sustained. The constant application of the eyes to minute objects gradually enfeebles these organs. The standing posture long maintained here, as well as in other occupa¬ tions, tends to injure the digestive organs. Some printers complain of disorder of the stomach and head ; and few appear to enjoy full health. Consumption is frequent. We can scarcely find or hear of any compositor above the age of fifty. In many towns printers are intemperate.
“ Bookbinders and pocket-book makers are similar employments. The work is remarkably easy, and keeps no muscles fixed, nor demands excessive action from any. The workmen suffer no annoy¬ ance, except occasionally from close atmosphere, and from the smell of the putrid serum of sheep’s blood, which they use as a cement. The selection of this substance is unwise, since white of egg or other albuminous matter would answer the purpose, without offend¬ ing the senses. The pocket-book makers have high wages, and are not compelled to keep hours. Hence they are often very dissipated. One master informed us that several of his people have died from consumption. This, however, I should attribute, not to the employ, but to intemperance.
Carvers and gilders are kept in a confined atmosphere, and often for long periods in a leaning posture. Hence they sometimes suffer from headache. Though the pallid appearance, general among
Mr. Thackrah on Health and Longevity. 1275
these workmen, indicates a reduction of health and vigour, life is not abbreviated in a marked degree.
“ Clockmakers have little objectionable in their occupation ; for though the making and fitting up are carried on in the house, the pos¬ ture is varied, and the men are frequently travelling to repair clocks in the country. They are generally healthy, and attain often advanced life. Watchmakers have a much worse employ. They sit all day with their trunk bent forward. The digestive organs almost always suffer, and the lungs are sometimes affected. The close and con¬ tinued application also greatly injures the eyes. Many youths apprenticed to watchmaking are obliged to leave the employ, and the individuals who remain rarely live to old age.
ft Smiths have an employment remarkably conducive to muscular power. The use of the large hammer powerfully excites all the muscles, and especially those of the arms, throwing on them a large supply of blood, and consequently producing their enlargement. Exertion like this, moreover, has a considerable effect on the circu¬ lation in general, and the functions with which it is connected. For youths of strong constitution, no labour is better than than of the smith. For those, however, naturally delicate, the exertion is too great, and young men of scrofulous constitution are particularly liable to sink under the employ. Smiths are subject to high tempe¬ rature, and frequent changes of temperature, but with no obvious injury. They are rarely affected with rheumatism and catarrh. The employment subjects the eye to the annoyance of smoke, and to excitement from the glow of the heated iron. But our examination of the smiths in this neighbourhood does not prove them subject to ophthalmia; nor does it show that vision is impaired by the excitement of the retina. When smiths are ill, the cause is most frequently intemperance. They do not however arrive at great age. We could hear of but one old smith in the town of Leeds.
“ Cabinet-makers are generally healthy, though employed within doors. The labour is good ; and there is no hurtful accompaniment, with the exception of the dust, which is produced by sawing certain kinds of wood.
“ Patten- makers are subject to no other inconvenience from their employ, than the bending posture required in cutting the sole or clog.
“ House-servants, from their confined situation in a smoky town, are rarely in full health. We find them often affected with disorder of the digestive organs and of the head ; the latter particularly fre¬ quent. Girls from the country soon lose their ruddy complexion, and suffer more than the natives of the town. Kneeling produces in housemaids a swelling of the bursa, near the patella, which produces considerable inconvenience, though seldom serious disease. Foot¬ men, who stand long behind carriages, are said to be frequently affected with hydrocele.
Waiters at inns, irregular and dissipated in their habits, are generally unhealthy. They die comparatively young.
276
Critical Review.
III. — A Brief Statement of the Progressive Imp>rovement of the Health of the Royal Navy, at the end of the eighteenth and beginning of the nineteenth century ; together with practical illustrations , and a narrative of some historical incidents connected with the subject. By Sir Gilbert Blane, Bart. M.D. Physician to the King, &c. & c. London, 1830. pp. 55.
We are much indebted to a medical officer of the navy, for the two tracts on the subject at the head of these remarks, as their perusal has afforded us great satisfaction, and as the information they contain is so highly important, we hope our esteemed correspondent will excuse us for making a few extracts, though the productions have not been pub¬ lished.
Any one acquainted with the naval history of this country for the last fifty years, must reflect w7ith pain on the great mortality of seamen before that period, and must feel sin¬ cere pleasure at this sort of improvement which has taken place in the health of seamen. This mighty change was effected by Sir Gilbert Blane, Bart, by whose exertions alone, are the wooden walls of England enabled to rule the waves at all seasons, and in all climates, for an indefi¬ nite length of time. Such are a few of the benefits con¬ ferred on science and humanity by this humane and talented physician, of whose career we gave an imperfect sketch in a former number. The first essay before us was presented to his most gracious Majesty at New York, at the date of its publication, and the second is now respectfully dedicated to the same illustrious and universally beloved sovereign, whose paternal love for the welfare of all classes of his people, is the theme of the first admiration of his devoted subjects.
These tracts are highly instructive, and exceedingly interesting. They cannot be perused without impressing the reader with the most favourable opinion of the head and heart of the author ; for an ardent love of science, of country, and of humanity, is displayed through every page, which is calculated to make a deep impression upon the minds of every class of readers. We hasten to illustrate our statement by a few extracts.
“ In the course of the year 1780, my first year of service as physician to the fleet on the windward station, I found from my own returns and from examining the records of the hospitals, that
Sir G. Blane on the Health of the Royal Navy. 2 77
the annual loss of lives from disease previous to our arrival, and some time after, had been at the rate of one in seven ; nor was this alarming rate of mortality imputable to the prevalence of the pecu¬ liar epidemic of the climate, for there were then very few cases of yellow fever ; and as the principal causes of it were such as seemed to me to be removable by practical and attainable means, I was anxious to state these circumstances at the source of authority. I found that in a fleet, of which the complement of men was 12,109, the mortality in one year had amounted to 1,518, besides 350 ren¬ dered unserviceable, a number more than equal to the equipment of three ships of the line. When this is duly weighed by a considerate mind, as it affects the most important interests of the state, together with the great difficulty and expense of replacing these valuable subjects by fresh recruits, and when the calamitous sufferings of the individuals themselves are brought home to our feelings, no case could be conceived more calculated to awaken sentiments of patri¬ otism and humanity.
“ No opportunity occurred of effectually removing these deplor¬ able evils till the autumn of 1781, when I attended Sir George, afterwards Lord Rodney, to England, whither he went in order to procure reinforcements, foreseeing that the windward station in the West Indies would become the great theatre of war. It was then I made such representations as brought about a total change in the state of health of the fleet.
<f In a memorial to the Board of Admiralty, I stated the causes of disease to consist in : —
“ 1st. The neglect of cleanliness, ventilation, and dryness in the interior economy of ships.
“ 2ndly. The want of the supply of an article, which had been found, by the most unequivocal experience to be infallible in pre¬ venting and curing scurvy, one of the most destructive scourges, and the most peculiar to the sea service, of any class of disease. The remedy alluded to is the juice of lemon or limes.
“ 3rdly. The abuse of spirituous liquors, not merely as the most common means of intemperance, but as the habitual beverage of seamen, even when diluted. I recommended the substitution of wine, and, I ought to have added, of strong malt liquor.
“ 4thly. The want of adequate nourishment and comfort for the use of the sick and convalescent on board of their own ships.
“ 5thly„ The want of proper bedding and of soap ; so that along with the suitable articles of diet, the means might be afforded of curing men on board of their own ships, the hospitals on that station being at that time too small, ill arranged, and extremely expensive ; the men by going ashore being also exposed to the epidemic and endemic of the climate, and to the most pernicious temptations, from the facility of procuring the means of intoxication.
“ 6thly. The want of a gratuitous supply of medicines, as well as necessaries to the surgeons, in order to enable them to cure as many as possible without sending them to hospitals.
278
Critical Review.
•* 7th. As hospitals are, to a certain degree, indispensable at the principal stations, especially for the relief of ships in which con¬ tagious diseases prevail, new regulations of them in point of space, separation, ventilation, and cleanliness, were also recommended.
“ Though all the recommendations here specified were not at first complied with in their full extent, enough was done to evince their expediency, and to lead to great future improvements. I had the immediate and high gratification of succeeding in the recommenda¬ tion of wine, and of being an eye witness of its almost incredible benefit in the new reinforcement which accompanied the admiral on his return.” — p. 22.
“ There are so many public advantages as well as sentiments dear to the heart of every good subject and good man, that they cannot be too much recommended, cherished, and dwelt upon. Of these subjects of reflection none seems of such magnitude as the consideration that, in consequence of the great improvement of health the efficiency of the navy is doubled, and the national trea¬ sure husbanded to an incalculable amount. What a consolation it is in the present state of the public finances, that in case of any future war, it can be carried on at sea with so great an abatement of trea¬ sure, and consequent burdens on the nation ! For it does not require any deep thought to perceive that at a time when a fleet, as we have seen, could not keep the sea for more than ten weeks with¬ out being rendered unserviceable by scurvy, and that national pro¬ tection required that when the channel fleet has been constrained to return into port in so short a time, another naval force, as nearly equal as possible, ought to be ready to replace it, for repelling inva¬ sion, or baffling the expeditions of the enemy. I was in the habit of saying that at present there was as much service in two ships as formerly in three ; but one of the most distinguished sea officers that ever lived, declared to me, that it was his conviction that two ships now are equal to four of former times. How must every young man’s breast therefore exult, when, from the moment he enters the service, he feels conscious of his contributing to these splendid results, while at the same time their hearts are swelling with pride that they belong to a country, which almost in their own memory, or that of their fathers, have made such displays of skill and gal¬ lantry as are unequalled in the history of the world, namely, the conflicts of the 12th of April, 1782, near Dominique, under Lord Rodney ; that of the 1st of June, 1794, on the confines of the Bay of Biscay, under Lord Howe ; that of the 14th of February, 1797, under Lord St. Vincent ; that of Camperdown, on the 11th of Octo¬ ber, of the same year, under Lord Duncan ; that of the 1st of August, 1798, at the mouth of the Nile, under Lord Nelson ; and that of the same great commander on the 2d of April, 1801, at Copenhagen; that of July, 1801, under Sir James Saumarez ; and, to crown all, that of the 21st of October, 1805, at Trafalgar, under the immortal Nelson.” — p. 17.
Sir G. Blane on the Health of the Royal Navy . 279
Our author deemed it expedient to enlighten the com¬ manding- officers of the navy, regarding the most effectual means of maintaining the health and vigour of the men, of preventing the invasion of disease, and of doing justice to the sick.
“ I felt it therefore as a matter of impervious duty to explain myself fully on this subject to the commanding officers of the fleet; This I did in a printed tract, 1780, which was distributed among the flag officers and captains. In this I endeavoured to set forth how much the health of the men, particularly with regard to the pre¬ vention of disease, depended on the good judgment and exertion of officers, who alone could establish and enforce the regulations respecting ventilation, cleanliness, and discipline. This was ex¬ tremely well received ;* and it is not for me to say what share it may have had in the great alteration in the conduct of the officers of the navy regarding these duties, and how far it may have con¬ tributed to the revolution which has taken place in later times in the whole system of the medical management of the navy. There can indeed be no situation in which there is more room for genuine virtue, praiseworthy conduct and address none to which there attaches more grave and solemn responsibility; none on which there is a more imperious claim on the conscientious discharge of duty, than that of a naval commander. The men are cast on his humanity and discerning judgment under various aspects. A ship in the middle of the ocean is a little world in itself, at the arbitrary disposal of an individual — seamen and marines are subjected by martial law to a more despotic exercise of power than the constitution of the state authorizes in civil life, or even in the army — naval officers can, at their single arbitrary discretion, inflict such a summary and severe punishment as cannot be inflicted in the army without the solem¬ nity of a court martial. Englishmen surrendering from considera¬ tions of public expediency what they hold most dear, and that of which they are most jealous — their liberty, becoming thereby the greater objects of grave decision and considerate feelings. All sea¬ faring people, especially those employed in war, are exposed to peculiar and unavoidable privations, hardships and dangers, which ought to be mitigated, as far as is practicable, by those at whose
* The author has in proof of this, not only the innumerable testimonies of personal regard which he has experienced during the after part of his life from these distinguished persons, but their interposition on his behalf on the conclusion of the war, when they unanimously made application, through the Admiralty, for a reward to him in peace, no half-pay being then established for physicians to fleets. In compliance with this, his majesty was pleased to grant him a pension for his services.
280
Critical Review.
absolute will they place their lives and limbs ; it is in their character to be unthinking and careless of their own welfare and interest, requiring to be tended like children, and, like children, are entitled to a parental tenderness from the country they protect and the officers they obey.” — p. 29.
Scurvy has been prevented, subdued, and totally rooted out, by the general use of lemon juice, since 1795, and has remained so, and fevers are entirely extinguished.
These improvements have extended to the naval services of all countries, and entitle their author to a place among the best friends of science and of mankind.
IV. — The Life of John Walker , M. D. Graduate of the University of Leyden, Licentiate of the Royal College of Physicians of London , and late Director of the Royal Jennerian and London Vaccine Institutions. By John Epps, M.D, Graduate of the University of Edin¬ burgh, Lecturer on Materia Medica and Chemistry, Di¬ rector of the Royal Jennerian and London Vaccine Insti¬ tutions, &c. & c. London 1831, 8vo. pp. 342. Whitaker, Treacher & Co.
The subject of this biography was one of the most strenuous supporters of the Jennerian discovery, and diffused its bles¬ sings among mankind under a variety of circumstances and in opposite climes. The career of this extraordinary and eccentric character, abounds with features replete with inte¬ rest. It would be foreign to the tenour of this Journal, to introduce a full account of the life of this worthy physician, more especially as it contains his literary, political and reli¬ gious opinions, which would be misplaced in a journal of this description.
His biographer and successor has done him ample justice, and executed his undertaking with much ability and judg¬ ment. His dedication is so singular, that it must be quoted.
“ To the World,
" To thee, thou mass of civilized and uncivilized intelligence, I present this work, containing truths of the highest importance. The individual whose life this is, devoted his existence to thy good ; and that thou wilt look to the promotion of his good (in the person of his widow) in return, in promoting the interests of this offering, is the hope of the biographer.
John Epps.
Dr. Epps’s Life of Dr. John Walker.
2S1
To those who knew the Doctor, that is the whole profes¬ sion in London, a few anecdotes of him cannot be void of interest. Dr. Walker was born in the borough of Cocker- mouth, in July, 1759. His parents were humble and indus¬ trious, and took great care to procure the blessings of edu¬ cation. While at the grammar school with his fellow townsman Dr. Woodville, it appears he had no great love for learning or the learned, as the following' anecdotes amply testify : —
“ While there, Walker exhibited that vagariousness of disposi¬ tion, which formed a constant feature in his life. At his tasks he was the idlest of boys; at his amusements the most active. His guilty looks, on repairing to school after an holiday, sufficiently evinced that the whole time had been spent in play. When obliged, however, he could write with considerable expedition his Latin themes, which were so well finished as to obtain for him considerable praise. Frequently he went to his master’s desk four or five times in the day to repeat his lesson in Virgil or Ovid, depending, espe¬ cially after his master’s dinner, upon the soporific influence thence arising. Cultivating this dependance, he learned generally only two or three of the first lines, and a few at the end of the lesson. Before completing the few he knew, the master began to nod. Young Walker kept his eye fixed upon the sleeper, keeping up, at the same time, a humming sound, without articulating a syllable, till the master, giving a greater nod than usual, awoke, when the young rogue repeated the last line of his task and went to his seat. When the honest pedagogue was sufficiently on the alert, the defi¬ ciency was detected, and Walker flagellated, was sent to his form.” — p. 5.
Having received a limited education, he became weary of the pursuit of his father, which was that of a blacksmith, and determined to go on board a privateer in the Bay of Dublin. On his arrival in the capital of Ireland, he was astonished at the splendour and elegance of the public buildings, a full and faithful account of which is given in his Universal Gazet¬ teer, published in 1795. ffThe attentions and familiar man¬ ners of his new acquaintances made him feel very soon at home.” He failed however to accomplish his object in going to sea, and was greatly reduced in circumstances, when chance threw him in contact with an engraver, named Esdale. With this worthy man he remained for four years, and in the year 1780 published Walker’s Hibernian Magazine. He had the use of a good library with his friend, and readily availed himself of its advantages, devoting all his leisure
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hours to acquiring* the knowledge of Greek, Latin and mathematics.
He now determined to become a schoolmaster, and braved the difficulties which at first appeared insurmountable to this accomplishment of his wishes, by adopting the axiom, Cf pos- sunt, quia credunt posse;” in other words, “ they must conquer who will.” He soon discovered, however, that this motto did not remove his difficulties ; he was scarcely able to meet his slender expenses, and was so distressed that he could not afford himself candlelight during the winter’s nights. This however arose from his expending* every penny he possessed, after the discharge of his bills, in the purchase of books at the auctions in Dublin, which are always numerous. On leaving these marts of literature, he often wished he could enjoy the light of the street lamps in his chamber, to enable him to prosecute the drawing and etching of a set of plates for a Latin edition of Euclid, then publishing by the Univer¬ sity. Such were the privations which this worthy lover of literature and the arts wras doomed to endure. Influenced by the motto we have inserted above, he discharged the duties of his little school with unwearied zeal, and was so fatigued by his calling that he was obliged to retire to bed after his labours were over at 5 p. m. and slept until midnight, when he arose to prosecute the arrangement of his geography and Gazetteer, which originally consisted of the substance of a course of lectures he delivered to his pupils, in his mathema¬ tical and classical academy on Usher’s Island. These works, so well known to the public, were finished in 1788. Time rolled on, he acquired many friends, his scholars in¬ creased to a hundred, so that in 1792, he was able to publish the quarto edition of his works. Here we must mention a curious feature in his scholastic discipline; he had no corpo¬ real punishment, very little coercion, and so far did he cul¬ tivate a familiarity of address with his scholars, that they always called him by his sirname. No man could be more interested with his vocation. A second edition of his works were called for, and as his resources did not enable him to incur the expenses of publishing*, he determined to com¬ mence a tour through England, Wales and Ireland, to solicit subscriptions, having committed the care of his school to competent assistants. These peregrinations conluded, he gave up his school to Mr. John Foster, author of the r‘ Moral Essays,” and repaired to the great metropolis of the world. He now entered himself a student at the medical school, Guy’s Hospital, where he became acquainted with Sir Astley Cooper and others, who have since attained con-
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siderable eminence. He there acquired a knowledge of ana¬ tomy and physiology, and was so fascinated with these branches of science, that he prefixed a sketch of the latter to his own work. The success of this production need not be mentioned ; its rapid sale enabled him to prosecute his medi¬ cal studies in London, Paris and Leyden. He remained three years in the celebrated school in the Borough, and in 1797 repaired to Paris, in further pursuit of knowledge. At this period the revolution raged in that city, which led our hero into some awkward embarrassments. Though not an ortho¬ dox Quaker, for he was never regularly admitted into the society of friends, he was one in garb and principles, and in support of the peculiarities of his sect, he refused to wear the national cockade, or to take off his hat in the council of the ancients. So strange did this conduct appear, that the news boys in the Palais Royal offered papers for sale, voci¬ ferating, among other remarkable events of the day, (t voila, citoyens ! voila le grand detail d’un homme assez singulier qui ne voulait pas oter son chapeau au tribunal du conseil des anciens. Voila le grand detail.”
In 1799, Dr. Walker obtained his medical degree at Leyden, and returned to England to complete a tender engagement under which he had been for some years. This subject, os well as the numerous incidents which occurred to him in Scotland, and more especially with the Edinburgh professors, we must pass over, with one exception, which was the assistance he received from Professor Campbell, author of The Pleasures of Hope,” in correcting the second edition of his Thesis, which he composed at Leyden, and also his Dissertation on the Structure and Functions of the Heart.
In the year 1800, he was appointed to accompany Dr. Mar¬ shall, who was sent to Naples to introduce vaccine inocula¬ tion. During the voyage, the protective influence of vacci¬ nation was exerted at Minorca, Malta, Gibraltar, Naples and Sicily ; and at length, we find the fleet before Alexandria. Here the victorious French were on one side and the invincible British on the other, and both looked with anxious suspence at the result of the conflict.
** The troops were ordered to land. The hostile shore bristled with bayonets. The carnage is terrific. One boat is sunk. Others are in danger. The admiral, not wishing to destroy his men in what he considered a fruitless attempt, ordered a return. The sig¬ nal was not, in the moment of excitement and confusion, noticed. The British persevere ; they land ; the battle is fought ; the shout
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of victory is heard, mingled with deep-toned grief at the death of Abercrombie. Dr. Walker grieved for Sir Ralph, and says of him,
‘ * he was not more distinguishable for his bravery than for his huma¬ nity and generoshy,” a very appropriate description.
“ The fact above noticed is rather interesting, and was never, it is believed, recorded till by the subject of this memoir. How extra¬ ordinary are the turning of events ! Benevolence led the admiral to hoist the flag of return, The confusion prevented its being per¬ ceived. Perseverance was the consequence, and success was the result. Had the order been noticed, Buonaparte might, perhaps, have extended even farther than he did his gigantic strides.
“ While our troops were using the weapons of destruction, Dr. Walker was busily employed in saving life. His work of vaccina¬ tion being completed, he attended the sick of the British navy and of the Turkish army. The word “ weariness,” while engaged in these works of mercy, he seems hardly to have known ; being assisted therein by his excellent friend, General Sir John Doyle, in prosecuting these labours of goodness. He was much pleased with the cleanliness of the public hospitals, being in this respect, and in that of attendance, better provided than the European ; each patient having a comrade (putting aside poetical augmentation) “ to fan him when he sleeps, and wait on him when he wakes,”
“ Foreigners, and it is grievous to mention it, appreciated his services more than the British government. From the Pacha at Rosetta, a town situated on the western branch of the river Nile, about twenty-five miles N. E. of Alexandria, he received a present, with an apology for its smallness, in the declaration that the French had diminished the resources of his country. The services, how¬ ever, which Dr. Walker rendered to the British seamen ashore, (no part, be it remembered, of his proposed duty) were not attended to by the British government. The government did not even refund the money he laid out for providing his suffering patients such necessary refreshments as the commissary’s stores could not supply. In making this provision he was authorized by the Inspector- Generals. It is right, however, to state that Dr. Walker believed that the Admiralty gave orders that his and his colleague’s disburse¬ ments should be paid ; an order which, from the changes in this department of the government at the time, has never been attended to. The sum voted was comparatively trifling ; being from the Admiralty only £.100, to be divided between Drs. Marshall and Walker ; and from the War Office £.100 each, and this simply from the kindness of the Duke of York. This sum did not equal a fourth of the expenses which they had to experience. And even this sum was not awarded until letters upon letters were written to the principal members of the various ministries which have existed since the time,
“ The declaration has escaped Dr. Walker in conversation that the neglect rests with a late secretary, who, having since been pro¬ moted, seems not likely to trouble himself more about the matter.
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The Doctor, too, not being a vindictive creditor, pocketed the loss, and endeavoured to find the best of all remuneration for his painful services, and his passing his nights on the hard ground at the camp before Alexandria, in the recollection of his usefulness — in the
“ Mens sibi conscia recti.”
“ This neglect, however, should no longer be allowed to remain, and the widow of Dr. Walker should receive, from the hands of the government, what her husband had a right to claim ; more especi¬ ally as the following testimonial from Major-General Hutchinson proves how diligently the now defunct laboured in the promotion of the cause of his countrymen : —
“ ‘ Dr. Walker accompanied the expedition, with the approbation of the Commander-in-Chief, to Egypt, and introduced the new practice into the army in general, which was found effectual in arresting the ravages of the small-pox, those soldiers escaping it who submitted to his operation, and doing their duty as usual ; while a few, who neglected the opportunity, were laid up. We now experience his services in another way, he having consented to be associated with the surgeon of the brigade of seamen on shore ; and, from Sir Sidney Smith finding it necessary to have the attend¬ ance of the surgeon at a distance from the camp, the medical care of the whole brigade falls upon him. Major-General Hutchinson feels a sincere pleasure in recommending Dr. Walker to his Royal Highness the Duke of York, who ever takes so lively an interest in whatever renders the situation of the soldier comfortable.’
“ Camp, four miles from Alexandria.
“ 8th of April, 1801.’
“ It is to be added, in order that mankind may appreciate the zeal of Dr. Walker, that Dr. Walker never received any salary from government. He went out without any expectations, except from the benevolence of individuals. He had no government funds at his command ; not even when on board his Majesty’s vessels. It was by permission, not by command, that he went with the fleet to its different stations. He was the apostle of vaccination.” — p. 53.
It will be an indelible blot on the page of English history, that the benevolent and highly important services of Dr. Walker should have been unrewarded by the government of this country, while his aged and helpless widow should be left in a state of utter destitution. We sincerely trust, that some of our readers may exert themselves in behalf of a person who has such strong and just claims upon the govern¬ ment. Many who peruse these pages could effect the desired object, and ameliorate the forlorn condition of the relict of a brother practitioner. Let them remind those in power ot
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the millions of public money squandered upon pensioners who have no claim upon the public ; and upon the strong claims of the helpless individual whose cause we advocate. Leaving* this painful subject, we return to the Doctor at Gizeh, where we find he encountered a curious adventure.
“ Dr. Walker had, as the reader will have perceived, the courage to be singular. He allowed, while in Egypt, his beard to grow, so as to look very like a learned Jew. One of the young and thought¬ less friends of his mess drew in chalk the French insignia, so hateful to the Turks, the fleur-de-lis, on his big white hat. Rising from dinner, the hat was put on, and falling into one of his musing moods, the bearded sage wandered through Cairo without any uniform. Conceive his astonishment, when, in the midst of his meditations, some Turkish soldiers fell upon him with great violence, believing, notwithstanding all his assertions to them, in an unknown tongue, that he was “ Inglese” — him to be a Frenchman. And let Britain be ashamed of her sons (many of them now, it is true, no longer able to abuse the name of their God), when they read the fact, that the Turks, in order to satisfy themselves whether Dr. Walker was
or was not a Frenchman, uttered the oaths “ God d - -,” “ by
God,” inferring that, if the subject of this memoir was an English¬ man, he would understand a language which they had heard so generally used. Dr. Walker, horrified at the oaths they uttered, especially as coming from strange lips, instead of smiling assent, as they expected he would were he “ Inglese,” shook his head. This they understood as a mark of his not understanding them, and, consequently, that he could not be an Englishman ! And the Arn- haut, who had applied this test, smiled triumphantly on his com¬ panions at his skill in detecting the Frenchman. They therefore seized him, and took him to prison to the citadel. The prison doors were before him ; and Dr. Walker, thinking that he might be put into one of the dungeons below, where he would, most likely, be never more thought of, gave himself up as one no more to enjoy the delights of home and its social pleasures. Much to his hap¬ piness, however, they bade him ascend a staircase, running their bayonets into him and knocking him with the butt ends of their muskets behind as he ascended. While thus maltreated, and in such peculiar peril, an English patrole happened to be passing, who informed the commanding officer who the bearded philosopher — imagined by the soldiers to be a French savant — was, and Dr. Wal¬ ker once more experienced the sweets of liberty, after enjoying the delicious dish called killaw, with the officer and the Mussulmans, who accommodated the unbeliever with a low stool and wooden spoon, while they sat cross-legged and with naked hands helped themselves to the savoury mess.” — p. 58.
Though one would think this occurrence must have excited caution in future, we learn that our erratic and eccentric
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philosopher failed to profit by it. He pursued his tour through the interior of a dangerous country, and exposed himself to a series of dangers, which few men of ordinary minds would choose to encounter. Among these, were a miraculous escape from drowning and starvation. At length he returns to his native country, where he experiences further troubles. On the arrival of the vessel El Carman, at Spit- head, quarantine was strictly enforced towards the ship’s crew, with the exception of Sir Sydney Smith and Colonel Abercrombie, who, with their servants, immediately left for London. Dr. Walker exposes this distinction with success.
“ Whatever fomites of * the pestilence that walketh in darkness, or of the destruction that wasteth at noon day,’ (Psalm xci. 5, 6) might be lurking in our clothes and luggage, certain officers in scarlet and blue — Sir Sydney Smith, from the shores of Egypt, and Colonel Abercrombie, from the interior thereof — with their servants, who had attended them in that ancient house of bondage, set out, * bag and baggage,’ on the instant of our arrival at Spithead, to that spot where the greatest number of British subjects are assembled toge¬ ther ; buttoning and unbuttoning, going to bed and getting up, from day to day, without a dream or a suspicion of the possibility of the plague again, through desolation of the inhabitants, causing the green grass to grow up in the streets, no longer crowdedly trodden by the busy feet of men.
<f Ihe prohibitions connected with quarantine, were, in respect to these remaining behind, so strictly observed, that even boats, con¬ taining refreshments, were not allowed to approach the vessel. Well might Dr. Walker exclaim on the occasion — “Ah, ca .”
“ The prohibitions, all can see, if applicable to one, are so to all. Why, then, this distinction ? The great are allowed to carry the plague ; the poor must be prevented. It is absurd, and John Wal¬ ker could see it so.” — p. 70.
The time allotted for the performance of quarantine having1 expired, Dr. Walker landed at Portsmouth, and proceeded alone to Stonehouse to meet the object of his affections. Even on this occasion his eccentricity continued, as we learn from his biographer.
“ He arrived at the village towards the close of the day, and there rested a short time ; the house where Mrs. Walker and her friends resided being at some distance from the village. On this and other accounts, prudence dictated that they should, early in the evening, lock the door, and take other precautionary measures in respect to the wanderers and to thieves.
“ The door was locked; the shutters were closed. The watch dog had received his honoured station of in-door protector, and the
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friends were musing, in rather a melancholy mood, on their absent objects of affection. This cast of melancholy had arisen from the circumstances, that though notice in the papers had been taken of the El Carmen’s arrival, no letter had been received from Dr. Walker. While in this pensive state, a loud single knock at the door was heard. For fear, no one answered it, save the barking of the dog. After some delay, the servant determined to look out of the window, when a voice utterred — “ A letter under the knocker!” The letter would have received the dews of night, had not an old servant, who was often employed in the shrubbery, shortly after requested admittance. When admitted, he, Avith all the language of astonishment written on his face, said that a strange-looJcing man , with a crape over his face, had come into the village that night. The wonder of all was actively excited ; and Mrs. Walker deter¬ mined to takg advantage of the man’s arrival, to go to the front door for the letter, cherishing, at the same time, the affectionate hope that this strange man might be her dearest friend, and that the letter might be from him. The hand-writing was his. The joy almost overpowered her, and no doubt would, had not the sound of his voice met her ear as she moved with agitated steps back through the shrubbery. Soon she found herself in his embrace ; yes, in the embrace of a man with a long beard (the crape of the country people.) The doctor cheered the domestic circle for some time with the enumeration of the various incidents of his tour, and again the brow cast aside its mantle of care to put on that of peace.'*’- — p. 71.
He commenced his labours as a vaccinator in Lombard- street, in August, 1802, and was stimulated in his laudable exertions by the melancholy fact, that many bodies destroyed by small-pox, were in the dissecting rooms throughout the metropolis. He now proposed to establish a public institution, an idea approved of by many medical friends, and speedily acted upon by the formation of the Jennerian Society. For full particulars relating to this useful institution, we refer to the interesting work before us. The Doctor was appointed Resident Vaccinator, but from his eccentricities and manners, “ his dress and address” was loudly complained of, and was finally obliged to resign. The London Vaccine Institution was established, over which he was again elected as chief vaccinator. This was a popular establishment, was well supported, while the former gradually declined, and finally was abandoned. Vaccination was now patronized and pro¬ moted in every civilized nation in the world, as appears from the correspondence inserted in the volume under notice. The description of the Doctor at the vaccine stations, is faithfully and graphically given, with the exception of his personal appearance, which we shall add to complete the picture. He was a thin spare person, far advanced in years, dressed in
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a snuff brown suit, with all the simplicity of his adopted sect His manners were rough and repulsive, and highly injurious to the promotion of the object he had in view. This will appear from the following extract, for the accuracy of which we offer our personal testimony: — -
“ Any person who wished to see Dr. Walker in his most extraor¬ dinary condition, went to one of the vaccine stations for the sight. There was beheld the man in all the activity of his natural disposi¬ tions — his self-complacency, at the same time, exercising a modify¬ ing influence over all the operations of his mind, being called into activity by the conviction of the dignified situation in which he was then placed. He there experienced the exalted pleasure of perceiv¬ ing the appreciation of his labours ; of feeling that confidence was placed in his superior judgment. In fact, at his stations, he was the great Dr. Walker. He was there, truly speaking, the director ; and any obstacle in the way of his plans did not long remain in an opposing condition.
“ The first thing that Dr. Walker looked to, when entering the room, was the table on which he expected to see his books. If any mother had put the child’s bonnet, pelisse, or any other person, his hat thereon, they were immediately swept away to the floor. If any woman stood in the way, he pushed her back, and would make her, if much irritated, stand up in the corner, as if she were a naughty child. He then marshalled his numerous company, and, having put them in their several ranks, gave a short, but very potent address to the mothers on the protection afforded by the vaccine inoculation. Having gone through these preliminaries, the director then issued the order for the children’s names, places of habitation, and age to be told ; and the individuals were exhorted to take care to speak plain. From the influ¬ ence of that state of mind, that makes its possessor believe that what he knows well himself others know equally well, the parents very often muttered out the names of their children, of their places of habitation, and their ages. This disturbed Dr. Walker very much. He often made the offending woman spell her child’s name ten or twelve times over, adding at the conclusion, “Now, thou wilt learn to speak plain.” Often at the constant tor¬ ment of being obliged to ask, over and over again, what the parents said, he became quite angry, and made the offender wait till the last.
Having collected all the names, the next process was commenced. This was to obtain some vaccine ichor for the purpose of vaccinating the children, not as yet protected. Here often was a great struggle. The “gemitus infantum” had now commenced. The few mothers that had the courage to bring back their children for examination were frightened, and looked towards the door with an anxious desire for escape. Some one, perhaps, attempted to fly ; Dr. Walker leaped to the door, and barracadoed it with his body, saying, “Thou foolish woman, if thou wilt not do good to others, I will bless thy
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little one,’* and forth witli drew his lancet, to gather the rich ichor, the produce of what he called his “ vaccine roses.” The screams of the terrified child, the complaints of the excited mother, and the apprehension written on the countenances of all, did not intimidate the courageous soul of the director. He finished his operation, and then, laying aside the frown of offended authority, and putting on the smile of benevolent delight, addressed the poor mother, “ Thy child is safe : fear not : fare thee well.”
“ The children always claimed Dr. Walker’s sympathy, although that sympathy was met on their part by a scream. This may readily be conceived, when it is remembered that young Astyanax, Andro¬ mache and Hector’s child, cried, when his brave father, helmeted, took him in his arms. Dr. Walker’s lank and long physiognomy, his broad-brimmed hat, and his tout ensemble, were sufficient to call forth the greeting of a scream, when he offered the welcome, even of the kindest feeling. The cries of the children (for children being imitative beings, when one commenced, the rest joined) were, some¬ times, to those not aware that children often cry from imitation with¬ out being hurt, truly terrific. Dr. Walker was used to it, and, con¬ sequently, regarded not tears, or cries, or screams, or threats, all of which he had daily to meet with.
“ He, it may readily be conceived, could not be interfered with, occupied as he was sometimes with the vaccination of perhaps fifty or sixty “ little Londoners” at one station. Towards the conclusion of his life, if any one disturbed him in the regularity of his plans, it vexed him very much. Sometimes a medical man would speak to him about something not at all important, and break the course of his proceedings. “ Cannot thou keep thy peace ? I will attend to thee last” — was the result of the disturbance, and the offender had the misery of looking foolish until every one else was supplied.
“ The vaccination for the day wras often concluded by a lecture, after which the mothers went away, saying, “What a cross old man !” 4‘ What a strange man!” “ What a curious old fellow !” “ I will not go again — such a cross old stick !” and many singular vulgar remarks. However, the mothers did go again; for there was a lurk¬ ing something in the “old Doctor,” as he was called, that enticed them back ; and also, then they had the satisfaction of hearing expressed, with the greatest confidence, by the director, “ Thy child is safe.”
“ The medical men, who came for supplies of matter, he always kept to the last, unless wanting their lancets charged, and then it was absolutely necessary that they should present the lancet properly opened and properly guarded (that is, so fixed that the ichor when put upon the lancet, could not be wiped off). If not so given, he would return it, often not saying a word. If a servant brought the lancet unarmed, he usually told him, “ Go to thy master, and tell him to send me his lancets properly, and then I will supply him.” If any one ventured forward before his turn, he was sure to be supplied last. Many young students who had not yet received sufficient rebuffs in life to teach them humility, came into the stations with all the impudent
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arrogance of conceit, saying, “ I want these lancets armed.” “ Dost thou ?” with a peculiar expression of dignified contempt and pity combined, " stand back there!” was all the Doctor said. On some of these occasions, when Dr. Walker had to do with such children of puppyism, an artist would have found the highest entertainment in the general expression of the old and venerable man.
“ It is due to Dr. Walker to state, that any medical student who was quiet, and sought proper occasions to obtain information, was sure to meet with kind attention. He delighted in diffusing the knowledge of vaccination, and was ever glad to have any to instruct in such a good cause.
“ Dr. Walker, in other words, was the monarch at the vaccine stations. His was the despotism of knowledge ; and he delighted in the exercise of this kind of despotic power as much as the autocrat of the Russians does in his. Thus gratified, and impelled likewise by a sense of his duty by the delight of doing good, and also by the plea¬ sure of cherishing a cause of which he was the principal support, it is not a matter of wonder that he should have never a missed a day, from the time when he was appointed till within a week or two of his death, in visiting the stations. It is becoming that these stations, at which he attended, should be noticed, in order to shew to the public the immense amount of service he contributed to the general good. At nine, a;m. Dr. Walkerwas to bemet with at 215, Strand; at a quar¬ ter past nine, 337, Strand; at half past nine, at 29, Haymarket ; at a quarter to ten, a. m., 27, Lisle-street; at ten, a. m., at 3, Broad-street, Bloomsbury; at a quarter past ten, at 144, High Holborn ; at half past ten, at 63, High Holborn. From that station he went to one of the prin¬ cipal stations, at 1, Union Court, Holborn Hill (still retained by the Society), at eleven ; from this he proceeded, at about a quarter to twelve, to 4|, Salisbury Court, Fleet-street, and then returned to his own house, at 6, Bond Court, Walbrook, where he vaccinated at two, p. m. Besides these journies, on every Monday, he went to the vestry of St. John’s Church, Horsleydown, kindly granted for the use of the Society ; thence to the Lancaster Royal Free School, 5, Thomas -street, Borough Hospitals ; and thence to the South Lon¬ don Dispensary, No. 1, Lambeth Road.
te Such was the life of this man of benevolent industry. Day after day he went his round. Sunshine or rain, it mattered not. Vacci¬ nation was the longing of his soul ; and nothing was sufficient to draw him from his course.” — p. 125.
He toiled in this way for nearly twenty-eight years, and continued to perform his duties till illness put a period to his existence.
The Report of the London Vaccine Institution for 1831, paid him the following just tribute : —
“ Doctor Walker was a man whose life was a continual activity in the pursuit of good ; who, day after day, month after month, and
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year after year, watched, with the care of a parent, the cause of which he was so experienced an advocate ; who was willing to know nothing but the object of his early love, vaccination ; who persevered, through good report and through bad report, in diffusing the bless¬ ings of vaccination ; who, for upwards of a quarter of a century, never omitted one lawful day going his rounds to the numerous stations of the institution ; and who, it may be said, almost ended his life with the lancet in his hand, for he went round to the stations two days before he died.” — p. 131.
The remaining part of the volume embraces the religious, moral and political opinions of Dr. Walker, with which we can have no concern. His defence of Napoleon, in regard to the poisoning of the sick troops at Jaffa, is satisfactory, and is a complete refutation of the assertions of Sir Robert Wilson and others. Indeed, this was scarcely necessary, after all that has been written by his medical attendants and staff at St. Helena ; but the testimony of such an upright and honest man as Dr. Walker, must carry conviction to the mind of the most sceptical.
We now conclude our remarks, by thanking Dr. Epps for the amusing and interesting facts he has so happily arrayed in this production. His task was difficult ; blit it has been ably executed. He has undertaken it for the benefit of an aged and distressed fellow-creature, a sufficient motive to induce the affluent members of our profession to afford their patron¬ age. The work is as interesting as a standard novel ; it will be perused with pleasure by the medical and the general reader.
V . — Physiology of the Foetus , Liver and Spleen. — By George Calvert Holland, M.D. Batchelor of Letters of the University of Paris, Lecturer on Physiology, and Joint Lecturer on Practice of Physic in the Sheffield Medical Institution. London, 1831, 8vo. pp. 229. Longman & Co.
The author of this work is very favourably known to the pro¬ fession by his “ Experimental inquiry into the laws which regulate organic and animal life,” a work evincing research, industry and much originality, and one which refutes many of the conclusions of John Hunter, Wilson Philip, and Edwards of Paris. It is obvious therefore that its author is eminently qualified to execute the task which he has undertaken on the present occasion.
Dr. Holland on Physiology of the Foetus , tfc, 293
In an exceedingly well written introduction, he describes
the causes which have retarded the attainment of sound principles in physiology.” He observes —
“ An inquiry into the nature and extent of those causes which impede or arrest the progress of science, must be a subject of inte¬ resting speculation, not only to the philosopher, but to very one who is engaged in the pursuit, or interested in the advancement of useful knowledge. Such an inquiry, if skilfully conducted, by detecting the fallacy of assumed principles, and exposing the errors of popular systems, would diminish that undue veneration for antiquity, and that servile reverence of great names, which have so frequently pre¬ vented the discovery of truth ; and by thus liberating the mind from the restrictive bonds of prejudice, would leave it free and unincum¬ bered to pursue its onward course, in the paths of scientific research. It is only when the fetters of authority and system have been cast off by a powerful and superior understanding, that any great advances have been made in the spacious fields of science, in which, instead of exploring new tracts, the philosophers of our age have generally been content with walking servilely in the footsteps of their predecessors, or, if they have dared to depart from them, it has too often been under the misguiding influence of some imaginary notion, rather than the sure direction of those sound principles which were likely to lead to any valuable discoveries. To this cause we must attribute the slow progress of physiological investigation. On no other principle can we account for the extraordinary fact, that so many centuries elapsed before any knowledge had been acquired of the circulation of the blood, the connexion between the powers of the mind, and the development of the brain, the exact states of the body which pro¬ mote or retard the generation of animal heat, and the true mode in which the foetus is nourished. These secrets might have been made known, long before the period of their actual discovery, by any man of ordinary capacity ; if, instead of being misled by prevailing opi¬ nions, he had carefully examined the phenomena which nature pre¬ sented to his view. Any thing intensely bright is seen more dis¬ tinctly by the eye through a coloured medium, but the objects of mental contemplation are apt to be distorted, and rendered obscure, when viewed through any other medium than that of plain and sim¬ ple facts, actually ascertained to exist, by careful and repeated expe¬ riments. He who recollects this truth will not be surprised at the slow progress of the science of medicine.
“ The ancients, though possessing much less general knowledge than ourselves, and not having nearly so accurate an acquaintance with the human frame, were almost as successful in the treatment of most diseases ; since their superficial knowledge of the constitution of the body, and their entire ignorance of many of its organs and operations, reduced them to the salutary necessity of close observa¬ tion, and a strict adherence to those means of cure which experience had discovered ; but, amongst the moderns, speculation too frequently
294
Critical Review.
occupies the place of experiment, facts are disregarded in an eager¬ ness to establish some favourite hypothesis ; and the instructive voice of sage experience is not heard amidst the loud exclamations of noisy partizans, contending for the truth of new theories, and ever varying doctrines. The ancients were generally more practical, the moderns are more theoretical ; the former may, therefore, be sometimes safely followed, the latter seldom : but it would be dangerous to rely implicitly on either ; the ideas of the one being often crude and ridi¬ culous, those of the other visionary or imperfect. It has been justly asked, with reference to the present backward state of medical science — What has medicine yet effected in increasing the bodily powers of man, in remedying his diseases, or in lengthening life, which can bear a moment’s comparison with the prodigies effected by education, in invigorating his intellectual capacities ; in forming his moral habits ; in developing his sensitive principles ; and in unlock¬ ing all the hidden sources of internal enjoyment ?” — p. 13.
He adverts to the law which held it a serious crime to question the correctness of the philosophy of Aristotle, or the medical dogmas of Galen, and he praises that spirit which has led men to disregard opinions and systems, how¬ ever consecrated by age or revered by mankind ; but he pro¬ perly contends, that the existing dogmas in medicine have been too often wholly received or rejected, after too super¬ ficial a consideration. We are next favoured with remarks upon the works of Darwin, Brown, Broussais, Clutterbuck, Lobstein and Abernethv, in which the merits of these distin- guished writers are justly estimated. He holds that some have advanced our science by facts, others by theories ; but upon the whole its advancement has been retarded by the multiplicity of its expounders. He justly observes that it is much easier to write on medicine than on the other sciences; to compose a work, even of a very humble kind, on natural or moral philosophy, requires superior intellectual powers, strengthened by much previous study, and long’ exercised in abstract speculations or experimental pur¬ suits, whilst such a work, even when creditably executed, does not bring its author either much reputation or profit. The medical practitioner, with a very ordinary understanding, few acquirements, and but little mental application, may easily compile a treatise on some branch of the profession, availing himself of the labours of his predecessors, drawing his matter from existing stores of medical knowledge, which he has only to arrange in a new form and slightly modify, to secure both considerable fame and emolument. He soon enjoys the confidence of the profession and public, until some new work appears, which throws him into the shade. This
Dr. Holland on Physiology of the Foetus , Sfc. 295
is a faithful picture of modern medical writers. Our author adduces further facts in illustration of the retardment of me¬ dical science, and the difficulties to be encountered by its cultivators. He says —
“ In investigating the operations of nature, the inquiring mind is perplexed by studying them through the medium of these ever vary¬ ing systems, which involve the most important subjects of medical and physiological inquiry in almost impenetrable obscurity. There are scarcely any truths in medicine, like the axioms in geometry, or the first principles in philosophy, so universally allowed, and fully established, that the student of this science can rely on their cor¬ rectness ; it is, therefore, absolutely requisite, amidst so many dis¬ crepant theories, clashing opinions, and opposite conclusions, drawn from the same experiments, to put every thing to the test of the most elaborate and tedious examination. Another cause, which has retarded the progress of medical knowledge, is an almost exclusive attention to experiments — p. 19.
He examines the claims of the most eminent physiologists, of Haller, Bichat, Richerand, Magendie, and points out their defects with great candour and impartiality. He offers satis¬ factory evidence that these illustrious men arrived at many erroneous conclusions. He contends that physiologists must exercise the mind even more than the hand and eyes, and patiently refer every hypothesis to the test of experiment. He turns to the systematic writers, and argues that they have attempted too much and adopted fanciful notions, assumed premises and false conclusions. This will be admitted when we consider the low state of medical science in the last cen¬ tury. His criticism on Good’s Study of Medicine is worthy of citation.
“ The Study of Medicine, by Mason Good, affords the clearest evidence of the advancement of this science in late years ; but I am disposed to think, that the merits of this treatise have been much overrated. It cannot be denied that it displays considerable learn¬ ing, and contains many important facts and useful observations ; but the value of these is much lessened by their being very frequently blended with false doctrines and physiological errors. The work is, indeed, enriched with a vast fund of knowledge, brought from almost every quarter ; but to render that knowledge really useful, it ought to be much more carefully examined and scientifically arranged.
“ The author would have conferred a much greater benefit upon society, if his plan had been more limited, if it had been confined to some particular branch of medicine, instead of embracing the whole of the sciences, the departments of which are too numerous in their present imperfect state, and too full of errors to be comprehended by
296
Critical Review.
one mind, or to admit of generalization. No system of medicine can indeed, be formed with advantage, till its principles are more thoroughly understood, and firmly established ; in the meantime, the best method of leading to a more perfect acquaintance with them, is for individuals to apply themselves to the study of those particular branches of the profession which circumstances afford them an opportunity, or nature gives them an inclination to investigate. The indefatigable industry and extensive knowledge of Mason Good fitted him for the task of compilation, and his Study of Medicine is cer¬ tainly an elegant and learned production : but his numerous and diversified acquirements were not calculated to render him practically useful as a physician, or eminently serviceable as a writer on medical subjects. The mind is, indeed, enriched by abundant stores of infor¬ mation, but the judgment is not proportionally strengthened ; and the time spent in the acquisition of varied and extensive learning, must necessarily be taken from that which ought to be wholly devoted by the medical practitioner to the exclusive studies of his profession. A general knowledge of many subjects, being almost necessarily received without due examination, is seldom exact, or correct ; this is particularly true of medical knowledge which does not admit of accurate calculation, and the correctness of which can be ascertained only by the long and tedious process of individual observation, accompanied by a spirit of candid and patient enquiry, unbiassed by prejudice, and seeking only for truth.” — p. 31.
The concluding' remarks of our author are manly and candid, and reflect much credit upon him, as a zealous and ardent friend to science. He says—
” In these introductory remarks, I have fully attended to those causes which appear to me to have principally retarded the advance¬ ment of the science of medicine, and in the following pages, with equal freedom, I have attempted to refute what I conceive to be the erroneous opinions of preceding writers, on a very important and dif¬ ficult subject of physiological investigation. I am well aware that with those, who are strongly attached to popular systems and pre¬ vailing notions, the freedom of my observations will, probably expose me to the charge of bold presumption : but the candid and intelligent reader will, I trust, acquit me of such presumption, when he con¬ siders that the most pernicious errors can be removed only by a fear¬ less refutation, and that it is the duty of every member of the medi¬ cal profession, to expose whatever is connected with it, that in his estimation, is either false in theory, or injurious in practice. I claim, however, no infallibility : and, if in attempting to correct the mis¬ taken opinions of my predecessors, I should myself have embraced others equally erroneous, I shall not only be most thankful to any one, who will candidly point them out, but be the first to reject them on a sufficient proof of their fallacy.” — p. 32.
Dr. Holland on Physiology of the Fcetns, <fc. 29 7
He commences the body of his work with an examination of th q physiology of the liver and spleen, and after admit¬ ting the difficulties of the subject, adverts to the opinions of Dr. Stukely, published °in 1723 and of Moresehi of Pavia, in 1803, tff that the spleen is an organ appropriated to the digestive function, supplying' blood according to its de¬ mands.” He thinks this view correct.
“ When the capacity of the stomach is enlarged by the food which is received, it is supposed to press upon the body of the spleen, so as to diminish the accumulation of blood in the splenic artery, and thereby to augment the action of those vessels which are distri¬ buted upon the stomach. This view, with slight and immaterial modifications, is the one proposed by both authors. The necessity of a vigorous circulation during the process of digestion can scarcely be called in question. This state of the sanguiferous system is to be regarded as indispensable, and the views which support it are much more consistent than the ideas at present entertained with respect to the efficiency of the nervous system.” — p. 2.
After a just compliment to Dr. Wilson Philip, for his numerous and well conducted experiments, he denies that they warrant the conclusion, that digestion ceases on the division of the eight pair of nerves from the immediate loss of nervous energy belonging to the stomach. He observes,
“ In a work, which I lately published, it was satisfactorily shewn that the division of the eight pair of nerves is injurious to the digestive powers of the stomach, in proportion only to the disorder induced in those of respiration and circulation.* When these were protected by the introduction of a small tube into the divided trachea, which enabled the animal to breathe with facility, digestion pro¬ ceeded as correctly, although a portion of the nerve on each side was excised, as when the nerves were left entire ; the trachea alone being separated, and a tube attached, as in the preceding instance.” — p. 3.
We cite authorities which prove, that the spleen may be partially or totally removed, and in some instances does not exist, and still digestion is effected. He notices the experi¬ ments of Sir E. Home, Malpighi and Assollant,in corroboration of the fact, that the spleen has been removed from animals, without injury to digestion, absorption, circulation, respira¬ tion, voice, secretion, nutrition, locomotion, sensibility, the instinctive faculties, and reproduction. He arrives at the con-
* See an Experimental Inquiry into the Laws which regulate the Phenomena of Organic and Animal Life.
Vol. VI. no. 34.
Q Q
298
Critical Review,
elusion, that the spleen is not necessary for the functions which has been ascribed to it, “ for if it were indispensable to the perfect digestion of food, this process would be impeded or destroyed, whenever the stomach was deprived of its assistance, which, however, is not the case.” He thinks the office of the spleen is not as yet discovered. We are much surprized at his silence on Mr. Dobson’s experiments and conclusions on this subject, which we noticed in our last volume ; and which appear to be more satisfactory than any hitherto offered. These views were not promulgated by the Medical Journals so extensively as they merited, and hence we may excuse our author for not having noticed them.
He states, that the physiology of the liver is as obscure as that of the spleen, and denies the legitimacy of the conclusion that the venous blood forms the bile.
“ From what has been previously explained, it is evident that the hepatic artery is regarded as the source of bile ; and believing the production of this to be only one function of the liver, it is my inten¬ tion to account for the great quantity of venous blood transmitted to it and the spleen. Both organs are well adapted to receive a great share of sanguineous fluid, whether we consider the texture as com¬ posed of blood vessels or of cells.
The' function of the spleen, as well as that of the liver, inde¬ pendently of the secretion of bile, is considered a diverticulum of the system. If the veins* which form the vena porta had passed directly to the vena cava inferior, a thousand accidents, arising either from mental or corporeal disturbance, would have continually placed the life of an individual in imminent danger. Every passion, whether of an exciting or depressing character, and every general and local disease, if severe, whether chronic or acute, would have been liable to have deranged the lungs and heart. 1 have already endeavoured to shew, that passions, of a depressing nature, bring the blood in greater quantity than usual from the inferior and superior extremi¬ ties, and also from the surface of the body to the chest ; and I have also stated, that the abdominal viscera participate in this engorge¬ ment. Since the body is continually liable to such changes, baneful effects would follow, unless nature had provided organs, whose situation, function and organization, enable them to diminish the burden imposed upon those, whose constant and almost regular action is indispensable for the maintenance of life. This object is beatifully answered by the liver and spleen. The organs within the chest must be regarded as possessing vital functions. If the lungs were surcharged with blood, or in a condition approaching to it, the properties and distribution of this fluid would be immediately dis¬ ordered, and with this primary derangement every part of the body would quickly sympathize.
Dr. Holland on Physiology of the Foetus, Sfc. 299
“ The liver and the spleen, from being placed close to the thorax, are calculated to relieve the congested lungs and heart, or rather to protect them from sudden and violent commotions ; and are also favourably situated to protect in the same manner the stomach, whose action is scarcely less vital.” — p, 20.
He reminds us of the minute ramifications of blood vessels in the liver and spleen, which prevent the sudden flow of blood to the lungs, an occurrence inevitable and fatal, had not these organs been wisely interposed. Man could seldom arrive at maturity, unless the constitution were endowed with these organs.
It has been long held, that the melancholic temperament is by far the most frequently characterized by disease, or augmentation of the liver and spleen. Our author endeavours to prove the validity of this position.
“ The greater pari; of the ancients supposed, that these organs were the seats or causes of this temperament, and although it is impossible to grant that any viscus or viscery of the abdomen can fashion the peculiar constitution of the mind, still the universal lan¬ guage of mankind proves, that these organs were generally large or diseased in individuals of this temperament. We very rarely find persons so constituted take constant exercise ; their habits for the most part are sedentary, and instead of enjoying the gaiety and hilarity of convivial parties, they generally prefer solitude, or are occupied in brooding over real or imaginary evils. In the chapter on the physiology of the passions, already alluded to, the manner in which the body suffers from a disorder in the powers of the mind is fully discussed ; and as the feelings of melancholy are considered to operate in the same way, as those which were referred to the division of mental sedatives, there is little further to add on the present occasion.
“ A life of inactivity, or one abounding in disagreeable sensa¬ tions, tends to determine the blood internally, and those organs which are best adapted to bear this determination, or state of con¬ gestion, will suffer to the greatest extent. The liver and spleen being formed in every respect, to receive the principal share, they will necessarily exhibit symptoms of derangement or disease, as if they were the only disordered organs, but in this state of the system we also remark, very frequently, if not constantly, acute headache, palpitation of the heart, sometimes cough and difficulty of breathing, or abberration of the mental faculties ; and unless the two abdo¬ minal viscera had been so constituted and placed, the whole train of the latter effects would have become too prominent for the exist¬ ence of the animal economy. If these principles are allowed to be correct, the treatment of nervous diseases must be considerably modified.” — p. 23.
300
Critical, Review.
After a variety of arguments in further proof of the doctrines already cited, our author arrives at the following conclusion as to the functions of the spleen, which is by no means satisfactory : —
“ If it be removed, and the individual recovers his wonted ener¬ gies, these may exist for a series of years; because their exercise does not depend upon the spleen, but upon the proper action of organic laws, which are equally independent of the same organ in the undisturbed state of the system. Its office is not to contribute, every moment, to the maintenance of life ; but only, on trying occasions, to develope the full powers of its functions, and, in con¬ junction with those of the liver, to protect the vital principle from destruction.” — p. 30.
If the conclusions of Mr. Dobson be legitimate, and they are deduced from experiment, the function of the spleen is exerted after digestion, a direct contradiction to the doctrine of this extract.
Our author deduces several arguments from comparative anatomy, in corroboration of his statements, but the insertion of these would be uninteresting to most of our readers. Though he has displayed much originality in this article, he has not adduced many authorities that might be quoted. We cannot overlook these omissions, as the work is ably executed. It is at once literary, scientific, and instructive, and well deserves a place with the first physiological pro¬ ductions of the day. We shall resume our analysis of the remaining part, on the physiology of the foetus, in our next.
VT. — A Manual of Analytical Chemistry. By Henry Rose, Professor of Chemistry at Berlin. Translated from the German by John Griffin. 8vo. pp. 454. London, 1831 : T. Tegg.
Though we have many excellent works on chemistry, we have not one which can be considered a perfect guide to analysis, and therefore a production of this description is a great desideratum. Few chemists are so justly celebrated as Professor Rose — as an analyst, he stands unequalled in the German schools. The translation of his work will be esteemed an advantage by every scientific practitioner. It
Mr. Rose on Analytical Chemistry .
301
is singular that the various German systems of chemistry, which are seldom equalled, and certainly not surpassed, should not have been translated into English. It is not easy to account for this apathy. The present specimen is well calculated to induce our countrymen to direct their attention to this branch of German literature. The accuracy and fidelity of this translation reflect much credit on Mr. Griffin. To the operative chemist this work will be invaluable. It is a production of great practical utility, and cannot fail to be encouraged. It is only fit for those who are versed in chemical science. It does not admit of analysis, and its arrangement only can be introduced. This appears in the author’s preface.
“ The first part contains instructions on qualitative chemical examinations. I have treated therein of the detection of those sub¬ stances only which occur most frequently. I have restricted myself thus, not only because these substances are of greater interest than those which seldom occur, but especially because the description of the analyses would have been rendered too difficult to follow, had I started with the supposition that the compounds to be examined could contain all possible constituents. The behaviour of rare sub¬ stances with reagents is described in the systems of chemistry, among others, in the system published by Berzelius. Every one, there¬ fore, who is sufficiently exercised in the qualitative examination of the substances which commonly occur, will experience no difficulty in detecting those which seldomer occur, providing his inquiries are directed by the information thus obtained.
“ The second part contains instructions for quantitative analysis. To every simple substance, oxygen excepted, a distinct section is allotted. In each section, I first describe the quantitative determi¬ nation of the simple substance and its compounds with oxygen. I then treat of the separation of this substance or its oxides from those which are treated of in every preceding section. In the beginning, come the simple bodies which, combined with oxygen, constitute bases ; then follow the bodies whose compounds possess acid properties. This order appeared to me to be the most advis¬ able, since it permits one to trace, without much difficulty, the particular steps of a process chosen for any quantitative analysis which may be presented. Only in a few places, and then but to avoid repetition, have I departed from this arrangement. By fol¬ lowing the plan, it has been rendered possible to treat of the sili¬ ceous substances which occur in nature under silica, of the simple and compound, factitious or native sulphurets under sulphur, and of nearly all the gases under hydrogen.
“ In order still farther to facilitate reference, an index has been added to the work.
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Critical Review .
The description of the practical contrivances employed in analy¬ tical chemistry, is almost entirely passed over. For the introduction of most of these contrivances, and for the greatest improvements they have received, we are indebted to Berzelius. He has accurately described them in the fourth part of his system of chemistry, with the translation of which (into German) Professor Wohler is now occupied. It appeared to me, therefore, to be unnecessary to describe them in this manual. In a few places only have I depicted by wood cuts some apparatus employed in quantitative analyses.
“ The chemical nomenclature is precisely the same as that em¬ ployed by Berzelius in his System of Chemistry. — Preface, p. xii.
ORIGINAL COMMUNICATIONS.
I. — Observations on Spasm of the Colon. By Felix W. Lyon, Esq. Surgeon.
I have presumed to offer the following remarks on a dis¬ ease, which I conceive to he spasm of the colon, in conse¬ quence of its more general cause (or at least that which I believe to be usually so) producing effects when the dis¬ ease has existed for some days, which may, I think, render it liable sometimes to be mistaken, so that effect alone might possibly be attended to, and the symptoms which at this period are present, be treated without inquiring minutely into the pre-existing ones.
The disease, so far as I have observed, is one to which females are more particularly liable, apparently from the simple fact of their utter carelessness in procuring daily alvine excretions. The symptoms are as follow : — The bowels are in the first instance costive, then pain comes on, that is, there are slight and sudden attacks of it, which continue to increase until occasional fits of violent spasms occur, but between these attacks there is never a total remission of pain ; the pain is usually referred to the trans¬ verse and descending portions of the colon, occasionally to the left iliac region. [This latter situation of the pain I have seen in women often declared to be indicative of disease of the ovarium, leeches have been applied to the affected part, and various things done without much benefit, when, on the exhibition of a few brisk purges, the symptom
Mr. Lyon on Spasm of the Colon .
303
has vanished,, and the patient recovered her accustomed health]. The abdomen is flaccid., pressure relieves the suffering., nausea and vomiting are sometimes present, but the latter is less frequent : out of ten or twelve cases I saw last year, I believe I met with it in only one, and in this it proved inconvenient rather than distressing ; neither was it followed by any unfavourable consequence — the tongue is usually moist, and covered with a white crust, the pulse rarely exceeds eighty-five in the minute — it is full, but compressible, there is but little thirst, the heat of the skin is slightly increased, and it is usually dry.
When the disease has existed for some days, in addition to the symptoms just mentioned, the patient is attacked with purging ; it is at this period, in my opinion, that the attention is most likely to be drawn from that which I con¬ ceive to be the more general cause of the disease, and which also produces the relaxed state of the bowels (viz. scybala), and the affection at this period to be treated as one of simple diarrhoea ; in one strongly marked case, I had an opportunity of proving the truth of the fact I have now advanced. 1 was requested to see a man who had diarrhoea, and had been attended for some days by a practi¬ tioner, whose treatment consisted in the administration of the compound powder of kino and other astringents, which only aggravated the disease ; on inquiring the symptoms he then had, and also into the previous history of his case, I found that he was then suffering from diarrhoea, and had for some time experienced attacks of spasms, and the other symptoms I have already noticed, wdiich induced me to consider the diarrhoea as arising from a very different cause to the one which had been ascribed to it by his previous attendant, and 1 was fully borne out in this opinion by giving him purgatives rather than astringents, under which mode of treatment he speedily recovered. When diarrhoea supervenes, the attacks of spasm are less violent, and on the whole less frequent, perhaps, than they are in the first instance ; the evacuations consist of liquid faeces, and among them scybala ; mucus is also frequently mixed with them, and they are occasionally streaked with blood ; these appearances of the evacuations, conjoined with attack of spasm, and inquiring into the previous history of the disease will, I think, sufficiently point out its nature, and the plan proper to be pursued for its cure.
The foregoing symptoms being present, induced me to con¬ sider the disease, spasm of the colon, as arising from indu-
304
Original Communications .
rated faeces. The objects I had, therefore, in view, were to relieve the spasm, and to procure free evacuations of the bowels, which were accomplished by the exhibition of aperient medicines combined with opium, such as the fol- lowing- :-r-
R Magnes. sulph. 5iss*
Infus. sennae, 5xi*
Tinct. opii. mj. viii. nt. f. haustus tota quaque hora sumendus.
This I have usually repeated, until the stools put on a natural appearance. If, however, the disease had continued some time, and the bowels were relaxed, the evacuations being mucous and bloody, I have usually substituted small doses of castor oil, (5iss. or 3ii.) mixed with the mucilage of gum arabic, for the infusion of senna, and sulphate of magnesia, repeated at intervals of six or eight hours, until the stools became healthy, and the following powder on going to rest : —
Hydrarg. cum creta gr. v.
Pulv. ipecac, compositi gr. viii. rrp f. pulvis.
These modes of treatment I have always found attended with success, and as soon as scybala. have ceased to appear in the evacuations, the pain and other unpleasant symp¬ toms have left the patient ; I then usually order some slight bitter infusion, with small doses of the sulphate of mag¬ nesia, to restore a proper degree of tone to the bowels, and a strict caution to the patient of the necessity of pro¬ curing daily evacuations for the future.
22, Dean Street, Soho,
March 6th, 1831.
II. — Rupture of the Liver— Ignorance of Lawyer Coroners. By Dr. Tuthill.
Four cases, in which death was produced by rupture of the liver, spleen, and an intercostal artery occasioned by vio¬ lence. Reported by Richard Tuthill, M.D. Assistant Sur¬ geon, 52d Regiment.
The night of the 27th of last July, I was called upon to visit a female named Anna Kelly, who was reported to have
Dr. Tuthill on Rupture of the Liver.
305
been very ill ; upon reaching' her house I found that she had died a few minutes previously, in consequence of severe blows inflicted upon the body by her husband. Sixteen hours afterwards I examined the body in presence of two medical g'entlemen. The liver was torn to the depth of an inch or more at the inferior and posterior part of the trans¬ verse fissure ; the rig-ht lobe presented two deep ruptures, one near the inferior edge, the other within about two inches of the superior thick edge. Between two and three quarts of venous blood were found in the inside of the peri¬ toneum diffused around the intestines and between the lay¬ ers of the great omentum. The liver was tolerably firm, a lit¬ tle paler than what is usually observed, the remaining abdomi¬ nal, as also the pelvic viscera were healthy. The integuments of the thorax and abdomen presented in several places, marks of bruises produced by some instrument, the skin was not broken in any place, no communication with the interior of the cavities could be discovered. 1 was examined by the coroner, and after stating that the above appearances were found, gave it as my opinion, in answer to his question, that the ruptures of the liver and the quantity of blood effused, were sufficient causes to have produced death, and that such injuries and their effects must have been occasioned by great violence. The case having been twice in the supreme court of this city, the 29th of October, I was called upon to bear testimony to the evidence given before the coroner : after having been sworn I recapitulated the above statement, respecting the appearances of the body and the cause of death, and I was submitted to the following examination by the council for the defendant:— -What are the functions of the liver? Is not the liver attached to the stomach by an elastic ligament — is it not attached by a peculiar ligament to the diaphragm ? Alluding to the ligamentum teres, is not the liver thrown into action in vomiting? How does the dia¬ phragm affect the liver when vomiting occurs ? Is not rum a poison ? Might not the liver be torn in the manner described dur¬ ing the act of vomiting? Does not rum produce in this country a peculiar disease, not generally known in England ? The learned gentleman had in view the delirium nervosum ebrio- sitatis, and he appeared somewhat astonished, when told that this disease was not uncommon in Europe, and that it was occasioned by porter, ale, gin, brandy and other spirits, as well as rum. Was the liver altered in its appearance — was it so changed, as to render it the more easily to be torn by any preternatural excitement of the neighbouring parts ? It
VOL. VI. no. 34.
R R
306
Original Communications .
will appear evident from the nature of the above questions, that an answer in the negative must have been given to almost every one of them.
Mr. Gibson, surgeon of the 52nd. Regiment was sworn, and after corroborating the statement I gave, was cross- examined by another counsel. One of the questions was, is not the liver surrounded by the diaphragm ? This alone suf¬ fices to shew the necessity of an anatomical course of study, for the lawyer as well as the medical man, and it is to be regretted that the more modern works on legal medicine should not contain a sketch of the various parts of the body, with a general description of them, and also more reference to the standard works on law and the modern chemistry, when the subjects connected with these are under considera¬ tion. The Nova Scotia newspaper for the 4th November, in which a full statement of the case may be seen, speaks thus. “ Both gentlemen underwent a cross-examination by the counsel for the prisoner, the object of which was to induce a belief that the ruptures of the liver were occasioned by violent retching ; nothing appeared to give colour to the supposition. Both gentlemen agreed in their description of the state of the body, and both gave their decided opinion that outward violence alone could have produced the inward appearances, and that such violence as the witnesses had described would have been sufficient.”
On the 13th October last, James Small, set 38, a carpen¬ ter, received a blow with the fist above the centre of the left chest, by which an oblique fracture of the seventh rib was produced. The fracture was not discovered until after death. About ten minutes after it had happened, he became faint and lay down, he complained of uneasiness about the pre- cordia, accompanied with dyspnoea, which gradually in¬ creased to laboured inspiration ; he became so restless, from general uneasiness, that he could not remain a moment in any position ; the pulse became gradually very quick and so feeble as at last not to be perceived. About six hours after he received the blow, death had occurred, and twelve hours afterwards the body was examined. The sac of the left pleura contained about a gallon of blood, which was partly coagulated, its colour was redder than venous. The inferior edge of the seventh rib was found fractured to about the extent of three lines, and a small foramen was discovered in the artery, which would admit only the point of a probe. All the viscera were healthy, and no other mark of injury could be traced. A coroner’s inquest was held, at which Mr. Stirling, the medical gentleman in attendance, was requested to state,
Dr. Tuthill on Rupture of the Liver.
307
what he had seen without any examination. A verdict of accidental death was the issue.
When stationed at Sierra Leone in 1827, I had charge of the regimental hospital of the African corps ; two European soldiers, patients in the hospital, had a dispute, one struck the other with a pewter pot over the spleen, which left a semi¬ circular mark in the integument, and gave rise to a rupture of some of its vessels, an immediate effusion of blood into the abdomen took place, and death ensued in the course of about ten minutes. Half an hour afterwards I examined the body and found a large quantity of fluid blood in the abdomen.
Some time after this a similar accident had occurred — two other European soldiers had a boxing match, one gave the other a blow with his fist over the spleen, which occasioned almost sudden death. The body was examined, and as large a portion of blood was discovered in the abdomen, as appeared in the preceding case. The spleen was ruptured wThere the vessels enter into it. In each of those cases a coroner’s inquest was held, at which I attended, and had merely to state what I had seen, without any further inquiry. In addition to the opinions lately published on medico-legal science, and connected with it, these few cases shew the necessity of a medical coroner. In making this observation, I do not mean to find fault with those gentlemen holding that situation with whom I came in contact, but the duty of a coroner is of such vital importance to the interests of society, that it must be evident to any man whose mind has been directed to the subject, and witnessed the evils arising from its being filled by a person ignorant of medicine and surgery, that no doubt can remain for the necessity of the office being occupied in all parts of the world by a medical man. The coroner’s examination should be as minute as possible, and unless Te have a knowledge of the structure of the human frame, and of forensic medicine, can he judge of those alterations to which the various parts of the human frame are subject, or of the effects of such sub¬ stances as are most likely to come in contact with it, if unacquainted with the animal machine, and the laws that influence it ? His ignorance in these important points, sub¬ jects which none, generally speaking, are acquainted with but medical men, may be the cause of his passing over very important matters; the culprit consequently has a much less chance for the escape of his life, and much less for the freedom of his person.
Halifax, Nova Scotia,
17th Dec. 1830.
308
Original Communications ,
III. — Observations on Homicide by Asphyxia.
By Dr. Ryan.
Asphyxia is the suspension of respiration by a mechanical obstacle to the passage of the atmospheric air into the lungs, as by submersion or drowning, strangulation, suffocation, by gases unfit for allowing the necessary oxygenation of the blood in the lungs, or heematose, as hydrogen, nitrogen, car¬ bonic acid, or deleterious gases, as carbonic oxide gas, sul¬ phuretted hydrogen, nitrous acid gas, sulphurous acid gas, ammoniacal gas, chlorine, &c. Asphyxia may be momen¬ tary, and respiration may be restored ; but when it is pro¬ longed, it is fatal. Various injuries and diseases may produce it, as division of the spinal marrow, formation of false mem¬ brane in the larynx or trachea, and syncope, &c. ; but with these causes the medical jurist can have no concern. I shall therefore describe those which claim his attention.
Asphyxia by submersion . The cause of death in all forms of asphyxia, is a want of oxygenation or haematose of the blood. This fluid passes through the lungs without any change, it possesses the characters of venous blood and is unfit for sustaining life ; the brain suspends its action, the muscles lose their nervous supply and cease to contract, the chest becomes immoveable, the blood accumulates in the lungs, and as the arterial is more contractile and elastic than the venous system, the latter becomes distended, as also the right cavities of the heart, and pulmonary artery, while the left cavities and aorta contain little blood or are empty, and the fluidity of the blood is characteristic, though some¬ times white fibrous clots are observed in the heart. In some cases apoplexy or syncope may occur from fear at the moment of immersion, and death will not be caused by want
bronchi.
In those destroyed by submersion, the face is red and tumid, the pupil dilated, the eyelid partly open, the eyes glassy, the tongue projected beyond the lips, a frothy fluid escapes from the mouth and nostrils, the skin of the trunk and extremities is remarkably pale, the trachea, and some¬ times the bronchi contain an aqueous sanguinolent froth, according to Louis, Goodwin, Berger, Orfila, and others, and this is formed during life (Piorry), as it cannot be pro-
309
Dr. Ryan on Homicide by Asphyxia.
duced by immersion of a dead body ; and is only a secondary cause of death, according’ to Orfila. The chest and epigas¬ trium are swelled, the fingers are deprived of skin, there is earth under the nails varying according to the soil of the bank near the water ; the brain is engorged, the epiglottises straightened, the lungs are dilated and crepitant, containing a certain quantity of froth. All these signs however are not con¬ clusive. Thus the pale colour of the skin might occur, if a person, destroyed by severe haemorrhage or inanition, was pre¬ cipitated into the water. The colour and tumidity of the face will not be present, should the submersion be effected rapidly and have caused syncopal asphyxia, or anger or drunkenness mightinduce it. The external appearances of the body will vary according to the length of time they have been in the water ; so that the indications afforded by them are illusory The frothy matter maybe seen in apoplexy, convulsions, epilepsy, in certain cases of poisoning ,and after strangulation or putre¬ faction. The states of the eye and eyelids are equivocal. The distention of the right side of the heart will be present in all cases where the circulation of the blood is suddenly sus¬ pended. The fluidity of blood is observed in scurvy, in those destroyed by electricity, and in many species of cache- xiee. The engorgement of the brain is still more uncertain, and may arise from a variety of causes. The condition of the lungs and elevation of the thorax arise from various causes. The presence of water, or any other fluid in which the body has been found in the stomach, is a strong proof ; as such fluid does not enter the organ, unless the body is in the erect position when immersed, and a body might be injected with water or fluid after death.
Considering all signs, we can seldom decide indubitably that the person perished by submersion. It is also impos¬ sible to decide whether the person has fallen into the water by accident, or has thrown himself in, or is the victim of homicide. Here we must recollect that persons intent on suicide have wounded themselves without causing death and then thrown themselves into the water. We should inquire whether the deceased was short sighted, affected with ver¬ tigo or insanity, and examine the state of the bank, marks of footsteps and various other circumstances. When there are ecchymoses on the neck or wrists, or traces of poisoning, we may suspect assassination, and in the former we must be careful in distinguishing ecchymoses from cadaverous livi- dity, in the manner already described in treating of wounds. We can generally distinguish wounds inflicted before and
310
Original Cdmmunications.
after death, though a person may fall against a stone and receive a wound in the water which can scarcely be distin¬ guished from one inflicted before immersion. When new born infants are drowned, we must discover whether they were born alive or not, by the proofs stated in the article on infanticide.
Asphyxia by strangulation, suspension, or hanging , is effected by mechanical pressure on the neck by a cord, cravat or any other means, which prevents the passage of the air to the lungs, and thus causes asphyxia. In sus¬ pension or hanging, there is strangulation, and often dislo¬ cation of the upper cervical vertebrae, causing pressure on the spinal marrow, paralysis of the respiratory nerves, paralysis of the thorax, and instant death. Laceration of the verte¬ bral ligaments, dislocation or fracture of the vertebrae, is caused by the modern mode of hanging, as the body is pre¬ cipitated, and its weight produces these effects. Are these certain signs indicative of death by strangulation? Can we distinguish when suspension is made before or after death, or whether strangulation be voluntary or criminal ?
The signs laid down by writers that strangulation has caused death are the following: the skin of the neck on which the cord has been applied is of a yellowish black colour, is dry and resembles parchment. These effects however are found when strangulation has been produced before or soon after death ; the existence of ecchymoses is very rare (Esquirol. Arch, de Med. 1823), in general where there is no effusion of blood in the subcutaneous cellu¬ lar tissue. When real ecchymoses are observed, the stran¬ gulation was produced during life. On the other hand stran¬ gulation may be caused, and this sign be absent, or it may be deep-seated in the muscles. Its absence on the skin is no proof that death has not been caused by this means. There is an apoplectic condition of the brain indicated by tumefac¬ tion and great redness of the face and lips, by the swelling of the eyelids, and lividity or blue colour, by the redness and prominence of the eyes, which appear as if starting from the sockets ; there is the livid engorgement of the tongue which is thickened and projected between the teeth ; there is a sanguinolent froth in the throat, mouth and nostrils ; the lungs and heart are gorged with black blood ; the extre¬ mities are violet, the fingers contracted, there is erection of the penis and seminal emission, or the latter without the former. The lividity of the face and congestion of the brain may exist, but disappear before the autopsy, or may be pro-
311
Dr. Ryan on Homicide by Asphyxia.
duced some hours after death, but not after twenty hours, (Esquirol): a vertical position will cause them to disappear or a declivity of the head of a dead body will produce them. The signs afforded by the eyes, eyelids and tongue are of little value. The presence of froth in the air passages, the conditions of the lung's and heart are seen in all species of asphyxia, and are of course inconclusive. The erection and seminal emission may not happen. The luxation and frac¬ ture of the vertebrae may happen before or after death, and unless accompanied by ecchymosis, superficial or deep-seated, are equivocal: there may be effusion of blood into the ver¬ tebral column.
Upon the whole, when strangulation or suspension causes death, there may be ecchymosis without any sign of putre¬ faction, and the certainty is complete, if there is lividity of the face, froth in the air passages, and the clothes stained by a recent seminal evacuation. But should all these signs be absent, there is no just ground for denying that strangula¬ tion has happened. To decide that strangulation has hap¬ pened after death, we must find wounds, fractures, contu¬ sions of the cranium, or other important organs or traces of poison in the intestinal canal : where none of these signs is present, we must conclude that strangulation was caused during life. Devaux met a case in which there was no sign of strangulation, except discoloration of the face, which fact led him to examine the body closely, when he dis¬ covered a small penetrating wound of the heart, which might have been overlooked, upon a superficial examination. It is difficult to decide between suicide and homicide. A person may wound himself, if he swings himself among surround¬ ing bodies. When blood is observed upon the individual, we may in general decide it a case of suicide ; but homicide may occur under such circumstances. In real strangulation, we have grounds for supposing it homicide, for an indivi¬ dual who intends to destroy himself in this way, generally wants the power to effect his wicked purpose. Such per¬ sons usually tighten the ligature by some instrument, as a piece of iron or wood. It is equally difficult to distinguish suicide from homicide in the case of suspension. Fracture or dislocation of the cervical vertebrae may occur in volun¬ tary as well as criminal suspension. Orfila, Chaussier, Pfeffer, Ansiaux. Orfila, however, concludes, that in general such lesions of the vertebral column are not the result of suicide. In all these cases we should consider, the habitude, morality, and intellectual state of the individual ; but it is
312
Original Communications ,
foreign to my purpose to introduce in this place all the causes of suicide.
Asphyxia by Suffocation. — Suffocation is different from strangulation,, it being produced by the introduction of some foreign body into the throat, or larynx and pharynx, which prevents respiration. Infants, and adults when intoxicated, are often smothered, the former by what is called overlay¬ ing, as when the bolster or bed clothes press on the mouth, and obstruct respiration. New born infants are often de¬ stroyed in this manner, as already described in the article on infanticide. Various foreign bodies, as cotton, tow, earth, sand, wood, &c. will be found in the pharynx, and may be introduced after death. When these bodies are hard, they will produce ecchymoses, excoriations and lacerations. In these cases death is caused by the prevention of the circula¬ tion through the lungs, these organs will be found gorged with blood, or contain some frothy mucosity, the brain will be congested; but these morbid conditions may be produced in the different species of asphyxia, and consequently afford no conclusive evidence. We must attend to the circumstantial evidence, which is the principal or only means to assist us in forming an opinion.
Asphyxia by non-respirable gases ~ Two divisions of gases ar$ described, which have seldom existence in practice as many are the products of art, and cannot be often applied. Some of these gases are non-respirable, and possess a direct deleterious influence on man, and kill, by causinga defect of oxygen producing the same morbid appearance as result from asphyxia by want of air : these are nitrogen, hydrogen, protoxide of nitrogen, carbonic acid, carbonated hydrogen, oxide of carbon, poisoning by charcoal. These and fol¬ lowing g'ases must be included in the second species, called deleterious gases, sulphuretted hydrogen, nitrous acid gas, the gas evolved in privies, ammoniacal gas, chlorine and hydrochloric acid gas. Many of these are only to be encountered in the chemical laboratory. Professor Christi- son divides gases into irritants and narcotics. The irritant gases are nitric oxide gas and nitrous vapour, muriatic acid gas, chlorine, ammonia, sulphurous acid, and others of little consequence ; the narcotic are sulphuretted hydro¬ gen, carburetted hydrogen, carbonic acid, carbonic oxide, nitrous oxide and cyanogen.
Nitrogen gas. — This gas is found in cellars, in which substances are placed, which have a strong aflinity for oxygen, as oils, & c. and sometimes in privies. The signs
313
Dr. Ryan on Homicide by Asphyxia.
of asphyxia from this cause, are pallidity or a greenish cast of skin, extreme anxiety, large and frequent respiration, and death occurs in a few minutes without any lesions of the nervous system. The arterial system is full of black blood. The effects of hydrogen gas are nearly similar, and can only be produced by chemical experiments.
Asphyxia by carbonic acid gas occurs from the com- busition of charcoal, common fuel, or in cellars, from fer¬ mentation of wine or malt, and from lime kilns, from coal pits, and draw wells. Brewers’ men are often destroyed by this gas, when they descend into large vats for the purpose of cleaning them, unless they use proper precaution. It is usual to lower a candle into the vat, which will be extin¬ guished as soon as it encounters the acid, which, from its greater gravity than atmospheric air, falls to the bottom of the vessel. I have been called to two persons who were destroyed by inattention to this precaution. The effects of the non-respirable gases are similar to those arising from want of renewal of air. This was well exemplified during our East Indian wars, by the horrible incarceration of our countrymen, by their savage opponents at Calcutta. One hundred and forty-six persons were confined in a chamber of twenty-four feet square, having only two small windows. The first effect on these unfortunate persons was abundant and continued perspiration, insupportable thirst, succeeded by great pain in the chest, and a difficulty of respiration, amounting to suffocation. They were attacked with fever, which increased every moment, and after four hours most of them were dead. Many became stupid, lethargic and delirious, and only twenty-three escaped alive. In those destroyed by want of air, the right cavities of the heart, and the venous system are filled with very black blood.
The symptoms produced by carbonic acid , or fumes of charcoal , are heaviness of the head, intense headache, which impels the sufferer to compress the temples, cerebral conges¬ tion increases and causes vertigo, drowsiness or profound sleep, tingling of the ears, impeded respiration and circulation, dazzling, the muscular power ceases, profound coma ensues, and death seems apparent. During the development of these symptoms, some persons experience a general feeling of pleasure, and the excretions are discharged involuntary. In these cases, the body remains warm for a long time ; the extremities flexible, the muscles are softened, the colour of the surface is congested, pale, leaden or violet, the face is red or flushed, the lips of a vermillion hue, the eyes ar«
VOL. vi. no. 34.
s s
3 1.4
Original Communications.
o
bright, the tongue is swelled, the epiglottis is raised, the veins of the brain and lungs are congested with very black blood, the stomach and intestines are red, the mucous sur¬ faces are ecchymosed, the blood remains fluid, and ail the lesions characteristic of asphyxia, are apparent. It is not as yet determined whether this gas is deleterious, or acts negatively, by causing asphyxia ; Dr. Christison thinks it positively poisonous; but it has been injected into the veins and produced slight effects, such as feeble muscular action, which disappeared spontaneously in a few days. (Nysten).
Asphyxia , by deleterious gases. Sulphuretted hydrogen, is known by its odour, which resembles that of rotten eggs, and causes a black precipitate in solutions of lead, copper, bismuth, silver, &c. A small quantity of it causes death, and even serious accidents, when mixed with atmospheric air. It is disengaged from the putrefaction of animal and vegetable substances. Its effects are great prostration of muscular power, oppression of the chest, with difficulty of respiration, headache, nausea, and marks of oppression of the nervous system, and probably a change in the blood.
After the death, the mucous membranes of the nose and bronchi are lined with a thick bluish mueosity, the blood vessels are filled with a blood of a similar colour; a colour which is observed in the brain, lungs, kidneys, and all organs and vessels. The muscles have lost their contractility, all the soft parts are easily laeerable, exhaling a fetid odour, and speedily becoming’ put rifled.
Asphyxia, produced by gas evolved in privies and drains. This is the hydro-sulphate of ammonia, mixed with a great quantity of air, is composed of twTenty-four parts in 100 of nitrogen, one or two of oxygen, four of carbonic acid and subcarbonate of ammonia. It is designated plomb , by the French jurists, and arises from privies of a peculiar form.
The symptoms produced by this poison, are headache, nausea, paleness of face, dilatation of the pupil, a frothy sanguinolent fluid in the mouth, constriction of the throat, sardonic laugh, violent cries, convulsions of the muscles of the chest and jaws, sometimes tetanic spasms, articular pains, coldness of the skin, irregular and embarrassed respiration. At other times, there is stupor, the visage is violet, the eyes glisten, the pulse is small and frequent, the breathing con¬ vulsive, the extremities are relaxed. At the approach of death, all the symptoms are aggravated, the sufferer roars loudly, the body is bent backwards, as in opisthotonos. The morbid appearances are similar to those observed by sulphu-
315
Dr. Ryan on Homicide by Asphyxia.
retted hydrogen or hydrosulphuric acid gas. This was said to be the cause of the fatal cholera at Clapham, which is denied by Christison.
Asphyxia, by sulphurous acid gas , nitrous hydrochloric , ammoniacal , arsenical gases, hydrogen, carbur etted hydro¬ gen, muriatic gas, and chlorine. — All these gases are irritant, inducing cough, suffocation, vivid pains in the chest, some¬ times hoemoptysis, and always mucosities in the bronchi. They act negatively, or by a defect of oxygen. When death approaches, there is hiccup, rale, great pain in the diaphragm, convulsive motions, delirium and inexpressible agony. The cause of death is irritation of the mucous membranes of the bronchi. The nitrous oxide, or laughing gas, protoxide of azote, destroys life in this manner.
There are many other gases which are destructive to life, which I have not described ; but these cannot become the subject of forensic investigation, as they produce their effects upon experimentalists, who may avoid them. A full account of them will be found in Dr. Christison’s elaborate Treatise on Toxicology, a work which ought to be in the hands of every medical practitioner. Vegetable emanations may produce syncope or asphyxia, either by the extrication of carbonic acid, or by the odour of their flowers, which can only be accounted for by peculiarity of constitution or idiosyncrasy. The descriptions of these cases cannot be of interest to the medical jurist.
Homicide by combustion. — The medical jurist is seldom called on to pronounce an opinion on a body destroyed by combustion, as murder is seldom perpetrated by burning. The records of legal medicine afford but few illustrations of homicide by combustion. When such cases occur, medical evidence may be required, as stated in the remarks upon burns or torrefaction. it is now admitted on the continent of Europe, though disbelieved in these countries, that spon¬ taneous combustion is possible, though its cause is as yet inexplicable. It is said to occur most commonly to aged females, who have long indulged in the abuse of alcoholic potations. Generally speaking, some matter of ignition, as a lighted candle, a pipe, &c. has been found pear the remains of the body; but cases are attested in which no ingneous sub¬ stances were discovered. Lecat, Kopp and Marc refer to the fact of spontaneous combustion having on the surface of the earth, and as friction on the extremities of certain per¬ sons, elicit electric sparks, why should not these excite inflammation or ignition of the alcoholic fluid, or of a gas
316
Original Commit n i cat ion $■.
contained in the cellular substance of onr organs ? In spon¬ taneous combustion, the flame is like that of certain meteors, and is extinguished with difficulty. The walls in the chamber in which this happens are covered with an unctious fetid humidity, such as results from the combustion of hydrogen gas. It rarely happens but some of the bones of the limbs remain, but the trunk is consumed, probably as it is con¬ nected with the large cavities, and on account of the laxity of the cellular tissue, and the evolution of hydrogen gas in the intestines. When the individual does not perish at the instant of the accident, sphacelus sets in or commences rapidly after death. If life remains for four or five days, an insupportable odour is exhaled, the nails are detached, and worms are generated. These characters cannot be confounded with accidental combustion, or burns ; in these the redness of the blisters and the eschars leave no doubt on the nature of appearances, and accidental combustion seldom destroys the whole body without extending to surrounding objects; all jurists admit the possibility of spontaneous combustion. The reader will find references in the works of Beck, G. Smith, Briand, Sedillot and others.
Death by inanition or hunger. — It seldom happens that homicide is committed in this manner, though it is well known that cruel and unnatural parents, step-fathers and step-mothers occasionally destroy children and young per¬ sons by famine or starvation. The ancient and modern his¬ tory of Ireland affords ample evidence of the destruction of life by this cause. Besides, persons may be found dead, when it will be important to inquire whether life has been ex¬ tinguished by cold, hunger, poison, &c. It is therefore i m- portant to state what are the signs of death by starvation. The body is emaciated, the eyes are red and open, the tongue, throat and buccal mucous membrane, are very dry, the stomach and intestines are contracted and empty, there is no fceculent matter in the bowels, the gall bladder is full, and bile tinges the stomach and bowels, and all the blood¬ vessels are empty. Many of these signs are different from those which characterise other causes of violent death.
[ 31? ]
IV. — Dr. Malins’s Introductory Lecture .
Gentlemen,
Established custom requires, that previous to commencing the exposition of a subject connected with science or art, a sufficient historical account of it shall be given, to enable the student to form some accurate general ideas of its origin, and the manner of its advancement to the state in which it is found at the present time. It is this preliminary measure which it is now proposed to fulfil with regard to Midwifery — a term, which in its ordinary acceptation, is held to denote a link only of the extensive chain of occurrences, which fall peculiarly within the notice of the obstetric teacher and practitioner ; for if the just definition of this important branch of medical science be, that it is the amount of our information relative to the perpetuation of the human species,* it will at once appear how comprehensive must be the studies belonging to it, and how wide a field of inquiry it opens to the philosophic mind. Nor can it be less evident, from its connexion with the subject of population, that a knowledge of its doctrines and resources is worthy the atten¬ tion of the politician and economist ; and, from its being conversant with the concomitant circumstances of prolicide, or the destruction of the human offspring, that a strict alliance obtains between it and some of the most usual and difficult points, which it is the office of the medical jurist to investigate.
It is then a self-evident proposition, that the art of midwifery took its rise, and is coeval with the existence of mankind ; to assign it any other origin, or to institute an inquiry into the date of its origin, would be equally absurd. The parturient pro¬ cess, in its liability to morbid interruption and dangerous com¬ plication, must have been essentially the same in all ages and coun¬ tries from the beginning of the world ; an assertion in proof of which, besides the convincing arguments deducible from the struc¬ ture of the human frame, we may adduce the positive declaration of the Deity to the first woman, that in sorrow she should bring
forth children.
In tracing the progress of midwifery from the creation of the world down to the present day, the sacred writings, as being both absolutely and' relatively the most ancient documents in existence, come first to be consulted. The information supplied from these records is, as might be expected, from its being only contingent, scanty and imperfect, and consists in not more than several inci¬ dental allusions. The earliest reference made to the subject of midwifery is in the 35th chapter of Genesis, where we learn that
* Velpeau.
318
O r ig inal Co mmu nictations.
Rachel, the wife of Jacob, died in giving birth to a son, although assured by the midwife that she need not fear. The second allusion is contained in the latter verses of the 38th chapter of the same book, and presents the description of a rare occurrence in the practice of midwifery. It is a case of twuns, and one of them presenting by the arm, on which, to distinguish it as belonging to the first born, the midwife tied a scarlet thread ; but the arm afterwards receded — the second child came down, and was eventually expelled first. From the next passage, which is part of the first chapter of Exodus, we learn that the Hebrew women were accustomed to be delivered sitting on stools, and that probably their labours were quickly terminated. It is to be noted that this circumstance is one of probability only, for though the midwives declared to king Pharoah, by whom they had been commanded to kill all the male children, that the Hebrew women were not as the Egyptian women, inasmuch as they were lively, and delivered ere the midwives came in unto them ; yet when we recollect that the declaration w7as urged in defence and extenuation of their not having complied with his cruel commands, it is not incumbent on us to attach truth to its literal and direct interpretation. A fourth testimony, relating to the obste¬ tric art among the Hebrew people, exists in the fourth chapter of the first book of Samuel, where we are informed, that through grief, premature labour, terminating fatally, wTas brought on in the wife of Phinehas, the high priest’s son. The same consolatory remark of fear was not applied to her by the midwives, as in the other fatal case, and from the construction of the sentence, may be as reasonably deemed a customary form of congratulation on the occasion of a birth under any circumstances, as an indication of ignorance in misapprehension of danger. The last citation from the holy wuitings to which allusion must be made, refers to the treatment of the umbilical cord, the division of w7hich, termed omphalotomy, was, without doubt, the first surgical operation performed, and may challenge the records of pure medicine for an instance of equal antiquity. Much futile, vain discussion, even among estimable authors, has taken place as to what was the management of the umbilical cord of the first infant Cain, but it is not my intention to occupy your time by the relation of their frivolities. It is at the beginning of the sixteenth chapter of Ezekiel, wrhere w7e read of the comparison of Jerusalem to a w7retched infant, whose navel was declared to be uncut on the day of its nativity,, that the first express mention of omphalotomy occurs ; and the inference drawui from it has been, that the Jews were in the habit of dividing, but not of placing, a ligature on the cord. This may have been the case, but the point is an inconsequential one ; and it appears from the simultaneous mention of salting and sw7addling, that if the cord w7as not secured by tying, at least other means were had recourse to for stopping the effusion of blood. Since also Ezekiel w7rote in tbe year of the world 3840, at a time w7hen the Jews had been in frequent and durable intercourse with other nations, it cannot be
Dr. Malins’s Introductory Lecture.
319
more than probable that section, though then in use, was the mode of separation that had been employed from the beginning.
Nothing of particular interest is made known to us by these passages, excepting that midwives seem to have been uniformly engaged in obstetric practice among the Hebrews, and that the as¬ sistance of men was never demanded, perhaps even not for a moment imagined. Such at least is the natural and legitimate conclusion to be derived from the fact, that male practitioners are never alluded to, either in the Old Testament, or in the writings of the Jewish historian, Josephus ; but there are not, on the other hand, wanting either writers or reasons inclining us to admit, that from a certain period of their national existence and in perilous labours, the Hebrews did resort to the aid which professors of the healing art could alone be supposed capable of affording. It must be confessed, however, that the belief is entirely conjectural, and rests on slender grounds. There is a passage in Herodotus, giving presumption to suppose that the eastern nations had recourse to the assistance of the physicians in the difficult labours of their women. Now, it was by these eastern people that the Jews were for so long a time held in captivity, and as conquerors have generally imposed their laws and customs on the vanquished, and moreover as constant intercourse between nations (not to mention the temporary assimilation which happened in the case under consideration) is known to induce the adoption of similar manners and usages, it is inferred that the Jewish people, from the time of their return from the second or Babylonian captivity, to that of their dispersion over the world, did, among other institutions of their conquerors, imitate that of employing male practitioners in all cases of difficult or impeded parturition.
From the consideration of the state of midwifery among the Jews, let us pass to that of its condition among the next most ancient people, the Egyptians. In the absence of direct testimony, it is only by reasoning on the few facts that we possess bearing on the question, that any conclusion can be arrived at ; and even then it is not entirely satisfactory or decisive. All that can be affirmed is, that there is a high probability that the profession of accoucheur was not unknown to the Egyptians ; for, in the first place, Hero¬ dotus distinctly states, that there was a subdivision of labour in the medical profession among them — that individuals attached them¬ selves to the treatment of particular classes of maladies, or the affections of particular organs, whence there were oculists, dentists, aurists, chiropodists, &c. — in the next, the Egyptians are known, by the monuments and relics which they have left behind them, as well as by the testimonies of the earliest profane historians, to have been a highly ingenious, inventive, and wise people ; — and lastly, they had continual commerce with the Greeks, who, as will be pre¬ sently mentioned, did employ accoucheurs during at least some periods of their history, and in the more cultivated states. From this combination of facts, — that other branches of the art of medicine
320
Original Communication s .
were distinctly exercised ; that the people were learned, polished and sagacious ; and from their frequent communication with a country in which they could see and observe the good effects resulting from the practice being in the hands of men, it does, I think, become very probable, and it is not a mark of credulity to believe, that among the Egyptians the office of accoucheur was known, and recognized as a distinct branch of medical pursuit.
The Greek and Roman authors occupy the next place, in a pic¬ ture of the progress of the obstetric art. At this era we first obtain authentic and often copious details of its practice, and are enabled to treat the subject altogether with more certainty and in the exact order of time. The origin of all medical knowledge, its separation from a superstitious philosophy, and its establishment as an inde¬ pendent science, depending for extension of its boundaries on exact observation, faithful induction, and ingenious experiment, are to be dated from the epoch of these classic writers, who as they are the first we are acquainted with in respect to their antiquity, seem also to have been more accurate observers than any who have succeeded them. As the notice of their opinions must necessarily be tedious, and yet cannot be dispensed with, I will commence their brief con¬ sideration without further introductory remark ; and in the first place, with those of the prince and father of medicine, Hippocrates, who was born in the Island of Cos in the Archipelago, and flourished and practised in different parts of Greece in the fifth century preceding the Christian era. Among the writings of this great man which have descended to us, there are four books on obstetric subjects, which are respectively entitled de nature pueri, de morbis mulierum, de exsec- tione foetus mortui, and de superfcetatione ; these being the earliest express records of midwifery which are known, their venerable author is rightly considered and termed the father of midwifery, as well as of physic. It is immaterial to the purpose to settle the contested point whether or not Hippocrates practised midwifery ; his precepts and observations alone claim our attention, and if he did not, as is commonly supposed, actually officiate during parturition, he yet dis¬ plays an extraordinary and intimate acquaintance with the details, both of the process and of its remedial or guardian art. His opi¬ nions on the particular branch of medicine we are considering present the same compound of sagacity and superstition, of justness and error, which are so conspicuous throughout his whole writings ; but, as far as relates to the mechanical management of labours, the erroneous views and directions greatly predominate. Thus, the only presenta¬ tion of the infant by which delivery should ever be attempted he con¬ siders to be that of the head, and into it he directs all other presen¬ tations to be if possible converted. Presentations of the lower extre¬ mities he says are dangerous, and generally fatal to the mother or infant, or to both ; and in nearly the same terms transverse positions of the child are spoken of, being ingeniously likened to an olive im¬ pacted and lying across the neck of a narrow-mouthed flask. Em¬ bryotomy, or the extraction of the child piece-meal, he directs to be
Dr. Malin’s Introductory Lecture. 321
performed whenever it is so swollen that it cannot pass, or the mal- presentation cannot be altered. In both these cases Hippocrates thought the child must be dead, and his directions to have recourse to embryotomy seem to refer therefore to dead children only, who, according to the belief then prevalent, could not be bom unassisted, inasmuch as it was considered that the act of parturition was consti¬ tuted by the voluntary efforts of the foetus seeking its way into the world. But when we recollect how uncertain and fallacious the signs indicating the death of the foetus are, it may be fairly enough supposed, that embryotomy, performed in all cases either of great swelling or ineducible wrong position, was as frequently the means of destroying living, as of extracting dead children. The instru¬ ments described as proper for the operation are six in number, and are variously intended to cut, comminute, and extract. The management of the placenta after the plan recommended by him, would be now considered not less improper than adherence to his precepts for conducting the birth of the child. Its removal, he said, was to be accomplished immediately after the expulsion of the child, and the methods of effecting this which he advises are, making for¬ cible straining efforts with the breath retained, the administration of sternutatories and a farrago of stimulant emenagogues, raising the bed from its head, so that the weight of the foetus might drag down* wards, placing the woman on a high stool and attaching weights to the umbilical cord ; or, if the child should be dead, allowing it to depend from the parts, but to rest at the same time on the surface of new wool or bladders filled with water and spread over with wool, by the puncture of which with needles the water would be gradually evacuated, and the infant subside slowly, so as to exert an equable and not too violent degree of traction. Notwithstanding the absurdity and danger of many of the practices of Hippocrates in the conduct of labours, he has left us some unequivocal memorials of his accuracy and exactness of observation. Such are the remarks that too early rupture of the membranes protracts the duration of labour — that venesection is useful in lingering labours when the habit of the patient is full — that implication of the funis about the neck or shoulders of the infant fre¬ quently destroys its vitality — and that in uterine hsemorrhage the application of cold water to the abdomen by affusion, cloths or sponges, and the plugging of the vagina, are essential means of checking it.
Of Aristotle, who was born at Stagyra, 384 years before Christ, and was tutor to Alexander the Great, it will not be necessary to say much. He has written little or nothing on the practice of midwifery, but in his Historia Animalium, has treated very profusely on concep¬ tion and generation. Some of his opinions are substantially correct, but the greater number of them are crude, hypothetical and super¬ stitious.
About 480 years after Hippocrates, or A. D. 35, Celsus flourished at Rome, and is the first author after the father of physic, who, as far as we know, has written on medicine, or given any directions on
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obstetric subjects. Though for the most part a copyist of Hippo¬ crates, Celsus has modified and deviated from his precepts in several important particulars. He advises that the feet of the child should be brought down in those cases of transverse presentation where they can be more readily seized than the head, and observes that ex¬ traction by the feet can be effected without much difficulty. Celsus gives judicious directions for dilating the os uteri when requisite, for conducting the extraction of the placenta, and for performing embry¬ otomy. In describing the proper modes of using the crotchet or hook (two kinds of which he describes) he notices that convulsions and imminent danger are produced by the slipping of the instru¬ ment, so as to lacerate the contiguous parts of the mother.
Moschion is the author to be next mentioned. He wrote in Greek expressly on the diseases of women, but at what time is uncertain. Some have considered that he lived before the commencement of the Christian era, while others having assigned him a date so low as some part of the third century. It is however probable that he did not write till after the period of Celsus, and it is nearly certain that his was the first book written specially on midwifery. The only other work which contests the honour of priority with it, is that de utero et pudendo muliebri of Soranus Ephesion, a writer who lived in the reigns of Trajan and Adrian, in the second century. Moschion ventures to recommend delivery by the feet with less reserve than Celsus, though he is by no means to be considered the originator of the operation of turning under the circumstances which in this country are now universally held to demand its performance, for with the exception of knee and breech presentations, he first attempted to reduce all others to that of the head, before resorting to extraction by the feet. And this plan is now adopted and recommended by several professors in Germany and France.* Moschion speaks of parturition rendered difficult by disease and deformity of the infant’s body, by presentation of the head in a wrong position, and by obliquities of the uterus ; from which it appears that he must have been an able and experienced accoucheur. Among those which would in the present day be considered bad practices, the worst per¬ haps was that which he advocated, of assisting delivery as soon as the head of the infant is protruded into the world, by grasping it and employing lateral tractive motion — a custom even now too prevalent among female practitioners, and a fertile source of that irregular action of the uterus, which produces the hour-glass contraction. f
Pliny, who was destroyed through his imprudent curiosity during the great eruption of Mount Vesuvius in the first century, is here
* Flamant, Ossiander, Siebold and others.
f Moschion has likewise given us a description of the chair or stool which was employed by the ancients in parturition, which he says is like a barber’s stool, having a lunar-shaped foramen cut in it, for the foetus to fall through.
Dr. Malin’s Introductory Lecture. 323
mentioned, not because he was a physician, or said any thing new on obstetric subjects, but from his stating among his paraphrases or copyings of the writers on midwifery who preceded him, that from the circumstance of children presenting by the feet being so seldom, or with so much difficulty born alive, they were called by the name of Agrippse, as if eagre parti. Hence Pliny thought that such positions should be always rectified.
The medical writer next following Moschion, or perhaps his con¬ temporary or predecessor, is Galen, who lived about 600 years after Hippocrates, and is principally famous for his diffuse commentaries on his great master’s works. Galen makes some excellent remarks on the diseases of women and children and has the reputation of being the discoverer of the Fallopian tubes ; but he achieved nothing worthy of notice in the art of midwifery.
Towards the termination of the fourth, or, according to some, of the fifth century, iEtius a Greek, and the first Christian physician of whom we have any knowledge, flourished in high repute at Alex¬ andria. He is a voluminous but not an original writer on midwifery, confessing candidly that he has compiled from the works of his pre¬ decessors ; and indeed, it is principally because he makes us acquainted with the modes of practice of otherwise unknown obstetric professors — particularly of the noted midwife Aspasia, and of Phi- lumenus — that his writings are interesting. AEtius treated uterine haemorrhage by styptic injections, astringent pessaries, and ligatures round the limbs ; makes a distinction of head presentations into natural, when it descends straight forwards, and preternatural, when - it is turned to the right or left side of the uterus ; alludes to, without minutely describing a dilator somewhat analogous to the modern speculum, and dissents from Hippocrates, holding similar opinions to those of Celsus and Moschion, with respect to pedal presentations and delivery. From Aspasia, who is supposed to have lived before the time of Hippocrates, and to have been the mistress of several Persian monarchs, iEtius cites very precise means for remedying obliquities of the uterus, and presents us with a copious list of substances for causing sterility or abortion, besides minute directions for the management of puerperal women. Of Philumenus, it is reported that he always in cases of locked head, endeavoured to turn before resorting to the performance of embryotomy — that one of the instruments employed by him in this operation was a forceps, armed with teeth for comminuting and extracting portions of bone — and that in adhesions of the placenta to the surface of the uterus, he attempted the separation, not by the forcible violent means then usually had recourse to, but by gentle efforts exerted in a lateral, rather than a straight direction, in order that there might be no risk of producing what he calls a prolapsus, but what would undoubtedly have been an inversion of the uterus.
Paulus Aginata follows next in chronological order to AEtius, and is the last of the Greek medical authors whose works have descended to us, but it is neither known where he flourished nor whether he
324 Original Communications .
lived in the fourth or seventh century. Dr. Friend inclines to the latter epoch, and to place his residence at Alexandria, since learning and learned men were already at that period banished from Europe ; while Le Clerc considers that it was in the fourth century that he wrote, and if so, it probably was from the eastern part of Europe. He was the first man to whom an appellation corresponding to our modern term accoucheur was applied — the Arabians calling him vir obstetrix, or obstetricus, but there is little doubt that others who preceded him merited the name equally well, though never given to or assumed by them. The writings of Paulus are for the most part transcripts from the works of his predecessors, and it is not therefore surprising to find that they are contradictory or inconsistent . From this circumstance also, he has been pronounced by some as a sagacious practitioner, while by others he has been denounced as rash and inju¬ dicious ; and, seeing that he advises the lower extremities of an infant to be amputated when they cannot be returned into the uterus, it would appear that the latter party are in the right.
It will be convenient to pause in this place for the purpose of taking a review of the state of the art In general among the ancients, and in particular with reference to its practitioners and professors. The concurrent testimony and allusions of all the old authors render it indisputable, that women were in the commencement the chief, if not the sole practitioners in midwifery, and that they likewise exerted the privilege of treating the diseases peculiar to their sex, as well during the pregnant and puerperal states, as at other times. Those persons therefore, who in the present day, raise an outcry against the employment of male practitioners, and are so fond of appealing to the customs and usages of the ancients for confirmation .of the propriety of their opinions, should extend their objections to the management, and, if themselves physicians or surgeons, should be prepared to relinquish the treatment of the diseases of females under any circumstances or conditions, for by doing so they would be enabled to fulfil, without at all exceeding the desires and directions of the people, whose usages they adduce. Peculiar names, indica¬ tive of their occupation and duties, were appropriated to the ancient mid wives, answering to the terms grandmother,* female physician, and cutters of the naval string in our own language. That they were held in considerable estimation seems probable from Socrates pro¬ claiming, with evident satisfaction, that he was the son of one, called Phainareta, whom he terms “ generosa et gravis obstetrix,” and from the circumstance of another having obtained the name of Sotira — “ salvatrix or conservatrix,” from the felicitous success of her prac¬ tice. The sister of the doubting philosopher Pyrrho seems likewise to have been a midwife. Besides superintending the process of par¬ turition, it was a part of their office to negotiate and assort marriages.
* Me *j«i, ictrpofjMictt, larpivotC, o/^af,olo/j,ot
325
Dr. Malin’s Introductory Lecture .
and to. teach their employers, as we learn from Plato, the art of pro¬ creating beautiful and healthy offspring ; and they were further in the habit of administering medicines to produce sterility or abortion, and were believed to have the power of controlling or exciting labour pains, and of preventing, as well as inducing abortion by their medi¬ cines and charms. A famous practitioner among these time-honoured matrons both for alleviating disease and for the invention of receipts and cosmetics, was a certain Cleopatra, whom some of the older writers, in their zeal for the honor of the art, have endeavoured to identify with the voluptuous queen of Egypt; but their assumptions do not rest on a better foundation than that a treatise on so mere¬ tricious a subject as the care of the complexion might naturally be expected from one who had so repeatedly profited by her personal charms. Their readiness to provoke miscarriage at the will and con¬ venience of their mistresses does not, however, appear to have been universal, for Pliny relates that Lais (not the renowned courtesan of that name, but a highly respectable midwife of Athens) strenuously opposed what she thought so unnatural and impious a practice, and presented in that laudable respect a remarkable contrast with an emi¬ nent rival, named Elephantis. That the custom very generally pre¬ vailed may be reasonably inferred from the precautions which we find to have been specially directed against it ; thus Hippocrates, in the oath which he obliged all who became his disciples to take, expressly condemns and exacts from them by its solemnity, the declaration that they will never be guilty of attempts to frustrate the designs of nature in this respect. Yet the venerable patriarch of our profession confesses that he did on one occasion designedly cause a singing girl to miscarry, an action that forms an unfortunate commentary on his rigorous precept; but which it is customary to reconcile, by consider¬ ing that he spoke in one instance as a philosopher, contemplating in the practice only an outrage and offence against the laws of nature, and acted in the other as a citizen of the world, in which capacity the deed might be justified to him by the prevailing practice and notions of others. But to return from this digression. — Of the particularities of practice of these midwives we have had transmitted to us little or no direct account, the only circumstance being that mentioned and approved by Aristotle, that before tying the umhilical cord they were accustomed to compress and urge the blood of its vessels into the abdomen of the foetus, with the view of rendering it vigorous and strong. But were it worth the task, it would not be difficult to accumulate a sufficiency of circumstantial evidence to shew that their proceedings were often reprehensible and dangerous. Some testi¬ mony of this kind will be presently afforded . Hysteria was one of the affections which they were more frequently called upon to treat than others,* and indeed received its name from them; and we know that
* Martial alludes to this circumstance in lib. i. of his Epigrams. Hystericam vetulo se dixerat esse marito .
Protinus accedunt medici, niedicaeque recedunl.
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Original Communications .
the relation of the etymology of the term to the cause of the complaint is for the most part well founded and correct. But though estimated from necessity, and prescribing from custom and prejudice for the accidents and disorders incidental to their sex, the midwives of Greece and Rome were not distinguished for sagacity or good behaviour; for we find Socrates likening himself to them in being bar ren or destitute of wisdom, and Terence not disguising the fact that they were addicted to wine, rash, and not worthy of being entrusted with the important charge of at least a first confinement.
Sane pol ilia temulenta est raulier et temeraria :
Nee satis digna, cui committas primo partu mulierern.
Andriae, Act 1
Yet there is every reason to believe that the ordinary practice of the art was in Greece, with a transient interruption, and throughout the Roman empire, from its commencement to its termination in the west, entirely in their hands ; and that male practitioners, who were the regular medical men, were looked upon as referees in extraordi¬ nary and difficult cases, and summoned only when the ability and strength of the midwife were inadequate te effect delivery. And it may be stated by anticipation, of the Arabians, the subjects of the eastern empire, and of the Europeans in general during the dark ages, that similar usages obtained amongst them.
In proof of such having been the case, we have, as far as male practitioners are concerned, the direct testimony of their writings, evincing a knowledge of the subject that could be derived only from experience ; — the nature of the operations so frequently described, which, it may be safely supposed have always demanded more anatomical skill, and physical, as well as moral resolution, than females can in general have possessed ; — and the fact that the instru¬ ments employed were inventions of men, and so not likely to be resigned altogether to the use of women. There are these positive and negative proofs that medical men were always engaged in the practice of midwifery, in cases of doubt and emergency ; while that females were previously and commonly employed, is abundantly evident also from their writings, and from the allusions contained in the works of the physicians, historians, poets, and philosophers, who were their contemporaries ; and moreover, would have been a natural and legitimate inference a priori, when the low ebb at which human knowledge comparatively stood, the state of society, and the circumstance that preceding and foreign people had principally employed women, were taken into account. In addition to the confirmations already given, may be mentioned the incident recorded by Suetonius concerning Livia, the wife of the emperor Augustus, to whom, after she had suffered a long time from lingering labour, the court physician, Antonius Musa, was called for the express purpose of hastening her delivery — “ pro partu accelerando,” are the words used by the historian. That it was always the physician
Dr. Malin’s Introductory Lecture. 3 27
or surgeon (for the distinction of office in the profession was not in those times established) who was called upon in cases baffling female skill, is clear, from the term “ medicus,” always used by Celsus, to denote the individual to whom his directions were in¬ tended to apply.
I said that in Greece the fair sex did not maintain their monopoly of midwifery practice uninterruptedly, and I now proceed to relate the occurrences connected with the suspension of their functions, as described by Hyginus, who wrote about the commencement of the Christian era. For some reason which does not appear, probably on account of the impoverishment of the state of its subjects in conse¬ quence of the inefficacy and unskilfulness of the midwives, the Athenians — that ingenious and polished people, whose name, even in the present day, is held to be typical of all that is elegant, intel¬ lectual and refined — enacted a law, prohibiting females and slaves from studying or practising any of the branches of medicine, among which midwifery was of course included. The direct tendency of this edict was to throw all the obstetric practice into the hands of men, or to deprive women of all assistance during parturition. Reduced to this alternative, many Athenian ladies (such was their high, but mistaken sense of modesty) preferred to perish in giving birth to their offspring, rather than admit the succour of male practitioners. In consequence of this unfortunate state of things, and moved either by motives of sympathy or cupidity, a young female named Agnodice, was led, after removing her hair and assuming male attire, to attend the lessons of an obstetric teacher, Hierophilus, in order that she might gain sufficient skill to admi¬ nister to the sufferings of her sex, in their hour of travail and difficulty. So extensively was she sought after, that the accou¬ cheurs, finding their interests to be greatly injured, and suspecting something to be wrong, caused her to be charged before the areopa- gus, with being an eunuch and corrupting men’s wives. Brought to trial on this accusation, she discovered her sex to the court, on which the accoucheurs became still more virulent and urgent for her punishment, and this would no doubt have been severe, but for the intervention of the most distinguished ladies of the city, who pleaded so eloquently and pertinently in her behalf, that she was not only liberated, but the obnoxious law was also rescinded, and free permission thenceforth given to females, both to practise the obstetric art, and to treat all the diseases peculiar to the female constitution. After this time, the male and female practitioners acted concurrently, the former being consulted in all probability only when their services were indispensably required.
The state of midwifery among the Greeks and Romans having thus been considered, let us transport our imaginations to its condi¬ tion among their successors in science and literature, the Arabians; for after the repeated irruptions of the northern hordes upon the fair and fertile regions of the south during the third and following centuries, the lights of learning and knowledge were soon extinguished in the
328
Original Communications.
west of Europe. It was then that the Goth and the Vandal vied with each other in the work of devastation and destruction, and the monuments of ancient glory and art were pitilessly defaced and con¬ signed to ruin, that the Huns emulated their sacrilegious and ferocious deeds, and that all the barbarians conspired to sweep away every vestige of intelligence and trace of human dignity from the face of the earth. The mental darkness in which Europe remained plunged for 1000 years followed; and as long as it continued, the grossest ignorance and superstition universally prevailed, and an entire check was given to the cultivation of art or science of any kind. The mists which enveloped the human mind, and clouded all the opera¬ tions of reason during this fearful and eventful period, were but too prolific in engendering errors and evils, that have scarcely yet passed away. But these mournful consequences must gradually vanish before the dawn of true wisdom and philosophy, and will at length be irrevocably dissipated by the piercing and radiant beams of that heaven -born knowledge, which aims at uniting mankind in firm and fraternal bonds of harmony and love.
The progress of mental cultivation, though arrested in the western parts of Europe by the overthrow of the empire, was not so com¬ pletely suspended in the east, where the arts still continued to flourish, though languidly and feebly, and to receive the counte¬ nance, in some measure, of the Greek emperors, but in a more zea¬ lous degree of the Arabian caliphs. It was about the year 640, that the Saracens, in overrunning Egypt, obtained possession of the books in the Alexandrine library, all of which they took care to consume, with the exception of those on medicine, from which they probably expected to derive some advantage, and accordingly pre¬ served. These were carried away and translated into the Arabic tongue, or at least, were copiously copied and borrowed from by those Arabian physicians whose writings have reached us.
Of these paraphrasing authors, the earliest Serapion, says nothing worthy of repetition.
The next, Rhares, who flourished at Bagdat towards the end of the ninth century, and gave the first description of small-pox, notices that in premature parturition the crural presentation is most common.
Aviceuva lived about A. D, 1000, and treats in detail of mid¬ wifery and the diseases of females. In the management of pro¬ tracted natural labour, by which a vertex presentation was implied, he first directs assistance to be afforded by the hand — if that is unavailing, by the application of a fillet or tape — if the additional power thus obtained does not suffice, forceps are to be used, instru¬ ments not like the forceps of the present time innocuous to the foetus, but destructive of its life — and if the forceps fail, the head is to be opened, and its bones comminuted in the customary way.
(To be continued.)
[ 329 ]
BIBLIOGRAPHY.
ANATOMY.
1. — I. Explanation of the Anatomical Atlas of Professor Weber, of the Royal Prussian University of Bonn. London. 1831. 8vo. Parts 1 and 11, pp. 127. A. Schloss, Southampton Buildings, Chancery Lane.
II. Anatomical Demonstrations, or Colossal Illustrations of Human Anatomy. By Professor Seerig. London. 1831. pp. 1, pp. 34. A. Schloss.
III. Arteriology of the Human Body. By Borremans, revised and adapted to the English Nomenclature, by T. King, Professor of Anatomy and Surgery, &c. &c. London. 1831. Feuillet, Dumus and Co. 1, Leicester Square.
Of all the Anatomical Plates we have hitherto seen, with the exception of Mascagni’s, which are unequalled, these are the best and cheapest. They are of natural size, and are executed with the greatest fidelity. The expense of the whole is a sum which can be spared by any medical student. If anatomy could be learned by plates, a facility is afforded by those before us. We strongly recommend them to every member of our profession. The publisher is entitled to the support of every friend of medical science. Professor Seerig’s views of the skeleton, are the most faithful hitherto published. Mr. S. has also a splendid collection of anatomical preparations in wax, which have received the approba¬ tion of the Medical Press as well as of the Royal College of Physi¬ cians, and the various other scientific societies of this metropolis.
We have already noticed the neuralogy of Borreman’s with our warmest commendations. The arteriology is still a more interesting plate to the practical surgeon and anatomical student. It is well executed. Both plates ought to have a place in every anatomical museum and lecture room in the United Kingdom. The publication of such valuable illustrations of the structure of the human body, facilitates the labours of the student, and refreshes the memory of the established surgeon on points of the greatest importance, which must be always fresh in his recollection.
MEDICINE.
2. On Oleum Terebinthince as a remedy for Salivation. By E. Ged- dings, M. D. Lecturer on Anatomy and Surgery, Charleston, S. C. — It was not until the winter of 1828 and 29, that we became acquainted with the efficacy of 01. Terebinth, in the treatment of this distressing affection. We were attending a young gentleman of the medical class, who became severely salivated from a small dose of calomel. A highly intelligent young gentleman, Mr. J. E. Pierson, at that time one of our pupils, now a respectable physician of Fairfield District,
VOL. VI. no. 34.
u u
330
Bibliography.
proposed the turpentine, which was accordingly employed, and afforded speedy relief. Since that time we have used it extensively, in both hospital and private practice, with the most satisfactory results. It has also been much employed by several of our medical friends, whose testimony in its favour, we are happy to state, fully sub¬ stantiates our good opinion. We usually direct two drachms of turpentine to eight ounces of gum arabic mucilage, with wdiich the patient is required to gargle frequently in the course of the day. We have, however, in some cases, employed the undiluted turpentine with the same happy effects. It usually occasions, at first, consider¬ able smarting, which, however, is of only temporary duration, and becomes less and less at each successive application. Indeed, in many Cases, the smarting is succeeded in a short time by a soothing impres¬ sion, similar to that which attends the use of the turpentine in cases of burns and scalds.
We will say nothing of the modus operandi of the medicine in cases of salivation, but will merely recommend a fair and impartial trial of it as a remedy for that distressing affection. — American Journal of the
Medical Sciences, Nov .
3. Case of Colica Constipata removed by inflation. By John King, jun. Surgeon, Irvine. — The importance of inflation as a remedy for obstruction of the bov/els, appears to me not to be sufficiently appre¬ ciated at the present day. It was first recommended by Hippocrates for the removal of intestinal obstruction ; in more modern times, it has been resorted to by Hoffman and Haller ; and notwithstanding the neglect it has since experienced, I cannot but regard it as worthy of an eminent position in the list of therapeutic agents. The treatment usually prescribed in cases of ileus or colica (without inflammation) is very discordant, as witness — warm baths, fomentations, injections of warm water and oil, rubefacients, and blisters ; contra, cold effusion and immersion, freezing lotions, pounded ice and snow ; not to men¬ tion emetics, purgatives, and mechanical distention by warm fluids, quicksilver, gold and silver balls, &c. ; and when all these remedies have failed, blood-letting, tobacco, in infusion and smoke, and lastly, gastrotomy. Yet this simple means of inflation, although probably the most powerful, and the least dangerous, is entirely overlooked. It paralyses, as it were, the constricted fibres of the bowels, and may be used in the following cases, if not with complete success, at least with advantage, viz. the various kinds of colic, proceeding from torpi¬ dity, spasmodic constriction, viscid meconium in new-born infants, impaction, bezoards, and other intestinal concretions, volvulus or intus-susceptio, and some cases of hernia. It was a happy thought of those who hit upon this means in the hour of danger, after all their other efforts had proved nugatory. For although tobacco, which is often used as a last resort, sometimes is successful, it is not uniformly so, and it too often happens, that the patient, rather than undergo a repetition of it, beseeches to be allowed “ to die in peace/’ We may also observe the hesitation with which the prac¬ titioner has recourse to it, not only because of its doubtful efficacy.
Medicine.
331
but on account of the danger there is of greater exhaustion being produced by it. I take the liberty of giving one case, as I conceive it may give some idea of the power of inflation.
In September, 1829, I was requested to visit Mrs. G. set. 26, of rather delicate frame. On the night previous to my visit, she experienced an uneasy sensation in the region of the stomach ; for which she took eight grains of calomel, combined with a half¬ drachm of compound powder of jalap, without any impression on the bowels. During the night this uneasiness increased to an almost intolerable pain, accompanied with obstinate vomiting; which con¬ tinued till the evening, when I saw her. In the course of the day she took two doses of castor oil, and received five injections. When I entered the apartment, she was sitting near the fire, and her body bent forward ; the face was wan, sallow, dejected, and of a dingy yellow colour ; the surface of the body and extremities inclihing to cold. Pulse 80, soft and much compressed — tongue, at the back part, covered with a brownish coloured mucous — she had obtained no alvine solution for six days. She took no notice of my being present, or any thing going on around her, but informed me, when questioned as to the seat and kind of pain, that it was of “ a violent screwing nature, working between the stomach and navel/' coming on in paroxyms, and ending in, or producing vomiting. I ordered the warm bath, and gave a teaspoonful of laudanum with compound spirit of lavender, which was soon afterwards vomited. Upon this, an effervescing mixture was given, then five drops of croton oil with some laudanum, and in about three quarters of an hour, five drops more without laudanum; but each in its turn was rejected, with a quantity of yellow coloured fluid. It was at this time, I first thought of inflation. For this purpose, I procured a pair of common bellows, and securing the bladder of a glyster bag to the nozzle of the bel¬ lows, the pipe was introduced into the rectum, while the patient lay on her right side, and the bellows was commenced being wrought. As soon as the air entered the rectum, the effect was immediate and satisfactory ; the countenance lost its anxiety, the eye brightened, and the patient said she felt quite relieved. A gurgling noise was heard in the bowel, with an escape of foetid air ; and in about a minute from the time the air began to enter the rectum, she requested to be allowed to go to stool. She had a copious dejection, and a good night’s rest ; and next morning complained only of being much' enfeebled, but was otherwise well.
I was deeply impressed, about five years ago, with the fatal result of a case of intus-susceptio, in a fine robust infant, six months old,
. which was supposed to proceed from the effects of half a teaspoon¬ ful of some syrup of poppy, made, as is commonly done, with opium, given for the purpose of procuring sleep during the period of teeth¬ ing. About eight hours after it was given, the child began to cry vehemently, having appeared restless and uneasy for several hours previously. Early in the forenoon, it passed a very scanty stool, streaked with blood ; soon after this, vomiting commenced, which
332
Biblio gr apk y .
continued until the little sufferer sunk. Is it unreasonable to imagine that if inflation had been used in this case, the result would have been otherwise ? I was hereby shown the necessity of seeking more powerful means, than fluid injections, et ceetera, And I hope, as I firmly believe, that inflation with common air is the necessary desi¬ deratum, I conclude with Dr. Cheyne, that “ a man dying of ileus, presents one of the most pitiable sights in nature ; and a leading object of this paper is to remove a part of the horrors of the scene, by withholding many of the bitter doses, which are forced upon him by the solicitude of his friends, and the officiousness of his phy¬ sician1” — Glasgow Med. Jour. Feb.
4. In an interesting paper in our esteemed contemporary, the Midland Medical and Surgical Reporter, Dr. Hastings, of Worces¬ ter, has narrated some highly important cases of incipient tubercular phthisis which terminated favourably, on which he makes the fol¬ lowing comments : —
“ Since the above cases and remarks were composed, the work of Sir Charles Scudamore, on consumption, has fallen into my hands. In this work, I see none of the facts brought forward in support of the process of inhalation, which at all militate against the position taken up in the foregoing paper, that we have hitherto not discovered any remedy for tuberculous consumption. Out of the sixteen cases related by Sir Charles Scudamore, four were fatal, from tuberculous degeneration of the lungs. Of the successful cases, it appears to me that the bronchial membrane, in most of them, may be supposed to have been the principal seat of the disease ; and there is nothing extraordinary in such cases recovering under the use of the remedies that have been long had recourse to in this species of disease.
“ But I cannot help expressing my astonishment, that a knight and a physician of eminence, who supposes he has made important discoveries in the mode of treating a very intractable class of diseases, should not have been very particular in giving a full and precise description of the manner of applying the remedies : concealment, in such circumstances, is not calculated to produce a favourable impres¬ sion of the author, who thus cannot fail to call upon himself the cri¬ ticisms of his professional brethren. Nor will the reason that is given for withholding this necessary information, be considered a sufficient apology for such an omission, viz.; “from an apprehension that patients themselves might be tempted to undertake the treatment of their own cases, with the great risk of receiving injury instead of benefit, I have avoided the introduction of formuke of the remedies for inhaling.”
“ By this omission. Sir Charles Scudamore has run a risk, not very favourable to his medical reputation ; for in consequence of it, some persons may be induced to regard his work, rather as a species of direction for the reader to his residence, in Wimpole -street, than as a praiseworthy offering upon the sacred altar of medical science.” — p. 388.
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It affords us much satisfaction that a physician of such high talents as Dr. Hastings coincides in the opinions we offered in our review of Sir C. Scudamore’s work, which clearly demonstrate the justness of our strictures.
5. Cases of Congenital Incontinence of Urine. By John C. Otto, M. D. one of the Physicians to the Pennsylvania Hospital, North American Medical and Surgical Journal , October.
[Read before the College of Physicians, June ‘24th, 1830.]
Case 1 . — When visiting a young gentleman, in the latter part of September 1827, my attention was directed by his mother, accidentally in appearance, to his younger brother, a lad ten years of age. He laboured under incontinence of urine, and as it had continued from his birth, his parents had presumed it was a natural defect, that was beyond the reach of medicine, and had not spoken to me upon the subject, although I had been their family physician many years ; nor had any other person ever been consulted. Possessing very delicate feelings, it was supposed his sense of shame might be addressed to some purpose, but it was in vain ; and very moderate correction was resorted to without any advantage. Nothing further had been attempted by his parents, except restricting him somewhat in his drink, especially in the evening. He had arrived at a period of life when his deplorable state was obvious to him, and lamented bitterly his situation. He was strong, of a florid complexion, and had ever been remarkably healthy in other respects ; his desire to make water had always been very frequent and urgent, and he discharged but a small quantity at a time. After he was four or five years old, he never wet himself in the day time, if he could retire immediately to a suitable place to void his urine, as soon as the desire occurred, for the urgency was always very great, and his powers of retention small and of short continuance. He passed very rarely a night without wetting his bed, and never two in succession, although great attention was paid to his making water when he went to bed, again when the family retired, most commonly once during the night, and always very early in the morning. After being made acquainted with the whole case, I told his mother, as no medical means had been employed, it ought not to be considered incurable, and should every attempt to give relief fail, he would not be in a worse situation than at present ; that -he might be essentially benefited, but should there be a want of success, she would have the consolation of having used such remedies as were supposed best calculated to cure him. She seemed much gratified on learning there was still some reason to hope, and placed him immediately under my care. I directed an ounce of the leaves of the uva ursi to be simmered in a pint of boiling water five minutes, of which he was to take a wine glass full four times a day ; and in order that the virtues of the medicine should be principally extracted, it was to be prepared twenty-four hours before giving it, and decanted as used. He was likewise to take fifteen drops of the muriated
334
Bibliography.
tincture of iron three times a day, in a sufficient quantity of water, and to have a gallon of cold water dashed on the perineum and nates morning and evening. He improved rapidly under the treatment, having wet his bed for the last time on the 18th of October, not having done it for the previous eleven nights. The cold water, on which I had placed some reliance as a tonic, was not used at all ; it was omitted at first from causes that were not satisfactory to me, and as he had become so much better when I was informed of it, the employment of it was not pressed. The urgency of making water gradually lessened, and the power of retention improved, so as to become natural in both respects. Although he was entirely restored in so short a time, the treatment was continued three months alto¬ gether, as the incontinence was congenital, and he has remained ever since free from his distressing malady.
The author has related four similar cases, in which in addition to the above treatment, a blister to the sacrum and a decoction of the rhus glabrum or sumach, an ounce of the leaves to the pint of water, the dose half an ounce three times a day, afforded great relief, and almost cured the disease. His object was to give tone to the urinary system. Should this plan succeed in other hands, it will be a great improvement in therapeutics.
SUKGEKY.
6. Treatment of Umnited Fractures by Seton. — Dr. Hays, one of the talented editors of our much esteemed contemporary, the American Journal of the Medical Sciences, comments in his number for Nov. on a sentence in one of Mr. Lawrence’s Surgical Lectures, extracted from our valued contemporary the Medical Gazette, which is as fol¬ lows : — “ I believe it may be said that there are two or three instances recorded, in which, after some weeks and months confinement, with a good deal of pain and danger, the union has been effected in this way, but in other cases the introduction of the seton has failed/’
“We confess ourselves at a loss how to notice this summary and contemptuous dismissal of a method of treating ununited fractures, and one which, contrasted with the painful, and sometimes fatal operation for which it was proposed as a substitute, it appears to us, can hardly be too highly extolled.
The apparent accuracy with which the lectures are given in the Gazette, seems to forbid our ascribing so material a mis-statement to an error of the reporter — the high character Mr. Lawrence has hitherto sustained for fairness and candour, equally prohibits the imputation of intentional misrepresentation on his part, and yet it is impossible to suppose that Mr. L. who is distinguished for extensive erudition, should be ignorant of cases published in the Medico-Chirur- gical Transactions of London, the Edinburgh Medical and Surgical Journal, the London Medical Repository, the Medico-Chirurgical Review, the London Medical and Physical Journal, the London
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Medical and Surgical Journal, the Dublin Hospital Reports, Charles Bell’s Operative Surgery, and Cooper’s Surgical Dictionary, in which no less than thirteen different cases of ununited fractures success¬ fully treated by the seton are related. Be the case, however, as it may, the statement has been put forth as coming from Mr. Lawrence, and until disavowed, subjects him to the charge of ignorance or want of candour ; we therefore think we are performing an act of kindness to him in calling his attention to this subject, that it may be explained ; and at the same time as an act of justice to the eminent surgeon who devised the method of cure under consideration, we shall give a brief summary of such cases of ununited fracture successfully treated by the seton, as we find in the works in our private library, not having time at the present moment to have recourse to more extensive sources of information. /
7. Case of Excision of the elbow joint. — Mrs. Rogers, set. 46, November, 20, 1829. The left elbow-joint is increased in size, and the integuments have a soft and puffy feel. There are four distinct openings discharging matter, through each of which the bone can be felt bare. Two of these openings are situate over the inner con¬ dyle of the humerus, the third over the external, and the fourth over the anterior part of the joint, besides the tendon of the biceps muscle. The motion of the joint is exceedingly limited, and she cannot .move it, or attempt to shut the hand without great pain. Her health has fallen much off within the last six weeks, and she was troubled very recently with a severe bowel complaint. This complaint began in March, with severe shooting pain in the region of the joint, generally increased during the night, and always aggra¬ vated by motion. After the pain had continued for some time, swelling took place, and afterwards the sinuses formed, and have continued to discharge matter constantly for nearly two months. Various remedies have been tried, but without any relief.
As her general health had always been good till the beginning of this complaint ; as the soft parts were not much diseased ; and as the caries appeared confined to the extremities of the bones, I thought it a fair case to try excision of the elbow -joint, and was happy to find that Sir George Ballingall had the same opinion.
On the 26th November, the operation was performed in the fol¬ lowing manner. : — An incision was begun on the back of the arm, about three inches above the joint, and carried in a straight line to about two inches below it, over the point of the olecranon process to the edge of the ulna, taking care to avoid the ulnar nerve. At each extremity of this incision a transverse one was made about two inches long, and the flap on the radial side was dissected back, exposing part of the humerus, radius, and ulna. The flap on the inside was next made, taking care not to cut the ulnar nerve. The olecranon process was found carious at its upper part, and slightly adhering to the humerus. It was easily removed by the cutting pliers, as also a small piece on the back of the ulna, that did not appear sound. The insertion of the brachialis muscle was not
336
Bibliography .
disturbed. The humerus was much diseased on its radial side, both in the joint and shaft of the bone. As about one-fourth of the articu¬ lation of the humerus on the ulnar side was sound, an oblique incision was made by the saw, so as to include three-fourths of the articula¬ tion, and extend about two inches up the shaft of the bone, and in¬ clude all the diseased parts. The cartilage was removed from the sound part of the humerus, as also from the top of the radius, which was not in the least diseased. No artery required to be tied. The parts were secured by stitches, and the arm put in a slightly bent position. The greater part of the wound healed by the first inten¬ tion, and in three weeks she could move her fingers without any pain, which she had not done for nine months before. By the end of December, the wound was entirely whole, and she was walking about, and moving slightly the joint, without any pain.
At this time, however, her general health began to suffer from repeated attacks of bowel complaint, and several abscesses formed in different parts of the cellular substance of the fore-arm, which pre¬ vented her from moving either the hand or the elbow-joint without considerable pain. These abscesses continued to trouble her con¬ stantly for nearly three months, notwithstanding a variety of con¬ stitutional treatment ; but at the end of March her health began to improve, and she has continued free from any complaint since that time. Her arm remains now in a slightly bent position, and cannot be put in a straight line with the shoulder ; but she can bring her hand to her mouth, and is in the daily habit of using the arm in all her domestic duties, and can carry with it a large iron fender without any pain. She says she is very sensible that the strength of the joint has increased within the last three months, and that it is still improving. The connection of the radius with the humerus does not appear so firm as that of the ulna. ■
To Sir George Ballingall, I feel myself under many obligations, not merely for his attention in this case, but for his valuable advice and assistance in a great many others. — Edin. Medical and Surgical Journal.
8. Cases of Lithotrity , or examples of the stone cured without inci¬ sion , followed by a description of the first symptoms of the disease. By Baron Heurteloup. London. 1831. 8vo. pp. 54. G. Underwood.
Since the introduction of lithotrity into England, by Mr. Costello, the colleague and pupil of its justly celebrated discoverer, Dr. Civiale of Paris, we have watched its progress with keen anxiety, so that full justice should be done to its merits. We accordingly read with attention, the different documents of the controversy which arose on the occasion of its introduction, between our countryman Mr. Costello and a foreigner, styling himself the Baron Heurteloup. This con¬ troversy, which was most ably and victoriously maintained by the former, exhibited in the clearest light, the claims of Dr Civiale to this truly valuable invention, the admirable simplicity and efficacy of the instruments which this gentleman, and his really scientific pupil, employ with such signal success, and the emptiness of the pretensions
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to improvement of the lithotritic instruments and operation which M. Heurteloup so pertinaciously asserts. As we have sufficiently shewn in our views of medical Ethics, we shall at all times set our faces against every attempt at conferring for covert views of private advantage, upon any therapeutical instrument or agent, a reputation of superiority to which it has no just claim. As honest journalists, it is our duty to expose such attempts, as have for their object an undeserved popularity, acquired at the expense of truth, justice, and the true interests of science. Lithotrity, which, in the hands of Civiale and Costello, has restored to health upwards of two hundred sufferers, stands in no need of equivocal auxiliaries. It requires no air ad captandum to be thrown over it. It possesses sufficient intrinsic merit to spurn all charlatannic efforts to fix its footing as triumphantly in England as it has done in France. We thought that the clear and able statements made by Mr. Costello, about eighteen months ago, had fully and satisfactorily proved the futility of the pretended im¬ provements of M. Heurteloup ; and thinking so, we are at a loss to conceive the obstinacy which again obtrudes these pretensions upon public notice, when the same overwhelming refutation awaits them. We confess, however, that we do not regret this, seeing that this refutation cannot be withheld, and that it must be now ample, com¬ plete and final, indeed we are aware, that the subject has been already taken up.
The subject of our present criticism is a thin pamphlet, the more ready and convenient for a publication, for the lucubrations of the numerous herd of pretenders to public notoriety, and the easy resource of persons of a certain stamp. It contains a series of cases, twelve or fourteen in number, the details, purposely or otherwise, are con¬ sidered of too little importance to science to be given, and it terminates with an expose of the symptoms of the calculous affection. Now and then we are told that the three-branched instrument of Civiale and Costello was employed for the operation, and that failing, the author’s own instruments are employed, and these in their turn failing, Civiale’s instrument is again employed, and both these failing, his brisecoque is employed, the ne plus ultra of instrumental perfection ; follow these, an artillery of pincers, forceps, virgules, scoops and sounds, surrounded by which, M. Heurteloup revels in his arsenal of machines, enjoying the pure beatitude of lithotritic eclectism. Thus armed cap a pee, he knows no difficulty, or if he should meet any, that will not yield, “ he proceeds incontinent to discover a new machine.” But, amongst all his apparatus, the brisecoque is his most distinguished favourite. Civiale’s instrument, he thinks, may now and then be useful in pulverising spherical calculi, but he finds, that it is altogether useless in cases of flat stone, and this he takes the liberty of proving, by his want of success when he employs it in such cases. “ Four, five, six times, nay oftener in the same person, says he, I employ Civiale’s instrument to break down a flat stone ; but, alas ! no result. Now, let us ask, have Civiale or Costello had no
von. vi. no. 34.
x x
338
Bibliography „
cases of flat calculi, occurring in the vast number of patients whom they have relieved ? Have all the flat calculi been reserved for M. Heurteloup ? Oh, fortunate brisecoque, thus to have your triumphs blazoned ! Neither Civiale nor Costello can meet with one, in failing to destroy which, they might at last open their eyes to the silliness of adhering to the use of a simple and safe instrument. We pity these men. All the flat stones are for Heurteloup and his brisecoque.
But, supposing, as M. Heurteloup will have it, that flat calculi are refractory to comminution by any other instrument than the brise¬ coque, still the whole question, with regard to the invention of this piece of mechanism, presents itself again, M. Heurteloup very quietly, and with becoming modesty, asserts in his pamphlet, that he is the sole inventor of it. Now, however much our confidence in his statements may have been shaken, we might, on account of the bold¬ ness with which he has persisted in this claim, have admitted it, but that we find in a work published on Lithotrity, pp. 41-42, by Dr. Civiale, ere yet M. Heurteloup was a lithotritist, the parent idea of this instrument. Speaking of fragments and small calculi, Dr. Civiale describes this instrument as follows : — “ It was for cases of this sort, that I had made at the same time (1822) several forceps with two branches, of different sizes and forms, and an instrument, which may be called a brise-pierre, This instrument consists of two blades of steel, rounded on one side, and flat on the other, slightly curved by an. extremity which terminates in the form of a serpent’s head, and pre¬ senting at the other extremity, two rows of teeth, those of the upper blade destined to receive a cogged wheel, by which the movement of this blade was regulated, those of the lower blade, to render it im¬ moveable, by means of a clavette or stop. These two blades are received separately, first the upper, then the lower blade, into a canula of the same length and diameter as the ordinary lithotrite. This canula serves as a sheath, and bears at one of its extremities, the wheel destined to move the blades together or separately, accord¬ ing to the effect intended to be produced.” Here, then, is a brise- pierre, with which M. Heurteloup must have been acquainted before he made his own, and differing in no essential from any of the dozen brisecoques that have been constructed by Amussat, Rigal, Colom- bat, &c. M. Civiale, whom we presume to be as good a judge of the value of such an instrument as any man living, used this instrument ; and as he affirms from experience, that it has no advantages over the ordinary or three-branched lithotrite ; and further, that from the absence of a central piece, he could not accurately ascertain the nature of the substance seized within the bladder, we are content to adopt his reasons for abandoning the use of it.
In one of the cases contained in this pamphlet, that of Mr. Castle, he admits, that five operations or applications of Civiale’s instrument, were made without any result. Five fruitless sittings ! ! ! We find nothing like this in Costello’s or Civiale’s numerous cases. Now, in
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perfect seriousness, we would ask, does this arise from M. Heurte- loup’s want of tact, or, are we to consider these five sittings as so many attacks made on the calculus, with the view of preparing easy work for his favourite brisecoque, and thus giving it the merit of a triumph, more the result of calculation than skill ? This case is given to shew the superiority of the brisecoque over Civiale’s three-branched instrument ; and here his coolness, in taking the conclusion, is admi¬ rable, “ for, let it be remarked,” he says, “ that this instrument was only employed when we discovered the almost utter impossibility of curing the patient with the perce-pierre;” he then says, “ in future 1 shall be more on my guard against those flat stones, and shall begin the operation at once with the brisecoque, and thus spare my patients “ the slow and useless attempts made with the perce-pierre slow and useless in M. Heurteloup’s hands, if you please, hut far different in the hands of the creator of lithotrity. Dr. Civiale, or in those of his pupil, Mr. Costello ! ! !
In another case, that of a Greenwich pensioner, a considerable number of operations were performed, and almost at each of them a new instrument was employed. We recollect very well, when the improvements in the lithotritic instruments were first spoken of by this gentleman, nay, even eighteen months since, he assured the world, that his modifications were so vastly superior to every thing of the sort that had yet appeared, that a large stone, instead of being reduced by successive perforations, according to Civiale’s plan, would be pulverized in one sitting. Now', how has this promise been kept to the sufferers, or to the world ? His first attempt to cure in one sitting was unsuccessful ; for we find, that it required ten very long sittings to effect a cure, which, after all, was due to Civiale’s instru¬ ment. Now, here was a fine opportunity to redeem his pledge. Yet how many sittings took place ? We are not told ; but we know they were wofully many ; we are sorry that want of space prevents our giving any lengthened extract from this case. This one must suffice. “ In a word, this case (the poor pensioner’s) was converted into a sort of study, by which all the medical gentlemen who w7ere present at the different operations, were enabled to form an idea of the means now existing in science for curing patients of the stone without in¬ cision.” Here we have realized the “ fiat experimentum in corpore vili.” Yes, poor fellow, he served M. Heurteloup’s purpose, to in¬ culcate on the minds of the medical gentlemen whatever opinions he thought proper. He served to shew his fertility as a modifier and borrower, without acknowledgment of Civiale’s instruments ; but he did not serve to prove that M* Heurteloup possessed the tact of Civiale. We shall terminate our reflections on this case, by observ¬ ing, that M. Heurteloup himself, as it w'ere, vi veritatis victus, here makes an admission, which, considering his opinions elsewhere expressed, we must look upon as involuntary, namely, that the perce pierre is on some occasions, a tolerably good instrument.
There are scattered through this pamphlet, here and there, asser¬ tions which force a smile from us Reviewers. This, however, may
340
Bibliography.
be very wrong, seeing that the whole performance is addressed more to the world at large, than to men of science. For instance, it is stated, that stones of a certain size, are seldom destroyed by means of Civiale’s instrument, and that, in flat smooth stones, it can never effect a cure. To this, the two hundred cases of Messrs. Civiale and Costello give an overwhelming answer. In another place, the composition and shape of the calculus is pretended to be ascertained by simple catheterism. A flat stone is thus distinguished from one of any other shape, unerringly. But, really the flat stones and the brisecoque are M. Heurteloup’s hobbies. In fourteen cases, four of the calculi are flat shaped, nearly one-third of the whole. Now, if it be true, that the three-branched instrument cannot destroy this refractory calculus, and that this form of calculus had presented itself with the same frequency to Messrs. Civiale and Costello, nearly sixty patients must have submitted to the operations of these gentlemen in vain, and subsequently sought relief from the brisecoque. What a pretty round number this would have made for M. Heurteloup? It is asserted, that it is for this kind of calculus, he invented the brise¬ coque. This has been said so often, that we must pass it by propter nauseam. Why, we know more of his powers of invention than we choose to state now, but we may yet enforce the maxim, suum cuique. These assertions prove abundantly, that this performance was not intended to throw any additional light upon the subject of lithotrity, for the benefit of medical men. Its destination lays quite another way. We shall mention the naive manner in which its real end and purpose is manifested. The symptoms of the calculous disease are detailed, the right of authorship is renounced, and the Society for the Diffusion of Useful Knowledge is invited to take advantage of so much disinterestedness, and to publish this invaluable premonition for the use and benefit of all those whom it may concern. This really over¬ steps every thing of its kind, with which we happen to be acquainted. What is it after all, but an emendation of the old version, try Dr. Eady. One proof more, that this work is beneath the level of science, and we have done. In speaking of the inflammatory affection of the testis, in the last case detailed, it is stated that the testis had inflamed before the operation was performed, and that this inflamma¬ tion never re-appeared, during or between the applications of the instrument. “ This circumstance, it is added, is a convincing proof, that when lithotrity is well performed, it will never produce inflamma¬ tion of these organs.” This sentence exhibits proof of ignorance of the structure of the kidneys, ureters, bladder, vasa deferentia, and urethra. Is there not communication between all these parts, by means of the mucous membrane which lines them, and are they not further connected by sympathies, by which the irritation existing in one part, may be rapidly transferred to another ? If this phrase is not uttered in ignorance, then it is dictated by a disposition to attri¬ bute to his own great tact, the avoidance of unfavourable consequences whenever they happen not to occur. From the exhibition of such vanity, we turn away with feelings bordering on disgust, and we call
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on Mr. Costello, the pupil of Civiale, and the partner of his immortal labours, to put an end to this silliness, by stating the truth on this subject, for we now see that it is vain to expect any information upon which we may rely, on the subject of this valuable operation, from such a quarter.
MISCELLANIES.
9. London College of Medicine. — Many of our readers are aware that a numerous meeting of surgeon apothecaries, with a few pure surgeons, has taken place within a few days, for the purpose of organizing a society, to be entitled the Newr London College of Medicine. Joseph Hume, Esq. M. P. presided as Chairman. — It was resolved, that the institution was to be founded upon the prin¬ ciple of admitting all legally qualified physicians, surgeons, and apothecaries, who are to enjoy the same rights and privileges, and to be entitled Doctors. According to this arrangement, there would be an annihilation of the Universities and Colleges of Physicians and Surgeons, and Society of Apothecaries in England, which obviously cannot be accomplished.
We are as sincere friends to medical reform as any member of the profession, but cannot agree to the plan before us ; because, it appears to us that it cannot be carried into effect. The proposers of this measure should have confined themselves to their own branch of their profession, and should have adopted the sensible and only practical course recommended them by Mr. Hume, to endeavour to improve and reform the present College of Surgeons, but not to propose a new one. We regret that this advice was not adopted and acted upon, and that instead of proposing a new institution, the meeting did not petition both houses of Parliament against existing abuses, and seek redress in the only way in which it is to be obtained.
They cannot seriously suppose that the government or legislature of this country would commence reform, and destroy the rights of the universities and corporations, without first consulting or remon¬ strating with the distinguished and influential heads of these esta¬ blishments, the result of which must be a death blow to the scheme of the reformers, as ample and repeated experience very fully attests.
Neither would the nobility and upper ranks of society, even con¬ sent to the union of the three branches of the profession, or employ the same individual as physician, surgeon, apothecary and obstetri¬ cian. In no country in the world is such a union tolerated, nor cannot in this, where our literary and scientific institutions are esteemed and almost venerated. It ought to be recollected that the members of both houses of Parliament, and the Government, are men who received their education in the universities, and -who cannot consent to the suppression of a single right possessed by these establishments. This is well exemplified by the difficulty which exists, from the hostility of these bodies, in obtaining a
342
Miscellanies.
charter for that great and splendid institution, the London Univer¬ sity. When we consider that the Lord Chancellor, and of course the present ministry, are the patrons and best friends of that establish¬ ment, and find it difficult to incorporate it, from the opposition of rival institutions, what chance can the proposed college have of success in obtaining the like privilege ? Besides, it must not only encounter this opposition, but the hostility of all the medical cor¬ porations.
Were the prospects of the intended college in the most favourable position, the influence of the medical corporations alone must blight them ; and we are convinced that the great majority of all classes of the profession must be against them. The indiscriminate admis¬ sion of all legally qualified apothecaries could not be tolerated by physicians and surgeons, as the largest proportion of them in this section of the empire, are druggists and oilmen, who were in prac¬ tice before 1815, who received neither a good general education, nor any medical education whatever. These men are surely not entitled to rank with licentiates in pharmacy, or with regularly educated physicians or surgeons. Such a union would be objected to by all, and can never be effected. No doubt it would be very agreeable to the surgeon apothecaries, or, as they are unclassically termed, gene¬ ral practitioners, pure apothecaries, pure surgeons, the druggists and oilmen who rank as apothecaries, and medical students, all of whom could have no objection to enjoy the rights and title of those who consumed their time and talents in universities, and complied with the regulations of the medical corporations, and whose general and scientific acquirements are infinitely superior to those of the above classes of medical men. No man who has studied in the medical and surgical schools of Scotland and Ireland, but must coincide in our opinion. Every man who has taken a surgical diploma in Dublin or Edinburgh, must acknowledge that the examinations are much more minute and severe in these places than in London, and it is well known that candidates who are rejected by the Dublin College, immedi ately proceed to Lincoln’s-inn Fields, and procure the diploma as a matter of course. Hence it is, that the members of the London College, who practise in Ireland, and they are a numerous body, are looked on with contempt by members of the Irish College, who will not meet them in consultation, and who will exclude them from hospitals, dispensaries, and all public institutions. The course of education required by the Edinburgh College of Surgeons, is also more extensive than that of the London College, and the course of education for the degree in medicine, is much more extensive than that for the diploma in Surgery, and yet the New College proposes to admit all members of the profession upon the same terms, and to include pure apothecaries, who know little or nothing of medicine or surgery. We might adduce many other objections, but enough have been advanced to convince any member of the profession, who will only reflect upon the subject, that the proposed College cannot pos-
Miscellanies.
M3
siblys ucceed. It has opponents, who never will allow it a legal foun¬ dation. Let its friends follow the judicious advice of the Chairman, to endeavour to reform the old institution, but let them not indulge in the vain hope of demolishing all the medical institutions in the country. The idea is Utopian. Let it not be said, that we are enemies to reform, we triumphantly refer to the pages of this Journal in.proof of our sincere advocacy in its favour, in which will be seen, we pro¬ ceeded to the lengths in exposing corporate monopoly and abuse, which no other physician in this kingdom Lad courage to attempt ; but in which reform or improvement in existing institutions, and not their suppression was defended. In offering thesej remarks, and declaring our opinions, we may incur the displeasure of the friends of the proposed institution, but in common, with the privileges of British subjects, we claim the right of freely expressing our opinions. We are not the advocates of any of the existing Medical Corporations, we have repeatedly proved all of them defective, and requiring reform. Having acquired the highest honours from four of the most respect¬ able of them, we may, we think, offer an opinion upon their rules, regulations and constitutions, which affect us individually, much more than any one who advocates the new measure.
10. Medico Botanical Society. — The gold medal of the Society is offered for the best essay in the English, French, German, or Latin language on the question, “ What is the vegetable substance which could be employed with success in the cure of hydrophobia V* And that the silver medal of the society should be offered for the best essay “ on the medical qualities and uses of any indigenous plant which is not yet sufficiently known, or on new uses and applications of any other indigenous plants/’ provided that such essay possesses sufficient merit ; and that they should be received till the close of the year, and that the medals should be bestowed at the next anniversary.
That each essay shall be accompanied by a sealed paper, contain¬ ing the names and address of the author, and marked in the same manner as the essay ; and that each essay to which a medal is not awarded, shall, according to the wish of the author, be restored to him or submitted to the council, in order to its being read at a general meeting.
11. London University .— W e are happy to inform our readers upon
the best authority, that the Government has determined to advise and recommend his Majesty to confer a charter on the London Uni¬ versity. The power of granting degrees in medicine and surgery on the plan of the University of France, will be given, and thus that salutary change or reform in the medical profession so long and so justly called for, will be established. Much opposition was given by the other Universities, but we need scarcely remind our readers that the present excellent and unequalled Ministry will not be deter¬ red from reforming whatever is found defective in the Institutions of the Country. • t
344
Miscellanies.
LITERARY INTELLIGENCE.
12. Dr. Uwins is preparing for the press a treatise on Mental Derangement, in which the subject of insanity will be considered in all its bearings, Statistical, pathological, preventive and curative. In this work Dr, U. will treat generally on nervous ailments and their connexion with disorders of the stomach and other organs.
BOOKS RECEIVED DURING THE MONTH.
1 Lecture, introductory to the Course of Medical Jurisprudence, delivered in the London University, on Friday, Jan. 7th, 1831. By A. T. Thomson, M.D. F. L. S. Professor of Therapeutics, &c. &c. Loudon. Taylor.
2. Address of Earl Stanhope, President of the Medico-Botanical Society, for the Anniversary Meeting, Jan. 16th, 1831, 8vo. London. Wilson.
3. Explanation of the Anatomical Atlas of Dr. M I. Weber, Professor at the Royal Prussian University, Frederick William, at Bonn, 8vo. 1831. London. A. Schloss.
4. Anatomical Demonstrations, or Colossal Illustrations of Human Anatomy. By Professor Seerig. Translated from the German, Part 2, 8vo. 1831. London. A. Schloss.
5. Lecture, introductory to a Course of Clinical Surgery, delivered to the Stu¬ dents of the Glasgow Royal Infirmary. By M. S. Buchanan, M. D. Member of the Faculty of Physicians and Surgeons, Glasgow, and one of the Surgeons to the Royal Infirmary, &c.
6. Professional Morality in 1831, or the Lawyer’s Defence of Medical Quackery, in which John St. John Long’s Discoveries are examined, and his claims to the confidence of the British Public, are criticised. By a Graduate of the University of Edinburgh, and a Master of Surgery and Arts, 8vo. 1831. Wilson. London.'
7 Proceedings at the Twelfth Anniversary Meeting of the Hunterian Society, held on the 16th of February, 1830, with the Report and List of Officers arid’ Members, &c. &c.
8. We beg to acknowledge the Receipts of Dr. Kennedy’s Tracts on the state of the Profession in India, which we shall notice in our next Number.
Books Received in Exchange.
The American Journal of the Medical Sciences, for Nov. 1830
The North American Medical and Surgical Journal, for Oct. 1830.
The Medico Chirurgical Review.
The Edinburgh Medical and Surgical Journal, for January, 1831.
The London Medical Gazette.
The Glasgow Medical Journal for Feb.
The Midland Medical and Surgical Rep.
We have received the National and Foreign Journals, with the exception of
some ot the french, which perhaps, may be accounted for by the state of Politics of our Contemporaries.
9. The best Surgical Plates we can recommend to Tyro, are the excellent illus¬ trations of Cooper s Surgical Dictionary, now in course of Publication by Mr Cocks. J '
AH Communications and Works for Review are to be addressed to the care of Messrs. Underwood, 32, Fleet Street; or to the Editor, at his Residence 61 Hatton Garden.
THE LONDON
MEDICAL AND SURGICAL JOURNAL.
No. 35. MAY 1, 1831. Vol VI.
CRITICAL REVIEW
L — Physiology of the Foetus, Liver and Spleen. By George Calvert Holland, M. D. Bachelor of Letters of the University of Paris, Lecturer on Physiology, and Joint Lecturer on Practice of Physic in the Sheffield Medical Institution. London, 1831, Svo. pp. 229. Long¬ man and Co. — ( continued .)
* - ’ ' . m t - •*
\j k - . - . - ■ ^ • •
Dr. Holland commences his physiology of the foetus with an account of the various opinions concerning its nou¬ rishment but a fevr, of these however, are detailed. He gives extracts from the works of Hippocrates, Galen, Harvey, Darwin and Bonetus, which prove that these writers sup¬ ported the theory of foetal nutrition by means of the mouth and umbilical vessels. He notices the opinion of Hoffman and Monro, primus , that the placenta was the chief source of nutrition, and then that of Mayow, Abernethy and Bos- tock, which is, the placenta was to the foetus what the lungs are to the adult.” Wilson Phillip’s hypothesis is next adduced, that the uterus generates a fluid similar to galva¬ nism. He next quotes the views of Geoffroy-St.-Hilaire, from the series of this Journal in 1824; next the doctrine of Buffon and Van-den-Bosch, which teaches the absorption of the amniotic fluid by the skin of the foetus, and lastly, the hypothesis of Dr. Lee, which will be noticed more fully in a subsequent article. Such are the writers referred to by our author; but they are only few who have discussed the sub¬ ject. This remark is verified by the following quotation from a work not expressly devoted to the physiology of the foetus.
vol. vi. no, 35.
Y Y
346
Critical Review.
“ Of all the questions of physiology, this has been the most dis¬ puted. Some have placed the source of nutrition in the water of the amnios, more than in the placenta, some in the vesicula umbilicalis and allantoides, others in the gelatin of the cord, and some in the decidua or epichorion.
“ Harvey and Diemerbroeck considered the water of the amnios highly nutritive and lacteous : and with Rudbeck, Haller, Darwin, La Courve, maintained it passed by the mouth to the stomach; while Alcmeon, Boheraave, Buffon, and Van-den-Bosch alleged it was absorbed by the skin. These opinions are refuted by the fact, that in cases of imperforation of the oesophagus, in acephalous monsters, and when the infant is born with all the outlets impervious, it is fully developed. It is foreign to the nature of this manual to notice all the physiological reveries upon this and other parts of my subject: but I cannot help inserting a few more upon this point. Lobstein held the fluid was partly absorbed by the genitals ; Osiander, Oken, and Muller, that it was absorbed and modified by the mammae, then conveyed to the thymus gland, and finally to the thoracic duct : while Schurigiqs, David, Rcederer, Scheele, Winslow, Heroldt, Beclard, and Geoffroy-Saint-Hilaire believe it to enter the trachea and bron¬ chi, and to be there elaborated for the purpose of nutrition. The general and received opinion of almost all physiologists is, that the placenta is the source of nutrition to the foetus. It has been said that the placenta is a respiratory organ to the foetus, and supplies it with oxygen.
“ During the early period of intra-uterine life, the embryo is nourished by the umbilical vesicle, which is continuous with the intestinal tube, which absorbs the fluid, which is carried by the omphalo -mesenteric vein to the heart of the embryo. The analogy of these vessels to the yolk of the egg renders this opinion probable. The absence of the meconium in acephalous cases (Elben), which, according to others, was the residuum of digestion, was considered an argument in favour of the passage of the amniotic fluid into the stomach. This fluid does depend upon the bile, and is absent when the liver is wanting. (Tiedemann.) The female nourishes her offspring with her blood, through the medium of the placenta; while the foetus possesses an organ for the further depuration of the blood, and the liver is that organ. (Bichat and others.) Tiedeman and Gmelin considered it the same in the adult. The researches of Dr. Stoker of Dublin, in his Pathology upon this point, are exceedingly interesting and satisfactory. — p. 82.
“ It has long been supposed that the great size of the liver in the foetus served some purpose, and, it is said is the organ which ef¬ fects certain changes in the blood. Lobstein thinks it the organ which effects certain colour of the blood (hematose) : Fourcroy, that it causes a decarbonization and a deshydro-genisition : and Stoker, a change in the hydro- carbonous principle of the blood; Prevost and Dumas, that it forms the globules of blood in the foetus; Geoffroy- Saint-Hilaire, that it secretes a large quantity of bile, which passes
Dr. Holland on Physiology of the Foetus, 8pc. 347
into the small intestines, and there determines the formation of an abundant quantity of mucus, which the foetus digests, and on which its developement depends. Dr. Robert Lee has endeavoured to prove, that the liver secretes an albuminous nutritive matter, which he found in the hepatic duct, duodenum, and small intestines; while he found an acid fluid in the stomach, and meconium in the large intestines. All these theories require further corroboration before they can be admitted.” — p. 86. Dr. Ryan s Manual of Midwifery or Compendium of Gynaecology, Third Edition, 1831.
Notwithstanding our author’s omissions, he evidently pos¬ sesses an intimate acquaintance with recent works on embry¬ ology, as appears by the following remarks : —
“ The striking difference that exists between the circumstances in which the human embryo is placed, as well as the degree of deve¬ lopement it attains during the first few weeks after conception, and those of the completely organized foetus, are of sufficient importance to form an essential distinction between embryotic and foetal life. — The term embryo is employed here to designate a being yet so imper¬ fectly constituted that few of its organs are formed, whereas, foetus is a denomination given to a being possessed of the principal organs which the animal exhibits when arrived at a state of maturity. — To a neglect of this distinction must be attributed the discrepant opinions which have, from time to time, been adopted to explain the nutri¬ tion of the foetus.
“ Those, who endeavoured to shew that it is entirely supported by the maternal blood, found a difficulty in accounting for its nourish¬ ment and growth during the time previous to a connexion being established between the uterus and the chorion; others, who ad¬ vanced a different opinion, were inclined to think that the foetus is altogether indebted for its nutrition to the fluids in which it is im¬ mersed. In support of the latter supposition it is stated, that these exist at a period when it cannot possibly have other means of suste¬ nance.” — p. 68.
“ The ovum which is found in the uterus immediately after impregnation, possesses within itself not only the principles of vita¬ lity, but fluids which are appropriated to the purposes of organiza¬ tion. The way in which these are modified, so as to assume a deter¬ minate form, is one of the secrets of nature, with which we are, and probably shall ever be unacquainted, but it cannot be denied that the diversified forms they assume are the result of vital operations. A vascular connexion, at this time, with the uterus, would be of no service to the embryo, because there are no internal organs suffici¬ ently developed to receive and distribute the blood, until the rudi¬ ments of a circulatory system exist; the sanguineous or any other fluid which might be derived from the uterus could not be applied to the formation of the embryo, but the warmth and moisture which
348
Critical Review.
the uterus possesses are perhaps as essential to its growth as the warmth communicated to the egg during incubation. When the vital actions have proceeded so far in the organization of the foetus, as to create, although imperfectly, the heart, the vena porta and the aorta, the umbilical cord may be distinctly perceived, and it very soon establishes a connexion between the chorion and the uterus.* When this union is fully established the embryotic is changed into foetal life, and the latter is exclusively nourished by the arterial blood of the mother” — p. 70.
This explanation of foetal life is not sufficiently clear or satisfactory,, or accordant with recent opinions. The im¬ pregnated ovum does not immediately descend into the uterus ; for it was found three days after conception in the uterine tube of rabbits, by Cruickshank and De Graafe j and, about the sixth or eighth day, in bitches, by Prevost and Dumas. Besides, it was held by W. Hunter, Chaussier, and almost all physiologists, that the decidua is formed immediately after conception, and becomes united to the chorion after the descent of the ovum into the uterus, about the fifth day after impregnation, according to Meckel, and the eighth according to Sir E. Home. The amnios has been injected from the mother by Monro and Weisberg, and from the foetus by Chaussier. Our author has also forgotten the existence of the vesicula umbilicalis, between the chorion and amnios. (Wolff, W. Hunter, Oken, Bojanus, Meckel, Pockels, Tiedemann, Duges and Velpeau, with its arteries and veins (the ompholo-mesenteric), a vesicle which nou¬ rishes the embryo for the first two months, by the albumin¬ ous fluid it contains. Professor Velpeau contends that the placenta is formed as soon as the ovule descends into the uterus. Elem. des Aecouch. 1829. According to this ample evidence, there is a vascular connexion between the uterus and embryo, before the organs of the latter are sufficiently developed to receive and distribute the blood.
Dr. Holland proceeds to disprove the opinion that the amniotic fluid, which he very strangely denominates the amnios, nourishes the foetus, and he occupies too much space in refuting an opinion which nobody of the present age maintains, neither need he take the trouble of exposing the fanciful hypothesis of Geoffroy-St.-Hilaire, that the aminios evolved respirable gas, which was absorbed by the
* Adelon, Physiologie del ’Homme, vol. IV. p. 345.
Dr. Holland on Physiology of the Foetus, <$fc. 349
cutaneous veins of the fcetus. This was also the opinion of Lassaigne, which was long since satisfactorily refuted by Chevreul. Our author observes —
“ That the amniotic fluid contains a respirable gas, is a fact proved, according to the statement of Geoffroy-Saint-Hilaire, by experiment. Is it not more than probable, that analytical processes to ascertain the exact composition of a fluid, discover not only what it possesses in its natural condition, but likewise disengage gases that were previously in combination with its different chemical prin¬ ciples ? If it were even allowed, that the amnios contains a respira¬ ble gas, insuperable difficulties are connected with its production and mode of action. It is imagined to be taken up by the pores of the skin, which act like so many tracheas. If these have sufficient energy to absorb, the skin must also be able to secrete : the two functions must coexist. What becomes of the secretions? As they are necessarily poured into the amniotic membrane, they must con¬ tinue to accumulate from the commencement of foetal life to its com¬ pletion; and therefore, it is improbable to suppose, that a pure oxygenating principle could exert any influence under such circum¬ stances.” — p. 83.
The next point upon which our author comments, is the universal opinion that the placenta is capable of oxygenat¬ ing the blood it receives. This is the opinion of Bostock* and almost all physiologists. Objections are urged against this doctrine.
“ The placenta does not exhibit one single property which can justify the physiologist in comparing it with the lungs. Its texture is widely different, and its situation and relations are as dissimilar, as it is possible for those of any two organs to be. Is an extraordi¬ nary galvanic or nervous influence connected with the placenta, and exercised in a mysterious manner during gestation ? Unless we believe in the existence of such an influence, it is absurd to suppose that the placenta is capable of aerating the sanguineous fluid. It may be stated, as a universal law, that whenever venous becomes arterial blood, air is received directly from without, and whatever is excrementitious is expelled directly from within. If venous blood be placed in a bladder, it becomes florid in appearance. In this case, oxygen disappears, and carbonic acid is formed. But how can the placenta improve the qualities of blood, without oxygen, and the con¬ currence of those organic adaptations which characterize the respi¬ ratory organs throughout the animal and vegetable kingdoms ! Can the blood act upon itself and cause such an effect? If the placenta oxygenate the blood, whence does it derive the necessary power, and how does it remove the excrementitious product? If it be acquired from the arterial fluid circulating in the uterus, whence does it derive the properties of nutrition ? The observation of Sir E. Home seems
350
Critical Review.
to imply, that air only is received from the mother. “ The foetal blood,” he says, is close enough to that in the vessels of the uterus, to have the air communicated to it.” It ha‘s been remarked, in the preceding pages, that venous does not become arterial blood, merely from the influence of oxygen, but from its qualities being continually renewed by chyle.” — p. 86.
There is a good deal of force in this reasoning, but we must bear in mind how very superficially the function of the placenta is described in this extract, and how very ques¬ tionable both the author’s premises and conclusions must appear on a minute consideration of the subject.
“ The circulation of the placenta is also differently explained. Some say, the foetal arteries deposit the blood in the cells of the placenta, whence it is absorbed by the maternal veins, is carried to the mater¬ nal lungs to be vivified, and afterwards brought by the arteries to the placenta. Others maintain, that a portion of the blood deposited by the umbilical arteries is absorbed by the veins of that name, and returns to the foetus. M. Velpeau raises a formidable objection to the first opinion. He says, if the blood of the umbilical arteries is deposited in the placental sinuses, it must evidently mix with that of the uterine arteries, which is effused in the same place ; it is there¬ fore necessary to suppose that the absorbent mouths of the umbilical vein have the faculty of choosing the arterial blood from this mixture, as the uterine veins do not take but the venous (arterial) blood. On the other hand, an injection will pass with the greatest facility from the arteries into the veins of the placenta, without effusing itself upon the uterine surface of that body; therefore the blood of the foetus is not taken up by the uterus. The reader should refer to the remarks upon the placenta in a former page for solid objections against this reasoning, where he will find strong arguments against this conclusion. M. Velpeau is inclined to sup¬ pose that the arterial blood of the foetus undergoes its changes by a molecular action in the placenta, which though inexplicable may be still correct. He thinks it may be compared to the capillary system after birth : to what takes place in secretory organs, and in the lung itself. The fluids of the ovum are in mediate contact with those of the woman; but a change may take place analogous to that in the lungs between the atmospheric air and the venous blood. However ingenious this hypothesis appears on paper, it is decidedly erroneous. It is only necessary to reflect upon the utter impossibility of suppos¬ ing the foetus to form its own blood, that is, to grow and daily increase in size without a supply from the mother. Again, every one at all conversant with obstetrics is aware of the innumerable vessels which pass from the uterus to the placenta, and the haemorrhage con¬ sequent to their rupture. It is really astonishing that a physician so intimately acquainted with obstetrics, and every branch of medical
Dr. Holland on Physiology of the Foetus , fyc.
351
science, as Professor Velpeau is, could seriously suppose such a doc¬ trine.” — p. 86. L )r. Ryan, ut supra.
The last hypothesis noticed by our author isDr.Lee’s, which is “ the liver of the foetus secretes an albuminous fluid, which is absorbed by the smaller intestines, and contributes to the support of the system.” Phil. Trans. Part I. 1829. Upon this hypothesis our author comments with great force and reason.
“ In examining impartially the merits of this hypothesis, we shall find it as unphilosophical and untenable, as those opinions which have hitherto been entertained on the same subject. 1st. In regard¬ ing the liver as an organ secreting the albumen, Dr. Lee does not appear to take into consideration the absurdity of attributing to an organ, two such opposite functions, as the secretion of albumen one moment before birth, and of bile the next moment. The peculiar secretion of an organ is not regulated by the quantity of blood it receives, but by its structure. Every organ, throughout the animal economy, has an independent and exclusive function. The differ¬ ence between the properties of albumen and those of bile, is as great as between any two secretions of the body ; and to say that the liver can secrete both, is as absurd as to assert that there is no necessary connexion between the quality of a fluid, and the structure of an organ which determines the nature of it.
2dly. It is allowed by the first authorities in physiology, that the umbilical vein carries to the foetus arterial blood: the silence of Dr. Lee on this point, and the importance which he attaches to the blood circulating in the liver, lead one to infer that he entertains the same opinion. If the blood received from the uterus is arterial, what occa¬ sion is there for its being converted into albumen, in order to nourish the foetus ? It might just as reasonably be supposed that the arterial blood of the adult, produced by digestion and oxygenation, cannot contribute to the nutrition of the body until it has been converted into albumen. If arterial blood, possessed of its ordinary properties, be communicated to the foetus, it requires no further change to render it fit for the purposes of nutrition ; if it be venous blood which is received, we have no evidence at all, that the system ever is or can be sup¬ ported by it, and still less that an organ furnished with it can secrete albumen. As albumen exists in the blood, it would appear, if the ideas of Dr. Lee were correct, that nature is not very consistent in her operations, while she, at one moment, draws from the blood nutritious properties, and, at another, absorbs them to convey them into the same fluid.
3dly. If the liver secrete albumen, its presence, it may be further observed, ought to be indicated by the same general appearances that prove the secretion of bile ; of the existence of the latter we have the strongest evidence. The gall-bladder and ducts contain, at all times a considerable quantity of it; but, during foetal existence, the gall-
352
Critical Review.
bladder is so far from being filled with albumen, or exhibiting the least appearance of it, that it contains bile; and instead of the hepatic and common ducts manifesting unequivocal traces of it, “in general,” Dr. Lee says, “the hepatic and common ducts of the liver have been found empty, or have contained too minute a quantity of fluid to be collected for chemical investigation ; but in the two instances above mentioned, it existed in unusual abundance, and was pressed out upon a plate of glass without mixing with the bile of the gall-bladder.” Dr. Lee examined above' twenty foetuses, and yet, in two only, found a sufficient quantity to be pressed out upon a piece of glass !
“ 4thly. If the liver be an organ which secretes albumen for the support of the foetus, how, I would further ask, is its nutrition to be explained in those cases of malconformation, in which the organ is entirely wanting ? Many instances of this kind are on record, Mr. Brodie relates a case, in which no liver could be found ;* others are mentioned by M. Mery,f Dr. Le Cat,f and Dr. Clark. §
Dr. Holland describes the functions of the placenta, and notices the opinions of Harvey, Fabricius, Prevost and Dumas, Magendie, Monro, primus, Adelon, Bostock, Bro¬ die, Sir E. Home, and arrives at the following' conclu¬ sions : —
“ 1st, The foetus derives its blood exclusively from the mother.
“ 2dly, The placenta is an organ incapable of producing che¬ mical changes in the blood.
“ 3dly, The foetus has not in activity any organs that can in the least oxygenate the blood it receives.
“ 4thly, Venous blood cannot support organic life.” — p. 95.
He agrees with the general opinion, that there is no direct communication between the uterus aud foetus. He holds the absorption of the maternal blood by the umbilical vein, and that of the foetus by the uterine veins. In fact, he has not added a single new idea to this disputed point of physiology. He compensates for this deficiency by a most ingenious view of the causes u of the temperature of the foetus.”
“ There are certain points connected with the consideration of the present subject, that have not as yet been fully explained, and which are intimately related to the views already proposed, concem-
* Lond. Phil. Trans. Part I. 1809. t Histoire de l’Academie Royale des Sciences, 1720. X Ibid, 1740
$ Lond. Phil. Trans. 1793.
Dr. Holland on Physiology of the Foetus, §c. 353
mg the nutrition of the foetus. It has been proved by experiment, that the temperature of the foetus is seldom above 92° or 95° Farh. It is said to be higher when the foetus lies dead in the uterus. “ If this fact is correct,” observes Magendie, “ the foetus must possess some means of lessening the temperature that does not exist after birth.” If according to the principles previously stated, we regard the foetus as receiving arterial blood from the mother, we shall find few difficulties in attempting to render these phenomena more intel¬ ligible. It is satisfactorily ascertained that the sanguineous fluid loses a portion of its animal heat, as it recedes from the centre of cir¬ culation. The foetus is supplied with blood from the spermatic and uterine arteries, and as this fluid in its passage to the placenta is con¬ siderably removed from the source of its oxygenation, it is reasonable to imagine that its temperature is slightly diminished, when it reaches this organ.
“ It will indeed scarcely be denied, that such a change is likely to be produced, when it is absorbed and conveyed to the foetus, which possesses no means of generating animal heat. Although the foetus is incapable of contributing to its own support, by renewing the vital qualities of the blood, yet, as the process of assimilation is active, and as the excretory functions of the skin are carried on in a modi¬ fied degree, those causes are in operation which must tend to diminish the temperature of blood circulating in the foetus. There is undoubtedly a great difference in the state of the sanguineous fluid in one body, in which it is continually renewing its heat, and in another, in which no similar change takes place.
“ There is another reason, which, in conjunction with the above, seems sufficient to account for the low temperature of the foetus. The whole of the adult blood passes once, every two or three minutes through the lungs, and is, consequently, completely acted upon by atmospheric air, but when the foramen ovale continues open after birth, the temperature is several degrees less than natural. This dif¬ ference arises evidently from the imperfect oxygenation of blood. The whole blood of the foetus is not exactly renewed in the same time as that of the adult, and on this account, the temperature of the foetus will be less. The arterial blood conveyed to the vena porta and the vena cava inferior, is mixed with the venous blood of the vena cava superior in the right auricle of the heart, and, therefore, the arterial blood of the foetus is not so purely arterial as that of the adult. It is not difficult to explain why the temperature of a dead foetus is higher than that of a living one. In the former, none of those functions are in action which diminish 1 he heat of the blood, as circulation, assimilation, and excretion from the skin, all of which exist in the latter.
“ If the dead foetus be regarded as a mass of inorganic matter, the degree of its temperature will illustrate a common law in physics, that heat has a tendency to diffuse itself through contiguous bodies until an equality of temperature is established. The warmest give
VOL. VI. no. 34.
z z
354
Critical Review.
out, and the coolest receive, until they have attained a uniform degree of heat. It is, therefore, manifest that as long as the dead foetus remains in the uterus, it will be of the same temperature as the mother. If this explanation is considered satisfactory, it is obvious that the conclusion of Magendie is fallacious, viz. that “the foetus must possess some means of lessening the temperature that does not exist after birth.” — p. 128.
The remaining chapters are on “ the origin of the liquor amnii and meconium ;” “ the nutrition and peculiarities of the foetus;” ft the brain, spinal cord, stomach, liver, pan¬ creas, and intestines not essential to foetal life tf of the functions of the liver, supra-renal capsules, thymus and thyroid glands in the foetus;” “ the mode of nourishment in the oviparous and ovo-viviparous animals, and on the influence of the mother’s imagination on the developement and constitution of the foetus.”
The whole of these subjects are ably discussed, and the author is exceedingly powerful in his refutation of the erroneous notion of the influence of the mother’s imagina¬ tion upon the foetus in utero. The work evinces much origi¬ nality, extensive research and powerful reasoning, and will be highly interesting to the physiologist. It will add to the well-earned reputation of the author.
IJ. — The Effects of the Principal Arts , Trades and Pro¬ fession s, and of Civic States and Habits of Living , on Health and Longevity. By C. Turner Thackrah : London, 1831. Longman and Co. Leeds, Baines & Co. — ( continued.)
We resume our analysis of this very important and instruc¬ tive little work, as its contents will be perused with advan¬ tage by young practitioners. The author observes —
** Colliers have considerable muscular labour, chiefly in the sitting or kneeling posture, and with the body bent over to the greatest de¬ gree. They work in an unnatural atmosphere, and with artificial light. They are exposed to changes of air, and occasionally they work with their feet in water. Perspiration at other times is so great as to cause them to be almost naked. They generally work from four a. m. to four or five p. m. and take little food while in the mine. — Colliers are generally spare men, the spine is almost always curved, and the legs are often bowed. The skin, of course, is loaded with
Mr. Thackrah on Health and Longevity .
355
dirt ; and when this is removed, the complexion seems sallow and unhealthy. Their eyes appear small, affected with chronic inflam¬ mation, and intolerant of full light. Colliers are subject to disorders of the head, muscular pains, particularly in the back, to rheumatism and asthma. They are well known to be liable to severe accidents from the fall of parts of the mine, and to much more dreadful effects from the explosion of the carburetted hydrogen. The air they com¬ monly inspire is adulterated with hydrogen and other gases. That of carbonic acid has, in certain circumstances, been so largely deve¬ loped by the accidental burning of the coal as to produce fatal or dangerous effects.*
“ Boys enter the pits at the age of six or seven, and are employed in opening the trap-doors, driving the horses, propelling the trucks, &c. and finally, when of sufficient age, they become colliers. Sickness and vomiting sometimes affect persons at their commencing the em¬ ploy ; and many, after a few years’ trial, are obliged, by the injury which their health has sustained, and especially by the weakness of their eyes, to leave the mines. Colliers are not habitually intempe¬ rate ; but in this neighbourhood they have a periodical debauch, for¬ merly once a fortnight, now once a month. They do not generally exceed the age of fifty, though many exceptions are to be found. We saw one asthmatic individual, seventy years of age, who had worked fifty years in the mine.
“ The prevention of danger in coal-pits is so well known as to require no detail. I need only mention the use of the safety-lamp, the examination of the state of the air, especially in pits re-opened, and the practice of ventilation. If the overseers and workmen prac¬ tised what they know, accidents would be comparatively rare.
“ Well-sinkers have great labour, and are frequently obliged to respire carbonic acid and other gases found in wells. While working in such impure atmosphere, they feel dizziness and a sense of suffo¬ cation, and if the injurious agency be in great degree, animation is suspended, and sometimes destroyed. By a less degree, when con¬ tinued for some time, health is affected. The men complain of head¬ ache, sickness, and loss of appetite, and are unable to work for days or weeks.
“ The evils of the employ, care would in a great measure obviate. Every workman knows that a light will not burn in the foul air : yet the simple experiment is often neglected. The introduction of fresh air by bellows into wells, thus found to be dangerous, has but a par¬ tial effect . A more promising plan is recommended in Rees’s Cyclo¬ paedia, Art. Well . — p. 29. >
* See in the Edinburgh Medical Journal , vol. 32, a short but interesting paper by Mr. Watson, of Wanlock Head, on a case of this kind Headache, giddiness, tingling of the years, vomiting, tremor, with extreme debility, succeeded to the par¬ tial or general insensibility, which the gas had produced. Three or four individuals appeared afterwards in a state of intoxication.
Critical Review.
Mr. Thackrah next considers “ employments which pro¬ duce dust , odour, or gaseous exhalations He adverts to operatives whose employments connect them with animal and vegetable substances, who are all subject to atmospheric impurity. The effects of animal substances are not deemed important enough to require consideration, and the odours, exhalations and dust, produced by vegetable matters, are then noticed.
“ Starch -makers are exposed to a fetid acetous odour, which rises from the fermenting wheat, or rather from the water in which the wheat has been steeped. The rooms are wet and cold. The men do not apparently suffer from the employ.*
Rectifiers of spirit, and men engaged in wine and spirit vaults, are subjected to a vapour which, though it sensibly affects those who are not accustomed to it, does no evident injury to those who inhale it daily.
“ Bricklayers, and particularly their labourers, are exposed to lime dust. This frequently excites ophthalmia and cutaneous eruptions, but not internal diseasef.
“ The remark applies also to lime- workers and leaders of lime.
“ Plasterers and whitewashers, who are also of course exposed to lime -dust, suffer from it no sensible injury. They are, however, more pallid and less robust than the men last noticed. They com¬ plain of the ammonia, cal gas evolved from the glue ; but I doubt its injurious effects.
“ Woolsorters are occasionally annoyed with dust from the lime, which in some kinds of wool is employed for separating the fleece from the skin. No sensible effect is produced on health.
“ Turners, when employed on bone, receive into the throat and air passages a considerable portion of dust. This, however, is said to be rather grateful than noxious.
“ Tobacco-manufacturers are exposed to a strong narcotic odour, and in the stoving department to an increase of temperature. Yet the men appear healthy. Here, as well as in several other employ¬ ments, we admire the agency of that conservative principle, to which I lately referred. Men breathe an atmosphere strongly impregnated with a poisonous substance, yet become insensible to its influence. The only ill effect we can find is from the heat of the stoving depart¬ ment, which all men cannot bear.
“ Snuff-making is more pernicious. The fine dust of the tobacco, combined with muriate of ammonia, and other substances, produces disorders of the head, the air-tube, and the stomach/’ — p. 33.
* I state of course what we observed : but the number of starch-makers in Leeds is comparatively small. Merat says that if the odours be in great quantity, they produce cough, difficulty of breathing, paleness, and emaciation.
. f We hear an adage in the mouth of the workmen, that “ bricklayers and plas¬ terers’ labourers, like asses, never die.”
357
Mr. Thaekrah on Health and Longevity.
Our author next describes employments in which the substances or odours evolved,, are generally or partially beneficial ; and these he illustrates by the following ex¬ amples : —
“ Rape and mustard- crushers inhale a peculiar odour from the seeds which they grind. This seems to act as a stimulant on the nervous and circulatory systems : for men fresh to the employ find their appetite and vigour increased. The heat of the room is con¬ siderable, often reaching 80° in summer. Though addicted to in- temperence, the men employed in oil-mills are generally healthy. * We remarked one man between 70 and 80 years of age, who had been all his life at the employ, and was remarkably strong and robust.
“ Brush-makers have a sedentary occupation, but their arms are actively exerted. Some dust arises from the bristles ; and some ¬ times carbonic acid gas is rather freely evolved from the charcoal fire which heats the pitch. But the chief peculiarity of the employ is the vapour of the pitch. This has a sanative effect in bronchial affec¬ tions, as chronic catarrh, and in some forms of asthma. The work¬ men are generally free from disease. Several in Leeds have been at the employ for thirty years ; and instances are mentioned of brush- makers reaching the ages of 80 and 90.
‘ ‘ Grooms and hostlers daily inhale a large quantity of ammoniacal gas generated in the stables. This appears beneficial rather than injurious. They have, moreover, full and varied muscular exertion; and if they took a more moderate diet, would be almost universally robust. Hostlers, porters, and under-male servants at inns, are generally sickly, and labour under congestion of the vessels in the abdomen and head. Their state evidently results from the ale and spirits they take so frequently.
“ Glue and size-boilers are exposed to strong putrid and ammo¬ niacal exhalations from the decomposition of animal refuse. The stench of the boiling and drying rooms is indeed well known to be highly offensive, even to the neighbourhood. Yet the men declare it agrees well with them — nay, many assert that on entering this employ, they experienced a great increase of appetite and health. All the glue and size boilers we saw, were remarkably fresh-looking and robust. Though exposed to frequent and considerable changes of temperature, to sudden changes also from an atmosphere of hot vapour to the dry cold air, they are not subject to rheumatism, pul¬ monary inflammation or catarrh. The only complaints we could hear of, were occasional pains in the loins and limbs, attributable to posture and exertion.
* At one mill we were informed that, rheumatic affections are frequent, and that men a day or two absent from work are particularly subject to pains in the joints, but we did not find this observation confirmed at other places.
358
Critical Review.
“ Buckram-manufacturers are exposed to the odour of the glue. This is well known to be so great as to offend the neighbourhood of the manufacture. Yet the men make no complaint of ill-health, and reach considerable age. Of the seven men employed at the Buck¬ ram-house, in Water-lane, one is 51, another 58, a third 68, and the fourth 7 6 ; and these individuals have been at the employ from an early age.
“ Tallow-chandlers, subjected to an offensive animal odour, enjoy health, and attain a considerable age. During the plague in London it was remarked that this class of men suffered much less than others.
“ Tanners, it is well known, are subject to disagreeable odours. They work in an atmosphere largely impregnated with the vapour of putrifying skins, and this combined with the smell of lime in one place, and of tan in another. They are exposed constantly to wet and cold. Their feet are scarcely ever dry. Yet they are re¬ markably robust ; the countenance florid ; and disease almost un¬ known. Tanners are said to be exempt from consumption ; and the subject has of late been repeatedly discussed in one of the medical societies of London. We have carefully inquired at several tan- yards, and could not hear of a single example of this formidable disease. We do not find old men actually in the employ ; and the reason assigned is, not the decline of health, but the inferiority of men past middle age, in undergoing the labour of the process. Persons, however, in advanced life, yet healthy, are found in other occupations, who have before been for many years in the tan-yards, and have not apparently suffered from the long continued exposure to their offensive odour. Hence we may infer that this employ, while it invigorates the constitution in youth and middle age, does not sensibly shorten life ; does not, in other words, give temporary health at the expense of premature decline.
“ Ramazzini tells us that at Padua the tan-yards were permitted only in the suburbs. Here also, as the stench would be considered a nuisance, tan-yards are at the outskirts. As a matter of medical police, however, we see no occasion for their exclusion from the town.
“ The observations under this head apply also to slaughter-men, but their employ was mentioned with that of the butchers.” — p. 37.
fe Employments producing a dust or vapour, decidedly injurious ”
“ Corn-millers, breathing an atmosphere loaded with the particles of flour, suffer considerably. The mills indeed are necessarily exposed to the air, — the number of men is comparatively small, and the labour is good. Yet millers are generally pale and sickly ; most have the appetite defective, or labour under indigestion ; many are annoyed with morning cough and expectoration ; and some are asthmatic at an early age. The average circumference of the chest
Mr. Thackrah on Health and Longevity . 359
in ten men, whom we measured, was 36 2 -5th inches ; and the quantity of air thrown out by a full expiration was somewhat less than seven pints. Though we found several who had borne the employ from boyhood to the age of 50 or 60, the individuals were by no means robust ; and we could not find an instance of an aged and healthy miller. The preceding statements do not apply to the men who drive the corn and flour carts, nor to the porters who un¬ load the grain. These persons are little exposed to dust, labour chiefly in the open air, and are generally selected for their muscular power. They are, however, like other men who carry great weights, subject to hernia.” — p. 37.
“ Maltsters are exposed to much dust, particularly in the grinding and screening departments, and to sulphurous fumes from the coke. The heat of the kiln is of course great. We have found the at¬ mosphere in the drying-room above 80°, and the malt on the floor 14U°. The men are frequently affected with bronchial inflammation, and many become asthmatic for life. The exertion is so great that it obliges some to leave the employ at an early age, and it is much too severe for the old. Hence we find no labouring maltster ad¬ vanced in years.
“ Tea-men, in removing tea from the chest, are much affected by the dust, especially by that from the green. But as this annoyance is occasional only, we can scarcely suppose it capable of producing permanent injury either to the nervous system or the lungs.
“ Coffee-roasters are affected by the odour, which the heat elimi¬ nates from the berry. And those who have been thus employed for years, are said to become asthmatic. The vapour is greatest when the coffee is stirred or shaken during the time of cooling. The heat of the process is of course great, and leads often to immoderate po¬ tation. Men, when they enter the employ, complain of oppression at the chest, difficulty of breathing and cough,— of headache and indigestion.” — p. 39.
Snuff-makers, rag sorters, paper makers, willyers in cloth mills, and workers of flax, suffer severely from dust, and are liable to bronchial affections. Our author makes many ingenious suggestions for substituting machinery for the performances of the work in many of these trades.
“ Cabinet-makers suffer from the dust, when they saw African, cam, rosewood, and Spanish mahogany. The first of these is most injurious. Its dust produces sneezing, headache, sickness and some¬ times vomiting. This wood, however, is rarely used. The other kinds are more frequently worked. They occasion indigestion, and sometimes diarrhoea.
“ Turners of wood suffer from the dust of the species just men¬ tioned, but are not annoyed by that of common timber. The
360
Critical Review.
removal of wood-dust would not, I conceive, be difficult. A cur¬ rent of air might be made to take it out of the building. See the plan suggested for the expulsion of flax dust.
“ Masons inhale particles of sand and dust, which arise from chipping the stone. They often use great muscular exertion in lifting weights ; they are exposed also to vicissitudes of the weather ; they are addicted to intemperance. We promptly find the effects of these circumstances on their physical state. From their exertion in the open air, their face has colour, and the figure is muscular and robust : inhaling dust, the bronchial membrane is often in a state of chronic inflammation : dissipated in their habits, they become sus¬ ceptible of atmospheric changes, and hence are frequently affected with pains in the limbs : finally, from the combination of these in¬ jurious agents, dust and dissipation, and the mutual reaction of morbid states thus induced, masons are short-lived, dying generally before they attain the age of 40.” — p. 48.
III. — An Introduction to the Study of Human Anatomy. By James Paxton, Member of the Royal College of Surgeons, Author of the Notes and Illustrations of Paley’s Natural Theology, with Illustrations. London, 1831, 8vo. pp. 414. Sherwood, Gilbert and Piper ; and J. Vincent, Oxford.
This work contains a clear and concise demonstration of the human body, and embraces graphic and descriptive anatomy on the same page. The author’s object is to furnish the student with sufficient directions for cultivating this branch of science in the shortest and most successful manner ; and for this purpose, a correct drawing, and an exact description of the parts, are given on the same page. The work is ably executed, and affords the student the greatest facility in acquiring information on anatomy. It contains two hundred and eight drawings, all of which are most faithfully executed. It is a work of great utility to the medical student and all scientific persons, as it illustrates human anatomy with great accuracy and fidelity. It has a great sale, and it well deserves it. It is a beautiful spe¬ cimen of typography ; the wood-cuts are executed in a superior style; the descriptions are simple and scientific; and the work, upon the whole, is interesting to the general and medical reader.
361 ]
IV. — Introductory Lecture, delivered at the Hull General Infirmary , Nov. 12, 1830. By James Alderson, M.D.
Fell ow of the Roval College of Physicians, London, &c. Hull, 1831 : Wilson.
In this lecture the author gives a popular account of the physiology of the animal and vegetable kingdoms, and such as need not be inserted here, as it is familiar to our readers. He illustrates his positions by several well- executed wood cuts, and affords much interesting information to the general reader. He then concludes his lecture by making some excellent remarks on the ethics of our profession, which are well worthy of attention.
“ I here conclude my brief outline of one of the branches of physiology, which I have entered upon only slightly, rather as a specimen of the fund of beauty and interest which may be drawn from a closer investigation, than to furnish you with an entire view of the subject, for which the space of many lectures would be insufficient. The young medical student will see, by this introduc¬ tory sketch, that he is not entering into a dry and uninteresting course of study, but one replete with evidences of the most perfect design, and objects calculated at every step to call forth feelings of gratitude and admiration, and to impress his mind with the great truth, that the Creator of nature does all things wisely and for the best. So far we may rather consider his progress through this branch of study as a delightful recreation. In the pleasure at¬ tending his pursuit, he must not, however, lose sight of the object he has to attain. In the words of Locke, I may remind him that “ the end of study is knowledge, and the end of knowledge prac¬ tice or communication.” It is not merely in the light of a profes¬ sion, considered as a means of living, that the practice of medicine ought to be regarded, but as a happy means of benefiting his fellow creatures, of administering comfort, and of prolonging life. And in the long and laborious process of qualifying for the performance of its duties, there are many branches of tedious and difficult study to be encountered, many where doubt and obscurity might almost dis¬ courage him, had he a less important object in view.
“ The value of medical science, even as a branch of general education, is strikingly set forth by one of our first moral philoso¬ phers, who, in speaking of the early studies of a still greater man, bears this testimony to its importance : — “ No science,” says Dugald Stewart, “ could have been chosen more happily calculated than medicine, to prepare such a mind as that of Locke, for the prose¬ cution of those speculations which have immortalized his name ; the complicated, fugitive, and often equivocal phenomena of disease,
3 a ' ;
VOL. VI. NO. 35.
362
Critical Review.
requiring in the observer a far greater portion of discriminating sagacity than those of physics, strictly so called; resembling, in this respect, much more nearly, the phenomena about which meta¬ physics, ethics and politics are conversant.”
“ The primary principle which influences the conduct of the upright medical man is, a desire to benefit his fellow-creatures by his profession ; unremitting diligence to attain the utmost height of scientific truth and practical information, is the means by which he acquires power to pursue this purpose ; and a careful cultivation of all the charities and courtesies of life enables him to give full value to his power of relieving, and to render his exertions .not only salu¬ tary but soothing and gratifying. I believe that I have here com¬ prehended all that comes under the head of Medical Ethics.
“ Zeal, and activity, and an entire devotion of time and intellect may reasonably be required for a profession which is not to be easily learned, or carelessly practised. When we consider that one error may never be retrieved, and may involve the life of a patient, an awful responsibility presents itself, and we may perceive an impera¬ tive obligation to bring every energy we possess to bear upon the duties of our calling.
‘ ‘ There is no qualification more valuable to the medical man than the power of coming to a prompt and rapid, though not hurried, decision. In many cases, indecision is as dangerous as bad prac¬ tice ; for while hesitating about the course to be pursued, the time for acting with effect may pass, never to be regained. He should therefore cultivate a habit of concentrating his reasoning faculties and his store of acquired knowledge, so as to apply them as promptly as possible to the exigencies of the case before him.
“ Obstinacy and prejudice are the attributes rather of a weak than of a vigorous intellect ; and consequently the man who is most active in drawing from the resources he already possesses, will also be most ready to receive and work upon any new suggestion from ..others, which his candid judgment will acknowledge to be valuable. The quack and the half-learned are alone averse to receive informa¬ tion, whether it proceed from their own brethren or from others ; and the plain good sense of the patient, and not unfrequently of the anxious and devoted friend who watches him, will sometimes sug¬ gest hints which the ablest physician may not disdain to improve.
“ It is of the first importance to the medical man that, in his intercourse with society, he should preserve a character of unble¬ mished purity. Moral obligations are in reality equally binding upon all, but to those in most other situations, the penalty of infring¬ ing them is comparatively remote, while to the medical man, repu¬ tation may be considered as a means of existence. He is placed in a situation of the utmost trust and confidence, and there is a peculiar delicacy attached to his character, which makes the breath of slander as dangerous to him as to the dearly-prized reputation of woman.
“ Indulgence and excess are known to be detrimental to intel¬ lectual as well as to bodily strength — they not only draw largely
Dr. Alderson’ s Introductory Lecture.
363
on the time which should belong to better things, but deprive the medical man of the power of always preserving that gentlemanly and appropriate demeanour which ought to distinguish him. He should always be at his post ; always in a fit state to attend to the responsible duties of his station. There is a delicacy both of senti¬ ment and of manner, which the sensualist never can preserve, and without which no man is fit to be admitted into the confidence of his patient.
“ The medical man, whose darling object is popularity, and who seeks from the hands of the public the reward of his labours, will often be disappointed. With him, patience is a lesson which will have to be frequently studied ; for the ignorance, the caprices, and the prejudices of society will all unite to destroy his equanimity. Every person conceives himself capable of giving an opinion on medical subjects, and of canvassing the merits of the practitioner ; and as we are sometimes made indignant by ignorant and unjust censure, we are, at others, no less humbled by blind and misplaced eulogium. But I shall not dwell upon the trials of our profession. Though we have all difficult and distressing parts to act occasionally, we have also many delightful and gratifying circumstances attending the practice of our calling ; — and, besides the happiness of being the means of restoring health and comfort, we have, in most cases, the satisfaction of meeting with the best feelings of kindness and gratitude.
“ The last requisites that I shall mention are gentleness — benevo¬ lence — sympathy. In a sick room, rough and noisy manners are peculiarly inappropriate ; mildness and tranquillity should alone pre¬ sume to enter there. It has been asserted, though I hope unjustly, that constant familiarity with disease renders the medical man less alive than he would naturally be, to feelings of compassion ; the contrary ought to be the case, When the spirits of the patient are weakened by disease and anxiety, the feelings are acutely sensible of the value of kindness and sympathy, — of
“ The graceful tear that streams from others’ woe.”
AKENSIDjJ,
A manner which indicates benevolent concern for the sufferings of the patient, is sure not only to give consolation, but, by strengthen¬ ing the physician’s influence, to increase his power of being useful. Benevolence, like mercy, is “ twice blessed, — it blesseth him that gives and him that takes and we may be thankful that we belong to a profession which affords such constant opportunities for its exercise.
“ I here cannot refrain from giving you one more quotation, because it contains the most perfect, and I hope well-deserved, com¬ pliment to those already in the profession ; and, at the same time, affords the strongest encouragement to those who are about to enter it.
364
Critical Review.
“ ‘ And here,” says the elegant and moral author of De Vere, “ let us not refuse to pay a tribute to this most amiable profession, which it deserves beyond all others ; that it contributes (and indeed cannot be exercised in perfection without it) to the moral happiness as well as the bodily sanity of mankind. Other professions have their evident importance ; and from requiring all the great virtues, are rewarded with wealth and honour. But none like this, winds itself into an intimacy with the secret heart of man, and thus obtains his confidence and acquires his love. Indeed it must be so, since half our diseases spring from mind ; and the cure of these depends more upon benevolence, kindness, and discretion, than upon medicine itself. Hence we may, I think, observe, that while the distinguished in other professions are more outwardly honoured, the friend of the sick room is most personally loved.’ ” — p. 30.
V. — Du Degre de Competence des Medecins dans les ques¬ tions judicaires relatives aux Alienations Mentales , et des Theories Physiolgiques sur la Monomanie Homicide, etc. Par Elias Regnault, Avocat a la Cour Royale de Paris. Paris and London, 1830, 8vo. pp. 361. J. B. Bailliere.
On the Competency of Physicians in Judiciary Questions , concerning Mental Alienation, and also the Physiolo¬ gical Theories on Homicidal Monomania, fyc. By Elias Regnault, Advocate of the Royal Court at Paris, &c. &c.
The author of this work is editor of the Journal Hebdo- medaire, from which we have repeatedly made extracts during the last year. He adduces all the contradictory opinions of his countrymen on mania, and concludes that physicians know nothing of mania until delirium appears ; and even then, that ordinary persons can form as accurate an opinion. He quotes M. Costa in support of this con¬ clusion, who says, any man of sound judgment is as com¬ petent as M. Pinel and M. Esquirol, and has, moreover, an advantage over them, being a stranger to all scientific pre¬ judice. Unfortunately physicians have taken too seriously the civility of the courts ; and, in examining questions sub¬ mitted to them, they too often substitute the ambitious ig¬ norance of the schools for the natural light of reason’’ — Journ. Univer. des sc, Med. t. xl. m. Juillet, 1826. “ This
passage,” says our author, <e full of force and truth, would dispense with my entering further into the question, if
M. Regnatilt on Mental Alienation. 365
several physicians had not believed that this concession at¬ tacked their right and skill. M. Georget, however,, opposed this doctrine in very strong terms, and is in turn attacked by our author. “ The sophistical reasoning,” says the former, te of M. Costa will deceive no one, who will believe that a person who is perfectly acquainted with an object, is less capable than another, who has never seen it, of recognizing it, and of distinguishing it from those with which it may be confounded.” — Arch. Gen. de Med. t. xxiii. M. Costa was also condemned by the profession in America as appears by our northern contemporary.” — Amer. Med. and Sur. Journ. 1828. M. Regnauit replies, that this is affirming what he ought to prove ; but what is M. Costa’s dictum — is it not the most gratuitous assertion which cannot be proved? Have not the most emiuent medical jurists of all countries opposed it? Our author, however, is not dismayed, but proceeds to examine “ if madness presents any special and particular symptom so distinct, that the physician can determine the existence of this disease when it is still con¬ cealed to every one else • for it is in this case only, that his presence is necessary in the courts. When madness is evident, we have no need of a savant, the physician is only needed when there is doubt, and he comes to dissipate it.”
Our author, when he penned this passage, forgot that there was such a thing as malingering ; and that all diseases, madness not excepted, may be so feigned that unprofessional persons may be readily deceived, and even medical men themselves.
He divides the symptoms of madness into classes. 1st. The disorders of the mind, of the thought, which constitutes delirium (delire). 2d. The disorders which supervene on the or ganic functions, such as cerebral irritation, increased action of the heart, disorders of the alimentary canal, heat of the skin, &c. Of these two classes he leaves the last only to the doctors, because they alone can recognise it.
In regard to the symptoms of the first class, every man, even the least instructed, can discover them. Who cannot dis¬ cover the disease of an unhappy peasant, who, in the insula¬ tion of misery, should discourse of his armies and courtiers, and who should count imaginary treasures on a mattress ? So that every time that there is general or partial delirium, it is useless to have it declared by a physician, as every sensible man can discover it as well as himself.
We have now remaining the symptoms of the second class. If there is a single one which belongs exclusively or
366
Critical Review.
especially to madness, so as to indicate it infallibly, then we must have recourse to the physician, who, as we have already observed, can alone recognise and judge the symp¬ toms. I appeal to every physician of good faith. Let him tell me, if he dare, before the delirium has shewn itself, decide that madness exists because the pulse is vibrating ; the tongue white or slightly yellowed, the skin dry, because there is present insomnia, head-ache, because the patient is losing his embonpoint , or in woman, suppression of the menstrua. Let him assemble all these symptoms, or let him isolate them, there is not a single one w'hich does not accompany numerous other affections. So that the phy¬ sician must wait before he can pronounce his fiat ; and as soon as the delirium appears, we can discover as speedily as himself. Still more, not only are not these symptoms cha¬ racteristic of madness, but they often do not accompany it ; and their absence does not prevent the existence of the disease.
What need have we of physicians to discover the disorders of the mind ? If madness is evident, every man can re¬ cognise it by its extravagance and by its fury. If there is a doubt, this doubt exists equally for the physician.
If the physicians could indicate to us the precise seat of madness, they would then claim with more justice the right of interfering in criminal cases, where doubt existed on the moral state of the accused. Let us examine rapidly the opinions given as to the nature and seat of madness. This will suffice for us to appreciate the point to which medical science has reached.
The humoral physicians, such as Galen, Boerhaave, Van Swieten, Stoll, ( les animistes ) with Stahl, Vanhelmont, have each raised their systems according to the ruling ideas; some in the bile, the blood ( the black bile, clots of blood from piles J, or the mucous pituite; some in the soul, in the vis naturse or archeus of Van Helmont, the vital principle or animal spirit.
Chrichton pretends that it is a disease of the nervous fluid. Pinel expresses himself thus : ef the prelude of the invasion and of the return of the attacks of madness may be very various ; but it seems that in general, the first seat of mad¬ ness is in the stomach and intestines, and it is from this centre that is propagated, as by a kind of radiation, the disorder of the mind. M. Esquirol says, sometimes the extremities of the nervous system, and of the seat of sensibility in different regions, sometimes the digestive
M. Regnault on Mental Alienation. 3GT
apparatus, sometimes the liver and its dependancies are the first seat of the mischief.
M. Fodere considers the vital principle as the seat of the disease ; the blood he regards as the vehicle of this vital principle, and hence of madness.
M. Georget assures us that madness is an affection of the brain; acknowledging at the same time, that the nature of the organic lesion is unknown to us ; finally, M. Voisin says that it is an affection proper to the brain.
Here are surely a sufficiency of contradictions to authorize us to repulse the especial competency of physi¬ cians. But two works which have appeared lately, confirm this opinion by the singular contrast they present. M. M. Bayle and Calmeil, after having studied the disease under the same masters, in the same places, and perhaps on the same patients, have published the result of their observa¬ tions. They write on that kind of alienation which is pre¬ ceded, accompanied or terminated by paralysis ; and they have arrived at different conclusions.
M. Bayle — this alienation depends on chronic meningitis. M. Calmiel contends it is caused by encephalitis ; according to M. B — the paralysis depends on the confusion exercised on the encephalon, at first by the injection of the pia mater and its sanguineous congestion, and afterwards by the secretion of serum, which takes place.
According to M. C. the paralysis depends on an especial disease of the brain ; it is absolutely distinct from the para¬ lysis, sanguineous congestion, or effusion, from acute ramol- lessement, or any other known alteration.
Bayle says, that the species of madness, of chronic meningitis, is the ambitious delirium, that is the first symptom ; the second is the general or partial paralysis.
M. C. asserts that in the madness of palsy, it has not always the same form or character ; in the greater part it presents the characters of ambition or noisy joy ; but, in others, it offers that of grief, melancholy, and the most sombre thoughts. Finally, M. Guerin de Mamers has pub¬ lished a treatise on mental alienation, in which, uniting metaphysics to physiology, attributes madness to the dis¬ order of thought, followed speedily by disorder of the organ of thought ; and it is only lately, that by the continuance of the madness, those profound lesions, which we discover on opening the bodies of lunatics, are formed. According to him, when we think there is an excitement of the brain when madness appears, a super-excitation; when the lesions are
368
Critical Review.
formed irritation ; this being1 the effect of madness, whilst all physicians have reg-arded it as the cause of the disease. Let us apply these reconciliations to other affections depen¬ ding on madness. Many physicians have considered suicide as a variety of mental alienation ; admitting for an instant that it is really a disease, I would ask the physicians, which organ is injured, since there is no disease without lesion of organs? It is evident M. Regnault is ignorant of the distinction between disorder and disease. Some will reply that its seat is in the abdomen, without fixing any thing- precisely; others in the spleen; a third in the biliary organs. Betz attributes it to a bilious plethora. M. Falret thinks it has its seat only in the brain ; M. Esquirol says, we must not expect one seat only for suicide, since this phenomenon is found in very opposite circumstances, and that it is more often secondary than idiopathic.”
I could continue thus for each of the other species of alienation ; hypochondriasis is to the person a disease of the abdomen ; with another, a gastritis ; with a third, a disease of the encephalon ; for a fourth, a bilious plethora ; Sydenham says it depends on an ataxia, or disorder of the animal spirits.
Stoll ascribes it to an increase of the irritability of nerves and muscles ; and to a rarefaction of the mass of humours.
Hoffmann places its seat in the stomach and intestinal canal. From this diversity of opinion, our author deter¬ mines that all is darkness, and that medical men are lost in conjecture.
Our author having determined that le delire is the only evident sign of madness, attacks first the name formerly given to monomania or partial madness, of madnes without delirium (manie sans delire), or the other name of reasoning madness (folie raisonnante). How can we form an idea of reasoning madness when madness is only the absence of reason ?
M. Esquirol,” he says, fe appears to have perceived the ridicule of this term, when he proposed the word mono¬ mania.” . This writer says the species of monomania take their name from the object da delire. Thus we say hypo¬ chondriacal monomania when the delirium has for object the health of the patient ; religious monomania when the de¬ lirium is on religious subjects ; erratic monomania for the amorous passions ; suicidial or homicidal monomania, ac¬ cording to the ruling passions.
Thus M. Esquirol proceeds, although the first definition
M. Regnault on Mental Alienation .
369
refused delirium to the madness ; and attributes all to de¬ lirium, or rather he mistakes delirium of the passions for that of madness.
According to this system, every weakness, every vice, every bad action will become monomania. Where then is the delire of a man, who pushing too far the fear of suffering, of disease, or of death, takes extreme care of his health, and views himself with continual precautions, and combats diseases which do not exist by anticipated remedies. I see in this conduct that of a weak and pusillanimous spirit. In vain I seek for traces of madness.” The Brachmans who passed entire days standing on one foot, in the burning sands, with eyes turned to heaven, were not madmen, but ignorant fanatics, who believed that they merited heaven by tortures. The excess of these sentiments may perhaps cause such a disturbance in the intellectual faculties, that madness may declare itself, but it will itself by other acts ; it will proceed further than merely taking care of their health, &c. : it will shew itself in other acts, and very fre¬ quently the impression which caused it is lost, and the acts of extravagance are on entirely different subjects. We can then see no longer in them monomaniacs, since monomania is madness on one point. So that they are monomaniacs so long only as we have occasion to reproach them with push¬ ing a taste or a passion too far. It may indeed happen, that this madness being on one idea only, seems to be ex¬ clusively occupied by that one idea ; but M. Esquirol’s definition is not more exact for that. Thus a man, given up to extreme devotion, owing to communicating with heaven in his thoughts continually, may imagine himself to be an angel, an aerial breath. His delirium will be no longer on re¬ ligious objects, but on his own nature. His madness will no longer be a religious monomania.
M. Esquirol says that homicidal monomania occurs from a lesion of the will — une lesion de la volonte. Our author denies this, and says it is because the desire of destroying, overcomes the desire of obeying the laws. But, say they, the monomaniac has no interest in destroying his victim, it is an idea which governs him, a desire which draws him along. Is pecuniary interest then the first or the only interest? He who slays to have money, does it to satisfy his need or his passions. He, who slays for the pleasure of slaying, is satisfied immediately by his action : the enjoy¬ ment is direct.
3 B
VOL. vi. no. 35.
370
Critical Review.
The publication of the murder committed by Henriette Cornier, caused several other women to commit similar crimes. This power of imitation, says M. Esquirol, is a frequent cause of madness. This M. Regnault cannot allow. Every action which is beyond the ordinary, even crime, excites man to imitation, because he is the friend of the marvellous, in evil as well as in good, but this imitation is not madness. The aspect of a bold criminal inspires frequently more curiosity than horror, more respect than hate, sometimes even admiration, and this admiration is not far from imitation, which will speedily act on a weak mind, though it will only glide on a powerful spirit.
Th is influence of the extraordinary is so powerful, that in religious sects, those which speak most to the imagina¬ tion, either by extravagant practices, or by torture, gain most proselytes. If Mahomet had not been epileptic he would not have acted so powerfully on the minds of his contem¬ poraries. And the Quakers (Trembleurs) would be less numerous in England, if their religious ceremonies were not a rite of inordinate motions, shrieks and convulsions .
From these reasonings, our author will not admit even monomonia sans delire. As there is not delire, there is a knowledge of evil ; if there be this knowledge, there is the power of choosing between the homicidal idea which draws him along, and that of duty which retains him — and this power is nothing else but liberty. He who placed between good and evil, can distinguish one from the other,, and chooses the last, can find no excuse in the violence of the motive or the desire.
Our author allows of monomania avec delire, or with extravagance of word or deed, but not otherwise. Surely medical men need desire no more.
Georget reckons nostalgia monomania, on which our author exclaims, (( a man, who, far from his native country, abandons himself to grief, shall be designated by the same name as a man who believes himself to be a cock.” Evi¬ dently, all ought to be confusion in a science where such different manners of being are comprehended under the same denomination.
It would not be difficult to fix what monomania is. A man thinks he carries his valet de chambre in his elbow, and finds him a very inconvenient weight. Another thinks him¬ self composed of ice, and dares not expose himself to heat, for fear of melting: yet they reason perfectly well on every
M. Regnault on Mental Alienation.
37 i
^ther subject. These are real monomaniacs — their madness is concentrated on a single point.
M. Regnault arrives at the following conclusions : — Physicians have improperly given the name monomania to excess of the passions. But there is no monomania without delirium. When there is knowledge there is liberty ; liberty excludes madness. Homicidal monomonia can scarcely exist in nature ; 1. where delirium consists , in many erroneous ideas, and then it is not monomania ; 2, where it consists of one idea anterior to murder, but this obviously depends on a pre-existing erroneous idea; the idea of homicide does not constitute the disease, it is only a symptom and a con¬ sequence ; 3, when the dilirium manifests itself in the act of homicide, and was hidden previously.
The author again extracts from M. Urbain Costa, having previously written several pages to prove that suicide is a religious, not a legal crime.
M. Costa says, <e suicide is often the effects of a disease.” If it always be the effect of disease, it would be pleasing for society to think so, and most persons, deceived by their own love of life, bear this judgment.
M. Costa appears reviewing', or at least attacking M. Palret. He thus quotes him.
M. F. tells us that the word suicide does not regard those maniacs who destroy themselves intentionally, as well as without knowledge of what they do ; those are only acci¬ dents from mental alienation, and he only recognizes suicide when there is a knowledge of the action, and that it is the result of the will.
This distinction (says M. C.) is, without doubt, well founded, but in spite of it, M. F. considers suicide as the effects of mental alienation ; so that suicide from mental alienation is not the one of which he treats, and yet the suicide of which he speaks takes its origin from alienation.
I know not, if he can easily prove, to save this apparent contradiction, that in the species of alienation which causes suicide, the will survives the reason. I think alienation and the will are two irreconcileable ideas. Certainly M. F. under¬ rates the absence of all moral liberty, when he says, some maniacs destroy themselves without a conscience of their action, and without this action being the result of the opera¬ tion of the will.
The faculties of a maniac obey a blind cause, as the mus¬ cles of one who is attacked by chorea, obey an irresistible impulse ; alienation is the chorea of the mind.
372
Critical Review .
From this reasoning*, M. Costa thinks he has reason to propose the following* dilemma to M. Falret : —
Either your suicide is the effect of disease, and in conse¬ quence an effect as necessary as fever, or else it is voluntary, and constitutes as such an act of liberty. But you cannot sustain that your suicide is at once the result of alienation, that is to say, of the alienation of the will itself, and also the result of the will.
In case of hallucination of one or more senses, the will is deceived by false motives, but it is not less free, and it is not the will itself which suffers. Pascal did not become mad after his accident at the Bridge de Neuilly ; but he thought he beheld continually an abyss open at his side. If Pascal had preferred a voluntary death to the torture of such a life, could we have said that his suicide was the catastrophe of alienation, of a disease? Would he not have immolated himself for certain motives, and after delibera¬ tion?
The hallucination of these senses is then completely distinct from the alienation of the mind, although it may induce this alienation.
The most reasonable and most tranquil man may feel a desire, I might say almost the necessity, of ending with the evils of life — such a thought may occupy his mind for a long time, without his being mad. This idea of suicide is not less familiar with madness ; but there is this difference, the madman is sick, a being who dreams in a state of wak¬ ing, and immolates himself to his visions. Suicide is then most frequently a free act of notions, which however, does not prevent its being frequently also an act of madness, and that the penchant to suicide may not be frequently the ruling idea of a madman. I content myself with observing, that when there is knowledge of the action, and this action is the result of the will, it is no longer, it can be no longer the phenomenon of disease, the effect of a physical and ne¬ cessary force.
M. Regnault agrees perfectly with M. C. and proceeds that a man, who kills another, in order to die by the hands of the executioner, deserves his death doubly — much more so than any other murderer, as it requires some courage to destroy life for a few crowns, or for the love of vengence, having the scaffold before his eyes, while the other is doubly a coward, for, not daring to face death, he arrives by tor¬ tuous paths and strikes another, because he dare not strike himself : he fears to live, and dare not die.
f 373 ]
V. — Prevalence of Dysentery in Scotland. From the Glas¬ gow Medical Journal, Feb. 1831.
Though much has been written on the etiology of dysentery and cholera, it must be admitted that the conclusions arrivea at by the profession are far from being satisfactory ; and therefore we are induced to reprint the following interesting article from the pen of Dr. Buchanan, one of the editors of our esteemed contemporary. We regret that want of space prevents us from inserting the whole essay.
“ We regard dysentery, cholera, and the numerous varieties of intermittent and remittent fever, many of them frequently verging into the continued type, as diseases belonging to one great family, being the products of the same morbific agent, variously modified by the circumstances we are about to indicate. The same evidence by which we infer any one of those diseases to be occasioned by exhala¬ tions from the soil, is alike applicable to all of them. As they come on and again subside at certain fixed periods in the course of the year, it is clear that they are connected, in some way or other, with the vicissitude of the seasons. The first idea which this coincidence naturally suggests, is, that the diseases in question are the effect of the peculiar physical states of the atmosphere, which follow with more or less regularity in the train of the seasons. The probability of this opinion with respect to dysentery, we have already discussed, and we need only further say, that our objections to it are tenfold greater when it is brought forward to explain the origin of the whole diseases mentioned above. Considering, therefore, the physical states of the atmosphere as only of secondary importance, we turn our attention to the revolutions in the vegetable kingdom, which accompany the seasons with still more invariable certainty. As regu¬ larly as the spring returns, the principles of vegetable life are awakened from their torpor and rise into activity ; as the year ad¬ vances the process of vegetation goes on till it is completed by the maturation of the seed destined to perpetuate the species ; vegetable life is then again suspended, and the herbage and foliage, the pro¬ ducts of the completed year, are resolved by the reaction of their own elements into the soil from which they sprung. Now, it is the last part of this series of events that demands our particular attention — the spontaneous decomposition of vegetable substances. By this process of decomposition, to which chemists have applied the name of putrefactive fermentation, the more fixed parts of the substance decom¬ posed are converted into vegetable mould, while those of a volatile kind are diffused through the atmosphere, constituting what physici¬ ans have named miasmata, and have in almost every age, although with views more or less distinct, regarded as the causes ef epidemic disease.
374
Critical Review.
“ Like every other fermentative process, that of which we here speak is regulated by the nature of the substances decomposed, and by the degrees of heat and moisture under the influence of which it is car¬ ried on. According to these circumstances, the volatile products differ in nature, just as spirits and vinegar differ, although produced by processes that are perfectly analogous, and only modified by cir¬ cumstances which we have learned by experience to adjust, and can thus regulate the products at pleasure. It is true, that the difference of the volatile products here in question is not equally palpable. We are not only unable to discriminate them by chemical tests, but we are even unable to demonstrate by such tests the existence of any one of them. It unfortunately happens that the delicate organiza¬ tion of the human body is the only reagent which we yet know of sufficient nicety to be capable of being affected by these subtle exhalations, and thus detecting and discriminating them. It was by the observation of certain effects on the body, and the application of the general reasoning employed above, that physicians were first led to recognise the existence of such invisible morbific agents.
“ Now, if that reasoning be admitted as legitimate, the diversity of the observed effects must in like manner be admitted to prove a differ¬ ence in the nature of those agents. The diseases which physicians believe to be engendered by exhalations from the soil being infinitely diversified in character, that difference can only be attributed to a corresponding difference in the causes from which they flow.
“ If the principles just stated be admitted as correct, and we believe few physicians of the present day will be disposed to contest them, it is easy to deduce an explanation of many of the laws by which this interesting class of diseases is regulated. It will be easily understood, for instance, how every different climate and country, and frequently even different districts of the same country, should be infested with diseases differing in kind, or at least marked by a pecu¬ liar physiognomy. In such cases we have a difference in the nature of the soil, or of the vegetation, or of both : and what is still more important, the degrees of heat and moisture are different, under which the process of decomposition is carried on. In such different circumstances, different morbific exhalations are evolved, and there is necessarily a corresponding diversity in the diseases which they engender. Perhaps of all such morbific exhalations, those inducing dysentery are the most generally diffused and the least apt to vary, the disease being the common scourge of every quarter of the world, varying rather in degree of severity than in more essential characters. The range of cholera is also extensive, but there is less uniformity in the nature of its exciting causes, as we are entitled to infer from the greater diversity of the aspects which it assumes. The exhalations inducing fever arc most apt to vary. Widely diffused over the globe, they differ in almost every region where their influence is observed. Hence the great diversity of character in the disease which they excite — mild, intermittent, and protracted, among the fens of Lincoln — remittent and continued in its course, and more violent in its symp-
Prevalence of Dysentery in Scotland.
375
toms, in Holland and Italy — still more rapid and intractable along the shores of Africa, at Batavia, and the mouths of the Ganges — and attaining its maximum of virulence and destructiveness in the yellow fever of the West Indies and America.
“ The same principles serve also to explain, how in a country sub¬ ject to the visitation of this class of diseases, they should vary in character at different periods of the same year. The dryness of the atmosphere and intense heat at the end of summer, invaribly gene¬ rate the poison of cholera. The presence of moisture in the atmos¬ phere seems essentially necessary to the generation of the poison of dysentery; and hence that disease generally begins to prevail when cholera is on the decline, after rain has fallen, or after the commence¬ ment of the wet season in countries subject to periodical rains. Dur¬ ing the winter, the process of decomposition is suspended: it recom¬ mences, however, in the spring, and continues during the summer, and being now carried on under different circumstances, the diseases generated differ in character from those that prevailed in the fall of the preceding year, as in the well known instance of the vernal and autumnal intermittents. It is exceedingly difficult to determine, how long the decomposing vegetable matter retains the power of generating noxious exhalations. It is well known, that, in warm countries, the vegetable mould itself is far from being innoxious, and that, in consequence, the turning up of the soil is one of the most dangerous of all employments. Among ourselves, again, from the less degree of heat, such exhalations are unknown, and the profession of a husbandman is looked upon as highly salubrious.
“We come, now, to a subject more intimately connected with our present inquiry. The principles here assumed serve to explain, how the diseases occurring in any particular country, although they pre¬ serve for the most part a unity of character corresponding to the more usual qualities of the climate, should nevertheless vary, more or less> according as particular seasons, remarkable for the predomi¬ nance of heat, moisture, or other physical states of the atmosphere, may impress a corresponding peculiarity of character upon the vege¬ tation of the country, and upon the process of vegetable decomposi¬ tion. Such deviations from the usual course of disease are observed in all countries : diseases of an unusual kind taking the place of those more generally prevalent. It is thus that the yellow fever is ob¬ served, from time to time, in the place of the bilious remittents of Spain, and that dysentery, in our own country, takes the place of the more usual autumnal affections. The diseases, that thus spring up unexpectedly, are regarded, as anomalous, by persons ignorant of the history of the country, where they appear. It will, however, be generally found, on investigation, that they have had their antetypes, at periods more or less remote, and, most probably, that they return at certain intervals, according to the usual rotation of the seasons. The reality of this rotation of the seasons has been long belived in by practical meteorologists. Their observations have not
376
Critical Review.
indeed afforded results so certain as to be subject of calcula¬ tion, but they are generally admitted to be founded in fact, and if so, there must also be a corresponding rotation of diseases. This idea was suggested by Sydenham, who professes himself, how¬ ever, unable to determine its accuracy. “ Haud equidem satis scio, an diligentius examen (quali rite instituendo vix unius hominis brevis setas par esse videatur) nos edoceret, epidemicorum alios continue quadam serie, ceu facto circulo, alios semper excipere.” It may appear presumptuous in us to offer any opinion as to a point, which this greatest of all medical philosophers, upon a field of discussion pre-eminently his own, has left undecided ; we do, however, think it probable, that the reality of the rotation of diseases suggested by Sydenham, would be established by observations continued during a long series of years, in a country not at the time undergoing any remarkable physical revoulution.” — p. 12.
“ From the same considerations, which lead us to believe that any disease which has once appeared will return at some period more or less remote, if the face of the country undergo no remarkable change, we infer, also, that no disease, belonging to this family, will appear, which is totally new, and unheard of at any preceding period. We must, therefore, beg to express our dissent from the opinion, lately promulgated by the learned gentlemen of the Medical Society of Westminster, that there is reason to expect we are, in this country, to receive a visit from the Indian cholera, which, after having travelled over land from Hindostan, is now approaching the shores of the Baltic. Such a disease was never heard of in these kingdoms, and if we may trust to the constancy of nature, there is no reason to apprehend so terrible a visitation. We believe cholera to be no new disease in the countries where it now prevails. It was at first described as altogether new even in India, but more accurate researches have shown that opinion to be erroneous, and we have no doubt, similar researches, if there are documents on which to found them, will establish that the disease has also prevailed, at former periods, in all the countries, which have been the theatre of its late devastations. We extract, from the Scottish Register, an account of the disease, as it occurred at Astrachan, from which our readers will perceive, that this is not the first occasion on which it has visited the shores of the Caspian. We believe the Indian cholera, like every other disease depending on exhalations from the soil, to have fixed limits, which it will not pass. Whatever diseases have prevailed at any former period, in this country, we believe may return. That the livid face of plague may be again seen in the land, we hold to be perfectly possible, and if from the ravages of war, or any other cause, the country were to relapse into its primi¬ tive state of rudeness, we should look upon that event as reasonably to be expected ; but that we are to be visited by the Indian cholera, we entertain no apprehension, as we consider such an opinion to be inconsistent with the observed analogy of nature in our western hemisphere.
[ 335 -j
ORIGINAL COMMUNICATIONS.
f. — Dr. Malins’s Introductory Lecture.
(Concluded front page 328 J
The last and greatest Arabian author is Albucasis, a distinguished practitioner, who lived in the eleventh or twelfth century. He has particularly described and illustrated by figures numerous obstetric instruments for every imaginable purpose. The most interesting of these are two kinds of forceps, about which, from their being dif¬ ferently represented in different editions of his works, a discrepancy of opinion exists. They are called misdach and almisdach, and according to some are both of a circular shape and filled with teeth, while others say the misdach is straight and armed with teeth, but that the almisdach is circular, and calculated to extract without injuring the foetal head. The former opinion is the better sup¬ ported, and therefore the more probable, and successfully impugns the notion that the Arabians were acquainted with any instruments designed to bring living children into the world.
From the greater strictness with which the oriental nations have ever preserved their women, it is probable that the Arabian accou¬ cheurs were allowed to interfere still less frequently than those of Greece and Rome, in the management of parturition. It would seem that they only gave counsels and directions, and that females, to whom all the precepts contained in their works are addressed, always officiated manually. And this exclusion was not limited to the obstetric branch of surgery — it extended to all the operations connected with the sexual apparatus, and hence Albucasis notes, that one of the greatest obstacles to the success of lithotomy in the female, is the difficulty of finding a medical woman , who is com¬ petent to perform it. When such is the case, he says that a chaste and prudent medical man should be procured, in whose presence, and by whose directions, the incisions should be made. Surgery in general was held in discredit and contempt by the Arabians, and the operations were left to be performed by slaves, so that a kind of dishonour attached to its exercise — a mis -estimation of which Rhares in particular bitterly and justly complains.
Though during the period that elapsed from the fall of the western empire to the revival of letters in Europe, the progress of human cultivation was impaired, and knowledge stood still, the communi¬ cations of the Saracens with the northern shores of the Mediterra¬ nean, and their conquests in Spain, could not fail to disseminate what little information they possessed. The Arabian doctrines of medicine were taught in those schools which then existed, and some glimmerings of knowledge were occasionally discernible in the midst
vol. vi. no. 35. v 3d
386 Original Communications .
of the general obscurity which overspread the earth. The chief of these colleges was that of Salernum, in the south of Italy, founded by Charlemagne, about the year 802, but no writing on midwifery emanated from its precincts at ‘all deserving of notice, excepting a book, “ De Arte Obstetricia, ” by a celebrated female, Trotula, who lived some time in the thirteenth century. A book on the diseases of women, dedicated by its author, Priscian, to an eminent midwife named Salviana, appeared in the eighth century, and these two are the only works relating to our subject, which appeared in Europe during the middle ages. From them, in combination with the cir¬ cumstance recorded by Marcellinus, that an empress once bribed a midwife to slay, by some negative means, the child of a detested rival, we infer that females, during the dismal period referred to, were, as in former times, the principal obstetric practitioners.
On the capture of Constantinople, and the extinction of the eastern empire by the Turks in 1453, learning took its flight back into Europe — the ancient manuscripts were conveyed to their ori¬ ginal birth-places, and from the discovery about the same time of the art of printing, a new impulse was given to the minds of men, and facilities wrere afforded for the acquisition and spread of infor¬ mation, which operated favourably on every branch of knowledge, and on none more than the manual division of the medical art. Like authors on every other subject, these on midwifery now began to increase and multiply, and are so numerous from that period to the present, that it will be possible only to mention the most dis¬ tinguished — those who by their talents or discoveries, or some peculiarity of circumstance, have an especial claim to be noticed in this sketch of the history of the art.
It was at this early period that, according to the authority of Haller, the C cesarian operation was first and successfully performed since its reputed origination ; but there are no details given by which to judge of the accuracy or inaccuracy of the report.
Ambrose Pare was born in 1509, and is to be considered one of the first and greatest improvers of the practice of midwifery. He taught that the head presentation alone was natural, and that in every other case the child, after being when necessary turned, should, be brought into the world by the feet. The credit, however, of being the first to lay down this valuable precept belongs to Pietro Trauco, the original proposer of the high operation for stone, who distinctly indicates its propriety in all cases of transverse pre¬ sentation. In many respects the practice of Par6 was not different to that recommended by the ancients, whose errors he either had not sufficient discernment to detect, or what is more likely, sufficient courage to expose ; for at the time he wrote the prevalent notions, which, like error in general, were adhered to with a tenacity pro¬ portioned to their absurdity, were those of Hippocrates and Galen. Even the judicious, but imperfect modifications of practice proposed by Celsus and Moschion were, it is probable, but little attended to, since, in the work of Eucharius Rhodion, published at Frankfort, in
Dr. Malins’s Introductory Lecture. 387
1548, it is stated that when the feet present, attempts should always be made to bring down the head in the natural position, and what is still worse and more gross, this natural position is affirmed to be with the face of the child towards the ossa pubis and abdomen of the mother. The work of Rhodion is otherwise remarkable, as it afforded materials for the first book published in the English lan¬ guage on midwifery, which was by Dr. Raynalde, in the year 1 565. He translated from the Latin copy, but informs us that the original of Rhodion was written in Dutch, and had been besides converted into French and Spanish, from which it would appear that it was a book in considerable repute, notwithstanding its disfigurement by the dangerous absurdities before mentioned. In the latter part of , the sixteenth century, much discussion was excited in France by the publication of the work of Rousset, on the operation then for the first time called Caesarean. Rousset advocates its performance in an ingenious and scientific manner, and relates many cases where it succeeded, but the weight of authority was opposed to him and Pare. Guillemeau, and at a later period, Mauriceau hesitated, from experience of its fatality, to sanction its recommendation.
Guillemeau was born in 1560, and was a disciple of Pare, whose erroneous views he rejected, and whose improvements he adopted, ex¬ tended, and confirmed. Thus, he directs turning to be performed where there is profuse uterine haemorrhage, though the labour is natural as far as the infant is concerned, and also when convulsions super¬ vene. Guillemeau was strongly averse to using the crotchet before the death of the foetus, and was a no less sound than conscientious practitioner ; but he seems to have been endued with fastidious delicacy, in wishing to confine the practice of midwifery as much as possible to the sage femmes.
The name of the distinguished practitioner in midwifery, which occurs next in the progress of our descent towards the present time, ought never to be pronounced without the profoundest veneration — nor by an Englishman without feelings of pride : it is that of Harvey, who lived, and lived for so many noble purposes, during the first half of the seventeenth century. Of his peculiar opinions on points connected with our present subject, the most singular relates to the cause of parturition. During the whole course of gestation he considers the foetus to be continually swimming about in the liquor amnii, which at the end of the ninth month, is supposed to acquire some vicious irritating quality, urging and stimulating it to escape from the contact, and compelling it at length to quit its tenement and seek some other abodes It is this attempt at departure, and the resulting movements of progression, which constitute the pro¬ cess of labour. If the foetus were not an active agent, how, he asks, could it be born during a fit of coma or hysteria, or, as it is sometimes known to be, after the death of the mother ? The posi¬ tion is supported by reference to the analogy offered by the young of birds, who break the shells in which they are confined with their beaks, and to the tediousness of those labours in which the infant is
388
Original Commun i cat ions.
expelled dead. In the latter instance, however, cause and effect are confounded, for the death of the child rather results from, than pro¬ duces, the unnatural duration of the process. Harvey believed likewise that super-foetation was possible, and that utero-gestation might be protracted beyond the term of nine months ; and is the first medical man of distinction who pratised midwifery in this country.
Between 1650 and 1700, lived several eminent accoucheurs, both at home and abroad. In France, Mauriceau, Clement and Pen were the principal.
Mauriceau’s writings were fuller than any which had previously appeared, especially on the diseases of females, and contain many excellent suggestions and observations. He invented an instrument to extract the head of the foetus after it had been opened and emptied, called a “ tire-tete,” but was ignorant of the forceps. He erred too, in denouncing the Caesarean operation as an inevitably fatal one, but on the whole is to be deemed an illustrious master in the obstetric art.
Clement was employed secretly to attend the mistresses of Louis the Fourteenth in their accouchemens ; to the first of which he was conducted blind-fold, while the king was concealed among the bed curtains, and the face of the lady enveloped in a net-wmrk of lace. The circumstance of these ladies employing Clement, principally contributed to bring male practitioners into fashion — the court hastened to imitate the examples of those who presided over it — the rest of the nobility and gentry were swayed by a practice that came so powerfully recommended to them, and the bourgeois or citizens could be but too happy in adopting or humbly copying any of the usages of their betters. The name of Accoucheur was now invented to designate this class of practitioners, whom it became so universally the mode to employ. The contagion of the example soon spread into neighbouring countries, and the custom, however whimsical or trifling in its origin, or resisted and opposed in its progress, is now generally established, conferring, beyond all doubt, great and daily benefits on the community.
Peu, who comes last in order of the French practitioners of the 17th century, is notable for his aversion to too frequent digital interference during parturition — for his opposition to obstetric opera¬ tions in general, and for his just discrimination of spurious from real uterine pains.
*In England during the latter half of the 17th century, the most famous and successful obstetricians were the Chamberlins, father and three sons, who enjoyed very extensive practice in London, from being in possession of a secret method of expediting delivery in difficult cases, which afterwards turned out to be the forceps. One of the brothers translated Mauriceau’s work, and in a note appended to the latter’s description of his “ tire-tete,” declares that his family possessed a better contrivance for the purpose of supplying the sus¬ pension of the natural efforts in the expulsion of the head, but what this was, remained unknown till Chapman described the forceps
Dr. Malins’s Introductory Lecture.
389
in 1733. Dr. Denman thought their instrument rather a lever than the forceps ; but the discover of the original models about fifteen years since, in a chest concealed beneath the floor of a closet in a mansion were Chamberlin resided in Essex, has shown his supposition to be incorrect. It may be remarked that male practitioners were employed as early in England as in France, and that therefore the usage did not come to us recommended as a foreign novelty, as has been observed in ridicule and depreciation. The introduction of French manners and customs in his court, by Charles the second, in consequence of a partiality derived from long residence on the conti¬ nent, may have had some influence in causing its adoption ; but a more efficient reason must be assigned in the extension of luxury and the progress of refinement and intelligence, which, by rendering females more sensible and susceptible of the precarious and hazar¬ dous condition, in which parturition and its sequences place them, would render them at the same time naturally desirous of securing such assistance as would be competent to avert or remove danger.
The other British authors and practitioners who figured during the epoch under consideration were Culpepper, who published a ‘‘Directory for Midwives Woolveridge, the title alone of whose work I have been able to find, which is “ Speculum Matricis Libernicum a Dr. Salmon, who had a share in the composition of the infamous work now so generally known and circulated among the lower order as Aristotle’s ; Willoughby, one of whose customs was to affect to liberate an impacted foetal head, by pressing outwards the os coccygis and manoeuvring with two fingers on the back of the pelvis ; Thomson ; and Jerman, physician to Charles the second.
The chief practitioner of this period on the continent, not French, was the celebrated Dutch anatomist, Ruysch, who expresses himself severely on the conduct of those midwives who precipitately extracted the placenta. He advises that its expulsion should almost always be left to nature.
In briefly mentioning the authors on midwifery after the periods already considered, I will confine myself still more closely to the distinguished among them, rejecting those of ordinary eminence, in order that the tediousness of the recital may be as much as possible diminished.
In 1701, appeared at Leyden, the work of Deventer, exhibiting, as its title page informs us, “ a new light to midwives.” However that may be, he has so admirably described the causes, conse¬ quences, and means of remedying obliquities in the position of the uterus, of which he has likewise given numerous plates, that although allusions to such pathological states are scattered in the writings of the ancient authors, he is come to be considered the earliest as well as best authority on the subject, and that in despite of the sneers of the experienced Smellie.
Lamotte was a French country practitioner of great modesty and excellent judgment, who was largely engaged in midwifery practice during forty years, and published in 1718. He turned in difficult
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Oiginal Communications .
\
cases of head presentation when practicable, and so averse was he to the use of instruments, that for thirty years he had recourse to the crotchet but twice. Of the existence of the forceps he does not seem to have been aware.
A new, and since generally adopted method of exerting compres¬ sion on the uterus, when it refuses to contract, and there is haemorr¬ hage after delivery, was contained in a pamphlet published in 1722 (but never extensively known), by Dasse, a surgeon-accoucheur of Paris. The method alluded to consists in rolling the abdominal parietes with a due degree of force, in different directions over the uterine surface, so as to bring all the fibres under the stimulus of the pressure.
The first teacher of midwifery in this country lectured in Bond- street, and was a Dr. Maubray, who lived about the year 1723, and wrote two books, both of which were plentifully and justly abused by the critics of the day. He opposed the use of the forceps, and wished to rectify all malpresentations and accelerate all lingering cases solely by manual means.
De Gorter, who wrote in 1731, deserves notice, as having par¬ ticularly insisted on the necessity of sufficiently and uniformly supporting the abdomen after the expulsion of the child. He invented and described an under garment proper for the purpose.
The second British teacher of midwifery was Chapman, whose observations were published in 1735. He is the first who depicted and presented to the public the short forceps invented by Cham¬ berlin, and was very partial to their employment, though aware of their inapplicability when the head is situated high in the pelvis. He exclaims strongly and in unmeasured terms against the crotchet, by which many children were, according to his knowledge, mur¬ dered. Haller says of Chapman, that he was “ vir bonus, candidus, qui neque nimis sibi tribuit.”
A Mr. Giffard, whose cases in midwifery were about this time given to the world by Dr. Hody, had been in the habit of using forceps before the invention of Chamberlin was publicly promul¬ gated, and if we do not suppose that he obtained private informa¬ tion of its nature, a point to the unravelling of which no clue exists, he must participate in the honor of having been among the first to devise and apply that description of instrument.
Sir Fielding Guide, of Dublin, gave, in 1742, the first description of the mode of passage of the child’s head through the pelvis, and was inventor of a perforating instrument called “ terrebra occulta,” the disqualifying qualities of which are smallness and weakness.
In 1747, a Dutch surgeon-accoucheur communicated to the pro¬ fession the account of an instrument very famed in Holland, which had been secretly used, and never divulged by its inventor, Roon- huysen. It had however long been in the hands of some other prac¬ titioners, though it was known, even after its publication, by the name of “ the Roonhuysian secret.” This instrument was a simple lever, though of very different construction and dimensions to that now in use.
Dr. Mai ins’s Introductory Lecture.
391
Levret, who is perhaps the greatest French obstetrician, wrote about this time. He illustrated in a scientific manner the mechanism of parturition, gave ample details on every thing relating to the pla¬ centa, the implantation of which over or near the os uteri he wras the first to teach, would inevitably produce haemorrhage, described and distinguished uterine polypi, and invented the long forceps, and other less useful instruments. He is a prolix though valuable writer, and was continually engaged in controversy and dispute.
Roderer, professor of medicine at Gottingen, published the first of numerous obstetric works in 1750. We are indebted to him for a series of good plates of the gravid uterus, and for confirmation of many points of practice of previous doubtful propriety, but he is to be condemned for too great a partiality to the use of instruments, and it is singular, that after all his labours and researches, he should have arrived at the conclusion that the ligature of the umbilical cord was not a necessary measure.
An important era in the history of midwifery is that of Smellie, who joined to very extensive experience, in his time a rare event, an eminent degree of sagacity and solidity of understanding, rare at all times. The first volume of his work was published in 1751, when he had been many years in practice, both in Scotland and London, and, as he himself informs us, had had more than nine hundred pupils to his lectures, exclusive of females. But he does not mention what Dr. Douglas opprobriously charged him writh — the crime of suspending a paper lantern over his door, having legibly inscribed upon it this announcement, “ Midwifery taught here for five shillings.’" Smellie’s chief merit consists in his having applied the laws of mechanics to the relation between the osseous excavation of the pelvis and the form and mode of passage of the foetal head. From considerations of this kind he deduced improved and safer rules for the application and use of the forceps, which before his time were attached in any way that was possible or most convenient to the operator, and then used forcibly and quite at random. He considerably modified the form and dimensions of Chapman’s forceps, and brought them very near to the common straight short forceps of the present day ; and likewise altered advantageously the perforating scissors used in craniotomy, by giving them a projecting rest, calculated to limit the extent of their intro¬ duction. The plates he published have served as models for all that have appeared since, either in this or foreign countries.
Contemporary with Smellie was Dr. Burton of York, the original of Sterne’s Dr. Slop. He was a skilful accoucheur, tainted with the foible common to many of his predecessors as well as successors, of being too fond of employing instruments. Besides a treatise on midwifery. Burton published a virulent letter, criticising and con¬ demning most of Smellie’s opinions and directions, which was answered by Dr. Watt, in his “ Reflections on Slow and Painful Labours.” It is worth remarking of this latter publication, that the cause of tedious labour is held to be want of irritation in
392
Original Communications .
the orifice of the uterus — an idea that in our own times has been assumed as original and propounded so ostentatiously by Dr. Power.
Smellie’s opponents were not limited to his medical brethren, for, in 17 60, a most violent diatribe against him and all other accou¬ cheurs, was issued by a Mrs. Nicol, the follies and impertinencies of which proved a complete antidote to the effect intended to be produced ; and though at the time the book was extolled as pro¬ digiously clever, and was translated into French, it is now unheard of, and unknown.
As the practice of midwifery since the time of Smellie, has been principally in the hands of the medical profession, writings on it after this date, become more numerous and frequent. To enumerate these, would be a tiresome task ; but to indicate the new suggestions they contain, to point out their merits and defects, and to give even the succinct account of them that has been presented, of the older writers on the art, of those who assisted it in its infancy, and laboured by their assiduity, and from their conviction of its importance to the good of mankind, to enlarge its narrow boundaries, and extend the sphere of its operations and benefits, when these were circumscribed by prejudice and ignorance, and restricted by a spurious and even cruel moral code ; to lay before you, gentlemen, equally brief par¬ ticulars of the improvements of more recent and living authors, would be, as well as an unwarrantable trespass on your patience and time, to exceed the limits of my present design, whose object has been to trace the steps by which midwifery has risen from a neglected, to the state of a cultivated art, and has emerged from a degraded to the level of an ennobling, because an inestimably useful pursuit. Having brought the account of it down to the period of its admission among the legitimate objects of preliminary pursuit, and of its practice having become to many members of the profession an affair of primary atten¬ tion and care, I am not solicitous to continue its history up to the present moment. A reference, however, to the existing condition, and some of the more recent triumphs of the art, and a slight demon¬ stration of its dignity and utility, will be neither superfluous nor misplaced.
Passing, then, over the names of the illustrious and judicious William Hunter, of whose discernment and industry we possess such splendid relics; of the sophistical and ingenious, but misjudging Osborne ; of the benevolent, candid, and cautious Denman; of Rigby, whom fruitful experience and well-directed labour enabled to worthily fill up an important void in obstetric literature ; and lastly, of the morbidly sensitive and eminently intellectual Gooch, whose premature loss science must ever deplore ; passing over, I say, this array of bright and honoured names, and arriving in the midst of the living, coming to consider the art as it actually is known and taught, what is the spectacle this branch of medical science exhibits ? What are its claims on the philanthropist’s applause, the legislature’s protection, the possession of public esteem ? It may be unhesitatingly affirmed.
Dr. Malins’s Introductory Lecture.
393
that he who is merely a well-wisher to the progress of human improve¬ ment, will be as gratified and delighted as the cultivator of science, when he looks around him and contemplates, though cursorily, the approaches to perfection which it has attained ; and that on every rightly constituted mind, it has as powerful claims for regard, and as just a title to consideration, as it has on legislative and corporate bodies for fostering and support. Connected, as a discharge of its duties is, with the most sacred earthly interests of society, and the nearest ties of domestic attachment, can there be a doubt that its cultivation should be recommended, urged, nay enforced ? And yet so far from this having been the case, it is well known, that until within a few months previous to the urgent remonstrances and forcible representations of the obstetric society formed in London, none of the corporate medical bodies of this kingdom exacted any knowledge of its principles from their candidates. While, in other countries, no person, either male or female, can undertake the practice of mid¬ wifery without examination and licence, in this there is no law or restriction to prevent the most ignorant from assuming it. Two of the chartered institutions of the metropolis do certainly now' require certificates, but to this equivocal demand the guarantees to society, that unqualified and improper persons shall not be let loose upon them are limited ; no inquiry into the proficiency of the candidate is instituted, and the consequence is, that the study, not being com¬ pulsory, is too often either totally neglected, or but very carelessly and indifferently pursued. When so lamentable a state of things is considered ; and that it is lamentable, must surely force itself on the conviction of any one who looks at the question without bias or pre¬ judice, and examines it solely on the broad principle of general utility and public expediency ; it is almost impossible to suppress our rising feelings of indignation at the supine conduct of those privileged and dignified bodies, who have been entrusted with so much power, but have exerted their control to the effecting only of such partial good. But I must request your excuse, gentlemen, of this digression, while I intreat you to allow the importance of the subject to justify the irrelevancy of its introduction in this place.
The existing condition of midwifery in this country, was about to be glanced at. The achievements of modern obstetricians have un¬ questionably been rather of a negative than a positive kind, but they are not on that account the less worthy of admiration, the less indi¬ cative of ability, or the less momentous to the welfare of the com¬ munity. To remove the accumulated rubbish of ages, flanked and fortified by hereditary and almost intuitive prejudices, and by clear¬ ing it away, to reduce the practice of an art to clear and definite rules, requires no ordinary merit and no common capacity. The efforts and labours of most of the professors of midwifery, during the last half century, have been directed to the simplification of its practice ; to the abolition of absurd and pernicious customs ; and to the diminu¬ tion of necessity for instrumental aid. They have comprehended
Vol. vi. no. 35. 3 E
Original C ommu n ications.
nature, whose intentions, when salutary and beneficial, the older practitioners did but too frequently thwart and oppose ; they have in¬ culcated that knowledge, and by precept as well as example, recom¬ mended a close study of the natural operations, injudiciously dis¬ regarded, because they were natural and simple, not only as the surest means of understanding and appreciating deviations from them, but also as affording the best lessons against that ofliciousness and meddlesome intrusion, which are so often practised, and as generally resented by some untoward and harassing occurrence. If, as is universally agreed upon among the reflecting and honest, the pro¬ duction of reform in other sciences and on other subjects, involves numerous points of difficult and delicate consideration, and requires to be approached on the one hand without rashness or presumption, and on the other, with uncompromising vigour and resolution ; why should the merit of having effected a salutary change in the practice of midwifery be depreciated ? Why should the honour of having judiciously rejected, cautiously but decidedly deviated, not un¬ sparingly nor yet unreasonably condemned, be denied to the teachers of its doctrines and rules ? It would be neither invidious with respect to others, nor adulatory with respect to the individual, to assert that the precepts of the eminent professor of midwifery in the University of Edinburgh, have contributed in an especial degree to induce this revolution . Thatpatriar chal practitioner has most certainly exerted an important influence by means of his admirable preelections on the modes of practice throughout the empire, and has assisted, not in a secondary manner, in maintaining the lustre and upholding the high character of the renowned institution to which he belongs.
The sound opinions, the results of mature reflection and personal observation, which characterize the wTritings of professor Burns, are to be estimated in a no less valuable light, as bearing the impress of that diligence in observing, and care in weighing facts, and that sobriety in forming deductions from them, which every disciple of our art should study, assiduously and unceasingly to imitate.
Nor should the quaint and plain-spoken Dewees be forgotten, in an enumeration of living men of eminence. The vein of strong original good sense which runs through his works, and the independent, un¬ prejudiced spirit of observation which has dictated his effusions, and guided his pen, render his works prominent and honorable specimens of the improved state of practice which now prevails.
But let it not be inferred, that the results of the zealous labours and active ingenuity of modern practitioners, have induced none but negative improvements ; for the reverse obtains, and the fact is far otherwise. Physiology and surgery have shed two of the most brilliant rays on obstetric subjects, and have supplied, from their fertile and constantly enlarging sources, remedial means which it has been the office of the obstetrician to apply successfully to the alleviation of human suffering and distress. Through the assistance of one, by which I would allude to the revived operation of transfusion, effects the most marvellous and gladdening have been produced. By its aid.
Dr. Malins’s Introductory Lecture „
395
the tottering and flickering spark of vitality, ready finally to depart from the frame which it animated, has been restored to stability and permanence ; its flight has been arrested, and its faint expiring glow at first gently supported, and afterwards fanned by degrees, into the full flame of life, and vigour, and joy. When all has seemed desperate, and death was apparently on the point of receiving his victim, when the powers of life have been drained, and its energies were about to succumb, by the influence of this wonderful remedy, the whole scene has been changed, the almost vanquished sufferer has been snatched from the jaws of death, to which she seemed inevitably doomed, and rescued from the brink of destruction, on whose verge she was trembling ; distressed relatives, spared the infliction of the pangs and wretchedness hovering around and threatening them, have been brought back to consolation and hope, and the house of mourning has suddenly been transformed into the house of gratitude and delight. Such is an outline of the benefits promised and afforded by timely recourse to transfusion ; how illustrious, then, ought its second inventor to be considered ; how distinguished his name among those of the benefactors of mankind ; how proud may not that science justly be, which numbers a Blundell among her votaries, and can claim him for her own.
The other important suggestion flowing from an enlightened sur¬ gery, and adapted to the relief of one of the most distressing maladies to which human nature is liable, is the removal, either totally or in part, of the womb. The honour of the origination of this great and terrible operation is not due to any of our countrymen, neither to any of our rival neighbours, but to the distinguished German, Osiander ; and though the question of its expediency has been somewhat acrimo¬ niously discussed, and by many its performance is considered unjus¬ tifiable under any circumstances, there is on record in the annals of medicine, both at home and in other countries, a sufficient number of successful cases to render it a feasible, and sometimes even an imperative step, on the part of the practitioner. Indiscriminately performed, it would deserve the strongest reprehension, and prove a greater bane and curse than the formidable disease, whose ravages it is intended to stay ; but resorted to in select instances, it is capable of answering the desired end of relief, which, previous to its intro¬ duction, was never attained, and, from the. utter inefficiency of all known remedies, had come to be considered hopeless and unattain¬ able. Surely it is better to make an attempt to rescue a sufferer from a state of misery, than to rest satisfied with fruitlessly lamenting and idly deploring the inadequacy of the resources of art ; and as surely must it be preferable to submit to a temporary increase of pain, with the prospect of future exemption and a chance of recovery, than to linger slowly onwards with accumulating distress to a certainly fatal and deplorable termination.
396
Original Communications .
TI. — Remarks on Obstinate Intermittent. By Medicus.
Joseph Graves, aged 21 years, was admitted on the first of September into the hospital at Antwerp, with intermittent fever ; he states the treatment followed was the application of ten leeches behind the ears, which caused great hemorr¬ hage for sixty hours, and induced much debility ; a blister was applied to the left hypochondrium, and kept discharging twenty-eight days ; the bowels were regulated by castor oil, and he took white powders, which were tasteless ; the fever was quotidian, and he had twenty-one accessions after his admission. Two days after the application of the leeches, and while suffering from great debility, he was seized with a fit ; his body was much convulsed and his in¬ tellect disturbed. The attendants put him in a strait jacket, and confined him in his bed during two days. In five days he had a second fit similar, and was subjected to the same restraint ; at unequal periods after, he had eight more fits ; his stay in hospital was about eighty days, which he left much emaciated, and feeling very ill ; but he was obliged to make way for more urgent cases. He remained in Antwerp three weeks, during which time he had no return of fits, and he regained strength. He has had since the first fit trouble¬ some cramps, and a heavy pain over the forehead. He applied to me on the 13th January, complaining of head¬ ache, pain in his limbs, loss of appetite, and general debility. His pulse was natural, rather slow, there was a marked wildness of manner ; his bowels were irregular in their action, but generally constipated. I ordered him Bii com¬ pound infusion of gentian, with Bij infus sennse, to be taken at two draughts during the day. On the next evening he was attacked with fever, and when I saw him in the morn¬ ing he was very desponding, fearing, as he said, such a spell as he had at Antwerp. I directed he should take, just as the cold fit was coming on, a draught, composed of five grains of camphor, one drachm of T. opii, and By* Aq. cin- nam ; and should obviate constipation the following morn¬ ing by taking as many pills, at intervals of an hour, as would answer the purpose ; he had to this end two drops of the croton tiglium oil, divided into six pills. The draught had the effect of producing re-action very quickly, and he slept wrell, but rose with great pain across his forehead ; he took during the morning five of the pills, and had a free evacua¬ tion of the bowels. At six o’clock p. m. of the 16th, he fell
Remarks on Obstinate Intermittent.
397
down in a fit, his body was greatly convulsed. I did not see him till ten p. m., he was then quiet, his pulse was full, not above eighty, his face suffused, head very hot, and he looked exceedingly wild ; his tongue was rather white, breathing oppressed. He endeavoured to give a rational account of his feelings, but had great difficulty in collecting himself, and said he felt crazed.
I considered this case at this moment requiring active treatment, but the previous debility and the first accession of these fits having come on while labouring under the effects of haemorrhage, I was disinclined to abstract blood ; I also had thought the continued pain in the head and unequal dis¬ tribution of nervous influence, might have arisen from effused fluid, or a diseased state of the membranes of the brain ; and intended, if relieving the alimentary canal was unproductive of benefit to mercurealize the system , but the accession of the fever and the recurrence of the fit, which I consider brought on by the narcotic, obliged me to modify my plan; I therefore desired to produce a diversion by depletion through the mucous surface of the bowels, and for this pur¬ pose ordered two drops of the croton tiglium oil to be given immediately, and repeated in two hours ; and directed the whole vertebral column to be rubbed for half an hour with two drams of the ung. hyd. fort, in which was incor¬ porated ten drops of croton tiglium oil. The medicine had produced eleven or twelve copious watery stools. He com¬ plained of great pain along the spine, pain in the head relieved ; I directed two other doses of the oil as yesterday, to be taken in the course of the day, and the inunction to be repeated at night. 10 a. m. 18th, medicine has kept him in motion all yesterday and during the night ; has had no return of fever or fit, complains of bad taste in his mouth ; on ex¬ amination found the gums inflamed, head-ache slight, mental faculties improved, feels himself altogether better. 20th, has no complaint but that induced by mercury ; appetite good but cannot masticate ; health generally improved ; he has only taken afewaloetic pills since the 18th. My object in sending to you this case is not from any value 1 attach to it per se,” but to prove the system may be brought under the influence of mercury, <f malgre,” very active evacuation taking place from the bowels. Where it is desirable to bring the system quickly under the influence of mercury, as in the yellow fever, and it is of equal moment to evacuate the ali¬ mentary canal of the vitiated secretions, so abundantly formed in that malady, might not such a practice lead to a favourable
398
Original Communications.
o
termination ? Cynanche trachealis is also a disease, in which the use of mercury has been ably advocated, and I think justly, if there was time to carry its powers into the system ; indeed the arguments brought by its opponents are chiefly relative to the period necessary to bring the system under its influence; a powerful one in its favour in this disease, its property of preventing the formation of fibrine, its use in this disease need not preclude general blood-letting and evacuations from the bowels ; and admitting it did not affect the system, I am confident rubbed on the part three or four times in twelve hours, a better effect than a vesicatory will be produced, therefore nothing could be lost by its trial in this disease, and benefit might rationally be expected to accrue. A fear of rendering this paper too prolix has prevented my enlarging on many parts, but I trust enough is advanced to excite the attention of practical readers.
TIL — Mr. Mitchell on Stricture of the Urethra and
Gall Ducts.
To the Editor of the London Medical and Surgical Journal .
Sir, — By inserting the enclosed observations on stricture in your valuable periodical, if of sufficient importance, you will oblige, your most obedient servant,
r Charles Mitchell, Surgeon.
March , 1831.
As much controversy still exists regarding the possible pro¬ duction of permanent stricture from spasmodic contraction, I shall detail two cases illustrative of its sequence, or at least what I have viewed as a consequence of the frequent repetition of that action.
Case I. — August, 1827, a man applied on account of difficulty in voiding his urine, which required some time and effort to accomplish ; he considered the impaired state to have been approaching for the seven previous months, during the course of which and for some time prior, had suffered immediately upon evacuation of the urine, severe grasping and painful contraction in the perineum : he was of a costive habit, and troubled occasionally with irritation in the neighbourhood of the anus ; when constipated pain in
Mr. Mitchell on Stricture of the Urethra.
399
going to stool, the stream of urine was considerably di¬ minished. The prostate was suspected, but upon examina¬ tion it did not seem to be materially affected. A bougie, as large as the orifice of the urethra would admit, was introduced, but its progress was arrested upon approaching the bulb; some degree of force was employed, but it became more impeded and impacted with some difficulty experienced in its removal.
He was put into a warm hip-bath, took two grains of opium, and had administered an emollient enema, rest was at the same ‘time strictly enjoined. The next morning he took one ounce of castor oil, it operated mildly. In the evening a small white bougie was introduced without en¬ countering any obstacle ; while it remained he complained of pain, which greatly subsided before it was withdrawn. The part of the bougie placed towards the floor or inferior part of the canal was marked longitudinally, apparently by irregular protuberances, a circumstance noticed by the celebrated Mr. J. Hunter. The bougie was introduced daily, and its size gradually increased, which effected rapid ab¬ sorption of the callous deposition, aided by aperients, the bath, and horizontal posture. Nothing appears, therefore, more probable than that the longitudinal muscular fibres (which have been observed) should, from some irritating cause, contract spasmodically consequent upon their great sen¬ sibility and irritability. The man attributed the spasms to the imperfect expulsion of the urine from the urethra; nothing in fact appears more plausible than the lodgment of a small quantity at the bulb, exciting irritation and consequent con¬ traction to which I have been repeatedly subject, more particularly when the muscles of the pereeneum have been extended (resulting from posture), although they did not seem to participate in the contractility, for the perineal por¬ tion of the urethra was reduced to the consistence of a cord of considerable solidity, rendering me unable to move until its subsidence.
I examined the body of an old man about a year ago, who died of jaundice. He had suffered from repeated attacks, which were subdued by emetics, purgatives, opiates, emol¬ lients, local depletion and blistering. The whole body was deeply tinged yellow, the marrow as well as the cancelled structure of the bones. The ductus communus eholedochus, throughout its whole course, was almost obliterated and reduced to a white cartilaginous cord ; the canal admitted with some difficulty a delicate needle. From this analagous circumstance, therefore, we are naturally led to infer that
400
Original Communications .
spasmodic action must have been primary, and the depo¬ sition secondary, of course not produced by any contractile power of the contingent parts, consequently we must be excused for assigning constriction of the vesical fourth of the urethra, to be independant of the neighbouring muscles, unless we from hypothesis, deduce as a natural consequence of rough particles of calcareous concretion, lacerating, irri¬ tating and inflaming the delicate lining of the duct, thereby inducing the deposition.
Case II. A man applied nine months ago*, had been subject to spasm in the perineum, without being able to assign any cause, excepting the imperfect expulsion of the urine ; the stream at the comntfencement was forked, but as it flowed the division coalesced. The introduction of a large sized bougie was once attempted, but with no satisfactory result. A regular succession of sizes produced no better effect, for the first had excited a resistance not to be imme¬ diately overcome. He was allowed to remain quietly in bed for two days, took a purgative, and had administered three hours before the next attempt, three grains of opium. I commenced by attempting the introduction of one above the middle size, after retrograding, one entered with some difficulty; and with as much, removed in consequence of a slight degree of spasmodic contraction. The impression was broad and distinct, involving the whole calibre. The daily introduction of a bougie for one month, rest, and occasional aperients effected the salutary removal of the impediment. Caustic, I have every reason to believe, has cf late become too frequent an application in the treatment of stricture ; indeed it appears to have been a great and obvious error in the practice of Mr. J. Hunter, but more so in that of Sir E. Home, for he details a case where it was had recourse to nearly five hundred times, a case which might have soon yielded to judicious management by dilatation. If Sir E. had properly ascertained the extent and form of the stricture, by means of a graduated white bougie, he would have been better enabled to establish a more efficient and less dangerous course of practice than that produced in many instances, besides the uncertainty of its application, severe febrile paroxyms, false passages, ulcerative action, retention of urine, independant of the eschar, hsemorrhage, corrosion, and inflammation of the sensible lining of the urethra, fis- tulee, and exquisite pain. I must confess, however, that I have found and seen its application indispensably necessary, after leeches to the perineum the administration of opiates
Mr. Mitchell on Stricture of the Urethra. 401
and the warm bath to allay inordinate andexcessive irritability, spasm, and pain in the bladder, with inclination but inability to pass urine. The alleviation of these by one or two appli¬ cations of the caustic, rendered practicable the introduction of a metallic instrument or bougie, a safer and more suc¬ cessful course, adopted with more propriety and with less detriment to the constitution.
The basis of strictures are considerably broader than their Organized productions, and of course less influenced by escharotics, therefore it becomes absolutely necessary in many instances to have recourse to the sound or bougie after the caustic, to aid in removing the organized and callous base.
Lamb’s Conduit-street,
March, 1831.
IV. — Homicide by Poisoning. By M. Ryan.
The name of poison is given to all substances, which, when applied to the organs of the body, cause death. In order to give judgment in cases of poisoning, the medical jurist should be acquainted with the different poisons, their phy¬ sical and chemical characters, their effects on the animal economy, the means of distinguishing them from all matters with which they may be confounded or obscured, or in their combinations with the various tissues. These studies are indispensable to medical men, so that they may act with honour and conscience in accomplishing the exigencies of science and justice. We shall, therefore, consider the vari¬ ous bearings of this subject as concisely as possible, but yet as comprehensively, as the present state of science permits.
Mode of Action of Poison on the Economy. — Every poison possesses peculiar effects upon the body, and is characterised by peculiarities which indicate the species to which it belongs. It may be employed in various ways, by being introduced into the stomach or bowels by the anus, or it may be applied to the mucous surfaces of the various outlets, to the serous and cellular tissues, to the lungs by respiration, as in cases of asphyxia, or it may be inserted under the skin by inoculation, or injected into the
3 F
VOL. vi. no. 35.
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Original Communications .
veins. It is scarcely necessary to mention, that all poisons do not act in the same doses, or through the same tissue.
It was long held by physiologists that poisons were ab¬ sorbed by the veins or lymphatics ; but there is every reason to conclude, that all act in the first instance on the nerves, as incontrovertibly proved by Morgan and Addison. — ( Essay on the Action of Poisons, fyc. 1829.) These experimenters admit with Fodere, Tiedemann, Gmelin, Magendie, Brodie, Wilson Philip, Barry, Laissaigne, and others, that absorp¬ tion takes place, but that death may be produced by the same poisons solely through the nerves ; and that this oc¬ curred when they divided all the tissues in a limb, except the nerves. The presence of poisons in the fluids of the body as repeatedly observed in the blood, urine, &c. does not invalidate the opinion, that their fatal results took place through the medium of the nerves of the vessels which con¬ tained them.
General Indications of the means of detecting poison¬ ous substances. — There is no subject which requires such minute precautions as the discovery or detection of poisons, from their varied combinations with the fluids and solids of the body. Hence the process for detecting them are exceedingly numerous. This will appear from a reference to the works of Orfila, Christison, and of other toxicologists. To the first illustrious professor we are indebted for a clas¬ sification of poisons which is now generally received, and is as follows : —
1, Irritants; 2, narcotics; 3, narcotico-acrids ; and, 4, septic or putrefiants. This arrangement is adopted by Christison, and differs from those proposed by Paris and Beck, and is decidedly the best.
Class I. Irritant Poisons. — The poisons comprised in this class belong to the three kingdoms of nature. The symptoms produced by irritant poisons, when taken into the stomach, are violent irritation and inflammation in one or more divisions of the alimentary canal.
There is a sense of heat and burning in the tongue, mouth, throat, gullet and stomach, the pain is acute and extends to the abdomen ; it is increased by drinks and the respiratory movements, the heat is acrid and corrosive, the breath is foetid, nausea is often an early symptom, there is vomiting of a tough mucous or of a brown, blackish, sanguilent matter, or clots of pure blood, which cause a sense of bitterness and acridity in the mouth ; the smallest quantity of drink is rejected ; sometimes the bowels
Dr. Ryan on Homicide by Poisoning. 403
are constipated^ but generally there are copious, foetid and bloody alvine dejections ; there is hiccup ; the skin is pale, cold, and bedewed with a cold, clammy perspiration ; the extremities become cold ; painful eruptions appear ; the face is pale, or leaden coloured, affected with convulsive contractions ; great prostration occurs ; the pulse is small, irregular and weak ; the agony and anxiety are extreme ; there is a desire to pass urine, which cannot be gratified ; sometimes the intellectual faculties are unimpaired, and the sufferer is conscious of his horrible pains and approach¬ ing fate ; or the nervous system is stupified, and death occurs without much agony. In some cases the stomach is affected without the mischief extending to the intestinal canal, but generally both are implicated ; in bad cases, the whole tube from the mouth to the anus is affected at the same time. In some instances there is irritation in the wind¬ pipe and lungs, and urinary organs.
When poisons are applied externally they cause redness, or blistering, or sloughing, by corroding the tissues chemi¬ cally, and some of them induce inflammation of the cellular membrane, which may be diffused between the muscles. Others are absorbed, especially if applied to a wound or ulcer, causing lesions of the nervous system, the lungs, heart and digestive tube. Hydrophobia, syphilis, small¬ pox, poisoning by narcotics, are examples of the last mode of action.
Lesions of Tissue. Autopsy. — There will be inflamma¬ tion of the mucous membrane, of the cheeks, throat, gullet, stomach and intestinal tube ; sometimes there will be only congestion, but generally there will be black spots on the stomach, caused by effusion of blood between its mem¬ branes ; at other times there will be ramollisement or soft¬ ening of its mucous, or muscular, or serous tunic, or com¬ plete perforation of the three coats. In some cases the small intestines are untouched, while the stomach and large intes¬ tines, especially the rectum, are highly inflamed. These phenomena are explained by the rapidity with which the poison passes through this part of the digestive tube, while it is delayed longer in the stomach and rectum. It is to be remembered that the effects of many natural diseases are easily mistaken for those of poisons ; and these are disten¬ tion and rupture of the stomach, inflammations of the stomach and bowels, spontaneous rupture of the stomach and duodenum, bilious vomiting and cholera, effects of drink¬ ing cold water, hernia or rupture, melsena hsematemosis.
404
Origin al C ommu nications ,
colic, iliac passion, and inflammation of the peritonaeum. The diagnosis in these cases is often extremely difficult, and is often exceedingly doubtful. Distention and rupture of the stomach may be caused by gluttony, and produce sudden death from congestive apoplexy, or from an impression on the stomach itself. The appearances on dissection will, according to Christison, enable us to form a correct con¬ clusion in such cases, and in simple rupture of the organ.
Drinking cold water, when the body is over heated, has caused sudden death from the compression on the nerves of the stomach (Duncan), or from inflammation of the organ, followed by gangrene (Haller.) Ices or iced water in hot summers, produce similar effects. (Bull, des se Med. v. 6.)
The symptoms of cholera are exceedingly like those pro¬ duced by the poisons under notice. In some cases it is im¬ possible to distinguish them. Dr. Christison offers the fol¬ lowing diagnosis in cholera: — the sense of acridity in the throat never precedes the vomiting; there is no sanguinolent vomiting, and in this country et death within three days is very rare indeed.” Death from irritant poisons is seldom de laved beyond two days and a half. Dr. Mackintosh and Mr. Tatham have known cholera fatal in a less period than that above mentioned ; the latter in twelve hours. Edinb. Med. and Surg. Journ. v. xxviii. Dr. Christison concludes that cholera in this country very rarely proves fatal, as early as irritant poisoning (work 1829), that is within two days and a half; while Dr. Mackintosh states (in his Practice of Physic, 1828,) that several fatal cases within this period have been reported to him. Idiopathic gastritis may perhaps exist, but inflammation of the stomach is usually caused by poisons, and the burning in the throat, if present at all, does not precede the vomiting. The symptoms and morbid appearances in enteritis and peritonitis are widely different from those induced by poisons. Spontaneous perforation of the stomach has been often confounded with effects of poisoning ; but it occurs after scirrhus, simple ulceration, and softening, or ramoilisement, or gelatenization (Christison.) The last form is ascribed by John Hunter and most British pathologists to the gastric fluid after death ; but the last author named as well as Andral (pathology) questions this conclusion. Mr. Allan Burns however found a perforation in the stomach of a girl who died of diseased mesenteric glands ; he sewed up the body, and after two days he dis¬ covered another opening. Edin. Med. and Sur, v. vi.
It appears from the testimony of Christison, that perfora-
Dr. Ryan on Homicide by Poisoning
405
tion of the alimentary canal by worms, colic, melaena, ileus and obstructed hernia, can scarcely be confounded with effects of poisoning1.
Irritant Mineral poisons. — The poisons of this class are sulphuric acid ( vitriolic acid, vitriol, and oil of vitriol.) Nitric acid ( aqua fortis ) hydrochloric acid (muriatic acid, and spirit of salt,) phosphorus cadine, liquid chlorine, potassa with lime, oxalic acid, nitrate of potas, soda, lime, barytes, liquid ammonia.
Mineral Poisons. — It has happened of late years that infants have been destroyed by the barbarous practice of pouring sulphuric acid into the mouth ; and the countenance has been disfigured, vision destroyed, by throwing this acid upon the face. The latter crime is a felony.
When mineral acids (especially the nitric acid) are ap¬ plied to the skin, they produce irritation, inflammation, and corrosion. They act by the transmission along the nerves of their local impression. The inside of the mouth is generally shrivelled, white, yellow, if from nitric acid ; brownish from sulphuric, and often more or less corroded ; there is intense burning pain in the throat, oesophagus, and stomach, which is followed by eructations of gases evolved by the chemical decomposition of the coats of the stomach, and the pain is much more intense than in ordinary gastritis.
The matter vomited is brownish, black, or mixed with shreds of membrane, or consists of coagulated mucus ; the patient is affected with tenesmus and urgent desire to eva¬ cuate his bladder ; the breathing is laborious, as the move¬ ments of the chest increase the pain in the stomach. The pulse is generally weak, but may be natural ; and sometimes there is no uneasiness or torture produced even after a large quantity of the poison. In some cases there is an eruption all over the body. The fatal effect from poisoning by acids occurs between half a day and two or three days, it has happened in two hours, and has been prolonged to fifteen days. The patient may linger for eight months; there may be imperfect or perfect recovery. Christison thinks that death may occur from inflammation and spasm of the glottis and larynx with¬ out the poison reaching the stomach or the gullet. In these cases the clothes shew red or yellow spots, when nitric or sulphuric acid has been taken.
Autopsy. — The lips, fingers, and other parts of the skin will be spotted or streaked from disorganization of the cuticle by the acid ; these marks are brownish or yellowish brown, and present, after death, the appearance of old
406
Original Communications.
parchment, or of a burn, or of vesication. The mucous mem¬ brane of the mouth is generally hardened, whitish or yel¬ lowish ; the pharynx is in the same state or very red, the gullet is often lined with a dense yellow membrane, the subjacent tissue is brown or red. The muscular coat of the mouth, throat, and epiglottis is sometimes exposed, and oc¬ casionally the gullet is unaffected, though the mouth and stomach are severely injured ; the peritonaeum is generally inflamed, but not always. The stomach, if not ruptured, is commonly distended with gases, and contains a quantity of yellowish brown or black matter, and is lined with a thick paste of disorganized tissue, blood, and mucous. The py¬ lorus is contracted, the mucous membrane is not always corroded. When the acid is diluted, the coats of the stomach may escape corrosion ; but there will be excessive injection, gorging and blackness of the mucous membrane with or without softening. Again, there may be perforation of the stomach ; the duodenum is affected with the other appear¬ ances of the stomach. In the second or chronic variety the stomach and intestines are greatly contracted, the latter to the size of a quill. The pylorus is so contracted as barely to admit a probe. There are red spots on the surface of the stomach, and its coats may be attenuated, especially where adherent to surrounding organs, on separating which per¬ forations become apparent. When sulphuric or nitric acid is injected into the anus after death, there is no sign of in¬ flammatory redness, the mucous membrane is yellowish and brittle, the muscular and peritoneal coats are white, as if blanched. — (Orfila). When all the appearances already described exist. Dr. Christison is of opinion that we may conclude without chemical evidence, that poisoning has been caused by mineral acids.
Treatment of Poisoning by the Mineral Acids. — The immediate exhibition of chalk or magnesia, or if these cannot be had, of any mild fluid, milk or oleagenous matters, and then a free use of diluents to facilitate vomiting should be employed. Should inflammation commence, it is to be treated as ordinary gastritis
Tests for Mineral Acids. — Under this head we shall merely describe the tests which interest the jurist, taking it for granted he is informed on the physical and chemical properties of the acids in a pure and diluted state. Thus the jurist has to determine whether sulphuric acid exists in the vomited matter, and when it is supposed to cause stains on the clothes.
Dr. Ryan on Homicide by Poisoning. 40 7
Sulphuric Acid. — The process is simple, for the detection of the acid in alimentary matter. The suspected matter is to be boiled for a few minutes, and after filtration, sub-car¬ bonate of lime added ; the mixture agitated when sulphate of lime is obtained, which is to be dissolved in boiling water, and tested by a salt of baryta, the product is to be calcined with charcoal, and this gives a sulphur, from which sulphuretted hydrogen will be evolved by a few drops of nitric or hydrochloric acid. (Sedillot, 1830.) Dr. Christison describes this process more minutely when diluted.
When diluted, it is to be tested with litmus and tasted. An acid having thus been proved to be present, a little nitric acid is to be added, and subsequently a solution of the nitrate of baryta. If a heavy white precipitate falls down, it can be nothing else than sulphate of baryta, because no acid but the sulphuric, forms with the barytic salts a white precipitate insoluble in nitric acid. The phosphate and car¬ bonate of baryta are both soluble in nitric acid. In apply¬ ing this test care must be taken to employ nitric acid entirely free of sulphuric, — an admixture which the common nitric acid of the shops almost always contains.
The test now mentioned is alone sufficient to indicate the presence of sulphuric acid, combined or uncombined. But as the duty of the medical jurist is to supply not only satis¬ factory evidence, but also the best evidence which his science affords, it is advisable in a criminal case to establish the nature of the precipitate still farther by the following pro¬ cess: —
“ Collect the precipitate on a filter, wash, dry, and remove it. Then mix a little of it (not more than two grains) with a small proportion of dry charcoal powder ; and subject the mixture for two or three minutes, in a covered platinum spoon or in a fold of platinum foil, to the flame of a spirit- lamp enlivened with the blow pipe. A portion at least of the sulphate is thus converted into sulphuret of baryta. To prove this, put the powder with a little water in the bottom of a small glass tube, add a littl e hydrochloric acid, and then hold within the tube, without touching the matter below, a bit of white paper moistened with acetate or nitrate of lead. Sulphuretted hydrogen gas is disengaged, which will darken the paper, and likewise often betray itself by its singular odour.” — (Chrristison.)
This process is to be applied for the detection of stains, the cloth or other solids being boiled, &c.
Nitric acid. — The process proposed by Christison for
408
Or iginal ( ommu ni cations.
detection of nitric acid when mixed with food, consists of neutralizing1 the acid with potass, evaporating to dryness, and ascertaining by the addition of sulphuric acid and the application of heat, whether nitrous fumes are evolved. Sedillot, who is one of the latest and best French writers, recommends a different plan, namely, saturate the suspected mixture of animal substance and acid, with saturated car¬ bonate of potass, filter and evaporate the fluid, and crystals of nitrate of potass will be obtained. Dr. O’Shaughnesy, an able analysist and jurist, objects to these tests, and after a satisfactory exposure of their fallacy, proposes an entirely new re-agent, namely, morphine, which, when brought into contact with nitric acid, in the minutest quan¬ tity, immediately produces a brilliant Vermillion colour. The mode of experimenting requires attention. st A capillary tube should be used to absorb the minutest drop of the sus¬ pected liquid, which should then be gently expelled on a particle of morphine, placed on a white porcelain surface, when the characteristic tint is instantly produced.” (Prac¬ tical Commentaries on Dr. Christison’s Processes for detect¬ ing Poisons. Lancet, 1831, vol. I.)
Muriatic or hydrochloric acid , seldom comes under the cognizance of the medical jurist as a poison. No chemical evidence can be valuable when applied to the contents of the stomach ; since free acid and muriates have been detected in the secretions of that organ, by Prout, Tiede- mann, Gmelin and Greaves. This acid is known by its peculiar vapour, and by the white fumes formed by its mixture with ammoniacal gas, on the approach of the open mouths of two bottles containing these substances. The precipitate caused by nitrate of silver is to be filtered, dried and heated in a tube. It fuses at the point of redness, is not decomposed at a red heat, and on cooling forms a translucent mass, which cuts like horn.” (Christison.)
Dr. O’Shaughnesy objects to the test of ammoniacal gas, as he says it will produce a similar result, though of a less degree, by exposing strong, nitric, sulphuric or acetic acids to it. He says a portion of the acid should be diluted, and to one part nitrate of silver, and to another nitrate of baryta is to be added : if a precipitate occurs in the former and not in the latter, the evidence of muriatic acid cannot be disputed. The former writer says that a similar precipitate is caused by the same test with many other acids and their salts. Work on Poisons, p. 121.
Phosphoric Acid. — The plan for detecting this is by eva-
Dr. Ryan on Homieids by Poisoning .
409
porating the suspected solution to dryness, saturating with ammonia and precipitating it by hydrochlorate of lime ; in treating the phosphate of lime with a little charcoal in a glass tube, phosphorus will be obtained. Poisoning by phosphoric acid is exceedingly rare, and is the only case recorded by Christison, in which there was no aphrodisiac effect produced.
Liquid Chlorine. — This substance is detected by its green yellow colour, and a peculiar odour, which can scarcely be mistaken ; it discolours all vegetable substances, evolves gaseous chlorine by elevation of temperature, and with nitrate of silver a white curdy precipitate, insoluble in nitric acid and soluble in ammonia, is produced.
Iodine. — When urged too far, is a violent poison, as it may accumulate in the system like digitalis and operate suddenly. The symptoms which follow it in ordinate use, are loss of appetite, pain in the stomach, vomiting, purging, rapid and extreme emaciation, absorption of the breasts and testicles, small frequent pulse, great constitutional disturb¬ ance and violent spasms. Orfila found small yellow patches and ulcers on the mucous membrane of the stomach of a dog. In one case there was intense peritonitis, adhesions of the intestines, enlargement and pale rose red colouration of the liver. There was effusion into the peritoneal cavity and chest. (Christison.) Dr. O'S. comments upon this account, and says, “ we believe that wherever death occurs later than sixty hours after poisoning by iodine, it will be sought in vain in the alimentary canal, whi,le it may have been readily detected during life in the urine.
Iodine, when taken into the alimentary canal, remains there but a very short time in a free condition. If the poisoned animal have recently eaten bread, potatoes, or other amylaceous matters, the iodine is almost immediately con¬ verted into the iodide of starch, and this again is, by some inexplicable digestive process, transformed into the hydrio- dic acid. So rapidly do these changes take place, that in one instance in which we administered a drachm of 'solid iodine to a dog, though vomiting took place in fifteen minutes, yet not a trace of free iodine could be detected by starch in the rejected matters, though hydriodic acid was found in large quantities.
“ Again, the hydriodic acid once formed, is rapidly elimi¬ nated through the several excretory channels. In forty minutes we have found it in the urine, in which, in the dog just alluded to, it was detected occasionally for five days;
VOL. vi. no. 35. 3 G
410
Original Communications.
viz., on the first and second, and on the fourth and fifth, when he died. Strange to say, though the same process was performed with every precaution on the third day, it gave no indications whatever of any compound of iodine. We found it, however, in the saliva, which was secreted in immense quantities on that day. After death not a trace existed in the contents of the alimentary canal. It is also worth recording that in this instance and four others, no trace of inflammation existed in the intestines, with the exception of a few ulcerations of the glands of Peyer and Brunner ; but the air-cells of both lungs were infiltrated with pus, and their substance was preternaturally soft.”
In Dr. Christison’s observations on the iodine poisons, these facts are entirely omitted as far as the analysis is con¬ cerned, and a mode of detecting the hydriodates is proposed, which would inevitably lead to total failure if applied to any complicated mineral fluid, such as the urinary excretion.
He sets out in his chemical examination, on the supposi¬ tion that some combination of iodine has been taken. In order therefore to ascertain whether any free iodine is pre¬ sent, the contents of the alimentary canal are triturated with a little cold solution of starch, which would immediately cause the mixture to assume a blue colour. If the blue colour appear, the mixture is, if necessary, diluted with water, and exposed to a current of sulphuretted hydrogen, by which the iodide of starch is decolorised and converted into hydriodic acid. If no blue colour have been produced, the mixture ie merely boiled with water and filtered. If the filtered fluid redden litmus paper, it should be neutralised with caustic potassa, and then reacidulated with acetic acid. He next adds the solution of the chloride of platinum, which with the most minute quantities of hydriodic acid, either causes a dark-red precipitate, or changes the fluid to a port- wine colour. It is then to be agitated with an ounce of ether, which dissolves the iodide of platinum, and separates it from the other fluids swimming on their surface, from which it may be removed by a suction tube. The ethereal solution is, finally, to be evaporated to dryness, and the iodide of pla¬ tinum heated by the spirit-lamp flame in a smalL glass tube, when the iodine is disengaged in its characteristic violet vapour, and condenses on the sides of the tube in dark den¬ dritic crystals.
The above process we have found to be extremely delicate and easy of execution. It is especially applicable to the urine or saliva. Occasionally in the urine, the simple addi-
Dr. Ryan on Homicide by Poisoning. 411
tion of cold solution of starch and sulphuric acid will strike the peculiar blue colour, which may be considered sufficient evidence. This experiment, however, is by no means so delicate as that just detailed, and it is, moreover, exceedingly liable to be interfered with by the animal matters which the urine contains.” — Ut supra.
Hydriodate of potass is preferred to iodine, as less inju¬ rious to the stomach and constitution as a medicine, but as yet no case of poisoning* by it has been recorded.
Oxalic acid. — This substance, when mixed with lime, gives a white precipitate, which is with difficulty soluble in hydrochloric acid, though very soluble in nitric acid ; the oxalate of copper, of a whitish blue colour, is also insoluble in the first named acid. The nitrate of silver causes a white precipitate of oxalate of silver ; if dried and heated on the point of a spatula, it burnishes its edges — it fulminates with a white fume. *
Dr. Christison’s process is as follows
f£ In determining the medico-legal tests for oxalic acid, it will be sufficient to consider it in two states, — dissolved in water, and mixed with the contents of the stomach and intestines or vomited matter. If the substance submitted to examination is in a solid state, the first step is to convert it into a solution. In the form of solution its nature may be satisfactorily determined by the following process : — The acidity of the fluid is first to be established by its effect on litmus paper. This being done, the re-agents might be applied at once. But it is better to neutralize the acid previously with any alkali, for then they act with greater delicacy. The remainder of the process consequently applies not only to oxalic acid itself, but also the soluble oxalates, which will presently be proved to be likewise active poisons. The tests are the hydrochlorate (muriate) of lime, sulphate of copper, and nitrate of silver.
Hydrochlorate of lime causes a white precipitate, the oxalate of lime, which is dissolved on the addition of a drop or two of nitric acid, and is not dissolved when similarly treated with hydrochloric acid, unless the acid is used in very large, proportions. The solubility of the oxalate of lime in nitric acid, distinguishes the precipitate from the sulphate of lime, which the present test might throw down from the solutions of the sulphates. The insolubility of the oxalate of lime in hydrochloric acid, on the other hand, dis¬ tinguishes the precipitate from the tartrate, citrate, carbo¬ nate, and phosphate of lime, which the test might throw
412
Original Commun icatio n s .
down from any solution containing1 a salt of these acids. The last four precipitates are re-dissolved by a drop or two of hydrochloric acid ; but the oxalate is not taken up till a larger quantity of that acid is added.
iC Sulphate of copper causes a bluish-white precipitate, which is not re-dissolved on the addition of a few drops of hydrochloric acid. The precipitate is the oxalate of copper ; it is re-dissolved by a large proportion of hydrochloric acid. This test does not precipitate the sulphates, hydrochlorates, nitrates, tartrates, citrates ; but with the carbonates and phosphates it forms precipitates, resembling the oxalate of copper. The oxalate, however, is distinguished from the carbonate and phosphate of copper, by not being re-dis¬ solved on^he addition of a few drops of hydrochloric acid.
Nitrate of silver causes a dense white precipitate ; the oxalate of silver, which, when collected on a filter, dried and heated, becomes brown on the edge, then fulminates faintly, and is dispersed. The object of the supplementary test of fulmination, is to distinguish the oxalate of silver from the numberless other white precipitates, which are thrown down by the nitrate of silver from solutions of other salts. The property of fulmination, which is very charac¬ teristic, requires, for security’s sake, a word or two of ex¬ planation in regard to the effect of heat on the citrate and tartrate of silver. The citrate, when heated, becomes alto¬ gether brown, froths up, and then deflagrates, discharging white fumes, and leaving an abundant ash-grey, coarsely fibrous, crumbly residue, which on the further application of beat, becomes pure white, being then pure silver. The citrate also becomes brown and froths up, but does not even deflagrate, white fumes are discharged, and there is left behind a botryoidal mass, which, like the residue from the citrate, becomes pure silver when heated to redness. Ano¬ ther distinction between the oxalate and tartrate is, that the former is permanent at the temperature of ebullition, while the latter becomes brown. The preceding process or com¬ bination of tests will be amply sufficient for proving the presence of oxalic acid, free or combined, in any fluid which does not contain animal or vegetable principles.
“ Of the modifications which are rendered necessary by the admixture of such principles, none are of any conse¬ quence, except those acquired in the case of an analysis of the contents of the alimentary canal or matters of vomiting. Here a word or two must be premised on the changes which the poison may undergo, in consequence of being mingled
Dr. Ryan on Homicide by Poisoning
413
with other substances in the stomach or intestines. There may either be organic principles contained in the body, or substances introduced into the body as antidotes.
As to animal principles. Dr. Coindet and I have proved that oxalic acid has not any chemical action with any of the common animal principles, except gelatine, which it rapidly dissolves, and that this solution is a peculiar kind, not being accompanied with any decomposition either of the acid or the gelatine. Consequently oxalic acid, so far as it con¬ cerns the tissues of the stomach or its ordinary contents, is not altered in chemical form, and remains soluble in water. In such a solution, however, a variety of soluble principles are contained, which would cause abundant precipitates with two of the tests of the process — sulphate of copper and nitrate of silver; so that the oxalates of these metals could not possibly be exhibited in their characteristic forms. The process for a pure solution, therefore, is inapplicable to the mixtures under consideration; but changes of still greater consequence are effected in the poison by exhibiting antidotes during life. It is now, I believe, generally known, since the researches of Dr. Thomson, and those of Dr. Coindet and my¬ self, that the proper antidotes for oxalic acid are magnesia and chalk. Each of these forms an insoluble oxalate, so that if either had been given in sufficient quantity, no oxalic acid will remain in solution, and the proof of the presence of the poison must be sought for in the solid contents of the sto¬ mach, or solid matters of vomiting. The following process for detecting the poison will apply to all the alterations which it may thus have undergone : —
“ The first object is to procure a solution. If an antidote has not been given, the contents and tissues, or vomited matter, are to be boiled, distilled water being added if required ; the acid is then to be neutralized with potass, and the whole filtered. If magnesia or chalk has been given as an antidote, the insoluble matter is to be separated by filtration, and boiled for twenty minutes in a solution of carbonate of potass, in eighteen or twenty parts of water. A double interchange of elements takes place between a part of the carbonate of potass, and a part of the oxalate of lime or magnesia, and in consequence, some carbonate of lime or magnesia is thrown down, wffiile some oxalate of potass will be found in solution. The fluid after filtration is to be acidulated with pure nitric acid, oxalic acid being now in solution, whatever may have been its original state ; the next step is to separate it from the animal and vegetable
414
Original Communications .
matter dissolved along with it. I have tried various plans for this purpose, but have found none to answer so well as precipitation with the muriate of lime, so as to procure an oxalate of lime, which, after being well washed, is to be decomposed by boiling it in a solution of carbonate of potass, as before. i\n oxalate of potass will again be found in solution. The excess of alkali is finally to be neutralized with nitric acid. The fluid is now to be tested with the three re-agents for the pure solution of oxalic acid.”
The other vegetable acids, tartaric, citric, malic and acetic, are seldom or never used as poisons, and conse¬ quently do not require further notice.
Fused potass , sub carbonate of potass. — These substances attract moisture from the atmosphere and deliquesce ; they turn the syrup of violet green, and litmus paper blue, and are saturated by acids. Watery solutions of them are not decomposed by subcarbonates of soda and ammonia ; hy¬ drochlorate of platina causes a yellow' precipitate, composed of potass, oxide of platina and hydrochloric acid.
Nitrate of potass, nitre, salt petre. — When this substance is thrown on burning fuel, it ignites with a crackling noise. If concentrated sulphuric acid is poured upon this salt nitric acid, vapour is disengaged. The indigo test proposed by Liebeg, is not decisive. Orfila proposed to mix some parti¬ cles with water and copper filings, and add a few drops of sulphuric acid, when the orange fumes of nitrous acid will be evolved. The morphine test mentioned, when speaking of nitric acid, is the last that has been proposed, and perhaps the most certain.
Soda , lime and baryta, are seldom, if ever, used as poi¬ sons, and need not be further noticed.
Ammonia and its salts are discoverable by a peculiar odour, and by tests known to every medical practitioner.
Preparations of mercury . The oxymuriate of mercury , deutochloride , bichloride corrosive sublimate, is the com¬ monest preparation of mercury employed as a poison. The mode of detection laid down by Dr. Christison, is considered almost infallible. The suspected substance is to be boiled in distilled water, and a small portion filtered for the trial. On addition of protochloride of tin, a pretty deep ash-grey, or greyish black colour is effected. This preparation of tin is prepared by boiling tin powder in strong muriatic acid, until the metal ceases to be dissolved ; the liquid should then be preserved in a closely stoppered bottle. The che¬ mical changes effected in this experiment are as follow : —
Dr. Ryan on Homicide by Poisoning.
415
The protochloride of tin strongly attracts more chlorine, thereby removing one atom of it from mercury, and reducing the latter to a protochloride (calomel) which is also deprived of its one remaining atom, metallic mercury, being preci¬ pitated in the form of a dark minutely divided powder.
Corrosive sublimate, when thrown on burning coals, is volatised in the form of thick irritating fumes, which tarnish copper. If the mercury, mixed with potass, in a glass tube, shut at one end, and sublimed, the mercury will appear in the form of globules on the sides of the tube. If a watery solution of the corrosive sublimate is mixed with potass or lime water, a yellow precipitate occurs, a white one by liquid ammonia, a black one by the soluble hydrosulphates, and finally, the ferruginous hydrocyanate of potass causes a white deposit, which soon becomes yellow, then more or less blue, from the formation of Prussian blue. If a plate of copper is immersed in a mercurial solution, it becomes covered with a slight coat of the metal, when oxymuriate of mercury is mixed with animal or vegetable substances in solution, and the re-agents produce no effect ; ether should be added, the mixture agitated, filtered and distilled with gentle heat, when a residue will be obtained, which, mixed with water, affords a pure concentrated solution. A fourth part of ether should be added, which has the power of abstracting the salt from its aqueous solution. After agita¬ tion for a few minutes, and allowed to rest for thirty seconds or more, the etherial solution rises to the surface and mav be removed ; it is then to be filtered, evaporated to dryness, and the residue treated with boiling water, which afforded the evidence already mentioned, on being tested with pro¬ tochloride of tin. This preparation of mercury may be de¬ tected in vomited matters, by drying them in a sand bath, mixing them with a solution of potass in alcohol, and cal¬ cining them at a red heat, when the metal will appear in globules in the neck of the tube.
The following mercurial preparations — the sulphate, sub- nitrate, red precipitate, acetate and cyanuret, when mixed with organic matter, may be decomposed, and the mercury separated by boiling with fused or caustic potass for an hour, an excess of nitric acid is to be added, which preci¬ pitates caseous and albuminous matter ; filtration is then to be concentrated by evaporation. If a slip of gold, bound round with a harpsicord wire, be plunged into the fluid, an amalgam of gold and mercury will be formed ; this is to be scraped off and sublimed in a glass tube, when globules of mercury will appear.
Original Communications.
416
When the corrosive sublimate is applied to a wound or ulcer* it is absorbed* and causes inflammation of the heart, inducing- brownish black patches on its internal mem¬ brane* as well as on that of the intestinal canal. When taken into the stomach* it produces greyish white patches, which do not result from any other poison. The best anti¬ dote is white of eg g, which reduces the salt to calomel. The ordinary symptoms of irritant poisoning will be pre¬ sent, and they have been already described. If the nitrate be the poison* the best antidotes are muriate of soda and carbonate of ammonia. The various oxides of mercury are less virulent poisons than the sublimate. The sulphate and cyanuret have induced death, but are seldom employed. Dr. Christison’s chapter on poisoning by mercury, and of the effects of that medicine on the body* is one of the best ever written, and ought to be maturely considered by every medical practitioner.
Compounds of arsenic.— Metallic arsenic has an iron- grey colour, is fragile and brilliant, when recently broken. It oxidates in air, water or alcohol. When exposed to air, it becomes rapidly tarnished, and forms a black powder. It sublimes at 356°. Farh. and in close vessels it condenses unchanged ; but in open air it rises in white fumes* wdth an alliaceous odour, and becomes white oxide, which consists of one atom of metal and two of oxygen, or of thirty-eight parts of the former* and sixteen of the latter. Metallic arsenic has a strong affinity for oxygen, which it rapidly extracts ; when two acids are formed* the arsenious and arsenic* the former appears in brilliant octohedral crystals.
The principal compounds which are formed by arsenic* are the arsenious acid or white oxide of arsenic, the arsenite of copper or mineral green, the arsenite of silver, the arse¬ nite of potass* the arsenic acid, the arseniate of potass, the yellow sulphuret or orpiment* the red sulphuret or realgar, and the impure sulphuret termed king’s yellow ; there is more¬ over a black compound termed fly powder* little known in this country* composed of the metal and arsenious acid.
“ The arsenious acid, when newly prepared, exists in the form of white transparent, vitreous lumps, which gradually become opaque by keeping. It is usually sold as a white powder ; when heated to 380° Fahr. it is sublimed, and con¬ denses unchanged in minute octahadres. The taste of arse¬ nic has been disputed, but Dr. Christison inclines to the belief that it is entirely insipid, and that the peculiar taste sometimes attributed to it, depends on the irritation which
Dr. Ryan on Homicide by Poisoning. 41 T
It quickly causes in the part. In this opinion we altogether coincide. The arsenious acid of the shops is soluble in boiling water in the proportion of 115 to 1000 parts,, and twenty-nine parts are retained on cooling ; temperate water again takes up, in thirty-six hours, 12-5. The solubility of the acid in water is impaired considerably by the presence of various organic materials, such as mucous, albumen, or astringent matter.
te The arsenious acid forms salts with the various salifiable bases, of which the most remarkable are the arsenites of silver, copper, lead, lime, potass and ammonia, all of which may be prepared either by bringing the arsenic acid into direct contact with the base, or by decomposing a salt of the base (such as the muriate of lime, nitrate of silver, acetate of lead or sulphate of copper), by means of a soluble neutral arsenite. Arsenious acid, added by itself to one of these salts, produces no decomposition, since its affinity for the base is weaker than that of the acid with which the base was previously associated. This fact is of the utmost im¬ portance, and deserves to be attentively studied.
<£ The arsenite of copper is a green compound, formed by adding the arsenite of potass, soda or ammonia, to the sulphate of copper. The arsenite of silver is yellow, and formed with the nitrate of silver in the same way. The arsenite of lead and lime are both white.
The arsenic acid never comes under the notice of the toxicologist in its free state, but it frequently occurs in combination with potass, as the arsenite of that alkali. This compound is formed by deflagrating arsenious acid with nitrate of potass, by which it obtains another atom of oxygen. Arsenic acid is produced, which unites with part of the potass, forming a neutral salt ; the nitrate of silver added to the salt (both in solution), causes the precipitate of a brown-red arseniate of silver.
Of the sulphurets of arsenic, two only aie of toxicolo¬ gical importance, namely, the pure orpiment and the impure king’s yellowT, the former occurs abundantly as a natural product, and is artificially produced when sulphur is treated with arsenious acid, or when sulphuretted hydrogen is passed through a solution of that substance. Both these sulphurets of arsenic are exceedingly soluble in alkaline solutions.” — (O’Shaug'hnesy, op. supra cit )
Treated with potass and charcoal, in the manner hereafter mentioned, metallic arsenic will be produced. Arsenious acid is dissolved in boiling hydrochloric acid, and precipi*
3 H
VOL. vi. no. 35.
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Original Communications .
tates on cooling-. It is very soluble in water, and an addi¬ tion of hydrosulphuric acid, which causes a precipitate of yellow sulphur of arsenic, which is entirely soluble in am¬ monia. The ammoniacal deuto-sulphate of copper, causes a green precipitate. On boiling this acid with potass, a yellow precipitate takes place by nitrate of silver. When white oxide of arsenic is mixed with vegetable and animal matters, the following processes are recommended for its detection : —
A small quantity of these substances is to be boiled for fifteen or twenty minutes, filtered and tested with the various re- agents already mentioned. The hydrosulphuric acid or soluble hydrosulphates, to which a few drops of nitric acid are added, are the best tests, as the yellow sulphate of arsenic is detected with difficulty ; when such suspected matter is much coloured, it will not be easy to recognize the precipitates ; and then a concentrated solution of chlo¬ rine should be added, and by this means the arsenious will be converted into arsenic acid, which is very soluble. On filtering the liquor, we are to observe if it give a white precipitate with lime water or baryta, a whitish blue with acetate of copper, a brick red with nitrate of silver. If this liquor is boiled with hydrosulphuric acid, the yellow sulphur of arsenic is formed.
When the liquor obtained by the first operation contains animal matter, which prevents the deposition of precipitates, it is to be evaporated, an excess of nitric acid is to be added and carried to the boiling point, which will destroy the animal matter ; the excess of acid is to be saturated with potass, a few drops of hydrosulphuric acid gives a precipi¬ tate of yellow sulphur of arsenic.
The contents of the stomach may contain arsenious acid in a solid or fluid state ; when solid it may be mechanically mixed, and subside on simple decantation. If the quantity amount to a grain, it is said to be large, and is to be divided into three portions ; the first is to be mixed with charcoal or black flux, prepared by deflagrating one part of nitrate of potass with two of supertartrate of potass, and sub¬ limed in the manner mentioned by Dr. Christison in the sub¬ sequent extract ; the second part should be boiled in dis¬ tilled wrater until dissolved, and a drop or two of the solution placed on three different watch crystals; nitrate of silver should be added to one, when a yellow precipitate takes place ; sulphate of copper and ammonia to the second, when a deep green deposit occurs ; and sulphuretted hydrogen
Dr. Ryan on Homicide by Poisoning .
419
should be brought in contact with the third, when a yellow precipitate or stain will be produced.
Dr. Christison examines the tenth of a grain in the fol¬ lowing manner : —
“ The only instrument which should be used by the inex¬ perienced, and the instrument which the chemist will always prefer when it is at hand, is a glass tube. When the quan¬ tity of the oxide is very small, it should not exceed an eighth of an inch in diameter.
“ The proper material for reducing the oxide of arsenic is freshly -ignited charcoal. With this substance the whole metal of the oxide of arsenic is disengaged. The black flux, which is usually recommended, is ineligible, if the quantity of oxide is very small ; for only a part of the metal is disengaged, the remainder continuing in the flux, probably in the form of arseniuret of potassium. If the quantity operated on is large, it should be mixed with the charcoal or flux before it is introduced into the tube ; if on the other hand it is small, a better plan is to drop it into the tube and cover it over with charcoal. The materials are to be introduced along a little triangular gutter of stiff paper, if the tube is large ; but with a small tube it is pre¬ ferable to use a little brass funnel, to which a brass or silver wire is previously fitted, for pushing the matter down when it adheres. In either of these ways the side of the tube is kept quite clean, which is a point of great consequence, especially when the black flux is used. In delicate experi¬ ments the material should not be closely impacted in the tube. By far the best method of applying heat is with the spirit lamp, at first suggested by Mr. Phillips. The upper part of the material ought to be heated first, and with a very small flame. Afterwards the heat should be applied to the bottom of the tube, the flame being previously enlarged by drawing out the wick with a pair of forceps. A little water, disengaged in the first instance, should be removed with a roll of filtering paper, before a sufficient heat is applied to sublime the metal. Whenever the dark crust begins to form, the tube should be held quite steady, and in the same part of the flame. By these precautions a well-defined crust will be procured with facility, even by a mere tyro in practical chemistry, as I have ascertained by repeated trials.”
[ 420
BIBLIOGRAPHY.
ANATOMY.
1 . On preserving Anatomical Preparations in Spirits. By Alex¬ ander Watson, Esq. M.R.C.S.E., &c. &c. — After enumerating the various causes by which an evaporation of the spirit employed takes place, Mr. Watson proposes, in order to obviate these inconveniences, to have glass-stoppers accurately ground to fit the preparation-bottles ; the stopple itself being hollow, with a rod across it, to which the threads, suspending the preparations, are to be attached, thus re¬ moving the inconvenience of the threads being brought over the neck of the bottle, in which case they frequently act as a syphon, and always cause a small crevice, which materially aids in the evaporation of the spirit. The mouths of the bottles should be as small as possible. Mr. W. also, employs a weaker spirit than the one in common use for preparations, as, “ after the preparation has been properly ma¬ cerated and prepared by repeated changes of water and spirits, a much weaker spirit than is commonly used is not only sufficient, but is in reality much better for preserving it by being less subject to evaporation.” The stopper is to be rubbed with lard before it is inserted, and melted wax poured over it afterwards ; it likewise appears a cheaper method than the one at present employed. — Edinburgh Med. and Sur. Journ. April.
SURGERY.
2. Sixth Report of the Edinburgh Surgical Hospital, from August 1830 to February, 1831. By James Syme, Esq. Fellow of the Royal College of Surgeons, London and Edinburgh, and Lecturer on Surgery, Edinburgh.
Fractures. — It appears that, altogether, since the hospital was opened in May, 1829, upwards of 140 cases of fracture have come under treatment.
From observation, and from some dissections which tend to throw light on the mysterious process of the re-union of bone, Mr. Syme has formed some opinions on that process, which are, we believe, some¬ what different from those entertained by the generality of surgeons.
Breschet, from his experiments on dogs and pigeons, concludes, that the formation of callus consists in the following steps : — “ 1st. In effusion into the surrounding soft parts, and gradual ossification of a layer of these exterior to the bones. 2d. In effusion into the medullary canal, and subsequent ossification of it. 3d. The forma¬ tion of an intermediate substance between the fractured surfaces, which, in course of time, it might not be until months had elapsed, became converted into perfect bone.
Mr. Syme proves that the bones are not merely united by the ossification of their periosteum, “ by cutting them through longi-
Surgery.
421
tudinally when the ends are found firmly united together, and even the medullary canal filled with osseous matter.” He states, how¬ ever, that at an early period the fractured surfaces are ununited ; and hence Duhamel, whose observations did not extend beyond the fifteenth day, was confirmed in his error.
Mr. S. formerly believed, “ that the new bone or callus resulted entirely from the old one ; being first, a gelatinous effusion becoming more and more firm, then cartilaginous, and at last identical with the tissue from whence it proceeded.
He acknowledges that analogy and the appearances of bone, some time after the fracture, tend to prove this, but he thinks that some facts afford unquestionable evidence against its truth.
In treating fractures of long bones, we find the mobility continues, generally for the best part of three weeks, during which period the crepitation is quite distinct ; it usually ceases very suddenly, and the limb all at once gains a degree of firmness sufficient to support its own weight : when such fractures are dissected within the first two or three weeks, the ends of the bones are found quite separate. These facts, Mr. S. thinks, are quite opposed to the idea that the process consists entirely in a deposit between the broken portions, in which case the mobility should cease gradually.
He gives two dissections of fractures in the early stage.
Case I. Catherine Adam, set 52, oblique fracture of the right thigh, at its lower third. She died, in about a fortnight, with symp¬ toms of oedema of the glottis.
On dissection, the fracture was found to extend obliquely from near the middle of the bone down to the external condyle. The muscular fibres and cellular substance in the neighbourhood of the injury were altered in colour as well as in consistence, by the effusion of gelatinous matter into their texture. A kind of bag or capsule was there formed, embracing the whole extent of broken surfaces, and containing two or three ounces of fluid blood. The parietes composing it were in some parts connected with the very edge of the bone, but in others they became adherent to it at a dis¬ tance of an inch or more from the extremity, leaving a space to this extent uncovered, and apparently denuded of periosteum. When carefully examined, this exposed portion was ascertained to be covered by a thin layer of gelatinous substance, which did not possess the toughness or other characters of a membrane ; and the respective surfaces of the bone had a covering of the same kind. The medullary membrane was very vascular, and more distended than usual.
In examining the structure of this bag, I endeavoured to ascertain which of the natural tissues entered into its formation, and in what parts of it, if any, ossification had commenced. On tracing the periosteum from the sound bone, I found that where the bag adhered, that membrane became thick and evidently continuous within its walls. It seemed probable that where the membrane had been stripped off the bone, as already mentioned, it might assist to form, in some
422
Bibliography.
small part, the sac in question ; the great extent of which, howrever, was evidently constituted by the neighbouring tissues, whatever they happened to be, muscle, tendon, fat, or cellular substance, all being reduced to the same appearance internally, by vascularity of the surface, and the same consistence, by the interstitial effusion of organizable matter.
On introducing my finger into the bag, so as to feel if there were any indications of ossification, I perceived some small grains or specks of bone, which, when minutely examined, presented a stellated appearance, and were ascertained to be in the substance of the cap¬ sular membrane. When examined in the same way near its con¬ nexion with the bone, it was found to contain much larger masses possessing osseous firmness. In order to ascertain the precise seat and origin of which, I carefully dissected the membrane where they existed, and then found that they lay completely imbedded within it, having a covering from it on both sides ; also that they did not ad¬ here to the bone, being separated from it by a thin layer of the mem¬ brane, so as to admit of a slight degree of motion ; but at these parts, the shaft itself had begun to shoot out a growth of new bone.”
It would appear from this, that not only arteries supplying the periosteum and the bone itself, can take on that action, but likewise the arteries of the surrounding parts. This dissection is a most im¬ portant and highly interesting one, and has been described and per¬ formed with Mr. S.’s well known skill and attention.
As we have devoted so much space to this case, we can only give an extract of the case which follows: — Mary Donaldson, set 70. A compound and comminuted fracture of the left leg, close to the ancle. The patient was admitted on the 27th September, on the 25th of October the cure appeared complete, and on the 5th of November she was discharged cured. About ten days afterwards she died, and Mr. S. procured permission to examine the leg. The bones on being freed from the muscles appeared nearly natural, but after maceration the tibia appeared composed of thirteen pieces, which constituted merely a skeleton, the central cavity remaining vacant. On examining the internal surface, ossification was ob¬ served to have been going on all over it, and Mr. S. has no doubt it would have become solid in time. The fibula presented similar appearances.
Mr. S. promises to return to the subject again at the first oppor¬ tunity. We expect it with impatience, as every fact of such a nature is of great value, to determine this point.
Four additional cases of excision of elbow joint are added, making fourteen in all ; three were successful : in the fourth, the disease for which it was performed was very extensive. Amputation was finally done, but the patient died the day after.
Urinary Calculus. — The next subject treated of, of consequence, is this disease.
In Mr. S.’s last report, he mentioned a case of stone that occurred in private practice, in which he extracted two large stones from the
423
ery.
urethra. Some uneasiness remained after the operation, supposed to be caused by a stricture of the urethra which existed, more especially as great relief was experienced by the use of bougies. When the stricture was cured, however, the uneasiness still remained, and in consequence an instrument was passed into the bladder, and a cal¬ culus detected. The stricture being situate in the anterior part of the urethra, the bougies were never passed beyond it, for fear of dis¬ turbing the healing process in the wound, through which the calculi were extracted. Mr, S. proposed its removal, but met with great opposition from one parent ; it has since been extracted.
This case shews, in the first place, how careful one ought to be in removing stones from the urethra, near the neck of the bladder, to ascertain at the time whether or no there are any in the bladder itself. Otherwise the patient will have all the horrors of two operations, and be ready to listen to any suggestions against the skill of the surgeon.
As it is impossible to ascertain the existence of the calculus pre¬ vious to the operation, and as it frequently happens that the first time of passing the sound, the stone is not felt, it would be better to divide the prostate so as to admit the finger, and make a complete scrutiny over the whole of the bladder.
A very curious case of stone follows ; in which, owing to the extreme suffering of the patient from the stone, he had been accus¬ tomed to take about sixty-two grains of opium daily.
The operation of lithotomy was performed with considerable fa¬ cility, and a small oval stone about the size of a pigeon’s egg ex¬ tracted. The question of what quantity of opium should be allowed him was then mooted ? If the quantity previously taken, danger was to be feared from it, the cause of the irritation requiring it being removed. On the other hand, a sudden discontinuance of his natural stimulus was likely to do considerable harm. In this dilemma, the patient’s feelings were allowed to be the guide, (by far the best that could be chosen) and he took in each of the first six days, from six to eight hundred drops of ladanum ; his bowels were opened by injections, which were and had been for some time indispensable.
On the 6th Sir G. Ballingall and Mr. S. thought the opium might be diminished. In the evening, he complained of exhaustion and general uneasiness, pulse had risen, tongue was dry. Laudanum was given in large doses, but he gradually sunk, with symptoms of chest affection. The day before his death, he complained of violent, in¬ cessant, and excruciating pain in the left lumbar region, which con¬ tinued until he died. On dissection, the lungs were gorged with mucus ; in the abdomen the only morbid appearance was an extreme contraction of the colon, exactly at that part where the agonizing pain was felt ; all the parts concerned in the operation were in a most satisfactory state.
Mr. S. ascribes the patient’s death to suddenly removing .a source of irritation in a very irritable system. In ordinary cases this dimi¬ nution of irritation counterbalances the irritation of the operation.
424
Bibliography.
But the previous irritation was excessive, while that from the opera¬ tion was comparatively mild, from the facility with which it was performed ; and hence the function might be thrown into disorder, and produce death. He is not, however, certain of this, and leaves it to the practical reader to explain as best pleases him.
Cancerous Sores of the Face. — When they can he eradicated, should be removed freely with the knife, as owing to the looseness of the surrounding integuments, cicatrization readily occurs. Some cases are given in point. A case of lacerated wound of the vagina is detailed, but from our long extract, it is impossible to do justice to it.
An attack of peritonitis ensued, which was combated by bleeding and tartar- emetic. The patient was cured in about three weeks. — Op. cit.
We cannot take leave of Mr. Syme without returning him our sincere thanks for the excellent paper we have just perused.
3. New operation for stricture. — Mr. Stafford observes : — “ I have myself now operated on upwards of forty cases of perma¬ nent stricture of the worst description, without a single failure. In no instance, has there been a false passage made, nor has the cutting through the contracted part either caused pain, haemorrhage, inflam¬ mation, or any other unfavourable symptom ; the hardened structure which composed the stricture has always been absorbed ; and I have never as yet heard of a return of the complaint after this treatment. In addition to the unvaried success in the use of these instruments in stricture, I have on two different occasions divided through an enlarged third lobe of the prostate gland, which in the one had caused total, and in the other, partial retention of urine. In both of these cases the disease subsided, and the patients recovered the complete power of the bladder.
It cannot but be gratifying to the profession to know, that although the employment of these instruments is not necessary in every case of stricture, yet when such cases do occur, and there appears to be but little hope left to the patient from any other remedy, he may be re¬ lieved, not merely without danger, but with very trilling inconve¬ nience. I say trilling inconvenience, because I have not always found it necessary, as I formerly recommended, to confine my patients, to apply leeches, or to leave the catheter after the operation in the urethra. They have, on the following day, usually gone about their occupations, and it has only been necessary to pass a bougie daily for a short time, and afterwards three times a week, until the cure has been completed. — Appendix to Work on Stricture.
4. Browne on Tracheotomy , in cases where a foreign body lies in one or other bronchus. — In the greater number of cases, the foreign body is in the right bronchus, which according to Cloquet, is more a continuation of the trachea than the left, and is also larger, and a lit¬ tle more forward.
From Mr. Key’s experiments, which have been repeated by Dr. Browne, it would appear, first, “ that a shilling could be forced, for
Surgery.
425
the distance of an inch, into the right bronchus, but not at all into the left : while a sixpence passed freely into either bronchus, but farther within the right : secondly, if a long slender forceps was passed into the trachea, without giving it any particular direction, it went invariably into the left bronchus : and lastly, that bones, six¬ pences, &c. could be extracted with equal facility from either of these tubes : as by inclining the handle of the forceps towards the leftside, the transverse direction of the right bronchus was, in a great measure, counter- acted.”
The irritation produced by these foreign bodies most frequently caused pulmonary consumption, and the patient’s death : though occasionally cases have been recorded, in which, after suffering for years from apparent disease of the chest, the patients have expelled the irritating cause : but these must be regarded as exceptions to the general rule, and though the operation is not unattended with danger, yet it offers the best chance of safety for the patient, more especi¬ ally if performed early.
Dr. Browne draws these conclusions from his observations.
1 . That the existence of foreign bodies in one or other bronchus can be ascertained by the use of the stethescope : by the seat of the pain, and other uneasy sensations : and by the previous history of the case.
2. That since by producing irritation, etc. they most commonly cause death, sooner or later, it is incumbent on us to attempt their extraction with the least possible delay.
3. That small round bodies move freely from the bronchus to the trachea, and the best way of promoting their expulsion, is by an opening in the trachea.
4. That sharp, angular substances generally become fixed, but may be extracted by forceps or other suitable instruments, passed through an opening in the trachea.
5. The sooner the operation is performed, the greater the chance of success.
This most interesting paper is followed by the description of a case of pulmonary abscess, caused by a chicken bone in one of the bron¬ chi, by Dr. Gilroy ; this case exemplified Dr. B’s paper, and in fact, caused the researches of the learned doctor to be directed to that par¬ ticular branch of surgery, in exploring which Mr. Key has led the way.
On examination after death, the bone was found in the right bron¬ chus, close to the bifurcation.
In the present number, there are several cases illustrating the use of acupuncturation : one of that painful affection termed tic doulou¬ reux, or by our continental neighbours, neuralgia faciei ; if this remedy, which Dr. Banks, the narrator, says causes little pain, should prove, successful in other hands in that most distressing complaint, it will prove an invaluable addition to our means of treating that disease. — Edinb. Med . and Surg. Journ. April.
vol. vi. no. 35. 3 i
426
Bibliography .
MATERIA MEDICA.
5. Observations and reflections on the employment of strychnine in the treatment of paralysis- By E. Geddings, M. D. Charleston, S. Carolina, &c. — The able author has paid a just compliment to the talents of that distinguished physician Fouquier, for the use of strychnine in paralysis, “a disease, which, under all circumstances is exceedingly difficult to manage, and too often baffled the best directed efforts.” The first case that the author used it in was one of hemiplegia of the whole of the left side. The patient was a male, aged 50. He was placed under Dr. G’s care in July 1829, and it appeared that he had been suddenly attacked, a month previously, while cutting wood, with violent pain in the head, the left arm and leg were insensible, to which succeeded loss of sensation and motion and double vision. The treatment principally consisted of active cathartics combined with jalap, head shaved and blistered, and sinap¬ isms to the legs, cups to the nape of the neck, and to be covered by a blister stimulating friction to the paralytic members, and the strych¬ nine was actively and judiciously employed. The first day he gave vi grains of the medicine in ^i. of alcohol, six drops morning and evening ; second day, he increased it to ten drops ; fourth, to fifteen drops ; ninth, to eighteen drops, three times a day ; tenth, to twenty four drops ; at the expiration of which, his leg was quite cured, but his arm remained diseased. The author has employed strychnine successfully in several similar cases, which are narrated; and in chro¬ nic irritation of the alimentary canal, and in' habitual constipation with success. — Amer. Journ. of the Med. Sciences , Feb.
CHEMISTRY.
%
6. On the Analysis of Elaterium. By Mr. Morries. — Having made an infusion of fifty grains of good elaterium, Mr. M. found that eleven grains had disappeared. From the remaining quantity, ten grains were removed by alcohol ; this tincture being evaporated to the consistence of oil, and allowed to cool, numerous masses of small spicular crystals were observed, these were washed with sulphuric ether, and dried. The rest of the extract was boiled in aqua potassse, to free it from the elatine or colouring matter, which Mr. M. con¬ siders as synonymous. After a few minutes, a small quantity of white crystalline matter fell down, this was likewise washed with sulphuric ether.
It may be obtained in greater purity, by evaporating the alcoholic tincture to the consistence of a thin oil, and then while warm, throw¬ ing it into boiling water, when a copious white precipitate ensues, increases as it cools. This is the elaterine : it is extremely bitter and styptic, insoluble in water and alkalies, soluble in alcohol, ether, and in hot olive oil, sparingly in dilute acids ; it is decomposed by the strong acids ; it is by no means distinctly ascertained to be alkaloid. By experiments it appears not to exert any purgative effect on animals, but in doses of a tenth, twelfth, or even of a sixteenth of a
Chemistry. 42 7
grain (when acidulated) has Been found to exert a powerful effect on the human system,
Mr. M’s formula is as follows :
Elaterinse gr j., alcohol ^i. acid nitrici gtt. iv.
Solve : sumat a 5 ss. ad gtt xl. in aquse cinnamomi ^ss.
From Edinburgh Med. and Surg. Journ. April.
MIDWIFERY.
7. Observations on Tetanus Infantum, or Lock-jaw of Infants. By John Hancock, M. D. — This disease happens to infants under nine days, seldom later. It appears to be very fatal in the West Indies.
Dr. Hancock attributes this disease to an “ irritative impression made on the nervous system by the compression of the umbilical chord, caused by the ligature which is applied to it at birth, a custom |which, to say nothing of its destructive tendency, is entirely unnecessary and uncalled for. It is one of those useless customs which has arisen from the doing of old women, or officious accoucheurs, who fancy that nothing can be well done unless they put their hands to it ; and most practitioners treading in their steps follow their ex¬ ample to the destruction of thousands.” From this specimen, it is evident Dr. H. is neither an obstetrician nor a jurist. An irritative impression on the nervous system by tying the umbilical chord ; surely the learned Doctor must have made a mistake, and in those cases he alluded to, the spermatic chord must have been cut down on, and tied.
Joking apart, how is it possible for the nervous system to be irritated by the tying of a chord, in which it is universally acknow¬ ledged no nerves exist? In fact, if nerves did exist, so far from being confined to the warmer climates, the disease must pervade the whole world, wherever the tying of the chord is practised ; and, we think, that Dr. Hancock will not assert that such is the case. Besides, the tying of the chord never produces pain in either the mother or the infant.
We would like also to ask Dr. Hancock on what he grounds his assertion, that the ligature is unnecessary : not surely on the certain consequence, namely, fatal hsemorrhage.
In all probability the disease arises from that which Dr. H. con¬ siders merely as one of the efficient causes, namely, the purging plan so commonly pursued, especially as in those warm climates, the constitutions are so much debilitated. In fact, infants when not too much fed, require little or no medicine, and the irritation produced by the free employment of calomel and castor oil may readily cause this disease ; in which opinion, we are confirmed by the remedy em¬ ployed to cure, namely, laudanum, which Dr. H., going on the rule that “ prevention is better than cure,” recommends should be given from the second day, gradually increasing its dose until the day of
428
Bibliography *
danger is past. Dr. H. proposes, instead of a ligature, the application of the actual cautery. This, we presume, would cause as much ir¬ ritation ; and besides burn down half the houses, in London, accord¬ ing to the present practice of dividing the chord ; and, of course, searing it (unless we wished the child to die of haemorrhage) under the bed-clothes. In concluding, we advise the Doctor to “ tak tent.” — Edinb. Med. and Surg. Journ. April. ' 10. :v?jrx:
8. Ergot in Menorrhagia. — Dr. John Bellinger, of Charleston S. C. informs us that he has tried the ergot in one case of menorr¬ hagia, as recommended by Marshall Hall, and that the haemorrhage was increased, and the sufferings of the patient greatly aggravated by the treatment. — Amer. Jour, of Med. Sci. Nov. 1830.
9. Case of Caesarean Section. By Dr. Mc.Kibbin. — Anne M. aet. 26, apparently well formed, seized with labour pains for the first time, on the evening of Sunday the 27th September 1829; On examination on Monday, the left side of the pelvis was found to be occupied by a large exostosis, filling up the hollow of the sacrum, and extending forwards to within a quarter of an Inch of the left ramus of the pubis, on the right side, the diameter at the widest part was from It? to If of an inch, and the long diameter from pubis to right sacro iliac synchondrosis, was calculated at from 2>\ to 4 inches. The patient entered the Belfast Lving-in-Hospital, on the Tuesday even¬ ing, when on consultation, the Caesarean section was decided on, as it was evident, that embryulcia would prove as dangerous to the mother as the Caesarean section, while by this last operation there was a chance of saving the child, of whose death doubts were entertained : accordingly the operation was performed by Dr. M’Kibbin at a quar¬ ter to eleven p. m. the same night. The child was dead; in spite of the greatest attention and skill, this unfortunate woman gradually sunk, and died the next day, seventeen hours after the operation. — Edin, %Med. and Sur. Journ. April.
Thus adding another to the list of unsuccessful cases of this ope¬ ration by British practitioners ; its unsuccessful termination is evi¬ dently owing to delay, when the patient has been so far exhausted by the continuance of labour, as to be incapable of withstanding such a severe operation : in the present instance, however, the delay was attributable to the friends, and not to the medical men.
MISCELLANIES.
- ' , ' , ')!■. 1 , ' . .jt ■ ■ A. *. k i - A.
PROFESSOR PATTISON.
10. To the Editor of the London Medical Gazette. — Sir, I have read from time to time with no little surprise, and not without incre¬ dulity, the accounts you have given of disturbances in the Anatomi¬ cal Theatre of the London University. I suppose, however, it is best to be surprised at nothing. It will only be fair if I admit, at once, that I am in some degree interested in the reputation of the professor of anatomy, from having been his pupil in Glasgow fifteen
Miscellanies.
429
or sixteen years ago. As I have always considered him to be an accomplished anatomist, I am necessarily slow in my belief of his recently discovered incompetency.
It was in 1812, if I am not mistaken, that Mr. Pattison, on the death of Allan Burns, whose demonstrator he had been and intimate friend, succeeded to the vacant chair in College Street. I am able to speak with confidence respecting the estimation in which he was held during three successive courses of lectures, of six months each, which he delivered in the winters of 1814, 15, and 16. His class¬ room accommodated, but with some difficulty, 128 pupils. I well remember that there never was one seat unoccupied in a single lec¬ ture. My impression is, that he was regarded by the students gene¬ rally as being by far the best teacher of anatomy in Glasgow : at a period, too, when, besides the University professor, Dr. Jeffrey, he had the late Dr. George Monteith as a competitor. He was parti¬ cularly noted for minute and accurate acquaintance with anatomy, and especially for his surgical anatomy. His demonstrations on the neck and face are not likely to be forgotten by those who had then the privilege of witnessing them.
Mr. Pattison’s manner as a lecturer was inferior to that of his opponents. Monteith was a handsome man, with a graceful deli¬ very ; while the other, professor Jeffrey, is (or was) one of the best looking men I have seen, and remarkable in his physiological dis¬ courses — a branch to which he devoted too much of his course — for dignified and most attractive eloquence. Pattison spoke with a lisp, and his delivery was peculiar and somewhat monotonous, but, I speak in the past tense, for I have not seen him for more than fourteen years — his language was sufficiently fluent, distinct, and impressive : and those who were attentive to the matter which he so zealously uttered, as all the students I believe were, had no fault to find with the manner. 1 i . .. 7j ' in ..
Mr. Pattison is still a young man, in the full vigour of his days. Of course I cannot pretend to say that he may not be changed from what he was when he so honourably filled the chair of Allan Bums. Years, it has been said, teach wisdom. It is strange if he have indeed gone backward in attainments, when the young gentlemen, his auditors, few of whom, perhaps, are half his age, are so forward in knowledge. This is a mystery too profound for me to solve. Perhaps, but I speak with the greatest diffidence, there is one way of accounting for his recent incompetency as a lecturer. Sixteen years ago students were less precocious and enlightened than they are now. They were modest, diligent, and many of them ardent, in the pursuit of professional knowledge. They formed themselves into clubs, it is true, but it was for literary and scientific purposes. They were then too simple to think of forming “ Committees,” in order to control and manage the affairs off their teachers. It certainly, at that period did not occur to them that they knew as much as their instructors. On the contrary, there were very many who lamented their
430
Miscellanies.
ignorance, and who trimmed the midnight lamp that they might satiate their thirst for that honourable knowledge, which, in the case of several, with whom I am proud to claim acquaintance, has con¬ ducted them to eminence in their profession, and no less to deserved estimation as members of society. This simplicity of theirs — this dawn of intellect, in comparison of the noon-day intelligence of our present illuminated order of students — is doubtless the reason why, in 1815, those who had sat at the feet of Allan Burns could, when he was removed, still listen with deep interest to the accurate anato¬ mical instructions of his friend and successor.
Believe me, Sir, to be, with humility.
Yours,
Manchester, March 31, 1831. S.
12. King’s College. — The following professors have been appointed. Head Master, Rev. J. K. Major, A.M. Professor of Chemistry, J. F. Daniel, F.R. S. Of Mathematics, Rev. T. G. Hall, A.M. Natural and Experimental Philosophy, Rev. H. Mosely, A. M. Na¬ tural History, James Rennie, A. M. Political Economy, N. W, Senior, Esq. Jurisprudence, J. J. Park, Esq. Principles and Prac¬ tice of Commerce. Joseph Lowe, Esq. Anatomy, Herbert Mayo, Esq. F. R. S. Surgery, J. H. Green, F.R. S. Theory of Physic. B. Hawkins, M.D. Practice of Physic, F. Hawkins, M- D. Mid¬ wifery, R. Fergusson, M. D. Botany, G. T. Turner, Esq.
13. Longevity. — Russia is the country for wronderful longevity. In the year 1827, there died in Russia 947 persons above a hundred years old, 202 above 110, 98 above 115, 52 above 120, 21 above 125, and 1 above 135 !
14. Prize JMedal . — The Hunterian Society offer their medal often guineas value for the best “ essay on unnatural growths and depo- sites of bone.” Dissertations must be sent to the Secretaries on or before the 14th of Dec. They must not be in the handwriting of the author, and his name must be contained in a sealed packet. Candi¬ dates need not be members of the society. Unsuccessful papers will be returned if required.
15. Statistical Medicine. — The Rev. Charles Oxendon, Bishop- bourn near Canterbury, has evinced great zeal, taken great trouble and incurred considerable expense in arranging a statistical report of the principal provincial hospitals in England computed to the latest annual returns of the respective Institutions. He has generously cir¬ culated the result of his labours among the medical officers of the establishments to which they refer : and afforded much valuable infor¬ mation free of expense. He solicits repqrts from all quarters, and hopes the love of humanity and science will stimulate the medical
Miscellanies.
431
attendants on hospitals to transmit him regular reports, which he will arrange and publish annually ; great praise is due to this benevolent gentleman for his good intentions, but we fear his wishes will not be gratified. He must not feel disappointed, for we must inform him that our hospital physicians and surgeons, are too indolent and lazy to give annual reports even of disease, much less of the various pecu¬ niary matters relative to the management of the institutions with which they are connected.
NECROLOGY.
16. Death of Mr. Abernethy. — It is with unfeigned feelings of regret that we record the death of the justly celebrated and renowned surgeon, J. Abernethy esq.; of whose talents and important contribu¬ tions to science, as well as of his great popularity, it is obviously superfluous to speak. We trust that some of his eminent disciples will place his character in a just light before the profession and pub¬ lic. He expired at Enfield on the 18th ult.
17. Library of the Royal College of Surgeons. — This splendid library is now open to the members from 10 a. m. to 5 p. m. except on Saturdays, when it closes at 1 p. m. Catalogues may be had by members or articled pupils at the cost price; The council have acted wisely in affording every facility to the best collection of medi¬ cal literature in this empire ; they also have it in contemplation to establish conversations two or three times a week.
18. Resignation of the Warden of the London University. — It has been rumoured, that Mr. Homer resigned in consequence of reduc¬ tion of his salary. This is incorrect. He has voluntarily relin¬ quished £200 a year of his salary, and resigned, as he was deprived of that influence and authority which were deemed necessary to a due and efficient exercise of the duties of Warden, and the main¬ tenance of proper discipline.
19. National Vaccine Establishment. — Copy of the last report from the National Vaccine Establishment to the secretary of state for the home department.
To the Lord Viscount Melbourne, secretary of state for the home department, &c. &c. &c. — My Lord, it has required all our industry and zeal to supply the numerous demands which have been made upon us for vaccine matter from all quarters of the Empire since our last report.
We have furnished the means of protection to the army and navy, to every county in England and Scotland, to Ireland, to the colonies, and moreover to several of the capitals of Europe; and nearly 12,000 of the poor of the metropolis and its immediate neighbourhood have been vaccinated in the course of the last year.
Whilst this affords an undeniable proof of the great diffusion of vaccination, and is a strong argument for the value of this institution.
432
Miscellanies.
it diminishes our satisfaction to be obliged to confess, that, if Parlia¬ ment should determine that enough had now been done to establish the superior merit of vaccination above every other security against the danger of small pox, and that it should be left henceforward to the discretion and good sense of the nation to continue the practice from the resources of individuals, such a determination would find the country unprepared and unprovided with the means of defence, and that a great mortality from small pox would be an early consequence of the breaking up of this establishment.
It is our constant care to admonish those to whom we send Lymph, of the propriety of taking advantage of the opportunity of providing a further supply for themselves. But it would seem, from the incessant applications which continue to be made to us, either that our warnings are not sufficiently attended to, or what we believe to be the fact, from the replies constantly made to us, it is imprac¬ ticable to keep up a continued supply any where but in the capital, where numerous appointed vaccinators assist and support each other.
The result of another year’s experience is a confirmation of the value of vaccination. We have evidence before us of persons being exposed to the severest trials of its power of protection in the midst of the contagion of the small pox, with impunity ; and though some constitutions do admit a secondary disease, yet this is almost always a safe one, though severe in some instances in first attack, and it is not so common as the chicken pox used to be after small pox given by inoculation.
We have the honour to be, my Lord, your Lordship’s obedient servants,
(Signed) HENRY HALFORD,
President of the Royal Coll, of Physicians.
Robert Bree, M. D. Censor.
George L. Tuthill, M. D. Censor .
ROBT. KEATE,
President of the Royal Coll, of Surgeons. JOHN P. VINCENT,
Vice President of the Royal Coll, of Surgeons.
Clemt. Hue , M. D. Registrar.
National Vaccine Establishment,
14th March, 1831.
20. The March of Intellect. — A respectable correspondent assures us, that at the comer of Percival- street, Wellington-street, Islington, is the following pithy inscription; “John Sutton, dealer in tea, coffee, pepper, &c. and is also a midwife and on a brass plate in large letters, “ Mr. Sutton man midwife and accoucheur.” This worthy amateur sells fruit in the streets, and has actually received a certificate from a respectable midwifery lecturer in this city, who admitted him to his lectures on the usual terms. Well may we exclaim; O Lucina, fave ! novus ingreditur tua templa sacerdos.
Miscellanies.
433
22. Defence of the professional skill of Mr. St. John Long, con* victed felon and illiterate quack . — By Francis H. Ramadge, M. D. Oxon. Fellow of the Royal College of Physicians, Lecturer on Medi¬ cine, &c. &c.
It affords us much satisfaction that a Fellow of the College of Physicians, should become the defender of one of the most illiterate and incorrigible empirics that ever figured in this country of quacks* and that no licentiate, none of the minus docti, the alieni homines , could be found to disgrace the dignity of our profession such a dis¬ reputable line of conduct. No, it is a fellow who, par excellence , is of a superior caste, one of the elect, one of the by -legal heads of the faculty, who has achieved this great event. Shades of Linacre, of Sydenham, of Mead, of Baillie, what say you of this ? Here is a convincing proof of the utter absurdity, the consummate folly, and gross injustice of placing fellows above licentiates, above men, who are with few exceptions their superiors, in talent, in science, and in public estimation. If proof were required of the truth of this state¬ ment, it is only necessary to refer to the list of fellows and licentiates, where we find there is scarcely a fellow, Paris and Elliotson excepted, whose name is known in the annals of medical science, while the fame of the medical literature of this empire is almost entirely maintained by the licentiates — by the aforesaid minus docti and alieni homines, who are not allowed to enter their own college without special invitation from the illustrious and renowned fellows. But the licentiates have to blame themselves for the arrogance, haughtiness and insolent disdain with which they are treated; for had they shewn proper resentment, and petitioned the legislature against the assumed and illegal usurpations of their rivals, they might have obtained redress ; and never was there a more auspicious period than the present, when a wise, and magnanimous, and really popular Monarch, with a real representative Parliament* governs a grateful people, and is sensitively alive to the wishes and wants of his subjects. The age of humbug has passed — never to return, the welfare of the people is the sovereign law, and why should the con¬ servators of public health be degraded ? Let the licentiates and all regularly qualified graduates unite, and an opportunity will be speedily afforded them ; and petition the new parliament against the imbecility of the College of Physicians, and the unlimited ravages of quackery, and medical reform must keep pace with the universal progress of reform in this country. We have been imperceptibly led into this digression by the perusal of the extraordinary production before us, which roused our indignant feelings against the corrupt and illegal code of by-laws, which destroys all friendly feelings and close connexion between the members of the college ; and according to a late legal writer, the division into fellows and licentiates is con¬ trary to the charters and statutes relating to this institution, and the College has full power to suppress quackery. See Willcock on the Laws relating to the Medical Profession, London, 1830.
Vol. vi. no. 35, 3 k
434
Miscellanies .
We cannot express our surprize at the defence of Long, by any respectable or scientific physician or surgeon, of a man who has been proved, beyond all possibility of doubt, to be utterly ignorant of a single ray of medical science, to be a rash and desperate person, whose very opinions are contrary to those of the principles and prac¬ tice of medicine ; a man who publishes to the world — he cannot only cure, but prevent the most incurable diseases. See his humbug Dis¬ coveries in the Art and Science of Healing, passim. And this is the man defended by a fellow of the college, and in a common news¬ paper! “ 1 know you, says Dr. R. to be far from the ignorant and illiterate person whom your illiberal and invidious traducers wished the public to believe — * * * — and to my knowledge having in an anatomical school where I lectured four years ago (without any per¬ sonal acquaintance with you at the period) purchased dead bodies, at a considerable expense, for the purpose, as I believe, of dissection, and study of visceral anatomy in particular/’ Now, it is passing strange that this evidence, which could of course be corroborated by the anatomical teacher, was not produced on either of the trials for manslaughter ; and now comes before the public for the first time. Again, if " this guiltless and cruelly persecuted individual,” possess the slightest knowledge of anatomy, how, we beg to ask, could he have published a tissue of the grossest nonsense, when he declares he can cure and prevent the most fatal diseases ? He knows as much about the structure and diseases of the human body, as he does of the logic of the man in the moon. We are totally unable to account for the preposterous conduct of Dr. Ramadge, in his publishing his advocacy in favour of such a person, more especially as he stands alone, the opponent of the whole profession. Doubtless he is right, and the faculty are in error.
The origin of his defence arose from a letter addressed to our author by the scientific and infallible Mr. Long, requesting his opi¬ nion on the practice of that enlightened personage in the cases of the unfortunate Miss Cashin, and the infatuated Mrs. Lloyd. This epis¬ tle bears date March 26th, and the Dr. replies through the medium of a newspaper, called the Sunday Times, March 31st, where he not only defends his correspondent, but exposes the mistakes, of ancients and moderns, more especially of Mr. Brodie, whom he grossly mis¬ represents, but also of Sir Astley Cooper, Sir Henry Halford, the fellows of the college, and divers other hospital physicians and sur¬ geons, in a manner the most unprofessional and unjustifiable on such an occasion. He has the modesty and good sense to compare the practice of these with Mr. Long’s, and argues that one is just as good as the other. Was there ever such unprofessional conduct as this displayed by a respectable member of any of the medical corpora¬ tions in these kingdoms ? Is such conduct to be tolerated by the profession, or sanctioned by the college ? Should the college tolerate such a gross insult to the dignity and honour of the profession, it richly deserves the contempt of every respectable physician, not only in the empire, but in the woild.
Miscellanies.
435
In justification of these remarks, we request the reader’s atten¬ tion to the following defence of the opinions and practice of Long in the case of Miss Cashin. But first, we must premise that Drs. Johnson, Thomson, Mr. Brodie, Mr. King, Mr. Hogg and others, swore at- the inquest and trial, that there was no disease of the lungs ; that there was intense inflammation, mortification and slough¬ ing on the back, which caused death. Our author, who was not present at the autopsy, and who perhaps forgets that the body was that of a person destroyed in rude health, thus proceeds : —
“ The post mortem examination of Miss Cashin satisfactorily proves to me the correctness of your judgment, as to the existence of pulmonary disease, and which, in my opinion, fully justified you in the steps you took, in the hope of suspending or removing an affection of such a fatal tendency ; and, whilst she was without fever or marked local uneasiness, to employ counter-irritation, as well as inhalation. I cannot possibly conceive how the same reme¬ dial agents, after having been used by numerous individuals, with¬ out their sustaining the least injury, can in any degree be assigned as a cause of what afterwards took place. Most ample experience in medicine has shewn me, how easily effects may be attributed to inadequate causes. For among all the months in the year, August is noted for those affections of the stomach and alimentary canal, which often appear spontaneously, and in females particularly, inasmuch as we find the former organ in them to be a great sym¬ pathiser. And I do in truth assert, that in some cases, owing to the continued irritability of the stomach, the vital powers have failed, and unexpected death has followed; leaving, upon the most minute dissection, nothing satisfactory for the fatal change.
“ Since such may take place, can we not easily imagine that a case of this kind might unfortunately occur in your’s, or any other person’s hands ? But when we find, on perusing the evidence against you, the great quantity of plums and purple grapes, eaten by the lady alluded to, and presuming that she had a great and natural solicitude for her sister’s sufferings, our surprise lessens whilst there existed such causes for local and general irritation — namely, that a high state of fever should supervene, and that what, without it, would have remained a trifling insignificant sore upon her back (it being merely an abrasion of the cuticle or scarf-skin), should give origin to so much pain, and subsequently assume those appearances, respecting which such a strange diversity of opinion was exhibited by the professional witnesses against you, and which I fear will contribute more than any thing in modern times, to shew the unstable grounds upon which, unfortunately, the art or science of medicine is founded.
“ Whilst the stomachic irritability kindled up constitutional fever, a sore of the most harmless nature might become highly inflamed, and even be the cause through sympathy for those violent retchings that took place afterwards, and might impair the vitality of that
436
Miscellanies .
prgan, through a diminution of which deaths occasionally occur, examples of which are at times seen in cases of spasm occurring through gout seizing the stomach, a violent blow upon that organ, &c.
“ To me, who have had for more than eleven years past, un¬ equalled opportunities of treating, and where death has taken place of investigating, numerous affections of the chest, I do not exag¬ gerate when I say that I have opened more than a thousand bodies of consumptive persons alone. It has always appeared to me, and the same opinion has been entertained by the principal modern continental pathologists, that the imperfectly formed cicatrices, one of which was found in the summit of each lung in Miss Cashin (though contrary to the statements made by some medical men who examined the body of the deceased), had been formed from tuber¬ culous matter (the presence of which constitutes consumption), which having undergone a softened state, and in this way being expectorated, allowed the cysts which remained to heal up like any ordinary abscess. I have numerous specimens in my museum, shew¬ ing the progressive changes which tubercles undergo, until their place becomes supplied with condensed cellular membrane.
“ With an observation or two more, I shall conclude my remarks upon the morbid appearances which were found at the expiration of six days from the time of Miss Cashin’ s death, by which means her disease was attempted to be satisfactorily ascertained.
The appearances in the chest, abdomen, and about the spine, might easily be met with in any individual, who had died of very little or no apparent injury whatsoever. The deep-seated muscles of the back, as every person who has had the treatment of fever, par¬ ticularly in neglected cases, can bear testimony, are susceptible of undergoing more extensive disease, by gangrene and actual mortifi¬ cation, than the medical witnesses against you wished the public to believe, and yet in this case these might not have been the proxi¬ mate cause of this young lady’s death, nor have been followed by fatal injuries of the spinal marrow, or its investing membranes. Hence it follows that even if the symptoms of the patient had been of a more aggravated nature than they are described to have been, still, ip my opinion, she might have lived. The natural gravitation of the fluids to the back, combined with a trivial previous irritation, would produce most of those which were regarded as signs of most extensive mischief. In common fairness, a much greater stress ought to have been laid upon the rapid decomposition which was every where going on. In fact, had I had as an impartial person a share in the post mortem examination, it would have been my bounden duty to have warned the friends of the deceased, to have placed, under existing circumstances, but a very moderate reliance on the expected results of such an investigation. Under any diminution of health for some time, no matter from what cause produced, I have every reason to believe that new crops of tubercles would have
Miscellanies.
43 7
appeared* and most probably, sooner or later have terminated her existence.”
It appears by this extract that the above named practitioners, every one of whom is much better known to the medical public than their critic (for all have contributed more or less to science), do not know sloughing or gangrene from abrasion of the cuticle. Again, this is the first time that plums and purple grapes have been discovered, which is rather singular, when' Mr. Long is so well acquainted with the causes of disease. We refer to our report of the trial for the most incontrovertible evidence of the fact, that the practice of Long, in treating the eschar on the back, was the most injudicious, dangerous and fatal. The gravitation of the blood to the back, might cause cadaverous lividity, but not ecchymosis, or abrasion of the cuticle, which could only be induced by putre¬ faction, which had not taken place. We challenge our author to adduce the authority of one medico-legal writer in opposition to this opinion. If there was merely abrasion of the cuticle, why take so much trouble to explain the signs of the most extensive mischief ?
We must pass over the unequalled opportunities of opening dead bodies, by merely observing, that it is certainly marvellous such should have occurred in a city where the aid of Mr. Long was to be procured, which could infallibly prevent such a tremendous mor¬ tality. Our author disposes of Mrs. Lloyd’s case, by making it ill- managed erysipelas : here again he contradicts Mr. Brodie and Mr. Vance. The following piece of ethics deserves attentive perusal -
“ A few years ago some of my pupils informed me, that high operations for the stone were performed at St. George’s Hos¬ pital, by Mr. Brodie ; the events were most unfortunate ; and, I believe, commented upon pretty freely, by more than one anato¬ mical lecturer in this metropolis, and the failures were ascribed to the want of necessary precautions in guarding the cellular membrane at the summit of the bladder from destructive urinous infiltration, by making a counter opening inferiorly, as advised by that successful operator, for the same disease, Mr. Carpue. The precocious deduc¬ tions of Mr. Brodie on points of experimental physiology, are, many of them, as I have myself ascertained, quite fallacious; and the few recently published facts, by a Physician and Surgeon of Guy’s Hospital, shew clearly, at all events, how much mistaken he has been on the action and effects of morbid poisons in the animal ceconomy.”
Mr. Brodie never performed the high operation for lithotomy, and never recommended it. — Letter in the Sunday Times, 24 th ult.
Passing over a case which was supposed to be similar to that of the late king, and mistaken by two royal physicians and a Univer¬ sity professor, and its real nature discovered by our author, we are next favoured with the following fraternal and benevolent exposure of medical abuses : —
438
Miscellanies .
“ Judging from a conversation I had with you, for the first time after the inquest upon Miss Cashin, you induced me to think chat as professional merit, under the present corrupt system of patronage, witnessed in the various responsible appointments to our universi¬ ties, colleges, court, hospitals, infirmaries, &c. was overlooked, you had no chance of fair competition ; and as nearly one-half the medi¬ cal profession are unlicensed, and practise under the names of sur¬ geons, accoucheurs, chemists, &c. you saw no reason why you should not act as a medical practitioner, having early had a taste for medicine, and also, to my knowledge, having, in an anatomical school, where I lectured some four years ago (without any personal acquaintance with you at that period), purchased dead bodies, at a considerable expense, for the purpose as I believe of dissection, and of studying visceral anatomy in particular. You seemed perfectly aware of the low condition of medical practice in this country ; for a man ninety years of age, or in a state of dotage, might, in Lon¬ don, be a surgeon to a public hospital. You seemed perfectly to understand that a titled surgeon publicly stated, that wherever he turned his eyes in two adjoining hospitals, he saw nothing but the abusive exhibition of mercury, even in cases where it is nowr univer¬ sally admitted by medical men to be perfectly useless. To the best of my recollection, I replied, that about two years ago, I formed one of a dinner party with two physicians (besides myself), and more than double that number of surgeons, and that one of them (himself a surgeon to an hospital), stated, I believe with a view to exonerate himself, that his relative (the accuser), rarely visited his own wards for a particular class of diseases, and that the nurses thereby being uncontrolled, regularly salivated each patient in order to entitle themselves to an additional gratuity of sixpence.
“ You complained to me much of the persecution you had endured from the medical profession, and you seemed to think, as I do myself, that had you not been very fortunate in gaining the confidence of the public, you never would have been the victim of their envy and malignity, however great your want of success might have been ; and you said, that if they did not prefer their own private advantage to the public, they would have long since turned their attention to the defective state of our hospitals, and other eleemosynary institu¬ tions, where frequently men without any apparent ability, provided they are near relatives or intimate friends of some influential medical officer, obtain appointments (some of them having been bargained for previously by bonds in heavy penalties) ; and also if the public health lay so heavy at their hearts, they would have recommended that more than one day in the week should be appointed by themselves for seeing their unfortunate out-patients , and also more than one day in the same space of time for the, admission of in-patients, accidents excepted. The value of medical opinion you spoke very lightly of, for you mentioned Dr. Brown of Edinburgh, who never practised himself, yet he wrote a work in favour of injurious stimulant agents, and that almost the whole profession eagerly embraced, for many
Miscellanies.
439
years, his doctrines, which generally led to the death of thousand* and even tens of thousands.
“ To shew the value of the concurrent testimony of medical men, you stated that a few years ago some medicines, and particularly the antimonial powder, and its prototype, that of the late Dr. James, were universally believed to be sovereign remedies in the cure of febrile and various other affections, and that there are numerous cases published of the efficacy of these medicines, which almost every practitioner of an unbiassed judgment now-a-days confidently believes to have never been otherwise than inert agents. To shew still further the value of medical opinion, you stated, that had you been old enough to have commenced practice twenty years ago, with¬ out completely salivating in particular disorders, after the fashion of the times, you most likely would have been persecuted as now, although your patients would have escaped many painful secondary affections, or perhaps the complete ruin of their health.
“You know that the late Dr. Armstrong was rejected by the College of Physicians in London as an incompetent practitioner, yet he was supported by the public, and hardly half a dozen years elapsed, before he realized a larger annual income than the resident, or any of the fellows who had rejected him, or in fact any physician attached to our metropolitan hospitals or dispensaries; to add to which, he was enabled to boast of having the largest class of medical students in the metropolis.
“ If you are accused by the profession of ignorance, you may with¬ out difficulty comprehend what degree of anatomical information is necessary to be a distinguished physician attached to one of our hos¬ pitals, and the adulatory protege of an old influential medical man, when I state that three medical friends of mine examined not long ago the body of a person supposed to have been destroyed by poison, who after removing the stomach and sewing up the body, it was re-examined, at the wish of some of the deceased’s friends, by the physician I allude to, who pronounced that death was not occasioned through poison, but that the stomach was ulcerated sufficient to cause the decease. However, I must add that this organ was in the possession of one of the previous examiners, and that the learned Doctor mistook a portion of large intestine which he opened for that viscus/’
In these extracts we have the quack consulted upon medical abuses, and his opinions held in high estimation. Now, is it not the highest presumption, in such a man as this, to presume to offer an opinion on the subject ? But he thinks very differently, for he has just published a half guinea octavo, in which he reviews the whole theories of physic, in past and present ages, or rather they are reviewed for him, for he knows nothing about them ; abuses Sir Astley Cooper, Mr. Brodie, indeed, the whole profession, and winds up the whole with Dr. Ramadge’s letter. This production, which has just appeared, is entitled “ A Critical Exposure of the Ignorance and Malpractice of certain Medical Practitioners,” in which we have
440
Miscellanies.
an account of the “ monopoly of the faculty, their too extensive and improper employment of poisonous medicines, the size of the irritation, (! ! !) erroneously and unjustly called a wound.” Mr. Brodie’s unscientific treatment of Miss Cashin, disgraceful prejudices of the faculty, fatal operation by Mr. Brodie, abuse of Mr. Law¬ rence, and Mr. Copland Hutchinson, for enormous scarifications in erysipelas, abuse of the medical attendants of the Duke of York, with other examples ; and lastly. Dr. Ramadge’s Letter.
It grieves us to see a respectable physician connected with such a production as this, which must inevitably ruin his character with all ranks of the profession.
Had Dr. Ramadge boldly exposed medical abuses in a legitimate manner, he would have acquired much popularity in the profession ; but his doing sq now, will be of little use to him, as it will be said he is influenced by personal feelings, more especially should the College enforce their obsolete moral statutes, and deprive him of his fel¬ lowship. Imbecile and lethargic as this body is, it cannot overlook this conduct, and should it do so, another proof will be afforded of the gross partiality and insolent behaviour of the managers of this Institution.
23. Apothecaries Company v. Ryan — The report of this tyrannical prosecution reached us too late for notice this month. We are delighted that the partial conduct of these insolent pharmacopolists were censured by the Judge, and their verdict set aside by the King’s Bench.
LITERARY INTELLIGENCE.
In the Press. — A Manual of State and Forensic Medicine, com¬ piled from the best medical and legal works ; comprising, — I, The ethics of the medical profession, ancient and modern, moral statutes of the British universities and colleges ; — II, The charters and sta¬ tutes relating to physicians, surgeons, apothecaries, obstetricians, chemists, druggists, and empirics in the British dominions ; — III, The rights, privileges, and immunities of the faculty ; — IV. The civil and criminal cases in which medical evidence is required ; V, All medico-legal questions, with the latest decisions ; being an Analysis of a Course of Lectures on Medical Jurisprudence, annually delivered in London, and intended as a compendium for the use of barristers, solicitors, magistrates, coroners, and medical practitioners. By Michael Ryan, M. D. Member of the Royal College of Phy¬ sicians in London; Lecturer on Practice of Medicine and Medical Jurisprudence, at the Medical Theatre, Hatton Garden, near St. Bartholomew’s Hospital, &c. &c.
Mr. Wallace, Surgeon to the Charitable Infirmary, and to the Infirmary for Diseases of the Skin, Dublin, will shortly publish the History and Treatment of V enereal Diseases of the Skin, including the Primary Symptoms and Eruptions ; illustrated by Delineations as large as life, and coloured after nature.
All Communications and Works for Review are to be addressed to the cave of G. Underwood, 32, Fleet Street ; or to the Editor, at his residence, 61, Hatton Garden.
THE LONDON
MEDICAL AND SURGICAL JOURNAL.
. - • V C*
No. 36. JUNE 1, 1831. Vol. VI.
CRITICAL REVIEW.
I. — Elements of Medical Jurisprudence. By Theodoric Romeyn Beck, M.D. Professor of the Institutes of Me¬ dicine, and Lecturer on Medical Jurisprudence in the College of the Western District of the State of New York, &c. &c. Third Edition, brought down to the present time. By John Darwall, M.D., London, 1829. 8vo. pp. 640. Longman and Co.
II. — Manuel Complet de Medecine Legale Consideree
dans ses Rapports avec la Legislation Actuelle , ouvrage particulierement destine a MM. les Medians , Avocats , et Jures. Par C. Sedillot, Docteur en Medicine de la Faculte de Paris, 1830. 18mo. pp. 511. Crochard, Rue
de Sorbonne, No. 3,
A Complete Manual of Legal Medicine , considered in its relations with Actual Legislation ; a work par¬ ticularly intended for Physicians , Advocates , and Juries. By C. Sedillot, M.D. of Paris. Paris, 1830, 18mo. pp. 511. Crochard, Rue de Sorbonne. London, J. B. Bailliere.
There can be no second opinion on the value of Beck’s Jurisprudence, it is decidedly the best work in our language. It stands a splendid monument of learning, industry, and talent ; and is unequalled in the annals of our literature. The present edition, however, scarcely differs from its pre¬ decessors, the annotations of its editor are exceedingly few and of little importance. Dr. Darwall has by no means brought down the work to the present time, and has taken
• : -• : . >v--i J *» * " • . ’• •
Vol. vi. no, 36. 3 l . v
442
Critical RevieuO.
very little trouble indeed in the execution of his task. We deem it right to give this information to those who possess the second edition by Dunlop, which we may say has been merely reprinted. This work ought to be in the possession of every man engaged in the practice of the healing art, for the period has now arrived when a knowledge of forensic medicine is indispensable to all classes of the profession.
M. Sedillot has condensed all the facts in leg-al medicine into the smallest compass, and has embodied every recent opinion, more especially of his countrymen. He has evinced great tact in selecting from all sources, but in many places he is much too concise, and not sufficiently explicit. He prefixes the law to each article, in imitation of M. Briand, in his more diffuse and excellent Manual of Legal Medicine, 1828, and has divided his work into the following chapters: — Part I. Legal dispositions relating to the practice of medical men- — judiciary and administrative reports — reports of estimation or on professional etiquette — certificates — medico-legal con¬ sultations. Part II. Of marriage, disqualifications for, nul¬ lity of, divorce — of pregnancy — delivery, viability of infants —slow births- — abortion— exposure, desertion — substitution of infants — of infanticide — outrages against decency — ex¬ amination of spermatic stains — of mental affections, som¬ nambulism, inebriation, delirium, epilepsy, idiocy, dementia, mania, monomania — deafness and dumbness — simulated and dissimulated diseases. Part III. Of inhumations, medico¬ legal autopsy, putrefaction — of age and identity — asphyxia — spontaneous combustion — death by inanition — medico¬ legal history of wounds — detection of blood stains — medico¬ legal history of poisoning — classification of poisons — Class 1. irritant poisons, their action on the animal economy. Class 2, narcotic poisons. Class 3, narcotico-acrid poisons. Class 4, septic and putrifiant poisons — adulteration of alimentary matter. Part IV. Certificates in all medico-legal cases — certificates in medical police for exemption from juries and various other civil offices.
It must surprise the reader that so many subjects can be discussed with any success in a single 18mo, when pon¬ derous volumes are devoted to the elucidation of even a few of them. We can state with truth, however, that M. Se¬ dillot has amassed a great deal of information, indeed all that exists upon every topic introduced, and we should illustrate this statement by extracts, had not the greater part of the matter been published in this Journal during the last and present year. We strongly recommend this Manual to
M. Coster’s Operative Surgery.
443
every, class of our readers, as its conciseness and brevity will save them much trouble in sudden cases, in which little time is allowed for reference to the more voluminous works. We have long- thought that a manual of this kind would be a valuable addition to the medical library, and under this impression we have arranged one which will speedily appear. It was arranged in 1829, and almost on the plan of that before us, but the introduction of Medical ethics, and of all the laws relating to the medical profession in this empire wrill be a new, and it is hoped a valuable addition to legal medicine. In this country the medical corporations are ex¬ ceedingly slow in adopting improvements in science ; and this is well exemplified by the inattention they have paid to the study of medical jurisprudence. This branch of me¬ dicine which, in fact, comprises the whole circle of the medical sciences, and embraces an immense variety of im¬ portant facts, which are never taught by lecturers on me¬ dicine, surgery or obstetricy, and so indispensably necessary to modern medical practitioners, is not as yet required by the Royal College of Surgeons in London, though required by the Colleges of Edinburgh and Dublin, and only a three month’s course is enforced by the Apothecaries’ Company. Why really one would think that these bodies are ignorant of the nature and extent of the subject, which every one knows, would require at least two six months’ courses to comprehend it ; and had not that noble institution, the Uni¬ versity of London, appointed a professor of medical juris¬ prudence, we have every reason to believe it would not have been required at all.
III. — Manual of Operative Surgery ; translated from the Third Edition of the French of J . Coster, M.D. By George Fife, M.D. Surgeon to the Northern Public Dis¬ pensary, Edinburgh, &c. &c. Edinburgh, 1831, 12mo. pp. 408, Maclachan and Stewart, and Baldwin and Crad¬ dock, London.
The translation of M. Coster’s Manual would have been a great boon to students and young surgeons, as it contains a concise description of all surgical operations as performed in Paris, had not the works we shall immediately notice ap¬ peared. This valuable work has gone through three editions in a few years, and cannot be spoken of but in
444
Critical Review.
terms of the highest respect, still it is superseded by the productions of Averill and Hargrave. The last is the best compendium of practical surgery in the English language ; it contains every fact in either of its predecessors, besides the relative anatomy of all parts concerned in surgical ope¬ rations. It must have been arranged at the time Dr. Fife was engaged on the production before us ; and this coinci¬ dence affords strong evidence of the want of works of this kind. Though Coster’s Manual is concisely and graphically written, and well deserving of patronage, yet it is deficient in one very important particular, that the methods of operating by British and American surgeons are omitted. The other works under notice, have a decided advantage in containing such valuable information. Coster’s Manual of Surgery founds its claims to approbation upon the grounds of brevity, accuracy, and portability. It contains a great deal of in¬ structive matter in a small space.
IV. — An Essay on the Influence of Temperament in modi¬ fying Dyspepsia or Indigestion. By Thomas Mayo, M.D. Physician in Ordinary to His Royal Highness the Duke of Sussex, Fellow of the College of Physicians, &c. &c. London, 1831, pp. 144. Fellows, Ludgate-street.
The author of this essay very ably proves that no single plan of treating dyspepsia can indiscriminately succeed. He censures the gastromania of the moderns, and indirectly alludes to the puffing of some eminent writers on indigestion. He proceeds to shew, that temperament has been almost en- t rely forgotten by many writers on this subject. He first considers temperament, then the symptoms of indigestion ; thirdly, the influence of the former upon the latter. In describing the common symptoms of indigestion. Dr. Mayo examines the opinions of Paris, Philip, Johnson, 1 Aber- nethy, and Hamilton, and concludes that many of them are untenable. This part of the work deserves quotation on many accounts.
“ There is a remarkable diversity in the methods in which medical writers have respectively undertaken the history of indiges¬ tion. In the three able writers, whose works justly enjoy the highest present reputation on this subject, Dr. Paris, Dr. Wilson Philip, and Dr. Johnson, I find but little reference to temperament or constitu¬ tion, as any ground of pathological distinctions. Dr. Wilson Philip
Dr. Mayo on Indigestion.
445
furnishes a very masterly description of the disease. He has looked at his subject analytically, and he places his reader in full possession of his view of it. But this view is, in fact, just such a one as might be expected to occur to a clear medical eye, after a careful abstrac¬ tion of those differences which a consideration of temperament would suggest. It will, I trust, appear in another part of this Essay, how necessary it is that such distinctions should be entertained and ad¬ mitted, with a view to the complete development of Dr. Philip's subject. It is indeed curious, that he should not have applied such distinctions to indigestion, considering the avowed object of his treatise, * to give arrangement to the affections termed nervous and bilious, and to ascertain the nature of the disease on which they depend.’
“ Without establishing any such division of the subject. Dr. Johnson’s admirable work furnishes a much larger stock of materials for it, than that of Dr. Philip. The principal difference between the views of these two writers is, that Dr. Philip places before us a definite complaint, — Dr. Johnson describes a morbid habit. The first delineates an attack of dyspepsia, and follows this to its termi¬ nation ; the second draws from the life many characteristic features of a dyspeptic person.
“ Now it will be expedient to consider the ordinary form of the dyspeptic disease, as given by Philip, and the ordinary features of the dyspeptic patient, as pourtrayed by Dr. Johnson. This will form a useful basis for the more immediate subject of this Essay, the inquiry into those influences, by which temperament modifies the common phenomena of indigestion.” — p. 38.
The symptoms of indigestion are next minutely detailed, chiefly from the works of Drs. Philip and Johnson ; and our author inclines to agree with Dr. P. and argues against Dr. Johnson’s statement, that there is pain on pressure of the epigastrium. Here we must remind bur author, that Dr. Johnson’s work is universally allowed by the profession in all countries to be one of the best ever written. Indeed, it alone is now sought for by the profession and the public, which is a strong proof of the high estimation in which it is held. On the other hand it is to be recollected, that a very small portion of the profession assent to the divisions of dyspepsia, maintained by Dr. Philip. Dr. Johnson holds that purga¬ tion and mercury, without withdrawing the cause of irrita¬ tion from the stomach, will not prevent indigestion ; and here he happily exposes the opinions of Hamilton and Abernethy, which are in fact seldom adopted to the extent advised by these talented individuals. As Dr. Johnson’s formula for an habitual aperient may not be generally known to our junior readers, we shall insert it.
446
Critical Review.
fy Ext. colocynth, comp.
- rhei aa gr. xv,
Pil. hydrargyri 3ss,
Pulv. ipecacuanhse gr. ij,
Saponis Venetianse gr. iij,
Olei caryophyllor gts. iij, m. ft. pil. x. capiat i. ij. vel iij. hora somni vel statim ante prandium.
After alluding to the influence of the liver on digestion, our author remarks, that persons biliously predisposed will have the influence of this organ proportionately augmented.
“ On the other hand, the inconveniences which indigestion pro¬ duces to the phlegmatic and the sanguine, are far milder than those occurring to the biliously constituted. And the symptoms of the nervous form of the disorder, though intensely severe, are in their apparent position often distant from the place really affected, and thus either lose entirely their character as symptoms of indigestion, or are traced with difficulty to that source. But in bilious indiges¬ tion, every bodily symptom is either an abdominal sensation, or so closely linked with, so immediately springing out of, one, that its connexion with processes of the digestive organs cannot for an instant be doubted. Few again, who have ever felt the moral and intellectual symptoms of bilious indigestion, are long in discovering by their sensations the strict alliance in which these symptoms are placed with some morbid state of the digestive organs.
“ The extreme importance of these moral symptoms would of itself justify my present principle of division. For they are con¬ nected with indigestion, not simply as indigestion, but as the in¬ digestion of the bilious temperament ; and are accordingly liable to receive very inappropriate treatment, if this distinction is not kept in view ; or in other words, if they are associated with a form of the disorder, with which in truth they have no alliance.
“ Nor is this indeed a groundless precaution. No mistake is more common, than that of imputing to bilious melancholia the tendencies and corresponding treatment of the nervous temperament, and thus improperly subjecting the patient to nervous medicines, antispasmodics and stimulants.
“ The question, to what extent moral defects may be subjected to medical as well as moral discipline, has a most immediate reference to the above distinctions. Thus, when such defects coexist with an arrested or vitiated state of the bile in any one, much more in the biliously predisposed, they claim, on their own account, the fullest and most careful application of those medical agents, which tend to restore the free passage, and the healthy state of the secretion ; otherwise, the intellectual powers want the material condition re¬ quisite to their healthy operation.” — p. 57.
Dr. Mayo on Indigestion .
447
Our author very properly maintains that the treatment, of what he terms bilious and nervous indigestion, or rather indigestion in persons of a bilious and nervous tempera¬ ment, should be widely different. Every experienced and sensible practitioner must agree with this opinion.
“ Bilious indigestion may perhaps be most usefully contrasted with the nervous. In the latter class of cases, it will be observed, that stimulants, stomachics, and tonics, are generally useful ; that ape¬ rients are only valuable as they are unavoidable ; or rather that the good which they confer must generally be measured against some corresponding evil. It would appear, that in removing nervous in¬ digestion, the stomach itself, in its sympathies and antipathies, must be primarily consulted. But in the bilious temperament, both the sympathies of the stomach, and also its antipathies, must occasionally be disregarded in the treatment of indigestion. Thus, instead of the direct application of strengthening and soothing medicines, we are here obliged often to exclude them. While, in managing nervous indigestion, we avoid irritation, sometimes at the expense of allow¬ ing constipation, by withholding aperients, on the other hand, in controlling bilious indigestion, we must assume, that the immediate comfort which may be derived to the stomach from cordials and stimulants, will be overbalanced by the mischief ultimately accruing to the whole system, from an over-stimulated liver. Thus dinner pills have given a dangerous and deceitful comfort to many a bilious sensualist.
“ Again, in nervous indigestion we shall have occasion to observe, that the question of local congestion is of very secondary importance. The fact of its occurrence is rare. The circulation in this tempera¬ ment is over-active, rather than sluggish. But in bilious indigestion, we have, at every point, to defend our patient against local conges¬ tion. Here, indeed, the diagnostic of Dr. Philip, namely, tenderness in the epigastric region, is extremely indicative of the practice which he recommends, when congestion is verging upon inflammatory action. Whereas, if we should apply leeches to the epigastric region of the nervous dyspeptic every time that he expresses slight or even acute tenderness at that point, we shall be inflicting constant mischief.
“ But of all the measures by which the bilious dyspeptic may obtain both immediate relief and protection against the severer symp¬ toms of his disorder, the frequent use of mild aperients is the most important. A very ill-founded prejudice is entertained against the continuous use of aperients. It is assumed that this practice implies an unnatural and artificial procedure, calculated as such to end in mischief. Those who hold this doctrine forget what are the prin¬ ciples on which the action of the bowels is maintained, where no medicine is used. In such cases, it is the daily food which excites the peristaltic movements, and elicits the secretions of the intestines, and thus occasions their requisite action. Now aperients do precisely
448
Critical Review.
the same thing ; and it will be difficult, by any reasoning, to make good the supposition, that small portions of aloes, of rhubarb, of ipecacuanha, or of compound extract of colocynth, have generally a more unwholesome purgative effect, than cabbages, potatoes, and turnips. Of this point I feel certain, that the state of the intestinal canal in many nervous persons, who are so far from requiring ape¬ rients, that a tendency to irritation is constantly besetting them, pos¬ sesses a more morbid character than the opposed condition of the bilious temperament. In the latter case, digestion may be very well performed, provided the aperients are well selected. In the former, or nervous case, it must frequently be hurried.” — p. 63.
The admirable work of M. Lorry, De Melancholia et Morbis Melancholicis,” is quoted in illustration. Melan¬ choly, combined with the formidable class of symptoms, attendant on bilious dyspepsia. Lorry’s semeiology is cer¬ tainly good, but his humoralism must of course be dis¬ carded. It would be a useless task to insert this author’s words, as they would have little weight with modern readers. Dr. Mayo cannot agree with Dr. Johnson, that “ indigestion is by no means essential to hypochondriasis. He thinks the onus probandi lies with Dr. Johnson. In describing the treat¬ ment of melancholy, combined with bilious indigestion. Dr. Mayo gives our modern mercurialists of the intestinal school, a very important lesson, when he details his ex¬ perience of the indiscriminate use of their favourite panacea.
“ With regard to the treatment of melancholia, viewed as an advanced stage of bilious indigestion, it must from the outset of that treatment, be remembered, that the state of the patient has by that time become a very debilitated one.
“ The bilious temperament is not essentially a feeble one, but he, in whom the mental disease has supervened upon dyspepsia, has become asthenic. If his powers of receiving food are not greatly im¬ paired, his powers of obtaining nourishment certainly are. Food, except when taken in the smallest quantities, generally oppresses him from the moment at which he has taken it, until some rapid aperient has freed him from it ; and this state has, in most cases, continued long before the mind obtains attention as a seat of disease.
,f The risk of depletory measures, as tending to convert this se¬ condary affection into an almost incurable state, the demence of the French writers, has accordingly become extreme. The lancet has no place here. The use of mercurials requires perseverance indeed, but caution and moderation. I have seen them, when pushed to salivation, change perversion of intellect into hopeless fatuity. This caution is the more required, in regard to our present subject, because melancholia or hypochondriasis, when a primary disease, and not the sequel or advanced stage of dyspepsia, bears on the whole more
Mr. Mayo on Indigestion .
449
active depletion, than that acute and noisy form of insanity which belongs to the nervous temperament.” — p. 73.
Our author confesses a serious error into which he fell in a former publication, when he inculcated the necessity of depletory measures in certain forms of mental derange¬ ment. Experience has long since convinced him of the danger of this practice.
The following case will be read with interest, though its comment is to us unintelligible : —
c£ A gentleman of a highly nervous temperament, placed in a situation of continued mental exertion, and much responsibility, in a West India island, was subjected, for some bilious symptoms, which were viewed without any reference to the predominant character of his constitution, to a severe mercurial treatment. He, at the same time, suffered from hemorrhoids, occasioning profuse discharges. His strength broken ; his circulation so disturbed that apoplexy at one moment, heart affection at another, seemed closely to impend; his skin constantly arid and giving no relief by perspiration to these last symptoms, he returned to this country. It is not my present purpose to detail the subsequent treatment of this case ; I wish to call my reader’s attention to the fact, that it was found necessary, in the course of his treatment, to allow a far longer suspension of the action of the bowels than accorded with the general principles of practice, or than was comfortable to his own feelings, rather than expose him to the intense nervous excitement and exhaustion, which was occasioned by the process of fsecal evacuation, even when con¬ ducted in the mildest way. The relief, indeed, from feelings of ob¬ struction, which purgatives were calculated to give him, his bowels being always in a confined state, was completely overborne by the attendant aggravation of all his other symptoms, such as flatulence, violent palpitation at the heart, with sense of approaching syncope, and vertiginous feelings in the head. All these sensations ensued upon the action of aperients so mild and so carefully chosen, as to imitate strictly the operations of nature, and yet to unload the bowels completely. Time, a patient endurance on his part of symptoms of which it was hazardous to attempt the complete relief, and a persevering abstinence on the part of his physician from such measures as might relieve present symptoms, and yet increase ex¬ haustion ; and, finally, a very cautious use of bark, ultimately restored him to health. The decisive and complete evidence of his recovery wTas, according to his own remark, the power of perspiring freely.
“ Now I do not adduce this case as an instance of dyspepsia, but as remarkably illustrating the effect of the nervous temperament in occasioning the ordinary functions of digestion, those indeed which we are usually compelled to excite and encourage in obviating morbid
Vol, vi, no. 36, 3 M
450
Critical Review
states of the digestive organs, to become, even in their moderate per¬ formance, a source of mischief through exhaustion.” — p. 78.
We are totally unable to comprehend the last paragraph, and must leave the reader to draw his own inference. The treatment of nervous and bilious dyspepsia deserves atten¬ tion.
“ If a nervous person bring on an attack of dyspepsia by excess, a diarrhoea often supervenes, or a very mild aperient achieves the same purposes ; the peccant matter is hurried away, and the disorder is far more easily pacified than in the bilious indigestion. But though the disorder is itself removable on far easier terms, and more promptly in the nervous than in the bilious subject, the severity of the shock, which it has inflicted upon the former constitution, is far greater. It is true that the bilious constitution may have re¬ quired a severer and more prolonged discipline for the removal of its dyspeptic symptoms ; but these measures leave the patient not only cured of his complaint, but in health ; while the relief given by the spontaneous diarrhoea, or the aperient, to the nervous person, leaves him shaken enfeebled, and yet excited : so that it has been often found expedient, as in the case above quoted, to let the immediate dyspeptic symptoms linger, by delaying the process that would afford them relief.
“ The relief of dyspepsia by spontaneous diarrhoea is not in¬ frequent in the bilious any more than in the nervous habit ; and in the first it is a source of immediate comfort. In each a deficiency of bile in the feeces often constitutes a sequel to this diarrhoea. And here a difference in the treatment required deserves to be noticed. In the bilious temperament it may be assumed as a principle, that, until the feces have resumed their healthy hue, the use of purgative and mercurial medicines cannot be safely discontinued. But in the nervous, such a deficiency constitutes no necessary ground for a repetition of such medicines. The return of an adequate secretion may often be securely left to the irritability of the patient’s system, which has more to fear from action than from torpor. Here indeed a purgative treatment might reproduce diarrhoea.
“ The above remarks illustrate the general influence which an excitable state of the nervous system may exert over indigestion, modifying the symptoms of the disorder and influencing its treat¬ ment. Now, pursuing this line of investigation, we may classify the general symptoms by which the nervous temperament produces this effect, under six heads, in most of which it is strongly contrasted with the bilious temperament.
“ First, The irritability of the nervous temperament renders it liable to diarrhoea, and at the same time renders this symptom a source of uneasiness and exhaustion. The relief is not wanted, as no excess of bile is supposed. On the other hand, bilious diarrhoea is a source both of benefit and of comfort to the bilious in temperate
Dr. Mayo on Indigestion.
451
climates, when the discharge is moderate. Accordingly purgatives do more good, and disagree less readily in bilious than in nervous cases.
“ Secondly, Pains in the head in nervous indigestion are acute, pungent, and limited in the space which they occupy, often attended by a bursting sensation that seems to proceed from within outwards. Pains in the head are in the bilious a dull heavy sensation, accom¬ panied with external tightness. A sense of heat is, I believe, common to both temperaments when the head suffers.
“ Thirdly, Acute neuralgic pains are readily produced at various points by the dyspepsia of the nervous constitution.
“ Fourthly, The symptom of flatulence, which exists nearly in an equal degree in the nervous and the bilious, in the former excites various forms of irregular action, besides the sensation of distended intestines, which is its direct result. This fact is indeed amply il¬ lustrated by the multitude of cases simulating organic affection of the heart, which are brought before the physician, and cured by him upon principles which his acquaintance with the nervous tempera¬ ment has established.
“ There is nothing inconsistent with this view in the fact that the medicines most applicable to the cure of these symptoms are often mercurials and aperients. The symptoms are, in fact, often the evidence of bilious obstruction or of simple constipation occurring in nervous constitution. The medicines, therefore, must be such as relieve obstruction, allowance being made for the character of the temperament in the mildness of the quantities administered.
“ Fifthly, It may be presumed that the various forms of hysteria must attend upon nervous dyspepsia. On this point, a wide field of useful information is laid open by the researches of Dr. Whytt, on the subject of nervous affections.
“ Sixthly, The inappetency, or even aversion, in regard to food which belongs to nervous dyspepsia in its more aggravated forms, and into which in all cases it seems liable to lead the patient, if it once gain ground in his constitution. But I shall reserve the subject of nervous atrophy until I shall have occasion to compare it with another class of symptoms equally deserving the generic term of atrophy, which I shall have to consider under the head of serous or phlegmatic indiges¬ tion. The inappetency of the bilious differs from the above in this material point, that it strictly accords with the other phenomena of the case. The bilious person loses his appetite for food, because he is generally ill, and only so far as he is so. The nervous person drops into this state out of vigorous health, and without any definite cause.
“ The above remarks, on the subject of nervous indigestion, apply to that branch of the temperament to which I have given the name, physical nervousness. They presume the existence of that bodily state, which Dr. Johnson terms a morbid sensibility of the stomach and bowels, as the basis of the disease. The other two forms, under which the nervous temperament may display itself now deserve some
452
Critical Review.
consideration. I allude to what I have termed, moral nervousness and intellectual nervousness.” — p. 86.
Dyspepsia in the sanguine temperament is next alluded to, and our author dwells more upon the nature of consti¬ tution, and the inattention of physicians to it, than upon any plan of treatment. There is nothing worthy of notice in this chapter. The next chapter is entitled, “ Indigestion of the Serous or Phlegmatic Temperament.” He considers there are two forms of this habit, one characterised by relaxation, the other by feebleness, having in common a liability to disorders of congestion and a freedom from feverishness ; the former is capable of great indurance, while the asthenic is easily exhaustible.
“ Now these two forms of the serous, or phlegmatic temperament differ remarkably in the treatment, wThich their incidental disorders require. Very active purgation, and at the same time very active stimulation, are generally found to suit the relaxed habit. It can bear, indeed it can profit by, profuse serous discharges. To the feeble temperament this, or any other lowering treatment, is absolutely inappropriate.
“ In bearing with advantage copious purgation under dyspepsia, the relaxed branch of the serous temperament has much affinity to the bilious, with, however, one remarkable distinction, namely, that the immediate union of tonics and aperients is highly suitable in the relaxed constitution ; whereas the more bilious his temperament, the less readily can the dyspeptic bear the constrictive effects of tonic medicines. This distinction is remarkably applicable to the use of steel. Mercurial medicines, used temperately, both relieve and excite the relaxed habit : in either effect they are beneficial.
“ All that class of applications, which promote activity of circula¬ tion on the surface of the body, are applicable to this temperament ; such as friction with liniments, or the flesh-brush, and cold affusion, or the shower-bath. The feeble or asthenic are sometimes depressed by these remedies ; the sanguine may be over- stimulated, the nervous may be irritated by them : but the relaxed habit is simply braced and invigorated by their use.
“ That persons thus predisposed should be moderate in their diet, so as not to overload sluggish organs of digestion, is a point of obvious importance. But I have had occasion to observe, that the system of dividing the allowance of food into small meals, with brief intervals, is, in this class of cases, an extremely bad one. The most whole¬ some of stimulants, namely hunger, is thus withdrawn, where it is most wanted, and a substitute must be found in an increased quantity of wine and cayenne pepper. Besides, I have reason to believe, that the relaxed stomach, when roused by a meal as large as it will bear, is in a much more efficient and vigorous state, than the same stomach, when inadequately supplied. Let the patient, however, in order that
Dr. Mayo on Indigestion.
453
this rule may not be abused, keep one other constantly in his mind ; namely, that he should always rise from his meal with an appetite.
It is with persons of the relaxed temperament, that a cautious economy of liquid food under dyspepsia has been found so valuable, as to have given to such abstinence the authority of fashion, in a very mischievous degree. The dry stimulating food thus supplied to the mucous membrane of the stomach, compelling it to secrete its juices freely, and to perform its contractions forcibly, may well be conceived to suit the state of atony, which I impute to it. On the other hand, this dry stimulating food is calculated to inflict the severest mischief on a stomach differently constituted ; one, for instance, in which the phenomena of indigestion coexist with a nervous irritability of membrane in the intestinal canal.
The same remark applies forcibly to the childish extension of the use of the white mustard seed. If this remedy be efficacious in any case, it must also be mischievous in those cases to which it is in¬ applicable, namely, in the same class of cases as would be injured by the dry system of diet.
Patients labouring under a tendency to scirrhous disease of the stomach, treated with this kind of diet, and this of stimulants for dyspepsia, have rapidly proceeded into the ulcerative stage of their disease.” — p. 101.
We have now given a fair specimen of this work, and think it proves the author to be a physician of sound judg¬ ment and great discernment. Had he described the treat¬ ment of the different forms of dyspepsia more minutely, his work would be much more valuable. Still the work will be perused with interest by the scientific physician, though by no means sufficiently explicit for the student or young practitioner. It is a sharp commentary upon the standard works on indigestion.
V. — La Manoeuvre de tous les Accoucliemens contre Nature reduite a la plus grande simj)licite, et precedee du Mechanisme de V Accouchement natural. Par Jules Hatin, M. D. &c : Paris, 1829. 18mo. pp. 311.
The Management of all Preternatural Labours, reduced to the greatest simplicity , preceded by the Mechanism of Natural Labour. By Jules Hatin, M.D. &c. Paris, 1829. Henry Leclercq.
The object of M. Hatin is to describe the management of preternatural labours, and to this duty he has chiefly con¬ fined himself. He has extracted from all the standard obstetric works of France, and enriched his production by
454
Critical Review.
copious original observations. We need scarcely state that the French practice differs very materially from our own ; and we think we shall render the medical student or junior surgeon a service by placing it before him.
M. Hatin commences with a description of natural labour, in order that the management of preternatural cases may be better understood. The reader must bear in mind that our Gallic contemporaries include breech or natal, knee and pedal presentations, under the term natural labour. This manual is so concise that we must quote it at length. The reader will not be a loser, though we are convinced that the British practice is by far the better. To the intelligent and experienced surgeon, we say, utrum horwm magis accipe.
Of the Management of Preternatural Labours.
The management of preternatural labours, has for its object the extraction of the foetus from without the parts of generation. This extraction is performed sometimes by the aid of blunt instruments ; lastly, at other times by means of operations performed on the mother or child. After this simple exposition, it is clear that preternatural labours should be divided into three classes, according to their manner of termination.
In the two first classes, the parts are generally well formed ; and the obstacle to the termination of delivery depends often on the want of proportion between the dia¬ meters of the pelvis of the mother and those of the foetus. It is therefore highly important, in order to distinguish this kind of impediment, and to obtain a suitable remedy for it, to know in detail the mechanism of natural labour.
To understand perfectly this mechanism, it is necessary to have a complete knowledge of the kind of bony canal which the pelvis of the mother presents on its interior parts, and the principal parts of the foetus at birth, such as the head, the shoulders and the breech. It is, in fact, on the relation of these numerous different parts to each other that the mechanism of natural labour depends.
PART THE FIRST.
Of the Pelvis of the Mother.
The pelvis is a kind of bony canal, situated at the base of the trunk, between the vertebral column, which it supports on its posterior and middle part, and the thigh bones, which are articulated with its middle, lateral, and anterior parts.
Dr. Hatin on Preternatural Labours . 455
It is divided into an external and internal surface, a base and a summit.
We shall here simply treat of the internal part,, since a knowledge of it alone is sufficient for explaining the pro¬ cess of natural labour.
The internal surface of the pelvis, comprehends the brim, the superior strait, the cavity of the pelvis, and the inferior strait.
Brim. — The brim is divided into four regions, an anterior, a posterior, and two lateral.
Anterior region.- — It exists only in the fresh subject, and is formed entirely by the abdominal parietes.
Posterior region. — It presents in its middle, the end of the vertebral column, and on its sides, the mark of sacro¬ iliac symphisis.
Lateral regions. — They are formed by the internal iliac fossae, which are filled in the recent subject by the psoas and iliaeus muscles.
Dimensions of the Brim.
Width . — From the middle of one iliac crest to that of the other, is about ten inches ; from the anterior superior iliac spine to the other, about nine inches ; from the anterior inferior iliac spine to that of the opposite side, about eight inches.
Depth. — About three inches and a half from the middle of the crest of the ilium to the superior strait; about three inches to the level of the anterior superior iliac spine.
Size , from before backwards.— The size of the brim can¬ not be determined in this sense, on account of the capa¬ bility of the abdominal parietes being extended more or less considerably.
Superior strait . — It is formed by that bony ridge which separates the brim from the outlet.
Shape. — Its shape is various, mGre generally it is elip- tical.
Dimensions. — The superior strait is measured by four diameters, viz. an antero-posterior , wdiich extends from the sacro-vertebral angle to the symphisis pubis : a transverse , which extends from one side of the pelvis to the other, and two oblique , which extend from the sacro-iliac sym¬ phisis of one side to the linea ileo-pectinea of the opposite.
The antero-posterior diameter measures four inches. The transverse in the skeleton five inches ; but in the fresh sub-
456
Critical Review*
ject it is about half an inch less, on account of the situation of the psoas and iliacus muscles ; so that in reality it pre¬ sents to the obstetrician a diameter of four inches. The oblique diameters are about four inches and a half.
Inclination . — When the woman is standing-, the superior strait is not situated horizontally, but its posterior part is much more elevated than the anterior ; so that it is directed obliquely from above downwards, and from behind for¬ wards. The inclination which it then presents, is from about thirty-five to forty degrees.
Axis — The axis of the superior strait may be represented by an imaginary line, commencing at the umbilicus of the woman, and directed towards the inferior part of the sa¬ crum, passing through the centre of that strait.
Cavity of the Pelvis. — The hollow of the pelvis is divided into four regions, an anterior, a posterior, and two lateral.
Anterior region. — It is slightly concave on each side, it presents the posterior part of the symphisis and of the body of the pubis, more externally and on each side ; the infra pubic opening filled by the internal obturator muscle.
Posterior region. — The posterior region is formed by the anterior part of the sacrum and coccyx. It is concave, and presents transverse lines which mark the points of union of the different pieces of which the sacrum and coccyx are composed. It also presents the anterior sacral foramina, which give passage to the nerves of the same name.
Lateral regions. — The lateral regions are almost smooth, inclining from above downwards, and present the sciatic hollows, converted into foramina by ligaments of the same name ; a square surface which answers to the cotyloid cavity ; and higher the ischiatic spine, which, projecting further into the interior of the pelvis than the parts situated anterior and posterior to it, forms by this disposition on each side two inclined planes, an anterior and posterior one. These are the inclined planes which give to the head the rotatory motion necessary to place its anterio-posterior diameter in apposition with the largest diameter of the inferior strait. The anterior plane of the one side, causes that part of the head which is directed forward to glide under the arch of the pubis, and the posterior one of the opposite side, causes that part directed backwards to slip into the hollow of the sacrum.
Dimensions of the Cavity of the Pelvis.
Ant ero- posterior diameter. — From the middle of the sym¬ phisis pubis to the middle of the sacrum, measures about five
Dr. Hatin on Preternatural Labours.
457
inches ; caused by the curve of this last bone, which pre¬ sents a depth of one inch.
Transverse diameter. — At the top of the hollow about four inches and a half.
This extent diminishes in proportion as we approach the inferior part of the pelvis.
Depth. — The anterior partition about eighteen lines,, the posterior four inches and a half, without following its curve ; the lateral three inches and a half.
Direction. — The hollow of the pelvis represents a canal very much curved anteriorly, and perpendicularly divided by its axis at its extremities.
Axis. — The axis of the hollow of the pelvis may be represented by a curved line, which, passing through the middle of the canal, follows almost the direction of the curve of the sacrum.
Inferior strait. — The inferior opening of the pelvis is thus named. Its appearance is bony before and on its sides, whilst posteriorly it is almost completely ligamentous.
Form. — Very irregularly round.
Dimensions. — The inferior strait, like the superior one, is measured by four diameters. An antero-posterior, which extends from the point of the coccyx to the inferior part of the symphisis pubis ; a transverse which extends from one ischiatic tuberosity to the other ; two oblique, which ex¬ tend from the ischiatic tuberosity of one side, to the middle of the sacro-sciatic ligament of the opposite ; all these dia¬ meters are generally four inches in extent; but the antero¬ posterior may be increased even to five inches by the retro¬ cession of the coccyx.
Direction of the inferior strait — Its posterior part, even to the tuberosities of the ischium, is inclined backwards and forwards, whilst its anterior part is directed downwards and forwards. This last part constitutes the arch of the pubis.
Dimensions of the Arch of the Pubis.
Breadth. — Above, from fifteen to twenty lines ; in the middle, two inches and a half ; below, four inches.
Depth . — About two inches.
Axis of the inferior strait. — The axis of the inferior strait may be represented by an imaginary line drawn from the sacro-vertebral angle to the centre of the strait.
Of the Principal Parts of the Foetus.
The principal parts of the foetus, connected with parturi¬ tion, are the head, the shoulders, and the breech. But the
Vql. vi. no. 86. 3 n
458
Critical Review.
intimate knowledge of these different parts not being neces¬ sary for the explanation of the mechanism of natural labour, we shall therefore at present confine ourselves to that which relates to their form and size.
Of the Head of the Foetus.
The head of the foetus, when separated from the trunk, is of an oval form, slightly flattened in different parts.
Division. — We generally divide it into five regions and two extremities.
The regions are, the vertex or summit, the base, the face properly so called, and the temporal regions.
The two extremities are represented, the one by the occipital tubercle, and the other by the chin. The summit of the head presents parts with which it is important for the obstetrician to be acquainted.
The principal are the anterior fontanel, the sagittal suture and the posterior fontanel. The basis of the cranium never presents, unless the head be separated from the trunk.*
The face offers characters so striking, that it is difficult not to recognise it.
The temporal regions offer the sutures and fontanels ; but when they themselves present, they are to be distin¬ guished by the presence of the ear.
Dimensions of the Foetal Head.
The foetal head has five diameters and two circum¬ ferences.
Of the Five Diameters.
The first extends from the occiput to the chin, and is called occipito-mental or oblique. Its extent is four inches and a quarter.
The second extends from the occiput to the forehead, and is named occipito-frontal. Its extent is four inches and a quarter.
The third extends from one parietal protuberance to the other. Its extent is three inches and a half.
The fourth extends from the summit of the head to the basis of the cranium. Its extent is three inches and a half.
The fifth extends from the mastoid process of one side to that of the other, and thus measures the breadth of the
* The author should have added — or in pedal presentations. — Ed.
Dr. Hatin on Preternatural Labours.
459
basis of the cranium. Its extent is from two inches and a half to three inches.
Of the two Circumferences .
The first divides the head perpendicularly into two late¬ ral hemispheres. Its extent is from fourteen to fifteen inches.
The second divides the head perpendicularly into two halves, the one anterior, the other posterior. The extent of these circumferences is from ten to eleven inches. The foetal head is composed of two very distinct parts ; the one superior, which is named the arch of the cranium ; the other inferior, and is named its basis.
The first of these parts is formed by bony pieces, sepa¬ rated from each other by intervening- membranes, which are called fontanels and sutures.
This disposition causes the arch of the cranium, when it is compressed, to diminish in size, by the approaching or overlapping of the different bones which compose it.
The basis of the cranium is incapable of diminution.
Movements of the Head on the Trunk.
The bead of the foetus may be bent forwards upon the superior part of the chest, backwards on the back, inclined on the one or the other shoulder. It may also describe a fourth of the rotation.
Of the Shoulders of the Foetus.
The shoulders of the foetus, considered relatively as to labour, present nothing worthy of interest but their size.
Measured transversely, they present a diameter of four inches and a half; but their structure permits a considerable reduction, and it has been remarked, that by simple pres¬ sure, the extent of this diameter can be diminished one inch.
The breech of the foetus, similar to the shoulders, is des¬ titute of interest, except as relates to its dimensions, yet its size never presents a real obstacle to the termination of labour, even when it is double the natural volume. It is moreover composed of fourteen bony pieces, separated by cartilages, the yielding of which may facilitate labour.
Conclusions deduced.
1st. From the comparison of the diameters of the pelvis of the mother, with those of the principal parts of the foetus ; 2d, from the different direction of the axis of the pelvis of
460
Critical Review.
the mother; 3d, from the difference of the length of its anterior and posterior walls.
1st. The largest diameters of the foetus exceed the extent of the smallest diameters of the pelvis of the mother ; but the greatest diameters of this last, exceed the extent of the greatest diameters of the foetus ; from whence we must necessarily conclude, that to obtain a natural termination to labour, it is indispensable that the largest diameters of the foetus always correspond to the largest diameters of the pelvis of the mother.
I 2d. The largest diameters for delivery, at the superior strait, are the oblique; whilst at the inferior strait, the greatest is the antero-posterior ; it follows, therefore, that the largest parts of the foetus, placed obliquely at the supe¬ rior strait, must undergo a rotatory movement, in order to be suitably placed at the inferior strait.
3d. The three axes of the pelvis represent a curved line, the concavity of which answers to the pubis, the convexity to the sacrum ; the foetus, in disengaging itself, must neces¬ sarily follow this direction.
4th. The posterior part of the cavity of the pelvis is five inches in extent, whilst its anterior part is but 18 lines. This difference of length explains why the occiput escapes first in labour by the summit of the head ; the two first positions are much more favorable than the two last ; since in the first case, the occiput to escape has to traverse but eighteen lines, whilst in the second it must follow an extent of nearly five inches.
Of the Mechanism of Natural Labour.
Labour may terminate naturally by presentation, of either the head, of the feet, of the knees, or of the breech.
Of Natural Labour by the Head.
Natural labour by the head may take place in the four positions, which correspond to the oblique diameters of the pelvis ; the position of the woman on the back.
First Position . Principal Relations. — The occiput answers to the left cotyloid cavity, or acetabulum, and the forehead to the Tight sacro-iliac symphisis. The posterior surface of the foetus looks forwards, and to the left, the anterior looks backwards and to the right — the feet are towards the fundus of the uterus.
Mechanism. — Pressed by the contractions of the uterus, the head is bent forward on the chest, and its occipito-
Dr. Hatin on Preternatural Labours.
461
mental diameter becomes parallel to the axis of the superior strait. It thus traverses the whole hollow of the pelvis ; but arrived near its inferior strait, it meets with the inclined planes, which give to it the rotatory motion, by means of which the occiput is at length placed under the arch of the pubis, and the face in the hollow of the sacrum. Then the largest diameter of the head is in conformity with the largest diameter of the inferior strait, and there is no op¬ position to the escape of this part of the child, but the resistance from the external parts of generation. Con¬ tinually pressed by the contractions of the uterus, the head advances further and further, and thus gradually effects the dilatation of the vulva ; but after each pain it re-ascends more or less into the cavity of the pelvis.
At length, after a labour more or less protracted, the resistance from the external parts of generation being over¬ come, the head escapes through the genital fissure. At this moment the occiput ascends under the arch of the pubis, and the different points of the face appear in front of the posterior commissure. Having become free, the head re¬ sumes its natural relations with the trunk; the occiput is directed towards the groin of the left side, and the face towards the posterior and internal part of the right thigh. This movement of replacement has nothing in it surprising, since the trunk has not participated in the movement of rota¬ tion which the head has experienced in order to escape the inferior strait.
The shoulders, obliquely engaged at the superior strait, traverse the cavity of the pelvis, and when they are arrived at the inferior strait, they meet with the inclined planes which give to them the same rotatory motion as to the head. The right shoulder is brought under the arch of the pubis, and the left into the concavity of the sacrum. At the same time the head changes its relations ; the face gradually turning to the middle and internal part of the right thigh, and the occiput to the middle and internal part of the left thigh. The shoulder, which is behind, constantly receiving the contractions of the uterus, soon appears at the vulva, which it passes, whilst that which is under the pubis serves as a point of support.
When once the shoulders are without, the rest of the body is expelled with great rapidity, which is easily ex¬ plained, since the parts of the foetus become smaller, and as the passage has been dilated by more voluminous parts.
462
Critical Review .
Second Position. Principal Relations.
The occiput answers to the right cotyloid cavity, and the face to the left sacro-iliac symphisis. The posterior sur¬ face of the foetus looks forwards and to the right, and the anterior backwards and to the left ; the feet are to the fundus of the womb.
Mechanism. — The mechanism of the second position is completely the same as that of the first, with the exception of the movements of rotation being in an inverse sense.
Third Position. Principal Relations.
The occiput answers to the right sacro-iliac symphisis, and the forehead to the left cotyloid cavity. The posterior part of the infant is directed backwards and to the right, and the anterior forwards and to the left. The feet are to the fundus of the uterus.
Mechanism. — The mechanism of natural labour in this third position, differs but little from the mechanism of the first, since the same diameters of the foetus are found to cor¬ respond to the same diameters of the pelvis of the mother.
Thus, at the superior strait, the head is bent on the chest, the occiput escapes first into the pelvic cavity. Arrived near the inferior strait, the head meets the inclined planes, which give to it the rotatory motion ; the occiput glides on the posterior and right lateral inclined plane, in order to place itself in the hollow of the sacrum, whilst the face slides on the anterior and left lateral plane, to place itself under the arch of the pubis. The occiput then receiving all the contractions of the womb, traverses the hollow of the sacrum, of the coccyx and perineum, at the same time that the face re-ascends into the pelvis, and is bent further forwards on the chest. The occiput soon appears at the vulva, which it gradually dilates ; after each pain it re-ascends more or less into the hollow of the pelvis.
At length the resistance offered by the external parts of generation being overcome, the occipital region of the head escapes through the genital fissure, the forehead resting on the posterior commissure, and the different points of the face disengage themselves from beneath the symphisis pubis.
Having become free, the head of the foetus resumes its natural relations with the trunk ; the occiput answering to the posterior and internal part of the right thigh, and the face to the groin of the left side.
The shoulders obliquely engaged at the superior strait, traverse the cavity of the pelvis. Arrived near the inferior
Dr. Hatin on Preternatural Labours.
463
strait, they meet with the inclined planes, which give to them a rotatory motion. The right shoulder is placed in the curve of the sacrum, and the left shoulder under the arch of the pubis. The head, at the same time changes its rela¬ tions ; the face looking directly towards the middle part of the left thigh, and the occiput to that of the right thigh.
The shoulder, which is behind, receiving all the contrac¬ tions of the womb, escapes the first, whilst that situated under the pubis serves to it as a point of support.
The shoulders being without, the rest of the foetus follows without difficulty.
Note. — This third position is sometimes naturally changed into the second; this favourable change takes place when the rotatory motion, impressed on the foetus, is suitably directed.
Fourth Position. — Princip>al Relations.
The occiput answers to the left sacro-iliac symphisis, and the face to the right cotyloid cavity. The posterior part of the foetus is directed backwards, and to the left and anterior part forwards, and to the right. The feet are to the fundus of the womb.
Mechanism. — The mechanism of the fourth position is entirely the same as that of the third, if it does not happen that the rotatory movements are made in an inverse sense.
Note. — This position may naturally change itself into the first.
Of the natural Labour by the Abdominal Extremities of
the Foetus.
Positions of the Feet. — The feet present in four principal positions, which correspond to the oblique diameters of the pelvis. In these positions, the foetus is disposed in such a manner that the thighs are bent on the pelvis, and the legs on the thighs, the heels applied to the breech.
First Position. Principal Relations. — The heels cor¬ respond to the left cotyloid cavity, and the toes to the right sacro-iliac symphisis. *
The posterior part of the foetus is directed forwards, and to the left, and the anterior backwards and to the right. The head is to the fundus of the womb.
Mechanism. — Pressed on bv the contractions of the womb, the feet escape without difficulty through the hollow of the pelvis and inferior strait. The breech is not long in en¬ countering the inclined planes, and undergoing the rotatory motion, by w hich the left hip is soon placed under the pubis
464
Critical Review.
and the right in the hollow of the sacrum. (This rotatory motion does not take place when the pelvis of the mother is of a certain size, and in that case the breech goes out obliquely).
The hip, which is behind, receiving the whole contractions of the womb, comes out first, whilst that which is in front serves to it as a point of support. The breech , after having escaped, resumes insensibly the position which it occupied before meeting with the inclined planes.
The shoulders are engaged obliquely at the superior strait, at the same time that the arms caught in a manner by this strait, ascend on the lateral parts of the head. Arrived at the inferior strait, the shoulders are placed perpendicu¬ larly, and that which is behind escapes first.
The head is engaged obliquely at the superior strait, the chin is bent on the chest. Arrived at the inferior strait, it experiences its rotatory motion ; the face being placed in the curve of the sacrum, and the occiput under the arch of the pubis.
The chin then traverses the whole extent of the curve of the sacrum, of the coccyx, and of the perineeum, and soon presents itself at the vulva. The different points of the face disengage themselves at the front of the posterior commissure, and the occiput escapes at the same place.
Second Position of the Feet — Principal Relations.
The heels correspond to the right cotyloid cavity, and the toes to the left sacro-iliac symphisis. The posterior region of the child is directed forwards, and to the right and the anterior backwards, and to the left. The head is to the bottom of the womb.
Mechanism. — The mechanism of the second position of the feet is completely the same as that of the first position, with the exception that the movements of rotation take place inversely.
Third Position of the Feet — Principal Relations.
The heels correspond to the right sacro iliac symphisis, and the toes to the left cotyloid cavity. The posterior part of the child is directed forwards and to the right, and the anterior forwards and to the left. The head is to the fundus of the uterus.
Mechanism. — The mechanism of natural labour in this third position, differs but little from the mechanism of the first, since the same diameters of the foetus are found to corres¬ pond to the same diameters of the pelvis of the mother.
Dr. Hatin on Preternatural Labours. 465
i
Thus the feet pressed on by the contractions of the uterus, burst without difficulty through the hollow and in¬ ferior strait of the pelvis.
The breech arrived at the inclined planes, is placed straight, or else it escapes obliquely, if the pelvis of the mother is very large.
The shoulders break through in an oblique direction at the superior strait, and are placed in a straight line at the inferior one.
The head is engaged obliquely at the superior strait, the chin is bent on the chest ; arrived at the inferior strait it experiences the movements of rotation, by means of which the occiput is placed in the curve of the sacrum, whilst the face arrives under the arch of the pubis.
The occiput then traverses the whole hollow of the sacrum of the coccyx and perinseum, whilst the face re-ascends into the pelvis ; but after a short time the neck deriving support from the posterior commissure, is turned backwards, and the face disengages itself from beneath the pubis. The occiput escapes last.
Note.-—' The spiral movement impressed on the breech of the foetus, wrhen it arrives at the inferior strait, may be sufficiently strong to convert this third position into the second. This change is favourable to the termination of labour.
Fourth Position of the Feet — Principal Relations .
The heels correspond to the left sacro-iliac symphisis, and the toes to the right cotyloid cavity. The posterior region of the foetus looks backwards and to the left, and the anterior forwards and to the right. The head is to the fundus of the womb.
Mechanism. — The same as in the third position, except that the rotatory movements take place in an inverse sense.
Note. — This fourth position may change itself naturally into the first.
Positions of the Knees.
The knees, like the feet, may present themselves in four principal positions, which correspond to the oblique dia¬ meters of the pelvis. The foetus is disposed in such a manner, that the legs are bent on the thighs, and these stretched over the pelvis,
Vot. vi, no. 36, - 3 o
Critical Review.
4(J0
First Position. Principal Relations.
The anterior part of the legs corresponds to the left coty¬ loid cavity, and the anterior part of the thighs to the right sacro-iliac symphisis. The posterior region of the foetus looks forwards and to the left, and the anterior backwards and to the right.
Second Position. Principal Relations.
The anterior part of the legs answers to the right coty¬ loid cavity, and the anterior part of the thighs to the left sacro-iliac symphisis. The posterior part of the foetus looks forwards and to the right, and the anterior backwards and to the left.
Third Position. Principal Relations.
The anterior part of the legs corresponds to the right sacro-iliac symphisis, and the anterior part of the thighs to the left cotyloid cavity. The posterior part of the foetus looks backwards and to the right, and the anterior forwards and to the left.
Fourth Position. Principjal Relations.
The anterior part of the legs corresponds to the left sacro-iliac symphisis, and the anterior part of the thighs to the right cotyloid cavity. The posterior part of the foetus looks backwards and to the left, and the anterior forwards and to the right.
Mechanism of the Four Positions of the Knees.
The mechanism of natural labour in the four positions of the knees is altogether the same as in the corresponding positions of the feet, with the exception that the knees pre¬ sent first.
Positions of the Breech.
The breech, in the same manner as the feet and knees, presents in four different positions. The foetus is disposed in such a manner that the thighs and the legs are raised, and placed on the anterior surface of the trunk.
First Position. Principal Relations.
The posterior part of the sacrum corresponds to the left cotyloid cavity, and the posterior part of the thighs to the right sacro-iliac symphisis. The posterior region of the foetus is directed forwards and to the left, and the anterior backwards and to the right. The head is to the fundus of uterus.
Dr. Hatin on Preternatural Labours .
467
> Second Position. Principal Relations .
The posterior part of the sacrum corresponds to the right cotyloid cavity,, and the posterior part of the thighs to the left sacro-iliac symphisis. The posterior part of the foetus is directed forwards and to the right, and the ante¬ rior backwards and to the left. The head is to the bottom of the womb.
Third Position. Principal Relations .
The posterior part of the sacrum corresponds to the right sacro-iliac symphisis, and the posterior part of the thighs to the left cotyloid cavity. The posterior part of the foetus is directed backwards and to the right, and the anterior forwards and to the left. The head is to the fundus of the uterus.
Fourth Position. Principal Relations.
The posterior part of the sacrum corresponds to the left sacro-iliac symphisis, and the posterior of the thighs to the right cotyloid cavity. The posterior part of the foetus is directed backwards and to the left, and the anterior forwards and to the right. The head is to the fundus of the uterus.
Mechanism of the Four Positions of the Breech.
The breech is engaged obliquely at the superior strait of the pelvis. Arrived at the inferior strait, it experiences a rotatory movement, by means of which one of the hips is placed in the hollow of the sacrum, whilst the other is placed under the arch of the pubis. The hip which is behind escapes first, whilst that which is under the pubis serves to it as a point of support. The trunk bursts through without difficulty, although the abdominal extremities be bent on its anterior region ; at length the axillse obliquely present at the superior strait, the arms are raised upon the sides of the head, and the labour terminates in the same manner as in the corresponding position of the feet.
[Here we shall pause for the present, and allow our junior readers a little time to digest the very able directions incul¬ cated by M. Hatin in the preceding pages. The doctrines inculcated are correct, though somewhat different from those of our countrymen. Obstetricy is now a science, and must be studied as such. — Ed.]
[ 468 ]
V. — Distinction without Separation. In a Letter to the President of the College of Surgeons on the present State of the Profession . By Joseph Henry Green, F. R. S. F. G. S. Professor of Anatomy to the Royal Academy, Professor of Surgery at King’s College, London, one of the Surgeons of St. Thomas’s Hospital, &c. London, 1831, 8vo. pp. 47. Hurst, Chance & Co.
This is rather a singular title ; it certainly leaves the reader to surmise its meaning. Mr. Green means that the dis¬ tinction between physicians and surgeons does not and cannot really subsist, and argues, that the disunion of the departments of the profession has been highly injurious. He rapidly glances at the origin and purpose of the medical corporations in this part of the empire, examines the grievances of the members of the College of Surgeons, defends the powers that be,” considers objections to these, delusive and fallacious, points out the evils of popular elec¬ tions, admits a want of sympathy between the Council of the College and the general practitioners, proposes a remedy, and offers suggestions for the constitution of one medical faculty for uniting all the departments of the pro¬ fession ; and finally, he describes the conduct and character of medical men in society. Such are the contents of this production. Mr. Green argues strongly in favour of the present state of management of the College of Surgeons, and has zealously endeavoured to prove his case ; he then suddenly turns round, and advocates in the strongest terms, the necessity of a complete reform in that body, and ab¬ solutely suggests a most obnoxious plan for the purpose. We are greatly surprised that a surgeon of Mr. Green’s standing and talents should treat the matter in this way. If he be a sincere advocate of the present state of things at the College, how can he with any consistency propose a thorough reform ? This kind of pleading reminds one of Mr. Serjeant Eitherside, or rather of Mr. Serjeant Bothsides ; but we must take leave to inform Mr. Green, he most pro¬ bably will discover that he has pleased neither side.
“ We are gravely told that the general practitioner has no equit¬ able grounds of complaint ; yet as exclusion, even where it is not reasonable, is too natural a source of dissatisfaction, it might per¬ haps be possible so to modify the charter, as to satisfy the excluded, and thereby strengthen the college without interfering with the prin¬ ciple of its foundation.
Mr. Green on Surgical Reform.
469
“ It is in this spirit, then, and solely with this view, that I would propose for consideration the following modifications of the charter, in regulating the administration of the affairs, and suggestions for the improvement of the regulations of the College of Surgeons. — p. 38.
Before we insert the proposed modifications, we beg to inquire, has the general practitioner no equitable ground of complaint against the College V* We answer in the affir¬ mative, and ask Mr. Green, can any member of the College who is excluded from all place in the institution, be said to have no reason to complain ? What privileges or rights have the general practitioners received ? Is there any class of medical men so badly treated, so unprotected, so infringed upon, as this ? No equitable ground for complaint indeed ! Are they not fleeced by chemists, druggists and empirics ? Verily they should immediately convene, and confer some signal mark of their estimation on the author before us. But we hasten to insert his exclusive and insulting panacea for the general practitioner.
“ 1. That the Government of the College should be vested in a President, a Supreme Council, and a General Council.
“ 2. That the Supreme Council should consist of the President and twenty members, who should have the entire management of the affairs of the College, and the conducting of examinations.
“ 3. That the members of the Supreme Council should appoint its own members from the General Council, and consist only of those who do not practise midwifery, nor dispense medicines.
“ 4. That the General Council should consist of the members of the Supreme Council, and of forty additional members, twenty of whom should be under the obligation not to practise midwifery nor dispense medicines,and the remaining twenty of general practitioners - — making the total number of the General Council sixty-one.
“ 5. That the General Council should appoint its own members.
“ 6. That the General Council should choose auditors of the accounts, and might suggest to the Supreme Council at their meet¬ ings any measures for the benefit of the profession. And further, that all public acts of the Supreme Council should be communi¬ cated to them.
“ 7 . That the eligibility of that class of members of the General Council, under the obligation of not practising midwifery, nor dis¬ pensing medicines, should be further determined by proofs of a longer course of study, and of superior capability, evinced by severe examina¬ tions. 1. On entering the profession, they should produce certificates at the College of having been instructed and undergone examinations in Latin, Greek, Mathematics and Logic. 2. That they should have devoted at least five years to the study of their profession, and
4TQ
Critical Review.
produce certificates of having attended lectures on anatomy, physi¬ ology, chemistry, materia medica, botany, practice of medicine, medical jurisprudence, comparative anatomy, midwifery, and that during that time they have attended a public hospital. 3. That they undergo three distinct examinations ; the first on anatomy and physiology, the second on pathology and therapeutics, and the third on surgery; and that they write a thesis on a given subject, in a closed chamber, without the aid of books.
“ 8. There should be a class of honorary members of the General Council, men of distinguished merit in provincial towns, the army, navy, or colonies.
“ 9. That general practitioners who have given up the practice of midwifery and the dispensing of medicines, should be eligible to the first class of the General Council.
“ 10. That teachers of anatomy and surgery should not only have undergone the examinations of the first class, but should have given public proofs of their capability to teach by delivering a lec¬ ture, the preparation for which should not occupy more than twenty minutes.
<( 11. That effectual means should be taken of enforcing the duties of masters to their apprentices or articled students, by a pre¬ scribed and definite course of instruction.
*' 12. In the provisions of a new charter, it should be impera¬ tive that no one should be allowed to practise surgery who was not a member of the College. Since without this check upon ignorance and empiricism, it is impossible that the College can exercise one of its most important functions- — that of protecting the public from the arts and practices of dishonest, unskilful, and incompetent pre¬ tenders.
“ 13. And lastly, that the charter should distinctly define, ex¬ press, and declare, the power of expelling all those who, by disho¬ nourable practices, have rendered themselves unworthy the charac¬ ters of members of a liberal profession, whether it be by the use of secret remedies, by advertising, by partnerships in trading concerns, by calumnious reports of their professional brethren, breaches of professional confidence, or whatever else may be considered deroga¬ tory to a professional character.” — p. 40.
There is scarcely one proposition in this extract which is not highly objectionable, as must be obvious to any man acquainted with the feelings of the profession. The author even admits, that were he a minister of state, he would pause before he granted such an enlarged charter.
“ For I should be led to reflect on the state of the whole medical profession, and considering its vital importance to the state, its objects and purposes, I should come to the conclusion, that however desirable it may be for its practical administration, that its depart¬ ments should be distinguished, yet that from the unity of its cha-
Mr. Green on Surgical Reform
471
racter and purposes, they could not be divided. Instead, therefore, of any partial alteration or regulation, I should advise that one faculty of medicine be constituted, with such powers and administra¬ tive regulations as would render it efficient in promoting the science, and controlling the practice of medicine in all its branches, as a great interest of the state. Of this faculty, the colleges of physicians and surgeons, as representing the great leading distinctions of the pro¬ fession, would naturally form the co-ordinates. In order to the admission of candidates to either, it might be required that they should have passed through the same course of study, which should be upon the most extended plan of a liberal and professional education, and that the examinations for ascertaining their proficiency, should be conducted by both ; and that then from the candidate expressing his wish to enrol himself in either, as intending to devote himself practically to one or other branch pre-eminently, whether medicine or surgery, such additional proofs of competency might be required, as might shew that he was entitled to the desired privilege, and thus the practical distinction between medicine and surgery would be acknowledged, whilst their scientific unity would be preserved.
‘ f Out of both would then naturally arise a third department, par¬ taking of the character of each, — that of midwifery. This might have its separate board or institute, and the candidates for admission having the same basis of general education, would follow a similar rule for the enrolment of its members, by requiring a special skill and knowledge in this department of the profession.
“ Next, as conjoining the functions of all three, the class of general practitioners would find its place : their institute forming a department of the faculty, which would in like manner regulate the admission of candidates, their education and qualifications, and watch over the affairs of their particular branch of the profession.
“ Lastly, from the colleges or institutes of medicine, surgery, midwifery, and general practice, might be formed a medical convo¬ cation, for the purpose of deliberating on all matters relating to the profession at large. And thus a body would be constituted in the service of the state, with whom the government might consult, and to whom the country would look for advice and assistance in all matters appertaining to the health of the community, and to whom all questions relating to epidemics, laws of quarantine, the health of the army and navy, the building of hospitals and prisons, punish¬ ments, drainage, sewers, nuisances, — in fine, all questions of medical jurisprudence and police might be referred. And to a faculty of medicine so constituted, might be entrusted the government and supervision of the practical departments of the profession, and that not only should none practice medicine, surgery, or midwifery, with¬ out their sanction, but that all keepers of houses of reception for lunatics, all druggists and chemists, dentists, cuppers, should be obliged to have their licence for their several callings. And if the government would render the benefit complete and national, they
472
Critical Review.
would root up the detestable upas-tree of quack and patent medicines. And thus, Sir, we might at length see a profession flourishing in this country, the motto of which would be Distinction without Separation.” — p. 44.
We fully assent to these views, and ardently hope that the day is not far distant when this union of the faculty will take place.
This desirable event may soon arrive, because it is utterly impossible that the present defective anomalous and anti¬ quated condition of the medical corporations in this empire can be longer tolerated. Reform must take place, but those who live by monopoly and corruption, will, like the fallen and despicable Tories, oppose it to the last. An au¬ spicious period for medical reform now exists. The London University will have a charter, and in this the union of the faculty might be easily accomplished. Why not make the Colleges of Physicians and Surgeons departments of this Institution? Why not imitate the University of France, and have the various corporations under a national institute ? That, London pre-eminent in wealth and splendour, and in all the advantages which the commerce of the world confers upon her, the Queen of cities, the emporium of the world, the chief seat of civil and religious liberty, should not have a university, while our minor towns and cities possess such institutions, is a defect — is an anomaly, which any man of scientific or literary attainments must desire to have removed. Yes, the time has arrived when an enlightened and wise government has forcibly and successfully assailed every form of corruption, and achieved inestimable benefits for the people, and will not stop in the middle of its splendid career, but will proceed prosperously to reform every thing that needs it, and the medical institutions must be included. The last part of this essay is powerfully arranged, and the whole a good example of a bold nervous style.
VI. — The Effects of the Principal Arts, Trades and Pro - fessions , and of Civic States and Habits of Living , on Health and Longevity. By C. Turner Thackrah : London, 1831. Longman and Co. Leeds, Baines and Co. — ( continued .)
The information contained in this volume, is so instructive and valuable that we cannot refrain from placing more of it before our readers.
Mr, Thackrah on Health and Longevity . 473
The subject which succeeds that noticed in our last, is the condition of miners. These persons, we are told, rarely work more than six hours a day, yet they seldom attain the age of forty. They take immense quantities of ardent spirits, to drown the distressing* idea that they are doomed to pre* mature disease. In the village of Arkendaie, during* the last year, there were not less than thirty widows under thirty years of age,
“ A parallel case to that of the miners occurs in the grinders of Sheffield. Dr. Knight, in the North-of-England Medical Journal, states that the fork- grinders, who use a dry grindstone, die at the ages of 28 or 32, while the table-knife grinders, who work on wet stones, survive to between 40 and 50.
“ Machine-makers are divided into several departments. The founding produces only the slight and temporary annoyance of dust from the charcoal sprinkled on the mould. The men, in Leeds at at least, are generally healthy. Dressing the iron, technically called f< fetling,” seems to be equally innoxious.
“ Turning, boring , and grooving wrought iron present nothing re¬ markable. But the turning of cast iron is so laborious, that the men can scarcely bear it for the wThole of the day. The particles of iron cast off in the process are large, and do not consequently affect the lungs in a sensible and great degree.
“ Draw-filing cast iron is a very injurious occupation. The dust is much more abundant, and the metallic particles much more minute, than in the filing of wrought iron. Does this difference arise from the texture, the degree in which the particles are united in wrought and cast iron ; or does it arise from the manganese and magnesia contained in the latter ? The particles rise so copiously as to blacken the mouth and nose. The men first feel the annoyance in the nostrils. The lining membrane discharges copiously for some time, and then becomes prseternaturally dry. The airtube is next affected. Respiration is difficult on any increase of exertion ; and an habitual cough is at length produced. At the same time, the digestive organs become impaired ; and morning vomiting, or an ejection of mucus on first rising, is not infrequent. The disorder varies of course with the constitution of the individual ; but the common termination, when men pursue the employment for years, is bronchial or tubercular consumption. The frequency of these fatal diseases is easily ex¬ plained. The sensitive membrane lining the airtube and aircells is irritated by the particles of iron inhaled at every breath : chronic in¬ flammation becomes established ; the constitution is seriously injured by the quantity of muco-purulent matter which is discharged, by the want of a full purification of the blood, and by the exhaustion which habitual cough produces : hectic fever and emaciation succeed. More certainly fatal is the case, where there exists in the constitution
3 p
Vol. VI. no. 36*
474
Critical Review.
a predisposition to the tubercular form of the disease. The researches of the French pathologists, as well as our own observations, prove the cartilaginous bodies, called tubercles, to be very frequent in the human lungs, to be slow in assuming a destructive character, and often to remain crude or latent for an indefinite period. The subject of the present paper scarcely requires a detail of the progress of these bodies, as affected by external agents and internal excitement, their augmentation, coalescence, change of hue, softening, the final purulent expectoration, b)r which successive masses are. removed, and the effects produced on the lungs, the airtube, and the constitution. Suffice it to urge, that a great proportion of our population is bom with tubercles, or a disposition to the formation of these bodies ; that various agents in civil life tend powerfully to excite their de¬ velopment, and none more than irritation of the bronchial membrane. This membrane is affected by gaseous agents; but much more by palpable substances. Dust of every kind irritates, but not in an equal degree. Much, I conceive, depends on the size and figure of the particles which enter the airtube. The dust from the roads produces no ap¬ parent mischief, while the mason’s chippings from the stone occasion serious and often fatal injury to his lungs. The dust from old iron, which is thrown off so copiously as to deposit a thick brown layer on the dress of the dealers in this article, produces no inconvenience ; while the less apparent detachment of particles by the file, is de¬ cidedly baneful to the workers in iron. It is then the form rather than the material, the spiculse, the angular, or pointed figure of the particles detached, which we conceive the chief cause of injury. The bronchial membrane is mechanically irritated or wounded ; and from the daily repetition of this injury, the lungs at length become seriously diseased.
“ On examining the chest of 17 machine-makers, we found the average circumference 3 8 -5 -three-fourth inches, and the average quantity of air expired at an effort 7-13-six- eighth pints. The figure of the chest, and the power of its muscles, do not therefore appear to suffer from the employ. Machine-makers seem to suffer only from the dust they inhale, and the consequent bronchial irri¬ tation.
" The filers are almost all unhealthy men and remarkably short¬ lived. One instance only in this neighbourhood can we find, of a man’s following the employ for 20 years. At two of the principal machine-manufactories of Leeds, there are only two filers of the age of 48 ; and in neither case, I believe, has the individual pursued the labour uninterruptedly from boyhood. The mortality among ma¬ chine-makers is not the result of intemperance ; for the men, in this neighbourhood at least, are generally steady. It is not the result of error in diet, clothing, or exercise. It can be ascribed only to the nature of the employ, and the train of baneful effects to which I have adverted.
" What can be done to prevent this lamentable waste of life ?
Mr. Thackarh on Health and Longevity.
475
Magnetic mouth-pieces, which attract the particles of iron inhaled in respiration, and thus greatly diminish the quantity which would enter the air-tube, wrere many years ago introduced in Sheffield, and ought ere this to have been tried in Leeds. But there is a strange apathy both among the men and the masters. Though very intelligent, and conversant not only with the science of their manufacture, but often also with knowledge in general, they are remarkably thoughtless on a subject which most deeply concerns them. Man after man dies of decay in the prime of life, and no warning is taken by the survivors. Machine-makers, indeed, are generally unwilling to admit the fact of excessive mortality. They naturally dislike the idea of being more subject than their neighbours, to disease and death. They will rarely admit that they labour under disorder, till consumption is established, and its effects apparent to every observer. To our ge¬ neral questions they reply, “ We are all pretty healthy.” And it is only by examining each workman that we find the deception. Had they the providence and the courage fairly to examine this impor¬ tant subject, some measures would be devised for correcting the evil. Magnetic mouth-pieces, or some contrivance still more effectual, would be speedily adopted. Though their own knowledge is much more likely to avail than any suggestion of mine, I would ask, if a change can be made in the smelting of iron, or advantage obtained by further purification ? The working of wrought iron we find to be much less injurious to health, than that of the cast. Could wrought iron be used for all purposes ? It is well known to be most suitable for common implements. Would it serve for large wheels, cannon, and the like ? Does the comparative softness of this substance pre¬ sent an objection ? The expense, however, I apprehend to be the great obstacle.
“ The grindstone used by machine -makers produces much dust. This, though it occasions little inconvenience to the young and healthy, greatly affects the aged and asthmatic. Some cover the face, with a handkerchief, but a more effectual plan might probably be adopted, viz. that suggested for the flax- spinners. A channel might be made under the floor, with one end opening beneath the grind¬ stone, and the other outside the room, and through this channel the dust be conveyed.
“ The preceding remarks apply chiefly to the iron- work in the making of machines. The brass work must also be noticed. The founders suffer from the inhalation of the volatalized metal. In the founding of yellow brass in particular, the evolution of oxide of zinc is very great. It immediately affects respiration ; it less directly affects the digestive organs. The men suffer from difficulty of breathing, cough, pain at the stomach, and sometimes morning vomiting. We did not find one brass founder more than 40 years of age ; though we have since been informed that there are two brass- founders in the neighbourhood, of the ages of 60 and 70, who have continued at the employ from boyhood. The turners, filers, and dressers of brass do not seem to be more unhealthy than the
476
Critical Review.
generality of our townsmen. We observe among the filers the hair of the head changed to green.” — p. 55.
Braziers are subject to noxious exhalations from the sol¬ der, but their employments are so varied as to preclude injurious effects, as they are not exposed for a considerable time at once.
Coppersmiths are injured by the fine scales which arise from the imperfectly volatized metal, and by the fumes of the spelter or solder of brass. They are liable to the same diseases as brass founders.
Tin plate-workers are annoyed by the fumes of muriate of ammonia and sulphurous exhalations from coke, which they burn. Tinners are subject to inconvenience from the fumes of soldering.
Plumbers are exposed to the fumes of volatized oxide of lead, which frequently induce vomiting. These artisans are pale and sickly, and very seldom exceed the age of forty.
House painters are affected as the plumbers, and suffer during the process of “ flatting,’' or finishing dead colours with turpentine. The usual symptoms are dizziness, colic and palsy. Are the effects,’’ says our author, pro¬ duced by an impression on the cutaneous nerves, and through them on the nerves in general ? Many painters imagine there would be no danger w7ere it not for the tur¬ pentine. If this be true, some other article ought to be substituted for it. We have known painters in this metro¬ polis who suffered severely from the effects of lead, and afterwards obviated its bad effects by admitting free currents of air into the rooms in wdiich they worked, and by ob¬ servance of cleanliness, more especially in manual ablution.
u Chemists and druggists are exposed to various odours, and the evolution of gases, many of which are injurious. Hence the persons employed in laboratories are frequently sickly in appearance, and subject to serious affections of the lungs. They are often consump¬ tive. Few old men are found in laboratories. Care on the part of the men, and ventilation practised as much as possible, would con¬ siderably diminish the effect of the baneful agents.
“ The men employed in the manufacture of gas for lights, are not aware of any injury resulting from the process. Even the individuals engaged in the purifying department, and exposed consequently to abominable evolutions of sulphuretted hydrogen, say they are well and hearty. The manufacture, however, being of a comparatively recent origin, does not afford us the opportunity of seeing its full and ultimate effects.
Mr. Thackrah on Health and Longevity. 477
“ The men employed in cleaning sewers are often affected by the fetid gases, and sometimes so severely as to suffer suspended ani¬ mation. They are not, however, as far as we could ascertain, subject to any serious disease : nor are they short-lived.” — p, 57.
Our author next adverts to the principal occupations which affect the health through the medium of the skin.
Potters suffer from the lead used in “ glazing.” Their hands are immersed in a strong solution of this mineral, which produces constipation, colic and palsy. Intemperate men suffer most severely. The use of lead in glazing’ might be discontinued, or the process might be effected by a machine. It is well ascertained that the glaze of common earthenware is soluble in animal oil, and more copiously in acid fruits when assisted by heat ; and there is every reason to think that visceral diseases of the poor are greatly to be attri¬ buted to this cause.
Hatters have their hands excoriated from constant immer-
iich is employed in and fingers are ex-
Grocers are subject to eruptions, principally impetigo and eczema, from handling sugar. Lime produces the same diseases on the hands of bricklayers. Flour irritates the skin of bakers, and causes psoriasis.
Chimney-sweepers suffer from cancer scroti, inflammation of the eyes, and bronchial irritation. These diseases are aggravated by intemperance, and the subjects of them are craving liquor at every house in which they are employed. This unnatural and shocking* occupation ought to be abo¬ lished.
Our author dwells with his usual ability on the necessity of cleanliness, by ablution and bathing, in all cases in which the skin suffers from dust.
He next describes the effects of wet and steam on the human body, and illustrates his remarks by describing these on the following artizans : — scourers of wool, dyers, brushers of cloth by steam, millers of cloth, giggers, hatters, brewers and paper makers. He also refers to men who are in the open air, and subjected to frequent and sudden transitions — as husbandmen, milkmen, cart-drivers, drovers, butchers, coachmen, postboys, &c.
“No men, however, exhibit more strongly the agency of wet in the open air, than brickmakers. We have adverted to their state under another head (page 11), as well as to that of husbandmen, coachmen, &c.
sion in a solution of sulphuric acid, wh the process of t( felting.” Their nails coriated and sore.
478
Critical Review.
*4 Whether we examine the agency of moisture on men in the open air, or those under cover, we find it much less than common opinion would expect. In this country almost all our maladies are ascribed to the agency of wet, or to “ taking cold.” Medical men adopt this notion. It is constantly heard in their expressions ; it constantly appears in their writings. The people of course have gradually adopted the medical doctrine, and carry it further than even its founders.* A reference, however, to the history of cases attributed to wet and cold, and an examination of the reasoning of the patients, are enough to expose the insufficiency of the evidence and the incorrect¬ ness of the inference. We might show, moreover, that persons most ‘ careful in avoiding cold/ protecting themselves with every variety of clothing, and shrinking at every change of weather, are not exempt from the evils which they fear. In fact, they are far more subject to catarrh, to pulmonary inflammation, and other disorders commonly attributed to * cold/ than persons who habitually expose themselves. Finally, a reference to the situation and employment of several classes of society, decidedly shows that wet and cold, without other agencies, do not produce the disorders ascribed to them. Look at the brickmaker, who is subject neither to rheumatism nor catarrh, though his bare legs are immersed all day in a puddle, — at the dyer, on a wet floor, and subject to great atmospheric changes both of humidity and temperature almost every moment, — at the bricklayer, who is exposed to every vicissitude of weather, and is generally careless of protection, — at the paper-maker, one hour per¬ spiring at the strong labour of the press, in an atmosphere of warm vapour, the next, standing in the same dress, in a room open on both sides to the wind, and merely putting up sheets of paper to dry, — at the wool scourer, the miller of cloth, and men in similar employments. Individuals, indeed in these departments, sometimes complain of pains, which they call rheumatic. But such complaints
* If a man suffer to-day from headache and sickness, the effects of yesterday’s debauch, he ascribes them to the cold he took in returning home. If bis bowels be irritable from the annoyance of undigested aliment, he has te taken cold.” If he suffer from an epidemic, he is sure it arose from <f sitting with his back to an open window.” If he have an attack of gout, it was from “ going out in a hazy day,” Nay, the unhappy victim of hereditary consumption, ascribes his illness to <c sleeping in a damp bed.” This subject is surely important in Preventive Medicine. If we err in the causes of disease — if we attribute our disorders to agencies which could not produce them, we overlook the agencies which do pro¬ duce them. A man who believes his stomach-complaint "to arise from cold, is not likely to correct that dietetic fault, which has occasioned the disorder. He who ascribes the affection of the head, which from its recurrence and severity threatens to produce at length serious disease, to his standing in the warehouse without his hat, or some such petty exposure daily committed with impunity, will not surely' be disposed to forego that excessive application of mind, which is really the cause of the cerebral excitement.
Old Parr, we are informed, was in the habit of sleeping in wet sheets as his cure for a cold.
Mr. Thackrah on Health and Longevity .
479
we find in all occupations and classes of men. The nature of these pains is obscure. They appear to be affections of the muscles. True rheumatic inflammation of joints is not frequent in any of the em¬ ployments I have mentioned. Though we find instances, these are not more numerous than among corn-millers, and less than among croppers. In our examination of the several classes, we have par¬ ticularly asked, ‘ Are the men, so much exposed to wet and cold, frequently laid up with rheumatic fever ?’ The answer has always been a negative. Of other acute diseases ascribed to cold, as in¬ flammation of the lungs, pleurisy, &c. the men generally appear quite ignorant.
“ lam far, however, from maintaining that vapour, wet, and cold never produce disorder. In certain circumstances, and when long continued, they certainly do. The re-action that ensues advances to fever or inflammation. But cases of this kind are rare. I contend that in the daily instances of common life, cold is not the great cause of disease, and that even in those which are considered as ex¬ hibiting indisputable evidence of its effects, a morbid predisposition has generally been formed by the person’s habit of life, as influencing the state of the circulation and secretions. Rheumatism, I presume, is the malady which the believers in the common opinion would adduce as the strongest objection to my views, it is the malady which I most readily adduce as affording the strongest support to these views. The men who are subject to rheumatism, are not the active and tem¬ perate, heedless of wet ground, and out in all kinds of weather, — but the indolent, the comparatively sedentary, or men who habitually or frequently take more liquor than the constitution requires, and especially fermented liquor ; — men with a large abdomen, and a feeble and sluggish circulation. Such persons are constantly pre¬ disposed to disease : they are constantly open to the influence of atmospheric changes. And wet or cold may excite in them, rheu¬ matic inflammation of joints, as readily, perhaps more readily than catarrh or pulmonary inflammation. I conceive, therefore, that the state of the constitution is the predisposing , — wet, cold, or atmos¬ pheric vicissitude the exciting cause. The observation is probably applicable to a few other maladies besides rheumatism, but by no means to the bulk of diseases which are supposed to be the effect of wet or cold. I would urge my conviction, that in nine-tenths of these diseases, wet or cold is no more the cause, even the exciting cause, than Tenterden steeple of Goodwin sands.
" The inferences, then, from our examination of particular em¬ ployments and classes of men, as well as those deduced from general practice, are 1st, that f wet and cold/ as they occur in ordinary life, are rarely adequate to the production of disease. And 2nd, That in the few cases in which they have such agency, they are only the exciting causes of disease.
“ In reference to the agency of mere aqueous vapour, — of steam, I mean, without frequent and considerable changes of temperature, our best subjects of observation are the men and boys employed in brushing cloth. See page 63. That this vapour should affect
480
Critical Review.
principally the stomach and bowels, is a circumstance which we should not have expected.” — p. 69,
T* , . ■
Our author next examines the health of those exposed to a high temperature , or to great variations of temperature . His observations upon this subject are deeply interesting- to medical men. In fact, there is not a medical practitioner, or a manufacturer in this empire, who should not possess this work. It is replete with information, equally valuable to the one as to the other. It reflects great credit on its author as a scientific, laborious, zealous and philanthropic individual. We trust the day is not far distant, when some other physician will investigate the Effects of the Principal Arts, and Professions, and of Civic States and Habits of Living on Health and Longevity, in this metropolis. To resume our analysis, we have to mention that our author next notices the health of bakers. These men are generally pale and unhealthy. The temperature to which they are exposed is seldom below 80<>, and often as high as 10CK The heat of the oven is about 180°. These men are subject to disorder of the stomach, to cough, and rheumatism. The twro former arise from dust, which is largely inhaled. It is supposed that as these persons reverse the order of nature, by working during night and sleeping by day, and thus in¬ jure their health. But watchmen, coachmen and others, do not suffer from this mode of life. Cooks and confec¬ tioners suffer from headache and indigestion.
Wool-combers are exposed to heat, but the lungs suffer from dust. They live to a good age. Men engaged in dry houses of cloth, are subjected to a hot dry atmosphere, ranging from 110° to 130°. They are half naked, and in¬ cessantly walking, carrying cloth from one room to another, and raising the iron tenter frames. They complain of lan- gour, drowsiness, dizziness, perspiration, thirst and defect of appetite. Fresh men soon lose their colour, and their digestion soon becomes impaired. These persons, though incautiously, passing into the cold air, seldom suffer from it.
Glass-workers are affected with catarrh, but not with pleurisy and pneumonia. Our author does not mention that these men are subject to amaurosis, which is generally known.
The following summary of the effects of high tempera¬ ture, concludes the author’s observations on the labouring classes, and must terminate our present notice : —
**' The high degree of temperature, which the human body can sustain without injury, is surprising. I scarcely need refer to the Well-known experiments of Blagden and Fordyce, Tillet, &c.
Mr. Thackrah on Health and Longevity .
481
<c A part of the subject, of more practical importance, is an ex¬ amination of the effects of heat long continued and alternated with cold : an examination of the state of men, who have for years been half the day in a temperature considerably above that of the atmos¬ phere, and the rest of their time exposed, like other men, to the ordinary cold and vicissitudes of our climate. From my observations on persons thus situated in this neighbourhood, I may draw the fol¬ lowing inferences : —
“1. That operatives habituated to high temperature, daily feel effects similar to those felt by persons who occasionally place them¬ selves in this temperature. Habit seems to have little power in rendering the body insensible to heat. The men daily have an excitement of pulse, — perspiration proportionate to the degree and continuance of the heat, and its complication with muscular labour, thirst, and langour. The complexion is rendered pale ; and the digestive functions are impaired.
“2. Persons exposed by their labour to great and frequent va¬ riations ©f temperature, are not more subject to inflammation of the lungs, or of the bronchial membrane, to pleurisy, or fever than other men. Even the founders and dryhouse-men, who many times a-day, make sudden transitions of temperature, equalling often 100°, or 120°, are neither sensible of inconvenience at the time, nor subject to pulmonic disorders.
“ 3. Affections termed rheumatic are, I think, frequent in this class. If the exciting cause of such complaints be referred to great and sudden changes of temperature, may not the predisposing cause be attributed to the unhealthy state of the abdominal viscera, induced by the excessive potation of fermented liquor ?
“ 4. Though the digestive functions are impaired, and perhaps the muscular power reduced, organic disease does not speedily result. Men working in high temperature are not often incapacitated for work.
“ 5. Is life shortened by habitual exposure to great heat ? I cannot yet form a decided opinion. Though the operatives of this section do not live as long as husbandmen, they do not, on the whole, appear to be shorter-lived than the bulk of townsmen.
“ The remedies which may be suggested for the evils referred to in this section are,
“ 1. Diminution of the muscular labour, which is performed in hot rooms. Raising the iron tenter-frames in the dry -house ought to be effected, and the hot plates of the stuff-pressers conveyed, by machinery. These, and similar modes of relief, are more worthy of mechanic ingenuity, than most of the ends to which this ingenuity is devoted. The men, moreover, should be less active, and carry lighter weights. In other countries, heat is considered a sufficient cause for the reduction of labour; while in England, operatives employ all their strength, as well in a temperature equal to that of the tropics, as in the open air of our winters. 2. The drinking
3 Q
Vol. VI. NO. 36.
482
O r io’ in al Communication s .
O
lemonade, or other diluent during the time of labour, rather than the noxious compound called ale. 3. The use of stimulants with the food, after labour. 4. The reduction of the period of labour.” —
p. 81.
ORIGINAL COMMUNICATIONS.
1.- — Dr. Short on Cholera in Russia.
To his Excellency Prince Lieven, fyc. fyc. fyc.
Sir,
Haying read in the Lancet of this day, of the rapid progress of the cholera morbus in Russia, and the similarity it bears to the Indian epidemic, I hasten to lay before you a few remarks on the nature and treatment of that formidable enemy to the human race, thinking, at the present crisis, a brief statement more valuable to the physician than a more elaborate treatise at a distant period. My acquaintance with the disease has resulted from a long residence in India, where I had frequent opportunities of closely observing the progress of the malady, of trying the various remedial agents, and of obtaining the opinions formed of it by the most experienced practitioners, and also from having suf¬ fered by the invasion of the disease in my own person. The conclusion l have drawn from these sources is, that the disease is produced by a peculiar state of the atmosphere, that the disease is not contagious ; that it affects the nervous system primarily, producing collapse of the external capil¬ lary vessels, deranging the sanguiferous system, and induc¬ ing congestion of the internal organs. I beg to refer to pp. 50, 51, of the accompanying pamphlet, on the croton tig- Jium oil, published by me during this year, where I have alluded to this disease, when engaged on the subject of bilious cholera, a very different complaint, though bearing the same name. The indication of cure, is to relieve as early as possible the internal surface, and the vital organs of the oppression, which will be best effected by the cautious and slow abstraction of blood from a vein. The caution to be observed in drawing blood in this disease, is the imme¬ diate effect produced on the circulation ; it will therefore be
Dr. Short on Cholera in Russia.
483
requisite the operator keep his finger on the pulse, and if he finds it increase in fulness, he may fearlessly reduce the quantity of the circulating- fluid. If, on the contrary, the pulse sinks after the loss of a few ounces, it is evidence against the further abstraction. When this operation has been performed, give four drachms of the following mix¬ ture every hour, or more frequently, according to the urgency of the symptoms. “ Take four drachms of tinc¬ ture of opium, made according to the London pharmaco¬ poeia, two ounces and half of compound tincture of car¬ damoms mix.” The restoration of the capillary circulation should be aided, by either the hot vapour or water bath, assisted by friction, or where these are not to be procured, friction over the body with warmed flannels. The stomach is generally so irritable in this disease, that fluids in any large quantity will be rejected ; even the above form of medicine will not always rest in the stomach sufficiently long to exert its beneficial influence. Opium, in its solid state, must then be had recourse to, and two grains may be given every hour during the urgency of the symptoms. Calomel has been found a valuable auxiliary in the hands of the practi¬ tioner, but to obtain its sedative influence over the irritable stomach in this alarming disease, it must be used boldly ; if given in smaller doses than twenty grains, it had better be dispensed with altogether, as disappointment will be the result. Opiate enemata, and opium as a suppository, will be available in this disease. The urgent symptoms being abated, the cure will be perfected by the use of mercurial purgatives, assisted by a combination of rhubarb and the tartrate of potass, or other laxative ; but as the peculiari¬ ties of constitution are almost infinite, the treatment must be various. In every case of epidemic cholera, the hepatic function is arrested, the use of mercurial purgatives is there¬ fore forcibly indicated.
I have the honour to be. Sir,
Your obedient, humble Servant
M. J. Short, M. D.
Extract from letter addressed to Dr. Short, by G. Benk- liausen. Esq. Russian Consul General at London.
March, 23, 1831.
te The Medical Board at St. Petersburgh, I am informed, have found in your pamphlet, besides the remedies therein
484
Origin at C ornmuni cations
stated, different useful and new observations, which, in the opinion of said board, will deserve the attention of the medical men who will have to treat the cholera.”
[It affords us much satisfaction to notice the flattering manner in which the Russian Medical Board has spoken of Dr. Short’s Essay, a production of which we spoke in just terms of praise in a former number of this Journal. The testimony of a physician who has extensively observed the disease, and who has repeatedly suffered from its dreadful ravages in his own person, is entitled to great consideration. We strongly recommend the original Essay on the Croton Tiglium Oil to our readers, both for the very valuable evi¬ dence it contains on the nature and treatment of cholera, and on the varied therapeutical uses of the Croton Tiglium. —Ed.]
II. — Dr. Blake on the Injurious Effects of Belts and
/Stays.
A paper on the danger of the custom so generally adopted of compressing the abdomen, by means of a belt or stays, as tending to the production of Hernise. By Andrew Blake, M. D. Member of the Royal College of Surgeons of Lon¬ don, late Surgeon to his Majesty’s Seventh Regiment of Dragoon Guards, and author of a Treatise on Delirium Tremens, &c.
The prevalence of the affection termed hernia, or rupture, among the inhabitants of all civilized nations, and the suf¬ ferings, as well as danger to life, which it entails on those who have the misfortune to be afflicted with it, are so familiar to medical men, as to render it unnecessary for me to offer an apology for calling their attention to one of its predisposing causes ; namely, to a very general practice which prevails in almost all classes of society, and which, in my mind, disposes in an eminent degree to the production of this loathsome complaint ; I mean the custom so gene¬ rally adopted of compressing the abdomen by means of a belt or stays. The comparative ease with which persons are enabled to take violent exercise when assisted by this application, owing to the relief it affords to the lungs, by
Dr. Blake on the Effects of Belts and Stays. 485
the pressure of the abdominal contents against the dia¬ phragm, and the consequent diminution of the thoracic space, at a moment when these organs are called upon by a quick¬ ened circulation to hurry their action, and make exceed¬ ingly short inspirations, may have first Jed to its adoption ; and the idea that it must restrain the disposition to embon¬ point in these parts, which is so frequently the consequence of advancing years, tended not a little to render its use still more universal, and a mistaken supposition that the support given by a belt to the abdomen diminishes the liability to rup¬ ture may likewise be numbered amongst the causes of its adop¬ tion. Thus we find individuals amongst all classes of society, from the fox hunter to the effeminate town dandy, alike endeavouring to rival the boarding school miss, in the degree of compression applied to the waist.
Cavalry soldiers are also constantly exposed to this cause of hernia, owing to their heavy sword being suspended from a broad leathern belt, which encircles the waist, and which they are obliged to tighten as much as possible, in order to preserve it in the horizontal position. It was this circumstance, and the prevalence of the affection alluded to, amongst even young dragoons, which directed my attention, as a cavalry surgeon, to the consideration of this subject.
The floating viscera of the abdomen, and the abdominal integuments or parietes, which retain them in their natural situation, may be compared to two forces. The one active and the other passive. Scarpa says, In the healthy state, the abdomen, considered altogether, is submitted to two opposite forces, which reciprocally balance each other. One is the pressure of the viscera against the abdominal parietes ; the other is the re-action of these same parietes upon the viscera which they contain. If these two forces were in perfect equilibrium in all individuals, and under all the circumstances of life, we should not be in the least subject to hernia. If, when the equilibrium has been broken, every point of the parietes of the belly were to yield equally to the impulse of the viscera, an increase of the volume of the whole abdomen would be the consequence ; but a true hernia would never happen.”*
* Vide translated quotations from Scarpa, in Cooper’s Surgical Dictionary, Sixth Edition, p. 641.
486
Original Communications .
In another part of his work on hernia, the same ingenious author says, “ But there are certain points of the abdo¬ minal parietes which present much less resistance than others, and which re-act with much less power against the pressure made from within outwards by the abdominal viscera.”
The points alluded to are too well known to require a particular description here. From what has been advanced, a very little consideration will, I trust, serve to explain, at least to all persons acquainted with the laws of natural philosophy, how much the application of a tight belt or stays, embracing the abdomen, must tend to destroy the equilibrium between the twTo forces already spoken of, and how, by preventing a large portion of the parietes of the abdomen from yielding equally to what may be termed the contre-coup from its contents. The conjoined forces will be directed to those points which are naturally weak, and at which hernia generally appear. The belt or stays act by compressing the superior regions of the abdomen, and, by preventing them from yielding, direct the entire impulse given to the viscera, against its naturally weak points, the rings, which are known to be situated at the lateral and inferior part of the abdomen, and to which points such artificial support does not extend.
The consequence of all violent exertion, such as leap¬ ing, &c. &c. under these circumstances will, in all proba¬ bility, be the production of rupture ; but should the impulse against the weak points not be sufficient to overcome the resistance offered by them, they must, at least, yield a little, and by frequent repetitions of the impulse, they will ulti¬ mately lose their tone, and allow the impelled viscera to protrude through them.
All persons who take much exercise on horseback, are in particular exposed to these consequences. I need scarcely advert to the repeated shocks experienced during the plea¬ sures of the chase, in all of which the impulse given to the intestines, is directed by the pressure of the belt or stays towards the inferior and weaker points of the parietes of the abdomen. The cavalry soldier, whose constrained and almost perpendicular position on horseback, resting well on the perinseum, and oftentimes without the support of stir¬ rups, must necessarily, while trotting, day after day, round a riding school, expose the rings to all the possible effects of gravitation, in addition to those arising from a tight, un¬ yielding belt, placed round the waist just above these
Dr. Blake on the Effects of Belts and Stays . 487
points. Hence, although the strength and elasticity of fibre consequent to youth, will resist for a time the violent shocks to which dragoons are exposed, yet numbers of them are lost to the service from the gradual dilatation of the rings, and the ultimate formation of hernise. Gutta cavat lapi- dem non vi sed ssepe cadendo.” On the same principle, while the parietes of the abdomen are prevented from yielding generally, by the pressure of the waist belt, the fibres entering into the formation of the rings, against which the whole weight of the viscera is propelled, gra¬ dually yield, and each succeeding jolt increases the breach, until, in a given time, sooner or later, according to the texture and construction of the parts concerned, it admits of the passage of the intestines, and the formation of the affection in question.
To prevent then, such consequences in all classes of per¬ sons, I would strongly recommend that the pernicious custom of compressing the abdomen should be altogether abandoned, a somewhat unsightly appearance from rotundity of the abdomen, is far preferable to the possibility of being afflicted with an artificial anus in the groin.
With regard to the cavalry soldier, I would take the liberty of submitting, for the consideration of the Com- mander-in-Chief, the propriety of substituting a sword belt, suspended across the right shoulder, instead of the unphi- losophical and injurious waist belt at present in use. By doing so, the dragoon would have a more uniform appear¬ ance, as the pouch belt would cross it ; and by such a change, I am thoroughly convinced, he would be rendered less liable to an affection, which, when it exists, incapacitates him from cavalry duty, and thereby deprives the country of the services of an individual, whose instruction alone is attended with very considerable expense.
Much has deservedly been said concerning the injurious effects of tight stays and lacing to the female frame, and were I disposed to lengthen the present paper, I might take advantage of such observations; but my object is to confine myself to the consideration only of their influence in the production of hernia, and should I have succeeded in explaining the danger attending the unnatural custom alluded to, and thereby have attained the object I contem¬ plate, I shall feel highly gratified at having given publicity to my reflections on the subject, however incongruously they may be expressed.
Lent 071, Nottingham, May, 1831.
488
Original Communications .
[It is almost unnecessary to direct the attention of the Army Medical Board to the very important suggestion of our talented and experienced correspondent. We are per¬ fectly satisfied that any hint which is valuable, for the pre¬ vention of disease among our invincible troops, will be duly estimated in the proper quarter ; which is distinguished by an ardent desire, and the utmost readiness on the part of the Director General and his esteemed colleagues, to pro¬ mote the comforts and welfare of that branch of the public service over which they preside. The opinion of such an able medical officer of the army as Dr. Blake, is entitled to attention and respect. — Ed.]
III. — Report of the Royal Westminster Ophthalmic Hospital. By Mr. J. Foote, Jun.
Purulent Ophthalmia.
This disease (the evil effects of which, under the treatment at present pursued by medical men, are constantly exempli¬ fied by unhappy infants, who have lost one or both eyes, being brought to this hospital at a period of the complaint, when it is no longer in the power of surgery to afford them any relief) has never been known to resist the plan of treat¬ ment employed at this institution. This disease may attack the offspring* of the most virtuous as well as of the most depraved : a simple weakness, as it is termed, in the mother, being as capable of producing it as the most virulent gonorr¬ hoea ; although the complaint, when arising from the latter cause is more dangerous, and more likely to run its course in spite of the remedies employed. This being the case, the disease, when unchecked, or, what is exactly the same, when treated by the simple and inefficient means most fre¬ quently employed by practitioners, more especially those of the old school, proving so fatal to the eyes, and causing our institutions for the blind to be crowded with unhappy objects of our compassion, depriving these unfortunates even from their infancy of the blessed light of heaven, debarring them from participating in the pleasure all mankind feel in beholding* and admiring the wondrous w'orks of the all-wise, rendering them objects of the contempt and sometimes even of the hate of ignorant and foolish beings, making their lives a burden to themselves, and, if paupers, on every one else.
Mr. Foote, Jun. on Purulent Ophthalmia. 489
who partakes of the spirit of real charity ; such being the case, is it not astonishing that in spite of the numerous cases published, attesting the signal benefits this peculiar mode of treatment ensures, that practitioners can be found, who disdain the new light thrown upon the darkness which has enveloped the study of ophthalmic medicine until lately, and determine to go on in the old routine way of practice, despite common sense and humanity, and careless of the injury they inflict. These remarks have been drawn forth from witness¬ ing the numberless cases that attend this hospital, having lost one or both eyes from this complaint. The rationale of the treatment adopted is as follows : —The disease of the eyes, producing a purulent discharge, whence the name, is an un¬ healthy inflammation, first involving the conjunctiva, finally extending, by contiguity of substance, to the cornea, and other parts of the eye. The ung. argent, nitr. is applied, on the old principle, that no two diseases can exist at one and the same time: it, being a powerful stimulant, excites a greater , a more healthy, and at the same time a more tran¬ sitory degree of inflammation than that already existing: and as the effect of one application is going off (which it generally does in a day or two, to be judged of by the re¬ currence of the previous symptoms), is to be repeated, so as to keep up the action, and, by this means, overcome the disease ; the purulent discharge acting as an unhealthy sti¬ mulus to the eye, keeps up the irritation, and, consequently, the disease. This should be washed out every hour, or even more frequently, as it accumulates ; and this is best done, by syringing it out from beneath the eyelids with an elastic syringe and a solution of alum ; which clears away the dis¬ charge, while the alum tends to constringe the vessels : the solution generally employed is, a drachm to a pint.
Case I. — Purulent ophthalmia, dependant on gonorrhoea in the mother — both eyes lost. Lydia Alderwood, aged one month. Admitted June 22, 1830.
About three days after birth, the eyes became inflamed, but no discharge appeared until the 7th, when the lids became much tumefied, and the discharge appeared in con¬ siderable quantity, thick and yellow.
At present, the discharge is not so great, the lids are still extremely swollen, highly injected, and are easily everted.
Both eyes are lost : the corneae are much diseased, being ulcerated and ruptured.
3 K
Vol, vi. no. 36.
490
Original Communications .
Her medical attendant has latterly syringed the eyes four or five times a day, and has twice applied the ung. nigr. : in consequence of which the discharge was lessened , and the eyes improved. The previous treatment was very inert, consisting of 7nilk washes , and so forth.
The child’s health is pretty good, bowels open.
App. hirud. j. cantho extern, sing, oculi.
Lotio. aluminis ter quaterve die usurpand.
Pulv. alter, ss. nocte et mane sumend.
23rd. The leeches, applied last night, bled so freely, that they sent for a surgeon to stop the haemorrhage.
The lids are less tumefied ; but the nurse says the discharge is greater.
App. ung. argent, nitr. ocul. sing.
Rep. pulv.
Lotio aluminis 2 da hora post applicationem ung. et tunc omni hora utend.
The child opened her eyes last night, and kept them open for half an hour.
24th. The child opened her eyes last night, and kept them so for two hours. The discharge is still very great, but not so much as it was : the lids are by no means so tumefied.
Rep. pulv. et lotio aluminis.
25th. The child is considerably improved, and the dis¬ charge is much lessened — the lids are also considerably less tumefied. The eyes may now be examined without difficulty ; they are both staphylomatous.
Rep. medic.
29th. Is going on well. Discharge lessened.
July 1st. The inflammation seems on the increase; the discharge is in greater quantity, and secreted more rapidly.
Rep. medic.
5th. The discharge is not great; the child is improving.
App, gutt. argent, nitr.
Rep. pulv. et lotio.
13th. Discharge very slight. Cont. omnia.
22d. Going on well.
Quinse. sulph. gr. ss.
Sacch. pur. gr. v.
Ft. pulv. bis die sumend.
Cured.
Mr. Foote, Jun. on Purulent Ophthalmia. 491
This case, which has chiefly prompted the remarks already made, exemplifies the use of this highly valuable remedy. It is very melancholy, that from the neglect of this com¬ plaint in the commencement, this unfortunate child should be doomed to a life of darkness, one who can feel the sun, but cannot behold its cheering rays, nor the wonderful effects it produces — whose future existence can be only a blank — a dark and dreary life, unblessed by hope, and ren¬ dered miserable by the physical if not moral darkness which surrounds her. It is mournful that all this, which might have been prevented at first by due and proper treatment, should have occurred by the negligence (not to call it by a harsher name) of her medical attendant to passing events.
Case II. — Purulent Ophthalmia: from Leucorrhcea. Henry Williams, aged nine weeks. Admitted June 8th, 1830.
Purulent ophthalmia, attacking both eyes, which appeared three days after birth.
His mother observed his eyes to be rather red on the second day: on the third, the lids were swollen, and a purulent discharge in great quantity took place : for this she consulted a surgeon, who gave her powders and lotions for the eyes. Under this treatment, the tumefaction and the discharge diminished.
At present there is a central opacity of the right cornea : the left is muddy, but not opake, attended with considerable discharge and chronic inflammation ; bowels open, good appetite. The mother owned, though with reluctance, to having leucorrhcea.
The discharge was previously well syringed out , and then the ung. arg. nitr. applied, and freely diffused over the whole of the eye by rubbing the lids.
Pulv. alter, ss. nocte et mane sumend.
9th. Is going on well.
Habeat lotionem aluminis
10th. Discharge very slight. Is nearly well.
Rep. lotio.
12th. There is still some discharge from the right eye ; the left eye is entirely free from it.
App. gutt. arg. nitr. ocul. dextr.
Rep. lotio, — et pulv.
14th. There is still some slight discharge.
App. ung. arg. nitr. ad dextr.
492
Original Communications .
16th. Is well, with the exception of the opacity of the right eye. The left is quite bright.
This case strongly marks the benefit derived from the black ointment; the discharge from the right, it appeared, would not yield to the lotio aluminis alone, or in conjunc¬ tion with the gutt. arg. nitr. ; but when the ointment was applied, it effected a cure as if by magic.
The cases which follow are marked H, and were commu¬ nicated to me by a highly intelligent and industrious student at the hospital, they having been under his own care.
Case III. Mary Piley, aged three weeks. Admitted April 26th, 1830.
Three days after birth, the child’s eyes began to discharge purulent matter, which has continued ever since with great inflammation and thickening of the lids : the mother has a gonorrhoea , which she got from her husband in November last, and is not yet cured.
When admitted, there was a great cloudiness of cornea, with a large speck on that of the right eye, a thick and granulated state of the lids, with considerable discharge of matter.
App; ung. arg. nitr. ocul. dextr.
Lotion, alum, sinistr.
Calom. gr. j
Sacch. gr. iij. m. ft. pulv. j. nocte et mane sumend.
28th. The right eye appears to have improved under the application of the ointment : discharge less: no improvement in the left: ordered to continue the treatment.
29th. No improvement in the left eye.
App. ung. arg. nitr.
May 1st. A large ulcer still appears in the cornea of the right, which is likewise very muddy, with much inflammation and swelling of lids.
Rep. ung.
6th. No great improvement in either eye: discharge great.
Rep. ung.
9th, There appears a gradual improvement in both ej/es ; cornea clearer : ulcer decreasing: inflammation lessened.
Rep.
27th. The child has been kept away for some time. When brought back to-day, the complaint .was considerably aggravated.
Mr. Foote, Jim. cm Purulent Ophthalmia.
493
The ointment was applied, and the use of the lotio aluminis directed ; but the mother never brought it back. — H.
Case IV.— Gonorrhoeal ophthalmia.
Ellen Nicholson, setat. 34. Admitted June 17th, 1830.
Is a married woman, with one child. About a fortnight since felt some pain in the lower lid of the right eye, which in the course of a few hours swelled very much, with very great inflammation of the conjunctiva of the ball. She had previously enjoyed very good health; says^she has never perceived any discharge from the vagina, or felt soreness about the genitals, though her husband has since told her that he had a gonorrhoea, of which he is still uncured.
When admitted to-day, there was great inflammation of the conjunctiva of the ball, with chemosis, some opacity of the cornea : ulceration round the edges of the lid : great discharge of purulent matter : no pain in the head, but little in the eye.
On examination there appeared some slight inflammation of the labia and round the vagina, and meatus urinarius ; she has felt some slight burning on making water.
App. ung. nigr. lotio. aluminis.
Pil. cal. et opii. gr. ij. ter. in die.
22d. Discharge of purulent matter less : ulceration round the edges decreasing.
Rep. ung. lotio. et pil.
26th. Continues improving ; chemosis gone ; cornea clearer, sees quite well, no intolerance of light ; mouth very sore from the calomel — ordered to discontinue it.
App. ung. nigr.
28th. Very great change for the better: ulcerations healed : mouth still sore.
Rep. ung.
This patient gradually got well, and was ef discharged, cured.”— H.
Case V. — Muco-purulent opthalmia, from accident to the right eye, the left soon becoming involved in the disease.
John Hawkins, setat. four years. Admitted Nov. 9th, 1830.
On Saturday, the 6th instant, the child met with an acci¬ dent, to which the mother attributes the complaint : a small piece of coal flying into the right eye whilst looking on at the breaking of some large coal : during the day the lids
494
Original Communications .
became tumefied and discoloured ; he complained of pain with great lachrymation. In the evening the bit of coal was removed, but he did not sleep well : on the morning of the 7th, a yellowish discharge was observed, and all the symp¬ toms aggravated ; in the evening the lids were highly tume¬ fied, he could not open them, and he complained of great pain, attended with considerable discharge ; the left eye became affected in the course of the evening. This state of the eyes has continued ever since with considerable aggra¬ vation of the symptoms.
At present the right eye is the worst : there is considerable yellow thick discharge, lids inflamed, highly injected, and tumefied ; cornese clear. The left eye is not quite so in¬ flamed as the other ; he sleeps badly ; appetite failing since the commencement of the attack ; tongue clean, pulse quick; bowels open.
App. ung. nigr. ocul. sing.
Warm fomentations to the eyes frequently during the day.
Pulv. alter, j. nocte et mane.
11th. The left eye is nearly well ; the right very much better : there is no longer any tumefaction, and the pain has disappeared : discharge very slight from the right ; none from the left.
App. ung. nigr. dextr. tantum.
Rep. pulv.
13th. Discharged, cured.
Case VI. — Pustular inflammation from injury.
Mary Kennedy, setat, 14. Admitted 8th June, 1830.
About a fortnight since, while nursing, she received a blow from a piece of wood in the hands of the child, a small splinter entered the outer canthus, and penetrated nearly to the ball of the eye : it remained there neglected for some days, when severe inflammation having come on, it was extracted.
She presented, when admitted, very great inflammation of the conjunctiva of the ball and lids : very great pain in the eye : sight a good deal affected — intolerance of light : cornea quite clear : no pain in the head — several small pustules forming round the cornea : great lachrymation.
App. ung. nigr.
K pil. hyd. gr. iij. nocte: sulph. magn. 3 ss. mane.
June 12th. No very great improvement : large red vessels running across the conjunctiva : great pain in the head.
Mr. Foote, Jan. on Ophthalmia from Lime. 495
Rep. ung. nigr. — Hirud. ij. nocte applic.
Pulv. cal. gr. iv.
Pulv. jalapse. gr. x. — M. ft. pulv. statim sumend.
14th. Some improvement is manifest.
Rep. ung. et hirudines. — Pulv. jalap, c. 3j. mane.
15th. Still continues to improve : vision much better : no pain in the eye or head.
Rep. hirud. et ung.
20th. Very nearly well : inflammation removed.
App. vin. opij.
Discharged, cured. — H.
Case VII. — Inflammation, with slight sloughing from the application of lime.
Thomas Clarke, setat. 89. Admitted 8th June, 1830.
Whilst walking in the streets about five days ago, some mortar fell into the eye. He washed it well with warm water, and has fomented it frequently since.
There is an eschar formed on the edge of the lower lid, and on drawing the lid down, another, rather larger, may be perceived in the folds of the conjunctiva, where it com¬ mences the covering of the sclerotic. The cornea is per¬ fectly clear ; he does not suffer any pain ; vision rather impaired.
Applic. ung. nigr.
Ik pulv. jalap c. 5j* mane sumend ex aqua.
10th. Is much better — the inflammation is lessened : he remains free from pain- — the sloughs of the lid have sepa¬ rated.
Rep. ung. et pulv.
Complains of pain in the head and giddiness. The pow¬ der to be taken every morning.
12th. Is much better. Continue.
17th. Complains merely of an itching sensation in the eye.
Rep. ung : usurp, ung. flavum hora somni.
22d. Rep. — Discharged, cured.
Case VIII. — Ophthalmia from lime.
Philip Thomas, setat. 26. Admitted October 21. A plasterer by trade.
Whilst at work yesterday he received a blow upon the eye from a lath covered with mortar, a quantity of which got in
496 Original Communications.
the eye ; some of his companions washed out the eye, and got away all the lime that could be seen.
When he presented himself at the hospital, there was great chemosis of the eye, conjunctiva of the eye and lids in a high state of inflammation, extremely painful, great lachrymation, tears hot and scalding: lower lid enormously swollen ; vision gone : no pain in the head : a poultice was applied last night,
C. C. ad Bxiv. tempori Pil. hydrargyri gr. v. nocte Sulph. magn. 3 ss. mane
22d. Eye free from pain this morning: chemosis has nearly disappeared : swelling of the lower lid much les¬ sened.
hyd. submur. gr. ij.
P. opij. — gr. J. ft. pil. ter. die sumend.
23d. Inflammation much lessened : pain in the eye en¬ tirely gone: vision still indistinct: very little lachrymation.
Rep. pil.
Of this case the notes were no longer taken ; the mouth was rendered sore, and he gradually recovered. When he was dismissed, the cornea was clear and vision good. — H.
Case IX. — Albugo : cured by insufflation.
William Sanson, eetat. 53. Admitted May 6th, 1830, with a large albugo, covering nearly the whole of the cornea, of a milk white appearance, resembling lime.
Insufflatur pulv. sacch. c cal. in ocul.
11th. A great deal better.
Iteretur insufflatio.
13th. Improving; says he sees much better: the albugo does not cover one-third the space it did.
Rep. insufilatio omni die.
20th. The albugo has nearly disappeared. Rep. —
Cured.
Case X. — For this case of amaurosis, cured by the antim. tart. & sulphate of magnesia, I am indebted to Mr. Nice, an intelligent student at this hospital.
Elizabeth Curman, setat. 49. Admitted April llth, 1831, suffering from an amaurotic affection of the right eye, which she considers to have arisen from a nervous attack, under which she has been labouring for some time previous.
Mr. Nice on Amaurosis.
49 7
This complaint (the amaurosis) commenced on Saturday week; she now complains of slight giddiness unattended with pain, but complains of the appearance of a web, as it were, floating over the eye ; sight imperfect.
R. magn. sulph. 3j.
ant. tart. gr. ij. — h. s. s.
The gutt. vin. opij. to be dropped in the eye directly.
13th. The emetic operated briskly, and the giddiness is much relieved; the web is still present.
18th. Much improved on the whole; but having caught cold, a slight catarrhal inflammation was the consequence; for which the ung. hyd. nitr. oxyd was directed to be used, and the other remedies still continued, as the dimness of vision was going off.
20th. Still improving ; the ointment has lowered the inflammation. The drops were omitted, but the rest of the medicines still employed.
22d. The misty appearance returning again slightly ; the drops and other medicines continued.
25th. Considerable improvement visible as well as felt ; the drops were applied, but the ant. tart, diminished one grain.
27th. Still improving; the ant. tart, did not operate as an emetic, but combined with sulph. magn. acted very briskly as a purgative.
Rep. vin. opij. et ant. tart.
May 2d. Much better. Rep. medicament.
9th. Improving. Rep. ant. tart. The drops changed to a solution of the nitras argenti.
13th. Is rapidly improving.
16th. Discharged.
[We are much indebted to Mr. Foote, Jun. and his zealous colleag’ues for the narration of the above cases, which can¬ not fail to be instructive to our junior readers. The senti¬ ments expressed on the great injury produced by inefficient treatment of purulent ophthalmia are just, and reflect much credit on our esteemed correspondent. It is a notorious fact that some public lecturers in London broadly assert, that no disorganization of the cornea follows the disease under notice ; and some of the auditors of such teachers seemed quite astounded, when we referred them to the various ophthalmic institutions for melancholy proof of the fallacy of such an erroneous assertion. — Ed.]
3 s
VoL. VI. NO. 86.
498
Ori gin al Communications . &
IV. — Dr. Ryan on Homicide by Poisoning ,
Observations on Arsenic. — ( continued .)
The appearances of the arsenical crust, formed by the pro» cess stated in the concluding- paragraph of the last article, are, according to Dr. Christison, imitated by no substance in nature. This is a most important conclusion, as Dr. Paris, Dr. Smith and Dr. Beck, have questioned the accuracy of the test by reduction. If any one persevere in denying the value of this test, the following process is considered cer¬ tain — indeed, almost infallible. It consists of oxidation by heat, according to Dr. Christison : —
“ The best method of applying this part of the test is to heat the ball containing its flux deprived of arsenic, to attach a bit of glass tube to the end, and to draw it gently off in the spirit flame, taking care to prevent the flux being driven forward on the crust. This being done, the whole crust, or, if it is large, a portion of it, is to be chased up and down the tube with a small spirit lamp flame till it is all converted into a white powder. In order to show the crystalline form of the powder distinctly, let the flame be reduced to the volume of a pea by drawing in the wick, and let the part of the tube containing the oxide be held half an inch or an inch above it. By repeated trials sparkling crystals will at length be formed, which are octahedres, — the crystalline form of arsenious acid. The triangular facettes of the octahedres may be sometimes seen with the naked eye, though the original crust was only a fiftieth of a grain or even less ; and they may be always seen with a lens of four powers, the tube being held between the eye and a lighted candle, or a ray of sunshine, either of which is preferable to the diffuse daylight for making this observa¬ tion. For the success of the oxidation test it is indispen¬ sable that the inside of the tube be not soiled with the flux, if the flux contained an alkali ; because the alkali would unite with the oxide. It is also requisite not to heat the tube suddenly so as to redden it before the oxide is sub¬ limed ; because then the oxide unites with the glass, form¬ ing a white, opaque enamel.
Such is the best and only process I should recommend for the detection of arsenic when in its solid form.”
When arsenious acid is mixed with the contents of the sto¬ mach, we should remember that various animal and vegetable
Dr. Ryan on Homicide by Poisoning .
499
principles are present, such as albumen, mucus, tannin, and caseum. To separate the acid, we must add silver, copper, lime or sulphur, which will form a compound, from which the poison can be subsequently disengaged. But Dr. Christison has proved the fallacy of these tests. He has shewn that nitrate of silver will cause a yellow preci¬ pitate with animal matter, similar to that produced when arsenic is present. A similar effect resulted from the sul¬ phate of copper. He recommends the following experiment in preference to all liquid re-agents. His object is to pro¬ cure sulphuret of arsenic, which he accomplishes by trans¬ mitting sulphuretted hydrogen through the solution. Acetic acid is to be first added in excess to the suspected liquor, for the purposes of neutralising any alkali that may be in the stomach, and of precipitating animal principles. The fluid is filtered, and a stream of sulphuretted hydrogen is passed through it for a quarter of an hour, when, if arsenic is present, a lemon coloured precipitate is thrown down ; or if the quantity is small, it is suspended in the fluid ; in both cases it is necessary to boil the fluid, in order to expel any excess of sulphuretted hydrogen, which would other¬ wise retain the sulphuret of arsenic in solution. This test, discovers arsenious acid in one hundred thousand part in water. The sulphuret of arsenic is to be mixed with recently ignited charcoal and carbonate of soda, and reduced in a tube as already described. The following mode of defla¬ grating the sulphuret of arsenic is recommended, in pre¬ ference to those proposed by Berzelius and Christison, by the Commentator, on the processes of the latter, in the Lancet : —
About a scruple of powdered nitre should be melted by the heat of a spirit lamp in a green glass tube about six inches long and half an inch in diameter ; the impure sul¬ phuret of arsenic should then be dropped into it in minute particles, one by one ; in this manner the decomposition of the organic matter usually takes place without flame, or at most with minute scintillations, and the sulphuret of arsenic is converted into the sulphate and arseniate of potass ; the tube should then be allowed to cool, and boiling water added to dissolve the saline mass ; the solution should then be filtered. Instead of lime water, we would now add the nitrate of silver, which causes a brown red precipitate of the arseniate and sulphate of silver, which is exceedingly insoluble in water. Finally, this precipitate should be dried.
500
Original Communications' .
©
mixed with recently ignited charcoal, and reduced in a tube.
“ We feel confident that this method will succeed in ex¬ perienced hands in many instances in which the complex precipitations of animal matter by the nitrate of silver, would frustrate the analyser’s expectations.”
The following’ information as to the detection of the other preparations of arsenic, by the same writer, are so valuable that I place thenr before the reader: —
“ Such are the several modes of proceeding in our search for arsenious acid. As we before observed, however, there are many other arsenical poisons which would elqde this mode of analysis : we may particularize the arsenite of cop¬ per (Scheele’s green), and the yellow sulphate of arsenic, orpiment : or King’s yellow. The two last, being entirely insoluble in water, remain undissolved in the solid contents of the stomach ; it will be recollected also, that the arse¬ nious acid, on the one hand, is liable to be converted into the yellow sulphuret by sulphuretted hydrogen in the sto¬ mach, or in the alimentary canal ; and, on the other, that the orpiment of the shops almost invariably contains the arse¬ nious acid.
After the boiling and filtering, therefore, which consti¬ tute the first step in Dr. Christison’s process for the arsenious acid, the solid matter should again be collected, introduced into a stoppered phial, and some weak ammonia added, which will take up either orpiment or Scheele’s green. After a few hours the mixture should be filtered, and acetic acid added to the fluid which passes through, when, if it contain the arsenite of copper, a green precipitate is slowly formed ; if it contain the sulphuret of arsenic, a yellow precipitate is soon deposited. If the precipitate be green, we have to seek for two metals in it, arsenic and copper. The first is recognised easily, by mixing the powder with charcoal and dried carbonate of soda, and heating it to redness in a tube, when the metal is reduced and sublimed, leaving behind it the copper, which may be detected by dissolving the resi¬ duum in dilute nitric acid, evaporating to dryness, mixing the dried mass with an equal quantity of borax, and acting on it with the blowpipe on charcoal. In the exterior flame, it forms a globule of beautiful green glass, which in the interior flame is coated with metallic copper, though the quantity be not more than the 500th part of one grain.
Dr. Ryan on Homicide by Poisoning . 501
For directions on the use of the blowpipe, see the article on lead.
If the deposition from the alkaline solution be yellow, it should be reduced in the manner already detailed, which it is superfluous now to repeat. It is here, however, neces¬ sary to re-dissolve the residuum in the tube, in water, and add a drop or two of a solution of the acetate of lead, which becomes blackened, both experiments indicating that the yellow precipitate is the sulphuret of arsenic.
The arsenical poison may also have been the arson iate of potass. Orfila has besides very recently asserted, that the arsenious acid is liable to be converted into the arse- niate of ammonia, when the body in which it is contained has long' been exposed to decay. A portion of the fluid prepared with acetic acid, according to Dr. Christison’s plan, should, therefore, before transmission of sulphuretted hydrogen, be touched with nitrate of silver, which in any solution will show the presence of the arseniate. Should a brown precipitate occur, it is to be collected for reduction with charcoal. The remark, however, applied to Dr. Vena¬ bles’ proposal, must be remembered here. Great difficulty, arising from empyreuma, will occur in the reduction ; a diffi¬ culty which, as yet, we have not been able to overcome.
“ How far the additional step of examining the solids is actually necessary in this country, it may be difficult to determine. Dr. Duncan has seen one case of poisoning by Scheele’s green, which he detected in pills, and a second of poisoning by orpiment, which had been mixed with tea. At any rate the additional experiment turns the solid sub¬ stances to account, which in Dr. Christison’s analysis are altogether neglected.” — Lancet , 1831, vol i.
Sediilot informs us that thereare two sulphurets of arsenic, the orpiment and realgar, from which, if heated with potass, metallic arsenic will be obtained by sublimation. MM. Geizer and Reiman, digest the mixture for some time wTith liquid ammonia, it is then filtered, and hydrochloric acid added in excess. If a yellow precipitate occurs, it is an indication of arsenic; but when there is no precipitate, we cannot pronounce negatively ; the fluid is to be evaporated to dryness, more ammonia is added, and the admixture is saturated as before with hydrochloric acid ; on adding a few drops of hydrosulphuric acid, a yellow precipitate takes place, if arsenic is present.
Arseniates of potass, soda and ammonia, when projected on live coals, volatilise in the form of arsenic acid. Mixed and heated with charcoal, metallic arsenic will be obtained.
502
Original Communications .
Action of arsenic , and the symptoms it excites in man. — Arsenic acts in two ways, most commonly by inducing in¬ flammation of the gastro-intestinal mucous membrane, or by lowering or arresting the action of the heart. Again, its effects may be purely narcotic. It may destroy life, and leave no mark of disease to account for death. It proves deleterious when applied to wounds, and sometimes even to ulcers, and when injected into the vagina or rectum.
To whatever part it is applied, unless death speedily follow, it almost always produces inflammation of the sto¬ mach ; even this inflammation is in some instances more intense when the poison is applied to the external surface of the body. From the experiments of Morgan and Addi¬ son, all poisons appear to act through the nerves. Dr. Christison thinks farther experiments necessary to confirm this conclusion ; but he has not offered a valid objection to this opinion.
Medical witnesses are often asked what is the smallest dose of arsenic which proves fatal ? This question cannot be answered but vaguely. The quantity is not as yet deter¬ mined ; and of course a great deal must depend on the state of health, age, habit, diet, in a word, on concomitant cir¬ cumstances. Hahnemann thinks four grains will prove fatal in twenty-four hours. Christison has related a fatal case of a child four years old, in which death took place in six hours, from four and a half grains in solution. The smallest fatal dose of solid arsenic he has read of was thirty grains. He thus describes the order of symptoms of poisoning with arsenic : —
The symptoms of poisoning with arsenic may be ad¬ vantageously considered under three heads. In one set of cases there are signs of violent irritation of the alimentary canal, and sometimes of the other mucous membranes also, accompanied with excessive general depression, but not with distinct disorder of the nervous system. When such cases prove fatal, which they generally do, they terminate for the most part in from twenty-four hours to three days. In a second and very singular set of cases there is little sign of irritation in any part of the alimentary canal ; perhaps trivial vomiting or slight pain in the stomach, sometimes neither; the patient is chiefly or solely affected with excessive pros¬ tration of strength and frequent fainting ; and death is sel¬ dom delayed beyond the fifth or sixth hour. In a third set of cases life is commonly prolonged at least six days, some¬ times much longer, or recovery may even take place after a tedious illness ; and the signs of inflammation in the ali-
Dr. Ryan on Homicide by Poisoning, 503
mentary canal are succeeded or become accompanied about the second or fourth day or later by symptoms of irritation in the other mucous passages, and more particularly by symptoms indicating a derangement of the nervous system, such as palsy or epilepsy. The distinctions now laid down will be found in practice to be well defined, and useful for estimating in criminal cases the weight of the evidence from symptoms.”
It is now ascertained that persons to whom arsenic is criminally administered, combined with food, do not expe¬ rience that acrid burning taste in the mouth and throat, so long considered characteristic of this poison. The first symptoms are usually sickness and faintness, which gene¬ rally commence in fifteen minutes, though in some cases they do not happen — indeed, no symptom has been ob¬ served for five hours (Orfila). The patient commonly sur¬ vives twenty-four hours, seldom more than three days, but may be destroyed in three hours, or survive for weeks. The symptoms commence in a few minutes, and this is a point of great importance to the medical jurist, as it enables him to detect persons who allege they had not felt them for some hours after the supposed poison was exhibited. In general, we observe in a few minutes after the sickness has commenced, there is intense burning pain in the stomach, which is greatly aggravated by pressure. Retching and vomiting ensue, especially when drink is taken, there is often a sense of dryness, heat and tightness in the throat, exciting a desire to drink ; but this train of symptoms may be absent. The powers of swallowing and speech are greatly diminished, and there is often a sense of suffocation. The fluid which is vomited is yellow or green, and sometimes streaked with blood. There is sometimes diarrhoea or bowel complaint, or a sense of burning heat, or actual inflammation along the digestive tube from the mouth to the anus. In other cases, the large intestines do not suffer. Again, the genito¬ urinary organs of both sexes may be irritated or inflamed, and of course their functions deranged. In consequence of the intense pain or inflammation in the stomach or bowels, the diaphragm cannot act freely, and the respiration will be more or less impeded. There are convulsive twitchings of the trunk and extremities, violent cramps of the legs, the pulse is small and soon imperceptible, the extremities cold, clammy and livid, the countenance is pale and sunk, the tongue and mouth are dry, and often covered with white ulcers or aphthse, delirium supervenes, and death closes the scene. In some cases the person expires calmly, in others
504
Orig inal Communication s.
with convulsions. When the sufferer survives for days or weeks, the body may be covered with eruptions of various kinds, sometimes resembling small-pox, petechiee, miliaria, &c. In some cases a remission of all suffering takes place on the second day ; but this is delusive, as all the bad symp¬ toms usually return with increased force.
These are the chief symptoms of poisoning by arsenic, but it is to be always recollected, that man}' of them may be absent, others less violent, and that they are not all present in every case, in a former number of this Journal {Med. Repository , vol. ii.). Dr. Yelloly, of Norwich, re¬ lated the case of a lad aged sixteen, who died in twenty hours from having taken half an ounce of the white oxide — he never complained of pain, though gastro-intestinal in¬ flammation was indicated by sickness, vomiting and purg¬ ing. Another extraordinary circumstance in this case was the slowness of the pulse, which was 40, and after some time only 30. Upon the whole, however, the symptoms of poisoning by arsenic are in general very uniform.
In some cases, when the patient dies within four or six hours, there is not sufficient time for the development of the symptoms related above. Here we have faintness amounting to syncope, stupor, coma or convulsions. There may be slight vomiting, but the symptoms of narcotism are prominent. In these cases, though half an ounce of arsenic may be found in the stomach, this organ will be healthy. Yet the patient has been destroyed in eight hours. The poison is supposed to act on remote organs, of course by nervous sympathy. Morgagni, Chaussier, Orfila and Chris- tison cite examples of poisoning by arsenic, in which the sto¬ mach and bowels were healthy. Again, the inflammatory symptoms may disappear, or nearly so, and nervous symp¬ toms supervene, as coma, palsy of the arms or legs, hysteria or mania. These occur when the patient has taken a small quantity, or from having vomited soon after, or when death takes place after a protracted illness. Delirium, tetanus, convulsions and coma, may be produced by the poison under notice. The preceding remarks contain, I believe, all that is absolutely determined of the effects of arsenic, when swallowed, on the human subject. I have drawn informa¬ tion from all sources, and very largely from Professor Chris- tison, whose language I have often condensed. Every fact stated might be corroborated by authorities, many of which will be found in his erudite and standard work. The object of these essays is to inform the student and young prac¬ titioner of the exact state of science on all topics discussed, and not to load his memory by references.
[ 505 ]
BIBLIOGRAPHY.
PHYSIOLOGY.
1. — On the Structure and Motions of the Heart, and on the Indi¬ cations of the Pulse. By Dr. Burne. — Dr. Burne premises a slight account of the anatomical structure of the heart, but combats the opinion of Behrands, that the muscular substance of the heart is not supplied with nerves ; he asserts that though scantily supplied, and small in size, the nerves are fully sufficient, as they are not covered by neurilema, and hence their influence will be as great as many larger nerves, which are composed in a great measure of neurilema.
Of the Order of Contraction , — Dr. B. considers, from his own ex¬ periments of the rabbit, and from experiments by Haller, by Dr. Knox also, in the heart of the shark, that the general opinion, that first the auricles contract simultaneously, and are immediately suc¬ ceeded by the ventricles, which contract simultaneously also, and then follows the period of repose, is not exactly right ; as he thinks from his experiments, that the contraction of the auricles is not simultaneous, but a successive action of the muscular fibres, the con¬ traction commencing in the sinus venosus, and ending in the appen¬ dix or proper auricle.
This order of contraction in the auricle is an additional example of the wonderful and wise provision of nature, in the mechanism of the human body ; for by it, the mouths of the great veins are closed, and regurgitation prevented, so that the whole force of the action of the auricles is thus brought to bear on the propulsion of the blood into the ventricles. It will account, also, for the absence of pulsa¬ tion in the large veins, when the heart has not been disabled by disease.
When speaking of the motions of the heart. Dr. B. writes thus : — “If the stethescope is applied to the cardiac region, the ear is slightly raised by the motion of the heart, and accompanying this is a sound somewhat dull, but distinct and gradual : immediately after, and without any interval, is heard a sound more sharp, and analo¬ gous to a valve raised, the crack of a whip, or the lapping of a dog ; but no motion sensible to the ear accompanies this sound. During this second sound, or succussion, the heart is felt to retire suddenly deep within the chest, which accords with the retiring of the heart from a diminution of its volume, by the contraction of the ventri- - cles,”
Of the Indications of the Pulse. — Notwithstanding the pulse is mainly produced by the action of the heart, it does not always cor¬ respond with that action. The action of the heart will sometimes be impetuous and strong, while the pulse is small and weak ; as in a narrowing of the orifice of the mitral valve from cartilaginous or osseous deposit.
Vol. vi. no. 36. 3 T
506
Bibliography.
The various characters o# the pulse may be represented by the following designations : — It may be strong, weak, hard, soft, wiry, sharp, harsh, grating, jarring, vibrating, falling back, fleeting; or full, large, small, thready ; or yielding, open, contracted, tight ; or rapid, frequent, accelerated, slow ; or it may be quick, free, equal, unequal, regular, irregular, hesitating, labouring, intermittent, flut¬ tering.
Each of these terms designates some notable peculiarity of the pulse ; and as they are numerous, and as most of them cannot be measured except by the sensation produced in the mind, it follows that the accuracy of this measurement must depend on the skill of individuals, and hence the difficulty of an acquaintance with the science of the pulse. But although the task is difficult, it may be accomplished by diligence and perseverance. The ready use of the stethescope, requires the ear to be educated ; and an education of the touch is necessary to a correct judgment of the pulse.
If time can be profitably spent in acquiring a knowledge of me¬ diate auscultation, much more may it be so spent in acquiring a knowledge of the pulse ; because the pulse is one of the most pro¬ minent signs in disease, and one of the most certain indications in the treatment. Without the assistance of the pulse, we cannot ad¬ vantageously, or even safely, employ blood-letting, which is the most powerful of all our remedial agents, the most beneficial when judi¬ ciously prescribed, the most fatal when prescribed in error.
The characters of the pulse are produced by three causes ; the heart, the volume of blood, and the artery ; and as these causes always operate, it follows that every given pulse must have several characters. Thus, the same pulse may bev strong, full, and firm ; the strength resulting from the heart, the fulness from the volume of blood, and the firmness from the tonicity of the artery.
Of the terms already specified, some belong to the heart, some to the volume of blood, some to the artery, and some to these causes combined.
Those which depend upon the heart are, strong, weak, sharp, jarring, rapid, frequent or accelerated, unfrequent, quick, slow, equal, unequal, regular, irregular, hesitating, labouring, intermittent, fluttering.
Those which depend upon the volume of blood are, full and small.
Those which depend upon the artery are, contracted, tight, yield¬ ing, open, harsh, grating.
Those which depend upon the above causes combined are, hard, soft, wiry, vibrating, falling back, fleeting, thready, large, com¬ pressible.
The pulse, in health, beats about 72 strokes in the minute, or there¬ about, and the number varies a little in the course of the day and night, being rather more than 72 in the evening, and less than 72 before rising in the morning. Its natural character is, equal, regu¬ lar, soft, and of moderate strength and volume.
Physiology.
50 7
The pulse of irritation is frequent, its stroke is quick, short, rather sharp, but not strong- ; the impression on the finger being rather smart, but not lasting. Its volume may be small or otherwise, but not full.
The pulse of pneumonia, pleurisy, apoplexy, compression, con¬ cussion, adhesion of pericardium, valvular disease of heart, after sudden haemorrhage, &c. are diagnostic.
The haemorrhagic pulse is frequent and open, and the stroke is quick and rather smart, but short and falling back, and leaves but a slight impression on the finger. This open character is sometimes mistaken for a full pulse, and the quick and rather smart stroke construed into strength, which may tempt a practitioner to extract blood, while the symptoms are already produced by the loss of blood; but the slight impression upon the finger, and the sensation of falling back after every stroke, will at once determine that there is a deficiency of strength and volume of blood.
In ascertaining the nature of the pulse, we must be circumspect, and take care that we are not led into error by any accident or idiosyncracy : for instance, any inflammation of the finger, or rheu¬ matism of the wrist, will affect the pulse of the affected arm ; or if one arm has been lying out of bed, while the other has been covered, the pulse in the two arms will differ exceedingly ; or there may be a naturally vigorous stroke of the heart, which is usually attended with a thick strong artery, and so on. — Midland Medical and Sur¬ gical Reporter, May.
PRACTICE OF MEDICINE.
2. On the Use of Tartar Emetic in large doses in Pneumonia. By M. Lades, D.M. Escoupens, Tarn.
Dr. Lades has written a long paper, detailing several cases in illustration of the use of this medicine in inflammatory affections of the chest. He has administered it only after bleeding, either general or local has been employed, and sometimes in conjunction with it. He recommends that it should be tried alone, without any other medicine. We think this would hardly suit dohn Bull’s temperament, he is rather too plethoric ; yet we know a case in which an incipient pleurisy was stopped, by keeping the patient under the influence of the ant. tart, for several hours. The author thinks himself justified in concluding, from the cases he has narrated, that “ the tartar emetic, in large doses, has a powerful action in the resolution of peripneu¬ monia, that when there is no irritation existing in the gastro-intestinal canal, it does not cause any, and much less does it give rise to an attack of the “ gastro-enterite,” that its action is not due to its evacuant properties ; that a great general excitement does not con¬ tra-indicate its use ; that it sometimes acts as a real sedative ; and that it is a highly useful remedy in the adynamic pneumonia, in which it is impossible to employ bleeding ; and in those cases in which bleeding can be pushed no further, and the disease still con¬ tinues, the practitioner may have recourse to this remedy, in the
508
Bibliography.
full hope of rescuing at least some of his patients from an almost certain death.” — From the Revue Medicate , Francaise et Etrangere.
We have lately used this medicine in the manner recommended by M. Laennec, in cases of pneumonia, with the greatest success. Ve¬ nesection was first employed freely. — Ed.
3. On the Operation of Physical Causes upon the Constitution, the Health, and Diseases of Man. By Edward Florens Rivinus, M.D.
This is one of the most interesting papers we have perused for some time ; but from its nature, does not admit of analysis. With one or two extracts we must, therefore, be content, and refer the inquiring reader to the Journal itself in which the paper appears. It shows great research and talents on the part of the learned writer.
“To the seasons correspond the zones of the earth, to each of which, by virtue of the same law of nature, its peculiar climate is allotted. The hot zone, where perpetual summer is modified only by periodical rains, generates bilious, nervous, and putrid disorders ; proofs of which are the cholera morbus of south-western Asia, and the yellow fever of the West Indies, and the Spanish Main. In con¬ sequence of the prevailing heat, a more active determination to the skin is induced in the living system, and the fluids are carried in greater abundance to the extreme vessels on the surface of the body. These facts authorize the watchful practitioner to look upon hot climates as the cradle as it were, of the majority of all contagious, as well as of the most dreadful cutaneous diseases ; hence lepra, elephantiasis, &e. are natives of tropical countries.
“ The cold zone, where an almost perpetual winter produces a poor, dwarfish, and weakly construction of parts, invites the patho¬ logist to look for diseases of a more lymphatic and cachectic type, such as dropsies, marasmus, atrophy, &c. It is only in the more moderate regions that man attains the highest degree of perfection, both as to his physical construction and intellectual powers. And here the climate of the hot and the cold zone being blended, the diseases peculiar to both seem to take leave of each other, and changing with the seasons, the changes themselves give rise to many other maladies of an intermediate character, such as catarrhal, rheu¬ matic, and inflammatory affections.” — p. 390.
“ Numerous diseases depend upon particular occupations. Scurvy, for example, is most frequently met with amongst sailors ; and the colica pictonum is peculiarly the inheritance of painters, glaziers, manufacturers of white lead, &c. ; psoriasis diffusa occurs in different shapes, most frequently in bakers, grocers, and washerwomen ; shoe¬ makers have the psoriasis palmaria locally, from the irritation of the wax they so constantly employ. In braziers, tinmen, silversmiths, &c. it seems to be produced by handling cold metals ; whilst flax- dressers, according to Morgagni, and manufacturers of muriatic acid are said to be particularly subject to phthisis pulmonalis.” — p. 396.
Whilst speaking of the almost lethargic indifference of the Turks, in respect to that scourge of their Eastern paradise, the plague, our author has these expressions, —
Medicine.
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** The Turks, whilst displaying an unaccountable apathy in some points, are, however, not such thorough-going fatalists as to neglect every means of precaution. They are well aware of the facts, that meat, animal substances in general, fresh bread, silk, cotton, cat’s hair, &c. are very apt conductors of the plague, while wood, water, and oil resist the infection. Oil is considered an antidote ; and it has been observed, that the carriers and venders of oil are rarely, if ever, attacked. Nobody touches with impunity any coin which has been in circulation for a long time. Therefore, the waiters and attendants in coffee-houses and shops never take the money immediately out of the hands of their customers, but receive it first on a wooden plate, after which they put it in a vessel filled with water, from whence they pick it up without any further danger. In like manner is meat always immersed into water, before the inhabitants receive it inside of their houses. Silks and woollen commodities, such as shawls, which cannot be immersed, are always more or less exposed to the action of the air, especially the night air, in open sheds, erected on the tops of their dwellings.” — p. 398.
These extracts will serve to shew the reader, that this paper will form an excellent addition to Thackrah on “ Employment.” It is, indeed, high time that the attention of the profession be directed to this interesting branch of “ the healing art” — that “ prevention is better than cure.” We take leave of Dr. Rivinus with every sen¬ timent of respect. — American Journal of the Medical Sciences, Feb .
4. Pleuro -pneumonia without stethoscopic signs, discovered by mediate percussion. — A young man was admitted into the Hotel Dieu with cough, hurried respiration without any rale, and with no particular resonance of the voice. Percussion, by means of the plessimetre, elicited a difference of sound to the left and behind. This partly disappeared when the patient lay on his belly, and was less sonorous on the left side. The disease was considered pneumonia, and was removed by the antiphlogistic treatment. M. Laherge is of opinion, that tubercles are discoverable by percussion when the stethoscope fails to afford aid. — Journ. XJniv. Hebd. de Med. et Chir. ut supra.
5. — Case of Tuber o-Carunculoid Liver. By Thomas H. Wright,
M. D. &c. (From the American Journal of the Medical Sciences.) A man of large person, middle age, and vigorous constitution, was admitted into the Baltimore Alms-house Infirmary, in November last, with acute pneumonitis of twelve days standing. The diagnosis was suppuration in inferior lobe of right lung, probably participated by the liver. The patient lingered and died thirteenth day in Hos¬ pital. . .
Dissection. — Thorax. Left lung sound throughout. Right lung totally extinct. In place of lung texture, the right pulmo-pleural sac was completely filled with a light-coloured, cream-like, inodorous pus ; no vestige of parenchyma. The cyst, (pleura) of this great abscess was entire every where, and its substance very much thickened.
510
Bibliography ,
The liver proved to be entirely free from decay. It was enlarged one third more than the usual bulk, but not sensibly morbid. The total surface of this viscus exhibited a group of eminences about the size of garden peas, individually distinct. On the concave surface they were more remarkable. They represented the small pox, in the first period of pustular maturation, they were regularly rounded, ob¬ tuse, and conoid. There was nothing palpably morbid in these ele¬ vations. They appeared to be healthy, and consist of the common pulp or parenchyma, and were all covered by the delicate, peritoneal, tunic of the liver. The colour of the liver and eminences was natural.
SURGERY.
6. Remarks on Morbus Coxarius, with an account of Dr. P. S. Physick’s method of treating this Disease. By J. Randoph, M.D. &c. &c.
The author of this paper informs us, that Dr. Physick has suc¬ ceeded in curing recent cases of morbus coxarius, where disorganiza¬ tion has not taken place. It is now decided that the cartilage of the hip-joint is the part primarily affected, and in ordinary cases, this is found to be in a state of ulceration. The author then notices the opinions of Messrs, Brodie and Ford, which we need not insert. The plan of treatment proposed by Dr. Physick consists of the re¬ cumbent posture, leeching and daily purgation, by means of the pulv. jalap comp.
“ Having pursued the above treatment for a few weeks, and ac¬ customed the patient to his confinement to bed. Dr. Physick next proceeds to the application of the remedy, which he considers to be the most important and efficacious one that has ever been employed in the treatment of morbus coxarius. This consists of a splint properly carved so as to be adapted to their regular size, shape, and position of the diseased hip-joint, thigh, knee, and leg. It must also be carved so as to fit the principal part of the same side of the trunk. The whole must be long enough to extend from the middle of the side of the thorax, nearly as far down as the external malleolus, and it should be wide enough to extend nearly half way round the parts to which it is applied. In those cases in which the thigh is bent upon the pelvis, and the leg upon the thigh at the knee-joint, the surgeon must by no means attempt to force the limb into a straight splint. On the contrary, the splint must be made angular at those parts so as to adapt itself to the exact position of the limb, however crooked it may be. After the patient has worn a splint of this shape for some time, the inflammation and swelling become so much relieved, that the limb can be placed in a much straighter position ; and now it becomes necessary to have a second splint con¬ structed which will adapt itself to the altered position of the parts. It seldom happens that more than two splints are required in the treat¬ ment ; it has, however, occurred to Dr. Physick, to be obliged to have recourse to three and even four. The inside of the splint must
Surgery.
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be carefully wadded, in order to prevent it from excoriating the skin, and it must be retained in its proper situation by means of two rollers, one of which should be attached to the upper end of the splint, so as to secure this part to the thorax and hips, whilst the other is applied to the splint and limb from the ankle to the top of the thigh.
“ The length of time which may be required for the performance of a cure, varies in general from six months to two years, though the usual period is about twelve months. During all this time the splint should be kept steadily applied ; the surgeon, in fact, should not remove it until sometime after all the symptoms and appearances of the disease have entirely subsided. As soon as there is sufficient reason for believing that the disease is completely cured, the exercise of the limb may be resumed in the most cautious and gradual manner.
“ When the splint is first applied, the child in general is restless and uneasy, and frequently complains so much that it becomes ne¬ cessary to remove it for a short time, in order to pacify him ; after a few days, however, he gets completely accustomed to the splint, and experiences so much relief from pain, that he is extremely unwilling it should be taken off, even for a short time.
“ It may be said that this treatment is not applicable to cases of morbus coxarius occurring in patients of a decidedly scrofulous con¬ stitution ; so far from this being correct, however, in several instances complete cures have been effected in such patients.” — p. 306.
7. Cancer by Ncevus twice excised , four times cauterized, and finally cured by methodic compression. — M. Recamier, one of the editors of the Revue Med. Franc, et Etrang. relates a singular case of nsevus, or what he has designated as above, which was finally cured by compression. He has succeeded in curing several cases of cancer by this method, and thinks it has failed in the Middlesex Hospital, from being injudiciously applied. He has proved that it cannot be used indiscriminately.
8. Cure of Gonorrhoea and Leucorrhcea by Iodine. — A man, aged 28 years, was treated in the ordinary way for a gonorrhoea without success. He was ordered 12 drops of tinct. iodinee, m. n. and cured in eight days.
His wife took 8 drops twice a day in cold water, and was cured of leucorrhcea in ten days. — M. Broglia inAnnali Universali di Medicina Gennajo, 1831.
9. Treatment of Neuralgia. — When this disease depends on the brain or spinal marrow, it will be relieved if not cured by tartarized antimony ; but when it depends upon the nerves, mercury is the best remedy. — Heldenhrand in same work.
10. — Dr. Buchanan’s Surgical Report from the Glasgow Royal In¬ firmary, for the Summer of 1830. — Among other cases, Dr. B. de¬ scribes a case of change in the colour of the skin, from the internal use of the nitrate of silver. He conjectures the man used two ounces of this deadly poison in twenty months.
It is of very little consequence, for a bachelor of 39, by trade a steam engine moulder, and six days of the week, like his neighbours
512
Bibliography.
as to complexion, to be thus changed ; but reverse the portrait, only let the masculine, hard, and stern features of this blacksmith, be converted, by supposition, into the soft, feminine, and angelic smile of virgin beauty, whose bodily and mental constitution, it may be, has been in a similar condition to that of Hattrick, and who, incau¬ tiously, may have- made use of the same medicine, — she by this means, it is true, has got rid of her disease, but I fear, that practi¬ tioner’s cred’t, who counselled the use of the medicine in such a case, will cease the moment the negress is developed.
It is not my intention in the present communication to go into the subject of the cause, or seat of colour in the skin of the various tribes of human beings, so amusingly and eloquently detailed by Le Cat, nor do I mean to inquire (as Mr. B. Cooper has lately at¬ tempted to prove) whether the rete mucosum, the generally supposed seat of colour, is composed of congeries of right angular veins, or acute angular arteries, such disquisitions on the history of the spe¬ cies, and such microscopic anatomy, being foreign to the object which I have at present in view, of shortly stating what trials were made use of to change this patient’s skin, and the result ; and though I cannot refer to the Journals of the house for the details, my notes are equally to be relied on.
Amalgamation by means of quicksilver, exhibited in the form of blue pill, was my first empirical attempt, and this I proposed to my¬ self, not only from its chemical action on the silver, but more parti¬ cularly as a general stimulant to the whole absorbent system ; for I am of opinion, that the rete mucosum is not the only texture influ¬ enced by the nitrate of silver, when internally administered, but that various internal organs and textures are permeated by it, either through the medium of the arterial or nervous systems. In this way alone, can we account for the marked effects produced by it in cases, like this, of epilepsy, or chorea, and mania ; where often structural, as well as functional derangement is strongly indicated. I cannot, it is true, affirm, that it has been found in the interior of the body, on inspection, but neither has mercury, and yet, who would hesitate to say, that this medicine does not pervade every the most minute part of the animal machine ? Again, it is no proof, in my opinion, that this medicine has not become generally diffused through the system, that the scalpel of the anatomist, or analysis of the chemist, has not detected it after death, for by neither manipulation could it be exhi¬ bited to the senses in the delicate and reticulated mucous tissue, unless light had, through the transparent cuticle, during life, dis¬ played its decomposition.
Gentle salivation was in about eight days produced, and this was persevered in for a fortnight, but without producing the least change, or if any, the poor fellow thought to the worse. Iodine and chlorine were thereafter successively made use of, both externally and in¬ ternally, but wTith the same result. I need scarcely say that their use was problematical, as wras that also of large doses of sulphur, and the external application of nitric, muriatic, and nitro-muriatic
Surgery.
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acids. These all, it may well be said, were empirical remedies ; but what medicine exhibited for the removal of any internal disease, is not, in some measure, of this nature, from the most sovereign spe¬ cifics for intermittents, as arsenic and quinia, to the heterogeneous and discordant nostrums for gout, phthisis, and dyspepsia, which have disgraced the pharmacopoeas both of modern and ancient times.
In the West Indies, it is often remarked, that the skin of the negro, when blistered extensively and severely, assumes a dusky hue, and, in some instances, is even changed into a dirty white colour ; following out this observation, I first tried, on his arm, the effect of powerful vesication by cantharides, and thereafter had a solution of chlorine applied to the vesicated surface ; but still, after cicatriza¬ tion was accomplished, there could not the slightest difference be detected, between the sound and lately blistered portion. The pa¬ tient having become tired at so many successive failures to alter his outer man, resolved to submit to no more experiments, unless I could give him some better grounds to expect a change ; this I at once declared 1 could not, entertaining, as I did, the opinion, that his black face would accompany him to the grave ; but having heard from Dr. Thomson, that my friend Mr. Rainy had some experience in lunar caustic cases, I held out some hope to him, that what had benefited others, would be the most likely means in his case also. I found, however, that it was the external application of this me¬ tallic salt, upon which he had been experimenting, and that, like most of my other medical friends, he had never seen, far less treated, an artificial mulatto. He suggested at the same time, but with his usual caution, as to its probable want of success, the external appli¬ cation of ammonia, complete seclusion from light, and thereafter, that chlorine should be used to the vesicated parts. I felt anxious to give this last application a full and fair trial ; for this purpose I dipped a thick piece of caddis in ammonia, and clapped it over the whole cheek; the patient bore it most manfully, and though vesication was extensively produced, the most complete darkness visible adopted, during the whole of next day, and the chlorine with the greatest assiduity applied — he remained in statu quo. — Glasgow Medical Journal. May.
1 1. — On Old Dislocations ; being an Essay read before the Glasgow Medical Society, 1st Feb. 1831. By James Laurie, M. D. Professor of Surgery in the Andersonian University. From the Glasgow Medical Journal for May. — Dr. Laurie states, that when the primary effects of a dislocation have subsided, the separated extremities of the bone form new connections with the neighbouring parts. These connections are modified by various circumstances, by the nature of the joint. 1st. In hinge or ginglymoid joints. As an example of this let us take a complete dislocation of the radius and ulna back¬ wards. The immediate injury done to the ligaments and muscles I need not specify : the ultimate connexions are nearly the following. Posteriorly, the ends of the ulna and radius form cellular connexions
Vol. IV, no. 36.
u
514
Bibliography .
with the posterior muscles of the arm, and anteriorly the condyles and articular surface of the humerus become intimately attached to the muscles of the forearm. Here each of the articulating surfaces forms connexions with the soft parts, and before such a dislocation can be reduced, both of their connexions must be destroyed. Be¬ sides this, from the nature of these joints there must always be more or less riding of the bones, and either from the first date of the in¬ jury, or soon afterwards, in consequence of the absorption of the intervening soft parts, the bones come into actual contact, and when v osseous matter is effused, and anchylosis is the result. Hence the well known fact, that joints of this description are very soon difficult to be reduced, and before long impossible.
2. In orbicular joints, the nature of the connexions varies accord¬ ing to the situation of the end of the dislocated bone. When it is thrown into a mass of cellular or muscular substance, the connexions are at first cellular, fibrin is effused and becomes organized, and the end of the bone forms for itself a bed in it, and the soft parts among which it has been thrown.
1st. When it comes in contact with a mere point of bone away from its original socket, the articular surface and the point on which it is thrown are changed. The former is altered in shape, its carti¬ lage is absorbed, and new bony particles are secreted and organized. A somewhat similar change is effected on the point of the bone upon which it presses. It rarely happens in such cases, that permanent osseous union takes place between the approximated points. Of this kind of orbicular dislocation we have an instance in dislocation of the humerus inwards, under the coracoid process and clavicle. 2d. When thrown on a flat bony surface. Here great changes take place. As regards the flat surface, a portion of it is absorbed, new bony matter is effused round its edges, and a socket is formed, rude, no doubt, and imperfect, but still closely resembling the one from which the displaced bone was ejected. The head of the bone itself is changed, its cartilage is removed, and in consequence of new de¬ position, the natural appearance of the end of the bone is destroyed. It is obvious that the degree of motion which such new joints admit of, must depend on the shape of the new socket. In general, it cannot be great.
The muscles become changed in appearance, and in direction, and frequently lose all power. The arterial, nervous, and venous trunks have frequently their course changed.
Having thus premised, we come to the important question, at what distance of time do old dislocations admit of reduction ?
Mr. B. Bell does not consider a dislocation “ old, until the sixth month;” he has reduced them at four months. Desault never at¬ tempted them after the third month. Sir A. Cooper limits us to three months for the shoulder, and two for the hip. M. Marx re¬ lates the practice of the Hotel Dieu during several years. The oldest dislocation he relates, as reduced, was at ninety-eight days, of the hip at seventy- eight ; both were reduced with considerable ease;
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out of twenty-seven cases, twenty-six were reduced without any permanent bad consequences, and one only was found irreducible. This argues well in favour of attempts at reduction. — Rep. Gen. 1829.
In attempting the reduction of old dislocations, we must be guided by the nature of the joint (ginglymoid joints sooner become anchylosed after dislocation than the orbicular), also by the condition of the joint. If it is easily moveable, it is favorable ; it is also favorable, when the head of the bone dislocated, is thrown among soft parts, as the connexions formed are cellular, and may be overcome. Incom¬ plete dislocations are unfavorable, from the end of the bone resting on the edge of the old socket, there exciting irritation, causing a new socket to be formed, and the old one to be destroyed, so that there is no cavity to receive the bone in, when reduced. In disloca¬ tions of the shoulder into the axilla, when the artery has followed the bone, and can be traced adherent to it, attempts at reduction may cause its rupture, or the formation of an aneurism.
Age, sex, and muscular energy exert great influence over these accidents, and must be particularly attended to, previous to attempts at reduction.
Manner of Reduction. — Position must vary with the different dis¬ locations, but, as a general rule, for the upper extremities, the sit¬ ting, the recumbent posture for the lower extremities.
The patient should not lie on the floor, as it will be found incon¬ venient to the surgeon, requiring as it will, the bent posture. The chair or table must be immoveably fixed, nailed to the ground, and the patient’s body should be firmly fixed on it. The counter-extend¬ ing force must be so applied as to prevent the muscles which are to undergo extension being compressed.
In regard to the extending force, the English employ pullies, the French assistants. The use of assistants allows the axis of the ex¬ tending power to be changed without relaxing it. We will here, however, allow Dr. L. to speak for himself.
I have bestowed some attention on the means of combining the power and steadiness of pullies with the mobility of assistants, and being no great mechanician, I have called in the assistance of my friend and pupil, Mr. Graham. Each of us has proposed a method applicable to hospital practice, in which its employment is princi¬ pally required. Mine appears simple ; its efficacy remains to be proved.
Let a table be fixed in the centre of any room, round part of which the segment of a circular rod of iron is passed on the same plain with the table. Care must be taken that the centre of the table be the centre of the circle of which the rod is a segment. To prevent the rod from yielding to the extending power, it must be attached to the wall by short rods so curved, that the point of attach¬ ment be on its outside. The hook of the pulley will thus pass with¬ out interruption along the rod.
By this simple and cheap contrivance the direction of the limb
516
Bibliography.
may be changed while the body remains fixed, without relaxing the extending power. The objection to this is the resistance which the friction of the iron surfaces would probably oppose to moving the hooks. Were the surfaces smooth and oiled, I do not suppose that the force could be so great as to resist the elforts of one or two assistants.
Mr. Graham proposes a more scientific but more expensive method, the principle of which is to move the pelvis on the thigh instead of the thigh upon the pelvis. This is accomplished by means of a table fixed to the floor by a central point, with a revolving body like a demonstrating table. On this the patient is laid ; the sound joint opposite to that to be reduced is made the central point, and fixed over the centre of the table. He is then strapped down in the manner recommended. The table is very easily moved, and a very slight turn makes a great change on the angle formed by the limb and pelvis. It might be possible to combine a table of this kind with the excellent operating table which Mr. Graham has already contrived.
By way of adjuvant, Dr. L. recommends keeping up severe sick¬ ness and relaxation, by means of tartar emetic or tobacco. He con¬ demns bleeding at first, but recommends it at the latter part, for the purpose of increasing relaxation and warding off inflammation.
Before concluding with Dr. L/s paper, we must beg to offer some remarks on the off-hand manner in which he gets rid of M. Flaubert’s excellent paper, published in the Rep. Gen. for 1827. He acknow¬ ledges he has never seen it ; and can merely speak from an abstract he perused in the paper of M. Marx, a paper professedly written in favour of attempts at reduction, while M. Flaubert’s was written against it.
Notwithstanding Dr. L. never beheld the paper, he has not any objection indirectly to accuse M. F. of not declaring all the circuim stances of the cases described in the first, the pectoralis major, shorthead of biceps, and the axillary artery torn across : the patient died. In consequence of the duration and mode of extension not being mentioned, he declares roundly, nay, he asks if it can be doubted for an instant, that the patient was killed, ( alias murdered ') by too sudden and powerful exertions. Alas ! for the profession, if the magnates, if the hospital physicians and surgeons, thus forget themselves, what must we expect from the minores ? If the great men, who, it is but fair to suppose, cannot have any interested motive, especially when the broad ocean rolls between them, if they act in so unprofessional, so unjust a manner, what can we expect from our juniors in the profession, who have to toil up the weary road to eminence, and who can only hope to gain the summit by industry or else covertly undermining their professional brethren. This is the first time we have heard of a paper having been reviewed without being even seen ; we hope it will be the last.
Then quoting another case on the same authority, he adds, what surgeon, not lamentably ignorant of the first principles of his profession,
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would force a dislocated humerus of seven or eight weeks (only seven at the utmost) by his own shewing, but we presume the eighth was added for the sake of the tautology) standing into its place, after seven or eight minutes extension. He is here again wrong on his own statement ; two attempts were made, and, of course, with an in¬ terval between them, surely quite long to tear cellular connexions of seven weeks’ duration ; hardly seven weeks, as the connexions as¬ suredly did not take place on the very day that the accident happened.
Our author has been unreasonably severe, more than severe, un¬ just, to M. Flaubert, and he must not complain of our notice. Our motto is, JUSTICE TO ALL.
The writer of these remarks is acquainted with M. Flaubert, and witnessed some of the cases and their reduction, which he has described. He can aver, and fearlessly also, despite Dr. Laurie and M. Marx, that there is not a more talented surgeon, a better ana¬ tomist, a more skilful operator, nor, though last not least, nay, what we attribute to him as the greatest part of his character, a more humane man to his pauper patients. M. F. is and has been for several years, surgeon to a larger hospital than any in London ; it contains above 1,200 beds. And we have frequently seen the hos¬ pital so crowded, that double rows have been obliged to be laid.
M. F. bears a great reputation in Rouen, both for his humanity and his skill : it is needless to say, that he is in consequence much beloved. On one occasion, we recollect perfectly well, a deputation from the garrison, waiting on him to thank him for his humanity to some soldiers (the hospital being military as well as civil) in a severe and dreadful accident which befel them. It was in the year 1827.
In conclusion, however, we beg to thank Dr. Laurie for attacking M. Flaubert under his own character, and not anonymously, as is, we regret to say, too often the case at present.
Altogether, the paper is excellent, and were it not for the great blot we have noticed, it would bear the palm.
We fear that the medical profession will be long ere it is raised to that rank in society which it merits : complaints are continually made of the manner in which we are regarded, and of the rapid progress downwurds, which we are making in the eyes of the un¬ professional public ; but can we wonder at it, when detraction, calumny, scurrility, and all the ignoble passions characterize a large portion of the faculty in an age so enlightened as the present ?
Had we been disposed to be cynical towards Dr. Laurie, we need not do more than refer him to the excellent report of surgical cases which occurred in the Glasgow Infirmary, among which he will observe an account of a case entitled “ Hernia punctured by mistake for hydrocele, death, inspection,” and this by a surgeon who resides within five miles of Glasgow. Dr. M. S. Buchannan, who published the report, refrains from disclosing the name of this enlightened Esculapian, and evinces more sense, judgment, and professional etiquette by so doing, than by calling him a murderer, as Dr. Laurie
Bibliography ,
538
has thought fit to designate one of the most scientific anatomists and surgeons of another country. If he takes the trouble to peruse modern medical literature, he cannot fail to discover, that fallibility is the lot of all practitioners; he will discover, that “ to err is human, to forgive divine.”
1*2. Case of Axilliary Aneurism , in which the Subclavian Artery was successfully secured in a Ligature. By Valentine Mott, M.D.
William Hines, aged twenty-eight, of Smithville, Virginia, came to New York, August 24th, 1880, and became my patient.
The account he gave of his case was, “ that about seven weeks ago he received a violent strain while carrying a canoe on hand-bars across the arms, which was followed by an extensive discoloration of the skin of the right arm, extending to the chest, and attended with considerable pain. It, however, yielded to the usual remedies in such cases. Three weeks subsequent to the accident he observed a swelling about the size of a pigeon’s egg under the right arm, which had rapidly increased.”
On examination, I found a tumour about the size of a goose egg, and decidedly an aneurism of the axillary artery. His general health being good, 1 directed him to keep quiet, to be bled, and to take some purgative medicines; and fixed on Monday, the 30th, for tying the subclavian artery.
At 11 o’clock, a. m. he was placed upon the table, with the shoulders elevated and inclined to the right side. An oblique in¬ cision was made, two inches in length, through the integuments and platisma myoides muscle, and corresponding to a middle line of the triangular interval formed on the inner side by the scalenus muscle, on the outer by the omo-hyoideus, and below by the clavicle. The cervical fascia was next divided to the extent of an inch, and ’with the forefinger and the handle of a knife, the adipose and cellular tissues were put aside, and the artery readily exposed as it passes from between the scaleni muscles. After denuding the artery a little of the filamentous tissue with a knife rounded at the point, and cut¬ ting only at the extremity, a ligature was conveyed around it, from below upward, by the American needle , and the artery tied a little without the scalenic muscles.
No other ligature was required. The patient lost less than two tea-spoonsful of blood. The operation lasted about fifteen minutes, and was performed, with the assistance of Drs. Vache and Nosacks in the presence of Drs. Barrow, Kissam, Rogers, and Wilks. The wound was closed by two stitches and adhesive straps ; the arm was immediately wrapped in cotton wadding ; no diminution of tem¬ perature took place.
8, p. m. Found the patient comfortable; says he has less pain in the arm than before the operation ; heat rather more than natural ; a faint pulsation in the right radial artery ; pulse 88.
31st. Morning. Passed a comfortable night after taking fifteen drops of the sol. sulph. morphine, which was given to allay the pain about the elbow, and which he considered rheumatic, having had
Surgery.
519
more or less of it for some time previous to the operation. This pain was no doubt caused by the pressure of the tumour upon the brachial plexus. Pulse 70 ; skin natural ; says that he feels very comfortable. — Evening. Complains of head-ache ; directed a saline cathartic ; pulse 90 ; skin pleasantly moist ; pulsation in the right radial artery occasionally very distinct and regular ; temperature of the right arm a little higher than that of the left.
September 1st. Pain of the arm obliged him to sit up most of the night in an easy chair — after the operation of the salts, took again fifteen drops of the morphine, and slept quietly about five hours. Feels at present very comfortable ; pulse 75 ; not the least evidence of febrile disturbance in any of his symptoms.
2d. Feels much more comfortable than yesterday; slept composedly all night ; little or no pain in the arm : pulse 80 ; removed the wadding from the arm, and enveloped it in flannel, which keeps it very comfortable.
3d. Slept well all night after taking his dose of morphine, and feels very well to-day ; pulse 74 ; pulsation of the right radial more regular and distinct,
4th and 5th. Continues to improve.
6th and 7th. Every way comfortable; right radial pulsates regu¬ larly, though more feeble than the left.
9 th. Dressed the wound and removed the stitches ; mostly healed, except where the ligature from the artery passes out. Pain in the arm for some days past has not been felt ; makes no complaint ; pulse in the radial artery very distinct and regular with the actions of the heart.
1 1th. Dressed the wound, which looks remarkably well ; every thing appears very favourable.
14th. On removing the dressings to-day, the ligature came away ; all promises well.
20th. Wound being just closed, permitted him to walk about the room, and to take his usual allowance of food ; aneurismal tumour much diminished in size, and very hard.
27th. Left the city to-day on his return by water to Virginia.
When I reflect on the disease for which this operation was per¬ formed, and upon the situation, importance, and size of the vessel which was tied for its removal, it appears to me almost incredible that but twenty-seven days should have been required for its cure. That it should have succeeded is particularly grateful to my feelings, inasmuch as it was first successfully performed by an American sur¬ geon, and is an additional proof of the triumph of surgery over disease and death. — American Journal of the Medical Sciences, Feb. 1831.
13. — Illustrations to Mr. S. Cooper’s Surgical Dictionary. — Each Part contains four lithographic plates, with letter-press descriptions and references to the text. These illustrations are published monthly, and eight parts have now appeared. Such a work as this has long been a desideratum, both to the student and established surgeon.
520
Bibliography .
Though nominally illustrations of the Surgical Dictionary, these are really delineations of every other system of surgery. The plates are faithfully executed, many of them beautifully coloured after na¬ ture, and so very cheap as to be within the reach of students. We wish the author that success which he so well deserves, and con¬ scientiously recommend his work to every class of our readers.
14. — The Surgical Anatomy of the Principal Vessels of the Head. Published by John Wilson, Princes Street, Soho. — This is an ex¬ ceedingly well executed delineation of the arteries and veins of the head, face, and neck in the adult, and deserves place in the collec¬ tion of plates of every anatomist. It is useful in explaining the danger of wounds of the parts which it represents, and facilitates the labours of the dissector, in this important piece of human ana¬ tomy. It reflects great credit on its author.
15. — Views of the Pelvis, shelving the natural Size, Form, and Re¬ lations of the Bladder, Urethra , Rectum , Uterus, Sc. Sc. in the Infant and in the Adult, taken from Preparations made for the Museum of the Royal College of Surgeons in Ireland. By John Houston, M.D., Curator of the Museum, and Demonstrator of Anatomy in the Royal College of Surgeons in Ireland, &c. — These views illustrate the relative situation of the pelvic viscera in the male, female, and in¬ fant, and will be referred to with advantage in the anatomy and pathology of these important Viscera. The lithotomist and obste¬ trician will find them well worthy of notice.
16. — Observations on Distortions of the Spine, with a few Remarks on Deformities of the Legs. By Lionel Beale, Member of the Royal College of Surgeons, &c. 8vo. pp. 102. — This is an Appendix to the author’s work on Deformities, which is now out of print. In reviewing that excellent work a few months ago, we spoke of it, as we do of all works that come before us, as it deserved ; and it affords us satisfaction to find our high opinion of it now amply confirmed. The essay before us is replete with instructive information on the various subjects enumerated in the title. We have no space, at this late period of the month, to make extracts ; but we assure our junior readers that this production is worthy of their attention. If it con¬ tained nothing more than the section on deformities of legs of weakly children, and the judicious advice for the management of these alarming though harmless complaints, it ought to have a place in every medical library. It contains a good account of spinal irrita¬ tion, inflammation, and curvature, with cases in illustration. We shall notice it fully in our next.
17. — The Art of Cupping- being a brief History of the Opera¬ tion, from its origin to the present time-, with a Description of the various Instruments employed, Sc. Sc. By George Frederick Knox, Cupper at the Westminster Hospital, Central Infirmary, &c. &c. — The young practitioner will find this work of great service, more especially if he is not a practical cupper, and even the established practitioner will peruse it with advantage ; of course we speak of that part of the work which relates to cupping itself : we cannot
Surgery.
521
speak so well of that part which relates to medicine ; but this de¬ traction is to be ascribed to the conciseness of the work. Mr. Knox forgets that, when recommending cupping in certain diseases, he should specify the particular states which require it ; or he may lead (perhaps) young practitioners into very serious mistakes. It is not, we believe, the practice at present, and it requires facts to prove its utility before it is recommended, to cup in cases of anasarca , huho, cephalalgia , catarrh , hernia humoralis, hydrocephalus, nodes, phthisis , ptyalism, &c. Our readers will perceive that many of these affections are more frequently symptoms than diseases, and symptoms even of very different diseases, so that a general rule for prescribing cupping in these complaints must be followed with great caution. As an excellent and cheap manual for the study of cup¬ ping, this production cannot be surpassed.
Mr. Knox describes a torch for exhausting the glass, which we believe is not in common use. We subjoin his account of it. “ It is nothing more than a brass or silver tube, abut six inches in length, containing as many folds of common lamp cotton as can be tightly pulled through by means of a piece of twine : one end of the tube is bevelled from the edge on one side to about three quarters of an inch, to allow of the better spreading of the cotton; to the other end is screwed on a piece of tube, about half an inch long, which is at¬ tached to a ring an inch in diameter, for the purpose of slipping over the finger, or for holding conveniently in the hand. A flat plate of the same dimensions would be equally serviceable.
The end of the cotton should project about half an inch beyond the tube, and be trimmed round with the scissors into something like a mop shape ; and in its use care should be taken, after it has been saturated in the spirits of wine, to squeeze it tightly against the neck of the glass as it is withdrawn, and to draw the lower edge over a towel. The object of this is to guard against the spirit in its inflamed state dropping upon the skin, which would otherwise hap¬ pen when the torch was moved with rapidity, or if the torch were grazed along the skin in its wet state. — p. 34.
He likewise mentions the glass-leech of Dr. Fox of Derby, by one application of which he has abstracted thirteen ounces of blood, and frequently eleven ounces. The scarificator, after being used, should always be sprung through a bladder of lard or some such substance to preserve the lancets in proper order.
Cupping on the temple is the most difficult and the most painful : a branch of the temporal artery should be selected, as the blood will flow more readily ; should it be necessary, the artery may be com¬ pletely divided afterwards with a lancet, to arrest haemorrhage or to prevent aneurism, which occasionally happens. After applying the glass, the lower edge should be gently and slowly raised to remove the pressure from the vessels, as, until that is done, the wounds will not bleed. On the back of the head, the part must be cleanly shaved, or the rough hair will raise an edge of the glass and admit air. The large scarificator should be used behind the ear, and on the throat ;
Vol. VI. no. 36.
x
522
Bibliography .
the oval glass and the temple scarificator are best. The position most favourable for cupping on the throat, is the recumbent, with the head bent towards one side.
“ Those who calculate the pain incurred in cupping by comparison with a cut finger, are very much deceived : in fact, there is rarely any pain felt in this part of the operation, nor is any inconvenience suffered from it afterwards.”
This is not always the real circumstance of the case. We know from personal experience, that when cupped in the contrary direction to the fibres of the muscles on the chest, whenever the arm was moved, the pain was very severe, resembling the drawing of a blister, as also when cupped on the deltoid. Upon the whole, we pronounce this a highly useful publication. It contains every information that can be desired for the successful and judicious performance of the very important operation of which it treats. It ought to be in the possession of every medical student and young surgeon.
MATERIA MEDICA.
18. On Peruvian Bark. Dr. Carpenter, of Philadelphia. In this paper Dr. C. describes a species of bark from Maracaibo, which is much superior to the Carthagena bark, containing more than double the quantity of cinchonia and quina, and also more extracts ; it bears the same price in the market. It is more compact than the Carthagena bark, breaks with a short and clearer fracture, and is more intensely bitter. It has only appeared within a year or two in the market. — American Journal of the Medical Sciences, ut supra cit.
19. On the Utility of Strychnia in certain forms of amaurosis . — If a person be suffering from loss or diminution of the power of vision from an atonic state of the retina, or other part of the nervous apparatus of the eye, or of the system generally, the local use of strychnia (applied in the following manner) — will be, in my opinion, the most likely means of removing the defect, more especially if it be of recent occurrence. But it will, in many instances, be found necessary to institute a most rigid examination, before deciding upon the necessity or propriety of the treatment : for instance, the history of the patient must be closely investigated, and the eye subjected to the most attentive examination, and if the result of this enquiry and examination lead to the opinion that the defect does depend on the atonic condition of one, or all the parts to which I have just alluded, he may, with safety, be subjected to the very tedious and somewhat painful plan of treatment it remains for me to explain; but it will be readily admitted that if this examination be not conducted in the most careful manner, it will be impossible to discriminate, with any approach to certainty, the particular conditions of the retina, and other parts of the nervous apparatus of the eye, productive of amau¬ rosis, which admit of alleviation or removal : nor can the trial of strychnia, without such a preliminary investigation, be viewed, as otherwise than a rash and criminal procedure ; a procedure which is
Materia Medica.
523
more likely to destroy the power of vision for ever, than to yield any prospect of relief.
The manner of employing it is as follows : — Place a narrow blister over each eye-brow, which must not extend beyond a line drawn upwards from the external canthus ; when it has risen sufficiently, cut away all the cuticle, and apply, for half an hour, a piece of linen, to absorb the serum, which is apt to be discharged in large quantities, for a short time after the removal of a blister, then dust the remedy chiefly in the situation of the supra-orbitary nerve, but not so thickly as to prevent the entire absorption of the whole layer of the powder, at the time of the second dressing, which should be, as nearly as possible, twenty-four hours afterwards; twenty-four hours between each dressing is a proper and necessary interval ; cover the blistered surface with a piece of linen very thinly spread with ung. cetacei, for, if much greasy matter be mixed with the powder, it is less easily and quickly absorbed; but, unless a little be applied, the linen adheres to the wound, and occasions great pain in its removal. Increase the dose of strychnia very gradually, until the state of vision is improved, or symptoms indicative of the injurious agency of the remedy occur. If there be much local pain excited by the application of the strychnia, dilute it with flour, or mix it with opium ; and if that does not succeed, suspend its emplo}^- ment until the stomach and bowels be improved, by a plan of treat¬ ment instituted expressly for their benefit, and then resume its use ; if severe pain in the head, convulsive muscular twitchings, great general nervous excitement, or other symptoms, denoting the inju¬ rious agency of the strychnia upon the constitution, supervene, and the condition of vision be not improved, it must be discontinued altogether ; as it would appear probable that in such case it was not likely to exert a favourable influence upon the disease, at the same time, that, from some peculiarity of constitution, it was calculated to do important general mischief.
This paper is highly interesting, in regard to its pointing out the particular cases in which the strychnia is serviceable — it will be found important to the practical reader.-— Mid. Med. # Surg. Rep.
MIDWIFERY.
20. Accidents caused by allowing a pessary for years in vagina related by M. Ricord. — The unfortunate subject of this case was aged 61 years, and had a pessary passed in 1825, since which time it had remained. M. Lisfranc divided the perinseum, in order to effect extraction of the instrument : death ensued, and there existed cancerous vegetations and gangrenous perforations in the bladder and rectum. — Journ. Univ. et Hebdomadaire de Med. Chir. Pratiques.
This case affords a salutary lesson to those surgeons who maintain that a pessary may be left in the vagina for an indefinite period, without producing mischief. Such is the sapient doctrine supported at our debating societies, and by those engaged in teaching ob¬ stetrics. The truth is, that we have lecturers on all branches of
524
Bibliography ,
medical science in London, who promulgate as ridiculous opinions as students of three months’ standing. This defect is at length per¬ ceived by the constituted authorities, who now deem it necessary to require strong proofs of the teacher’s competency to warrant his re¬ cognition. On the occasion to which we allude, it was held to be quite unnecessary to withdraw a pessary once a week, for the purpose of cleaning it ; that the speaker had known a case in which one was worn for three years without removal or inconvenience. Now any medical practitioner, of the most ordinary comprehension, must, on a moment’s reflection, see the utter fallacy of such statement, when he remembers that the presence of a foreign body, on a mucous surface, must inevitably induce irritation, and inflammation, and ulceration in a shorter period than two or three years. It must be unnecessary to dwell farther on a matter so obvious. The negative assertion was one of these false facts with which the faculty is so redolent at the present period.- — Ed.
21. Signs of Pregnancy before the fourth month. — M. Bescaria informs us in the Italian Journal, from which we have already quoted, that there is a circumscribed pain in the occipital region, or according to Gall in the reproductive organ, soon after conception ; somnolence soon supervenes, and pains return daily at the same hour.
CHEMISTRY.
22. — On a New Process for -preparing Medicinal Prussic Acid. By W. Thomas Clark. — It is of the highest importance that a medicine, so powerful in its operation, so sudden, and so transient, should be of an uniform strength, and as it is impossible to rely on the manu¬ facturer’s preparing it in such a manner, Mr. Clark has been induced to give a formula for its preparation by the apothecary ; it appears easy, and, if generally adopted, will obviate such, at least, of those objections to the use of the hydrocyanic acid which arise from the uncertainty of its dose.
Take of
Tartaric acid - - 72 grains.
Cyanide of potassium - - 32 do.
Distilled water - - 1 ounce.
In an ounce phial, furnished with a cork or stopper, which should by previous examination, be ascertained to be sufficient, dissolve the tartaric acid in the water. Then add the cyanide of potassium, and immediately thereafter insert the cork or stopper, which for a little must be preserved firmly in its situation by the finger. Meanwhile agitate, keeping the vial immersed in a basin of cold water, in order to repress the heat produced in the process. When all action has ceased, set the phial aside in a cool and dark place for twelve hours, in order that the cream of tartar formed may subside. Afterwards decant the liquor, which preserve in a phial in a cool and dark place.
A decomposition ensues, and cream of tartar and hydrocyanic acid are formed : the supertartrate of potass is precipitated in a great measure, and is to be removed ; a small portion (about one-fifth of a
Chemistry .
535
grain in a dose, supposing the ounce to contain twenty-five doses,) remains dissolved, but it is so inconsiderable as to require no atten¬ tion to be paid it. Indeed, chemical purity is often obtained at the expense of medicinal uniformity.
The ounce contains about thirteen grains of hydrocyanic acid — somewhat similar to Vauquelin’s prescription. Mr. Clark antici¬ pates that when this process is generally adopted, the cyanide of po¬ tassium will be supplied by the manufacturers ; but we incline to think, with all due deference to Mr. C., that it is something like “mettant la charuce devant les bceufs.” We think the cyanide of potassium must be freely obtained, before this process will be put in use by the apothecary.
The method of obtaining the cyanide of potassium is rather too complicated for any gentleman at all engaged in practice to employ. It is to be obtained from the prussiate of potash of commerce, which consists of one part of water, two of cyanide of iron, and five of cyanide of potassium. In this process —
The water is to be driven off by moderate heat, the residue to be finely pounded, and again moderately heated, by which we obtain a white powder, weighing seven drachms.
Now, out of every seven drachms which remain, two are cyanide of iron, and five are cyanide of potassium ; and these two cyanides are very different, in this respect, that if exposed to heat the cyanide of iron is entirely decomposed, but hot so the cyanide of potassium, at least in close vessels : I say in close vessels, because if the cyanide of potassium were strongly heated in contact with oxygen, or with steam, it also would be liable to decomposition. Therefore put the dried powder (to the extent of forty or eighty ounces, if you choose) into a wrought iron bottle, such as apothecaries get mercury in. This bottle must be furnished with an iron tube, which must screw into the bottle, in the place of its iron screw stopper. This tube should also be bent in a curve at a few inches from the bottle, so that while the bottle is perpendicular the straight part of the tube may be horizontal ; and to the open end of this tube one more flexible must be joined, so that the open end of the latter may be immersed in a cup of water. Now-a-days nobody can have any difficulty in getting such tubes ; for the people who fit up gas pipes have them in abun¬ dance.
The iron bottle, thus filled and thus furnished, is to be put on a smart fire, and to be kept there so long as gas is evolved. Cyanide of potassium remains intermixed with iron and charcoal, resulting from the decomposed cyanide of iron. We dissolve out the cyanide of potassium by water ; we filter ; we concentrate by evaporation ; we set aside for crystallization ; we concentrate again the mother liquor ; and thus continue till we entirely separate the cyanide of potassium. This salt being deliquescent, is to be dried at a gentle heat, and to be kept in bottles well corked.
It is likewise considerably cheaper. — Glasgow Med. Journal. May.
[ 526 ]
MISCELLANIES.
23. Expulsion of Dr. Ramadgefrom the London Medical Society .— The Medical Society of London, the oldest and one of the most respectable in this metropolis, expelled Dr. Ramadge, for his advocacy of Long, the Quack, and his abuse of the medical profession. We have been informed, upon the best authority, that the College of Physicians will adopt a similar proceeding.
24 — Dr. Ramadge’ s Reply to the Editorial Remarks on his Defence of Long the Quack. — It is almost unnecessary to make a single com¬ ment on the following letter, which is no reply whatever to our strictures on the impropriety and unprofessional conduct of any re¬ spectable physician or surgeon, in defending such an illiterate humbug as this empiric. The London Medical Society has confirmed our opinion, which indeed must be that of every respectable member of the profession. We have no wish to prolong this painful discussion, but may inform Dr. Ramadge that we know much more about it than he imagines. It appears he did not send the letter to the Sun¬ day Times ; but any man of common sense must see it was intended for the public eye. He next endeavours to escape from his assertion, that there was only abrasion of the cuticle in the eschar on the back of Miss Cashin, though it was proved in evidence by Mr. Brodie, Mr. King, and others, there was a sore or eschar the size of the mould of a hat, or of a supper plate, and a large slough in the centre. Dr. R. labours under a mistake, when he supposes we have not seen an account of the autopsy. He will find it at length in our fifth volume. As to the extracts quoted by him, we have never denied nor contradicted them ; and our only regret is, that he to whom they applied should descend from his high station to bring them to his aid in defending a notorious aud incorrigible Quack. We leave the reader to form his own opinion on the value of the fol¬ lowing very polite letter : —
To the Editor of the London Medical and Surgical Journal.
Sir, — As it is impossible for me to reply to the numerous unmanly and mendacious attacks made upon me in some of the medical jour¬ nals, and in yours among the rest, I shall here confine myself to noticing one or two errors under which you appear to labour.
In the first place, it is not true that I sent any letter to Mr. Long through the medium of the Sunday Times. The letter in question was addressed by me to Mr. Long in answer to one in which he appeals to me as an honorable man to give a candid opinion on the cases of two ladies who had previously been under his care, but who died in the hands of Mr. Brodie and Mr. Vance. It first appeared in Mr. Long’s last publication, and from thence found its way into the newspapers.
In the next place, it is not true that Miss Cashin had no disease of the lungs, or never was consumptive. In proof that the contrary of what you state is the fact, I beg leave to refer you to the report of
Miscellanies .
52 7
the post-mortem examination by the medical witnesses, which docu¬ ment you do not appear to have seen, as well as to my letter inserted in the London Medical Gazette of the 14th of this month. You are pleased to assert that there was no abrasion of the cuticle from the effects of putrefaction, which last you say had not taken place. This is false ! The commencement of the report runs thus : “ An¬ teriorly over the abdomen and thighs the skin peeling, apparently from the effects of decomposition. The skin of the neck, shoulders, and face covered with green reticulations in the course of the blood vessels, the neck above the clavicles swelling and puffy, feeling when pressed as if containing air ; likewise all the cavities of the heart were in a state of effervescence and decomposition.”
To your illiberal remarks, and the ridicule you wish to excite against me respecting the opportunities I possess of examining dead bodies, I shall merely reply by quoting your own words, which I extract from your Manual of Midwifery. At page 53, you observe, “ my much respected friend Dr. Ramadge, whose opportunities of opening dead bodies are unequalled, and whose industry has been in¬ defatigable in the pursuit of morbid anatomy for many years, has a beautiful specimen of disease under consideration in his select and valuable museum, a part of which can be seen at the Central In¬ firmary, Greville-street. I am deeply indebted to the kindness of that able pathologist ; the result of whose labours l am happy to say ere long will be submitted to the profession, as the work of Dr. Baillie is universally acknowledged to be defective.” At page 92, is the following : — “ Dr. Ramadge has a most extraordinary specimen of diseased uterus; the organ weighed ten pounds, and contains various structures, as cancer, schirrus, calcareous depositions, mus¬ cular thickening, fungus and bone.” Moreover, in speaking of ovarian disease, in your preface you speak of the museum of “ my able and talented colleague Dr. Ramadge.”
How you can reconcile these your former observations with the sentiments you express towards me in the last number of your Journal, it is not for me to determine ; but on these points I have much pleasure in reflecting that your readers are competent to form an opinion of their own*
To conclude, I have only to state, that whether the opinion I have given in the two cases referred to, be or be not palatable to the me¬ dical profession, is to me a matter of perfect indifference. I know enough of the subaltern membeis of the faculty, to be able to ap¬ preciate their factious and illiberal proceedings. I have seen enough of their acts and deeds to be convinced that he who wishes to arrive at eminence and be useful in his vocation, must disentangle himself from their petty cabals, and those orgies where ignorance is a virtue, and passive obedience a duty.
Requesting the insertion of this letter in your next number,
I remain, Sir,
Your obedt servV
F. H. RAMADGE, M. D.
21s£ May, 1831, Ely Place.
528
Miscellanies.
25.— London University. — Dr. Elliotson has been appointed Pro¬ fessor of Practice of Medicine in the London University ; and it is said that Mr. Quain, the distinguished anatomist, of Aldersgate- street School, will be the successor to Mr. Bennet. There are few lec¬ turers more popular than Mr. Quain, as he possesses the rare qualities of eloquence and sterling talents. His appointment would be highly advantageous to the University, and very satisfactory to the profes¬ sion. ' -
LIST OF BOOKS RECEIVED DURING THE MONTH.
1. Illustrations of Mr. S. Cooper’s Surgical Dictionary, published monthly. Parts VII. VIII. IX. X. XI. and XII. each containing Four Lithographic Plates, with Letter-press Descriptions and References to the Text. London, Longman and Co. 8vo. 1830. See our present number.
2. Views of the Pelvis, shewing the natural size, form, and relations of the Bladder, Urethra, Rectum, Uterus, &c. &c. in the Infant and in the Adult, taken from Preparations made for the Museum of the Royal College of Surgeons in Ireland. By John Houston, Curator of the Museum, and Demonstrator of Ana¬ tomy in the Royal College of Surgeons, Ireland, etc. Dublin, Hodges and Smith, and Leekie; T. and G. Underwood, London; and Maclachlan and Stewart, Edinburgh. 1829, 4to. Noticed in this number.
3. Surgical Anatomy of some of the principal Vessels of the Head. Wilson, London. See a proceeding page.
4. The Art of Cupping ; being a brief History of the Operation, from its origin to the present time ; its Utility ; minute Rules for its Performance ; a List of the Diseases in which it is most beneficial, and a Description of the various Instru¬ ments employed, &c. &c. By George Frederick Knox, Cupper at the Westmin¬ ster Hospital, the Central Infirmary, See. & c. Dedicated, by permission, to the Physicians, Surgeons, and Pupils of the Westminster Hospital. London, T. and G. Underwood. See our present number.
5. Lectiones Celsianse et Gregorianee ; or Lessons in Celsus and Gregory, con¬ sisting of Passages from those Authors syntactically arranged, with copious Obser¬ vations explaining the Difficulties of Construction, and a Lexicon of the Words. To which is added, a succinct and comprehensive Grammar, written and adapted for the work. For the Use of Medical Students. By W. Cross, Teacher of the Classics, and Medical Latin. Wilson, London. l2mo. 1831.
6. The Art of preventing the Loss of the Teeth ; with Instructions calculated to enable Medical Practitioners, Heads of Families, and others, travelling or re¬ siding in distant parts, to adopt the Author’s Practice of treating the Diseases of the Teeth and Gums; including the stopping of decayed Teeth, and curing of Tooth Ache, by the Use of the Anodyne Cement, &c. See. Also stating the Improvements in fixing Artificial Teeth, and a Description of the Sciliceous Pearl Teeth, and Teeth Renovator ; with Testimonials from their Majesties’ Physicians and Surgeons. By Joseph Scott, Dentist. London, Simpkin and Marshall. 8vo. 1831.
NOTICE TO CORRESPONDENTS.
We have been informed that Dr. O’Shaughnessy is not the author of the Com¬ ments on Toxicology, to which we referred in our last ; but we were led to think otherwise by the accuracy and profound knowledge displayed in these essays— qualities which characterize all his productions on the detection of poisons.
Mr. Pereira will find the matter in our next.
ERRATA IN OUR LAST.
Page 370 — 20th line from top, for “ rite,” read “ series.”
- 373 — 2d line from bottom, between “distinct” and “ regarded,” insert
“ been.”
- 402 — 3d line from bottom, for “ sanguilent,” read “ sanguinolentrJ’
- 405 — 7th line from top, for “cadine,” read “iodine.”
- 412 — 16th line from bottom, for “ citrate,” read “ tartrate.”
- - 426 — 16th line from top, after “ blister,” add a comma.
All Communications and Works for Review are to be addressed to the care of Messrs. Renshaw and Rush, (near Exeter Hall,) 356, Strand; or to the Editor, at his Residence, 61, Hatton Garden.
I N D E X,
VOL. VI.
Page
A. •
Abernethy, Mr. death of. . . 431
Acids Mineral, poisoning by . 414
- - poisoning by. Dr.
Ryan, on . 404
- symptoms, and au¬ topsies..... . 405
■ - treatment of . 406
- - - tests for .
- sulphuric & nitric, tests for 407
- hydrochloric (muriatic)
phosphoric . 408
- oxalic . .411, 414
Acupuncturation, Dr. Banks on ... . 425 Air, change of. Dr. Johnson on. . . . 257 Alderson, Dr. introductory lecture
by . 361
Alison, Dr . outlines of physiology
by. . 191
Alienation mental, M. Regnault on 364 Albugo, case of, by Mr. Foote. . . . 496 Amaurosis, case of, by Mr. Nice .. . 496 Amaurosis, case of strychnine, in .... 521
Anatomical atlas, by Weber . 329
Anatomy, Mr. B. Cooper’s lectures on 35 Anatomy, Dr. Quain’s lectures on. . 197 Anatomy, Mr. Heurteloup’s know¬ ledge of . 328
Anatomy, Mr. Paxton on . 360
Anatomy, surgical of the head . 520
Andral’s Pathology, by Townsend
and West . . Ill
Aneurism of the abdominal aorta . . . 178 Aneurism of the axillary and sub¬ clavian arteries . 518
Aneurism of the external iliac, case of 25 Aneurism of the common iliac. .... 27
Aneurism of the gluteal artery, liga¬ ture on the internal iliac, by
Stevens . 31
Annual Medical, by Dr. Reece .... 247 Antimony, tartrite of, large doses
of, in pneumonia . 2, 507
Antimony, tartrite, use of in neu¬ ralgia . . 511
Aorta, ligature on, by James and Crampton . . . 25, 27
Page
Apoplexy of lungs, value of ste¬ thoscope in . 188
Argenti nitras, colour of skin from. 511
Arsenic, effects of as a poison . 416
Arteriology, Borreman’s, bv Mr.
King . . ‘ . 329
Asbestos, M. Aldini’s dress of .... 254 Asphyxia, Essay on by Dr. Ryan. . 30S
Atlas, anatomical, by Weber . 329
Autopsy mode of in infanticide .... 126 Auscultation, value of in diag¬ nosis . . 6, 188
B.
Banks, Dr. on acupuncturation .... 425 Barlow, Mr. on fungus hcematodes. 32
Beale, Mr. on deformities . 520
Beatty, Dr. on aneurism of the aorta 178 Beatty, Dr. on instruments in diffi¬ cult labours . 181
Beatty, Dr. on cancer uteri, cure of
by coition . 187
Beck’s Jurisprudence, by Dr. Darwall 441 Billing, Dr. on principles of me¬ dicine . 39
Billing’s, Dr. case of hydatids in
liver, lungs, &c . 58
Blake, Dr. on bad effects of tight
lacing . . . 484
Blane, Sir Gilbert, on Naval me¬ dicine . 236
Browne, Dr. on tracheotomy .... 424 Browne, Mr. E. on natural phi¬ losophy . 65
Buchanan, Dr. on dysentery . 373
Burne, Dr. on the motion and ' structure of the heart . . 505
C.
Calculous diseases, Mr. Hutchinson
on . • * • • . 125
Calculus urinary, Mr. Syme on ... 422 Cancer of the nose M. Lisfranc on. 74
- - uteri, cure of, by coition 187
- cure of, M. Recamier on 511
Castle’s, Mr. Manual of Surgery . . 196 Cautery actual, cu^ of vesico-va-
ginal fistula, by . 50
Y
530
INDEX.
Page
Cerebri Fungus, by Dr. Tuthill ... 42
Csesarean operation, by Mr. Stirling 44
- - - by Dr. McKibbin 428
Change of air, Dr. J. Johnson on 257 Charter of London University ...... 343
Chemistry, Rose’s, by Mr.. Griffin 300 Chest Diseases, of Drs. Graves and
Stokes on . 1
Chlorine, poisoning by . 409
Cholera, Dr. Ryan on . 212
— - Mr, Searle on . 404
- Dr. Short on . . 482
Cock’s, Illustrations of Surgery . . . 519
Clarke, Mr. on new mode of pre¬ paring prussic acid . . 524
College, Ring’s, appointments at 254, 430
- of Surgeons, regulations of,
relating to their library . . 431
Colies, Dr. on diseases of the rectum 170 - - on vascular tumors . 176
- - - hsBtnorrhoidal excrescence. . 11
Colica constipata, cured by inflation,
by Mr. King . 330
Collins, Dr. on lacerated uterus, &c. 187
- - on extra uterine foetation 190
Colon, transverse, found in the chest 11 Congenital incontinence of urine, by Dr. Otto .... ............... 333
Consumption, Sir C. Scudamore on the cure of, by inhalation .... 33
Cooper, Mr. B. on anatomy . 35
Coster’s Manual of Surgery, by Fife 443 Cornea, .sloughing of, from lime,
by Mr. Foote, junr . 495
Crampton, Mr. on tying the com¬ mon iliac . 27
Cranium, Fractures of, by Dr. Tuthill 41 Croton, Oil, efficacy of in inter-
mittents . 396
Cupping, Art of, by Mr. Knox . . 520 Cusack, Dr’s. Report of the Wellesley Lying-in Hospital . 12
D.
Davy, Sir H. Life of, by Dr. Paris. 139 Defence of St. John Long, by
Dr. Ramadge . 433
Defloration, Female, medico -legal
questions on . . . . 132
Deformities, Mr. Beale on . 520
Demonstrations, anatomical, by
Seerig . 329
Dislocations, old. Dr. Laurie on . . . 513
Dissection, mode of, in infanticide . . 126
Dublin Hospital Reports . 1, 169
Dublin Lying-in Hospitals, account
of. . 12
- - Medical Transactions . 181
Dupuytren’s, operation for obli¬ teration of vagina . 76
Page
Dysentery, causes of, by Dr.
Buchanan . 373
Dyspepsia, Dr. Mayo on . 446
E.
Elaterium, analysis of . 426
Elements of Surgery, by Mr. Liston 37 Ellioison’s, Dr. Appointment to the Chair of Medicine in the London
University . 528
— - on Glanders in human
subjects . 125
Emetic tartar in pneumonia . 1, 507
Emetic tartar in neuralgia . 1, 511
Enlargement of the Spleen, Mr.
Swift on . 49
Epps, Dr. Life of. Dr. Walker, by 280
Ergot of rye in menorrhagia . 428
Excision of the elbow-joint, Mr.
Syme on . 335
Expulsion of Dr. Ramadge from the London Medical Society . . . 526
F.
Femur, fracture of neck, &c . 75
- shaft, cured
by wire seton . . 122
Ferguson, Dr. J. C. on pulmonary
apoplexy . . . 188
- on anomalous labor 191
Fistula, vesico-vaginal, cure by actual
cautery . ; ....... i < 50
- cases from pessary . 523
- Recto-vaginal, by same .... 523
Foetation, extraordinary case of . . . 255 Foetus, Physiology of. Dr. C. Hol¬ land on . . . 292, 345
Follicular origin of vaginal tumours 163 Foote’s, Mr. Junr. Report of the Westminister Ophthalmic Hospital 488 Foote, Mr. Junr. on the cure of
purulent ophthalmia . 489
- Cases of purulent
ophthalmia from gonorrhoea . 489
- - - . leucorrhoea. 491
— - - •gonorrhoeal ophthalmia 493
- - muco-purulent . 493
- pustular inflammation .. 494
- ophthalmia from lime. . 495
- - sloughing of conjunctiva
from lime . 495
- - - albugo, cure of . 496
Fosbroke, Dr. versus Mr. Darwin.. 243 Fractures of crainum. Dr. Tuthill on 42
■ - - — femur and pelvis . . 75, 122
Fungus cerebri. Dr. Tuthill on ... . 42
Fungus hsematodes, Mr. Barlow on 32 Fungus hsematodes, cured by am¬ putation _ . * . 245
INDEX.
531
Page
Gall-bladder, hydatids of . . 58
Geddings, Dr. on ol. terebinth in
salivation . 329
- — .on strychnia in
paralysis . 426
Glanders, in man cases of, by Dr.
Elliotson . 125
Gonorrhoea syphiloid, Mr. Swift on 51
Gonorrhoeal ophthalmia, Mr. Foote,
Jun. on . 492
Graves, Dr. on diseases of the chest 1 Gray, Mr. Supplement to the Phar¬ macopoeia . 81
Green, Mr. on distinction without
separation . . . . 468
Greening, Mr. case of infantine
survival at sixth month . 247
Gregory, Mr. Report of the Coombe
Lying-in Hospital . 12
Griffin’s, Mr. Translation of Rose’s
Chemistry . 300
Guaco, effects of in hydrophobia . . 255
H.
Hsemathorax, Dr. R. Tuthill on . . 304 Hancock, Dr. on trismus infantum 427 Hargrave’s, Mr. operative of surgery 38 Harty, Dr. on polypus of the heart 191
Hastings, Dr. on phthisis . 332
Hatin, M. on difficult labours . 453
Hays, Dr. on ununited fractures . . 334
- criticism on Mr. Lawrence 334
Head and neck, surgical anatomy of 521 Health and disease, operation of
physical causes on . 508
- - pursuit of. Dr. J. Johnson on 257
- and longevity, Mr. Thac-
krah on . . 266, 354, 472
- of the Royal Navy, Sir G.
Blane on . 276
Heart, polypus of. Dr. Harty on . . 191
- Dr. Burne, on the motion
and structure of . . 505
Hernia, produced by tight lacing . . . .484 Heurteloup’s claims to improvements
of Civiale’s instruments . 337
- knowledge of anatomy 338
Hip-joint disease of . 209, 510
Holberton, Mr. on swelling of the
lower extremities in phthisis . 124
Homicide, Medico-legal questions on 142 Holland, Dr. on the physiology of
the foetus, &c . 292, 345
Hospital, Dublin Reports, review of 12 Hospitals, Dublin Reports of, 1,24, 48 Houlton, Mr. on the effects of cold
on plants . 74, 75
Houston, Dr. on valves in the rectum 178
Page
Houston, Dr. on views of the pelvis . . 520 Hunterian Society, Prize Medal of 430 Hutchinson, Mr. on calculous di s-
eases . 125
- appendix to the same. 125
Hydatids, case of in liver, lungs and gall-bladder, by Dr. Billing 59 Hydrostatic test, value of, in infan¬
ticide . 63
Hyosciamus, Mr. Houlton on de¬ terioration of . 77
I. J.
Impotence and sterility. Dr. Harrison
on . 242
Incontinence of urine, congenital... 333 Infanticide, various causes of. Dr.
Ryan on . 59
Influence of temperament, in dys¬ pepsia, Dr. Mayo on . . 446
Insanity, M. Regnault on . 364
Intellect, march of . 432
Intermittents, Medicus on . 396
James, Mr. ligature on the external
iliac and aorta, by . 25
Iodine, in enlargement of the spleen 49
- in gonorrhoea and leucorrhoea 511
- poisoning, by tests for . 409
James, Mr. on tying the aorta _ 25
John Long, Trial of, for man¬ slaughter . . 248
- defence of, by Dr.
Ramadge . 433
Johnson, Dr. on change of air .... 257
K.
King, Mr. on arteriology . 329
King, Mr. J. on colica constipata 330 King’s College, appointments at . . . 430 Knox, Mr. on cupping . 520
L.
Lacing tight, injurious effects of . . . 484 Labours difficult, management of . . 453 Laryngitis, acute and chronic cases of 9 Law, Dr. on gangrene of the lungs 189 Lawrence, Mr. on phlegmasia dolens . 123 Leucorrhoea cure of by iodine .... 511 Lithotomy, lithotrity, Velpeau on.. 75 Lithotrity, claims of Civiaie, Costello
and Heurteloup to . 336
- - Heurteloup’s success ui . . 338
Lisfranc, M. on cancer . 74
Liston, Mr. on surgery . 37
- on restoring the columna
nasi . 165
Liver, hydatids of. Dr. Billing on. . 58
- - rupture of . . . i 394
London College of Medicine . 341
Hospital Reports from . 58
.532
INDEX.
i
Page
Long, St. John, Report of trial fox-
manslaughter . 248
Longevity in Russia . 430
Lungs, hydatids of . 58
Lying-in Hospitals, Dublin, Repts. of 12 Lyon, Mr. on spasm of the colon. 302
M.
M’Dowell, Dr. cure of vesico-va--
ginal fistula, by cautery . 50
Mac Kibbin, Dr. on the Caesarean
operation . 42S
Malins, Dr. on peritonitis during
gestation . 52
- lecture on midwifery 317, 385
Manual of legal medicine, by Dr.
Sedillot . 442
Marshall, Mr. on vaccination . 216
Mayo, Dr. on temperament in dys¬ pepsia . 446
Medical Annual, Dr. Reece’s . 247
- - Reform, Mr. Green on . 468
Medicine, First Principles of, by Dr.
Billing . 39
- State of, in Turkey . 244
- - - Naval Improvement in . . 276
- Statistical * . 430
Medico-Botanical Society, Reports of . ...77, 255 343
Medico-Chirurgical Transactions . . 122 Menorrhagia, Ergot of Rye in .... 428 Mercury and its salts poisoning by. . 414
- Effects of in neuralgia ... 511
Mental Derangement, Dr. Uwins on 344 Metallic Poisons account of, M.
Regnault on . 364
Midwifery, History of, by Dr. Malins 317
Mitchell, Mr. on hip-disease . 209
- ■ - on stricture of gall-
ducts and urethra . 398
Monstrosity, case of . 11
Mott, Dr. case of ligature on the
subclavian, by . . 518
Morbus Coxarius, remarks on .... 510 Natural Philosophy, Mr. E. Browne
on . 65
Nffivus, cure of by compression. ... 511 Neuralgia cubito-digital, Mr. Swift
on . 48
- -new cures for . 511
Nitrate of Potass, poisoning by ... 414
Nice, Mr. on Amaurosis . 496
Nose Cancer of, extirpation of . 74
- restoration of, by Mr. Liston. . 165
Nottingham Dispensary, disputes in 243
O.
Old Dislocations, Dr. Laurie on... 513
- Critical strictures on .... 516
Oleum Crotonis Tiglii, remarks on .. 396
• O
Operation of physical causes on
health, &c . 508
Operative Surgery, by Mr. Hargrave 38
- Coster’s, by Dr. Fife .... 443
Ophthalmic Hospital (Westminster)
Report of . 489
Ophthalmia purulent, Mr. Foote Jun. on . 489
- - leucorrhcea .... 491
- muco-purulent . 493
- pustular . 494
- - from lime . 495
O’Shaughnessy, Dr. on poisons ... 408 Otto, Dr. on congenital incontinence
of urine . 333
Outlines of physiology, by Dr. Alison 191
P.
Paracentesis Cranii, by Dr. Conquest 255 Paralysis, Dr. Geddings on stry¬ chnia in . . . 426
Paris, Dr. Life of Sir H. Davy, by 199
- Hospital Reports of, 74, 75, 76
Pattison, Professor, defence of .... 428 Paxton, Mr. on human anatomy. . . 360
Pelvis views of . . 520
Percussion, discovery of tubercles
by . 509
Peritonitis fatal, by Dr. Malins ... 52
- Chronic, duration of. Editor
on . 55
— - Mr. Rees on . 213
Peruvian Bark, new species of .... 521
Pessaries, injuries 'caused by . 523
Pharmacopoeias, Mr. Gray on the.. . 81
- ■ Mr. Rennie . 83
- - Drs. Barker, and
Montgomeny on . 86
Phlegmasia Dolens, Mr. Lawrence
on . 123
Phthisis, in last stage, cure of .... 242
- Dr. Hastings on . 332
Physiology outlines of, by Dr.
Alison . 191
Physiology of the foetus, &c. Dr.
Holland on . 292 345
Pleuritis,hydro-thorax, stethoscope in 7
Pleuro-pneumonia, detected by per¬ cussion . 509
Potass fused and nitrate of, poison¬ ing by . 414
Pneumonia, cure of, by tartar-
Poisons, action of, on the economy.
Dr. Ryan on . . 402
Poisons, on the detection of, . 402
- irritant symptoms of . 403
mineral, symptoms of . 405
INDEX
533
Page
Poisons, autopsies by . 406
Poisoning by mineral acids and
‘ tests for . 407
- mercurial preparations and
tests for . 414
- - Compounds of arsenic . . 416
Pregnancy, phrenological sign of . . 524
- Chronic peritonitis in 213, 521
Preparations, anatomical mode of
preserving . . . 420
Productiveness, extraordinary case of 255 Prussic Acid, new process for pre¬ paring . 524
Pulmonary Apoplexy, Dr. J. C.
Fergusson on . 188
- Abscess, Dr. Gilroy on . . 425
Pulse, Dr. Burne on the . 505
Purulent Ophthalmia, Mr. Foote, Jun.
on . 489
Pustular Ophthalmia . 494
Q.
Quain, Jones, Dr. on Anatomy, &c. 197
R.
Ramadge, Dr. Defence of Saint John
by . . .
expelled by the London
Long,
433
Medical Society - reclamation of
526
526
511
150
520
247
213
468
364
Recamier, M. on Cancer .
Reclamation, of Mr. Searle . . .
Rectum valves in, discovery of .
Reece, Dr. Medical Annual, by Rees, Mr. on chronic peritonitis Reform Medical, Mr. Green on Regnault, M. on mental alienation .
Remarks on morbus coxarius . 510
Rennie, Mr. on the pharmacopaeia. 83 Respiratory Organs, Diseases of . . Richmond Hospital, Report of, bv
Mr. Swift . . ........ 48
Rivinus, Dr. on the operation of
physical causes . 508
Rose’s chemistry by Griffin ....... 300
Rupture of the liver, &c. by Dr.
Tuthill . 304
Russia, Longevity in . 430
Ryan, Dr. on infanticide . 59, 126
- the hydrostatic test . 63
• viability of new-born in¬ fants . 63
- on the autopsy of . 128
- on the violation of women 131
- signs of defloration . 132
- - purulent discharge from the
genitals of children . 135
- - - ■ ■ violation, whether
ever
followed by conception . 141
- on unnatural offences ... 141
Page
Ryan, Dr. on homicide . . . . . . 142
- - on wounds. See . 144
- -on the judiciary examina¬ tion of wounds . . 236
- - on homicide by asphyxia . 308
- - by poisoning, 401, 498
S.
Scudamore, Sir C. on consumption. 33
Searle, Mr. reclamation . 150
- - - on cholera . 212
Sedillot, M. on state medicine . 442
Seton, use of in ununited fractures
122, 334
Short, Dr, on cholera in Russia ... 482 Society, Hunterian Prize Medal of. . 430 Somme, Dr. on ununited fracture . . 122 Spasm of the colon, Mr. Lyon on 302 Spleen, enlargement of, cured by
iodine . . . 49
Stafford, Mr. by operation for stric¬ ture . 424
Stays, effects of, in producing hernia 484 Stevens, Dr. on tying the internal
iliac . 31
Stethoscope, failure of . 509
Stirling, Mr. on the Caesarean opera¬ tion . . 44
Stomach found in the chest . . 11
Stricture, new cure for . 424
Strychnia in paralysis. Dr. Gedding
on . 426
- - amaurosis . 521
Sublimate corrosive of, poisoning by 415 Surgical Report of the Glasgow In¬ firmary . . 511
Swift, Mr. Report of the Richmond
Hospital . 48
- on cubito-digital neuralgia 48
- enlargement of the spleen 49
Syme, Mr. on excision of the elbow joints . 335
- re-union of fractures . . . 422
' ■ urinary calculus ........ 422
Syphiloid gonorrhoea, case of . 51
T.
Tartar-emetic in pneumonia .... 1, 507 Tartar-emetic in amaurosis, Mr.
Nice on . 496
Terebinth ol. in salivation . 329
Tetanus infantum. Dr. Hancock on 427 Thackrah, Mr. on health and lon-
Townsend, Dr. translation of An-
dral’s pathology, by . S6
Tracheotomy when a foreign body is
in rhe bronchus . 424
Trades and professions diseases caused by . 266, 354, 472
534
INDEX.
Page
Tubero-carunculoid liver . . 509
Tuthill, Dr. on fractures of the
cranium . 41
■ ■ '■ on fungus-cerebri . 42
- on rupture of the liver, &c . 304
Typhus Fever at Warwick Bridge . . 254
U. V.
Urethra Strictures of, cure of •••• 398 Vaccination, Mr. Marshall on .... 216 Vaccine Establishment, annual re¬ port of . . . . 431
Velpeu, on lithotomy and lithotrity . 75
Violation Female, medico-legal questions on . 132
Page
W.
Walker, Dr. Life of, by Dr. Epps 280 West’s, Dr. translation of Andral’s
pathology . 86
Warden, of the London University,
resignation of . 431
Wounds, medico-legal questions
on . , . 142, 150
- — judiciary examination of,
by Dr. Ryan . 236
Utero-gestation, phrenological sign
of . . 524
University of London, proceedings of 528
THE END.
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