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THE

LONDON
MEDICAL AND SURGICAL

J OURNAL;

INCLUDING

THE LONDON MEDICAL REPOSITORY.

EXHIBITING

A VIEW OF THE IMPROVEMENTS AND DISCOVERIES IN THE
VARIOUS BRANCHES- OF MEDICAL SCIENCE.

EDITED BY

MICHAEL RYAN, M. D.

Querere Verum. Hoaxes.

vol. v. x^t:^

FROM JULY TO DECEMBER, 1830.

LONDON:

pn|II.I8SBI> BT THOMAS AND GEORGE UNDERWOOD,

32, FLEET STREET.

1830.

OUTHRIB, PRINTER, 15, 8H0B LAVK.

THE LONDON

MEDICAL. AND SURGICAL JOURNAL.

No. 25. JULY 1, 1830. Vot. V,

CRITICAL REVIEW.

I.— Observation* on Puerperal Inflammation, commonly
called Puerperal Fever, being the subject of an Oration
delivered before the Hunterian Society of London, in
February, 1830. By J. T. Conquest, M. D., Physician
to the City of London Lying-in Hospital.

?I.— Des Fievres Puerperales, observees a la Maternke de
Parti, pendent V annee 1829, des diverges Methodes
therapeutiques employees pour les combattre et speciale-
ment des Mercurieux, des Vomitifs. et des Evacuations
Sanguines. Par M. Tonnelle, A^oien Interne des Hopi-
taux, Arch. Gen. de Med. Mars et April, 1830.

Observations an the Puerperal Fevers, observed in
the Maternite of Paris during the year 1829, with the
different Modes of Treatment ,- especially Mercurials,
Emetics, and Sanguineous Depletions. By M. Tonnelle.
Taken from the Records of the Hospital, with the consent
of M. Desobmkaux, Chief Physician to the Institution.

Ik contrasting these essays, we wish to shew the reader the
opinions of two physicians who have had ample opportuni-
ties of observing puerperal fever; and leave him to draw'
his own conclusion as to their respective merits. The sub-
ject is of such vast importance, that we deem it unnecessary
to apologise for the extent of space we devote to its eluci-
dation. There is 8 great identity of opinion between our
authors on many of the leadiftg features of the disease.
Dr. Conquest proceeds as follows :~

" By Puerperal Inflammation, correctly so called, is meant one of
those affections which are known among practitioners under the
vague and indefinite term of Puerperal Fever ; a generic term, which
in reality designates only a prominent symptom of disease, but
which, in ordinary usage, embraces complaints having little or no

voi. v. wo. 26. b

2 Critical Review.

resemblance or connexion, either in their essential nature, their seat,
or their treatment. For I fearlessly appeal to every cautious, intel-
ligent, and reflecting man present, whether the term is not in daily
use, equally to designate spasmodic and inflammatory affections of
the peritoneal investments of the uterus and abdominal viscera;
inflammation of the muscular fibres ; inflammation of the veins of
the uterus ; phrenitis ; irritative fever ; diarrhoea ; and spasm of
the intestinal canal, so frequently confounded with inflammation.
Indeed, it is truly lamentable to find among our most distinguished
pathologists the greatest imaginable discrepancy of opinion on the
nature and treatment of these formidable complaints. And where
is the medical man, who has seen any thing of practice, who has
not had painful demonstration of the correctness of these remarks,
and on many occasions had to deplore the confusion of his own
pathological views of this fell disease, which is so incessantly carry-
ing heart-rending desolation and despair into the bosom of families,
and cutting off, in the bloom of life, and under the most endearing
and interesting circumstances of relationship, those members of
society which give to it its purest pleasures and its highest joys ?

' • It is of moment to dissociate this disease from several others
with which it is often confounded, and for which it is treated in
every day practice ; for, unless our diagnosis be correct, there will
ever be the most conflicting statements as to the nature and seat of
Puerperal Inflammation, and the utmost discordance of opinion as to
the treatment to be pursued.

" Those complaints to which I more particularly refer are,

" First. — That high though transitory febrile excitement of the
constitution, to which lying-in women are liable, called Ephemera,
or Weed, referrible to some slight and casual disturbance in the
breasts or small intestines. This is never epidemic. Secondly.
Various disturbances and disorganizations of the brain. Thirdly. De-
rangement of the intestinal canal, constituting puerperal diarrhoea
Fourthly. Remittent pain of the intestines, from detained faeces,
producing violent spasm of the larger bowels. Fifthly. Irritative-
fever, from a portion of retained placenta, or membranes, or coagula.
Sixthly. Hysteria. Seventhly. Hysteralgia, or that alarmingly
painful spasm of the uterus, characterised by the earliness and ra-
pidity of its accession and departure, the periodical remission of pain,
and the absence of rigors. And, Eighthly. All that train of ano-
malous symptoms, referrible to exhaustion from fatigue, anxiety, or
loss of blood. All these affections are incessantly liable to be mis-
taken and treated for genuine Puerperal inflammation ; affections in
which opiates and fomentation are alone admissible." — p. 5.

'* When this disease runs a very rapid and fatal course, destroying
the patient within twenty-four or forty-eight hours, it is astonishing
how little will be found to account for death. Perhaps there may be
slight efflorescence and turgescence of parts, with a very little sero-
sanguineous effusion, or an isolated spot of gangrene ; and these
disputable evidences of inflammation are sometimes confined to a fal-
lopian tube or an ovary. These equivocal and umimportant changes

Dr. Conquest on Puerperal Inflammation. 3

are more particularly noticed in those most distressing and untract-
able cases ushered in by extreme and overwhelming depression of the
nervous energies, with almost irrecoverable prostration of the vital
powers; and these occur in great numbers in particular districts, in
lying-in hospitals, in crowded neighbourhoods, and under a peculiar
condition of atmosphere, when puerperal diseases have not borne the
abstraction of blood, or any other depletory measure, but with ex-
treme caution. Under these circumstances, although there is effusion,
it is small in quantity and peculiar in quality. It is like dirty red
water, without any flakes of coagulable lymph, and often pervades
every part of the contents of the pelvis. The uterus itself becomes
unnaturally soft, and not only is there this effusion formed between
the muscular parietes, and in the cellular tissue, but under the pe-
ritoneal covering. It may also be traced under the investment of the
broad ligaments, ovaries, and every contiguous organ.

" Inordinary phlogistic cases, the appearances after death are very
diversified. The substance of the uterus is sometimes infiltrated
with pus, and becomes livid and spongy, or it may contain small ab-
scesses ; and the uterine veins, particularly those containing blood
from the spermatic arteries, may be inflamed, and contain coagula or
pus. At other times, spots and patches of gangrene will be per-
ceived externally ; and not unrrequently the inner surface or cavity
is black, ragged, and covered with flakes of coagulable lymph. When
the disease has originated with, or been principally confined to, the
peritoneal investments of the uterus, bladder, and pelvic and abdo-
minal viscera, they will be agglutinated in one morbid mass, or there
will be more or less turbid serous effusion of a dirty white colour,
mixed with pus and flakes of coagulable lymph.

In the chest, particularly in those cases in which respiration has
been hurried from the commencement, there will be found slight ef-
fusion in the cavity of the pleura, in the bronchial tubes, and in the
cellular substance of the lungs.

" But so anomalous is Puerperal Inflammation, that not unfre-
quently the extent and variety of mischief shall be infinitely more than
could have been expected, a priori, from the duration or severity of
symptoms during life, and only to be explained by admitting that the
disease must have existed, and been making sure, though unnoticed
progress before delivery ; or to the possibility of the inflammation
having run a very rapid course, and destroying in a few hours the
vitality of parts which had been previously brought into such a con-
dition, in consequence of the prostration of nervous energy, as to be
unable to resist high excitement ; and effusion or destruction inevi-
tably and rapidly follows." — p. 7.

" In attempting to describe Puerperal Inflammation, as it is pre-
sented to us in that best of schools, the lying-in-room, I would say it
attacks women irrespective of the duration, mildness, or severity of
their labours, women of all ages, and during every season of the year ;
but the type of the inflammation will be so varied and modified by cir-
cumstances as to be scarcely recognised as the same disease in its es-
sential character in different women, in different districts, and during

4 Critical Review.

peculiar constitutions of the atmosphere. It will soinetimes be strictly
tonic and phlogistic, and at other times atonic and typhoid.

" I have seen some cases in which the poise has been fall and hard
but slow, the breathing has been laborious, the countenance dusky,
and every function oppressed. There has appeared to be venous
congestion overpowering arterial action, and preventing the full ma-
nifestation of disease. The crassamentum of the blood first drawn, has
less firmness, and it does not become bufly and cupped until the cir-
culation is relieved by bleeding. It is true the appearance of the
blood supplies but very fallacious guidance. In these cases deple-
tion will lessen the simulated debility, and the concealed disease wxU
become more clearly developed.

" Indisputably, this disease is often conveyed by medical men and
nurses, as well as by patients themselves. We now possess unques-
tionable evidence to support this statement.

" The disease is most frequently epidemic during the winter and
spring, and has always been most fatal during and immediately after
severe and long-continued frosty weather ; and yet, strange and in-
explicable as is the feet, during the prevalence of cold it runs its
course most rapidly, and often assumes the low type, as during this
season, (1880.)

"lam particularly solicitous to establish,

" First. The momentous and influential fact, that gestation and
parturition produce a change in the physical condition of the female,
which so modifies disease, as to give to it a specific character. This
is familiar to every medical man who frequents the lying-in-room,
and is remarkably illustrated when puerperal patients become the
subjects of Scarlatina or of any other exanthematous disease. Such
women will lose their lives, although many other members of the
family, labouring under the same disease, have escaped with the most
trifling and unimportant indisposition. I consider this, as it were, a
elue to the peculiarities and difficulties of all puerperal diseases, ancb
if not borne in mind, I think it is impossible to understand or to
manage complaints incident to parturient women. Secondly. It is
of importance never to forget the inexplicable and pernicious influ-
ence of season, or the constitution of the atmosphere, and of certain
situations, as they produce and characterise the inflammatory diseases
of the puerperal female. This is occasionally seen when the com-
plaints of the lying-in-room become epidemic and very unmanageable.
Nothing is more common than for particular districts of this metro-
polis to be thus infested. Thirdly. It must ever be borne in mind,
that this dire disease may, and generally does, begin during gesta-
tion, from mental depression, impure air, bodily fatigue, low living,
or stimulating food, and bursts forth in its full developement after the
uterus has expelled its contents. Many sporadic cases of this cha-
racter must be familiar to every observant practitioner, in which he
has been able to connect pre-existing, threatened mischief with the
subsequent inflammatory action. How often does this occur in young
women of previously good character, who have been seduced, and
who suffer bitterly from mental despondency and broken spirits dur-

Dr. Conquest on Puerperal Inflammation. 5

ing the long and tedious months of seclusion which precede their con-

lf the uterus be primarily affected, constituting Hysteritis, it is
manifested by severe* constant, and darting pain about the hypogas-
tric region, greatly augmented by pressure. Constitutional excite-
ment, with bluish-white tongue, thirst, and vomiting, are present*
and the lochia become suppressed* Generally, although the inflam-
mation begins in the uterus, sooner or later it extends to the duplica-
tors of the peritoneum, producing Peritonitis, or inflammation of the
peritoneal lining of the abdomen* which often exists at its commence-
ment, independently of inflammation of the uterus, and without sup-
pression of the lochia. Sometimes the approach of this formidable
mflsjQunatkm js so extremely obscure, that extensive and important
disease, amounting to destruction* will elude detection. In many
cases even pain is absent, or so unimportant a symptom as not to be
adverted to but m common with general uneasiness, restlessness, and
exhaustion ; and it is only by long-continued and deep pressure that
the slightest degree of suffering can be detected. This is principally
the case when the disease is epidemic, and assumes a low type;
while in sporadic and phlogistic, cases, either a particular part, or the
entire superflces of the abdomen, will be the seat of constant, acute,
and agonizing. pain.,

' ' Puerperal Inflammation usually seizes women within a few days,
but sometimes not rill some weeks after delivery, and is ordinarily
ushered in by severe rigors, though often only by horripilatio or slight
dnHs. The temperature of the. surface is usually augmented; but,
should the disease be of .a. typhoid character, it will be even below
the standard of heat. The pulse is accelerated, though varying much
in frequency, force, and fulness, being either hard and incompressible,
or yielding and powerless. The countenance always expresses either
anxiety or suffering ; now and then, from the commencement, it puts
tn a distressingly saddened and apprehensive character, with severe
and tensive head-ache. The tongue is not always white and foul. I
have known it perfectly clean through the entire course of the malady,
and have soften seen amendment follow when the tongue has lost its
loaded, cream-coloured appearance, and become brovn and dry.

" If the disease is not checked. and subdued, it generally proceeds
rapidly, and the abdomen becomes tympanitic, and swollen to a size
nearly equal to what it was before delivery. From the inflamed con-
dition of the parts, and the exquisite pain which exists, the very
weight of the hand or bedVclothes is intolerable ; and in order to en-
dure her distress the patient is obliged to lie on her back, with her
knees bent upwards, to relax the abdominal muscles. The slightest
pressure or motion greatly harrasses her. The stomach is often se-
verely affected from the first, and vomiting is a not unfrequent at-
tendant ; regurgitation of the contents of the stomach almost always
attends the disease towards its close. The bowels are constipated,
but this is not uniformly the case ; now and then numerous scanty
and extremely offensive motions rather tease than relieve the intes-
tines. The hepatic and intestinal secretions are not healthy. The

6 Critical Review.

bladder is usually affected either with a constant inclination to empty
itself, or there is a suspension of the renal functions. The secretion
is turbid and high-coloured, sometimes milky, and this has been
deemed a highly dangerous symptom. As the disease advances, the
abdominal tumefaction augments, and great difficulty of breathing
ensues. The secretion of milk, in most cases, becomes diminished,
and it soon ceases altogether. The breasts are flaccid and empty, and
if the uterus was not primarily concerned, now the lochial discharge
is put a stop to, in consequence of participating in the disease. If
the disease proceeds in its course, all the symptoms become highly
aggravated ; and, at last, a deceitful remission, or a total cessation of
pain occurs, though occasionally the patient is agonized to the last ;
the pulse becomes extremely small, feeble, intermittent, and scarcely
to be counted ; the tongue dry and brown ; the countenance wild,
and expressive of great distress ; the skin alternately hot and cold ;
and the teeth covered with sordes ; cold, clammy sweats break out
over the whole body ; the urine and the faeces come away involun-
tarily ; the extremities are cold ; and the patient, often in full pos-
session of her intellectual consciousness, dies within four or six days
from the accession of disease,— sometimes within a few hours from
the prostration of the sensorial functions, owing to inexplicable sym-
pathy subsisting between the vital powers and the destructive process
in a remote organ, however trifling may be its degree. But there is
a great difference in the duration of this disease. In strictly active
inflammatory cases, death occurs much more distantly from the ac-
cession of the complaint, than in those cases which commence with
extreme prostration of the vital powers, and rapidly assume a typhoid
character.

" Treatment. When this disease becomes epidemic, in defiance
of the best concerted plans of treatment, the insatiate monster death
moves on in his desolating path, without our being able to alter his
course or stay his progress. At this very time, in one of our largest
metropolitan hospitals, although directed by some of the most intel-
ligent and devoted men that adorn our profession, such has been the
mortality, that its inmates have been expelled, and its doors closed ;
in another, with which I am myself connected, it is raging like the
plague ; and while I am speaking, women are dying under every
form and variety of this overwhelming malady, notwithstanding
those intensely anxious attentions which the magnitude of the evil is
securing for them. In our hospitals it is extremely difficult to detect
incipient inflammation. Women become terrified by the activity of
the means, the employment of which they hourly witness, and will
most positively deny the existence of pain, and artfully conceal every
symptom of disease.

" The epidemic of one season may differ essentially from the epi •
demic of a preceding and following year, and may consequently de-
mand very different management ; and it is always found that the
more generally prevalent the disease may be, the more fatal is its
course. Sporadic cases are managed more successfully than those
more strictly epidemic. Every case must be isolated and studied

Dr. Conquest an Puerperal Inflammation. 7

alone, and looked at by itself; and its management must depend on
its type and its stage. Measures of paramount value and of impera-
tive necessity in one case, and at some periods of the disease, Will be
valueless and detrimental under other circumstances. It is very un-
usual for any case to preserve an unwavering uniformity of character
during its entire progress; and consequently, the treatment must
vary with its exigencies ; and if we expect to bring the disease to a
satisfactory termination, we shall be compelled so to alter our course
of proceeding, as to incur the risk of being chargeable, by the novi-
tiate and inexperienced, with vacillation and indecision.

" Our treatment must be at once simple and decided ; prompti-
tude is as necessary as activity, because the curable stage rapidly
passes away, — often in a few hours. Should the case be decidedly
inflammatory, with a hard, unyielding, vibrating pulse, and acute,
constant pain, the abstraction of blood, locally and generally, early
and copiously, with the steady exhibition of purgatives, mercury and
opiates, constitute the remedial means on which our hopes must be
suspended ; all other measures being merely auxiliary and subordi-
nate. Much depends on the early and liberal detraction of blood.
One bleeding of twenty or thirty ounces within the first six hours of
the attack, will accomplish more than the loss of twice the quantity
in several small bleedings after twelve hours have elapsed. Neque
temere, neque timide, should be engraven on every lancet. Blood-let-
ting will always be in discredit in the management of inflammation
of vital parts, if used with timidity, or resorted to too late. It is owing
to the inefficient influence of a small bleeding, begun too late, or re-
peated after too long an interval, that the natural and rapid tenoency
of the disease to assume a low or typhoid character, has been sup-
posed to be the result, or at least to have been aggravated by this in-
valuable, but in these cases ill-managed, remedy. The necessity of
proportioning blood-letting in all cases to the actual effect which it is
merred to produce on the pulse of the patient, and on her pain, and
not on any arbitrary measure of ounces, if we would do justice to our
patient, and obtain the full agency of the remedy, must be the only
limitation of the quantity of blood to be withdrawn, provided all that
is requisite be abstracted within the first twelve or twenty-four hours
of the disease.

" Now I entreat you, Gentlemen, not to infer that I am a convert
to the modern practice of almost ^discriminate bleeding in the ma-
jority of diseases. So far from it, I deem the present rage for blood-
letting in almost every ailment to which the human frame is liable, as
most injudicious and injurious.

" But to return to the disease under consideration. One early
and plentiful bleeding, inducing a temporary collapse of the system,
will generally suffice for an acute attack of the most active kind : the
temporary debility resulting from such a bleeding may be greater, but
the permanent weekness is certainly less. Fainting is very desirable in
the abstraction of blood in this, and, indeed, in all inflammatory diseases,
because it implies an almost entire cessation of circulation. This
is most readily accomplished by having our patient's head raised, pre-

8 Critical Review.

serving the body in a recumbent posture, and by suddenly drawing
away blood from a large orifice, or permitting it'to flow from two
veins at the same time* It will be thus found that the abstraction of
a less quantity of blood will be required for every stage of this disease,
superseding tie practice of small and repeated bleedings, which ex-
haust the strength as much as the original excitemetft, and inevitably
accelerate the fatal termination of our patient's sufferings. Still,
blood-letting is not allowable beyond a certain extent, and must not
be repeated when the. danger of organic mischief has disappeared, or
general exhaustion rapidly ensues ; immediate depletion may produce
a universal and irrecoverable suspension of the vital principle, or at
least leave a vacillating state of the circulation, or a hurried re-ac-
tion of the heart and arteries, or congestion of the venous system, or
effusion of serum ; thus instituting a disease almost as dangerous as
the one removed. I need scarcely add, that the application of leeches
to the abdomen, and cupping from the loins, are adjuvants of consi-
derable value; and especially when some dregs of inflammatory
disease may remain after copious general bleeding.

" Yet there are unquestionably very many cases so modified by
constitution, by season, and by other circumstances above noticed,
and which run so rapidly towards a state of collapse, that the abstrac-
tion of blood from the arm is tantamount to signing the death-war-
rant of the patient. It is in these cases, and they are by feu* the moat
numerous in and about this metropolis, that local bleeding by leeches
is an invaluable remedial measure. While genera! bleeding diminishes
the force of arterial action, topical bleeding unloads and relieves the
capillary vessels. When copious and general bleeding is inadmissi-
ble and injurious, fifty or a hundred leeches should be applied to the
abdomen ; and this will scarcely ever be done without sensible relief,
—often to such an extent that the poor woman will again and again
solicit their reapplication. In the epidemic and typhoid form, this is
often the only allowable method of abstracting blood ; and in every
stage of this unmanageable disease, even when effusion is manifest
and death is inevitable, leeches will smooth the ruggedness of the
path. The bleeding may be encouraged by a large, soft, warm poul-
tice.

" Considerable benefit will result from the application of a blister
over the entire abdomen, when topical bleeding is no longer advisa-
ble; and sometimes very marked relief will be afforded, on the
principle of revulsion or counter-irritation, by repeatedly covering the
bowels with flannel dipped in hot oil of turpentine. This may be
used every six hours, for ten minutes each time, until high erethe-
matous efflorescence takes place.

" Immediately after bleeding, the most effectual means of empty-
ing the bowels must be had recourse to, so that an evacuation once
in three or four hours may be obtained for two or three days, or
longer if necessary. The existence of diarrhoea, which is sometimes
attendant on this disease, must not prevent the exhibition of purga-
tives, because the feces are scybalous, slimy, and fetid ; such only
keep up an incessant irritation in the abdomen, which will be beat

M. Tonnelle on Puerperal Fever* 9

remedied by cathartics. Saline purgatives do not appear to be well
adapted to this disease. They produce irritation and distention, and
lead the unwary to suspect inflammation. They seem to accelerate
the peristaltic action of the bowels, discharging frequent and watery
stools, while the hardened scybala, in the arch and head of the colon,
remain unmoved by their operation.

" A full dose of calomel, say a scruple or half a drachm, with or
without jalap, or jalap in cinnamon water, with a little citric acid,'
may be exhibited. If jalap be not combined with the calomel, castor
oil should be given an hour or two after it. By these means we
shall completely unload the intestinal canal of its contents, allaying
irritation in its course.

" Perhaps oil of turpentine, in all cases not admitting of much re-
duction of power, is the best purgative that can be given. It may
be combined with castor oil and laudanum*, and by this combination
we shall freely unload the intestines, and produce gentle excitement
and a healthy action of their mucous coat. In those alarming cases
of spam of the uterus and large intestines, which are constantly
being mistaken for Puerperal Inflammation, this combination will
act as a charm.

" Purgative and emollient glysters are decidedly beneficial, and
fomentations to the abdomen are always found to be soothing and
useful.

" Opiates combined with mercurials are invaluable. Opium used to
be thought to afford only an insidious truce, and rather tend to ob-
scure and prolong the disease than to contribute to its subjugation.
I place great dependance on large doses of opium and calomel in all
cases after bleeding and purging. They must be exhibited in such
doses as will make a decided impression on the sensorial functions,
and speedily bring the constitution under the specific influence of
mercury ; and when we succeed in doing this, the case will generally
assume a favorable character.

" Camphor in scruple doses, combined with opium, will be found
a very efficient anodyne in cases of great restlessness with compara-
tively little acute suffering.

" Digitalis, Nitrate of Potass, Ipecacuanha, and Antimony, are of
great value as adjuvants, but cannot be exclusively relied upon, be-
cause irreparable mischief may take place while waiting for their
operation. The infusion of digitalis is most speedy in its influence,
most decided in its effects, and most capable of being controlled in
its operation." — p. 16.

M. Tonnelle prefers the term puerperal fever, to perito-
nitis, or metro-peritonitis, because it is more comprehensive
than the others ; it expresses nothing by itself, and does not
prejudice the nature of the disease. He commences his
essay by detailing the unsettled state of opinion on the

vol. v.— no. 25. c

10 Critical Review.

nature and treatment of the disease, and endeavours to ex-
plain the cause of this confusion. He next observes, that it
is not in a few months or years, or even an epoch, we
can arrive at correct views of the nature and treatment of a
disease ; and cites the opinions of Sydenham on the nature
of epidemics, and the influence of season on diseases. He
then informs us, that his object on the present occasion is
to give a succinct and faithful account of the puerperal fevers
that prevailed in the hospital, and during the period alrea4jf
mentioned. He says —

" During the year 1829 puerperal fevers were more grave and
frequent in the Maternite than at any period since the establishment
of the hospital. They were epidemic in the months of January,
May, August, September, land October, but it is an error to suppose
cold and moisture have had more to do in causing them, because in
the preceding December there was little disease. The influence of
humidity admits of controversy, for though these diseases prevailed
in the cold and wet months, they were equally prevalent in the
spring, which was remarkably dry. The vitiation of the air of
hospitals, or moral affections, will not explain the difficulty, for the
disease appeared under opposite and varied conditions, when none of
these causes were discoverable ; it ravaged for a week, or month, then
disappeared, and again returned. The influence of constitution, antece-
dent disease, lactation, tedious or difficult delivery, and other causes
enumerated by authors, do not explain, the simultaneous appearance
of the disease in a large number of patients, for it often attacked
ten or twelve women in the course of a day or night. Contagion
does not explain the developement of those affections, inasmuch as
every form of puerperal disease was to be seen in one ward, and these
fevers of the worst form combined with slight affections. There was
nothing to warrant the belief of the influence of contagion. Women
in separate cells were as readily affected as those in the common
wards. The cause is not known."

Our author observes, that peritonitis is most commonly
observed in these cases, but it is a great error to think that
it is constantly present.

" In many cases there is no appreciable change in the peritofieum,
or it contains a small quantity of inodorous transparent citrine or
reddish serosity, the first effect of inflammation, and where it has
made the fugitive traces to disappear, or the simple result of the
contracted respiration and circulation in these diseases. It is in the
most violent and fatal cases, that the integrity of the peritoneum is
most constantly observed. It exists almost always when there is
alteration in the uterus, its vessels or appendages. The anatomical
characters of peritonitis are not always identical ; there may be slight
effusion into the abdominal cavity, or vivid redness on the convohi-
tions of the intestines, or effusion with lymph, false membrane, of

M. Tonnelle on Puerperal Fever. 11

a yellowish colour ; or pus such as we see in a phlegmonous abscess.
The peritoneum is mostly inflamed in the hypogastric region, and is
concentrated about the uterus ; or it is general, or affects certain
points, as the surface of the liver, mesentery, and epiploon When
the last part, nodosities are presented, and perceived during life
across the abdomen ; sometimes the false membranes are brown, and
improperly styled gangrenous, an error which pathological anatomy
has done justice to, and need not be dwelt on, had not recent writers
on peritonitis revived it.

" Alterations of the Uterus. — These are simple inflammations of
the uterus and its appendages, suppuration of the veins and lympha-
tic vessels, and ramollissement or putrescence. The anatomical
characters of hysteritis are found in its internal membrane, external
or peritoneal tunic, and proper tissue. The internal surface of the
atem is almost always covered with a putrilaginous matter of a
red brown colour, and often of an insupportable foetidity. Is this
product the result of inflammation ? It is seen in women who die
of diseases unconnected with delivery. It is probably an alteration
or ramollissement of the internal membrane. We often find on the
internal surface of the organ a crowd of small greyish granulations*
or again a purulent matter, concrete, thick and yellow, which lines
the whole of the uterus. It may favour the absorption of the lochia,
or oppose their free discharge ; and when detached may be mistaken
for a portion of die tissue of the uterus, or be supposed a gangrenous
degenerescence of the organ that does not exist. The peritoneal
tunic of the uterus is crimpled, by the effusion of a sero-purulent or
genuine purulent matter. This sometimes bursts, when the uterus
appears uncovered, as the skin does after' the removal of the cuticle
by a blister. The alterations in the proper tissue of the uterus are
rare, except ramollissement or putrescence. In the most violent
it is not red or injected, and if pus form it is about the
cervix, or where the fibres are lax. Pus is constantly observed in
the cellular tissue, at the base of the broad ligaments or neck, or
in the veins or lymphatic vessels. If proper care be not taken in
dissection, it will be supposed abscesses of the proper tissue exist,
when the vessels are affected. The broad ligaments may contain
pus ; it is very rarely found in the uterine tubes. The ovaries may
be injected, tumefied, softened, or may contain a serous or purulent
matter; in the latter there is a singular friability of their tissue. The
pus more commonly is effused as in an abscess of the lung. In one
case abcess opened through the rectum, in another into the abdomen ;
and it is not very uncommon that the uterine appendages adhere to
the abdominal parietes, and it opens externally ; which was observed
by Ruysch, Delamotte, Desormeaux, and others."

Our author next adverts to suppuration of the veins
and lymphatic vessels of the uterus, so accurately described
by M. Dance, and inserted in an essay on .phlegmasia dolens
by the editor of this Journal in a late number. He main-
tains that inflammation of these vessels resembles phlebitis,
and was seen in three out of five cases of puerperal fever,

12 Critical Revieio.

and is nearly as constant as peritonitis. It may exist alone,
or be combined with the preceding alterations. It in general
does pass beyond the uterus, but sometimes extends to the
ovarian, hypogastric, and abdominal veins. In some cases
it is confined to certain veins, in others no part of the uterus
can be incised without pus being effused in drops from the
divided vessels. It is on the sides of the uterus and near
the broad ligaments that the vessels are usually inflamed.
It exists more rarely near the insertion of the placenta,
though M. Dance has asserted the coutrary. The lymphatics
are easily distinguished from the veins by their superficial
position on the sides of the uterus, by the tenacity of their
parietes, by their whitish and milky aspect, their communi-
cation with the peritoneum, their contiguity to the large
veins, their flectuosities, and swelling at different points.
These swellings often contain pus, and may admit a cherry
stone or bean. We must not confound these with abscess of
the substance of the uterus. The internal membrane of
these vessels is seldom changed, it maybe thick and yellowish.
It should be remembered that the lymphatics may take up
puriform, acrid, or foetid fluids after delivery, and become
inflamed. The presence of pus in the vessels, and its neces-
sary transmission through the circulation, causes rapidly an
evident palpable infection in the mass of blood, and a certain
number of phenomena which impress on puerperal fever an
especial character — a characteristic physiognomy. The fol-
lowing cases, taken from a hundred, furnish the proof :—

Case I. Puerperal Fever, with Uterine Phlebitis.— Vic-
toire Arno, set. 22, in excellent health, was delivered after
an easy labour. The fourth day she complained of rigors,
and pains in the hypogastric region, which were combatted
by an application of fifty leeches. 5th. — Abdomen tumid,
with extreme sensibility ; face red, animated, pulse hard and
frequent ; lochia and milk suppressed ; leeches repeated,
oleaginous draught and hip-bath. 7th. — Inflammatory symp-
toms succeeded oy profound prostration, face pale, eyes dim,
tongue dry, pulse small, frequent, and irregular ; articula-
tion difficult, rigors and involuntary evacuations. In the
evening there was delirium. 8th. — The body covered with
a viscid sweaty extremities cold, and death approaching ra-
pidly. Mercurial frictions, in the quantity of three ounces,
were used daily, calomel and hyociamus freely employed
with great attention during this last period. Autopsy, twenty-
four hours after death. — The internal surface of the uterus
was covered with a putrilaginous foetid matter, but was un-
changed ; the section of the organ presented the veins and
lymphatics filled with pus towards the base of the broad

M. Tounelle on Puerperal Fever. 13

ligaments, the ovarian and hypogastric veins were filled with
brown, fluid blood, without pus. The cavity of the perito-
neum contained a small quantity of sero-purulent fluid, and
some false membranes. The other organs were sound. In
this and many other cases, we are told, the symptoms were
at first inflammatory, but soon typhoid. There is a striking
analogy between the putrid puerperal fever of the ancients
and that caused by absorption of pus.

Cask II. Puerperal Fever, with Uterine Phlebitis, and
rapid progress. — The symptoms and treatment were as in
preceding case. Autopsy. — The uterus filled the pelvis, its
internal surface was coated with a putrid foetid sanies, the
neck of the organ, the broad ligaments, and the cellular
tissue under the peritoneal coat were infiltrated with pus,
as also most of the veins and lymphatics ; the tubes were
inflamed and reddened, the ovaries softened, the lymphatic
glands of the pelvis and loins very swollen. The peritoneum
presented no alteration, and the other organs were healthy.
When fever arises from the absorption of pus afforded by
external surfaces, several days elapse before the constitution
is affected, while in twenty-four nours the uterus is bathed
in pus, in the cases under notice, and the fever at its height.
The author offers some hypothetical opinions in explanation
of this fact.

Case III. Puerperal Fever, with Pus in the Uterine Lym-
phatics, and Thoracic Duct — considerable Tumefaction,
end Softening of the Ganglia of the Groins and Loins. —
A female, set. 31, of sound constitution, was delivered of
her first child after an easy labour, in August 25, 1829. The
same day she complained of rigors, pain in the hypogastric
and lumbar regions, and intense fever. M. Desormeaux
ordered a copious bleeding, and fifty leeches to the abdomen.
26th. — Pains excessive, suppression of the lochia, nausea,
redness of the face, and vivid febrile re-action : v. s. and
leeches repeated. 27th. — Prostration, delirium, meteorism
of abdomen, incontinence of urine and faeces, small and
irregular pulse ; death same day. Autopsy. — Pus was in-
filtrated between the folds of the oroad ligaments and uterus,
as also the lymphatics, near this situation. The lymphatic
ganglia of the groins and loins were the size of a pigeon's
egg, their texture greyish, and easily lacerable, and filled
with pus. The thoracic duct was the size of a swan's quill,
contained a yellow fluid, which was deemed pus. The peri-
toneal cavity contained about half a pint of flocculent
serosity, the rest was healthy.

Case IV. Suppuration of the Uterine Lymphatics, and
Thoracic Ductm—The patient was aged 21, was admitted in

14 Critical Review.

the eighth month of pregnancy, with oedema of the lower
extremities which was followed by rigors, vomiting, head-
ache, convulsions, and coma. These symptoms were re-
lieved by active remedies, and she was delivered of a living
child. The symptoms and treatment were now as already
described, with the exception of free mercurial inunction,
and blisters to the legs. Autopsy.— The internal surface of
the uterus was brown and softened superficially ; the cellular
tissue which unites the peritoneum to the body of the organ,
and the broad ligaments, were infiltrated with pus; most of
the lymphatics were filled with the same fluid, and were en-
larged about the latter parts of the organ. The lymphatics
of the abdomen were tumefied and of a milky colour ; the
thoracic duct was enormously distended, ana filled with a
fluid like pus (et remplie de pus en nature). The cavity of
the peritoneum contained a great quantity of puriform se-
rosity. The left ventricle (of the heart) was slightly
hypertrophied — the rest sound. The author has seen seve-
ral similar cases, but the limits of his essay preclude their
detail. He asks, was the pus formed first in the vessels ;
or was conveyed to them by absorption ? He thinks both
opinions may be sustained.

Case V. Puerperal Fever, with Inflammation of the
Hypogastric, Crural, and Iliac Veins. — A healthy female,
art. 28, was seized with severe symptoms of puerperal fever,
the third day after an easy delivery. The symptoms were
removed on the eighth day by copious local bleeding. She
was then seized with head-ache, noise in the ears, agitation,
prostration, and delirium. The thirteenth she experienced
riffors, and the abdominal pains returned with increased force.
Mercurial frictions were used daily, to the extent of two
ounces. She was relieved and appeared to convalesce, her
appetite returned, but slight fever remained. On the 22d
day the lower extremities were enormously infiltrated.—
29th. The abdominal pains, the vomiting and febrile symp-
toms returned, and disappeared no more. She died on the
31st. Autopsy. — The cavity of the peritoneum was filled
with pus, and lined with false membranes, which adhered to
the convolutions of the intestines. The uterus was healthy.
The hypogastric veins were considerably dilated, and filled
with a great quantity of thick greyish pus ; the two crural
veins, the iliac, and a part of the inferior cava contained a
dense clot, which contained pus in its centre — it obstructed
the course of the blood. The parietes of all these vessels
were thickened, unequal, aud reddish — the superior part of
the inferior cava, which did not participate in the alteration,

M. Tonnelle on Puerperal Fever. 15

was empty, white, and remarkably healthy. The other
organs were in a natural state.

The phlebitis of the large vessels, and the escape of those
of the uterus, were curious features in this case It was
evident that the phlebitis was developed in the commence-
ment of this tedious disease. In the preceding cases the
absorption of pus from the uterine vessels produced death
without any appreciable lesion of the tissue of organs ; but
hi the following cases the alteration of the fluids acted on
the solids, and caused lesions of the most formidable cha-
racter.

Case VI. Puerperal Fever, with Uterine Phlebitis, Per-
foration of the Stomach, and RamolissetnGnt of all the
Organs. — A patient, aet. 28, of a good constitution and ex-
cellent health, was delivered, after a favorable labour in
July, 1S29. The third day she complained of rigors and
abdominal pains, for which forty leeches were applied.
4th. — She had much vomiting and fever, the abdomen was
tumid and sensible, respiration anxious, pulse contracted and
very frequent, prostration and stupor ; leeches re-applied.
5th. — Delirium, vomiting, and she refused her drinks. Mer-
curial frictions, two ounces daily. 6th. — Delirium continual,
nice sunk, pulse small and frequent, coma, refusal of drinks,
death. Autopsy. —The peritoneal cavity contained a small
quantity of sero-purulent fluid. The uterus occupied the
whole pelvis, its, veins were filled with thick yellow pus,
which was poured forth from all points of the organ, but
especially its lateral parts ; towards the superior angles nu-
merous, large lymphatic* were, filled with pus, which were
prolonged into the, broad ligaments, and ascended with the
ovarian veins to the abdomen. The great curvature of the
stomach was pierced by three apertures, each as large as a
three franc piece, the edges irregular and ragged, remarks
ably soft, and of a brown colour, which gradually disap-
peared; some soft adhesions of recent formation united
these openings to the spleen and) left lobe of the dia-
phragm. The lungs were strewed with circumscribed nodo-
sities, analogous to hemoptoic engorgements. The brain,
the heart, the liver, and in general all the organs offered a
softness and extreme flaccidity, which contrasted singularly
with the fine develepement and rich coloration of the mus-
cular system. The influence of pus. in the whole circulation
was imprinted in strong characters on all the organs. The
disorganisation with perforation of the stomach appears a
cadaveric phenomenon, but the symptoms, observed during
life, the blackieb colour of the vicinal pasts, the ramollisse-
mati of all the other organs, and finally the adhesions which

16 Critical Review.

commenced round the perforations, exclude the idea to which
we refer. The ramollissements of dissimilar organs arose
from a deleterious cause exercising its baneful influence on
the whole economy, as in the pestilential diseases, in typhus,
in the poisoning of the blood by miasm, or in animals by
the injection of putrid matter in the veins.

Cask VII. — Puerperal fever, with peritonitis, and uterine
phlebitis ; gangrene of the lungs, softening of the mucous
membrane of the stomach, abscess of the leg.

Case VIII. — Puerperal fever, with uterine phlebitis, col-
lections of purulent matter in the psoas, iliac, and tricepy
muscles.

Case IX. — Puerperal fever, with uterine phlebitis, abcess
in the muscles of the leg, thigh, fore-arm, and knee-joint.

Case X. — Puerperal fever, with suppuration of the uterine
veins and lymphatics, abscesses in numerous muscles and
keee -joint.

Our author observes, that he could augment the number
of these cases, if he would extend his dissertation. Such
cases are not very rare, their progress is insidious, their
symptoms so obscure as to deceive the most vigilant ob-
server ; and they are described in many works, especially
those of Leake, 'Doublet, and even in the epidemics of Hip-
pocrates, and especially by M. Dance on a late occasion. Toe
reader will find the account of the last-named writer, $ts also
of Dr. Lee and Mr. Arnott, in an editorial article on phleg-
masia dolens, in this Journal, April, vol. iv. p. 325. The nar-
rator observes, that the collections of pus under notice differ
in many respects from common abscess ; these seldom affect
the substance of muscle, they occupy the cellular substance,
which separates organs from their fascia, or the subcutaneous
cellular tissue ; they form rapidly, and are accompanied by
violent pain. Common abscess is defined, but the collections
of pus are diffused, and not absorbed. In ordinary inflamma-
tion we do not see twenty points affected at the same time, and
with the same violence. Our author is of opinion that collec-
tions of pus in the muscles and joints in phlebitis are a direct
and immediate effect of absorption of pus, and its mixture
with the blood ; that the purulent molecules fix themselves
in the substance of muscle, and on the surface of serous
membranes, causing inflammation and rapid suppuration —
in effect as the mercurial globules, in the experiments of
M. Cruveilhier penetrated the muscles. We admit that
in nutrition there is a deposition of particles in the tissues,
and why not of heterogeneous particles likewise ? It is said
on the other side, that pus is deposited, in the cases before
us, without any local change ; out this is difficult to be a

M. Tonnetle on Puerperal Fever. 17

admitted. He lias not been sufficiently explicit on both these
hypotheses. The advocates of the latter hold that pus is*
deposited by the arteries or capillaries without inflammation ;
the former that pus is absorbed into the circulation, the
blood is vitiated, and when deposited in the delicate tissues
causes irritation, inflammation, and suppuration. Accord-
ingly it is said that the vascular organs are most commonly
and easily injured, as the lungs, liver, spleen, &c. or any
organ or tissue predisposed to disease.

Cases XI. and XII. — Typhoid fever, consecutive to ute-
rine phlebitis, terminating favorably.

Cass XIII. — Typhus after haemorrhage, death.

Cass XIV. — Typhus after delivery, gangrenous diathesis,
disorganization 01 the stomach.

Our author agrees with M. Desormeaux, that many cases
of puerperal fever depend on uterine phlebitis. He discusses
the question, whether puerperal diseases depend on deli-
very or are to be considered accidental. We need not follow
him in this intiuiry. He next describes ramollisseraent and
putrescence of the uterus, and details a Case XV., which
proved fatal in twenty-four hours. Two-thirds of the uterus
irere changed into a brown pulp, and offered no traces of
organization, He then inquires whether the disease depend
od gangrene or inflammation, or whether it be analogous to
the softening' of the brain, heart, and stomach. He concludes
by observing* —

M Snah a» the numerous alterations we have observed in puerperal
fewer, a disease extremely complex in its anatomical lesions, and
not less so in its symptoms."

The following table will give a general idea of the dif-
ferent alterations :— In 222 cases, the peritoneum was af-
fected in 193; the uterus and its appendages in 197; the
•Iterations of the uterus and peritoneum, were differently
combined in 165; those of the former were isolated in 29,
of the latter in 26. The alterations of the uterus Were,
ample metritis, 79; superficial ramollissement, 29; pro-
found ramollisseraent, 20 ; inflammation of the ovaries, 58 ;
with ulcers, 4 ;— total, 190.

Alterations in the uterine veins and lymphatics. There
was pus in the veins in 90; in the lymphatics in 32 ; in the
thoracic duct, 3 ; with inflammation and suppuration of the
lumbar and inguinal glands, 9; in all, 134; — total altera-
tions of the uterus, 324.

Suppuration of the veins with those of the uterus, 32 ; with
mmoilissement or putrescence, 11 ; with metritis and ramol-

vol. ▼. — no. 15. d

,18 Critical Review.

lissement, 5 ; with peritonitis without any other alteration,
34 ; entirely isolated, 8 ; — total, 90.

Suppuration of the lymphatics with the veins, 20 ; with
those of the uterus, 13; with ramollissement of the uterus
with suppuration, 6 ; with simple peritonitis, 3 ; without any
other alteration, 2 ; — in all, 44.

Inflammation of the ovaries with simple peritonitis, 29 ;
with alterations of the uterus, 27 ; with simple metritis, 8 ;
ramollissement, 7; suppuration of the vessels, 12; with all
the preceding alterations, 16; — in all, 62.

It appeurs from these tables, that the alterations of the
uterus, taken collectively, exceed those of the peritoneum in
a slight degree, but much exceed the la Iter if taken isolatedly,
and that both are frequently combined. Another remarkable
result is afforded by tnese tables, that in 134 cases there was
pus in the veins and lymphatics. M. Tonnelle concludes by
observing that the term peritonitis, or metro-peritonitis, is
not applicable to many or the alterations whicn he has de-
scribee!, while the term puerperal fever, though it does not
embrace all the disorganizations, it prejudices none of them,
and may be applied to all as a more general expression. He
adds a table or the diseases of the different organs, observed
in the cases, as pleurisy, pneumonia, &c, which were acci-
dental, and add nothing to the elucidation of the malignant
puerperal fever. He divides the fevers into inflammatory,
typhoid, anomalous or ataxic, and describes the semeiology
of each.

The inflammatory fever depends on phlegmasia of dif-
ferent organs, as the peritoneum, uterus, and its appendages.
The typhoid form, on alteration of the blood consecutive
to suppuration of the vessels; or concomitant with pu-
trescence or ramollissement.
The ataxic form, on lesion of innervation.
These we shall describe in a future number, and observe
that we have condensed these clinical reports very consider-
ably. All must agree that this is a most graphic and scien-
tific description ot the causes of the fatal diseases denomi-
nated puerperal fever ; and that science is deeply indebted to
the author. The solidists will learn here a lesson which
must convince the most sceptical amongst them of the
absurdity of ascribing fatal child-bed fever to peritonitis.
They will also learn the impropriety of sneering at the
opinions of those who have seen most of the disease, a list
of whom will be found in our review of Dr. Gooch's work,
and who maintained tjiat the disease was not peritonitis. The
disciples of Armstrong-, Hey, and Gordon, and they were
numerous, must now bite the dust; these men who cured the

M, Tonnelle on Puerperal Fever. 19

hospital puerperal fever by antiphlogistic measures, and who
denied its typhoid or putnd origin.

In the numerous cases of uterine phlebitis, there was but
one with oedema of the lower extremities, but not a word
about phlegmasia dolens, which is said to depend on uterine
phlebitis by a recent British writer. It is also evident, from
the facts adduced in the able essay which we have placed
before our readers, that the term peritonitis is fully as objec-
tionable as the derided denomination, puerperal fever. So
much for the Taunted advantage of our mania for morbid
anatomy, which of late excluded all other etiology with a
large portion of the profession in this empire.

III. — Observations on the Pathology of Venereal Affec-
tions. By Benjamin Travers, F. K. S., Senior Surgeon
to St. Thomas's Hospital. 8vo. pp. 75. London, 1830.
Longman and Co.

This little volume consists of an annual discourse, comme-
morative of the Hunterian Society, delivered by Mr. Travers
at the close of his presidency of that body. The object of
our author is au unsuccessful attempt to prove the identity
of gonorrhoea, or we would say venereal uretritis, and sy-
philis— an opinion maintained by Mr. Hunter, and denied by
almost all his successors. Mr. Travers has set little value
on modern works on the venereal disease, indeed he has not
condescended to notice one of them ; and probably as there
was not one that takes his view of the subject. He is also
forgetful of the arguments of those who are diametrically
opposed to bis conclusions. In a word, theTe is scarcely an
assertion he makes which cannot be easily refuted ; and it is
quite astonishing that a surgeon of his eminence could hold
such heterodox opinions. His fame and eminence as a sur-
geon stamp an authority on his work which will insure it a
general perusal ; and as his conclusions are calculated to lead
to the administration of mercury in common gonorrhoea — a
practice unnecessary and injurious according to the universal
voice of the profession, we cannot but examine his positions
with great attention.

Mr. Travers argues, that as certain forms of leucorrhcea

affect the husband, and cause purulent ophthalmia, there*

tore gonorrhoea is not referrible to toy specific quality of

matter. We admit the premises, but deny the conclusion.

10 Critical Review.

" During the year 1829 puerperal fevers were more grave and
frequent in the Maternite than tit any period since the establishment
of the hospital. They were epidemic in the months of January,
May, August, September, 'and October, but it is an error to suppose
cold and moisture have had more to do in causing them, because in
the preceding December there was little disease. The influence of
humidity admits of controversy, for though these diseases prevailed
in the cold and wet months, they were equally prevalent in the
spring, which was remarkably dry. The vitiation of the air of
hospitals, or moral affections, will not explain the difficulty, for the
disease appeared under opposite and varied conditions, when none of
these causes were discoverable ; it ravaged for a week, or month, then
disappeared, and again returned. The influence of constitution, antece-
dent disease, lactation, tedious or difficult delivery, and other causes
enumerated by authors, do not explain, the simultaneous appearance
of the disease in a large number of patients, for it often attacked
ten or twelve women in the course of a day or night. Contagion
does not explain the developement of those affections, inasmuch as
every form of puerperal disease was to be seen in one ward, and these
fevers of the worst form combined with slight affections. There was
nothing to warrant the belief of the influence of contagion. Women
in separate cells were as readily affected as those in the common
wards. The cause is not known."

Our author observes, that peritonitis is most commonly
observed in these cases, but it is a great error to think that
it is constantly present.

" In many cases there is no appreciable change in the peritoneum,
or it contains a small quantity of inodorous transparent citrine or
reddish serosity, the first effect of inflammation, and where it has
made the fugitive traces to disappear, or the simple result of the
contracted respiration and circulation in these diseases. It is in the
most violent and fatal cases, that the integrity of the peritoneum is
most constantly observed. It exists almost always when there is
alteration in the uterus, its vessels or appendages. The anatomical
characters of peritonitis are not always identical ; there may be slight
effusion into the abdominal cavity, or vivid redness on the convolu-
tions of the intestines, or effusion with lymph, false membrane, of

M. Tonnello on Puerperal Fever. 11

a yellowish colour ; or pas such as we see in a phlegmonous abscess,
lie peritoneum is mostly inflamed in the hypogastric region, and is
concentrated about the uterus ; or it is general, or affects certain
point*, as the surface of the liver, mesentery, and epiploon When
the last part, nodosities are presented, and perceived during life
across the abdomen ; sometimes the false membranes are brown, and
improperly styled gangrenous, an error which pathological anatomy
has done justice to, and need not be dwelt on, had not recent writers
on peritonitis revived it.

" Alterations of the Uterus. — These are simple inflammations of
the uterus and its appendages, suppuration of the veins and lympha-
tic vessels, and ramollissement or putrescence. The anatomical
characters of hysteritis are found in its internal membrane, external
or peritoneal tunic, and proper tissue. The internal surface of the
uterus is almost always covered with a putrilaginous matter of a
red brown colour, and often of an insupportable foetidity. Is this
product the result of inflammation ? It is seen in women who die
of diseases unconnected with delivery. It is probably an alteration
or ramollissement of the internal membrane. We often And on the
internal surface of the organ a crowd of small greyish granulations,
or again a purulent matter, concrete, thick and yellow, which lines
the whole of the uterus. It may favour the absorption of the lochia,
or oppose their free discharge ; and when detached may be mistaken
for a portion of the tissue of the uterus, or be supposed a gangrenous
degenerescence of the organ that does not exist. The peritoneal
tonic of the uterus is crimpled, by the effusion of a sero-purulent or
genuine purulent matter. This sometimes bursts, when the uterus
appears uncovered, as the skin does after' the removal of the cuticle
by a blister. The alterations in the proper tissue of the uterus are
very rare, except ramollissement or putrescence. In the most violent
metritis it is not red or injected, and if pus form it is about the
cervix, or where the fibres are lax. Pus is constantly observed in
the cellular tissue, at the base of the broad ligaments or neck, or
in the veins or lymphatic vessels. If proper care be not taken in
dissection, it will be supposed abscesses of the proper tissue exist,
when the vessels are affected. The broad ligaments may contain
pus ; it is very rarely found in the uterine tubes. The ovaries may
be injected, tumefied, softened, or may contain a serous or purulent
matter; in the latter there is a singular friability of their tissue. The
pus more commonly is effused as in an abscess of the lung. In one
case abcess opened through the rectum, in another into the abdomen ;
and it is not very uncommon that the uterine appendages adhere to
the abdominal parietes, and it opens externally ; which was observed
by Ruysch, Delamotte, Desormeaux, and others."

Our author next adverts to suppuration of the veins
and lymphatic vessels of the uterus, so accurately described
by M. Dance, and inserted in an essay on .phlegmasia dolens
bjr the editor of this Journal in a late number. He main-
tains that inflammation of these vessels resembles phlebitis,
and was seen in three out of five cases of puerperal fever,

10 Critical Review.

" During the year 1829 puerperal fevers were more grave and
frequent in the Maternite than at any period since the establishment
of the hospital. They were epidemic in the months of January,
May, August, September, land October, but it is an error to suppose
cold and moisture have had more to do in causing them, because in
the preceding December there was little disease. The influence of
humidity admits of controversy, for though these diseases prevailed
in the cold and wet months, they were equally prevalent in the
spring, which was remarkably dry. The vitiation of the air of
hospitals, or moral affections, will not explain the difficulty, for the
disease appeared under opposite and varied conditions, when none of
these causes were discoverable ; it ravaged for a week, or month, then
disappeared, and again returned. The influence of constitution, antece-
dent disease, lactation, tedious or difficult delivery, and other causes
enumerated by authors, do not explain, the simultaneous appearance
of the disease in a large number of patients, for it often attacked
ten or twelve women m the course of a day or night. Contagion
does not explain the developement of those affections, inasmuch aa
every form of puerperal disease was to be seen in one ward, and these
fevers of the worst form combined with slight affections. There was
nothing to warrant the belief of the influence of contagion. Women
in separate cells were as readily affected as those in the common
wards. The cause is not known."

Our author observes, that peritonitis is most commonly
observed in these cases, but it is a great error to think that
it is constantly present.

M. Tonnelle on Puerperal Fever. 11

a veflowish colour ; or pus such as we see m a phlegmonous abscess,
lie peritoneum is mostly inflamed in the hypogastric region, and is
concentrated about the uterus ; or it is general, or affects certain
points, as the surface of the liver, mesentery, and epiploon When
the last part, nodosities are presented, and perceived during life
across the abdomen ; sometimes the false membranes are brown, and
improperly styled gangrenous, an error which pathological anatomy
has done justice to, and need not be dwelt on, had not recent writers
on peritonitis revived it.

" Alterations of the Uterus. — These are simple inflammations of
the uterus and its appendages, suppuration of the veins and lympha-
tic vessels, and ramollissement or putrescence. The anatomical
characters of hysteritis are found in its internal membrane, external
or peritoneal tonic, and proper tissue. The internal surface of the
uterus is almost always covered with a putrilaginous matter of a
ted brown colour, and often of an insupportable foetidity. Is this
product the result of inflammation ? It is seen in women who die
of diseases unconnected with delivery. It is probably an alteration
or ramollissement of the internal membrane. We often find on the
internal surface of the organ a crowd of small greyish granulations,
or again a purulent matter, concrete, thick and yellow, which lines
the whole of the uterus. It may favour the absorption of the lochia,
or oppose their free discharge ; and when detached may be mistaken
for a portion of the tissue of the uterus, or be supposed a gangrenous
degenerescence of the organ that does not exist. The peritoneal
tunic of Hie uterus is crimpled, by the effusion of a sero-purulent or
genuine purulent matter. This sometimes bursts, when the uterus
appears uncovered, as the skin does after' the removal of the cuticle
by a blister. The alterations in the proper tissue of the uterus are
very rare, except ramollissement or putrescence. In the most violent
metritis it is not red or injected, and if pus form it is about the
cervix, or where the fibres are lax. Pus is constantly observed in
the cellular tissue, at the base of the broad ligaments or neck, or
in the veins or lymphatic vessels. If proper care be not taken in
dissection, it will be supposed abscesses of the proper tissue exist,
when the vessels are affected. The broad ligaments may contain
pus ; it is very rarely found in the uterine tubes. The ovaries may
be injected, tumefied, softened, or may contain a serous or purulent
matter; in the latter there is a singular friability of their tissue. The
pus more commonly is effused as in an abscess of the lung. In one
case abcess opened through the rectum, in another into the abdomen ;
and it is not very uncommon that the uterine appendages adhere to
the abdominal parietes, and it opens externally ; which was observed
by Ruysch, Delamotte, Desormeaux, and others."

10 Critical Review.

nature and treatment of the disease, and endeavours to ex-
plain the cause of this confusion. He next observes, that it
u not in a few months or years, or even an epoch, we
can arrive at correct views of the nature and treatment of a
disease ; and cites the opinions of Sydenham on the nature
of epidemics, and the influence of season on diseases. He
then informs us, that his object on the present occasion is
to give a succinct and faithful account of the puerperal fevers
that prevailed in the hospital, and during the period already
mentioned. He says—

" During the year 1829 puerperal fevers were more grave and
frequent in the Maternite than at any period since the establishment
of the hospital. They were epidemic in the months of January,
May, August, September, *and October, but it is an error to suppose
cold and moisture have had more to do in causing them, because in
the preceding December there was little disease. The influence of
humidity admits of controversy, for though these diseases prevailed
in the cold and wet months, they were equally prevalent in the
spring, which was remarkably dry. The vitiation of the air of
hospitals, or moral affections, will not explain the difficulty, for the
disease appeared under opposite and varied conditions, when none of
these causes were discoverable ; it ravaged for a week, or month, then
disappeared, and again returned. The influence of constitution, antece-
dent disease, lactation, tedious or difficult delivery, and other causes
enumerated by authors, do not explain, the simultaneous appearance
of the disease in a large number of patients, for it often attacked
ten or twelve women m the course of a day or night. Contagion
does not explain the developement of those affections, inasmuch as
every form of puerperal disease was to be seen in one ward, and these
fevers of the worst form combined with slight affections. There was
nothing to warrant the belief of the influence of contagion. Women
in separate cells were as readily affected as those in the common
wards. The cause is not known."

Our author observes, that peritonitis is most commonly
observed in these cases, but it is a great error ta think that
it is constantly present.

M. Tonnelle on Puerperal Fever. 1 1

a yellowish colour ; or pus such as we Bee in a phlegmonous abscess.
The peritoneum is mostly inflamed in the hypogastric region, and is
concentrated about the nterus ; or it is general, or affects certain
points, as the surface of the liver, mesentery, and epiploon When
the last part, nodosities are presented, and perceived during life
across the abdomen ; sometimes the false membranes are brown, and
improperly styled gangrenous, an error which pathological anatomy
has done justice to, and need not be dwelt on, had not recent writers
on peritonitis revived it.

" Alterations of the Uterus. — These are simple inflammations of
the uterus and its appendages, suppuration of the veins and lympha-
tic vessels, and ramollissement or putrescence. The anatomical
characters of hysteritis are found in its internal membrane, external
or peritoneal tonic, and proper tissue. The internal surface of the
nterus is almost always covered with a putrilaginous matter of a
red brown colour, and often of an insupportable foetidity. Is this
product the result of inflammation ? It is seen in women who die
of diseases unconnected with delivery. It is probably an alteration
or ramollissement of the internal membrane. We often find on the
internal surface of the organ a crowd of small greyish granulation8>
or again a purulent matter, concrete, thick and yellow, which lines
the whole of the uterus. It may favour the absorption of the lochia,
01 oppose their free discharge ; and when detached may be mistaken
for a portion of the tissue of the uterus, or be supposed a gangrenous
degenerescence of the organ that does not exist. The peritoneal
tunic of Hie uterus is crimpled, by the effusion of a sero-purulent or
genuine purulent matter. This sometimes bursts, when the uterus
appears uncovered, as the skin does after' the removal of the cuticle
by a blister. The alterations in the proper tissue of the uterus are
very rare, except ramollissement or putrescence. In the most violent
metritis it is not red or injected, and if pus form it is about the
cervix, or where the fibres are lax. Pus is constantly observed in
the cellular tissue, at the base of the broad ligaments or neck, or
in the veins or lymphatic vessels. If proper care be not taken in
dissection, it will be supposed abscesses of the proper tissue exist,
when the vessels are affected. The broad ligaments may contain
pus ; it is very rarely found in the uterine tubes. The ovaries may
be injected, tumefied, softened, or may contain a serous or purulent
matter; in the latter there is a singular friability of their tissue. The
pus more commonly is effused as in an abscess of the lung. In one
case abcesB opened through the rectum, in another into the abdomen ;
and it is not very uncommon that the uterine appendages adhere to
the abdominal parietes, and it opens externally ; which was observed
by Ruysch, Delamotte, Desormeaux, and others."

2b Critical Review.

and frequently does communicate a constitutional disease, bearing'
incontestible evidence of a poison analogous in general character,
but milder in degree, more limited in the sphere of its operation, and
from this and other circumstances capable for the most part of
being distinguished from that of syphilis. The signs of distinction
are becoming artificial and obscure, and the bases of them will in all
probability be eventually overlooked and forgotten. Further, a sore
of any kind formed on the genitals of a person whose blood circu-
lates the gonorrhoea! poison, Incomes capable by its secretion sui
generis, the type of the poison, of communicating syphilis, viz. of
raising a vesicle or pustule, followed by a circumscribed, excavated,
hard edged ulcer, which, if not restrained by the action of mercury,
is disposed to extend in depth and breadth, and in short destroy sub-
stance indefinitely, which is the local characteristic of the most
active syphilitic poison.

" From what has been stated I derive the following conclusions —

" 1. That absorption does not take place from sound surfaces, and
therefore the poison of gonorrhoea, if it be one, is not developed in
the system. In the very rare? cases in which constitutional symp-
toms follow gonorrhoea in the absence of a visible sore, I refer their
existence to absorption from an ulcer in the urethra.

"2. That gonorhooeal matter, though apparently the simple secre-
tion of an inflamed surface, is capable, when absorbed into the sys-
tem, as from sores, of acting as a poison in the production of con-
stitutional symptoms.

"3. That the venereal poison is essentially one ; for analogous
secondary or constitutional symptoms succeed to analogous primary
sores, in systems previously healthy.

"4. That the distinction between the gonorrhoea! and syphilitic
orders of symptoms, primary or secondary, is demonstrative of the
difference between the secretions of a system previously healthy,
and the secretions of a system already charged with a poison." —
p. 27.

It may be interesting to contrast the conclusions of an-
other distinguished surgeon with these before us, and select
those of Mr. Lawrence, which were lately delivered at
St. Bartholomew's Hospital. He candidly acknowledges
that we know nothing of the poisons of gonorrhoea or syphilis,
in the abstract, but merely by their effects, which are totally
different ; and therefore he is of opinion that the causes of
these diseases are essentially different. He refers to the
antiquity of the former, which was described for several
centuries previous to the introduction of syphilis. He dis-
sents from Mr. Hunter's opinion, " that the difference of the
two diseases arises from the difference of the texture to
which they are applied, that is, if the poison is applied to a
mucous surface, as the urethra or vagina, it causes gonor-
rhoea ; if applied to the cuticle, it causes a primary sore."

Mr. Travers. on the Venereal Disease. 27

If this were true, women should almost invariably labour
under gonorrhoea, as the virus is applied to the vagina, but
they are as frequently attacked with syphilis. Again, men
should be invariably attacked with the latter, as the virus is
applied to the prepuce or glans penis; but gonorrhoea is
much more common — indeed, according1 to Mr. Travers, in
the proportion of 30 to 1. Another objection to this hypo-
thesis is, the identity or continuity of the epidermis and
mucous membrane, and if this be the fact, the idea that the
same virus produces an ulcer on one part and purulent
gonorrhoea] discharge on another part of the same tissue,
is absurd. Other arguments might be easily adduced to
overturn the opinion, but enough has been said to convince
the most sceptical. If gonorrhoea be the result of simple in-
flammation in an unbroken surface, and become a poison
when ulceration occurs, and contaminate the system, then
it follows that in the numerous cases of ulceration of the
vagina, secondary symptoms ought to occur, which every
man acquainted with obstetricy or female complaints knows
is not the case. Our author reiterates his arguments in sup*
port of the preceding conclusions, and adds, that " a chancre
is never produced by matter which is the production of a
simple sore ;" but a gonorrhoeal sore, contraeted by a poi-
soned system, that is, one charged with gonorrhoeal poison,
may communicate the second order of venereal symptoms,
or those denominated syphilitic. When the blood is' con-
taminated by the poison of gonorhoea or syphilis, fresh
primary sores are infectious. This is totally at variance
with the preceding statements. We are next favoured with
the following pathology, which appears to us purely con-
jectural:—

" A man having syphilis in a secondary form, provided he be free
from all affection of the genitals, communicates no taint to his pro-
geny, more than to his wife. But a healthy wet nurse getting a
■ore nipple from suckling a pocky child, and secondary symptoms in
consequence, communicates the constitutional disease to the foetus
of which, during the existence of these symptoms, she becomes
pregnant. The evidence is thus complete, the blood of the mother
being contaminated, that the embryon which is nourished by it par-
takes of the poison, although in the absence of genital sores the party
cohabiting is quite beyond the sphere of its influence. As the seminal
fluid of a syphilitic male does not infect his paramour, so neither
does the milk ai a syphilitic nurse infect the infant which she nou-
rishes ; the natural secretions, by a most happy economy, however
they may deviate from a healthy standard, not being in any case a
vehicle of this poison. Had it been otherwise — had not sores been
the exclusive medium of infection — how incalculably would the sum
of human misery have been augmented ! " — p. 33.

28 Critical

Mr. Lawrence and Mr. Hey of Leader (Mad. Chir, Trent*
vol. vii.) are of opinion, that a husband labouring under se*»
eondary syphilis, without sores on the genitals, may infect
his wife and progeny. This has been the opinion of the
best obstetric writers, and the following case offers the
strongest evidence of the fact:— -A gentleman, set. 26, of a
sanguine temperament and scrofulous habit, had an herpetic
eruption on the prepuce, after impure connexion. His
medical attendant diet not consider it syphilitic ; however,
to be on the safe side, he administered mercury. The sores
healed, and in a few months sore throat appeared. Alterative
doses of mercury, with the free use of sarsaparilla* were
employed until health was restored. About six months
from the disappearance of the genital ulcers, the patient
consulted his medical attendant whether he might marry
with safety, having no symptom of the disease. He was
told he might do so with safety. Soon after his marriage,
his wife was attacked with sore throat, decidedly syphilitic,
which withstood a free use of mercury and sarsaparilla.
She was also pregnant. At the seventh month and a half
she was delivered of a dead and putrid infant, the cuticle
desquamated in many parts. She was a woman beyond sus-
picion. She#was advised to continue the use of Plummer's
pill and sarsaparilla, which she did for nearly six months,
while she was pregnant, but again and again sbe had. dead
infants between the seventh and eighth months. She always*
fek the motion of the infant to the seventh month, but then
it gradually declined, and soon ceased. . In January 1828, we
were consulted in this case, as also Dr. Joseph Clarke, the emi-
nent physician to the Dublin Lying-in Hospital. He was of
opinion that the husband and wife laboured under ill-cured sy-
hilis,and that mercury and sarsaparilla ought to be employed
y him and his wife. This he stated by letter, ill which we
fully concurred, but with an impression on our mind, that as
the lady had missed a catamenial period and was probably
pregnant, that she would again lose her infantas before. This
turned out to be the case, and we then advised a separation
between the parties for a few weeks, while both should give
mercury and sarsaparilla a. fair trial. This a,dvice was strictly
complied with, and the result was that the lady bad a living'
child in 1829, and is in the last month of pregnancy at this pe-
riod. It was a curious coincidence that this lady was always
r regnant during the use of mercury until after her delivery in
828, when she observed a marital separation as already
stated. The case also controverts an opinion of Mr. Aber-
nethy, that the foetus in utero is unaffected by syphilis until
after the sixth month ; and indeed it is not a little surprizing'

Mr. Travers om the V&mettaL Disease.

that <o tttttBei* a ohysielegist could have arirrod at soeb a
coaolueiori. Dr* Hamilton, hag long taught that ill cared sy-
philis in either parent wat a oaose rf premature labour after
the seventh month, and Dr. Beatty of Dublin, has published a
valuable paper in confirmation of the opinion, wbieh We haw
noticed elsewhere ia describing: this kind of labour.

" The infant, if bom aRve, is weak and delicate, and seldom Eves
-it generally dies in the womb ; and its death is marked by a shiver-
ing fit, cessation of motion in it, and flaccid breasts. This sort of
pregnancy frequently occurs to the same woman. A course of mer-
cury before conception is the only remedy, when a venereal taint is
suspected ; and it must be used by both parents. Trans* Dub. CoL
of Phys. 1824, v. 4. AlsoDrs. Joseph Clarke and Hamilton. I
have lately met with two cases of this disease : one woman miscar-
ried at the seventh month, with a copious discharge of amniotic fluid*
and a putrid infan£ ; she had lost six children in this way, and three
at the eighth month — According to Dr. Beatty of Dublin, both parents
must use a full course of mercury ; and- unless a large quantity be
taken, a cure will not be effected. His papers, in the transactions of
the Dublin College of Physicians, vol. 4, p. 24, are worthy of se-
rious perusal. He informs us, that, the Dublin physicians have held
this opinion since 179S. Dr. Hamilton inculcated it in 1619 and
1820. After taking a profcer quantity of mercury* healthy infanta
will in future he produced. — manual qf Midwifery, p. 183.

Mf. He? alto attest* to the fact that a woman whd k in-
fected with syphilis through the medium of the breast from
the mouth of a syphilitic infant, may have successive infants
born with the disease. It is also well known that infants'
with ulcers on the lips may communicate primary sores to
several women in succession. Mr. Travers asserts that the
milk of a syphilitic nurse will not infect the infant which she
nurses. Dr. Blundell stated in his valuable lectures, the case
of an infant which was under the care of Dr. Lowder, and
was twice cured by mercury ; but the symptoms recurring a
third time be suspected the infection was drawn from the
mother's milk ; the child was weaned and cured without fur*
ther difficulty. Mr. Lawrence, on the othar hand, relates a
ease which warrants a different conclusion. A nurse was in-
fected through the breast, and had secondary syphilis ; but
her own infant which continued to derive its nutriment from
the sound breast was not affected. When we consider the
influence of depraved milk id women affected with scrofula
phthisis, hepatic disease and irregular passions on infants, it
if Dot easy to deny that a woman contaminated with syphilis
must produce milk very injurious to the infant. The influ-
ence of the diet of a nurse on the infant is too well known to
require illustration ; neither need we refer to the writings of

90 Critical Review.

those who ascribe rickets and various other diseases to dete-
riorated milk. But to return to our author ; we find him stat-
ing his opinions on the treatment of venereal disease/and we
are happy to meet him once more a practical surgeon and li-
berated from the reveries of hypotheses. His remarks on the
use of mercury are highly important, and bear the strongest
evidence of extensive and faithful observation. He proceeds
as follows : —

" Mercury is its specific remedy, but neither the condition of parts
nor of constitution is at all times ready to receive the remedy.
Hence its incautious and premature employment aggravates instead
of curing the disease. The two states absolutely prohibitory of its
immediate use are, 1st. Excessive inflammation. 2d. Excessive
weakness. In the first, the ordinary methods of resolving acute
inflammation are to be employed, as blood-letting and purgative
salts with antimony, and if much pain and irritation be present,
Dover's powder, hemlock, or opium in any suitable form and re-
quired dose. In the second state, the sarsaparilla extract dissolved
in the decoction is the most appropriate ; indeed an invaluable
remedy. If a higher tonic however be required, the extract, with
the decoction and compound tincture of yellow bark, are more to be
depended upon than the quinine in my experience ; but a free allow-
ance of nutrient food, wine, or porter, is most of all important.

" Whoever has witnessed in three successive cases the efficacy of
mercury in arresting acute syphilis must, nolens volens, be a believer
in its absolute controul over the disease. At least if he refuse his
testimony to its power, he should be prepared to deny that of quinine
and arsenic over the paroxysms of an intermittent. That the active
inflammation may be arrested by continued antiphlogistic measures
combined with rest and soothing applications, I do not deny ; but
the object is to save structure and to induce healing; and I am
bound to maintain that mercury is the only remedy entitled to confi-
dence on this ground. This is sufficient apology for having recourse
to its aid, without inquiring if it renders the secondary symptoms
more or less probable, or should they follow, more or less obstinate
or severe. It is obvious, however, that the early cure of the primary
ulcer is the object most desirable to be accomplished, as well in
reference to what may follow, as to that which is in hand." — p. 41 .

" If ulceration is making rapid strides, the better plan is to in-
troduce the remedy by the skin in frictions, night and morning ; and
if the system resists its entrance, to aid the process by the pill. In
cases of great debility, I begin with the oxymuriate or the mercury
and chalk, as a test of the capability of the system to bear it. The
anodyne, if need be, and the tonic of coarse should be continued.
In most cases mercury and bark or sarsaparilla are exhibited with
excellent effect at the same time. In ulcers of the throat fumiga-
tions are of the greatest efficacy. I often depend upon them alone
in weakly persons, while other medicines are directed to the sup-
port of the system. They effect an improvement more rapid in

Mr. Travers on the Venereal Disease. 31

•

these cases than the constitutional action alone. I should say gene-
rally, that to render the action of mercury powerful over the disease,
ind to preserve the system from its injurious operation, the support
of the patient's strength becomes the principal object of the surgeon's
attention. Indeed, the successful treatment of the disease turns
chiefly upon his knowledge and consistent pursuance of this indi-
cation.

"The treatment of venereal ulcers, primary or secondary, re-
quires the same attention to the prevailing character as other sores,
and nothing more than this. Their excessive irritability is best
allayed by a saturated watery solution of the extract of opium. The
calomel and lime water wash, with or without mucilage and opium,
the dilate lunar caustic, and nitric acid washes, are the best cleansers
and stimulants to healing action. The mercurial ointment with
opium is also a beneficial application. In sloughy ulcers of the
throat the linimentum aeruginis is most effective." — p. 43.

He adverts to the recent plan of treating syphilis without
mercury, and concludes that the mercurialists and their op-
ponents discourse of very different things. He then returns
to the treatment.

He enumerates the secondary eruptions, and observes that
the profuse and wasting action of mercury k never called for,
that we know little of its mode of action, except as a stimu-
lant at the same time to the arterial and absorbent actions,
and consequently a purgative to the whole secretory system.
Our author next considers the injurious effects of a combina-
tion of the venereal poison and the action of mercury upon
the system, subject to additional aggravation from scrofula
and the operation of cold and intemperance. The cachexias
thus derived are a most formidable class of diseases. The ef-
fects of mercury are the predisposing, and colds and dram
drinking the exciting causes of these diseases.

The only "mercurial eruptions," according to Mr. Travers,
are eczema and impetigo rodens,and the immense number as-
cribed to this cause by many, are almost invariably subjected
to the use of the medicine which is supposed to induce them.
The emaciation, pallor, fetor, the deep, eroding, foul ulcers,
the worm eaten bones of the whole cranium, the sloughing
of the posterior fauces, of the soft and hard palate, the fall-
ing in of the nose, the loss of the genitals, the agonizing
night pains, the severe hectic, and offensive sweats, &c.
are best relieved by infusion (decoction,) of sarsaparilla in
lime water. " Its power," says Mr. Travers, " is the most ex-
traordinary, more so than of any other drug with which I am
acquainted. To regard it as inert, as a mere diluent, or an
inoffensive nutrient, is eithera proof of very limited experience

S3 Cratioml Review. \^j

or a ray pnjadiced observation .J* We fuitr *gre« with ow : «fe

author on the last point, and are convinced were the me- - 21

dicine properly prepared, we should have heard much less of —4»

its failure. Mr. Travers next describes a peculiar and for- -s

inidable form of venereal, which we .shall place before the :~^

reader in his own words. - ^ a

- ■-)

":1

*' I shall avail myself of this opportunity to notice a peculiar and
very formidable distemper, arising from the unlimited intercourse - r
of young and delicate girls of scrofulous temperament, chiefly with ^r
fbreign sailors, many of them lascars or men of colour, frequenting' ^
the brothels in the vicinity of the Bast and West India and London. : _
Docks. The district of St. Catherine's (until recently converted into *~
docks) was the most notorious for the propagation of this pestilence,
and a place in that quarter called ' Swan Alley,' has given the sore
that appellation in St. Thomas's Hospital. The subjects of the dis-
ease are almost exclusively females. I remember only one instance
of a boy similarly affected, in whom the disease went unchecked to
a :fatal termination. The girls are slender, with very thin fair skins,
and often light hair, and generally from 15 to 25 years of age. They
have been a few months before decoyed by the Jews who keep these
houses, and are systematically on the' look out in the great neighbour-
ing thoroughfares. The girls, newly arrived in London, while in
search of lodgings until they procure places, become victims to these
miscreants.

" They receive the visits of as many men as there are hours in
the day, and are supported on scanty food and abundance of guv.
Their visiters do not always restrict themselves to natural connection.
When they become constitutionally ill, their keepers send them to
the hospitals. The Magdalen ward of St. Thomas's is seldom with-
out one or more of them. They have been only two or three dars
in the house when the character of the sore displays itself; for oy
reason of the previous illness they are rarely detained in their occu-
pation long enough for the ulcer to have assumed its genuine fea-
tures. It is a circumscribed irregular ulcer with an inflamed blunt
edge, usually situated at the lower angle of one labium, or in the
cleft of the nates. When the sore inflames, its edge acquires a dark
crimson polour to some distance around ; the surface is covered with,
a deep, tenacious, ash-coloured slough, and it extends so rapidly,
as to be increased visibly from day to day. It is generally attended
with excessive unremitting pain, a very rapid and contracted pulse,
great paleness of the surface, total failure of the appetite, and great
depression of strength and spirits. It is, in fact, acute gangrenous
inflammation. Where they recover, no secondary symptom of lues
appears ; nor is the disease in any degree contagious, The treat*
ment now adopted seldom fails to arrest it, unless admitted in a very
advanced stage, as after the sloughing process has been some time
established, when the devastation is truly terrific. In addition to the
slough of the pudendum, I have seen the entire lower opening of

Mr. Travers on the Venereal Disease. 33

N*« deprived of its soft parts. The girl dies typhoid with a dry
U tongue, and is first delirious, t then comatose.

" When the pain is severe, and the disc qf inflammation strongly
■wked, blood-letting is beneficial to both. I usually apply tint
toddened in a saturated solution of the extr. opii. over this a poultice
d linseed meal, and cover the whole with a fomentation flannel.
This seldom fails to relieve, if not to remove the pain. The exposure
<* the sores and the change of dressings much augment it ; the con*
tamed application of warmth and moisture as much abate it. After
desring the bowels with castor oil, I give a draught of camphor
jakp -with a drachm of ether, and ten minims of the tinct. opii.
rrery four hours ; and half a grain of opium additionally, if the pain
» rery urgent. If the slough is fast, and the ulcer extends, the
*B£aee is washed freely with the strong nitric acid, and it is remark-
able that very shortly afterwards the girl expresses great relief. The
London treacle poultice I likewise find an excellent application,
covered by the fomentation flannel. The object to be looked to for
Erecting the application, is the colour of the surrounding skin; when
uus pales, the dilute nitric acid lotion, ten drops to an ounce of
water, is the best application. Fresh eggs and milk, and as the sto-
nach acquires tone, a mutton chop, and from ten to twelve ounces
of port wine daily, are an appropriate support. The occasional re-
petition of the oil or the common enema should not be neglected
under the habitual employment of opium.

" The strong acid must be repeated each third or fourth day, till
the whole surface granulates. When the girl sleeps and takes nou-
rishment, notwithstanding an immoderately quick pulse, she does
wefl ; and the sore, when once clean, heals rapidly under the dilute
acid lotion and simple cerate. The bark is useful at this period, but
very secondary to the opium, wine, and nutriment. The former
should be gradually reduced. A lotion of the chloride of lime and
caustic soda, three' drachms of the first and one drachm of the last
to half a pint of water, acts with magical celerity in 'clearing the
sloughs in many cases ; but I have not found it so applicable or effi-
cacious dozing the stage of acute inflammation, as when it is sub-
dued. I once saw mercury rubbed in to rapid salivation, with
manifest acceleration of the destroying process, and the vital powers
were further greatly sunk by it. I have seen the inflammation begin
after the taking of half a dozen blue puis, one every night and morning,
which had been prescribed upon the girl's admission for a sore, which
was then small and indolent, in ignorance of its character and ten-
dency/*—p. 53.

The last topic illustrated by our author is the origin of
the venereal disease. This being a point of no practical uti-
lity, we shall pass it by, and content ourselves by referring
the reader to the original work. We cannot conclude with- *
out observing that the revival of an exploded opinion, — the
identity of gonorrhcea. and lues, will make very few converts ; '

VOL. V.— NO. 25. F

34 * Critical Review.

and we regret that a man of Mr. Tracers' just celebrity
should be the champion of such a doctrine, as his name may
influence some few to employ mercury in the cure of go-
norrhoea, a practice contrary to that of the most eminent
tnen in our profession.

IV. — A Treatise on Deformities; exhibiting a Concise
View of the Nature and Treatment of the principal Dis-
tortions and Contractions of the Limbs, Joints, and
Spine ; illustrated with Plates and Wood-cuts. By Lionel
J\ Beale, Surgeon. * 8vo. pp. 248. Five Plates. London,
1830. John Wilson.

' (Coottoued from Vol. IV. p. 488.)

After a minute and graphic description of the symptoms
and progress of lateral curvature, our author details the
anatomical characters of the disease : —

" Anatomical investigations have ascertained that Hie bones are
seldom diseased in lateral curvature. In those cases which originate
in very early life, they are usually soft and spongy, and lose their
shape by pressure, but in the most frequent instances of this variety
of curvature, we may consider it as established, that the bones are
never altered in structure, nor is their figure changed but in old, and
permanent deformities. The muscles, and ligaments, are found con-
siderably altered both in form and texture : they are stretched and
elongated on the convexity of the curves, while on the opposite side
they ' are contracted, as is also the skin. When the deformity
has been of long continuance, the muscles are found wasted
pale or yellow, and flaccid. When the ribs have for many
years been placed in close apposition, or ride one over the other, the
intercostal muscles will be nearly obliterated, this will also be the
case with other muscles, which have been totally inactive for many
years. In some old cases, the tuberosity, the neck and head of some
of the ribs have been found completely anchylosed with the transverse
processes, the whole being enveloped in bony matter and confounded
together.

" The fibro-cartilages are always reduced in thickness in the con-
cavity of the curves. Mr. Shaw states that he never found them
diseased, but that they always retained their peculiar firmness and
elasticity : this is true with regard to lateral curvatures dependant
principally on muscular debility. In cases resulting from the, action
of scrophula, or chronic inflammation of the intervertebral substance*
it will be found softened and distended, its texture infiltrated with a
gelatinous fluid, as the analogous structures are found in similar af-
fections of the knee, or other articulations.

" The influence of this distortion on the animal economy can be
readily imagined by considering the anatomy of the parts implicated.
The functions of the lungs and heart will suffer according to the

Mr. Beale on Deformities of the Limbs, $c. 35

degree of the deviation of theparieties of the thorax. The large vea-
eeb, tiie thoracic duet, and great sympathetic nerves, follow the
course of the spine, and make the same carves. The viscera of the
abdomen are also displaced and often compressed* bat they suffer less
m general, than in curvature forwards."— p. 151.

The next section is on " curvature forwards," or on the
excurvation of other writers. This disease is almost as
common as the last, takes place at all ages, though more
rarely after 40, but from very different causes. It is common
in ricketty children, and is caused by inflammation of the
fibro-cartiiages, or muscular debility. The bent back of
rheumatic and old persons is an example familiar to all. In
this form of spinal disease a few or the whole vertebras may
be affected.

" When the malady depends on muscular debility, the curvature
wiQ be most extensive: when it results from intumescence of the
fihro-caitilages, there will be first a projection of only one or two
spinous processes, but the disease will soon extend above anpl below
the original seat, and if not arrested very considerable curvature will
ensue. In cases arising from the disease of bone, fewer vertebrae are
concerned, and we consequently have, from this cause, rather an an-
gular projection, than a curvature.

" In many instances, where muscular debility is the principal
cause, there have been no symptoms leading to any suspicion of ap-
proaching mischief, but as in lateral curvature from the same cause,
the incipient deformity will first draw attention to the spine. Even
where there is disease in the fibre-cartilages, or the bones, the pain is
often so obscure, that the nature of the complaint is not suspected,
until one or more of the spinous processes project backwards.'1 —
p. 153.

Our author next describes " angular projection," " curva-
ture backwards," and then considers " the influence of mus-
cular action as a cause of spinal distortions, disease of the
fibro-cartilages, disease of the bones," and lastly, the treat-
ment of these diseases. It is impossible to condense the
language of the author, and it would be as unjust as un-
reasonable to expect that we should reprint it. Every page
of the work is replete with important information, and no
practical man can be without it. The machinery which is
employed for the cure of deformities is so ingenious, that
we cheerfully place representations of it before pur readers,
and this is the main point for the consideration of practi-
tioners. Mr. Beale does not attempt to delineate a tenth
part of the machinery invented for the cure of deformities,
but still gives a very judicious selection. Much unjust pre-
judice prevails among British surgeons with regard to the

Critical Review.

use of machinery in diseases of the spine and other deformi-
ties, but these means have been long employed in the nu-
merous establishments on the continent, and indeed in this
country, by Dr. Harrison, with great success* It is easy to
conceive the dreadful consequenoes which must ensue from
the injudicious application of machines to certain forms of
spinal disease. The ill consequences of mechanical treat-
ment were so frequently observed, that in this country we
had almost abandoned the use of machinery altogether. But
all these means may be beneficial when applied to proper
cases, and of this fact the strongest evidence is afforded by
the success of Dr. Harrison, Mr. Amesbury, and Mr. Beale.
The representations of the different machines by Mr. Beale,
and his concise yet comprehensive description of the dif-
ferent cases to which they are applicable, supply a great
desideratum in the medical library. The first wood-cut re-
presents the plan proposed by Ambrose Pare in 1649, for
the cure of excurvation. The patient was placed on his
face on a table, and napkins passed und£r nis arms, and
round his loins. Traction was then made by both assistants
without violence, for unless such v extension was made, resti-
tution was not to be hoped for, from the faster knitting of
.the vertebrae. Then the prominences were forced in with
the hands, or two pieces of wood were applied after the
manner delineated. After the vertebrae were restored, splints
or plates of lead were applied, but in such a manner as not
to press on the spinous processes, but only on the sides.

Mr. Beale next alludes to the various instruments invented
for the treatment of spinal distortion, and gives a compara-

Mr. Beale on Deformities of the Limbs, $c.

fire view of the value of each of them. He informs us of
the complexity of those of France ; and that form used for
stretching the spine is illustrated as below. The contortions
and inflections of the spine are pressed on both night and
day; and a figure is represented undergoing the process,
which is effected by machinery concealed in the frame of
the bed. The lateral bracings are intended to operate on
the respective curves of the spine.

Our author states that all the advantages of this complex
machinery will be effected by a screw, similar to that of
the tourniquet acting on a bandage round the pelvis, the
head being fixed in one of the common head-pieces of the
inclined plane, or by an apparatus similar to that represented
in the sketch.

The following wood-cut is copied from Delpech, and re-
presents a contrivance by whicn the muscles of the arms,
chest, spine, with many of those of the lower limbs, may
be exercised by convalescents froih spinal diseases, where
the weight of the upper parts of the body cannot be allowed
to press on the spine. The inclination of the machine with
the horizon may be altered to suit the strength of the indi-
vidual using it. When perfectly horizontal, the exertion
required to move forward is trifling ; by raising its inclina-
tion the exerfcise will be rendered more difficult, and better
adapted to increase the powers of the muscles.

Critical Review.

" The machine ia supported en a basis, which moves on four toI-
lere, in a grooved platform. The frame on which the cord is
stretched, is connected with this basis by a pivot, by which the
angle formed with the horizon may be altered. Below the axis
there is a windlass in the frame which increases the tension of the
cord. The car is mounted on the tense cord by two pulliea, one an-
terior and one posterior ; its aides cannot be supported on the sides of
the frame, without impeding motion, which renders it necessary to
maintain the equilibrium, by the action of the lower extremities.

Mr. Beale on Deformities of the Limbs, $c. 39

" Below is a figure practising this exercise and in the act of ad-
eending. The cord is borne down by the weight of the body, the
knees are pressed against the sides of the frame to maintain the equi-
Khrinm of the car, the body is raised by the exertion of the arms pul-
ling at the side rails. This exercise obviously calls into play most of
the muscles of the arms, chest, and spine, together with many of
those of the lower limbs/' — p. 242.

Two other wood-cuts are given, illustrating the instru-
ments for deformities of the feet— three of varus, valgus,
and pes equinus; and two of angular projection of the
spine.

We now take leave of our author with .every sentiment
of respect, and have only to reiterate our favourable opi-
nion of his work We can truly state that it is compiled
with proper attention to the value of its separate parts;, it
is at once scientific and practical ; and presents a condensed •
and accurate sketch of tne many points on spinal and other
deformities, to which every man must frequently have occa-
sion to refer in practice.

ORIGINAL COMMUNICATIONS.

I, — Ethics of the present Period. By M. Rtan, M. D.

" I will never set politicks against ethicks, for true ethicks are but as a handmaid
to divinity and religion."— Bacon.

An obstinate adherence to an unsuccessful method of treat-
ing a disease inust be owing to a high degree of self-conceit
and a belief in the infallibility of a system. It has been the
cause of the death of thousands, ratients ought to be in-
dulged in every thing consistent with their safety ; and if
they are determined to try an improper or dangerous medi-
cine, a physician should refuse his sanction, but he has no
right to complain of his advice not being followed.. A phy-
sician is often at a loss in speaking to nis patients of their
real situation, when it is dangerous* A deviation from truth
is, in this case, both justifiable and necessary. It often hap-
pens that a person is extremely ill, but he may recover if.
he is not informed of his danger. Again, a man may not
have settled his affairs, though the future happiness of his
/kmily depends on his making a settlement. In such cases
die physician may apprize the friends, and occasionally the
patient, of the necessity of the arrangement and disposal .

40 Original Communication*.

of his property. In all dangerous cases, the real situation
of the patient should be communicated to his nearest rela-
tives, as it gives them an opportunity of calling other assist-
ance, if they think it necessary. The patient is not to be
deserted when his case is despaired of ; it is as much the
duty of a physician to alleviate pain, and to smooth the
avenues of death, when inevitable, as to cure diseases ; his
presence and assistance as a friend may be both agreeable
and useful where his skill is of no further avail. In some
cases we should caution the indiscreet enthusiasts among the
clergy against too much zeal, as they often terrify the pa-
tient and contribute to shorten a life which might otherwise
be saved. Medical men should never involve their patients
in private and professional quarrels, in which the sick have
no concern. All personal feelings should be forgotten in
consultations, the good of the patient ought to be the chief
and only consideration. The quarrels of the faculty, when
they end in appeals to the public, generally hurt the con-
tending parties, discredit the profession, and expose it to
ridicule and contempt. Nothing can justify the refusal to
consult but want of temper, nor can such circumstances as
the university where a person has taken a degree, " or whe-
ther he had any degree at all, justify the refusal." This
assertion, I may observe, is at variance with the usages of
the profession, though society has sanctioned it. Fellows
of the College of Physicians refuse to meet graduates of all
the British and foreign universities in consultation, until
admitted into the College. But of this .hereafter. It be-
comes young practitioners to be particularly attentive to the
propriety of their behaviour when consulting with their se-
;^k>rs. Besides the respect due to age, these are entitled to
a particular deference from their longer and more extensive
experience.

The revolutions, indeed of medical hypotheses and systems
are so quick, that an old and a young physician seldom
reason m the same way on subjects of their profession ;
although the difference be sometimes rather apparent than
real, wnen they use only a different language to express
sentiments essentially the same. But it generally happens.,
that the speculations which principally engage the attention
of young physicians, seldom in any degree affect their prac-
tice ; and therefore, as they are in a great measure foreign
to the business, they should never introduce them in me-
dical consultations. They shew equal want of sense and
good manners, when they wantonly take opportunities of
expressing contempt for opinions as antiquated and exploded,
in which their seniors have been educated, and which they

Dr. Ryan on Ethics of the Present. Period. 41

hold as firmly established. A little reflection might teaeh
them, that it is not impossible but in the eourse of a few
years, their own most favourite theories may be discovered
to be as weak and delusive as those which have gone before
them ; and this should lead them to consider how sensibly
they may be hurt themselves, when they find those idols of
their youth attacked by the petulant ridicule of the next
generation; when, perhaps, they are arrived at a time of
life when they have neither abilities nor temper to defend
mem.

Dr. Gregory defended the necessity of medical men being
versed in all the branches of the healing' art, and concludes
by observing, " Every department of the profession is re-
spectable, when exercised with capacity and integrity. I only
contend for an evident truth, either that the different branches
should be separately professed, or, if one person will pro-
fess all, that he should be regularly educated to, and tho-
roughly master of all. I am not here adjusting points of
precedence, or insinuating the deference due to degrees in
medicine. As a doctor's degree can never confer sense, the
title alone can never command regard ; neither should the
want of it deprive any man of the esteem and deference due
to real merit. If a surgeon or apothecary has had the
education, and acquired the knowledge of a physician, he
is a physician to all intents and purposes, whether he has a
degree or not, and ought to be respected and treated accord-
ingly. In Great Britain, surgery is a liberal profession. In
marry parts of it, surgeons or apothecaries are the physicians
in ordinary to most families, tor which trust they are often
well qualified by their education and knowledge; and a
physician is only called where a case is difficult, or attend&F
with danger. There are certain limits, however, between
the two professions, which ought to be attended to : as they
are established by the customs of the cotintry, and by the
rales of their several societies. But a physician, of a candid
and liberal spirit, will never take advantage of what a nominal
distinction, and certain privileges, give him over other men
who, in point of real merit, are his equals; and will feel no
superiority, but what arises from superior learning, superior
abilities, and more liberal manners. He will despise those
distinctions founded in vanity, self-interest, or caprice ; and
will be careful that the interests of science and of mankind
shall never be hnrt, on his part, by a punctilious adherence
to formalities.

Much stress has been laid on the formality of a physi-
cian's dress, but there is no reason in preferring one garb to

vol. v. — jro. 25. •

42 Original Communications,

another. In some cases there is great impropriety m having'
any distinguishing formality in dress and manners.

Die attendance should be in proportion to the urgency
and danger of the disease. A patient or his friends have a
curiosity to know the nature of the medicine prescribed,
which it is often very improper to gratify ; but other cases
occur in which it may be proper to acquaint the patient with
the nature of remedies, as tiie peculiarities of cpnstitution
require great attention, both as to the quantity and quality of
certain medicines. Such are the chief of the duties of medical
men, according to the amiable and revered Dr. Gregory ;
the observance of which cannot fail to promote the honor
and dignitv of the profession. He included many minor
topics, which need not be recorded at the present period.

There are certain duties belonging to the learned profes-
sions which are supreme, and which no individual and no set
of men can either, for themselves or their successors, vio-
late, renounce, or neglect, without substantial injustice.
These duties, so far as they relate to physicians, are com-

?rised in!the oaths required by the Universities, Colleges of
'hysicians, and iu one of the Colleges of Surgeons, in this
empire. The substance 6( these oaths is that proposed by
Hippocrates nearly 2000 years ago, and the oath was for-
merly administered in all Universities in which medicine was
taught, to those wKo were created doctors, and to those who
were licensed to practise by the Colleges of Physicians. The
oath required by the Edinburgh University is in the follow-
ing words. After an invocation of the Deity, the graduate
pronounces these words : " Turn porro artem medicam caute,
caste, probeque excercitaturum, et quoad potero omnia ad
cegrotorum corporum salutem conducentia cum fide procu-
raturum quae denique inter medendum visa vel audita silere
convenit non sine gravi causa vulgaturum. Ita presens spon-
dentiadsit numen.* " To practise physic cautiously, chastely
and honorably; and faithfully to procure all things conducive
to the health of the bodies of the sick ; and lastly, never,
without great cause, to divulge any thin? that ought to be
concealed, which may be heard or seen during professional
attendance. To this oath let the Deity be witness.'9 I be-
lieve no similar oath is required by the Universities of Ox-
ford, Cambridge, Dublin, Glasgow, Aberdeen, or Saint
Andrew's, or by any of the Colleges of Physicians or Sur-

feons, except those of London. The Royal College of
hysicians requires the following promise from its members,
fellows, and licentiates, and prescribes a code of moral sta-
tutes:— "Dabis fidem te observaturum statuta Collegii, aut
mulctas tibi contra facienti irrogandas prompt e persolu-

Dr. Ryan on Ethics of the Present Period. 43

turum, omniaque in medicina facienda, pro viribus facturum
in honorem Collegii et reipublicee utilitatem." " You faith-
fully promise that you will observe the statutes of the Col-
lege, and that you will promptly discharge all fines imposed
on you for the breach thereof, and. that you will do every
thing in the practice of medicine for the conservation of
health, to the honour of the College, and the utility of the
realm." The following are the Moral and Penal Statutes
of the Royal College of Physicians of London in 1830: —

De Conversatione Morali et Statutis Pcenalibus.

1. Nullus sive Socius, sive Candidatus, sive Permissus
fuerit, Socium aut Candidatum aut Permissum ignorantisd in
arte sua vel maleficii nomine, nisi coram judicibus legitimis
accuset, aut coram quibusvis afficiat contumeliis. Si quern
contra fecisse Praesidenti et Censoribus aut eorum raajori
parti ionotuerit, prima vice solvat quatuor librae, secunda
vice duplicetur mulcta ; qu6d si tertio quis similiter dilique-
rit, et modo praedicto convictus fuerit, si quidem Socius aut
Candidatus fuerit, expellatur e Societate nostra, vel e Can-
dida torn m ordine; sin idem sit e Permissorum numero, solvat
decern libras. Quam quidem decern librarum mulctam quo-
tiescunque idem Permissus ejusdem delicti modo preedicto
denuo convictus fuerit, ipsi irrogandam statuimus.

2. Nollus Socius, Candidatus, vel Permissus salutatione
officiosa, vel animi benevoli obtentu, opem medicam ultro
offerat, nedura submioistret seero cuihbet, quern Medici
cojusvis, sive Socii, sive Candidati, sive Permissi, cure
commissum esse cognoverit, et ad quern non accersitus
fuerit

3. Si quis autem malitire hujusmodi convictus fuerit,
prater ignominiae notam quam isti (quantum in nobis est)
inari vouimas, quadraginta solidos mulctetur a Presidente
et Censoribus.

4. Si quis paciscatur cum Pharmacopolis de aliqua pretii
parte ex meaicamentis preescribendis percipienda, si sit
Socius aut Candidatus, et hujusce delicti arraesidente et
majore parte Sociorum in Comitiis majoribus sive ordinariis
sive extraordinarus prosentium convictus fuerit, e Societate
nostra, vel e Candiaatorum ordine, expellatur.

5. Sin Permissus delicti hujusce a JPraesidente et Censo-
ribus, aut eorum majore parte, convictus fuerit, decern libras
qootiescunque id admiserit, mulctetur.

6. Medicus quisque, sive Socius, sive Candidatus, sive
Permissius fuerit, singulis suis schedulis, in quibus ©gri cu-
ratio prescribitur, diem prescriptionis, ®gri nomen, et * su

44 Original Communication*.

denique nominis litems initiates adscribat ; nisi causa intermit
a Pnesidente et Censoribus ap probanda.

7. Si p lures Medici curationis gratia convenerient, consul-
taddum est summa modestia, et non nisi semotis arbitris a re
alienis. Nee quisquam praescribat, irod ne inmiat quidein,
quid agendum sit, coram eegro, aut adstantibus, priusquam
junctis consiliis inter ipsos Medicos curandi tnethodus fuerit
constitute. Sin autem Medici in diversas iverint sententiaa,
ita ut in eandem medendi methodum consentire nequeant,
summit tareen prudentia et moderatione se gerant ; eorumque
dissentionem ita, yt tam ©gro quam ainicis ejus quam mini-
mum molestise pariat, ordinarius medicus segro aut adstanti-
bus signified.

8. Qui leges has consultandt non observayerit, et a Prse-
sidente et Censoribus aut eorum majore pafte convictus fuerit,
quinque libras mulctetur.

9. Nullus denique Medicus, sive.Socius, sive Cabdidatus
sive Permissus, consilium ineat de rebus Medico propriis, in
civitate Londino et intra septem milliaria in circuitu ejusdem
nisi cum aliquo £ Sociorum vel Candidatorum Tel Permisso-
rum nuraero, sub pc&na quinque librarum quotiescunque hu-
jusce delicti a Preesidente et Censoribus, aut eorum majore
parte convictus fuerit.

10. Omnes mule tee quee per statuta nostra irrogatse fue-
rint illicd solvantur.

1. — No fellow, candidate, or licentiate shall accuse a
fellow, candidate, or licentiate of ignorance or mala praxis
of his art, unless before legitimate judges, or before those
concerned. If it be known to the president and censors, or
the majority of them, that any person shall so act, he shall
pay £4. for the first offence, and the fine will be doubled
for the second ; but if he transgress a third time, and be
convicted in the manner mentioned, if he is a fellow or can-
didate he shall be expelled from our society, or from the
order of candidates ; and if he is a licentiate he shall pay
£10. and we ordain,- that licentiates shall be fined a like
sutn for every similar transgression.

2. — No fellow, candidate, or licentiate shall afford medical
aid or prescribe for a patient whom he knows is under the
care or another physician, whether fellow, candidate, &t
licentiate, and to whom he has not been duly called.

3»— If any one be convicted of this vice, besides the known
ignominy which we wish him to suffer, he shall be fined £2.
by the president and censors.

4. — if any one shall bargain with apothecaries for any
p*r centage on prescriptions, if a fellow or candidate, and
it convicted in the manner before meutioned, he shall b&

Dr. Ryan an J£thics of the Present Period. 45

expelled from the fellowship, or from the order of candi-
dates.

5. — If a licentiate, he shalL be fined £10. for each offence.

6.— Every physician, whether fellow, candidate, or licen-
tiate, shall inscribe his initials, the date of the prescription
and name of the patient, on every prescription, unless some
cane intervenes which shall be approved by the president
and censors.

7. — If many physicians be called to a patient, they are to
consult with great modesty, and not without the absence of
witnesses unconnected with the affair. Nor shall any one
prescribe or insinuate what is to be done before the sick or
attendants, before he has stated his method in consultation.
But as medical men have different opinions, so that they can-
not agree in the plan of treatment, they are to conduct them-
selves with the greatest prudence and moderation ; the ordi-i
aary attendant snail signify to the sick and attendants their
dissention, so that it may appear as trifling, and as slightly
disagreeable to the patient or his friends as possible.

8. — Whoever will not obey these rules of consultation,
and be convicted by the president and censors, shall be
fined £5.

9. — Finally, no physician, fellow, candidate, or licentiate
shall consult in the city of London, or within seven miles
thereof, unless with a fellow, candidate, or licentiate, under
a penalty of £5. as often as convicted by the president and
censors, or majority of them.

10.— All fines imposed by these statutes must be paid.

It is much to be regretted that the great bulk of the pro-
fessions—University graduates in medicine, surgeons, and
apothecaries, have no opportunity of being acquainted with
these admirable statutes, or have nothing simitar to inform
them of the etiquette they owe to each other. In printing
these statutes and placing them before the medical public,
I hope and trust I may add to the honor and dignity of the
profession. The majority of the tenets maintained in them
are highly conducive to the fame of every class of medical
men ; and if duly observed would extinguish that base and
unprofessional and ungentlemanly behaviour, which of late
has characterised too many medical practitioners, and hfta
debased and degraded the profession. The disputes and
calumnies of medical men have been so frequent, so violent,
so notorious of late, that the character of the, profession is
Wered in the estimation of the public to a degree un-
equalled in the history of medicine. Actions against medical
men by their contemporaries, or their patients, are no\v
amongst the most frequent in our courts of justice. This

46 Original Communications.

degeneracy of the profession is not confined to this country, it
extends throughout Europe, and has even crossed the Atlantic
Ocean ; and it arises from the exclusion of medical ethics
from the prescribed courses of professional education. This
malignant spirit pervades every branch of the healing art,
the physicians, the surgeons, and the apothecaries are the
most prominent of litigants in our courts of justice. What
a falling off is here ! If we turn to private practice, we find
those uninfluenced by the statutes under consideration, vitu-
perating' each other, " by look, gesture, and suspicious
silence, ' and often without any disguise ; and the injured in*
dividual has no remedy afforded him by the body to which
he belongs, and which gravely promises him rights, privi-
leges, immunities, and protection in the discharge of his
vocation ; his only remedy is an appeal to the laws of his
country. But the fact is, our Colleges of Surgeons and
Companies of Apothecaries have no power to protect their
members; nor is there any country in the world in which the
laws relative to the practice of the medical profession are so
imperfect and defective as in the British empire.

But to return to the subject immediately under considera-
tion, I have to detail the oath required by the Royal College
of Surgeons in this city, which is as follows : — "You swear
that while you shall be a member of the Royal College of
Surgeons in London, you will observe the statutes, bye-laws,
ordinances, rule's ana constitutions thereof; that you will
obey every lawful summons issued by order of the court of
assistants and examiners of the said college, or of either of
them, having no reasonable excuse to the contrary : that you
will pay such contributions as shall be legally assessed upon
and demanded of you : that you will demean yourself honor-
ably in the practice of your profession ; and to the utmost of
your power maintain the dignity and welfare of the college —
So help you God." It is to "be feared that some surgeons
* forget to demean themselves honorably in the practice of their
profession, more especially as their rivals, the apothecaries,
or as they are most unclassically denominated " the general
practitioners," are under no such obligation. From the open
violation of our laws relative to the practice of medicine, the
surgeons act as physicians, and must become apothecaries in
self-defence ; the apothecaries act as physicians and sur-
geons, while the chemists and druggists, without any medi~
cal education whatever,act as physicians, surgeons and apo-
thecaries ; and as to quacks, they are allowed to flourish to
an illimitable extent, and to destroy more than the sword,
famine and pestilence united. Such is a true picture of the

[ 47 ]

medical profession in the greatest nation upon . earth«-**in a
country pre-eminent for literature, science, and the arts.—
Such is the state of medical practice in England.

II. — Case of chronic disease of the Liver.
By 6. Q. Wabd£n, Esq. Surgeon,' Limehouse Fields.

Ma. Charles Warden, of Woolwich, aged thirty-three, in
the year 1821, when in Paris, was attacked with hepa-
titis, from which period he was never to say healthy, yet
was capable of very active employment ; but from the time
of his indisposition a gradual increase of the size of the
abdomen took place in the right side, and in the begin-
ning of the year 1826, there were evident symptoms of
some morbid growth of some of the abdominal viscera ;
at the latter part of the same year, the respiration became
considerably impeded, attended with great* debility. I saw
him in this state, and on examination conld distinctly trace a
tumour of considerable size, extending from below the ensi-
form cartilage into the right hypochondriac region, but
could not distinguish any fluctuation. Further advice was
suggested, and Sir Astley Cooper was consulted, who pro-
nounced the case to be " either ny da t ids or abscess/' ana re-
commended the empl. hydra rg. c. ammon. to be applied over
the region of the tumour ; and inf. ros® c. mag. sulph. 3
table spoonsful to be taken two or three times a day ; and
when the skin became red over the tumour, the same was to
be punctured; after continuing this mode of treatment for
some time, no change in the symptoms was manifest, except-
ing the debility was not so great. — Mr. Fitzpatrick, sur-
geon of the Royal Artillery, was requested to see the esse, who
ordered the removal of the plaster, and directed the system to
be put under the influence of mercury. The unff. hyd. fort,
was rubbed over the region of the tumour, and some mer-
curial preparation taken inwardly, (I believe the pil hyd.
submur comp.) until ptyalism was excited, from which treat-
ment he considerably improved and gained comparative
health and strength, but no apparent decrease of the size of
the tnmour. He continued in this state with occasional slight
indisposition, until 8th of October, 1829, when very serious
symptoms made their appearance; about a pint ana a half of
coagulated blood was discharged from the mouth whilst
wslkmir in his garden, without any pain being previously
felt or any particular feeling, excepting that of a sudden

48 Original Communications.

nausea. Medical assistance was immediately sent for and
refrigerating medicine administered, pulse 100 intermittent,
great debility, lOth^— About 10 or 12 ounces of blood were
again ejected, not so oongealed and of arterial colour, pulse
varying from 120 to ISO. 11th.— V.S. to5xij.i2th.— No return
of nsematemesis, 1 3th. — Pulse 100, regular, debility not so
great, difficulty of keeping1 the bowels relaxed. 14th.— Left his
room and came down stairs ; when sitting on his sofa, he com-
plained of a sensation of something having suddenly burst
in the abdomen, which immediately produced syncope; Mr.
Fitzpatrick was immediately sent for, and on examination
the tumour could be distinctly traced, and the abdomen had
assumed a regularity of form. An operation was proposed,
and a trochar was introduced midway between the superior
spinous process of the ilium and the last inferior costa, and
two pints of serous fluid were extracted. A second opera*
tion was proposed to be performed in the tinea alba, a little
above the symphysis pubis, but on account of the diversityof
opinion of the medical attendants respecting its propriety, it
was deferred. From the drawing off of the fluid, he gradually
improved so much so as to be able to take exercise (the sys-
tem being kept up by stimuli) until the 28th of March last,
6 p.m. when walking with Mrs. W. he requested her tolead him
home, as he was losing his recollection, and expired the fol-
lowing day, at the hour and day he prognosticated he should
die.

Necropsy of the body 32 hours after death.-~On examining
the contents of the thorax, no particular morbid structure was
to be observed, except that there was more fluid than usual
in the pericardium, and the heart rather of the larger size, but
on inspecting the abdomen, a tumour of about six inches in
diameter, the coat of which was of cartilaginous structure,
lay directly under the scrobiculus cordis, and was firmly ad*
herent by cellular tissue to every part in contact with it. The
adhesions to the diaphragm and stomach, were so firm as
required great care in separating them, several tendinous
bands extended from the tumour to the peritoneum of the
left hypochondriac region ; dissecting down to the car-
diac orifice of the stomach to the oesophagus, for the pur-
pose of removing the intestines, the most beautiful adhesions
were seen. After the removal of the intestines, which were
to all appearance as if they had been macerated, the tumour
was found to occupy the situation of the left lobe of the
liver, and which seemed to be absorbed in the tumour. The
peritoneal coat of the liver covered the tumour. The right
lobe, the lobulous spigelii and gall bladder were perfectly

Mr. Fischer on the Cure of Hydrophobia. 49

healthy, the kidneys were healthy, the spleen was much en-
larged and hepatized ; the tumour displaced the whole of the
abdominal viscera. It is now in the possession of Mr. Fitz-
patrick, Royal Artillery.

Query. — What was the tumour that contained the fluid,
extracted in the operation, and what could ha^e become of
the coats of the tumour, as no traces of the same were to
be found in the post mortem examination ?

Query. — What could be the contents of the tumour now in
the possession of the gentleman alluded to ?

Query. — Whether the tumour was the cause of death,
after so long a period had elapsed ?

Query. — Whether the stimuli taken tended to shorten ex-
istence 5 or whether if these stimuli had not been taken the
patient would have sunk from exhaustion ?

It is worthy of observation that previous to his last indis-
position, he was extremely abstemious, but subsequently the
appetite became voracious, and the inclination for stimulating
beverage excessive, although the smallest quantities seemed
to satisfy him, and he never took the same article a second
time.

IV. — Observations on the cure of Animal poisons by the lo-
cal application of table salt, and probably of hydropho-
bia*— By The Rev. J. J. O. Fischer, formerly aMissionaiy in
South America, communicated by Dr. Sutton, of Greenwich.

Thb newspapers teeming of late with most unfortunate cases
of this horrible malady,! beg leave to state that since 1803,
I often wag determined to make known a simple remedy
against the bite of mad dogs, or any rabid animal, provided
the position be true, that, whatever cures venomous serpents*
bites, will also cure the bite of mad dogs, as the general
opinion is, for instance from the late use of the South Ame-
rican Plant, Mikania Guaco, which is held to be an antidote
for serpents* bites, consequently from that general opinion
physicians have lately administered it as an antidote to hy-
drophobia, but the trial has failed.

As to cure die bite of serpents in South America, where I
was a missionary amongst the Indians for a series of ten
years, viz. at Surinam, Berbice, and Demerara, between the
4th and 7th degree of latitude, I never heard there of the Mi-
kania Guaco, but I actually and effectually cured all kind of
rerjr painful and dangerous serpents9 bites, after they had been

rot. v. — so* 25. h

50 Original Communication*.

inflicted for many hours, for immediately after I had applied
my remedy , the pain subsided and the patient calmed, which
remedy was nothing else than common table salt, m. soda,
and I Kept it on the place or wound, moistened with water,
till all was healed within several days, without ever any
bad effect occurring afterwards.

I for my part never had an opportunity to meet with a
mad dog3 or any person who was bitten Jby a mad dog, I
cannot therefore speak from experience as to hydrophobia ;
but that I have cured serpents* oites always without fail, I
can declare in truth.

If then any antidote for serpents' bites will cure hydro-
phobia, my specific salt, viz. common kitchen or cooking
salt, which is in every poor man's house, will undoubtedly
cure hydrophobia.

That this is not merely a supposition or opinion of my own,
I beg leave to adduce the writings and trials of others.

From a paragraph in the " Courier, July 27th, 1827, taken
from Dr. Sulzer's Analysis of Dr. Urban'* remarks on the
rabid virus, in Hufeland and Osann's German Medical
Journal, among six methods, which Dr. Urban employed
and by which he had performed many cures, this is the most
preferable.

" A thick pledget soaked in any saline solution is to be
applied to the wound and retained by a bandage, and if there
be no wound, but merely a mark of the tootb, without tear-
ing of the skin, be visible, the same pledget is to be applied
and kept on every one of such spots or marks, as on every
wound.

" The solution is to consist of kitchen salt, as this salt is
preferable, as producing the greatest humidity. One ounce
or one and a half ounce of salt is to be put into one pound of
plain water : the wound is to be kept constantly humid with
the salt.

" The lint is to be renewed and soaked twice a day, and
the patient be ordered to wet the pledget every two hours,
and even the places be washed by the patient, which had
been bitten, so as never to forget the spot, in case of any in-
dication of a relapse, as itching and pain should manifest
themselves.

" Dr. Urban is neither a partisan of excision nor of caute-
rization, the method, recently and successfully opposed by
Dr. Schneemann.

" He also disapproves of the different modes of treatment
by means of belladonna, mercury, &c."

A case of salt being an antidote to mad dogs' bites, in the
county of Kent, in our immediate neighbourhood occurred,

Mr. Fischer on the Cure of Hydrophobia. 51

as a Sunday Paper, " The News," London, July 29th 1827,
states the following.

" From the Kent Herald and Morning Herald, July 28th.
A friend of ours was some years since bitten by a dog, which
a few hours afterwards died raving mad.

*• Immediately upon receiving the bite, he rubbed salt for
some time into the wound, and in consequence never ex-
perienced the least inconvenience from the bite, the saline
qualities of the salt having evidently neutralized the venom,
and prevented in all probability a melancholy death by hy-
drophobia.*9

Having quoted the above journals, I shall now inform the
reader of what caused me tojtry and apply salt to serpents'
bites. It is a page of the late Bishop Loskiel's, (with whom
I was personally acquainted,) in his History of the Missions
of the Moravian Church in North America, which says, as
far as I recollect, that at least among some tribes, they were
not at all alarmed about the bites of serpents, having always in
use such a sure remedy as salt, for the cure of them so much
so, that they would suffer a bite for the sake of a glass of
rum.

It was this, that induced me to try the cure of venomous
bites with salt and the trial has exceeded my expectations.

Thousand times since 1803, the first year of my residing in
England, have I wished to see this remedy applied, aud
generally introduced and made known, and often have I ap-
plied to eminent practitioners in London, to insert my ex-
perience in their journals, but in vain, to my sorrow.

I hope and trust that I now shall succeed by beginning
with making it known in public print, through the press, and
shall never rest, until some physicians, or any other sort of
men, will take up my proposals, to give salt a general trial,
all over the kingdom.

One should suppose it impossible or incredible for medical
professors and practitioners, to neglect the trial of this
simple remedy. But it is so, they did lend a deaf ear to my
conversations and letters, therefore I shall now apply not
only to those I had applied to again, but also to the whole
public, and surely some few will be struck with my informa-
tion, and make use of it. It is not only to others we may do
good, but even to ourselves and our families as we are all
liable to be afflicted with such a great misfortune, as the bite
of a mad dog, and to die of its horrible consequences.

P. S. — The advice of killing all dogs, is neither practicable,
nor necessary ; apply salt to man and dogs, the bitten and
the biter, all will most probably be well.

A most extraordinary instance, an English Journalist said,

52 Original Communications.

some years ago of the fatal consequence of hydrophobia,
has, occurred at Bombay.

" A gentleman was bitten by a dog, and in his parlour he bit
a friend, who came to see him ; both lingered some time and
died."

" Can no one immortalize himself by discovering a
remedy ? Government indeed should offer a princely sum
for a cure of it."

V. — The Navus Mat emus (or Mark of the Mother), cured

by Vaccination.

TO THE EDITOR OF THE LONDON MEDICAL JOURNAL.

Sir, — Should this relation of a case, exemplifying the fur-
ther benign extension of the property of vaccine lymph, be
favoured by your approbation and insertion in a work so
pre-eminently conducted and widely circulated as the Lon-
don Medical and Surgical Journal, it will be highly gratify-,
ing and sensibly felt by your obedient and obliged servant,

John Marshall.
53, Jenny n Street, June, 1830.

The history of the following case relating to surgical prac-
tice, and connected with vaccination, may, it is hoped, be
deemed worthy of communication. It proves an important
fact, that ncevus maternus may be effectually removed by
the lenient means, yet powerful agency of vaccine lymph.
This method of cure, in such cases, being of compara-
tively recent date, it may not as yet perhaps be generally
known ; and therefoie the primary object is to assist in fur-
ther extending the knowledge of the advantage derivable
from the practice.

That the sufferings of mankind from small pox are greatly
diminished by the substitution of vaccination, is most rea-
dily admitted by all the members of the faculty, as well as
the public. But it is found to manifest its influence by ob-
literating the ncevus maternus without danger or pain. This
disease is obviously named after, and also attributed to the
imagination of the mother, during the period of gestation,
whose tender bosom is wounded by sensations of the deepest
regret, while she surveys tbe fascinating, but disfigured fea-
tures of her offspring. The distressing apprehension of
danger and suffering, arising from the dread connected

Mr. Marshall an Nmvus Matemus. 53

irith its removal, by the painful excision with the knife of
the surgeon, is completely dissipated by the mild; operation
of vaccina.

The turgid and vascular state of the navus, together with
the surrounding blood vessels leading to the part, when
divided by the knife, invariably produce an alarmingly active
haemorrhage ; which is also increased through by the rapi-
dity of the infantile circulation, and the sobbings caused oy
the frightful and painful horrors of the .operation. Such an
immediate cause of debility unavoidably occasions a tedious
convalescence, and a protracted recovery of health. But
excision, after all the suffering it occasions, even when
skilfully performed, is sometimes: little better than the
disease, and therefore an adequate degree of requital is
bat rarely obtained, in consequence of the excavation ef-
fected by die scalpel leaving a deep eleft, surrounded by
an unsightly scar; and when situate on the irritable
muscles of the face, the operation is liable to induce
a distorted expression of ^countenance^ more especially
during the healing of the wound, in defiance of the
utmost Tigilance of the surgeon. The result, however, of
the following case, may effectually serve in future to assist
in dispelling the apprehension of all each casualties. It
will also be exemplified, that however extensive the. black
scab may be, nevertheless the superficial vaccine scar, even
in those constitutions which are most susceptible of its im-
pression, bears no comparison with that which is formed by
the knife.

This experiment, it is freely acknowledged, was tried in
compliance with those which have already so happily suc-
ceeded, under the immediate and skilful management of
those excellent surgeons, Mr. Lawrence and Mr. Earle.

On the 13th of May, 1830, a healthy girl, at the age of
one year and eight months, was vaccinated. On the exter-
nal condyle of the right elbow a ncevus matemus was dis-
covered, bounded with an irregular margin, in length three
quarters of an inch, in breadth full half an inch, with three
angular projections, the whole resembling a parallelogram,
and of a deep red or claret colour. After maxing five punctures
on the left arm, a proposition was made to the mother, who,
with a feeling of intelligence readily complied, by allowing
the entire surface, as well as the surrounding vicinity of the
mevus, to be freely punctured with a lancet, repeatedly
armed with fluid vaccine lymph. It may be interesting in a
practical view here to remark, that after effecting each of
the punctures, whether on the left arm, at the hollow occa-
sioned by the termination and insertion of the tendon of the

54 Original Communications.

deltoid muscle, or on or about the ncevus, an unusual
flow of blood instantly followed from each orifice. In order
to guard ag-ainst apprehension arising* from such an occur-
rence, of either a total or partial failure of final success,
the usual precaution under such circumstances was strictly
observed, namely, allowing the bleeding punctures to re-
main untouched, until the oozing blood had stopped and be-
came hardened by drying, and it did not trickle downwards,
but only formed a spherical drop, resting on the lips of each
orifice.

On the eighth day (May 20), the numerous assemblage
of vesicles, in number twenty-three, of a pinky and pearly
hue, five on the left arm, and eighteen attached to the
n&vus, were all satisfactorily progressing, with only a slight
ring1, indicating the insipient stage of areola. The ap-
pearance of the latter cluster was very peculiar, six dis-
tinct vesicles covered the surfacef of the ncevus, so closely
arranged, that their circular edges, were distorted into
figures of triangles and hexagons, with the twelve sur-
rounding vesicles perfectly distinct, and placed equidistant,
and thus the whole contour resembling a broach set round
with pearls. From the elevation of the vesicles occupying-
the whole surface of the n&vus, and filled with transparent
lymph, even at this early period its deep red tint was quite
imperceptible ; the colour, I presume, however, is confined
to the cutis vera.

On the tenth day (May 22), the circumambient areola
was rapidly advancing, but not yet arrived at its height,
that surrounding the mark extending about an inch and a
quarter beyond the group of its vesicles, and that on the left
arm about three quarters of an inch. The vesicles had lost
their pearly appearance, and were now of a turbid yellow,
inclining to brown, but darker, in the central indentation.
These also, on or about the ncevus, were greatly altered in
character and number by having run into each other, and
thus resembling nine large vesicles. From their local
situation they were unavoidably exposed, more especially
during the night, to friction and pressure, which caused
them to yield a glutinous discharge of lymph, which ad-
hered to the bed clothes, but they were carefully defended
from further injury by means of a bandage.

On the twelfth day (Mav 24), the vaccinated parts [had
passed their height. But ttie vesicles on the elbow had all
conglomerated into a large scab, having a smooth and po-
lished surface of a horny variegated tissue, in length one inch
and a, half, in breadth a full inch and a quarter, having an
edge waving with segments of circles, and exceeding tho

Mr. Marshall on Navus Mat emus. 55

size of the tuevus, as originally intended. The concentric
circle, as in all other ordinary cases, bounding the extent
of areola, reached its acme during the antecedent night,
and it was, unexceptionably, the finest we had ever beheld,
of a dull vermillion red, half an inch in breadth, the inner
side softened imperceptibly away ; extending from the
upper margin of the crust three inches and a half, from
the lower edge the same leugth, and four inches, across
its shortest diameter, and thus according to the geometrical
figure of an ellipsis.

It may be asked, how came the left arm to be vaccinated
as well as the ncevus ? the latter, however, was not heard
of until the right was presented. But it goes still further
to prove a practical axiom, that all apprehension of over
doing this disease is groundless, and our experience informs
and compels us to tell the truth, and again to embrace this
opportunity of declaring, that the operation of vaccination
has not, in divers cases, been sufficiently performed ! But
this experiment also unfolds to demonstration another very
important practical induction, namely, that after the lapse
of thirty one years, there is no discoverable decadence of
the vaccine virus, and by vanquishing. the navusmaternus,ihQ
full display of the energy of the vesicular areola and con-
centric circle, prove now greatly it retains its pristine
force.

The patient, under the influence of so many vesicles, had
a slight degree of fever on the ninth day, which continued
about two or three hours.

On Friday, the sixteenth day, (May 28) the black scab
having been the day before prematurely detached, in con-
sequence of its being disturbed by the frequent movement
of the joint, it afforded the gratifying opportunity of ob-
serving, that the nmvus bad entirely vanisned, its original
site being occupied by flesh coloured skin. A slight ulce-
ration, about the size of a sixpence, free from inflammation,
was rapidly healing' ; the cicatrix was quite superficial, and
the child was capable of moving the arm with perfect free*
dom; the areola and concentric circle had wholly disap-
peared.

The success of the operation appears to be wholly de-

Kndant upon a large number of vesicles, sufficient to excite
i action of the absoijbent system, but above all by form-
ing a crust large enough to cover the whole surface of the
navus, which holds mechanically in its substance the colour-
ing vessels of the part, which during its progress, is at
(earth cast off by a re-production of skin.
We understand that the operation has sometimes proved

56 Original Communications.

,«

unsuccessful after making thirty punctures, since only three
oc four vesicles resulted, Such an unfortunate dilemma is
much: to be regretted, though easily, obviated by timely
interference, because it is evident, in the event of posterior
vaccination^ when the vesicles have passed their climax,
that die full. power of the lymph is for ever comparatively
lost*, and that all suck cases demand our utmost care and
ingenuity in the manipulation* But sorely the only feasible
remedy in .such instances of threatening; failure is to follow
up re- vaccination with all possible dispatch. For if either
onto, two, or three vesicles are allowed, to proceed uncbn-
tscouled, without prompt reinforcement, they become* a for*
midable . and treacherous enemy, by rapidly advancing,
defeating the operator, and achieving* a triumphant, yet tin-
welcome victory by wholly precluding the chance of all fu-
ture success by means of vaccina, and the sharpened blade
becomes the only alternative.

The ncBvus maternus is variously defined by anatomists ;
the etymology of this word, however, is well under*
stood to comprehend, a natural imatk, freckle, spot, blemish,
or excrescences in the body.' The foregoing case^ althoagh
deep in cblour, and of an average flize, did not project be-
yond the natural surface of the skin, while others extend
a Utile above, and are fount), perhaps, of a more direct
aneurismal affection of the cutaneous arteries. But never-
theless, they equally require removal; and the mode of
operating and curing by the vaccine lymph is just the same,
and applicable to all.

• ' The niebus mdternus has been lately extirpated by an
eminent. surgeon, who has most kindly communicated the
principal . phenomena ithat accompanied the' case ; which;
however, tell short of the termination we had at one time
reason to anticipate, as the treatment was not followed tip
while opportunity offered* As matay of the incidents cotf-
.nected with the case were somewhat peculiar, they became
so. particularly interesting, that they' were deemed worthy
of promulgation ; inasmuch as they may assist in illuqtrat^
ing Uie superior advantage of obliterating the disease
through the innocent medium and gentle means already
exemplified, and notwithstanding the total failure of the
•ease,* we may be permitted to say, *' fas est ab hoste
doceftV- \

•>. A male infant was afflicted with a nmvus mat emus, ex*
eeeding an inch in : length, and forming a narrow parallels
gram, situate upon the upper part of the cheSt, near thfe
right collar bone. Since it was evidently increasing in size,
its removal was deemed expedient by means of excision.

Mr. Marshall Nasvvs Maternv#t 5£

The operation was accompanied by a profuse h&diorfiia&ty
and several enlarged, cutaneous vessels were secured t^
ligature ; the wound, however, quickly healed, but ufifoft*
tunately, a part of the mark escaped the knife, which, by
enlarging, nastily acquired the size and form of the flat
surface of a split pea. The young gentleman, however,
not having been vaccinated, the remaining part of the mark
was freely punctured and innoculated with recent

, lymph ; all of the punctures bled so much as to firustfate
the operation. The patient having been also vaccinated in
one of the arras, a solitary vesicle resulted, which, however,
from the general failure of the rest caused a state of vex-
atious disappointment, and after all the circumstances of the
case, this vesicle turned out to be an unwelcome intruder.
The following plan was projected, but through the hurry
of other avocations it fell to the ground, but nevertheless,
the vfelue of the intended practice remains unshaken. To
prevent as much as possible the threatened diminution of the
power of the vaccine lymph, both constitutionally and lo-
cally, arising from this maturing- vesicle ; the nmvus was to
have been re-vaccinated on the fifth day, subsequent to the
original puncturing, with recent lymph from sixth day vesi-
cles, with the confident hope of thus ensuring a higher
chance of success. ' The adoption of this measure was
strongly recommended, because we have frequently ha^
occasion to remark, in the course of practice, that th*
earlier the lymph is employed, the greater is the certainty
of successful vaccination. In private practice, it is readily
allowed that parents and guardians are generally better
satisfied with the appearanoe of the vesicle oh the eighth
day, although it partakes of ancient prejudice, yet in a case
of so much importance, where the aim is humanely intended
to supersede the casualties of a cruel operation, a little ar-
gumentative reasoning, with a faithful explanation, would
Speedily remove the objections of the most fastidious.
Hence we are justified, of the charge of inconsistency in
all such pressing cases, to deviate even from the golden
rule of vaccination, which we have laboured to inculcate
never to be acceded ; or should the operation have been
already, or primarily done from eighth day lymph, that in
the possible event of either a total, or more especially a
partial failure of the punctures, as soon as this important
point can possibly be -accurately ascertained, the adoption
of even the fifth or sixth day's lymph hid better fet sub-
diluted for the eighth.

rou v. — xo. 25 . *

$8 Original Communications.

Suffice it to say, by way of concluding this subject, that
the foregoing reasoning is, not built on theoretical fiction,
but op the solid basis of practical truth.

V. — Cases of Rheumatism affecting the Ovaria, with Prac-
tical* Remarks. By James Copland, M.D. Consulting

L Physician to Queen Charlotte's Lying-in Hospital, Senior
Physician to the Royal Infirmary for Diseases of Children,
&c.

I believe that the circumstance of rheumatism occasionally
attacking the organs proper to the female has scarcely been
hientioned by practical writers. It is an occurrence, how-
ever, of sufficient importance to have attracted notice, and
Is certainly not so infrequent as to warrant entire neglect on
the part of the systematic pathologist. Rheumatic affections
of the male organs of generation are sometimes met with,
and the circumstance is familiar to well-informed practi-
tioners of both medicine and surgery. Analogy, therefore,
would lead us to expect occasionally to meet with similar
attacks in the organs of the female also. The only writers,
as far as my information extends, who have incidentally
mentioned the Occurrence of rheumatism of the uterus, are
Pouteau,* M. ViLLENEUVE,t and M. Nauche.J Neither of
these authors notice rheumatic affection of the ovaria ; and
]M. Nauche alone gives the subject of rheumatism of the uterus
that degree of consideration which it deserves. The only
author who has alluded to rheumatism of the ovarium is M.
Murat,§ and he mentions it, incidentally, as rarely a cause
of inflammation of these organs — inflammation of the ovaria
occasionally proceeding from metastasis of the rheumatic
affection. During the course of my practice I have seen
several instances of rheumatic disease of the uterus, and two
cases of distinctly characterized attack of rheumatism of the
ovaria. To these latter only I will at present confine my-
self. The first case was not a case of metastasis of rheu-
matism, although the affection of the ovaria became some-
what aggravated as the disease of the muscular and aponeurotic
structures abated, but rather a complication of rheumatism

** tEiivres posth. t*. iti, p. 5ft .

f M. Villeneuve Diction, de Sciences Medicates, t. xlviji. p. MO.
X Den Malades propres aux Femmep, p. 56$ .
§ Art. Ovalre Diction, des Scien. Med. t. xxxix. p. 15. •

Dr. Coplaud on Rheumatism affecting the Ovaria. 59

of the ovaria, with a similar disorder of more external parts ;■
the former, however, greatly predominating. The second1
case was one of metastasis, and, in many respects, was similar
to the first. The symptoms in the one case were carefully
noted in ray common-place book, after each visit, and, as
may be seen from the treatment, its nature readily recog-
sised. The history of the other was taken in the manner
here stated, at the termination of my attendance, more
particular details having been considered unnecessary, a#
the phenomena and treatment were very nearly the same as
those of the first case.

Case I. July 3, 1820. — I yras called at ten o'clock, p.m. to
Mrs. P. residing at Walworth, aged about 30, of a full habit
of body, and sanguineus temperament, married, but without
children. She had been ill about three days, and she attri-
buted her attack to having slept in a damp bed.

She complains, at present, of violent pains in her back
sod shoulders, also in the hypogastrium, on both sides, near
the groins. The pain in this latter situation is much increased
on pressure ; and the pains, generally, are greatly aggra-
vated during the night. The muscles of the right side of
the chest were at first most severely affected, but the appli-
cation of some leeches and fomentations, which had been
resetted to before 1 saw her, had removed the pains front
this place, but they had become aggravated in tha situations
in which they* are now felt. She has also been -distressed
with nausea and vomiting this morning, and with shooting
pains in both breasts. She has no head-ache, nor pain of
the limbs, or joints of the extremities. Tongue foul and
coated ; bowels very costive ; pulse 88, and oppressed.
On account of the lateness of the hour the following pills
and draught only were prescribed until my visit theibllowiug
morning : —

&- Hydrarg. subranr :

Pair, iptcucuanha? aa. gr. vij ;. !

Opii pari qr* ij ;

Syrup, simp. q. s. m. fiant pilulae iij. statin sumeeda).
Br Mist. Camphors, Jjss.

Magnes. Sulphatis, Jss. ;

Tine. Colchici, Jj, . <.

Spirit La Fan d. Comp. 5ss. m. a fiat haua£as quamprimam mane
capieodos.
4th. Noon. — The pills procured her a good night, with
copious perspiration; and she had two bulky, bilious, and
offensive morons this morning from the draught. She com-
plains now of the pains more towards the lumbar region,
wfcere they are stilt as severe as ever ; and they shoot across

HO Original Communications.

the tJiec regions to the inferior pert of the hypogastrHrra, oo
e*eh side, in the situation of the ovaria, where the pain- is
permanent and severe. It is increased on pressure. Urine
in small quantity, high coloured, with a frequent desire to
pass it. Darting petes in the mamttras, with nausea. False
90, and oppressed, much Ybirat, bo appetite, tongue still
loaded. The perspiration continues copious* but without eav
lief of the pain. 1 now directed a full blood-letting from the
arm, which was performed by my friend Mr. Bryant, to the
extent of eighteen ounces, and prescribed the following :
|V Mass* Pilul. Hydraxg. 3j.
Hydrarg. Submur. gr. v.
Extracti Colocynth. co. 9j. m. fiant pilule viij.
Capiat binas statim, iterumque eras, primo mane.
fy Mist. Camphors, Jyjss. ;
Tinct. Colchici, jss. ;
Spirit iEtheris Nitrici, 5uj. ;

Syrup Aurantii, 3J88. ; m. fiat Mist, cujus Cochlearia ij. large
capiat tertiis horis.
fy Hydrarg. Submur. qr. vj ;
. Pulv. Ipecacuanha, qr. yjj ;
Opii puri, gr. ij ;

Syrup, simp. q. s. m. fiant pilulae iij. hora somni sumendte.
4th. — Reports herself much better from the bleeding1; blood
buffed, but not cupped. Puise 88, and fuller. Tongue still
loaded. The bowels have been five or six times acted on
since last visit. Stools still black and offensive. Pain in the
hypogastrium and iliac regions, and the sickness somewhat
diminished. She perspires freely, but .with little relief of the
pain of the back. Urine still high-coloured, and in small
quantity, but with a very frequent desire to pass it.

Continue the purgative pills and the mixture a£ prescribed
yesterday. The pills with calomel, ipecacuanha, and opium
to be repeated again at bed time.

5th. — The symptoms are nearly the same as yesterday ;
but the pulse is harder, quicker, and more contracted. Tlie
tongue is still loaded, notwithstanding frequent bilious eva-
cuations have been procured since my last visit. The pain
in the back is diminished, but that in the internal iliac re-
gions and hypogastrium is much increased, so that she
scarcely can bear th# weight of the bed-clothes. The fre-
quent calls, she formerly complained of, to pass the urine,
have now passed to a state of strangury; and the sickness,
this morning, has been more urgent; but that it is not
occasioned By the mixture is evident from the circumstance
of her feeling no increase of the sickness after taking it.
Upon examining the lower region of the abdomen, a small

Dr. Copland Oft Rheumatism affecting the Ovaria. 6?

Uunear may be: felt in each iliac region, rising above the* pit*
bcs in the situation of the ovaria, they are paiafulon pressure*.
Complains also of the darting pains and soreness of -the
flsnuD®. The mercurial taste is now evident in the motithi
Mereurial preparations were therefore omitted.

Admofeaatur harudines xviij. iido abdominis poeteaque foveetar

£. Aquae Menth. Virid. Jviss ;
Magnesia Sulphatis, Jj ;
Tiact. Colchici, 3vj ;
Spirit Lavandul. Comp. 3js<5 ;
Olei. Caryoph. m. yj.
Capiat Cochlearia ij. larga tertiis horis.
^. Pulv. Ipecucuanhse, gr. vj.
Opii prai. gr. ijss.
Syrup. Simp. q. s. m.
Fiant Pilulae ij. hora somni sumandee.
6th. — The bowels have been freely opened, but the mo-
lions are still bilious and offensive. Tongue also loaded in
the middle, hut cleaner towards the edges. The pain in
the situation of the ovaria is much diminished since the ap-
plication of the leeches, which bled freely. , Sickness also
is much less troublesome. Pulse 88, and softer. Urine
paler, and accompanied with less pain and difficulty to pass it.
There was some appearance of the catamenia early this
morning, although a fortnight before the time ; but they
hare now disappeared.

Use a hip-bath, and a broad flannel bandage, wrapped
several times round the hips, loins, and belly,
ft. Tinct. Aloes. Comp.

Castor ei aa, 3rj.

Colchici, Jss. •

Aquae Menth. piper. 5yj.

Olei. Juniperi Sabinae, m vj. misce; Fiat Mist, cujus cochlea*
ria duo larga tertia quaque hora sumat.

7th. — The pains are greatly relieved. The catamenia
have re-appeared and become abundant. Bowels open:
toogue cleaner. She now complains of the sickness in the
moraine only. Thirst much diminished, and the affection
of the bladder has almost altogetheridisappeared. -

The pain still continues to shoot occasionally to the iliac

regions, but is not now so readily increased by pressure in

these situations; and there is still a 4anm£ Pa">. ln *!*e

mammae sometimes felt, but the sorenesses has disappeared. .

Continue the mixture prescribed yesterday. Asffee^had

tome return of appetite, she was permitted to have some

light fish for dinner. ' ..

|3 Original Communications.

8th. — The oatameoia are now abundant; and she
plains only of slight eioknesa in the morning, and of occa-
sional, shooting pains in the region of • the oyaria, and
in the mammse. Tongue not quite clean ; appetite rtturn-
ing. The bowels have been freely open ; evacuations mere
natural.

0j Infus. Calumtae, Svjes.; "»

Tinct. Calumbse.

Spirit iEther. Sulph. Comp. aa. &*., M.
Fiat mist, cujus sumat cochlearia duo ampla tertiis vel qaaitu horia^
^ Pulv. Rhei, gr. xv ;

Magnea. Carbonatis, gr. xxv ;

Pulv. Ipecacuanha, gr. j ;

Zingeberis, gr. vijj ;

Aquae Menth. pip. Jiss. ; m. fiat haustus hot* sonni smnenriwa,
prius agitata phiala.
9th. — r eels quite recovered this morning1, and is now able to
leave her bed. Tongue clean, and pulse out little above the
usual standard. The sickness ana shooting pains disss p-
peared soon after taking the mixture. The cotamenia
abundant. The draught procured a copious and healthy
evacuation this morning. Appetite has returned, and shfe
complains only of weakness.

Alter this she continued to recover rapidly. She took re-
gularly the mixture and draught last prescribed for some
days. The catamenia were more than usually abundant.
From this time she continued healthy for four years, when
she was seized with inflammation of the uterus, for which I
attended her. She is now in good health.

Remarks. — It will be perceived, from the details of this
case, that I gave calomel, the simple powder of ipecacuanha
and opium, in what has since been considered as large doses,
and as being a novel method of cure in this disease. Al-
though this case occurred in 1820, 1 then did not consider
this mode of treating acute rheumatism as particularly re-
markable, otherwise T might have given publicity to it, aa
well as to other cases of rheumatism, treated in the same
manner even long previous to the occurence of this. But in
point of fact, there was no material difference in this mode of
treatment from that which 1 had recommended for acute rheu-
matism, and published as far back as 1815.

* Another circumstance, deserving of notice in this case, is
the relation subsisting between the affection of the ovaria,and
the supervention of the catamenia, much more abundantly
than usual, and before the expected period. The indication
df cure which nature here afforded, was taken advantage of
successfully, for the symptoms of inflammation of the ovaria,

Dr. Coplaud on Rheumatism affecting the Ovaria. 68

which in this case were particularly well-marked, rapidly
disappeared after the establishment of the menstrual flux. Id
this case I derived advantage from a plan I usually recom-
mend in similar circumstances, namely, the use of the hip
bath, and causing the patient to be somewhat firmly bound
around the hips and loins, with a broad piece of flannel, suffi*
ciently long to wrap several times around her, immediately
upon cooling out of the bath, which should not be of a less
temperature than 100° of Fhar., and which may be raised a
few degrees above this, after the patient has been in it a short
time. The relation existing in this case, between the pre-
sence of the rheumatism and accumulations of bile, in the
biliary apparatus, and disordered secretions and faecal
matters in the alimentary canal is very well marked. This
relation I have seldom found absent in rheumatic attacks,
the morbid biliary and other matters detained in the biliary
system and digestive tube, being not only a powerful cause
of predisposition to rheumatic aud gouty attacks, upon the
least exposure to the occasional or exciting causes of the
disease, but even acting as an efficient and direot cause in
many cases owing to the injurious impression which those
matters may be considered as exerting upon the nerves of
organic life, supplying the viscera and circulating system; 1
allude to this, as I am convinced from extensive observation,
that this relation of morbid states is not sufficiently attended
to in practice.

Case l\.—\7th March, 1826.— I was called to Mrs. C. re-
siding in Portland-street, aged 34, married and the mother of
three children. She had experienced two abortions, and had
had several attacks of rheumatism. The menstrual secre-
tion had been regular and abundant, and somewhat more,
frequent than usual. She had been, during the preceding
fortnight, labouring under a severe, attack of rheumatism of
the left thigh and hip, and referrible chiefly to the situation
ef the sciatic nerve. For tbi* she had had recourse to some
liniment or embrocation which she had used assiduously >
bot had taken no other medicine ; sopn after the use of thss,
she was seized with severe pain in thereto side of the hypo-,
£B*trium and loins, with darting pain in the left mammae ; but
die pain had quite left the original seat. . Upon examination,
by the hand a tumour of about the size of an egg could be
kit deeply seated in the region of the left ovarium. She!
bid much fever, occasional sickness : the pulse was 96 and
somewhat full and hard, and the tongue loaded and furred.

64 Original Communications.

The bowels were costive and bad not been freely evacuated
for some time. Urine scanty, in small quantities, and passed
frequently and with pain. Three weeks had elapsed since
the last menstrual period.

I directed twenty leeches to be applied on the hypogastric
region, and these to be followed by warm fomentations. Pills
of calomel, ipecacuanha and opium, similar in respect of the
quantity of each of these substances, to those prescribed in the
first case, were directed to be taken at night, and a purgative
draught early in the morning ; a mixture, consisting of mist,
camphors, magnes. sulphas., tinct. colchici and spirit ether,
nitrici. was ordered to be taken through the day ; and an
emollient so line enema was administered, in order to remove
any faecal accumulation and cause of irritation which might
exist- in the colon. These medicines acted copiously, and
brought away bulky, feculent, dark and offensive motion*.
Considerable relief was procured from these means, which
were continued without change during the 18th and 19th.
The pain and tumefaction of the ovarium still, however,
continued : but the symptomatic fever was diminished ; the
tongue was cleaner and the evacuations were of a better
colour and less offensive.

' On the 20th and 21st, there was little or no amelioration ;
she still complained of the pain in the ovarium .and loins, of
the frequent call to pass her urine, and of the darting pains
of the left mammas. On the latter day the hip-bath was di-
rected to be used, and the hips, loins, and lower abdomen to
be closely enveloped in several folds of flannel, immediately
on coming out of the bath.

On the, 22nd, she complained of an increase of pain in tbe
left hypogastrium and breast, and in the loins, with sickness,
but on the following day she had a scanty appearance of the
catamenia. The same medicines were now prescribed 'as
were resorted to at the same time in the former case ; and on
the 24th the menstrual evacuation was more than usually
abundant. After this all the symptoms of the affection
quickly subsided, and the tumid ovarium soon was no longer
to be felt upon examination.

The features of this case are so nearly like those of the
former, that no remarks are necessary, excepting that it fur-
riishes one of many proofs which have come before me of
the impropriety of suppressing, by means of local remedies,
the rheumatic affection of an external part, without havings
previously carried off all morbid matters, which have been
accumulated in the biliary system, and prima via ; for as
long as those remain, the chief source of disorder continues

Dr. Copland on Rheumatism affecting the Ovaria. 65

in operation, and the suppression of the external manifesta-
tion of disease will often be followed either by an attack of
some other external part, or by a serious affection of an in-
ternal organ.

1, Bulstrode Street, Cavendish Square, .
. 26th June, 1830.

BIBLIOORAPAHY.

ANATOMY.

1. Irregular distribution of Arteries. — Dr. Green, of Trinity
College, Dublin, has just published " An Account of the Varieties in the
Arterial System of the human body,"* the object of which is to direct
the attention of the profession to a branch of anatomical knowledge
which has been hitherto almost overlooked in these countries. He
observes : — * ' •

" En proportion to the study bestowed on the Varieties in the
Arterial System, they are found to be more numerous, and of more
frequent occurrence ; the subject, therefore, daily requires more inte-
rest and importance, not merely from constituting a curious part of
the history of the structure of the human body, but from its great
practical utility in Operative Surgery. It has been calculated by
Meckel, that some deviation in the origin of the primary branches
from the Arch of the Aorta, oocurs once in eight times .f — I am con-
vinced, by a careful examination of a great number of dead bodies,
that varieties of the principal arteries in the upper extremity, exist at
least as often as once in every four individuals — the variety which occurs
most frequently in the human body, affects in a very important man-
ner, the commonest operation in surgery, I mean venesection. I
have so often seen the radial artery (and in some instances the ulnar)',
when it arises from the brachial or the axillary, pass almost directly
over the place in which the operation of bleeding is performed, that
it has been to me matter of much surprise, how the vessel has not
been more frequently injured. The origin of the left carotid from
the innominata is another irregularity, by no means very unfrequent.
In this case, the vessel usually crosses, in front of the trachea, to th«
left side of the body, the possibility of such an occurrence every
toTgeon should be acquainted with, before he attempts the operation
of tracheotomy.

* Dublin, 1830. 8vo. pp.39. Seven Plates. Leckie. London,
l&Q, 3vo. pp. 50.

t J. F. Meckel; Manuel d'Anat t. ii. p. 318.

vol. r. yo. 25.

66 Bibliography.

" Varietur in* the arterial tjatom appear to be regujbtad bjr the
• tame laws wjiich -govern irr^ilarftjea, of structure in e$er p«t# <tf
the body. These are frequently nothing but the union of pa£ta natu-
rally separate, or the separation of parts naturally united. . Thjs rate
is illustrated by many varieties of the arch ; as the separate origins
of the right carotid and subclavian ; or the union of the left carotid
and subclavian to form an innominata on the left side. Another
law, more general in its operation, is, that departures from the general
mode of formation are imitations of the structure in animals, parti-
cularly in the monkey tribe. In the muscular system, although de-
viations are extremely rare, this analogy is striking : thus the absence
of the gemini and the gast^ocnemii ; tfre occurrence of three supina-
tors ; the double pronator teres ; the accessory psoas parvus, and the
extension of the rectus abdominis On the chest, are imitations of the
structure in the monkey. Analogous to the structure in birds, have
been found a third pectoral muscle, a double rectus lateralis, and, the
biceps separated into three distinct muscles. Many other examples
might be enumerated, which tend to prove that one great scheme of
structure pervades the animal kingdom, and that varieties are not
occurrences of chance, but the adoption of one mode of formation
instead of another. An attempt has been made to reduce the varieties
of the arterial system under this rule : those who are better acquainted
with the structure of animals will, I hope, be able, to perceive many
analogies which have escaped my notice. An interesting , circum-
stance connected with the history of these irregularities i$, that we
have reason to suspect they are sometimes hereditary. Pelletan
(Clin. Chirur. t. i. p. 101, 2,) mentions a case corroborative of this
opinion : the anterior tibial artery ran. superficially along the front. of
the leg, in both a father and daughter. \

" When I commenced the description of the variations in the
arterial system, I had intended to give accompanying outlines of all
the deviations ; but the publication of the plates of Tiedemann by
Dr. Knox has rendered it unnecessary: I have therefore confined
myself to the delineation of such varieties as have hot hitherto been
published ; or, if known, have not, as far as I am acquainted, been
exhibited in drawing.*1

The author describes varieties in almost all arteries, both, from,
anatomical works, a& well as many from personal observation,
which may render surgical operations extremely dangerous and diffi-
cult. His observations evince great research, the most extensive
practical experience in human dissection, and offer1 to the surgeon
very important information. This very unassuming, but valuable
work, ought to have a place in every surgical library, am} is highly
creditable to the zeal and industry of the author. It is published at
a price so moderate, that the humblest student can possess it ; while
4he operating surgeon will find it a. worthy .companion to Mr. JJar-
rison's valuable work on the arteries.

2. Artificial Anatomical SubjectB.— At a • late meeting ,of the
Academy of Medicine, of Paris, M. Auzou exhibited an artificial
subject, intended to ftupply the place of the dead body, by a correct

Anatomy. 67

qeialspeaacnt of the human structure. The musdes are detached by
f*-g", m-wkccbmme layers, until the skeleton is expose;!. The in-
vents* next removes the calTariom, when the brain is presented: in
secthnavand the origin of the nerVes, plan of the eye, nasal fossa?,
back of the tnoutiH &c are ahnost nataraUy displayed. He removed
the inteatlaps, and demonstrated the portal and circulatory systems,
the dmphiagm, hmgs, pericarditim, and cavities of the heart, con-
taining i*d and Mack blood: The labour of twelve years warn
bestowed on. this grand apiece of mechanism, and similar models are
executed at the price of 300f, or 130/. . This invention is valuable
if at even convey general notions of descriptive anatomy: but the
ajlrnrlirt platee of Mascagni, in which every organ and tissue of the
body are most accurately represented of the adult size, and
may be inspected at our publishers, are, we hesitate not to
the most accurate delineations ever made by human in-
genuity. These magnificent engravings excel those of this or former
ages. They present the most complete resemblance — a perfect imita-
tion of the human structure. They are published under the sanction
of BerJinghieri* Bartelloti, and Rosini, professors in the University of

ifOnfilO AJtATOlfY.

~ 9. A work entitled, " A Vademecum of Morbid Anatomy t medical and,
CUrnrgkal, with pathological observations and symptoms, illustrated
Jy 359 drawings,9* has been recently published*, and contains " Ob-
servations on, and illustrations of, the changes of structure found in
the brain, thoracic, abdominal, and pelvic viscera, and of the organs
of generation in both sexes. It likewise gives the pathological symp-
toms, by which we judge of disease during life, and a true description
of tiie changes are exhibited after death." This is a useful work,
and win be referred to with advantage by young practitioners. The
plates are well executed, and illustrate many varieties of diseased
structure. The symptoms of each disease are given in general with
accuracy, and are placed opposite to the plate illustrative of the
malady. The engravings are executed with great clearness, the
morbid appearances are well represented; and we can safely recom-
mend the work both for the accuracy of its design, and the elegance
of its execution. It nils up a void which has long existed in an im-
portant department of medical science. To the profession generally,
it will be found a most valuable acquisition. It is evidently compiled
by a man of sound sense, practical experience, and very extensive
knowledge of the subject. It is the only work of the kind in a con-
venient form ; its materials are carefully collected and judiciously
iunstrated ; and its price is very moderate. ,n

OBSTBTBICT.

4. Extraordinary OBsteric Figure*— -Dr. Azenne has constructed a
figure for facilitating the acewement of obstetricy. He has sue-

* Plates, 48 — Drawings, 250. Burgess and Hill.

68. Bibliography*.

ceeded in constructing an apparatus composed of an elastic body,-
which exemplifies in a wonderful manner every part of the mechanism
of natural and preternatural parturitions. It represents the external
generative organs, the vagina, and os uteri. When the hand is in-
troduced, it experiences the pressure of the uterus as in natural labour,
the os uteri is gradually dilated, and the membranes regularly pre-
sented, and caused to recede after the artificial contraction. In the
interval of the contraction the finger feels the head of the foetus
within the membranes, and finally, the head passes gradually, as in
natural labour, being adapted to the different admeasurements of the
pelvis. What particularly enhances the value of this curious piece
of mechanism is, that it may be made to represent, with the same
fidelity, all cases of difficulty in this branch of surgery. Finally, the.
elastic body employed in the construction of this very ingenious ap-
paratus is atmospheric air. The inventor has now the largest obste-
tric class in the French metropolis.

MEDICINE.

5. Hydrophobia. — Two works have just issued from the press on
the nature and treatment of this formidable malady. One by Mr.
Murray,* the other by Mr. Youatt, veterinary surgeon.f Mr. Murray
gives a concise view of the various opinions on the nature and treat-
ment of hydrophobia, and conjectures that the simultaneous occur-,
rence of rabies canina in different parts of the country is connected
with some universal principle. He observes, " electricity is, as far
as we know, the only agent likely to be associated with a generaliza-
tion so extensive. The present season remarkably confirms our ob- ,
servation, and we consider that the latent germs were the produce of
the late severe winter." This is leaving the subject pretty much in the
state in which the author found it. Mr. Murray has collected all thatt
has been written upon the subject to the period at which we write.
He mentions two facts extremely interesting in a physiological point
of view, which are as follow : — A pregnant woman was bitten by a
rabid dog ; she died after delivery, but the child was .unaffected, and
grew to manhood — a fact, proving that the. poison does not pass
through the maternal blood to the foetus, and thus differs from other r
animal poisons, as lues. A sow in farrow afforded an analogous,
case. She was bitten by a mad dog in December, 1826 ; she littered -
in January, and on the 24th was rabid — the young pigs did not
seem affected, though it was deemed prudent to destroy them.
"These cases," says our author, "evidently prove, that the milk,
whether in the human or brute creation, does not taint the offspring."

* Remarks on the Disease called Hydrophobia, prophylactic, and
curative, 1830, 12mo. p. 86. Longman and Co.

f On Canine Madness, comprizing the symptoms, post mortem ap-
pearances, nature and cure of rabies in the dog and other domestic
animals/ 1830, Svo. pp. 52. Longman and Co.

Medicine. 69

Mr. Youatt's observations on canine .madness were published in al
series of papers in the Veterinarian in 1828, 1829, and 1830, and* *
are now reprinted in another form, which will be better known to our,
profession. He gives an account of the symptoms of the disease in
the dog, horse, ox, sheep, swine, cat, and human subject, and also*
the morbid appearances on dissection: This is a very interesting
production, and merits a place in every medical library: We cannot
review it at any length, at this advanced period of die month, but
must give a few extracts. After describing the symptoms of hydropho-
bia in the different animals enumerated above, our author sums up in
these words : " The symptoms of rabies are very similar in man, and
in all our domesticated quadrupeds. In all there is the same affec-
tion of the respiratory nerves ; the same howling, or at least choak-
ing noise ; the same excessive excitability, and incessant and uncer-
tain action ; the same-singular delirium, affection of the stomach, and
discharge of saliva ; the same inevitably fatal termination of the .dis-
ease ; and, I am disposed to believe, nearly the same morbid ap-
pearance after death. • : ■ . t
" The human being, however, has a dread of water, which the
quadruped has not. It is true that the dog is unable to swallow,
but he flies eagerly to the water ; and all other quadrupeds, with per-.
haps an occasional exception in the horse, drink with ease and with
increased avidity." - •

He arrives at the following conclusions, that " rabies is an affec-
tion of the respiratory system of nerves, caused by inoculation alone
— the virus must be received on some abraded, or wounded, or
mucous surface — the virus resides in the saliva alone — the power of
the virus dies with the animal." Several very interesting cases are
detailed in corroboration of these conclusions. He also holds/. that
"the virus of every rabid animal will communicate the disease— ^com-
parative predisposition to take on the disease — nature of the virus-
it lies for an uncertain period dormant in the wound — period between
the bite and the appearance of the disease." He next details a case
of rabies in a dog in which warm water was injected into veins, and
bronchotomy performed, without success. Our author suggests V a
tax on every useless dog" as the best preventive of hydrophobia. He
tells us, that he has been bitten four times by dogs decidedly rabid,
and says, " at each time I freely applied the caustic to the wound ;
and I am living to the present day. I have operated on. more
than four hundred persons, all bitten by dogs, respecting the
nature of whose disease there could be no question. I have not
lott a patient. One poor fellow died of fright, but not one. be-
came hydrophobous. To what can I so naturally attribute this,
as to some chemical affinity between the nitrate and the virus, by
which an insoluble and inert compound is formed ?" The caustic; n.
argent, should he applied at any period before the commencement, of
the disease. " Seventeen of my patients had been bitten more than a
week before the operation ; two more than a fortnight, and the ma-
ioritv more than twenty-four hours." He tells us, that one .of
fkmtreonjs of St- George's Hospital has informed him, that he and

7&) Bibliagrmpky*

hb cuMU^hmJuiu .lyrrtad oft 400,000 persons biflWb by dogs (he
acrid not say that all of them were rabid) and be was not aware tfiat
on* ef thenvhad been lost. "Thi* at least, is most consolatory,
whatever .may* become of my theory of the caustic.** ' He alto states*,
tkat excision after the appearance of the disease, may save ffie-pfc-
tipat; ssvi if the symptoms recur, they may be again subdued by te-
smieion. Med. Chfr, Annidsof Altenburg, 1821. Ironist. He pre-
fers theoaoBtic but candic&y admits, that it and the knife may fail,
and that re*inocu]aitks) has been produced by the latter. Lastly, he
describes the effects of virions preventives, ■' the box— aKsma plan-
fay hetiadiTuia ■ Scutellaria — combinations of druga— -experiments
on the scnteUaria and belladonna combined, bleeding, cauterization of
the pbll, mercury, opium, ammonia, canfharidea, guaco, veratrntn
se^edilla, the1 tietmas." All of which are meffieacfotB. Wcstxongljr
iecommmri Mr. Youatt's very scientino pamphlet to our readers.

& Fijmrim In Intermittent Fever.— Dm. Elliotaon and Rriupell
have recently spoken of the Talue of piperine in the cure of inter-
mittent ; but the article is so very expensive in tins country, Hint it
cannot come into general use for some time.

7. Land** Medicdl Society.— the last meeting of this .society,
for the season, took place a few evenings ago, when a paper wan.
rand by Mr. Stephens, on suppuration of the joints, after maHjnvt,
unpreceded by inflammation. Dr. Copland alluded to cases of
uterine phlebitis* hi which purulent deposits took place, and he wan
inclined to think from the suddenness of the formation of the absceses
without inflammation He alluded to the opinion prevalent oh the
eootinent, that pus might be eleminated from the minute vessels
unaccompanied by inflammation.

Dr. Whiting opposed this pathology, and denied that pus could be
ehxnlated through the system and deposited in its ordinary form.

Jtfiw Lloyd, Mr. Proctor, and Mr. Dendy agreed with, the l^st

Dr. Ryan observed that there were two opinions on the action of
pas absorbed into the circulation. The one stated by Dr. Copland ;.
the other that the blood was vitiated, and on being deposited in the
extreme vessels of the different tissues, excited irritation, iniflainina-
twn, ami suppuration. He agreed with those who considered sup-
puration, in the cases before the society, as consequent inflammatipn.

Mr. Callaway congratulated the society on the interest of the
debates during his presidency, and hoped that the next session, which
Would commence the last week in September, would be equally
interesting.

, 8, Chorea. — Jf . Dupuytren has treated chorea for many years with
great success by cold bath, or cold allusion. Hie patient is to be
held in the bath for an instant, and the immersion is to be .repeated
ire or six times in the space of fifteen or twenty minutes.* The im-
mersion produces most violent spasms of the muscles and particu-
larly those of the chest. The sensation which the patient experiences
m most disagreeable, she supposes that she must be suffocated every
instant, but she is soon relieved from this feeling, she is to take ac-

'Median*. 7i

tire exercise .%£fc*K *n tow ot aorhpu* after the bath. Thosjrmp-
toms become wminiahed in a abort time, •and after fifteen days, or a
ujoath. a chorea tbat bad existed for many yeaia will bt entirely disf
aipated. Simple aifesion of cold water on the head and body, je*
peated seven or eight toes in succession, produces the aamejBQM
effects. Thia method ia preferred when women are affected. Tmgee
cases recently cured by this plan, in the Hotel Dieu, are relate^
The frst case waa that of a,, boy, set, 16, who had been affected
with chorea for many years. He was admitted the first week of
April last ; and was ordered decoction of valerian and cold batiu*r,an
already mentioned. The fourth day there was decided -amendment,
and in five weeks, May .15, he left the hospital, perfectly; cured,.
The* second case was one of a girl, est. 17, w-ao bad been one, month
affected with obcreji. Cold; affusions* only were— applied, randr irj.
three week* she was cured. The tjiird case was*one,of a girl, **$,
13, sister to the* first patient. ' She had never menstruated, ami was
three yeara affected with chorea. The whole body~and both aides
were attacked with the disease. ' She was subjected to twelve .cold
sfttfions on the 16th of May v they were continued tQl the 38th,
vheaishe had no-.sjgn of the disease. a}he used no other* i*inedyt~*r
/•a**; Hebdm. Ann.

9. Wefenve lately been consulted in a violentcase of Chorea oi the
ligjei aide* and finally of the left, combined with hysteria, by Mr.
Bradford, of Fleet Street. 'The lady waaraged 1$, had menstruated
t*i£e*bat ate* interval of some months between the periods. The
sjgfc inferior extremity was 'constantly ansqfee^ with,. painful apeanu
and often flexed on tfee pelvis. * The right arnvwas also in constant
*otieja. There swasi1jhe globus hystericus. The bowels were
sasatiiJiTly constipated. Th# oempJalnt was ascribed' ta^exceasive
jMptal: eaertkm at eeheol. - 8b Aatfey Cooper bad seen, the case,
an* reeoeamended small rdoaea of oxym, hyd. Thia remedy pro-
duced bo es^ect ; the- aymptoma became aggravated, the limbs were
(Timet antly affected witfc spawn, and the patient ccmtiimally screamr*
jagjtafr pakxt such waa the state of the sufferer .at our visit; The
hew lis having been psoperly regulated, ahe was ordered carb.ferrit
in doe** of 1$ grains, three times ej day— the dose to be gradually in*
creased sntol a etixlnaeonmpo^ opting Valerian um.,tiiict .fetid,
tifret, cantor., eulph* aether., and tmct. opii.-~and the cervical and
dares! vertebra* were rubbed with tragi tart. aut. three times daily,
esrentoaasendedbyM&Tete. This plan of treatment was* continued
fav-time anys, with an increase of the iron to 25 grains, with, some
relief; wbcu the hysteric paroxysm increased to the highest degree,
and the patient appeared as if affected with opisthotonos? Ibr two
eeore. ♦ It appeared to* us that this paroxysm was probably a critical
change* ami tMa opinion we communicated to the ordinary attendant
on oar way to aee the patient. On our arrival she* waa much more
tranquil than during our attendance ; the motion of the: Jimbe waa
i«tfh less ; the pulae, however, 130. The relatives were so much
ifaimed at the late paroxysm, that they seemed desirous of having
father advice, though they expressed the fullest confidence in the

72 Bibliography.

attendants ; but lest the case . might terminate unfavourably, ther
should be more satisfied with themselves by having further aid. With
this very natural feeling those in attendance most cordially com-
plied, at the same time assuring the relatives that the nature and
treatment of the disease were perfectly understood, and that they
were quite certain there. could be no difference of opinion in a con-
sultation. Dr. Addison, of Guy's Hospital, was called in, and con-
curred in the plan of treatment. He advised a combination of tonics
and purgatives.' There was no recurrence of the hysteria from the
period already described The pustulation of the antimony appeared
the day after the last paroxysm, and was an excellent illustration of
the value of that remedy, as described by Mr. Tate, whose work we
reviewed in our last number. - It is right to mention that the patient
had had no sleep for three nights previous to the intense paroxysm,
and that in consequence 3ij of tine. opii. were added to the mixture,
which was taken every second hour, and she had taken about 100m.
of tine. opii. the day before the critical paroxysm. A question might
Arise as to the effect of opium under such* circumstances, but there
are few practitioners who have not seen it urged to a much greater
extent in violent cases of hysteria. We reccollect a case in the
Edinburgh Hospital in which 3ij were given' at once, and' with
singular success ; and this practice is very generally resorted to' in.
such cases. In the case under consideration there was no occasion .
to repeat the antispasmodic mixt. with opium after the intense
paroxysm, the o. of iron was continued, and in a few days the patient
was convalescent. In this case the cold bath suggested itself;' but
such was the muscular spasms,' and the sense of suffocation/ that we
were afraid to try it Colocynth pill with cal. was prescribed
during convalescence.' The pathology of hysteria proposed by Mr.-
Tate was verified in this case— the uterine function was defective.— Ed.

10. Fever in Dublin. — We have been favoured with the perusal of the
forthcoming Medical Report of the Cork Street Fever Hospital, Dublin.
The records of this hospital, says Dr. O'Brien, furnish evidence that the
mortality has never increased regularly in proportion to the admissions ;
but on the contrary, when the admissions have been most numerous,
the relative mortality has, generally speaking,' been least. Thus; in
the three great Epidemic Fevers which occurred in Dublin, in the
fcburse of the last 20 years, the mortality in 1815, was 1 in 20; in
1818; 1 in 30; and in 1826, 1 in 28; while in the three years 1823,
i "in 1824, 1825, which present a considerable reduction in the
admissions,' the total mortality was 1 in 11 ; and in the two past
years 1828 and 1829, in which the admissions were also much di-
minished; the total mortality was 1 in 14.

The inference from this fact is, that the majority of cases which
constitute our Epidemic Fevers, are of a mild character, a dispensa-
tion by which Providence interposes to mitigate the severity of its
own inflictions.

SUROKBT.

.11. Ligature on the internal Iliac Artery. — The internal iliac
artery, on which Dr. Stevens operated at Santa' Croix in "1812, is now

a the* amam ef the Royal College of Surgeons. Tbe/ preparation
had boon sent to London several yearn since, and wM pfeced in a
mQw, w&ere it might stifi have remained, had not the attention of
lb. frtovwo been directed to it, by the doubt thrown on the opera-
«n* by Mr. Lawrence, is his. last course e# lectures at St. Bartnolp--
bmw^s Hospital. The preparation was examined by that gentlemaxt,
and several otfcev eminent surgeons, who admitted that the vessel had
been tied. The patient lived ten years after the operation. The m-
tetaal iliae has also been tied in this tountry by Atkinson-, but con-
secutive haemorrhage destroyed the patient : it was tied in America
by Dr. Pommeroy White, in the West indies, (the preparation sent
to Sk A. Cooper* and placed hi the museum ei Guy'* Hospital) and
•Jbo in iafc. Petenbuig. ft was said that Mi. take Bett perforated
tan operation.

12. Sfrphyhrepfyx — Reun*en o£ the soft nalat#» M. Boux pen
fecmed thk operation an the 4*b ef May, the, forty eighth, time- wdk
snecene- The opeajflg in the palate we* slight, three sutures went: ap-
pfod a^d adhesion wee perfectly effected, op. tit.

V|U ^Mriffnjr a/ jjtafcta* Pari* ifey, 4.— Hydrophotesu M.
fwjne, jepegfed on a, memoir, by M. Chaume* of Ihe departasiit oi
t#ir*t, which contained ae account of m persona who were bitten
by a, afc* wolf im September, four ef whom died, and two- weve near m
health* They were most severely? bitten, and weae saved by efaaisionj
oC the injured part*; the mode of perform*** this opejatioat Wee pee*-
Km, lm| apt described until a* fitfufie sitting, whan i* watt bej ruty
detnjfed. The; thanks ef the aeademy as aha their medal went
e*erfed to the a*»ttar~. The wolf wa» MUtdV but no, trace of asmw-

ajafeetdwrnflgl* a> a*.

H- ^n#nriant qf tf* 4mv* e»d «w**.— <M. taffrey » presented & ma*
tgodfrimft 3G to 4& affected with hypertrophy ei the hem*, wfamt
^tate wa» wy Jerly unproved und** the iafluenjse of mow* end

F*ys4o*q«s.
*S. IcVvoZ Jcedbwiu ?fi Msejicme, *em, *h» 23d.— M. Horry
leporeed to- the Acadaatv* the result ef his experiments en> the fneuJL
nation oi Ac lunge of mingrabbits, of the lungaofsheep, and- mam
arte* donah. He concluded, 1st, that insufflation seldom oeaeee in>
nana of the huge unless toe long and toe- violently continued, that
death is eeuBod by a mixture of air and bloed in tile heart, or-fey a
dmddehydfceiherm^evbythedislm^

mmcc* aaay cause subplcural, but not interlobular emphysema, an*
thatinaramVatiunof the digestive tube ia almost as promptly mortal a*
that of tnefamg*,by preventing the descent of the diaphragm and im-
annum? respiration. 2ndly. That crepitation always indieotea disease,
and depends on froth in the bronchi, or on tile mixture* of atr
with an effused fluid, giving rise to rate and causing asphyxia or death .
3n%. Tha£ the effusion, of bleed into the tiaekea from, a, Kounjck is
jangrrraia, a* it ia exnectojatedor ahaotbed. witlLdi%ttUy*and i*4i*A
mated ta he converted iata* froth. 4th- If water pa*a w to tba tufl^pa
daring submersion, it is easily poured off by giving a declining posi-

Vot v — xo. 23. l

74 Bibliography.

tion to the superior parts of the body ; but if a person respire on the'
.surface of the water, the water which passes into ,the trachea will
he frothy and not easily removed : it is therefore necessary to remove all
water before we commence insufflation. 5th. We should remember
that the fluid effused during the agony (death) may be the sole cause
of extinguishing life. Many members, presented confirmatory re-
flections on the opinion of Mr. Piorry, as to the innoccuity of insuf-
flation in a great majority of cases. Arch. Gen.

MM. Leroy, Magendie, and Dumeril are opposed to M. Piorry *s
opinion.

CHEMISTRY.

16. Institute of France, Meeting, May 10. — Salicine substitute for
quinine. M. Magendie read in his own name and in that of M. Gray
Lussac, a report on a memoir by M. Leroux, apothecary of Vitry-le-
Francais, relative to a chemical analysis of willow bark, and on the
discovery of its immediate principle as a substitute for sulphate of
quinine. M. Leroux had considered this substance a new alkali, but
he renounced this opinion after having experimented before the above
commissioners as the extract of willow did not combine with acids as
alkaline substances do, it was decomposed by them, and by commixture
lost all its properties. He therefore was mistaken in thinking he had
discovered a sulphate of salicine. His report was nothing more than
the discovery of a substance called salicine, which in a pure state
presented itself in the form of very fine white pearly crystals, very solu-
ble in water or alkahol, but not in ether, its taste very bitter and
aromatic. It is obtained by boiling Ibiij of the bark, salix helix,
(Defontaines), for an hour, then drying and powdering it, in Oxv of
water impregnated with carb-potas 3iv. when cold, liquid acetate of
lead Oij. are to be added, when a deposit takes place ; it is filtered
and treated with sulph. acid, and the lead precipitated by a current
of hydro-sulphuric acid. The excess of acid is saturated by the c.
calcis, filtered, the liquor concentrated and saturated to neutraliza-
tion by diluted sulph. acid (etendue,) it is black and filtered while
hot, it is crystalised and dried without exposure to light. This ope-
ration affords an ounce of salicine, but on a large scale double th e
quantity is obtained. Mr. Magendie has employed the remedy on se-
veral occasions in June 1829, and has found it an excellent febrifuge.
He has cured many cases of intermittents in a day, by three doses of
salicine of six grains each. M M. Miguel, Husson, and Bally of
the Hotel Dieu and Le Charite' and many other practitioners have
tried it with similar success, and all declare that from 20. to 30 grains
will arrest the febrile access of whatever type. M. M. BrugnateBi.»
Buckner and Fontaine had experimented on this substance, but were
unable to isolate it pure and crystalised, which M. Leroux only has
accomplished. — Journi Hebdom* Mai. 15.

Hygib^e.

17. Vaccination. — We hgve. received a communication which con-
demns in no measured terms tie manner in which vaccine disease is
introduced into the system, at, a certain hospital m this city. The

Hygiene. 75

writer states that thirty and even forty punctures are made in a line
fra» the middle of the deltoid muscle to the elbow ; and that in con-
sequence, the whole arm becomes inflamed during the progress of
the disease ; and exposes the infant to unnecessary pain and suffer-
ing. The writer requests us to explain the necessity or propriety of
such operation, to which we reply that the proceeding is as barbarous
i«s unnecessary, and contrary to the directions given by the National
Vaccme ^Establishment. We cannot agree with him, that this me-
thod is resorted to, for the purpose of frightening mothers and ren-
dering them averse to vaccination. Degrading and base as the prac-
tices now too common among all classes of medical men are ; we
cannot assent to the opinion of our correspondent. We should be
rather inclined to ascribe it to ignorance, or over caution, than to
baser motives.' -The Royal Academy of Medicine, in Paris, has re-
cently recommended vaccination in the strongest language and even
.addressed circular letters to the clergy of several departments of
•France. This distinguished body fully concurs in opinion with the emi-
nent physicians and surgeons who form the National Vaccine Board in
this country, as to the protective influence of the Jennerian discovery,
and the profession throughout Europe and the vast continent of Ame-
rica are equally convinced of the inestimable value of vaccine innocu-
lation.

MISCBLLANIK8, ♦

18. Royal College of Physicians, May 3 1 . — Dr. Turner in the chair.
*IV. Hawkins read a paper detailing experiments, relative to the pre-
Tvntson or; cure of Hydrophobia, and the bites of Serpents by Caesar
Hawkins, Esq. surgeon to St. George's Hospital. The author of this
paper has arrived at the conclusion, that there are two forms of
hydrophobia both in man and animals ; or that the disease may be.
nuld or severe. He remarks, that little attention has been paid to
the Incipient symptoms which are too often overlooked. He had em-
ployed the guaco, but with no better effect than when he had admi-
nistered prussic acid, and his experiments led him to conclude that
the effects of this antidote are extremely doubtful.

The Harveian Oration was delivered by Dr. Bright on 25th ulto. in
the presence of a large meeting of the members of the college. The
composition of the oration was truly classical ; and the orator spoke
with great clearness and distinctness. Two fellows and four licen-
tiates were admitted after the conclusion of the address. 'l

June 14. — Dr. Roberts in the chair. A paper was communicated
by Mr. Chevalier on the use of quinine as a 'tonic in combination with
purgatives in constipation. • He has ^jlsed it in this way for five years
wftfc success. The dose of the purgative may be gradually dimi-
nished. The following formula! he recommends for adults and

Jfr S. Quinae, gr. xxiv. Pil. Cambog: o. gr. xxxvi. fiat pill xij.
fy i^iiv. Ipecac, gr. J hyd. c. crcta, gij. S. Quinse, gr. es., magncs.

vel. jmlv. rhei q. s. m. ter indie'sumundae.

76 Miscellanies.

- - KOYAJL SOCIETY OF LONDON.

19. XitferWi^— Thisinte^
gerjr* is now benaaiqg to attract universal attention. M a saeotsag
of the Royal Society on Thursday 19th ufeo*, the motet crowded of any
which took place this season, a paper was read from the pen of Mr.
W. & Costello, entitled " lifltofrty ; it* apjdtisbitity, <* «• qgjiianua
/or the cure o/ &oae, iUmstoated i§ a wrist +f <*se* ." Mr* vestesb
is an Englishman, and has, till lately, been the coUeftgoc of the A-
oororer of this method, Dr. Civiale, of Paris, conjointly with Khali
he has relieved a great number of person* outferingfreu thin flsafauy.
la Branca, Lithotaity has already taken ksaaak aawngst aunjjoal ope-
rations, and it is this gentleman's object* as he exprcBUS it hi his
gaper, " to endeavour to reader this method of operation avpvlarsn
EaglaiicL" £iace his arrival «a London* last July, several very re-
mfiryT,k1a cure* hare beea effected by him.

• Mr. Costello's paper begins by stating the importance of easjuosng,
'whether the benefits Lkhotrity pieteadstoefier, be not mote specious
than real; and far the purpose of guiding this enquiry, hesabsnitiso
the lioyml Society a soma of eases illustrating its advantages. H3*
paper embrace* other objects* The importance of the newsnethod
of curing atone, having excited the attention of the public, a dear
statement of facts is rendered necessary — " 1st, in order to set bounds
to the enthusiasm of those, who expect more from it than this method
can accomplish ; 2nd, to enable practitioners in general to discrimi-
nate those cases, which are within the scope of this operation ; -and
lastly, to impress on the minds of the sufferers themselves, the neces-
sity of applying in time* the cure of this cruel disease; — the new
method being always certain, and attended with very little pain in isb
early stages.

With this view, Air* Costello establishes four classes, whereby the
different gradations -of difficulty which its application may encounter,
are exhibited. In die first class he places the simple cases, in which
the stone is of recent formation, and the general health unimpaired.
In the second, cases in which the malady has existed for some time,
and lias produced derangement in the general health, and commenc-
ing organic alteration. In die third class, die oigaas are more or
less profoundly diseased — and in the fourth class, the calculous con-
cretions are of large volume, the urinary apparatus disordered, and
the general health destroyed. This last class of cases can obtain no
relief from fine lithotritic operation; the three former classes admit its
application. In the first class, that of the simple cases, Mr. Costello
gives tibe history of four cases of the application of this method.
From ttie minute nature of the details, it cannot of course be ex-
pected fliat we shall follow him closely in his narration. Suffice it
to say, that in this class the operation is fully efficacious, and not only
is it exempt from danger, but almost from pain also. In one of these
cases, a gentleman who had been suffering for mix months was cared in
three minutes; in another, the patient has beea afflicted fcrtwelve
mutrihs, Bad was cured in five minutes; in a third, the result was equally

fortunate ; and tire fourth, -who required two application* of the ia-
aroxflent far bin .cure, thought «o lightly of die matter* that at the
second siting;, he told the operator, " 1 have eaffered^severely for the
hat jaii, and I dreaded the cutting operation of all thing* ; but I
dull now take no more trouble about regimen, for if my disease re-
turn, it ia ably the business of five minutes to be rid of it."

Sir, Ceetefio closes the narration of the simple eases by the follow-
ing reflections ;— -" These cases exhibit the operation of Iithotrity m
the mast favourable point of view, and are well oalqulafced to shew
the safety and efficacy of this method. It ia obvious, the earlier dais
operation la resorted to, the more certain and easy will be the Cure.
When tune ia not give* to bring on the general sympathy of the eaav
stitution. with the local irritation, — and local irritation has not gone
the length of producing organic alterations in the urinary apparatus,
then is the application of Li thourity certain in its effects, and attended
with little or no pain, or to speak -more strictly, with none beyond that
produced by ordinary catheteriam* The importance of an early ap-
plication of this method* is well established by the results of our
practice. in France. In 1824, only one-third of the sufferers,
whosonght for relief by the new method, were considered in a fit state
lor its application. Progressively, their number augmented, to ooe>
half and two- thirds. During the last, year M. Civile had. occasion
to perform the cutting operation in only two instances out of upwards
at thirty cases, and he lately observes in bis correspondence with me,
that he has not had any of those formidable cases so frequent in the
cosamencement of his practice. Iithotrity in France has thinned the
number of calculous patients ; and those who in their turn have the
misfortune to be afflicted with stone, now begin to apply m time.
The establishment of a Lhhotritic ward in the H6pital-Neoker, under
the care of my friend. M. Civiale, will contribute mainly to the ad-
vancement of an sera in Surgery, when cutting for stone wiU be a
rare event indeed. Though unsupported by the great dexterity aad
aaigical tact of the inventor of this operation, yet, I venture to hope,
that its progress in this country will be equally prosperous ; indeed,
such must be the desire of every friend to suffering humanity/1 •

After this modest, allusion to himself, Mr. Costello paid a very
handsome, and, we have no doubt* a well deserved compliment to
Sir Astley Cooper, for the zeal he has evinced m making tiis method
more extensively known* and in patronising it with all the influence
of his high name.

Mr. GosteUousheremthenarrationof the cases contained mtheseoond
class, by appropriate reflections. He candidly admits that their treat-
ment is more tedious, painful, aad difficult, than that of the cases in
the preceding series ; but he adds, even in these cases the success of
the new method is equally certain, and free from danger. In one of
these cases, the forceps a[ Sir A. Cooper had been employed but
without success, the calculi being too large for extraction by this in-
strument. The patient was ouretl in three sittings, (the last of which
took place in Sir A. Cooper's drawjaa>room ;) and after the opeta-
•fca walked down stairs, ia company with the medical men who had

7-8 Miscellanies.

been present on this occasion, and Sir Astley Cooper seeing; ham
smiling, observed, " Really, gentlemen, it is extxaopimaTy, after an
operation for stone to Bee the patient walk down stairs with us, and
laugh at it, as if it were the very reverse of serious/' and again he
exclaimed, " This is indeed the most splendid discovery of modern
tones." The coincidence is curious enough,- that this patient's name
should be Stone, and his place of residence Folkestone. In another
case in this class, the forceps had also been used without success.
The patient in this case was Gaptain Poulden, of Filton, near Bristol,
who was relieved in four sittings, and is now perfectly cured.

The third series, embraces cases in which the obstacles to the suc-
cess of Lithotrity are serious indeed. We the more readily pay at-
tention to Mr. Costello's opinions on this point, as they seem to be
exposed with no other view, than for the benefit of science. If he
had brought forward a pretension, that no difficulty was opposed to
the application of Lithotrity, and that his success was certain in all
cases, we should have distrusted his statements altogether : science is
best served by candour, and in this respect we have no room to find
fault. Before he enters on the narration of the cases contained under
this class, he says, " hitherto, we only considered those cases in which
the success of lithotrity is certain ; but unfortunately, our task is not
always so pleasant. • Cases too frequently occur, which require the
greatest care and caution in its application, and in which nevertheless,
the result is doubtful. In this class, the case of Mr. Hall, of Dart-
ford, will be read with great interest. This gentleman was operated
•on in France." Air. Costello terminates this case by saying—'* Mr.
• Hall has shewn his gratitude to Lithotrity, and at the same time
evinced the high opinion he entertains of. it as a curative method, by
introducing to me, since my return to England, two other gentlemen,
labouring under the same disease : they are not only cured, but are
here present at the meeting of the Royal Society. One of these
gentlemen who had been more than ordinarily affected by the danger
of his situation, and took the trouble of going to Dartford to see Mr.
Hall, was re-assured by him in the following words : — ' There is nothing
terrible in this operation ; be of good cheer, your life is in your own
hands/ The case of Mr. Kearn, parish priest of Rathfarnham, near
Dublin, aged 74, is also a very interesting one. That of Hannah
Stewardson, operated on at St. Bartholomew's Hospital, was one of
great difficulty, and is mentioned as the first instance in which this
operation was performed in any public hospital in England ; but the
case of Mr. W. Bowdery, bookseller in Oxford-street, exhibits the
triumph of lithotrity in the most marked manner of any in the
series. This patient had several calculi, together with an adven-
titious growth within the bladder. He had laboured under this com-
plaint for six or seven years. Mr. Costello triumphed over the
numerous difficulties of this case, in a manner highly creditable to his
skill and patience, as well as to the method which he is so laudably-
engaged in propagating. He terminates the narration of it by the
following words : — " Mr. Bowdery's case presented a very serious,
and happily a rare complication. The treatment was long. It is

Miscellanies, 79

tnje, tt might have been considerably abridged ; but the patient lived :
near me, in town, and for his sake as well as of that of lithotrity in .
England, 1 felt bound not to be precipitate, lest I should have. ex-
posed myself, or the method, to a chance of failure." There is
another case to which we deem it proper to advert, though in as .few
words as possible ; it is that of Mr. J. V. Batley, a young painter of .
great promise. This gentleman had laboured under this complaint
for the space of ten years, the calculus had attained the size of a hen's
egg (the largest which Mr. Costello's instrument can grasp,) and he
was wasted to a skeleton ; notwithstanding these unfavourable cir-
cumstances, Mr. Costello effected his cure.

The paper, which was of considerable length, was listened to
throughout with the deepest attention. — The thanks of the Royal
Society were voted to Mr. Costello for his valuable communication.
A second demonstration of his very ingenious instruments took place
subsequently in the Library of the Society.

20. Medico Botanical Society, June. — Mr. Houlton, Professor of
Botany to this Society, delivered his introductory lecture at the last
meeting in May, and took a most extensive view of the subject.
He was listened to with great attention.

Dr. dendenning, Professor of Toxicology, delivered his intro-
ductory lecture at the succeeding meeting, in which he evinced an
intimate acquaintance with the primitive records of medicine, espe-
cially the works of Hippocrates, Galen, Dioscordes, &c. — while his
quotations from the earlier Greek and Roman works proved his
attainments in classical literature. The lecture evinced great re-
search, and drew forth an unanimous vote of thanks from the society,
and a request that it might be published for distribution among the
members.

Mr. Houlton gave a demonstration of several medicinal plants,
which were on the table.

Dr. Whiting, Professor of Materia Medica, explained the medical
oses of the most important of those described by the lectrueron
Botany.

BOTANY.

•

21. Protraction of Vegetable Life ina dry state. — Mr. Houlton, pro-
duced abulbous root, which was discovered! n the hand of an Egyptian
mummy, in which it probably had remained for 2,000 years. It germi- .
nated on exposure to the atmosphere ; when placed on the earth it grew
with great rapidity. After a meeting of the 22d, Mr. H. demonstrated
several medical plants, hyocm. digitalis belladonna, conium, &c. and
stated the very important fact that hyociamus of the first year's
growth is usually sold in the market, and is inert, that of the second
year, collected in June or July, can alone be depended on. This
readily accounts for the uncertainty of the remedy. Mr. H. has also
observed that digitalis does not always flower the second year, as
toted in books, and he shewed a specimen of the plant in flower of
tf* third rear's growth. He is of opinion that both digitalis and hyocia-

80 Miscellanies*

mns should be in lower when collected for medical use, without refer-
ence to age. A paper was read from Dr. Hanoc<& on a South American
plant, which he has found as valuable aa cinchona, and he doubted
veay much the febrifuge properties of the latter.

D*. Whiting also very much doubted the tonic power ascribed to
thai andotee? medicines.

Eh?. SSgmoad strongly advocated the received opinion, and called
on Dr. W. to state his reasons for differing from the general opinion.

Dr. W. dbi not consider himself at liberty to enter into a debatev
as- the constitution of the society was against diseussion. The mat-
ter here dropped. It would perhaps be as well if the professors* of tbjsr
society confined themselves to an exposition of the received opinions*;
for if they indulge in theorising or opposing the reeerred dectMen.
they cannot expect that many talented physicians who hear them
wilt Eaten to suck declarations without replying to them.

Mr. Everet was unanimously eleeted professor of chemistry ta tfce
Society.

22. Prospect** of the Metropolitan Society of General Practitianetm
in Medicine and Surgery. — While almost all public bodies, whether
professional or commercial, form associations, corporations, or com-
panies for the purposes of legislating for their mutual protection and
for the advancement of their prosperity, k is found that no association*
of thenuineroue class of medical men comprehended under the term
General Practitioner*, has yet in any manner been formed for the pro-
tection of their particular interests.

Various branches of the medical profession have colleges, ehartem,
and corporations, from which the Oenerai Practitioner is either alto-
gether excluded, or attached as an appendage only ; he i» net ad-
mitted to a participation in their councils, or to share in their hononwn;
as a General Practitioner, he belongs exclusively to no one branch,
and is, therefore, virtually excluded from all.

A Society has, therefore, been formed, entitled " Th» Mnrnopo-

LITAN SOCIETY OF GbMUAL PnAGTITfOUVRe IK MBBieilf* AND 8lJB-

obbt," which is intended as an union of the Pactitioners of thin clean
throughout England and Wales, for the protection of their mutual,
and individual interests ; having the following objects ; —

1st— Sufch alteration of existing laws ami enttiema aa sJbatf pro-
mate the prosperity, and wpeotobiUfcu o£ the &mxA tad? ofpiacti-
tionajn.

xnfl\— The adoptim of each measurefl w may b^ c^uA»pw ^ tn. fee
adtnacenoent oi medioal, scienoe, aM*£ piftfflflfwml i*bm*1'm>

3rd.— The perindieajl aeaamWinfr oi th* »ejnben% for titftfajy a#4.
scientific dtaiiaattn^fer the cjUtivaJionei &omi tntenxmjse, and far
the c*n#id»*tim. oi ganexel meajujeA relative ft the. Sgnjety.

4A>— The cetaJaonof. a fend to ha annaopnat^ tp tjie nKttactiau
of tha Manihare and fee th* gtatwi exjgenefea of t^% Softietx.

nahr^The aateetsameirt Qf a fawafent frn4, by cj*tributi*fis. few*
Mcmfcm oi the Smfmiou, eA laiga and other ohfiMble pemona, for
the Belief of diatomd medical me* and *«» frmjlie*

. Miscellan ies. 8 1

•

The limits of a prospectus will not alio* of a full detail of the ob-
ject* contemplated ; but it may be observed, in addition to the fore*
going general statement, that it is intended, as soon as practicable,
to effect some regulation respecting the mode of professional com-
pensation ; and, if necessary, to procure a legislative enactment to
authorise the General Practitioner to make a fair and open -charge for
his services. It is also intended to protect, individually, those mem-
bers who may become involved in questions which may be considered
by the Committee to affect the interests of the Society as a body.

Notwithstanding that there are numerous charitable funds for re-
lieving distressed members of particular branches of the Medical pro-
fession, it is found that there are many Members of that Profession
who are not objects of relief from any of those funds -, and it is, there-
fere; to supply this desideratum, that the Plan of a General Benevo-
lent Fund has been adopted, the applicatoin of which, it is intended,
whmdd not be confined to this Society exclusively, but should be extended,
at the discretion of the Committee, to every Member of the Prqfes-
no*.

The affairs of the Society are under the management of a President,
Vice-President, and a Committee.

A bouse, or chambers, will be engaged, as early as possible, for the
use of the Society.

The Society will meet at such stated periods, and in such manner,
as will be hereafter determined.

The foregoing is a brief statement of the views of the Founders of
this Society, and of the advantages intended from its institution, the
plan of which may be enlarged, or curtailed, according to the support
it may receive.

The Conunitte of Management entertain a confident hope that the
Society will be of great utility to the general body of Practitioners,
whose attention to this subject is earnestly recommended.

William Gaitbkell, President.

23. Ophthalmic Hospital, St. Petersburg.— From May 1828 to May
1829, 5751 individuals. presented themselves at the hospital; of these
3797 were men, and 1954 women, the number of their visits was
17,687. The number of the operations was 520 — 4 for artificial pu-
pil, 78 for cataract, 205 for contraction of the eyelids, 34 extirpa-
tions of tumours, 131 extractions of foreign bodies, 5 operations for
staphyloma, 10 punctures of the cornea, I for fistula lachrymalis, and
43 for different operations.

24. Diagnosis from the appearance of the Tongue. — M. Piorry has
arrived at the following results from his observation. When the pulse
is strong, frequent, full and developed, the conjunctiva, cheeks, lips,
pharynx and gums are red, the tongue partakes of the coloration.
After large evacuations of blood, and' after chronic diseases, all the
tiseaes are pale, and also the tongue. The gastritis, enteritis and
dysentery attended with slight fever, the tongue is more or less pale,
in the traumatic fevers, in acute pneumonia without gastric symptoms;

vol. v. — jro. 25. m

82 Mis cell a n ies .

the tongue is generally of a vermillion colour, and sometimes very
red. It becomes pale after repeated bleedings, or when the stomach
or liver become consecutively affected. This coloration of the
tongue does not often exist but at the edges, the middle may be of
various colours, but when these are removed, the whole organ is of a
uniform colour. The apex does not often redden but by the effort,
which the patient makes to protrude the organ; when the muscles of
the organ relax, the redness disappears immediately. The dryness of
the lingual surface arises from the evaporation of the liquid which
moistens it. Every cause which obliges respiration by the mouth
tends to % dry the tongue. In coryza and all diseases of the nasal
fossa?, the tongue is dry. All causes which force the air through the
buccal canal, induce dryness of the tongue. Accelerated respiration
produces this phenomenon. The tongue is very dry in general in in-
tense pneumonia, especially if accompanied with coryza, also in pleu-
risy. Fever accompanied by frequent contraction of the heart, and
consequently frequent respiration, disease of the liver, stomach, pe-
ritioneum, constraining the descent of the diaphragm, and accelerat-
ing respiration will have the same effect. The repeated observations
and experiments on the saliva and mucus treated by beat, have con-
vinced M. Piorry that the formation of the various coatings of
the tongue and teeth arise from the different degrees of exsiccation
of the fluids which lubricate them. He thinks the coats of the
tongue depend on the elements of the blood, as the saliva and buccal
mucus must of course depend upon the vital fluid. So in diseases of
the liver, all the tisssues are coloured yellow, the urine and sweat in
the same manner, and it is probable that the fluids of the mouth par-
take of the colour and cause the appearance of the tongue in such
cases. — Abridged from the Journ. Hebdom.

25. London Medical and Surgical^ Journal. — We felt not a little
flattered, on looking over the two numbers for January and February,
1830, of the above Journal, to find that its editor has taken no less
than eighteen articles from the Quarterly Summary of our October
number, verbatim et literatim. It is really a matter of no small self-
gratulation, that the intelligence contained in our digest from the
continental Journals should still be in time, after re-crossing the At-
lantic, to meet the wants of a British editor, and gratify the curiosity
not only of British, but London readers. We dare hardly trace this
success of ours in manufacturing the raw material from France and
Germany, so as to meet the wants of the London market, to the ta-
riff ; for in this case so iar from our having a premium for our labours,
we. have not even the marketable return of acknowledgment — no
credit having been given to our Journal for the articles borrowed. —
We would venture to suggest to the editor of the London Medical and
Surgical some slight deviation from the words of our Quarterly Sum-
mary, at least when we refer to a former volume and page, otherwise
the reader of his work will be somewhat puzzled at finding the total
inapplicableness of the reference. — North Amer. Journ.

Miscellanies. 83

'Worthy Jonathan, " lay not the flattering unction to thy soul,"
that die London Medical and Surgical Journal has drawn on the pages
<rf its homonyme in North America to the extent, or any thing like
the extent stated. The mercantile form into which this reclamation
of oar trans-atlantic contemporary is thrown, most happily shadows
«p the good old counting-house form of a " bill of lading," at which,
k all probability, he may have tried his hand, previously to his exal-
tation to the editorial dignity. This suspicion is strongly borne out,
if an adroit insinuation, that he had a hand in framing the tariff,
|j his lugging in the technicalities of " raw material" and mar-
ket, with the familiarity of a sturdy pacer upon 'change. We meet
tfus seer on his own ground ; and now for the facts. 80 far from
having done him the honour to quote so largely from him without
acknowledgment, our first article was a condensation of the substance
<rf a very verbose one of his, spread over eighteen pages, to which
ire thought ample justice might be done in fourteen lines, and which
we duly acknowledged. So much for the verbiage with which his
readers are regaled, and so much for His notions on copying verbatim
H literatim. The next extract occupied thirty-two lines, and con-
tained three articles, not one of which was original in his Journal,
bat perhaps by some form of ratiocination peculiar to himself, he may
deceive himself into the belief that the periodicals from which these
scientific gleanings were extracted, were not as accessible to us as to
him. We pity the delusion under which he labours, when he chuckles
at the very silly idea, that we, or any of our contemporaries in Lon-
don, chose him as our oracle, to be informed of the progress of sci-
ence in Europe.

The idea is so ridiculous as to admit of no other explanation than that
it is the offspring of a diseased brain, and yet we know of no malady
in the Nosology, to which we may refer his politico-literary niaiserie.
In truth, the part of our Journal into which his name has crept, and
which we are persuaded, notwithstanding his querulousness, he will
ever remember with gratitude, is that which is devoted to the hors
famrc It is occasionally confided to subaltern hands. We have,
however, given strict charge that none of the insipid entremets of the
North American Journal be found there in future.

Iv commencing another volume of this Journal, we hope we may
be excused for offering a few remarks on our past labours. We have
to acknowledge with gratitude the many encomiums which have
been passed on our exertions; and we feel deeply sensible of the
approbation and patronage which the profession in this and foreign
countries have been pleased to bestow upon this periodical. Such
Ottering rewards are powerful motives to urge us to render the work
uore worthy of attention. Our great object has-been to exhibit a
▼few of the progress of discovery in Anatomy, Physiology, Pathology,
Medicine, Surgery, Obstetricy, Materia Medica, Chemistry, Phar-
owcy, and Medical Jurisprudence ; and we refer to our two !»«*

84 Miscellanies.

volumes for the best and most convincing evidence that this object has
been accomplished. The variety of arrangement which we have adopt-
ed, and the varied information which we communicate, have given our
work so decided a preference in public favour, that its circulation has
increased to an extent which we did not expect or anticipate. The
terms in which our reviews have been spoken of, are of the moat
pleasing description. In our Analysis of works, we impute praise or
blame to authors with candour and equity ; we assert the truth, and
maintain it by argument and fact ; we vindicate the best authen-
ticated doctrine ; we affirm what we know ; assert what we believe ;
aver facts, attest them by evidence, and assure from conviction.
However distinguished in rank or talents, or eminent in the profes •
sion an author may be, if he contradicts the received opinions without
the most positive proof of the validity of his own, he receives no
fulsome adulation, no delicious flattery, no ill-deserved compliments
from us. On the other hand, we encourage and advance works of
utility, whoever may be their authors. We endeavour to give fair
and impartial reviews of all works at the earliest possible period after
publication, and especially those of practical interest ; and here it may
be stated with truth, that we often anticipate most of our contem-
poraries. We defend our criticisms by argument, justify them by
reason and authority, and establish their fairness by proof. We fear-
lessly impugn false theories, • idle fancies, and dangerous doctrines,
by sober argument or ridicule. We censure and correct faults, and
endeavour to rectify errors and mistakes. We praise every work that
is meritorious. We never disparage the abilities or rank of authors
or rivals ; we do not detract from their merit, traduce their characters,
or depreciate their understandings or acquirements. Our sole object
is impartial criticism, and not personal animadversion. Among our
Original Communications are essays of great practical interest ; and
here we gratefully acknowledge our obligations for the accession of
eminent contributors, and take this opportunity of soliciting contri-
butions from every rank in the profession. Our Bibliographical de-
partment is enriched with all the additions made to science by the
most illustrious writers of the present age, comprising many subjects
unnoticed by our contemporaries. Every article in this department
is either abridged or carefully revised before its insertion ; and here
we submit the latest intelligence in recent inquiries and discoveries,
as we aspire to detail the progress of all the branches of the medical
sciences . This section of our Journal condenses whatever the learning,
the skill, the industry, and the geniusof eminent men abroad and at home
may produce, for the interests of science and mankind. Our last depart-
ment is entitled, Miscellanies ; and comprehends original reports of the
proceedings of our Colleges and Societies, medical police, regulations
of education, literary intelligence, lists of recent publications, &c.
In a word, The London Medical and Surgical Journal comprehends
every branch of medical science ; contains an abundance, of scientific
and practical matter, and includes every thing of importance. It will
be found a valuable compilation to those who live at a distance from

Miscellanies. 85

large towns, and who may neither have opportunity nor pecuniary
means of becoming acquainted with the multifarious medical produc-
tions, domestic and foreign, which daily issue from the press. This
Journal can be procured through the Clerks of the Roads, General
Post Office, at a trifling additional expense. It is published the ist
of every month, the price 2s. Sd.

Appeal to the Profession on behalf of a distressed Member.

A gentleman advanced in life, who received his education in the
Medical School of St. George's Hospital, under the illustrious
Hunter, Cruickshank, BaOlie, and the splendid galaxy of talent of
their day, has through unforeseen events been reduced to great dis-
tress. However numerous the appeals of this description are unfor-
tunately of late, we Jiope and trust, that the wonted benevolence of
our profession will be displayed on the present occasiqn, and that
those who enjoy the advantages of fame and fortune will not forget
that esprit de corps which has ever distinguished their predecessors,
and, we hope, will always continue to distinguish our profession.
The most satisfactory documents, in proof of the literary and scientific
attainments and deplorable condition of the gentleman whose cause
we advocate, may be seen at our publishers', where contributions
will be received.

The London University. — We are sorry to perceive that a serious
misunderstanding has occurred between the Council of the London
University and its Professors, The cause of the existing differences
has not transpired, and feme with her thousand tongues has of course
been active on the occasion. Mr. Bell has resigned, as he considered
the promises made to medical students in his introductory lecture
could not be fulfilled. We cannot understand the force of this reason,
as every candid man must, admit that the medical professors in
their respective departments are men of the first rate talents^ and
as a body stand unequalled in the medical schools of this metropolis.
Every one oi them' has his name inscribed in the annals of science —
a fact that deserves consideration from those who attempt to depre-
ciate the character of the medical department of the University. The
establishment of a royal rival institution may have some effect on
those who are so very prominent in the ranks of the opposition ; . but
we very much doubt whether the embryo college will equal its pre-
decessor. Tempore mutantur, 4c

86 Miscellanies.

BOOKS KBCBIVBO DURING THE MONTH.

1. Remarks on Nervous and Mental Disorders, with especial reference to recent
Investigations on the subject of Insanity, By David Uwin«, M. D. London,
1830. T. and G. Underwood, Fleet Street 8vo. pp. 41.

%* Dr. Uwins has devoted great attention to the study of mental disorders, and
is among those who are averse to the separation of iusanity from other mala-
dies which are allied to it in nature, and differ from it in degree. We shall
defer further remarks on this production, until our notice of other works on
the same disorder, in our next number.

2. Modern Medicine, influenced by Morbid Anatomy : an Oration delivered »t
the Fifty-seventh Anniversary of the Medical Society of London. Also, an Apo-
logy for Medical Nomenclature. By Leonard Stewart, M. D., &c, Physician
to the Farringdon Dispensary, and Vice President of the Medical Society of London.
London, 1830. Longman and Co. , and Burgess and Hill. pp. 56.

*»+ This Essay is at once literary, scientific and instructive.

3. Cholera, its Nature, Cause and Treatment ; with original Views physiological .
pathological and therapeutical, in relation. to Fever; the Action of Poisons on the
System, &c. ftc. By Charles Searle, Surgeon of the Hon. East India Company's
Madras Establisdment London, 1830. 9vo. pp. 255. John Wilson.

4. A Popular Description of the Aldinian Defensive Dresses, ftc. Ac. for
rescuing Human Life and Property from Injury or Destruction in Cases of Fire.
London, pp. 24. J. Ridgway.

fl. A Manual- of Descriptive Anatomy. By Cloquet, translated -by Thos. King,
Surgeon. Part IV, with Plates.

- 7. An Inquiry concerning the Indications of Insanity, with Suggestion* for the
better Protection of the Insane. By John Connolly, M.D. Professor of Medicine
in the University of London. London, 1880, 8vo. pp. 496. John Taylor.

•*• An accurate, well digested, well written work, evincing deliberation, research,
judgment and fidelity.

8. Flora Medica, No 31. Loudon, 18S0. John Wilson.

9. A Practice of Physic, comprising most of the Diseases not treat?d of in - " Dis-
eases of Women," and «' Diseases of Children. By Wm P. Dewees, M. D. Ad-
junct Professorof Midwifery in the University of Pennsylvania, &c. &c. &c. Phi-
ladelphia, 1830. 2 vols. 8vo. pp. 833.

+#* The eminent author of this work is favourably known to the profession in every
country, and the present production adds much to his reputation as a practical
physician ; while it demonstrates the fallacy of a ridiculous rule, long aban-
doned by all sensible men, that obstetric physicians should not practise medi-
cine generally. We shall review this excellent work in our next.

Miscellanies, -87

10. Oo the Diseases and Injuries of Arteries, with the Operations required for
their Cure — being the Substance of the Lectures delivered in the Royal College of
Surgeons in the Spring of 1829. By G. J. Guthrie,|F. R. S. Professor of Anatomy
lad Surgery to the Royal College of Surgeons, Surgeon to the Westminster Hos-
pital, to the Royal Westminster Ophthalmic Hospital, &c &c. London, 1930, 870.
pp.416. Burgess ad Hill.

•*• A work of great practical utility.

The following Journal* are received regularly —

U. Medsco>Chirurgical Review and Journal of Practical Medicine. Edited by
fanes Johnson, M. D. &c.

12. The Edinburgh Medical and Surgical Journal. July.

13. Hie London Medical Gazette, June.

11 The Midland Medical and Surgical Reporter. May.

16. The American Journal of the Medical Sciences, Feb. 1830. Philadelphia.

16. The North American Medical and Surgical Journal. Published under the
utpieei of the Kappa Lambda Association of the United States. April, 1830.

17. Gazette Medicate de Paris, Journal de Medecine et des Sciences accessories
Ptrtiasant tons les samedis. No 1 to 14>.

16. Bulletin des Sciences Medicales. Par M. le Baron de Ferussac.

19. Revue Medicale Francaise et Etrangere. Mai and Juin, 1880.

SO. Journal des Progres des Sciences et Institutiones Medicales en Europe et
Aaeriqoe. Tome i, 1830. Paris.

21. Annates de la Medecine Pbysiologique. Mai.

22. Journal Universel des Sciences Medicales.
33. Journal Generate de Medecine Juin.

21 NouveDe Bibliotheque Medicale. Juin.

23. Archives Generates de Medecine. Juin, 1830.

26. Journal de Chemie Medicale de Pharmacie et Toxicologic. Juin.

27. La Lancette Francaise. Juin. »

,28. LaChniqoe, Annates de Medecine Universelle. Juin.

"2D. Journal Hebdomadaire. Juin,

30. Journal der Chirnrgie nnd Augen Heilkunde. Herausgegeben von C. F. V.
Gnefe end Ph. V. Wajther.

88 Miscellanies.

31. Aichiv fur Anatomie imd Physiologie. J. P. Meckel's.

32* Journal der Pratischen heilkunde. Hufland & Osan's.
i.

33. Magaxin far die gesammte heilkunde. Rust's.

34. Annali Universali di Medicina del Dottore Omodei. Milan.

35. Remarks on Hydrophobia prophylactic and curative. By John Murray,
P. S. A. P.L.S. &c. &c. London, 1830. 8vo. pp. 82. See Bibliography.

36. On Canine Madness; comprising the Symptoms, Post-mortem Appearances,
Nature, Origin, and preventive and curative Treatment of Rabies in the Dog, and
other domestic Animals By W. Youatt; V. S. & P. Z. S. Lecturer on Anatomy
and Diseases of domestic Animals, &c. &c. London, 1830. Longman and Go-
fihro. pp. 52. Reviewed in this Number.

37. Account of the Varieties in the Arterial System in the Human Body. By
P. H. Green, A.B. M.D. Trin. Coll. Dublin. Seven P^atee. Dublin, 1830. 8vo.
pp» 39. J. M. Leckie. Reviewed in the present Number.

I •

38. Neurology of the Human Body. By BarrenJans, revised and adapted to. the
English Nomenclature* By Thomas King, late House Surgeon .to the Hotel Dieu,
Docteur en Medecine de la Faculte de Paris, Member of the Royal College of .Sur-
geons in Lofidon, and Lecturer on Anatomy at the Aldersgate Street Medical School:
Ten splendid Plates, with description. London, 1830. 8vo. pp. 16. FeuilUt, Du-
mus, and Co.^cestex Square. *•••-..

%* These' splendid plates can be so arranged as to represent the body of the adult
siae. They not only illustrate the minutest ramifications of the nervous jy stein-,
but various other tissues and Organs. They are beautifully and accurately .exe-
cuted, both plain and coloured;, and the adaptation of the description to our
nomenclature is highly creditable to the attainments and industry of Mr. King.
They are rendered at a price so moderate as to be attainable' to' students^ and are
well worthy of a place in every medicariibrary lecture room and jnivate surgery.

Communicationehave been received from Dr. Sutton of Greenwich, Mr. Marshall,
Dr. Stoker of Dublin. Mr. Boyle of Dublin, Dr Dewees of Philadelphia, Mr.
Poote, Mr Warden, etc.

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. 28. AUGUST 1, 183J. Vol. V.

CRITICAL REVIEW.

1 — A Practice of Physic, comprising most of the Diseases
not treated of in €€ Diseases of Females," and " Diseases
of Children ." — By Wllliam P. Dewees, M.D. Professor
of Midwifery, in the University of Pennsylvania, &c. &c.
Philadelphia, 1830. Vol. II. pp. 833, Carey and Lea.

II.— A Manual of Therapeutics. — By L. Martinet, D. M. P.
translated with alterations and additions, by Robert Nor-
ton, M. D. Extraordinary Member of the Medical Society
of Edinburgh. London, 1830. 12mo. pp. 323, William
Jackson.

The first work on our list requires no formal introduction to
the medical public. The former productions of Dr. Dewees
have been so eminently successful, that any work of his will
be favorably received by the profession. In the volumes
before us, he evinces his usual good sense, so uud judgment,
great research, and the result of his experience after forty
years observation. He has done for medicine in America,
what Dr. Mason Good, has accomplished for it in this em-
pire ; but being a practical physician of much greater expe-
rience than our countryman, whose profound erudition and
distinguished literary attainments were pre-eminent, his prac-
tical precepts are entitled to more attention -and respect.
But Dr. Good is unequalled in the purity and elegance of
style, in the classic beauty of his nomenclature, and inelabo-
rate research, and happy condensation of his authorities, and
produced a work, which stands a splendid monument of
learning industry, and talent, and whose utility if equalled,
m not surpasses by any modern publication. Dr. Dowee*

rot. r.— jwo. 26.

90 Critical Review.

on the other baud, has solely directed his attention to patho-
logy and therapeutics, omitted nosology altogether, and Con-
sidered style and composition of secondary importance, so
that his work is totally different from Good's " Study of
Medicine." Its chief merit is in pathology and therapeutics,
it is deficient in semeiology, and it sets all nosological ar-
rangement at defiance. Thus we have rubeola after typhus,
next apoplexy, and then scarlatina ; erysipelas is placed
after dropsy, next phlegmasia dolens, then haemorrhages,
epilepsy, chorea, paralysis, colic, scrofula. Though all no-
sological arrangement is liable to objection, yet surely the
description of diseases of different kinds can answer no
useful purpose in the order adopted by our author. The
work contains a description of those diseases, not' treated
of in the author's treatises et on Diseases of Females and Chil-
dren," and these are so few, that the production, as a system
of practical medicine is much more limited, than those of
Cullen, Thomas, Gregory or Good. Those who possess all
our author's works have a complete system of medicine,
well worthy of a place in the library, with the. systems of this
and other European countries. The work under notice con-
tains much important information, and will be perused with
advantage by the most experienced practitioner. It embraces
excellent descriptions of the following1 topics: — " General
observations on the duties and qualifications of nurses;
faithful administration of medicine ; of giving drinks and
nourishment ; cleanliness, quiet, and ventilation of the sick
chamber, examination of the excretions, management of
patient, and various other duties in the sick room. Chapter
1. of Fever in general ; ch. ii. Intermittents ; ch. iii. Remit-
tents ; ch. iv. Yellow Fever; ch. v. Continued Fevers; ch.
vi. Typhus ; ch. vii. Rubeola ; ch. viii. Apoplexy ; ch. ix.
Scarlatina ; ch. x. Urticaria ; ch. xi. Phrenitis ; ch. xii. Hydro-
cephalus internus ; ch. xiii. Diseases of the Eyes, conjunc-
tivitis, sclerotitis, corneitis, &c. ; ch. xiv. Catarrh ; ch. xv.
xvi. xvii. Cynanche, and species of; ch. xviii. Pertussis; ch,
xix. Diseases of the Chest ; ch. xx. Pericarditis ; ch. xxi.
Peritonitis, Puerperalfever, hysteritis, enteritis; ch. xxii. Dy-
sentery ; ch. xxiii. Diarrhoea ; ch. xxiv. Rheumatism ; ch.
xxv. Gout; ch. xxvi. Dropsy: ch. xxvii. Erysipelas ; ch. xxviii.
Phlegmasia dolens; ch. xxix. Haemorrhages; ch. xxx. Epi-
lepsy; ch- xxxi. Chorea; ch. xxxii. Paralysis; ch. xxxiii.
Colic; ch. xxxi v. Scrofula, prescriptions, glossary of terms,
&c. The author has conferred an important advantage on
the profession by this able production, which adds much to
his well-earned reputation as a practical physician ; while he
has demonstrated the fallacy of a once foolish rule, that

Dr. Dewees on the Practice of Physic. 91

physicians who devote themselves to the practice of obste- .
tricy, should not jteajch or practice medicine generally. He
had only to refer to France, Germany, and Italy, for prece-
dents, where he found the first physicians and surgeons and
most eminent writers, practical obstetricians. But in this
country we have our artificial distinctions so well illustrated
by the documents recently published by the obstetric society,
nod which prove to demonstration our love of standing still,
and venerating- antiquity, while our contemporaries in other
countries are in rapid motion. How long in the name of sci-
ence and common sense are such antiquated inanities to con-
tinue ? But we are digressing, and must return to the work
which gave rise to these observations. We have only to
add in conclusion, that we have no hesitation in recommend-
ing it as decidedly one of the best systems of medicine
extant. The tenour of the work in general reflects the
highest honour on Dr. Dewees' talents, industry, and capa-
city for the execution of the arduous task which he bad
undertaken. It is one of the most able and satisfactory
works which modern times have produced, and will be a
standard authority.

The second work at the head of this article is M. Mar-
tinet's Practice of Medicine, which is a proper companion
for his well known and justly esteemed Manual Pathology.
This is an excellent compendium of the French practice,
while it is adapted to our own by the emendations of Dr.
Norton. We have not met a work for a long time which
contains in the same space so much useful matter ; and we
strongly recommend it for its accuracy, perspicuity, and the
valuable practical precepts with which it abounds. The
grounds upon which it founds its claims to approbation are,
brevity, accuracy, and natural arrangement. We are satis-
tied that no medical man, young or old, can peruse this work
without gaining much information and knowledge.

" It will be proper/* says Dr. Norton, " and it may obviate
prejudice on account of Us foreign extraction, to mention,
that this work is not an exact translation, for professing to
offer to the English student a manual of practice, I consi-
dered it necessary to sacrifice the duty of a translator to that
of an instructor, whenever the two seemed incompatible."
Professor M. Martinet adopts the following arrangement in
this work, which is more natural, more simple, and of course
more useful than any of the nosologies. He commences
with the diseases of the brain, arachnitis, acute hydroce*
phalus, chronic hydrocephalus, apoplexy, encephalitis, sof-
tening of the brain, epilepsy, hysteria, chorea, catalepsy,

92 Critical Review.

hypochondriasis, mania and nightmare. He next describes
the diseases of the chest, including those of the lungs and
heart, diseases of abdomen or digestive organs, diseases of
the tissues, mucous serous, and cutaneous, next general
diseases, as scorbutus, syphilis and scrofula, then the fevers,
and lastly, the treatment of poisoning. This excellent and
graphic work ought to be bound with its predecessor, the
Elements of Pathology, and is still more valuable. The
information it contains is so extensive, so various, and so
judicious, that the work cannot fail to be encouraged by
every class of medical practitioners. We understand it has
a great sale, and it well deserves it.

III. — An Inquiry concerning the Indications of Insanity,
with suggestions for the better protection and care of
the Insane. — By John Conolly, M. D. Professor of Medi-
cine in the University of London. London, 1830. 8vo.
pp. 496, John Taylor.

There is nothing more worthy of fixing the attention of a
physician or philosopher, than the constitution of the human
understanding. This is a truism attested by the primitive
archives of the healing art, as well as by the annals of
medicine in all succeeding ages. We have shewn in our
review of Dr. Pring's work* that many of our best metaphy-
sicians were members of the faculty. Without troubling
the reader with citations in proof of this position, we may
briefly remark that Locke, Hartley, and Brown, of Edin-
burgh, were physicians. It affords us much pleasure to see
the author of the work before us enter the arena, and are
happy to 6tate that he has acquitted himself with great
ability and unprecedented success. His work is purely
metaphysical, without any mystical jargon, and yet has all
the interest of a romance, qualities which cannot foil to
render it acceptable to the general reader, the lawyer, the
statesman, and even especially to the medical practitioner.
He has traced the progress of the mind from its simplest to
its most perfect state, and has founded his conclusions upon
common observation and sound sense. He has ably des-
cribed the faculties of the mind, and appealed to the expe-
rience of mankind for the truth of his positions, he has not
involved himself in assumptions, or in wild and gratuitous
reasonings, he has avoided all inquiry as to the seat of

• In eilectual and Moral Relations, 1890 See out Jan. No. vol. iv, p, 28.

Dr. Conolly on Indications of Insanity. 93

thought, and by induction and careful analysis, be has hap-
pily contrasted sanity with insanity. The style is pure and
unadulterated English, no slight merit in these times, while
the tone of the work is manly, unprejudiced, and impartial,
and impresses the reader with a very favourable opinion of
the bead and heart of the author, who has thrown tne shield
of reason and philanthropy over that unfortunate class of
beings who are deprived ot the chiefest faculty of our species,
which makes man the lord of the creation, and elevates him
far above its transient and useless concerns. We have no
hesitation in declaring this to be one of the most able and
satisfactory works on the philosophy or rather physiology of
the human understanding which has been hitherto produced.
Dr. Conolly has done for this branch of science what Dr.
Arnott has done for physics ; he has produced a work which
will hare an honourable place in the annals of medicine,
while it reflects great lustre on the splendid institution to
which he belongs. We must however observe that it is not
a finished performance, for it is silent on the pathology of
insanity, a defect which we did not expect in a production
by the learned and experienced author. All our metaphy-
sical writers have included as much pathology as he, but he
has exceeded all in the simplicity, beauty, accuracy, and
fidelity of his description of the constitution of the human
mind. Instructive and interesting as his description is, we
most decline to attempt its analysis, as the majority of
modern readers are mueh more partial to practical than to
theoretical details, and will be satisfied with being informed
of our author's conclusions. In justice however to him and
to the favourable opinion we give of his work, we must make
a few extracts, most strongly recommending the original to
every class of medical men.

The contents of the volume are as follow : — Introduction —
the present condition of lunatic bouses and lunatics — the
constitution of the human understanding — the various
degrees of perfection in which the faculties of the under-
standing are possessed by different individuals — inequalities,
weaknesses and peculiarities of the human understanding
which do not amount to insanity — modifications of the intel-
lectual activity and power by various stimuli, by disease,
by age — insanity — application of the inquiry to the duties of
medical men when consulted concerning the state of a
patient's mind — suggestions for the better protection and
care of the insane.

In a well written introduction our author dwells with great
force on the facility with which men may be consigned to
mad houses, and on the difficulty when they are once con-

94 Critical Review.

fined of regaining their liberty. He also comments with
much reason on the inattention paid by students to mental
disorders, and on the defects of medical education upon this
point He commences his introduction in these words : —

" For many years past, during five of which I held the appoint-
ment of Inspecting Physician to the Lunatic Houses for the County
of Warwick, I have availed myself, both in this and in other coun-
tries, of such opportunities as presented themselves to me of examin-
ing the correctness of the opinions contained in the following
pages.

" In offering them for the examination of others, my desire is to
render the recognition of insanity less difficult, by showing in what
it differs from those varieties of mind which approach the nearest to
it ; and to point out those circumstances which, even in persons de-
cidedly insane, can alone justify various degrees of restraint.

" That an inquiry of a difficult nature, and opposed, in this
country, by peculiar obstacles, must be incomplete, I freely admit.
The interests of the public greatly require that medical men, to
whom alone the insane can ever properly be entrusted, should have
opportunities of studying the forms of insanity, and of preparing
themselves for its treatment, in the same manner in which they pre-
pare themselves for the treatment of other disorders. They have
at present no such opportunities. During the term allotted to medi-
cal study, the student never sees a case of insanity, except by some
rare accident* Whilst every hospital is open, every lunatic asylum
is closed to him ; he can study all diseases but those affecting the
understanding,-— of all diseases the most calamitous. The first occur-
rence, consequently, of a case of insanity, in his own practice,
alarms him ; he is unable to make those distinctions which the rights'
and the happiness of individuals and of families require ; and has
recourse to indiscriminate, and, generally, to violent or unnecessary
means ; or gets rid of his anxiety and his patient together, by sign-
ing a certificate, which commits the unfortunate person to a' mad-
house. In the plan of his medical study, therefore,' attention to
diseases affecting the mind forms hardly any part ; and it has thus
happened that many individuals have been ignorantly confined, and
unjustly detained in houses for the reception of lunatics; and persons
of all ages, suffering under temporary mental derangement, from
temporary causes, shut up with the incurable ; nor is it any exag-
geration to say, that such treatment has in many cases destroyed all
hope of recovery." — p. 3.

He animadverts on the conduct of those who grant medical
certificates to consign their fellow-subjects to seclusion, on
the exaggerated and self-interested misrepresentations of
relations, and graphically describes the influence of irritation
and domestic quarrels on patients who are about to be visited
by medical men, outrages that often make sane persons furnish
abundant proofs of undeniable madness. He points out the

Dr. Conotly on Indications of Insanity. 95

conduct of keepers of asylums with a degree of fidelity that
bear 8 conviction to the mind of every candid man; and
clearly demonstrates the caution which ought to be observed
hj those who are called to give certificates in cases of alleged
insanity. The subject of our author's inquiry is important
to every man, and for the solid reasons assigned by him.

" Every man is interested in this subject ; for no man can confi-
dently reckon on the continuance of his perfect reason. Disease
may weaken, accident may disturb, anxiety may impair it ; and if
every departure from sound mind may subject the person so affected
to an indiscriminate treatment, including deprivation of property and
personal liberty, no man can be sure that he may not, with a full
oonciousness of his sufferings and wrongs, be one day treated as if all
sense and feeling were in him destroyed and lost; torn from his
family, from his home, from his innocent but eccentric pursuits, and
condemned, for an indefinite period, to pass his melancholy days
among the idiotic and the mad." — p. 9.

Want of leisure and of space preclude us from analysing
the different chapters of the work before us, nor indeed is it
atall necessary, as this production will find a place in every
medical library. We pass therefore to the chapter on the
constitution of the human understanding, in which the author
attempts to give an intelligible statement of the healthy
functions and natural actions of the human mind. He pro-
ceeds as follows: —

" Observation of what passes in ourselves and in others, shows us
that man derives his principal knowledge of the things around him
from the exercise of certain senses, by means of which his mind be-
comes impressed with the ideas of certain properties, existing, or
deemed to exist, in surrounding objects. These senses are so ordered
as not merely to contribute to the preservation, but to the enjoyment
of the individual ; and so along as they are in a healthy state, he re-
ceives such impressions of form, colour, number, distance, consistence,
dryness or moisture, temperature, sound, odour, flavour, &c. through
the medium of what are called the Five Senses, as agree with the
common experience of these impressions in the generality of man-
kind ; and accompanied with such emotions of pleasure, or of unea-
■neas or pain, as the generality of mankind derive through them.

" Each of the sensations excites that state of the mind which is
called Attention ; that is, each excites a momentary attention ; but
if we continue to attend to the sensation, the act of so doing is
voluntary, either arising from a wish to prolong a sensation which is
agreeable, or to understand 'it, in consequence of a desire, which
teeau to be very early developed in the human mind, of learning the
mftire of the things which affect it. We can direct our attention to
a sensation or withdraw it ; we can direct it to one of many sensa-
tions arising at the same time from one object, to the smell of a rose,

96 Critical Review.

or its colour, or to the arrangement 01 the petals ; to the smell of
a cyBt of musk, or to its globular form, or the nature of its strong
and bristly covering ; to the spires of a distant city, or to the varie-
gated beauty of the intermediate plain ; to the lowing of cattle in
the pastures, or the tinkling of a sheep-bell, or the sound of carriage
wheels advancing or dying upon the ear. We can attend to each of
these separately, and to each alternately, according to our inclination.

*•• When the impressions of any sense' have been experienced, we
find that we have the wonderful power of recalling both the impres-
sion made by the sensation, and by the object which excited it, in the
absence of such object. The rose, the musk, the landscape, are re-
called with all the sensations belonging to them, although no rose, no
musk, no landscape, is before us.

" When, instead of merely recalling past objects and sensations,
we receive new impressions from other objects, and sensations either
resembling those experienced before, or differing from them ; we can
pay an alternate attention to the new sensations, and to those which
we can recal to our minds, just as we could to those presented at
one time to us. This alternate attention constitutes Comparison." —
p. 41,

" This alternate attention, or comparison, consequently produces
a decision, or an opinion, or judgment, concerning the relative nature
or degree of all objects and all sensations, present or recalled. This
decision, or opinion, or judgment, when exercised, as it commonly
is, concerning the relative power of objects or impressions to produce
pleasure or pain, is productive of choice, or preference, or desire/; —
p. 42.

" In these operations, we observe, then, the offices of Sensation,
Attention, Comparison, and Memory, with a limited exercise of the
Imagination ; the act of recalling impressions with the objects which
first excited them seeming to be conjointly performed by this faculty
and the memory.

" But, if we attend to what passes in our own minds in almost
every instant of our lives, we shall perceive, that not only do the
memory and imagination, in conjunction, revive past impressions in
connexion with the objects with which they were first presented to
the attention ; but can continue to revive, and are continually re-
calling successive images in a long associated series ; and that this
operation is performed very often without any evident desire of our
own, or involuntarily. One object, or image, or impression, is re-
vived, or recalled, or suggested, after another, in consequence of the
slightest bonds of resemblance, contrast, or other connexion. The
image with which the chain commences may be an external object
acting on a sense, or an internal recollection, or the memory or ima-
gination of any object formerly the subject of sensation.

" Over these chains of thought we can still exercfse some power;
we can direct their revival, by a voluntary effort, according to the
order in which the first impressions were made ; we can retain some
links of the chain, dwell upon them, abandon them at will. Or we
can give indulgence to the imagination, which then exerts unlimited

Dr. Conolly on the Indications of Insanity. 97

power over them, disconnecting and uniting the several links in an
infinite number of series.

" In these processes we see, then, what appears to be a conjoint
office of the memory and imagination, which has been sometimes .
called the Association of Ideas. We see also another operation, in.
which, if the Memory has still some part, the Imagination takes a
Teiy preponderating share." — p. 45.

Further citations are unnecessary to prove with what perspi-
cuity and force Dr. Conolly treats his subject. It must be
admitted by the most fastidious and cynical critic that his
descriptions are faithful, his deductions natural, his reasoning
conclusive, his arguments decisive, his proofs convincing,
aud his conclusions legitimate. He has avoided the wild and
extravagant reveries in which former writers on the human
mind so invariably indulged — he has appealed to the obser-
vation and experience of every man. In his account of the
modifications and inequalities of mind in different individuals
be has cited the works of ancients and moderns illustrative
of the eccentricities and oddities of mankind in every age ;
and has afforded us an amusing and instructive narrative, in
a style not surpassed bv our best novelists. He has adduced
numerous cases of this kind from personal experience, and
concludes, that in many instances persons are insane on a
certain point, though sensible in the ordinary affairs of life.
He arrives at the following conclusions on the nature of
insanity: — €€ The judgment is but the result of comparison ;
comparison is alternate attention ; attention IB a faculty
dependent on the brain — the judgment is perverted in insa-
nity, though in different degrees. The impairment of any
one or more of the faculties of the mind, accompanied with,
or inducing a defect in the comparing faculty is insanity."
He illustrates these conclusions by a most minute analysis
of an immense number of cases of insanity detailed by
others, and arrives at the conclusion that men were insane
on a certain point, though rational on all others. But he is
of opinion that no man ought to be confined, unless he is
disposed to injure himself or others. He proves by the best
reasoning, that many of those who were consigned to mad-
houses on account of some harmless eccentricity, should
have been left at liberty, and were perfectly competent to
manage their affairs. This part of the work 'will be perused
with gTeat interest and advantage. We cannot conclude our
remarks on this section of the work without observing, that our
author has shewn an intimate acquaintance with general as
well as medical literature, of both the past and present ages.

vol. v. ko. 26. o

98 Critical Review.

The next chapter is entitled " Application of the inquiry to
the duties of medical men, when consulted concerning the
state of a patient's mind.'1 The cautions and advice which
are given under this head are deeply interesting, and worthy
of universal adoption. The author inveighs in the strongest
terms against the practice of signing certificates in alleged
cases oi insanity, and authorising' force in cases in which the
patient has never been seen. He clearly and forcibly de-
monstrates that no man, however respectable, is exempt
from the danger of being consigned to a mad-house, by the
conduct of any man who calls himself a practitioner. The
whole duty of a medical man resolves itself into two parts.
1. To determine whether the individual in question oe of
sound mind. 2. To give an opinion concerning the treat-
ment required, and especially concerning the necessity of
restraint, and the degree and nature of the restraint. In
visiting such patients we should present ourselves to them
with the same .openness of manners, and the same good
intention with which we approach the bed-side of a patient
in a fever. Our author describes minutely the conduct of
medical men in the vast variety of cases of insanity* which
we regret our inability to condense or copy, from the
extent of the subject; but we have placed his principal
opinions before our readers. The last chapter is devoted to
" Suggestions for the better protection and care of the
insane ; " in which our author has proposed many valuable
improvements. However interesting bis opinions are as
topics of state medicine, they cannot prove so to medical
practitioners in general, and therefore we decline inserting
them. In taking leave of our author, we have to reiterate
our favourable opinion of his work, which is executed with
consummate skill and accuracy. We think no reader,
medical or civil, can rise from its perusal, without the con-
viction that it is the production of a highly gifted and
benevolent mind. It may be productive of great benefit to
society, a* it will be perused by the many eminent statesmen
who are among the council oi the University, of which our
author is one of the professors, and who most probably may

ftropose to the legislature the great improvements suggested
or the care and management of the insane. Were this object
effected, the author would have much cause of gratification ;
but on other accounts, he has rendered the profession and the
public bis debtors.

I aa ]

IV.— On the Diseases and Injuries of Arteries, with the ope*
rations required for their cure ; being the substance of the
Lectures delivered in the Theatre of the Royal College
of Surgeons, in 1829. By G. J. Guthrie, F. R. S.,
Professor of Anatomy and Surgery to the Royal College
of Surgeons, Surgeon to the Westminster Hospital, to
the Royal Westminster Hospital, &c. &c. London, 1830.
8?o. pp. 416. Burgess and Hill.

The work before us does not admit of analysis, and we
cannot explain the author's object in publishing it better
than in his own words.

" My object in the first part of the following work, is to demon-
strate the value and importance of that portion of the pathological
collection in the museum of the Royal College of Surgeons, which
relates to the subject of Aneurism ; and to prove, that the labours
and researches of Mr. Hunter anticipated nearly all the observations
wbich'have been made by his contemporaries and successors.

" I have entered more fully in the subsequent part into the con-
sideration of the nature and treatment of Wounds of Arteries, illus-
trating these points principally by observations and cases which
occurred during the late war in Portugal, Spain. France, and the
Netherlands ; and 1 would fain hope it will give to this part of surgery
a precision which it has not hitherto universally attained. I have
endeavoured to be as concise as possible, compatible with clearness
of expression, and have avoided, as far as lay in my power, quo-
tations and references, which would have made made a book, already
larger than I expected, of twice its present size.

" The matter contained in this part has been many years an-
nounced as preparing for the press ; and although it has not been
published, it has been annually promulgated in my surgical lectures
for the last fourteen years ; and if any practical information which it
may contain has been delayed, it has certainly not been withheld." —
p. vi.

That a work of this description is much wanted, as Mr.
Hodgson's excellent production is long out of print, must
be admitted ; and we are happy that a man of Mr. Guthrie's
talents and experience has undertaken the task of supplying
the want. If nis first paragraph be correct, and we have no
reason to doubt it, what must the profession think of the
College of Surgeons, who have voluntarily withheld for a

ETiod of 30 years, the promulgation of the claims of Mr.
unter to the correct pathology of aneurism. What ought
the profession think of men who suppressed such important
information, and allowed foreigners to claim a priority of
discovery, to which it appears they have had no just title ?
Who can view such conduct without indignation. Our

100 Critical Review.

medical corporations in this empire have zealously imitated
the oligarchy mentioned by Aristotle, whose oath was, " We
will do the multitude all the evil in our power : " and not
one of these bodies but may shake its drowsy head, aud
exclaim, " thou can'st not say, but I did it." And so the
multitude of your brethren accuse you. But to return to
our author, who is one of the legitimate heads of the College*
-of Surgeons, we find him admitting with great naivete, that
after all the disputations which have agitated the medical
world during the last half century, on the pathology of
aneurism, Mr. Hunter had anticipated nearly all the obser-
vations which had been made by his contemporaries and
successors. Verily this discovery comes almost too late.
There is not a single point in the pathology of aneurism
described by our author, which has not been admitted and
recorded by French writers. Yet the work will be new to many
readers. It contains a great deal of information, and is a
valuable addition to the surgical library. It is a work of
great practical utility, indeed of standard authority. It is
the production of a man of distinguished rank and talents,
and of eminence in his profession— -of one to whom surgical
literature is already much indebted. It is of course a com-
pilation with many claims to originality ; and enriched with
the very extensive observation of the author. After having
described the anatomy of arteries, we are next informed of
their diseases, arteritis, phlegmonous and erysipelatous,
calcareous deposits in the middle-coats. Atheromatous and
steatomatous depositions are next described. Our author
agrees with the continental writers, that none of the exclusive
theories of aneurism are correct, there being several ways
in which the disease may occur, " a conclusion," says Mr.
Guthrie, " which surgeons in England might have arrived at
thirty years ago, if they had taken the trouble to examine
the specimens of aneurism in the Hunterian collection."
We have no doubt of the fact, but surgeons were allowed
no opportunity of examining the Hunterian museum— a right
whicn was withheld from them until within a few years. Our
author has for the first time described several preparations
in the Hunterian museum, which attest the truth of this
assertion. When the whole circumference of an artery is
dilated, Mr. Guthrie applies the term, preternatural dilata-
tion, but when the vessel is dilated partially, for example on
one side, this he holds is aneurism. It would be well if
writers agreed in the use of terms. The French deem these
terms synonymous, the former they apply to true aneurism,*

• Diction, de Med. etdc Chir. Pratiques. Art Anevrytmt.

Mr. Guthrie on Diseases' of Arteries. 101

and they maintain that facts the most numerous and authentic
have proved this to be the cause of aneurism, as well as
rupture of the internal coat of the vessel. This is the
opinion of our author, who also asserts that no coagula occur
in preternatural dilatation, but are seen after the abrasion or
rupture of the inner coat, " a distinction/', says he, st esta-
blished particularly in England, for the sake of clearness of
expression, without being of any practical utility, and the
same may be said of all internal aneurisms." p. 49. This
distinction is not confined to this country, it is also held in
France,* and is said to be of great practical utility, simply
because, if concentric layers or coagula occurred in the
former, they would prove fatal. Our author calls partial
dilatation of the vessel true aneurism, and here he is again
at issue with our Gallic contemporaries. He is very properly
opposed to Scarpa's opinion that rupture of the inner and
middle coats of an artery is the sole cause of aneurism. We
shall not follow him in his description of the various kinds
of aneurism, but observe that he considers chronic irrita-
tion or inflammation the most probable cause of all. He has
not explained the modus operandi of such causes ; but we
may remind the reader that chronic inflammation diminishes
the force of cohesion of the parietes, deprives them in a great
degree of their contractibility, which in the natural state
enables them to resist the impulse of the ventricle. This
property being weakened in any part of an artery, dilatation
is inevitable, and may be complete or partial, according to
the degree of arteritis. The intensity of the circulation on
the arches of arteries may cause aneurism ; and our author,
as well as Scarpa, has shewn that the most powerful causes
of the disease are calcareous, terreous, atheromatous, and
ulcerous conditions — all the results of arteritis. Mr. Guthrie
next considers " the termination and spontaneous cure of
aneurism,9' which may be, 1, by coagulation of its contents ;
2, by sloughing ; S, by accidental pressure of the sac upon
the artery. These methods are well illustrated by our
author. He proves the certainty of their occurrence, but is
unable to explain it satisfactorily. He next considers the
" symptoms of internal aneurisms,1' and clearly shews that
the diagnosis in such cases is extremely difficult. The suc-
ceeding section is on the " symptoms and diagnosis of
external aneurisms ; and in such cases the disease is of course
more readily discovered ; and numerous cases cited which
must be familiar to every surgeon of ordinary observation.
The "medical treatment of aneurism" is next described;
which consists of rigid abstinence, approaching to starva-

• Op. Cit. — Art. Anevrysme.

102 Critical Review.

tion, repeated venesection, leeching, &c. ; and when the
symptoms are abated, the food and drink are to be gradually
increased, and mental emotions, stimulating' food and drink
avoided. This plan has been found successful by Valsalva,
Albertini, Morgag-ni, Lancisi, Guattani, Sabatier* Corvisart,
Pelletan, Laennee, and Hodgson. Mr. Guthrie devotes his
next section to the influence of "the collateral circulation/*
contrasts the ancient and modern opinions, and arrives at
these conclusions.

" 1. That the collateral vessels are at alljtimes and under all na-
tural circumstances capable of carrying on the circulation in the
upper extremity, whatever disease or injury may affect the principal
trunk. Whenever the reverse takes place, it is an exception to the
general rule.

2. That after operations for aneurism in the lower extremity, the
collateral branches are almost always equal to carry on the circulation
through the limb.

3. That when the principal artery of the lower extremity is sud-
denly divided, without any previous disease having existed, mortifi-
cation is not an uncommon occurrence, and is more likely to take
place in old than in young persons.

4. That when under such circumstances the principal vein is also
divided, mortification seldom fails to be the consequence." p. 141.

Our author next gives a lucid account of " the surgical
treatment of aneurism." He exposes the prejudice of the
French surgeons, and their attempts to deprive the illustrious
Hunter of the honour of his operation for aneurism ; and
after an able analysis of the facts of Mr. Wardrop's plan,
he arrives at the conclusion, that it is not only dangerous
by causing arteritis which may extend to the heart, but
also objectionable from the well-known fact proved by John
Hunter, that in aneurism the artery is generally diseased,
between the dilated portion and the heart. His conclusions
are so just and incontrovertible, that we must place them
before our readers.

" 1 . Whenever the operation for aneurism succeeds from placing' a
ligature below or beyond the tumour, it does so by giving rise to
inflammation in the aneurismal sac and in the artery both above and
below it ; and unless it does this, it fails.

" 2. That this operation, as well as all others, is exceedingly dan-
gerous in the vicinity of the heart, from the facility with which the
imflammation may be communicated to that, as well as to the neigh-
bouring organs.

" 3. That it will not effect a cure,, in cases of aneurism of the
innominata or arch of the aorta, although it may give temporary
relief by the partial diminution of the tumour.

" 4. That being as likely to destroy the patient as to give this
relief, it ought never to be performed until the life of the patient is

Mr. Guthrie on Disease* of Arteries. 103

in extreme danger from the size of the tumour, when the person may
have the opportunity of choosing between a more sudden death or a
temporary relief1; but the chance of a cure should never be calculated
upon.

" I have watched two cases of aneurism, supposed to be of the
mnominata, for the last two years, on both of which it had been
proposed to perform this operation, but which the patients refused to
undergo. They are still nearly in the same state ; and although in
many instances the disease proceeds with rapidity, it is in others slow
in its progress, occasionally receding and again increasing in size,
until at last a new impulse seems to be given to it, which tends
rapidly to a fetal termination. It is then only that an operation of
this nature should be thought of, and the result, even as to temporary
relief, must always be very doubtful." p. 208.

The next Section is on " Wounds and injuries of arteries,"
in which our author gives a concise yet comprehensive sum-
mary of the various opinions of ancient and modern
surgeons, on. the means adopted by nature for suppressing
haemorrhage. He observes—

" In the different theories I have noticed, and especially in that of
Dr. Jones, it does not appear that the gentlemen who proposed or
maintained them have ever conceived that there was a difference in
the means employed by nature, according to the size of the artery
injured or divided ; that the difference of structure between an artery,
such as the carotid or the inguinal, and the tibial or the radial, could
cause any deviation from the process they described as taking place,
and as they presumed in one invariable manner in all arteries. I
shall venture however to say, that on the size and variation of struc-
ture of the artery, the process employed by nature essentially
depends ; that it is not the same in large as in small arteries ; and
that it is not even quite the same in the upper and lower ends of the
same artery.

" An artery of moderate dimensions, such as the tibial or brachial,
and particularly all below these in size, are in general capable by
their own intrinsic powers of arresting the passage of the blood
through them without any assistance from art, or from the surrounding
parts in which they are situated. This overthrows at once the whole
theory which relates to the sheath of the vessel and its offices, and
in a great measure to the importance derived from the formation of
an external coagulum." p. 223.

He proves by a variety of cases, in which large arteries
were wounded, as the axillary, posterior tibial, radial, ulnar
and femoral, that haemorrhage will be arrested through their
own efforts ; and he has no hesitation in declaring that the
power or influence of the heart over the circulation has
oeen greatly over-rated, and the sooner surgeons undeceive
fiemselves upon this point the better. " The heart exerts a

104 Critical Review.

comparatively trifling influence over the circulation, a fact
which may be easily proved by any one disposed to take
the trouble of examining it."

" If the axillary artery be laid bare, previously to an operation
for amputation at the shoulder, and the surgeon take it between his
fore finger and thumb, he will find that almost the slightest possible
pressure will be sufficient to stop the current of blood through it.
Retaining the same degree of pressure on the vessel, he may cut it
across below his finger and thumb, and not one drop of blood will
flow. Further, let the artery be fairly divided by the last incision,
which separates the arm from the body, without any pressure being
made upon it, and the result will be, that it will propel its blood with
a force more apparent than real. All that is required to suppress this
torrent, is to place the end of the fore finger directly against the
orifice of the artery, and with the least possible degree of pressure
consistent with keeping it steadily in one position, the hemorrhage
will be suppressed ; and what is more important is, that if the orifice
of the artery, from a natural curve in the vessel, or from accidental
causes, happens at the same time to retract and turn a little to one
side, so as to be placed in close contact with a solid piece of muscle,
die very support of contact will be sufficient to prevent its bleeding.
These are facts, the two first of which I have placed beyond a doubt
twenty times in my life." p. 227.

Even a divided femoral artery will cease to bleed by the
formation of a coagulum, as Mr. Guthrie has repeatedly seen
during the Peninsular war. This part of his work is so im-
portant, that it is worth the whole price of the volume. It
establishes a fact of great interest and value, namely, that
surgeons have no need of fright and alarm on seeing a
wounded artery. He proves by repeated observation, that
the contraction and retraction of the extremity of a wounded
artery favor the formation of a coagulum, which extends to one
or two inches. The external orifice of the artery is covered
by a yellowish green coloured matter or lymph, which soon
becomes organized, p. 248. Numerous cases are detailed
illustrative of the preceding statements.

Another curious and interesting fact is attested by our
author, that the lower end of a divided artery is more prone
to secondary haemorrhage than the upper, so much so,
indeed, that when bleeding occurs after four hours, it takes
place in all probability from the lower end. This is known
by dark blood flowing in a continous stream, and not with
any arterial impulse. Mr. 6. is inclined to think the con-
traction and retraction of the lower extremity of a divided
artery are less permanent and perfect than of the upper, and
that the collateral circulation when active, soon fills the
former, and causes the blood to regurgitate. Whether this

Mr. Guthrie on Diseases of Arteries. 105

explanation be correct or not, the fact is certain. A prac-
tical hint of great importance is the following : —

" When an artery ia merely cut or torn, but not completely
divided, it ia in the same state with regard to hemorrhage, aa if it
bad given way by ulceration. It can neither retract nor contract,
i&d wOl continue to bleed, unless pressure be accurately applied and
maintained, until it destroys the patient. The practice to be pursued
k to divide the vessel if it be a small one, such as the temporal
utery, when it will be enabled to retract and contract, and the
bleeding will soon cease. If an artery «f larger dimensions be
mounded, a ligature should be applied above and below the wound,
tad the vessel may or may not be divided between them, at the
pleasure of the surgeon/' p. 253.

Mr. Guthrie next describes " operations on wounded
arteries/' and animadverts with much force on the plan
recommended for tying the posterior tibial artery, wuieh
consists of a tedious, painful, and complicated piece of
dissection, from the unnecessary alarm of dividing the gas-
trocaemii muscles. He shews, that such fear is highly ludi-
crous, that in wounds of the gastroenemius and soleua
muscles, union will take place as in other wounds. He
criticises Mr. Harrison's directions for tying tile posterior
tibial artery, and proposes cutting down upon the vessel as
in other cases of wounded arteries. This plan is more
simple, and therefore preferable.

The opinions of Mr. John and Charles Bell are next as
severely animadverted on, and pronounced •' to be contrary
to the true principles of surgery," 268. M. Dupuytren's
opinions on the application of ligatures are keenly contested,
awl his proverbial want of candour well illustrated in his
ascribing to Anel what was due to Hunter. Mr. Guthrie
convicts the worthy Baron on his own admission, and places
him in a most pitiable condition. The Baron, like many of
"the race who write," has* published opinions already on
record, and by his contemptuous silence on the just claims
of British surgeons, exposes either ignorance or envy, and
nchly deserves the lash of criticism, which has been freely
applied on the present occasion. Mr. Guthrie illustrates his
operations on wounded arteries by numerous cases, and
arrives at the following conclusions, which are so important
that we place them before our readers :—

" 1* When a large artery is divided and bleeds, the wound should
be enlarged if necessary, and a ligature placed on both the divided
**ds; hut if the artery be only injured and not quite divided, the
hgitures should be applied one above, the other below the injured
Put* The artery may or may not be then cut across, at the pleasure

Vol v— no. 26. r

* w

106 Critical Review.

of the operator, but the limb or part must be placed in the relaxed
position. A bandage should not be applied, and the edges of the
wound should be simply brought together by adhesive plasters,
which do not extend completely round the limb.

" 2. If muscular fibres intervene between the artery and the*
surface, they should be divided, if they cannot be readily turned
aside, so as to give a clear and distinct view of the wounded vessel
and its accompanying veins or nerves.

" 3. If the wound pass indirectly to the principal artery, from the
back of the thigh for instance to the femoral artery in front, or from
the outside of the arm to the humeral artery on the inside, the surgeon
may (on satisfying himself of the part likely to be injured, by the
introduction of a probe) cut down on the vessel opposite that part
supposed to be wounded, by the most simple and approved method.
When the artery is exposed, the probe will point out the spot at
which the vessel has in all probability been wounded. Pressure
made below this spot on the artery, will cause it to be distended and
to bleed, if the flow of blood be not prevented from above ; when the
artery is to be secured by two ligatures, and the lower one should if
possible be applied first.

" 4. A tourniquet should never l>e applied in an operation for
aneurism or for a wounded artery. Compression by the hand is
allowable in the course of the vessel when wounded.

" 5. The blood from the upper end of a divided artery, or that
nearest the heart, is of a scarlet arterial colour.

" 6. The blood from the lower end of a divided artery, or that
which is furthest from the heart, is of a dark or venous colour, when
it happens to flow immediately after the division of the vessel. At a
subsequent period it may assume more of the colour of arterial blood,
but it rarely does so for several days after the receipt of the injury,
and always flows, or at least until a very late period, in a continued
Stream.

" 7. This regurgitation or flow of blood from the lower end of a
divided artery is a favourable sign, inasmuch as it shows that the
collateral circulation is in all probability sufficient to maintain the
life of the extremity.

" 8. The collateral circulation is in almost every instance capable
of maintaining the life of the upper extremity when the axillary artery
is divided.

" 9. The collateral circulation is not always capable of maintaining
the life of the limb when the femoral artery is injured. It is scarcely
ever equal to it when the vein is divided at the same time, or ren-
dered impervious.

" 10. The collateral circulation is sufficient to maintain the life
of an extremity in almost every case in which an aneurism has
existed for seven or eight weeks, although it might be incapable of
doing this if the principal artery had been suddenly divided, without
any previous disease having existed in the part.

" 11. The theory and the operation for aneurism are never to be
-applied to the treatment of a wounded artery, whilst the external

Mr. Guthrie on Diseases of Arteries. 107

wound communicates with the artery, unless it is impossible or im-
practicable to tie the bleeding vessel.

" 12. When an artery is wounded, and the external opening
heals, so as to give rise to a diffused or a circumscribed aneurism, it
is to be treated according to the theory of aneurism occurring from
an internal cause, with this difference, that as the artery is sound the
operation may be performed close to the tumour ; and that if any
doubt exists as to the capability of the collateral circulation to sup-
port the life of the extremity, the operation should be performed at
the injured part, as in a case of wounded artery. See Mr. Collier's
case, page 310.

" 13. When a circumscribed or diffused aneurism has been opened,
whether by accident or design, it is then placed in the situation of a
wounded artery, and must be treated as such, unless the wound can
be permanently closed. If the aneurism has arisen from disease
of the vessel, and the wound or opening into it cannot be perma-
nently closed, the limb is in a worse state than if the artery had been
wounded by accident ; because a ligature or ligatures placed on a
diseased artery is little likely to be successful. It is liable to all the
difficulties and inconveniences attendant on the old operation for
aneurism.

" If a case of the kind should occur in a poplitial or femoral
aneurism, situated at or below where the artery passes between the
triceps and the bone, amputation will be the best remedy. If the
swelling should occur higher up, and the opening can be closed with
a prospect of its healing, a ligature may first be placed upon the
artery above it ; but on the recurrence of hemorrhage, the artery
must be tied below, or recourse be had to amputation. It is, how-
ever, to be observed, that amputation under these circumstances,
when resorted to as a third operation, rarely succeeds.

" 14. When an artery is wounded with a simple fracture of a
bene, or with a comminuted fracture of smaller bones, with an
external comminuting opening, both ends of the artery are to be
secured, and the limb is to be treated in the usual manner.

" 15* When the bone broken is the femur, and the artery divided
is the femoral artery, the operation of amputation will generally be
stdvisable. It will always be so if the fracture is a comminuted one,
or the shaft of the bone is extensively split.

" 16. When the broken bone injures the artery and gives rise to
an aneurism, the treatment is to be first of the fracture and then of
the aneurism, as soon as circumstances render it advisable or neces-
sary to have recourse to the operation for aneurism,

" 17. When mortification takes place in addition to, or as a con-
sequence of a wounded artery, amputation should be had recourse to
forthwith.

" 18. The place of operation should be in almost all cases at the
teat of the original injury, out there may be an exception ; viz.

" 19. When the injury has been a mere cut, just sufficient to
divide die artery and vein, immediately below Poupart's ligament,

108 Critical Review.

and mortification of the foot supervenes; amputation should be per-
formed at the place of election just below the knee.

" This rule is founded on the observation, that great efforts are
made by nature to arrest mortification a little below the knee. Some-
times they succeed ; when they fail, death is inevitable ; and on the
fact that amputation at this part or above the knee is less dangerous
than at the great trochanter. The life of the part of the thigh left
between the injury and the amputation will in all probability be
maintained; and under the worst of circumstances, a chance yet
remains by the high operation.

" The nature and extent of the original injury may admit of. some
variation in the practice, but the general rule only is given.

" 20. When mortification has commenced, and has continued for
several days, and is spreading without having once stopped, the con-
stitution of the patient being implicated as marked by fever; the
amputation should not be performed until the mortification has been
arrested and the line of separation has been formed. But,

" 21. If the mortification has once stopped and then begins again
to spread, it will never again cease to extend, and an amputation may
give some chance of life.

" 22. When an aneurismal tumour mortifies, it is unnecessary
and improper to tie the artery above the tumour, because it will be
obliterated if the mortification is arrested by the efforts of nature,
which the operation may interfere with, and even prevent. Whilst,
if the mortification spreads, it will be a matter of supererogation,
and only hasten the patient's dissolution. When an aneurism in-
flames, and is opened by ulceration, it is a proper case for amputation,
if such an operation can be performed. See No. 13.

" 23. When mortification takes place after the operation for
aneurism, the surgeon must be guided by the state of the patient's
constitution, in resorting to or refraining from amputation.

" 24. When hemorrhage takes place from the surface of a stump,
the artery should be tied at the part from which the blood comes;
but if the bleeding proceeds from several small vessels, and cannot
be arrested, the principal trunk should be tied above the diseased
part, and the patient removed to a purer atmosphere." p. 340.

The remainder of the volume is devoted to ihe description
of operations on the principal arteries, and contains a vast
deal of valuable information. Want of space prevents us
from farther analysis. We recommend the work tor its accu-
racy, perspicuity, fulness, and practical details on all points
connected with diseases of the arteries. It is a work of
great practical utility, and should be iu the possession of
every surgeon. It will add to the author's well-earned re*
putation, and we hesitate not to say it will be a work of
standard authority.

[ 109 ]

V. — A Treatise on the Nature and Cure of those Diseases,
either Acute or Chronic, which precede change of
Structure, with a view to the preservation of healtht and
the prevention of organic diseases. By A, P. W. Philip,
M. D., F. R. S. L. & E. &c. London, 1830. 8vo. pp,
432. Longman and Co.

The eminent author of this work is long known to the
profession in every country, from his many valuable con-
tributions to medical science, which are familiar to every
erudite member of the faculty. His object in the present
production is to place the facts which have fallen under his
own view, and the inferences deducible from them, before
the medical public, without indulging in speculative doc-
trines. The present treatise is in a great measure a republi-
cation of the former works of our author, at least constant
reference is made to them, but technical language is avoided,
as he wishes to be intelligible to the general reader. In this
last intention our author has failed, for he is too learned to
be a popular writer on medicine. He tells us that in his
treatise on the vital functions he gave a view of the func-
tions of the animal body, which enabled the general reader
to understand all that is said in it, and in the second part of
this treatise he has endeavoured to render the practical part
intelligible to the same class of readers. In this lauduble
intention he has not succeeded, and we must take leave to
state, that not a man out of the profession can comprehend
it. Indeed the whole work is nothing but a running com-
mentary on certain parts of the theory and practice of
medicine, and affords no information which is not known to
every well educated practitioner. Our author attests this
statement. He says, " I do not offer it to the members of
our profession as a regular treatise on the subject, or as com-
prehending all its parts, but merely as the result of my own
experience, not during* a few months or years, but nearly
half a lifetime."' Preface IX. We need scarcely observe,
that so far as the work extends it is ably executed; but what
can be said on the treatment of diseases of the head, chest,
and abdomen, which is not well known, after the numerous
treatises we have upon these subjects. As a popular treatise
this is a complete failure, and as a professional one we are
at a loss to state to what class of the faculty it can be inte-
resting. It is neither a text book, nor a book of reference,
it is too abstruse and difficult for the student, and only eal*
culated for the erudite and experienced practitioner. Vet it
is an original work and contains many peculiar notions on
the nature and treatment of many dangerous diseases ; but
we apprehend there will be little found in it which does not
exist in the author's former publications.

[ no ]

VI. — A Treatise on the Pathology of the Animal Fluidi
and Solids. By William Stoker, M. D., &c. &c. Dublin,
1830. 8vo. pp. 123.

Among our original communications will be found a letter
from Dr. Stoker, explaining the cause of the imperfections
of this volume, which arose from it having been printed in
Scotland, and consequently his inability to revise and correct
typographical errors. The object of this production is a
reply to the Strictures of the Medico CWrurgical Review,
and Hamburg Magazine of Literature, on the author's late
work, with further proofs deduced from morbid anatomy in
support of his principles, and some interesting* clinical
reports on the efficacy of millefoil, yarrow, (Aohillis milli-
folium, Liu.) in dropsy, pompholyx diutinus, pemphigus,
gangrenosus, or burnt holes and other eruptive diseases. Our
author apologises for the marks of haste in this and his former
works, and states in excuse that in one of the institutions with
which he is connected, during the period of a quarter of a
century, considerably more than 80,000 patients have been
received into its wards, and the number of applicants has been
120,000. Yet this is the physician who has been gravely
told by a writer in our esteemed contemporary, that he
knows nothing of fever. He cites the last works of Mason
Good, Armstrong, Burne, Clanny, Lawrence's Lectures, and
this Journal in support of his opinions. He says,

" I shall begin with the ' London Medical and Surgical Journal/
as on many accounts it demands my first attention, and I willingly
avail myself of the opportunity of making my acknowledgments to
the writer of the critique in it, on my works, for his liberality to one
who had not the honour of being previously known to him, and for
the urbanity with which he expressed his difference of opinion from
mine." — p. 15.

After citing all our remarks ; he turns to those of a writer in
our contemporary, for the able editor had not written the
article, and reiterates all the charges we made against the
reviewer, of misconception and partial quotations from the
work on which he was commenting. With these recrimina-
tions we have nothing to do, and have only to observe that
our author has convicted the reviewer of partiality and
special pleading.

In illustration of his opinions on the pathology of the
fluids, he narrates a case of hydrophobia, which is so gra-
phically detailed that we place it before our readers.

" Case of Hydrophobia, by Mr. Kir by, Lecturer on Surgery. —
James Conner, twenty-four years of age, was admitted into St.

Dr. Stoker on. Animal Fluids and Solids. Ill

Peter's and St. Bridget's Hospital, on the 7th of April, four weeks
after he was bitten by a dog, which in a fit of drunkenness he pro-
voked, but he does not believe to have been mad. The wound
healed in a fortnight. He continued in health until yesterday
morning, when he was seized with his present disease, which he is
disposed to attribute to having got drunk with beer on the preceding
night.

" There does not appear any particular expression in his counte-
nance, though he sometimes Bmiles and wonders at his own sensa-
tions. He seems to watch every person with great attention as if he
was apprehensive that they designed to surprise him. Countenance
pale ; eye lively and unusually shining, but not in the least suffused :
pupil greatly dilated. He complained of no particular pain, except .
a slight uneasiness in the wound, extending in a trifling degree
towards the axilla, and which was excited by the motion of the arm.
He was very restless and refused any solicitation to go to bed, saying
* that it would be useless, as he knew that he could not sleep.' He
often observed, he would give any thing for a drink of water, and
vet that it was strange when he saw it or attempted to take it his
breathing was always so affected he was obliged to desist. He
referred much of his distress on these occasions to his throat and
praecordia. When I laid my hand on the latter, he was violently
convulsed. But he used to say with a smile that ' he was amused at
bis catting so many capers, without knowing why or wherefore.'
He frequently alluded to the manner, in which he passed the pre-
ceding night. Spoke of his dozes broken by hideous dreams, and
the terror which seized him whenever he tried to compose himself to
deep. He seemed rather to court than to avoid society. He was
act in the least disturbed by a crowd of pupils whose sympathy and
curiosity it was impossible to restrain, and when asked whether he
would rather be left alone, he replied in the negative. His skin was
of moderate temperature ; and though he wished for a fire in his
room he did not make any complaint of being cold. Tongue clean
and can be thrust from the mouth, without exciting spasm. Pulse
96, regular, rather full.

" Tne frequency and severity of the paroxysms yielded to the
application of a tourniquet to the affected arm, and while it was
applied, he said ' egad, I think I could eat a morsel now if I had it, '
and he appeared to drink with a little less difficulty. This instru-
ment, however, produced so much pain that he refused to bear it.
He feels very hungry, has called for some bread which he can chew
and swallow without much inconvenience. One morsel must be
introduced before the first is swallowed, otherwise he feels that he
could not continue to eat ; after he had used his bread he wished for
aome water. When it was given him in a tumbler, he raised it
above his head, and then gradually brought it down by his ear
towards his mouth. He then made a sudden effort to swallow it,
and succeeded, remarking that he had paid dearly for the gratification
of the thirst he had felt ; ' and truly so, every one must think who
witnessed the severity of the agony he appeared to suffer* He used

112 Critical Reviev.

to reply with great sharpness, seemed very talkative, and heard with
unusual acuteness. He would look upon a watch and observe the
time without disturbance, unless it was suddenly pushed towards
him, and then he made a retiring movement, from which after a few
seconds he returned. The noise of fluids in the vessels which con-
tained them produced no unpleasant effect, and were observed by him
with indifference.

"He contrived with considerable agitation to swallow a bolus,
containing ten grams of calomel and jalap. Three drachms of mer-
curial ointment were rubbed in, in Hie space of two hours, between
two and nine o'clock in the evening, he had taken without any
visible operation, five grains of the extract of Stramonium, with
nearly a drachm of blue pill ; a cathartic enema was administered
by which he was dreadfully excited.

" By this time he was rather worse, accused a severe cold as the
cause of his suffering ; he never once attributed his illness to the
bite he received. He readily submitted to any operation I might
think it right to perform on his finger. I accordingly seized the
opportunity of his consent to remove one inch of each of the digital
nerves. From the effect produced by the application of the tourni-
quet the hope was entertained both by my friend Mr. Kirby, and
myself, that some alteration of the symptoms would take place. He
bore the operation with resoluteness, complaining but little, unless
when the nerves were touched, or caught in the forceps, on which
occasions he screamed loudly, and was thrown into convulsions. On
bbserving him to rinse the sponge that I might wipe the wounds, he
advanced his hands to the bason without any effort, but was greatly
agitated the moment he touched the water. As the symptoms con-
tinued with unabated virulence, I dissected the trunk of the nerve in
the fore arm, and removed a piece from it. During the operation he
felt great pain in his thumb. The power of bending the hand and
fingers was destroyed in a great measure. The violence of the
disease, however, was not abated. The Extract of Stramonium
and blue pill were continued until twelve o'clock. He was then
worse. Complained of thirst and hunger. The paroxysms were
more frequent and were accompanied with shorter and more sobbing
inspirations. He was more talkative and more apprehensive. He
sat on his bed with his body bent forward, but he could not be pre-
vailed on to lie down. At length he said he would oblige me, by
trying to Bleep. He now placed himself upon his side in a horizontal
position, and seemed for a few seconds to be completely composed.
He then in great alarm and agitation, suddenly started up and turned
quickly round to them who stood behind. He could not be induced
to *lie down a second time: endeavoured to smoke and chew, but
could not swallow. For a short period after this, he was so tranquil
and felt so well that he was surprised at the calmness he experienced,
f I am now,' said he, 'quite well, and I could take a drink of water if I
had it.* ' It was brought to him in a tin porringer, at which he looked
without disturbance. He desired it to be placed at some distance
from him on his form, until he could bring his mind to take it. After

Dr. Stoker on Animal Fluids and Solids. 113

tome hesitation he exclaimed in despair, ' Well I cannot. Is'nt it
a wonder how well I am now until I go to take this villainous water.'
Still he persevered, turning his head away from it, and stretching his
hand towards, until he seized it and swallowed its contents in a fit
which it was terribly distressing to witness ; when the spasm ceased
be asked, ' did I not do that cleverly, hut faith I cannot drink that
well/

" At one time on this evening I found him sitting near the fire,
the heat of which he said he found very comfortable. He looked at
it steadily, and was not at all disturbed by its blaze, and yet he could
not endure the approach of alighted candle, from which he withdrew
suddenly, making a succession of short sobbing inspirations. When
I inquired how he did, he replied, ' Egad I am middling, Sir, I would
be very well only for breath, and if 1 could drink, but I can do that
some better than I did. To show me how much he was improved in
this particular, he called for some water. ' Give- me some water,
that I may shew Mr. Kirty the capers I'll cut in swallowing i$.'
The effect, however, was followed by consequences as frightfully
violent as those which had taken place at any preceding period. At
twelve o'clock at night his pulse was stronger than in the morning ;
less easily compressible, • and fuller. At palf -past twelve, blisters
were applied to the back of the neck, throat, and interior part of the .
thorax. In an hour afterwards he was very delirious ; he refused to
take his pill, and endeavoured to sing a favourite air. He grew calm
before two o'clock, expressed his gratitude . for all the attention
that was paid to him, attributed his tranquillity to his blisters, which
he thought the ' best job yet that happened to him/ but still refused
big medicine. At two he swallowed his bolus, compound of Stra-
monium, and Pil Hydrarg. ; and had a motion, at which circumstance
he was much pleased. He drank some water from a sponge, and he
thought his breath much stronger.

" At three o'clock, he took his medicine again ; drank another
sponge full of water, and felt better.

" At half-past three he drank another sponge full of water ; was
induced to sleep, and observed that he. could swallow his spittle*
Between this period and hnlf-past four o'clock, he had some sleep,
interrupted however every ..ten minutes, by frightful dreams and
sudden startings. He often imagined that he was haunted by a
Hack man, and some times ' that he was burning in the fire.' He
took his medicine twice, and two sponges full of whey, but not
without much obstruction and sudden and violent effort. Before
nine o'clock it was necessary to remove the blisters ; so great was
the irritation they produced, that he became furiously violent, he
threatened to beat the pupils who were in the room with him, and
declared that he would be revenged for the uneasiness I had created.
After the blisters were removed he again became calm, and said he
felt better. His countenance was still pale ; his eyes were more
brilliant than at his admission, and were altogether obedient, to his
*fll. They did not exhibit the slightest marks of suffusion ; the
pupils continued dilated. At this period he was troubled with a
vol. r.—no. 26. * q

114 Critical Review.

short cough, which appeared to proceed from a voluntary effort to
discharge a viscid plilegm, which clung among the fauces. Every
attempt of this nature was accompanied with short sobbing inspira-
tions and stampings with his feet. He spit out with great violence,
and always on the ground. One yellow rather solid motion ; skin in
a slight degree warmer than natural. Pulse 130, full and strong;
its regularity was now interrupted whenever the sobbing inspirations
returned.

" When he next called for his sponge soaked in whey, I -gave htm
one which contained half an ounce of tincture of opium, which he
continued to suck from it, but with the usual difficulties. After he
returned the sponge I pressed from it about one drachm of laudanum.
He now complained of slight giddiness, refused to take any more of
that medicine, desired some drinks, and suggested ' that perhaps he
could take it out of a pipe.' I fixed a tin to a gum elastic bottle
filled with water. When I moved towards his mouth he turned
away from it, and in an irresistable manner begged ' I would not
hurry him but let him take his time.' The attempts to drink by
this contrivance were as painful and as fruitless as the former. His
violence now began to increase and for the first time he showed his
aversion to some of his attendants. He was pleased to see his
brothers, shook them continually by the hands, and then desired them
to go away. On hearing bis mother's voice he was distressed a good
deal, and wished to have her with him.

" What had been done hitherto having availed nothing, it was
proposed to take a large bleeding from the arm ; upwards of thirty
ounces were drawn accordingly, in a full and rapid stream- The
blood was so unusually florid and issued with such force, that it
might be imagined it issued from an artery. It likewise coagulated
more slowly than usual, formed but a very small proportion of serum,
and did not exhibit the least appearance of buff. Though his pulse
grew much weaker, his strength was not reduced, nor did he feel
debilitated by the evacuation.

" Returning to him at eleven o'clock, I found five of his relations
in the ward, I expressed my disapprobation at the presence of such a
number, and wished that two only should remain with him. These
commands threw him into a violent fit of passion, he flew from his
bed towards me and swore he would murder me if I turned one of
them away from him. His anger quickly subsided when he perceived
that I desired them to sit down, and he then introduced each of them
to me, calling one girl his sister, to whom he was to have been mar-
ried in a few days. He returned to his bed, sat upon its edge and
turned his legs into it, desired to be left alone and drew the bed-
clothes over him. I placed myself at the foot of the bed to observe
him, this annoyed him, he frequently asked what I looked at, and
desired that I would not watch him. At length he bid me ' get out
of that' in a fretful and hurried tone. I did not at first obey him ;
he then said he would kick me if I did not — when I moved he
addressed me, ' I beg your pardon, Mr. Kirby, I cannot help myself
sometimes, I would have kicked at you had you remained there,

Dr. Stoker on Animat Fluids and Solids. 115

though all the time may be I'd think you were at the Black Rock,
and my heart would not let me injure you.' Having expressed a
wish to feel his pulse, he stretched his arm cheerfully to me and
nailed ; it then beat 140 and was weak. When I had done with my
examination he shook my hand affectionately, was unwilling to let
it go, and thanked me for the ' great attention I gave him/ At one
time he imagined he could take a drink of butter-milk, and he desired
his intended wife to procure some. After it was set before him, he
deliberated for some time as if he was summoning resolution to
drink, it. In an under tone and in great despair, he was heard to
say, ' I'd give a pound I could drink it/ and then he repeated the
same words in a loud and emphatic exclamation.

" It was now evident that every thing which had been hitherto
done made no impression on the disease, and that he seemed to resist
the medicinal powers of every remedy that had been used. In a
conversation with Dr. Leahy, Mr. Daniel* and Mr. Brumley, it .
was proposed to administer the Prussic acid, with which I was
obligingly furnished by Mr. Moor, Apothecary of South Anne-
Street, whose laboratory yields every thing prepared with the greatest
accuracy. Ten drops of acid were administered on a lump of sugar
by Mr. Daniel.

" Every minute henceforth added to the frightful severity of his
disease. Every thing excited a paroxysm. He felt a constant
inclination to offend and injure whoever approached. Those whom
he caressed some hours before he now warned away from him. The
sight of a stranger disturbed him exceedingly. At last I was obliged
to leave the room, so painful was the effect my presence seemed to
produce.

" At nine o'clock in the evening, Dr. Leahy and I visited him,
with a view to get him to take some wine. He was then sitting on
his bed without his coat and vest. His relations were at tea, of
which we were told he had partaken. On our entering the room he
lost his calmness, and rushed towards the window, in a dreadful
burst of passion. I was alarmed by the apprehension, that he would
throw himself out of it, but we soon learned that it was done with
the view to retain himself from the feeling of suffocation. It did not
appear that the coldness of the night ever was perceived by him.
Returning to his bed he sat with his back towards us. He would
sometimes turn round sharply and angrily. He seemed as if he
suspected some sudden surprise from behind him; his inspirations
were very short ; he was very talkative ; looked wildly — was quite
pale — the glossiness of his eye increased — he was greatly agitated
when he heard a whisper among his Mends, though not in the least
disturbed at the noise of the tea things, or at their presence. Some
wine, butter-milk, and tea, being placed before him on his form,
while we all observed a dead silence, he looked at them with atten-
tion, turned round and took a suspicious view of us, and then he gave
the following delirious sollioquy: — 'There is wine, nay, there are
three happy couples, that now happy people, but I'll not touch it—
and there is butter-milk that another happy couple, its very good.

116 Critical Review.

but I cant drink it — and there is tea,' he then flew into a dark ad-
joining room and called hard to his brother Pat, ' follow me with the
tea.' His brother having disobeyed him in taking wine to him, he
became very furious, attempted to strike him, and was with great
difficulty appeased. He frequently accused him of treachery , * he
thought he might depend his life on him, but he found he deceived
him. Why would you bring me wine.' He renewed his affections
for his brother, by often kissing his hand, which he latterly pressed
too closely to his mouth. When he found this disposition increasing
he suddenly set his hand at liberty. His fury was now excited by
every thing. He grew tranquil whilst they sung some favourite airs
to him. He desired them to pray for him, and appeared to be relieved
while they continued in a posture of devotion. He was incessantly
striving to hawk up the phlegm which accumulated in his throat.
Pulse 160. Skin of no unusual temperature ; as the disease ad-
vanced, every time he walked he reeled and was unsteady as a man
intoxicated." — p. 89.

Dr. Stoker argues that in cases of hydrophobia the interval
between the insertion of the rabid poison and its effects on
the system, implies absorption and mixture with the circu-
lating fluids, lie is not an advocate for exclusive solidism or
fluidism, but contends that one system is as well established
as the other. He observes,

" That morbid changes in the blood were manifest, I endeavoured
to shew, by first giving the descriptions of that vital fluid in its
Wealthy state, and then comparing it with the blood drawn in various'
forms of disease : and with respect to the destruction of fluids and
solids, I preferred the simplest definitions I could find for them in
works of science. The primary causes of the morbid changes were
not involved in my enquiry, which was directed much more to the
consequences of these changes. That some of them, however, such
for example, as the sizy or buffed blood, was the result of functional
derangement, was, I think, quite apparent, and rendered still more
obvious by the distinctive characters of the bufiy coat on blood
drawn in Gastric, Pulmonic, and Hepatic diseases.

: "Of the great importance of the distinctive characters of the
buffy coat as diagnostics, not only between different diseases, but
also between different stages of diseases, I am fully convinced, and
am the more gratified to find the share which I have had in bringing
it into notice, recognised in an able and liberal criticism on my last
work, in the 16th and' 17th numbers of the London Medical and
Surgical Journal, October, 1829, and even this observation, which I
deem mainly the result of my experimental inquiry into the effects of
the function of the Liver on Sanguification, establishes the utility of
that observation in pathology at least ; but I still indulge hope, that
its utility in physiology also will yet be as liberally recognised."—
p. 82,

Dr. Spillau's Supplement to the Pharmacopoeias. 117

Our author next enters into a long disquisition in support
of his opinions, and concludes by describing the effects of
Yarrow , Millefolium, in dropsy, rheumatism, and certain
cutaneous affections. He recommends the following for-
mulae.

J* foliorum recent Millefolii %\y; infunde per horam in Aqua
tallientis quantitati sufficients ut coletur. unciae duodecim, etcolaturw
adde.

Syrupi aurantii 3j.

Dosis oncia quater in die.

fr folior. recent millefolii.

Adipis preparatae aa 3jj *

Adipis ovili 5j.

Folia adipe incoque leni calore donee crispentur dein exprimendo
cola ut fiat unguentum quo curentur partes affectse his in die.

In cases of anarsarca, chronic rheumatism, and pompholyx
this is used with great success, and seems well worthy of at-
tention. In taking leave of Dr. Stoker, we do so with every
respect, for we think him entitled to great credit for the
assidui y and zeal with which he has prosecuted his en-
quiries. He has not gone to the length of others, who
ascribe fevers to a dissolved state of the blood, but merely
contends the blood is diseased as well as other constituent
parts of the body. Thus far he has gone, but no farther.

VII. — Supplement to the London, Edinburgh, and Dublin
Pharmcopaeias. — By D. Spillan, A. M. M. D. Dublin,
1830. Hodges and Smith, pp. 218.

It affords us much pleasure to observe the profession in Dub-
lin shaking off that lethargy which has so long and so unac-
countably oppressed them, and at length contributing to the
records of medicine. The works which have issued from the
Irish press have justly received great encouragement, and
are among the best extant. The Hospital Reports, Transac-
tions of the College of Physicians, the works of Carmichael,
Harrison, Cheyne, Mills, Stoker, Townsendand West, Dub-
lin Dissector, &c. &c, are valuable contributions to science,
and afford ample proof of the validity of our assertion. The
various productions of the alumni of the Dublin Schools,
both in the public service, and in private practice, in this and
other countries, fully attest the fact. But the members of the
profession are one great family, to whom the ample volume
of nature is open, and all may profit by its perusal. We
have been led into these remarks, by the very valuable work
Wore us. Dr. Spillan has written a very interesting and

118 Critical Review.

instructive volume, which is merely an abridgment of a syste-
matic work, whose publication only awaits the judgment of
the profession on the present production. The work before
us consists of a concise view ox the Atomic Theory and doc-
trine of Definite Proportions; with the application of this
doctrine to pharmaceutical purposes, and an epitome of the
last edition of M. Magendie's Formularly of the New Medi-
cines. The remainder of the volume is devoted to the con-
sideration " of the action of Medicinal substances on the liv-
ing system," in which the author has given a satisfactory ex-
position of this important and neglected department of me-
dical sciences, and explained in a simple and concise manner,
the rules which ought to be observed in prescribing. He
has treated his subject in a masterly manner, and may be
confident that a systematic treatise on therapeutics executed
in the same style, cannot fail to obtain applause, and ensure
him a niche in the republic of medical literature. Iu justifi-
cation of these remarks, and to shew that our praise is not hy-
perbolical, we shall place our author's views before our
readers. In describing the action of medicines on the human
body, he proceeds as follows : —

" Medicinal substances produce effects on the living system only
when placed in contact with some part of that system ; and the parts
of that system adapted to receive these medicinal substances are
always covered either by the skin or by a mucous membrane. The
principal parts of the human body to which medicines may be ap-
plied, are, 1. The stomach and small intestines. 2. The large
intestines. 3. The skin. 4. The surface of the eyes. 5. The
pituitary membrane. 6. The interior of the mouth. 7. The vast
extent of the air passages. 8. The meatus auditoribs. 9. The
interior of the urethra and bladder. 10. In the female, the vagina,
and, in some cases, the cavity of the uterus.

" With respect to the relative importance of all these parts for the
reception of medicinal agents, the gastro-intestinal surface obviously
holds the first place, as well from the vast number of absorbents with
which it is supplied, and which take up the medicinal particles into
the system, as also because of the great' number of nerves which
it receives from the cerebral and ganglionic systems, by which either
surface is connected with the brain, spinal cord, heart, and lungs,
so that the impressions made on it by medicinal, agents are commu-
nicated to all these organs.

" From the universal sympathies thus established between the
.stomach and the rest of the system, we need not wonder that it
should be affected in almost all diseases.

" The practitioner should well consider the state of the stomach
when about to administer medicines, as the pathological conditions in
which it may be, modify very much their action as well as their

Dr. Spill an' s Supplement to the Pharmacopoeias. 119

effects. Thus, for instance, when the stomach is in a state of irri-
tation,* nothing could be more mischievous than the exhibition of
medicines possessing tonic, stimulating, or acrid properties.

" The large intestines, though by no means so favourably circum-
stanced for therapeutic purposes as the stomach and small intestines,
soli, from the great supply of nervous filaments distributed over their
surface, by which they are connected through the great sympathetic,
with the rest of the system, and also from their great absorbing
powers, great advantages may be derived from the application of
medicinal substances to their surface. By acting on this surface, on
the principle of revulsion, great advantage has been derived in
affections of the head, lungs, and of the stomach itself. The pre-
caution above alluded to, with respect to the stomach, should be
observed when the surface of the large intestines becomes the seat of
irritation.

" The skin, amply supplied as it is with absorbing vessels, presents
terv favourable means for the introduction of medicines into the
system, more particularly, when the state of the stomach would not
warrant their internal exhibition. Thus, when the gastrointestinal
surface is in a state of irritation, should the practitioner wish to bring
the system under the influence of mercury, he introduces that sub-
stance through the skin.

" With regard to the other surfaces, to which medicinal substances
nay be applied, they neither possess the same interest, and more-
over, the effects to be produced by application to them are merely
local.

" With respect to the way in which medicines act on the living
body, we may set it down as a principle, proved both by clinical
observation and physiological experiment, that medicines act on the
Bring body* 1. by a direct impression on the organs which receive
them ; 2. by their molecules being absorbed into the mass of blood ;
3. by the play of sympathies ; 4. by contiguity of organs ; 5. by
revulsion.

" In illustration of the direct action of medicines, we may instance
the different astringents and tonics, which, when taken into the
stomach, cause a contraction in the muscular fibres of that organ,
and thereby give it strength to perform its functions. The different
collyria, applied to the surface of the eye, may also be quoted as
instances of the direct action of medicinal agents.

" On the absorption of the particles of Medicinal Substances, —
Hat the particles of medicinal substances are taken up by absorp-
foa, carried into the blood, and thence distributed through the
system, to the different organized tissues, are points which now
appear established by the experiments of several physiologists. Thus
the colour of the urine is obviously affected by taking rhubarb or
ttffrori; when nitre has been taken into the stomach, its presence is
detected in the same excretion. The pulmonary transpiration

* This gastro-inlestinal irritation often exists, in the course of phthisis, in
«*airie diseases of the heart, intermittent ancj continued fevers ; a circumstance
*weh ihouW modify the treatment to be adopted.

120 Critical Review.

contracts the odour of garlic, onion, alcohol, or other such substances,
The bitterness of wormwood is detected in the milk of these animal*
who eat it : it is well known that some of the purgative principles of
senna are deposited in the nurse's milk, three or four hours after she
has has taken any of the preparations of this substance. That all
these phenomena take place by the absorption of the molecules of
these substances, and their being carried into the blood, and thence
Conveyed to the several secreting and exhaling organs, are matters
too clear and too striking to admit of serious objection. For though
we may suppose certain direct communications, by which the mole-
cules of the several substances were conveyed from the stomach to
the breasts and bladder, still we must admit that in order to arrive at
the cutaneous and pulmonary surfaces, these molecules must have
traversed the blood vessels.

" As medicinal substances are taken into the circulation, the
phenomena which they excite in the animal economy must be attri-
buted to the impression made by their molecules on the organic
tissues. Some have denied the existence of these particles in the
torrent of the circulation, in consequence of not being able to detect
their presence therein ; this, however, may be explained by the con-
sideration, that these particles, dispersed through the entire mass of
blood, cannot be found in any part in a quantity sufficient to be
detected by chemical re-agents. The experiments of Majendie,' of
Tiexlmann and Gmelin, have decided the question, these physiologists
having detected the odour of alcohol, camphor, musk, and other
substances in the blood of animals, to which they had administered
these substances.* With regard to the readiness or facility with
which this absorption takes place, several objects of consideration
present themselves. 1. Intimate contact, between the medicinal
substances and the mouths of the absorbents is necessary. 2. As the
absorbents do not act with the same vigour on all surfaces, the prac-
titioner should consider the absorbing power of the surface, to which
he applies a medicinal substance. 3. He should consider, whether
the surface proper for the application of the medicine be in a morbid
state or not. 4. As the contact of the substances with the surface

• It may not be amiss here to state, that some physiologists deny the en'rance of
medicinal substances into the circulation ; among others, Dr. Chapman, Professor
of the Institutes of Medicine in the University of Maryland, in his "Elements of
Therapeutics,*' has advanced several very plausible arguments against the doctrine,
considering it a mere relic of the humoral pathology. That medicines enter the
circulation, howeier, and in this way frequently produce their sanitive effects, is the
opinion of the first pathologists of the present day. Mr. Andral, in his recent
work on Pathological Anatomy, in describing passive congestion of the long,
succeeding acute pneumonia, which frequently remains stationary, notwithstanding
the use of antiph logistics and repulsives, and yet yields immediately to the use of
tonics, such as decoctions of polygala or cinchona, expresses himself thus: r< Is
it not reasonable to conclude, that those substances, whan absorbed and
carried into THE CIRCULATION, produced the resolution of the pulmonary con-
gestion, either by directly stimulating the coals of the pulmonary vessels in their
passage through diem, or else by exciting the centres of the nervous syMem, &c. &c."
See the elegant translation of this work by Dr. Townser.d and Dr. West, vol. i.
pages 58 aud 59.

Dr. Spillau*s Supplement to theiPhar-nwcop&ias. 121

may be painful to the organ receiving it, it may happen that it may
be expelled, and so escape absorption : as when a medicine may be
rejected from the stomach by vomiting; or when, after arriving at
the intestines, it excites the muscular contraction in them, and is
then expelled the system, so as to escape absorption. 5. A plethoric
state of the system has been found to retard absorption.

" On the Actum of Medicines, as affected by Sympathy. — All medi-
cines do not derive their activity from absorption ; the nerves, on
some occasions, appear to be the conductors of' the action of medi-
cinal substances. We oftentimes see a medicine influence all the
functions of life immediately after arriving in the stomach. Medi-
cines acting by sympathy make an impression on the nerves of the
surface receiving them ; this impression is propagated to the brain,
and thence transmitted to the other parts of the system, and thus the
brain being in direct correspondence with all the living tissues,
renders general an impression which was at first isolated and local ; '
thus ipecacuanha or squill being given as expectorants, first acts on
the stomach ; this impression, by sympathetic action, is transmitted
to the pulmonary organs, and thus their expulsive power is awakened.
Some medicines appear to act both through tbe medium of absorption
and- sympathy ; as alcohol, and other stimulants. In the administra-
tion of medicines, which we consider to derive their influence from
sympathetic action, it is important, 1. to consider the extent of the
impression made by this agent on the part of the body receiving it.
2. To consider the relations and connexions subsisting between this
part 'and the principal organic apparatuses. Lastly, the actual state
of die surface to which t^e medicinal substance may be applied ; viz,
whether its sensibility be greater or less than natural, as in the former
ease both the physiological and therapeutic effects of any given
medicine will be much more intense and more strongly marked, and
m the latter much less so, than in the natural state of the part.

" On tke Action of Medicines, as effected by Contiguity. — Expe-
rience has proved, that, when a medicinal substance comes in contact
with any part of the body, its action is not confined to the mere
parti but often propagates itself through the subjacent tissues to
deep-seated organs. On this principle, when the liver and bladder,
or other internal organs are affected, emollient applications are made
to the surface over them. On the same principle, cataplasms, oint-
ments, &c. covering tumours, swelled glands, &c. are found useful.
Physiology proves to us, that by irritating the excretory duct of a
gland, the secretions of that gland are excited and accelerated.
Thus, purgatives, when they enter the duodenum, irritate the ductus
choledochus, and thereby cause the liver and pancreas to secrete
aore abundantly.

" On the Action of Medicines, by Revulsion, -^-Vf hen a medicinal
substance, applied to any part of the body, irritates that part, it causes
an tfflnx of blood to it, and thereby a proportional diminution in the
quantity of that fluid contained in, the vessels of the contiguous parts.

rot. ?r— »*. 26« «

122 Critical Review;

lib principle is often taken advantage of in the removal 0} trrifatitai
*&d inflammations. In this way, sinapsisms, blisters, rubefacients,
Ac* prove efficacious in removing inflammations of the thoracic ft?
abdominal viscera. On the same principle, also, purgatives, by excit*
ing a temporary irritation in the intestines, are found useful in some
affections of the head and chest. Diaphoretics, diuretics, and em*
menagogues may also be considered as acting on this princ'ple. • By
exciting the action of the cutaneous vessels, of the urinary and
taterine organs, ihey exercise on the other organs a revulsive influence.

•* On the Power of Habit over the Action of Medicines. — If the
same medicinal substance be applied every day without interruption
to the same part of the body, it is observed to lose its power by little
and little, and to fail in affecting parts in which it had previously
excited the most striking effects. As the medicinal substance itself
has obviously undergone no change, and as it still retains all its pro-

{>erties, both physical and chymical, it must be the vital state of the
iving tissues, and the susceptibility of the parts to which the medicine
!s applied, that has undergone this alteration. This phenomenon,
curious as it is in a physiological point of view, is still more im-
portant, when considered in reference to thempeutics. We may
learn from it, that we should progressively augment the dose of these
medicines, whose use we intend to continue for any length of time,
if we wish them to retain the same uniformity and extent of actidn,
and also that we should suspend their exhibition from time to time,
lest the different organs may, from the power of habit, become insen-
sible to their impression. It may not be amiss here to observe, that
narcotic medicines are much more under the influence of habit, than
those of a stimulant or irritating property. Whilst the power of
habit may thus render one surface insensible to the action of a
■medicine, it will not necessarily exempt the other parts of the system
from its influence, provided its molecules have been taken up by
absorption. This independence of the general on the local action
does not however hold good with respect to the effects arising from
sympathy, which take their origin in the organ immediately receiving
the substance. The sentient extremities of the nerves of this
organ being no longer affected by the medicine, the nervous commu-
nications which transmitted its virtue to distant parts are broken off*
and then the sympathetic effects are no longer produced.

•• On the effects of Medicines. — The effect* of medicines are of two
kinds . 1st. The immediate or physiological. 2. The secondary or
therapeutical. By the former are meant those changes produced in
the movements and functions of the different organs, the direct and
immediate consequence of the impression made on the system, whe-
ther through the medium of the absorbents, or through the comma-
nicating powers of the nerves.

• It may be observed here, that blisters should never be applied at trte cotn-
fnenoementof an inflammation, as, from the irritation they necessarily excite, they
wonld rather augment than d minish 1 he evil. The ctoStuutioftat fcjmptMss iftoold
be Arst subdued by the proper measure.

Dr. Spillan's Supplement to the PharmacQpceias. 123

" fiy the secondary at therapeutical effects are meant those modi-
Bastions and changes produced ill the movements and functions of the
several organs, whereby, in a body actually diseased, some important
result may be produced, which shall counteract and arrest the efforts
of the disease, and excite those of an opposite character, which may
prove aalutary

" The immediate effects of medicinal substances comprise all the
changes, which the development of their activity may produce in the
animal economy. Their influence extends to all parts of the system,
though the phenomena produced are not so obvious or demonstrable.
Thus the modifications which the blood and the organic elements
aodergo will ever remain concealed from the scrutiny of our senses ;
h is only by the manner in which the several functions are discharged,
that we can appreciate the nature of the impression made en the
tissues of our organs by the several medicinal substances When
the budy is subjected to the influence of a medicine, the action of the
latter may be exerted. 1st, on the fluids of the body; 2d, on its
solids ; 3d, on the movements of the several organs. With regard
to the first, viz, the action of medicines on the fluids of the body,
as little can be advanced that is not conjectural and hypothetical,
we shall say nothing. *

" The only way in which we can conceive medicinal sulistanceft
to exert their actions on the solids of the body, is by their producing
a change in the physical disposition, in the length, cohesion, density,
&c.of the elementary fibres which constitute the tissue of our organs.
As the elementary fibres constitute by their approximation and inter-
lacement the several tissues, so these several tissues form the organs,
whose aggregate constitutes the entire living structure." — p. 1 18.

Our author further adverts to the immediate effects, pro*
duced od the tissue of orgaus by medicines.

" Thus, when we observe a stimulant produce an agreeable feeling
of heat in the epigastric region, excite an appetite and accelerate
digestion, is it not obvious that this agent has stimulated the tissue of
the stomach, has developed its vitality, and increased its natural
powers ? whereas, when we observe an opiate to destroy all desire for
food, which had previously existed, or to suspend the process of
digestion which was already commenced, is it not evident that it
oust have, as it were, stupified the fibres of the stomach* or at least
perrerted their proper action ? In the same way, when we see an
alcoholic medicine accelerate the pulse, does it not prove tjjat the
tissue of the heart then receives an impression which stimulates, its
fihjpes ? It may here be observed, that all the living solids or organic
tissues are not equally sensible to the impression of medicinal sub •
stances. The parts most susceptible of these impressions are the

* ■ -Pf^r- ,l |> ■ ■■■ i ■ ii i ■ ■ ■■ |« miiwn 1 1., -»— — — «W— — ■ pn— -»»■— p^wr

• The principal advantage which the practice of med'eine hat derived from a
koovMge of the action of medicines on the fluids, is in the case of preventing and
obviating the /i/A*e acid dialhesii, viz. by saturating with an atftali the free acid,
vhkb precipitates the lithic acid from its combinations.

124 Critical Review.

tissues of the digestive and respiratory organs, those of the heart,
arteries, and .capillaries, that of the brain, and its appendages, those
of mucous and serous membranes and of the secretory organs,
whilst on the other hand, the cellular tissue, the lymphatic ganglions,
aponeurotic and cartilaginous structures are nearly insensible to all
such impressions. It is of great importance, in a therapeutical point
of view to remark, that disease modifies very much the susceptibility
of all the organic tissues. Thus, in fever and inflammation, • the
brain and circulatory apparatus; the lungs, stomach and intestines,
$c. are much more sensible to the action of medicines, than in the
state of health. Nay more, so great is the difference which disease
induces in the operation of medicines, that when any organ is in-
flamed, it is to it almost exclusively that the entire power of the
medicine seems to be directed. Thus, if a tonic bs administered in
any inflammatory affection, the part so affected feels an increase of
heat, pain, and tension, whilst the ordinary tonic effects of die sub-
stance so given are not at all perceptible in other parts of the system.
Thus a person having an ulcer in any part, experiences in that part
lancinating pains, after taking more stimulating food or drink than
usual."— p. 120.

From what has been said on the actions of medicines, on
the several tissues, it is obvious, that the only true way to as-
certain the medicinal properties of each substance, is to ob-
serve the modifications produced by it in the functions of the
organs. This constitutes the physiological effects of medi-
cines ; which are local or general. Thus a tonic acts on
the stomach, a collyrium on the eye, &c. or medicines act on
the functions of digestion, circulation, respiration, secretion,
&c, and modify them, and upon such modifications the
therapeutic effects mainly depend. We thus possess great
dominion over the animal economy, in regulating and modi-
fying iis functions to a considerable extent. The following
luminous e.xposition of these points, is worthy of attentive
consideration, indeed oi general adoption, and especially
that part, which we have marked in italics, or as our con-
temporaries on the other side of the Atlantic would say,
kalicised.

" Thus let us suppose each of the organs of the body in its natural
state ; should We wish to accelerate the" functions of digestion, we
may do so by administering a stimulant ; should we, on the contrary,
wish to retard or suspend that function, this can be accomplished by
means of a narcotic. Again, do we wish to strengthen the stomach,
and to render it more able to discharge its functions, we can effect
this by means of a tonic. Over the circulation of the blood the
physician has equal dominion; he can accelerate it by some sub-
stances, and retard it by others. We know that animal heat is also
under the influence of medicinal substances. The respiration too
can be accelerated or retarded by certain medioinal agents. The

Dr. Spillan's Suj/pl&nerii to the Pharmacopeias. \23

secretions and ex halations are likewise under the influence of the
physician. We know that by the exhibition of a purgative or emetic
the liver is stimulated to a more copious secretion of bile ; the cuta-
neous system, as also the action of the kidneys, can be excited at
will.

" It is, however, with regard to the cerebral apparatus, that the
physician should attentively study the action of medicines. The
impressions made directly by them on the cerebrum, cerebellum, and
spinal cord, and also the sympathetic influence propagated to these
parts from other organs to which medicinal substances may have been
applied, are the sources of numberless phenomena which develope
themselves in the mental faculties, in the muscular movements, and
even in the circulation, respiration, &c. It is well known how, when
the brain, spinal cord, or their membranes are excited, the vitality of
other parts is also developed : should the impression thus made be
confined to the brain, and be continued too long, its functions
become disturbed ; if the spinal cord or the great sympathetic be the
seat of the impressiou, we observe corresponding alterations in the
functions of the parts connected with them ; the action of the heart
becomes irregular, the pulse unequal, respiration becomes difficult,
aad the functions of the stomach and intestines are disturbed.

" When we thus consider the power which medicinal agents
exercise over the animal economy, we have sufficient reason to be
surprised both at its extent and importance. By means of it the
physician appears to have all the organs of the body, and their
respective functions, as it were, under his control. Through it he
possesses manifold and valuable resources, by which if he cannot
always destroy the cause of disease, he can frequently attack morbid
lesions with success, combat the prevailing symptoms which threaten
to prove ratal, and by opposing a medicinal to a pathological distur-
bance, arrest the further progress of the disease.

" With respect to the secondary effects of medicinal agents, they
ire, as has been observed, consequences of the primary ; they are
dependent on them, and both these effects stand to each other in the
relation of cause and effect. We have seen these agents, by the
properties they possess, submit the animal economy to an operation
more or less marked, more or less extensive; the several organs have
experienced a temporary change in their state and in their functions ;
these changes must be attended with some results. In a stale of
health, this disturbance passes off after a time, and is no longer
perceptible after the medicine has ceased to act. But in disease,
where the functions of life are disturbed, and the movements of the
several organs are deranged, these effects become much more im-
portant. It is in the midst of this pathological disturbance that the
medicine produces that state of the system which corresponds to its
properties. It is impossible that this its action should not influence
the development and progress of the disease ; it will alleviate some
affections, and exasperate others ; this change so effected constitutes
the secondary effects. The necessity of carefully distinguishing
between the primary and secondary effects of medicinal agents, will
appear, if we consider the confusion and seeming contradictions

196 . Critical Review. .

trhich occur in works on therapeutics, from the want of tfeia aliatiatv
tion. When any medicinal agent is said to have the property of
strengthening the tissue of an organ, or of relaxing it, of accelerating
or retarding its functions, of irritating the surfaces to which it is
applied, its immediate effects are designated ; hut when it is said to
possess a febrifuge, antiscorbutic or antispasmodic property, a dif-
ferent order of effects is meant, which can be obtained only on those
who are affected with fever, scurvy, or spasm ; in fact, the secondary
effects are thus designated. '

" When we compare the primary and secondary effects of medi-
cines, the following distinctions present themselves : every medicinal
substance contains in it an active force, depending on the chemical
principles which constitute it ; whilst the secondary or curative effects
are not at ail connected in this way with the chemical constituents of the
substance, and are merely devised to explain the advantages derived from
these substances. Again, the primary or immediate effects "are
always constant and the same, and should any dissimilarity appear in
them, this will always be found to regard the degree rather than the
kind. For example, senna acts with different degrees of intensity on
different individuals, producing on some but slight, on others exces-
sive purging, whilst in others it excites^ vomiting. Still its physiolo-
gical operation is the same, that is, it irritates the gastro-intestinal
surface.

" Such constancy and uniformity cannot be attributed to the
secondary or therapeutical e fleets which are, for the most part, rela-
tive or conditional. It too often happens that the medicine, from
which experience has taught, us to expect the greatest benefit, pro-
duces an effect diametrically opposite : the same remedy, instead of
relieving the patient, will render his state much worse. It was to
this instability in the therapeutic effects of medicinal substances that
Hoffman, alluded, when he said, that the same medicine, employed in
the same disease, with the same precautions, in the same dose, and
at the same time, is oftentimes serviceable to one individual, useless
to another and pernicious to a third.

" To the question whether there are such medicines as absolute
tonics., i. e. substances which constantly and uniformly produce an
increase of vigour in the animal economy, and a more free and easy
discharge of its functions, we would answer no. Such an effect is;
always conditional, and regard must be had to the state of the system
at the time of their administration : it is clear these medicines, classed
under the head of tonics, would produce effects entirely opposite, if
administered during the existence of inflammation of any organ*
The last distinction which we shall here remark between the primary
and secondary action of medicinal agents is, that the former is always;
single, whilst the latter are often observed to be manifold ; thus, in
the practice of medicine we daily find a -substance whose primary
action is stimulant, to possess the virtue of a stomachic, antiscorbutic,
vermifuge, febrifuge, laxative, &c.

^ " The ancients considered that medicines acted on the pauses of
disease ; whilst they are now more properly considered to act on thq

Dr. Spiilan's Supplement to the Pharmacopeias. 127

organs. They attended exclusively to their curative effects ; we shall
attend first to the changes which they effect in the movement* of the
seteral organs in the exercise of their functions, and from these we
shall make their curative effects to flow. These curative effects
depend on the immediate effects which they cause, whether their
action be local, or general, orat once both local and general. Some
medicines are no doubt useful by reason of their possessing a specific
influence on the causes of disease. These, however, are. few in
Bomber, and confined to a very small number of diseases. Verminij^e
medicines seem to belong to this class. Sulphur, found so useful in
Nome skin diseases, seems to produce its good effects by acting
directly on the cause ; perhaps mercury also may derive its beneficial
effects in syphilitic affections by acting directly on their cause. We
iball confine our attention here, however, to those medicinal agents
which derive their therapeutic properties from the impression they
make on our organs, and the changes thereby brought about in the
exercise of their functions." — p. 127.

Dr. Paris, and many other pharmacological writers, hnvd
long since shewn the absurdity of attending to strict chemi-
cal principles in prescribing medicines. Indeed every man
who is at all conversant with the treatment of disease, is
We'll aware of the fact, that many unjhemical prescriptions

;roduce the best effects in the alleviation or cure of disease,
'hose who object to such medicines are gcuerally theorists
or chemists, and seem to forget their absolute ignorance of the
changes, which the most chemical formula? must undergo,
before 'mixing with the circulating fluids. We are not surA

Cised at this ; for mankind high and low, have in all ages
en led astray by theorists. The chemical physician ex-
claims against the combination of acetate of lead and opium ;
the clinical physician finds it a most efficacious remedy. We
might illsutrate this diversity of opinion, by innumerable
examples ; but it must be unnecessary to adduce proof of
a position universally admitted. Here we close our extracts
for the present ; but shall resume in our next, wi h the fol<-
loiriugvery interesting corollory, " medical substances pos*
sessnot any specific property, distinct from their physiologic
eal action, and to which the curative effects, following their
use can be attributed." The opinions maintained in this lit-
tle work are so conclusive and valuable, that we thought it
but justice to allow the author to introduce himself to our
readers ; and we are happy in being able to congratulate him
on the ability he has shewn in the execution of his task. He
has revived the consideration of a neglected region of science,
«nd decidedly the most important that can occupy the atten-
tion of the practitioner. We strongly recommend this work
U Itadent* aad juniftr membera of the profession.

•

[ 128 .]

ORIGLNAL COMMUNICATIONS.

I.— Case of Poisoning by the Lancaster or Black Drop,

a preparation of Opium.

On Saturday the 5th of September, 1829, Mr. J. Foote was
summoned to attend a man, resident in Bartlett's-court, Bow-
street, reported to have taken poison. On the way there he
was informed by the man's wife, that she had called on
several medical gentlemen in the neighbourhood, the whole
of whom refused to attend when they learnt it was a poison
case, alleging that they did not like to attend inquests. [A
short time before a poor girl was taken to a medical man's
shop, as I am informed, having taken oxalic acid, and all
assistance was refused, the same excuse being alleged — in
fact, few medical men will attend to such cases, unless in the
higher ranks of society, because they are unwilling to sub*
ject themselves to the insults and petty authority of every
Jack-in-office and his satellites, losing their time without
the slightest prospects of remuneration.]

When Mr. J. Foote got there, he found the man perfectly
sensible, complaining only of drowsiness and head-ache, ana
expressing a great desire for sleep. On questioning' the
family as to what poison he Jiad taken, his wife said, that
finding him taking something out of a* small vial, she knocked
it out of his hand on the tiles of the house, where it broke
in pieces, so ttiat she could not tell what it was. The man
hearing this, said, " I'll tell you what it was ; it was a small
bottle of the Lancaster Drop,*' the contents of which he had
taken about a quarter of an hour ago. [One part of the
Lancaster drop is equal to four parts of the Tinct. Opii.
of the London Pharmacopoeia, so that, if, as he averred, he
had taken half an ounce of the Lancaster drop, he took a
quantity of opium equal to two ounces of laudanum.]

An emetic of twenty grains of Sulphate of Zinc in two
ounces of distilled water was instantly administered, and a
stomach pump sent for: — this emetic having co effect in ten
minutes, while the drowsiness and inclination for sleep were
rapidly increasing, another emetic of the same strength was
administered, and this likewise failed in its emetic effect.
The stomach-pump (Weiss') bein^ now brought, was immedi-
ately introduced, put, owing to the struggling and exertions
of the patient, it was some time .before it could be brought
into play : the oesophagus-pipe being introduced at least half

Mr. Foote on Mental Disturbance. 129

•

a dozen times, and each time the patient by a sudden jerk
drove it out again, notwithstanding he was held in his chair
by several powerful men — even'when the piston was in action
he grasped the pipe in such a manner that it prevented the
fluid from flowing several times : the pump was used several
times for the space of two hours, until the fluid ejected was
do longer coloured" by the poison. He drank plentifully of
warm water in the intervals. [And let me now pay a just
tribute to Mr. Weiss, for a more excellent instrument, when
in action, I never beheld.]

When the stomach was cleared, he was left for a time, his
friends having directions to keep him awake and walking
about. He was likewise directed to take the fourth part of
the following mixture every -four hours.

ft. Acet. Destill. 5j-
Aquae Destill. $v.
Mft. Mist.

11, p. m. Reaction has taken place; the pulse has risen,
J* freer from drowsiness, and complains of severe head-
ache, bowels confined.
Fiat Venaesectio.
?r Acid. Citric, gr. xxx.
Pulv. acacia*. 3ij.
Aq. Pur». Jv.
Syr. Croci. 3iij-
M. ft. Mist, de qua sumantur cochlear ; amp] ; tria, omni tertia
tor*. '

He was likewise directed to take some strong coffee, and
he was to be kept awake as long as possible ; a dose of castor
oil early in the morning, and repeated until the bowels were
freely opened.

Sept. 6th, free from head-ache — bowels open — going on
well. He now proceeded to a cure, without any bad symp-
tom, as far as regarded the effects of the poison ; he
remained under treatment for a short time for a rheumatic
affection of the loins.

H. — Case of mental disturbance, caused by disorder of
the stomach. Communicated by Mr. Foote, Jun.

H. S., set. 26, a waiter at an hotel, of tall stature, and pale
countenance, accustomed to drink freely, but never to in-
toiication, arose from sleep on May 22d, in his ordinary^
good health. . About 10, a.m., he became much agitated,
▼ol. t. no. 26. a

130 Original Communications.

face flushed, eyes bright and glistening, skin, especially of
the scalp, hot, very loquacious, and calling for his ac-
quaintance, " that they might take warning by him." He %
was apprehensive of losing his speech, and continually
changing the subject of his discourse; but frequently re-
verting to his previous ideas ; in addition to which, he was
fretful and impatient, flinging his arms about, and striking
his th&ha: tongue rather furred, pulse did not deviate much
from the natural standard ; did not complain of pain in the
head or giddiness. He was bled from the arm to sixteen
ounces ; his hair was cut short, and cold water was applied to
the head — when this was done he was very anxious to see
himself in the glass, but was pacified on being told he was
not much changed in appearance.

fy Hydrarg. submur. gr. v.

Confect. Roste. q. s. ft. pilula, statim sumenda.

IJr. Magnea. sulph. 5ij*

Infaai Sennse Sij.

Magnea. carb. 3j.

M. ft. haust. J hone post pil. sumend.

When the pill was brought to him, he exclaimed, " O, tis
of no use, I do not want medicine, I want better advice ;
send for Charles (an acquaintance) tell him to take warning
by me." After a little time spent in this manner, he became
sick, and vomited some green viscid bile, after which he was
better. Soon after this he took the pill, exclaiming, "that
it would not do him any good," and about twenty minutes
after this he had the draught, which was soon rejected,
unmixed with bile or any 'other matter. As a marked
amendment took place after each Vomiting, an emetic was
administered.

£•. Pulv. Ipecac 9j.

Antim. Tart', gr. ij. v

Aquee, Destill, Jij- M.

Fiat haustus emeticus statim sumendus.

He took it readily, observing that he knew it would do him
good — it began to act in about ten minutes, and he brought
up a great quantity of green viscid bile : during the vomiting-
and previously, his face was flushed, but directly after it had
ceased, the face became pale, and the heat of the scalp
much diminished.

1, p. m., The vomiting continued frequently, bringing Up
large quantities of bile — he was now calm ana sensible, sod
could recollect a great part of what had pamed- The
flinging of his arms had ceased, he was free from pain .in the

Mr. Foote on Mental Disturbance. lSl

head or giddiness, complained only of the unpleasant sen-
sation of emesis, and some faintness.

39 p. M. He complains only of the emesis, which still
continues, be vomits small quantities of 1>ile, and at consi-
derable intervals — countenance pale, skin of the scalp a
little hotter than that of the body, eyes still glistening,
though not so much as they were. A few minutes ago he
had a copious bilious stool, which has greatly relieved him.

$. Potass. Carbon. 5s».

Aq. DestiU. $x.

Syropi, Jj. M.

0r. Acid. Citric, .gr.xvj.

Aq, Destall Jss. M. his additis moxque in ipso acta effervescentisi
hauriat, et post horam repetend.

Half-past 5, p. m. The first effervesciug draught quieted
the stomach, and stopped the eraesis, since when a desire
to sleep has arisen, and been indulged in until now — com-
plains only of weakness — let him have the other draught.

7, p. m. Is going on well — is allowed toast aud water, and
soda-water.

Br. {iyd9 Sabm. gr. iij.

Extr. Colo. Comp. gr. viij. M. ft. pilule ij. h. s*s.

Br. Magn. Carb. 3j.

Syr. Simp'3j.

Potass. Subcarb. 3j.

Sued. Limon. Jss.

Aq. menth. vir. Jj. M. ft. haus(. hora nona vespertina, et primo
taane sumendus.

23d. Has not slept much during the night, owing to tbe
action of the pills, which have brought away several stools
with great quantities of bile. Another source of irritation
was toe disturbed state of the sensorium, continually pre-
senting objects before him whenever he closed his eyes,
which, with the noise inseparable from a frequented hotel,
prevented sleep during the greater part of the night? His
present symptoms are, pulse 86, tongue rather furred, but
not dry, skin hotter than usual* no head-ache, bowels freely
open, the pulse of tbe radial find carotid arteries synchronous
—has not vomited, is quite free from pain,

fir. Liq. Potass. Citrat Js*. - .

Mftgn. Carbon, gr. xv.

Aq. M. Vir. 5vj.

rasas, nitrat. gr. iv.

8}r. Siftip. 5j. M. ft. hanst. ter die sumend.

Br. Ryd. Snbmur. gr. ij.

Extr. Colo. C. gr. vij.

Porv. Antim. gr. ij.

01. Carui. gtt. j. M. ft. pil. ij. ft. s. e.

132 Original Communications.

H^ is perfectly sensible, and is about to leave town;

8&h. Slept the first part of the night, after which his
sleep was disturbed, dozing only ; felt a little nausea this
morning, which, since the operation <?f the pills, has gone
off-— pulse 76, and soft, tongue cleaner, no head-ache, appe-
tite pretty good, is quite collected.

ROYAL WESTMINSTER OPTHALMIC HOSPITAL.

III. — The Oleum Terebinthince in Diseases of the Eye.

From the extensive trials which have been given to this
remedy in deep-seated inflammations of the eye, there can
no longer be any doubt as to the beneficial influence it exerts
in these complaints, and the numerous advantages which
arise from its introduction into practice. It is very valuable
in those cases, which sometimes occur, in which the admi-
nistration of mercury would be dangerous, and even in every
other case, the unpleasant effects which occasionally arise
from turpentine, and which may be very quickly relieved, are
far more to be endured than the disgusting state invariably
attending the use of mercury. This, however, will not be
considered, from the certain cure which we confidently
expect from the exhibition of the latter, until repeated evi-
dence from experience shall prove, that the former is nearly
as efficacious, and at the same tirne much less unpleasant
and injurious in its modus operandi.

With this view the following cases may perhaps prove
interesting.

Case 1. James Brown, ect. 24, admitted June 20th, 1830.
Last April was attending at this Hospital, with iritis of the
right eye, which was speedily cured by the oil of turpentine.
He had gonorrhoea at the time, but the discharge from the
urethra ceased soon after the eye became inflamed, and has
not appeared since. His left eye is now attacked by the
same complaint ; says, that it has been inflamed for the last
three days, accompanied with pain and dimness of sight.
The iris is discoloured, pupil slightly irregular and dilated,
and there is a bright zone ot pink vessels round the cornea.
The other tunics remain comparatively healthy. Complains
of severe pain round the orbit, and slight intolerance of
light ; sight very dim*

Habeat, 01. Terebinthinae 5i. ter- die.

Oleum Terebiiithintz in the Diseases of the Eye. 133

Jane 23d. Pain much relieved. Inflammation and dim-
ness of sight, however, remain, as before. Has taken the
medicine regularly without any uneasiness in the urinary
organs. Ordered to continue the turpentine.

24th. Not so well. Circumorbital pain worse. Conjunc-
tiva and sclerotica more inflamed ana pupil more irregular;
Complains of slight strangury. To continue the turpentine,
but to drink>plenttfully of linseed tea. To lose also twelve,
ounces of blood from his left temple.

26th. Much the same. . Pain and inflammation not relieved
by the cupping. To take a drachm of the turpentine four
times a day.

July 3d. Has taken his medicine regularly, with the pre-
caution of drinking plentifully of linseed tea, and has not
experienced the slightest strangury. He may now be con-
sidered, as cured, only a slight tinge of redness of the
sclerotica remaining. The pupil is regular and acts freely.*
He says' that he suffers no pain, and that his sight is
completely restored. As the turpentine gives him no incon-
venience, he is directed to continue it a day or two longer.

Case II. Jane Spittle, set. 36, was admitted May 18th,
having syphilitic iritis of the right eye, accompanied with
sore throat, and eruptions on the skin. She was ordered a
pill composed of three grains of calomel, and a quarter of
a grain of opium, three times a day. Had not applied here
again Until -now, June 29th, and says that she had only
taken four pills when her face became very much swollen,
and she was confined to her bed for three weeks, suffering
under a dreadful salivation, from which she has not yet
quite recovered. Her eye and throat, however, gradually
got well, during that period. She has now returned with a
similar attack of inflammation of the led eye, which has
been gradually getting worse for the last week. She com-

Slains of the most acute pain over the brow, and extending
own that side of the face, so intolerable at night that she
cannot sleep. The conjunctiva and sclerotica are very much
inflamed, leaving, however, a very distinct white line round
the margin of the cornea; iris much darker than natural;
pupil of the same size as the other, but rather irregular and
axed. Coroea remains clear. The lids are rather swollen
and inflamed. Three days back to relieve the pain she was
capped, and took a drachm of the Vinum Colcnici at night,
hut without benefit- She complains ajso of great weakness

"ith sickness and loss of appetite; pulse quick and small;

bowels confined-

134 Original Communications.

Habeat Pulv. Jalap. Comp. 3j. statim.

Capiat. 01. Terebinth. 3j. terdie, et

Pulv. Ipecac, comp. gr. x. nocte.

July lst.# Inflammation continues muoh the same. Pain
however has been much less severe at night. To continue
the medicines.

3rd. Says that she suffered more pain last night and attri-
bute* it to not taking her medicines yesterday, the turpentine
having caused a good deal of nausea and strangury, bowel*
very much confined. To continue the turpentine, and drink
plentifully of linseed tea.

Sumat. Pulv. jalap. Comp, Jiss. statin.

Oth. Much better. Inflammation considerably diminished.
Very little pain now at night.

Rep.med.

8tb. Nearly well, very Httle redness remataibtf , pupil
rather small, but regular. Says that she is quite Tree from
pain, and her sight very much improved.
Rep. med.
Applicetur Empl. Bellad. tempori. sinietro.

10. The eye appears perfectly healthy. She is to continue
the medicine, however, a few days more, as her sight is not
quite so distinct as it was.

-r

III. — Dr. Stoker on the Pathology of Dropsy.

To the Editor of the London Medical % Surgical Journal.

Sir — Having been much gratified by your approval of
my principles and practice, I would have thankea you be.
fore this time for the liberal support you rave them in your
truly scientific and excellent Journal, had I not been engaged
in writing the " Treatise on the Pathology of the Animal
fluids and solids," which I have the pleasure of sending you,
and in which I have availed myself of the aid and encourage-
ment with which you have favoured me. A friend induced
me to have it printed in Scotland, and this fact I state in at-
tenuation of the misprints with which it /abounds, and for
which I solicit your indulgence. I regret however to add
that some of the manuscript was mislaid, and that I am now
under the necessity of stating facts of importance which have
been omitted in this communication.

I endeavoured to oppose the strictures in the Medico Chu-
rurgical Review, on my attempt to arrange facts ; by those of
the Westminster Review and Hamburg Magazine for not ge-
neralizing enough towards a system. Secondly, to show
that by contrasting the practice in the Dublin Fever Hospi-

Dr. Stoker on the Pathology of Dropsy. 135

tab, with those of London, as stated by Dr. Hawkins ; I of-
fered arguments deduced from morbid anatomy, for the prin-
ciples I have adopted, in preference to those lauded by the
London criticism ; but a leading object of the publication was
to prove by cases that the ratio symptomatum was available,
in suggesting the ratio medendi. The cases which I selected,
were from private and hospital practice and were chiefly
those of dynamic dropsy and appeared to me well calcu-
lated to shew that morbid condition of the blood, returned
to the greater circulation, by the vena cava from the want of
few changes in its4 passage through the liver becomes the
source of morbid actions or embarrassment in the functions
of the viscera of the chest, and of consequent dropsy there
and elsewhere, and the successful employment of medicines
by these principles tended further .to establish them. The
application of leeches to the verge of the rectum, to diminish
the accumulation of dense veinous bfood in the mesentery,
of blisters to the region of the liver, and the use of warm
mercurial purgatives, to relieve the biliary system in general,
and remedies to restore the healthy functions, have frequently
removed symptoms which have been generally attributed to
diseases of the heart. I' also stated my experience in the
use of millfofl, yarrow, (Achillea Millefolium) in dropsy
and gangrene, as a rubifacient aud hydragogue, and as a
restorative of the function of sanguification and the aqueous
secretions. I request you will have the goodness to forward
a copy imperfect as it is to the editor of the Medico Chirur-
gicaf Review mentioning to him the circumstances under
which it is presented and I hope that gentleman will per-,
ceive there is no object in view besides the promotion of
medical knowledge ; and therefore will receive my explana-
tion in the proper feeling In which it is offered. I cannot
conclude without offering you my best thanks for the kind
observations wifh which you have favoured me, which are
the more valuable as I have not the honor of your acquaint-
ance, both in your reviews of Dr. Good's work, of Dr. South-
wood Smith's, and more recently of Dr. Steven's essay on
the blood.

I have the honor to be Sir,

with great respect and esteem,

your obedient servant.

W. Stoker.
21, York Street, Dublin,
June 25th 1830.

It affords us much pleasure that our reviews, on the. present
and indeed almost every occasion are admitted impartial,

136 Original Communications.

and we are proud to state as yet we have received no recla-
mation. We feel deeply sensible of the very complimentary
terms in which so eminent a writer as Dr. Stoker has been
pleased to speak of us, which will be further seen in a pre-
ceding part of this number. — Editor.

V.— \Ethics of the present Period. By M. Ryan, M. D.

I will never *et politick* against <
*' to divinity and religion." — Bacon.

" I will never set politick* asrainst ethicks, for true ethicks are but a handmaid

sltcion/' — I

That medical men should practise cautiously, chastely 9 and
honourably, and observe strict secrecy in all delicate eases,
and in all domestic affairs, which may fall nnder their notice
during professional attendance, is not only consonant to the
usage of the profession, but to common sense and justice.
It would be highly improper to divulge the nature of certain
diseases, or expose the affairs of families, to gratify idle
curiosity, impertinence, or serve the purposes of an interested
knave. The law however compels us to violate these prin-
ciples; and hence the exception in the Edinburgh oath, " not
to divulge without weighty reasons." In sucji cases the vio-
lation or renunciation of our moral and professional duties is
compulsory. Chastity and honour are general moral duties,
and not peculiarly belonging to any one profession. The
duty of caution in practice means " care not to expose the
sick to any unnecessary danger." The best rule of conduct
on this important point, is the simple and comprehen-
sive, religious and moral precept, " do unto others as you
would they should do unto you. ' Whatever the practitioner
does or advises to be done, for the good of his patient, and
what he would do in his own case, or in the case of those
who are dearest to him, if he or they were in the same situa-
tion, is not only justi6able on his part, but it is his bounden
duty to do. The patient should have the chance, whether
it be 100 to one, or only one in 100 in his favour. Whatever
may be the result, the practitioner has the greatest of all
consolation — the consciousness of rectitude, " mens conscia
recti.'* — this will be his solace, should the case terminate un-
favourably, when the vulgar, the ignorant, the envious, the
malicious, and the interested, will not fail to blame him for
the death of his patient. But if he administered a dangerous
medicine, merely to gratify his own curiosity or zeal for
science to ascertain the comparative advantage or disadvan-
tage, of some new remedy, either proposed by himself or
suggested by others ; he is held guilty of a breach of ethics

Dr. Ryan on Ethics of the present Period. 137

on this important point, is the simple and comprehen-
sive, religious and moral precept, " do unto others as you
would they should do unto you. * Whatever the practitioner
does or advises to be done, for the good of his patient, and
what he would do in his own case, or in the case of those
who are dearest to him, if he or they were in the same situa-
tion^ not onlyjustifiable on his part, but it is his indispensable
duty to do. The patient should have the chance, whether
it be 100 to one, or only one in 100 in his favour. Whatever
may be the result, the practitioner has the greatest of all
consolation — the consciousness of rectitude, " mens conscia
recti." — this will be his solace, should the case terminate un-
favourably, when the vulgar, the ignorant, the envious, the
malicious, and the interested, will not fail to blame him for
the death of his patient. But if he administered a dangerous
medicine, merely to gratify his own curiosity or zeal for
science, to ascertain the comparative advantage or disadvan-
tage of some new remedy, either proposed by himself or
suggested by others ; he is held guilty of a breach of ethics
and of a high misdemeanour, and a great breach of trust to-
wards his patient ; and if the patient died , I apprehend, he
might be severely punished. Medical men have tried the
most dangerous experiments upon themselves, from their
zeal for science ; and even sacrificed their lives, but patients
in general have no such «eal for science, no ambition for
such a crown of martyrdom, and generally employ and pay
their medical attendants for the very opposite purpose. It
must be admitted that men who would try experiments upou
themselves, would be very apt to try experiments on their
patients. It is a melancholy truth, but cannot be denied.
The profession however, has always reprobated such conduct,
and the medical phrase of reproach and contempt for it,
" corio kumano fat&ere" to play with the human hide*
abundantly testifies -in what abominaton it has been held by
the faculty. It is unnecessary to dwell upon this point in this
age, because all experiments are made upon the inferior ant*
mals; .and the just- reproach entertained by the faculty, in
former times, is new inapplicable. But every man of com-
mon understanding well knows, that neither physic, nor sur-
gery can be practised without some danger to the sick. It
ts universally known that many surgical operations are dan-
gerous to life ; and that all our most powerful remedies are
highly dangerous, and more especially when improperly em-
ployee? or when they cannot be borne. A safe medicine is
often extremely dangerous, from the peculiarity of consti-
tution ; and the great and urgent danger in many diseases

v©t. ?.-no. 96. T

138 Original Communications.

requires the immediate use of dangerous remedies. It
is admitted by the best practitioners, that many remedies
are still wanted for tbe cure of disease, and this want leads
us most justifiably and almost inevitably to try new remedies
on mauy occasions ; and such experiments are not blameable,
for they are necessary : sic enim medicina orta ; subiitde
alio rum salute 9 aliorvm interritu perniciosa discernans a
talutaribus. From these causes, there results much inevi-
table danger in the practice of physic. From this acknow-
ledged danger, results the important duty of caution in a
physician, or care to make the danger as little as possible.
Whatever is best for the sick, it is the indispensable duty of
a medical man to do for them. It is his duty and obliga-
tion, " faithfully to do all things conducive to the health of
his patients ;" and this is so complete and indefeasible, that
it cannot be set aside by any motion whatever. Such is the
code of ethics which ought to influence medical men, both in
public and in private practice ; " but it is matter of question,'*
says Dr. Gordon Smith, " whether it has in reality an ex-
istence."* This is a truism that cannot be doubted ; and" yet
the rising members of the profession are expected to support
the honor and dignity of the faculty, without any rules to guide
them, without having heard a single word upon the subject^
during their education. Hence the cause of that improper
conduct which has degraded the profession to a degree un-
paralleled in the annals of British medicine. I shall not pro-
secute this subject at present, as it will be more properly
considered in ray account of the laws relative to the
practice of every branch of medicine in this country, and of
the constitution of the faculty.

From the preceding brief account of the ethics by which
medical men are directed, it is obvious that the profession of
medicine is the most noble and disinterested of human avoca-
tions. This has been admitted in every age and country,
since the foundation of medicine as a science. History at-
tests the fact. It now only remains to apply the noble prin-
ciples of medical ethics to public and private practice, and
here Dr. Percival shall be our guide, but we will endeavour
to condense his precepts, without destroying the spirit of their
meaning.

• Analvsis of Medical Evidence.

[ 139 3

Of Professional conduct relative to hospital and othif
medical charities, and in private practice.

Hospital physicians and surgeons should display tenderness,
steadiness, and condescension in enforcing their authority.
They should allow the sick to choose their favourite practi*
tioner, or at all events call him into consultation occasionally,
and thus ensure the patient's confidence. The feelings and
emotions of the sick ought to be regarded as much as in
private practice; and the discussion of the nature of their
diseases, in their presence, ought to be avoided. Delicacy in
female cases, should be ever regarded. Parsimony hi pre-
scribing medicine and diet, should never have iufluence. A
discrimination between medical and surgical cases should in-
variably exist ; and new remedies or operations are justifiable
under the circumstances already mentioned. The history of
every important case .should be recorded, and the nature of'
the disease, the ratio symptomatum and ratio medendi,
should be noted and explained to medical students when thef
attend. This is the only safe mode of initiation into the heal-
ing art, a practice unattended to in all the London hospi-
tals. The medical officers should examine and approve of all
medicines, but ought to take no part in the management of
the domestic affairs of hospitals, or other public institutions
to which they may be attached. They should consult in all
dangerous cases, and no capital operation ought to be per-
formed unless sanctioned by the majority of the physicians
and surgeons of the institution. The junior physician or sur*
geon should deliver his opinion first, and the others in the
progressive order of their seniority ; a majority to be deci-
sive; but if the numbers are equal, the attendant should de-
cide. In mixed cases, the junior surgeon should deliver his'
opinion first, and his brethren afterwards, according to se-
niority, and then the junior physician. This is agreeable
to the rule " incipiat junior medicus, concludat se-
nior," The attendant is to state the case. The order of se-
niority may be determined by the date of admission into the
colleges, or appointment to the hospital ; due notice should
be given of a consultation, and no one should be present but
the medical officers, unless with their consent. It is im-
proper to hold consultations on Sunday, or perform opera-
tions unless in cases of urgent necessity. It is improper to
have a stated day for operations, as it may cause improper
delay or unjustifiable anticipation, " when several operations
are to take place in succession, one patient should not havs

140 Original Communications.

his mind agitated by the knowledge of the sufferings of ano-
ther. The surgeon should change his apron when besmeared ;
and the tables or instruments should be freed from all marks
of blood, and every thing that may excite terror." Morals
and religion must be attended to in hospitals, but all indis-
creet zeal is not only injurious in dangerous cases, but evea
fatal. Intrusion on the religious opinions of the sick is highly
improper, and is too often allowed or encouraged in many
hospitals. The sick should choose their own clergyman. la
many cases it is necessary to advise the patient to make a
will, as the inmates of hospitals are often possessed of pro-
perty, of in expectation of it, and their heirs might lose it.

The relief afforded by hospitals, though they are institu-
tions of the most benevolent kind, is procured with difficulty ;
Eatients are admitted only one day in the week, no matter.
ow dangerous their eases, fees are often required, the sick
are removed from their families, the nurses are ttran^ers.
These defects are so manifest, that the public have wisely
established dispensaries to obviate them. In these establish-
ments medical assistance is obtained with the greatest
facility every day ; it is afforded to one parent, without re-
moving him from the means of earning support for himself
and family, and to the other without withdrawing, her from
the superintendence of her domestic concerns. Besides the
natural affections which every philanthropic mipd must wish
to see cherished, are reoiproeally called into exercise, and
strengthened, where the parent is the patient, where the
wife oecomes the nurse, and the children .assistants, and
medical aid is rendered more efficacious whep the mind ia
relieved from the anxieties necessarily attendant upon a se-
paration from family, and a removal from home. The early
application on the first feelings of indisposition prevents the
diffusion«of contagious diseases; and pestilence, which once
stalked forth, spreading terror and desolation around, is now
arrested in its progress, or strangled in its birth ; and it is
not too much to assert that the general healthiness pf the
metropolis, and the less frequent recurrenoe of contagious
disorders, are to be in a great measure attributed to their
early suppression in the abodes of poverty, by the activity,
and vigilance of the medical officers of dispensaries. It lq
also apparent that without the medical assistance thus af-
forded the poor, the demand on parochial rates would be
increased in a very considerable degree, and the medical
establishments of every parish would be increased to double
their ordinary expenditure.

It is quite contrary to the objects for which hospitals and
dispensaries are founded, to render them subservient to those

Dr. Ryan on. Ethic? of the present Period. 141

in affluent circumstances, au abuse which exists in every one
of them. This is an imposition on charity, and a direct
injury to the profession, yet the medical officers connive at
it. It is o fact, which cannot be controverted, that a large
proportion of the patients admitted into the hospitals, espe-
cially of this city, and relieved at dispensaries, are not
real objects of charity, and are often the relatives or personal
friends of the governors or subscribers ; and thus the junior
members of toe profession are seriously injured. This
abuse exists in every part of the empire, but to a vast extent
in this metropolis. I have often remonstrated with my col*
leagues* ana with governors on this impropriety, but the
reply was ready, " these things are tolerated in every public
institution." Dismissing the subject for the present, 1 have
to allude to the conduct of medical men in the various public
situations in .which they are placed, in lunatic asylums,
prisons, &c. &c. The same principles of conduct should
guide them in public and private practice, and these have
been amply detailed in the preceding pages. A few obser-
vations may be made on points relative to private practice,
not hitherto considered.

Punctuality in visits to consultations should be always
observed. This was well exemplified by Dr. Baillie, as is
related by Sir Henry Halford, in his observations on his de-
parted friend, delivered at the College over which he presides,
" Such was his condescension, that he often incurred great
inconvenience to himself by his punctual observance of
appointments with the humblest practitioners. In consulta-
tion he was candid and liberal in the highest degree; and
the physician who called him in never failed to find himself
in the same possession of the good opinion of the family, as
he was before the circumstances of the case made a con*
saltation necessary.'*

Consultations, says 'Dr. Percival, should be promoted, in
difficult or protracted cases, as they give rise to confidence,
energy, ana more enlarged views in practice. On sueh
occasions no rivalship or jealousy should be indulged. Can-
dour, probity , and all due respect should be exercised towards
the physician or surgeon first engaged; and as be may be

[resumed to be best acquainted with the patient and with
m family, he should deliver all the medical directions
agreed upon, though^ he may not have precedency in senio-
rity or rank* It should be the province, however, of the
senior physician, first, to propose the necessary questions to
the sick, but without excluding his associate from the privi-
lege, of makxvg farther enquiries, to satisfy himself, or to
elucidate the case.

142 Original Communications.

As circumstances sometimes occur to render a special con-
sultation desirable, when the continued attendance of another
physician or surgeon might be objectionable to the patient,
the gentleman of the faculty, whose assistance is tequired
in such cases, should pay only two or three visits ; and sedu-
lously guard against all future unsolicited interference. For
this consultation a double gratuity may reasonably be ex-
pected from the patient, as it will be found to require an ex-
traordinary portion both of time and attention.

In medical practice, it is not an unfrequent occurrence,
that a physician is hastily summoned, through the anxiety of
the family/ or the solicitation of friends, to visit a patient,
who is under the regular direction of another physician, to
whom notice of this call has not been given. Under such
circumstances, no change in the treatment of the sick person
should be made, till a previous consultation with the stated
physician has taken place, unless the lateness of the hour
precludes meeting, or the symptoms of the case are too
pressing to admit of delay.

In cases of doubt or danger, the medical man who refuses
a consultation must be extremely arrogant or inhuman, and
probably both. The patient has an undoubted right to call
as many of the faculty as he pleases, though it is often very
difficult to make him understand that he is not the property
of his attendant, and that on the contrary, the services of
the latter are not his property. In general, consultations are
objected to in small towns, where the faculty are obliged to
scramble for fame and fortune, and daily bread, and whose
rivalships, and disputes, and altercations, too often end in
open quarrels and implacable animosities. The sick ought
never to suffer by such disputes, and hence we find men who
are not on speaking terms, meeting in consultation. It has
been a maxim with the faculty that a prac'itioner of standing,
a senior, should be called over the ordinary attendant. This
rule is often violated, and indeed it is not an easy matter to
observe.it on many occasions. The late eminent Dr. Gregory;
of Edinburgh, has commented with his usual force on this
point. He says, but mere standing or seniority, superadded
to the most complete and regular education in the profession,
will neither procure confidence from the public, nor success
and employment to any person. We are well accustomed
to see many juniors surpass, and most deservedly surpass
their seniors, perhaps even their own instructors ; and leave
them so far behind, that, before half their race is run, they
can have no. farther hopes of success.

Some individuals soon shew by their talents, and the use
which they make of them, that they can profit more by sereh

Dr. Ryan on Ethics of the present Period. 143

years of observation and experience, than others could do in
the longest life. And very many soon shew that they are
incapable of ever improving'; from a real natural want of
those faculties which would enable them to observe accu-
rately, to compare different observations together, to reascn
acutely and fairly, and ultimately to draw just and useful
practical inferences from what they had observed. Many,
not naturally deficient in their intellectual powers, become
so from defects or improprieties in their education; espe-
cially the want of that general preliminary education which
improves the faculties, while it extends the sphere of know-
ledge, and directs the attention to proper objects. And
man}' more, who have no such excuse either from natural or
accidental defects, never improve, and soon shew that they
never will, purely by their own fault. They think the
knowledge or improvement they bad acquired, when they
fret entered on the exercise of their profession, sufficient for
all purposes, or at least for their purpose ; they find the
effort of attention in observing, comparing, reading, and
thinking, too laborious ; and, as they natter themselves it is
unnecessary for them, they soon cease to make it.

Of course, all chance of improvement in them is at an
end; they grow older, and yet grow never the better or
wiser. On the contrary, as they often become more negli-
gent, they grow worse in every respect, and really become
more ignorant, forasmuch as they acquire no new knowledge,
and forget much of what they had formerly learned.

They become a kind of drones, content to do their business
in a humdrum workman-like sort of a way ; by which they
have the best chance of escaping reflections or censure.
Their faults are much more frequently sins of omission than
of commission. For once that they do any thing positively
and immediately pernicious, they miss, from negligence, or
ignorance, or both, an hundred opportunities of doing good.
None but those in the secret have any notion how faithfully
laany physicians aad surgeons go on for thirty or forty years,
or longer if they live longer, employing, even in the com*
monest diseases, the remedies which they were taught when
young, though useless at best, if not pernicious ; how faith-
folly many great and grave writers have transcribed from
their predecessors, from generation to generation, the same
frivilous, absurd, or dangerous precepts, the same useless or
pernicious prescriptions, and the same sitly remarks ; how
tenaciously many practitioners adhere to old receipts, so
extravagantly absurd as to contain perhaps fifty or a hundred
ingredients, of which probably not more than three or four
•re of any use ; and how manfully they fight against the in-

144 Original Communications.

traduction of other remedies, the most simple, powerful, and
safe ; which they reprobate, and will not employ, for no other
reason but because they are new.

Men of such talents, characters, and habits, whether phy-
sicians or surgeons, can neither improve by experience them*
selves, nor contribute to the instruction of others, and the im-
provement of their art. They are peculiarly unfit to practise
in nn hospital, where, on account of the great number and
urgency of the cases to be treated, the greatest extent and
accuracy of knowledge, the greatest quickness, precision,
add discrimination in applying it, ana, in one word, the

Sreatest effort of attention and thought is required.. Any
eficiencies in them, which in private practice might weft
have escaped observation and censure, must soon become
conspicuous on so public a stage ; just like those of a lawyer
at the bar; and Will not only bring on themselves reproach
and contempt, but will in some measure affect the character
of the hospital itself. Whatever lessens the confidence of
the public in the administration of it, arid of the patients* who
resort to it, in the skill of those to whose care iheir health and
lives are entrusted, tends strongly to frustrate the benevolent
purpose of the institution, and re, in truth, n very great injury
to the public. Some men, naturally of good dcne^and
quick discernment, and active, vigorous minds j who attend
accurately to what passes around them, are distinguished
even at an early period of life for sagacity, prudence, deci-
sion, and quickness in conduct, and a thorough knowledge of
the characters of men, and the management of business*
They are accordingly respected in the world, and often 'con-
sulted on nice and difficult occasions by those who are
acquainted with them, and who very wisely rely more on the
judgment of such men than they would do on their* own.

But such men are not the majority of mankind* An in-
finitely greater number are either so deficient in natural
talents, or so culpably negligent in the use they make of them,
that they appear to acquire ho improvement at all by their ex-
perience or men and things. At the age of fifty or sixty, they
are a good deal more dull, but not a jot wiser, than they were
at twenty- five or thirty. They become as arrant .drones in
common life as any are in law, or physic, or surgery. No
man of sense, who knows them, would ever think of consult-
ing them, or relying on their judgment, in any business
whatever, any more than he would think of consulting a
lawyer when he was sick, or a physician when he was en-
£Hged in a lawsuit.

A man of Tm«h a character never can deserve respect, or
confidence, or employment, even in his own profession : and

Dr. Ryan on Ethics of the present Period. 143

there are many such in law, in physic, in surgery, and in all
the employments of life.

It must be unnecessary to enter into serious proofs of the
importance of consultations. The mere want of medical
assistance, says the distinguished physician whom I have
just quoted, is in many cases so bad, as to imply almost
certainly very pernicious, if not fatal consequences. In such
cases' to withhold it voluntarily; would be almost as criminal
as to suffer a wretch to perish by withholding food from
him. This point being proved, a few words may be said
od the utility of numerous consultations. The opinion of
Dr. G. is so excellent upon this topic, that it must be
quoted. With respect to physicians and surgeons both,
and their patients, it is plain that all the good that can be
expected from a consultation maybe obtained from one of two,
or three, or four, at the utmost; at least as well as from one
ten times as numerous ; and I should think it almost as plain,
that much of that good may be prevented, and much positive
e?il done, by a very numerous consultation.
' On this point, I presume, without vanity, to know as much
as most men. For full half of my life, I have been a pro-
fessor of physic in* the University of Edinburgh, during which
time consultations have been a great part of my business, to the
number certainly of some thousands. Nineteen times out of
twenty at least I have been the youngest physician of the con-
sultation ; and of course, when any written directions were
to be given to the patient, have had the honour to put them
in writing, to the number, I presume, of two or three hundred
at least. I can say with confidence in point of fact, that I
never knew any good come of a very numerous consulta-
tion ; arid I doubt much whether any physician or surgeon
of competent experience will give a different account of the
result of what he has observed. The conduct of physicians
and surgeons; when themselves or any of their families are
sick; affords a still better proof and illustration of the same
truth, and is indeed supreme and decisive authority with re-
*[*<* to what is useful, or what is useless, or worse than
useless, in medical consultations. With us all considera-
tions of economy are out of the question. Bad as we may
he thought, we are not such Cannibals as to prey on one
another: We may all have, for nothing, to ourselves and
our families, as much assistance in point of physic and
8°rgery as we choose. We feel strongly, that we have not
efficient calmness and firmness to judge and act properly,
when the lives of those are at stake in whom we are most
tenderly interested : and as to ourselves, when sick, we all

* • »

vol. v. wo. 26. v

146 Original Communications,

know, for it is a long settled point in physic, that every
man who doctors himself, has a fool for his patient.

For these reasons we are all accustomed, when ourselves
or our families are sick, to ask the assistance, not of all, but
of some of our professional brethren. A numerous consulta-
tion is a kind of debating society, in which, the patient's
welfare, which ought to be the only object in view, is nearly
forgotten. The illustrations of such consultations by Moliere,
Le Sa^e, Fielding, and many others were just, though inap-
plicable at present. In former times the odium medicum was
as violent as the odium theologtcum, even matters went so far
that the disputants resorted to arms; but there is tittle
danger of modern theorists taking the field in support of
their opinions, though they war with words fully as bitterly
as their predecessors.

Great caution should be used by the practitioner called in
as to the character of the former attendant Dr. Percival
has illustrated this point with great ability. Officious inter-
ference, in a case under the charge of another, should be
carefully avoided. No meddling enquiries should be made
concerning the patient ; no unnecessary bints given, relative
to the nature or treatment of his disorder ; nor any selfish
conduct pursued, that may directly or indirectly tend to
diminish the trust reposed in the physician or surgeon em-
ployed. Yet though the character of a professional busy-
body, whether from thoughtlessness or craft, is highly repre-
hensible, there are occasions which not only justify but re*
quire a spirited interposition. When artful ignorance grossly
imposes on credulity ; when neglect puts to hazard an im-
portant life ; or rashness threatens it with still more immi-
nent danger ; a medical neighbour, friend, or relative, ap-
prized of such facts, will justly regard his interference as a
duty. But he ought to be careful, that the information on
which he acts, is well founded; that his motives are pure
and honourable; and that his judgment of the measures
pursued is built on experience and practical knowledge, not
on speculative or theoretical differences of opinion. The
particular circumstances of the case will suggest the most
proper mode of conduct. In general, however, a personal
and confidential application to the gentleman of the faculty
concerned, should be the first step taken, and afterwards, if
necessary, the transaction may be communicated to the pa-
tient or to his family.

The next point for consideration is this, ought a physician
to consult with an apothecary or not? The Royal College
of Physicians in London decide in the negative, as also the
Dublin College. Dr. Grattan of Dublin, observes,

Dr. Ryan on Ethics of the present Period. 147

If physicians will consult with apothecaries and meet them
at the appointed hour, on successive days, during the whole
course of a long protracted fever, what are the public to in-
fer ? The natural inference is, that the physician must de-
rive some information from the apothecary , and that he does
not consider the absence of the apothecary from his shop as
a matter of any consequence. This again leads to other
conclusions, until at last it is supposed that the apothecary
having seen so much of the physician's practice, must be 93
well qualified to prescribe as the physician himself, Of
course, on all future occasions he is applied to, and the phy-
sician no more thought of, until symptoms of the most ur-
gent nature have presented themselves, and the apothecary
begins to consider it not altogether prudent in him to allow
his patient to die, unattended by a physician.

After a physician has been thus called in over an irregular
practitioner, and when he performs merely the part of a use-
less pageant in the gloomy scene which is soon to follow, his
want of firmness, and of steady adherence to' that candour
which his duty to the profession, and the public, requires, by
no means tends to promote even his private interests. He
gives occasion to the very person, who perhaps objected to him
in the first instance, to observe that there was little use in
employing him, and that it was evident he could have done
nothing more than had been done before he was consulted.
Thus are the public deceived ; thus is the respectability of
medicine injured, and thus are more lives annually sacrificed,
than it would be possible to calculate.

The presence ofan apothecary ata consultation, can be of no
use whatever to the patient, and is very often injurious.
Physicians, in bis presence, cannot deliberate as freely as
they would do, were they by themselves, They feel that
they are under the surveillance of a person who may have a
partiality towards one physician, and a prejudice against ano-
ther, and who may pass what comment he pleases on their
opinions and practice. The effect of this is, to create a degree
of caution and reserve on their part, altogether inconsistent
with the object of a consultation ; and which often renders it
little else than a mere matter of form.

The presence of the apothecary has also a decided influ-
ence over the physician with respect to the medicines which
he prescribes, so that, however honest his intentions, he can-
not avoid ordering more than he otherwise would. If a phy-
sician were to pay two successive visits to a patient, when an
apothecary was in attendance, without prescribing any medi-
cine, what would be the consequence r It would probably
be suggested that he knew nothing of the disorder, or that he

148 Original Communications.

wished to protract, its duration, by not ordering such me
dicines as some other physician had prescribed, with the
greatest success, in a case exactly similar : that it was a

J>roof of the greatest avarice and illiberal ity to take his fee
or doing nothing ; — in short, that he ought to be immedi-
ately dismissed, and that Doctor should be sent

for.

BIBLIOGRAPHY.

ANATOMY AND PHYSIOLOGY.

1 . Globules in the humoiirs of the eye. — MM. Ribes and Donne,
have lately discovered globules in the humours of the eye, of a smaller
size than those of the blood. There are three orders of them ; the
first are in sinuous chaplets and very apparent ; the second are isolated
larger than the others, and surrounded by a black circle ; the third
or last distinct, and resemble a kind of mist. The authors are dis-
posed to question the utility of so many parts of the visual organ in
the production of impressions on the retina. It is known that the re-
moval of the crystalline lens by extraction, does- not destroy vision.
The rays of light must be considerably modified by the globules of
the humours. — Arch. Gen, de Med. Mai.

2. New Theory of Vision. — Dr. Reae, of Cork, has recently de-
livered a course of lectures on the anatomy and the physiology of the
eye, at the Mechanics Institute in this metropolis, in which we un-
derstand, he has proposed a new theory of vision. He has paid great
attention to opthalmic diseases, and is about to publish the result of
his experience ; we have been informed by one of his auditors that he
holds the cornea to be the seat of vision ; but we cannot surmise upon
what reasoning he could have arrived at this conclusion. We think
there are many fatal objections to his theory, but refrain from urging
them until his work appears. We have had the pleasure of being in-
troduced to him at the Royal Westminster Opthalmic Hospital, and in
a conversation with Mr, Guthrie, he mentioned an operation for fis-
tula lachrymalis, which obviates all inconvenience in that disease. It
consists in making a small puncture in the. superior part of the. lachry-
mal sac, and keeping this puncture open. He produced a patient on
whom the operation had been performed eight years ago, and so lit-
tle of puncture remained that it was impossible to decide which sac
was affected. On pressing the affected sac, the tears gushed forth
freely through an aperture not perceptible to the naked eye. Mr.
Guthrie observed that he had performed a similar operation on a
Spanish Marchioness whom he named, and with equal success.

MORBID ANATOMY.

3. Official Report of the Morbid Appearances, which were
observed at the post-mortem examination of the body of his late

Morbid Anatomy. 149

Majesty George the Fourth. — The body exhibited but little sign of
putrefaction; and the anasarca had disappeared, excepting some
slight remains of it in the thighs.

Notwithstanding the apparent emaciation of his Majesty's person,
i very large quantity of fat was found between the skin and the
abdominal muscles.

ABDOMEN.

The omentum, and all those parts in which fat is usually depo-
sited, were excessively loaded with it. The abdomen did not contain
more than an ounce of water.

The stomach and intestines were somewhat contracted ; they were
of a darker colour than natural, in consequence of their containing
mucus tinged with blood, and in the stomach was found a clot of
pare blood, weighing about six ounces.

The liver was pale, and had an unhealthy granulated appearance.

The spleen, although larger than usual, was not otherwise diseased,
tod the pancreas was in a sound state.

The sigmoid flexure of the large intestine had formed unnatural
idhesions to the bladder, accompanied by a solid inflammatory deposit
of the site of an orange,

Upon a careful examination of this tumour, a sac or cavity was
bond in its centre, which contained an urinary calculus of the size of
» filbert, and this cavity communicated by means of a small aperture
with the interior of the bladder at its fundus. In other respects the
bladder was healthy, and the prostate gland did not appear to be
enlarged. The kidneys were also free from disease.

THOBAX.

Two pints of water were found in the cavity of the right side, and
tbee pints and three quarters in the left side of the chest. The left
tag was considerably diminished.

The lower edge of each lobe of the lungs had a remarkable fringe,
which, upon examination, was found to be formed by a deposit of fat.

The substance of the lungs had undergone no change of structure,
bat the mucous membrane lining the air tubes was of a dark colour , in
consequence of its vessels being turgid with blood.

The pericardium contained about half an ounce of fluid, but its
opposite surfaces in several parts adhered to each other from inflam-
mation at some remote period.

Upon the surface of the heart and pericardium there was a large
quantity of fat — and the muscular substance of the heart was so tender
38 to be lacerated by the slightest force. It was much larger than
uttaral. Its cavities upon the right side presented no unusual ap-
pearance, but those on the left side were much dilated, more espe-
cially the auricle.

The three semilunar valves at the beginning of the aorta were
totificd throughout their substance, and the inner coat of that blood-
vessel presented an irregular surface, and was in many parts ossified.

The original disease of his Majesty consisted in the ossification of
the tufa* of the aorta, which must have existed for many years, and
which, by impeding the passage of the current of blood flowing from

150 Bibliography.

the heart to the other parts of the body, occasioned effusion of water
into the cavities of the cheat and in other situations. This mecha-
nical impediment to the calculation of the blood also sufficiently
explains those other changes in the condition of the body ''which were
connected with his Majesty's last illness, as well as all the symptoms
under which the King had laboured.

The immediate cause of his Majesty's dissolution was the rapture
of a blood-vessel in the stomach.

Hinet Halvobd.

Matthew J. TrrarzY.

Astlbt Cooper.

Benjamin Bbodib.
4. Pest Mortem Examinations of the Kings of France from
Charles IX. to Louis XVIII. From authentic documents arranged by
Dr. Henry Dupuy. — There is a disposition inherent in the human
mind to invest those removed from the common sphere of life, with
attributes that appertain not to ordinary mortality. Who that reads
the exploits of Alexander, can picture to himself the Macedonian
demigod subject to those little corporeal annoyances that chafe the
temper of Mr. Thomson or Mr. Smiths-can imagine Hercules
troubled with constipation of the bowels— or Julius Ccesar plagued
with corns, albeit

He had a fever whilst he was in Spain I

But human nature is human nature still, however the grand, the
moral, the intellectual spiritus may dazzle the eyes of the astonished
world; and a hero and a costermonger suffer in no very unequal
degree from those bodily inconveniences and ills to which flesh is
heir. SyDa was destroyed by the lousy distemper-— Napoleon le
Grand, Tlnvincible, as a foolish universe once thought its scourge,
died of a malignant disease — and our own race of kings have noto-
riously suffered from tile complaint which is usually the property of
the squalid and the needy — scrofula. Some very curious and inter-
esting documents have been published in France, respecting the exa-
minations of the bodies of their kings, from Charles the IXth to the
last Louis. Previously [to the time of Charles the prejudices of the
people and the opposition of the clergy restricted the examination of
bodies to that of executed criminals. It was not to be supposed that
the haughty sovereign of a feudal nation should descend to the level
of felons, of those whom the ideas of the times would scarcely have
ranked in the same class of beings as himself. It required some ex-
traordinary event to establish the necessity for royal dissections, and
such an event presented itself in the remarkable death of the ninth
Charles. This Gaulish representative of the Neros and Domitians
of the world, is execrable to all time by the massacre of the Hugo-
note at Paris, on St. Bartholomew's day, in 1572. When the hour
for that dreadful outrage approached, being upbraided with indecision
by the savage Catherine de M6dicis in his mother and the regent, he
exclaimed, " well then let not one be left to reproach me with breach
of faith !" He even fired with his own hand on the miserable wretches
endeavouring to escape across the Seine. It was said that from this

Morbid Anatomy. J 51

time to faia death, which took place in May, 1674, he never enjoyed a
tranquil hour, and various reports were bruited about respecting the
mode of his decease. Many regarded the event as a punishment for
his enormous crime, and asserted that he fell the victim to a sweating
•f blood; othera an the contrary attributed it to the machinations and
imbition of the Duke d'Alencon. In order to set at rest all rumours
and dispel these suspicions, Catherine decided that the body of her
dear son should be examined, and Charles was thus the first king of
Prance, the first descendant of Charlemagne, whose body was pro-
faned by the scalpels of his subjects. From that time to this, 'the exa»
mutations of their monarchs after death has become a matter of court-
etiquette in the French dominions. Before we proceed to the ac-
count of the dissection of Charles, it will be interesting to recite a few
particulars respecting his mortal illness.

P. Masaon, a writer of those times, states that Charles X. fell ill in
the month of October, 1573, whilst attending his brother, afterwards
Henry III, onhis departure for Poland. He was firstattacked with paint
is the chest, which were not all understood by his medical attendants,
and continued to increase'; he was worn down by an " erratic"
fever, sometimes Quartan sometimes continued ; and in spite of all
that MaziUe, his first physician, could do, the disease proved fatal*
L'etofle gives an interesting account of the last days of the suffering
long. On the Friday, says he, preceding the Sunday when Charles
died, about two o'clock in the afternoon, he called for Mazille, and
after complaining of the pain he endured, inquired if it was not pos-
sible for him, and the many other physicians whom he had in his
kingdom, to procure some alleviation of his miseries. MaziUe replied,
that all which depended on their art had been done, that the very
day before the faculty had assembled for the purpose of giving relief,
bat that, to speak the truth, God was the only, and sovereign physi-
cian for such diseases to whom he could have recourse. " I believe/*
said the king, " that what you tell me is true, and that you know of
nothing else. Tirez mot ma custode, quefessaye a y repoaer" It is
reported by Guy Patin, and other writers, and with every appearance
of probability, that poor Mazille narrowly escaped hanging by order
of Catherine, for not having called a consultation sufficiently early.
We cannot help thinking, that if some such plan were adopted now*
a-dayg, it might save some patients at the expense of a doctor or two,
and otherwise be attended with much service. The Latin account
of the post mortem examination is curious.

" Rapport dv corps moet du fbu roi Charles IX.

" ' Anno domini miles, quinquent. septaag., quarto pridnkaLjunii,
horn a meride quarta, facta est dissectio corporis Caxoli IX. regis Gal-
haimn christ., assidentibus medicis hie subsignatis et chirurgis qui
earn adnunistyarunVin qua accurate heec observata et deprehensa

■QDt.

" * 1. Hepatia totum parenchyma arefactum, exangue, et extret
ri* lobis ad simas partes vergentibuB nigricans.
" ' 2. Folliculus felliB a bile vacuus, in sese considens, subater.
" ' 3. Lien nullo modo maid affectus.

152 Bibliography.

•< ' 4. In ventrksulo nulla noxa, et stomachi cum pyloro integri-
ty.

" ' 5. Inteatinum colon fiavum colorem contraxerat, cseteria bene
fcabentibua.

" ' 6. Epiploum male coloratum, supramodum extenuatnm ; parte
aliqua mptum, et omnia pinguidinia ezpera.

" '7. Ren uterque nullo vitio obaceaaua, nullo similiter vesica,
nullo ureteres.

" ' 8. Cor flaccidum et velluti contabeacena : omnia aquoao hu-
more, qui pericardib contineri aolet, abaumpto.

M « 9; Pulmo qui in partem sinistram thoracis incubebat, a coetii
illegitimisad claviculaa usque totua lateri adhserebat, ita nrmxter et
obstinate, nt avelli potuerit sine dilaceratione, et diacerptione cum
putridine substantias, in qua aeae prodidit vomica rupta, e qua collu-
viea purulenta, putrida et giaveolena effluxit, cujua tanta fuit copia,
ut in aaperam arteriam redundant, et preclusa respiratione prsecipitw
et repentini interitua cauaam attulerit.

'• '10. Alter pulmo sine adhaeau fuit, magnitudine tamen natura-
lem conatitutionem, turgidua et diatentua auperana (ut et sinister au-
perabat in substantia, inaignem corruptelam pre ae ferena) parte au-
periore putris, refertua et oonapurcatua humore pituitoao, mucoao,
epumoso, purinnitimo. \

" ' 11. Cerebrum omni vitio carens."
" Medici qui priefuerunt,

" Regit Mazille. Vaterre. Alexia Gaudin. Vigor, Lefevre, Saint
Pons.

Parisienses. Pietre, Bngard, Lanl6 et Duret.
Chirurgi regit qui admimstraverunt, Par6, d'Ambroise, Portail,
Euatache, Dioneau Dubois, Lambert et Cointenel.'*'

H appears to us from the foregoing account, that Charles IX. died
of inflammation and suppuration of the left lung.

Henri III.

This prince died from a wound inflicted by the knife of an aaaaaain
in the hypogaatrium. He lived for about eighteen hours after the in-
jury, and suffered from frequent fits of weakness, suffocation, fever,
intolerable thirst, and the greatest agony; We learn by the notes of
the dissection, that a portion of the ileon was pierced through and
through by the knife, and that the mesentery was also wounded in
two places, with incision of its vessels. The contents of the thorax*
abdomen, and head, were otherwise healthy.

Henei IV.
. The Alfred of France, Henry the Great, was stabbed in his carriage
on the 4th of May, 1610 ; he died almost immediately, after uttering
a few words and discharging blood by the mouth.

. On the left aide of the chest, about the level of the Becond and
third rib, was a wound capable of admitting the finger ; it ran on the
pectoral muscle towards the nipple for the length of four inches, but
did not penetrate the cheat. Below this was another wound between
the .fifth and sixth rib, about two fingers' breadth; penetrating the
thorax, piercing one of the lobes of the left lung, and wounding the

Morbid Anatomy. 153

trunk of the pulmonary artery, a little below the left auricle. There
vsi much blood extravasated in that aide of the chest, and both lungs
were filled with it.

Louis XIII.

This document is written in Latin, and graces de Dieu such Latin,
by the doyen or dean of the Ancient Faculty of Medicine, which from
the dissection of the present King downwards, has been required to
URet at the mournful ceremony.

A circumstance is related of this Louis en his death bed, which is
wth transcribing. " When/' says the historian, " his physician, at
Us earnest desire, numbered the fleeting minutes that remained, and
pronounced that his life could not exceed two or three hours, he re-
ceifed the intelligence with resignation and even satisfaction ; and
looking fervently up to heaven, added, " Well ! I consent with all
ay heart." Here is the account of the dissection.

" Postero autem die (id est 15 mensis maii 1643), hora sexta ma-
tstuHt defuncti/egis cadaver apertum prsssentibus serenissimo principe
ic domino de Nemours, marescalco sive castrorum prefecto primario ;
domino de Vitry, domino de Swvre, primo cubiculario nobili sive
bter nobiles, regi a cubiculis primario, medicia regis ac reginae pri-
mariis aliis quoque medicis et chirurgis, ex utraque familia chirurgo-
nnn Paris .... Atque in hoc regis cadavere ulcera plurima pure sania
« tabo manantia reperta sunt, variis partibus inusta, mesocolo in-
terims omnibus crassioribus, sed unum colo extremo insederat, quod
iatestmum ipsum exederat et perforaverat, unde purulenta multa ex
ptrefactis pnedicti mesocoli gkndulis et vasis emanans et alvo in-
feriore, coercita et cumulata trium librarum semisestariorum parisiso-
lium mehsuram implere poterat. Deprehensus quoque in rene dextro
afecesstis sed exiguus, et ferme nihil faciendus. In fundo ventriculi
lientre abraso viciuis grandior et alii perexigui plures, et humorti
^sci, fuliginosi atque ex viridi nigritantis copia hisignis, quo, auk
tinuli omnia ad unum intestina, usque ad extremum rectfe referta
want.

" Vesicula fellea hepati subjecta et imis ejusdem partibus, affixa
ib humore bilioso crassiore prope vacua Hepar exsuccum plane ao '
rctorridum.. ..simile quod et duriusculi contra ventrem lanabat et
solvebatur in grumos. Pulmonis sinistri lobus, pleura? firmiori adhe-
rens et affixus ulcere maximo et profundissimo, pure plurimo confer-
va, ct putrefactus apparuit."
Louis XIII. would thus appear to have died of phthisis pulmonalis

with ulcerations of the bowels.

Louis XIV.
Sictio Cad aye bis. — The whole of the left side of the body ap-

pared gangrenous, from the extremity of the foot to the top of the

tad. The epidermis was generally detached from the cutis, the right

*tde was gangrenous in several places, but less so than the left, and

the belly was excessively blown up.
On opening the abdomen, the intestines, especially those on the

left ode, were found "altered," with some marks of inflammation;

ta tag* intestines were enormously dilated. In the left kidney was
Von. v, no. 26. x

154 Bibliography.

a small stone, similar to what the King had frequently voided during
life, without any evidence of pain. The Kver, spleen,' stomach, and
bladder, were healthy.

On opening the chest, the lungs were sound, as was the heart.
The extremities of the blood vessels, and some of the valves, were os-
sified ; all the muscles of the throat were gangrenous.

On opening the head, the whole of the dura mater was found ad
herent to the cranium, and the pia mater had two or three purulent
spots along the falx* The.brain was otherwise healthy.

The left thigh internally was in a state of mortification, as were
the muscles of the hypogastrium, and indeed this condition existed
as high as the throat. The blood and lymph were universally fluid
in the vessels.

The disease of which the King died, appears to have been an ex*
treme degree of the gangrena senilis.

Louis XV.

No examination of the body of Louis was instituted, on the follow-
ing singular, and somewhat ludicrous account : —

The superstitious fears entertained regarding small pox completely
drove the attendants in the palace from the body of the dead monarch.
The first gentleman of the bed chamber, more faithful or more bold
than the rest, demanded of Lamartiniere, then chief surgeon, why he
did not proceed to examine the corpse, and added, that he must do so.
" My Lord Duke," answered Lamartiniere, with his usual brusquerie,
" your office renders it imperative upon you to hold the head of the
deceased during the process. I declare to you, that if it is opened,
neither you, nor I, nor any one of those assisting, will be alive eight
days afterwards." Need we add, that Monsieur le Due said no more
about the matter !

The seeds of the revolution which had been sewn in the immora-
lities and arbitrary acts of the preceding reign, ripened into the un-
equalled horrors and atrocities of that of Louis XVI, With him the
guillotine took the place of the scalpel, the executioner's report was
substituted for that of the Dean of the Faculty of Medicine, the re-
mains lay rotting in a lime pit, instead of reposing amidst the dust of
Charlemagne and Henri Quarte, at St. Denis. Like the body of the
Roman, it vanished in the tempest !

Louis XVII.

The son of the last king never ascended the throne of France, but
died whilst young, in the durance of the regicides and revolutionists.
That no foul play, at least no overt violence, was inflicted, the ac-
count of the dissection, and the respectable names of Dumangin, Pel-
letan, Lassus, and Jeanroy are sufficient guaranty. The document
signed by these gentlemen purports, that in pursuance to a warrant
from the Committee of General Safety, they repaired to a second-
floor apartment in a tower of the temple, where they found the body
of the son of the deceased Louis Capet. He appeared to be about
ten years old, and was known to two of the subscribed, who had at-
tended him for some days during life. They were told that he had
died at three o'clock on the preceding afternoon, and putrefaction
was commencing on the belly, the scrotum, and inside of the thighs.

Morbid Anatomy. 1 55

The whole frame bore the aspect of marasmus ; the belly was tense
and tympanitic. On the inside of the right knee was a tumour with*
oat change of colour of the skin, and another smaller tumour over the
os radius over the left hand. The tumour of the knee contained
about two ounces of greyish matter, a mixture of pus and lymph, si-
tuated between the periosteum and the muscles ; that over the radius
contained matter of the same kind, but more consistent.

On opening the abdomen, about a pint of yellowish and very fetid
seropurnlent fluid flowed out. The intestines were blown up, pale,
adherent to one another, and to the walls of the abdomen, and studded
with a great number of tubercles of different sizes, which contained
the same description of matter as that in the internal tumours. The
omentum and mesentery were filled with " lymphatic tubercles" like
the former, and others were dispersed over the peritoneum. The in-
terior of the stomach and intestines, the liver, the spleen, the pan-
creas, and the kidneys were sound.

The lungs adhered universally to the sides of the chest, the diaph-
ragm, and the pericardium, but their substances was sound and only
i few tubercles were found in the neighbourhood of the trachea and
oesophagus- The heart and pericardium were natural. The brain
and its appendages were also sound.

The reporters add that the disease of which this unfortunate young
prince died was evidently chronic in its march and scrofulous in its
nature. It was chronic inflammation and tubercular affection of the
peritoneum.

Louis XVIII.
Sectio Cadavehis. — The bones of the anterior part of the skull
were very thick, whilst those of the posterior part were thinner than
usual The brain was very large, but the left side was more de-
veloped than the right.

The lungs were perfectly healthy— the heart large, flabby, and
empty of blood.

The stomach was very large, distended by gas and mucous mat-
ters, and it presented small red patches on its internal surface. The
intestines were sound, but a steatomatus tumour of considerable size
▼as found in the folds of the mesentery ; it had occasioned no pain
daring life, and its existence had not been indicated by any percepti-
ble symptoms. The other viscera were healthy.

The superior and inferior extremities were much wasted ; the left
thigh shewed on its inner side the mark of an ancient blister. Both
legs, from the knees to the extremity of the feet, were converted into
a yellow lardaceous substance, in which the cellular, the muscular,
and even the osseous structures were confounded. A knife penetrated
easily into the bones themselves. The right foot and the small of the
leg were sphacelated, the bones softened, and four toes had been suc-
cessively detached in the progress of the gangrene. The left foot was
sphacelated likewise, but only as high as the tarsus. — Revue Medi-
ate; Sept. 1829.— Med. Chir. Rev.

Medicine.
a. Treatment of Puerperal Fevers. — M. Tonnelle\ whose valuable
otanations we published in our last number, has given a report of

156 Biclography.

the remedies employed in the core of puerperal fevers at the Maternity.
Of all the remedies employed he thinks mercurial frictions among the
best. He relates three cases of recovery from this plan, and other
cases in which the patients convalesced, but formerly expired.

6. Two cases of Stricture of the Large .Intestines, about the point
of the termination of the Sigmoid Flexure in the Rectum ; with observa-
tions. By John Burne, M. D.

Case 1. — Scirrho-contraction of the Large Intestine. — A gentle-
man, between 45 and 50 years of age, of a sanguine and very irrita-
ble temparament, and accustomed to live well and keep late hours,
consulted me in February, 1826* on account of some troublesome
superficial small ulcers in the mouth, which had teased him for se-
veral weeks, and had resisted the remedial means employed. Ac-
companying these ulcerations, was a state of heat and dryness of the
mouth and pharynx, with some little trouble in deglutition. The
temperature of the body was increased and the surface dry, and the
pulse was accelerated and rather tight ; and the first hours of the
night were passed restlessly, the bowels being habitually regular.
The above assemblage of signs, except the regular state of- the bowels,
will be recognized as the frequent precursors of stricture of the oeso-
phagus, which I thought it my duty to intimate to the patient, that he
might be alive to such admonitions.

By the use of leeches to the side of the throat, and by saline ape-
rients, the ulcers healed, and all the other signs abated in about ten
or twelve days.

In November of the same year, and in February 1£27, I was again
consulted by this gentleman, on account of some dyspeptic symptoms,
which were soon relieved by medicine, his body being as usual, na-
turally and freely open every day. From this time, I saw nothing
more of him for twelve months, when in February, 1828, he again
applied to me, on account of his usual dyspeptic complaints, but with
this difference, that his bowels, which had been exceedingly regular
all his life, were now sluggish, and required the frequent use of ape-
rient medicine. On this occasion, 1 prescribed the comp. rhubarb
pill of the Ed. ph. which proved effectual, and together with other
treatment, gave him so much relief, that again I heard nothing of
him for five months, when in July, 1828, he called upon me, and
complained much of flatulence, acidity, and irregularity of the bowels.
He was this time also very much relieved by aperients, but the ac-
tion of these medicines was not so certain as formerly ; and when
the bowels were not freely moved, he suffered much from ful-
ness.

Hir symptoms, although relieved, returned whenever he relaxed in
attention to the bowels ; on which account, together with the fa-
vourable season of the year, I advised him to go to Cheltenham. The
Cheltenham waters acted like a charm ; the bowels emptied them*
selves freely every morning, and his appetite and digestion became
exceedingly good, as did his spirits and general health ; but imme-
diately after he had quitted Cheltenham, the irregularity of the bowels
returned, and with it all the dyspeptic troubles ; and as from these

Medicine. 157

he suffered considerably, and from his age and sallow face, and obsti-
nate complaints, there was reason to apprehend that organic disease was
establishing itself, I proposed a consultation, and the friends fixed
upon the late Dr. Armstrong.

Hie Doctor and myself examined the abdomen very minutely, as I
had done before, without being able to discover any indication of
disease ; pressure was borne in every part, and the only uneasiness
complained of, excepting griping, was a pain which sometimes shot
through the tipper port of the sacrum. Blood was directed to be ab-
stracted from this part by cupping, and, in addition, an alterative
aperient plan was agreed upon ; but these measures not being fol-
lowed by amendment, it was proposed to ascertain if any cause of ob-
struction existed in the rectum. On first introducing the finger into
the got, no trace of disease was discoverable, but by passing it for-
ward as far as was practicable, I met with a hard immoveable tumour
the size of an egg, and further backwards and upwards, I reached
with the tip of my finger, a contraction of the bowel, having an open-
ing not larger than a swan quill, surrounded by a hard knotty struc-
ture, which altogether exactly resembled a schirrhous os uteri. v

The case was now made out, and I recalled to mind the tendency
to stricture of the oesophagus, manifested upwards of two years be-
fore.

Saline aperients diluted in imitation of Cheltenham water, were
now prescribed, and succeeded very well in evacuating the bowels.
A mechanical obstruction having been discovered, it was deemed
proper to take the opinion of a surgeon as to the practicability of giv-
ing relief by a bougie or otherwise, and the late Mr. Wadd was
called in. On his first examination, Mr. Wadd did not reach the
disease, but when after several days, he satisfied himself of its exist-
ence and malignant nature, he gave it as his opinion that surgery
could do nothing. Saline aperients were laid aside and castor oil sub-
stituted, which, although it excited the action of the intestinal canal,
did not procure evacuations ; the muscular efforts of the intestines
were most violent, and gave rise to excessive spasmodic pain ; the in-
testines could be seen and felt to move the integuments, making in-
effectual attempts to force the feculent matter through the stricture,
•ad the agony was so great during these spasms, that the patient de-
sired death. The spasms were much allayed by large doses of lauda-
num, bat were, nevertheless, succeeded by a sharp attack of inflam-
mation, which did not subside for several days ; and when the patient
had struggled through this danger, it was only to encounter similar
torture at some early period. Extreme difficulty was always found
in procuring evacuations, and being driven, as we were, to ex-
totality, further surgical advice was desired, in order to consider, a
Mcond time, the practicability of facilitating the evacuation of the
colon. With this view, Mr. Copeland, Mr. Brodie, and Sir Astley
hooper were consulted in succession, and all concurred with Mr.
Wadd on the hopelessness of the case, and the inexpediency of sur-
gical interference. Mr-. Brodie and Sir Astley Cooper did make some
attempts to pass a bougie, but did not feel justified in persevering,
lest they should rupture the intestine.

158 Bibliography.

Injections and saline aperients were had recourse to unremittingly
with partial success ; the violent spasms returned frequently, and the
most severe were followed by inflammation. The violent contractions
of the intestine constituting the spasms, were always more or less
relieved by laudanum ; but opium, in this form, made the mouth and
tongue dry, and was followed by head-ache and languor. From
these ill effects, the liquor opii sedativus was free, but the most effi-
cacious preparation was the acetate of morphium in the form of a pill,
and in die dose of from £ to the £ of a grain, repeated as circum-
stances required. The last preparation was found a most valuable
medicine, and never railed to mitigate the excruciating pain and
other sufferings of the patient's last days.

In this way the patient lived on, passing, scarcely any feculent mat-
ter, and suffering pain and inflammation by turns till the 20th of
February, 1829, on which day the spasms returned violently about
six o'clock in the morning, and soon after seven the patient felt a
sudden and dreadful pain dart from the left side across the belly above
the navel, Vhich he compared to the discharge of a pistol. Quickly
afterwards the belly became tense, the respiration difficult, and the
powers of life depressed. It at once occurred to me that the colon
had given way above the stricture, which I stated to the friends, and
prepared them to expect the rapid dissolution which took place in
the course of eleven hours.

Sectio cadaveris. — The abdomen being opened, a large quantity of
feculent matter, of soft consistence, was seen lying among the intes-
tines and upon the mesentery, and was found to proceed from a trans-
verse rupture of the colon, about an inch long, at the spot from
whence die violent pain darted. The whole of the colon was filled
with feculent matter of the same kind ; the sigmoid flexure was seen
stretching across the brim of the pelvis to the right side, when it
turned quickly upon itself and terminated in the diseased portion,
which was situated directly under the promontory of the sacrum.
The diseased part was about the size of an egg, and consisted of a
scirrhous degeneration of those structures of the intestines situated
between the mucous and peritoneal coats. The aperture of commu-
nication between the colon and the rectum through the diseased part
scarcely equalled the size of a swan quill, and had a curved direction,
which proved the correctness of the opinion, that force used in at-
tempts to pass a bougie would be likely to rupture the bowel. The
lower opening looked backwards and downwards to the hollow of the
sacrum, and its margin was knotted and irregular as has been de-
scribed. There were adhesions of the sigmoid flexure to the small
intestines, and the scirrhous mass was adherent to the sacrum.

Case II. — Annular Contraction of the large Intestine. — Of the se-
cond case, which was an annular stricture, I regret that I am only
able to present a few particulars, not having the means of obtaining
the early history. It occurred in a female pauper in Covent Garden
workhouse, who had been admitted three weeks before her death, in
a state pf extreme emaciation, and with a remarkably distended flatu-
lent abdomen ; she passed scarcely any feculent matter during the

Medicine. 159

three weeks, and was constantly vomiting, so that nothing . except
brandy and water and similar beverage, could in any way be retained
on the stomach.

Sectio cadaveris. — Before the abdomen was opened, traces of the
conralntions of the intestines were evident, by corresponding eleva-
tions of die integuments : these convolutions were found to be dis-
tended with Gas, and the colon was full throughout of soft feculent
matter ; and at the termination of the sigmoid flexure in the rectum,
vat a circular contraction of the bowl forming the annual stricture.
Tnere was no thickening or disease about the part, and the contrac-
tion had the appearance of the bowel tied with a ligature, except that
there were neither folds nor puckering.

Observations. — The ulcerations, the heat of the mouth and trouble
in deglutition, detailed in the history of the first case, shewed a con-
dition of constitution prone to morbid action, which having first fixed
ca a part of the digestive canal, determined that canal to be the even-
tual seat of disease.

A very prominent circumstance in the dissection of both these
cases, was the soft consistence of the feculent matter, particularly
when it is rememembered that, from the slow accumulation, th<* fe-
culent matter had been lying in the colon for several weeks in u;e
feit case, and in all probability tor several months in the so >>)<;.
This is the more curious, because in ordinary constipation r»f :!)«
bowels, the feculent matter becomes hard and knotty in eight *•..<•
forty hour?, sometimes in twenty -four, and continues so till ,-c-
coated ; hence it occurred to me that the soft consistence above al- '
laded to, was probably one of those remarkable provisions which na
tore is often observed to make against disease, and if this is the case,
the same soft condition of the retained faeces may be expected in all
eases of stricture. Experience, however, does not afford me a suffi-
cient authority of facts to come saiely to a conclusion on this point,
bat the probability which I have expressed is much strengthened by
two cases, one of which occurred in private practice, and was men-
timed to me by Mr. , a pupil of Guy's Hospital, who wit-
nessed the dissection ; and the other in a patient in the same hospital,
in the both of which the accumulated faeces were in the same soft
state. I do not know that this circumstance has been hitherto
noticed, nor can I find in the works upon stricture of the rectum, any
evidence that bears satisfactorily on the question.

Did the faeces undergo the same change as in ordinary cases of
constipation, there would be no possibilty of evacuating them through

* stricture, and the irritations and accumulations would be quickly
ud uniformly fatal ; whereas the reverse is a matter of daily obser-
vation. The sympathies by which this usual change in the faeces re-
tained in the colon is prevented, are the more remarkable, because
they influence only the part of the large intestines above the stric-
ture, for the soft feculent matter which gradually oozes through the
contractions into the gut below, very soon becomes solid and figured,

* I had an opportunity of witnessing in the first case, in which it
*** not uncommon for solid figured peices to come away, al-

160 • Bibliography.

though all above the stricture was quite soft, as seen by dissection.
This last fact is also mentioned by Mr. White.*

The soft feculent matter was also of a most healthy character,
being homogeneous, and containing an abundance of good bile ; from
which it may be concluded that digestion was perfect, notwithstanding
many of the symptoms said to be indicative of indigestion were ur-
gent, as flatulence, fairness, aridity, and eructations; whence* it is
apparent that the sufferings usually referred to the stomach, may
arise from another cause than disorder of that organ.

In both instances the patients died from the mechanical obstruc-
tion ; in the one the disease was not malignant, in the other the ma-
lignancy had not come into operation, the patient having died before
the destructive effects of cancer had taken place, as ulcerations
sloughing, discharge, and sympathetic irritations and fever; the sub-
ject for consideration, therefore, was the treatment of the obstruction;
the observations on which refer only to the first case.

The eminent surgeons consulted were unanimous as to the inex-
pediency of attempts to force a passage by the bougie, owing to the
situation as well as to the malignancy of the disease ; in which opi-
nion all must concur, who have witnessed the torture that attends
the use of a bougie in scirrhous disease of the rectum, and which is
not recompensed by any benefit ; this stricture not admitting of dila-
tation, the effect of the bougie is to bruise and hasten ulceration, or
increase it if present. Although the most desirable means by way
of operation, was the introduction of a hollow tube through the
stricture to facilitate the passage of injections, yet this was found im-
practicable, the distance of the strictured part from the anus being
too great to admit of the finger as a guide, and without this, the ca-
pacious and yielding rectum left no chance of effecting the passage
of such an instrument. In this dilemma, and in my frequent consul-
tations with Mr. Wadd, I suggested for discussion the propriety of
making an artificial anus, which although he discouraged, I cannot
but think might be attempted under favourable circumstances as re-
gards the operation, and urgent circumstances as regards the prolon-
gation of the patient's life.

It may be said, that between the two evils of a stricture and an
artificial anus, it is difficult to choose, to which I assent generally ;
but when the patient's life must fall a sacrifice to the mechanical ob-
struction, and when the prolonging his life for a few months only is
of great consequence to his family, the suggestion is worthy the con-
sideration of surgeons ; for in the first case, the malignancy of the
disease would not have destroyed life for months in all probability ;
and in the second case, there being simply an annular contraction,
life would have been preserved by an artificial anus, which would
have permitted the regular evacuation of the bowels. To render the
operation justifiable, the colon should be empty, and the means of
attaining this end are the object of the medical treatment of stric-
ture generally.

All are agreed that the aperients which must be necessarily
given, should be of a mild character, and the recommendations of

• Observations on Stricture of the Rectum, 3d edition, page 37.

Medicine, 161

authors who have treated on the subject, are limited to castor oil,
tenna, and sulphur ; thus leaving unnoticed saline aperients, which
as will presently be seen, are the most efficacious. . These medicines,
castor oil, senna and sulphur, although desirable from their mild qua-
lities, are very uncertain and ineffectual in cases of stricture ; it is
true they promote a moderate, and so far, a proper peristolic action
of the intestines, but as they do not render the faeces watery, this
action is not followed by sufficient evacuation, and therefore not
of sufficient relief. Sulphur is objectionable on other grounds; it
bas been known to form into balls when taken in large doses,
and in this way may add to the mischief. The same objection ap-
plies also to magnesia, which has been found accumulated in a large
quantity above the stricture.

While the subject of the first case was at Cheltenham and taking
the waters, the evacuations were so thin that the colon emptied it*
self effectually every day, and under these favourable circumstances
the patient lost all complaint and improved surprisingly. This first
suggested to me the use of saline aperients, which were given in the
form of Seidlitz powders and of sulphate of magnesia, in a very di*
luted solution ; and they were found to operate much more pleasantly
and efficiently than other aperients. These, however, and the Chel-
tenham water itself drunk in town, were by no means so certain in
their operation as the waters drunk at Cheltenham, owing, no doubt,
to the want of auxiliary circumstances which are known to favour
die operation of mineral waters, as change of scene, absence from
the fatigue and anxiety of business, early rising, and exercise. On
one occasion, when castor oil was substituted for salts, its effect was
exceedingly injurious ; it duly excited the action of the intestines,
hut as it did not render the faeces watery, they could not pass the
stricture freely, and the consequence was violent spasmosdic pain
and vomiting.

Drastic and heating purgatives are very properly objected t6 fax
all cases of stricture ; nevertheless, the distress of the patient on one
occasion was so great for the want of evacuations, that a person of
ray great practical attainments was induced to propose the adminisV
trations of, croton oil, the propriety of which was much discussed, on
account of its irritating properties and violenjt action ; but its employ-
ment being much urged by the proposer on the score of its unrivalled
purgative power in other cases, it was exhibited in the dose of one
&op, which was repeated in the space of half an hour. The effect,
as was anticipated, was nearly fatal; it produced most violent con*
tractions of the intestines, and spasmodic pains, with a distressing
heat along the whole alimentary canal, and constant and urgent, but
ineffectual efforts, to go to stool, the scanty evacuation consisting of
nothing more than a bloody secretion from the rectum, the product of
excessive irritation.* The violent action of the intestines led one to

• Ai from the vast accumulation of feculent matter found on dissection, it was im*
P°»ble that any particle of the croton oil could have reached the rectum, the ei
****• irritation must have heen the result of sympathy, which may go far to ex-
Pjtia the phenomenon of the inflammafion of the rectum which occurs in easts
* pouoamg from arsenic.

Vol. v. no. 26. y

163 'Bibliography,

fear a rupture of the colon, of which the sequel of the case proved
there was great danger.

In the medical treatment of stricture of the large intestines, then,
saline aperients are the best and most efficacious ; and where the
disease does not admit of relief by surgical interference, the physiciun
would best consult the interest of his patient, by urging him to reside
at Cheltenham or Leamington, and by the aid of warm bathing and
of drinking the waters regularly, to avail himself of the means which
will most certainly mitigate his sufferings and proldhg his life. —
Midland Medical Reporter.

7. Observations on the Treatment of Delirium Tremens, and on
the use of the Warm Bath in that disease. — The means commonly
employed in the treatment of temulence and delirium from intem-
perance, were uniformly successful in the Baltimore Alms-house
Infirmary, in a multitude of cases, for two years antecedent to the
spring of the present year, 1829. Those means were emetics—
afterwards mild cathartics, (Epsom salts and magnesia,) in cases
complicated with gastric and biliary derangements, or much febrile
disorder ; the evacuants followed promptly by anodynes, graduated
in force or repetition, by the amount or persistence of nervous dis-
turbance. In cases of the disorder already arrived at the stage of
per vigilant delirium, miscalled • mania a potu,' (as is correctly re-
marked by Dr. Coates.) if higher vascular tumult attended, we here
also employed an emetic, afterwards a nauseant, tartar solution — as
a sedative, and concurrently with the effects of the latter, opiates,
in doses designed to enforce sleep, made full, and renewed so fre-
quently as to have the effect of each successive dose to come in aid
of the impression of those preceding.

" The opiate employed was Dover's powder, zij. grs. — or pure
'opium, one or two grains— or laudanum, forty drops— or black
drop, z. gtt. ; the interval of exhibition usually two hours, but re-
gulated by the symptoms. Where sensorial and nervous irritation
were greatly exalted, attended by deficient reaction, and signs of
general atony, small, quick pulse — cold surface — livid complexion,
&c. all evacuants and direct sedatives were omitted, and the patient
entered at once upon the use of opiates. But here the doses were
made smaller than in those cases where the sum of vital power was
less obviously deficient or expended, and the force of opiate was
graduated as nearly as possible to the torpor or exhaustion of £he
function of general life. Here too cordials of the vinous or spiritont
class were allowed, concurrently with the employment of the
opiates ; and it was to this stage of temulence that spirits and sti-
mulant drinks of all kinds was restricted. It was only in cases where
'the tumultuous excitation of the cerebral and nervous functions was
found associated with cold congestive torpor of the distributive
system, or with a low, irritative grade of excitement, tending to
rapid collapse, that we deemed it either medically or morally right,
to renew even the temperate use of the primary agents of the
disorder.

Medicine. 1£3

" In emetnas, then, nauseants, anodynes, and cordials, regulated
or combined in their exhibition by the character of cases falling
voder treatment, we had for a long time found efficient and unfailing
means of controlling the various forms of temulence and delirium a
poto. In no case of temulence advanced to the stage of delirious
excitation, did we mid emetics alone induce sufficient restraint of
the cerebral and nervous derangements, to allow perfect tranquillity
of mind, or sound Bleep, Vomiting often took off too much of the
halmcination of the patient, and substituted some intelligence for
previous total folly 4 but there was a constant tendency to relapse
into mental error, and we found it better to confirm the advantage
gained from, the emetic, by calling in the aid of opiates afterwards,
father than await the return of the delirious paroxysms, and trust to
subdue them by repeated emetics. The possible consequences of
vomiting as a debilitating mean, suggests a caution in the repetition
of emetics in temulent cases : and confidence in their permanent or
Jbal efficacy in those cases, is abated by the fact, that it is not
uncommon to find some of the worst forms of delirium tremens,
complicated with, and aggravating under, almost constant sponta-
neous vomiting.

" In cases of temulence with strong vascular action, which
vomiting did not sufficiently calm, or where in such cases emesk
was deemed improper, nauseants were employed in the form of
drinks, charged with medicines of that class, sometimes tartar, or
ipecacaan, or zinc. This given for some hours, seemed often to
prepare the nervous impression by opiates, and we had frequent
reason to infer, that after this mode of previous treatment, we suc-
ceeded in inducing quiet and sleep, with smaller and fewer doses of
opiates, than in cases where such preparation was omitted or deemed
muuitable.

" The opiate course of treatment did not always succeed without
difficulty, and sometimes not without an auxiliary of the sedative
class. Cases of vigilant delirium which had resisted opiates singly,
ia mil doses, repeated two, three, or four times, at intervals of one
to two hours, were sometimes quieted by a liberal portion, either t*>
ten grains, of camphor, added to the next opiate dose. In a few
instances, where opium alone, or in combination with camphor, had
been used freely and diligently, without producing either quiet or
sleep, the addition of musk to the opiate has seemed suddenly to
suspend the general temulent irritation, and sound sleep has soon
followed. We have tried various modes of exhibiting the opiate in
temulence, hoping to find some rule for its use, combining the
greatest efficiency with the smallest quantity of the agent. . We
have administered it in half-grain doses, repeating every thirty
aunutes, and in doses of one grain every hour — again beginning
with half a grain, we have doubled the dose at every exhibition, in
me ratio of compound increase, as far as we dare carry it on this
raje. Each of those plans has succeeded; but my experience leads
jae decidedly to prefer half-grain doses of opium, or an equivalent
mlaudsiram, repeated every half hour. The plan of doubling the

164 Bibliography.

dose at every exhibition, with the view of multiplying; equally or
more, the sum of quieting influence, often disappointed my expecta-
tions, and it was frequently necessary to arrest the experiment, and
retrograde in the dose toward the first quantum

" The form of opiate employed in temulence seems sometimes to
influence the result, as well as the amount. The pulv. Doveri an-
swered well in habits giving an inflammatory character to the grade
of excitement associated with temulence, but from its tendency to
depress the tone of stomach, impair the appetite, and occasionally to
vomit, as often as repeated, it sometimes became necessary to with-
draw it before sufficient opiate impression had been made. Even
where its depressing or disturbing effect upon the stomach did not
interfere with its continuance, it seemed to conduce to sleep less
than equal quantum of good opium or laudanum. Pure, dry opium,
(the older the better, if well kept,) was long esteemed by us our
surest antidote. In this disorder, however, experience taught us,
that in obstinate cases, varying the form of the agent was sometimes
productive of benefit. In one case, where opium of the best quality
had been exhibited to the amount of sixteen grains in twelve hours,
without the smallest indication of submission to its influence, fifteen
drops of black drop, at one dose, was followed by sleep in thirty
minutes, which lasted, with a single interruption of a few moments,
fourteen hours. ♦

The web of the black spider has received commendation from many
respectable sources, as a sedative angent, capable of calming with
peculiar ease and certainty, morbid excitability of the cerebral and
nervous systems. On the credit of those qualities it has been em-
ployed in the various forms of temulence, and not without a share of
reputed success, sufficient to entitle it to consideration in that state
of constitutional irritation/' — American Journal of Sciences.

8. Endemic medication. Cure of Intermittent*, by the application
of quinia to a blistered surface. — Dr. Gerhard, relates the result of
his observation in 200 cases, in which he tried endermic medication.
He does not state the nature of these cases, but relates five of inter-
mittents in which a blister four inches square was applied to the epi-
gastrium, and dressed with four grains quroua and strach sprinkled
on the surface four times a day. Some of these cases were obstinate
and were cured in a few days by this methed. He has written an
interesting paper on the value of this method in the North American
Med. and Svr. Journ, April.

SURGERY.

9. Fractured Neck of the Scapula* — John Harrison, *t. 85, an
active old man, was admitted on the 13th September, 1828, into the
Norwich Hospital, under the care of Mr. Cross . On examining the seat
of injury there was much the appearance of a dislocation of the left
shoulder ; viz. loss of its roundness from sinking of the deltoid
muscle, and the head of the humerus felt in the axilla. He stated
that he met with the accident from a fall in the street a fortnight
before. As far as could be ascertained, the blow was received upon

• Surgery, 165

the shoulder, and the arm was not extended at the time, as it usually
is when a dislocation has taken place. He bad gone about without
orach pain, ancThad sought no advice respecting his case till a day or
two ago, which he was induced to do at that time, because the arm
and hand had become much swollen and cedematous. By raising the
afcoolder, the bone was moved into its place, but it sunk again as
mm as the support was removed. This explained the nature of the
cue, and in corroboration of its being a fracture, a crepitus was felt
by placing the hand on the shoulder and raising the arm. The cora-
coid process also fell, and became imperceptible to the finger, when
tiie shoulder was allowed to sink. A roller having been applied' to
the forearm and arm, the fractured bone was reduced by raising the
humerus, whilst parallel to the chest, and drawing its head outwards.
It was maintained in this position by a conical pad, the base of which
▼as placed in the axilla, and fixed in that situation by tapes crossing
od the shoulder, and tied on the opposite side. A roller round the
body and arm kept the elbow applied to the chest, so as to throw the
bead of the humerus outwards.

Oct. 30th. — The bandages have been renewed every week or ten
&ys, and the patient has been walking about well during the whole
time.

Nov. 6th. — The limb has been supported with the sub-axillary pad
and bandages up to this time, and on removing them to-day, the
thonlder is found to have a good rounded shape, and is firm, as if
anion had taken place, but the apparatus is to be applied for another
week.

14th. — The pad and bandages were removed torday, and the
dwulder is perfectly rounded and well shaped. The limb bears to be
ooved freely ; and as there is no doubt of firm union having taken
place, the man is discharged. Two months afterwards, Mr. Cross
**ted that he saw him enjoying full and free motion of the injured
dwulder.

Two days previously to admission, the patient applied to a surgeon
for relief, who, after a slight examination, sent him to the hospital
°nder an idea that he had met with a dislocation of the humerus into
the axOla. The similarity, in appearance, which the two accidents
usually present, readily leads to the occurrence of such a mistake,
*hich, however, may easily be obviated by a strict and minute ex-
amination, and by attending to the circumstances pointed out in the
relation of this case, viz. the ease with which the parts are brought
to their proper position ; the returning of the deformity as soon as
the limb is left unsupported-: and the falling of the coracoid process
tbog with the limb, so as not to be felt in its usual situation. — Med.
(kzkte.

10. Elephantiasis of the Scrotum. — " When the scrotum is the part
affected, I apprehend that, after a certain time, the lymphatic vessels
become so much enlarged and relaxed, that they continue constantly
to poor out their contents, so that the tumour increases independently
°f the febrile attacks. Where the penis is affected as well as the
«rotam, those parts enlarge together in an equal ratio ; but if the

166 Bibliography.

MD|tnm only be atfjected, then the penis, a* the scrotum enlarges,
jbpomes drawn iii, so as ultimately to disappear and become com-
(yetely imbedded in the tumour ; the prepuce being distended elon-
gates, and opens by a naval-like aperture on some part of the anterior
surface, or even at the yery end of jtfre tumour. There is no limit to
the magnitude which tumours of this kind may acquire. The tes-
ticles at first may be plainly felt in their natural situation in the
centre of the swelling, but in a more advanced stage they cannot be
(discovered in consequence of the great thickness of the intervening
jbteguments. For the most part they are healthy ; though they may
he simultaneously affected with any other disease to which they are
subject, without reference to this. Hydrocele of one or both tunica?
yagpiajes is a very frequent occurrence, and the disease may be com-
plicated with hernia.

" There are many remarkable cases of this disease to be found
in various authors. Dionis relates a case* the history of which,
together with a drawing, were transmitted to him from Pondicherxy
in 1710, and this was, for a long period* I believe, the only case on
peeoxd, but since that time almost innumerable examples of the same
affection have been published. The tumour, of which Dionis makes
mention, occurred in a negro, and is represented as being uneven.
And hard as a stone ; it was one foot three inches in length, the same
in breadth at the lower part, and its circumference was three feet six
finches; the weight, as well as could be judged, was sixty-three
pounds. The scrotum of the negro, of whom Cheselden has given
a plate in the fourth edition of his anatomy, was of the same dimen-
sions as the above. The tumour, which Walther dissected after the
4eatjh of the patient, descended to the knees ; the skin of the scrotum
was was three times thicker than natural, and the cellular membrane,
which surrounds and lies between the testicles, was distended by a
viscous fluid, on which the weight of the tumour, which was nearly
forty pounds/ principally depended. Morgagni mentions two cases
of tumours, which he calls sarcoceles, but which were evidently of this
pature j one joi them was very similar to the case of Walther, a
print of which was sent to him from Syracuse, and its authenticity \pa»
confirmed by the public authorities of that city. The other was seen
by Morgagni himself at Padua, in the year 1730, in a man whp
passed through that town on his return to Eate, the place of his
residence ; this tumour was the size of two men's heads united
4pgether, it was unattended with pain, and had been many years m
.attaining that magnitude.

" The person who had the tumour of which M6h6ede la Touche
has given a description was seventy years of age ; it was one foot
six inches in length, and three feet one inch in circumference ; the
penis was imbedded in the tumour. There is a case, however, of
•which Chopart speaks, more remarkable than any of the foregoing,
both with regard to its size and weight. The individual was pre-
sented to the academy of surgery in the year 1768 ; he was a negr*
from the coast of Guinea, aged 50 years, robust, and five feet five
inehgs in height ; he had lately arrived from Martinique, where ht

lived for twenty-two year*. The dcrbtiim reached fe fee aride**
andiras twd feet two inches in circumference at the upper port, arid
three feet t#o inches at the lower; its length was two feet and *
half, and its Weight forty pounds. The man was placed in thg
Bicetre amongst the invalid pensioners, and died soon after df a
ferer. Chopart was of opinion that the extirpation or amputation of
ftis monstrous Barcocele would only have tended to hasten the negro's
death, and informs us that an operation of this kind was performed1
msaccessfully by M. Raymondou, on a matt forty-two years of age,
who had a similar kind of tumour of the scrotum, but much lea*,
being twenty-three inches in length, and thirty-two in drcumference
ia the largest part ; it had attained this size in thirteen years, and
eaosed neither pain ttor inconvenience except from its Weight.
M. Rayrnondon, imagining that the tumour contained an effused fluid,
Bade a deep puncture with a ttacar, but without letting out any
fckL A second puncture was made with the same result *, the ifact
&r, with the advice and in the presence of several surgeons, he
lapntated this tumour near it* summit, preserving the penis and
right testicle which was Sound, but the left being diseased was
removed. The patient died Six hours after the operation. The
tumour weighed twenty-nine pounds.

" lmbert de Loftnes removed a tumour of tins kind, weighing
fey pounds, from the celebrated Charles de la Croix, formerly
sinker for foreign affairs in France ; it had existed fourteen year*,
2nd the operation, Which lasted two hours and a half, was successful,
tat is not otherwise described.

" Baron Larrey describes tins disease under the name of Sarcocefe
ad says that all the persons he saw with it were, at the same time*
aore or less affected with elephantiasis. He relates the case of an
agricultural labourer, who came from Upper Egypt, whose scrotum
vas estimated to weigh fifty pounds ; and states, that in different
countries in Egypt he saw ten or twelve others nearly as large. An
*M man of sixty, an inhabitant of Cairo, sent for the Baron, to?
consult him respecting an enormous sarcocele, reaching to the lower
P*rt of the leg, which he had had for twenty years, and which from
ta size compelled him to keep in bed. His anxiety to be relieved
fom so frightful an infirmity had induced him to take the advice cf
fa medical men of the country, who had tried without effect various
measures, as caustics, incisions, powerful discutients. He next cottv
suited an English physician who was travelling in Egypt, and in the
tape of obtaining a perfect cure he consented to allow him to apply
fa actual cautery ; but the repeated application of this agent prd*
<bftd no effect, and the tumour continued in the same state. Borne
7*1* afterwards he applied to a Spanish physician, who was also on
& travels ; he passed a sharp instrument deep in the tumour, under
fa supposition of its being a hjrdro-sarcocele, but nothing WastiSl*
cfcttged but a small Quantity of blood. The sarcocele, far -from
Wing to these measures, increased.

." Ths propriety of removing the diseased parts having b&h <fete*~
Bined upon at a consultation, the following day was appointed for

169 Bibliography.

performing the operation ; but the Baron received a sudden order to
follow the -army, which had commenced its march toward* Alexan-
dria, and was thus prevented from carrying his design into execution.
He, however, did remove from a cook, in a convent of Capuchins at
Grand Cairo, a sarcocele of an oblong form, weighing about three
pounds.

" The following case is related by Dr. Hendy, of Barbadoes;— A
black man, aetat 50, formerly healthy, about four years ago was first
seized with the glandular disease, attended with a very considerable
inflammation and enlargement of the scrotum. From his own
account, as well as from the symptoms, the local affection seemed to
haye been entirely confined to the scrotum and cellular substance,
for he never had any symptoms that argued a diseased state of the
testicles. On each attack, the lymphatic glands, both in the thigh
and groin, were enlarged and painful for several hours before the
commencement of fever, which was ushered in with the usual symp-
toms of coldness, shivering, &c. In. about thirty hours the fever
went off with profuse sweating, but the inflammation of the scrotum,
which came on with the hot fit, continued for several days, and
always left behind it a proportional enlargement. For the first two
years the attacks were frequent, and the increase of the scrotum
consequently was very rapid; afterwards they were less frequent,
but the enlargement from each was more considerable ; and, from its
enormous weight, he was sensible of a gradual increase even during
the intervals. The surface of the immense mass was very rough and
uneven, and felt to the touch as if it contained a half coagulated
fluid. No part of the penis could be discovered, and the urine was
voided at an opening towards the inferior and anterior part of the
tumour. From an accurate admeasurement its dimensions were
found to be, from the pubes to the opening above mentioned twenty
inches ; its whole length twenty-four inches, and its circumference
six feet. The left leg was also enlarged by the disease, but in no
uncommon degree. A mortification of the part terminated the mi-
serable existence of this poor creature ; and Dr. Hendy states that
five other cases had come within his knowledge, where the scrotum
being much enlarged, had sloughed, leaving the testicles entirely
denuded.

" In the case of Paunchoo, related by Mr. Corse, in the second
volume of the Transactions of a Society for the Improvement of
Medical and Chirurgical Knowledge, it would appear that the tumour
had formed without being preceded by febrile attacks. He states,
that the patient first perceived a slight pain at the raphe* , in the lower
part of the scrotum, which gradually increased, and, in four days a
swelling came on, which was confined to the skin of the scrotum.
The pain abated, but the swelling continued to increase, and in the
course of five years the penis and scrotum were blended in one mass.
The length of the tumour was twenty-five inches ; the circumfer-
ence, at the middle thirty-eight inches, at the root fourteen, and at
the protuberance near the end twenty inches.
•; " Never having seen nor heard of any case similar to this, Mr.

Surgery. 169

Cone was at a loss to know what name was applicable to the dis-
order, and; doubtful of the propriety of attempting any operation for
his relief, he carried him to Calcutta in January, 1791, and got him
admitted into the general hospital. It being agreed, on a consulta-
tion, that nothing could be done for him, he soon returned to his
place of residence, and Mr. Corse tried various medicines, but
without effect.

" In the Philosophical Transactions mention is made of a case on
the coast of Africa, in which the scrotum was so large as to prevent
the individual leaving his bed.

" Mr. Wadd relates a case of this disease (of which he gives a
drawing) affecting the integuments of the penis The man was a
native of Africa, twenty-five years of age, and being useless to his
master, was sent from the West Indies to England for the purpose of
being disencumbered of his burthen. Amputation of the diseased
prepuce was proposed, but the operation was delayed from the novelty
and curiosity of the 'case, and the vessel leaving the port of London
•ooner than was expected, the patient returned with his disease.
The length of the penis was fourteen inches, and the circumference
twelve inches and a half.

" Soon after my return to the island of St Christopher, having
finished my medical education, amongst many other estates I was
appointed to the medical care of one belonging to Mr. Bourryau, and.
there I found a negro named Montserrat, who, though young and
otherwise healthy, was rendered useless to his owner and burthen -
tome to himself, from an enormous enlargement of the scrotum.
The disease prevented him from walking further than a few yards,
and this was accomplished with great difficulty ; he was thus almost
entirely confined to his hut. The tumour was somewhat of an oval
form ; its neck extended from the symphysis pubis to the anus, and
the body of the tumour projecting a considerable distance both before
and behind, descended to within an inch of the ground, dragging
down the abdominal integuments : it measured in length twenty-nine
inches, and in circumference forty-three ; the spermatic cords could
be distinctly felt, somewhat enlarged, but without hardness or in-
equality. The testicles could not be discerned. The penis was
deeply imbedded in the tumour, and the urine was discharged at a
navel-like orifice, situated (when the patient was standing) nine
inches below the symphysis pubis. Oft stretching this passage
laterally, the extremity of the penis could be seen at the distance of
three or four inches up this canal, which was formed by an elonga-
tion of the prepuce. The surface oC the tumour was equal and
smooth ; the superficial veins were much enlarged ; the superior part
was thinly interspersed with hair, and the inferior was at times scaly. '
The integuments felt extremely thickened, but were not of equal
firmness all over, and they retained for a time the impression of the
finger. The man's appetite and general health were good. He-
sated that when in bed, and under the influence of lascivious ideas,
he was subject to erections of the penis, at which times this member
▼oold project at the orifice above mentioned (which from his hori-

Vol. v. wo. 26. y

17Q Bibliography.

zontal positiou approached, of course, much nearer to the pubesi),
but said that they were never attended with seminal emissions,

11 After a careful examination, I informed him that I considered
the extirpation of the tumour practicable/ though the operation would
necessarily be attended with extreme hazard. He replied that life
was quite burthensome to him, that he would rather die than remain
longer in his present condition, and that he would readily submit to
anj operation, how great soever the risk. My friends, Drs. William
and Thomas Swanston, having done me the favour to visit the man*
and concurring with me as to the practicability of its removal, we
decided on the operation ; but it being then the hurricane season of
the year, a period always unfavourable for the performance of surgical
operations, he was recommended to wait until the weather became
more settled, Finding there was a possibility of being relieved of
his incumbrance, he became so importunate with me to have the
operation done immediately, that, with a view to quiet him, a large
blister was applied on each side of the scrotum, and kept open for
some time by means of the unguentum sabinse. A very deep seton
was afterwards made on each side ; but, notwithstanding these dis-
charged freely for neatly six weeks, no diminution of .bulk was
observable.

" On the 5th of December* 1813, I performed the operation,
assisted by my friends, Drs. Swanston and Dr. James T- Caines, in
the following manner ; — the patient being placed upon a table on his
back, with his breech towards the edge, and being properly secured
and supported, an incision was made, commencing at the symphysis
pubis and extending in a line towards the opening of the prepuce ;
the dorsum of the penis was thus exposed, and its point being held
between the finger and thumb of an assistant, the prepuce was cut
across and the penis dissected out. A flexible catheter was then
introduced into the bladder ; all our previous attempts to accomplish
this object having failed, in consequence of the retrocession of the
penis ; the spermatic cords, which were at a great depth, were next
cut down upon, a temporary ligature passed around, each by mearis of
ah aneurism needle, and they were then divided. The incision being
carried backwards on each side to the verge of the anus, the. opera-"
tipn was finished by detaching the tumour from its connexions with
the perineal fascia and adjacent parts. 'The temporary ligatures
placed on the cords were then removed, and the arteries, secured
separately. The integuments were brought together and retained by
a few sutures and slips of adhesive plaster, and were sufficient to
cover the perineum and to surround the root of the penis, so that this,
member was the only part which remained uncovered by integu-
ments. The haemorrhage during the operation was less than we
could have expected, considering the magnitude of the tumour.

" The. man recovered without experiencing an unpleasant symp-
tom. The wounds in the groins and in the perineum were, united at
the end of three weeks, but the penis was not completely cicatrized
before the beginning of. April.

" On examination of the tumour after its removal, the testicles,
were found to occupy their natural position. The left was about the

Surgery. 171

ase of a hen's egg ; the tunica vaginalis of the right contained three
pint* of fluid, and the testicle was considerably diminished. The
layers of membrane investing the spermatic cords were filled with
ftoid and gelatinous matter. The substance of the scrotum at the
upper part was about two inches, but nearer the base it increased to
four and a half inches in thickness, and much fluid oozed from its
substance ; its cavity was filled with a gelatinous matter and fluid/
which formed a jelly on cooling. The tumour weighed seventy1
pounds avoirdupois.

" I transmitted the history of this case to my much-respected
friend and preceptor, Mr. Thomas Blizard, by whom it was read to
the Mediro-Chirurgical Society on the 20th December, 1814 ; and
it is published in the sixth volume of their Transactions.

" A few months after the foregoing operation, . my .friend Dr.
Gaines performed one of a similar kind on an elderly negro, named
Caatello, at which I was present. In this case, there was a hernia on
the right side, the sac of which adhered almost universally to the.
adjoining parts, and to separate this required a tedious dissection.
This being- accomplished, and the hernia with its sac returned into
the abdominal cavity, the operation was conducted as in the former
cue. The tumour weighed fifty pouuds. On the 10th July, 1£16,
I assisted the same gentleman in a similar operation, and again in
1820. In the former case the scrotum was nearly as large as Cas-
tello's, and there was a hydrocele on each side. All the patients ,
rccoverea.

" On the 26th June, 1816, I operated on three men with ele
phanriasTrt of the scrotum. On the 9th August, 1817, 1 removed the !
scrotum of a negro ; the right testicle was enlarged to the size of a,
nan's fist and indurated, and, on dividing it, I found a portion of
the centre awlferl . 'On the 21st June, 1819, I performed a similar
operatkm. AH the patients recovered.

" But the most remarkable tumour of this description, which 1
bare either seen or heard of, was attached to a man belonging to the"
estate of the Rev. Mr. Verchild ; and from this the late Mr, Wilkes
endeavoured to separate the unfortunate possessor on the 6th Feb- .
rosry, 1815. I was accidentty prevented from being present at this '
operation, but the following particulars were communicated to me by
Mr. Wilkes: The length of the tumour was two feet five inches \
its circumference five feet ten inches ; and its weight one hundred
and sixty-five pounds avoirdupois. Hie operation occupied nearly
eight hours, and the man died apparently from exhaustion towards
its conclusion ; a copious venous haemorrhage followed each stroke
of the knife ; the lymphatic vessels were very much enlarged and
▼ere apparent, traversing the rumour. My friend Mr. Jordan, of
Weymouth-gtreet, at that time stationed in St. Christopher, as
surgeon to the forces, was present, as were also Messrs. Richards
and Waterson of the 15th regiment, and Dr. Clifton, a practitioner
<rf the island. The operation was likewise viewed by several gentle-
men not of the profession, and the tumdur was seen by the Rev. Mr.
VerehOd and Mr. Goldfrap.

i 72 Bibliography,

" I once assisted lit an operation of this kind which terminated
unfavourably. The tumour in this case measured in length twenty
inches, and in circumference forty -four. The patient was a young
man, and, although anxious for the removal of the tumour, yet he
was under a state of great alarm, as was evident both from his coun-
tenance and manner. Notwithstanding the operation was performed
with great dexterity and celerity, not having occupied half an. hour,
and the haemorrhage was very trifling, yet the poor fellow most un-
expectedly died on the table,

" Whilst these swellings are yet of moderate size the operation is
comparatively easy; but when they have attained a magnitude ap-
proaching to that of my first case, then it becomes, probably, the
most laborious piece of dissection that occurs in the practice of
surgery." — Titley on Diseases of the Male. Genitals.

MinwiFEEY.

1 1 . Case of Gastro-hysterotomy (Cesarean Section) in case of seven
months9 pregnancy, in which labour commenced, ceased, purulent dis-
charge from vagina, passage of arm, forearm, and carpal bones — opera-
tion performed nearly nine months after the cessation of parturient
action. — Dr. Toy, of Virginia, relates the very interesting case,
whose title is now given, the facts of which are, as follow. The
lady, who was the subject of this case was seized with apparent la-
bour, Nov. 1,1 828, the os tinea? dilated membranes burst and two or
three gallons of water, escaped. The next, she complained of pain
in the abdomen which was tumid, tense and hot, pulse, small and
quick, great restlessness and anxiety, os tinea? soft and dilated and
the external parts swollen and inflamed. Fomentations, secale cor-
nutum, febrimge medicines. No part of the foetus was felt. The
patient did not expect to be confined until Dec. 10th. Face, feet
and legs were swollen, and considerable fever present. 12th. An
offensive discharge from vagina " resembling matter from an ulcer."
18th. All unpleasant symptoms abated except swelling and discharge.
The latter continued till January, and the bones had passed three
weeks previously. Tonics were employed. The first week in April
a small discoloured spot appeared above the umbilicus on the right
side, which was painful. May 7th, There was an aperture through
the spot, through which a small probe could be introduced. The dis-
charge from the vagina had ceased about the end of Jan., but it was
now slight from the abdomen. An operation was proposed, but re-
fused ; tonics and palliatives employed. On the 12th August, the
operation was performed, and we shall let the narrator describe it in
his own words. »

" We proceeded to remove the bones on the 12th of August, her
husband, an old woman, Dr. Banks, and myself being the only per-
sons present. The aperture had increased in size considerably, being
about two lines in diameter at the surface. I made the first incision
about four inches long, in the direction of the linea alba, commencing
two inches above the umbilicus, and one inch to the right of it. This
was continued through the parietes of the abdomen and uterus into

Midwifery* 173

u>e cavity of the latter, the incision 1 crossed in its centre, by another
tt right angles with it of equal length' and depth. The top. of the
cranium was found presenting, the bones appearing to be firmly

united.

" I attempted to introduce a pair of small obstetrical forceps, with
the view of removing; the head at once This, however, WW
found to be impracticable without using more force than I judged
prudent, as the uterus was firmly and rigidly contracted around it. I .
used therefore, a pair of strong forceps from a pocket case, and with
these succeeded in detaching and removing the bones of the cranium
separately and successively ; all the other bones of the foetus remain-
ing. We found that adhesive inflammation had united the uterus to
the parietes of the abdomen for some distance around the opening,
the diameter of the .circle of adhesion was more than ah inch. The
operation occupied about fifteen minutes. After repeatedly washing
the part, the edges of the wound were brought together, and dressed
with adhesive plaster. . Stitches were found unnecessary. Over this,
pledgets of lint and a compress of old linen were applied, and a roller
paased round the abdomen. Before the wound was dressed the lady
expressed herself entirely relieved from the uneasiness which the pre-
sence of the bones had so long occasioned. She complained of some
P«n about the uterus.'

*' On our visit the next day, she was in all respects doing well. The
pain which she . complained of the preceding day had continued for
some hours, but she was now entirely easy, and expressed in strong
terms the relief which she had felt since the removal of the bones.

" In six weeks she was entirely well, and had visited several of her
neighbours. The opening which had existed previous to the opera-
tion was not entirely filled up, but the incisions united by the first in-
tention.

• " I saw this lady inDecember last — she was then in fine health and
▼ery fleshy. The catamenial discharge had returned and was how
regular.

** This case could not have been one of extra-uterine conception, for
the early history of the case together with the discharge of the soft
puts and bones per vaginam, prove incontestibly that it was uterine,
even if the operation had not demonstrated the fact. Neither can it
he believed that there had been rupture of the uterus at any period
daring the progress of this case, for when the bones were removed
they were' firmly enclosed in the uterus, and there was no other open-
ing but the passage externally, for which we think there is little diffi-
culty in accounting. The pressure of the bones against the walls
of the uterus, produced inflammation and suppuration, which, passing
by continuity of surface to the parietea of the abdomen occasioned the
aperture. The inflammation thus excited also produced adhesion be-
tween the uterus and abdominal parietes, which union must still
exist— indeed, when I last examined her, the parietes of the abdomen

we considerably drawn in by this attachment, '
Believing this case to be of considerable interest to the medical

174 Bibliography.

world, and besides^ one of rare occurrence. I hare been induced to
*Obm it it for pubHcfttion."-^rf*«!r . /ownt. 0/ lf«f. Science*.
. The history of Uncase is defective, and dcesnotafrbrdany clue to
the exact nature of the phenomena detailed. The author has not given
any account of the former history of the patient, not thrown' any
tight on the cause of retention of the foetus after natural labour had
commenced. The case however is of great value, and entitled Dr.
Toy tip great credit for the bold and judicious manner in which he
treated it. The result of the operation clearly demonstrates the fea-
sibility of gastro-hysterotomy, when the vital powers are not too
much reduced.— --En itob.

MIBCBIOANIB8.

12. Pathology of Purpura Hemorrhagica.— Dr. Haity, of Dublin,
hasr^lishedaaioterestmgpaper, onpurpareh»movrhagica9inflKeBdhi.
Med. Journ. July, in which he maintains that the disease depends on
a disordered state of the alimentary canal, or abdominal viscera*, and
that this state is obviated by continued purging for several days.
Mercurial purgatives are to be preferred, and depletion employed
sparingly to diminish febrile action* He details some oases fltastra-
tire of the efficacy of mercurial medicine.

IS. Stethoscope. — Dr. Forbes has published two lectures on the
value df auscultation and percussion in disease* of the chest; which
we strongly recommend 40 those about to commence the study of the
only smreimodeof ascertaining the diagnosis of this importsaftelfesB of
diau—a. Mb mam mm mad Shis exposition without the ooavfction of
the guest value of anscuttanwa and penmwsliirt m theracic aJa&eats,
and the ahla author hag demonstrated the4acilHy with wrrirft this im
portant knowledge can beacqsired. We are happy to states As* Dr.
Forbes has been appointed physician to His Royal Highness the Duke
of Suarica* [which, affords another example of the beneficence of our
gracious Sovereign* .in rewarding talent and merit. His motto, seems'
to be " palmam qui meruit, ferat."

14. Popato Lecture on the oompeweat parte of the Animal body. —
Mr. Dewhurst has published a lecture on the component parts of
the animal body, in which he displays much ability, and gives a good
outline of the structure of the human body. Tho student or general
reader may acquire a good deal- of infb-ination, by the perusal of this
dissertation.

15. Report of the Corh-street Fever Hospital ZHrWt*.— We have
been favoured with a copy of the report of the Fever Hospital, •
Cork-street, Dublin, from 1829, to January, 1830, with the medical
report annexed, which we believe to be the production of Dr>
O'Brien* We have only space to observe that the report is ably
drawn up, and affords ample proof of the judgment and ability of
the author as a practical physician. We shall analyse' it in our next;

16. The London University.— We are sorry to observe the dis- '
putes which agitate this valuable institution. The professors and'
council are the contending parties, and all seem unmindful of the
axiom, that " a house divided against itself cannot stand." There is

Miscellanies.

175

one feint of dispute on which we wait animaxfrejrt, an4tfc*t ia4 the
discovery of the council, which command* one of t^e profesTiora U*
appear before tjiem, to have his -competency examined by oge of hi*
own pupils. Such an absurd and ridiculous mandate has never die*
graced the history of any similar establishment, end it dearly proves
ty incompetence and arrogance of those individuals, the majority el
whom are ignorant of the science on which they pretend |q t4$u-
dkate.

We understand that Dr. Paris*, haa lately made a very curious die*
forerr, relative ta the solvent powers of water upon lead, which will
havetke effect ot modifying the theory of Six H. Dfcvy, relative t*
the protecting influence of metals upon each otfcer, and of offering a
new field of investigation. The experiments have not yet begs pub*
liahed.

After the foundation of the College of Physicians, it is true, em-
pirics were c^xononafiy treated in the most summary manner, and
their dealings with the credulous must have been wicked and gross, to
have deserved swab a punishment aa the following, recorded by Stow,
in his chronicles :

" A counterfeit doctor," says he, "was set on horseback, his face
to the hone's tail, the same tail in but hand as a bridle, a collar of
Jordans about his neck, a whetstone on his breast* and soled through
the City of London, with ringing of basins, and banished. Such de-
ckers, continue the chronicles *'no doubt, are many, who, being
■ever trained up in reading or practice of physic and chirurgery* da
taft to make g^eat cures, especially on women, as to stake then*
straight that before were crooked, corbed, or crump in any pest of
their bodies, &c. But the contrary is, true ; for some have received
$M, wjhen they have better deserved the whetstone."— Family £*-
fasy. Nq; XIV*

17. Sight restored by Lightning.— A singular circumstance oe«
cured in the bouse of Ed. Parker, Walker Street, Toxteth Park,
ou the night of the 25th u}t An old. man, aged 101, named
Charles Kigby, who has been blind for. the last seven, years, was
lying in bed about seven o'clock on that night, when a flash of
lightning entering the room had such an effect upon him* that
west "y«i>dittteTjr he partially recovered his sight, and he infovn»
^ that it baa been getting stsonger every day since that time.

l$..Cqfee.-~-The roots of succory* and those of the dandelion,
form one of the best substitutes tor coffee. Dr. Hewispn, of Edinn
kogh, prefers dandelion coffee to that of Mecca ; and many per-
wos, afl over the Continent, prefer a mixture of succory and coffee
to coffee alone* Oig up the roots of dandelion, wash them well.,
kit do not scrape them ; dry them ; cut them in bits the size of
peas, and then roast them in an earthen pot, or coffee roaster of
my kind, and grind them in a coffee mill, or bruise them in any
vay. The great secret of good coffee is to have it fresh burnt and
bah ground.— Loudon's Manual of Cottage Gardening. $c

176 Miscellanies.

19. On the action of Medicines, effected by Contiguity. — Expe-
rience has proved, that when a medicmal substance comes in con-
tact with any part of the body, its action is not confined to the
mere part, but often propagates itself through the subjacent tissues
to deep-seated organs. On this principle, when the liver and
bladder, or other internal organs are affected, emollient applications
are made to the surface over them. On the same principle, catap-
lasms, ointments, &c. covering tumours, swelled glands, &c. are
found useful. Physiology proves to us, that by irritating the excre-
tory ducts of a gland, the secretion of that gland are excited and
accelerated.' Thus purgatives, when they enter the duodenum,
irritate die ductus choledochus,' and thereby cause the liver and
pancreas to secrete more abundantly. — Spillan.

BOOKS R1CBIYBD DURING THE MONTH.

1. Report of the Managing Committee of the House of Recovery mod Fever
Hospital in Cork Street, Dublin, for one year, ending 4th January. 1830. with
the medical report annexed. Dublin, 1880. 8vo. pp 11*2. Richard and Webb.

8. An Introduction to Systematical and Philological Botany, illustrated with
explanatory engravings. By Thomas Castle, F. L. S, Member of the Royal
College of Surgeons, &c. London, 1829. 12mo pp. 285, coloured plates. Sold
by E. Cox, Southwark ; Baldwin and Cradock, Paternoster Row, and T. and G.
Underwood, Fleet Street.

3. A Concise Treatise on Dislocations and Fractures, being a selection from the
most approved Foreign and English surgical authorities, from the days of Celsos
to the present time, illustrated by fourteen plates. London, 1830. 12mo. pp. lUf
published by James Bukock, Chelsea.

4. A Treatise on the Mineral Waters of Harrogate and Hs vicinity. By Adam
Hunter, M: D., &c. &c. Set. London, 1830. 12mo. pp. 138. Longman and
Co. Black, Edinburgh.

6. An Inquiry as to the Expediency of a County Asylum for Pauper Lunatics,
second edition, with considerable additions. By W. Palmer, D. D. a magistrate
of the comities of Devon and Somerset. Exeter, 1830. 8vo. pp. 86. Trew-
man and Co. Exeter ; Rivingtons, and T. and O. Underwood, London.

' 7. Two Lectures on some of the Physical Signs of Diseases of the Chest. By
John Forbes, M.D., F. R. S. Portsmouth, 1880. 8vo. pp. 86.

8. ^Dissertation on the Component Parts of an Animal Body. By Henry
'**•-"■ - - - Published for the

Sherwood, Pater-

Wm. Dewhurst, Surgeon. London, 1830. 19mo. pp. 64. Published for the
author by Callow and Wilson, Princes Street, Soho, and Sher

noster Row.

All Communications and Works for Review are to be addressed to the care of
Means. Underwood, 32, Fleet Street; or to the Editor, tt his Residence, 61,
Hitton Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 27. SEPTEMBER 1, 1830. Vot. V.

CRITICAL REVIEW.

I.— Cholera, its Nature, Cause, and Treatment ; with
original views, Physiological, Pathological, and The-
rapeutical, in relation to Fever ; the action of. Poisons
on the System, fyc. §c. ; to which is added, an Essay
on vital temperature and nervous energy ; explanatory
more particularly of the nature, source, and distribu-
tion of the latter ; and of the connection between the
mind and the body, $c. qc. By Charles Searle, Sur-
geon of the Hod. East India Company's Madras Esta-
blishment. 8vo. pp. 255. London, 1830. John Wilson.

It is a maxim in medical literature that style and composi-
tion are not so necessary as in other kinds of writing ; but
we could never comprehend a particle of reason in support
of this assertion. Of late years the worst species of writing
is medical, and rarely do we find a work written correctly.
The work before is an excellent illustration of our state*
ment, it is contrary to every rule of composition, and of
course must be ambiguous, if not unintelligible. The first
sentence of the preface extends to twenty-eight lines of
small print, in which there are almost as many transitions
from subject to subject as there are. lines, and which ought
to have been divided into several sentences. The same
defect appears in every page, and renders the meaning of
the author doubtful, and often incomprehensible. In fact,
the work seta criticism at defiance, for no man could under-
lie the task . of exposing its inaccuracies. It is right to
illustrate the justness of our censure by a quotation.

" The object of this work, is the improvement of our practice,
u the attempt to define principles of treatment of a disease, the
pathology and nature of which from being but imperfectly under*
*°od, many — very many, annually fall a sacrifice — at least such

vot. v. xo. 27. z

178 Critical Review,

is my belief; not that I charge my professional brethren with any
culpability in which I am not equally implicated ; no, it was the
experience of want of success* in my own practice, with the loss of
a relative, on the same occasion that the public sustained bo heavy
a one, in the death of the late revered Governor of Madras, Sir
Thomas Munro, who also fell a victim to this disease ; leading me
to the conclusion that there was something radically wrong in our
views and treatment, induced me to investigate the numerous public
records on the subject ; from which I had deduced certain inferences,
and was embodying my thoughts in a shape suitable with the inten-
tion I meditated, of submitting my views to the Medical Society
of Madras, then existing, when becoming myself the subject of
its attack, it not only afforded me an opportunity of verifying the
conclusions I had arrived at, with regard to the line of practice
which should be pursued in the treatment ; but under this personal
experience, having strictly attended to the progression of the symp-
toms, and my feelings, it gave me a clue, which enabled me to
solve the difficulties I before laboured under, with regard to the
explanation of the symptoms and nature of the disease ; in short,
the explanation I arrived at, operating upon my mind with all the
force of the most perfect conviction, induced me to extend my
original design, and to submit my views to the press at Madras, in
an Essay, under the title of ' Cholera Pathologically and Practically
considered/ " — p. vi.

Without troubling the reader with further extracts, we
shall endeavour to detail faithfully the author's views on
the nature and treatment of cholera. More than half his
work consists of extracts from the Madras medical reports,
various periodicals and monographs, and contains a
good, though very confused description of the disease. It
appears by the concurrent testimony of the majority of the
numerous writers whom he quotes, that in severe cases of
cholera, there is pallidity and coldness of the skin, some-
times lividity, imperfect* oxygenation of the blood in the
lungs, as the blood is dark and thick both in the veins and
arteries. Such is said to be the condition of the blood
when drawn from the temporal artery. The necroscopic
appearances are congestion in the brain, lungs, and alimen-
tary canal. In some cases there were effusion, and extrava-
sation in the brain ; the lungs were so congested " as to
resemble a mass of bruised flesh," the liver and spleen were
not invariably affected, but were often filled with dark
blood. The gall-bladder was almost invariably filled with
bile, though its duct was pervious. The mucous surface
of the stomach and intestines was dark with patches of red,
the urinary bladder was empty and contracted. The general
opinion on the etiology of the disease is, that it arises from
malaria, the product of swamps, stagnant water, or putri-

Mr. Searle on the Cholera of India. 179

tying animal and vegetable substances ; and this opinion is
attested by the singular fact that cattle and poultry were
destroyed in the contaminated districts, and presented the
same appearances of congestion as the human subject.
Mr. Searle cites a host of authorities in proof of cholera
being caused by malaria, and he is silent on the question
of the contagiousness of the disease. He next; describes
the effects of malaria on the different functions, and arrives
at the very iinphysiological conclusion, that " the primary
operation' of. the febrile cause is not on the brain and
spinal marrow, bat on the skin and lungs, the poison is
absorbed from these parts, is mixed with the blood, which
it contaminates and renders unfit for the purposes of life.
The brain is secondarily affected by its' receiving contami-
nated blood. To this deranged state of the circulation
he refers all the phenomena of the disease. This theory
is manifestly untenable, it is contrary to the received opi-
nion in every country, as to the primary effects of malaria
or contagion on the body, and is most completely annihilated
by the incontrovertible conclusions of Morgan and Addison
on the effects of poisons. The spasms he ascribes to con-
gestion at the roots of the spinal nerves, a condition first
pointed out by Dr. Sanders, of Edinburgh, and which
Mr. Searle has found to exist in every case which he has
examined. He 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. He
divides the disease into three species, which he has infeli-
citonsly designated cholera aspnyxia, cholera congestiva,
and cholera morbus. The classical scholar will be shocked
at these terms, and the clinical practitioner will question
their accuracy. Every one of these terms are objectionable.
The frord cholera was employed alone by the ancient '
Greek and Roman physicians, and the addition of the word
morbus, is an excrescence of modern growth. It would be
just as correct to say typhus morbus, or podagra morbus,
terms that would strike the veriest medical tyro as barba-
rous and superfluous. The first species, cholera asphyxia,
(asphyxiata ?) is ushered in by great prostration of the vital
powers, mortal coldness, cessation of the circulation, and
sudden death, which is sometimes preceded by convulsions.
Such formidable symptoms often characterise typhus fever,
yellow fever, and plague, but as yet no writer has appended
the word asphyxia to these diseases.

The second species, cholera congestiva, is thus defined : —
The patient is suddenly seized with vertigo, borborygmi,
»wi diarrhoea, dejections of a conjee or barley water ap-

180 Critical Rexiew.

pearance, succeeded by great prostration of strength, tremor
or twitching of the extremities, " alias clonic spasms/'
countenance sunk and ghastly, cold damp skin, feeble pulse
and precordial oppression. A sense of burning heat soon
arises in the stomach, attended with great thirst and an
insatiable desire for cold water, and violent spasms affecting
every part of the body, especially the lower extremities,
supervene, which are speedily followed by collapse, lividity
of the skin, cold clammy perspiration, coma and death.

The third species, cholera morbus, is ushered in by the
usual symptoms of fever, which are soon accompanied by
vomiting and purging of a slimy bilious matter, attended
with griping, violent bead ache, and painful spasms, and
soon terminate like the second species.

Mr. Searle proceeds to describe the treatment which he
adapts to his theory of the disease, and which appears in
many points objectionable. Thus he considers mercury
almost a specific in the cure of the disease, " aided, of
course, by such remedies as circumstances require to fur-
ther its action." Very few practitioners depend on mercury
at th6 present day, and we must observe, that its power as
a stimulus, in the first species of cholera, in which the vital
powers are prostrate, and congestion of all the viscera pre-
sent, appears to us inactive and doubtful practice, which
we should not think of employing in the fever of this coun-
try when characterised by such symptoms. The author
virtually agrees with us, if we -understand him rightly, for
he adds, in the same sentence in which he recommends mer-
cury, that general and local stimuli are indicated, such as
external heat and friction, the recumbent posture, ammonia,
warm spirits and water, &c. — and stimulating saline clysters
" with a view of increasing serous exudation, and by con-
sequence, removal of congestion from the mesenteric and
gastric vessels as well as from the brain, thus aiding ab-
sorption of our remedies from the stomach and bowels.' *
He endeavours to. explain this mode of treatment by the
experiments of Magendie, which shewed that absorption
does not take place on congested surfaces ; and here, as in
all other details of treatment, our author theorizes too
much, and leaves an impression on the reader's mind, that
his recommendations of cure are more speculative than prac-
tical or real. His observations on blood letting are curious ;
he holds that blood should be drawn from a small orifice,
the patient being in the recumbent posture, as venesection
is resorted to for the purpose of exciting the heart's action
only.. He says, the greatest caution is required during the
operation, and that the rising or flagging of the pulse is the

Mr. Searle on the Cholera of India. 181

only certain indication as to the propriety and safety of
continuing the depletion. But in a succeeding part of the
work, we are informed copious depletion is the sheet anchor,
and the most efficacious of all the modes of treatment.

Dr. James Johnson was, we believe, the first who recom-
mended depletion in cholera, and superseded the empirical
practice of large doses of mercury. Subsequent experience
has corroborated the excellence of his judicious advice.
When excitement has commenced, our author recommends
bleeding, purging, calomel, leeches over the affected organ,
clysters, sinapisms or blisters to the extremities. He ad-
verts to the state of collapse, so common after excitement,
and states positively that he has rescued many persons from
the jaws of death by quinine, a practice which he thinks
highly important in the intermittent, remittent, and typhoid
fevers, and which he suggests to the notice of Drs. Smith and
Tweedie — a practice which has been successfully employed
by the most eminent physicians which this empire has pro-
duced, and which we have found most beneficial in some
thousands of cases. But it does not accord with the solidism
of the day, and hence it has been most preposterously
decried. A section is introduced on the effects of opium
on the system in health and disease, and our author con-
cludes that this remedy is useful in the stage of collapse
only. The next chapter is a popular description of the
treatment of cholera. First, the patient is to be put to
bed in an airy chamber, and an emetic of black mustard
seed, two table spoonsful in half a pint of warm water
exhibited, which acts better than any other emetic, and
causes a flow of warmth throughout the system. After
this the following enema should be administered every half N
hour, or oftener: — A dessert spoonful of table salt, a pint
of warm water, and a spoonful of common or castor oil.
This remedy tranquillizes the stomach, and enables it to
retain a scruple of calomel, which is to be washed down .
with a table spoonful of brandy, and two of warm water.
The remainder of the treatment is described in the following
words: —

" If the case is urgent, the same dose of calomel may be re-
peated every hour ; otherwise, in two hours ; or if the patient is
much improved, in half the quantity ; and thus prolonging the
interval, or reducing the quantity — it must be continued, according,
to the state of the patient, till bilious stools and urine are produced ;
the spirit and water, or mulled wine either ; or where the system
is very low, thirty drops of (sal volatile) aromatic spirits of ammo-
nia, or of hartshorn in half a wine-glassful of water, may be singly,
or alternately administered, every quarter or half hour ; with the

182 Critical Review.

precaution before given, to avoid oppressing the stomach by undne
quantity.

" In addition to these means, if the skin is cold, warm flannels
should be constantly applied ; or if the skin is damp and the patient
suffers by cramps in his legs and arms, the parts may be well com-
pressed, and rubbed with the flannels besprinkled with hot salt.
We have yet omitted to mention a very important remedy, one
capable of producing much good, or no less harm — this is blood-
letting— which if the patient is an European, or native of pretty
robust habit, should be early resorted to — if the pulse admits of it,
that is; if compared with another person's — it is of pretty moderate
strength ; the object to be borne in mind by bleeding in this case,
is to excite, by removing oppression from the brain and circulation,
and ntft to subdue the action of the heart, that it should be taken
from the patient whilst continuing in the recumbent posture, — and
here I must insist once for all, that an no account and for no pur-
pose is the patient to be permitted to sit up, or leave the recumbent
state, or sickness almost immediately takes place ; the evacuations
should therefore be received in a bed-pan, or cloth ; and the blood
be taken from a rather small orifice, that, the stream being in con-
sequence small, the system may have time to accommodate itself to
the deprivation, — the effect of which, however, should be carefully
watched — the operator keeping his finger during the time on the
pulse, at the same time encouraging the patient by suitable con-
versation ; when, at the instant it is found to flag, without reference
to the quantity withdrawn, whether much or little the finger should
be placed over the orifice ; but it must be borne in mind, that fear,
nausea, or sickness may occasion this result, that should the quan-
tity taken have been small after a few minutes — if the pulse reco-
vers its wonted strength, as it is an object to carry it to as great an
extent as the circumstances of the patient admit— the finger may be
removed from the orifice in the vein, and the blood allowed again
to flow, with the precautions before specified; but should, after a
further small loss, the same result ensue, it is clear that any addi-
tional attempt at this time would be injurious ; though it may be
afterwards practised, as excitement becomes developed, either in
relief of spasms, sense of burning heat in the stomach, or pain in
the head, or oppression of breathing ; and with the precautions I
have given, may be frequently put into practice, and without the
possibility of harm — but on the contrary with the happiest effect ;
for in this disease small bleedings in relief of the engorgement of
the brain, .stomach, and heart, are clearly and most forcibly indi-
cated. (See case A. in the Appendix.) The same intention is
partially fulfilled by the clysters, but as warmth and excitement
become developed, evinced too by the desire the patient has for cold
water — these may be aided, or superceded by a weak and cold solu-
tion of Cheltenham or Epsom salts, or of cream of tartar, with
which the patient may be now indulged — in the,* quantity of a wine-
glassful at a time, instead of the cordials, which would now prove
injurious ; these will not, however, supercede the calomel, the ne-

Mr, Searle on the Cholera of India. 183

cessity for which still continues, not only till bilious stools are pro-
cored, but even then, though in smaller doses, till healthy evacua-
tions follow. It may however now, on febrile symptoms taking
place, be well to combine it, with an equal weight of James's
fever, or antimonial powder, and give it, if it is preferred in the
form of pill ; but mind if the calomel is thus combined, acids, such
as cream of tartar, are not admissible, as an emetic compound would
be the result. The calomel and antimonial powder we would now
advise, in the proportion of two grains of each, every two hours,
with a tea-spoonful of Epsom or Cheltenham salts, in a claret-
ghssful of water with every second dose ; and if there is much
thirst, the patient may at the same time be allowed a wine-glassful
of barley or cold water every half hour ; and the same be continued
till the secretions of bile and urine are restored ; when, and not
before, may the patient be allowed some sustenance, the best of
which will be light beef tea, or chicken broth, for it must be re*
membered, and borne in mind, during the convalescence, that in
proportion to the feeble state of the patient, so is the stomach weak,
ud powers of digestion..

" Many have an objection to salts, where this is the case two
table spoonsful of castor oil may be substituted, or a dose of rhu-
barb and magnesia when this is preferred. Should the operation
of the purgdtive be attended with much exhaustion, it may be ne-
cessary to support the patient with some spiced broth, wine and
water, or mulled wine ; or it may even be necessary to moderate it
tf there is much sinking, by a dose, of from twenty to forty drops
of laudanum ; but this is providing against contingencies, which
with moderate care and attention will seldom be found necessary.

" Hie secretions (torn the bowels are now sometimes so exceed-
ingly acrimonious, that in passing along the line of bowels and
from the anus, they produce, from extreme irritation, very con-
siderable exhaustion ; when this is the case it will be advisable to
inject an occasional emollient clyster, of starch or conjee water,
wnth oil ; to the first of which, may be added a tea-spoonful of
laudanum, and this repeated if necessary ; at the same time hot
flannels may be applied to the belly." — p. 119.

When the disease comes on insidiously, with symptoms
of indigestion ' and diarrhoea, a grain of opium is to be
added to the calomel, and the remainder of the treatment
is the same as already described, except that rhubarb and
magnesia, or castor oil is preferable to salts. Should
there be burning heat of the stomach, calomel is to be
giren every hour, small quantities of cold water to be
allowed, and a dozen leeches applied to the epigastrium.
If spasms supervene, bleeding may be employed with the
precautions already mentioned. Great relief is afforded by
the fan or hand ptipkah, which aids the respiratory function,
sod is extremely Agreeable to the patient.

184 Critical Review.

In the asphyxiated form of cholera, the treatment con-
sists of the exhibition of brandy and water, aromatic spirit
of ammonia, calomel saline clysters, frictions over the
heart, stomach, and extremities, and when excitement com-
mences, stimulation is to be diminished, and depletion cau-
tiously employed.

The third species differs little from common cholera, and
is to be heated by an emetic in the cold stage, and after
fts operation by calomel, warm wine and water, or ginger
tea, and when excitement commences, cautious depletion,
warm bath, and clysters are to be employed. In the stage
of collapse, calomel and opium are highly serviceable as
stimulants, blisters are to be applied to the head and sto-
mach, and. tiie skin previously rubbed with a composition
of ten grains of oxymuriate of mercury, a drachm of can-
tharides and a little oil of turpentine ; and further, that
camphorated mercurial ointment be well rubbed in the
axillae and on the inside of the thighs. Mercurial inha-
lation is also strongly recommended, and advised to be
procured by sprinkling some red sulphuret of mercury or
calomel, on an iron heated to redness, and placing it near
the patient. Mr. S. thinks this kind of inhalation would
be useful in poisoning by narcotics. He proposes a simple
and expeditious means of procuring" and employing' vapour
in fever, rheumatism, and other diseases. He proposes to
place the patient on a cane chair, under which some ardent
spirit is ignited, the patient and chair being1 covered with
a blanket. This is somewhat similar to the plan proposed
by Dr. Murray, in his work on Heat and Humidity, which
we noticed in a late number.

The next chapter is on the prevention of cholera. We
find nothing novel in this, for the only advice given, is to
avoid the predisposing and exciting causes ; in a word, to
avoid all causes of debility, and regulate the bowels and
attend to the general health. The appendix consists of re-
ports of cases, and occupies half the volume.

If the pathology proposed by Mr. Searle be correct,
there is a striking analogy between cholera and yellow fe-
ver, as well as typhus ; and the successful plan of cure
recommended by Dr. Stevens is well worthy of a trial.
Had our author been less digressive, and solely confined
himself to his subject, his work could not fail to be encou-
raged. In its present form, it is too speculative, and con-
sequently will be looked on with caution or suspicion as a
practical guide. The author should havfc given much more
of his own experience, and much less of that of others.
The work will be useful to those who are destined for
India, and the general reader of that country will find it
instructive and important.

. [ 185 ]

\l.—A Supplement to the London, Edinburgh, and Dublin
Pharmacopoeias. — By D. Spillan, A. M. M. D. Dublin,
1830. Hodges and Smith, pp. 218.

W£re8ume with infinite pleasure our analysis of the valu-
able and unassuming' work before us, and commence with
the able author's proofs of the following proposition: —
" Medicinal substances possess not any specific property
distinct from their physiological action, and to which the
curative effects following their use can be attributed."

" No medical substance ever produces an amendment in a
disease, without primarily producing an organic operation in the
body affected. The primary or immediate, and the secondary or
curative effects, are so closely connected that the former must al-
ways precede the latter. Again, when from any cause a medicinal
substance has lost its power of acting on the organs, or when, from
the force of habit or of idiosyncrasy, the organs are insensible to
it* action, so that its exhibition causes no change in the system, it
becomes useless as a therapeutic agent. We may observe also, that
those substances which produce the most extensive changes, and
give the greatest shock to the system, are those whose therapeutic
powers are best demonstrated and least disputed ; we may adduce
as instances, tartar emetic, opium, the several preparations of
bwk, &c. Moreover, medicines sometimes, instead of proving useful,
and of putting a stop to the morbid phenomena to which they wete
opposed, produce a fatal exasperation in the symptoms, which no
one hesitates to refer to the unseasonable impression made by them
°o the seat of disease. Why should we not make their more favour-
able effects flow from the same source ?

All acknowledge that medicinal substances, in order to be useful,
must be exhibited at the proper time, inasmuch as a substance which
would prove useful at the commencement of a febrile attack, would
he of no avail in the middle of it, and even injurious at the termi-
nation, which could not be, if those agents possessed positive and
absolute virtues, whereby they must cure such or such a disease
"dependent of the address of the physician who prescribes them,
and who selects a proper time for their exhibition. As a further
proof of the truth of our position, we often find that external cir-
J^HJistances, which are capable of producing a shock or revolution
* the system, oftentimes serve as most effectual remedies in disease.
Thus, a sudden fright has oftentimes cured an intermittent, by excit-
^g a violent shock in the system, at the moment when the fit was
about to commence ; we often see a new* disease put a stop to one
of long standing, which had resisted all the medicinal substances
gloved for its cure. No one certainly will say that these circum-
tkaces possess curative virtues independent of the primary impres-
sion they make on the system. From all this we may fairly con-
done that medicinal substances derive their property of curing or

Vol. t. ko. 27. a a •

186 Critical lie view.

alleviating disease from their active powers, and that the advantages
arising from their use proceed not from any specific virtue intended
to produce them. Thus the words, •• febrifuge," " antispasmodic/'
" antiscorbutic," &c. should be looked on as conventional terms
admitted into medical language, not so much to designate any real
existence, as to announce a probable or likely result from the use
of substances to which these attributes are attached." — p. 129.

Every man of experience will freely acknowledge the
correctness of these opinions, . The student ought to give
them his most serious consideration. The author has ren-
dered science his debtor by his very graphic description of
the action of medicines on the living system, and by his
exposure of the incorrectness of many of our medical
terms, which all must admit to be purely conventional.
He proceeds as follows :— -

" The advantage arising from the administration of medicinal
agents being dependent on the primary impression made by them
on the several organs, when the physician prescribes them, he knows
merely whether he shall stimulate the organs; whether he shall
retard the rapidity of their movements ; whether he shall augment
or diminish the tension of the several tissues ; whether he shall
irritate a surface, or augment a secretion, &c. but beyond this he
knows not ; the benefits to be derived from this organic operation
are the work of nature. To be sure the experience of the physician,
aided by the light of physiology, may enable him to calculate on
the probable effects of the medicine, whether it will bring about the
desired amendment or not ; but farther he cannot go. All his
hopeB of putting a stop to, or alleviating the morbid affection, must
ultimately depend on the workings of that conservative principle*
implanted in animal nature, whereby life is sustained from the be-
ginning to the end of its existence, in opposition to those noxious
and destructive causes, which are constantly assailing it. If medi-
cinal substances were endowed with the virtue of curing certain
determinate diseases, it would follow, that the same medicinal sub-
stances should be employed for the cure of the same disease:
whereas, on the contrary, we know that different practitioners ad-
minister different medicinal substances, and pursue different modes

* The existence of the restorative principle here alluded to, called by some
the vis medicatrtx natures, is too obvious to be denied ; we see wounds heal,

On this

the wot k of nature; for the operations of art consist merely in regulating it,
either by exciting it when languid, restraining it when vehement, in changing
morbid action, or in obviating pain, or irritation, when tbey oppose its salutary
course. This, I apprehend, is so well understood among well educated phy-
sicians, that the woid tutes as applied to their own merits, is proscribed as
presumptuous." — Med. Leg. sect vi. p. 259.

Dr. Spillan's Supplement to the Pharmacopoeias. 187

of treatment in the same diseases, and all with the same ultimate
success ; the only mode of accounting for this apparent anomaly,
is by admitting that it is nature, and not medicine, which restores
the diseased organs to their natural state. Medicines are no doubt
the occasional cause of this happy result, by exciting salutary mo-
difications in the state of the effected parts, by exciting evacuations
from the different emunctories, and by aiding the favourable efforts
of nature ; but in all this they act but as indirect causes, and the
cessation of the pathological affection cannot be set down as the
necessary consequence of their inherent principles acting on the
several organs. It is from the circumstance that medicinal sub-
stances possess not any specific power to cure disease, that their
dose and mode of administration always decide their success. It
is not sufficient merely that the patient should take the medicine
called for by the disease; it is necessary that the physiological
change produced by it in the system should be proportioned to the
pathological changes caused by the disease. The mode of admi-
nistering medicinal substance will also claim attention ; the prac-
titioner who believes that it is these substances that by their inhe-
rent virtues cure disease, feels quite indifferent as to the immediate
effects caused by them ; it is enough for him that the medicine has
been administered ; he is totally regardless whether the physiolo-
gical effects produced are proportioned to the intensity of the
disease, whilst he who considers that the advantages to be derived
from these substances are consequences of their primary effects on
the organs, and of the modifications which they excite in their
fractions, is careful to watch these effects, and to proportion them
to the pathological disturbance.

" From what has been said* it appears, that in order to be able
fully to appreciate the advantages which may be derived from medi-
cinal substances in the practice of medicine, it is absolutely neces-
sary to attend to .their primary effects. In every age, however,
from the very infancy of the healing art, the contrary course has
been pursued, and the curative effects alone have been the object of
research with medical men ; from whence it comes to pass, that the
Materia Medica is a collection of false conclusions and misrepresen-
tions, rather than a true science. Thus, the practitioner who be-
lieves in the curative virtues of medicinal substances, confines his
undivided attention to these, and when he studies the action of any
Rich substance, it is merely to find out what disease it can cure.
When he administers a medicine in any disease, he merely attends
to the change which will come on in the symptoms, always con-
cluding that the exhibition of the medicine, and the amelioration
which may succeed, are closely connected, and stand to each other
in the relation of cause and effect ; post hoc, ergo propter hoc. On
such a fragile basis has the science of medicinal substances been
founded ; hence it is that it has too often consisted of observations
engendered by false experience, and propagated by easy credulity.
Did we but reflect on the many cases in which unassisted nature
triumphs over disease, and on the spontaneous tendency which the-

188 Critical Review.

several organs of the body have to resume their healthy functions,
and also on those temporary as well as permanent amendments,
which must be attributed to the influence of the vital principle,
we certainly would not feel so sanguine in our hopes to be able to
distinguish, after the exhibition of a medicine, the change which
may result from its operation, from that which may be the result of the
vis medicatrix naturae : nor is the conservative principle of nature
the only source of error which the physician should avoid in inves-
tigating the properties of medicinal substances. Whilst diseases
are running through their several periods, how often do we not see
amendments take place, which must be attributed to the influence
of external causes ? The practitioner who refers every amendment
to the action of the medicine which may have been used, takes not
into account the share which these causes may have had in inter-
rupting the progress of the disease, in alleviating symptoms the
most alarming, and even in re-establishing health.

" In order, then, to be secure from falling into these errors, and
to be able to distinguish the results of the action of a medicine
from those which appear during its use, but independently of it,
our only method is carefully to note the primary or immediate effects
produced, since it is from these the therapeutic advantages which
follow must proceed. Not to be led astray in deciding on the
merits of any medicinal substance, we must first attend to its pri-
mary action on the several organs, note the changes caused by it in
the performance of their functions ; then consider the pathological
lesions, the cure of which we attribute to it, their character and
their extent. Then, on comparing the operation of the remedy,
and the disease, we shall see whether there exists a connexion
between them. The physiological effects produced by such sub-
stances should always explain the cures attributed to them, and
there should exist between them the relation of cause and effect.
It is this relation that should be established and proved. Such is
the ground-work, such the proper object of pharmacology." —
p. 134.

Our author next details the therapeutic effects of medi-
cines, and affords much instruction upon this important
point.

" With regard to the period when the therapeutic effects of
medicinal substances developc themselves, it is to be observed that
some produce their effects immediately after exhibition, others not
until they have been continued for a considerable length of time ;
thus, when we give a tonic in weakness of the stomach, the benefit
caused by its impression on that organ immediately appears. In the
same way, after administering an emetic or a purgative, we can judge
whether their operation has been favorable or not. But the evidence
of the therapeutic effects of medicines is not always so prompt or so
striking. It often happens that these effects are not observable until
after their use has been continued for weeks or even months. Such
effects are seldom however the simple product of the medicine em-

Dr. Spillan's Supplement to the Pharmacopoeias. 189

ployed; other causes may have contributed to their production, such
as diet, exercise, change of climate, change of season, &c. The ad-
ditional efficacy imparted to medicinal substances by hygienic means,
could not but strike physicians, and inspire them with a desire
to avail themselves of such aid in therapeutics. This combination of
medicinal and hygienic means, directed to the cure of disease, and
regulated so as to produce one common effect, is what forms the
atratiw method. - This may be distinguished in two parts, one posi-
tive, and the other negative ; the first .including the medicines em-
ployed, the hygienic circumstances made to act on the patient, &c.
whilst die second includes those habits of living, diet, &c. to which
the individual had been previously accustomed, and from which it is
necessary that he should now abstain, as being likely to prove in-
jurious."—p. 135.

There is no practitioner who will not subscribe to the
valuable opinions laid down jn this paragraph. How often
do we observe the force of this statement illustrated in
practice. How important did our predecessors consider the'
influence of what they quaintly designated the non -naturals,
which were but the causes adverted to by our talented
author ? The following observations are also deeply inter-
esting, and of great practical utility : —

" The therapeutist should study the nature, and know the extent
<rf the lesion which constitutes the disease. These become manifest
either by direct signs, such as are seen on the parts affected, as red-
Mas, increase or diminution of volume, induration or softening, in-
crease or diminution of temperature, variation in the sensibility, &c.
<v by indirect signs, as in the change which the functions of the se-
veral organs undergo, the increase or diminution of their secretions,
&c. These latter signs are in general our only guides in the affec-
tions of the organs contained in the different cavities of the body.
The symptoms, signs, and morbid phenomena should engage attention,
however, only so far as to enable us to arrive at a knowledge of the
lesions which exist in the body, wherein they manifest themselves.
*^e physician who collects them for the purpose of constituting a
disease of them, and of finding a place for it in a nosological arrange-
ment, loses sight of the cause of the disease and of that which keeps
it up. He, on the contrary, who uses the symptoms as guides to
conduct him to the state of the lesion, and to discover to him the
character and extent of the disease, at once sees what he has to
dread, and to what his attention should be directed. The former
asb, what the disease is ? whilst the latter inquires, where it is ?

" In investigating the seat and nature of a disease, the following
order has been recommended. The head should be commenced with
including the cerebrum, cerebellum and their membranes ; then pro-
ceed to the spinal cord ; attentively consider the alterations which the
cerebral apparatus may undergo, and which may be inferred from the
ptia, heat, tension, weight, &c. felt by the patient in different parts

190 Critical Review.

<# the.appajajbua ; ajry change also, which the mental faculties may
exhibit, as also the organs of sense* and the action of the muscles,
will assist in directing our inquiry. From the head we pass, on to
the cfieqt, and examine the statcof pulmonary and circulatory organs ;
from thence we proceed to the abdomen, and from the appearance of
the tongue and lips, and by the application of the hand, by pressure,
and by the number and nature of die alvine evacuations, we infer the
s\ate of the viscera therein contained ; nor should we be inattentive
to the state of the urinary apparatus, manner in which the functions
of the skjn.are performed, |cc. By means of this inquiry we may
easily arrive at> the seat of the disease, be enabled to judge of the
character and nature of the pathological lesions which may exist ; and
consequently be directed in our choice of the medicinal means, which
these lesions call for, and in the degree of strength required in the
operation of our remedies, as also in the manner of employing them.
Whilst this method will clearly point out to us the indications which
the physician should fulfil, it will, at the same time, point out the
contra-indications which should be kept in view. An organ, for in-
stance, is the seat of a pathological lesion ; this lesion calls for s
medicine endowed with a certain virtue; but some other organ,
equally the seat of disease, will be injured by this same medicinal
agent ; consequently its employment is contra-indicated.

" From investigating disease by the several organs in the manner
now laid down, this advantage will result, that we shall no longer
see physicians, when examining the same patient, differ as to the
nature of the disease with which he may be affected, inasmuch as
they will not set out with preconceived notions, and neglecting
symptoms, which they may deem of little importance, direct their
exclusive attention to others which may conform more closely to
their particular doctrines. By passing in review all the several
organic apparatuses, no lesion can escape, facts cannot be disfigured,
nor an arbitrary association of symptoms be any longer admitted." —
p. 138-

The succeeding remarks are a valuable lesson to those
pathologists who invariably expect to find the causes of
death on dissection. Exclusive solidism, that short road
to the end of physic, seems to be blocked in many parts by
recent writers ; and we cannot help thinking, it will be de-
serted as impassible in a few years. We leave its few ad-
mirers to digest the following' comments, and to refute
them if they can : —

" It would at first view appear, that post mortem examinations,
by discovering to us the lesions which caused the disease, should
point out the mode of treatment. But the weakness of such a con-
clusion will at once appear, on considering that the parts, which
were the seat of disease, are no longer what they were during life.
Those circumstances which formed precise therapeutic indications
have now disappeared ; those causes which kept up threatening and

Dr. Spillan's Supplement to the Pharmacopoeias. 191

alarming symptoms, are now effaced by death. A general and
uniform coldness has now taken the place of those elevations of
temperature once so sensible. In met, it is not the lesions, such as
they are seen in the' dead body, that the physician is called on to
combat, but such as existed before death, such as the symptoms
revealed them. Nor should we forget that post mortem examina-
tions present to our view the product of the disease, rather than
the disease itself. The frightful appearances which then present
themselves, justify the diagnosis or the physician ; they discover
what the pathological affection was ; they allow us to conjecture
the order which it followed, and to represent to our minds the pro-
gressive changes which the diseased parts underwent, in order to
arrive at the state in which they now are. But the therapeutist
should consider that these alterations take place only after a con-
aderable lapse of time, that they have had a beginning and an
increase, and that in the time during which they existed, several
periods may be distinguished. These reflections are of consider-
able importance ; for, on observing the modifications which the
tissues experience, the lesions which the viscera undergo, the dis-
organization of which all the parts of the body are susceptible, one
cannot help being surprised at their number and extent, as well
as discouraged on comparing with them the power of medicinal
agents.

" The researches of pathological anatomy seem then to have
a tendency to diminish the physician's confidence in medicine, and
to inspire him even with a determined prejudice against * it. But,
&a has been already said, it is not the lesions, such as they now are
seen, that our therapeutic resources are intended to combat. These
lesions have then attained their termination ; they have passed the
point, where their course might have been suspended. These lesions
have had a beginning, a developement : when they were recent,
slight, and before they had penetrated too far, they were by no
means above the therapeutics; there was then some proportion
between these lesions and the power of medicinal agents. It is no
longer difficult then to conceive, that such agents may bring about
the cure of affections similar to those, whose anatomical products
have been just now stated, by their being attacked at the commence-
ment, and before they could effect all the mischief which post mor-
tem examinations present to our view. The utility of therapeutic
means depends on the period of their employment. Means, which
if used to day, would certainly cut short a disease, will be inappli-
cable or insufficient some days later. In conclusion, we shall add,
that it is a living lesion which the therapeutist has to treat ; that,
in order to ascertain the nature of the remedy called for, he should
represent it to himself, such as it is during life, with its colour,
temperature, the changes in its sensibility, and that it is necessary
to attack it a proper time, before it has destroyed the natural
texture of the parts where it has its seat, if he Wishes that the
operation of medicinal agents should be of any avail.

" These principles give to the practice of medicine a solid basils ;

192 Critical Review.

nor can the art of healing be still considered as all conjecture, first,
when it determines the lesions which constitute disease, assigns
their seat, measures their extent, and announces the modifications
which they cause the several organs to undergo ; secondly, when
it declares beforehand the physiological effects which medicines
produce, and foresees the primary operations of the means to which
it has resourse. No doubt, the therapeutic effect of the operation
is always uncertain ; too often it corresponds not with the expecta-
tion of the physician : but can medicine hope to cure all the lesions
of which organs are susceptible? Have not limits been put to its
power by the Creator himself ?" — p. 140.

How often have we been wearied with the exhibition of
morbid specimens at our debating societies, while those who
presented them could give no account of the symptoms
that existed during the illness of those from whose bodies
they were taken ; and yet meeting after meeting have such
exhibitions taken place, to use a technical phrase, usque ad
nauseam. We hope this useless practice will be discoun-
tenanced in future, and that the time of our societies will
not be wasted by the display of disorganizations, with
which every man of ordinary information must be familiar,
and which only remind us of the imperfect state of medical
science and practice — a piece of information which every
hour's experience impresses upon our memory. It affords
us much 'gratification, to perceive the sentiments of a writer
of Dr. Spillan'8 talents accordant with our own. But to
resume our analysis.

Having concluded the consideration of the operations of
medicines, our author proceeds to detail the effects of the
different classes of remedies. He adopts 'the classification
of Mr. Barbier, which has for its basis the physiological
operation of medical agents, aid is more permanent than
the arrangements founded on their therapeutical effects.
The classification is as follows: —

" 1. Tonics, or medicines which strengthened the tissue of the
organs.

"2. Excitants. ") Medicines which stimulate the tissue of the

" 3. Diffusibles. J organs.

" 4. Emollients. Such as relax their tissues.

'• 5. Temperants. Such as moderate the too great activity of
the organs,

" 6. Narcotics. Such as diminish cerebral life.

" 7. Purgatives. Such as irritate the internal surfaces of the in-
testines.

" 8. Emetics. Such as irritate the gastro-duodenal surface.

"9. Laxatives. Such as disturb the natural movements of the
intestines.

Dr. Spillan's Supplement to the Pharmacopoeias. 193

" 10. Medicines, whose mode of action is not well determined,
or which cannot be referred to any of the preceding classes" — p. 149.

The observations on the effects of tonics on the vital
functions are so exceedingly important, that we quote them
at length, as they have been almost forgotten by practi-
tioners. We promise our readers that they shall be amply
repaid for the trouble of perusing them. There is no part
of medical science so much neglected as that under notice ;
and therefore we need not apologize for devoting so much
space to its consideration. The only person to whom we
owe an apology, is the author whose work we place under
*nch ample contribution. The following are Dr. Spillan's
news on the effects of tonics : —

" Hie medicinal substances ranked under the class of tonics, in-
clude the several species which have received the name of coroborrants
or strengtheners, styptics, astringents, &c. The active property, of
these substances determines in the several organs a change or modi-
fication of their tissue, which shall now be pointed out. In order
hfly to appreciate the impression which medicines of this class make
on the several tissues, it is necessary to see them successively in con-
bet with these tissues ; 1. In their natural state. 2. In a state of
morbid debility. 3. In a state of irritation or inflammation. If the
organ on which we desire to study the action of a tonic ie in its na-
tural and healthy state, the influence of this tonic is difficult to be
^covered during its action on the body ; the organs will not change
fair mode of action ; the several functions will be performed with
fair usual regularity. Should the organs on which the force of the
tonic is exerted, be in a weakened condition, then the impression
made by the medicinal substance will have the effect of producing
manifest changes in it. Their movements, before enfeebled and Ian-
grid, win become stronger, and it may be observed, the greater the
debility and languor, the more striking will the effects of the tonic be.
When the vital properties of the several organs are more developed
fan natural, the effects of tonic medicines will still be discoverable.
By increasing the already too great activity of the several parts of
fa system, they excite disturbance, and the pathological state which
fcOows their use, still further proves the nature of their powers, that
fete being generally of an inflammatory character.

" From what has been said on the subject, it will appear, that
they may be used with advantage in morbid affections arising from
general debility. It is also manifest, why their effects on the animal
wonomy are so little perceptible, their action being directed entirely
*° the insensible contractility of the organs, the tissues of which be-
come in consequence more firm and more condensed.

" A tonic medicine given in a small dose, has merely a local ac-
***; whilst if the dose be augmented, and the active principles be
fawbed in sufficient quantity, the entire system is subjected to its
^foace* It may not be uninteresting to run through each of the

Vol. v. jro. 27. b b

194 Critical Review.

systems of the body, and to note the changes made in their action by
the exhibition of a tonic. We shall thus be enabled to form a just
idea of the importance and extent of the properties of this class of
medicinal substances, -and to see what advantage therapeutics may
derive from their employment. We shall commence with the diges-
tive apparatus, and first consider how it may be affected in its
healthy or physiological state.

" Observation demonstrates, that after the exhibition of a tonic
medicine, the coats of the stomach experience a fibrillary contraction,
whereby they become more firm and more compact, and the stomach
in a manner contracts on itself. We are equally warranted in sup-
posing, that according as the substance advances into the interior of
the intestinal canal, a similar effect is produced on its coats. The
exhalations, and several secretions which ordinarily moisten the mu-
cous membrane of these parts are suspended. The impression made
on this membrane is communicated to the muscular tunic, the fibres
of which become contracted ; inconsequence of this change the body
of the intestine becomes harder, firmer, and more resisting, whilst its
cavity is at the same time diminished. The changes observed in the
function of digestion, after the exhibition of a tonic, points out that
its influence on the organs subservient to this function is to strengthen
their tissue and augment their vigour. We see tonics given in a
small dose increase the appetite and bring it on sooner than usual ;
several individuals find their digestion facilitated and expedited by
their employment; a digestion, habitually languid and difficult, by
reason of debility of the digestive organB, is rendered stronger and
less distressing after the use of a tonic. It may be observed, that
the alvine Evacuations "acquire an unusual degree of consistence from
the employment of tonic medicines, and sometimes appear diminished
in quantity. This maybe accounted for by the encreased degree of
absorption' along the intestinal surface, whereby the residue of diges*
tion is deprived of its liquid parts. '

" When tonic substances are taken in very large quantities into
the stomach, they produce considerable disttrrba&ee in the functions
of the digestive organs. They excite a sensation' of heat in the epi-
gastrium, which is difftised over the abdomen, is propogated to the
chest and to the head, and is even felt in the Hmbs. When (lie sub-
stance has eiitered into the intestines/ these become distended and
swollen by the exhalation of gas,- whilst the muscular fibres are affec-
ted with spasmodic contractions, giving rise to coHicky pains.

" Sometimes however we may perceive tonic medicines produce
liquid and even abundant dejections. From having observed this re-
sult* Cullen considered himself warranted in placing bitters under the
head of purgatives.

" Pathological state. When the stomach or any portion of it is in
a state of irritation, the exhibition of a tonic substance disturbs- the
action of this organ, and prevents the regularity of its functions.
Irritation of the stomach manifests itself by redness and dryness of
the lips and tongue, by the smalmess and diminished appearance of
the latter organ, by thirst, sensibility of the epigastrium, &c ; these

Dr. Spillan's Supplement to the Pharmacopoeias. 195

symptoms are all aggravated by the use of tonic medicines. If the
ftomach, instead of mere irritation, is actually inflamed, the exhibi-
tion of tonics will give rise to phenomena still more striking ; their
we is followed by a painful sensation of heat in the epigastrium,
which the patient compares to a consuming fire, by swelling of this
put with great pain on pressure, great thirst, anxiety, oppression,
and different other phenomena presented by the organs of circulation,
respiration, by the brain, &c.

" Hie coats of »the stomach sometimes undergo a morbid change,
which gives them a softened appearance, which change causes great
debility in the powers of this organ ; there is anorexia, a dislike of
mucilaginous or fatty aliments : in such cases the use of tonics has
the most happy effects ; they re-establish the natural functions of this
tocos, by inducing a more free and easy digestion.

" If the tissues of the stomach are hardened, if scirrhus or cancer
occupies any portion of it, the effects of tonic medicines cannot be
determined before hand. They vary according as these lesions are
fltnated towards the cardiac or pyloric extremity, near the great or
small curvature of the stomach. In such cases tonics have occasioq-
*% afforded temporary relief, by retarding the vomiting, and dimi-
nishing the frequency of the sour eructations which so often accom-
pany such affections, and by inducing a desire for food, which pre-
viously had not existed.

" The action of tonics on the intestines in disease merits particular
attention. When the mucous membrane is in a state of irritation,
the exhibition of tonics will have the effect of exasperating the dis-
ease. Should inflammation exist in these parts, the effects of tonics
*31 be still more intense, ^hen blood is exhaled from the mucous
tufece of the intestines, a tonic may have the effect of arresting the
fanorrhage. If this happens to be at the same time the seat of uj-
ceiatiqns, as is seen in dysentery, the efferts of tonics will no longer
be certain: they will vary with the pathological condition of the in-
testinal surface.

"In wasting of the intestines, which is observed in the examina-
tion of dead bodies, and which is, in general, the result of long pro-
tracted disease, in addition to the diminution in substance, there is
usually great irritability, and consequently frequent alvine evacuations,
thereby the aliment is carried off by stool previous to its complete
location. In such cases tonics may be of. advantage, by assisting
the function of digestion, and rendering the stools more regular.

" If ulcerations exist on the surface of the intestines, the effects
d tonics will be found to vary according as these are observed to be
of an ojd or recent date, superficial or deep-seated, and according to
the state of the ulcerations. If these be recent, tonics may by de-
veloping the vitality of the parts bring on cicatrization ; should in-
JMMnation accompany them, tonics may have the effect of exasperat-
ing the case. It is necessary to observe, that ulcerations seated on
^ luge intestines cannot be much influenced by tonics taken by the
nratb, inasmuch as their active principles are almost all absorbed in

196 Critical Rerie*.

the small intestines, before they can reach the large. The best mode
of applying tonics in such cases is by injection.

" It often happens that the stomach and intestines are affected
only in their vitality, without their tissues experiencing any structural
or organic lesion. This arises from the increased, diminished, or ir-
regular distribution of nervous influence to these parts. The origin
of such affections maybe referred either to the brain, whose influence
on these tissues of the stomach and intestines is changed, or to the
nervous cords received by these parts. If the nervous influence be
increased, the digestive organs "become more than ordinarily sensible ;
digestion itself causes the sensation of weight and of painful tension.
If it be irregular, there appears a crowd of phenomena, such as
spasm, colic, sudden swelling of the intestines, pains communicating
with the vertebral column, vomiting, &c. If the nervous influence be
diminished, we observe want of appetite, languid or imperfect diges-
tion, diarrhoea, &c. In the two first cases tonics will but exasperate
the affection ; whilst in the latter they will, if taken in moderate
doses, regulate the digestive function ; a result, no doubt, depending
on the influence of the tonic on the nerves of the stomach and intes-
tines.

" Tonic substances, though not coming in immediate or direct
contact with the other parts of the digestive apparatus, as the liver,
pancreas, and spleen, may however, act on those organs ; 1. by that
sympathy which the nervous plexuses establish between all these
parts ; 2. by the entrance of their molecules into the circulation ; 3.
by the contiguity of the intestinal tissues to the organs. The liver is
more than any other organ, subjected to the action of medicinal sub-
stances. In its healthy state the action of tonics has no appreciable
effect on it ; but when in a state of irritation or inflammation, the
exhibition of a tonic never fails to exasperate all the symptoms.
Bilious vomiting may be the consequence ; the inflammation will often
spread to the other parts of the abdominal cavity, particularly to the
stomach and intestines. If there be a diminution in the volume of
the liver, tonics will excite the action of nutrition, and they will con-
cur in restoring to it its natural or physiological dimensions. This
morbid state of the liver is very common ; it arises directly from
langour in the assimilating functions of this viscus, or may proceed
from an inordinate absorption, which carries away the materials be-
longing to its substance ; this change may take place at the end of
acute disease, in which the liver has been somewhat inflamed. We
sometimes meet with the liver very much enlarged ; in such cases the
vitality of the organ being inordinately developed, an excess of bile
is secreted ; a reflux of which into the stomach brings on bilious
vomiting. The skin assumes usually a yellowish tint. When such
an affection exists tonics augment it, by increasing the already too
great assimilating powers of this organ, and exciting still more the
secretions of bile." — p. 149.

We have here ample matter for reflection* aud that which
is of immense importance in practice. It would be an act

Dr Spi11an*s Supplement to the Pharmacopoeias. 197

of injustice on our part to mutilate the remaining observa-
tions on the action of tonics on the circulatory, respiratory,
and nervous system, and at the risk of being accused of
drawing too freely on our author's pages, we must make ano-
ther long quotation, which shall conclude our analysis for the
present; but such is the importance of the work, that we
must resume in our next number.

" Penological it ate. Tonics influence the organs of circulation in
two ways; when taken into the stomach, the impression made by
them on the nerves of that viscus is continued to those of the heart,
iod this sympathy may change the action of this organ. But it is by
the molecules of these substances being taken into the circulation,
and thus coining in immediate contact with the substance of the
tart and arteries, that the organs subservient to this function are
principally influenced. When a dose of tonic medicine has been
taken sufficient for its influence to become general, it is easy to per-
crire that the contractions of the heart are performed with greater
awgy, and that this organ propels the blood with greater force into
the blood-vessels ; the coats of the arteries also become more resist-
ing and more rigid; the pulse becomes more firm and harder, the
Teasels appear under the finger diminished in size, and at the same
time more tense. It is at the same time worthy of remark, that the
course of the blood is not quickened, it being one of the characters of
atonic to strengthen the organs without accelerating their action.

" It is necessary to distinguish the effects of a tonic medicine aris-
ing from the impression of its molecules on the tissues of the heart
*nd arteries from those which do not appear until after a long con-
tinued use of this substance. Thus, one dose of a tonic will render
te pulse either more full or more frequent, but after the continued
exhibition of this substance for some time, it will assume all these
characters ; these changes will be referrible to the change made in it
by the function of nutrition.

" Pathological state. When in febrile diseases the pulsations of
the heart are become more quick than ordinary, and its contractions
stronger and more rapid, and the pulse at the same time is accele-
rated, it is natural to suppose that these organs are in a state of- irri-
tation, whether this irritation arises from the sympathy between the
heart and any other part of the system which may be diseased, or from
a direct affection of the heart itself. This state of irritation in the
organs of circulation presents itself in a great number of diseases.
The effects of tonics under such circumstances are sufficiently obvi-
°°»; when to a patient with a quick, frequent, and hard pulse, burn-
ing heat and dryness of the skin, a tonic is given, we uniformly find
ffl the symptoms exasperated after each dose, the pulse is redoubled
m force and frequency, the heat becomes more oppressive ; presently
there comes on anxiety, restlessness, &c. If any organ be in a state
of inflammation, observation shews us that the exhibition of a tonic
never mils to heighten and extend the disease, the capillaries of the
inflamed organ being irritated by its particles; From what has been

198 Critical Review.

stated* it is unnecessary to detail the mischief which would result
from the administration of tonics, when the organs of. calculation are
in a state of actual inflammation.

" In hypertrophy of the ventricles, particularly of the left* tonics
render the pulse stronger and quicker, and the beating of the heart
more violent, and never fail to augment the cerebral disturbance, as
well as the other symptoms usually accompanying this affection.

" In atrophy of this organ tonics render the pulse stronger for a
.time, and the pulsations of the heart itself more sensible. This state
el the organ is frequently observed in convalescence from fever,
.during which the tissue of the heart may undergo considerable modi-
fications, its firoetioa of nutrition being interfered with during the
.process of the disease.

." The functions of the heart may be perverted independently of
any structural lesion* This may be attributable either to the exces-
sive or deficient supply of nervous influence. La the former caae
there will be .violent palpitation of this esgam, and great irregularity
An the poise ; in the latter the action of this viscus will be slow and
weak* as will also tibe pulse. In the one case tonics will generally
exasperate the symptoms, whilst in the other they may prove ser-
yieeaMe.

. <c "With reapect.te the action of tonics, on the Okgaxs of Rbspi-
bAtaqn ha their heakkp rise*,, little can be said either interesting or
important. But when any part of these organs aappefi to be die
seat of inflammation, whether the mucous membrane, as in bron-
ehitis, ortheir parenchyma, as in pneumonia, or the pleura, the
/exhibition of ,tonic& will he 'found invariably to exasperate all the
symptoms. • In hemoptysis tonics.may serve to oonstriage the capil-
lariea of the bronohial membrane, and thereby put a atop to the
evacuations but in such eases the injudicious use of this class of me-
OKsmefi may do much harm.

. " The action of tonic medicine on the Bbaiv and its appendages
in their physiological state is by no means striking, fiat when this
organ or its membranes are in a state of irritation or inflammation,
we invariably find medicines of this class considerably to augment
all the symptoms. When the arachnoid is inflamed, the exhibition
of a. tonic exasperates the acute headache accompanying such a
state* as also the restlessness, delirium, intolerance of hght and
sound, &c. In the course of febrile diseases, the spinal arachnoid
is often the seat of irritation, giving rise to symptoms which are
developed in the chest, abdomen, and in the limbs. There is pain
.in the neck, between the shoulders, along the back, in the lobs,
according as the irritation occupies one or other of these regions.
In such cases the use of tonics will do considerable mischief. The
cerebral mass itself may be affected either by congestion, efluaion,
or actual inflammation. The fanner state is oftentimes induced by
the use of tonics in febrile diseases. It is unnecessary to state,
that in all such affections medicines of this class are entirely contra-
indicated.

Dr. Spillan's Supplement' to the Pharmacopoeias. MH>

" The substance of the spinal card may also experience several
sorts of lesions: from its intimate connexion tarith.-the system rff
the ganglionic nerves, or with the trisplanbhnicpje iidrve, it become*
impassible to distinguish the affections peculiar to each of these two
important parts of the cerebral apparatus. From the ciraiOBfenice of
me apmsicbrd and ganglionic system of nerves, holding all the vis-*
oen noder their control, it comes to pass, that lesions 4>f these' parts
atmfest themselves in different parts of the system,' by disturbing
organs which are perfectly sound. Thus, spasms oB the oasophag&sy
dfficnhy of deglutition, palpitation of the heart, crumpr of the sta-
ndi, colics, &c. oftentimes arise by no means from any lesion of the
pots where these symptoms are developed, bat from a lesion df the
spal card or ganglionic plexuses. ConvuLrionsi shaking of the
to; Saint Vitas' dance, oftentimes depend on irritation of the spinal
cord or its membranes. Hysteria and epilepeey have their original
bjwmfly in the cord.

" The substance of the spinal cord may likewise be the seat of
awe; there is then manifested great disturbance iff the functions
of respiration, circulation, and digestion, so that one might refer the
disease to the thorax and abdomen, and not to the cord itself. Or-
ganic disease of the heart has been frequently suspected, from the
fafarbed and irregular action of this organ, where the spinal cord was
nil? tiie seat of disease. It is to be observed, as before, that in all
cues of hrrtetkHfltoiP the cotd tonics are contra-indicated.

" Besides these structural affections of the cord, it is also subject
to what may be considered vital lesions. Thus weakness in the
heart's action, in the functions of the stomach, of the intestines, and
of the lungs, may exist without the tissues of these viscera presenting
tie least alteration, and are to be referred to a diminution in the
quantity of the nervous influence distributed to those parts. In such
cases tonics will prove serviceable, as well as by exciting the vitality
*f these viscera, as by stimulating the spinal cord to resume its
aatural influence over the viscera. It is in thiB way, no doubt, that
tasks act when given to remove weakness of the stomach, '-loss of
iftetite, slow digestion weakness of pulse, &c.

" As the effects of tonic medicines on the other parts of the system
&> not possess any considerable interest, we shall now consider the
therapeutical employment of this class.

" Tbe nature of the impression made by tonics on the several
tissues, as well as the physiological changes caused by them, should
feet physicians in their employment. The immediate effects which
&ey produce, compared with the pathological lesion which they are
blended to combat, will point out whether advantage or injury will
result horn their exhibition. As in the treatment of disease it is to
&e morbid lesion to which the attention of the therapeutist should be
faceted, so it is in the several- organs that he must seek them. We
thall commence with affections of the digestive apparatus.

" Tonics have been strenuously recommended in cases of loss of
appetite, of indigestion, &c. and their efficacy in these cases appeared
*o well established as to have procured them the name of stomachics.

200 Critical Review.

However, the practitioner will do well to investigate the cause of
these affections, and to observe with care the nature of the lesion
which disturbs the natural functions of the stomach.

" Should this disturbance depend on irritation of the. mucous
membrane of the stomach, it is obvious that tonics would but increase
the mischief, whereas if it depended on debility, or a diminution in
the quantity of nervous influence transmitted to this viscus, their use
will be productive of much benefit. The same observation may be
made regarding the intestinal canal.

" In nervous affections of the heart, tonics have been found ad-
vantageous ; but where there is organic disease of this organ, as hy-
pertrophy of one or both ventricles, their use is contra-indicated.

" In pneumonia and pulmonary catarrh, after all inflammatory
symptoms have been combated, tonics are frequetly found serviceable
in assisting expectoration.

" In diseases of the lymphatic system, as in scrofula, tonics from
the basis of the different methods of cure. By their use the diges-
tion is improved, and the function of nutrition is carried on with more
regularity." — p. 156.

The only remark we shall make on this important extract
is, that Dr. Elliotson recommends large doses of quinine,
when abdominal or thoracic inflammation is present— a re-
commendation contrary to the universal opinion of the pro-
fession. Med: Chir. Trans, v. xiij. p. 464. However highly
we esteem Dr. Elliotson 8 talents, we cannot help agreeing
with the multitude, but leave the reader to form his own
opinion.

III. — Clinical Illustrations of Fever, comprising a Report
of Cases treated at the London Fever Hospital in
1828-9. By Alexander Twhedie, M. D. Member of the
Royal College of Physicians, London, Physician to the
London Fever Hospital. London, 1830. ovo. pp. 204.
Whittaker and Co.

VJ.— Report of the Managing Committee of the House of
Recovery and Fever Hospital, Cork Street, Dublin, for
the year ending 4th January, 1830, with the Medical
Report annexed. By John O'Brien, M. D. Physician to
the Cork Street Fever Hospital, Dublin. Dublin, 1830.
8vo. pp. 1 13. R. D. Webb.

The greater part of Dr. Tweedie's work consists of reports
of cases treated in the London Fever Hospital in 1828-9;
and the treatment differs in no respect from the ordinary
plan pursued; his original views on the nature of the disease

Dr. Tweedie on Fever. 201

can be detailed in a few words. Tn common with the largest
portion of the profession, he maintains that fever is prima*
rily a general disease, and that local inflammation is a
secondary affection of very frequent, but not • of invariable
occurrence. He holds that the brain and nervous system
are primarily engaged in the febrile action ; the disturbance
in the brain, is in the beginning simply functional, though
it may sooner or later, according to particular circum-
stances, assume an inflammatory character. The circula-
tion and secretions are next disordered, and " in simple
fever there is no preponderance of action in any organ,
all parts of the system partake equally in the general dis-
turbance." When excitement occurs, the transition to
inflammation is very rapid, and will affect the brain in one
patient, the organs of respiration in another, the abdominal
viscera in a third, the mucous coat of the intestines, or
many organs may be simultaneously affected.

" Fever is not inflammation — it is therefore not cured by reme-
dies, that effectually remove the latter, though its violence may be
litigated, and its duration shortened by the judicious modified
application of the same measures." — p. 8.

Our author further states, that he daily sees examples of
simple fever without any evidence of local inflammation ;
but remarks, that the latter may come on imperceptibly, or
with scarcely, any premonitory indications. The brain and
nervous system are. very generally, if not universally in-
volved in the febrile action — but these are secondary effects
of fever. In such cases the most vigilant measures should
be at once adopted to prevent those changes of structure
which, so speedily take place, and render the case almost
hopeless. Dr. T. has seen but one case of paralysis conse-
quent to celebral affection. He next adverts to the fre-
!|uency of affections of the respiratory organs m fever,
n one hundred and three cases the lungs were more or less
affected in one third. In pneumonia and bronchitis after
bleeding, the best effects were produced by the exhibition
of one or two grains of tartarized antimony, every second,
third or fourth hour — a plan highly praised by our author's
colleague, Dr. S. Smith. In numerous cases the inflam-
mation of the chest was overlooked by the attendants pre-
viously to the admission of the patients into the hospital,
and in such case the .utility of the stethoscope was unques-
tionable.

Dr. T. considers the morbid condition of the intestinal
mucous membrane one of the specific effects of typhus ;
but unfortunately for his opinion such condition is far from

Vol. v. ho. 27. c c

202 Critical Review.

being invariably present. Another point dwelt oil is the
change of the blood* and its non-Coagulation when ab-
stracted in the last stage of typhus, an occurrence noticed
at least five thousand times before. Indeed, we do not
know a single work on fever in which this morbid stage of
the blood is not attested, from Sydenham to Glanny,
Stoker, Stevens, &c.

Simple typhus, or the adynamic fever of k Pinel, is said
to be a disorder of function only, and of rare occurrence
in this country, and this opinion is supported by Dr. South-
wood Smith, while Dr. Burne maintains that this species is
characteristic of the continued fever of London.

The next subject discussed is the complication of typhus,
with inflammation of the contents of the head, chest, and
abdomen, which is said to be of frequent occurrence.
Every man conversant with fever is aware of the fact,
Dr. Tweedie cautions, his contemporaries against the deoep*
tion which arises from absence of pain in muco-enteritis,
while inflammation proceeds slowly but steadily. We have
shown in our last volume now peritonitis may prove 'fatal,
though undiscovered during life ; and how muen more likely
may inflammation of the intestinal mucous tunic be over-
looked.

The vermilion colour of the tongue, so miidh dwelt 0ft
by the Erench and other's, is not a Certain diagnostic of
disease in the bowels ; we* have a patient at this period
whose tongue alwdys1 presents this appearance when he is in
good health.

Dr. Tweedie proceeds to describe the causes of fever,
and here we 6nd nothing novel ; — cold, intemperance, fii*
tigue, and malaria, are said to be the most common causes
of the disease. Famine is a powerful predisposing cause,
and in illustration of this positibli, dtif author states that
he did not recollect a single instance of a butcher being
sent into the hospital. The exemptidn of this class of peo*

le from plague, when it last Visited London, is mentioned

y those who described the disease at that period.

Our author follows the multitude as a contagidtrist, and,
like his associates, arrives at the very unphilosophical con*
elusion, " that fever will spread by contagion, but that the
probability of its extension depends Very much on cleanli-
ness, the proper ventilation of the sick chatttber, and the
purity of the surrounding atmosphere." Suppose we were
to substitute the word syphilis, a really contagious disease,
for the word fever, ill tnis sentence, how untenable and
ridiculous would the position appear. And yet the sentence
before us, when strictly examined, is equally objectionable.

Dr. Tweedie on Fever. 203

At one period contagion was the only cause of fever ; but
now debilitating causes, however numerous, are allowed to
dure the power of that ideal phantom. . But all debilitating
causes, moral and physical, cannot produce any of those
diseases which are really contagious. Dr. Tweedie adduces
the following facts as a positive proof of contagion: —

" The London Fever Hospital is placed in an 'open space, situate
in the vicinity of the metropolis, close to the Small-Pox Hospital.
Both these establishments stand in the centre of a large field, where
the production of malaria is extremely improbable. I can state,
from the most authentic sources, that every physician, with one
caption, (the late Dr. fiateman) who has been connected with
the Fever Hospital, has been attacked with fever during his atten-
dance, and that three out of eight physicians have died.

" The resident medical officers, matrons, porters, laundresses,
ad domestic servants not connected with the wards, and every
female who has ever performed the duties of a nqrse, have one and
all invariably been the subjects of fever; and to show that the
disease may be engendered by fomities of clothing, the laundresses,
ihose duty it is to wash the patients' clothes, are so invariably and
frequently attacked with fever, that few women will undertake this
tarthsome, and frequently disgusting duty. p. 88."

Now this evidence, though considered conclusive, is by
do means sp to us. It must be recollected that the present
physicians to the London Fever Hospital are staunch conta-
gionists ; and consequently their precautions while visiting
tW patients; qute calculated ,to intimidate all persons con-
nected with the sick. Feax, that powerful debilitsmt, rankles
in the hea/t pf eyery one of these attendants ; the frir of
the wajrfs, how.eyer well ventilated, must be more or less
contaminated, the progress of fever is accompanied with
consequences fritfbuul and disgusting to ordinary attendants,
all eminently calculated to depress both mind and body,
vid produce the disease. That these causes produce fever,
independently of malaria or contagion, cannoj be doubted
by any man who is acquainted with the history of the epi-
demic fevers of this empire. Again, we do- not discover
the medical and civil attendance of all fever hospitals
affected with the disease, to any thing like the extent in the
instance before us. The records of medicine bear ample
evidence* that those who fear fever, whether medical or
civil, seldom escape the disease, and are generally destroyed
hy it, while those who entertain no such apprehension al- '
most invariably escape* This fact was abundantly exem-
plified in the epidemic fever of 1818-19. Agaio, the ab-
sence of fever id the Small Pox Hospital, tnough conti-
guous to the Fever Hospital, proves uothing. In the for-

204 ' Critical Review.

mer, there are few patients, mid none labouring under fever ;
while in the latter there are the worst forms of fever, con-
gregated from the most unhealthy parts of the metropolis.
Under such circumstances, and for the reasons already
mentioned, the contamination of the air in the fever wards
may bp such as to cause fever independently of contagion.
But whence the perpetual immunity of medical men in ge-
neral from contagion ? This simple problem has never
been answered, nor it never can be solved by exclusive
conragionists. The idea of men being daily exposed to
contagion, and conveying it in their apparel from family to
family, and escaping themselves from Us effects, is one of
the greatest absurdities that ever disgraced the theory of
medicine. The late celebrated Dr. Gregory was wont to
observe in his lectures, that he must have been exposed
some thirty thousand times to fever, and yet he escaped
the disease, so accommodating was contagion to the illus-
trious professor. Yet he was a staunch contagionist. If
we look to the history of fever in Ireland, we find it attes-
tated by the writers of several centuries, that famine and
fever bear to each other the relation of cause and effect,
and that the cause being removed the effect ceases, while
the disease has spread over the whole face of the country.
How can this fact be reconciled with the doctrine of con-
tagion ; how can the exclusive contagionist explain the
sudden cessation of disease at a time it is so extensive, that
it is impossible to Separate the healthy from the sick. Such
is the dilemma of those who advocate the doctrine of con-
tagion, who maintain that it is the sole cause of fever. But
it is useless to argue with the admirers of antiquity, who
despise legitimate induction, who refuse to acknowledge
the result of faithful observation and multiplied experience,
and who put reason and common sense entirely out of the
question.

Our author has given a tabular view of the mortality of
fever in different hospitals ; and this varied so much in the
same hospital at different times, and must always vary from
situation and diversity of epidemics, that nothing conclu-
sive can be learned in respect to treatment.

We have now to notice Dr. Tweedie's method of treat-
ment. He is of opinion that there are few cases which are
not benefitted by blood letting, " but it is not a remedy
which should be indiscriminately adopted, as if fever were
identical with inflammation,' and that " an epidemic may
appear which will uot bear the same bold treatment whicn
has been recommended/'

Dr. Tweedi« on Fever. 205

He states that 280 lost blood— 146 from the arm, 70
locally, and 64 both generally and locally ; the average
quantity of blood drawn was about 19 ounces.

Of the whole number bled (280) there were

Average
quantity
Cases. of blood.

Of Simple fever ......26-'--- 8 ounces.

Affection of the brain - - - 110 - - - - 20

< chest - - - 81 - - - - 17

abdomen - - 22 - - - - 15

head and chest 20 - - - - 21

— ' head and ab-
domen - 12 ----16

head, chest and

domen ------ 9 - - - - 24

280"

Bloo<J letting was generally employed in the early stages,
but in some cases, when the disease was advanced, and
visceral inflammation supervened, which could be arrested
by the lancet only. Our author is not an advocate for in-
discriminate depletion, and on the use of this as on all
remedial agents, he lays down admirable and judicious
rules. In bronchitis of fever he prefers cupping to leeches ;
he rejects emetics and diaphoretics, which he deems inert
and productive of injurious effects, by excluding more pow-
erful measures. We doubt much the concurrence of the
profession with the notion of rejecting diaphoretics, espe-
cially antimonials ; and daily observation must convince us
of their utility, from the praises bestowed on them by the
largest proportion of practitioners. Cold affusion 'never
extinguished fever, but the cold dash is lauded to extra-,
ragance, both by our author and Dr. Smith. This consists
of pouring cold water on the naked scalp, the stream being
gradually raised as the patient can bear it.

Wine was given with the best effects, in fourteen cases
out of 521. Purgatives were freely employed, but never
produced intestinal inflammation, so much dreaded by the
French.

Such are the opinions of Dr. Tweedie, which are credit-
able to him as a practitioner ; but are by do means entitled
to that extravagant commendation bestowed upon them by
H>me of his reviewers. His work is a safe guide so far as
it extends, but that it is superior to all other productions on
fever, because the author happened to witness the treatment
of this disease in the Edinburgh Infirmary, is an assertion

906 Critical Meview.

tpQ fwf oftftrofM to ittquiae serious notice. W« believe
titer* 13 scarcely a writer on feaer in this country wji© has
not enjoyed tha same advantage, if there is aoy advantage io
the matter ; but with all due veneration for ojur alma mater,
we cannot help thinking That the reputed superiority of
modern Athens alluded to on this and other occasions, is
estimated by a very considerable portion 01' the faculty of
may -parts of this empire, as a very vain and gratuitous
assumption. Such are the prevailing sentiments of the
largest portion of the profession in this section of the nation ;
and we remind our contemporaries of tjie fact, when they
forget themselves so far as to land an imperfect essay on
such shallow ground, apd condemn a systenaafcic work,
which in point of style, cwqpos&oi^ Ana information, is
infinitely its superior.

The universal advancement of the age in medical science,
and above all, its diffusion by the press, have destroyed all
individual claims to superiority ; and the less attempts at
pre-eminence the mora accordance with the spirit, of the
age. 'Strcfc ompty pretensions do not suit the taste or
feelings of the profession at present^ and cannot be tole-
rated. We feave been led into these remarks by the ful-
some adulation, gross flattery, and ill-deserved compliments
bestowed on one wofk on fever ; while another, wnich the
best and ipost impartial judges in our profession have de-
clared to be one or the best, was censured with an acrimony
of feeling, an asperity of reproof and a harshness of ex-
pression perfectly uncalled tor, and unwarrantable. We
nold it to be the duty of an impartial critic, to impute
praise or blame to aumors with candour and equity, and
die reviewer who acts otherwise will not enjoy the confi-
dence of the profession.

Da. O'Brien commences Jt?is interesting report by observing,
fhat a revolution, not unusual in epidemic maladies, and
similar to those which tfiarjk the vicissitudes of. other great
natural phenomena, has occurred with respect to fever in
Dublin. Not only has this disease fallen below its ordinary
numerical standard, but appeared evanescent and altogether
extinct. At one period there was not a case of typhoid
fever in the Dublin Hospital. This occurred when public
distress had obtained its greatest height in that city : and
is an exception .to the universal observation, that faoautf
and fever have almost invariably borne the .relation of cause
and effect. The author admits the power of distress in

Dr. O'Brien on Fevet in Dublin. 307

exjunction with certain moral habits at the chief Muse
of fever ; but he holds that these ev its alone ante ittesfpaM*
of causing continued fever in any individual instance, much
less in its epidemic form ; and that to produce this effect,
aootfeer set of cause?, called exciting, is indispetts&bly
necessary. These causes will operate tenfold on ait impo-
rerished multitude, but *hen they dre absent, he ftrts, we
are instructed by the. events of the past year of the immu-
nity fraxh fever Out author is at issue with an overwhelm*
ing majority of his contemporaries upon this point, as will
be seen by referring to the works of Hbrty, Barker, Cheyne,
Stoker, and many others. It would have been interesting had
lie accounted for the frequency of fever in Dublin and every
other part of Ireland ; and its iufravqnency in Engkfnd and
Scotland. The difference of climate- will not explain the
difference— there mast be something in the physical and
•oral cowditkta of the Irish people.

Ao importer* table fe gfit cm of the adtei&iefe, discharges,
and mortality iir the Cctfk Street Hospital, troth 1st of
January 1829, to 1st of Jamfary 1830; by tfhifcft ft appears,
the admissions were 31 5&— males 1114— females 2039;
cured 2836— died, of rnaletf 97— females 135— total 232*
mortality for males 1 lb 1 1 — for females 1 in 14 — total mor-
tality 1 in l&flg.

" The retards of this hospital famish evidence that the mortality
taseyer increased* regularly in proportion to the admission^; but
on the contrary, trnfen the admissions have been most numerous,
foe relative mortality has, generally speaking, been least. "Thus,
in the three great epidemic fevers which occurred in Dublin, in the
<*mse of the last 20 rears, the iifurtality in 1813, *as 1 in 20 •
in 1M8, 1 in 30 ; and in 1S26, 1 in 28 ; while in the three jreara
1823. 1824, 1825, which presents a cdnrfdefabW reduction in the
aAniaioiis, the total mortality wto 1 in tt, and hi die tW6
P» J&n 1828 and. 1829, hi which the admissions were also rttitfi
diminished, the total mortality was 1 in 14.

" the inference from this fact id, tip* the majority of cfeste which
Mnrtttnte our epidemic feters, are of a mild character, a dispensa-
tion by which Providence interposes to mitigate the ttvetfty 6i 1«
wn inilietibaB/' — ^^. 9.

Oar author appends a table shewing the ihortalify in the
London and Dublin Hospitals, for a series of yearsj by w^hfeh
? appears the mortality was much greater in the formed than
«J the latter. We leave those who think the London praotiee
*ne comparatione to reflect on this fact.

208 Critical Review.

The following table, and the comments of our author
are highly instructive and deeply interesting :—

Year. London. Manchester. Dublin.

Mortality. Mortality Mortality.

1816 one in 11.8 — — 15.30

1817 — 12.25 — — 15-94

1818 — 5.75 — 11.75 — 30.5

1819 — 6.72 — 9.5 — 17.6

1820 — 9.97 — 8.25 — 14.64

1821 — 5.04 — 8.0 — 12.7

1822 — 6.18 — 7. — 16.92

1823 — 6.11 — 6.33 — 11.71

1824 — 6.0 — 6.83 — 12.13

1825 — 5.1 — 6.4 - — 10.17

1826 — 5.34 — 6.66 — 285

1827 — 7.25 — 9.86 — 19.13

1828 — 7,22 — 10.25 — 15.35

" In the last epidemic fever which prevailed in Edinburgh, from
November 1826, to June 1827, the mortality in the Infirmary and
Fever Hospital of that city was 1 in 10.33. — Ed. Med. Jour:

" The reason assigned by the authors above-mentioned for the
high rate of mortality in the London Fever Hospital, is the advanced
period of the disease at which patients apply for, and obtain admis-
sion. The neglect of an early application, however, is a subject of
constant complaint in the Dublin as well as the London Fever Hos-
pital : and we think this circumstance alone insufficient to explain
the great difference of mortality in both hospitals. We believe the
fact to be, that the proportion of very severe or bad cases to the
aggregate of admissions, is greater in the London than the Dublin
Hospital ; but whether this is to be attributed to the comparatively
limited scale of accommodation in the London Hospital, and the
consequent exclusion of all but the more violent cases — or whether
the peculiar habits and modes of life of the lower classes in the
British metropolis, palpably so different from those of the same
class amongst us, do actually communicate a more dangerous and
malignant character to the disease under consideration, we have not
been able to dicide.

" We do not exactly agree with the opinion of Dr. Hawkins,
that the . difference in medical treatment, either in the same or dif-
ferent hospitals, exercises no material influence on the mortality ; as
the admission of such a principle is calculated to induce carelessness
and apathy into the practice of physicians, and it is also objection-
able as tending to equalize and confound the information, judgment
and experience of men. We are far, however, from the meaning
to ap^ly this remark to the London and Dublin Fever Hospitals, in
the fb?mer of which the practice, though a little differing from ours.
particularly in the article of blood-letting, is notwithstanding able
and judicious*" — p. 11.

The mortality in the London Fever Hospital was double
that of Cork Street Hospital some years back, a difference

Dr. O'Brien on Fever in Dublin. 209

very considerable indeed, which our author is inclined to
attribute to local circumstances with which he is unac-
quainted ; and which operate more powerfully than any
difference of type which may exist between the fevers of
both cities. He illustrates this point by further valuable
observations :—

" In St. Thomas's Hospital, London, the mortality for a period
of ten years, among the physician's cases, according to Sir G.
Blane, has been 1 in 7 for males, and 1 in 10 for females. In
St. George's Hospital, the reports for 1825 and 1827 afford a mor-
tality of about 1 in 9. In the Royal Infirmary, Glasgow* the mor-
tality from typhus .fever, in the year 1827, was 1 in 9 ; the mortality
from dysentery was 1 in 8 for males, and 1 in 10 for females.

" In the great hospitals of Paris, Vienna, Berlin, &c. the mor-
tality has been still higher than in London, and the general inference
we are warranted in drawing from the information communicated by
Dr. Hawkins is, that the mortality of Cork Street Hospital has
been less than that of any similar institution in Europe, This fact
most prove highly gratifying to the physicians of this institution."
—p. 13.

The following remarks coincide with those of Drs. Smith
andTweedie, and establish an important fact, the frequency
of local inflammation as a consequence of fever :—

" It would be a mistake to suppose that the mortality of this
boapttal arises solely, or even principally, from continued fever;
for, in fact, this disease constitutes but a small proportion of the
mortality, except in the epidemic visitations of the disease. The
majority of fatal cases in the past year arose from the usual local
phlagmasiae of the thoracic and abdominal viscera, among which
■cute and chronic bronchitis (the peripneumonia notha of former
times) and dysentery occupied, and generally occupy, the highest
place ; and a considerable number also died of the chronic diseases
of those organs which passed from the acute to the chronic stage,
cither in the hospital or previous to admission.

" The mortality of this class of diseases, is always considerably
greater than that of idiopathic or simple fever; hence, when this class,
of diseases predominates over fever, as it did in the year 1 829, our mor-
tality is considerably higher than when simple fever forms the ascen-
dant disease. The best proof of this is, that during the prevalence
of the two great epidemic fevers of 1818 and 1826, when all our
cases were exclusively composed of pure fever, the mortality was
not half so great as in the two past years, the mortality in 1818
being only 1 in 30— in 1826, 1 in 28."— p. 13.

Dr. O'Brien next adverts to the various theories of fever.
It is superfluous to trouble the reader with a detail of the
discrepant theories of fever, which we have so often placed

vol. v. ho. 27. d n

210 Critical Review.

before him ; and shall content ourselves with stating the
peculiar views of our author. He commences by defending
Dr. Cullen's definiton of fever.

" Dr. Cullen defines simple or idiopathic fever, to be " Pyrexia,
sine morbo locali primario." This definition, if taken in a strict
and literal sense, is not only at variance with Dr. Cullen's own
notion as to the proximate cause of fever, for he believed it to
arise from irritation of the brain; but we submit, is contrary to
common sense ; for it appears impossible to conceive how any
morbific cause, operating on the human body, could act, except
by affecting parts in succession ; and to say, that a general disease
exists without a local primary disease, is to say, that a disease
exists without a beginning or origin ; — the same observations wOl
apply to the essential fever of M. Pinel. Against this point in the
doctrine and definitions of his predecessors, M. Broussais has le-
velled all his artillery, both of argument and irony ; and has intro-
duced the term •• ontologie," or essentialism, to ridicule the ab-
surd abstraction, as he conceives, contained in the term essential
fever ; i. e. a fever without a local origin. To complete and render
intelligible Dr. Cullen's definition, it would be necessary to add the
word " evidente ;" t. e. " Pyrexia sine morbo locali primario evi-
dente ;" and we have no doubt, from what Dr. Cullen says in his
" First Lines," that this was the sense, in which he intended the
definition should be understood. According to this construction of
it, we shall find the definition describing fever as a disease, which
may have a local origin ; but that origin not perceptible to our
senses, and unknown. Whether this be true or false, as a matter
of fact, it will, at least, render the definition intelligible, and free
from the charge of " essentialism." — p. 18.

Every acute observer will agree with Broussais and our
author, that a morbific cause must act upon some organ
or organs, and these organs are manifestly the cerebro-
spinal system.

Dr. Burne, in his interesting work on fever, objects to
the term typhus, and recommends its rejection from pyrec-
tic nosology, on the ground of its various and different
applications by medical writers. The suggestion is worthy
of adoption, but we fear no term can be proposed which is
less objectionable. Thus Pinel makes adynamic fever a
species of the essential fevers of the French, and Dr. Burne
employs it as a generic or ordinal term " to express the es-
sential fevers of the French, and epidemic fevers of the Irish
writers." Dr. O'Brien, however, states that of late year§,
the fevers of Ireland have been more of the synochoid
than adynamic type. He doubts the propriety of consi-
dering typhus and synochus distinct genera, he agrees with

Dr. O'Brien on Fever in Dublin. 211

those who include both in the genus typhus, and sub-
divide it into inflammatory and simple typhus.

" The author confesses that he agrees in sentiment with those
authors ; he believes that the distinction between those divisions of
fever arise from circumstances purely accidental, and not from any
precise generic, or specific difference existing in nature ; and that
they are modifications of the same disease, growing out of those
circumstances. The modifying circumstances may appear to be,
let, the strength or debility of the constitution, or powers of life
in the individual who receives the infection ; and, 2dly, the quan-
tity or dose of the morbific material, whatever its nature be, which
produces it. In a constitution naturally feeble, or in one exhausted
and debilitated by external causes, or by age, the reaction is feeble,
and the •synochoid period is accordingly short lived, indistinct, or
evanescent ; and thus, the exquisite typhus may be formed ; again,
when the constitution is vigorous, the frame athletic and youthful,
the reaction will be energetic, and the synochoid period will be of
bug duration, and strongly marked. — Similar modifications will
arise out of the different doses of the infecting material by which
the disease is generated. Between those extremes a multitude of
intermediate shades of type will exist, as there are various degrees
of the modifying causes, which it will be difficult to reduce to either
of the original genera.

" Of this difficulty sufficient evidence will be found in the writ-
ings of authors who have treated of this disease, in the works o£
no two of whom a perfect accordance will be found, as to the no-
menclature and arrangement of fevers. Further, in the synochus
(i. e. synocho- typhus), of Dr. Gullen, numerous varieties of type
arise out of the different relative lengths of the synochoid and ty-
phoid stages. In the short fevers of this country, as the five and
seren-day fevers, and the ephemerae, the typhoid stage is short, or
altogether absent, while, in protracted fevers, the synochoid stage is
of various lengths, but always much shorter than the typhoid.
These endless varieties of type cannot, it is clear, be expressed by
any two definite terms, but may, with less confusion, be comprised
under a more general or ordinal term— the author shall accordingly
adopt the term typhoid fever, to express every form of fever, of
of which typhus or typhoid symptoms form a part or the whole —
which again he shall subdivide into two species, the synochus or
synocho-typhus and the perfect typhus. This division is not essen-
tially different from Dr. Cullen's, but merely an expansion of it." —
p. 21.

Our author next details sixteen cases which exhibit the
different types of fever which prevail in Dublin, from which
he deduces the following general conclusions : — First,
that there exists a primary gastro-enterite, attended by a
ferer of a peculiar kind, approximating in some respects to
lyphus, like all phlegmasia^ of the gastro- intestinal canal,

212 Critical Review.

yet differing from it by so mo striking peculiarities. The
following* train of symptoms is peculiar to this disease : —

" Pain, uneasiness, and generally fulness of the epigastrium,
or abdomen, or both aggravated by pressure, and. accompanied by
head-ache, nausea, or retching, and, in many instances, by fre-
quent vomiting, particularly after the introduction, even of the
smallest quantity of fluid or solid aliment, into the stomach. The
appearance of the tongue is peculiar and characteristic ; it is either
of a vivid or dark red colour, over its entire surface, or it is red at
the edges and point, but covered with a dark white fur in the centre,
through which specks of red are occasionally visible ; t)ie centre,
however, is also frequently brown, or even of a yellowish hue,
whilst the edges are dark red, as above described, and the papillae
all over the surface unusually prominent ; and this organ, on the
whole, presents a most striking appearance of irritation and sub-
inflammation in this disease than in any other type of fever. The
pulse is usually deficient in fulness*; it is small, frequent, and com-
pressible, and approximates more to the typhoid than the synochoid
character. It is also accompanied by a lower temperature of the
skin ; and, in a word, displays none of the signs of that strong
re-action, which marks the early stage of synochus. It is distin-
.guished, however, from typhus by the comparative mildness of the
cerebral affection; the author has, indeed, been frequently sur-
prised at the clearness and integrity of the intellectual acuities, in
the midst of that extreme depression of the muscular powers which
characterises this type of fever. This disease is slow and gradual
in its access as well as its progress; the patient feels himself ill for
some time, affected with loss qf appetite, costive bowels, uneasi-
ness, and occasionally twitches of pain at the epigastrium and in
the abdomen, which continue until the febrile movement is deve-
loped, when the train of symptoms before described, sets in with
all its violence. The progress is also remarkably alow, the disease
being frequently protracted to the sixth or seventh week before
convalescence takes place. It is further distinguished from typhus
by the absence of petechia, a black crust on the tongue, or black
' sordes of the teeth and gums, which the author has never observed
in any of the clearly marked cases of this disease he has witnessed.
The bowels are either constipated, or too relaxed, and occasionally
these two states alternately succeed each other. The abdomen is
tumid, resisting and tender to the touch, when pressure is employed
externally ; — the sleep is uneasy, interrupted, and delirious ; but
when awake, the patient seems to suffer little diminution of his
intellectual powers.

" As a further proof of the real nature of this affection, it may
be stated, that the author has invariably observed, that In propor-
tion as the abdominal symptoms were mitigated or subdued, the
affection of the head and the febrile symptoms suffered a simulta-
neous mitigation or removal. The colour of the akin in this disease
is commonly one of the shades of yellow ; — occasionally the tint is

Dr. O'Brien on Fever in Dublin. 213

deep and dark, as in the case of Kitts (No. 1,) where it approached
to one of the lighter shades of mahogany. The intense bright yel-
low colour of the skin, peculiar to jaundice, and, we presume, to
yellow fever, has not occurred in this' hospital since the epidemic
fever of 1826; but, from the author's recollection of the cases
which then occurred, he is inclined to consider them as modifica-
tions of the disease we have been considering.

" Secondly. — The disease now described may be secondary, that
is, may supervene on typhoid fever, a predisposition being probably
fanned by previous disorder of the stomach and alimentary canal,
functional or organic, or by the prevalence of that 'epidemic con-
stitution or malaria which disposes to diseases of the stomach and
bowels, as cholera, dysentery. &c. This adjunct to typhoid fever
may occur at an early period of the disease, but it is more fre-
quently observed to accompany the advanced stages.

" In those cases, we are taught by numerous dissections made
by modern pathologists, that the principal, in many instances, the
sole seat of disease, is the lower part of the ileum, near its junc-
tion with the ctfcvm, which is probably to be attributed to the
densely glandular structure of this part of the intestine, and partly,
u we believe, also to its inferior situation, which favours the accu-
mulation of acrid secretions in this part. In a disease like typhus,
where the sensibility is greatly impaired, or even destroyed alto-
gether, this affection may exist, without being felt or complained
of by the patient ; but it will very seldom, indeed, mil to be de-
tected by careful examination externally, or by diarrhea, or a tym-
panitic state of the abdomen — which latter are its appropriate
eigne, when the patient is in a state of coma or insensibility.
Another of its symptoms, more rare than those above-mentioned,
is haemorrhage from the bowels, which, if superadded to a tympa-
nitic state, presents the most intense and hopeless form of this
affection. With respect to the colour of the alvine discharges of
this affection, it is stated by Dr. Bright, that they are generally
ochre coloured ; but the author has more frequently seen them of a
dirk or mnd colour, yet he has also frequently observed them as
described by Dr. Bright/'— p. 64.

Dr. O'Brien is of opinion tbat there are good grounds in
nature for dividing idiopathic continued fever into two great
classes, which lead to important indication of treatment;
synochse, or inflammatory fevers ; synochus and typhus, or
typhoid fevers; but between classes are various interme-
diate shades of type, which it is difficult to allocate to either
class. In the first class, the heart and arterial system are
chiefly affected, the seusorium and nervous system being
comparatively exempt from its influence. In typhus, the
brain, nervous system, and spinal chord are first affected,
aod through them the heart, arteries, and their capillary
extremities. The modifications of the various speeies will

214 Critical Review.

depend on the modifications of the morbific cause, or on
the original conformation or constitution of the sick ; but
here the relation between cause and effect is as vet beyond
our comprehension. In typhus, the prominent features of
the disease from first to last are nervous, modified by the
various degrees of arterial and vascular action by which
they are accompanied. The author proceeds to illustrate
the pathology of fever, and offers the following reflections
on tne subject, which shall conclude our remarks for the
present : —

" If we examine the first of the two species of typhoid fever,
(synochus) we shall observe the phenomena to succeed each other
in the following order : — first, a stage of nervous and vascular de-
pression ; secondly, a stage of vascular excitement or reaction ;
and thirdly, a stage of universal exhaustion and debility, announc-
ing a more complete depression of the nervous, vascular, and mus-
cular powers than in the first stage. In the perfect typhus again,
the whole series of phenomena exhibit only increasing degrees of
nervous, vascular and muscular depression; the power of arterial
reaction is annihilated, and the state of the system approaches to
that of general paralysis.* The outline of this description has
been already published by the author in the Annual Report of this
hospital, for the year 1814,f and the principles of practice which
flow from it inculcated in all his subsequent ones. Whether the
power applied to the sensorium, in this case, be sedative, as
Dr. Cullen thought, or excitive, is a question evidently beyond our
power to determine ; we merely know its visible and palpable
effects. This leads us to the consideration of the physiological
condition of the brain itself in this disease. It appears that in
every case of typhoid fever, at least the exceptions are so. rare that
they only serve to establish the rule, there is a determination of
blood to the head, sufficiently manifested by the red and injected
eye, the burning forehead, the throbbing temples, and the acute
head-ache, which accompany this disease at variable intervals of
time after its developement. This state of the organ is by some
called inflammation, whilst others, although they admit a determi-

• To this state the term adynamia has been applied ; bat the author is un-
willing to render a subject, sufficiently obscure in itself, still more so, by involv-
ing it in scholastic and ill-defined terms.

Every physician, we believe, who has treated this disease, will at once admit
that exhaustion and debility form one of the most striking and characteristic
symptoms of perfect typhus. We are far, however, from supposing that this
debility is the cause or essence of the disease, and we doubt if any modern
physician thinks so ; — we believe it to be a consequence— a symptom only, but
one of the utmost importance, and of which the practitioner should never loose
sight.

f " Tlie first train of symptoms are nervous, the second vascular, the third
vascular and nervous." — Annual Report for 1814.

Dr. O'Brien on Fever in Dublin. % 215

nation of blood, yet deny that the state induced possesses the cha-
racters of inflammation ; and the term congestion has been intro-
duced to express the condition of the cerebral vessels under those
circumstances. Thus it appears, that the dispute on this subject is
primarily one about words ; but it is also a dispute about the pre-
cise nature of inflammation itself, with which, in truth, we are but
imperfectly acquainted. We know, however, with certainty, and
to this fact, perhaps, our knowledge in every case of inflammation
is limited, that the ordinary condition of the brain in typhoid fever
is that of vascular fulness and distension ; but beyond the expression
of tins simple fact, strict philosophy will not permit us to proceed.
Dissection may, indeed, occasionally discover the vestiges of acute
inflammation in the brain ; but we believe, in the majority of cases,
it has failed to detect it. This condition of the brain, the author
holds to be consecutive, not primary, in the morbid series, which
constitutes the disease, but when once fully established, it becomes
itself a new source of morbid actions, re -acting on the sensorial
disorder which produced it; and thus, by its direct and reflex
influence, producing the characteristic phenomena of the disease.
But this condition, which may be called typhoid inflammation, may
also be propagated to other organs essential to life, as the lungs,
stomach, &c. ; and we are instructed by dissection, that nearly the
whole of the mucous surface, or internal lining of the body, is in
a state of vascular-distension in typhoid fever.

" 4thly. — We are not as yet sufficiently advanced in the science
of the animal fluids to determine what part the blood plays in the
generation of fever, but so far as experiments have been made, it
has been found, when drawn in the first or second day of perfect
typhus, but little altered from its natural state ; we know, how-
ever, with certainty, that in a short, but indefinite period after the
disease, the blood and other animal fluids suffer a manifest altera-
tion in their physical properties ; and thus, in their turn, become a
part of the morbid circle, which constitutes the disease.

" From all that has been above stated, it follows, as a necessary
inference, that M. Broussais's doctrine is chiefly erroneous in its
indefinite application and its universality, in extending the significa-
tion of terms, proper only to the species, to a whole class, and in
laying down as the etiology of the class what is only true of the
species.

" The author is far, however, from wishing to deprive M. Brous-
sais of his just meed of praise. Although the gastroenterite had
been previously accurately described by other writers, yet to him
belongs the merit of directing the attention of physicians in a more
particular manner to this disease, and more - clearly and completely
developing its pathology ; and hence, we do not hesitate to say,
that we number him among the improvers of practical medicine,
and the benefactors of mankind^

" Hie original describers of this species of fever, and not inferior,
perhaps, to any of their successors, were the German physicians
Hcederer and Wagler, who describe this disease as having prevailed

21ft Crkictil Retoieto.

at &ottrngen, in an epidemic fcrth, in the year 1760, (4* de Morbo
Mucoso") and whose work exhibits ail admirable history of its
symptoms, and morbid anatomy.

" The disease was subsequently described by M. Pinel, partly
under the titles of " Fievre Gastrique," and •• Ettbarras Gas-
trique," and partly tmder that of " Fievre Muqueux ;" and in
England, it has usually been known under the general appellations
6f bilious disorder, and bilious fever, titles inappropriate, and
which by no means express its real character. In FVance, ft again
became the subject of investigation by M. Petit and Serres, and
by M. Breaton&eau, and more recently, in an elaborate work by
M. Louis ; but all these authors appear to me to have confounded
the primary with the secondary form of the disease ; and M. Louis,
in particular, has adopted the theory of Broussais in its fullest
extent. In England the subject has received further illustration,
from the cases published b^ Dr. Bright, of London, and the trea-
tise pf Dr. Burne." — p.58.

IV. — A System of Medical Nosology. By I. M acbraire,
M.D. L.E. Member of the KoyaJ College of Surgeons,
Edinburgh, Assistant Physician to the London Hos-
pital, Physician to the London Dispensary, Vice Presi-
dent of the Hunterian Society, &c. : sm. 8vo. pp. 107.
Latin and English. Longman and Co. 1830.

The, importance of nosology, the doctrine or science of
diseases, to the healing art, leads us to notice the volume
before us;— we should hail an unquestionable improve-
ment in this branch of medical literature as the greatest
boon the press could afford us.

Nothing shows this importance more clearly than the fol-
lowing consideration: — every individual, on commencing
the study of physic, must adopt some methodical arrange-
ment of the subject ; he must have a text book or a guide
to his inquiries ; the subject is one which will not admit of
an artificial and arbitrary disposition, principles must form
its basis, and, in the present state of our knowledge,
theories Will enter into its. composition,, by which means,
opinions are formed and prejudices are engendered ; these
become the prevailing doctrine of the day, and rooted first
impressions from this source alone, have operated and con-
tinue to operate, powerfully and wofully in retarding the
progress of inquiry and improvement.

That the system of Dr. Cullen effected much good, at
the period which gave birth to it, and that its author was

Dr. Macbraire on Nosology. 217

deserving of the hi^h encomiums with which he met ; that
his genius, simplicity, ingenuity, intrepidity, and perse-
verance, will claim the admiration and thanks of physicians
for ages, and that an acquaintance with it is necessary to
a medical education, : — even now, that its errors and inade-
quacy have become a trite and universally accorded theme,
we, in common with his greatest admirers, are willing to
allow ; but that,

"The recent improvements*' (our author means since the
time of Cullen,) " made in the medical science, have been
so numerous and of so important a character, that some
change appears indispensably necessary in the system of
nosology, which has been so long the student's text book,"
is equally evident, and has been acknowledged by the pro-
fession at large for years past. The prevalence of this
opinion has £iven origin to various new systems ; those of
Macbride, Crichton, Darwin, Parr, Young, and last in series,
but first in importance to the physiological system of the
late Dr. Mason Good.

The Cullenian system, so ably propounded by its master,
and so enthusiastically supported by its admirers in every
school of importance in Europe, was for years the text
book of physic ; in process of time it became inadequate
for its purpose, ana has long been gradually falling into
disuse and disrepute ; moreover, with the system the science
itself has sunk in the scale of importance, and instead of
being looked upon as one of elementary consequence, it is
totally neglected by the medical student of every class, and
by the practitioner is referred to more as an object of
curiosity than one of necessity, or as having any direct
beneficial tendency.*

One principal cause for this neglect, has been the total
exclusion by the different examining bodies of a knowledge
of nosology, as a necessary qualification for those about
to enter the profession ; and this again may probably be
accounted for by the consideration, that the system of phy-
sic of Dr. Cullen came into the world with a species of
authority which none other since has had the advantage of;
it held its domain supported by the highest talent and the
greatest enthusiasm, until " The March of Intellect'9 out-
stripped its popularity, and that it has not been superceded
by any other, is admitted universally to be preferable.

Our author's intention is to improve upon Cullen9 s Trea-
tise, and to render it " more in conformity with the pre-

• Dr. Cullen's Nosology is still a Text Book in Edinburgh.— Ed.
Vol. v. ho. 27. * b

218 Critical Review.

sent advanced state of medical knowledge " principally
for the use of " students,9* as a " text book ; we shall
give our readers a brief statement of this performance,
closing with one or two observations.

We must premise, however, that the production of our
author is a complete failure, it is objectionable in classic
beauty, in arrangement, both natural- and scientific ; is
even inferior to Cullen's nosology, and cannot be compared
to Good's. The author should have made himself master
of all the nosologies extant, and improved upon them ; but
on the contrary, he seems to be unacquainted with many
of them.

In the first place, we have three classes corresponding to
those of Dr. Cullen, the names only being altered from
pyrexia, neuroses, and cachexia, to angloses, neurica,
and cachexii, to which is added a fourth class-— cutanea,
and the class locales of the prototype, is rejected alto-
gether.

Instead of five orders in the first class, we have here only
two— febres and phlegmases ; the exanthemata are al-
lowed to a genus of continued fevers; the hemorrhagic
are denied a place in the system as being only the sequel
of diseases ; and of the profluvia, catarrhus is a species
of phlegmases, viz. bronchitis and dysenteria, a variety
of another species of the same order — clonitis chronica.
The febres are divided into continues and interm&tentce,
with a definition, the first comprising four, and the latter
three genene ; in the phlegmases we find a similar division
into p. membranarum mud p. viscerum ; we have four genera
of p. membranum, according as the cellular* mucous, se-
rous or fibrous textures may be effected; but the nine
species of which the p. viseerum is composed* hare too
generic distinctions whatever.

The second class, or neuricae, has two orders, encepha-
licee and nervosae, each containing two genera. The ence-
phalica relationeSy comprise the comata and several of the
Spasmi of Cullen. Encephalicar mentales*, answers to the
order vesaniae ; nervosa vita ctnimalis has only the one
species neuralgia, and nervosa vita organic* is made up of
the principal remaining genera of the order spasnri reduced
to species.

Class. 3.—Cacheorii has no ordinal division, it comprises
four genera only ; viz. scrophulus, scorbutus, syphylus, and
phthisus. The marcores and intumesentise, including all
dropsies, are like the haniorrhagiaa, denied a plaoe in the
arrangement, as being " sequela morborum"

Dr. Maebraire on No#olqgy. 219

In class 4, cutanea, the arrangement of Willan, is adopted,
with the exception that the order exenthemato, pemphigus
of the order bullae, variola of the order pustules, and vari-
cella, miliarias and aphtha of the order vesioulee, are trans-
ferred to class the first.

As specimens of the ability of the doctor to form genuine
and specific essential character, we select the following : —

" CL 1. Or. 1. Div. 1. Gen. 4. Exanthematicse Sp. 3. Scarla-
tina febris aniens contagiosa. Quarto morbi die fades aliquantum
tumens : aimul in cute passim rubor floridus, papulis exigius tandem
ooakscentibus, post tres dies in squamulas furfuraceas abientibus
inflammatione tonsillane seepe comitante, dein saepe supervenien-
tibia pulmonam oedemate et anas arcs.

" CI. 4. Or. 1, Gen. 1. Strophulus.

" Papulae, infantum cutem occupantes.

" CI. 4. Or. 1. Gen. 2. Lichen.

" Papulae, adultorum, et infantum cutem occupantes.

This brief statement will be sufficient for our readers to
form an opinion of the merits of the plan. In regard to
the nomenclature, the examples given serve to show that by
its adoption we should incur all the inconveniences resulting
from a change of names, without any of the advantages ex*
pected to be derived from one corrected and simplified
throughout ;-— we are surprised the learned author, occu-
pied in such an undertaking, should retain such terms as
tearlatinis, scorbutus, &o. The higher division of the sys-
tem are unprecedently irregular and imperfect ; the clauses
ire insufficient in number to comprise the whole catalogue
of human maladies ; and we may remark in passing, that
the locales of Cullen, or the anomalae of Sauvage, are far
preferable to no place whatever, for a great variety of dis-
eases in a system of nosology ; the principle which ex-
eludes hemorrhages and dropsies might be applied to many
affections admitted; again, the generic and specific defini-
tions are either diffuse or obscure ; of the former there are
only about forty-six in number. We could point out many
irregularities, and a deviation from scientific principles in
their construction, but this article is sufficiently extended,
aad enough has been said to answer every useful purpose.

In conclusion, we cannot help expressing our surprise
that the learned gentleman should have taken no notice
of the systems which have intervened between his own and
that of Dr. Cullen, and that in his preface he treats the
'object as if such authors had not existed. As we find
Dr. Good's name frequently quoted in the notes, we pre-
sume he was well acquainted with that physician's works, and

220 Original Communications.

with his physiological system of nosology ; a production
far superior to any other which has appeared upon the
subject, the general adoption of which by teachers and
examiners, and the consequent revival of nosology as a
necessary branch of education would, we believe, contri-
bute greatly to the best interests of the profession ; and
we do not hesitate to recommend it strenuously to those of
Dr. Macbraire's pupils, who have advanced as far as the
study of medicine.

ORIGINAL COMMUNICATIONS.

I.— Observations on Judicious Necrotomy.

I shall be glad, through the medium of your excellent
Journal, to lay before the members of the profession two
points for consideration, hoping that in some way cr other
they may be attended with advantageous results, though
they may be neither very speedy, nor at first of a very deci-
sive nature. One of the matters in question is of incessant
recurrence ; the other is comparatively rare, but connected
with considerations of no small importance.

The slovenly manner in which the coroners of this country
generally discharge their office has long been proverbial ;
but there is no doubt that they are frequently encouraged
in carelessness, if not led into error, by medical practi-
tioners. I hold it to be an axiom, that very rarely will any
of us be able to assign the indubitable cause of a person's
death, without el post mortem inspection of the body. We
may, it is true, form a tolerable accurate opinion where we
have had access, to observe a train of symptoms during*

Erior disease — at least for private satisfaction ; but when it
ecomes a matter of positive statement upon oath, and the
death has been sudden, he must be very presumptuous who
would venture before the public with a confident assertion,
that may brine an innocent person to the bar of a tribunal
on a charge affecting his life— or (what is not at all impos-
sible) so speak, and speak in ignorance, as to let a guilty
assassin escape.

But there is connected with proceedings of this nature, a
question of economy, of a more sordid description cer-
tainly, to which I hope that the attention of the profession
may with propriety be drawn.

Observations on Judicious Necrotomy. 221

Any medical man is liable to be summoned before an
inquisition ; and if it so happens either that his knowledge
of the case is limited, or that he is called upon for an
opinion as to its nature, he will seldom indeed be in a con-
dition to speak to the cause of the person's death. We
may suppose such a course of examination to be entered
upon as the following : — " To what do you attribute the
death of this person V " I cannot tell without having the
body opened." " But by means of that operation you
could 1" " In all probability a very accurate opinion would
then be formed/' " Have the goodness to proceed to make
the necessary examination.91 " I am willing to perform any
professional act, but I require reasonable remuneration for
my loss of time in doing it, for the trouble, risk, and re-
sponsibility which 1 must incur ; and my demand is —."

There is no fund out of which the medical man can be paid
this just and equitable demand ; and it has sometimes
happened, that the jury has been obliged to separate with-
out coming to any other decision than that they had found,
or been shewn a dead body. This is a mockery of the mat-
ter altogether. But in some instances the parish surgeon
performs the operation, and receives an inadequate fee for
so doing ; or it may be that this cast of his office is included
in the general contract ; and it is not likely that a sufficient
and intelligent examination will be instituted where the ob-
ject with all parties is to get through the business as rapidly
as possible, and give as little trouble as may be.

I consider this to be one of the causes of the failures so
remarkable on the part of medical witnesses on capital
trials arising out of inquisitions. The preliminary steps are
taken so inefficiently, that the proceedings before the coro-
ner, and the opinion solemnly pronounced by his jury as to
the perpetration of a wilful murder, are frequently, very
frequently, perhaps it would not be too much to say most
frequently, overturned upon more accurate investigation,
aod the medical witness finds the opinion given by him for-
merly, and for which instances might be quoted, of votes
of thanks, most completely refuted, often by himself ! Let
the medical man be paid for assisting to promote the ends
of public justice, as well as the coroner, or any other func-
tionary, and then deal smartly with him if he do not per-
form his duty. It is gross nonsense to talk about throwing
impediments in the way of justice. * Public justice is not
a pauper, and her proceedings ought not to depend on
gratuitous contributions of labour and skill any more than
of money. I exhort the profession to insist upon an equit-

2S& Original Communications.

able stipulation for such important services ; and where it
is refused, decline to assist. The coroner can compel
attendance for the purpose of telling what we know ; but
I Question much his power to order us to seek knowledge.

The other point for consideration 1 shall state very briefly,
and I have no desire to interfere with abstract questions,
either of a legislative character, or matters of personal
feeling on the part of our brethren ; believing? myself, at
the same time, to be exempt from all unusual squeamish-
ness and affected delicacy. But I must declare that 1 look
upon the part which surgeons (for it professedly devolves
upon them) perform in the punishment of convicted mur-
derers, to be rather at issue with their true respectability.
This question has been repeatedly discussed, and 1 am
quite willing to leave every one to the enjoyment of bis
own opinion, without wishing to think the worse of bim
for not considering himself in a situation analogous to that
of a public officer, whose respectability is not rated very
high. I admit readily that to teachers of anatomy, the pre-
sent of a healthy subject is a boon, and such of course do
right in accepting of it, But there are many practitioners
throughout the country to whom the consignment must be
quite the reverse, and my object, on the present occasion,
is to inquire by what law any surgeon whatever is compelled
to dissect and anatomize the body of a murderer? At pre-
sent I know of nope; and with all my desire for the spread
of anatomical knowledge, I question whether it would not
do good, if difficulties were made about carrying this part
of the sentence into effect. The law would, in some way
or other, have to be altered* and I think the interests of
anatomy would gain,. For my own part, were I living in a
country town, and the authorities call on me to assist is
punishing a felon, any way connected with professional acts,
whether by trying a dangerous remedy upon him while
living, putting him to death by means of poisons or sur-
gical operations, or dissecting and anatomizing him after
the executioner had done bis part of the process, I say,
I might possibly seek to know by what act of parliament I
am compelled to join in this sort of business, if I do not
choose it; and whether, if J choose to undertake the ear*
nificious office, I should not be entitled to remuneration
from the county fund }

These views of the subject are not, as fer as I kn^w,
entertained in any other quarter; but as I do not pique
myself unduly upon their importance, I consign them to
the pages of the London Medical and Surgical Journal,

Dr. Ryan on state of the Medical Profession. 823

without the publication of my natne. The editor know*
whence they came, and will be satisfied ae to (he nature
of my motives in forwarding them.

IL— Dr. Ryan on state of the Medical Profession.

The dubious state of the English law on the right of
apothecaries to demand compensation for their attendance,
has {riven rise to a svstem injurious to the profession and
public, that of presenting an unnecessary quantity of medi-
cine, and by this means acting contrary to their own feeling's
as men of education, and virtually imposing upon the public.
Tbey must have some remuneration for loss of time, or how
are they to support their families and establishments? Can
it be expected that an apothecary or sorgeon apothecary in ex-
tensive practice m London, will spend his time in driving from
ooe part of this immense city to the other, without some com-
pensation for his services ; and this he is compelled to acquire
in the disreputable manner already mentioned. It will be said
by physicians and surgeons, that the general practitioners,
aa they are unclassically denominated, are intruders, and
have no legal right to practise medicine and *urgery. No
doubt they have too legal right to practise physic or surgery ,*
but it is equally clear that they are patronized and generally
employed oy the public. The want of such a class of prac-
titioners arose from the exorbitant fee for medical attendance,
physicians and surgeons demanding a guinea for every visit
or prescription, a sum much more than the majority of society
can afford. The junior members of these professions are
compelled to make the same demand, and in this way the
public to a great extent are precluded from procuring the ad-
vice or attendance of physicians and surgeons. The apothe-
cary becomes the general practitioner, because people will
prefer his opinion to their own, and especially as tie is con-
sidered entitled to no fees. This line of practice has become
to general, that some few doctor^ and a large proportion of
surgeons have adopted it. The character of this body of
practitioners, however, is naturally less esteemed by the pub-
lic, as they are compelled to sacrifice reputation to interest,
and to subject themselves to the humiliating mortification of
being compounded vtith druggists and chemists, while the

* i - * * . *

* The laws relating lo the Medical Profession. By J. W. WUlcojk, Eflfc.
Bvrfeter at "Law. London, 1830.

224 Original Communications.

legitimate physicians and surgeons regard them as intruders,
and treat them with jealousy or contempt. As the law was
said to allow no compensation for aavice, they were ac-
counted unreasonable when they made a specific charge for
attendance ; and they were obliged to order an unnecessary
quantity of medicine, and charge a high price, to remunerate
tnem for attendance, to thegreatannoyance of the public, and
to the degradation of the profession. From this mode of re-
munerating general practitioners, which is distressing to the
, majority of that body, and which is happily at an end, by a
recent decision of the King's Bench, the sick were obliged
to take more medicine than was required for the cure of their
disease ; and this is still too often tne case, when a physician
is called in by the attending apothecary. The esteem and
veneration entertained for the profession at large are di-
minished, the medical character is lowered and degraded by
this state of things, and the public confidence fn the healing
art is so much injured of late, that many deprive themselves
of its aid altogether. The profession, though brought to a
degree of perfection hitherto unequalled, has its dignity and
degrees so despicably fallen, that the most illiterate assume
and usurp its titles, and the university graduate is almost
ashamed to be styled Doctor, since he must share his title in
common with the surgeon, the apothecary, the chemist, the
druggist, and the nefarious quack. Every man may stile
himself Doctor, and impose on the public with impunity.
Such is the state of physic in London, in 1830. The English
apothecary however is as much " sinned against as sinning.19
He is obliged to receive a medical and surgical, education,
expend five years in acquiring pharmaceutical knowledge,
and undergo examination, oefore ne is legally qualified. He
then commences his profession, and has the mortification to
discover that any man may usurp his rights, by placing the
words chemist and druggist over his door. He also learns that
his illiterate rival, who has received no medical education,
robs him of his real vocation, the composition of medicine,
vends drugs at half the price he charges, compounds nearly
all physicians' prescriptions, prescribes for the sick ; in a word
is physician, surgeon, apothecary, and obstetrician. The
Apothecaries' company have the power to prevent all this
abuse, if they would only do their duty. In Scotland, the
surgeon apothecary must be a licentiate of the Royal College
of Surgeons of Edinburgh, and. must have received an ex-
cellent medical and surgical education.

In Ireland, the apothecary is not obliged to receive a me-
dical or surgical education, though he practises every branch
of the healing art, and has his peculiar rights infringed on,

Dr. Ryan on the state of the Medical Profession. 225

especially in the remote parts of the country, by his old
colleague the grocer.

Under all these circumstances, can it be expected that the
regular physician or surgeon ought to meet the general prac-
titioners of this empire, and those who assume the title of
such in consultation ? The Colleges of Physicians and Sur-
geons have invariably decided in the negative. If the mem-
bers of each branch of medicine received the same educa-
tion, of course there could be no objection to their meeting
io consultation ; but this has never been the case, and
therefore the law and the public have wisely decreed a dis-
tinction of medical practitioner*, which no class of the faculty
can destroy. That it is quite preposterous to attempt it, the
recent history of medicine in this country amply testifies. It
may be said, that the science and art of medicine are " one
and indivisible," and therefore ought to be studied and prac-
tised by every member of the profession. Granted, if every
man could either comprehend or understand the science and
the practice of the healing art, but as yet no man has had
the temerity to boast of a perfect knowledge of the subject.
Hippocrates, who afforded the best evidence of the most ex-
tensive knowledge of the various branches of medicine' of
any of his successors, candidly acknowledged that he bad
not arrived at the end of physic. But now a days, it is se-
riously asserted, that every young gentleman of one and
twenty, who qualifies at the Apothecaries' Hall, or Royal
College of Surgeons, is perfectly acquainted with medicine,
and competent to treat all diseases incidental to humanity.
Such is the march of intellect of the age. Unfortunately
for this assertion, the most eminent members of the profession
are of a different opinion. They unanimously maintain that
no man, however talented, can be a complete master of the
seience and practice of medicine in its full acceptation, that
every man ought to acquire as much information as possible
m all its branches ; but that the practice of any one branch
is as much as he can undertake with satisfaction to himself,
or benefit to mankind. Such is the received opinion, with
respect to practice in the large cities, in which a division of
the practice of medicine is universally observed. After alt
that has been stated on the contrary, there is no instance in
the history of the profession, of one individual having pro-
duced a good system of physic, surgery, midwifery and
pharmacy, much less a complete system. The reason is
obvious, any one of these branches is sufficiently extensive
to occupy the mind ; but a complete knowledge of all is far
beyond tne limits of the human understanding. If this

Vol. v. no. 27. r v

386; Original Communication*.

position be admitted* and where is the well educated phy-
sician or surgeon who can deny it, it follows thai the division
of the medical profession is consonant with reason, ootnmon
sense, and expediency.

Tbk division however is most valuable to the affluent ;
and is manifestly injurious to the great mass, of society* the
middle and lower classes* who are precluded from enjoviAg
the advantages it affords. To supply the wants of these
classes, the general practitioners are supposed to be neces-
sary, indeed. indispensible, though this is very doubtful when
we consider how easily the aid of young physicians and sur-
geons may be procured, as well as the aid of their seniors
at the numerous charitable institutions. But the lowest class
of society ought to be enabled to purchase the services of
well educated practitioners, and this could be easily accom-
plished, by regulating fees according to seniority, the fee of
the junior being such that all might afford to give it. This
plan has been adopted in France and other countries^ with
the best, effects to the profession and the public. The young
physicians and. surgeons of France, men of the first rate
education <and talents* some of them the best writers- of the
d<ty, take fees of one, two, three, five, ten francs, aud so oa to
Oi*e or two louis, according to their standing ; and this plan
does , not degrade their characters any more than the supal-
tem officer or midshipman is degraded by his situation, or
the admiral or general by having passed through the lower
stations, or the clergy who receive their tithes in proportion
to the wealth of individuals. Were the medical profession
in this country to follow this example, there would be no
inducement to prescribe unnecessary medicines, a great many
uselps^if not dangerous practitioners might be spared, young
physicians and surgeons would be employed, who under
the present circumstances have no chance of practice in
consequence of requiring fees similar to their seniors, and
who must commence their career, after an expensive, educa-
tion, by affording gratuitous advice. The change would ele-
vate the medical character, by removing the temptation to
many degrading* practices, ,nov? too common among all
classes of practitioners. Though this regulation of remu-
neration is. not formally adopted by the legal heads of the
profession, still it is sanctioned by the majority of physicians
and surgeons in this metropolis to a certain extent, as the
mpst eminent accept a fee of half a sovefiegn for.adviqe at
their own .houses. This is not generally known, but it is a fact;
apd many talented young barristers accept a similar fee for
chagdbgr advice. The Apothecaries' company of Ireland
have regulated the fees of the respective grades of their body,

Dr. Ryan on the state of the Medical Profession. 227

apprentices, afes&t&flt* and licentiates. The apprentice is
entitled to half a orown, thb assistant to a crown, atttd the
muter to ten shillings for each visit, or to a guinea if called
tfp at night. These feee are regularly -charged and paid.
The price of medicines, draughts, mixtures, pills, boluses, fee.
ate regulated, and Ae bills of apothecaries may be taxed at
the Hdl in Dublin There is no power given by the Irish Act
34 Geo. 3. to regelate fee*, or the price of medicine, but 'the
onifto of law have repeatedly decided upon the legality of
the proceeding. This is a good hint to the company in this
country, whose powers are much mere extensive, by the 55th
Geo. 4>. Besides the decision' in the ease of Hendy v Han-'
•on has established die right of English apothecaries to fees,

Kviddd they charge a fair anrimoderate price for medicines.*
b good -effects of this decision will be speedily felt by the
profession, and in-due tune by the public. According tothe '
present system the British ana Irish apothecary, by whom the
medicines prescribed by physicians are presumed to be pre-
pretf, is scarcely ever in his shop. Themoment he receives
lis licence he ceases to be an apothecary. Prom that mo-
ment he considers himself a< general practitioner, and regards
bin business as a secondary pursuit. He procures a school
boy as an apprentice, and to him is intrusted the serious and
importMtt office of compounding medicines. The most ac-
tiv« poisons are placed within his reach, and are at his dis-
posal. That dmoue accidents, and even die destruction of
nfe occur from this cause, the public prints daily inform us.
The fact is, there is no such person as the law.styles apothe*
cary in the British dominions. The apothecary prescribes in
all eases, he seldom permits a physician to be employed un-
ices he considers the patient. past recovery ; and the physician
called in by the apothecary conceals his mistakes, and often
consults hhn precisely as if be was a regularly educated prac-
titioner. In extreme cases the presence of the physician only
serves to hide the blunders, had protect from blame the to-
6o*ipetency of the former attendant, but the physician who
is a party to the delusion, can be actuated only by corrupt and
mercenary motives. He mutt also act against his conscience
m prescribing or sanctioning much more medicine than is
necessary, though it is an axiom, that " the best physician is
he who orders the least medicine.* ' The practice of consult-
ing with apothecaries leads to this monstrous state of things,
and the majority of apothecaries themselves feel the bad
effects of the system, as well as every one eke, and would

• Willcock, op. cit.

228 . Original Communication*.

never lend themselves to it; unless actuated by necessity.
But the surgeons infriuge upon the physicians as well as the
apothecaries, and this has been so much felt that the Royal
College of Physicians in London, cautioned certain eminent
surgeons against the practice ; a caution which was despised
in the teeth of the law. The fact is, we have the various
classes of the medical profession, educated and illiterate, en-
croaching on the rights and privileges of each other, in-
trenching beyond the lawful boundaries, violating treaties
and engagements, and openly transgressing against the
laws. This will appear very obvious, by a reference* to the
valuable treatise of Mr. Willcock, already quoted. Under
such circumstances it is impossible for harmony and good
feeling to be cherished by tne profession. The want of an
esprit de corps, so remarkable in other professions, exposes
ours to disrespect and contempt in the eyes of the public.

It would far exceed the limits by which I am circumscribed,
were I to attempt to enumerate the defects of the medical
profession in tnis country ; I shall, however, attempt to
depict the most prominent of them when detailing the laws
relating to the practice of medicine. Notwithstanding all the
abuses detailed, the finest feelings of our nature actuate us
\n the discharge of our professional duties. The institutes
of our conduct are not exceeded in excellence by those of
any other profession. The preceding sketch of ethics attests
the fact. To return to the pleasing subject of ethics, we
have to enumerate a few other rules which guide the higher
orders of the profession, and which were proposed by
Dr. Percival.

Whenever a physician or surgeon officiates for another,
who is sick or absent during any considerable length of time,
he should receive the fees accruing from such- additional
practice: but if this fraternal act be of short duration, it
should be gratuitously performed; with an observance
always of the utmost delicacy towards the interest and cha-
racter of thd professional gentleman, previously connected
with the family.

Some general rule should be adopted by the faculty, in
every town, relative to the pecuniary acknowledgments of
their patients ; and it should be deemed a point of honour
to adhere to this rule, with as much steadiness, as varying
circumstances will admit. For it is obvious, that an average
fee, as suited to the general rank of patients, must be an
inadequate gratuity from the rich, who often require atten-
dance not absolutely necessary ; and yet too large to be ex-
pected from that class of citizens, who would leel a reluc-

Dr. Ryan on the, state of the Medical Profession. 229

tanee in calling for assistance, without making some decent
and satisfactory retribution.

But in the consideration of fees, let it ever be remembered,
that though mean ones from the affluent are both unjust and
degrading, yet the characteristical beneficence of the pro-,
fession is inconsistent with sordid views, and avaricious ra-
pacity. To a youn^ physician, it is of great, importance to.
have clear and definite ideas of the ends of his profession ;
of the means for their attainment ; and of the comparative
value and dignity of each. Wealth, rank, and independence,
with all the benefits resulting from them, are the primary,
ends which he holds in view ; and they are interesting, wise,
and laudable. But knowledge, benevolence, and active vir-
tue, the means to be adopted in their acquisition, are of still
higher estimation. And he has the privilege and felicity of
practising an art, even more intrinsically excellent in its me-
diate than its ultimate objects. The former, therefore, have,
a claim to uniform pre-eminence.

Dr. Percival adds in a. note ; at a period when empirics and
empiricism seem to have prevailed, much in Rome, the ex-,
orbitaht demands, of medical practitioners, -particularly for.
certain secret compositions which they dispensed, induced
the Emperor Valentinian to ordain, that no individual of the,
faculty should make ah .express charge for his attendance on
a patient; nor even avail himself of any promise of remu-*
Deration, during the period of sickness ; but that he should
rest satisfied with the donative voluntarily offered at the close
of his ministration.* By the same, law, however, the Emperor
provided that one practitioner, at least, should be appointed
for each of the fourteen sections into which the Koman
metropolis was divided with special privileges, and a com-
petent salary for his services; thus, indirectly, yet explicitly
acknowledging, that a physician has a full claim in equity, to
his professional emoluments. Is it not reasonable, therefore,
to conclude, that what subsisted as a moral right, ought to
have been demandable, under proper regulations, as a legal
right ? For it seems to be the office . of law to recognise
and enforce that which natural justice recognizes and sanc-
tions.

The Roman advocates were subject to the like restrictions,
and from a similar cause. For their rapacity occasioned the
revival of the Cincian ordinance—", qua cavetur antiquitas,
*e quis ob causam orandam pecuniam donumve accipiat"
But Tacitus relates, that when the subject was brought into,

• Vide Cod. Tbeodos. Lib. XIII. Tit. III.

S30 Original Oonwamnkxtions.

discussion before1 Claudius Cmsar, amongst other aiguincsru
in favor of receiving fees, it was forcibly Urged mUmtu stu-
dioram prrtiis, etiam stadia peritura ; and that in conse-
<}<tfsnfee, the prince " capiendis pccunii* posmit modum usoue
ad d&ut sestertia qua egrem repetundartm ttnerentur. *

A precise and invariable modus, however, would be inju-
rious Doth to the barrister and die physician, because the lees
of each ought to be measured by the value of bis time, the
eminence of his character, and by his general rule of
practice. This rule, with its antecedents-, being wfell known,
a tacit compact is established, restrictive on the chums of the
practitioner, and binding on the probity of the patient. Law
cannot properly, by its ordinances, establish the custom,
which will and ought to vary in different situations, and
under different circumstances. But a court of judicature,
when formally appealed to, seems to be competent to autho-
rise it if just, and to correct it if unjust. Such decisions
could not wholly change the honorary nature of fees ; because
tlhey would continue to be increased, at the discretion of the
affluent, according to their liberality4 and grateful sense of kind
attentions ; and diminished, at the option of the physician, to
those who may from particular circumstances, require bis
beneficence.

From the Romian code, the established usage, in different
countries of Europe, relative to medical fees, has: probably
originated. This usage, which constitutes common law,
gi&etn* to require considerable modification to adapt it to
the present state of the profession. For the general body
of the faculty, especially in the United Kingdoms of Great
Britain and Ireland, are held in very high estimation, on
aecount of their liberality, learning, and integrity. And
it would be difficult to assign a satisfactory reason why tbey
should be excluded from judicial protection, when the just
remuneration of their' services is wrongfully withheld. In-
deed, a mfcdioal practitioner, one especially who is settled
in a ptfbtincial town, or in die country, may have accumu-
lated claims from long protracted and even expensive atten-
dance ; and his pecuniary acknowledgments may be refused
from prejudice, from captiousness, from parsimony, or from
dishonesty. Under such circumstances, considerations of
benevolence, humanity, and gratitude, are wholly set aside :
for when disputes arise, they mast be suspended, or ex-
tinguished ; and the question at issue can only be decided
on the principles of commutative justice.

Lib. XL Ptg. 109. Edit Upsii.

Dr. Ryan on. the state of the Medical Profession. 231

All member* of the profession, including apothecaries
well as physicians and, surgeons, together with their wive*
and children* should he attended gratuitously by any one or
more of the faculty, residing near them, whose, assistance
naay he required, , For as solitude obscures the judgment,
and is accompanied with timidity and irresolution, men
dical men, under the pressure of sickness* either as affect-
ing themselves or their families* are . peculiarly dependent
upon each others But visits should not be obtruded officir
omLy> as such unasked civility may give rise to embarrass-
ment, or interfere with that choice, on which confidence da*
{tend*. Distant members, of ,the faculty, when they request
attendance* should, he expected to defray the charges of
travelling. And if their circumstances be effluent, a pecu-
niary acknowledgment should not be declined ; for no ob
ligation ought to be .imposed, which the party would rather
compensate than contract

When a physician attends the wife or child of a member
of the faculty, or any: person very .nearly connected with
him, he should manifest peculiar attention, to his opinions,
and tenderness even, to nis. prejudices. For the dear and
important interests which the one has at stake, supersede
e?ery consideration of, rank or seniority in the other ; since
the mind of a husband, a father, or a friend, may receive
a deep and lasting wound, if the. disease terminate fatally,
from the » adoption, of means he could not approve, or the
rejection of those he wished to. be tried. Under such deli-
cate draimstanees,. however, a conscientious physieian will
sot lightly sacrifice his judgment ; but will urge, with pro-
per confidence, the measures he deems to be expedient, be-
fore he leaves f hq final decision concerning them to his more
responsible coadjutor.

Clergymen, who experience the. res augustas domi, should
be visited gratuitously by the faculty. And this exemption
ahould be an acknowledged rule, that the feeling of indivin
dual obligation may be rendered less, oppressive* But. suoh,
of the clergy as are. qualified, either from their stipends or
fortunes, to make a reasonable remuneration for medical
attendance, are not. more privileged than any other order of
patients. Military or naval subaltern, officers, in narrow
eirciimstanee*, are also proper objects of professional libe-
rality.

As the first consultation by letter imposes much more
trouble and attention than a personal visit, it is reasonable,
on such an occasion, to expect a gratuity of double the
swal amount. And this has loaj» been the established
practice of many respectable physioians. But a subsequent,

232 Original Communication*.

epistolary correspondence, on the further treatment of the
same disorder, may justly be regarded in the light of ordi-
nary attendance, and may be compensated as such, accord-
ing to the circumstances of the case, or of the patient.
. Physicians and surgeons are occasionally requested to fur-
nish certificates, justifying the absence of persons who hold
situations of honour and trust in the army, the navy, or
the civil departments of government. These testimonials,
unless under particular circumstances, should be considered
as acts due to the public, and therefore not to be compen-
sated by any gratuity. But they should never be given
without an accurate and faithful scrutiny into the case ; that
truth and probity may not be violated, nor the good of the
community injured, by the unjust pretences of its servants.
The same conduct is to be observed by medical practi-
tioners, when they are solicited to furnish apologies for
non-attendance on juries ; or to state the valetudinary in-
capacity of persons appointed to execute the business of
constables, churchwardens, or overseers of the poor. No
fear of giving umbrage, no view to present or future emo-
lument, nor any motives of friendship, should excite to a
false, or even dubious declaration. For the general weal
requires that every individual, who is properly qualified,
should deem himself obliged to execute, when legally
called upon, the juridical and municipal employments of
the body politic. And to be accessory, by untruth or pre-
varication, to the evasion of this duty, is at once a nigh
misdemeanour against social order, and a breach of moral
and professional nonor.

The. use of quack medicines should be discouraged by the
faculty, as disgraceful to the profession, injurious to health,
and often destructive even of life. Patients, however, under
lingering disorders, are sometimes obstinately bent on hav-
ing recourse to such as they see advertised, or hear recom-
mended, with a boldness and confidence which no intelligent
physician dares to adopt, with respect to the means that he
prescribes. In these cases, some indulgence seems to be
required, to a credulity that is insurmountable And the
patient should neither incur the displeasure of the physician,
nor be entirely deserted by him. He may be apprized of
the fallacy of his expectations, whilst assured, at the same
time, that diligefnt attention should be paid to the process
of the experiment he is so unadvisedly making on himself,
and the consequent mischiefs, if any, obviated as timely as
possible. Certain active preparations, the nature, compo-
sition, and effects of which are known, ought not to be
prescribed as quack medicines.

Dr. Ryan on the state of the Medical Profession. 233

Among; the various kinds of imposture practised in po-
lished society, quackery bas been the most successful, in
consequence of the inestimable value justly set on health.
It is unnecessary to expatiate on this theme, as it is gene-
rally acknowledged. The whole of our medical laws were
enacted for the suppression of empiricism, but at no period
of our history was it so general as at present. In every
other nation in Europe it is suppressed, quack nostrums are
prohibited, and it is only in this enlightened country they are
tolerated, and blazoned forth as cures for incurable dis-
eases. The Colleges of Physicians possess power to abate
this evil, but on this and every other occasion they have
neglected the interests of medical science and the public.
They have calmly and heedlessly witnessed the degradation
of the profession. The grand secret of the encouragement
of quackery is this, that the government derives an im-
mense revenue, at least £.100,000 annually, from stamp
doty on patent medicines and quack advertisements. During
the last session of Parliament, it was admitted that the
revenue on patent medicines, in England alone, and ex-
clusive of advertisement duty, which was treble the sum at
least, was £30,000 a year. The duty derived from this pol-
luted source in Scotland and Ireland was not stated. The
income estimated above, is obviously less than the real
amount. How disgraceful to the British pharmacopoeias is
this state of things, and yet the framers ot the pharmaceu-
tical codes are perfectly indifferent about the matter. It
would be an insult to the reader, to offer serious proofs of
the injury inflicted by unrestrained empiricism, both on the
profession and public. We shall dismiss the subject by
observing, that quacks are subject to two years imprison-
ment in France, or to be sent to the galleys for five years.
Again, no man is allowed to practise obstetrics unless duly
educated, even midwives must be instructed, and apothe-
caries must confine themselves to their proper business,
compounding medicine.

At the close of every interesting and important case,
especially whep it has terminated fatally, a physician
should trace back, in calm reflection, all the steps which
he had taken in the treatment of it. This review of the
origin, progress, and conclusion of the malady ; of the
whole curative plan pursued, and of the particular opera-
tion of the several remedies employed, as well as of the
doses and periods of time in which they were administered,
will furnish the most authentic documents, on which indi-
vidual experience can be formed. But it is in a moral view

Vol. v. wo. 27. o o

234 Original Communications.

that the practice is here recommended, and it should be
performed with the most scrupulous impartiality. Let no
self-deception be permitted in tne retrospect ; and if errors,
either of omission or commission, are discovered, it be-
hoves that they should be brought fairly and fully to the
mental view. Regrets may follow, but criminality will thus
be obviated. For good intentions, and the imperfection of
human skill, which cannot anticipate the knowledge that
events alone disclose, will sufficiently justify what is past,

firovided the failure be made conscientiously subservient, to
lit u re wisdom and rectitude in professional conduct.

The opportunities which a physician not unfrequently en-
joys, of promoting and strengthening" the good resolutions
of his patients, suffering under the consequences of vicious
conduct, ought never to be neglected. And his councils,
or even remonstrances, will give satisfaction, not disgust,
if they be conducted with politeness ; and evince a genuine
love of virtue, accompanied by a sincere interest in the
welfare of the person to whom they are addressed.

The observance of the Sabbath is a duty to which medical
men are bound, so far as is compatible with the urgency of
the cases under their charge. Visits may often be made with
sufficient convenience and benefit, either before the hours
of going to church, or during the intervals of public wor-
ship. And in many chronic ailments, the sick, together
with their attendants, are qualified to participate in the
social offices of religion; and should not be induced to
forego this important privilege, by the expectation of a
call from their physician or surgeon.

A physician who is advancing in years, yet unconscious
of any decay in his faculties, may occasionally experience
some change in the wonted confidence of his friends.
Patients who before trusted solely to his care and skill, may
now request that he will join in consultation, perhaps with
a younger coadjutor. It behoves him to admit this change
without dissatisfaction or fastidiousness, regarding it as no
mark of disrespect ; but as the exercise of a just and rea-
sonable privilege in those by whom he is employed. The
junior practitioner may well be supposed to have more
ardour than he possesses, in the treatment of diseases ; to
be bolder in the exhibition of new medicines ; and disposed
to administer old ones, in doses of greater efficacy. And
this union of enterprise with caution, and of fervour with
' coolness, may promote the successful management of a
difficult and protracted case. Let the medical parties,
therefore, be studious to conduct themselves towards each

Dr. Ryan on the state of the Medical Profession. 235

other with candour and impartiality ; co-operating, by mu-
tual concessions, in the benevolent discharge of profes-
sional duty.

The commencement of that period of senescence, when
it becomes incumbent on a physician to decline the offices
of his profession, it is not easy to ascertain ; and the deci-
sion on so nice a point must be left to the moral discretion
of the individual. For, one grown old in the useful and
honourable exercise of the healing art, may continue to
enjoy, and justly to enjoy, the unabated confidence of the
public. And whilst exempt, in a considerable degree, from
the privations and infirmities of age, he is under indispen-
sable obligations to apply his knowledge and experience in
the most efficient way, to the benefit of mankind. For the
possession of powers is a clear indication of the will of our
Creator, concerning their practical direction. But in the
ordinary course of nature, the bodily and mental vigour
must be expected to decay progressively, though perhaps
slowly, after the meridian of life is past. As age advances,
therefore, a physician should, from time to time, scrutinize
impartially the state of his faculties ; that he may determine,,
bona fide, the precise degree in which he is qualified to exe-
cute the active and multifarious offices of his profession.
And whenever he becomes conscious that his memory pre-
sents to him, with faintness, those analogies, on which me-
dical reasoning, and the treatment of diseases are founded ;
that diffidence of the measures to be pursued, perplexes his
judgment, that from a deficiency in the acuteness of his
senses, he finds himself less able to distinguish signs, or to
prognosticate events; he should at once resolve, though
others perceive not the changes which have taken place,
to sacrifice every consideration of fame or fortune, and to
retire from the engagements of business To the surgeon
under similar circumstances, this rule of conduct is still
more necessary. For the energy of the understanding often
subsists much longer than' the quickness of eye-sight, deli-
cacy of touch, and steadiness of hand, which are essential
to the skilful performance of operations. Let both the
physician and surgeon never forget, that their professions
are public trusts, properly rendered lucrative whilst they
fulfil them ; but which they are bound by honour and pro-
bity to relinquish, as soon as they find themselves unequal
to the adequate and faithful execution.

The following admirable rule of conduct of physicians
towards apothecaries, was laid down by Dr. Percival, and
cannot fail to be approved of by every honourable practi-
tioner : —

236 Original Communications.

In the present state of physic, in this country, where the
profession is properly divided into three distinct branches, a
connexion peculiarly intimate subsists between the physi-
cian and apothecary, and various obligations result from
it. On the knowledge, skill, and fidelity of the apothecary
depend, in a very considerable degree, the reputation, the
success, and usefulness of the physician. As these quali-
ties, therefore, justly claim his attention and encouragement,
the possessor of them merits his respect and patrouage.

Tne apothecary is, in almost every instance, the precur-
sor of the physician ; and being acquainted with the rise
and progress of the disease, with the hereditary constitu-
tion, habits, and disposition of the patient, he may furnish
very important information. It is in general therefore,
expedient, and when health or life are at stake, expediency
becomes a moral duty, to confer with the apothecary be-
fore any decisive plan of treatment is adopted ; to hear his
account of the malady, of the remedies which have been
administered, of the effects produced by them, and of his
whole experience concerning the juvantia and laedentia in
the case. Nor should the future attendance of the apothe-
cary be superseded by the physician ; for if he be a man
of honour, judgment, and propriety of behaviour, he will
be a most valuable auxiliary through the whole course of
the disorder, by his attention to varying symptoms ; by the
enforcement of medical directions; by obviating misappre-
hensions in the patient, or his family ; by strengthening the
authority of the physician ; and by bein^ at all times an
easy ana friendly medium of communication. To subserve
these important purposes, the physician should occasionally
make his visits in conjunction with the apothecary, and re-
gulate by circumstances the frequency of such interviews;
for if they be often repeated, little substantial aid can be
expected from the apothecary, because he will have no
intelligence to offer wnich does not fall under the observa-
tion of the physician himself; nor any opportunity of exe-
cuting his peculiar trust, without becoming burthensome to
the patient by multiplied calls, and unseasonable assiduity.

This amicable intercourse and co-operation of the phy-
sician and apothecary, if conducted with the decorum and
attention to etiquette, which should always be steadily ob-
served by professional men, will add to the authority of
the one, to the respectability of the other, and to the use-
fulness of both. The patient will find himself the object
of watchful and unremitting care, and will experience that
he is connected with his physician, not only personally, but
by a sedulous representative and coadjutor. The apothe-

Dr. Ryan on> the state of the Mtdioal Profession. *37

cuy will regard the free communication of tbeiphysiei
a privilege and mean of improvement ; he will have . a
deeper interest in the success of the -curative plans pur*
sued, and his reputation will be directly involved in the purity
and excellence of the medicines dispensed, and in the skill
and care with which they are compounded.

The duty and responsibility of the physician, however, are
so intimately connected with these points, that nodepen*
dence on the probity of the apothecary should prevent the
occasional inspection of the drugs which he prescribes. In
London, the law not only authorizes, but enjoins a stated
examination of the simple and compound medicine kept in
the shops. And the policy that is just and reasonable in
the metropolis, must be proportionally so in every provin-
cial town throughout the kingdom. Nor will any respect*
able apothecary object to this necessary office, when per-
formed with delicacy, and at seasonable: times; since his
reputation and emolument will be increased by it, probably
iothe exact ratio, thus ascertained, of professional merit
and integrity.

A physician called to visit a> patient in the oountry,
should not only be minute in his directions but should com-
municate to the apothecary the particular view which he
takes of the case; that the indications' of cure may be
afterwards pursued with precision and steadiness ; and that
the apothecary may use the discretionary power committed
to him, with as little deviation as possible from the general
plan prescribed. To so valuable a class of men as the ooun-
try apothecaries, great attention and respect is due. And
as they are the guardians of health through large districts,
no opportunities should be neglected of promoting their
improvement, or contributing to their stock of knowledge,
either by the loan of books, the direction of their studies,
or by unreserved information on medical (subjects. When
such occasions present themselves, the ma^im of our judi-
cious poet, is strictly true, " the worst avarice is that of
sense. ' For practical improvements usually originate in
towns, and often remain unknown or disregarded in situa-
tions, where gentlemen of the faculty have little intercourse,
and where sufficient authority is wanting to sanction inno-
vation.

It has been observed, by a political and moral writer, of
great authority, that " apothecaries' profit is become a bye
word, denoting something' uncommonly extravagant. This
great apparent profit, however, is frequently no ' more than
die reasonable wages of labour. The skill of an apothe-
cary is a much nicer and more delicate matter than that

238 Original Communications.

of any artificer whatever ; and the trust which is reposed in
him is of much greater importance. He is the physician of
the poor in all cases, ana of the rich when the distress or
danger is not very great. His reward, therefore, ought to
be suitable to his skill and his trust, and it arises generally
from the price at which he sells his drugs. But the whole
drugs which the best employed apothecary, in a large mar-
ket town, will sell in a year, may not perhaps cost him
above thirty or forty pounds. Though he should sell them,
therefore, for three or four hundred pounds, or a thousand
per cent, profit, this may frequently De no more than the
reasonable wages of his labour charged, in the only way
in which he ean charge them,' upon the price of his drugs.'

The statement here given, exceeds the emoluments of the
generality of apothecaries in country districts. And a phy-
sician, who knows the education, skill, and persevering
attention, as well as the sacrifice of ease, health, and some-
times even of life, which this profession requires, should
regard it as a duty not to withdraw, from those who exer-
cise it, any sources of reasonable profit, or the honourable
means of advancement in fortune.

Practices prevail in some places injurious to the interest
of this branch of the faculty, which ought to be discouraged.
One consists ip. receiving" an annual stipend, usually degrad-
ing in its amount, and m the services it imposes, for being
consulted on the slighter indispositions to which all families
are incident, and which, properly fall within the province
of the apothecary. We could name a physician in Bath,
who, though a saint, acknowledged that he farmed whole
families in this way ; and in Cheltenham, we are told, that
a physician farms a respectable individual, in a public situa-
tion, at £.25 per annum ; and a veterinary surgeon farms his
horses at £.200.

Physicians are sometimes requested to visit the patients of
the apothecary, in his absence. Compliance, in such cases,
should always be refused, when likely to interfere with the
consultation of the medical man usually employed by the
sick person, or his family. It would be for the interest and
honour of the faculty to have this practice altogether inter-
dicted. Physicians are the only proper substitutes for phy-
sicians, surgeons for surgeons, and apothecaries for apothe-
caries.

When the aid of a physician is required, the apothecary
to the family is frequently called upon to recommend one.
It will then behove him to learn fully whether the patient
or his friends have any preference or partiality ; and this he
ought to consult, if it lead not to an improper choice. For

Dr. Ryan on the state of the Medical Profession. 239

the maxim of Celsus is strictly applicable, on such an oc-
casion ; ubi par scientia, melior est amicus medicus quam
extraneus. But if the parties concerned be entirely indif-
ferent, the apothecary is bound to decide according to his
best judgment, with a conscientious and exclusive regard to
the good of die person for whom he is commissioned to
act. It is not even sufficient that he selects the person on
whom, in sickness, he reposes his own trust; for in this
ease, friendship justly gives preponderancy, because it may
be supposed to excite a degree of zeal ana attention, which
might overbalance superior science or abilities. Without
any regard to any personal, family, or professional con-
nexions, he should recommend the physician, whom he
conscientiously believes, all circumstances considered, to
be best qualified to accomplish the recovery of the patient.

In the county of Norfolk, and in the city of London,
benevolent institutions have been lately formed, for pro-
viding funds to relieve the widows and children of apothe-
caries, and occasionally also members of the profession,
who become indigent. Such schemes merit the sanction
and encouragement of every liberal physician and surgeon.
And were they thus extended, their usefulness would be greatly
increased, and their permanency almost with certainty secured.
Medical subscribers, from every part of Great Britain, should
be admitted, if they offer satisfactory testimonials of their
qualifications. One comprehensive establishment seems to
be more eligible than many on a smaller scale. For it
would be conducted with superior dignity, regularity, and
efficiency ; with fewer obstacles from interest, prejudice,
or rivalship ; with considerable saving in the aggregate of
time, trouble, and expense ; with more accuracy in the cal-
culations, relative to its funds, and consequently with the
utmost practicable extensions of its dividends.

Such are the admirable institutes proposed by Dr. Per-
oral, for. the regulation of .professional conduct, and I
have quoted them at length, as I was unable to offer any
so excellent. They have entitled him to a niche in the re-
public of medical literature, and will pass his name down
to our latest successors. The preceding rules of ancient
and modern ethics, afford ample materials to our colleges
of physicians for arranging a complete code, such as is
much wanted by the profession at the present period, while
it may inspire young practitioners and students with those
ooble sentiments which have invariably distinguished the
profession. In order to afford further means for the for-
mation of a code of ethics, I shall give a concise account

240 Original Communications.

of the laws relative to the practice of medicine in the
Uifited Kingdom of Great Britain and Ireland.

Laws relating to ike Medical Profession in Great

Britain and Ireland,

Aftbr a great deal of research and labour, I had compiled
and arranged the materials for this essay, when my labour
was lost, by the publication of Mr. Wilfcock's, which has
just issued from the press. It affords me much gratifica-
tion, that most of the information I had gained is now
{tlaced before me, authenticated by the authority of a ta-
ented lawyer, of a gentleman quite free from partiality
towards any of the colleges, and who instructs the legal
as well as the medical profession. His work is one of deep
interest to medical men, as it shews that the London Colleges
of Physicians and Surgeons, and the Apothecaries' company,
have full power to correct all the anuses which now de-
grade our profession. In fact, Mr. Willcock's treatise con-
tains much more information than the conjoint production
of Dr. Paris and Mr. Fonblanque, and illustrates many im-
portant points of medical police, unnoticed by the latter
writers. As this excellent and instructive work contains the
fullest account of the laws relating to the practice of me-
dicine in England, it would be superfluous in me to execute
my original design, and I shall therefore content myself
with condensing the chief points of value, without destroying
the spirit of their meaning, while I shall enumerate the laws
relating to the duties of medical men in judicial investigations,
which are omitted by this author.

It must be superfluous to enumerate the ancient orders of
the medical profession, including regular and irregular prac-
titioners, neither is it necessary to enumerate the present or-
ders of the faculty, which are generally known in every
civilized country. Mr. Willcock devotes his first and second
chapters to these topics, and next details the whole of the
statutes and patents relative to physicians, surgeons, and
apothecaries, as also those of a general nature which
affect the profession. After a luminous commentary on every
act and charter, and on every decision relative to medical
men, he maintains that the law is at present as follows : —

Physicians. — Any- person who is not a member, fellow, or
licentiate of the Royal College of Physicians in London, and
who practises physic in or within seven miles thereof, is lia-

Dr. Ryan on the state of the Medical Profession 241

He to a penalty of £5. a month, or if in the country, unless
he is a graduate of Oxford or Cambridge. Every person so
practising in any part of the Kingdom, even though his
practice was not attended with serious consequences, is also
guilty of a misdemeanour at common law. These rules do
not apply to a person who may happen to administer medi-
cine to the best of his ability, to such as may be unable to
obtain the assistance of a regular practitioner.

" The penalty of £5. is recoverable from such only as
have continued tiieir practice for one month at least, and to
prove this, it is necessary to shew that the defendant has
continued to hold himself forth to the public as a physician,
for one entire month within the precinct of London, if the
proceeding be instituted by the college, or in the country if
it be instituted by the common informer ; and to shew some
instances, or at least one instance of his actual practice within
that period, from which it may appear that such practice
was in the character of a physician. The word physician by
no means implies the necessity of shewing that the defendant
was or assumed to be a graduate in physic, the statutes aim
against such as were not graduates in physic."

Our author respectfully questions the decision in Dr.
Harrison's case, and denies its legality. The verdict was
£iven on the ground that the case was surgical, but the
judge considered the evidence sufficient to shew that the
Doctor had professed and acted as a physician. " But with
the utmost deference to so high and impartial an authority,
1 venture to submit that the earlier cases, and cases decided
upon argument in full court, but which seem not to have
been noticed in arguing Dr. Harrison's case, are directly and
clearly contrary." Two decisions of the King's Bench and
one of the Common Pleas were made upon the point, besides
which the Statute 32 Hen. 8. has expressly declared that
surgery is a special member of physic, and within the legiti-
mate range of the physician's vocation. " My assumption is
that an action will lie at the suit of the college, although the
practice proved be surgical, unless the defendant by his
plea, show that he is legally entitled to practise as a surgeon,
by specially setting forth his licence by the College of Sur-
geons."

By the original charter and by the Statute 32 Hen. 8. it is
evident tbat every person of the same faculty, of or in Lon-
don, was entitiled to be admitted into the association of
eonunons and fellows. But as to the persons who should
afterwards enjoy that distinction! the original charter and all
subsequent statutes are silent, pp. 34, 44.

▼ol. v. wo. 27. ■ h

24*2 Original Communications.

" It is directly in the teeth of the statute, that no persons
can become candidates, who are not graduates of U&ford,
or Cambridge."

Surgeons. — " There is no doubt that the surgeon can
make and compound all medicines and medicaments ap-
plicable to the diseases, submitted to the superintendance
of his branch of the faculty. And he may either administer
them himself, or prescribe what he thinks proper to be ad-
ministered to others/' By the 3rd Hen. 8. persons can be
punished for practising surgery in any part of the Kingdom,
except in London, or within seven miles thereof. None can
practise in or within seven miles of Loudon, until examined
and admitted by the College of Surgeons ; but there may be
two classes of surgeons throughout the rest of the Kingdom.
First, the members of the college who may practise in every

f»art of bis Majesty's dominions, and secondly, the surgeons,
icensed under the 3rd Hen. 8, who may practise within any
Particular diocese in which they are licensed, except in
London and Westminster, and within seven miles around
these cities.

" Every person, except a physician, is liable to be fined £.5
a month, unless a member of the college, who practises in
London or Westminster, by action in any court held in the
city of London. The same penalty may be enforced for
practice in the country, unless the person be a member of
the college, or licensed by the ordinary of the diocese, or
in his absence by the vicar general, (3 Hen. 8.) and the
proceedings are the same as against unqualified physicians. "

BIBLIOGRAPHY.

PHYSIO LOOT.

1 . Structure and functions of Spleen. — Mr. Dobson has published
" An Experimental Inquiry into the Structure and Functions of the
Spleen." He first gives a succinct account of the various conjee-
tures on the use of this organ, and proves them all unworthy of adop-
tion. He made the following experiments to ascertain the precise
period at which any alteration takes place in the spleen by the
digestive process : —

Exp. 1. — I gave to a middle sized dog a hearty meal of beef and
mutton ; the animal ate heartily, In four hours after, I opened the
abdomen, and exposed the spleen immediately; it was large and
firm ; its veins appeared completely gorged with blood ; on cutting
the organ, a large quantity of dark-coloured blood flowed out : the
exact amount could not be estimated ; but I should suppose there

Physiology. 343

was about four ounces : it concreted in a very short time. The
coagulated mass, however, was soft, easily broken down, and pre-
sented more the appearance termed grumous blood, than the proper
sanguineous fluid.

Exp. 2. — A dog was procured as near in size as the one in the last
experiment as could be met with ; the animal took a full meal of
beef and mutton ; in five hours after, the abdomen was opened ;
the spleen was very large and turgid, with blood. The appearance
of the blood was very similar to that in the last experiment ; the
quantity, however, was much greater.

Exp. 3.— The spleen of a dog (of an equal size to the preced-
ing) was examined twelve hours after any food had been taken ; a
very remarkable difference was observable ; it was very small and
fffly* and contained only a very small quantity of blood. The ap-
pearance of the blood differed little from that in the preceding ex-
periments ; I thought it not quite so dark.

To ascertain the comparative bulk of the spleen in dogs, I pro-
cored two of equal size, and examined their spleens at the same
period after a meal ; the difference in size was bo trifling, as not to
invalidate in the least the conclusions I intend to draw from the pre-
ceding statements.

Not wishing, however, to rely implicitly on these experiments,
for fear that some accidental circumstance might have influenced
fee appearances, I repeated them, but found the results to be pre-
cisely similar. Other experiments also were performed at various
periods during the digestive process and after its completion ; the
size of the spleen was invariably found to be in a ratio to the quan-
tity of nutriment taken into the system, and to the period at which
it was examined after the animal had eaten, that is to three hours
after a meal, little alteration in this organ was perceptible ; but in
four hoars after, it was large ; and in about five hours appeared to
arrire at its maximum, and then gradually to decrease in bulk for
twelve hours, which was as for as I observed its condition.

My next experiments were to remove the spleen from dogs, and
to observe any effect which might be produced in the system.

Exp. 1.— The spleen of a dog was removed; the animal appa-
rently suffered little from the operation. On the following day I
gave it a quantity of food ; it ate voraciously ; for three hours after
no perceptible alteration was produced ; but in four hours after,
indications of uneasiness were shown ; the animal became restless,
and lastly sunk into a nearly torpid state ; it was often moaning,
the pupils were dilated, — the heart labouring ; there was frequent
micturition; the respiration 'was exceedingly laborious, and, in
short, there was every mark of plethora, or over-fulness of the
vascular system. In the course of two hours from this period, the
animal began to recover ; and in about three hours these symptoms
had subsided, considerable languor remained. The animal took a
large meal twioe or thrice in twenty-four hours, and after each,
precisely similar effects were presented. The animal became more
feeble daily — in a month after the operation, it died.

844 Bibliography.

Exp. 2.— I next removed the spleen from another dog, but in-
stead of giving full meala, as in the last experiment, I gave a small
quantity of food every hour, or every two hours. The animal ate
voraciously ; no unpleasant symptoms occurred ; this plan was pur-
sued for three weeks, when the animal to all appearance was quite
well ; in fact, it became fat ; the ligature from the splenic artery
had come away, and the wound in the abdomen healed. I then
commenced giving full meals twice in twenty -four hours, the same
train of symptoms followed each meal, and at the same period, as
in the last experiment, though perhaps not so urgent ; the animal
died in a month from the commencement of this plan of feeding.

In both dogs I observed that the intestinal evacuations were of a
lighter colour thai) natural. On examining the body of each after
death, a small quantity of limpid serum was contained in the bag
of the tunica arachnoides, and more than a natural quantity in the
lateral ventricles ; the veins of the brain were in a highly con-
gested state; the abdominal viscera presented no unnatural ap-
pearances, but the portal system of veins was much gorged with
blood. The deductions to be derived from these experiments, and
from the former ones seem sufficiently obvious ; but previous to
making them, it may be requisite to refer in a succinct manner to a
few circumstances connected with the digestive and circulatory sys-
tems, so far as they may bear on this question.

From these experiments our author draws the following con-
clusions : —

" That the spleen acts as a reservoir for containing the additional
quantity of blood which the vascular system has received, by means
of the nutritive process. It is evident from the remarks on chylifi-
cation there is a greater quantity of blood in the system at five
hours after a meal than at any other period ; and as we have pre-
mised, that the blood-vessels are not capable of containing this
increase with impunity, I infer, that the spleen serves as a reser-
voir to hold this surplus ; because 'at the time the chylifactive pro-
cess is at an end the spleen is found distended with blood. Then,
as detailed in the third experiment, at twelve hours after a meal,
the spleen was small, and contained very little blood ; the reason of
this phenomenon is obvious ; at five hours after a meal, the nutri-
tive process is nearly completed ; at five hours after a meal, the
spleen arrives at its maximum size : now, as secretion goes on in
the various emunctories, there must consequently be a reduction of
the circulating mass ; and to compensate for this, blood is simul-
taneously expelled from the spleen, so that in twelve hours the
whole is removed ; no more circulating through that organ than is
necessary for its support.

" We have now to examine the second series of experiments.
When the spleen was removed from a dog, and full meals given to
the animal, the effects indicated clearly that a greater quantity of
blood had been formed than the vessels were capable of containing,
compatible with the free action of the vital organs ; but as the fluid
became diminished in quantity by the secretory functions, healthy

Pkyuolpgy. 24$

action in there parte was again established. But it was observed,
that if a small quantity of food was given at a time, though often
repeated, no deleterious influence was exerted; that is, if the increase
in the volume of blood was not more than equivalent to what had
been previously expended by the secretions, no injurious effects were
produced.

Mr. Dobson endeavours to establish this principle, " that the
circulatory Teasels axe capable of containing only a certain quantity
of blood with impunity, and that when an increase in the volume is
produced, aa after digestion, the spleen performs the office of a re-
servoir to receive the surplus ; they show also, that when the fluid
contained in the vessels becomes reduced in quantity, as from bleed*
nig, the spleen affords a supply, so as to enable the various organs
to perform their necessary offices ; and further, they afford colla-
teral evidence of the spleen being more elastic than the blood-
Teasels.

When we find such a change produced in the spleen after a meal
of solid food, we naturally inquire the. effect of a quantity of fluid.
When a man sits down and drinks ten or twelve pinto of ale, or
two or three bottles of wine, a considerable quantity of fluid must
be absorbed into the system ; and were there not a reservoir at-
tached to the circulation, injurious consequences would undoubtedly
ensue. Though relief in these cases might be obtained in some
measure from the secretory organs taking on an increased action,
still that would not be sufficient to relieve effectually the vascular
system. But so wise is that mechanician, our Creator, that he con*
structs his machines not only to suit ordinary states, but to sustain
them under casual exigencies. I have twice had an opportunity of
euinining the spleen in men who had been accustomed to take
large quantities of ale, &c. and in both, the spleen was much larger
thai natural. In one of these cases the spleen was enormously
enlarged, and gave the idea, on pressing it, of a bladder half
filled with oil.

Oar author offers some interesting observations on the pathology
of the spleen, which deserve attention.

" The moat common change which the spleen undergoes is an
fragmentation in its size, termed " ague cake ;" this state being
observed after long and inveterate cases of intermittent fever, more
especially if the system has been previously debilitated by intem-
perance, or the individual be of a scrophulous diathesis. After pro-
tracted intermittents, the spleen is often found to weigh from three
to fire pounds. There are cases on record of this Organ weighing
from thirty to forty pounds. It has occasionally been found like a
mere bag ; and during life so much enlarged as to be felt through
the abdominal parietes. Opportunities for **«niniwg the spleen after
intermittents are much more rare at the present day, than formerly,
when this malady prevailed to a much greater extent. The expla-
nation of those morbid conditions of this organ is obvious ; the
spleen receives a surplus of blood every twenty-four hours during
the cold stage of the paroxysm> or according to the type of the

(i.ii , it* vtasci* and it* elaafk tmtiopt ace cm

iniJiitMlf «t*i* of dilatation, and before they can i

Ihh<I i.oiidilWH wutWiur rush of blood come* rato '

•looHivuly. milil tlwir power of contractility » e

viilm p nimmt »f tlt« urgun it the natural consequence, ma sane b bk

\\\\, inlluuiimilUin ami il« effect* ensue, thickening of the cMO*j|

nf h IuIh-U'I'I«VwI »UIb iJ that membiane; tubercles aha) are oc-

t-H>|i<uaUv fouwil JfaWwUaM throughout the substance of the

ttaMU<

\hi iu w uu uW observation, and one winch baa been cn*j fc ■■■**'
V.v iu'hLiu uajjwwuoo. that hemorrhage bean the nose ia often con-
\ umiwuL vi >iii ubaUuuliuD of the epteen,

U uuuuu* to bo u>ve»tigated what iaftaimi the spleqi eierU in
Vln }<iv-i\uk'li(ii oi dropsical efunicn* ; bbai ml 'mm on thia point may
pml«M| uutuou u* to direct aoaae ansasthau to the agency of thai
vi». in, iumiv particularly hi reference to ■— 11 1 ■ and ascites.

tji'iuuutiwge from the hatetinea, though of cornparativery rare
uiiumaiiT, doe* take place; this aaay arise fraaa aotne fault in the
mL =liuul veaaela, bat I feel aaapnacd. aa aaoat cases, to anapect the
bjilti 11 to be implkaaud ; aaal the fanttion of Una organ being de-
ranuad, nature renews laaaJf by these veaaela.

Are (uaenorrhosi and naransnngaa depuarknt on, or connected
with, disordered fumtiun* of the spleen ?

Pain in the left hypotaaMaaraaaa ■ a wry common complaint
amougat female* about tfacnniniiii of the cat* menial epoch ;
the pain ia referred to the precise seat of the spleen, and ia often

Bpleniua i* an snTectaun deacrihed by — Kr^t authors aa rarely

occurring. It is atated that relief haa been obtained in aome cases

by TOtainng of a dare: coloured fluid, very aaneh resembling coflee

ground*, and also, by In mot ihaaa fraaa the heaaorrfaoidal veaaela.

The author dedocea the amoving practical ootxhwiona : —

Every reflecting individual, w3I, I fed persuaded, accede to the

opinion, that the cnxuhunry apparatus m adapted to contain a cer-

e of blood ; and on the parity, or on a certain state of

combined with quantity coweaponding to the capacity of

» data thia apparatus preserve in mtegrity and tnie action;

wee the blood-vessels receive blood of an impure quality,

idoc quantity, disordered action results. From whatever

blood acquires thia unhealthy quality, the circulation of

the vaaa laaornm will afreet the Teasels, and thru, their

1 of action being disturbed, it will readily be conceded,

Wti«*fl quantity of fluid will not only act in PMdptonulig

d state, but augment it.

If in a case of inflammatory fever, a state of the ays-
ly excited, and ezciteable. I increase the quantity of
irdcring fluids to be drunk. . What will be the effect ?
be absorbed into the vessels, the Teasels must be further
xn dastenakm, and the impetus of the whole vascular sys-
urily augmented to convey it ; and this principle is espr-

347

natty applicable to the spleen. If tfeia organ, as I have endea*
vonred.to prove, be a reservoir for the superabundance of blood in
the system, when the spleen is affected with disease of any kind,
any addition to the mass of blood must increase inordinate excite-
nest already existing in this organ ; and even m healthy organ is
lieJyto suffer when the volume of blood is greatly augmented;
that harmony which naturally exists between the contained and
containing parts being subverted. This principle will, I am per-
maded, be a powerful means, not only in the removal of disease*
hot in preventing its accession.

Hie practical inferences I have to offer, as deduced from these
■tatements, are the following ; —

1st.' That the quantity of fluid usually taken into the system at
one time, is greater than the apparatus is capable of containing
with impunity ; and in consequence of this, excited vascular action,
with all its train of morbid consequences, is a common effect.

2nd. That in disorders affecting the spleen, as in intermittent
fever, and as well of the whole vascular system, the practice of
giving large quantities of fluid, is not only unphilosophical, but
deridejly injurious." — We strongly recommend this essay to the
attention of our readers.

2. Absence of the Pulse— The pulse is in some instances entirely
absent, without interfering with health. This circumstance occurred
in the mother of Dr. S. of this city. The pulse disappeared during
an attack of acute rheumatism, which did not appear to retard her
recoreiy, and- it never returned during her subsequent life. She
ww active in mind and body, and possessed unusual health. In no
put of the body could a pulse be detected. I attended her during
a part of- the time of her last illness, which was an acute inflam-
mation .of the intestines, but no pulse existed. She died while I
was absent from the city, and an examination was not made to
elucidate the cause of this remarkable phenomenon. — Dr. Jackson,
•• An\er. Joam. of Med. Sciences.

3. Theory of the 8ource$ of Animal Heat. — The bodies of animals
are endowed with the faculty of preserving the same heat in every
wiety of climate. Though this subject has been an object of
ranoeuy in all ages, it is still involved in obscurity. In almost all
the theories which have been constructed, and particularly in the
riew winch I am about to submit, the lungs, in the mammalia at
least, are supposed to be the organs by which the heat is evolved,
and regulated, and transmitted through the body. The elasticity
of their structure is of such a nature, that when extended into a
larger volume, as in the act of inspiration, a multitude of internal
cavities, similar to those which are found in sponge, &c. must be
fanned, the dimensions of which will together be equal to the dif-
ference between the dimensions of the lungs in -their collapsed and
expanded states. These cavities, which are all of equal calibre, and
ouRstchiefly of the bronchi, and the pulmonary arteries and veins,
with their ramifications, must necessarily be occupied by some ex-
traneous substance. The ramifications of the bronchi, or air ves-

140 Bibliography.

fever ; its vessel* and its elastic envelope are extended beyond their
ordinary state of dilatation, and before they can resume their na-
tural condition another rush of blood comes into them, and so on
successively, until their power of contractility is entirely abolished ;
enlargement of the organ is the natural consequence, disease is set
up, inflammation and its effects ensue, thickening of the covering
or a tuberculated state of that membrane ; tubercles also are oc-
casionally found disseminated throughout the substance of the
organ.

There is an old observation, and one which has been confirmed
by modern experience, that hemorrhage from the nose is often con-
comitant with obstruction of the spleen.

It requires to be investigated what influence the spleen exerts in
the production of dropsical effusions ; observations on this point may
probably induce us to direct some attention to the agency of tins
viscus, more particularly in reference to anasarca and ascites.
- Hemorrhage from the intestines, though of comparatively rare
occurrence, does take place ; this may arise from some fault in the
intestinal vessels, but I feel disposed, in most cases, to suspect the
spleen to be implicated ; and die function of this organ being de-
ranged, nature relieves herself by these vessels.

Are amenorrhcsa and menorrhagia dependent on, or connected
with, disordered functions of the spleen ?

, Pain in the left hypochondrium is a very common complaint
amongst females about the commencement of the catamenial epoch ;
the pain is referred to the precise seat of the spleen, and is often
very difficult and tedious to remove.

Splenitis is an affection described by medical authors as rarely
occurring. It is Btated that relief has been obtained in some cases
by. vomiting of a dark coloured fluid, very much resembling coffee
grounds, and also, by hemorrhage from the hemorrhoidal vessels.

The author deduces the following practical conclusions : —

Every reflecting individual, will, I feel persuaded, accede to the
opinion, that the circulatory apparatus is adapted to contain a cer-
tain volume of blood ; and on the purity, or on a certain state of
tile blood, combined with quantity corresponding to the capacity of
the vessels, does this apparatus preserve its integrity and true action;
and whenever the blood-vessels receive blood of an impure quality,
or in an undue quantity, disordered action results. From whatever
cause the blood acquires this unhealthy quality, the circulation of
it through the vasa vasorum will affect the vessels, and thus, their
equilibrium of action being disturbed, it will readily be conceded,
that an additional quantity of fluid will not only act in maintaining
that excited state, but augment it.

Ex. gr. If in a case of inflammatory fever, a state of the sys-
tem already excited, and exciteable, I increase the quantity of
blood by ordering fluids to be drunk. . What will be the effect ?
they will be absorbed into the vessels, the vessels must be further
excited from distension, and the impetus of the whole vascular sys-
tem necessarily augmented to convey it ; and this principle is espe-

Physiology. 347

dally applicable to the spleen. If this organ, as 1 have endea*
wared to prove, be a reservoir lor the superabundance of blood in
the system, when the spleen is affected with disease of any kind,
any addition to the mass of blood must increase inordinate excite*
meat already existing in this organ ; and even a healthy organ is
likely to suffer when the volume of blood is greatly augmented;
that harmony which naturally exists between the contained and
containing parts being subverted. This principle will, I am pcr-
maded, be a powerful means, not only in the removal of disease,
bat in preventing its accession.

Hie practical inferences I have to offer, as deduced from these
statements, are the following : —

1st. That the quantity of fluid usually taken into the system at
one time, is greater than the apparatus is capable of containing
with impunity ; and in consequence of this, excited vascular action,
with all its train of morbid consequences, is a common effect.

2nd. That in disorder* affecting the spleen, as in intermittent
ferer, and as well of the whole vascular system, the practice of
giving large quantities of fluid, is not only unphilosophical, but
decidedly injurious." — We strongly recommend this essay to the
attention of our readers.

2. Absence of the Pulse — The pulse is in some instances entirely
absent, without interfering with health. This circumstance occurred
in the mother of Dr. S. of this city. The pulse disappeared during
an attack of acute rheumatism, which did not appear to retard her
recovery, and it never returned during her subsequent life. She
was active in mind and body, and possessed unusual health. In no
put of the body could a puke be detected. I attended her during
a part of- the time of her last illness, which was an acute inflam-
mation .of the intestines, but no pulse existed. She died while I
was absent from the city, and an examination was not made to
dacidate the cause of this remarkable phenomenon.— Dr. Jackson,
« Amer. Jour*, of Med. Sciences.

3. Theory of the Sources of Animal Heat. — The bodies of animals
are endowed with the faculty of preserving the same heat in every
variety of climate. Though this subject has been an object of
curiosity in all ages, it is still involved in obscurity. In almost all
the theories which have been constructed, and particularly in the
riew which I am about to submit, the lungs, in the mammalia at
least, are supposed to be the organs by which the heat is evolved,
and regulated, and transmitted through the body. The elasticity
of their structure is of such a nature, that when extended into a
larger volume, as in the act of inspiration, a multitude of internal
cavities , similar to those which are found in sponge, &c. must be
formed, the dimensions of which will together be equal to the dif-
ference between the dimensions of the lungs in 'their collapsed and
expanded states. These cavities, which are all of equal calibre, and
consist. chiefly of the bronchi, and the pulmonary arteries and veins,
with their ramifications, must necessarily be occupied by some ex-
toaaeoas substance. The ramifications of the bronchi, or air ves-

S48 Bibliography.

sels, Seem to compose the chief part of the pulmonary structure, and
freely cbmmunicate with each other. The blood-Teasels are the
pulmonary arteries and veins, the capillary terminations of which
have two communications which require to be noticed. Hie arte-
rial capillaries have a communication with the venous, through
which the blood circulates from the arteries to the veins. Besides
these, the pulmonary arteries, as well as those belonging to the
larger circulation, have terminations through which red blood is not
transmitted. These open into the internal surface of the bronchi,
and, from their office are called exhalants. It is now well esta-
blished, that the veins are also well furnished at their extremitieswith
openings which do not admit, in ordinary circumstances, the red
part of the blood. That the pulmonary veins are furnished with
Such openings, sufficient proof will be supplied in the seqnal. These
openings perform an office the reverse of that of the arterial exha-
lants. They take up substances from the surface of the bronchi, and
cm that account they have been termed imbibers. To enable these
vessels to accommodate themselves to the various sizes required by
their office, there must, then, be passages of supply and discharge
for the materials which fill them on inspiration. The air vessels are
supplied through the windpipe, but it is net so evident from what
sources the materials are drawn to allow the blood-vessels to expand,
or through what channel their contents are discharged. The mate-
rials cannot consist of blood, for no blood can enter the pulmonary
arteries, or pass out of the pulmonary veins, except through the
portals of the heart, and these portals do not open and ctofte in
correspondence with the required periods of supply and discharge.
The movements of the heart are not timed by the movements of the
lungs. Four pulsations of the heart may generally be counted dur-
ing each complete respiration. It may indeed accidentally happen,
that a discharge of blood may be made into the pulmonary arteries,
at the moment in which inspiration commences, but, at the same
moment, an equal quantity is abstracted from the pulmonary veins
to fill the enlarging auricles of the left side of the heart. When-
ever, then, a quantity of blood is thrown into the chest, an equal
Quantity is, in the same period, discharged out of it, and also every
discharge of blood from the thorax is accompanied by the entrance
of an equal quantity through another channel. The quantity of
blood therefore at any time contained in the lungs does not appear
to be at all modified by respiration.

Our Bearch, therefore, for other channels of supply, has led us
to the following view of the origin of animal heat.

As the blood-vessels of the lungs must be filled, the air received
into the windpipe will not terminate its progress with the bronchi,
but will pass through the openings (now greatly enlarged) between
the bronchi and pulmonary veins, will enable the latter to assume
their proper dilatation, and will intimately mingle with the blood
in a thousand minute passages. Partly by mechanical, and partly
by chemical agency, a portion of this air, while the blood with
which it is commixed is still in the lungs, is converted from the

Physiology. 249

aerial into the fluid state. The consequence of this conversion is
veil known to be, an evolution of heat. But all the inspired air
is not converted into liquid in the pulmonary veins. After the pas-
sage of the blood out of the lungs, a portion still retains the gaseous
condition ; it is mingled with the blood in the form of small globules*
and while it circulates through the system, is gradually converted
into liquid, and evolves heat, and preserves throughout the tempera-
ture of the body. The impurities of the body are at the same
time absorbed into the blood, and occasion the colour of the venous

During inspiration, the blood of the pulmonary arteries is sub-
jected to a diminished pressure. A part of it is consequently con-
rerted into air, and reduced in temperature. At the same instant
air in the veins is converted into fluid. Thus the heat of the blood
in the arteries is kept up at the temperature at which the ebullition
is continued. The impurities of the venous system most readily, in
these circumstances, assume the gaseous form. By the formation of
an elastic fluid, the pulmonary arteries are enabled to assume the
augmented calibre, to which they are urged in consequence of the
expansion of the lungs. In the succeeding expiration, the lungs
press these vessels into their former calibre, and expel some of then*
contents, the aerial matter finds a ready exit through the capillary
▼easels of arteries which open into the bronchi, and which, in
ordinary circumstances, do not carry red blood, and then makes its
exit through the windpipe, the blood shows its liberation from adul-
teration by resuming the vermilion hue, and is again fitted to be the
vehicle of heat and nutriment to the whole system.

According to the preceding view, then, the greater part of the air
which we inspire, is received into the blood-vessels of the lungs, is
mingled with their contents, and gradually changes into liquid as
it circulates. The part of the air which has been inspired is dis-
charged from the windpipe in an undecomposed state. . On the con-
trary, the greater part of the air expired has proceeded from the
Tenons blood returned to the lungs, and consists of the usual gaseous
products of the vegetable and animal fermentation, — nitrogen, hy-
drogen, carbonic acid gases, and a little vapour. Accordingly, an
examination of the chemical relations between the atmosphere
breathed and the lungs, tends to prove that nitrogen and carbonic
acid gases can find access into the bronchi without entering by the
windpipe, and that there is no source whence these gases could have
sprung but the blood in the pulmonary vessels, and that the air
inspired may find its way from the bronchi, without being trans-
mitted back through the windpipe or without being decomposed.
What further proofs are there, then, by which the existence of the
supposed passages for the air from the bronchi into the pulmonary
veins is believed to be established ? First, it is rendered probable
by the analogy of structure. That openings exist between the ve-
nous capillaries belonging to the larger circulation, and that the
principal part of the office of absorption is performed by these
capillary ramifications, is rendered probable by the explanation of

Vol. v. no, 27. n

250 Bibliography.

the causes by which venous blood is moved, and has been esta-
blished beyond all doubt by Majendie. There is every reason to
suppose, that the veins of the lungs are constructed in the same
way with the veins in other parts of the system, and that such
'ramifications are to be found between those veins and surfaces of
the bronchi. Analogies are also supplied by comparative anatomy.
The air vessels in many insects, as in the locust and silk- worm, are
observed to communicate freely with the blood-vessels, from which
the return of air or any liquid is prevented by well adapted valves.
Substances, also, capable of being inspired, and of indicating their
presence by sensible qualities when mixed with blood, as fine pow-
der of stone and of metal, were found after death, by Bertier of
Bordeaux, to have obtained a passage from the lungs into the pul-
monary veins, and the left chambers of the heart. The next ques-
tion is, What becomes of the air which is admitted into the pulmo-
nary veins during inspiration ? The air taken into the blood-ves-
sels in the way now alleged must be received in infinitely divided
portions, and intimately mingled with the blood. It may be ab-
sorbed by the blood, it may be chemically combined with some
parts of it, or it may be mixed with it, still retaining its gaseous
form. There is every reason to suppose that each of these processes
takes place in part. By the operation of the two first, a portion
of the air will be changed from the gaseous to the liquid form while
it is still in the lungs, and heat will necessarily be evolved, but the
temperature of the blood in the lungs is prevented from rising be-
' yond a certain degree by a process which has already been alluded
to. The remaining portion of air drawn into the pulmonary veins,
is transmitted, with the blood in which it floats, and heat is dis-
engaged. This change may not be supposed to be completed be-
fore the blood has finished its journey in the arteries, and then its
colour is converted from vermilion into purple. Loaded in the man-
mer supposed by Dr. Crawford, and in which I am disposed to
acquiesce, with these products of decay from the body, the blood
returns to the lungs, where the products are discharged from it into
the bronchi, and thence out of the system through the windpipe,
in the form of impure air. Thus purified, it is transmitted into the
pulmonary veins and resumes its vermilion hue.* — Condensed from
the Paper of Dr. Carson, of Liverpool. North of England Journ.

4. Dysentery. — Dr. Gilby, a physician to the Lunatic Asylum,
West Riding of York, has found acetate of lead and opium highly
efficacious, after the inflammatory symptoms had been removed by
leeches and mercury, and when a bloody diarrhoea continued. —
When the purging was the effect of relaxed and irritable membrane,
the sulphate of copper and opium, as recommended by Dr. Elliot-
son, were given with the happiest effects. Op. cit.

Acetate of lead and opium may be given in every stage of dysen-
' tery with the best effects, and will generally cure the disease with-
out general or local bleeding. Repeated experience has convinced
us of the success of this combination, and has led us to think that
the Cullenian pathology of the disease is the best. — Ed.

Medicine, 251

FRACTICB OF MEDICINE.

5. Endermic method. — Dr. Carbutt, of Manchester, has published
a case of quotidian intermittent, which was cured by sprinkling a
few grains of sulphate of quinine on a blistered surface. He has
also cured haemoptysis by large doses of quinine after venesection,
acetate of lead, sulphate of zinc, and sulphuric acid had failed. —
Condensed from the North of Eng. Med. and Surg. Journ. Aug. '

6. Syphilis cured in an infant by mercurial frictions applied to
« goat that suckled it. — Dr. Vere" Delisle communicated a case to the
Academie Royale de Meclecine, in which a woman, three months
after delivery, contracted a syphilitic disease, caracterised by ulcera-
tions on the inside of the labia and a gonorrhoea! discharge. The
child whom she suckled was soon affected with venereal pustules
and ulcerations round the anus. It was now made to suckle a goat,
and the inside of the thighs of the animal having been shaved, two
drachms of mercurial ointment were rubbed in every other day.
The child was cured in a month. — Archives Generates.

8URGEKY.

7. A concise Treatise on Dislocations and Fractures, being a selection
from the most approved Foreign and English Surgical authorites, from
the days of Celsus to the present time, illustrated by fourteen plates.
London, 1830. 12mo. pp.110. — This little volume exhibits a concise
and correct account of the nature and treatment of dislocations, and
fractures, illustrated by plates representing the various forms of these
diseases, and the most approved methods of operation, with the ap-
plication of splints and bandages. The student and young practi-
tioner will find this work one of the most valuable of modern times.
It is compiled from the writings of the best surgeons ; it embraces an
account of the symptoms, and treatment of every dislocation and
fracture, illustrates them uncommonly well by wood cuts. The price
of the volume is remarkably moderate, and this useful elementary
work may be procured — a disideratum which was long felt in conse-
quence of the extravagant price set on former publications on the
subject, which placed them totally l>eyond the research of the great
hoik of practitioners. In place of expending two guineas in the
purchase of a work on this branch of surgery, the student has now to
expend the sum of four shillings and sixpence. The medical pro-
fession in common with the public patronizes cheap literature ; and
we are confident that ponderous quartos, and bulky octavos, must
ere long give way to more modest, and no less useful productions, in
the unassuming form of duodecimos. This is only as it should be,
knowledge will be more extensively diffused, and the interests of
science and humanity better promoted.

8. Cure of Subcutaneous navus by the set on. — Mr. Fawdington, of
Manchester, has published three cases of nasvus cured by seton.
He advises the remedy in cases where the size of the tumour
precludes the use of the knife, caustic or ligature. He states that
it will be used with more success than tying the artery which sup «

252 Bibliography.

plies the tumour ; and that it is followed by scarcely any disfigure-
ment. The akain of thread should be large enough to fill up the
apertures made by the needle, and thus to arrest haemorrhage, and
by using this precaution, a sufficient degree of irritation will be
produced to excite inflammation and suppuration throughout the
diseased mass. The first case was that of a fine male infant, about
three years and a half old, who had a nsevus between the angle of
the jaw, and mastoid process extending upwards to the zygomatic
arch. The whole formed an oval tumour, which measured five inches
and a quarter in its long axis, and four inches transversely. It bad
no pulsation, was purplish, soft and compressible, and had large
veins on its surface. A skain of common sewing thread was passed
through it with a sadler's needle, and no dressings were applied.
On the third day the tumour was inflamed, and on the sixth in a
state of suppuration, on the tenth resembled the site of an abscess
or common boil, and at one part but a portion of the tumour re-
mained, through which a seton was passed with similar results.
In four months there was not a vestige of the original disease.

The second case was one of an infant of ten months old, who
had a uaevus on the forehead. A seton partially removed it, a
solution of sulphate of copper was applied, which produced inflam-
mation and suppuration, but a second* seton was required to com-
plete the cure. — Condensed from the North of Eng. Med. 3t Svr.
Journ. August.

MATERIA MEDICA.

9. Practical Remarks on the nature and effects of the expressed Oil
of the Croton Tiglium, with cases illustrative of its efficacy in the cure
of diseases. By Michael John Short, M. D. London, 1830. Longman
and Co. — This interesting essay is embellished with a fine engraving
of the croton tiglium. Dr. Short comments on the progress of me-
dicine, on the mutation of opinion, and on the additions which have
been recently made to the materia medica, which bring him to the
immediate subject of his work. He commences with a botanical
description of croton tiglium. He gives the Lannsean description of
the plant, but states the first account of it was given -by Jacob Robert*
in " Plantarum Historia, Oxoniensis universalis, in 1649, torn, ii. p.
349, which our author cites at length. It was also described by
Ramphius in his Herbarium Ambynense, torn. iv. p. 98 ; by Rheed in
hisMelabaricus, torn. ij. p. 62 ; by Burman in his Flora Seylonica, by
Geertner in his work, de Seminibus, by Laureiro in his Flora, Conchin
China; by Lunan in his Hortus Jamaciensis ; by Murray, Bergius and
Dr. Hemming in his Asiatic Researches. Our author next informs us
of his object in publishing the present treatise.

" My object in the publication of the present treatise is, to extend
the now limited use of the 01. Croton Tiglium to diseases in which
it has not as yet been generally administered ; and by the commu-
nication of cases which have occurred to me in the course of a long
experience of its nature and properties, in India as well as Europe\ to
give it that place in the opinion of the profession to which its many
valuable properties entitle it.

Materia Medica. 253

Hie unmerited disrepute into which this medicine has Mien, from
the adulterations to winch it is usually subjected before it comes into
the hands of the medical practitioner, has rendered it a medicine
rarely to be found in the prescriptions of the physician, even in eases '
where the exhibition of die genuine oil would be attended with con-
siderable advantage : and nothing short of a practical illustration of
its benefits will restorte it to that celebrity, which it possessed shortly
after its re-introduction into European practice by Dr. W. K. Er
Cbnwell, of the Madras service."

A number of cases is detailed in which the oil of the Croton Tig-
limn, was given with success though obviously contra-indicated.
From its send properties it has been deprecated in inflammation of
the stomach and bowels, but the following cases are detailed by
Professor Monchini of Rome, to prove its efficacy and safety in such
diseases.

He relates two cases of inflammation of the bowels (gastro ente-
ritis), in which he employed the oil. He mixed one drop of the oil •
with an ounce of simple syrup, which was taken at two doses, at half
an hour's interval. The first patient, who was a female, felt no
warmth in the throat. She had, in two hours after taking the medi-
cine, one evacuation from the bowels, and twelve others during the
night. It affected her very much, but the pain was much less con-
siderable. The other patient, aged 25, previous to the visit of the
Professor, had fever, rigors, pain and tension of the belly, hard pulse.
fashed face, anxiety, nausea, and the bowels had not been opened
for seven days, although many glysters of oil and common salt had
been administered. At three o'clock he took away twelve ounces of
Wood, applied fomentations and frictions with oil to the belly, besides
several enemata of a decoction of oil and marshmallows. At eight
o'clock in the evening, finding that the bowels had not been opened,
he ordered a drop of the Croton Oil to be given in an ounce of the
syrup of marshmallows, in two doses, with an interval of two hours,
provided the first had no effect. The first dose, however, in a short
time, produced seven Btools. The patient then fell asleep : and
although there remained a little fever in the morning, it was not
necessary to use any other remedies but fomentations and a diluting
beverage to complete the cure.

Dr. Short relates the following case ; —

David Cleveland, a mariner, aged 38, had visited tropical climates,
where he had suffered from inflammation of the liver, which left that
viacus enlarged, and, as he describes it, as hard as a stone. This
state of disease had existed about five years ; during this time he had4
visited various countries, living freely whenever opportunity offered.
He came under my care in November, 1828. He had lately returned
from sea, and attributed his illness to sudden exposure to cold after
great exertion. He complained of great pain in the region of the
liver, could not bear the sligtest pressure, and was nearly bent dou-
ble. Great difficulty of breathing. Pulse 120, hard and full.
Tongue coated. Fully satisfied, from much experience, of the efficacy
°f the Croton Tiglium as a febrifuge purgative, I ordered two drops

254 Bibliography.

to be taken immediately in a little mucilage, and to be repeated every
four hours ; the patient to drink freely of warm gruel. I visited him
after he had taken the third dose, when his pulse was softy and redu-
ced to 80. . Dyspnoea much relieved, and the pain considerably less.
He had had innumerable watery stools, and the operation of the me-
dicine had even produced deliquium animi. The acute form of the
disease was thus cut short ; and I had only to contend with the
chronic complaint, which was treated as follows : — Pil. hydrarg. gr.
v, made active with mfs of the 01. Croton Tiglii, taken every night.
Cold infusion of sarsaparilla, acidulated with acid, nitric. fi>i. per
diem ; keeping up a pustular eruption over the right hypochondrium
with a liniment composed of 01. Tiglii & Lin. Saponis, one part of
the former to three of the latter. He was discharged cured on the
20th of February following, all hardness and enlargement of the liver
having disappeared.

Much has been urged against the adniinistratiou of a medicine so
active in its operations, in the ordinary forms of disease ; I can,
however, fully testify to its perfect safety, and its utility in every case
where a purgative was indicated, in infancy and adult age, either as
a simple purgative, an hydrogogue, or where I desired to produce a
sensible effect on the system, and objected to venesection on account
of the permanency of its effects. In corroboration of this, I insert
extracts of letters, written by M. Majendie to the Academic des
Sciences de l'lnstitut de France ; by Dr. Le Fort, Physician to the
King of France, and Chief Medical Officer at Martinique ; by In-
spector Tegart, of Barbadoes, to the principal Medical Officers of
Stations in the Windward and Leeward Islands, dated Barbadoes, 21rt
June, 1821 ; by the same to Sir James M'Grigor, Director General
to the Army Medical Department,>4ated Barbadoes, "30th Nov. 1821 ;
by the same, addressed to the Army Medical Board, and dated Feb.
28M, 1824.

Efficacy of Croton Oil in constipation, and as a hydrogogue exem-
plified by cases in the London Hospital.

John Hickman, aetatis 21, was admitted an in-patient of the hos-
pital on the 24th of August, 1827. He represented his illness to
have commenced ten days before, with a violent twisting pain in the
bowels, attended by constipation. During that time his medical
attendant had given him 160 grains of calomel, a pound and a half
of salts, and a pound of castor oil, besides venesection, twice, to the
amount of sixteen ounces each time, with enemata innumerable. The
removal of this patient from his bed to the hospital caused a general
depression. On his arrival, his pulse was scarcely perceptible ; pain
on pressure of the abdomen. Two pills, each containing one minim
of Croton Oil, were given immediately, and, as refaction did not take
place for some time, he was put into a warm bath. When put to
bed a second time, the bowels began to act, and continued all night
aneTpart of the following day, when an immense quantity of feculent
matter was dislodged ; by this all pain and uneasiness was removed!
and in a fortnight he was discharged, cured.

Mary Ann Robertson, aetatis 16, reported on her admission, that,

Materia Medic ti. 255

for four months before, her belly had gradually increased in size ; that
she had been under medical treatment out of doors, but without hav-
ing derived any benefit

After her admission, three days were allowed to pass without en-
tering on any particular plan of treatment, as the fluctuation was
Toy obscure. After the lapse of that time; two minims of Croton
Oil were administered in the evening, which began to operate about
twelve o'clock, p. m. The number of stools were not counted by this
patient, as she was greatly distressed by the involuntary discharge of
mine. So great was the quantity discharged, that it ran through the
bed, and literally overflowed the ward ; the tumefaction entirely sub-
sided ; and in ten days she was discharged cured.

Our author cites the history of a case of tetanus, successfully treated
by Mr. Lawrence by the Oil, which has been published in his lectures,
and therefore need not be introduced in this place ; the following
cases of phrenitis and hydrocephalus, are worthy of perusal.

A. S. aged 38, had been troubled some days with severe pain of
the head and throbbing at the temples. He had been cupped twice
within the last thirty-six hours. When I saw him, it required three
men to keep him in his bed. His face was flushed, eyes glassy and
starting, conjunctiva much injected, scalp hot and constricted, pulse
small and hard, tongue covered with a dark coating. Took twenty-
four ounces of blood from the arm ; ordered cold lotion to the head,
and one drop of Croton Tiglium oil, to be repeated in an hour if the
bowels be not freely opened. I saw the patient again in six hours.
The second dose of the oil had produced several loose stools. He is
more quiet ; but the pain in the head is very 'distressing. Ordered
twelve leeches to the temples, to continue the application of the cold
lotion, and one drop of the Croton oil to be given every six hours.
The following morning he was much relieved ; has been for nearly
the last hour constantly on the water-closet. Pulse softer, face and
eyes of a more natural appearance. He vomited, during the night; a
dark bilious fluid. The stools black and very offensive ; complains
of inclination to vomit on taking any fluid into the stomach. Ordered
effervescing draughts of aerated kali, with recent lemon juice, every
four hours. In the evening the symptoms of cerebral affection returned
with nearly as much severity as ever. I ordered him to take ten
grains of calomel immediately, and one drop of Croton Tiglium oil
every two hours during the night, and the cold application to be con-
tinned to the scalp. Morning ; has had innumerable stools of a dark
watery character, and mixed with scybalse ; pulse soft and natural ;
complains only of weakness. Ordered one drop 01. Tiglii. three
times a-day, with the following draught, —

fy Potass. Subcarbon. 9i.
Confect. Aromat. 5ss.

Aquae Menth. Sat. 3iss. *

Succ. Limon. recent. 5i. .

Next day. Has improved since yesterday; stools more natural;
tongue becoming clean ; pains in the head quite gone. This treat-

256 Bibliograghy;

ment was continued two days longer, when a little tonio only waste-
. quired to re-establish his health.

The following cases of hydrocephalus I submit without a com-
ment:—

Kilbx Chalk brs, aged 5 years, was brought to me by her mother
who bore the marks of the scrophula, She said the child had been
weakly from birth. Her present illness had been of eight or ten
days' duration. The circumstance which first excited her alarm was
the great enlargement of the head. The pupils were dilated, sleep
disturbed, bowels constantly constipated. I ordered half a drop of
Croton oil to be given in a little powdered sugar three times a-day.
and the whole of the spinal column to be rubbed with an ointment
formed of one part of Croton Tiglium oil and four parts of Ung.
Hydrarg. fort, night and morning. The third application produced
extensive pustular eruption. The oil acted well on the bowels.
The character of the alvine evacuations was altered, from a green
curdy matter to almost natural fasces, in the space of three days ;
and every distressing symptom was removed in twelve days fromthe
. commencement of tie treatment. The head was much decreased in
size ; and I recommended the country air, and to continue to give a
drop of the oil in sugar occasionally.

Bsachbt, aged 4 years, had been ill about a week. The

mother obsevring an irregularity of the bowels, had given a purge of
infusion of senna. The symptoms becoming alarming, I was sent
for. I found the child in bed, rolling the head. Any attempt to move
him appeared to distress him much, and was attended with screaming.
The pulse was quick and small ; the skin hot : the tongue much fur-
red; pupils dilated; and his sleep disturbed; with those peculiar
screams which are so characteristic of hydrocephalus ; refuses all
kinds of food ; desires only cold water. I ordered five grains of
calomel with ten of jalap to be given immediately ; half a drop of
Croton oil three times a-day; a blister to the back of the neck. Hie
following .day, the blister had drawn well, and the bowels had dis-
charged frequently ; motions dark-coloured and watery. The akin
was not so hot ; the pulse slower ; the other symptoms as yesterday.
Ordered the blister to be dressed with Cerat. Sabinte, and the Croton
oil to be continued.

Third day.— Slight amendment. Treatment continued.

Fourth day.— Stomach very irritable, rejects every thing — medicine
, producing several stools of a dirty brown colour, and very offensive
smell. Ordered a blister over the stomach. Hie blister at the back
of the neck inflamed, and discharging freely. The savine dressing to
be discontinued, and bread poultice to be applied. The Croton oil
to be continued.

Fifth day. — Stomach quiet; has slept undisturbedly nearly four
hours; evident amendment.

Sixth, Seventh and Eighth days. — The treatment was continued.

Very little affection of the head remaining. The bowels seem to

; have become habituated to the medicine, which now produces only

•two ar three morions in the twenty-four hours. The tongue etfll

Materia Medua. 25?

-coaled. Ordered tydrarg. earn eretagr. v.every night. Half a drop
of the Croton oil twice a-day. Tkis treatment was continued twelve
days, when tke child was quite restored to health. Twenty months
hs?e now elapsed, and it still continues well.

We insert the following account of Cholera in India, which
corroborates that of Mr. Searle, and will be found in a preceding

There are two species of cholera prevalent in the East Indies—
the specks peculiar, perhaps, to that country, and the bilious
cholera, similar to that of England, hut, as is to be expected from
the mature of the climate, exhibiting in India much greater severity
ia its symptoms, and inflicting more permanent injury bn the consti-
tution it attacks. The one seems to arise from some ]>eculiar state
of the atmosphere, and, like other diseases produced by miasmata,
appeal* to exert its agency primarily and principally on the nervous
system. The other is undoubtedly caused, in some cases, by an in-
flammatory state of the alimentary canal, from the application of cold,
&c ; but in nine cases out of ten, by the presence of acrid bile,
which at tins time is poured out by the liver, much increased in quan-
tity, and, I have no doubt, considerably altered in quality. The for-
mer, like all other diseases where the nervous system is primarily
«ffected, is rapid in its progress ; so rapid, indeed, that it affords little
time for the interference of the medical practitioner. The latter is
slower in its effects, and allows sufficient time for the application and
operation of medical treatment. The usual mode of treatment
fallowed in India is the exhibition of calomel, opium in its various
forms and afterwards saline purgatives with senna. I was induced,
however, from the opinion I had formed of the cause of the complaint,
to begin with the purgative plan ; and the success which has attended
my practice warranto me to recommend it with confidence to the
consideration of the profession.

Of all other purgatives, I consider the Croton Tiglium Oil by far
Ac best in all cases of this kind. If there be any inflammatory ac-
tion going on in the intestinal canal, either from external causes, or
from the presence of irritating matter within, the Oil will be found
the most effectual application, as it will remove the cause of irritation
sooner than any other purgative with which I am acquainted ; and at
the same time, diminish inflammatory action more speedily, and, in
By opinion, more effectually, than even the abstraction of blood. As
• proof of these assertions, I have selected the following case, from
many similar ones which occurred to me in my practice in Madras,
daring a period of four years ; not because the effects of the exhi-
bition of the Oil were more obvious or more satisfactory, but because
at the ordinary mode of treatment had been -frequently applied before
in the same patient, and under the same circumstances, we are thus
enabled to institute a comparison, and this case is consequently mote
conclusive.

A lady, of a nervous temperament and bilious habit, aged about
35, came under my care, labouring under a severe attack of bilious
cholera, a oompleint of which she had had frequent serious attacks.

Vol. t. ho. 27. x x

258 Bibliography.

I found the vomiting of black bilious matter and the purging exces-
sive. Wishing to evacuate the contents of the bowels as soon as
possible, I ordered one drop of the 01'. Tiglii. in 5ij. of syrup to be
given every four hours-, and told the lady to drink freely of warm
barley-water. Three doses of the medicine completely cleared out
the bowels, removed the spasmodic action, and' appeared to have re-
stored the healthy action of the liver ; for, on the next day, no ail-
ment existed ; the appetite had returned, and in the evening she said
she felt quite well. In all her former attacks, she had been treated
with large doses of opium, which produced great stupor, without
relieving spasm. Calomel and the other usual remedies had also been
applied ; and it was generally upwards of a month before she had
perfectly recovered.

Dr. Short has also exhibited the remedy in hysteria epilepsy, gout,
spasmodic colic, toenea, and rheumatism with great success. He
thinks it superior to other purgatives. He has used it externally as
an irritating liniment, and is convinced it is preferable to tartanzed
antimony or lytta, it stimulates the skin much sooner than either of
them, diffuses more warmth, and can be better regulated as to its
effects. He has employed it in this way in acute and chronic rheu-
matism, in neuralgia, in glandular, and other indolent swellings, and
in pulmonary complaints. In combination with Ung. Hyd. the mer-
curial action is speedily produced.

Such are the valuable effects of the Croton oil, and we think the
profession deeply indebted to Dr. Short for the information he has
given. His treatise is well worthy of attentive perusal, and every
practical man will freely acknowledge the value of its contents.

9. Sedative effects of the spider's web. — The web of the black
spider has received commendation from many respectable sources,
as a sedative agent, capable of calming, with peculiar ease and cer-
tainty, morbid excitability of the cerebral and nervous systems. On
the credit of those qualities it has been employed in the various
forms of temulence, and not without a share of reputed success,
sufficient to entitle it to consideration in that state of constitutional
irritation. In the summer of 1827, we tried this article in many
cases, and in full doses. To test its qualities, it was given, where
the state of the patient admitted, uncombined with opiates. .When
thus used, its effects were generally partial or doubtful, and its powers
inadequate to the production of tranquillity or sleep. In one case
only have I found this substance to exert great or decided sedative
attributes. This was the case of an intelligent young man (in
private practice) who, after consuming, by his own report, three
quarts of brandy, in thirty-six hours, fell into a state of temulent
excitation so excessive, that he was incapable of keeping a recum-
bent or even a sitting posture, for more than a minute, but paced
his chamber with a ceaseless step for two days and nights. He
was not delirious : on the contrary his conversation was rational,
though hurried and vehement. But he was so far under the in-
fluence of spectral hallucination, that if he closed .his eyes for a
moment, day or night, he was instantly visited by a host of phan-

Chemistry. 259

toms of frightful aspect ; hence his aversion to lie down, or make any
voluntary effort to sleep. This patient took opium, opium with
camphor, and black drop, at short intervals, and in roll doses,
until the quantum of opiate approached the utmost limit of probable
aafe administration, without even partial relief of constitutional
irritation, or any apparent proneness to sleep. The temulent ex-
citement kept unabated for twenty-four hours, the second night
passed in constant vigilance, locomotion, and mental excitement*
and it seemed probable that excitation so intense, protracted, and
unremitting, must soon lapse into delirium or convulsions. At this
time, the morning of the third day (the second of my attendance)
he began the use of the fresh web in pills of five grains every hour.
Its effect was prompt and unequivocal. He calmed, even sensibly
to himself, with every dose, and watched with dsjrire for the time of
repeating the pills. The first effect of the web was to abate his
restless movements about the room, he became disposed to sit down,
and kept his chair, with short intervals of walking, for some hours.
In the evening he consented to go to bed, got up once or twice, but
retained to bed without difficulty ; took an opiate at night, the first
for eighteen hours, and slept continuously for eight hours. The cure
was completed without difficulty, by repeating the web less fre-
quently next day, quiet, suitable nourishment, and another opiate
at night The patient spoke emphatically, both the first and second
day, of the soothing influence produced by the pills. He was not
at the time informed of their composition. — American Journal of
Medical Sciences.

CHBMI8TBY.

10. Preservation of Blood — Sugar refiners and others are often
inconvenienced by the difficulty of obtaining blood at the time when
it is required for use. M. Toursel has endeavoured, in part, to re-
store this difficulty, by proposing a method of preserving this agent
for some time without injury. It consists in putting the blood into
bottles, or other vessels, with very narrow mouths, and being careful
to fill them up to the neck ; a layer of oil, to the depth of at least
half an inch, is then put upon it to cut off communication with the
atmosphere, and the whole is left to itself. M. Toursel states that
he has, in this manner, preserved blood, with all its physical and
chemical qualities, from the 1st of December, 1827, to January,
1829.— Jowm. de Commerce.

MEDICAL JURISPRUDENCE.

U. Shocking effect of Quackery in London. — We have often re-
minded the College of Physicians of their power to suppress
quackery, and never was there an instance better calculated to rouse
them from their lethargic slumbers, than the melancholy one which
we are about to relate. Can it be credited, that the lives of the
community may be sacrificed in a country that boasts of superior
orflization, in the following manner ?

A lady in perfect health, and in the - prime of life, twenty-four

260 Medical Jurisprudence.

years of age, accompanies her lister to the boose of an audacious
# quack, who not only pretends to cure consumption, but to prevent
all diseases, and whose votaries ate the Peerage and Commoners erf
England. Tbe wily empiric tells another patient, tint the lady
Whose tragic fate we are about to detail, must die of consumption
in leas than two months, unless she submits to his mode of treat*
ment. The unfortunate female consents, and the treatment Is com-
menced, whieh consists of the application of a powerfal esckarotie to
the back, which produces such inflammation and sloughing, that the
deluded victim is destroyed by constitutional irritation, and when in
the act of dying, is assured by the ignorant pretender to physic,
she is doing exactly as he wishes, and that he would give one hun-
dred guineas could he effect similar sores on more of his patten**.

A coroner's inquest is held, when the following evidence is pro-
duced, which we copy and condense from the public papers.

Inquest on the body of Miss Cashin, lately wider the care of Mr. St.
John Long, curer of all diseases, who is patronized and encouraged
by the Peerage and Commoners of the United Kingdom of Great Bri-
tain and Ireland, and tolerated by the Royal College of Physicians
in London, contrary to the law of the country which constitutes that
body, and originally incorporated it for the suppression of qtiackert,
and protection of the lives and health vf his Majesty's liege sub-
jects.

On Saturday, the 21st ultimo, a coroner's inquest was held at the
Board Room, Hampstead Road, to inquire into the cause of the
death of Miss Cashin, a young lady of the highest respectability,
a native of Ireland, who died in consequence of the treatment em-
ployed by a person named John St. John Long, residing in Harley
Street, Cavendish Square, a man who professes to prevent and cure
all diseases, but particularly consumption.

Mrs. Roddis deposed, that she accompanied the deceased to
Mr. Long's, in Hafley Street, on Friday week, to ascertain bis
opinion of her back, when he declared " it was precisely what he
wished it to be." On the following day, witness was called to the
young lady's apartment, and found her in the greatest agony, and
on looking at her back, saw it in a state which it was impossible
for her to describe. In the evening Mr. Long came, and pronounced
the back to be in a very good state, and that he " would give a
hundred guineas if he could produce a similar wound upon the per-
sons of some of his patients." Witness pointed to a certain spot,
and inquired the cause of its appearance, which he said arose from
inhaling, which was a part of his system, and without such appear-
ance no good could be expected. Witness wished he would eider
a composing draught, Dut he replied, a tumbler of mulled port wine,
was better than all the doctors in the world could prescribe. He
denied the patient was in danger. Mr. Brodie was called* ordered
some medicine, which relieved the sickness of the stomach,- and re-
commended a poultice to the back. On the following day the
patient expired. The lady was in perfect health when she applied to
Mr. Long, and did so, as site was told l he could prevent any com-
plaint with which a person was likely to be affected.

Meduai Jutiiprudtnoe- 3SI'

Mr. Brante depend* that am anaascaine} the tack** the dumij

atoesttiied a slough as large as the pate of b*aban&. these**
wawaliag skin i» nfaned, she had inaanssati w>mjtjng., {bpwhieaj
is pieseribed what remedies ha thought heat. Gat the. foUfflriag
day he found the patient dead, and the aloegh coneiieraHy extended.
He considered the wound in the hack the cause of death.

Mr. Sweetmaa, friend to deceased, stated, that the sister of de-
eevedhed died that day, aad was also under the care of Mv> Long* —
a declaration which produced an extraordinary scnaatian among the'

Sk Francis Bardett, M. F. came forward to speak ef Mr. Long'*
caopetaney. He, Sir F, had called on him* aa he had heard of two
persons owed of \m doloureux by him, with, a vievr ta faasje wee-
ftcr any relief could he afibtded the Marquis of Anglesey, and fieesa
what he saw, was convinced there was no danger in his laode of
treatment; for having the gout in his hand, he suffered the recaedy
to be applied, though, with the conviction that it could do him no
good, and in order that he could report to the Marquis of AflgV?my
tie efest. His lordship got better at the time ; hat so satufed
vas deponent of. the effects of the practice, that be leoawrumdad
Mr. Long two patients*

Mr, Wakiey, who attended aa a friend ta tha retaaweav ceoea-
rarnmrd Sir Francis, when the rbUawing evidence was given*-*- .

lhat wmness did not know any person relieved by fybiLeng: that
at derived no benefit whatever free* the apptioatftoti; that Lord
8fi§j> tnid him he was cawed of the gout by Mr% Long, and that he>
Sfr P. had net made meditate his study; knewnotfaingof Mr Tnag'i
preparation, and could not distinguish prusam acid ffoni water.

Dr. Alexander Thomson gave a aaoat minute detail of the morbid
appawaaeti, and BOfaahninded it wfclh technicalities, as to bewilder
bath oaroaer and jury. He proved " there was no sloughing on
aa back/' and coakk net take upon himself to say what was the
enae af death, nntfl he had examined the head and spine. The
hanest was adjeasned tern the purpose, and after the dissection, he
teased, that the brain was healthy, the sheath of the spinal cord
leahnV the pleura and stomach highly inflamed, and that there was
as dnTeeeace of opinion between Mr. Brodie and himself.

Mr. King was present at the dissection, the brain was healthy-**
the body appeared that of a healthy person who died after a shout
fflnese, observed a large scar on the back, nearly aa large as the
crowa of a hat, as if a red hot iron had been applied ; the swv
rouading parts gorged with serum, dad not examine the pleura t»
tfonuch ; was of opinion that the state of the back was produced by
* very strong ecsharotic, and should say very few persons could re-
cover after such an injury ; the injury on the hack was the sole
cause of death ; believed the patient was not consumptive.

Mr. Wildgoose, surgeon, appeared for Mr. Long. The gist of
as evidence was, that " he should not have supposed the state eff
the baek would have caused death."

Mr. Wakley cross-emamined this witness in a manner waioh^
excited much laughter.
Dr. John Hogg was present at the examination of the spine ;

262 Medical Jurisprudence.

observed the cord discoloured opposite the injury on the back, it
was of a crimson appearance and thickened, the cord was healthy, as
also the brain ; " the violence done to the nervous system was quite
sufficient to cause ' death, particularly in the case of a nervous and
delicate young lady. He should not think of making such a wound
in any case."

Dr. Goodeve corroborated the preceding evidence.

Dr. James Johnson deposed, that the sheath of the spine was
slightly discoloured, but the whole was not thickened ; did not
think the redness was the cause of inflammation ; was of opinion
that the patient died from several effects, the primary cause being
from the local inflammation which produced incipient gangrene,
fever resulted from that inflammation, and the inflammation of the
stomach, and pleura resulted from the fever. Death was produced
by these combined circumstances, all depending on inflammation
of the back;

Mr. Mackelcan and Mr. Evans coincided with the other medical
witnesses.

Mr. Sweetman ' corroborated the evidence of Mrs. Roddis, and
stated farther, that Mr. Long informed him how deceased, became
his patient. " He told me that a young lady, one of his patients,
asked him what he thought of Miss Catharine Cashin, who was in
the habit of going to his house with her sister Ellen, and Mr. L.
told the young lady, that Miss Cashin would be seized with con-
sumption in less than two months, unless she allowed herself to
be rubbed by him with his mixture. She told her mother, who
consented to her undergoing this treatment, lest she might have to
accuse herself of any neglect in the cure of her children."

The following classes of persons came forward to prove the safety
and infallibility of ,Mr. Long's practice, either on themselves or
their families. A marchioness, a lady of title, a general, a surgeon,
a solicitor, and a number of ladies and gentlemen ;— one gentleman
proved that he was under the care of Sir Astley Cooper, who con-
sidered his case a dangerous one, and afforded him no relief, and
that he was cured by Mr. Long. Another was sent home to die of
consumption by Sir Anthony Carlisle,* and cured as if miraculously.
In fine, all the witnesses, who amounted to sixty-three, were under
the care of regular practitioners, and derived no benefit, but were
either cured or relieved by Mr. Long's friction and inhalation, which
were employed in every case. The escharotic lotion was applied to
the chest, back, temples, hands and legs, and always produced
violent inflammation and sloughing. In one case it was applied to
a leg affected with erysipelas, it produced a great pain, but cured
the patient in a few days. The marchioness swore that she applied
Mr. Long's lotion to her hands without injury.

This melancholy case affords us another excellent opportunity of
commenting on the medical evidence. It is clear from the evi-
dence of Dr. Thomson, that he is a tryo in medicine, and presents
a good example of the necessity of enforcing the study of medical
jurisprudence. He first affirms there is no slough on the back,

• ' Sir A. has contradicted this.— Timet . Aug. 31st. Ed.

Medical Jurisprudence. 263

though proved, by one of the most scientific and eminent surgeons
in London ; and next, he cannot say what is the cause . of death,
until he examines the brain and spine. Could any practitioner of
common observation, have the slightest hesitation in ascribing the
cause of death to the extensive eschar on the back, or hesitate half
a moment to ascribe the other morbid appearances to this cause ? Is
there a met better attested than this, that the constitutional irrita-
consequent to such a cause, would destroy life, unless arrested by
proper treatment. And whoever heard of grmrnTiiTig the brain and
spine in such a case, to discover the cause of constitutional irritation
tion, or, in other words, of death. As well might one examine, the
brain to discover ' the cause of death from a severe burn, tetanus,
hydrophobia, &c. Again, of what utility was it, to puzzle the court
fay a technical description of every organ in the body, and cause the
body to be disinterred without the slightest necessity ; for there was
not a well informed man in the profession, who perused, the evi*
dence, but would declare such sloughing on the back produced by a
strong escharotio, and moreover on a person in perfect health, was
the cause of death ? Gould any man acquainted with the effects of
local and constitutional irritation, hesitate a moment in forming ^an
opinion on the cause of death in this unfortunate case I But there
are exceptions in the parsons of Dr. Alexander Thomson and
Mr. Wildgoose. Of all the medical evidence in this case, Dr. John-
son's was the best; the most scientific, concise, and conclusive ; it
wis such as men of scientific acquirements and actual experience
would have given. We may remark, that it is a principle in judi-
cial medicine, that medical men should be as intelligible and as
conclusive as possible, avoiding all unnecessary displays of techni-
cality and rigmarole. This was well exemplified by the evidence of
Mr. Brodie. Dr. Hogg, Mr. King, and Mr. Wildgoose, allowed
themselves to wander too much from the real question, and the
latter appeared more in the character of an advocate than a medical
witness.

We should strongly advise some of the medical men who figured
in this inquiry, to look into some work on medical jurisprudence,
before their next appearance in a court of justice, and also to
peruse some standard work on the question on which they intend to
pre evidence. One would think science had fled from the profes-
sion, when its members come before their contemporaries and the
public, and broach the most heterodox and absurd opinions.

For the information of our continental and transatlantic contem-
poraries, we state, that Mr. Long has been hitherto the most suc-
cessful pretender to physic in London, his income was estimated at
£.10,000 a year, his patients were every class of society, from the
peer to the peasant It appeared in evidence, at the above inquiry,
that four short years ago, he was a painter or limner, and having
received, by inspiration, the gift of preventing and curing all dis-
eases, in the manner so powerfully illustrated in this article, he
commenced to practice, " the science and art of healing on new
principles.'' Of his gross ignorance, we afforded ample evidence in
our notice of his work in a former number ; than which a more

964 Miscellanies.

ignorant prodactian. never 'emanated from ttie press; .There ww not
a correct reauurk from am cover Id the other, bat a tissue of Tile
tank, Dram beginning to end; and it only surprizes ub that any
peiBoa of comsaan sense, sanea mare that our nobility and
gentry* could be duped by such a production. We should hate
passed Mr. Lone; anaoftsaad, had not his baneful practice afforded
us a aad example of, we fear, frequent occurrence, nor should w«
even notice aim at preterit, had the reenlt of the coroner's inquiry
the slightest effect upon bin life or liberty, for such is the defectors
state of the iaw in this country, that tha said ioqairy is simply
" mnch ailo about nothing." Our humane law, as exemplified in
Van Butcbell'B case, will bear him harmless. Much higher motives
have induced us to publish lias inquiry, namely, the better con-
servation of the public health* La another part of this number,
arill be found sa account of the amplest power intrusted to the
GoUeae of Fhysicians for tins purpose. We shall conclude, by
allowing one of the fellows of the college to speak upon this point.
Dr. Brooke Faulkner observes, in speaking of the fcolLege prose
cations of regular Doctors :—

" Yet such is your eagerness in your prosecution of tnen Hke
these, when they refuse to take out your licence, that the country
may overflow with the rankest vermin of empiricism, from Pall
Mall East to the Land's End, end you take no concern about the
matter. The informer appeals before you, narrates, with every
minutia of circumstance, the depredations of divers charlatans in
his neighbourhood, slaying on the right hand and on the left, and
every day gaining name and fame, just in proportion as they give
employment to the undertaker. There is no lack of evidence here
to enable you to prosecute. All the facte and particulars are ready
in full, tangible proof ; every moving circumstance is touched upon
by your informant that can add pathos to his appeal ; you are
besought by the responsibility of your trust ; and every daim of
humanity is eloquently urged in the imploring petition. The answer
is, you are busy prosecuting Dr. Harrison."*

i i IM

MEDICAL CORONERS.
It affords us much pleasure to observe the support which Mr. Wakley has received
in bis canvass for the coronersMp of the countv of Middlesex. Though we differ
from him on many subjects, we are ready to admit, that his coming forward on this
occasion* at the miioitauon of a large body of freeholder*, whether the result
be successful or otherwise, must be productive of much good, as the question of
the fitness of medical men for the office of coroner has been fairly brought before
the public. Should he be elected, and we sincerely wish him success, a great
improvement will he effected in an ancient and valuable department of our judi-
cial proceedings; for the ^example of Middlesex, or more properly of London,
should he be elected, will be generally followed throughout the empire, and the
interests of the medical profession and of the public, considerably promoted.
— ■ ■ ■ ' !■ — ^—— ^ — ~ ■»— »— . — — iii ■

* Letters addressed to (he Royal College of Physicians, on their Constitution and
Charter, with prefaratory observations, to his Grace the Duke of Wellington.
Ey Sir Arthur Brooke Faulkner, Bellow of the Royal CoUege of Physicians,
tendon*. 1«S9.

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. 28. OCTOBER I, 1830. Vol V.

CRITICAL REVIEW.

I. — A short Tract on the Formation of Tumours, and the
peculiarities that are met with in those that have become
Cancerous 3 with their mode of Treatment. By Sir Everard
Home, Bart. V.P.R.S. F.S.A. F.L.S. Serjeant Surgeon
to the King*, &c. &c. &c. 8vo. pp. 98. 4 plates. London,
1830. Longman and Co.

The venerable author of the work before us, concludes hi*
distinguished literary career with the present production.
The high reputation of this distinguished man will never
cease to be remembered while medical science has its vota-
ries. It is quite superfluous for us to detail his valuable
contributions to science ; they are universally known and
appreciated. We may briefly remark, however, that his
" Lectures on Comparative Anatomy, in 6 vols. 4to., with
numerous engravings ; his Practical Observations on the
Treatment of Strictures in the Urethra and CEsophagus,
3 vols. 8vo. ; his Observations on the Treatment of Diseases
of the Prostrate Gland, 2 vols. 8vo. ; and his numerous Essays
in the Philosophical Transactions, &c." evince extensive re-
search, indefatigable industry, accurate discrimination, sober
reflection, repeated observation, and much originality. —
Posthumous eulogy will do the talented author ample
justice.

It affords us sincere pleasure to observe such, an eminent
member of our profession, commence a work with the fol-
lowing declaration, which is alike honourable to him as a
philosopher and a man, and offers strong proof that en-
lightened medical men are not so indifferent to religion as the
world imagines. The public, who are generally fools, are
of a different opinion ; but those acquainted with medical
history may triumphantly refer to its pages, where the fact

Vol. v. no. 28. ll

266 Critical Review.

is attested beyond dispute, that the most eminent members
of the faculty have been distinguished for their piety ;
among whom we find the illustrious names of Harvey,
Locke, Sydenham, Boerhaave, Haller, Arbuthnot, Hoff-
man, Sthal, Baglivi, Steno, Riverius, Brown, DeHean, and
in our own day, Gregory, Baillie, Bateman, Davy, and a
host of others who are still the ornaments of the profession.
But the really learned of the faculty have never been in-
fected by the poison of infidelity. Sir Everard commen-
ces his preface as follows : —

" As this short tract is the last of my professional labours that
will be submitted to the public, I cannot, at the age of seventy-four,
make a better preface to it, than by an humble prayer of grateful
acknowledgment to the Allwise Creator, who has permitted me to
continue the investigation of his most wonderful works for so long a
period, and thus enabled me, in many instances, to alleviate the
miseries of suffering humanity, and to glorify the name of the Author
of our existence."

It will be recollected, that our author published an ac-
count of tumours in the thecro of nerves in 1800, in the
Trans, of a Society for the Improvement of Medical and
Chirurgical Knowledge, and in 1805 a Tract on Cancer,
and his object in the present work is to make known the
facts he has since observed respecting tumours in general, and
cancerous ones in particular. He makes the following re-
marks upon the pathology of these classes of diseases :—

" As the blood is the fluid in which these materials are circulated,
and the arteries are the vessels which, under the agency of the nerves,
deposit the supplies required, while the lymphatics carry off the parts
rendered useless, we must first acquire a knowledge of these vessels,
and of their actions when the body is in health ; since it is only when
such actions are perverted, or otherwise interfered with, that the
produce of disease is met with.

These subjects I have treated of in another work ; and here we
have only to consider those cases where either the blood or some part
of its ingredients, in consequence of external violence, are deposited
in greater proportions than is required to repair the injury, as it is
from this accumulation that tumours are produced ; and in general
they resemble in structure, more or less, the substance of the natural
parts by which they are immediately surrounded. Fatty tumours are
nothing more than a deposit of fat in parts that have been slightly
injured, and have never recovered their healthy actions, but go on
depositing that substance where it was not required.

Where the injury has been more severe, the materials of which the
consequent tumours are composed differ according to the quantities
and new combinations of the extravasated materials ; but although

Sir E. Home on the Formation of Tumours. 267

unlike one another, still, however, in general, in their texture, they
bear a resemblance to the healthy parts by which they are sur-
rounded."— p. 4.

, He describes a particular kind of tumour situated in the
substance of nerves, which deserves attention.

" A lady, twenty years of age, had a tumour on the outer side of
the biceps muscle of the right arm, the size and shape of a pullet's
egg; it was moveable in the surrounding parts ; it had been several
years in acquiring its present size, and was very painful when pressed
upon. Its rapid increase induced her to have it removed by the
knife. When the parts were fully exposed, the surface was smooth
and shining. At both ends the tumour terminated in a white cord.
Upon cutting through the outer covering, the real tumour was found
to be enclosed in a nerve. When this discovery was -made, it was
thought prudent to divide the nerve at both ends, and remove the
whole. The akin did not unite by the first intention, but the parts
healed very kindly. The patient had no use afterwards of her thumb
and fore-finger, and had a numbness in these parts ; the skin which
covered them was unusually rough and dry, and the cuticle came off
in scales. On examining the tumour, three inches of the nerve itself
had been removed ; it was separated into two portions, each much
flattened, and passing over the sides of the tumour. There was also
a thin nervous expansion, not thicker than a membrane, completely
investing the whole. This was readily separated, although more
firmly attached at the extremities.

" The tumour, when its substance was examined, had the appear-
ance of being made up of serpentine fibres running in the course of
the nerve ; these were separate from each other, and the interstices
fiQed jap by the substance of the tumour ; but near its surface the
tumour had a radiated structure." — p. 7.

A singular tumour is described and illustrated by plates,
which arises from the diploe of the skull in consequence of
injury, makes its way through the external table without
injuring the internal one, and is certainly not generally
known. An extraordinary case is given, in which the tumour
arose underneath the external table of the right parietal bone,
and rested on the shoulder; its cranical attachment was
osseous, and was divided by a saw. There was no local
or constitutional irritation after its removal, and the woman
has continued quite well, now a period of fourteen years.
She is a nurse in St. George's Hospital. A similar case was
successfully treated, by Mr. Robert Keate, of the same
hospital. The appearance of our author's patient, before
and after the operation, is admirably represented. These
cases disprove the doctrine' of phrenology in a remarkable
manner.

268 Critical Review.

" Cases of this kind completely expose' the fallacies of the doc-
trine of craniology, than which nothing can be more absurd ; since
the external surface of the internal table of the skull, and that of
the external table, can never be under like circumstances, nor have
similar changes in them produced from the same causes or corres-
ponding circumstances ; and yet the sole foundation of this doctrine
is a supposition that the effect of the developement of the brain
upon the internal table is produced in an equal degree at the same
time in the external table, which, from the nature and texture of
the diploe, can never happen." — p. 17.

The remainder of the volume is devoted to the subject
of cancer, and affords no new information. A number of
cases are detailed in which operations were performed;
but the pathology of cancer is left as obscure as ever. Our
author is of opinion, that the same parts in different indivi-
duals, under similar circumstances of violence, do not
always form cancerous tumours, so that these tumours must
depend on peculiarity of constitution ; and therefore in
their origin cannot be cancerous. There seems to be a
contradiction of terms in this statement, at least there is
much ambiguity, for in the succeeding paragraphs, we are
told there are no hereditary diseases. Again, it is implied
that defect of constitution is the cause of cancer. Every
one is aware that tumours of the breast may or may not
become cancerous ; and in proof of this fact, our author ad-
duces a case in which a policy of assurance was disputed, in
consequence of a discrepancy of opinion between himself
and Mr. Cline, which is worthy of attentive consideration.

" A gentleman who had a similar accident, followed by a tumour
in the breast, which he did not believe of any consequence, insured
his life, and declared himself labouring under, no disease. He after-
wards died from a cancer formed in that tumour. Mr. Cline was
consulted, and said that the tumour in the pectoral muscle was a
cancer, and had been so from its first formation. In this opinion he
was supported by another surgeon ; and therefore the office refused
paying the insurance, as the gentleman died in consequence of the
fungous excrescence which this tumour afterwards produced. The
case came before Sir William Grant, then Master of the Rolls, who
was staggered by Mr. Cline's affidavit, but not convinced, and called
upon me to know my opinion. I stated, that if Mr. Cline was cor-
rect, all such accidents would be immediately followed by cancer,
which I knew was not the case, and gave him several instances in
confirmation of my assertion, in particular, that of Mr. Hunter;
and the gentleman's executors gained their cause ; since Mr. Cline
could bring no proof when the cancerous disposition first took
place ; and as the gentleman, at the time he took the oath, could
have no knowledge that the swelling brought on by the accident
could be the forerunner of any disease/' — p. 21.

Sir E. Home on the Formation of 'Tumour*. 269

There are few cases of forensic medicine which are so
often disputed as policies of life insurance, or such as
require more judgment from the practitioner. It would be
well if we had a good treatise on this subject for the
guidance of young practitioners, as extensive frauds are
daily committed by the respective parties in these transac-
tions. To return to the subject more immediately before
us, we have to observe, that our author considers the serum
and lymph globules are the parts vitiated, and capable of
propagating the poison. This of course is pure conjec-
ture, and is even doubted by the author himself in a future
page.

He adduces cases of hydatids of the breast, which were
mistaken for cancer, as evidence against this hypothesis.

Sir E. next describes the progress of cancer, and in proof
of his competency to undertake this task, he states that he
lived with Mr. Hunter till his death, and had the superin-
tendence of all his numerous cases, and that his whole
observation has been derived from a practice of fifty-seven
years. He details several cases in illustration of tne pro-
gress and treatment of cancer, but they are generally de-
void of interest, as they throw no new light on the sub-
ject. " I am sorry to add," says he, u that very little
progress has been made, either towards a cure or a preven-
tion of the disease taking place." He has found the inter-
nal and external use of hemlock of most value, and claims
the discovery, that the powder is the most restorative pre-
paration of sarsaparilla, an opinion he has maintained for
the last fifteen years. Ample experience has convinced
him that the power of sarsaparilla is greatly weakened by
heat.

Such are the opinions contained in the work before us.
The production is worthy of attentive perusal, as it con-
tains numerous clinical reports, which will be perused with
adrantage by operating surgeons.

II.— -4 Treatise on the Venereal Diseases of the Eye. By
William Lawrence, F.R.S. late Professor of Anatomy
and Surgery to the Royal College of Surgeons in Lon-
don, Surgeon to St. Bartholomew's Hospital, and Lec-
turer oh Surgery in that Hospital, &c. &c. &c. 8vo. pp.
337. London, 1830. John Wilson.

Our author informs us, that the work before us is drawn up
entirely from his experience, and its contents are as follow : —

270 v Critical Review.

Ch. I.—- An introductory and historical view of the subject*
division of the diseases of the eye into gonorrhoeal and syphi-
litic. Ch. II.-^-The symptoms, diagnosis, prognosis, causes
and treatment of gonorrhoeal inflammation of the conjunctiva.
% Ch. III. — Mild gonorrhoeal inflammation* of the conjunctiva.
Ch. IV.— Gonorrhoeal ophthalmia of the external tunics and
iris, including details of xxrv cases, which occupy sixty-
six pages. Ch. V. — Syphilitic diseases of the eye, with
symptoms, diagnosis, prognosis, and treatment, exemplified
by xxix cases, the account of which extends to nearly a
hundred pages. Ch. VI>— Syphilitic ulceration and erup-
tions of the eyelids, illustrated by five cases. The different
diseases are first described, ana references so constantly
made to the cases, that it is totally impossible to attempt
an analysis of the work, without occupying an extent of
space which far exceeds that by which we are circumscribed,
and which* could be converted to better use than to the dry
details of cases. The whole .opinions of the author might
have been given in a dozen pages ; indeed, we are confident
that we could condense them into even half this space.
We expected a much more comprehensive work from
Mr. Lawrence, one that would comprise the whole diseases
of the eye, and still not more expensive than the present
publication. The work before us is by far too expensive
for the quantity of matter which it contains, and we pro*
phesy that the respectable publisher will speedily discover
the truth of our prediction. There is as much original and
important matter in Mr. Travers' little essay, at a fourth of
the price ; and we must further observe, that the author
and publisher ought to have been aware of the profes-
sional taste for cheap literature, and that some of the
most distinguished surgeons of this capital have ruined the
sale of their works by the exorbitance of price, and stimu-
lated others to publish pirated impressions at a cheaper
rate.

We shall now proceed to place before our readers,
Mr. Lawrence's opinions on the nature and treatment of
venereal diseases of the eye.

He commences by alluding to the delicate and compli-
cated structure of me eye, its liability to common disease,
with the various results, the modification of morbid affec-
tion in scrophulous, gouty and rheumatic constitutions ; its
liability to cancer, fungus, hoematodes, melanosis, and ve-
nereal disease. The last named disease, he observes, has
been unnoticed by some receut writers in this country,
though St. Yves, Astruc, Camerer, Swediaur, Benjamin
Bell, and Richter, have described gonorrhoeal ophthalmia.

Mr. Lawrence on the Venereal Diseases of the Eye. 271

Iritis was first noticed by Professor Schmidt, of Vienna,
in 1801. Mr. Hunter was not aware of gonorrhceal ophthal-
mia, though he speaks of supposed venereal inflammation
of the eyes. Mr. Pearson knew nothing of gonorrhceal
or syphilitic affectt&ns of the eye, as appears from his letter
to Mr.Briggs, the learned translator of Scarpa's treatise on
diseases of the eye, which letter is quoted by our author.
He also expresses his surprise that two such writers as the
illustrious Hunter and the erudite Pearson, whe were al-
lowed to be intimately acquainted with venereal disease,
should be silent on the affections under notice ; and he
endeavours to explain this ignorance, by observing, that the
study of ophthalmic surgery bad been entirely neglected in
this country until within a few years, and that eminent sur-
geons were accustomed to send their ophthalmic patients to
ignorant oculists. Recent writers have proved themselves
acquainted with this subject, but none of them have con-
sidered venereal affections of the eye professedly or gene*
rally ; and hence our author has undertaken the task, and
has drawn his views of the symptoms, progress, effects*
and various forms of treatment from his own experience,
which we need scarcely observe is extremely extensive.

Mr. Lawrence divides the venereal diseases of the eye into
the gonorrheal and syphilitic ; the first consists of three
distinct forms of ophthalmia ; 1st, acute inflammation of the
conjunctiva ; 2d, mild inflammation of that membrane ; 3d,
inflammation in the sclerotic coat, sometimes extending to
the iris.

Our author gives the synonyms of the first form, which
are as follow : — Acute gonorrhceal inflammation of the con-
junctiva, gonorrhceal ophthalmia, blepharophthalmia, and
ophthalmia gonorrhoiea vera of Beer. This bears a close
resemblance to the purulent ophthalmia of British writers,
and has been so graphically described as to render a copy
of the author's account of it .wholly unnecessary, more
especially as it is accurately given in his lectures on sur-
gery. We may briefly remark, however, that he tells us,
" it is the most violent and rapidly destructive inflamma-
tion to which the eye is subject, and fortunately it is one of
rare occurrence." The changes which it commonly pro-
duces in the cornea are sloughing, ulceration, and inter-
stitial deposition, ending in opacity, or escape of the hu-
mours and collapse of the globe, obliteration of the ante-
rior chamber, and flattening of the front of the eye, sta-
phyloma, prolapsus iridis, obliteration of the pupil, and
anterior adhesion of the iris. The progress of every one
of these diseases is minutely described, and numerous

272 Critical Review.

references made to cases illustrative of them. The prog-
nosis is as follows :—

" The violence of the inflammation, its rapid course, and the
disorganization or changes of structure, which it so speedily pro-
duces in the cornea, are attended, under all circumstances, with the
greatest danger to sight, which, in a large proportion of these cases,
is either lost or seriously injured. Thus of the fourteen cases which
I have related, loss of vision took place in nine from sloughing,
suppuration, or opacity of the cornea. . In two of these one eye
was lost, and the other recovered; Sight was restored in the other
five, with partial opacity of the cornea, and anterior adhesion of the
iris in three of the number. So short a period intervenes between
the commencement and the full developement of the complaint, that
in many instances irreparable mischief is done to the eye before our
assistance is required. If we see the complaint in the first or second
stage we may expect to arrest its progress by active treatment ; bat
success does not invariably attend our efforts even under such favour-
able circumstance, as Case V. proves. Our prognosis will princi-
pally turn on the state of the cornea ; if that should possess its
natural clearness, the eye may be saved. If it should become hazy
and dull, and more particularly if it should have assumed a white
nebulous appearance, consequences more or less serious will inevi-
tably ensue." — p. 26.

Our author cites the opinions of Pearson, Beer, Scarpa,
and Vetch against the idea, that gonorrhoea! matter pro-
duces the disease under notice, but he adduces cases from
his own practice, which leave no doubt of the converse of
these opinions. He admits, however, that in a great pro-
portion of gonorrhoea! ophthalmias, we cannot trace the dis-
ease of the eye to the application of infectious matter,
either from the same or another individual. The eyes are
said to suffer by metastasis, and according to Richter,
Scarpa, and Beer, the urethral discharge is suppressed, but
thi3 did not happen in our author's cases, nor in those
detailed by Delpech — the discharge was lessened but
not suppressed. Again, the suppression of the discharge
by surgical treatment, is not followed by ophthalmia. Since
the disease of the eye may occur while the urethral dis-
charge continues, and since it does not take place when
the discharge is stopped, we cannot admit, says our author,
"that the affection of the eye owes its origin to the cessa-
tion of the diseases in the urethra."

" I am inclined to refer its occurrence to the state of the con-
stitution, without being able to point out in what that state consists,
and to regard it as a pathological phenomenon analogous to those
successive attacks of different parts which are observed in gout and
rheumatism. The two other forms of ophthalmic inflammation,
which take place in conjunction with gonorrhoea, show themselves
only in rheumatic subjects, and generally in connection with other

Mr. Lawrence on the Venereal Diseases of the Eye. 273

arthritic sufferings; and the difference between one of these and
the affection now under consideration is only in degree. This view
of the subject may throw some light on the circumstance that,
though direct infection operates equally on both sexes, the gonorr-
heal ophthalmia, said to originate in metastasis, seems to be confined
to the male. I have never seen it in the female ; and Beer, in the
passage last quoted, says, that he has observed it only in the young,
robot, and plethoric men." — p. 35.

We now arrive at thfe treatment of this disease, which
will appear to many physiologists and pathologists fully
as dangerous as the disease itself. No doubt the disease
requires the most active treatment, but we cannot help
thinking, that many practitioners would hesitate to employ
depletion to the extent recommended in the following ex-
tort, for the injury done to the constitution must un-
questionably produce most fatal diseases, if not death itself.
In making this remark, we do so on mature deliberation,
awl we refer those who choose to doubt its accuracy, to the
test works on physiology, and especially to Dr. Marshall
Hall's work " on the curative and morbid effects of blood
letting," and to M. Andral's Pathology. Indeed, it must
be obvious to every man of practical experience, that de-
pletion, carried to the extent recommended, and employed
indiscriminately, in all ages and constitutions, for no excep-
tion is made, could not fail to produce more fatal effects
than the disease before us. We shall adduce the most
respectable evidence in favour of our opinion, after the
insertion of Mr. Lawrence's plan of treatment.

" The only chance of arresting this violent disorder, and pre-
saving the eye from its destructive effects, is afforded by the
Oddest antiphlogistic treatment ; particularly by the freest abstrac-
tion of blood generally and locally. We must bleed largely from
the ana, and take blood by cupping on the temples, or by nume-
rcos leeches applied round the part ; and these measures must be
repeated at short intervals, until the vascular congestion is relieved,
and the attendant pain removed. The other parts of the antiphlo-
gistic treatment must be combined with this free abstraction of
bjood; but our great reliance must be placed on the latter. In Case
». blood was taken very largely, both locally and generally, and
°thej powerful antiphlogistic means were resorted to ; these mea-
t*0** were employed in a very early period of the complaint ; yet
the eye was lost. From the unfortunate termination of this case,
f&d from the unfavourable issue of others recorded in this paper, I
jafer, not that antiphlogistic treatment is incapable of arresting this
flfammation, but that it has not been employed to a sufficient
extent ; and if I had to treat some of these cases again, I certainly

▼ol. IV. no. 28. iff m

274 Critical Review.

should bleed more freely. / think that as much blood should be taken
from the arm as will flow from the vein, and that the evacuation should
be repeated, as soon as the state of the circulation will allow us to oft
more. This plan of depletion should be pursued until the local ex-
citement is subdued. ' These/ says Mr. Bacot, ' are case*,
which defy all the usual etiquette of regular and ceremonious visits.
If we wish to save our patient from the destruction of his vision, we
must scarcely depart from his bed-side until the inflammatory
symptoms are controlled. The lancet must be hardly ever out of
our reach, for if ever there was a disease in which blood may be
taken away without limitation, it is this.' Mr. Wardrop informed
me, that the only case of gonorrhoea! ophthalmia he had seen in
which the eye was saved, was that of a young woman, in whom
venesection was repeated as often as blood could be got from the
arm. She lost 170 ounces in a few days, and looked as if every
drop of blood had been drained from her body ; the akin having
nearly the hue of a wax candle. In the cases which terminated
most favourably, among those recorded in this paper, blood wm
taken very largely. In Case VIII. forty ounces of blood were taken
from the arm on the 6th November, being the 6th day of the disease,
and twenty-four leeches were applied. The same number of leeches
was repeated on the 7th, 8th, 9th, and 10th ; on account of a relapse
eighteen leeches were applied on the 13th, twenty ounces of blood
taken by cupping on the 14th, and twenty-four ounces by vene-
section on the 15th. In Case IX. twelve leeches were applied on
the 20th September (the fourth or fifth day of the disease) ; sixteen
ounces were taken from the temporal artery on the 21st, and forty-
four ounces from the arm on the 22nd, twelve leeches being applied
•on the same day ; twenty leeches were applied on the 23rd, and on
the 24th ; twenty ounces by cupping on 26th ; thirty-six ounces by
venesection on the 27th, and the same quantity on the 28th. In
Case XII. although the loss of blood was not considerable, it
operated very powerfully on the circulation and strength of the
patient.

" For the slighter symptoms, which may show themselves after
the inflammatory action has been subdued, local bleeding will
suffice. The more vigorous depletion is recommended where the
inflammation is fully developed, without the cornea being yet affected-
or where the condition of the cornea may be doubtful ; that is, where
we may entertain the expectation of saving the organ from all
injurious change.

" If sloughing or suppuration should have already occurred, it
will be of no use to pursue this very active treatment, although
more moderate depletion may stOl be necessary. General sloughing*
or general suppuration of the cornea, is usually attended by diminu-
tion of the inflammation,1 and cessation of pain, or at least com-
parative ease ; the loss of blood therefore is no longer required for
the relief of suffering ; and it would be without an object, as vi»on
is irreparably destroyed.

" But inflammation may continue with undiminished violence

Mr. Lawrence on the Venereal Diseases of the Eye. 275

after the occurrence of partial sloughing ; and active depletion may
gtfll be necessary, both to limit the extent of the mischief, and to
favour the processes of separation and restoration. In Cases VIII.
and IX. very free depletion, both general and local, was employed
after the cornea had suffered partially in this way ; and the treat-
ment was completely successful in preserving sight. In Case HI.
where one cornea had sloughed entirely, and the other eye was
actively inflamed, the venesection and local bleeding employed on
account of the latter had no prejudicial effect on the former." —
p. 39.

He says, experience does not warrant us in ascribing
much efficacy to blisters, but they may be resorted to after
antiphlogistic means. The ordinary local applications pos-
sess little efficacy, whether hoi or cold, and must be changed
according to the feeling* of the patient. Astringents and
tonics are useful when the inflammatory symptoms are sub-
dued. The best forms of astringent applications are from
two to ten grains of alum to an ounce of water, the solu-
tion of the nitrate of silver, and the undiluted liquor plumbi
subacetatis. Such is the plan of treatment proposed by
the eminent author, and which appears to us objectionable,
for the reasons already stated, and also for those we shall
immediately offer. He bas not said a word on active pur-
gation, diaphoretics, or active counter irritation. He states
the testimony of others to which we alluded above, and
which shews that his depleting plan need not be employed
to any thing like the extent recommended by himself and
many other surgeons.

" The use of a strong astringent has been recommended in the
very commencement of the affection, as a means of cutting it short,
and preventing the development of the inflammation. Mr. Melin
proposed this mode of proceeding in ordinary conjunctival inflam-
mation, having considered that acute ophthalmia was in general
treated too actively, and that a mere local disorder could not require
each extensive depletion as was usually practised and recommended.
He was further induced to try the practice, from having witnessed
the good effects of a solution of lunar caustic, in some cases of
gonorrhoea, both in allaying the pain and suppressing the discharge.
The strength of the solution employed was four grains to the ounce
of distilled water, which was dropped into the eyes twice a day : it
excited pain and a sensation of roughness, with an increased flow of
tears for about twenty minutes, after which the eyes felt much
relieved, and in a few days the cure was effected. ' Since that
period/ says Mr. Melin, ' I have treated nearly three hundred
cases of acute ophthalmia, without either local or general bleeding,
ud I have had ample opportunities of proving its efficacy.— p. 43.

276 Critical Review.

" Very strong testimony in favour of the. astringent plan of treat-
ment in ordinary purulent ophthalmia, is given by Dr. O'HaHoran,
who had enjoyed ample opportunities of observing the disease, as an
army-surgeon, for many years, and in various climates. He -had
become dissatisfied with the antiphlogistic treatment, from having
found it frequently either insufficient or injurious, and was hence led
to use astringents, not only in the early stage of the disease, hut
when the purulent discharge and chemosis were fully established.
He employed the sulphate of copper in substance, rubbing with it
the inner surface of the eye-lids after everting them, or he dropped
into the eye the ten grain solution of nitrate of silver ; and generally
used one or the other once a day. He gave purgatives and applied
fomentations. If the symptoms indicated that the internal parts of
the organ were affected, he directed the application of leeches.
After mentioning a case treated successfully with the sulphate of
copper and the caustic solution, he adds, • the foregoing case with
some hundreds on record, of the different varieties, shew with* what
efficacy and safety blue-stone may be applied to the eyes when under
disease ; its effects in removing the affection of the parts and allay-
ing the irritation are remarkable. I can safely say, that abstraction
of blood will be rarely necessary in this disease, if the plan recom-
mended be strictly attended to ; and I moreover am of opinion, that
if any inquiry be instituted amongst the army-surgeons, it will be
found that those, who used the greatest depletion, were the least
successful practitioners, and that sloughing, ulcers, &c. more fre-
quently succeeded the evacuating plan, than when the patient was
partly left to nature." — p. 45.

Our author states in a note appended to this extract,
that since he has written it, he has employed the caustic
solution in a case of gonorrhoeal ophthalmia with the best
result, and he has also purged his patients freely. He refers
to cases treated with mercury by Mr. Macilwain and
Dr. Hennen, but adds, that it did not check simple puru-
lent or gonorrhoeal ophthalmia in his own practice.

He adverts to the practice of Richter and Scarpa, who
consider suppression of the gonorrhoea as the cause of oph-
thalmia, which consists of the antiphlogistic measures, emol-
lient poultices, and injections and bougies ; the former re-
commending the bougie to be smeared with gonorrhoeal
discharge or red precipitate ; the latter contentiug himself
with the simple bougie and injections of warm oil. Beer
thinks inoculation is the most certain method. Mr. Law-
rence is of opinion that these measures are recommended
rather cm theoretical grounds than from experience, as none
of the writers mention the results of their own practice.
Again, when the violence and rapidity of the disease is
considered, and the slowness of this practice, we cannot but

Mr. Lawrence on the Venereal Diseases of the Eye. 877

thkk that irreparable mischief would be done to the organ
during the lost time in such .attempts. ...

Dr. Archer, 6f Virginia/ after free antiphlogistic measures,
ks found great advantage from " a blister applied directly
over the eyes, and much injury from it when applied oyer
the temples." In the second stage of the disease, the in-
fusion of datura stramonium, applied by means of* cloths
to the eye, and continued from one to three hours, accord-
ing to the violence of the pain, never failed to relieve it.
To prevent irritation from the motion of the eye, he recom-
mends one or two grains of oxym. hyd. in an ounce of
olive oil. His practice is detailed in our March No. v. 4,
p. 230. Mr. Travers recommends free depletion, active
purgation and nauseating doses of tartarized antimony, to
keep up perspiration, nausea, and faintness. When inflam-
matory action is reduced, astringents and tonics are to be
employed. We might multiply authorities to a great ex-
tent in* favour ; of Mr. Travers plan, of treatment, while- we
most confess ; that we know of no* writer who agrees with
our authot in his recommendation of abstracting blood,
while any can be procured from a vein. In fact, we are
inclined to suppose there is a typographical error in the
passage which contains this advice, as we are sure that a
writer of the author's great and well deserved experience,
would never have made a proposal, which, employed indis-
criminately as he advises, is little short of ordering patients
to bleed to death, or at least, ruining their constitutions, and
exposing them to many fatal diseases.

Taking the author's account of gonorrhceal , ophthalmia
upon the whole, it is far inferior to that o£Mr. S. Cooper, in
the Surgical Dictionary, and reflects no great credit upon
turn. It would be superfluous to contrast Mr. Cooper's
account of the disease with that before us, as his work is
in every body's hands, but we fearlessly maintain it is much
better, and inculcates a much safer practice.

The next chapter, is on " mild gonorrhceal inflammation
of the conjunctiva." Moderate depletion and the caustic
solution, are said to effect a cure.

The sclerotic tunic and iris may be affected with gonorr-
hoea! inflammation. The former is of a pink or purplish
red; the conjunctiva is slightly engaged in the disease, and
there is great intolerance of light. Though the pupil may
be contracted, and the sight dim, recovery. may take place,
even when a lotion only had been applied. Copious deple-
tion will be necessary for the cure of the disease if violent,
W capping* and leeches will suffice in milder instances.

278 Critical Review.

Warm fomentations are generally most agreeable to the

Eatient's feelings. When the inflammation is diminished,
listers may be tried, and the cure completed by Plummer's
pill. If the disease supervenes on rheumatism, colchicum
will be used with advantage. The disease may be com-
bined with conjunctivitis, or the urethra, eyes, and joints
may be inflamed at the same time, or successively. The
following graphic description deserves great attention : —

" The affection of the eye last described is exactly the same as
rheumatic inflammation of the sclerotica and iris occurring indepen-
dently of gonorrhoea. Both this and the mild purulent inflammation
of the conjunctiva are to be regarded as rheumatic affections of the
organ excited by gonorrhoea; that is, they take place in individuals,
in whom this constitutional disposition is shewn by inflammation
affecting either the synovial membranes or the fibrous structures of
several joints. Although the organs seem at first view very dis-
similar, there is an analogy of structure between the parts which
suffer in the two instances ; that is, between the synovial mem-
branes and the conjunctiva, and between the ligaments and fibrous
sheaths, and the. sclerotica. Hence we need not be surprised at
finding that the eyes suffer under the influence of that unsound state
of constitution, which leads to these affections of the joints. The
structure originally- affected, the lining of the urethra, is also a
mucous membrane, which sometimes becomes inflamed, and poors
out a puriform discharge, in gouty and rheumatic subjects, from in-
ternal causes. That the essential cause of this combination of mor-
bid phenomena is peculiarity of constitution, may be inferred from
the repetition of attacks, and the length of time for which some
individuals are harassed by successive appearances of disease in
various parts. In Case XVI. rather severe purulent ophthalmia
occurred in August, 1822, and a similar one followed soon after;
from that time to the present, six attacks of rheumatic iritis have
taken place. In Case XIX. discharge from the urethra without in-
fection occurred four times ; then inflammation of the foot ; three
years after, severe inflammation of the chambers of the aqueous
humour; then gonorrhoea and mild, purulent inflammation of the
conjunctiva, followed by rheumatic inflammation of various joints ;
and afterwards severe rheumatic inflammation of the sclerotica and
iris. In Case XXI. violent gonorrhoea was followed by acute in-
flammation of the external tunics; a second gonorrhoea excited, first
purulent ophthalmia, the acute inflammation of the external tunics,
and subsequently rheumatic inflammation of various joints. Two
years after severe rheumatism was brought on by cold. I lately
saw a gentleman with gonorrhoea, mild purulent inflammation of
the eye, and rheumatic affection of the foot and back ; it was the
fourth attack he had experienced of the same combination of symp-
toms. One patient seen by Mr. Brodie had undergone four attacks,
all of which began with gonorrhoea ; it was followed, first by pum-

Mr* Lawrence on the Venereal Diseases of the Eye. 279

lent ophthalmia,' and then by inflammation of the synovial mem-
branes of several joints. In another there had been eight attacks
at virions intervals during a period of seventeen years.

" As the train of diseases just described must be referred prin-
cipally to peculiarity of constitution, gonorrhoea! infection is not
ffwntffl to their production ; it is only to be regarded as one of the
noting causes, and perhaps the most frequent. There could be no
doubt that gonorrhoea had been contracted in the six cases from
XVI. to XXI. inclusive. On the other hand, in Case XVI. the patient
iu convinced that he had not received infection ; according to this
description, the usual characteristic of gonorrhoea virulenta had been
muting. Mr. Brodie seems to have considered that the discharge
from the urethra, in some of the instances which he had seen, was
not caused by infection. In the case of the gentleman, who had
bad eight attacks, inflammation of the urethra with discharge was
the first symptom, and occurred before the age of twenty ; he
believed, however, that he had not been exposed to the risk of
infection. In three of the attacks, purulent ophthalmia was the first
symptom, being followed by discharge from die urethra and inflam-
mation of the synovial membranes. In the other four attacks,
inflammation of those membranes occurred without any previous
disease of the eye or urethra. In another case discharge from the
urethra brought on by the use of the bougie was the first symp-
tom."—p. 6.

The succeeding seventy pages are occupied with details
of cases of gonorrheeal ophthalmia, corroborative of the
author's views in the preceding narrative, and may be
perused with advantage. His next chapter is on syphilitic
iritis, and here we find nothing novel. The fact is, that the
author's opinions are already before the public in his pub-
lished lectures, and we are unable to divine what induced
him to reprint them in a separate form, unless to illustrate
them by notes and cases. He gives a luminous description
of iritis, and concludes that it is not caused by mercury.
He also states that it seldom attacks children, and out'of
numerous cases, he has only seen it in two instances. The
prognosis is minutely described., and after due consideration
of all circumstances, is favourable, if proper treatment be
employed. The various modes of treatment are next ad-
verted to, and may be reduced to the antiphlogistic and the
mercurial. Mr. Lawrence maintains that both methods are
indispensable, and clearly shews that exclusive dependence
on either will lead to unsuccessful results. In some cases
depletion and mercury are moderately employed, while in
others, salivation has been kept up for three months, and
with complete success. Whenpain is violent over the orbit
at night, great relief will be afforded by rubbing six grains

280 Critical Review?

of mercurial ointment, and two of powdered opium; before
the time at which the nocturnal pain is expected to recur.
This plan,, however, does not arrest the inflammation, as the
internal use of the remedy does.

Artificial dictation of the pupil is a point of great im-
portance in the treatment, and mis is to oe effected by cer-
tain narcotics, as belladonna, hyosciamus, laurocerasus, and
stramonium. Our author recommends the extract of bella-
donna or hyosciamus, in the proportion of a scruple, to be
rubbed down with an ounce of distilled water ; the solution
to be strained through linen, and a few drops to tye intro-
duced between the lids ; or the extract to be brought to
the consistence of* honey with distilled water, and to be
robbed over the bresr, and after an hour may be washed
off. It may dilate the pupil for hours or days, sometimes
injure vision, but never permanently ; it has been used with
effect for fifteen years, and retained its power of dilating
the pupil during that period. Belladonna, or the other
narcotics, do not exert their power when the iris is highly
inflamed, though they may elongate or separate adhesions,
and liberate the pupillary margin. This effect will be greatly
promoted by the use of mercury ; and our author attests
such separation from his own practice. The writer neit
endeavours to explain the mode of action of mercury in
iritis, but confesses that as yet we know little of the ope-
ration of that medicine. He adduces the evidence of Beer,
Saunders, and Farre in its favour. He observes,

" If mercury be capable of stopping that increased and altered
action of the capillary vessels of the iris, in • which inflammation of
the texture consists, we should expect to find it equally useful in
other inflammations, since the process is essentially the same through-
out the body. I have found it no less efficacious in inflammation of
.the retina, whether acute or chronic. We cannot indeed, offer
equally clear evidence of its power in this case, because the affected
texture is hidden from our view. But . I have so repeatedly seen
diseases in which the symptoms left no room to doubt that the
retina was inflamed, give way to the use of mercury, after resisting
the simple antiphlogistic treatment, that I employ the remedy on such
occasions almost as confidently as in iritis. Strumous inflammation
of the cornea, proceeding to interstitial deposition and consequent
change of structure in die part, may generally be arrested by the
mercurial treatment. I have many times seen disturbance in the
circulation of the head yield to mercury after resisting for a long
time antiphlogistic treatment and other means. Common observa-
tion has established the fact, that the free exhibition of calomel,
after direct depletion, is of great advantage in inflammations gene-

Mr. Lawrence on the Venereal Diseases of the Eye, 281

nflj; and recent experience has shewn that this plan ia particularly
beneficial in inflammations of the serous membranes, especially the
pericardium, pleura, and peritoneum. In these, as well as in croup,
where the power of the remedy has long been recognised, the effu-
sions of lymph form a striking analogy to the case of iritis. 1 have
lately used mercury with most decided success in an extensive
phlegmonous inflammation of the thigh, where it prevented sup-
puration; and in a more chronic inflammatory affection of the
integument and cellular tissue at the back of the neck, very similar
to that of carbuncle. The inflammation, swelling, and induration
in the latter case, slowly increased, in spite of the free use of leeches
with other suitable antiphlogistic treatment, until mercury was used,
•nd they regularly gave way to the influence of that remedy. A
Anther evidence of its general antiphlogistic power is afforded by
the common belief, founded on experience, of its utility when
administered for a long time as an alternative in various chronic
enlargements. Hence we may conclude that the utility of mercury
ia inflammation of the iris does not depend on its possessing any
specific power over that texture ; and we shall be disposed to concur
with Dr. Hamilton, of Lynn, who first recommended its employ-
ment in inflammations, as now practised, in ascribing to it a
general power of arresting inflammatory disturbance.' ' — p. 201.

Another remedy has beenproposed for the cure of iritis, by
Mr. Hugh Carmichael, of Dublin, in cases which " mercury
is inadmissible, in consequence of its occasional injurious in-
fluence, or of the debility produced by protracted disease.
The following ia the formula recommended: — JV* olei tere-
binth, rectif. $j. vitellum ovi. unius ; tere simul et adde
gradatim, emulsionis amygdalarum $iv. syrupi corticis au-
Hutii 5y- sp. lavend. comp. 5iv. olei cinnamomi. m. iij. su-
nat cochlearia duo larga ter die.* Mr. L. has no expe-
rience of this remedy, but it has been tried by Mr. Guthrie
in some cases with success, and in others without benefit.
The reader will find an account of the efficacy of the re-
medy published in the last volume of this Journal, by
Dr. Tuthill, Mr. Poote, and also in our August number,
*H of which evidence was afforded by the practice of
Mr. Guthrie, at the Royal Westminster Ophthalmic Infir-
uury. Such are the chief points in the chapter on iritis,
and these are supported by details of thirty-nine cases, which
occupy one hundred pages of the volume. The . last chap-
ter is on " syphilitic ulceration of the eyelids," illustrated

• Observations on the Efficacy of Turpentine in the Venereal and other deep-
mted inneaunattons of the Eye, with epme remarks on the influence of that
*•&« on the system, accompanied by cases. 8vo. Dublin, 1820.

Vol. v. wo. 26. * v

382 Critical Review.

by cases, the substance of which is, that the disease may
be easily mistaken for common ulceration.

We have now arrived at the end of our labour, and have
endeavoured to place the substance of this volume before
our readers. If they find nothing novel in it, we cannot
possibly help it. We must persist in our former statement,
that the author's lectures contain the principal part of this
work ; in fact, the number' of either of our hebdomadal
contemporaries, which contains his lectures on diseases of
the eye, contains infinitely more useful and varied matter
than the goodly 8vo. before us. We must further observe,
that the narration of sixty-eight cases, illustrative of three
diseases, gonorrhoea! ophthalmia syphilitic iritis, and sy-
philitic ulceration of the eyelids, was an unnecessary
detail, and by no means complimentary to the under-
standing of the profession. The author is undoubtedly one
from whom a great variety of information might be ex-
pected, in 337 pages of octavo. His fame, however, will
insure the work some circulation ; and it will be lauded in
the strongest terms by some of our contemporaries. It
wodld be a valuable production if its contents were not
already before the profession. It is painful to us to speak
•in these terms of a work emanating from so eminent an
author, but truth, candour, and impartiality compel us to
do so.

III.— Practical Observations on Leucorrhcea, Flvor Alius
or Weakness , with cases illustrative of a new mode of
treatment. By G. Jewel, Member of the Royal College of
Surgeons, one of the Accoucheurs to the St. George's
and St. James's Dispensary, Lecturer on Midwifery, &c.
8vo. pp. 108. London, 1830. John Wilson.

The object of this work is to direct the attention of the
profession to the pathology of leucorrhoea, which our au-
thor believes has not been well understood. He says he
has taken a new view of the subject, and proposes a new
.mode of treatment. He has avoided the description of ex-
tensive structural charges or displacement of parts, and con-
fined himself to the elucidation of functional disorder, though
he thinks the line of demarcation between disorder of
function and disorganization of structure, scarcely appre-
ciable. But we must remark, on this part of the preface,
.that the author has not confined himself to the description
of functional disorder only, but embraced inflammation,
excoriation, tumours, &c. He recommends the use of
nitrate of silver in strong terms for the cure of leucorrhoea,

Mr. Jewel on Lencorrhcta, $c. 283

|nd very properly observes, that time and experience must
determine its efficacy in the hands of others. The only
caution, we must premise, upon this point is, that the re*
commendation of the remedy is too general, that the form
of disease in which it may be useful, is not sufficiently
defined, and that its indiscriminate use in the various stages
of inflammation and ulceration, which cause various forms
of leucorrhcea, would be, in our opinion, not only question-
able but injurious practice.

Mr. Jewel commences with his views on the pathology
of leucorrhoea, which differ in no respect from those gene-
rally received. He alludes to the sympathy of the uterine
apparatus with the various organs of the body, but does not
illustrate this point so well as he might have done. He
details the opinions of Drs. Clarke, Barns, Pinel, Dewees,
Gardien, and Cullen, which need not be stated, as they
are known to every one, and exist in most of the works on
obstetrics. He also refers to the opinions of Drs. Hamilton,
Gooch, Marshall Hall, and Addison, which are likewise
generally known. He details some cases illustrative of his
treatment, an example of which we shall insert. He informs
us, that in all cases of profuse leucorrhoea, there is ten-
derness of the cervix uteri, and that many such cases are mis-
taken for seirrhus. He dwells upon the irritable uterus, so
ably described by Gooch. We shall insert a few of his cases,
and offer some remarks upon them.

" Case I- — S. J., atat 49, residing in Bridle Lane, a patient
under my care at the St. George's and St. James's Dispensary, on
the 10th of June. She is the mother of fourteen children, exclu-
sive of two abortions, and has, during the last twelve months, been
■abject to profuse catamenia, and excessive leucorrhceal discharge of
a yellowish colour. She has pain in- the loins, shooting in pa-
roxysms through the region of the uterus, in which there is also a
•ease of fulness, and throbbing. She complains of great languor,
with loss of appetite, and uneasiness at the pit of the stomach-
She is frequently attacked with the globus hystericus, and disturb-
ance about the head, and says that a flow of tears affords her much
relief. Pulse 85. Bowels confined.

" Ten ounces of blood to be abstracted from over the sacrum by
cupping.

5r Magnes. Sulph. 3vi.
Infus Rosae. Jviiss.

Acid. Sulph. (lil 5i- — M. ft. Mist, cujus sumantur
Cochleaxia duo vel tria ampla, mane, quotidie*
|V Argent. Nifcrat." gr. xii.

Aq. distill. $vi. — M. ft. Injectio.
" 14th. During a period of twenty-four hours after the cupping,
she felt extremely faint and sick, and now complains of increased

384 Critical Review.

languor. Says the has used the injection regularly, notwithstanding
the presence of the catamenia, and that it occasioned no degree of
pain, except a little smarting, the parts having been for some time
in an irritable state.

" To omit the aperient medicine.

" The strength of the injection to be increased from grs. ij. to
grs. iv. to the ounce of water ; and to take a pill, containing fire
grains of the extract of hyoscyamus and half a grain of opium, at
bed time.

" 18th. The sanguineous discharge, has ceased, haying con-
tinued only a week, its usual period being from ten days to a fort-
night. The leuoorrhoeal fluid has become " white and thinner than
it has been for several months." The local pains are greatly re*
lieved, but she still complains of occasional heat and throbbing
about the womb.
« "To continue the injection.

'* 22nd. The leucorrhoea has ceased, and the local heat and
pains have almost left her. There is still great languor, and loss
of appetite.

JV. Infus. Rosae, Jviiss.
Sulph. Quinin. 9i.

Tinct. Card. Comp. 3ss. — M. ft, Mist, cujus
sumantur Cochlearia duo ampla ter die.
" To continue the injection.

" 26th. The vaginal discharge has not re-appeared. Her spirits
are better, and the appetite improves.

" Continuentur remedia.

" 30th. There is no leucorrhoea. Her general health continues to
improve, and she intends to go into the country in the course of a
few days. Discharged cured." — p. 21.

There was no vaginal examination made in. this case, and
consequently no correct idea can be formed of the morbid
condition which gave rise to the disease. Besides, injec-
tions of the liquor aluminis compositus, would have effected
a cure as readily as the remedy employed. The fact is,
that alum injections, varied in strength, according to the
pathological condition of the vagina and cervix uteri, will
cure leucorrhoea in nine cases out of ten, and that in a few
days after the patient had been under the tonic and con-
stitutional plan for months or years. We have described
this mode of treatment at length elsewhere,* and in a single
chapter, have embodied a much more extensive account of
the various forms of the disease, than there is in the pro-
fessed treatise on the subject before us. That there are

• Sac Manual of Midwifery.

Mr. Jewel On Leueorrhaa, £c. 285;

case* of morbid sensibility of the vagina, accompanied by>
leucorrhcea, which defy the usual injections, is a fact kiiownr
to every practitioner of ordinary observation, and in such'
eases we agree with the author, that the nitrate of silver is
a valuable remedy ; but that it ought to be employed in
every case of leucorrhoea, whether dependent on slight in-
flammation, congestion, or ulceration, is a practice to which
we cannot five our assent.

Our author makes the following judicious remarks on
the diagnosis, between tenderness of the cervix uteri and
scirrhus, which deserves attention : —

" This inflammation of the cervix uteri, like scirrhus, or any
organic disease of the uterine system, attacks occasionally at the
period of life when the catamenia are about to cease, but I have
more frequently found it to exist in married females, from the age
of twenty-six or twenty-seven to that of forty, and I have recently
teen several cases occurring in young married females, within three
months after the birth of the first child. The local symptoms in
bom diseases, are very nearly allied. There will be occasional lanci-
nating pains through the region of the uterus, with a constant dull
kind of pain about the inferior portion of the sacrum, the hip or
groin, attended by an irritable bladder, or frequent desire to void the
urine, and in some severe instances, by tenesmus, and pain within
the vagina when in the sitting posture. The vaginal discharge is
commonly of a milky or cream-like colour, now and then having
i glutinous consistence ; and is often, in the more acute cases,
Doed with a dark coloured or grumous secretion. Menstruation,
if not interrupted by lactation, may be resumed with its usual
regularity, although, after a time, some deviation takes place : gene-
rally, in the first instance, by its continuing several days beyond
the accustomed period. 1 have remarked that, although the local
puna are not unfrequently increased in severity at the commence-
ment of menstruation, a great relief is afforded as soon as the
ttlammial secretion becomes more abundant. Upon making an
examination per vaginam in this disease, the os uteri will not be
fond open to the same extent as in scirrhus, (an exception may
be made in the case of a woman who has had a numerous family,)
nor will its margin present the same cartilaginous hardness to the
touch. The pain does not appear to be situated in the edges of
the os uteri, as described by some authors, but in the cervix, as
pressure upon this- part alone occasions the patient to complain.
The uterus will be found projecting lower in the vagina than
natural, but this will depend upon the nature of the disease ; the
more acute, the further it will have descended. It should be
recollected, that prolapsus uteri is a very common effect of pro-
tracted leucorriraeaj when, in addition to the symptoms already
enumerated, there will be fulness about the pudendum, or weight
on the perhueum, and a dragging sensation about the loins, with

286 Critical Review.

difficulty in Tending the urine, and sometimes extreme pain in eofcu,
whilst the discharge will be frequently tinged with blood. These
symptoms become modified or severe* according to the degree of
descent which has taken place, or the excitability which exists in
other and distant organs; hence, in a case of simple relaxation,
there will oftentimes be merely a sensation of weakness, and ful-
ness about the pubes, with an increased, but mild, mucous dis-
charge from the vagina. I have seen several cases of prolapsus
uteri, in their incipient state, most effectually relieved by the ap-
plication of the means hereafter named*

*" But even supposing that no diagnostic marks existed, to guide
the judgment of the young practitioner, in distinguishing between
chronic inflammation and incipient scirrhus of die cervix uteri,
two questions will arise, to which no very decisive answers can be
given. Is it not possible for inflammation, in its ordinary form, to
terminate in carcinoma, or, to say the least of it, in disorganization ?
If the disease is confirmed scirrhus, may it not be arrested in its
progress, if not entirely removed ? I would reply to the last ques-
tion, by observing, that I have seen more than one case, where a
morbid affection of the cervix uteri had been pronounced by emi-
nent practitioners to be carcinoma, but in which the disease had
been afterwards totally eradicated, the uterus again taking on its
healthy functions, and the woman bearing children as before." —
p. 29.

The following case affords a fair illustration of our
author's practice, and deserves attention : —

" Case II. — Mrs. C, «tat 33, called on me, on the 24th. of
February, 1829, at the request of a medical friend, Mr. Reid, of
Charlotte Street, Bloomsbury. She had been delivered three years
before of a healthy child, after an easy labour. For the last two
years and a half she has been subject to constant and profuse
leucorrhoeal discharge, with frequent and shooting pains through
the region of the uterus, and about the right groin, with occasional
dysuria and tenesmus. The general health is greatly disturbed ;
bowels irregular, with loss of appetite. ~ Upon making an examina-
tion per vaginam, pressure of the finger upon the cervix uteri
occasioned considerable pain, which, in subsequent examinations,
often continued several minutes after the finger had been withdrawn*
The os uteri was considerably more open than natural, but its
margin was not indurated. She had been under the care of several
respectable practitioners, and the impression on her mind was that
she was labouring under cancer of the womb.

" In the first. instance, the usual mode of treatment was adopted;
Uood was abstracted by means of cupping from over the inferior
portion of the sacrum, to the amount of eight ounces, and repeated
three times, with an interval between each of about three weeks.
•She had taken aperients frequently, and injections of various kinds
had -been used with little or no benefit.

Mr. Jewel on Leucorrh&a, $c. 287

" July 2d. The nitrate of silver was conveyed by means of a
tabs, and applied to the cervix uteri for the space of a minute,
which occasioned no degree of pain, except what might have been
produced by the introduction of the finger.

" 6th. The nitrate of silver again applied as before.

" 9th. The discharge has diminished, but the pains not having
abated, eight leeches were ordered to be applied to the right groin.

" 12th. The nitrate of silver again applied.

" 18th. The discharge is lessened considerably ; and the patient
sow expresses a belief that she shall soon be restored to health,
having previously imagined her case to be hopeless. The nitrate of
silver again applied.

" 27th. The pain is relieved ; her general health is improved, and
the sleeps well at night. The nitrate of silver applied in the usual
Banner. It is necessary to observe, that she has taken the hyos-
cyamus at night, (one drachm of the tincture,) and the bowels hare
been regulated by aperients. The following . tonic has been pre-
scribed:—

{V Infus. Rosae, Sviiss.
Sulph. Quininse, 38s«

Elix. Vitriol. 5i- — M. fiat. Mist, sumantur
Gochlearia duo ampla ter die.

" August 8th. The discharge is scarcely perceivable. The nitrate
of surer applied as before.

" 25th. The patient is perfectly well, having neither vaginal
discharge nor local pains." — p. 32.

Our author next adverts to the opinions of Drs. Denman
*nd C. Clarke, on the treatment or cancer, which warrant
the conclusion that incipient scirrhus uteri may be arrested,
if not cured, by antiphlogistic measures. He thinks it a
dangerous and unscientific doctrine, to suppose that cancer
exists throughout the system, and that when eradicated
from one part, it may appear in another, as it puts a stop
to all pathological inquiry, and leads to palliative and in-
efficient treatment. We cannot agree with him upon this
point, as the records of medicine afford ample evidence of
the negative, and of the recurrence of cancer after the best
performed operation.

The causes of leucorrhcea are next described, and very
accurately enumerated, and some good hints are given on
its pathology. Thus in twenty-four necrotomic inspections,
by Blattin, the secretion proceeded from the uterus in nine
cases; from the cervix uteri and vagina in thirteen cases,
and in two from the uterine tubes. From this statement,
it is manifest that the nitrate of silver, or any other remedy,
is not applicable in all forms of the disease. In some in-
stances a* mucous discharge is said to arise from excoria-

288 Critical Review*

tions about the nymphss, and here our author recommends
his remedy as the most efficient. He next gives a good
-account of leucorrhoea in children— in pregnant women, and
at the turn of life, and notices the colour and consistence
of vaginal discharges. He details the opinions of C. Clarke
and Dewees upon this subject, which are universally known ;
and describes the predisposing and exciting causes of leu-
corrhoea, among which he properly includes the influence of
seasons, of contaminated air, of epidemicia, hereditary pre-
disposition, metastasis, irritation from ascarides and leu-
corrhoea of habit. Lastly, he describes the treatment, and
notices the opinions of many of the best modern writers.
It must be unnecessary to trouble the reader with an ac-
count of treatment usually employed in this disease. But
we refer him with pleasure to the author's testimony in
favour of iodine, in induration of the uterus and ovaries.
In almost all cases he has found its effects " marked and
decisive." He says, ^

" I may here notice a case of diseased ovary, in which this little,
but important, organ had morbidly increased to the size of the
foetal head. The general and visceral disturbance occasioned by its
presence in the pelvic cavity, had become so distressing, that the
patient, notwithstanding the fatality of an operation had been re-
presented to her, often expressed an earnest desire to have it
removed! After various means had been employed, without any
beneficial result, she was put upon a course of iodine, commencing
with ten drops of the tincture three times a day, gradually increasing
the dose to thirty-five. She has been under the influence of this
medicine about ten weeks, and at the present time, the tumour is
scarcely to be felt. She has suffered nothing from such large doses
of the medicine, but, on the contrary, her spirits are greatly im-
proved, and she anticipates, with great confidence, a perfect resto-
ration to health. Dr. Thomson, the able professor of materia
medica at the London University, has related a case of ovarian
dropsy, in which, after the woman had been tapped in the usual
manner, and seven quarts of albuminous serum, mixed with pus,
removed, iodine was administered, and carried to the extent of
thirty-six drops of the tincture three times a day. The result was,
that the tumour wholly disappeared, and the woman was perfectly
restored.

' " Dr. Coindet has said, that the iodine acts in a particular man-
ner on the uterine system in deficient menstruation.

" In the Transactions of the Licentiates of the King and Queen's
College of Physicians in Ireland, there is a jteper by Dr. Thetfbrd,
in which he describes the complete success which attended the use
of iodine, in an indurated enlargement of the uterus. The os uteri
projected nearly to the labia, the uterus itself having become of
osseous hardness, and so large as nearly to fill the pelvic cavity.

Mr. Jewel on Leucorrhwa, %e. 289

Mercurial alteratives had been tried without success. The tincture
of iodine was then administered, beginning with seven drops three
times a day, in a wine glass of water, the dose being gradually
increased to ten. Progressive absorption of the diseased substance
of the uterus rapidly took place, and the catamenia were regularly
restored: The iodine had been continued six weeks. It can scarcely
be necessary for me to remark, as the subject has been so often
alluded to by others, that the effects of iodine upon the system
should be carefully watched, inasmuch as when the constitution of
the patient is delicate or irritable, or where an idiosyncrasy exists,
its exhibition, even in small doses, is occasionally followed by
symptoms of a peculiarly distressing kind, such as palpitation of
the heart, and other nervous feelings, vertigo, sickness, &c. when,
at least, a temporary cessation of the medicine will become neces-
wry."— p. 81.

Mr. Jewel next describes the effects of nitrate of silver.
He considers its efficacy is to be ascribed to its producing
a new action or excitement in the part from which the secre-
tion has its origin. There caBnot be a question of the
validity of this reasoning, but it is equally clear that the
remedy cannot be applied to diseased surfaces in many
cases. The truth of this observation must be admitted by
every practical man, for the reasons already assigned, and
for those afforded by the author's description of the manner
of applying the remedy, which is as follows : —

" The mode I have adopted in the application of this agent,
has been either to conceal it in a silver tube, as it is employed in
cases of stricture, (except that the tube should be adapted to the size
of the argent, nitrat.) or in the form of solution, in the proportion
generally of three grains to the ounce of distilled water, the strength
being gradually increased. A piece of soft lint may be* moistened
with the solution, and introduced, for a short period, into the vagina
several times in the day r or a bit of sponge, firmly and neatly tied
to the end of a slip of whalebone, may be passed into the vagina,
op to the OS and cervix uteri, well saturated with the solution. This
can easily be effected by the patient herself. It is necessary that
the application should be frequently repeated, or no permanent
benefit can be expected. Should it become requisite to employ a
strong solution, and to apply it to a certain part, or ulcerated sur-
face, it can be accomplished with a degree of nicety, by means of a
camel's hair brush, introduced through the speculum, or dilator.
This, however, can only be done in the absence of excoriations, or
tenderness, as the introduction even of a common syringe, some-
times produces a considerable degree of pain and irritation ; inde-
pendently of which, some females will not submit to the introduc-
tion of any instrument. In married women, there is not the least
difficulty in using the dilator, neither does its introduction, under
common circumstances, occasion any degree of pain. By means of

Vol. v. ho. 28. o o

290 Critical Review.

this instrument, the condition of the cervix uteri and vagina can be
readily ascertained,

" A few remarks upon the use and choice of the syringe, when
injections are employed, will not, I trust, be considered a digression.
It must be obvious, that if the act of throwing in the injection be
attended by any muscular effort, the injected fluid cannot reach its
destined point, namely, the neck of the womb, and upper part of
the vagina. In using the common straight syringe, a degree of
bodily exertion cannot be avoided, whatever may be die position of
the patient, and consequently the operation must prove very ineffi-
cient, if not altogether useless. The pipe of the syringe ought to
be curved, so that when introduced, its point may come in imme-
diate apposition to the os uteri, and the patient should place herself
in the recumbent posture, in which position she should remain at
least several minutes after the syringe has been withdrawn. The
principal advantage in injecting tie fluid is, that if any superficial
ulcerations exist, they will be readily healed.

" It is very satisfactory to observe, that the nitrate of silver,
when judiciously used in either of the forms above recommended,
gives no pain nor irritation, at least no more than is occasionally
produced by the injection of any common astringent." — p. 85.

Our author details a few cases in which the remedy was
successful, and then endeavours to form a diagnosis between
leucorrhoea and gonorrhoea. He notices the latter disease,
as the remedy " is, in. almost every instance, the most cer-
taiu in effecting a cure." The severity of symptoms in
gonorrhoea, is the diagnostic mark of the disease. The
nitrate is to be used as m leucorrhoea.

Such are the peculiar opinions of Mr. Jewel on leu-
corrhoea. His work, though by no means as perfect as it
might be, will be perused by young practitioners with ad-
vantage. *It contains much valuable information, and de-
serves a place in the library of every man engaged in ob-
stetric practice. Had the author described the different
species of leucorrhoea, as laid down in the works of Hamil-
ton, Burns, C. Clark, Dewees, and many other writers, and
considered their pathology, he could not have arrived at
the conclusion, that nitrate of silver is a certain cure for
so many morbid conditions as induce the disease in question.
He should also have given a correct diagnosis, and ought
not to recommend a single remedy as a specific, for the
different decrees of diseased action, which produce the nu-
merous discharges generally comprehended under the term
elucorrhcea, both by the profession and their patients.—
Should he adopt these suggestions in another edition, his
work will be considered one of reference and authority.

[ 291 ]

IV.— 7\oo Memoirs read be/ore VAcademie Roy ale des
Science, at Paris, on the successful Inhalation of Di-
luted Chlorine, in the early stages of Pulmonary Con*
sumption. Translated from the French of M. Gannal.
By William Horatio Potter, M.R.I. Operative Che-
mist. 8vo. pp. 90. London, 1830. Callow and Wilson.

V. — A' Treatise on Pulmonary Consumption : its Preven-
tion and Rtmedy. By John Murray, P.S.A. F.L.S. &c.
pp. 156. London. Whittaker and Co.

The works before us are offered to the profession by two
operative chemists, as containing an account of a certain
cure for consumption. The authors ought to have recol-
lected the slender pretensions they must possess to instruct
medical men in the cure of disease. Their zeal in the cause
of humanity has induced them to overstep the boundaries
of discretion ; and common sense ought to have restrained
them from obtruding their opinions with too much confi-
dence upon the faculty. The first work merits attention, as
it is a translation of the production of a French physi-
cian ; the second has no claims to consideration, as its ten-
dency and object are intended to inform medical men, not
only of a cure for consumption, but for divers other dis-
eases, by one remedy ; in fact, it must be considered em-
K" ical, as will appear by the sequel. The original of the
t work was read before the Royal Academy of Medicine
in Paris, in 1827, and made a deep impression upon that
learned body. The doctrine it proposes is scientific, and
of course worthy of notice. It affords some evidence in
proof of the value of chlorine gas in pulmonary consump-
tion. Its author delivers the result of his experience with
candour and modesty, and with the' greatest deference to
the opinion of the profession. He is not an enthusiast,
but a faithful observer ; while Mr. Murray advances his
opinion with as much dogmatism as even Paracelsus him-
self. The sect of chemical physicians has long since ceased
to exist, but we are occasionally favoured with the conjee- ,
tures of operative chemists on the cure of diseases. We
are ready to grant that much good has resulted from
modern chemistry, by exposing the incompatibility of cer-
tain medicines when combined in prescriptions; but we
ought to recollect that we are perfectly ignorant of the
numerous changes which the most chemical formula must
undergo in the human body. It is therefore obvious, that

292 Critical Review.

chemists ought to be more reserved and cautious, in speak-
ing too dogmatically upon the effects of remedies. We
need only refer to the records of medicine in proof of our
assertion.

It is now generally admitted that there is scarcely any
medicine, when taken into the stomach, which has a direct
action on the lungs, and hence the fatality of the diseases
of these organs. Even the direct application of, medicinal
agent 8 to the mucous membrane of the lungs, can have
little effect upon the various disorganizations of the organs
themselves. If proof were required of this opinion, it is
amply afforded by the failure of inhalation of the various
gases, factitious airs, fumigations from pitch, tar, oil, oak
bark, arsenic, sulphur, muriatic acid gas, &c. A late writer
accounts for this want of success, by maintaining " that
the gases were inhaled in a dry state, for dry or anhydrous
air only irritates, and parches the minute ramified membra-
neous tubes, of which the bulk of the lungs is composed,
and that the tissues are not pervious to the natural progress
of oxygenation, unless they are moist and the gases hu-
mid." Such is the opinion of Dr. Murray, of Belfast, in
his excellent work on the Influence of Heat and Humidity,
with observations on the inhalation of iodine, and various
vapours in the cure of pulmonic complaints. This opinion
is further confirmed by the testimony of M. Gannal, who
maintains that chlorine gas must be humid to ensure its
effects. Thus Mr. Potter observes in his preface—

" Among the numerous publications of various pretensions to the
public favour, which are daily presented to the medical world, — few
or none contemplate the direct application of remedial agents to
ulcerated lungs. To fill up this chasm in medical literature is the
object of the present memoirs ; they prove in an incontestible man-
ner that Chlorine gas, diluted with a large proportion of common air,
and softened further by its combination with aqueous vapor, is a
powerful therapeutic means of cicatrizing ulcers of the lungs, where
they exist, and of preventing their formation when a predisposition is
indicated. And even where the system has already succumbed to the
baneful influence of this disease, which causes so many thousands,
in this country especially, to become early tenants of the tomb, even
in these cases where, by the presence of all the fetal symptoms recog-
nised by the practitioner, as indicating if not a speedy, at least a cer-
tain dissolution, the effect of this agent has been evidently to pro-
long life and palliate suffering: and, in some few instances, has
effected an absolute and permanent cure. Such is the combined
testimony of several eminent and scientific Frenchmen, and it remains
for the sounder and more steady judgment of the English experi-
mentalist, to ascertain the extent of its claim to public credence." —
Preface.

Mr. Potter on Cure of Consumption. 293

The following reasons have induced M. Gannal to direct
his attention to the employment of inhalation of gases :—

" Two modes of treatment have been adopted by physicians to
ward off the terrible inclusions of pulmonary consumption ; the first
we may denominate indirect or revulsive, and it consists either in the
external application of topical stimulants upon the principle of coun-
ter-irritation, and thus opposing the internal inflammation by one
created artificially upon the surface, of sufficient energy to effect a
cure, ox in administering by the mouth certain medicines capable of
reducing the too great intensity of vital action, and thus procuring
relief.

" These modes are generally united in practice, but such is their
inefficiency, that they seldom do more than arrest the progress of a
disorder, which, when once fully developed, as manifested by the
hectic fever and diarrhoea, is considered incurable by the majority of
practitioners. Convinced of the insufficiency of either external or
internal remedies, physicians have at different times, demanded of
chemical science, some gaseous substance, which being blended with
the air and carried with it to the lungs, might by direct contact sooth
the irritation of the organ, modify the secreting power of its mucous
membrane, or cicatrise p™ting ulceration.

" Great expectations were elicited by the employment of this
novel and direct mode of treating phthisis ; aqueous vapours pro-
duced either from water alone, or certain mucilaginous decoctions,
the vapour of tar, of sea-weed, and various other substances were
employed, and were at first found useful in slight cases, but their
success in cases of longer standing, where inflammation had already
made considerable progress, was unsatisfactory and doubtful.

" Towards the close of the last century, that brilliant epoch, when
modern chemistry preceded that revolution which raised it to the
foremost rank among the useful sciences ; at this epoch, I repeat,
the theory of Lavoisier respecting inspiration, and the important con-
siderations which flow from it, relative to the influence of oxygen
gas upon the animal functions, caused many to imagine that this gas
might prove beneficial to consumptive patients. Various experiments
were made to this end between the years 1781 and 1790, the results
were at first encouraging ; the dyspnoea was relieved, pain was lulled,
the expectoration was gradually diminished, the cough was eased,
and every one now thought that a cure was at hand. But this happy
state of things was not of long duration, fifteen days after these first
effects of vital air, acute symptoms of excitement showed themselves
in the lungs, blood was brought up in the sputa, the fever increased,
the colour became more lively, the heat greater ; thus it was found
necessary again to recur to antiphlogistics, and the disease which
seemed checked, now resumed its course, and proceeded with greater
rapidity towards its fatal termination than before the gas was ex-
hibited. Fourcroy, at once a witness and relator of these facts,
declared that oxygen gas was far from being a remedy applicable to
phthisis, as had been imagined. ITiis check suspended further expe-

294 Critical Review.

rimenta^ inquiry, and' crashed that enthusiasm which had already
taken possession of the minds of many." — p. 12.

The efficacy of chlorides on ulcerated surfaces, and in
arresting mucous discharges from the vagina, afforded
analogy, that it might produce the same happy effects in
ulcers and increased mucous secretions, which, for the most
part, constitute consumption. Accident proved this to be
the fact.

" Being, in the year 1817, attached to a manufactory of St. Peak,
I observed that those workmen who happened to be affected with
phthisical symptoms experienced relief, and quickly recovered their
health, while exposed to the exhalations of the chlorine disengaged in
the various processes. I communicated this fact first to Dr. Bourgeois,
then to the celebrated Laennec himself, who, in the year 1823, after
my communication, made some trials with the chlorine fumigations,
at the Hopital de la Oharite* at Paris, which however were not fol-
lowed up. M. Laennec made use of the solution of the chloride of
lime sprinkled about the room of the sick, and also upon some sea-
weed with which the floor was previously covered. This nurture,
although it was not possible to say to which substance should be
ascribed the effect produced, gave favourable results, but not suffid-
ciently decisive to occasion them to be continued.
. " Since this period I have had occasion several times again to be
a witness to the good effects of chlorine, in pulmonary complaints.
.In Sept. last, in consequence of a letter inserted in the journals, the
object of which was to claim the priority of applying- this agent, I
was invited by several physicians to exhibit it to then* patients.'^ —
p. 16. '

•Dr. Murray has attested this fact, in his observations on
•the: bleaching manufactories, near Belfast. Dr. Sanders, of
Edinburgh, had long since recommended the fumes of mu-
riatic acid gas and of ether, in pulmonary ulcerations of
depraved condition. This plan could not succeed, as it

Sroduced too much irritation ; and it is proved beyond all
oubt, by the author1 before us, that chlorine gas must
be pure and diluted to be useful.

" Though I will not at this time venture to speak positively on
• this point, I think that the chlorine disengaged from the chloruretted
•oxides (potass, soda, and lime) is contaminated with some particles
eof a foreign nature, which affect its. purity when it is immediately
applied to the delicate organs of respiration. This statement is ren-
dered more probable by considering what follows: — I caused some of
.my patients to respire chlorine evolved from a chloruretted oxide, but
at the third fumigation they experienced a lively sensation of warmth
in the chest, constriction of the throat, thirst, and all the signs apper-
taining to a powerful stimulus, which made me quickly desist.

" Chlorine then, as produced from its combination with oxides, is

Mr. Potter on the Cure of Consumption. 296

not of au0kaeat purity to warrant oar applying it to the delicate and
already irritated organs of the phthisical patient.
' " To remedy this inconvenience, I make* use of a solution of the
pure gas in distilled water. I take a three-necked bottle, the first
opening receives. a straight tube, the extremity being plunged into
about four ounces of water; the second opening has a tube, which
leaving the top of the bottle is bent at right angles, and terminates
in a flattened embouchure; the third is furnished with «v glass etop^
per: it is by this last opening that the water is changed* and the -gas
introduced. The water in die bottle at the time of fumigation
should be at the temperature of about 32° of the centigrade thermo-
meter equal to. 89* 6' of Fahreinheit's scale ; a certain quantify of
liquid chlorine is then added ; and by gently shaking the bottle, a por*
tion of the gas is disengaged* which may be breathed by applying
die mouth to the extremity of the bent tube. As the air is gradually
withdrawn from the bottle, a fresh quantity is supplied from the atmos-
phere by the straight tube, bubbles up through the weak chlorine
solution charged with the gas. The fumigation may -be continued
Sor the space of four or six minutes, after which the disengagement
of gas ceases,*,

It is of the utmost importance, that we proceed with the greatest
caution, being guided by the consideration of the energetic nature of
the means employed, as also of the delicate fabric of the organ con-
cerned. In my practice I commence with ten drops of the liquid
chlorine* to two volumes : if the patient can: well bear this dose, and
according to the susceptibility of his lungs, I raise it gradually to
12, 15, 20, 30, 50, $0, 72 at a time. However, there are scarcely
two persons who can bear exactly the same doses ; we must there-
fare, ss it were, carefully explore the state of the organ to be acted
upon, and from thence deduce the proper quantity.

" The same reasoning holds good as regards the number of fumi*
gatioiis, during the twenty-four hours. > They must be regulated by
the effect produced, and tile sensibility of the parts, generally the
number may be from six to eight. It appears evident according to
the shove process, that the chlorine inhaled cannot enter the lungs
unless impregnated with a number of aqueous particles ; from which
circumstance it is much less irritating than in the dry state ; and
lastly, not being commixed with any foreign matter, its action con*
fined to itself is not complicated with any superadded irritation.

" We may also just observe that the apparatus required for its
exhibition, is simple, easily obtained, and moreover portable, and
being made entirely of glass, the chlorine cannot possibly become
contaminated with metallic molecules, and thus interfere with fits
parity; it cannot for example act upon the copper, convert into
a chlorine, and in this state painfully affect lie lungs, or as there
have been some instances, cause extensive inflammations." — p. 29.

The author concludes his first memoir with these re-
marks—

• The apparatus may be procured at 11, Old Complon Street.

296 Critical Review.

" Inspiring the gas in its pure state is certainly better than in*
haling it, as produced from the chloruretted oxides, or when con-
ducted through metallic tubes to the organs of respiration.

" Lastly, it is to be observed, that by the influence of chlorine,
all the patients breathed freer, dilated the chest more easily, that
they felt a pleasant sensation while inhaling the gas in a remarkable
manner, and that their appetite returned, and often so as to render
it necessary to increase the quantity of food allowed them. All
these facts indicate a diminution of pulmonary irritation, and an
increase of energy communicated to all the vital powers.

" It follows, therefore, from what has been premised, —

" 1st. That in no case has the inspiration of chlorine proved
hurtful or troublesome.

" 2nd. That in cases where the disease had made considerable
way towards its consummation, and was therefore incurable, it
afforded relief and prolonged life.

" 3dly. That in cases where other medicinal aids were of no
avail, it succeeded in effecting a cure after a shorter or longer in-
terval and that from all these considerations, it is one of the most
efficient means that medical art can oppose to tubercular phthisis."—
p. 34.

The second memoir consists of details of cases, in which
the chlorine afforded great relief, and in some instances
produced a complete cure. The following cases are the
most remarkable : —

" Madame Mitteau, 25 years of age, short, and of a delicate con-
stitution, experienced, in consequence of a shock occasioned (April,
1827) by a sudden announcement of bad news, a violent degree of
oppression, attended by difficult respiration. Having consulted a
physician, she was bled in the right arm ; in the evening, 25 leeches
were applied, part to the anus, and part to the right side of the lower
belly ; refreshing drinks were prescribed with a low diet, or at least
very little aliment was allowed for several days. This treatment
produced great relief, and for a month the patient was tolerably well ;
however, every now and then she felt a pricking at the upper part of
the right shoulder.

" At the end of a month, this pricking sensation became a sharp
and lasting pain, which was not referred to the posterior part of the
thorax alone. The whole of the right lung had become painful, and
the upper part seemed particularly to be the seat of disease. Ma-
dame Mitteau had a cough, which from being at first dry and seldom,
was now frequent and accompanied with purulent expectorations;
leeches were applied to the sternum, which produced some benefit.
Thus matters went on until November, at which time the expectora-
tion became more abundant. Inflammation attacked the abdomen,
and the patient made water with difficulty, which was attended, for
the space of two months, with violent pains ; the menses were sup-
pressed, and Madame Mitteau's health was much on the decline till
the end of the winter, Dr. Honlet, who attended her for three

Mr. Murray on the Cure of Consumption. 297

months, invited me to see her ; she was at this time excessively thin
and weak ; her appetite was gone ; her sleep short and restless. A
febrile paroxysm was observed every evening, with frequent colic and
diarrhoea. The left side of the chest indicated a healthy state, but
the upper part of the right side had a dull sound, which was con-
tinued to the upper third part. In the centre was heard a mucous
rattle with wheezing. The expectoration was surprisingly abundant,
very thick, and of a most repulsive odour. It was in this state that,
on the 28th of March, I commenced the fumigations.

" During the first eight days no change was perceived, but to-
wards the 18th of April she felt stronger ; her rest was also more
tranquil ; the skin became firmer ; the chest freer, and the appetite
returned. The relief appeared wonderful. The patient coughed
less from the early part of May, at which time she was so far re-
covered as to be able to walk on the boulevards.

" Early in June the expectorated matter had lost its bad smell, be-
came mucous and less abundant. The strength was so far restored,
that the patient could walk, every day, from No. 129, Faubourg, St.
Denis, to No. 31, la Rue Bourbon — Villeneuve. Madame Mitteau
still feels, occasionally, slight pains in the upper part of the right
shoulder, but they are not of long duration ; the left lung seems per-
fectly healthy. In the right may be observed marked pectoriloquism,
towards the upper part, but the rattle that was there remarked, is
now scarcely audible, She goes on as well as it can possibly be ex-
pected, although she is not particular in her choice of food, nor in
tiie quantity she eats. We must surely consider the disease, if not
cured, at least singularly ameliorated.

" The effect of the chlorine, in this case, has been evidently to
prolong life, relieve pain, and to restore to her usual pursuits, a pati-
ent whom every one had given over."

Another case, of apparently confirmed phthisis, was
cured by chlorine ; there was no hope of recovery enter-
tained by numerous physicians. The work deserves the
serious consideration of the profession.

Mr. Murray recommends the chlorate of potas, not only
as a cure for consumption, but as a specific for cynanche
tonsillaris, ulcerated trachea, and adduces a number of
cases, authenticated by practical medical men, in proof
of his assertion. These cases, however, are so loosely
detailed, that they afford no evidence of the existence of
the diseases which they purport to describe. Some of them
occurred to Mr. Murray himself, who is not a medical
practitioner, and therefore are of little value. But we shall
allow him to speak for himself.

" Shortly after our return from France we had occasion in our own
person to put the efficacy of this medicine to the proof, in conse-

vot. IV, mo. 28. » *

296 Critical Review*

quenoe of having received a serious fall, by which we voided a con*
siderable quantity of blood. We commenced with doses of eight
grains three times a day ; the immediate relief obtained was remark-
able, and in a few days the cure was complete. Since that period
it has been used on our recommendation with great success, by a
clergyman of the Church of England, who had twice ruptured a blood
vessel. — and even in violent uterine haemorrhage, a medical gentle-
man of Derby has employed it in his practice on our suggestion with
the most beneficial effects.

" Though its more direct agency seems to be connected with the
circulation, it also exercises a very marked one in a torpid state of
the liver, and a physician wrote us he had employed it in a case of
this kind, at our special request, and that it had proved triumphant
where all other remedies had constantly failed. Nor is this a soli-
tary case of the kind, since we possess many others, but this volume
was never intended to be a register or catalogue raisonnee of cases.
In our own person, and in that of many others, it has been found a
specific in cynanche tonsillaris, from which we have been in the habit
of suffering at regular periodic returns, in spring and autumn, and
the only anterior relief was the lancet applied to the abscess. By
the exhibition of 6 or 8 grains of the chlorate morning and evening,
it has been always immediately subdued ; by persisting in this for
several times on its first attack, it has been banished from the system,
. and we have remained free these several years from its visitations.
Of its efficacy in morbid glandular affections, there can therefore be
no doubt. In chronic catarrh of many years standing, it has effected
a complete and permanent cure. Though personally susceptible, we
scarcely know, in propria persona, what a permanent cough is, since
we find it is soon dismissed by judicious doses of chlorate of potassa.
We are not particularly attentive to quantity, but generally com-
mence with 6 or 8 grains, and have given it one of our children, a
few months old, in doses of two or three grains, with the most
salutary effects. At our suggestion it has been made up into lozenges,
and thus become a convenient mode of exhibition in catarrhal
complaints.

" The agency of chlorate of potassa on the system is very mild
and gentle. It speedily reduces febrile excitement, and in a case
which was supposed to be ulcerated trachea, two doses of eight grains
each reduced die pulse from 120 to 97 ! The system, however, so
far from being lowered, is contrariwise strengthened — facts which we
have personally experienced as often as years have passed over us.
Its effects are somewhat diuretic, at least in morbid glandular affec-
tions, and from that interesting circumstance we doubt hot but its
judicious administration, in combination with other medicines, might
give relief in hydrothoiiax, and in an early stage of the disease perhaps
effect a cure. We are supported analogically in this belief, from
having witnessed its beneficial results in anasarca pi the legs attend-
ant on a case of phthisis." — pp. 130 — 132.

Allowing :fu)l credit to the statements of this extract, we

Mh Murray on the Cure of Consumption. 999

must remind the author, that ulcerated trachea and pulmo-
nary consumption are very different diseases. Besiaes, ac-
cording to M. Gannal, chlorate of pot as is not the best
mode of employing chlorine. There is only one point of
yalue in his recommendation, and that is, that the remedy
can do no injury, and therefore it deserves a trial ; but we
repeat our position, that medicines, taken into the stomach,
can have little, if any effect, in diseases of the lungs ; and
this objection also obtains in cases of ulcerated trachea.

If there be any probability of alleviating consumption, it
must be by inhalation* and a judicious use of counter irrita-
tion, in the fullest sense of the word. A great deal of error
is committed by the majority of the profession, and, of
course, by non-professional persons, who consider all the
diseases of the chest consumption. Well informed medical
men will only smile at this prevailing error, and lament the
gross credulity of the public in such absurdity. But we
need not lose time in commenting on topics which are so
universally understood, and therefore snail conclude by
inserting two cases, detailed by two surgeons, Mr. Hughes,
of Stafford, and Mr. Hall, of Apeton, in favour of the pro-
posed remedy. Mr. Hughes proceeds as follows: —

" A young married woman, not lately pregnant, and who had
miscarried two or three years ago, consulted me about two months
since. She had the usual symptoms of phthisis, with evident indi-
cation of tubercular deposit, ascertained both by percussion and the
stethoscope. Hie gas, aided by counter-irritants, sedatives, and
aperients, has nearly, if not quite, restored her to health.

" I have this evening, June 8, seen the married female whose
case I related in my last ; she has now no pain in her chest, nor any
other symptom of phthisis. Her chest sounds well, yet there is a
very slight dulness on her left side above the mammae, — the former
seat of pain.

" Mr. John Hall, of Apeton, near this place, a member of a very
consumptive family, having lost a sister and a brother, the latter of
whom I saw during his illness, permits me to communicate to you
the following particulars, the result of our mutual reminiscence. —
He was attacked in the Christmas of 1828, after exposure to wet
and cold, with violent pain in his chest, cough, &c. ; a surgeon bled,
blistered, and physicked him, and he partially recovered. In May
following he came under my care, conceiving himself ill ; his breath-
ing was so bad that he could not walk two hundred yards ; he was
greatly emaciated, though his appetite continued good, and had pain
in the right side of the chest. The indication of disease afforded
by percussion was most striking. I detected the seat of pain thereby
alone. There was no other disorder than phthisis ; no violent symp-
toms, yet he was evidently sinking. I immediately began with the
potass* oxym. and the gas. He went home much better in a fort-

300 Critical Review.

night, and I saw him not again at that time. In six weeks he was
so well that he discontinued the use of remedies, too soon, he thinks.
Soon afterwards he frequently walked six miles and back in a day,
without any unusual effort or inconvenience. Toward the end of
November he had an attack of pleurisy, as before, and the early
treatment was the same. He had severe pain on the left side, slight
cough, but little expectoration, and inability to inspire deeply. When
he came to me, a fortnight afterwards, the symptoms were mitigated,
yet he had still some pain on coughing, or filling his chest, was much
emaciated, and very weak. He hod no night sweats; could not
count audibly more than six or seven at a breath ; chest sounded well
on the left side ; the right, as formerly gate a dull obtuse sound.
Staid in Stafford a fortnight. Treatment as before. Could walk
better, but began to loose breath* after walking three-quarters of a
mile on his way home.

" On the 10th of last February, when this account was taken, he
had recovered flesh and colour. His own words follow : " Lusty as
ever I was : no cough, no pain— can walk two or three miles with
pleasure, — get stronger and better every day:" the chest sounds well
to seventh rib on left side — to third rib on right side. The dulness .
on the right side is less in degree — in intensity. His pulse was near
a hundred when lie first applied for relief, on both occasions ; and
was reduced in frequency to the natural number (seventy or eighty in
a minute) before he left. His age is about forty. It will be perhaps
not unimportant to introduce the case by stating that Mr. Hall ap-
plied, not to me in the first instance, but to my father, an old and
able practitioner ; and that my father referred him to me, knowing I
wished — thanks to you — to have the treatment of cases of Consump-
tion. Considering Mr. Hall's disorder to be decidedly of that hitherto
hopeless kind, he smiled incredulously when I expressed my expecta-
tion of curing it.

• ." I this morning made inquiry of a lady in this town respecting
the present state of health of her late servant, whom I had the satis-
faction to treat successfully after your plan two years ago. Informa-
tion that the young woman continues in perfect health had reached
the lady as late as a month from this time. When under my care her
age was about twenty-one years : she was pale, slender, particularly
flat-chested, and stooped. Her disorder, having advanced gradually
and insidiously, had almost quite disabled her before she felt the
necessity of seeking medical aid. Perhaps too she was deluded by
that false and fatal hope, which is almost diagnostic of tubercular con-
sumption. At last her mistress insisted that she should have profes-
sional advice, having previously provided her with a separate bed, lest
her breath should induce the same disease in her young fellow-ser-
vant. (I state this last particular as affording indirect evidence.) —
The woman, when I first saw her, had a rapid pulse, cough, humid
respiration, and spoke only in a whisper. She had pain in the chest,
and a very obtuse sound on striking the sternum between the upper
part of the mammae. She was compelled to move about very slowly,
and could only count four or five at a breath. At the end of six

Mr. Murray on the Cure of Consumption. 901

weeks from this time all these alarming symptoms had subsided : she
could move as quickly as she wished without distress or difficulty,
and readily inspire air enough to enable her to pronounce twelve or
fifteen syllables in a full voice — not a whisper as at first. In this
case the nitrous acid and oxymuriate of potassa, were (with occasional
aperients) the only medicines used." '—pp. 143 — 146.

As other remedies were employed with chlorate of potas
in these cases, it i3 not easy to discover what share the
latter has had in the alleviation. There can be no objection,
however, to give it a trial, as it may possess some medi-
cinal property when taken into the circulation of the blood.
Mr. Murray is entitled to our thanks for having published
his remedy. He has clearly shewn that it may be employed
with safety, and perhaps with some advantage.

VI. — An Important Address to Wives and Mothers, on
the Dangers and Immorality of Man- Midwifery. By A
Medical Practitioner. 8vo. 1830.

VII.— Eyes for the Blind. — Man- Midwifery exposed, ^c.
By M. Adams. 8vo. 1830.

Of all the beastly, licentious, demoralizing, and menda;
cious productions of this age, these before us stand unpa-
ralleled. Miserable and half-starved booksellers have often
been indicted for publications much less indecent and ab-
horrent. These are of course anonymous, but rumour has

ascribed one and both to a silly old man named C

not the notorious wretch who has so often debased man,
below the lowest of the brute creation, by his horrible
publications, but an exact prototype. We shall not pollute
our pages with the filthy and disgusting trash contained in
these miserable pamphlets, but shall refute the groundless
assertions which are maintained in them. We must premise
that the reputed author has never practised midwifery, and
consequently is ignorant of its dangers and difficulties,
though he has the effrontery to declare that man-midwifery
" is a disgrace to morality and feminine dignity," that medi-
cal aid is unnecessary ; and that medical men solicit the chas-
tity of their patients, and seduce them generally. What a
doting, ignorant person, the man must be, who seriously
maintains such aosurd opinions. How grossly ignorant
must he be of the innumerable difficulties attendant on par-
turition. But no man acquainted with obstetric practice could
entertain such opinions ; and one unacquainted with the

302 Critical Review.

•abject,' must be extremely foolish to expose his ignorance.
Has" this licentious and profligate pamphleteer ever penned
a treatise on obstetricy ? Has he ever considered that men,
a thousand times more- talented than he, have published
large volumes upon the subject ? Does he presume to
think, that he is right, and nine-tenths of the profession are
wrong ? If he be of this opinion, some brace of mad
doctors ought, out of sheer compassion, and for the main-
tenance of professional dignity, have him confined as a
lunatic ; for now a-days men are deprived of their liberty
on much more slender proof of mental aberration. We
are quite serious in our suggestion, for there is not a sha-
dow of doubt, but the author of these infamous produc-
tions is a monomaniac on the subject of what he ?ulgarly
denominates man-midwifery. It must be unnecessary to take
the trouble of offering' a serious refutation of the absurd
opinions advanced by this pitiable writer. But as he pro-
bably enjoys lucid intervals, a few observations may be
useful to him, and contribute to expel the singular delusion
under which he labours. We must inform this man
" of enlarged intellect," from personal experience, that
the confidence inspired by the presence of a medical man,
will greatly abridge the sufferings of a parturient female,
and that his aid in difficult and dangerous cases is invaluable,
as it frees the patient from the most painful sufferings,
which, without it, must continue for hours or days to the
iinal destruction of the lives of both parent and offspring.
Savage and unfeeling is the man, who would inculcate the
doctrine of depriving his fellow creatures of relief, under
such circumstances. He is a disgrace to his species, and a
malignant libeller of his profession and of humanity. He
has forgotten the primeval malediction, which has for ever
doomed the human female to the agonies of child-bed, and
he is ignorant, or pretends to be so, of the innumerable
difficulties which may aggravate her sufferings, and which
can only be removed by the aid of our profession. In
further illustration of this reasoning, we shall cite our own
remarks on another occasion.

" Happily for humanity, the process of labor is safe and free d
.danger, in a vast majority of cases, especially where females live
according to nature's primitive laws ; but among the higher and
middle classes, where these laws are violated or forgotten, where
the constitution is impaired by the luxury and dissipation of modern
times, the process of child-bearing is attended with considerable
danger, both before and after it shall have been completed. These
observations are equally applicable to the lower classes in our cities,
whose customs, habits, pursuits, and constant inebriation, render

An Important Address to Wives and Mothers. 303

them liable to many accidents during parturition, and to a vast
number of inflammatory and febrile diseases after delivery. The
universal testimony of all unprejudiced medical men confirms the
troth of these assertions. It is well for suffering humanity, the
process of parturition may be greatly accelerated, and the greatest
of mortal suffering relieved by the skilful exertions of the obstetri-
cian, and with the most perfect safety to the parent and offspring.
It is well known that the very presence of a medical man will often
afford relief, without the performance of any manual operation what-
erer. The confident assurance to the patient of her safety will
inspire that balmy hope, which will hasten delivery much better than
any other means. On this account there are few intelligent females,
who do not prefer medical attendance during labour, to that of any
other description. This is the case in every oivilized country, as
women are well aware of the superior knowledge which medical
men possess of their constitutions ; and hence in modern times, we
observe a wise and judicious preference given to male obstetricians,
andmidwives are scarcely ever exclusively employed, unless among
the ignorant or lower classes." — Manual of Midwifery by M. Ryan,
M.D.

This is a sufficient reply to the position, that medical aid
is not required at the nativity of our species. If more evi-
dence were wanted, we need only refer to the voluminous
works on obstetrics, from the time of Hippocrates to the
present period. These were unnecessary, according to our
sensible author, and their authors who appeared in different
countries, during a period of even two thousand years, had
employed themselves unprofitably and uselessly. Happily
the opinion of the profession is against this author, .who,
Goth as he is, must yield to reason and to science, which he
cannot control. The voice of the profession, and the sanc-
tion of an enlightened public, are against him. All are
fools, but this mighty Daniel. The most serious charge
made by this defamer is, that medical men solicit the chas-
tity, or generally seduce the females under their care. The
obscene and beastly remarks on this point are so gross,
that it astonishes us how any man of an ordinary education
could be capable of inditing them. We cannot find lan-
guage sufficiently strong to express our reprehension of such
sentiments, and more especially when the writer is a mem-
ber, a most foolish one, to be sure, of our profession.

To assert that medical men solicit the chastity of females
in the agonies of childbed, when stretched upon the rack
on which nature has laid them, is an idea as absurd as it is
unnatural. The feelings of every man must convince him,
that sensual impulse is not excited by parturient screams and
tortures. Gallantry and brutality are as incompatible with

304 Critical Review.

one another, as this writer's nonsensical reveries are with
common sense. His cerebellum must be peculiarly deve-
loped, it would be interesting to learn its phrenological
description. Here we are reminded of our misfortune in
not being phrenologists, but having lately learned that emol-
lient cataplasms are applied to the occiput for the (tare of
fonorrhoea, by the disciples of Gall, perhaps such might
e useful in this case, though our own opinion is, that some-
thing in the shape of Mr. St. John Long's innocent lotions
would be more efficient in extracting " the acrid matter"
from the diseased site of sensuality, than. any thing else. If
medical men betrayed the moral duties they owe the public,
and acted as this .wholesale defamer asserts, they would be
degraded by society, and severely punished by the law of
the land. Their immoralities could not escape detection,
and their punishment would be public execration, and the
utter ruin of their professional character. If the gratuitous
and ridiculous assertion against which we argue were cor-
rect, our courts of justice would be constantly occupied
with actions against medical men, and yet in the annals of
these venerable institutions, we find only two examples of
such actions recorded, and these of recent occurrence. We
need scarcely state that both delinquents were obliged to
relinquish the profession. We must apologize for impugn-
ing such false assertion and malignant libel by sober argument,
which we should have treated with ridicule and contempt.
The charge of immorality is refuted by daily observation.
Censure need not be applied to such insufferable nonsense.
Conduct so absurd and ridiculous, as this pamphleteer has
been guilty of, must excite general contempt ; in fact, it
could have little effect upon the mind of a rational being.
This trash has been shouted through the streets, for the lauda-
ble purpose of exciting the " green-eyed monster" in the minds
of the ignorant, and to sow the seeds of discord in families,
while it tends to lower the* characters and morals of British
females, who were hitherto considered patterns of chastity and
virtue. Englishmen, husbands, fathers, and brothers, what
say you to this ? You all will reply, verily the intellect of
this defamer of the human race must be sadly perverted.

No treatment can be too bad for the depravity of the writer
in question. He is as insensible of shame as he is to the censure
of the profession to which he belongs, and to which he is the
greatest original afforded by its annals. He is much more
obscene and disgusting than the most infamous quack in this
city of empirics. He is the worst enemy of decency and
public morals, and ought to be prosecuted by the society
for the suppression of vice, or by his Majesty's Attorney-

An Important Address to Wives and Mothers. 306

General. Fellows much less guilty have been prosecuted,
but he moves in respectable society ; he is not a proper
object for prosecution, there being one law for the rich, and
another for the poor in this country. Had he been a starv-
ing bookseller, prosecution would speedily overtake him,
and arrest his iniquitous career.

ORIGINAL COMMUNICATIONS.

I. — Affection of the Heart, $c. By W. Dobson, Esq.

H. S. aet. 21, a plethoric girl. Had uninterrupted good
health until five months ago. Has been accustomed to carry
great weights up fifty steps, many times in the day. Felt
severe pain in the back after carrying one of these loads.
Since, has had a feeling of fatigue in the spine, after exer-
tion; or being in the erect posture for some time, but no
pain. Four months ago began to suffer from palpitation and
dyspnoea, on the slightest exertion, which have gradually
increased. Pain in the centre and left side of the chest.
For which she was bled ; had blisters and other counter-
irritants applied to the chest, but only affording temporary
relief. Numerous medical men had seen her, who concurred
the heart was diseased, and were assured she must inevitably
die in a short time. July 9th. I was called to see her.
States she has every evening a severe paroxysm of palpita-
tion of ihe heart, and most distressing difficulty of breath-
ing, which continues for two or three hours — sometimes
longer. In the intervals is pretty comfortable : tongue
white: appetite deficient : flatulence, especially after eating:
.bo web constipated : secretions unhealthy : fulness and ten-
derness at the epigastrium, and in 'the whole course of the
colours. Cataibema regular. On pressing the spinal column,
complains of tenderness in its whole extent, but especially
owthe2d, 3d, and 4th cervical, the 5th, 6th, 9th, 10th,
and 11th dorsal vertebrae ; at these parts the slightest pres-
sure produces great suffering. Previous to my examina-
tion, was not conscious of any pain there.

During one of the paroxyms I was called ; the heart was
throbbing violently : the pulse rapid (110) and bounding:
skin universally cold: face pale and swollen. The respira-
tion exceedingly hurried and laborious. In short, it seemed
to be performed by the - effort of the will ; and as if the

Vol. v. wo. 28. a Q

306' Original Communication* *

diaphragm was either in a slate of itctive eorifr&fction, wrtfi-
o«t corresponding relaxation * or totally paralysed. Sto4
jibtUtr of the akin increased. : troublesome itching of the
skin about the neck and breast: muscular twitchings of the
left fore-arta : dull pain in the oourse of the large nerves
of the arm : heart very excitable : the most trifling circum-
stance (as a rap at the door) excites it to very rapid action.

By tne successive application of leeches, blisters, and
various counter-irritants to the spine, the disorder of the
heart and lungs was soon removed. In fact, the disturb-
ance in these parts abated, just in proportion to the diminu-
tion of the spinal tenderness. The common antiphlogistic
measures were enjoined. Attention being paid particularly
to the intestinal secretions. Nux vomica, I found a valu-
able adjunct in relieving, manifestly, the dyspnoea, the mus-
cular twitchings, and the pains of the arm.

In the course of a month all those formidable symptoms
had disappeared ; only slight epigastric tenderness remained,
t}ut which was soon removed by a blister, and restoring the
qecretipns from the bowels to a healthy state,

I have omitted the details, as it would have occupied too
much of your valuable pages.

The, dependants of the heart's action on the nervous sys-
tem, is by many practitioners entirely overlooked. The heart
is supposed to be excited to contraction, by the blood in its

S&vities, acting, either from some inherent stimulus, or by
istending the walls of that viscus, or by these conjointly.
To ground the heart's action, on sensibility, is, at the least,
a paradox; it being so well known that the heart will con-
tinue to act for a considerable period after its removal from
the body. At the time of Harvey, when the physiology of
the nervous system was so imperfect, it would appear
plausible to account for the heart s action on this principle.
put since the investigations into this intricate system have
developed the causes of many a phenomena, previously
inexplicable, we may now carefully make new inductions,
and attempt to illumine those deep recesses of physiology
and pathology, which hitherto have been in entire obscurity.
That the heart's action is connected with the circulation of
blood through its cavities, no one will deny. But that it
is directly dependent on this operation, is quite erroneous ;
qnd one familiar illustration, out of many that might be ad-
duced, will suffice to confirm this idea, viz. syncope, a state
ivhere consciousness is abolished* and every action suppressed
for a variable. period. Now, the first mark of recovery, is pul-
sation of the heart, and we enquire, what caused the heart
to move ? Was it the entrance of blood into its cavities ? No :

Mr. Dobson on Affection of the Heart, $c. 80/

the blood is passive in its motion. Did the vessels' gvfe fthfe
blood motion? this is denied. Then, the obvious inference
is, the heart is excited to act by. some others agenf;.*nd
such is the ease-. That, the heart resumes its.afction fro*i a
principle in its nervous and miucular Structure, <apd from if*
communication with .the ganglia of the sympathetic, main*-
tains this property, seems perfeetly evident, and is totally
independent of the blood in its cavities. And it were easy
to prove, both by fact and analogy, if we could change
the route of the blood, so that not aq atom should pas*
through the heart's cavities, the movements .of tj>is orgaji
-would be equally energetic; and so far frojn the. blood's
potion being the direct cause of the .heart's Action, the
circulation is only the effect of these acfrWcoubraetions. .*
• All must agree that tha heart is active in its agency,, And
not a passive organ, not excited to move by the blood in its

The connexion which subsists between the. sympaibeftjb
and the cerebiro*spinal system, accounts for derangement in
the heart's function, when the spinal marsow. is; diseased.

From the history of the preceding case, it would appear
that from over exertion of the. spinal calami*, the spinal
narrow became primarily diseased, and it is an allowable
conjecture, there was extension of thjts to the ganglia of
the sympathetic (by the communicating nerves), and pro-
bably its branches also,, participated in' the same, from con-
tinuity, and thus produces derangement in the organs sup-
plied. For we can as readily conceive, disease in the
mrves-t inducing disorder in their situations, as of disease fr
the ganglia, manifested, in the parts, where their nerves are
distributed, Where we find analogy in anatomy,, we mujt
look for the same in pathology.

It wil| be observed, there was no uniform irregularity off
thepulsfe. This circumstance, I consider a strong evidencte
of the non-existence of organic disease, in the heart. '*'•''

The deranged action of the diaphragm <as evidenced- by
the dyspnoea) the epigastric tenderness^ and all those aiio5-
malous symptoms detailed, seem equally referable to dis^
order of the nerves, atid their connexions. The tfrgent dysp-
noea, was undoubtedly dependent on that exquisite teridei*-
ness over the centre of the cervical vertebra, where thfe

!>hrenic nerves originate-1 The muscular twltchings of thfe
ore-arm, on the origin * df the axillary plexus, and that -off
the in&rcostals, on the corresponding portion, of the spinai
rnairow. The palpitations on the* cervical ganglia and their
communicating neires.* - * 3

30S Original Communications.

What influence the "nervus vagus" exert on the heart,
is not yet established. It is considered neither a " sensi-
tive/' nor a " motor" nerve.

Dr. W. Philip's researches show, that when a narcotic
('as opium) is applied to the brain, or spinal marrow, the
heart's action is either retarded or accelerated, but not
irregularly. Does the nervus vagus serve as a medium of
impression from the brain to the organs it supplies ? As
when mental emotions produce increased action .of the
heart (so strikingly manifested in this case) -and loss of
appetite, &c. its use may be analogous to the communi-
cating nerves, between the spinal marrow and the sympa-
thetic, viz. to convey the mandates of the will to the heart,
the lungs, and the stomach, &c.

The sympathetic, endowing the organs it supplies with
that special power of action.

The nervus vagus, to bring these actions under the in-
fluence of the brain.

These few observations, though very concise, may assist
in calling the attention of practitioners to this formidable,
and not uncommon malady. The interesting and very valu-
able treatise of Mr. Teale, on " Neuralgic Diseases," can-
not be too attentively perused ; but it contains more in-
trinsic value than any panygeric I could bestow.

14, Arabella Row, Pimlico.

II. — State of the Medical Profession in Dublin. By

Unus Quorum.

As you have taken so much interest in fearlessly exposing
the abuses and defects of our profession, and more than
once alluded to the state of matters in Ireland, I enclose
you a few remarks on the state of the profession in Dublin.
We had been led to think that oar Royal College of Sur-
geons would have acted liberally on receiving their new
charter ; but I need scarcely observe, that their new regu-
lations are as narrow and as selfish as before. It was
rumoured that the College would have been thrown open to
to all who presented themselves for examination, and a woe-
ful drawback would be made from the coffers of the junta
at Lincoln' s-Inn-Fields, by giving Irish students in general
an opportunity to qualify at home, but no such thing was
meditated. The college, ever true to narrow-minded prin-
ciples, .and extremely sensitive of personal aggrandizement.

State of the Medical Profession in Dublin. 300

have virtually closed their portals against all, save their
ewn apprentices. They effected this by requiring a much
longer, and more expensive course of study, a double fee
for their licence, and more severe examination from those
who are deprived of the means of paying the exorbitant
fees required of apprentices. They forsooth offer an ex-
amination on such conditions, and in the true Stock Ex-
change method, require the sum of £.60, to be deposited
in the national bank, the sum from apprentices being £.30,
and the fee in London £.22. Thus it is that wealth is a
passport to medical science in Dublin ; and talent is neg-
lected and degraded. . But no candidate will apply for ex-
amination, as he is certain of rejection, unless he has
apprenticed himself to some one of the examiners. The
only resourse he has to adopt is, to present himself at the
London College, where he is sure to be treated in a gentle-
manly manner, and have a fair and impartial examination.
But on his return home, he is treated with contempt by the
scions of the Dublin corporation, he cannot be surgeon to
a county hospital, and he will not be met in consultation.
He is a regular surgeon, and according to your excellent
article in your last number, has an undoubted right to prac-
tise in any part of his Majesty's dominions. But as he has
not condescended to be one of the " forty apprentices,"
which some of the college party possess, he is a fit and

C roper object for contumely and scorn. In vain he exhibits
is diploma, and points to the illustrious names of Astley
Cooper and John Abernethy, they procure him no respect,
and his document is only ridiculed. He meets a fellow
student of the apprentice tribe, who heard the same lectures
with himself, and whom he often assisted in his studies ;
and from him too, he experiences coldness and disrespect*
And this monstrous system is to continue, because half a
dozen Hospital surgeons and censors of the college glut on
apprentice fees. If there be not a fatality attending every
measure in which the college are concerned, By what excess
of folly has it happened, in an age like the present, that
these ungracious regulations which have ever distinguished
their administration, should carry with them a strong ap-
pearance of pers'onal interest, where no such interest ought
to exist, to the injury of the largest portion of the profes-
sion, and to the highest dishonour of themselves. These
principles and proceedings, odious and contemptible as they
are, in effect are no less injudicious. An enlightened profes-
sion are roused 'by 'every appearance of monopoly and
oppression ; and will one day or other make common cause
in opposing them.

WO Original CvrftnUhicfiiionf:

• As Ireland has been a'lwagf 4ocfm4d to play the' ." Cjtf
medy •f^Srifrrs,'.' in every ; thing,, t^e reform promiised by
LOrd Clotrer, , in pharmaceutical matters, ..will of course be
forgfltten.*. His lordship is do longer connected with, this
country, and peace be with hhn, say I,-fand consequently
wiU forget his soloinn promise to amend the apothecaries
aet; The Dublin company of drug venders, are. much of the
lame stamp as their fellow labourers at your side of the
prater. Thjey are not quite so impertinent 4s yet, and they
want courage to interfere with the rights of &e phyaiciaos
and* surgeons. ' But no doubt they wiU imitate the gloripus
example of their seniors in Lgmao?, and by and by, pro-
sedd'tp .stultify the Colleges fcf Physician* and .Surgeons,
as the .London company have 00 ably accomplished. Our
?' ohi bigs of, Bbuoarb Hjdl," do not examine in physic or
«ujrg»ryiia«d' for » good reason, they dare not attempt it
But they, are rnore alive to their own proper calling than Uw
Londoners, for they threaten tosfin^ all irregulars, and heVi
frightened tik^se interlopers out of their senses. . I hare
often laughed, heartily, at the threats of the worshipful com-
pany, being, aware th&t it would: cpst them £.200, to enforce
a fine of &2Q.'t ,Xbey are cunning enough, however, to suc-
ceed, by sending «n inspector through the province©, who,
informer lik*, tak^fc ^ognizfcnce of those unfortunate appren*
tines and assistants, who open shops without a liqenee,.or.iii
modern phrase, a diploma, threaten them with the v^pgeaoe?
1»f. thte Hall, but- promise the required licence, on the payf
jbent of the naulet — the druggists and grocery are left urn
molested, but the profession (done must suffer. ;

, I was happy to per Use. yopr extracts from Dr. Grattan*
essays on tie staite of the prafes$ion here, and I should be
jstiU happier if you noticed Mr. Donovan's more recent pub-
lication on the .subject • This gentleman is ffovernpr of the
Hall, and has dealt destruction among the pharmacop.olisfe.
He bad the manliness and independence to preside at the
radical meet u% ; and was literally turned out of the est*
UUhment ef which he is the legal head. This was truly
^Hibernian, you will say. However, he has received Af
opmmendations of every independent man in the prtffe*
*ion. • • " ' .

We are now preparing for the winter campaign of lec-
tures, and our forces have mustered in great numbers* . We
•Jiafe fneny rival schools, and a wonderful Change in the
-demeanour of the monopolists. It woxdd surprize you., to
observe the affability and communicativeness of our great
lecturers and hospital, surgeons, their former pride and inso-
lent muteness no longer exist. ' Such are the good effects of

Metropolitan Society of QeneraV Practitioners. 31 I

apposition'. Then lass regidatiorfs of the Bn£iish cdlle^ey
which Hberalfy recognked all bur hospital*/ -have largely
toitribufed . to the marvellous improvement iir the maimers*
•f our surgeons .and teachers. 1 assure' you', that a poor
greea-hprh of a student, is no longer sneered at for asking
t question, and'that aphonia, which was wont to seize the
surgeons when visiting their patients, pnless when applm-*
ticeswere present, is no longer prevalent j loquacity,' Bor-
dering on garrulity, is how the order of the day.
■ Another great improvement 'has been recently effected;
hy the establishment of a few rival obstetric institutions.
Instruction is now afforded at half the expense, and the*
monopoly of the once famous Lying-tin Hospital, k nesritf
destroyed. Thanks to Dr. Montgomery, Dr. Gregory, ; ana
Dr. Cusack, for this improvement. A* I have refrained
from censuring individuals in this letter, I shall not begirt
towards its close, though the conduct of some of the pier*
sons connected with obstetric establishments, loudly calls'
tor exposure. But on another occasion I shall trouble you
with a brief sketch of some • of the. crying abuses of our
hospitals and schools. I have passed by our college phy->
siciang, and have merely to observe that they proceed in thd
old humdrum manner, and are as nsensible to the interests
of science and the public as any of their fraternity. They
hav* lately, done one laudable act, in appointing the tetldnteot
sad experienced Dr. Lahy Professor of the Practice of
Medicine-
Dublin, Sept. 20th, 1S30.

HI. — Metropolitan Society of. General Practitiohetsl

Sis,— The journal which you so ably conduct, was once the
advocate of the general practitioners, and I trust you will
allow an old subscriber to offer a few words in defence of
the Metropolitan Society of General Practitioners. Some
objections nave been raised to the principles of this society,
hut I can discover nothing in them which, any reasonable
practitioner can object to. The general practitioners are* a
distinct body,, and differ frctm any of the former classes of
the profession. They are surgeons and apothecaries, and
wt&ttlled into existence by the wants and wishes of the
jroVRff; '£& your valuable papers on the present state of tfre
professlbs^ irriich do you infinite honour, for their indepen-
dence and impartiality, you have clearly shewn how 'the

312 Original Communications.

body to which I am proud to belong was established by the
public. How is it possible that the middle and lower classes
can procure proper advice on the usual terms of physicians
and surgeons ? The thing is utterly impossible ; and could
only be effected by diminishing the fees of the legitimate
practitioners. You have referred to the sanction of this
plan by the French ; but 1 am confident the high aristocra-
ticar feelings of the colleges would be against the introduc-
tion of such an innovation. The real cause which gave rise
to general practitioners, is the toleration of chemists, drug-
gists, and infamous quacks, all of whom have ruined the
legitimate apothecaries, the physicians and surgeons ; and
hence the former, in self defence, were obliged to adopt
the present mode . of gaining support. Though regular sur-
geons for the most part, and regular apothecaries, yet they
found the whole practice of physic, surgery, pharmacy
and midwifery, in the hands of those I have mentioned, and
hence compelled to adopt some plan of pursuing their pro-
fession. Have not even physicians been obliged to unite
with them ? They are, however, looked on with a jealous
eye by physicians and surgeons, though the colleges of these
bodies, and the company of Apothecaries, are solely to
blame for the present anomalous state of the profession in
this kingdom. Each and all Qf them have grossly neglected
the duty they owe the profession and the public. None of
them patronizes the general practitioners, and therefore the
latter must look to their own interests. I can see nothing
improper in their doing so ; every man, whatever may be
his station in society, endeavours to protect his own in-
terests.

I am, Sir, yours, &c.

A General Practitioner.
London, Sept. 15, 18*0.

IV. — Extraordinary instances of Reproduction.
By Michael Ryan, M.D.

•

I was requested by Mr. Sandell, of Gray's Inn Road, to
visit Mrs. P. of Paradise Street, Battle Bridge, who laboured
under aggravated hysteria and dyspepsia, which she ascribed
to repeated abortions. The history of her case is one of
interest, in a physiological point of view. She is aged 41,
of a sanguine temperament; she menstruated at 12, and
married between 18 and 19 ; had a seven months child in

Extraordinary instance of Reproduction. 313

the eighth month of her marriage. Has had twin9 about the
fourth month, three times during the year 1829, and again
in December 31st, when she was attended by Mr. Whitmore,
of Cold Bath Fields, and delivered of two infants ; and on
Jauuary 28th, 1830, she was attended by Mr. Thomas, of
Bagnioge Wells Road, and delivered of an infant, which he
considered of the same age as the preceding. On the 7th
of June last she aborted, at the 3rd month ; on the 9th a
second foetus was expelled, she was attended by Mr. Sandell ;
and as there was no discharge whatever, from that time to
this, considers herself still pregnant. The abdomen is about
the size of a woman in the fifth month of utero -gestation ;
she has had twenty-four children in twenty-one years. She
menstruated regularly previous to marriage. She is always
in good health when suckling, and ill when breeding ; she is
always pregnant about the fifth month of lactation ; men-
struation has often taken place during pregnancy, and was
followed by abortion ; she has never suffered from leucorr-
hoea ; her diet consists of bread and porter, but no animal
food; she often rejects large quantities of bile, and can
foretell its approach " by the smell of her breath." Her
mother is seventy years of age, and in good health ; has had
eighteen children born alive.

The wife of her husband's first cousin, resides at Mount
Pleasant, in this neighbourhood, is in her 45th year, and
has had thirty-two children, including miscarriages. Within
a few years " she bred with dropsy ; her legs burst, and
the water spouted across the room," but she went to the
full time ; she is now in good health, and has not ceased to
menstruate.

Two cases of dysmenorrhcea have lately fallen under my
care, both aggravated by marriage, and both followed by
pregnancy— facts which disprove the general opinion, that
impregnation scarcely ever takes place when the disease is
present. My friend, Mr. Bradford, of Fleet Street, had
attended one of these cases, her age was twenty-three ; the
other was under my own care, is eighteen years of age, and
in the fifth month of pregnancy. Neither of them passed
the membraneous shreds, described by obstetric writers.

V,— Laws relating to the Medical Profession, (continued.)

By Michael Ryan, M.D.

It has been asserted, at the late reform meetings, that the Col-
lege of Surgeons had no power whatever, and ceased to have an
existence in law, but a little reflection would have convinced
those who entertained this opinion, that such an inflr
vol. v. no. 28. a a

314 Original Communications •.

body could not fail to procure the notice of the legislature,
if such were necessary.

Apothecaries. — " The proper practice of an apothecary,"
says Mr. Willeock, op. cit. " consists in preparing with ex-
actness, and dispensing such medicines as may be directed
for the sick, by any physician lawfully licensed to practise
* physic, by the president and commonalty of the faculty of

giysic in London, or by either of the two universities of
xford or Cambridge, and in applying or administering the
same. They are also at liberty to administer medicine of
their own authority, and without the advice of a physician.
It is not usual for them to prescribe medicine to be, pre-
pared and supplied by others, no person is bound to pre*
pare such medicine, and I am not aware of any penalty
incurred by compounding it."*

The Company of apothecaries consists of one master, two
wardens, and twenty-two assisfants, and no man can be
elected to any of these offices, who has not previously
been a member of the society for ten years. The master,
wardens, or court of examiners, may appoint five apotheca-
ries in any county of England and Wales, except in or
within thirty miles of London, to examine assistants to
apothecaries, but no person is eligible who has not been an
apothecary for ten years.

No person can practise as an apothecary in England o*
Wales, until he has been examined by the court of ex-
aminers appointed by the company of apothecaries, and
has received their certificate of his being duly, qualified, to

?ractise, unless he was in practice upon the 12tn of July,
815, and also upon the 1st of August, 1815, and no pegsoo
can claim to be examined until he is twenty-one yeajrs of
age, has served five years to an apothecary, and produce^
testimonials to the satisfaction of the . court, of a sufficient
medical education, and of good moral conduct. Any fal-
sified certificate or statement renders the licence void inlaw,
and subjects the person who makes or offers it to fine and
imprisonment. The court can decide what is a sufficient
medical education, though they cannot in this respect spake
rules wholly unreasonable. The, applicant for examination
is required by the statute to give notice to the clerk of the
society, on the Monday previous to the day of examination,
and to deposit his testimonials at the same time with the
beadle. The day of examination is every Thursday, at
half past four o'clock. No person can act as assistant unless
approved of by the court of examiners, or by the country,
examiners. The sum of ten guineas is paid for a licence to

■ i ■ ■ i ■■■ — — — — — ^— — — — — — m— ■— i — ■ — ^mm n*— — — — — ^m — — — m

» A Treatise on the Laws relating to the Medical Profenioo, 1880.

Dr Ryan on Laws relating to the Medical Profession. 315

Eractise as an apothecary in London, and six guineas for a
eeuce to practise in the country, or within ten miles of
London, and the difference of four guineas must be paid
if such person settle in London. The sum of two guineas
b charged on the certificate of any assistant to an apothe-
cary.

Chemists and Druggists. — The right of chemists and
druggists to prepare and dispense medicines, according to
physicians' prescriptions, has not as yet been brought into
question. " And, as apothecaries have, in the course of
time, established as a right, what was at first considered an
encroachment on the department of the physician, the admi-
nistering of medicine to the sick of their own authority ;
so the druggists seem to have acquired, by general acquies-
cence, a right of compounding medicines according to the
prescription of a physician, which was certainly at first an
infringement on the privileges of apothecaries.' Willcock,
op. cit. The 55th Greo. Ill, has expressly secured the rights
or chemists and druggists.

Accoucheurs ana Midwives.— There is no restriction
placed on affording assistance to parturient women ; but it
is illegal to treat diseases antecedent to or consequent upon
child-birth.

Administration of Medicine gratuitously, is not a viola*
turn of any law relative to the medical profession.

Unqualified Apothecaries. — A penalty of £.20 is imposed
on any person practising as an apothecary in England and
Wales, without a certificate from the court of examiners,
unless such person had acted as an apothecary on or before
the 1st of August, 1815. This fine is recoverable in the
courts of record, and the company must prove one act of
practice. The penalty of £5. for acting as assistants, is re-
coverable by an action of debt, brought by the common
informer and the company, but not by the latter in thoir
corporate capacity.

Mal-practice in Medicine. — There are four kinds of mal-
practice, which relate to physicians, surgeons, or apothe-
caries.

1. Wilful mal-practice, which has for its object the destruc-
tion or injury of the patient, or of a child of which a woman
is pregnant If death or bodily injury ensue, the accused is
guilty of murder or felony. There is only one case in which
the premature expulsion of the foetus is warrantable, and
that is, when the woman is so deformed, that the infant can-
not be born alive at the full period. Here the operation is
performed to save the life of the infant and mother, though

316 Original Communications,

the law does not justify the operation. — Cabinet Lawyer,
1830.

By 43 Geo. Ill c. 58f Lord Ellenborough's Act, enacts,

€c Administering* drugs, or using; any other contrivance to
destroy a living infant, unborn, is felony, not only in the
person who actually perpetrates the offence, but in those
who counsel and assist therein. And, though the mother is
not quick with child, to attempt to procure an abortion, is
punishable with fine, imprisonment, whipping, or transpor-
tation, for any period less than fourteen years. Women
concealing the birth of an illegitimate child are liable to
two years' imprisonment."

The provisions of this statute are extended by Lord
Lansdowne's Act, 9 Geo. IV. c. 31, June, 1828,

" Using any poison or noxious thing, or any instrument,
to procure the miscarriage of any woman quick with child,
, or counselling or aiding therein, is felony, punishable with
death ; the same offence as to a woman not quick with child,
or proved to be such, is felony, punishable by transporta-
tion for not exceeding fourteen nor less than seven years, or
imprisonment with or without hard labour not exceeding
three years, to which imprisonment (if the court think fit)
once, twice, or thrice public or private whipping may be
superadded.

" Concealing the birth of a child by burial of the dead
body or otherwise, is a misdemeanor, punishable with im-
prisonment for any term not exceeding two years ; and it
shall not be necessary to prove whether the child died be-
fore, at, or after its birth ; provided, that if any woman
tried for the murder of her child shall be acquitted, the
jury may find, in case it shall so appear in evidence, that
she was delivered of a child, and attempted to conceal the
birth, upon which the court may pass such sentence as if she
had been convicted upon an indictment for the concealment
of the birth." s. 14.

" Every person convicted of the abominable crime of
buggery, committed either with mankind or with any animal,
shall suffer death as a felon." s. 15.

" Every person convicted of the crime of rape, shall
suffer death as a felon." s. 16.

" Unlawful and carnal knowledge of any girl under ten
years of age is punishable with death ; above ten and under
twelve, with imprisonment with or without hard labour for
such term as the court shall award." s. 17. .

" It shall not be necessary, in any of the four precediug
cases, to prove the actual emission of seed in order to con-

Dr. Ryan on Laws relating to the Medical Profession. 31T

statute a carnal knowledge, bat the carnal knowledge shall
be deemed complete upon proof of penetration only."

8. lo»

2. Avaricious mal-practice has for its object the lucre of
the practitioner, who employs improper drugs or treatment
to the injury of the health of the sick. This prevails among
druggists and low apothecaries, who substitute one drug for
another; and constitutes a cheat at common law, and is punish-
able by fine. and imprisonment. The discovery and correc-
tion of this abuse is confided to the medical corporations.

3. Negligent mal-practice, is where there is no criminal or
dishonest object, but gross neglect of that attention which
the patient requires. This is a misdemeanor at common
law.

4 Ignorant mal-practice, is that which has for its object the
practice of medicine, surgery, or pharmacy, without due
information and legal authority. " This is a great misde-
meanor at common law, whether in a licensed or unlicensed
practitioner." The party injured suffers a private wrong,
and may bring an action for damages adequate to the loss
he has sustained.

The censors of the College of Physicians have full power
to correct defaults in the exercise of the profession, which
includes physic, surgery, and pharmacy, in London, and
within seven miles thereof, and this power may be exerted
over all graduates in physic of any university, or whether
they do or do not assume the style of doctor or the cha-
racter of a physician* Op. cit. It is necessary that the mal-
practice should be in physic, but it is apprehended that this
would include surgery and pharmacy. The censors are to
determine what is, or what is not mal-practice, and the
unfitness or unsoundness of the medicine prescribed. They
may fine or imprison, or fine and imprison the party ; or if
they impose a fine alone, they may enforce payment of it
by imprisonment. The fine must not exceed £20. " They
still retain," says Mr. Willcock, " the authority, and in the
present state of the metropolis, they ought to resume the
exercise of it, and they may, in the discharge of their duties,
with impartiality and moderation, confidently rely upon the
succour of the courts of Westminster. A court of justice
canuot be obsolete by the neglect of its judges, the present
censors may exercise these powers as fully as if they had
been daily exercised by their predecessors, from the time
of Henry VlII. ; not only may they receive their jurisdiction,
but they are bound to revive it ; in so much that should
they reject a charge of mal-practice preferred by any per-

313 Original Communications.

sta, tbecburt of King's Bench would, by mandamus, com-
pfel them to convene, and to hpar and decide upon the Accu-
sation."

It appears, from the same authority, that the president
and Vice-presidents of the Royal College of Surgeons in
London, have full power to correct mal-practice in surgery,
by members, or irregulars, and the observations made on
the power and duty of the censors of the College of Phy-
sicians, are equally applicable to them. The same authority,
so often quoted, declares that the Apothecaries' company
have no power to appoint inspectors of shops, or to fine
persons for keeping* bad drugs ; at least, doubts may be
entertained upon this point.

Civil responsibility of Medical Practitioners.— An action
will lie against a physician, surgeon, apothecary, and every
other person professing to cure wounds or diseases, for fertery
injtiry that may arise from his want of skill or want of
Attention. An action will also lie against a physiciatt, Who
makes experiments for any injury produced by them, unless
the experimenter informs the 'patient bf his intention, and
obtains his consent.

If a 'physician, surgeon, 'apothecary, or other -medical
practitioner, Undertake the cure of any Wound or disease,
and, by neglect or ignorance, the party is not cured, or
suffers materially in his health, «ucn medical attendant is
liable to damages in an action of trespass on the case ; but
the person must be a common surgeon, or One who makes
public profession of such business as surgeon, apothecary,
&o«; for dthferwise it was the plaintiff's own folly to trust to
an unskilful person, unless such person expressly undertook
the ctire, and then the action may be maintained against
him also.

An action will lie against a surgeon for any deviation
from the established mode, -as. trying a new instrument, if it
injure the patieiit. Slater v. Baker and Stapleton, 2 Wile.
350. The defendants disunited a callous of a fractured
leg by a new instrument. Damages £500. Verdict con-
firmed by the whole Cotfrt.

An action will lie against a surgeon for gross ignorance
of his profession, as well as for negligence and carelessness.
Scare v. Prentice. 8 East's R. 348. Quere the authority of
this case? In the case of Neale v. 'Pettigrew, the plaintiff
dislocated his arm; it was badly set by the apprentice of
defendant, for which -the master suffered damages £800.

Remuneration of Medical Practitioners — A physician
cannot maintain an action for his fees, for they are honorary

Dr. Ryan on Laws relating to the MedicpU Profession. 319

and not demandable of right, and it is mu.ch.more. for, the
credit and. rank of that body (the physicians), and peruana
for their benefit also, that they should he, sq, considered,;
" and I much doubt/' savs Lord Kenyan* " whether tfyay
themselves would not altogether disclaim such, a rights
would place them upon a much less respectable footing ia
society than that which they at present hold." . Chorley 0.
Bolcpt, 4 T. R9 37, It was contended, in. this cafe, that
there was not authority in the books f or. placing pbypiciaps
and barristers* fees on the, same footing, the regulations
with regard to barristers being founded on the ground of
public policy, a* appears in Tacitus

But though a., physician cannot recayer, his. fees. by a
process df ikw, yet pro concilia . imp&HQ and.impend^nda
these are a good and valuable consideration for, aa, annuity*

9 W„ Rep. ,50, 7 Cou Rep, 10,28,

If a bond, bill* or note were, given for medical attendances,
the consideration, would be. good, though the .original .fees
could not be recovered.

If a medical practitioner who has no diploma, pass himself
off as a physician, he cann^t.maintain an action tor his, fees*
Iipscotnbe v. Holmes. 2 Camp, 441. Though a$ a surgeon
he might have recovered compensation* and evej* if ha. were
no regular surgeon, he . could .recover in an action of, as-
sumpsit Gremairfe tv Le Clerc. Bois Valor, 2 Camp, 144,
But query, the- authority ,of this case-

If there , be any arojniae, a physician may recover on a
quantum meruit.. Shepherd *, Edwards, Hill 11, Jac, 2,
Croke 370.. lW , plaintiff here declared he was a physician
and surgeon* had^ured the defendant of a fistula, and had
jodgnwnt^ but. query* did not he sua a* a surgeon? , Bui

10 Dale t>. Copping. Bulst. p. 1, 39, the promise of aa
infaijfi to pay a certain sum to the physician, to cu/e him of
epilepsy, w*a,a contract and held .binding*

But can a doctor of medicine who is npt a member of
the London College of Physicians, or a graduate of either
of the English universities, recover as a pbyeiqiaa unless on
a promise which .amounts to , a contract ?

The Scotch and « Irish schools of physic and surgery are
corporations not confirmed hy law, and their Graduates or
licentiates- are not allowed to practise in England unless
they be re-examined by the London College, of Physiciaps.
Bat, the common law of England extendi. to Ireland* It

9 Elements of Medical Jurisprudence by Peris and Fonblanque, vol. i. 1838.

320 Original Communications.

would be prudent then for all medical men to have a verbal
or written promise, a bond, bill, or note for attendance, in
order to entitle them to recover. Some recent decisions of
importance took place in Ireland on the recovery of medical
compensation, which shew the unsettled state or the law on
the subject.

A case was decided at the Kilkenny summer assizes, 1824,
before Mr. Justice Johnson ; it was that of Ryan v. Gorman.
The plaintiff was a doctor of medicine of Edinburgh, and a
surgeon of Edinburgh and London Colleges, who attended
defendant and his family for several weeks through fever,
at the request of defendant's wife, who promised him the
ordinary remuneration, as also did defendant. He per-
formed no manual operation, except the removal of a blister,
which was not within the province of a surgeon. It was
contended for defendant, that as plaintiff acted as physician,
and the disease being a medical one, he could not recover ;
but the court decided that the promise was binding, and on
being handed the report of the case of Sheppard 0. Hill
above quoted, and also Dale v. Copping, the judge gave a
verdict to plaintiff on a quantum meruit.

A similar case, if correctly reported, was differently
decided at the Clonmell spring assizes, 1826, before Mr.
Justice Moore. It was that of Kelly v. Latham. The
plaintiff, a physician and surgeon, attended the defendant's
mother, who sent for him and promised to pay him when he
was able. The disease was a medical one, consumption.
On the last admission, " Mr. Doherty called for a nonsuit on
the ground, he could not recover for his attendance in a case
purely medical." Mr, Serjeant Lloyd observed, that what-
ever capacity he acted in, whether physician, surgeon, or
apothecary, he should be paid. " The jury," said his lord-
ship, " have to try whether Mr. Latham employed Dr. Kelly
generally as a medical practitioner without any reference
to his being a physician or surgeon, and the evidence to
what Mr. Kelly was employed for. A verdict was found for
the defendant, with 6d. costs.

Surgeons.— A surgeon is entitled to recover reasonable
remuneration for his care, attendances, skill, labour, medi-
cines, and applications in surgical cases, but not if he put
his attendances in the character of a physician, either by
prescribing as a physician, or assuming to hold the degree
of doctor in medicine, or by sending in his account with
blanks opposite to the statement of his services ; for, in the
former case, he has relinquished the character of a surgeon,
and assuming to be a physician, the court will not allow

Dr. Ryan on Laws relating to the Medical Profession* 321

him to put off that assumed character, merely to entitle him
to that remedy which he has relinquished by his illegal act
and affectation of dignity, and having left the amount in
the latter case to the discretion of the patient, he must be
content with what may be paid. Willcock, op. cit. Hie
reasonableness of a surgeon's charges will be decided by the
jury. He will be allowed for his medicines when such are,
used as are within his proper province. But if he infringe
on the physician or apothecary, his conduct being illegal,
he ha$ no remedy for the recovery of remuneration. lb.

Apothecaries.— Ail apothecary may charge for his attend-
ances, provided he only charge the intrinsic value for his
medicines. Handy v. Henson, op. cit. This has been the
case in Ireland for a long time.

Protection of Medical Character. — If a man libel a phy-
sician, by saying Dr. — is a bad one, or employed mala-
ftraxis, the slander admits the professional qualification, and
egal evidence of his qualification will not be required.—
4 T. R. 366. Smith p. Taylor, 1 N. R. 196. Phil, on Evi.
v. 2, p. 154, But where the slander denies qualification, legal
poof must be given. Op. cit. 155. The degree of doctor
of physic may be proved by the original book of the uni-
versity or corporation, which contains an entry of the degree
having been conferred ; or it may be proved by an examined
copy of this entry, Moises v. Thornton, 8 T. R. 303, 307.
Or if the medium of proof is a diploma of a university,
bearing its seal, the instrument must be proved by legal
evidence. If the written instrument be produced as the
original act of the university which conferred the degree, it
must be proved that the seal affixed is the seal of the uni-
versity, which may be done by any one who knows it to be
such. S. 6. 307. If the instrument produced is a copy of
the original act of the university, it must be proved in the
usual way, as a copy for the university cannot, under their
seal, give evidence that the, plaintiff had taken such a de-
gree.— Phillips on Evidence.

Physicians.— By the 14th and 15th Henry VIlL the
king's charter for incorporating the College of Physicians
of London is confirmed ; they are to choose a president, and
have perpetual succession, a common seal, and ability to
purchase land and make by-laws. Eight of the chiefs of
the college are to be called elects, who, from among them-
selves, are to choose a president yearly.

Physicians in England shall be examined by the College,
and have testimonial letters from the president and three

Vol. v. no. 28. s s

322 Original Communications. m

elects, unless they be graduate physicians of Oxford or
Cambridge. Physicians practising in London, or within
seven miles, without being approved, forfeit £5. ; and, in
any other part, unless approved by the bishop of the dio-
cese, they are subject to the like penalty.

By the 32 Hen. VIII. c. 40, four physicians shall be
chosen by the College to search apothecaries' wares, and,
in company with the warden of the mystery of apothecaries,
may destroy adulterated drugs. Apothecaries refusing to
be searched forfeit £5. ; and physicians to act, 40*.

Physicians may practise surgery in London.

The fees of a physician, like those of a lawyer, are
honorary, and not demandable of right ; consequently, a
physician cannot maintain an action for them, 4 T. R. 317.

Surgeons. — By the 32 Henry VIII. the barbers and
surgeons were incorporated into one company, but, at the
same time, a distinct line of division was drawn between the
practice of the two branches of the profession. By this act,
no person practising the art of barbery is to intermeddle with
that of surgery, except as to drawing of teeth, which barbers
may continue to do as before ; and, on the other hand, no
person devoting himself to surgery, is to exercise what is
pithily called " the feat or craft" of shaving.

By the 18 Geo. II. the union of surgeons and barbers of
London is dissolved, and the surgeons of London were made
a separate corporation, with power to enjoy the same privi-
leges as by former acts or grants.

Candidates to serve as surgeons in the army or navy shall
be examined by the Surgeons' company.

By the 25 Geo. II. the bodies of murderers, convicted and
executed in London or Middlesex, shall be delivered to
Surgeons' Hall ; and, in any other county, to such place as
the judge shall direct.

By the 34th & 35th Henry VIII. any subject of the king,
having knowledge of the nature of herbs, may minister to
any outward sore, wound, or disease.

An action on the .case lies against a surgeon for gross
ignorance and want of skill in his profession, as well as for
negligence and carelessness, to the injury of a patient.
Seare v. Prentice, 8 E. R. 348.

Apothecaries.— Apothecaries were originally associated
with the grocers, but obtained a separate charter of incor-
poration from James I. in 1606.

By the 6 Will. III. c. 4, apothecaries free of the com-
pany in London, practising there, or within seven miles, are
exempt from parochial offices, and from serving on juries,

Dr. Ryan on Laws relating to the Me dical P rofession. 32 S

producing a testimonial of their freedom. Apothecaries in
other parts,, brought up in such art, or having served an
apprenticeship of seven years, are also exempted.

In the session of 1815, an important act, the 55 Geo. III.
c. 194, passed, for regulating the practice of apothecaries
through England and Wales. By this act, the masters and
wardens of the Apothecaries1 company, or persons ap-
pointed by them, may enter the shop of apothecaries, and
examine arugs, and impose and levy fines for such as are
unwholesome or adulterated. Penalty for the first offence,
£5.; for the second, £10.; for the third, and every subse-
quent offence, £20. Vide ante, p. 98.

Any apothecary refusing to compound, or unfaithfully
compounding the prescription of a regular physician, is
liable to be fined £5. ; ana for a third offence of the same
kind; forfeit his certificate.

By the same act, amended by the 6 Geo. IV. c. 133, no
apothecary, after the 1st of August, 1815, (except persons
in actual practice on or before that period,) is .to practise,
unless he has received a certificate of being duly qualified.
No person can be admitted to be examined unless he be
twenty-one years of age, and have served an apprenticeship
of, at least, five years, with an apothecary or a surgeon.
Penalty for acting without certificate, £10. ; or if only an
assistant, £5.

By the same acts, no apothecary shall be allowed to re*
cover any charge claimed by him m any court of law unless
he was in actual practice on or before the 1st August, 1815,
or that he has obtained a certificate to practise as an
apothecary.

By the 6 Geo. IV. surgeons in the navy and army, and
apothecaries in the army might practise without a certificate
from the court of examiners, or without having been in actual
practice prior to 1st August, 1815. This act is repealed.

In the constructions by the courts under these acts, it is
held that an apothecary who claims an exemption, on ac-
count of having practised prior to the 1st August, must have
actually exercised his proper vocation, — namely, the making
up of a physician's prescription ; without this, unless he has
received a certificate, he cannot recover for medicines.
Apothecaries' Company v. Waburton, 3 B. & A. 40.

In an action to recover the amount of an apothecary's
bill, the plaintiff, who proves a certificate from the Society
of Apothecaries, need not also prove an apprenticeship
servea. Sherwin v. Smith, 1 Bing. 204.

324 Original Communications.

The acts do not extend to chemists and druggists.

Privileges of Medical Men. — Physicians who are licensed
by the Royal College in London, are exempt from serving on
juries or all inquests whatever, but this exemption does not
extend to graduates of the universities. 14 Hen., 8. 6 Geo. 4.

The members of the Royal Colleges of Surgeons in Lon-
don, Dublin, and Edinburgh, when in actual practice, are
exempt from serving on juries. 6 Geo. 4. Apothecaries are
also exempt by this statute. Fellows and licentiates of the
College of Physicians, regular surgeons and apothecaries,
are exempt from watch, ward, constablewick, and the other
offices of the city of London, and from bearing arms.
32 Hen. 1. 1 Geo. 4.

Privileges in respect of Insane persons. — No, person,*
except a parish pauper, t can be admitted into any house kept
for the reception of insane persons in England, without a
certificate, bearing date not more than fourteen days before
such admission, and signed by two medical practitioners,
each of whom must be a physician, surgeon or apothe-
cary,]; unless any special circumstance have prevented the
patient being repeatedly visited by two such practitioners,
in which case he may be admitted on the certificate of one
practitioner, but such certificate must be signed by some
other medical practitioner, within seven days after the pa*
tient's admission.|| The certificate must state the patient is
a fit person tp be confined, the day on which he nas been
examined, the name and abode of the person who directed
the examination, the relationship or connexion of such per-
son and the patient ; the name, age, residence, and former
occupation of the patient ; the asylum, if any, in which
he was previously confined— and whether he has been found
a lunatic or of unsound mind, under a commission issued
by the Lord Chancellor, Lord Keeper, or Commissioners
of the Great Seal ; or if any such particulars cannot be
inserted, the special circumstances preventing such insertion
must be stated, also if only one medical man has certified.
9 Geo. 4. c. 41. By the same act, any medical man cer-
tifying without having examined the patient, is guilty of
a misdemeanor, as also the person receiving the patient ;
and no medical man who is proprietor or part proprietor, or
attendant of a house for reception of lunatics, can certify
in a case connected with such circumstances.

• 9 Geo. 4. c. 41 f 9 Geo. 4. c. 40.

\ Ibid. || Ibid-

Dr. Ryan on Laws relating to the Medical Profession. 385

Every establishment containing one. hundred patients must
ha?e a resident physician, surgeon, or apothecary, and if it
does not contain 00 many, it must be visited twice a week
by a physician, surgeon, or apothecary:, unless it is kqpt by
a regular medical man; and the medical attendant, must
report to the keeper the condition of the house and the state
of the patients' health, and must, once a month, enter the
same in a book in a form prescribed by the: act.

The same certificate is required for committing an insane
person to a private asylum, public hospital, or other cha-
ritable institution, except Bethlehem Hospital, the Military
and Naval Hospitals, and the Lunatic Asylums, established
under 48 Geo. 3, or 9 Geo. 4.

Commissioners are appointed in London anid Middlesex
to grant licences, and examine into the state of lunatic
asylums. The act requires that some of the commissioners
should be . medical men. In England no medical man can
be employed in any of the. public services. unless a member
of the colleges, universities, or apothecaries company. The
governors of some .public institutions adqpt the same pro-
visions.' The following acts relate to .the ^ppqintment of
medical men to public -offices :— 43 Geo. 3, c. 90, 53 Geo.

3, c. 65, and 11 Geo. 4,. and 1 Will. 4, to. militia men; 4 Geo.

4, c. 64, and 4 Geo. 4, c. 69, to ..prisons ; 6 Geo. 4, c. 80,
and 30 Geo. 3, c. 49, to workhouses ; 43 Geo. 3, c. 56, to
ships carrying fifty. persons.) The surgeon, in the last case,
may be a meeaber of the London, Dublin, or Edinburgh
colleges, and must be. provided with a niedicine chest, fie
must keep a journal, containing a true and correct account
of every thing relative to the food, health, disease, and
mortality of the ship's crew, in a form prescribed by the act
under a penalty of, 1002. The bedding of each .passenger
must be aired daily upon deck, if the weather permit, and
the vessel must be fumigated with vinegar at le^st twice a
week, under a, penalty of vQl. for each neglect.

The following statutes and patents relate to the medical
profession in England, according to Mr. Willcock :—

Statutes-r-Physician*. 9 Hen. 5, 22 Hen. 6, 19 Hen. 7,
3, 5, 14, 15 and 32 Hen. 8, 1 Mar., 3 Jac. 1, 10 Geo. 1,
6 & 10 Geo. 4.

Surgeons. 3, 5, 32, 33, 34, 35 Hen. 8, 18 Geo. 3,
6 Geo. 4.

Apothecaries. 32 Hen. 8, 1 Mar. 6, 7 Will., 10 Geo. 1,
55 Geo. 3, 6 Geo. 4.

General Statutes. 5 Hen. 4, 33 Hen. 8, 1 Ed. 6, 1 Mar.
5 Eliz. 2 Jac. 1, 8, 9 Anne, 9, 16 Geo. 2, 42, 43 Geo. 3,
6, 9 Geo. 4.

S26 Original Communications.

Patents.— Physicians. 32 Hen. G, 7 Eli*., 15 Jac. 1,
15 Cap. 2.

Surgeons. 3, 4 Hen. 5, 25 Hen. 6, 1 Edw. 4, 15, 19
Hen. 7, 2, 3 Hen. 8, 2 Jac. 1, 5 Car. 1, 40 Geo. 3, 3
Geo. 4.

Apothecaries. 19 Edw. 3; 20, 27, 30, 34, 35 Hen. 6.
13 Jac. 1.

I shall now add the statutes and charters relative to the
profession in Scotland and Ireland.

Scotland. The universities and college of physicians of
Scotland are incorporations, and as far as my research ena-
bles me to state, are not confirmed by acts of parliament, with
the exception of the Royal College of Surgeons in Edin-
burgh. The college of surgeons was incorporated in 1505,
and afterwards confirmed by numerous statutes. This body
is empowered to grant a licence to practise surgery ana
pharmacy in Scotland only. The University of Edinburgh,
in conferring the degree in medicine, authorizes its owner
to practise ubique gentium, but it is evident, from the expo-
sition of Mr. Willcock, that such graduates cannot practise
legally in England ; and, as there are positive statutes, con-
ferring rights and privileges on the Dublin College of Phy-
sicians, it is clear that the degree in question can have no
force in Ireland. This was exemplified by a decision of the
Court of Kind's Bench in Dublin, in 1818. An action was
brought by the Apothecaries' Company, of Dublin, pur-
suant to their act, 31 Geo. 3, against Mr. Butler, who had
been duly qualified in London, agreeably to the 55 Geo. 3.
But it was decided by the court, that he had no right to
practise in Ireland, until he had a licence from the Apothe-
caries' Company of Dublin. It is also obvious that a licen-
tiate of the Dublin company could not practise in England,
nor in Scotland. It is doubtful, however, whether the Dub-
lin College of Physicians are vested with sufficient power
to prevent graduates of the Scotch or other universities from
practising in Ireland ; but they refuse to meet such graduates
in consultation, until they have become licentiates of the
college, and this by-law almost amounts to a prohibition.
The nest account I have found of the laws relative to the
physicians in Ireland, is in Mr. Scully's Penal Laws, which
is as follows : —

Ireland. — " A society of physicians in Dublin, was incor-
porated in 1691, by royal charter, under the name of "The
King's and Queen's College of Physicians." This charter
purported to arm the society with powers of an extraordinary
ana extensive nature, which (if confirmed by act of Par-

Dr. Ryan on Laws reletting to the Medical Profession. 327

liament) would invest in them a monopoly of the practice
of physic, as well as of medical honours. One of its pro-
visions directed, " that no physician, or other persons,
should be permitted to practise physic in the city of Dub-
lin or its liberties, without the licence of this society."
The charter, however, has not acquired any legal validity
in this particular ; for, its confirmation has never been ob-
tained from the Legislature, although frequently solicited.

" The Legislature has, however, recognized the existence
of this society, without adopting its charter.

" Thus, in 1761, an act was passed, authorizing* the
King's and Queen's College of Physicians in Ireland, to
enlarge their number by admitting four learned and worthy
doctors of physic into the fellowship of their body— -to
appoint inspectors of apothecaries' shops—to frame a phar-
macopoeia or code of drugs, &c.

" In 1767; it was enacted, that no person should be ap-
pointed physician to any county infirmary, unless examined
and certified by this college of physicians.

" In 1785 and 1791, this college was empowered to elect
the members of a school of physic, to be established in
Dublin, to consist of three professors, (and, upon a certain
contingency, of four professors) called professors upon the
foundation of Sir Patrick Dunn, and to appoint clinical
lectures, to be given in Dublin.

" This college has also been incidentally noticed by the
legislature upon other occasions of lesser importance, but
without any addition to its powers."

The 5, 6, 7, 8, 13, 14, 15, and 16 Geo. 3, authorize the
erection and establishment of the different county hospitals ;
and by the 26 Geo. 3, no person can be appointed surgeon
to any of the said hospitals," unless certified by the Royal
College of Surgeons in Dublin ! By 45 Geo. 3, grand
jurors are empowered to present for specified sums, for the
support of such hospitals or infirmaries, and also for dis-
pensaries, and this statute is further amended by 54 and
58 Geo. 3, which comprize fever hospitals, and order a sur-
geon, and not a physician, to be the medical attendant of
these institutions. 11 Geo, 4, and 1 Will. 4. The salaries of
medical attendants on prisons, and expense of medicines,
are regulated by the 7 Geo. 4. c. 74. The dispensary act,
45 Geo. 3. c. 91, is as follows : —

" And whereas the distance of many parts of each county
from the infirmary therein established, does not allow to
the poor of those parts the advantages of immediate medi-
cal aid and advice which such infirmary was proposed to

888 Original Communications.

afford ; be it therefore enacted, that in all cases where the
said corporation shall certify to the grand jury of the county
wherein snob corporation it established, that they have ac-
tually received, from private subscription or donation, any
sum or sums of money since the preceding1 assizes, for the
pmrptee of establishing in any town or place therein a dis-
pensary for furnishing medicine and giving medical aid and
relief to the poor> it shall be lawful for such grand jury to
present to be raised on- the oounty at large, and paid to the
said corporation, a Bum equal in amount to the sum or sums
so received by such corporation, . to be applied .by the go-
vernors, and governesses thereof, or suoh committee of them,
no* fewer in number than five, as they shall appoint for the
purpose at any general quarterly meeting, together with the
monies so received by private subscription or donation, in

{providing medicines and medical or suraioal aid and advice
or the poor of such town or plane and its neighbourhood,
ia such manner as they or the said committee shall in their
discretion deem most advisable ; and. that all monies, so
raisfcd for suoh local dispensaries, as well as all monies so
received from private subscription or donation for their use,
shall be aecouuted for upon oath at each summer, assises
before the grand jury and the court

te And be it further enacted, that every person who shall
subscribe and pay towards the establishment ormainfenanfle
of any such local dispensary, or towards the county hos-
pital or infirmary, any sum not Leas than one guinea, shell
be a member of the body corporate of the infirmary or
hospital of such county for one year, from the (late of the

Eayment thereof to the said body corporate, so far as re*
ites to the management and direction of such local (Jispen-
saries; any thing in the said' act to (he contrary not with4
standing. This act is amended by .58 £tao. 3.

The grand juries reauire the medical, attendants of dis-
pensaries to have attended lectures on midwifery.

Surgeons.— The Rojral College of Surgeons was kftsor*
poratsd by 24 <2eo. 3, in the year 1784, and this charter
raving espined, it vas-nenewied by the 10 Geo. 4, during the
last year. The members of this college refuse to meet
those of the London <and Edinburgh Colleges in consulta-
tion, and look upon them as. an inferior order of surgeons,
and exclude them from all situations of value, though, ac-
cording to the authority of Mr. Willcock, a member of the
London College has an undoubted, right to practise, and
of course enjoy his rights and privileges in every part of his
Majesty's dominions.

Dr. Ryan on Lmtos relating to the Medical Profession. 329

Apothecaries. — By the 31 Geo. 3, the company of apo-
thecaries are empowered to prevent all persons who act as
apothecaries without their licence, the action to be brought
in the Courts 6f Record in Dublin, and the penalty of £z0.
The statute requires an apprenticeship of seven years to
qualify for examination for the licence. The act atso re-
quires, that every apothecary shall keep a record of the
names' of all persons to whom he sells arsenic ; and not to
supply it but to respectable persons. •

*r Medical practitioners are allowed remuneration for at-
tending coroner* 8 inquests, but the sum shall not exceed
five pounds, no matter how far they have to travel.—
10Ged.4.

The legislature of this empire has entrusted vast power
to the legitimate members of the medical profession, in
deeming their evidence conclusive, in an immense number
of civil aiid criminal proceedings ; and confided to them the
protection or destruction of the best privileges of our glo-
rious constitution— 4he life,- liberty, honour, and property
of every tfarik in society. Every man of sense in the pro-
fession ought to reflect seriously on the great responsibility
he owes (he public, the dignity of the faculty and his own
reputation, when he is called upon, as every man may be,
to discharge the duty of medical jurist. In order to re-
mind him of this most important duty, I shall insert a list
of cases in which medical evidence is required, and shall
follow the arrangement of Sir W Blackstone, in his Com-
mentaries upon the Laws of England. Cases in which m«-
dicat evidence is required. In the first place, such evidence
maybe called for by all courts of judicature, in respect to
the absence of witnesses or jurors, who plead indisposition
as an excuse ; and no medical man can, consistently with his
duty to the laws of the realm and to the dignity or his pro-
fession, certify otherwise than truly. In a word, the prac-
titioner should feel himself bound, by every principle^ of
honour, not to impede the administration of public justice,
nor to grant a certificate for exemption from attendance
unless on proper grounds. This principle should guide us
in all cases, and especially in applications for absence from
military or naval duty. The medical jurist is morally and
legally bound, on all occasions/ to speak " the truth, the
whole truth, and nothing but the truth."

But in criminal process they are often referred to,. as ih
certain cases of reprieve. The. niost common example of re-
prieve! which is referred sometimes to medical men, is
*here a woman is capitally convicted, and pleads pregnancy

voi. v. mo. 28. t T

330 Original Communications.

in stay of execution. Upon this point the law is very
defective, for it supposes the foetus inanimate unless it has

S[uickened, though the infant is alive the moment of its
orjnation. The law is as follows : — *

" In this case, the judge directs a jury of matrons to
inquire into the fact) and, if they bring in thejr verdict,
quick with child, (for unless the child be. alive in the womb,
it is not sufficient) the execution is stayed, either till she is
delivered or proves, by the course of nature, not to have
been with child at all. But if she proves with child a
second time, she cannot have the benefit of this reprieve ;
for she may be executed before the child quickens, and the
law will not be evaded by ner incontinence •

" Another cause of reprieve is, if the offender become
insane between the judgment and execution ; for, though a
man be sane when he commits a crime, yet, if he become
insane after, he *hall be indicted ; if after indictment, he
shall not be convicted ; if after conviction, he shall not
receive judgment ; if after judgment, he shall not be or-
dered for execution."

Medical evidence is required when a prisoner affects in-
sanity, or when an impannelted juror pleads illness.

Liability as Witnesses. — The next subject that claims
attention is medical evidence. There is no part of the duty
of medical men of such serious consequence to the public
and to their own reputation, nor one which is generally
more unpleasant to their own feelings. lake all other wit-
nesses, " they must appear when supoenaed, or forfeit one
hundred pounds to the king, and ten pounds to the party
aggrieved, with damages equivalent to the loss sustained by
their want of evidence, but no witness is bound to attend,
except his expenses are firfet tendered to him, unless he
reside within the bills of mortality, and is summoned to
give evidence within the sape.

By 7 Geo. 4. c. 40, " all persons appearing upon recog-
nizance or subpoena to give evidence in prosecutions for
felony, either before the examining magistrate, the grand
jury, or on the trial, are entitled to their expenses and a
compensation for loss of time, and this although no bill
of indictment be preferred. The same provision extends to
cases of misdemeanor, with the exception, that no allow-
ance is made for attending the examining magistrate."

It is right to state that medical men must divulge profes-
sional secrets when giving evidence in courts of law. Phil,
on Evid. v. i. p. 135. Elem. of Med. Jurisprudence, by

Dr. Ryan on Lgws relating to the Medical Profession. 331

Paife and Fonblanque. Yet -this seems contradicted in a
receg$ work, but the witness will be directed by the court.

The next division rebates to persons and classes in every
nmk of society, as clergy ana laity, civil and military,
masters enf servants, and a variety of minor divisions.—
With respect to the clergy, there is one point worthy of the
attention #f medical men, namely, that the Archbishop of;
Canterbury " exercises the right of conferring all the de-
grees nbjch are taken in the universities." It need scarcely
be stale!, thai the Primate of all England has very recently
conferred the degree of medical doctor. The class in. so-
ciety jf composed of the nobles and commons, and here the
rule of precedence only need be alluded to. In the table
of precedence., we find the order as follows: — Next to
knigpts' younger sons, stand colonels, next doctors, then
esqpires, and next gentlemen. " The title of esquire is
nop commonly conferred on literary characters, the higher
olesses of • merchant!, bankers, attorneys, solicitors, and
feedical men."

Divorce*— -The Jaw of this country is as follows : — " A
total divorce is given* whenever it is proved that corporeal
imbecility existed before marriage. In this case the con-
nexion is declared to have been null and void ab initio.
Imbecility may, however, arise after marriage, but it will
not vacate it, because there was no fraud in the original
contract, and one of the ends of marriage, the procreation
of children, may have been answered." Blackstone's Com-
mentaries, by Christian, v* )• p. 140. An excellent account
of the causes of impotence and sterility is given in Dr.
Beck's Medical Jurisprudence, and by M. Boiisquet, in a
work entitled De 1' Amour Conjugal ; the latter includes the
moral as well as the physisal causes. Dr. Blundell related
a case in his lectures, which proved impregnation may take
place, though the urethra open twougn the corpus spon-

S'osum. " The infant was the exact similitude or the
then" I have known a case in which two inches of penis
sloughed, the patient recovered and had a child. The penis
may slough to the pubes, and op recovery the sufferer may
procreate.* These cases are exceptions to the received
opinions. The subject of doubtful sex or hermaphroditism,
is fully considered by the writers already referred to. Black-
stone asserts that monsters can inherit, and shall be con-
sidered male or female, according to that kind of sex

• See otor lait volume, p. 8%), Mr. Hard's case.

332 Original Communications.

which doth prevail, (B. 2. p, 2470 and it ought to be bap-
tised. " Coke Littleton, 8. a. The same rule guides in
cases of tenant by. the curtesy." The ancients have war-
ranted cases of procreation between hermaphrodites, which
are entirely unworthy of credit, for every anatomist knows
the difference between the male and female pelvis, a dif-
ference that renders the process of parturition through that
of the male physically impossible.

Parent and Child. — The law defines ,c a legitimate cbHd,
is one born in lawful wedlock, or within a competent time
after a lawful marriage/' Though pregnancy ' is commonly
terminated at the ninth calendar month, it may be pro-
tracted to a longer period, to the tenth, eleventh, eleventh
month and a half, and no limit is placed "by the law oq tlie
subject.*

Mights of Authors. — "' lu the case of Abernethy r. Hut-
chinson, an injunction was applied for to restrain the publica-
tion of the surgical lectures of the plaintiff ; the application
was, refused, on the ground that the lecturer had no written
copy of his lectures, prior to their delivery. The principle
laid down was, that, though any one may have a property
in an oral discourse, or even his own thoughts, yet, to esta-
blish a right to such property, there must be a visible and
tangible record, by writing, of its existence, otherwise it
cannot be identified, and the owner's claim established/9

Libeb— A fair criticism on the works of a professional
artist, in the course of his professional employment, is not
actionable, however mistaken it may be ; if it is unfair and
intemperate, and written for the purpose of injuring the
party criticised, it is actionable. Soane v. Knight, Moo. &
Mali. 74. M.S. 1827.

-Cotton Mills. — The 6 Geo* 4. c. 63, comprises important

Erovisions for the preservation of health, and regulating the
ours of work of children who are placed in such fac-
tories

Insurance of Lives. — A medical man can insure his life
for the amount of property he derives from his profession.
It is right to mention what the law considers good health.

" Where there is an express warranty that the person is
in good health, it is sufficient that he is free from any exist-
ing ailment ; for it can never mean that he is free from the

• Ryan's Manual of Midwifery, &c. Ifl29, ark Pjirajion .of Pregnancy. See
further observations by the same auihor, Lond. Med. Gaz. Dec. 19, 18207
p. 371.

Dr. Ryan on Laws relating to the Medisal Profession. 383

seeds of disease. Even if t{le insured labour under a par*
ticular infirmity, if it can be proved, by medical men, that
it did not at all, in their judgment, contribute to i his death,
the warranty of health * has been fully complied frith, and
the underwriter is liable.

" With respect to the risk which the underwriter is te run,
it is usually inserted in the policy, and includes all suicide ;;
or death by the hand of justice. When the risk is oaas
began, there can be no apportionment or ratarn of pre-
mium, though the underwriter is discharged."

Offences against the public peace —If a medical man,
attend professionally at a duel, he is liable to be. indicted
for murder, should the opposite party lose his life. Heape
medical men remain some distance from the scene of action*.
but sufficiently adjacent to afford atyd if necessary*

Ofence* against the public health.-^rAvf trade or husk
oess injurious to the public health, whether fay the of action
of an establishment, which might contaminate the air by.
noxious inhalations, is a misdemeanor at oommoa law.

Exposing a child abroad, when labouring under sinall pos*
either inoculated or natural, i$ an indictable offence.

The 43 Geo. 3. c. 66, Lord Ellenberough's act. alrefuty
referred to, in speaking of abortion, included cases of shoot"
ing, pr attempting to snoot, stabbing, or cutting with. sham
instrument, as felonies ; but this act js extended by 9 Geo, 4.
c 31, I^ord Lansdowne's act, which comprises any attempt
tODoison, drown, strangle, stab, cut, or wound, even with
a blunt instrument, as capital offences ; and the conceals
ment of the birth of a child, whether by a married or single
womani is made a misdemeanor.

Self destruction. — The usual practice of juries, in cases
of self-murder, is to bring a verdict of insanity j judging,
probably, that the act of self-destruction is such a strange
auomalv in human conduct, such a wide aberration from the
principle of self-preservation, which universally aotuaten
sentient beings, as to form of itself unequivocal testimony
of deranged or maddened intellect.

The medical practitioner ought to be intimately acquainted
with general and morbid anatomy, or the elements which
compose the different tissues of every organ in the human
body, otherwise it is impossible for him to appreciate the
changes produced by" disease. We have now works of
reference on this point, those of Dr. Craigie, Mr. Grainier,
Mr. Storer, Martinet, &c. &c. It is unnecessary to adouc?
arguments to prove that the life, liberty, and reputation of

334 Origmml Communication*.

those accused of homicide, chiefly depend upon medical evi-
dence*

Rape. — Rape is the offence of having* carnal knowledge
of a woman by force, against her will, which, by the 18
Eliz. c. 7 3 is felony, without benefit of clergy.

The carnally knowing and abusing any woman-child,
under the age of ten years, in which case the consent or
non-consent is immaterial, as by reason of her tender age
die is incapable of judgment or discretion, is felony. Car-
nal knowledge of a child, between ten and twelve years
old, with or without consent, is a misdemeanor.

A boy, under fourteen years of a^e, is deemed in law in-
capable of committing a rape, and, it seems, is not punish-
In an indictment for rape, the party ravished is an admis-
sible witness hut the value of her testimony ratut hm left
to the jury. For instance, if the witness.be of good fame,
if she presently discovered the offence, and made search
of the offender ; if the party accused fled for it ; these are
concurring circumstances, which give greater probability to
the injury, after she Had opportunity to complain of its
perpetration; if the place where the fact is alleged to have
been committed is where it was possible she might have
been heard, and made no outcry : these. carry a strong, but
not conclusive, presumption that her testimony is false or
feigned.

Moreover, an assault to ravish, however shameless and
outrageous it may be, unless it amount to some degree of
consummation of the deed, is not a rape.

It is the essential character of this crime, that it must
be against the will of the female on whom it is committed.
And if a woman be beguiled into her consent, by any artful
means, it will not be a rape ; and therefore, having carnal
knowledge of a married woman, under circumstances which
induced her to suppose it was her husband, was held, by a
majority of the judges, not to be a rape. RuSs. Ry. C. C.
48/. However, the crime is not mitigated by showing that
the woman yielded, at length, to violence, if her consent
were obtained by duress, or threats of murder; nor will
any subsequent acquiescence on her part do away with the
guilt of the ravisher- It is a rape to force a prostitute
against her will ; so it is for a man to have forcible know-
ledge of his own concubine, because the law presumes the
possibility of a return to virtue. A man, however, cannot
fee himself guilty of a rape upon his own wife, for the ma-
trimonial consent cannot oe retracted. 1 Hale, 629 ; but he

Dr. Ryan on Laws relating to the Medical Profession. 335
aw be criminal in aiding and abetting another in such a

<Mfen.
Xfli

who are present, of both sexes, aiding in the perpe-
tration of rape, are principals in the second degree.

Unnatural Offence. — Buggery, from the Italian bugge-
rare, is a eluroal copulation against nature ; as a man or
woman with a beast, or a man with a man, or a man unna-
turally with a woman. It was anciently punished with burn-
ing, some say burning alive ; but it is pow a capital felony,
andpunished, as other capital felonies, with hanging.

The law requires die same evidence of penetration and
completion in this case as in the preceding crime ; both
parties are equally guilty, as well as all present and assist-
ing therein. If committed on a boy under fourteen, it is
felony in the agent only. 1 Hale, 47*

Blackstone properly observes on this truly unnatural
offence, that it is a " crime which ought to be strictly and
impartially proved, and then as strictly and impartially
punished, out it is an offence of so dark a nature, so
easily charged, and the negative so difficult to be proved,
that the accusation should be clearly made out; for, if
false, it. deserves a punishment inferior only to the crime
itself." This law is modified by the 9 Geo. 4. c. 31, already
cited.

Anatomy. — The exhumation of dead bodies, even for the
purpose of anatomical science, is a misdemeanor, it being
contrary to common decency, and repugnant to the general
feelings of mankind. 2 Leach, 560.

Curtesy, by the law of England, is where the wife had an
estate in fee, and has issue born alive, but the mother dies,
and the husband holds thb lands during life. I have else-
where cited cases of this kind, in which medical evidence
alone decided the question. — Manual of Midwifery.

BIBLIOGRAPJIY.

PHYSIOLOGY.

1. Singular Phenomenon produced by Opt**.— M. Cavalier states
flat he* had used an enema, consisting of two ounces of mucilage
■ad a gnrin and a half of opium. He was seized with nausea, but
no vomiting;' and having removed the cover of the night-lamp, the
tppetrance of the light produced vomiting, and this increased
whenever he submitted to the action of light. He endeavours to
explain this curious phenomenon, but leaves it as obscure as he
tand it — Rev. Med. Pran. and Stronger*. x

.386 . Bibliography.

BUEG1BY.

2. M. thtpuytren On wounds produced by fire-arms, especially thw
received in the late vevolutionary struypk. — His introductory remarks
related to the state of the hospital recently', at the period in question.
The first combats took place in the Palais-Royal and in the streets
Bt, Honofe* and rtichelleu on' the evening* of the 27tii, when six or
feeven gufl-shot cttsetf were carried into the HoteMHeu r but it was
on the day of the 48th; and rffornhig of t&e 29fll tfiat tffe greatest
ttttmbeV w&r received* The height at which the thermometer stood
daring the two latter days was rdntarkabte ;' and it may not benm-
worthy of flotioe, that it was in summer, and at a like elevation of tern-
gjWatwa, that the great insurrections of the Rerohrtbir otteurred.—
Jfrhe fad kkft to the physiologists lor explanation j it will be more
fcriportabt for us to consider the effects of Jthis state of the atmosphere
. on the wounded patients. The vulgar opinion is* that hot weather
is unfavourable for the treatment of wounds — the contrary is' the
truth; hot weather, in fact, is never the exciting cause of hospital
sore or gangrene. M. Laxrey has long since made this remark ;
. he observed that in Egypt the cure of wounds went on far more
easfly and rapidly at a very exfatordinaiy' elevation of tetnperaCare
than in cold countries— in Russia, for example. Several, bowerer ,
of theiatal dases which have occurred in' the Hotel Diett may be in-
directly attributed to the temperature ; for* many of th6 patients,
oppressed with the heat, threw off their garments and beXi-olotbes,
.while exposed to currents of air injudiciously established to the
wards, and thus were attacked with severe abdominal inflammations.
Oases of arachnitis, pleurisy, pneumonia/ and liver complaint, be-
came freojimrt~Hna4y of them fatal j while the. smell of the wounds
and the crowded wards had apparently no il} effect. It ougjbt to be
made an invariable rule in hospitals never to open opposite Casements
at one and the same time ; but first those of one siaej and then the
other lalternately. ,

The Hotel Dieu was most centrally .situated with, regard to the
principal scenes of action, and hence received by mr the greatest
number of the wounded— about 4007; those chiefly who were injured
in the combats of theCh^e,the€hatelet, and the Louvre. The hos-
pitals 8t. Antoine and St. Louis were also pretty well supplied. It
must be observed, that the combatants in these struggles were very
differently circumstanced ;> on- one aide there* was a numerous army
(not less than 9 or 10,000 men), well provided with arms, well dis-
ciplined, and expert ; on the TJther, throngs of people in a state of
excitement, full of ardour, vnd -coinage, but without order or com-
tinted, then' only arms pintols, old muskets* fowling-'pieoes, broad-
swords, and some cannon (when they eosdd be procured), but cannon
without proper tanmurntura/ they being obliged to Charge their pieces
of ordnance with paving stones, wedges of wood, lump*, of /Iced,
ttlfcaroVbaUa, ta it will henoe be easily accounted Cor why the
wounds inm'cted by the military were. so nsjuch more serious tban
those made by theckuena. > Atuch leas ravage, hawevex, has been

SUrgery* 33fr

produced %y cannon-balls than might have been expected, in conse-
quence, no doubt, of the irregularity of the streets and the numerous
indentations and places of shelter ; for more mischief was done by
case-shot, which was very abundantly made use of. Nor has any.
instance been observed in the Hotel Dicu of the total removal of a
hmb by artillery ; portions have been carried off by pieces of balls, &c.
one woman has had a great part of the deltoid taken away by a piece
of ballet — the head of the humerus is exposed, but she is going on
well. A young man, in the ward Sainte Marthe, has received ft
severe wound in the chest ; the ball entered at the anterior superior
region, and has been extracted from the back ; he also is pretty well.
It was asserted that the soldiers used chewed balls, and the people
hammered ones, in order to render the wounds the more grievous.
This was not true. To chew a ball is by no means so simple a busi-
ness, and all that the best teeth can do upon it is to make a number
of holes on the surface without prominences — not certainly tending
to render the projectile more murderous ; and as to the compressing
of the bullets, if a hammer was at all employed for the purpose, it
was simply to beat them out, so as to make them fit the fusils whose
calibre would not otherwise admit them. It was asserted, too, that
some of the arms were poisoned ; but this was also a complete^felse*
hood. — Journ. Hebdomadaire..

MIDWIFERY.

3. Extra-uterine Pregnancy. — Dr. Wilmans relates a case of
extra-uterine pregnancy in Hufeland's Jurn. der Parkt. Heildkund
Marcht, 1829, in which the festal bones escaped by the rectum
and bladder. During th'j period in which the bones were passing,
the woman had had four natural labours.

Mr. S. Cooper has requested our advice in a case somewhat similar.
The woman has* had a living child during the passage of the bones
per vaginam, a femur, a rib, and one parietal bone of a foetus of
four months have only passed as yet.— Ed.

MATERIA MEDICA.

4. Mode of Solidifying Turpentine, Oil of Turpentine, and
Bottom Oopaiva. — M. Faure, apothecary at Bordeaux, proposes the
followingt mode for effecting the object at the head of this article.
He triturates 14 drachms of pure clear turpentine, and S6 drachms of
calcined magnesia in a marble mortar, until they are accurately
mixed*, and he next places the compound in a close vessel. In twelve
hours it will be of the proper consistence for pills. He employs
nearly rhe same process for the solidification of the essential oil.
He mixes 6 drachms of pure turpentine, 2 of oil* and 36 of calcined
magnenJB. He places' the compound in a close vessel, and agitates
it from time to time. In six or eight days it will be of the pillular
consistence. The balsam is also hardened by magnesia. — Jour, de
Med. Pratique de Bounteous.

5w Efficacy of Belladonna in Perfuse*. — tA* Mequel has ad*
ministered belladonna in the commencement of hooping cough, in

Vol. v. no 28. uu

338 Bibliography.

progressive doses, until signs of narcotism have appeared, sucliaj
agitation and redness $f the face, when the dose is to be dimi-
nished, or the medicine entirely discontinued ; the remedy loses its
effects, if kept for a year, when two-thirds of the grain of the root
will have little effect on a child two years old. The dose of the
fresh root is one-eighth of a grain three times a day. — Arckfitr
Mediz. Er.fah rung, 1829.

6. Cure of Fascial Neuralgia by Belladonna. — M. Claret asserts,
that he has cured six cases of fascial neuralgia by friction, over the
painful part with ten grains of belladonna, reduced to the con-
sistence of honey by admixture with water. — Rev. Med. Fran, et
Etrangere.

7. Efficacy of Secale Comutum in Hemorrhages. — Dr. Spazani
has related cases of menorrhagia, epistaxis, uterine congestion,
haemoptysis and hematuria, which he cured with secale comutum.
He thinks the medicine contra-stimulant, and that it possesses a
peculiar action on the minute vascular ramifications. — Annali linker,
di Medicines, Marzo.

8. Use of the Fumes of Belladonna in Phthisis. — Dr. Palozzi has
derived great benefit in liis own and other cases from smoking the
leaves of belladonna for a quarter of an hour, morning and evening.
— II Raccogtfatore, No. 1.

9. Use of Nitro-muriatic Pediluvia in Diseases of the Liver.—
Dr. Tannini has spoken in high terms of the value of the nitro-
muriatic bath in chronic affections of the liver. — Osservatore Medico
di Napoli, April e.

10. Menstruation continued to the 94th year. — A case is recorded
in the Ann. Univ. di Med. of a female, aged 94, whose relatives
were remarkable for their longevity, and who continued to men-
struate from the 53rd to the 94th year, and at present she is in
perfect health.

CHEMISTRY.

1 1 . New mode of preparing the carbonate of iron.— -Take of sulphate
of iron and sub-carbonate of soda, each 8 ounces. Pound each salt, and
dissolve them separately in warm water, It necessary/ filter. Being
filtered and cool, mix the solutions in a deep vessel* capable of holding
one or two gallons of water, which fill up cold. Stir, let subside,
and then decant the clear liquid from the precipitate. Fill up again
with water, and likewise again decant ; and repeat this operation two
or three times, so as to separate the soluble salts. Next put the pre-
cipitate on a filter of cotton or linen cloth, supported by a square
frame. When the water has ceased to pass, gather into one hand
the edges of the filter, so as to make it a sort of bag, and with the
other twist it round from the holding hand downwards, so as to
squeeze out the remaining water. The precipitate will now have the
appearance of clay, too soft for moulding. With soft sugar and aro-
matic powder,* in suitable proportions, make it into an electuary.

Chemistry. MP

Tbus we obtain a carbonate of iron, uniform in its properties, hardly
deteriorated by the process it undergoes, and little liable to change
by keeping*

The precipitated carbonate of iron, while yet moist, is soluble in
carbouk acid. Hence a teaspoonnil of the above electuary is soon
dissolved iu a glass of ginger beer, except the aromatic powder it
contains. It may be asked, therefore, whether an eligible medicine
might not be obtained as follows : — " Having filled a dozen of bot-
des with ginger beer, divide among them the precipitate from an
ounce of sulphate of iron, and an ounce of sub-carbonate of soda ;
then cork and set them, aside, as usual, till they be ready. I pre-
sume that the production of carbonic acid, by the fermenting process,
would go on as u$ual, and that when drawn in due time, we would
fiad the carbonate of iron entirely dissolved in the ginger beer. —
Glasgow Med. J own.

BOTANY.

12. An Introduction to Systematical and Physiological Botany;
illustrated with explanatory engravings. By Thomas Castles, F. L. &
Mtmber of the Royal College of Surgeons, $c. London, 1830. 12°. pp.
2£5. E. Cox. — The design of the present work is to place before the
student a comprehensive outline of the Science of Botany in as plain
a manner as possible. The author who is favourably known to the
profession by bis numerous publications, evinces his usual zeal and
industry in the work before us. He has arranged a very useful in-
troduction to the study of .Botany, divested as free from technicalities
as the subject allows. His work is therefore calculated for the gene-
ral reader. Its contents are as follow ; — history of botany, elements
of botany, language of botany, Linnscan artificial system, Linnsean
natural system, Jussieu's natural system, anatomy and physiology of
plants, and harmonies of vegetation. As an elementary work, this
production may be perused with advantage. It is a popular work
not calculated for medical students, but they will find the author's
introduction to medical botany worthy of attention.

MEDICAL POLICE APOTHECARIES' COMPANY*

13. Regulations to be observed by Students, whose attendance on
Lectures shall commence on or after the 1st of Jan. 1831.* — Every
candidate for a certificate to practise as an apothecary, will be required
to produce testimonials of having served an apprenticeship f of not
less than five years to an apothecary.

* Students who are at present pursuing their medical studies, and those who may
hepin to attend lectures at the commencement of the next medical session (viz.
October), will be received as candidates for examination by complying witfi the
regulations heretofore published.

t The apprenticeship must have been served wtyh a person legally qualified to
practise as an apothecary, either by having been in practice prior to or on the 1st
of August, 1815, or by having received a certificate of his qualification from the
Court of Esanrine-s.

340 Bibliography.

Of having attained the full age* of twenty-one yean:
. 0£ good moral conduct t : and,

Of having devoted at least two y'habs to an attendance on lectores
•and bc^pita! practice.

The candidate must have attended the following courses of
lectures J: —

Chemistry — Two courses, each coarse consisting of not less than
forty "five lectures.

Materia Medica and Therapeutics— Two courses, each course
consisting of not less than forty-five lectures.

Anatomy aud Physiology — Two courses. Anatomical Demonstra-
. Uons—Two courses ; of the same extent as required by the Royal
College of -Surgeons, of London.

Principles and Practice of Medicine — Two courses, each course
consisting of not less than forty-five lectures, to be attended sub-
sequently to the termination of the first course of lectures on Che-
mistry, Materia Medica, arid Anatomy and Physiology.
Botany — One course.

Midwifery; and the Diseases of Women and Children— Two
courses. To be attended during the second year.

Forensic Medicine — One course. To be attended during the
second year.

Students are moreover recommended diligently to avail them-
selves of instruction in Morbid Anatomy.

The candidate must also have attended for twelve months, at least,
she physician's practice at an hospital, containing not less than sixty
beds, and where a course of clinical lectures is given ; or for fifteen
months at an hospital wherein clinical lectures are not given; or for
fifteen months at a dispensary $ connected with some medical school
recognized by the court. The whole of such attendance to be sub-
sequent to the first year of attendance on lectures.
- The testimonials of attendance on lectures, and hospital practice,
must.be given on a printed form, with which students may be sup-
plied, on application, at the under-mentioned places.
In London, at the beadle's office, at this Hall.
In Edinburgh, at Messrs. Mac Lachlan and Stewart's, book-
' sellers.

In Dublin, at Messrs. Hodges and Smith's, booksellers.

* As evidence of age, a copy of the baptismal register will be required in even-
case where it can possibly be procured.

f A testimonial of moral character from the gentleman to who.m the candidate
has been an apprentice, will always be more satisfactory than from any other
person.

X The lectures required in each course respectively, must be given on separate
days.

§ Certificates of attendance on the physician's practice at dispensaries will con-
tinue to be received until the 1st of Jan. 1833, from all such as have heretofore
been admitted, but after that time the present regulation will be strictly adhered to.

Medical Police* 341

In the provincial towns, where there are medical schools, at the
hospital, or from the teacher who keeps the register of the school.

Students are enjoined to observe 'that no other form of testimonial
will be received ; and that no attendance on lectures will qualify a
candidate for examination,- unless the teacher is recognized by the
court.

The teachers in Dublin. Edinburgh^ Glasgow, and Aberdeen, re-
cognized by the constituted medical authorities in those places respec-
tively, are recognized by the court.

REGISTRATION.

A book* is kept at the Hall, of the Society for the registration,, at
stated times, of the names of students, and the lectures, hospitals,
or dispensaries they attend.

All students, in London, are required to appear personally, and to
register the -several classes for which they have taken tickets ; and
those only will be considered to have complied with the regulations
of the court whose names and classes in the register correspond with
the testimonials of the teachers.

The book will be open for the registration during the first twenty-
one days of the months of February, June, and October, from nine
o'clock until two.

The court also require students at the provincial medical schools
to register their names in their own hand-writing, and the classes
they attend, with one of the teachers f hi each respective school,
within fourteen days from the commencement of each course of lec-
tures, and those students only will be deemed to have complied with
die regulations whose names are so registered.

Each student, at his first registration, will receive the printed form
on which he is to obtain the certificates of his teachers.

The examination of the candidate will be as follows.: —

1. In translating parts of Celsus de Medicina, or Gregory Con-
spectus Medecinae Theoretical, Pharmacopoeia Londinensis,
and Physicians* Prescriptions.

2. In Chemistry.

3. In Materia Medica and Therapeutics.

4. In Botany.

5. fn Anatomy and Physiology.

6. In the Practice of Medicine.

NOTICE.

Every person offering himself for examination must give notice in
writing to the clerk of the society on or before the Monday previ-
ously to the day of examination, and must also at the same time de*

• The book will be opened for the registration of those students whom these regu-
lations affect, on the 1st. of Feb. 1831.

f The students will be informed at each school, respectively, of the name of the
teacher to whose care the register will be confided.

342 Bibliography.

posit alt the required testimonials at the office of the beadle, where
attendance is given every day, except Sunday, from nine untfl two
o'clock.

Candidates will be admitted to examination in the order in which
their names stand on the notice paper ; and those neglecting to at-
tend agreeably to their notice, will, upon a subsequent application,
be placed at the bottom of the list. "

By the 22d section of the Act of Parliament no rejected candidate
can be re-admitted to be examined until the expiration of six months
from his former examination.

The court meet in the Hall every Thursday, where candidates are
required to attend at half-past four o'clock.

(By order of the court) - John Watsox, Secretary.

Apothecaries' Hall. Sept. 9, 1830.

The Act directs the following sums to be paid for certificates.

For London, and .within ten miles thereof, ten guineas.

For all other parts of England and Wales, six guineas.

Persons having paid the latter sum become entitled to practise in
London, and within ten miles thereof, by paying four guineas in
addition.

For an assistant's certificate, two guineas.

For information relative to these Regulations, medical students are
referred to Mr. Watson, who may be seen at his residence, 43, Ber-
ners-street, between the hours of nine and ten o'clock every morning
(Sunday excepted) ; and for information on all other subjects con-
nected with the " Act for better regulating the Practice of Apothe-
caries," application is to be made to Mr. Edmund Bacot, clerk of the
society, who attends at the Hall every Tuesday and Thursday, from
one to three o'clock.

It is expressly ordered by the court of Examiners, that no gratuity
be received by any officer of the court.

MEDICAL JURISPRUDENCE.

14. Dr. Gordon Smith has taken the trouble to reply to our
comments on the medical evidence delivered at the late inquest on
the unfortunate Miss Cashin, and not only defends that given by
Dr. Alexander Thomson, but has been good-natured enough to
make a few Bharp personal animadversions upon our competency to
form an opinion upon the subject. In order to place the justness of
his remarks fairly before our readers, we must premise a few words
ib explanation, and observe, that " a man always speaks with pain of
himself." In common with many eminent men, Dr. Smith was
pleased to favour us with the highest eulogy for our articles on
Ethics and Medical Jurisprudence, and employed language such as
" these articles will immortalise you," &c. &c. In a letter which
was to be read at the Medico-Botanical Society, when the noble
president, Earl Stanhope, and council proposed the editor of this
journal, as Professor of Toxicology, he stated " If the expression of
my opinion as to your elegibility can be of the slightest use to you,

Medical Jurisprudence. 343

it is at your service in any shape ; and I hope the day is not far
distant when we shall be fellow labourers in the strictest sense of
the word, and for .the benefit of society, in a department of science
hitherto known almost (I grieve indeed to say it) only to our-
selves." In a communication dated August 9th, requesting our
opinion on a matter of vital importance to the interests of the study of
jurisprudence, he said, '• I shall give any alterations you may
propose the most candid and deferential attention." Unfortunately
we forgot the story of Gil Bias and the archbishop of Toledo, and
in an evil hour, did suggest some alterations in the matter, and
hinc ilia lachryma. In justice to ourselves and our critic, we must
observe, that our suggestions • were generally adopted, and we
firmly believe chiefly contributed to the subsequent acquirement
of the object we both had in view. We received the warmest
acknowledgments from our correspondent, and again on the appear-
ance of our last number ; but with an expression of regret for our
strictures on Dr. Thomson's evidence In ten short days afterwards.
Dr. Smith publishes his reply in the " Lancet/' doubts all our pre-
tension and competency to teach or even offer an opinion on me-
dical jurisprudence ; and gravely advises us to study the best works
upon the subject. But to crown all, he has since favoured us with
a most friendly letter, in which he says, "Allow me to congra-
tulate you upon the formidable position of the medical jurist, and
also on the distinguished part you will now be called upon to
perform in that capacity. The Apothecaries' Company have done
their duty, as you will perceive by their new regulations. . You and
I must pull together if possible, notwithstanding the jobation I have
given the Medical and Surgical in the " Lancet." This is rather
strange language addressed to one who knows nothing of juris-
prudence, and whose incompetency was so lately pronounced by the
writer ex cathedra. We are extremely sorry that Dr. Smith, to
whose talents we have ever paid that tribute of respect which they
so well merit, should be placed in so awkward a position as the
eulogist and censurer of one who never gave him any cause of
offence. If his opinion of us in the reply which we hasten to insert
be the real one, what was that of the above correspondence ? or
vice versa. Could he not discuss a scientific question without descend-
ing to personality, or must he convey sneers as little worthy of bis
own character and station, as we shall • shew they are useless to
his defence ? But enough : we shall refute his reply by his own
published opinions. He must have forgotten the recorded opinions
in his " Principles of Forensic Medicine," and in his " Analysis of
Medical Evidence," when he broached the most contradictory doc-
trines in the " Lancet." We must leave him to explain which
be wishes to be of standard, authority. Leaving him to arrive at a
conclusion, we fearlessly affirm that we could cite the whole of the
writers on ethics and state medicine in this and other countries
against this assertion, " Dr. Thomson is a good example of what a
medical jurist ought to be," as exemplified at the late inquest, but

344 Bibliography,

our opponent shall be our chief authority. In reviving this dis-
cussion, Br. Thomson has to thank his chivalrous friend ; and we
must assure him that we should not have done so voluntarily, and
also that we should be extremely sorry to give him pain, much less
offence. He will recollect that his evidence, and that of all the
other medical men, are fair subjects for impartial criticism ; and he
will bear in mind, that our talented contemporary, the Med.
Chir. Rev. and the Med. Gazette, have been much more caustic on
the occasion than ourselves.
We shall now insert Dr. Smith's reply, and add our rejoinder.

To the Editor of the Lancet.

" Sib, — In the last Number of one of the monthly medical
Journals, I was sorry to find some animadversions upon Dr. Alexan-
der Thomson, and upon the report delivered by him to the jury,
which so carefully investigated the cause of Miss Cashin's death. To
these I beg to offer a few words in reply.

" I agree with the writer of the article that the Doctor presents
"a good example," &c, but my assent to the truth of the observa-
tion is dictated by a different view of the cause. He is, in my opi-
nion, most decidedly a good example, and if such an example were
generally imitated, we should not be disgusted so often as we are
with the unintelligible slip-slop and unredeemed nonsense, uttered by
medical men, upon occasions of judiciary investigation."

Dr. T. is really a good example of what a medical jurist ought
not to be, for the following reasons. He swore there was no slough,
and that he could not state what was the cause of death without
examining the brain and spine, after Mr. Brodie had sworn there
was slough or mortification on the back, which was the cause of
death.

" When there is a great difference in .the testimony between
medical witnesses, there must be something wrong." — Principles of
Forensic Med., by J. Gordon Smith, MJ), 2d. ed.p* 527.

Endeavours were made to reconcile this discrepancy, which were
neither satisfactory to the profession nor to the public. *• It will not
do under such circumstances to receive one statement first and after*
wards substitute another. Such practice would strike at the foun-
dation of evidence."—- Analysis of Med; Evid. by same, p. 43.
To retract what has been decidedly affirmed would be rebutting his
own evidence. — op. tit. p. 75. "A scientific witness would be
truant to his own character, if when publicly called upon to speak
of his knowledge, he gave an imperfect or erroneous statement,
which it might fall to the share of others to correct ; and it does
appear to me, that it would be little more in his favour if he cor-
rected himself upon compulsion. — p. 88. " The report goes put to
the world, and the testimony of the medical man runs the gauntlet
of all those who may be able or disposed to display its defects and
more serious vices." — p. 89.

It is contrary to the principles of ethics and medical jurisprudence

Mediml Jurisprudence. 345

far a medical witness to act as counsel for the prosecution, to cross
examine witnesses, to appeal to the coroner and police magistrate for
the' committal of the accused, to appear before a judge when holding
the accused to bail ; in a word, to become the prosecutor. We
defy Dr^ Smith or any one else to cite one volume out of 10,000 on
forensic medicine, which maintains that such a witness is a good ex-
ample of a medical jurist. We shall allow the Doctor to speak upon this
point He observes in cautioning the medical witness against bias
or partiality, " without proceeding farther in the general denun-
ciation of this impulse," &c. * * * * I shall confine myself to a
simple warning of danger to the witness. " I believe it is a general
role of evidence, that no person interested in the question can be a
witness." — op. cit. 70, 71. And we most firmly believe, that Dr.
Thomson's evidence will go for nothing at the Old Bailey, for this
very reason.

" 1 hardly apprehend that the Doctor is exactly " a tyro in medi-
cine," for I remember being present, many years ago, when he elo-
quently and learnedly took a conspicuous part in a discussion at the
Medico-Ohirurgical Society ; and I have ever since entertained a
high respect for his talents and acquirements. I believe he has, in
the interim, been sedulously and successfully engaged in applying the
first of these advantages to the improvement of the other. But I
take it for granted, that the writer does not know him personally, and
from certain facts which have recently transpired, you may possibly
conceive him to be now*, if not juvenis, in the profession."

To this we answer, that Dr. Thomson was a student at the
London University last winter, and from his evidence as published
in our last, is both novvs ondjuvenis in the profession. This is also
the opinion of the editors of the Med. Chir. Rev. and Med. Gazette,
so that if we err, we do ao in good company.

" Fault is found with his report, upon the following general
grounds ; into particulars it is neither requisite nor possible for me
to enter : — 1. That he ought to have had no hesitation about the es-
char being the cause of death ; 2dly. That the examination of the
brain and spine was unheard of as the means of discovering the cause
of death — appending to this remark the surmise, that the cause of
death — from several circumstances specified, might be looked for in
the brain with utter hopelessness of success ; 3dly. That the Court
was puzzled by his technical description of every organ in the body ;
4thly. That the body was disinterred without the slighest neces-
sity ; 5thly. That there is not a well informed man in the profes-
sion who would not declare the sloughing to be the cause of death ;
&hly. That no man acquainted with the effects of local and consti-
tutional irritation, would hesitate a moment in forming an opinion on
the cause of death in this unfortunate case ; fthly. That it is a prin-
ciple injudicial medicine, that medical men should be as intelligible
and as conclusive as possible ; 8thly. That they should avoid all un-
necessary displays of technicality and ''rigmarole.**

Vol. v. no. 28. x x

346 , Medical Jurisprudence*

" Such are the charges quoted in die order in which they appear,
and I proceed to consider them seriatim : —

"1. It is observed that the existence of the eschar was proved by
one of the most scientific and eminent surgeons of London. No one
will question the claims of the gentleman alluded to ; but it is not
always the most eminent practitioner who forms the best medical
witness. I record this as a principle in judiciary or forensic medi-
cine, and could very easily quote practical illustrations in support of
it; but of some of these the writer is or ought to be well enough
aware already. Thomson acted upon a knowledge of the importance
of the occasion, and of the rules which, in similar circumstances,
ought to direct our conduct. He was quite right in hesitating before
pronouncing a positive opinion in a matter of such moment. It is
also to be observed, that the surgeon alluded to had. froinhftri all that
part of the investigation which devolved upon him ; whereas the gen-
tleman who has received (without incurring) the censure of the critic,
was at the time yet engaged in pursuing his."

The last paragraph scarcely requires refutation, lor it refutes
itself. If Dr. T. was quite right, Mr. Brodie was quite wrong, and
this requires no farther comment. The profession will judge for
themselves. But if the reverse was the fact, as our contemporaries
and every man of science we jnet with during the inquiry admitted,
then the gentleman alluded to incurred the censure he retimed. We
are ready to admit, that he was actuated by the best, motives in
defending the interests of science and humanity; but that is not the
question at issue.

" 2. I should have expected a teacher of medictd jurisprudence to
have bestowed commendation, instead o£ disapprobation, concerning
the second article animadverted upon ; but I am compelled to take
him as I find him. So far is the course of grftTniimtwrn instituted by
Dr. Thomson from being " unheard of/' that no other is observed by
the best medical jurists. All the cavities must be «rinmTi»fl before
any necrotomist can swear to the real cause of death. For, although
he may not find traces of a positive nature, the result of such a care-
ful and minute inspection will enable him to deny the existence of a
variety of causes which might be alleged without foundation ; and
such denial he cannot possibly be in a condition to make, unless such
a course of examination shall have been attended,"

We should like to see Dr. Smith cite some medical authority for
examining the brain or spine, in such a case, or in cases of severe
burn, tetanus, and hydrophobia, for the actual discovery of the
cause of death. We would'advise him to refer to (" and study") the
works of Sir A. Ckwper/ Mr. Travers, &c. for the received opinions
on the effects of severe, local irritation when produced in a person in
perfect health ; and inform us what morbid appearance in the brain
or spine can explain the cause of death. We repeat that such an
examination U never made, is unheard of; and even admitting that
congestion, inflammation or effusion was discovered in the head or

Medical Jurisprudence. 347

•pine, and produced by an eschar on the back, the size of the crown
of a man's hat, what would be the inference, but that the injury on
the back was the cause of death ? Is it not, we ask, a received
opinion, that intense pain of any kind, if allowed to continue, must
destroy Hfe, independently of all structural lesion ? Will not
the slightest wound induce tetanus and death, and the brain be
found healthy? We never said a word against examining the
cavities, and therefore this part of the reply was gratuitous and
requires no answer. We regret our opponent's disappointment at
cur nUlacy of dogmas as a teacher of medical jurisprudence ; and
we hope he may speedily regain his usual spirits, and not distress
himself too much about our deficiency. With respect to the ne-
cessity of technical expressions, we must insert another paragraph
before we offer our reply.

" 3. I am not aware that the Court complained of having been
puzzled by him ; he was at hand to explain any thing of an obscure
or unintelligible nature. It is the prudential and proper line of con-
duct to be pursued, in drawing up official reports, to use professional
or technical expressions ; for these go before the public, and it is a
fertile source of error and confusion to adopt popular terms, in which
the foundations of science were not laid, and which are not, even
now, admitted into the nomenclature."

" 4. The disinterment of the body was rendered necessary, be-
cause the family of the deceased opposed an inspection to the full and
requisite extent ; it therefore became essential to be armed with au-
thority for the purpose of judiciary satisfaction. In the mean time
the interment had taken place; and whatever further investigation
it was thought onerous to make, you will agree with me could not be
conveniently performed in the grave. Disinterment is a frequent
occurrence for such purposes.

" Had it been my duty to have occupied the place of the
author of the report cavilled at, my report would have been at
least as technical, leaving it to the Court to ask for explanations
where such might have been wanted. Allow me, as things hap-
pen to be, to ask into what domesticated terms Dr. Thomson's
censurer would render the following, which occur in the report ? —
Reticulation; abdomens tense; tumid; acromion process ; spinous pro*
cess of the occipital bone; cellular tissue; fascia; mediastinum;
pkremc; sanious; diaphragmatic : congestion ; bronchitis; purulent;
pleura; costal; pericardial; tubercle; abscess'; mucous membrane;
capsular; stellate; pulmonary artery ; valves of the heart; efferves-
cence*, petechia; peritoneum ; cardiac portion of the stomach; duo-
denum; mesentery; ilium \ colon; rectum; feculent matter ; flatus ;
arachnoid; and some others which I have not quoted. Who can
render these into plain English ? Or are there not some of them
which, if by circumlocution they could be so rendered, the public
prints would not hesitate, if they were even able, to express ?"

To this we reply, that there was no morbid appearance in the body
which could account for death, exceptthe eschar on the back ; and there-

348 Medical Jurisprudence.

fore it was unnecessary to employ such irrelevant technical expressions
or render them into domesticated terms ; and we reiterate our opinion,
41 that the court was, and according to Dr. Smith, must have been
puzzled by a technical description of every organ in the body," which
were all healthy except the stomach and pleura, and were unnoticed
by the most experienced of the witnesses. " For any witness to
babbie in a court of justice is highly indecorous ; for a man of science
to do so on matters of opinion would be ridiculous." — Principles of
Forensic Med. supra, cit. The same author directs us in giving
evidence " to advance our judgments in the most precise and simple
manner, and condemns the plan of overwhelming the court by a flaw
of garrulity, and that a witness may gallop off in this way, and
perhaps proceed to some distance, sed cui bono." — Analysis. " His
opinion ought to be conveyed in a perspicuous maimer." — Hasktm,
Hutchinson. " He should avoid as much as possible all obscure and
technical terms, and the unnecessary display of medical erudition." —
PercivaFs Ethics. " He should study logic and not rhetoric," —
J. Gordon Smith, M.D.

" 8. The last article of animadversion is completely answered by
this reply to No. 7. But I must request some explanation of the
term " rigmarole." Although my early manhood, and the prior por-
tion of my professional life, were spent in the service of his Majesty,
wherein we may learn the meaning as well as the application of queer
terms, I should have stretched myself under many a bush before I
had found out " rigmarole" to be applicable to such a report as the
one in question."

Our capacity is too limited to enable us to comprehend the exact
meaning of this paragraph, we are totally at a loss to discover the
relevancy of the writer's campaigns in his Majesty's service,
" wherein he learned queer terms, and his stretching himself under
a bush," to discover the applicability of rigmarole " to the report in
question." As we have not enjoyed such great facilities of acquiring
our etymology, being engaged for the greater part of our lives in the
medical schools of Dublin, Edinburgh, London, and Paris, we admit
our opponent's superiority, while we refer him for the solution of
the important point at issue to his old acquaintance Samuel Johnson,
who will inform him that the import of the object of his fruitless
research is nothing more nor less than " a repetition of idle words,"
which was strictly applicable to the greater part of the report in
question. And the same authority informs us, that our opponent's
term for such evidence happens to be synonymous with our own for
babble, means to " talk idly," so that here we may join issue. We
must in turn request some explanation of the term "jobation" So
much then for our opponent's defence of Dr. Thomson's evidence ;
we leave him to enjoy the fruits of the victory he has achieved.
We shall not disturb him in his triumph in demolishing so feeble an
antagonist; but ask him a simple question at parting. Does he
seriously believe, that there is one eminent physician or surgeon in

Medical Jurisprudence. 349

this empire who agreed with him, that his friend is a good example
of a medical jurist ? His last paragraph refers entirely to ourselves,
and deserves consideration.

" For the present I shall go no further ; hut if the writer in ques-
tion seriously intend to teach medical jurisprudence, I fear that 1
must exhort him to study the most approved authors upon the prin-
ciples of that singular science. I thought that medical jurists
entertained no difference of opinion upon such matters. It re-
mains, therefore, to be cleared up, whether such a difference be-
tween the writer and myself really exists, or whether this display on
his part does not entitle me to question the validity of his pretensions.

I am, Sir, your obedient servant,

J. Gordon Smith.

Professor in the University of London.
September, 1830.

We are deeply indebted to the writer for his very sincere and
friendly exhortation, but beg to inform him that we have long since
carefully studied the most approved authors on the subject, and
among them even his own productions. We fear, however, from the
facte stated in the first part of these remarks, and the tenour of his
" reply/' it behoves us to call to mind the salutary admonition,
Timeo Danaos, &c. Without questioning his infallibility, we must
observe, that our published opinions on this singular science, are
not contradictory, and we suspect that we have proved to his satis-
faction, that the difference of opinion which he has fancied to exist
between us, is simply the offspring of his own imagination. Be this
as it may, we doubt much whether this display on his part does not
entitle us to question the validity of his pretensions to an infallibility
and a superiority which he imagines he enjoys over all his con-
temporaries. He will please to bear in mind that the science of
forensic medicine flourished long before his time, and was encouraged
in Edinburgh many years before he was found amongst its culti-
vators, and will continue, even though deprived of his patronage,
and therefore its friends and advocates ought not to excite either
peevishness or jealousy in his bosom.

We can also tell him in the most positive terms, that he will ere
long have more rival teachers than one to demolish, and when he
commences his next attack, we would strongly advise him not to
commit himself as he has done on this occasion, by giving his
opponent an opportunity of refuting his arguments by his own re-
corded opinions. The lateness of the inquest which concluded on the
day of publication of our last, prevented us from commenting as we
wined on the medical evidence on the occasion in question ; and we
shall now offer a few remarks upon it. The discrepancy of the
medical witnesses is most remarkable, we find them confounding three
different diseases. Mr. Brodie swore there was sloughing, " a term,"
says he, " synonymous, or nearly so, with mortification." — JMed.

850 Medical Jurisprudence.

Chir. Rev. — While every tyro. 10 aware that these terms ere
perfectly distinct from each other, and from gangrene.— Vide
Cooper's Surgical Dictionary, 1830. Dr. Thomson affirmed, " there
was no sloughing, for by sloughing we mean the coming away of
a dead part/' Dr. King, or Dr. Hogg, or Mr. Wildgoose did not
state the scientific term for the state of the back, whether gangrene,
mortification or sloughing. Dr. James Johnson designated the state
of the back incipient gangrene ; but all agreed that the state of the back
was the cause of death. The diversity of opinion among the medical
men as to the exact nature of the disease, is highly diflcrfditahlp to
die majority of them, as men of science and as medical jurists.
We entertain no doubt but all will receive a formidable cross ex-
amination at the trial ; and we cannot help thinking, that an intel-
ligent jury of plain strait forward Englishmen would be puzzled to
pronounce what was the exact disease of the back in this case. It is
even quite impossible for any scientific man who has perused the evi-
dence, to say what was the exact morbid condition of the eschar ; but
every medical man of common sense and ordinary acquirement must
at onoe declare that the eschar was the cause of death from its effect
on the nervous system. We apprehend the judge will expatiate
upon the discrepancy of the evidence ; and as to Mr. Long, he will
come off with flying colours. His fame, however, will suffer ; his
patient* will decline, his power of preventing and curing all diseases
will be questioned ; and gullible as John Bull naturally is, he wOl
display his ordinary good sense, and say, has not this man lost two
sisters in one week? That the public should be imposed on by
quacks is what any sensible medical man must expect, when he
looks at the' state of the profession, when any illiterate scoundrel
may proclaim his infallibility, while the president and censors of
the College of Physicians, with ample power to prevent them, are
busy in intriguing about the court for their own personal aggrandize-
ment, and forgetting to discharge the sacred trust reposed in them by
the legislature, for the protection of public health, and the interests
of the whole profession, of which they are but an insignificant part,
and when their conduct is fairly examined, they must be pronounced
by every thinking man, as dangerous and arrant humbugs in the true
sense of the word, as the villainous empirics whom they allow to
sacrifice his Majesty's subjects. We have shewn from Mr. Will-
cock's work, in a former article, that the Colleges of Physicians and
Surgeons have full power to punish quacks and irregulars ; and why
in the name of reason, science, and humanity, do they not do their
duty?

15. Trial 0/ Quacks. — At the Lancaster assizes, J. Ferguson, aged
30, was indicted for killing Betty Kay, at Great Bolton, on the
12th July. It appeared he was not regularly educated as a medical
man, but lived in his youth with his brothers, who were auigeons in
Bolton, . that he had relinquished the profession, and employed
himself as a weaver, but attended women in childbed, tie agreed
for 5s. 6d* to deliver deceased ; was intoxicated, inflicted injury on

Medical Jurisprudence. 351

her, and allowed her to die of haemorrhage from retained placenta.
He was found guilty, and sentenced to sht months imprisonment
only I

At Bristol assizes, an action was brought against a Dr. Soligman,
who represented himself physician general to the army of the King
of Prussia. He advertised to cure " watery gout, broken navels,
dry bumkins, windy cramps under the breath rib, &c." The plaintiff,
alfr. Greenhorn, brought an action for the recovery of 7s. 6d. a day,
far 90 days, which he paid the doctor for attending on his son, who
had dislocated his ancle. The treatment consisted of frictions to
the shoulder* which were to. replace the bone with loud roaring,
but unluckily failed to produce this effect* The physician general
recovered the suit, as the plaintiff was satisfied with his terms.

Copy of Petition presented to the House of Commons, by Mr. Humei .

Tuesday, July 6, 1830.
To the Honourable the Commons of the United Kingdom, in Par-
liament Assembled :
The Petition of the .undersigned, Member of the
Honourable Society of the Inner Temple,
Humbly sheweth,

1. That your Petitioner considers the toleration of that
abominable nuisance, Medical Quackery, or Smpiricism, as a dis-
grace to a country professing Christianity and civilization, and has
long regretted that the vjle and destructive trade of tampering with
the lives and health of the community should have received a
legal sanction and protection by virtue of the Stamp Duty on the
TiSanous trash.

2. That the mischievous trade of Quackery and imposition is
daily increasing, and that honles of empirical jugglers are engaged
in its propagation in every quarter of the metropolis, and make their
periodical circuits throughout the country, scattering death and
destruction among the population of the empire, and fattening on
the murders which they are continually perpetrating with their
poisons : and, to add to the monstronsj combination against the
lives and health of the community i that the aid of even the pulpit
has been invoked to further the propagation of the imposture.
Instances are on record, where mercenary dissenting preachers have
been wicked enough to sermonize and expatiate on the pretended
and miraculous virtues and benefits. of the poisonous nostrums of the
mountebank jugglers and impostors* *"

3. That the culpable toleration of the frauds of those vermin, and
of the secret and wide-spreading jdeetruction of health and life which
it the consequence of their murderous nastrums, is a national oppro-
brium, equally disgraceful to the legislature and the government,
and has been so stigmatized by many eminent foreign writers. Was
there ever a more monstrous absurdity exhibited in the most bar-
barous country and the most uncivilized age, than that empirics and
impostors of the most detestable description should be legally and an*
thoritathrely enabled to rob mankind of their health, their property,
and their fives, and to announce that they practise their impostures

352 Miscellanies,

under the sanction of a government Stamp Duty, and vend their
nostrums as " prepared and sanctioned by his Majesty's august
authority /" and that all this mischief should be allowed to be in-
flicted on society merely for the sake of the paltry and disgraceful
revenue, arising from the pest, to the Exchequer ?

Wherefore your Petitioner prays, that your Honourable
House will be pleased to devise some wholesome
regulations, calculated to suppress the frauds and
murderous designs of jugglers and impostors of all
descriptions, and at the same time to repeal that
most monstrously impolitic statute, the Patent
Medicine Act.
And your Petitioner, as in duty bound, will ever pray,

(Signed) John Dingwall Williams.
Inner Temple, June 21, 1830.

MI8CKLLANIB8.

Metropolitan Society of General Practitioners.
To the Editor of the London Medical and Surgical Journal.
16. Sir, — As your Journal was once the advocate of apothecaries,
I trust you will do an old subscriber the favour of inserting a few
remarks on the utility of the " Metropolitan Society of General
Practitioners." In the formation of this society every effort was
made to avoid giving offence to any portion of the profession, nor
can any of its friends perceive in its rules any thing which they have
cause to regret. That the great body of general practitioners, who
are excluded from all connection with the medical corporations,
should endeavour to protect their own interests is not very un-
natural, and that they should endeavour to establish a fund for
the relief of distressed members of the profession, including all
classes, is not an objectionable proceeding. They are not apothe-
caries nor surgeons, but a distinct class of practitioners which society
has sanctioned. .They only seek to defend their interests; and
what class of the profession has not done the same ? A great deal
has been said against the society, because it has not been established
at a public meeting and so on ; but allow me to ask what good has
resulted to the cause of reform from public meetings ? What has
become of all the intended meetings — when are they to take place ?
The truth is, Sir, that sober-minded men are opposed to such
meetings, and will never come forward as public disputants. The
editor of the Lancet and yourself object to the term general prac-
titioner, but neither of you have condescended to propose a sub-
stitute * for it. 1 repeat that those who adopt that title are not

* We readily insert the above, though it reached us too late for the department
of this journal allotted to original communications. We have never said a word
against the society in question, as it appeared to us to be unobjectionable aod
worthy of support from the class of the profession it more immediately concerns.
True we have objected to the unclasaical and unmeaning term, General Practitioner,
which we defy any man to translate into any of the learned languages ; under this
Impression we acknowledge our inability to propose a substitute for it. — En.

Miscellanies 353

surgeons or apothecaries, that their education differs from that of
either, though it comprises that of both, and consequently entitles
them to practise surgery and pharmacy. Jf the public sanction
them, I am at a loss to discover of what import is a title.

I am, sir, your obedient servant,

A General Practitioner.

The interests of the public and of the profession will be thus greatly
promoted, and one important step gained towards the cause of
medical reform. Hie nefarious quacks, and the ignorant pretenders
to physic will receive that chastisement they so well deserve ; and
legitimate members of the profession will have some opportunity of
enjoying their rights, and obtain that recompence for which they
sacrificed their time, talents, and property. We need scarcely
observe, that the example of Middlesex would be followed by every
county in the united kingdom.

17. London University. — Mr. C. Bell has resigned the professor-
ship of surgery, and Mr. Pattison has been appointed his successor.
Mr. Bell continues to teach physiology. At the suggestion of Mr.
Pattison, Mr. Bennett has been associated with him in the chair of
anatomy. Mr. Bennet is assisted by Mr. R. Q uain in the demon-
strations and dissections.

18. Expense of Medical Education in the London University. — The
expense of the course of medical education in this institution is 661.
which is from 20/. to 30/. more than in the majority of private
schools in this metropolis, and far exceeds that of the schools in
Dublin or Edinburgh. This is bad policy.

19. Metropolitan Society of General Practitioners. — We are happy
to inform our readers, that the Society of General Practitioners have
taken premises at 4, Regent-street, where tbey have a reading-room
•applied with the medical periodicals, magazines, and daily papers.
They invite all classes of the profession to become members of the
society. An institution of this description was much wanted, and
eaxmot rail to receive that encouragement which it so well merits.
We cordially wish it success.

20. Medical Coroners. — Though Mr. Wakley has lost his election
for the coronership of Middlesex, yet he has much reason to be proud
of the immense support he received from above 3.500 of the in-
dependent freeholders of the county. The contest has effected one
grand object, and that is in informing the public of the necessity of
appointing medical coroners. Had the public press acted impartially,
Mr. Waldey would have been successful. There can be no doubt of
bis success on the next occasion, which is near at hand, and then the
empirics and the thousands of unqualified practitioners in this me-
tropolis will have cause to tremble. The public health will be more
carefully attended to, and every class of medical men, in every
relation of society, must discharge their duty with care, caution,
attention, and according to the received opinions of the profession.

Vol. v. wo. 28. x x

354 * Miscellanies.

Medical Appointments at Court

21. " There is much whispering in the Profession relative to the re*
cent medical appointments about His Majesty's person, and to the
use made of a delegated authority, which we notice that if the ru-
mours be incorrect they may be the sooner set right.

All the medical appointments of His Majesty as Duke of Cla-
rence are said to have been superseded, and the name of one
party only to have re-appeared among those appointed to attend the
Ki g. Sir H. Halford, Sir Gilbert Blane, and Sir Matthew Tierney,
ha\ e been appointed Physicians in Ordinary to His Majesty, to which
a salary of 3001. per annum is annexed. Sir Henry Halford, as Pre-
sident of the College of Physicians (a regulation procured by himself
from the late King, but for some reason or other never acted upon till
now) is ex officio one of the Physicians to the King, nay the first
Physician ; but, as he may not always continue President, he has
taken the precaution to be appointed Physician in Ordinary in the
usual course ; which double appointment of the same person to the
same office is said to give the fortunate holder a right to a double sa-
lary, that is, six hundred instead of three hundred pounds per annum.
Sir Henry Halford stands doubly at the head of the list, though in
conjunction with Sir Gilbert Blanes a physician of greater age, of the
highest scientific character, the oldest and longest medical adviser of
his late Majesty, at the head of his list during his whole reign, as
well as that of his present gracious Sovereign before his Accession,
and the only one of the gentlemen whose names are above recorded
who had the honour of attending the Duke of Clarence in early life.
It is also said that a Dr. Hawkins, a young physician of singular good
fortune as a medical pluralist (there being fewer stipendiary places in
the medical profession than any other) has been appointed Physician
to the Royal Household (Sir Gilbert Blane, being dismissed from this
place also) holding at the same time the appointment of Registrar to
the Royal College of Physicians, Physician to the Middlesex Hospital,
and Professor to the King's College ; also, last if not least, about to
become nephew by marriage to the President. When the appoint-
ment of Physician to the Household was first announced, there was a
general impression that it was Dr* Bisset Hawkins, a most promising
young physician, and already very favourably known to the philoso-
phical and professional world by an ingenious and scientific work :
but this turns out to be an error.

We stated, lately, that owing to some influence of the back
stairs, the name of Sir Gilbert Blane, which was directed by His
Majesty to be placed first on the list of his Medical establishment,
had been, notwithstanding His Majesty's injunction, placed after that
of the President of the College of Physicians, that is after that of Sir
Henry Halford's. We were unwilling at that time to go farther, in
order to allow the authors of this intrigue an opportunity of rescind-
ing an act equally derogatory to their own honour and to his Ma-
jesty's best interests.

As our hint has been disregarded, we shall now redeem our pledge
with the public, and state some circumstances from which it may be
seen how far we were authorized in the assertions we have already
made.

Miscellanies. 355

We affirm, on authority which none of the parties concerned will
dare to contradict, that His Majesty wrote, with his own hand, to
Sir Henry Halford, requiring him to place Sir Gilbert Blane's name
first on the list of his physicians. We affirm also, that Sir Henry
Halford, in answer to the inquiries of a certain official of the house-
hold, did write, that in consequence of His JUajeMys pleasure, ex-
pressed in his own kand writing, he had placed Sir Gilbert's name fore-
most on the list. We affirm, thirdly, that the list, as it now stands,
and by which the two first places are assumed to himself, is such as
it came from the hands of Sir Henry Halford himself. It is no part
of our . duty to reconcile words with actions. We state the facts
plainly and simply, as we believe and as we know them to be. - It is
evident, however, that here a great act of injustice has been done,
and that the King's kind intentions have been intercepted by a ser-
vant, and a delegate.

These are not times to trifle with the faith of Princes. The world
is witness, in other countries, of the ruin induced by the falsehood
and selfishness of courtiers. We trust that our present gracious
Sovereign, whose benevolent intentions have been so unequivocally
manifested, will be preserved from the snares of such false friends." —
Attn. — John Butt. Fiat justitia, mat ccdum.

. Nothing has occurred for a long time which has excited
more disgust and disapprobation throughout the profession than
the late appointments of the medical attendants to his most
gracious Majesty. Even the silly and ridiculous bulletins, which
were pure nothings, were consistent when compared . with the
appointments in question. Every one inquired " who is Eh;. A. ?
who is Dr. B. ? and who is Dr. C. ? I have never heard of any of
them. They are unknown in the annals of science/' But most of
them are fellows of .the College of Physicians, and the. personal
friends or tools of the president ; and to him they owe their uu merited
elevation. There >is nothing extraordinary in a man serving his
friends or dependents, provided he does not sacrifice the interests of
those who have stronger claims to notice. That our gracious and
truly magnanimous sovereign would supersede his former attendants,
men to whom he confided the care of his health for many years, is
an idea which no man in his dominions would entertain for a
moment. So far from this being the case, we know from authority
that cannot be doubted, that his Majesty actually inserted, with his
own hand, some of the names of his former physicians, and first on
the list that of the talented and erudite Sir Gilbert Blane, Bart.
By a degree of insolence on the part of some of his seivants, which
forcibly reminds us of Cardinal Wolsey, who, in corresponding with
the court of Rome, modestly commenced with , •• Ego et rex metis,"
Sir Gilbert was deprived of one of his appointments to make room
for a juvenile successor, and his name was placed second on the list.
Oh, shame, where is thy blush ! It is impossible to designate this
audacious and unjust conduct in appropriate language. Of the
parties concerned, we speak impartially; we do not enjoy their
personal acquaintance, but when we see an individual of Sir Gilbert
Blane's splendid talents and distinguished character, one who has

856 Miscellanies.

stood high in official situation, who has been associated in those
splendid naval events which have raised the glory of this empire,
who has made naval medicine what it is, by his wise and prudent re-
gulations, which have mainly contributed in the prevention of the
horrid diseases of our fleets, armies, and hospitals, and which even
received the admiration of Lord Spencer as First Lord of the Ad-
miralty, who appointed him one of the Commissioners of the Sick
and Hurt ; and so interested our most gracious Monarch, then Duke
of Clarence, through whose influence he was appointed Physician
Extraordinary to the Prince of Wales, and Physician to the Royal
Household ; and who had numerous other marks of respect tram the
toyal family and the government at different times, when we see
such a man as this slighted by base intrigue, we must in common with
the independent part of the profession use the strongest terms of
reprobation of such conduct. But to return to Sir Gilbert. In
addition to the many distinctions already enumerated, he has been
repeatedly applied to by his own and other governments for instruc-
tion and advice on important matters of public health. He was
called upon, in conjunction with the royal physicians and other
leading characters, to draw up the regulations on the subject of
quarantine, which formed the basis of the act of parliament on this
head. He was also called upon in 1800 to offer his advice on the
best mode of managing the convicts in the Hulks at Woolwich, to
prevent infection, and visited Newgate for the same purpose by the
authority of the Secretary of State for the Home Department. He
was likewise consulted by the Secretary of the Colonies, as to the
beat mode of transporting our army from Egypt, to avoid the
danger of importing plague. The Board of Controul applied for his
suggestions in ameliorating the regulations of the medical service
in India, and of the transports to Botany Bay. The committees of
the House of Commons have also requested his opinion on various
subjects. He was dispatched to Walcheren to give his opinion;
and it was novel that a naval physician should supersede the first
army medical authorities. His report, made conjointly with the
army physicians, caused the governmennt to abandon the expedition,
too late to repair past evils, but in time to save the lives of thousands.
On his return, the Prince Regent conferred upon him the title of
Baronet. As a * literary and scientific writer, he stands one of the
first. His Medical Logical holds a first place in our medical litera-
ture. He is the only physician in England who is a member of the
Royal Academy of Sciences of Paris, and was elected in preference
to Hufeland and six other candidates, We said he was consulted
on the subject of state medicine by other governments. He received
a gold medal from the late Emperor of Russia, and another from the
King of Prussia; and a letter of thanks from the President of the
United States of America, written with his own hand. He was
personally known to George the Third for more than half his reign,
and received from him great attention ; and enjoyed the confidence
of his late Majesty, who appointed him his physician, and also to
the household, a situation m which, contrary to the will of the
sovereign, he has been unjustly deprived in the late appointments.

Miscellanies 357

" He is one of those/' says his biographer, " who though Officially
connected with the court, has neither sacrificed his own dignity nor
his scientific pursuits, at the shrine of favouritism and dependence ;
on the contrary, he has studied to owe his professional distinctions
to merit alone, and who would scorn to draw his pre-eminence from
college monoply to the exclusion of talent wherever it came from*
or to obstruct its progress. Sir Henry Halford should, have been
aware that those professional characters in whom his Majesty has
ss much confidence as in himself are licentiates, some of them even
with Scotch honorary degrees/' Sir Gilbert is a Fellow of, the
Royal Societies of London, Edinburgh, and Gottingen,. a proprietor
of the Royal Institution, and Member of the Imperial Academy of
Sciences of Petersburgh, and of the Royal Academy of Sciences
of ftuii, as already mentioned. We are indebted to a work en-
titled " A Picture of the Royal College of Physicians of London in
1827/* for much of this narrative ; a work which also contains a
feithml memoir of Sir Henry Halford himself* and concludes that of
Sir Gilbert Blane in these words :—

" Before closing the memoir of this distinguished physician, whom
we may not improperly term " President of the Licentiates," for be
has, it well known, declined being a Fellow; we cannot avoid
Baking acme comparison between mm and the present President,

The head of this learned body should certainly always stand
wa literary character, and be distinguished no less for his learning,
than his mere professional knowledge. We do not mean to say that
Sir Henry Halford is deficient in medical acumen, but, compared with
Sir Gilbert Blane, lie is not equal as a scholar or a writer. His only
work, already noticed, his Grand Climacteric, is a production of which
it has been sarcastically said, that it had neither subject nor object ;
the subject (the disease) being a nonentity, and the object (the cure)
being not even touched upon. Certainly, much might have been said
on the Laws of Longevity, and the Regimen adapted to old age. Sir
Henry's failure in these respects, perhaps gave rise to Sir A. Carlisle's
treatise on Old Age and its Diseases.

Sir Henry's pamphlet on the Appearance of the Remains of King
Charles I., when exhumated at Windsor fifteen years ago, particu-
larly the appearance of the vertebrae cut through by the axe, was
merely written for the moment, to mark him as the chosen attendant
of royalty on this melancholy occasion. For besides these, there ap-
pears only one paper under his name, in the 6th volume of the Col-
lege Transactions, on "the sudden and unexpected Fatality of certain
P»eases." It would be invidious to criticise this, as the intention
ttgood ; but is clear, the writings of a professional man are the only
criterion of his real merit, and it will be decided more impartially by
posterity, when court favour and court intrigue are past, whether the
physician, at the head of practice and of the College, was also at this
period at the head of Medical Literature."

Sir Gilbert, has offered prize medals for the encouragement of me*
<fcal officers of the Royal Navy, and die improvement of physic and
surgery, in that part of the public service, theterms on which these are
to be obtained, we insert hereafter. The medal is now in full opera-

356 MiicdUatit*.

atood high is official situation, who hse been associated ia those
splendid naval events which have raised the glory of this empire,
who boa made naval medicine what it ia, by his wise and prudent re-
gulations, which have mainly contributed in the prevention of the
horrid diseases of oar fleets, armies, and hospitals, and which even
received the admiration of Lord Spencer as First Lord of the Ad-
miralty, who appointed him one of the Commissioners of the Sick
and Hurt ; and so interested our most gracious Monarch, then Duke
of Clarence, through whore influence he was appointed Physician
Extraordinary to the Prince of Wales, and Physician to the Royal
Household ; and who had numerous other marks of respect from the
royal family and the government at different times, when we see
such a man as this slighted by base intrigue, we must in common wrdi
the independent part of the profession use the strongest terms of
reprobation of such conduct. But to return to Sir Gilbert. In
addition to the many distinctions already enumerated, be has been
repeatedly applied to by his own and other government* for instruc-
tion and advice on important matters of public health. He ma
called upon, in conjunction with the royal physicians and other
leading characters, to draw up the regulations on the subject of
quarantine, which formed the basis of the act of parliament on tail
head. He was also called upon in 1800 to offer his advice on the
best mode of managing the convicts in the Hulks at Woolwich, to
prevent infection, and visited Newgate for the same purpose by the
authority of the Secretary of State for the Home Department. He
was likewise consulted by the Secretary of the Colonies, as to the
best mode of transporting our army from Egypt, to avoid the
danger of importing plague. 'Hie Board of Controul applied for his
suggestions in ameliorating the regulations of the medical service
in India, and of the transports to Botany Bay. The committees of
the House of Commons have also requested his opinion on various
subjects. He was dispatched to Walcheren to give bis opinion ;
and it was novel that a naval physician should supersede the first
army medical authorities. His report, made conjointly with the
army physicians, caused the governmenut to abandon the expedition,
too late to repair past evils, but in time to save the lives of thousands.
On his return, the Prince Regent conferred upon him the title of
Baronet. As a literary and scientific writer, he stands one of the
first. His Medical Logical holds a first place in our medical litera-
ture. He is the only physician in England who is a member of the
Ho,
to 1

•• He is one of those/' says bis biographer, ««
connected with the court, has neither
his scientific pursuits, at the shrine of fa:
on the contrary, he has studied to owe hia _
to merit alone, and who would scorn to drawhis
college monoply to the exclusion of talent
or to obstruct its progress. Sir Henry Halford
*ware that those professional characters in when
•* much confidence as in himself are licentiates,
vith Scotch honorary degrees." Sir (KKbest i
Royal Societies of London, Edinburgh, and Gt
of the Royal Institution, and Member of the
Sciences of Petersburgh, and of the Royal
of Fnria, as already mentioned. We are i
&fed " A Picture of the Royal College of Ph
1827/' for much of this narrative ; a work
totbml memoir of Sir Henry Halford himself,
air Gilbert Blane in these words:—

" Before closing the memoir of this
we may not improperly term " President of Use
"», it well known, declined being a FeOcn
■aking some comparison between him and the

The head of tins learned body should cerl

* a literary character, and be distinguished

"an his mere professional knowledge. We do
faff Henry Halford is deficient in medical mem
^fGubert Blane, "he is not equal aa aschol*
I*0** already noticed, his Grand ClimaeUrie,

* baa been sarcastically said, that it had
£® aabject (the disease) being
**JS not even touched upon,
^ w Iawb of Longevity, and the o
Jf*%J 8 Wlure in these respects, perhaps
^*!im OM Age and its Diseases.

Q*V*f*f* pamphlet on the Apjpearasjce
krl v exhumated at Windsor a

|2l appearance of the vertebrae
^p^y Written for the moment, to
£*|y*!ty on this melancholy oc
^ only one paper under his
™ 1,an*actions, on " the sodden

It would be invidioos to
Us. eleata.fte writings of

358 Miscellanies.

tion, all but the engraving of the die, which will cost the benevolent
donor 1501. and the whole expense, will cost him more than 5001. It
is highly gratifying to observe this venerable character, as warmly
engaged as ever, in promoting the interests of mankind and this pro-
fession : and every one of his enlightened and independent contempo-
raries must feel highly indignant at his having . been treated with
contempt or neglect. But he is only one of the numerous distin-
guished physicians, who have been badly treated in the late appoint-
ments. It would be invidious to name others ; but we ask, why have
the medical attendants of our gracious and truly beloved Monarch,
when Duke of Clarence, been deprived of that promotion to which
they were justly entitled? It is universally known through the profes-
sion that the exclusion of these individuals, was contrary to the King's
wishes and commands, and is solely to be ascribed to those, to whom
he delegated the power of appointing his medical attendants. It is
truly astonishing that this power should be partially exercised, and
still more so, that a sovereign distinguished for every virtue that
adorns the human character, should be represented as having forgot-
ten the interest of his former medical attendants, in whom he had re-
posed the utmost confidence for many years, and treated them with
cold indifference and neglect, and blasted all their long cherished
hopes, and just prospects of preferment. The conduct of those who
have placed their august master in such a light, deserves his greatest
displeasure ; and it has received the strongest reprobation of every in-
dependent member of the medical profession. The silence of our
contemporaries upon this subject is highly inexcusable, but we agree
with Junius. " that the liberty of the press, is the palladium of all
civil, political, and religious rights of Englishmen" ; and with Cur-
ran, that it is, " that great sentinel of the state, that grand detector of
public imposture * * * * when it sinks, there sinks with it, in one
common grave the liberty of the subject and the security .of the
crown." The press is the grand, and only corrector of abuses in our
profession, and as such we Bhall ever fearlessly employ it.
Plan and Regulations of the establishment and adjudication of two

Prize Medals for the encouragement of the medical officers of the
royal navy, and the improvement of physic and surgery in that
department of the public service. Founded by Sir Gilbert Blane,
Baronet, First Physician to the King, F.R. SS. Lond. Edin. Gdtt.
Member of the Imperial Academy of Sciences of Russia, of the
Institute of France, &c.

Sanctioned by the Board of Admiralty, 2d March, 1830.
1. The founder considering how much it will conduce to the
advancement of the public service, that emulation should be excited
among the medical officers of the royal navy by honorary distinctions
for professional merit, has vested the sum of three hundred pounds in
the three per cent, consolidated bank annuities, in the Royal College
of Surgeons of London in trust, with the dividends which shall be
from time to time receivable, for the purpose of conferring, once in
two years, two Gold Medals of equal value, on two medical officers,
surgeons of ships of war, in commission, or assistant surgeons of
king's shipB in commission, not bearing surgeons, who, in the time

Miscellanies. 359

required, shall have delivered, into the proper office, journals, evincing
the most distinguished proofs of skill, diligence, humanity, and
learning in the exercise of their professional duties ; these journals
to be delivered in the form in which they have been kept from day
to day, stating the symptoms, as they shall have occurred at the
time; but without prejudice, or hindrance, to their making such
observations practical or theoretical as they may judge proper to
annex to them.

2. The first selection to be made by the medical commissioners on
the 12th August, 1831, from the journals delivered between tl'-e
12th of July, 1827, and the 12th of July, 1831. All future selec-
tions, to be made on the 12th of August, at the interval of tuo
years from each other, from the journals delivered in the two pie-
cedirig years up to the 12th of July immediately preceding such
selection.

3. In the selection of these journals the founder proposes that the
medical commissioners of the navy shall, out of the whole journals
delivered to them in the course of the intervals above specif cd,
make choice of such as in their judgment possess the highest de*;i ee
of merit, in number not more than ten, nor less than five, which el all
be transmitted to the founder during his life- time, for his select ion
out of the number so sent, of two, or one, in case there should not
be another of sufficient merit, the author or authors of which, in his
judgment, may be most deserving of the prizes. And after his
decease, the said journals to be conveyed to the president of the
College of Physicians, who, after due examination, is to communicate
them to the president of the College of Surgeons, and after proper
deliberation, the said presidents are to call to their assistance the
Senior Medical Commissioner of the royal navy, and jointly will) him
select from the said journals one, or two, the author or authors of
which, in the opinion of the majority, possess the highest merit, and
become thereby entitled to the medal or medals. The medal or
medals, when adjudged, are to be put into the hands of the attending
medical commissioner to be by him presented to the successful
candidate or candidates. All the journals of the first selection to be
returned into the custody of the medical commissioners.

4. In case of the impossibility of performing the before mentioned
duties through the illness or unavoidable absence of the parties de-
scribed, the duty is to devolve on the next in rank, that is 4 n the
Senior Censor of the College of Physicians, the vice president of the
College of Surgeons, or the Junior Medical Commissioner.

5. In case it should happen at any of the periods of adjudication,
that in the opinion of the founder, or of the two presidents, rJter his
decease, there shall not be found a journal or journals of adequate
merit to entitle any candidate to the prize, the medal or medjls shall
be withheld until the next period of adjudication, and the iinadjudi-
cated medals are to be conferred on such, as may possess sufficient
merit over and above those subject to adjudication at thiit period.
But this regulation is to be so construed and limited, that no more
than four prizes shall be adjudicated at any period ; and if the un-
adjudged medals should exceed this number, their value in money is

360 Miscellanies.

to be given to the Supplemental Fond for the children of medial of-

6. In ease at any time the founder, or the two presidents shall omit
to make the adjudication for a longer period than three months, they
shall be considered as having forfeited their right, and the ultimate
selection shall devolve on the medical commissioners, who in case of
difference of opinion may call in such a referee as they may judge ne-
cessary or advisable.

7. The founder shall provide and deposit with the Royal College
of Surgeons, the die engraved for the medal, from which they will
cause the medals to be struck at the prescribed periods, an£ to be
delivered to the medical commissioners to be presentedjby them to
the successful candidates.

8. No successful candidate to be admitted aaa competitor a second
time.

9* The presidents of the Royal Colleges of Physicians and Sur-
geons, and the senior medical commissioner, to ; be considered as
guardians of the fond and its equitable administration.

10. In case any of those surgeons, whose journals have been ap-
pointed to an hospital, or any other situation on shore, except that of
medical commissioner, such surgeons shall still be deemed eligible
candidates for the medals in case, of adequate merit.

11. After a lapse of not leas than ten years from the decease of
the founder it shall be competent for the presidents of the two royal
colleges, and the medical commissioners of the navy, to hold an
interview for the. purpose of consulting whether any and what ad-
ditions and alterations would be advisable in the preceding plan and
regulations, and to adopt them, in case of their being unanimous for
the adoption: subject themselves to the approbation of the Lord
High Admiral, or the commissioners for executing the office of
Lord High Admiral.

■ The founder, with all deference to the high professional authorities
who are to adjudge the medals, begs to suggest and recommend as
tibHow-"-

l* That a book be kept in the custody of the medical <xnaami£sion-
ers of the Royal Navy, wherein is to be transcribed the plan and re-
gulations, and to serve also as a record of the periodical Adjudica-
tions, and wherein not only the names of the successful candidate*
may be inscribed, but also of all those of the first selection ; among
whom it cannot be doubted, that there will be found tokens of merit,
which may go without their due reward from the limited number of
medals, and all of whom will of course possess a considerable share of
merit above the unoelected, and be deserving of consideration.

£. That there be transcribed into this book of record such remarks
as may have arisen out of the examinations, deliberations and discus-
sions of those appointed to adjudge the medals, and which may prove
a source of much vuluable information, not only for the interests of
the. Navy but of the community at large, while it will open a. source
of liberal and useful intercourse between the members of the different
public professional institutions of the Empire, provided some degree
of publicity should be given to them.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 29. NOVEMBER I/IS90. Vol. V.

CRITICAL REVIEW.

\.—A Practical Treatise on the Diseases of the Eye. By
William Mackenzie, Lecturer on the Eye in the Univer-
sity of Glasgow, and one Qf the Surgeons to the Glasgow
Infirmary. London, 8vo. pp. 861. 1830. Longman & Co.

II. — Traiti Pratique sur les Maladies des Yeux, 6u Le~
cons donnees llnfirmarie Ophthalmique de Londres en
1825 et 1826, sur FAnatomie, la Physiologie et de la
Pathologie des yeux. Par le Docteur W. Lawrence.,
traduit de Vanglais avec des notes, et suivi d'un Precis,
de Vanatomie pathologie de Voeil. Par le Docteur C.
Billard (,d' Angers.) 8vo. pp. 499. London and Paris,
1830. J. B. Bailliere.

Mr. Mackenzie's work is decidedly the'best and most com-
prehensive on the diseases of the eye ever published ih this
country, and will be one of reference and standard autho-
rity. He describes about two hundred and eighty diseases,
and- many more, if we include the different species. Such
a work was much wanted, for there is nothing equal to it
in our language.. It is a work of great practical utility,
and will find a place in every medical library. The author
has afforded ample proof of great observation, extensive
experience, considerable research, and high talent. No man
can say of this production, ".a book is a bo6k, aWrough
there. is nothing in it.1' The contents alone occupy ten
pages of small close print. There is no book making here,
the pages afre large and solid, arid every one df them re-
plete with valuable and varied information. It ' is quite
impossible to review a work of this extent, we cah only
notice a few articles. The following account of gonorrhoea!

VOL. V. HO. 29. Y Y

362

Critical Review.

ophthalmia forms a great contrast to Mr. Lawrence's de-
scription detailed in our last, but especially as to the treat-
ment. We are extremely happy to observe our comments
on the dangerous plan recommended, of abstracting blood,
while any can be obtained from the vein, supported by
such high authority. A moment's reflection must convince
any man who calls to mind the difference of age, sex, tem-
perament, habit, state of general health, and idiosyncrasy,
that no rule can be safely laid down as to the quantity of
blood which ought to be taken ; for the effects of loss of
blood are so various as to set all rules at defiance. Hence
few practitioners of the present day will order a definite
quantity ; they use the caution, so well expressed by the
phrase, pro ut ferant vires ; and the man who orders the
removal of a certain quantity, forgets one of the most
important and valuable principles of science. The exces-
sive and profuse depletion upon which we comment, is not
deemed necessary by the author before us.

" Treatment. This ought to be exactly the same as in the Egyp-
tian ophthalmia. Abstinence from all stimulants ; blood-letting, both
general and local ; and the exhibition of purgatives, or emeto-pur-
gatives, and diaphoretics, are to be had recourse to in the early
stage. The discharge is to be frequently and carefully removed
with the muriate of mercury coUyrium, the conjunctiva is to be
touched once or twice a day with the nitras argenti solution, and the
lids are to be prevented from adhering by the use of the red preci-
pitate salve. Counter-irritation ou&ht to be employed from the very
first, by means of sinapisms and blisters to the neck, between the
shoulders, or behind the ears. If either the pain of the eye is pul-
sative, or the circumorbital region affected with nocturnal paroxysms
of pain, calomel and opium are to be given, till the mouth is sore.
Warm fomentations, the vapour of laudanum, opiate friction of the
head, and the like, will serve to moderate the pain ; but our chief
reliance must be placed on depletion, counter-irritation, scarification,
and smarting applications to the conjunctiva, for removing the
disease. Snipping out a portion of the chemosed membrane, so as
to procure a considerable flow of blood, is highly serviceable.

" Bleeding alone must not be depended on. ' '1 he inflammation
produced,' says Mr. Bacot, ' in the four instances that have come
under my observation, is of the most violent and intractable descrip-
tion, and has produced the total destruction of the organ of vision,
in the space 'of two or three days, notwithstanding the most vigorous
employment of general and topical blood-letting, and other anti-
phlogistic means/

" The acetate of lead and the sulphates of zinc and copper, at
least in the early stage, will be found to aggravate the symptoms.
These are the local remedies recommended by Mr. Allan ; and the
case already quoted, the publication of which does great credit to

Mr. Mackenzie on Diseases of the Eye. 363

his candour, shows how little adapted these applications are to this
disease."— p. 370.

Our author describes purulent ophthalmia of new-bom
children, which is so important, that we insert the article
in full.

" Infants, soon after birth, are subject to a puro-mucous in-
flammation of the conjunctiva, commonly denominated ophthalmia
neonatorum, or the purulent ophthalmia of infants. We have reason
to believe that this disease is, in general, an inoculation of the con-
junctiva by leucorrhoeal fluid, during parturition ; und that, there-
fore, it may be prevented, in almost all cases, by carefully washing
the eyes of the infant with tepid water, as soon as it is removed
from the mother. This is too seldom attended to; the child is
allowed to open its eyes, the nurse sitting down with it on a low
seat before the fire, or in a draught of cold air from the door, and
nothing is done to the child for perhaps half an hour or longer.
Exposure to the light, to the heat of the fire, or to the cold draught
from the door, are all likely enough injuriously to excite the eyes
of the new-born infant ; and, accordingly, some have been led to
attribute the purulent ophthalmia which so frequently shows itself
about the third day after birth, to these causes. It will, in general,
be found, however, that when the child becomes affected with this
ophthalmia, the mother has had leucorrhoea before and at parturi-
tion, and that the eyes have not been cleaned for some time after
birth. To this the ophthalmia seems to be owing, for, like a
disease communicated by contagion, it is sudden in its attack, and
much more violent than we almost ever see catarrhal ophthalmia,
so that it resembles in this respect the Egyptian, or the gonorrhoea!
inflammation of the conjunctiva. That some of the cases of puru-
lent ophthalmia, in ' infants, are catarrhal, is by no means unlikely ;
occasionally they may arise from the application even of gonorrhoea!
matter from the mother ; but by far the greater number, I believe
to be the consequences of leucorrhoeal inoculation.

" Symptoms. It is commonly on the morning of the third day
after birth, that the eyelids of the infant are observed to be glued
together by concrete purulent matter. On opening them, a drop of
thick white fluid is discharged, and on examining the inside of the
lids, they are found extremely vascular and considerably swollen.
If neglected, as this disease but too often is, or treated with some
such useless application as a little of the mother's milk, the swel-
ling of the conjunctiva goes on rapidly to increase, .the purulent
discharge becomes very copious, and the skin of the lids assumes a
dark red colour. In this state the eyes may continue for eight days,
or a few days longer, without any affection of the transparent parts,
except perhaps slight haziness of the cornea. About the twelfth
day, however, the cornea is apt to become infiltrated with pus, its
texture is speedily destroyed, it gives way by ulceration, first of all
exteriority to the pus effused between its lamella?, and then through

364 Critical Review.

its whole thickness, and this either in a small- spot only, or over
almost its whole extent, so that sometimes we find only a small
penetrating ulcer, with the iris pressing through it, in other cases
the whole cornea gone, and the humours protruding.

" It is melancholy to reflect on the frequency of destroyed vision
from this disease, especially as the complaint is completely within
control, if properly treated. The attendants unfortunately are not \
alarmed sufficiently early, by what they consider as merely a little
matter running from the eye ; and but too often it happens that
medical practitioners are also betrayed into the false supposition,
that there is nothing dangerous in the complaint, till the come*
burst, and the eyes are for ever destroyed. Many children have
been brought to me in this state ; but the most deplorable instance
which I have witnessed of the effects of this disease, when neglected
or mistreated, was that of two twin infants, from Perthshire, for
whom I was consulted, some time ago. One of the children had
lost the sight of both eyes totally, while the other retained a very
partial vision with one eye.

" That this disease is a puro-mucous or blenorrhoeal conjunctivitis
is sufficiently evident. It is scarcely necessary to spend time in
refuting Mr. Saunders's notion of its being an erysipelatous in-
flammation. His opinion regarding the mode in which the cornea is
destroyed in this disease appears of more importance, and equally
incorrect. He maintains that it is by sloughing, not by suppuration
and ulceration, that the destruction of the cornea is effected. The
opportunities which I have had of watching the progress of the
affection of the cornea have convinced me of the contrary. Onyx
or infiltration of pus between the lamella* of the cornea is the uni-
form harbinger of destruction ; the lamellae exterior to the pus give
way by ulceration ; the ulcer spreads and deepens, till the cornea is
penetrated, and often almost altogether destroyed. Any thing like
mortification, or sloughing, 1 have never seen. The coming away
of the purulent infiltration, exposed by ulceration, must have given
rise to Mr. Saunders's notion of successive sloughs.

" Infants labouring under this ophthalmia are fretful and
uneasy, and rest ill during the night. The tongue is white, and
bowels deranged. If the disease is neglected, the flesh wastes away,
and the integuments become loose and ill-coloured.

" Prognosis. When a child is brought to us with this disease,
our first business is carefully to clean and examine the eyes, ex-
plaining to the nurse the manner in which she is to remove the
purulent discharge from time to time, and stating plainly what is
likely to be the result of the morbid changes already present in the
corneas. If these important parts are only free from ulceration,
and from purulent infiltration, however violent the inflammation may
be and profuse the discharge, our prognosis may be favourable — the
sight is safe. If there is superficial ulceration, without onyx, pro-
bably a slight speck may remain. If the ulceration is deep, an
indelible opacity must be the consequence. If the iris is protruding
through a small penetrating ulcer, the pupil will be permanently dis-

Mr. Mackenzie on Diseases of the Eye. 365

figured, and vision' more or less impeded. If the ulcer is directly
over the pupil, the probability is that the pupillary edge of the iris
will adhere to the cicatrice, and vision be lost until a lateral pupil be
formed in after-life by an operation. If there is a considerable
onyx, we can promise nothing, for although under proper treatment,
the matter may be absorbed, this is by no means a certain result ; the
purulent exudation may, on the contrary, increase, the cornea burst,
and the eye become partially or totally staphylomatous. Whenever
the person who brings the child to me announces that the disease
has continued for three weeks, I open the lids of the infant with the
fearful presentiment that vision is lost, and but too often I find one
or both of the cornea gone, and the iris and humours protruding.
In this case, it is our painful duty to say that there is no hope of
sight,

" Treatment. 1. As it is of the utmost importance to remove the
purulent discharge, from time to time, in the course of the day, I
may perhiips be excused for explaining minutely how the eyes are
to be cleaned. The surgeon lays a towel over his knees, on which
to receive the head of the child, whom the nurse, sitting before him,
lays across her lap. The fluid for washing the eyes is the tepid
solution of one grain of corrosive sublimate in eight ounces of
water. The lids are opened gently, and, with a small bit of sponge,
the purulent discharge is removed. The lower lid, and then the
upper, are next everted, and wiped clean with the sponge. The
upper lid has a tendency to remain everted, especially if the child
cries. This is overcome by pushing the swoln conjunctiva into its
place, and bringing down the edge of the lid. All this ought to be
repeated three or four times, or oftener, in the twenty-four hours,
by the nurse.

" 2. The corrosive sublimate coUyrium, used in cleaning the
eyes, tends gently to repress the discharge. Alone, however, it is
not sufficient for that purpose) and we have recourse, therefore, to
astringent applications of more power. The solutions of nitras
argenti and sulphas cupri are those I have found most useful. Once,
or at most twice a day, I apply, with a large camel-hair pencil, the
solution of four grains of the former, or six of the latter, in an
ounce of distilled water, to the whole surface of the inflamed con-
junctiva, immediately after having cleaned it as above described.
Not only the local, but even the constitutional good effects of
removing and restraining the purulent discharge are very remark-
able. Tne first night after the use of the collyrium and drops, we
generally find that the infant has been much quieter than it had been
when the disease was neglected.

" 3. To prevent the eyelids from adhering during the night, the
red precipitate ointment is to be applied along their edges at bed-
tune.

•

" 4. The above remedies are perfectly sufficient to remove this
disease, if had recourse to within two or three days after the first
symptoms have shown themselves. I have seen two applications
of the nitras argenti solution, viz. on the third and fourth days

366

Critical Review.

after birth, or first and second days of the disease's showing itself, re-
move the complaint completely, although thick matter had been se-
creted by the conjunctiva. In cases attended by a discharge less dis-
tinctly puriform, the use of the red precipitate salve at bed time has
sometimes been sufficient. In cases, again, which have been neglected
for perhaps eight or ten days, it is necessary to take away blood
from the conjunctiva by scarification, or from the external surface
of the eyelid by the application of a leech. The latter may be had
recourse to in the first instance, and unless followed by marked
abatement of the redness and swelling on the inside of the lids,
the conjunctiva may next day be divided with the lancet. The
taking away of blood in either of these ways is productive of much
benefit, and ought by no means to be omitted, if there be any ten-
dency to chemosis or any threatening of haziness of the cornea.
A more profuse loss of blood than can be obtained by the methods
here recommended, I do not consider necessary.

" 5. A remedy of great service in this disease is the application
of blisters behind the ears, or to the back of the head. Cantharides
plaster spread on a bit of candle-wick, and laid between the head
and the external ear, is a convenient mode of breaking the skin ;
and by continuing this application either constantly, or several hours
daily, a continued discharge will be procured. As soon as there is
a discharge of matter from the blistered parts, we find an amend-
ment in the affection of the eyes ; but if the ears are allowed to
get well, we often observe a renewal of the inflammation of the
conjunctiva, and a more copious flow of puriform matter, which
again subside if the blisters are reapplied.

" 6. An occasional dose of castor oil will be found useful.

" 7* Recovery from this disease is often tedious. For weeks,
we continue the treatment above recommended, and although there
is no change for the worse, nor any affection of the cornea, and
perhaps but little purulent discharge, still the conjunctiva continues
inflamed, and the symptoms on the whole stationary. Under these
circumstances, I have found small doses of calomel highly useful.
From a quarter to half a grain daily will be sufficient.

" In threatened disorganization of the cornea, Mr. Saunders has
strongly recommended the extract of cinchona. The sulphate of
quina will probably answer better, and be more easily administered.
Half a grain may be given twice or thrice daily.

" 9. The relaxed conjunctiva, after the purulent discharge has
entirely subsided, may be advantageously touched once a day with
vinum opii, in place of the metallic solutions. I have sometimes
treated cases with the vinum opii throughout, but I consider this
remedy as more applicable for the chronic stage of the complaint than
for the acute." — p. 365.

We endeavoured to give a listx>f the diseases of the eye de-
scribed by Mr. Mackenzie, but it was impossible to condense
one line of his extensive contents, or to occupy ten pages of
our space in the mere enumeration of the diseases of which he

Mr. Mackenzie on Diseases of the Eye- 367

has so ably and lucidly treated. The following comprehen-
sive account of scrofulous ophthalmia merits attention : —

" Scrofulous ophthalmia is distinguished from all the other inflam-
mations of the eye by symptoms so very striking, that any one who
has seen the disease once or twice, cannot mistake it, even although
the general habit of the patient be concealed from him. Slight red-
ness, great intolerance of light, pimples or small pustules on the con-
junctiva, and specks on the cornea, resulting from these pimples, are
the symptoms which characterize this ophthalmia ; a disease to which
scrofulous children are so liable, that out of the 100, 90 cases of in-
flammation of the eyes in young subjects are of this kind. It is very
often the first manifestation of a scrofulous constitution; and, ne-
glected or mistreated, becomes the frequent source of permanently
impaired vision, or even of entire loss of sight. This disease seldom
attacks infants at the breast ; from the time of weaning till about
eight years of age is the period of life during which it is most pre-
valent. Sometimes only one eye is attacked ; at other times, both
are affected from die first. Not unfrequently, the disease passes from
the one eye to the other. When both are inflamed at once, the one
is generally much worse than the other.

" Symptoms — 1. Redness. At the commencement of the disease
the redness of the conjunctiva is very slight. It often exists only on
the inside of the lids. Sometimes a few scattered vessels are seen
coursing through the conjunctiva towards the cornea ; in other cases,
no enlarged vessels are perceived, so that the disease in this incipient
stage, is distinguished more by intolerance of light than by any direct
signs of inflammation. In most cases three or four enlarged vessels
are discovered, running from either angle towards the cornea, or over
its edge towards its centre. They are evidently superficial, and even
project above the level of the conjunctiva. Not unfrequently they
form a considerable fasciculus ; and we know from abundant experi-
ence of this disease, that at the end of such a cluster of vessels, a
pimple is very likely to appear, if already there does not exist some-
thing of that sort too small as yet to attract notice. Although in by
for the greater number of cases, the redness is scattered, it sometimes
happens that it is pretty general over the conjunctiva, even from the
first. As the disease advances, the redness becomes increased, and
the sclerotica also appears somewhat inflamed.

" 2. Pustules — Ulcers — Protrusions — Specks. This ophthalmia is
an eruptive disease. It affects the conjunctiva, not as a mucous mem-
brane, but as a continuation of skin over the eye. One of the most
remarkable symptoms of the disease is that at the apex of each of the
handles of blood-vessels, there arises one or more phlyctenules or
minute pustules. In many instances, a single minute elevated point,
of an opaque white colour, near the centre of the cornea, is all that is
to be seen of this kind ; in other cases, numerous pustules or phlyc-
tenule are scattered over different parts of the conjunctiva, some on
the cornea, and others over the sclerotica. - The edge of the cornea
is a very common situation for them. They vary in size according to

368 Critical Review.

the part of the conjunctiva in which they appear, being commonly
smallest on the cornea.

" Beer has particularly mentioned phlyctenular as distinguished
from pustules in this eruptive ophthalmia. We unquestionably meet
with pimples of different sizes in this disease Some patients have
them all small like what are termed phlyctenular and others have
them all large like pustules. The former contain a smaller quantity
of fluid, and that thin and colourless. The fluid contained in the
latter is greater in quantity and more like pus. I have not been able
to decide whether there is any specific difference between the phlyc-
tenular and the pustular cases. I have frequently observed that the
pustular cases are not, in general, attended with so much intolerance
of light. The cases in which children lie for weeks and months with
their eyes shut, are phlyctenular. The pustular variety certainly
does not differ from the phlyctenular merely in the inflammatory
action being more severe in the former ; for we meet with cases of
very large pustules, in which the inflammation and pain are mode-
rate, compared to what attend some cases of phlyctenula. The
ulcer which succeeds to phlyctenula is sometimes superficial, but at
other times it grows deep, and penetrates into the substances, or
even through the cornea, so that no distinction can be grounded
on the kind of ulcer which follows the bursting of these pimples.

The phlyctenular and pustules which occur in scrofulous ophthal-
mia may be absorbed ; and then, if situated on the cornea, they
leave a little albugo, the effect of that effusion of coagulable lymph
which surrounds every circumscribed abscess, but which will, in
general, be totally removed by absorption in the course of time.
Occasionally it happens, that after an albugo is removed by absorp-
tion, a transparent dimple is left in the cornea, which is long of
filling up. In some cases, we see the albugo begin to spread over
the cornea in an irregular manner ; pretty considerable red vessels
running into it, and additional lymph being supplied to it, so as to
form what I call vascular speck, which is a very tedious and trouble-
some symptom.

" Fully as often, these pimples burst, and become small ulcers,
sometimes superficial and considerable in extent, more frequently
deep and funnel-shaped. This forms one of the most distressing
and formidable symptoms of the disease. Over the sclerotica, indeed,
an ulcer, arising from the rupture of a phlyctenula, or pustule, is of
less consequence, but, on the cornea, the transparent inlet of light,
an ulcer of any description is an event exceedingly to be depre-
cated. It is very apt to disfigure the eye : and by the opaque
cicatrice, which it leaves behind, permanently to obscure vision.

" The formation of an ulcer, especially if it be situated on the
cornea, always produces an increase of pain and redness ; the pain
being greatly aggravated on any attempt to move the eye, and ac-
companied by a gush of hot tears.

" The ulcer produced by a pustule is apt to become surrounded by
a soft reddish edge, easily excited to bleed, especially if situated in the
loose conjunctiva over the sclerotica ; but on the cornea, the edge of

Mr. Mackenzie on Diseases of the Eye. 369

the ulcer is sharper and more abrupt, and the surface of a gray or
ash colour, is frequently covered with an adhesive flocculent matter.
It but too often happens that this kind of ulcer is permitted, by
neglect or mismanagement, to penetrate gradually through the whole
of the lamina? of the cornea, into the anterior chamber. Through
the little fistulous opening of the cornea thus formed, the aqueous
humour is discharged, and a small portion of the iris protruding,
looks not unlike the head of a fly. Hence this symptom is termed
myocephalon. This piece of iris unites, by adhesive inflammation,
to the opening through which it is prolapsed, the ulcer around it
gradually contracts .and whitens at the edge, the protruded portion
of iris disappears, and a white indelible cicatrice of the cornea par-
tially or entirely prevents vision. A cicatrice of the cornea is called
a leucoma, in contradistinction to albugo ; the latter opacity being
the result of effusion, not of ulceration. If the ulcer has extended
deep into the substance of the cornea, and much more if it has pene-
trated through it completely, the leucoma which follows remains
for life, although in the progress of growth, and after a length of
time, it may contract considerably. The cicatrice resulting from a
superficial ulcer may entirely disappear. Indeed the cicatrice from
a superficial ulcer is sometimes transparent from the first.

" If several pustules form on the cornea at the same time, it some-
times happens that they unite with one another before they burst,
so that the purulent matter is infiltrated between the lamellae, and
thus a kind of onyx is formed. At other times, onyx appears at the
lower edge of the cornea, independently of the existence of pustules.

" In some cases of ulcer of the cornea, the progress of the ulcer is
unimpeded till the whole thickness of the cornea is penetrated, except
the lining membrane ; which seems to arrest the ulcerative process,
but being unable to withstand the push made by the aqueous
humour, is projected through the ulcer in the form of a small vesicle.
This is what is called hernia corneoe. At last this vesicular pro-
trusion gives way, the aqueous humour escapes, prolapsus of the
iris follows, and a dense opaque cicatrice will be the result.

" Where there has been an extensive prolapsus of the iris, through
an ulcer of the cornea, the pseudo-cornea which is formed over the
protruded portion of iris, is sometimes unable to withstand the pres-
sure of the aqueous humour, but is pressed forwards so as to form a
partial stahpyloma."

Our author next accounts for the pain, intolerance of
light, epiphora, occasionally iritis, ophthalmia tarsi, and
wen makes some pertinent remarks upon the strumous
diathesis, food, air, exercise, clothing, climate, exciting
causes, as measles, scarlatina, small pox, dentition, and
injuries applied to the eyes. He then* describes the treat-
ment.

" We are obliged to speak of the treatment of strumous ophthalmia
in very different language from what we employ in advising remedies

Vol. v. no. 29. z z

370 Gh'itical Review,

for almost any other inflammatory disease of the eye. In other oph-
thalmias, we say, follow this plan of treatment which we recom-
mend, and the disease will speedily be overcome. We speak thus
of the catarrhal ophthalmia, and of several others, but we cannot
speak in this way of the scrofulous. We are forced to confess that
in many cases this ophthalmia proves rebellious. IT it be asked
why it does not yield even to the best directed treatment, we answer
this question by proposing another ; namely, why does an inflamed
gland of the neck, in a scrofulous individual prove so troublesome,
going on to suppurate in spite of every means adopted to promote
resolution, and after it has suppurated and burst, continuing to dis-
charge for years ? The strumous constitution is the cause of the
extreme tediousness of this ophthalmia, as well as of the frequently
intractable nature of other strumous diseases ; and till we discover
means for curing scrofula, this ophthalmia will continue occasionally
to mock, by its stubbornness, even the best and most carefully
pursued plan of cure.

"Is it curable then? Are we to do nothing for it ; but shake
our heads, and leave the eyes to be destroyed ? Not at all. Much
may be done to relieve this disease. Although it is very difficult to
cure it thoroughly, especially when the patient continues exposed to
the influence of the same causes which originally produced it, yet it
is care indeed that medical treatment does not moderate the symp-
toms, and avert those changes in the transparent front of the eye,
which in neglected cases are so often the cause of loss of sight. But
when the practitioner does meet with cases, as sometimes he must
do, which receive no benefit for weeks and months, but perhaiis rather
get worse, notwithstanding all that is done for them, he must not
blame himself too much, but reflect on the intractable diathesis with
which, in such cases, he is called to contend, and which he cannot
change, and but too often can scarcely in the smallest degree
ameliorate.

" In the treatment of this disease, it is necessary constantly to
bear in mind that it depends on a constitutional cause. To relieve
the local affection, therefore, will not be sufficient We must en-
deavour to improve the general health.

"1. General Remedies. 1. Bleeding. General blood-letting is
hardly ever required ; nor need local bleeding be had recourse to,
unless considerable febrile excitement, as well as local distress, he
present. When the inflammatory action runs higher than ordinary,
or where it is suddenly or violently augmented by the formation of
pimples or ulcers on the cornea, it is proper to moderate the impetus
of the blood by the application of leeches to the eyelids or the
temple. If the constitution is not as yet impaired by long con-
tinuance of the disease, and the employment of many debilitating
remedies, -repeated recourse must be had to the use of leeches, so
long as the redness of the conjunctiva is considerable, and the in-
tolerance of light acute. It must be kept in mind, however, that
not unfrequently we may dispense with bleeding entirely, by
putting the patient under the influence of tartar emetic ; and that by

Mr. Mackenzie on Disease of the Eye. 371

depletion alone, no case of this disease can ever be cured. On the
contrary, repeated bleedings, without the use of other remedies,
reduce too much the general strength, and render the eye more sus-
ceptible of destructive changes.

'* 2. Emetics and navseants. One of the most powerful and
successful methods of treating scrofulous ophthalmia is by means of
tartar emetic, either in such doses as to produce vomiting; in
smaller quantities frequently repeated, so as to excite nausea ; or
combined -with a purgative. There is perhaps no remedy in the
whole materia medica which possesses equal powers of a sedative
kind in this disease. It reduces very considerably the necessity of
general and local blood-letting.

" I generally commence die treatment of a case of scrofulous
ophthalmia with an emetic, either of ipecacuan or tartrate of an-
timony, and with uniform good effects.

" In cases where there is considerable quickness of pulse, I fre-
quently put the patient on a course of nauseants, or of emeto-cathar-
tics. For instance, to an adult a mixture may be given of from one
to four grains of tartar emetic, with from one to two ounces of
sulphate of magnesia, dissolved in a pound of water. Of this solu-
tion two or three tablespoonfuls may be taken every half hour till
vomiting is excited; after which, the dose is to be repeated at
intervals of three, four, or six hours, as circumstances may require.
This is the method to be followed in acute cases. In chronic cases,
the nauseant may be exhibited at longer intervals. It may then be
more conveniently exhibited in pills; each pill containing from a
quarter to half a grain or more of the tartar emetic.

" In cases of children, the same solution of tartar emetic and salts
may be employed, or a solution of tartar emetic by itself, or powders
of the same rubbed up with a little sugar. From the twelfth to the
sixth of a grain, may be given according to the age of the child,
thrice a day. When there is much quickness of pulse, this plan
will often prove effectual, while purgatives or tonics would produce
little or no good.

" 3. Purgatives. In children labouring under strumous ophthal-
mia, there is commonly a full and hard abdomen, and a loaded state
of the stomach and bowels. Even in feeble and emaciated children,
it will usually be found, that, by the exhibition of purgatives, a large
quantity of unnatural feculent matter will be discharged. In such
cases the administration of purgatives is followed by marked benefit ;
without these, other remedies avail but little. In recent cases, a
purge of calomel, with jalap, rhubarb, scammony, will often be
sufficient to remove the attack of ophthalmia altogether. Such a
purgative is to be repeated at intervals of two, three, or more days,
according to the urgency of the symptoms. It not only empties the
bowels*; but reduces very powerfully the impetus of the blood in the
affected part, increases the action of the absorbents, and restores to
a healthy state the secretions of the digestive organs. It proves, in
short, alterative, as well as depletive ; and its use as such may be
persisted in, in many cases, for a length of time, with very decided

372 Critical Review. ^

benefit. I have found the purgative plan to be more useful than
any other, in those cases in which an impetiginous eruption over
the body accompanies the affection of the eyes. Care, however,
must be taken not to push its debilitating action too far.

" 4. Tonics. There are several remedies of this class, which
prove strikingly beneficial in the treatment of scrofulous ophthalmia.

" After a trial of numerous and various internal remedies in this
disease, I have found none so useful as the sulphate of quina. It
exercises a remarkable power over the constitutional disorder which
attends this ophthalmia, and thereby over the local complaint. The
dose which I employ is generally a grain thrice a day, rubbed up
with a little sugar ; in very young children, half a grain ; and in
adolescents or adults, two grains. Cinchona is not a new remedy
in this ophthalmia. Dr. Fothergill recommended it many years ago
in very strong terms ; but its powers, in the form of powdered bark,
or in any other form in which I have tried it, are insignificant in
comparison to those of the sulphate of quina. In most instances, its
effects are very remarkable; and, indeed, (although I have met
with a few cases which appeared to resist its beneficial influence),
in' most of the little patients to whom I have administered it, it has
acted like a charm ; abating, commonly in a few days, the excessive
intolerance of light and profuse epiphora, promoting the absorption
of pustules, and hastening the cicatrization of ulcers of the cornea.
The use of this medicine may be begun as soon as the stomach has
been cleared by an emetic, and the bowels put to rights by repeated
doses of calomel with rhubarb, or some other such purgative, unless
the pulse is very quick, when small doses of tartar emetic will be
preferable, or when an impetiginous eruption is observed on the
surface of the body, in which case a course of purgatives ought to be
adopted."

Chalybeates are used next to quinine ; the precipitated car-
bonate of iron and tartrate of potass and iron, are the forms
of iron said to be most useful. Rhubarb and super carbonate
of soda are also recommended, and the mineral acids, espe-
cially the sulphuric, will also be found useful. Tepid baths
are soothing in the acute stage, while cold balking and
change of air, are highly beneficial after the attack ts sub-
dued. A dry, warm, inland situation, is preferable to the
sea coast. The glow from the sea is very apt to aggravate
slight attacks, and give rise to relapses.

"5. Alteratives. Calomel is very often administered in strumous
ophthalmia ; more frequently, however, as a purgative than as an
alterative. That this medicine is injurious to children, does not
admit of doubt. That their constitutions are often shattered by an
indiscriminate use of calomel, and that in this way they are rendered
more susceptible of suffering from the exciting causes of scrofula,
is a truth which, at the present day, is overlooked to a most la-
mentable degree.

Mr. Mackenzie on Diseases of the Eye. 373

11 Given as an alterative in strumous ophthalmia, 1 have frequently
known mercury prove injurious, because mistimed ; that is to say, it
was administered before the irritation depending the acute stage of
the disease was moderated by depletion, After local blood-letting,
and the use of evacuantB, we sometimes find decided advantage from
the exhibition of calomel with opium. This combination may even
be pushed, in some cases, till the mouth is affected, with benefit.

" 6. Diaphoretics. Keeping up a healthy action of the skin is of much
importance in this disease. This may be done by the tepid bath every
second or third day, followed in adults by the use of the flesh- brush.
Dover's powder at bedtime sometimes proves useful, by promoting a
healthy action of the skin, as well as soothing irritation, and procur-
ing sleep. In cases where the perspiration is immoderate, this medi-
cine is not less remarkable for its good effects than where the surface
of the body is dry and husky. Tartar emetic operates also with
good effect on the skin, and sympathetically on the conjunctiva.

"7. Diet. During the continuance of an attack of active inflam-
mation, abstinence from animal food, and from all kinds of fermented
and heating liquors, should be strictly enjoined ; but when the acute
symptoms have subsided, and the disease assumed a chronic charac-
ter, the patient ought to be put upon rather a generous diet. As there
can be no doubt that unwholesome food is one of the chief causes of
scrofulous ophthalmia among the poor, it is of much importance to pro-
care for the patients in these circumstances, a more invigorating diet.
It is necessary strictly to forbid the use of articles likely to derange
the stomach ; as pastry of every sort, comfits, vegetable jellies, and
preserves; and indigestible substances, as unripe fruits, nuts, and
the like.

" 8. Temper. This disease is extremely apt to render the child
fretful, and by mismanagement to lay the foundation of bad temper,
which, on the other hand, tends much to prolong and aggravate the
symptoms. We find in good-natured children, and in those who are
under proper management, that the disease disappears much more
readily ; while in spoiled children, who cry perhaps for hours after
the eyes are examined, or after the application of any remedy, it is
apt to become almost incurable.

" 9. Position in bed. The head should be raised as much as possible*
during the night. On no account, ought the child to be suffered to
lie burying its face in the 'pillow.

" Local remedies. 1. Shading the eyes. The morbid irritability
which marks this disease so strikingly through all its stages is to be
relieved by wearing a broad green shade over the forehead ; and by
avoiding all employment of the eyes upon minute objects, especially
iu a strong light. It will not be necessary to confine the patient to
* dark room, nor to forbid him from going abroad in fine weather.
We often see children labouring under strumous ophthalmia with
handkerchiefs bound over their eyes, especially when they are taken
out of doors. This practice is decidedly injurious, heating the eyes
too much, and adding to the intolerance of light.
" 2. Evaporation. In recent and slight attacks, the inflammation,

3T4 Critical Review.

pain, and iiritability, may be moderated by die use of evaporating
and slightly astringent lotions, applied tepid or cold according to the
reelings of the patient. In most instances, they agree better in the
tepid state. A decoction of poppy-heads, with a few drops of al-
cohol ; a weak 8>lution of acetate of ammonia ; a little rose water;
or a solution of one grain of corrosive sublimate in eight ounces of
water, will answer the purpose. The application of cold water to
the eyelids, face, and head, generally gives relief in this ophthalmia ;
but in many cases, the reaction which follows is hurtful. The same
may be said of alum curd, and cold sugar of lead poultices, enclosed
in a thin linen bag, and laid over the lids at bedtime.

" 3. Fomentations. When the symptoms are in any degree
severe or of long continuance, warm soothing applications will be
found more useful than cold ones. With a bit of sponge or flannel,
the eyes may be fomented once or oftener in the day with hot de-
coction of chamomile flowers, or of poppy-heads, or with a hot
infusion of opium. Much relief is experienced from exposing the eyes
to the vapour of laudanum, or of camphor, raised by means of a cupful
of hot water. Warm poultices during the night are often useful
They are to be made with crumb of bread, warm water, or sugar of
lead water, and a little fresh butter ; and never with milk.

" 4. Scarification of the inside of the eyelids, especially in chronic
cases, where the palpebral conjunctiva is much loaded with red
vessels, will be found one of the most valuable means of cure. In
cases of vascular speck, division of the fasciculus of vessels running
over the sclerotica to the albugo, cannot be dispensed with ; no
other remedy having the same power of checking this very annoying
and dangerous symptom.

" 5. Counter-irritation. We derive great benefit from blistering
in this disease. The intolerance of light is often suddenly and
almost completely removed by this remedy, the child being enabled,
in a few hours after the blister rises, to open its eyes, although it
had not done so for months before. The temples, behind the ears, the
crown and back of the head, and the nape of the neck, are situations
generally chosen for the application of blisters. The last is the
most painful, but not the least effectual. In general, the discharge
ought to be kept up, by the use of some stimulating dressing; or if
this is not done, a quick succession of blisters ought to be employed.

" Friction with tartar emetic ointment? has sometimes been had
recourse to in this disease, for the purpose of bringing out a crop of
puBtules. This is a practice much more painful than blistering, the
pustules if considerable in size leave indelible pits, and from mis-
management of the remedy large portions of the skin are sometimes
made to slough; so that, on the whole, blistering is preferable.

44 Issues in the neck or on the arm are beneficial, both in relieving
the symptoms of strumous ophthalmia, and in preventing relapses

" 6. Stimulants applied to the inflamed surface of the eye, in this
disease are decidedly useful. Indeed it is scarcely possible to effect
a cure without them. The impetiginous state of the conjunctiva, or
in other words of the skin covering the eye, which constitutes stru-

Mr. Mackenzie on Diseases of the Eye, * 325

mous ophthalmia, not merely bears stimulants, but like most other
chronic cutaneous diseases, is uniformly benefited by their applica-
tion, if they be well chosen, carefully used, and properly timed.
They often act as the best local sedatives, if applied after the acute
inflammatory excitement is subdued by the general remedies already
enumerated. Employed before this is effected, they will scarcely
fail to prove hurtful. In this respect, the treatment of scrofulous
ophthalmia is directly contrary to that of the puromucous inflamma-
tions of the conjunctiva ; for in them we employ stimulants from the
very first, but in the scrofulous ophthalmia we must delay till the
symptoms of irritation are somewhat abated.

" Various stimulants have been used in this ophthalmia ; but the
nitres argenti solution and the red precipitate salve are the most
deserving of confidence. Next to them, I would place the vinum
opii. Whichever be selected, its application must be continued with
regularity once a day, or once every two days, the child being laid
in the horizontal position, the head fixed between the knees, and the
lid opened so as fully to expose the diseased membrane. The solu-
tion of four grains of the nitras argenti in one ounce of distilled
water is the stimulant which I generally employ. It evidently pos-
sesses very considerable power in abating the vascularity of the
conjunctiva, hastening the absorption of pustules, cicatrizing ulcers,
and clearing specks of the cornea. The relief which it affords to
the intolerance of light is not the least of its good effects. In this;
it probably operates by inducing the healing of minute ulcerations,
and the contraction of enlarged blood vessels, both of which give
rise to the sensation of sand in the eve, to spasm of the lids, and
epiphora. Whenever ulceration is present on the cornea, recourse
should be had to the solution of nitras argenti. A stronger solution
than that of four grains to the ounce of distilled water may be employed,
and with a small camel-hair pencil applied directly to the surface of
the ulcer, without permitting the solution to spread over the rest of
the eyes.

" 7/ Solid Caustic. Where an ulcer threatens to penetrate deep
into the substance of the cornea, or when it has already perforated
into the anterior chamber, with or without prolapsus of the iris, it is
proper to touch the ulcer, or the myocephalon, every second or third
day, with a pencil or lunar caustic, filed to a sharp point. Scarpa
has given the best account of the effects of this remedy, to which I
shall again have occasion to refer, under the head of ulcers of the
eomea.

" 8. Belladonna. The case of James Tassie, already detailed at
page 394, strikingly illustrates the utility of applying the extract of
belladonna in cases of central ulcer of the cornea. Even when the
edge of the pupil is involved in such an ulcer, the dilating power of
the belladonna may be sufficient to free it, and thus to preserve the
pupil entire. In cases of perforating ulcer near the edge of the
cornea, I am inclined to refrain from the use of belladonna; for,
while the dilatation cannot in this case be carried so far as to remove
the iris from the vicinity of the ulcer, I believe the state of palsy,

376 Critical Review.

into which the iris is thrown, is apt to favour rather than prevent
prolapsus.

" Relapses. No disease is so apt to recur as scrofulous oph-
thalmia. It is therefore necessary for children who have once
suffered from it to he submitted, from time to time, to the inspection
of their medical attendant, who must endeavour promptly to subdue
every sympton of a re-attack, and to conduct his patients safely
through that period of life which is most exposed to the disease.
In this way, much mischief will easily be prevented, which, neg-
lected, may require years to remove, or prove altogether beyond
remedy." — pp. 400.

Variolous, morbillous, and scarlatinous ophthalmias, are
generally neglected by practitioners, though they are amon?
the most common diseases destructive to vision. We there-
fore place them before our readers.

" In former times small-pox proved but too often the cause of
serious injury to the eyes, or even of entire loss of sight. It was by
far the most frequent cause of partial and total staphyloma. Rut
since the introduction of inoculation, and still more of vaccination,
such injurious effects from variolous ophthalmia are much more rare.

" Symptoms. In most cases of small -pox, pustules form on the
external surface, and on the margins of the eyelids. When they are
numerous, as in confluent small-pox, they cause such swelling of the
lids as completely to close the eyes. As the disease proceeds,
matter is discharged partly from the meibomian follicles, partly from
the variolous pustules, the eyelids are glued together so that the
eys cannot be opened for days, and merely from this state, without
any pustules being formed on the conjunctiva, the eyes are irritated
and painful. At last, as the disease subsides, the swelling of the
lids falls so that they are again opened, and the eyes may be found
uninjured. It is in this way that the vulgar talk of persons being blind
in small-pox for so many days, and then perfectly recovering their
sight. But although the cornea has not suffered in these cases, the
eyelids and the lachrymal apparatus are often left in an injured state;
and not unfrequently small-pox proves the exciting cause of strumous
affections of the eyes and eyelids, which may continue troublesome
for years. The small-pox pustules on the lids are apt to destroy the
eyelashes, to leave red marks and scars, render the edges irregular,
and liable to inflammation and excoriation from slight causes, and to
produce ophthalmia tarsi, and very frequently trichiasis and dis-
tichiasis. Chronic blenorrhoea of the lachrymal sac, and pustular
conjunctivitis, are also frequent sequelae of small-pox. *

" Schemes have been proposed for preventing the pustules of
small-pox from spreading to the face, or at least for moderating the
effects of the eruption. We find that this disease is apt to attack
with peculiar severity any part of the surface of the body labouring
at the time under accidental irritation, and hence it has been sup-
posed that soothing applications may moderate the eruption and its

Mr. Mackenzie on Diseases of the Eye. 377

effects. Covering the face wit6 a cloth spread with cerate, and
fomenting it from time to time with chamomile decoction, have been
used for this purpose, and can do no harm. When the pustules on the
eyelids are folly matured, we may afford considerable relief by prick-
ing them one by one with a needle, so as to evacuate their contents ;
and by carefully removing the crusts which form after the pustules
buret, having first softened them with some mild ointment. The lids
are frequently to be bathed with tepid milk, and bits of sugar rag
moistened with the same are to be laid over them.

" There is in every case of small-pox, some redness of the con-
junctiva. But danger is chiefly to be apprehended when a variolous
pustule or pustules appear on the cornea, where, unfortunately, they
are much more apt to occur than on the conjunctiva covering the
sclerotica. A pustule on the cornea, forming at the time of the
general eruption, is extremely apt to prove destructive. When it
bursts, the ulcer thus formed but too often deepens and spreads, the
cornea is penetrated, the iris advances and adheres, the pupil may
thus be obliterated, or the cornea being much changed in structure,
and adherent, in a great part of its extent, or completely, to the iris,
partial or total staphyloma may be the result. In bad cases, almost
the whole of the cornea is destroyed, by infiltration of matter and
ulceration. *

" During the suppurative stage of small-pox it is difficult to say
what extent of mischief is going on in the eye, under the closed and*
iwoln eyelids. If the patient feels pain in the ball itself, with dry-
ness, stiffness, and a sensation of sand in the eye ; if the uneasiness
be much increased on attempting to move the eye, or on exposing it
to light even through the swoln lids ; and if in addition to the matter
discharged from the pustules on the edges of the lids and from the
meibomian follicles, there is a frequent discharge of hot tears, then
it is probable that there is acute variolous conjunctivitis, and perhaps
pustules on the cornea. But if the eye is easy, only shut up from
the state of the lids, there is probably no danger. The eyes, however,
are not safe, even after the small-pox pustules over the body have
blackened and the scabs fallen off. I have seen both pustule of the
cornea and onyx produced after the general eruption was completely
gone. This has been called with sufficient propriety, secondary va-
riolous ophthalmia. It sometimes occurs as late as five or six weeks
after the patient has recovered from the primary disease. It is cer-
tainly not so severe an affection as the primary, but is still dangerous
in regard to vision. A dull whitish point is observed in the cornea,
*ith surrounding haziness ; the whiteness becomes more extensive,
amounting perhaps to the 1 2th of an inch in diameter, and then the
part becomes yellow. If two or more points should form, the whole
co»nea is rendered nebulous ; or this effect may be produced from
one large variolous pustule. An onyx at the same time may appear
at the lower edge of the cornea. The sclerotica is reddened. Pain
and epiphora are excited on exposure to light.

The secondary variolous ophthalmia seldom leads to destruction
of the cornea. . By proper treatment, the matter of the pustules or

Vol. v. no 29. 3 a

378 Critical Review.

onyx is sometimes absorbed. In other cases, ulceration takes place,
leaving, after cicatrization, a permanent leucoma or white speck.
The surrounding haziness of the cornea is gradually dissipated ; vision
is injured according to the situation and size of the leucoma. Br
the formation of an artificial pupil, vision may in many cases of
this sort be restored. Even when partial staphyloma has formed,
this operation is often applicable.

" Treatment. The best general treatment of small-pox must be
followed ; a moderate temperature, tepid ablution, and a cool re-
gimen. Emetics are occasionally useful ; even blood-letting may be
cautiously employed in some cases, and laxatives are always to be
administered. If the eyes are particularly affected, they must be
frequently bathed with tepid water or poppy decoction, and the
edges of the lids smeared with a little cold cream. In many cases,
the lids are so much swoln, and so completely sealed up, that it
would be in vain to attempt any application to the conjunctiva, till
the eruption begins to fade and the swelling to fall. Leeches may
be applied, not only without impropriety, but with decided advan-
tage, behind the ears or on the temples, and followed, if it appear
necessary, by blisters. About the eighth or ninth day of the erup-
tion, free purging will be found useful, not merely in reducing the
suppurative fever, but in relieving the uneasy and inflamed state of
-the eyes. The lids now begin to be opened, so that a little fluid can
be injected between them and the eyeball. A weak solution of
nitras argenti, or diluted vinum opii, may be used for this purpose.

" As to the treatment of secondary variolous ophthalmia, I have
found tartar emetic, given so as to vomit and purge freely, to be
productive of the best effects, evidently abating the inflammation,
and promoting the absorption of the pustules and onyx. Leeches
and blisters are also useful. As soon as the acuteness of the inflam-
mation is somewhat abated by these means, much advantage will be
gained by putting the patient on a course of sulphate of quina.
Undiluted vinum opii appears to answer best as a local application.
The eye is to be touched with it once a day. Belladonna is to be
applied to the eyebrow, in order to keep the pupil dilated.

" A certain degree of conjunctivitis always attends measles and
scarlet fever, but is in general much less severe than the variolous
inflammation of the eye. In measles and scarlet fever, the change
which the skin undergoes, amounts to little more than vascular con-
gestion, and the conjunctiva, a prolongation of skin, betrays there-
fore little more during the presence of these diseases, than some
degree of redness, with intolerance of light, slight pain, and epiphora.
Occasionally, however, we have phlyctenulae, onyx, and ulcers of the
cornea, brought on by the morbillous and scarlatinous ophthalmia,
particularly when the subject is scrofulous. Indeed, it is difficult to
distinguish either of these ophthalmise from the scrofulous, till the
eruption on the skin makes its appearance. On the other hand, we
often hear of the dregs of the measles and of scarlet fever producing
affections of the eye and eyelids. By this, is generally meant that
the scrofulous diathesis has been called into action by these diseases,

Mr. Mackenzie on Diseases of the Eye. 379

and that ophthalmia tarsi or phlyctenular conjunctivitis has been the
result.

" In measles there is a catarrhal affection of the Schneiderian
membrane, with sneezing and cough, and occasionally the attending
conjunctivitis is not so much eruptive as blenorrhoeal. I have seen
cases in which the eye had been destroyed by severe puro-mucous
ophthalmia excited by measles.

" In some rare cases of scarlatinous ophthalmia, the iris and
capsule of the lens become affected. I operated some time ago on a
boy of about eight years of age, in whom specks of the anterior
hemisphere of the capsule were brought on in this way.

" Treatment. The affection of the eye in measles and scarlet
fever, does not in general require active treatment. The eyes should
be guarded from strong light, bathed occasionally with tepid water,
and the bowels kept freely open. If the symptoms are more than
commonly Bevere, leeches may be set on the temples, and blisters
applied behind the ears, or to the nape of the neck. The nitras
aigenti solution will be found highly useful, whether the ophthalmia
be eruptive or puro-mucous. Sulphate of quiua may be given
internally with good effects -x-p. 406.

The remaining sections in* this chapter are as follow :—
rheumatic, and catarrho-rheumatic ophthalmia, scrofulous
corneitis, rheumatic, syphilitic, pseudo syphilitic, scrofulous
and arthritic iritis, choroiditis, retinitis, aquo-capsulitis,
inflammation of the crystalline lens and capsule, inflamma-
tion of the hyaloid membraue, traumatic, compound and
intermittent ophthalmias. In conclusion, we have to state,
that every disease of the eye is described in this work. We
strongly recommend it for its accuracy, perspicuity, compre-
hensiveness, and the very important' practical details with
which it abounds. It is an accurate, well digested, well
written work, evincing deliberation, research, judgment and
fidelity. It is one of the best monographs which modern
times have produced, and is a valuable addition to our
medical literature. It will add to the well-earned reputa-
tion of the author, and it is highly creditable to the univer-
sity to which he belongs.

Mr. Lawrence's excellent lectures on the anatomy, phy-
siology, and pathology of the diseases of the eye, formed
the best and most comprehensive work, until the appear-
ance of that whose analysis we have concluded. We need
scarcely observe, that these excellent lectures were pub-
lished in the Lancet, hi 1825, and are. now translated into
French, and further extended by Dr. Billard, the accurate
translator, who was pupil to the author, and obtained his
permission to publish the edition before us.

380 Critical Review*

It would be a work of unnecessary labour, to trouble
the reader with Mr. Lawrence's opinions, which must be
familiar to every one, and we may merely observe, that they
comprehend a faithful account of fifty-seven diseases of the
organ of vision and its appendages, to which are added, by
the translator, the following:— -defects of primitive confor-
mations, anopsie, monopsie, augmentation of the number
of the eyes, anormal situation of the eyes, defect of con-
formation of the lids, anomalies of the lachrymal gland,
anomalies of the iris, optic nerve, and lens, congenital
alterations of the humours of the eye, general considera-
tions on the lesions, and accidental tissues of the globe and
dependencies, congestions, inflammations, divers alterations
of the eye, accidental productions, divers modes of disor-
ganization of the eye, hypertrophy, and atrophy* This is
a cheap and valuable wort, which ought to be in the posses-
sion of those who have not an English edition, as it contains a
good deal of highly valuable information. It is well translated,
and the additions of Dr. Billard a#e interesting and instruc-
tive. We strongly recommend it to students as a substitute
for the former, which is treble the expense, and too volu-
minous for this class of readers. Young practitioners, who
are setting out in their career, will find it a valuable addi-
tion to their libraries, and even the most experienced must
be instructed by the additions, which are not to be found
in any work hitherto published on ophthalmology in this
country. On many occasions Mr. Lawrence differs from his
contemporaries, and the opinions of a man so eminent are
entitled to notice and respect.

III. — On the recent Improvements in the Art of distin-
guishing the various Diseases of the Heart, being the
Lumleyan Lectures delivered before the Royal College
of Physicians in the year 1829. By John Elliot son,
M.D. F.R.S., &c. &c. London, 1830. Folio, pp. 36.
Longman and Co.

Dr. Elliotson is a powerful advocate of auscultation, and
strongly defends Laennec, to whom he pays the just tribute
which his great discovery deserves. The avowal of our
author is candid and honorable to his own high character,

as will be seen by the following extract : —

•

" The discoveries made by Laennec in- the symptoms of these
disorders are great enough to entitle him to all the honours which

Dr. Elliotson on Diseases of the Heart. 381

have ever been acquired in our profession. He has enabled us to
judge of diseases, often not otherwise with certainty distinguishable
or not at all, and this with an accuracy inconceivable to those who
are unacquainted with his investigations ; to distinguish diseases of
the heart, which were formerly, and are still too often all, either
expressed by the easy term disease of the heart, without a spe-
cification of the parts affected in the complicated organ; or as
often passed over entirely, while the case is mistaken for hydro-
thorax, or some pulmonary affection, and to distinguish diseases of
the lungs, which, in many cases, could not be pronounced upon
with accuracy, of which, in others, the diagnosis was always uncer-
tain, and moreover to point out the very part affected.

" But the very accuracy of Laennec's discoveries is objected to.
We are asked Cut bono? The answer is plain. It is universally
allowed that every disease should be described,, and its nature
ascertained, as accurately as possible. Now with every advance in
accuracy of description, and in knowledge of the source of symp-
toms, diagnosis imperceptibly and inevitably becomes more accurate.
To condemn accurate diagnosis is therefore to condemn accurate
knowledge — to rest satisfied with imperfect information when in-
dustry would give us more — to admire ignorance when knowledge
is within our reach. Besides, diagnosis ought to be universally
cultivated without reference to its utility in particular instances. . It
is a part of our science ; every part must be cultivated for the per-
fection of the whole, and what may not be practically useful to-day,
may become so to-morrow, &c.

" But there is immediate utility in the discoveries of Avenbrug-
ger and Laennec. No one will pretend that the diagnosis in chronic
diseases of the chest is, with the exception perhaps of phthisis,
generally satisfactory. Before I adopted auscultation, I know that
1 frequently discovered diseases of the heart after death where I had
not previously suspected it, and frequently found the organ sound
when I had suppoesed it diseased. When I was correct in expect-
ing to see organic affection of the heart, I was often wrong as to
the precise nature of the lesion. Too often has auscultation at once
revealed distress of the heart to me, when, by good practitioners,
no affection of the heart, or even of the chest, had been suspected,
or the case had been named nervous palpitation or asthma, when
the longs had been regarded as the seat of the malady, or the case
been treated with the more violent remedies of hydrothorax. Re-
peatedly have I seen chronic bronchitis, with extreme conjestion
of the longs, mistaken for hydrothorax, and unavoidably, so, from
the omission of percussion and auscultation, because the symptoms
were precisely the same, with the exception of those which percus-
sion and auscultation only could disclose. Inflammation, of the
substance of the lungs takes place continually during other diseases,
without .being obvious before death to any but the auscultator and
percussor. Without the aid of the ear, who can ever distinguish
emphysema of the lungs, or in every case pneumato-thorax ?
Both may be readily mistaken for hydrothorax," &c.

382 Critical Review,

Dr. Stokes, of Dublin, and Dr. J. C. Gregory, of Edin-
burgh, have adduced ample proofs in corroboration of our
author's opinions ; indeed, every ardent cultivator of science
bears similar testimony, and it is only the lazy routinists,
who oppose the splendid and important modes of discrimi-
nating pulmonic and cardiac diseases in the manner sug-
fested by the proposers of auscultation and percussion. Dr.
llliotson, however, is of opinion that semeiology must be
duly considered, and by both methods an accurate diagnosis
may be arrived at.

He details some interesting cases of diseases of the heart,
which are well worthy of attentive perusal, the narration of
which would far exceed the limits by which we are circum-
scribed; and after all there could be little practical advan-
tage derived by placing them before our readers. Unfor-
tunately cardiac diseases must be ranked among the opprobria
of our art, though it is a matter of great interest, to be able
to draw a correct diagnosis and prognosis.

There is one great fault in this production, and that is,
it is published in folio, and at a very high price for the
small quantity of matter which it comprises ; the plates are
good, and well engraved from the accurate drawings of
Mr. Alcock, which might be reduced to the quarto or octavo
form. It is a great and prevailing error to publish works
at extravagant prices, which render them inaccessible to the
largest portion of the profession, and stimulate the unprin-
cipled to piracy. Sir Astley Cooper and Mr. Charles Bell
have fkllen into this error, and may be fairly said to have
printed, but not published, many of their works, and thus
excluded nine-tenths of the profession from the advantages
their productions afford. Hence the cheap and spurious
editions of expensive works, which compel the jpuolishers
to reduce their exorbitant charges. Had Dr. Elliotson's
work appeared in an humbler form, it would be in the
hands of every practitioner, as no physician in the kingdom
stands higher, and more justly so, than he does in the
estimation of his contemporaries. He defends Laennec's
opinions on the motions of the heart, in opposition to Dr.
Corrigan and others, and we shall now place the opinions
of all parties before our readers.

" Laennec's correctness, in ascribing the first of the two sounds
of the heart's action in health to the ventricle, and the second to
the auricle, has been called in question, some asserting that the first
sound is the result of the auricular contraction, and the . second of
ventricular ; some that they occur at the moment of the dilatation,
not at the moment of the contraction of the cavities ; and some that

Dr. Elliotson on Diseases of the Heart , 383

Laennec was right in regard to the ventricular sound, hut* that the
second sound cannot arise from the contraction of the auricle, as
Harvey, Haller, Senac, all declare that the auricle may he seen to
contract immediately before the ventricular actions ; and they con-
sider, therefore, the sound which follows the ventricular, to be pro-
duced by some unknown cause, and the auricular contraction to be
without sound, two very singular and very considerable supposi-
tions. The alteration of the sound in narrowing of the respective
openings proves, I think, that Laennec is right ; for if the opening
from a ventricle is narrowed, the healthy sound ascribed by Laennec
to the ventricles is altered ; and if the opening from an auricle is
narrowed, the healthy sound ascribed by him to the auricle is
altered. An argument, in favour of the priority of the auricular
contraction, has been deduced from the veins of the neck, in some
cases, regularly swelling, immediately before the pulse is felt. But
the obstruction of the auricle causing this swelling, does not, I
apprehend, occur during their contraction, for at that moment there
is a free space in the ventricles to receive the auricle blood, and it
is only a part of the auricle that has the power of contraction.
The obstruction which produces the swelling must take place as the
ventricles becomes filled, and the auricular blood consequently
accumulates, and therefore the swelling of the veins must be ex-
pected when the ventricles will receive no more, viz. immediately
before they contract, or while they are contracting. There is no
wonder, theiefbre, that the arteries, according to this account, beat
first ; then a second sound of the heart is heard, 1 presume the
auricular action; and then a short interval occurs before the veins
pulsate — before the blood accumulates in the nuricles previously to
their contraction. The jugular veins are said, by some, always
to be dilated quite synchronously with the pulse of the arteries.

" Since the delivery of these lectures, Laennec's accuracy has
been called in question by others, and the stroke of the heart's
apex, and the first sound of the heart, declared to happen before
the pulse, and to be produced by the dilatation and repletion of the
ventricles ; and the second sound to occur at the moment of the
contraction of the ventricles, and to arise from the flapping of the
parietes of the emptied ventricles together.

" I would reply in the first place, as before, that when an obstruc-
tion exists at the mouth of the aorta, or pulmonary artery, a morbid
sound occurs at the moment Laennec supposes the ventricles to
contract, and when at either auriculo-ventricular opening, at the
moment he supposes the auricles to contract. This could not happen
had he mistaken the periods of the ventricular and the auricular
contractions. Secondly, when the pulse at the wrist follows the
stroke of the heart, it does so after only a very minute interval — such
« may be explained by the distance of the radial artery from the
heart — and actually occurs decidedly before the auricular sound, that
which is now declared to be the ventricular. Moreovei,. when the
pulse at the wrist is observed to follow the stroke of the heart, the
pulse at the innominata (so much nearer the heart) may be found

384 Critical Review.

to precede that at the wrist, and to occur all hut simultaneously with
the heart's stroke, so that the relative distance of the parts explains
the whole difference, and the pulsation of the arteries in all cases
clearly arises from the stroke of the heart. If an artery is observed
still nearer the heart than the innominata, no interval between its
pulse and the stroke of the heart is perceptible. Id four cases < f
aneurism of the ascending aorta, producing a strongly-pulsating
tumour to the right of the sternum, this and the newt, when the
fore-fingers were placed upon both, were felt, and by all seen to
pulsate quite synchronously. When the obstruction is at the mouth
of the aorta or pulmonary artery, the preternatural sound I have
always noticed synchronously with the pulse ; when at an auriculo-
ventricular opeuing, in the intervals of the pulse, afW or before it.
It sometimes, in the latter case, is so prolonged as to last till the
pulse is again felt, so that there is no interval, but merely an equal
alternation of the ventricular and the preternatural auricular sound ;
or even an interval occurs after the ventricular stroke, probably
from the auricle not being disposed for contraction at the usual time,
on account of its contraction having been so lengthened by the dif-
ficult escape of its blood, that a longer rep me is required tlian just
during the ventricular contraction ; here the auricular sound occurs
first, then the ventricular, and then the interval.

" Thirdly, the sounds considered by Laeunec to be auricular
and ventricular are heard loudest both in health and when mor-
bid, at the seat of auricles and ventricles respectively."

Dr. Corrigan's opinions are corroborated by Dr. Stokes
and Mr. Hart, in a short paper in the October number of
our northern contemporary ; and also by another from the
pen of our talented correspondent Mr. Dobson. It is a
curious fact, that these three gentlemen should have arrived
at the same conclusion with Dr. Corrigan, and without the
slightest knowledge of each other's experiments. Dr.
Stokes and Mr. Hart have recorded the following opi-
nions : —

" 1st. That in a state, of health the impulse of the heart precedes
that of the arteries.

" 2d. That the interval between the impulse of the heart and the
pulse in the arteries is in the direct ratio of the distance of the ves-
sels from the centre of the circulation. Thus the interval between
the impulse of the heart and that of the arteria innominata is often
so slight as to be scarcely perceptible : the pulse of the carotid pre-
sents a longer interval, and so on with the rest.

"3d. The pulsations of arteries in different parts of the body,
but at equal distances from the heart, are synchronous. Thus be-
tween the pulsations of the femoral and the radial artery, as felt at
the wrist, no difference could be observed.

" 4th. The greater the distance the longer will be the interval;
^hen the pulsations of the radial artery -always precede those of the
tibial.

Dr. Elliot8on on Diseases of the Heart. 385

5th. That, although the actual pulsation depend on the systole
of the left ventricle, yet the diastole of the vessels does not occur
synchronously in all parts of the body, but is progressive.

" All these observations are most easily made on the healthy
adult subject, whose heart is acting slowly, but at the same time
strongly."

Mr.Dobson's opinions will be found in our last, to which
he has added the following proof in the Lancet ; —

" Having introduced my hand into the thorax of a dog, I grasped
the two venae cava?, so as to preclude the entrance of blood into the
heart. What was the effect ? Why the action of the heart was still
maintained ! Though somewhat enfeebled, it continued to dilate and
contract alternately and regularly. The circumstance, which seemed
rcmarkahry peculiar, was, the diastole, both of the auricles and ven-
tricles, was apparently more energetic than the systole. In this ex-
periment I witnessed the following phenomena :—

" 1. That, during the diastole of the ventricles, the heart was
visibly augmented in size ; and that, during the diastole, it was when
the stroke against the side of the thorax occurred, not only the apex,
bat the anterior surface of the heart, impinged against the thora-
cic wall.

" During the systole of the ventricles, the heart diminished in size,
and receded into the thorax.

" Remembering that, as taught in the schools, this stroke of the
heart against the chest resulted from the aorta endeavouring to
straighten itself, when blood was thrown in, tilting the apex against
the chest. To obviate this effect I grasped the venae cava?, and thus
removed that attributed cause, but the phenomena occurred as before.

" These experiments and observations were made at the least
twelve months ago; consequently, previous to the publication of
Dr. Corrigan's interesting essay."

We shall closely watch the progress of this inquiry, and
place it as early as possible before our readers.

IV.— Transactions of the Association of Fellows and
Licentiates of the King and Queen's College of Physi-
cians in Ireland. New Series, vol. i. Dublin, 1830. J.
M. Leckie.

Another volume of the valuable Transactions of the Dublin
physicians has just issued from the press, which, like its
predecessors, is replete with sound practical information.
We feel much obliged for an early copy of the work,
and shall place a portion of its instructive contents
before our readers. There are two . papers by Dr. Mont-

Voi. v. ho. 29. 3 b

38G Critical Review.

gomery, Professor of Midwifery to the College, which are
deeply interesting, and prove the author to be a man of
acute observation and sound judgment. The first is entitled
" Case of Ovarian Disease of a remarkable Character/'
illustrated by two well executed plates ; — the second, " De-
scription of a very remarkable malformation in a foetus, in
which nearly all the abdominal viscera and the intestinal
canal were external to the body ;" illustrated by an engrav-
ing. We shall notice each of these curious and valuable
papers, and allow the author to introduce himself to our
readers.

" Ovarian Disease. — Mary Clarke, aged 45, the mother of nine
children, the youngest of whom was nine years old, was admitted
into Sir P. Dun's Hospital, and came under my care on the 15th of
August, 1828. She complained of a tumour in the right iliac
region, which she had first perceived about seven years before ; in
addition to this she had slight ascites, which had commenced within
the last four months. She formerly had hernia at both sides, greater
at the right ; the intestines, however, did not now descend, but the
sac was distended by the descent into it of some of the dropsical
fluid. She said that she had been for some time annoyed by fre-
quent discharges from the vagina of the fluid like water, which came
away in small quantities, and she had suffered occasionally from
uterine haemorrhage; on examination per vaginam, I found that
there existed a small cauliflower excrescence of the os uteri ; the
urine was scanty, and the pulse weak, but not much accelerated.

" The countenance had the peculiar expression of distress, which
we so frequently observe in patients reduced and harassed by ail-
ments depending on considerable organic alteration in some internal
viscus or structure, and exhibited a Very unpromising appearance ;
this expression of the countenance, to which, I confess I attach
much weight, taken in combination with the disease of the os uteri,
the tumour in the abdomen, and the ascites, which I looked on as
its effect, justified, I thought, the most unfavourable prognosis;
and although I determined on, and adopted the administration of
diuretics and other remedies, I had but little hope of advantage from
their use.

" After the bowels had been freely emptied, she took a combi-
nation of calomel, digitalis, and squill in pills, and a solution of
crystals of tartar, which was afterwards exchanged for decoction of
broom tops. This treatment was after ten days discontinued, as
the bowels appeared to be disordered by it.

On the 17th, a good deal of uneasiness and tension, with some
pain in the right side and across the abdomen, were complained of,
which symptoms were relieved by the application of leeches to the
abdomen, and the use of the warm hip bath. Pills of calomel and
squill to be taken, which in two days so disagreed, that they were
omitted on the 29th. At this period a great increase had taken place
in the quantity of urine ; but notwithstanding this increase of natural

Dublin Medical Transactions. 387

secretion, the effusion into the abdomen had greatly accumulated,
and occasioned a most distressing sensation of tension.

" I 'wish here to remark particularly, that the distress, complained
of was altogether out of proportion to the degree of distension, and
in consequence, the poor patient was excessively anxious to have
the fluid drawn off by tapping, before it was apparently necessary,
and when the tension was not sufficient to admit of the operation ;
in two days more, however, the fluid had considerably increased in
quantity, causing a great addition of suffering, which the patient
described as affecting her chiefly at the right side, and across the
lower part of the abdomen, the situation chiefly occupied by the
tumour.

" August 31. — She was. tapped by Dr. Jacob at the left side,
as far as possible from the tumour ; and about six quarts of a clear
yellow fluid were drawn off with great and instantaneous relief,
both of the pain in the side, and indeed, of all the uneasiness pre-
Tioosly complained of. I observed that as the fluid was passing
through the canula, several thin membraneous flakes passed with it,
and on examining these afterwards, I was impressed with the idea
that they were portions of ruptured hydatids.

" The evacuation of the fluid, and the consequent flaccidity of
the abdoininal parietes, allowed a more satisfactory examination of
the abdominal tumour, which could be traced down into the pelvis
at the right side, and extending beyond the median line of the
abdomen ; the liver did not appear to be at all enlarged.

" September 3.— Uneasiness about the bladder and perineum ;
relieved by leeches and a warm bath.

" September 4. — Four days after the operation of tapping, an
accumulation of the fluid in the abdominal cavity was evidently
taking place, and anasarca appeared in the left leg and thigh. I
directed pills of blue pill, squill and opium, with draughts contain-
ing nitrous ether, and the abdomen to be well rubbed three times a
day with a liniment composed of three parts linimentum ammonias,
and one part oil of turpentine..

" September 8. — In consequence of heat of skin, full pulse and
some pain in the side, I had eight ounces of blood taken from the
arm, which produced no relief.

" September 9. — Complained of diarrhoea, to which I directed
immediate attention.

" The means hitherto used for the cure of the dropsy were
totally inefficient, and the fluid re-collected so rapidly, that the
operation of tapping was again performed on the 1 1th of September,
at the earnest desire of the patient. The same quantity of fluid as
before was drawn off, and a substance of a reddish colour, and
uenbrano-gektinous consistence, escaped through the canula as on
the former occasion ; and, as before, the most complete relief fol-
lowed the operation.

> " On examining the. abdomen, the tumour was manifestly greatly
increased in size ; as well as I could judge, it was at least half as

388 Critical Review.

large again, as at the time of the first tapping, though the interval
was only twelve days.

" The question may naturally occur, what was done for the dis-
ease of the os uteri ? In truth, I paid it no separate attention, the
excrescence was very inconsiderable in size, and the quantity of
watery discharge so trifling as to be of no importance ; for which
reasons, I deemed it advisable to direct all my attention to other
circumstances.

" The diarrhoea still continued unabated, notwithstanding the
means used to restrain it, so that at the end of five dayB she was
much weakened and exhausted ; but the dropsical effusion did not
now accumulate with so much rapidity as before.

" September 17. — Ordered a grain and half of sulphate of qui-
nine, with extract of gentian three times a day, port wine, and rice
boiled in milk.

" September 19. — Evidently sinking ; complained of pain in the
stomach and bowels, which appeared to arise from flatulence, and
was completely relieved by a carminative draught containing acetum
opii.

" September 20. — Still lower ; entreated for a repetition of the
draught, which she got ; was perfectly collected.

" September 21. — Was unable to swallow, but spoke plainly,
and was quite collected ; died at 5 p. m.

" Examination, eighteen hours after death. — Great emaciation
of the body ; the left leg and thigh much enlarged by anasarca;
on opening the abdomen the bowels were found much inflated, and
immersed in a considerable quantity of a deep yellow coloured
serum, similar to what had been previously evacuated by tapping;
on turning over the body to get rid of this fluid, a quantity of pus,
certainly not less than two pints, escaped from the abdominal cavity ;
I remarked generally of the viscera, that very little blood remained
in their vessels.

" On turning aside the integuments, a very singular ap-
pearance presented itself; a tumour chiefly composed of fine mem-
branes, dividing it into innumerable cells, which, with their fluid
and transparent contents, resembled, at first sight, hydatids; the
membraneous septa dividing the cells were supplied with blood
vessels of a considerable size running along their edges, so that the
whole tumour presented a clear red colour.- At its upper and left
part there was a deep cleft or fissure, into which the open hand
might be passed without any force, and when carried downwards,
and towards the right side, it entered a round sac equal in size, and
much resembling a large flat turnip ; this was the right ovary which
lay just under, and was filled with the same structure as the part of
the tumour first brought into view.

" In fact, it seemed as if the peculiar structure had at first grown
in the ovary, which thereby became greatly enlarged, until at
length the coat of the ovary had given way, and out of the fissure
so formed, the morbid growth continued to enlarge, turning over

Dublin Medical Transactions. 389

the edges of the fissure, and covering the front and sidea of the
ovary in which it had formerly been contained, so that the tumour
was in a great measure turned inside out:

" This change in the state of the tumour might, I conceive, have
happened in one of two ways ; either by the coat of the ovary giving
way to the pressure of the morbid growth within it, which seems
probable, from the circumstance of that substance having evidently
continued to grow out of the fissure ; or the breach in the coat or
capsule of the ovary might have been produced by external violence
or accident, a cause but too probably true, as I afterwards ascer-
tained that the poor creature had been exposed to a great deal of
ill-treatment from a brutal husband. The tumour was of such a
size, that while its inferior extremity was in the pelvis, its superior
border was as high as the ensiform cartilage, its length being twelve
inches, and its breadth nine.

" Some slight, but firm membraneous bands connected the tu-
mour to the neighbouring parts ; these I divided, and the uterus and
bladder were removed from the pelvis along with the tumour, their
natural connexion being carefully preserved. On examination, the
uterus itself was found enlarged to twice its ordinary size, and
scirrhous ; the os uteri exhibited the numerous flocculent processes,
which are all that remain of cauliflower excrescence after death ;
the left fallopian tube was healthy, but the ovary was somewhat
enlarged, tuberculated on its surface, and very hard ; the right fal-
lopian tube was healthy, and the marginal process by which its
fimbriated end is ordinarily connected to the remote extremity of
the ovary, was attached over the surface of that body, in this case
so enormously enlarged. The liver was rather smaller than usual,
and perfectly healthy.

" On this case and dissection I would now wish to make two or
three brief observations. With regard to the tumour itself, without
wishing to theorize or offer any opinion on its peculiar nature, I
believe, in the first place, that it is a form of disease not before
observed, as affecting the ovary, or at least not hitherto described,
as far as my research enables me to speak. I have dissected a great
number of cases of ovarian disease, and have preserved specimens
in my museum, of almost all the different species enumerated by
authors, but to none of these does the disease in this case bear the
slightest resemblance in character; another peculiarity, which I
look upon as very remarkable, consists in the open state of the
tumour, and its internal surface being in consequence exposed in
the living body, and literally in a great degree turned inside out.

" From the surface thus exposed, serum must have been abund-
andy poured out, and hence perhaps a cause, or at least one Bource
of the effusion into the peritoneum, and whether the circumstance
can be fairly attributed to this, or to some other more general cause,
it is to be recollected, that during the period in which the effusion
took place most rapidly, the tumour was found to have nearly
doubled its fiurfacc.

390 Critical Review.

" The state of the tumour appears to me also to account for the
great disproportion between the uneasiness felt, and the degree of
distension existing.

" It seems not so easy to account for the oedema of the thigh
and leg occurring at the left side, while the tumour was at the right.
A very intelligent pupil, Mr. Dwyer, who gave me his valuable
assistance in the dissection, suggested that it might perhaps have
been caused by the weight of the tumour pushing the enlarged and
scirrhous uterus forcibly to the opposite side of the pelvis, and I
agree in the probable correctness of this ingenious suggestion.

" The situation of the tumour explains at once the reason why
the intestine did not descend into the hernial sac.

" A circumstance of much interest is the formation of such a
quantity of pus, as evidence of very considerable inflammatory action
having taken place, without its existence being indicated either by
the degree of pain or the character of the pulse. At no period
during her illness was the pain at all, severe, but consisted rather in
a sense of general uneasiness ; and free pressure could all along be
borne with little or no inconvenience ; the pulse though frequently
rather quick, between 90 and 100, was as often not accelerated,
and always soft and feeble. Throughout the whole course of the
treatment, I considered general blood-letting not only uncalled for,
but absolutely inadmissible, except on the day mentioned, and then
it was productive of no benefit, but the removal of the fluid from
the cavity of the abdomen in both instances, produced at once com-
plete relief, so that every part of the abdomen could be pressed and
handled with die greatest freedom, without inconvenience to the
patient.

" This appears an interesting illustration of the met long since
noticed by Morgugni and Van Swieten, and recently so ably insisted
on, and established by Dr. Abercrombie, that abdominal inflammation
may exist even in its destructive form, without its existence being
indicated either by pain, or the state of the pulse.

" Perhaps I ought not to omit to mention that I was much struck,
as were those present at the examination, with many points of iden-
tity in the appearances presented to us, with those usually witnessed,
as the pathological results of puerperal fever.

" The appearance of the tumour, and its relation to other parts,
are represented in the engravings ; the parts themselves, exactly as
they were removed from the body, are preserved in my museum."—
p. 11.

The author commences his description of a malformation
in a foetus, by referring to Geoffray St. Hilaire's Philoso-
phie Anatomique Monstruosities Humaines, for a case some-
what similar, but which scarcely lessens the claim to
novelty in this instance. The lady was delivered at the
seventh month, and the foetus presented the following ap-
pearances : —

Dublin Medical Transactions. 391

" The size of the foetus is what might be expected in the seventh
month, its length being fourteen inches: the upper part of the
thorax, with the arms and hands, are well formed and justly propor-
tioned, as are also the head and face, the features of which are
even more than usually handsome and expressive ; a rare circum-
stance in cases of monstrosity of this particular description; Bee
plate 3. The lower part of the thorax is compressed, both from the
sides, and backwards towards the spine, and this compression back-
wards is still more remarkable in the integuments of the abdomen,
outside of which lies the whole of the alimentary canal (except the
oesophagus,) together with the liver, pancreas and spleen. Viewed
anteriorly, the liver is the object which most prominently arrests the
eye, and below it the convolutions of the intestines ; if the liver be
raised or turned aside, the stomach, pancreas, and spleen present
themselves immediately behind it.

" The placenta remains attached by its funis, which is very short,
not more than four and a half inches long, and having its vessels
running parallel, instead of being twisted round each other, as they
should be ; attached to the circumference of the placenta are the
natural membranes, and an additional membranous pouch is firmly
attached to one part of its anterior surface, which will require a more
particular description.

" There are neither genital organs, nor anus, in the usual situation
of these parts. In the monster described by St. Hilaire, these parts
were in their natural situation, which was also the case with those
described by Rudolphi : see pp. 188 and 199.

" The left thigh and leg are well formed and naturally placed,
hot the right limb is distorted, and from its connexion with the
pelvis, returns at an acute angle with the body, so that the foot
lies when undisturbed, towards the right ear.

" Viewed posteriorly, the tabulated external surface of the pla-
centa, one lobe of the liver, the stomach with its great arch directed
upwards, the spleen, and a tumour about as large as a goose-egg,
springing from the lower half of the spinal column, are the objects
which appear necessary to notice, in order to complete this general
description of the. external appearances.

" Dissection. — The contents of the thorax did not differ in any
respect that I could observe from the ordinary condition of the
viscera contained in that cavity.

" The abdomen, of course, presented several peculiarities. In the
first place, the anterior integuments lay in contact with the spine

almost throughout, so that in fact there was but little cavity, except

in one situation, which was immediately behind the umbilicus, and

there collected into one spot, lay the only abdominal viscera which

were internal.
" They lay in a sort of sac of about an inch and half diameter,

sod consisted of one kidney, with its renal capsule and ureter, the

oteras and vagina, ' 11 n 'etait reste\ dans la cavite* abdominale

chez notre monstre, d'autres visceres, que ceux des systemes urinaire

tfsexuel.' St. Hilaire, p. 191.

392 Critical Review.

" The kidney lay towards the left side of the sac, with its renal
capsule in its proper situation, the ureter was about two inches and
a half long, somewhat convoluted, and alternately distended and
contracted throughout its length ; I could not, after the most careful
examination, ascertain where it terminated ; air blown into its renal
extremity first distended its cavity forcibly, and then gradually
escaped from the remote end; but where I could not discover by
dissection. I traced it to the surface of the uterus, where its tube was
so diminished as to be incapable of transmitting a bristle : it passed
through the peritoneal covering of that organ, and was insensibly
lost ; neither could I discover any organ or cavity like the bladder,
nor could I, as I have just said, trace the single ureter to any ex-
ternal opening by which fluid might escape, had it been secreted by
the kidney.

" In St. HOaire's monster there were two kidnies, with ureters
following the usual course, and terminating in the bladder, p. 190.

"A little to the right side of the entrance of the cord into the
abdomen, is a small regularly formed circular aperture, with promi-
nent edges ; marked G in plate 3 ; this is the external orifice of, or
entrance into the vagina, which lies immediately behind the integu-
ments, and is in form of a circular pouch of about half an inch, or a
little more in diameter ; into the remote end projects the os uteri of a
natural form and appearance, but the uterus itself is malformed, being
of this shape, and having only one fallopian tube running off from its
apex, as if it were a continuation of the part, and having a continu-
ous cavity as in the bicorned uterus of a quadruped. I could not
discover any ovary at either side of the uterus.

" Immediately over and at each side of the small external aper-
ture of the vagina, are two corrugated and prominent bodies of a
spongy texture, and about as large as peas : from their situation and
structure, I presume they are imperfectly and malformed labia.
Between these bodies and a little to the right of the orifice of the
vagina, is a very small circular aperture, marked H in plate 3, which,
from its situation, I concluded was the orifice of the urethra ; but no
such duct exists, and this small aperture is impervious, and merely a
very short cul de sac.

" St. Hilaire's monster was a male, and the genitals presented but
little irregularity, p. 199.

" The anterior integuments of the thorax and abdomen were quite
closed both above and below the umbilicus, nor was there any de-
ficiency of integument in that part; a circumstance in which this
specimen differs from the examples of external viscera, which I hare
been able to find recorded. In that described by St. Hilaire, the
trunk was open anteriorly, ' superieurement jusqu' a la naissance
des clavicules, et inferieurement jusqu'a la symphyse des os ante-
rieurs du bassin/ — Philosophic Anatomique, p, 184.
* " The oesophagus occupied its natural situation from the fauces to
near the cardiac orifice of the stomach, where it issued from the ab-
dominal cavity to join the stomach which lay outside ; its passage
through the integuments beingprotected by a close union with the parts

Mr. Montgomery on Malformation in a Fcetus. 393

through which it passed : the stomach, spleen, pancreas, and liver,
were placed as nearly as possible in their natural relations with
regard to each other, and were perfectly well formed, as was also the
intestinal canal, which consisted almost exclusively of small intestines
only ; by tracing it from the stomach downwards, I found that its
termination was at the opening of the ileum into the coecum, where
it forms the ileo-coecal valve, which however, in this instance, opened
externally, and the contents of the intestines passed out freely when
pressed the valvular orifice at M ; the appendix vermiformis is at-
tached to this opening, but there is no further portion of the coecum,
colon, or rectum to be found ; in fact the whole of the large intestine
is deficient.

" These abdominal viscera were evidently, during the uterine
existence of the child, contained in the pouch of membrane already
mentioned as adhering at one of its extremities to the serous Burmce
of the placenta ; and at the other end attached all round the umbilicus
to the edges of the circular space, within which are the orifices of the
vagina and intestine, labia, &c. and then enlarging, it formed a flask-
shaped bag or sac, within which lay the external viscera, to which
it had in this way the relation of the abdominal peritoneum, and for
which, indeed, we may look upon it as having been a sort of
substitute,

" On more minute examination of the relations of this membranous
pouch, I find that it is formed by the amnion disposed in a curious
way ; the pouch lies between the cavity of the amnion and the in-
resting chorion, but yet having amnion both inside and outside of it;
it seems that while the child lay as usual in the general cavity of the
amnion, the abdominal or umbilical region remained in contact with
the amnion, as it always is in the first period of foetal life, and then
the external viscera, as they grew, pushing forward, carried before
them the amnion with which they were in contact, and reflected it
upon itself, forming a pouch, just as the abdominal peritoneum is
related to the liver or stomach.

" I find this arrangement corresponds remarkably with the account
given by St. Hilaire of the disposition of the membranous septa ob-
served in his case, which he describes as ' disposes pour la plupart
eomme les lames du peritoine, ils dtaient une continuation des mem-
branes de ramnios.' see p. 210.

" This preternatural union between the foetus and its placenta is
made by St. Hilaire, the essential character and cause of a class of
monsters in which the brain is partially outside the cranium, and en-
veloped in the attached membranes ; to this class he has given the
oame hyper encepkali.

" Very lately also a book has been published by Rudolphi on this
subject, entitled • Monstrorum trium, prater naturam cum secundinis
coalitorum disquisition These were all hyperencephali, and except
m the formation of the head, exhibited nothing remarkable; the
work contains nothing to illustrate the specimen I am describing.

" The umbilical cord ran along the reflected portion of the amnion
of nearly five inches in length, and instead of being free as usual,

vol. v. no. 29. 3 c

394 Critical Review.

with the membranes surrounding it, it was bound down by the
amnion, and lay quite flat on the surface of the placenta, and alon*
the duplicative of the amnion ; it contains only one vein and one
artery ; the exact origin or course of the single artery, I regret 1 am
unable to describe ; the parts having been so dissected before 1 dis-
covered the peculiarity, that I could not trace the artery to its
source.

" The tumour on the back is spina bifida, arising from the lumbar
vertebrae, and presenting nothing but the ordinary construction of
such tumours ; its size was (before opening it) such as to contain
about six ounces of fluid, and having cut out the back of the ver-
tebral column all along from the connexion with the skull, the dura
mater is displayed from its exit from the cavity of the cranium along
the spinal canal, from which it issues, where the lumbar spinous
processes are deficient, and dilating, forms the lining membrane of
the tumour.

" The bones of the pelvis, posteriorly, are very loosely connected
to the sacrum, and anteriorly have no connexion at the symphysis,
the bones of the pubis being separated from each other to a distance
of nearly three quarters of an inch, so that in fact there is no pelvic
cavity.

" The spine is very much distorted, having both an anterior and
lateral curvature.

"A very accurate cast of this monster was taken before the parts
were disturbed, and is preserved, together with the body of the
monster, in my museum ; for a correct representation of the general
appearance and form, see plate 3."

V. — The Dublin Hospital Reports and Communications in
Medicine and. Surgery. Vol. V. 8vo. pp. G31. Eight
Plates. Dublin, 1830. Hodges and Smith.

It affords ns much gratification to notice another volume
of the Dublin Hospital Reports, and also to inform our
readers that it far excels its predecessors in importance and
varied practical information. It is admitted by every welt
informed medical man, that the Dublin Reports and Transac-
tions are among the best, if not the very best, of our
clinical productions ; and we are happy to state that
" arrangements have been made to ensure the co-operation
of the physicians and. surgeons of the Dublin Hospitals,
and it is hoped that the Reports will in future contain a
much more extensive series of hospital communications,
and consequently it is in contemplation to publish them nt
shorter intervals. The first part of the sixth volume will
appear on the 1st of March, 1832." — Preface.

Dublin Hospital Reports. 395

• The contents of the volume before us ore As follow :—
2. Clinical Report of Cases in the Medical Wards of the
Meath Hospital during the Session of 1828 and 1829, by
Robert J. Graves, M. D., &c. and YVilliam Stokes, M.D.,
&c. 2. Practical Observations on certain Diseases of the
Anus and Rectum, by A. Colles, M. D., &c. 3. Observa-
tions on the Mucous Membrane of the Rectum, by J.
Houston, M. D., &e. 4. A case of Aneurism of the
Abdominal Aorta, with Dissection and Observations, by
T. E. Beatty, M. D., &c. 5. History of two cases of
Aneurism successfully treated by Ligature, by W. H.
Porter. M. R. C. S., &c. 6. Physiological and Practical
Observations on the Utero Placental Circulation and the
Phenomenon of the Placental Sou ffiet, with its utility in
detecting the existence of Pregnancy, and the death of
the Foetus in Utero, by Evory Kennedy, M. D., &c. 7.
Observations on some of the Affections of the Fingers and
Toes, attended with Fungous Growths, by F. Rynd, A. B.
&e. 8. A case of Ruptured Intestine, with remarks on
some effects of Contusion of the Abdomen, by J. Hart*,
M.R.I.A., &c. 9. Pathological Observations, by John
Houston, M.R.I.A. 10. A case of Obstinate and Exten-
sive Psoriasis successfully treated, by W. West, M. D.,
M.R.I.A. 11. Cases of Diseased Brain, by Robert Law,
A.M., M.D. 12. Small and frequently repeated Bleed-
ings in Haemoptysis and Incipient Phthisis, recommended
in a Letter to R.J. Graves, M.D., from John Cheyne,
M. D., &c. 13. Contributions to Ophthalmic Surgery > by
Arthur Jacob, M. D., &c. 14.-4 case of Inflammation of
the Vena Cava, Iliac and Femoral Veins, by John Cramp-
ton, M.D., &c. 15. Cases of Cancer Uteri, with Observa-
tions chiefly intended to illustrate . the pathological
changes caused by that Disease, by W. F. Montgomery,
A. M., &c. 16. An account of two newly discovered
Muscles for compressing the Dorsal Vein of the Penis,
in Man and other Animals, and also of a similar pro-
vision for compressing the Veins of the Chameleon s
Tongue, by John Houston, M.R.I. A., &c. 17. Report
of the wVellesley Female, Institution, by Samuel Cusack,
M.D., &c. 18. A case of Encysted Abscess in the centre
of the Spinal Cord, by John Hart, M.R.I. A., &c. 19.
Experiments relative to the Carbonic Acid of Expired Air
in Health and in Disease, by James Apjohn, M. D., &o.

20. A case of Chronic Cynanche Laryngea^ in which the
operation of Tracheotomy was performed, by W. H. Porter.

21. On the Effects produced by Posture, on the frequency

396 Critical Review,

and character of the Pulse f by R. J. Graves, M.D., kc.
'2*2. Report of the Coomb e Lying-in Hospital, by Richard
Reed Gregory, Member of the Royal College of Surgeons,
and Master of the Hospital. 23. Case of Foreign Bodies
in the Trachea, by Rawdon M'Namara, M.R.I. A., &c.
34. Observations on a peculiar convulsive Disease affecting
young Children, which may be termed Spasm of the Glottis,
by h! Marsh, M. D.f &c.

The authors of these papers are generally professors or
lecturers on medicine and surgery, and, with tvro or three
exceptions, .are hospital physicians or surgeons. Every
article is ably treated, and abounds with valuable practical
information. We are sorry to state that the volume reached
us too late for analysis in this number, except Dr. Mont-
gomery's articles, which arrived earlier, but we shall notice
it very fully in our next and succeeding ones. The report
by Drs. Graves and Stokes occupies 128 pnges, and coiri-

? rises an account of a great variety of interesting cases,
"he succeeding papers are equally valuable; the whole
deserve unqualified approbation. We strongly recommend
the work to every class of practitioners. We only wish
that the medical officers of all large hospitals in Great
Britain would imitate the example of their Dublin contem-
poraries— a wish entertained by the whole profession. There
is no reasonable excuse to be offered for the neglect of the
hospital physicians of England and Scotland, and that
usually given, " want of leisure," might be as justly offered
by the writers before us, many of wnom are in the most
extensive practice.

It would be much better for the medical officers of the
metropolitan hospitals to report their own cases, and
authenticate them, than have them garbled and mutilated
as they generally appear at present. Authenticated reports
would be much more satisfactory to the profession than the
anonymous and imperfect ones now given. If the medical
officers treat their patients scientifically, they can have
nothing to fear by publishing their cases. Let any unpre-
judiced man compare the London, Dublin, Edinburgh, and
continental hospital reports, and he must be surprised at
the vast contrast between them. This is a fact which can-
not be doubted by those acquainted with the present state
of clinical literature. Of late years, we seldom see the
age> constitution, temperament, habit, or former diseoses of
the patient recorded, so that the majority of cases pubrr<tied
are of no value, as the treatment must be modified by
the above circumstances. In all the foreign reports, these
circumstances are invariably attended to, and thus are the
cases valuable.

[ 397 ] •

VL—Mcdico-Chirnrgical Transactions, Vol. XV: Part II.
8vo. pp. 451. London, 1830. Long-man and Co.

This volume contains only three papers, and is one of the
most insignificant hitherto published by the society. The
first paper is " on the anatomical characters of some ad-
ventitious structures," by Dr. Hodgkin. The author com-
mences with a description of cysts formed by serous mem-
branes, which, he says, differ from hydatids. He divides
them into two species ; — 1st, simple cy^ts, wjiich have not
the power of reproduction ;— 2ud, compound cysts,, which
reproduce. The first kind is exemplified by cysts in the
choroid plexus, and the second, by those in the ovaries
and folds of the broad ligaments of the uterus. Simple
serous cysts are found in the base of the brain, choroid
plexus, eyelids, and along the edges of the tarsi, or deep
in the eye, lungs, female mammae, folds of the broad liga-
ment and ovary. When present in the ovary, they form
ovarian dropsy. *

The second class of adventitious serous membranes, are
found in the broad ligaments, uterus and ovaries. The
internal surface of these cysts present elevations more or
less rounded, and of various sizes, covered by the lining
membrane of the sac. These tumours are cysts of a secon-
dary order, containing a serous or mucous secretion. On
the internal surface of these secondary cysts, are clusters
of tertiary cysts covered by the lining membrane of the
cyst in which they are contained. The membranes of these
cysts are liable to inflammation, both adhesive and suppu-
rative. When adhesion occurs, it becomes difficult to dis-
cover the structure of the cyst, and when suppuration is
present, it is confined in one or more sacs, as we see exem-
plified in paracentesis of ovarian dropsy.

The secondary cysts are of three kinds ; the first has
neither slender necks nor broad bases ; the second has
slender peduncles ; the third has a broad attachment and
flattened form.

Adventitious cysts, assuming the form of reflected mem-
branes are also found in the testicle, female mamma and

Dr. Hodgkin proceeds to consider the heterologue de-
posits confounded by anatomists, under, the names of can-
cer, scirrhus, and carcinoma. He thinks they may be
grouped in one family. He gives the following account
of their structure : —

" If we carefully dissect down to the- surface of these tumours/'
«*ys Dr. H. " we shall usually find that it has a capsule or covering,

398 Critical Review.

which has, I believe, generally been supposed to consist of the altered
and condensed cellular membrane of the parts which have given way
before the growth of the tumour. This idea is probably correct with
respect to the unequally thick external part of the capsule ; but if we
dissect carefully, and examine those tumours in which the process of
decay has either not commenced, or has made very little progress,
we shall find that surface which is next to the mass of the tumour
more or less smooth and even, and on raising it we find that it is
reflected over one or more somewhat periform bodies, attached by a
base, which is generally narrow and peduncular, to some part of the
circumference of the enclosing capsule. Unless the tumour is very
small, it is much more common to find several rather than a single
body of this kind, and as there is often little, if any fluid intervening
between them and the enclosing capsule, their form is somewhat
modified by their mutual pressure. Sometimes, though more or less
closely applied to each other, these pedunculated bodies are perfectly
detached at their sides, and may, consequently, be readily traced to the
point which forms the common origin of their peduncles. At other
times these bodies are so adherent amongst themselves, and the mem-
brane covering them is so tender and delicate, that without very
great care the arrangement of their structure may be overlooked, in
consequence of the pedunculated bodies being broken or torn through
in a different direction from that to which their mode or formation
would naturally dispose them. * * *

" If we continue dissecting and raising the outer cyst, forming
the reflected membrane which covers the radiating pedunculating
bodies, we shall generally find, that on one or more sides it dips
down deeply into the mass of the tumour, and forms a part of the
septum which separates the one packet of pedunculated bodies from
the others which generally concur to form the mass, of the tumour;
for it comparatively rarely happens that the tumour is composed of a
single cyst filled with pedunculated bodies. On examining the
different encysted packets of pedunculated bodies which compose the
tumour, we shall often find some indication of their having taken
their origin from nearly the same spot, which is generally the most
indurated part of the tumour. We may likewise observe, that the
different secondary tumours, or encysted bundles of pedunculated
bodies, are in very different stages of progress."

Dr. Hodgkin gives the following account of scirrhous
tumours : —

" True scirrhous tumours appear sometimes to depend on a single
primary tumour, at other times, several may be satisfactorily made
out. That part of the tumour which appears to have been the com-
mon origin of the primary cysts, where there are more than one, or
from which the contained pedunculated bodies radiate when there is
only a single primary tumour, is in general the most indurated
portion, and is, at the same time, the most indistinct in its structure.
When examined externally, after the surrounding natural structures

Medico-Chirurgical Transactions. 399

have been carefully dissected off, this part of the tumour is found to be
the most irregular, has a somewhat corrugated appearance, and sug-
gests the idea of its having been the sort of root by which the adventi-
tious growth was implanted on the natural structures. The radiated
appearance so strongly insisted on by most authors who have described
scirrhous tumours, and the rationale of which I trust I have shown,
is particularly conspicuous when the section passes through this
point. The fluid part of a true scirrhous tumour bears in general a
very small portion to the rest of the structure, it has a viscid or
mucous character, more especially where softening has not taken
place ; but where this process is going on, it assumes the character
of an offensive ichorous discharge, and acrid and highly deleterious
qualities have by some been ascribed to it.

" The process of softening sometimes commences internally at
one point, at other times in several small isolated points ; in others,
again, the ulceration through the integuments is the first part of the
process of decay.

" True scirrhous tumours, notwithstanding the length of time
during which they continue to grow, very rarely acquire a con-
siderable size. Indeed, it not unfrequently happens, that the wast-
ing of the neighbouring structures, and more especially of the female
mamma, which is by far the most frequent seat of true scirrhus,
more than compensates for any increase of volume dependent on the
new formation.

" The tumours now under consideration, in many instances re-
main for a length of time in an indolent state, without passing into a
state of softening, or producing an external ulceration. Before this
ulceration takes place, the tumour becomes adherent to the skin, and
though there is generally but little redness observable in these
tumours, a spot, most frequently of small extent, becomes of a bright
and cherry-red or of a purple livid colour before the continuity of the
integuments is destroyed. It is needless that 1 should again describe
the characters of a malignant ulcer, which are in general very com-
pletely seen in the ulcerative stage of true scirrhus. It may, how-
ever, be said, that the ulceration of true scirrhus is attended with a
more decided loss of substance than that of the next form of tumour
of which I shall speak— viz. cerebriform cancer, and which is often
attended with large, rapid, and irregular growth from the ulcerated
surface, whence the names of fungoid disease, fungus medullaris, &c.
have in all probability been derived. .The ulceration of true scirrhus
is indeed bounded by its elevated wall of circumvallation ; but the
central parts, gradually hollowed away by the softening of the very
imperfectly organized structure, present a foul and deep chasm."

Our author inclines to believe that scirrhous tumours may
be thrown off by sloughing, granulations occur, cicatriza-
tion follow, and a cure be effected. He states that scirrhus
uteri does not present cells or cavities, though the tumour
acquires a greater size than in other parts. He next de-
scribes the growth of encephaloid tumours, cerebriform

400 Critical Review.

cancer, medullary sarcoma, spongoid inflammation, fungus
hoematodes, and fungoid disease. The diagnosis offered,
differs in no respect from that which is generally found in
works upon the subject.

The second paper is entitled r* Observations on the state-
ment made by Dr. Douglas, of Cheselden's improved Ltcral
operation of Lithotomy," by John Yellowly, M .D. The
object of this* essay, is to prove the error committed by
Douglas, John Bell, and others, which is as follows : —

" His knife first enters the groove of the prostrated or straight
part of his catheter, through the sides of the bladder immediately
above the prostate, and afterwards the point of it continuing to run
in the same groove in a direction downwards and forwards, or to-
wards himself, he divides that part of the sphincter of the bladder
that lies upon that gland, and then he cuts the outside of one half
of it obliquely, according to the direction and whole length of the
urethra that runs within it, and finishes his internal incision, by
dividing the muscular portion of the urethra on the convex part of
his staff."— p. 346.

•

This mode of operating is not mentioned by Cheselden
in any of the editions of his works, and is one, according
to Dr Y. " which makes it difficult to believe that it was
actually performed."

The third paper is entitled " Pathological Researches on
inflammation of the veins of the uterus, with additional
observations on phlegmasia dolens," by Robert Lee, M. D,
We have noticed this m our last vol. pp. 330, 331, in an ori-
ginal essay on phlegmasia dolens, and shewed how Dr. Lee,
in a preceding vol. of the Trans, before us, maintained phle-
bitis of the crural veins was the cause of the disease. In
further disproof of the opinion, we refer the reader to our
notice of M. Tonnelle's autopsies of puerperal fevers, which
shew extensive uterine phlebitis without any swelling of the
inferior extremities — a fact also attested at p. 331, already
referred to. The cases narrated by M. Dance, of the Hotel
Dieu, and referred to in the essay on phlegmasia dolens,
are also exceptions to the pathology proposed by Dr. Lee.
We are ready to admit, however, tnat swelling of an infe-
rior extremity, may possibly arise from uterine phlebitis,
but contend that it is by no means so frequent an occurrence
as one is disposed to imagine.

C 401 ]

ORIGINAL COMMUNICATIONS.

I.— Mr. Mitchell's case of Calculi in the Vesicula

Seminal es.

To the Editor of the London Medical and Surgical Journal.

Sir,— The following' case will probably merit a place in
your valuable Journal; if so, you will oblige your most
obedient servant,

Charles Mitchell, Surgeon.

A tall man, of good complexion, aged 45, was attacked
with rigors after exposure to cold in the month of January,
accompanied with cough and pain in the chest ; the rigors
were most severe during the night, continuing sometimes
upwards of an hour, upon the decline of which warmth
ensued, followed by profuse perspiration.

He applied to Dr. Pinkard, under whose care he con-
tinued for six weeks, during which time he took nauseating
powders, but objected to bleeding, which was proposed \
and finding that no advantage accrued from the powders,
he left them off. A week after, while walking in the street,
conversing with a friend, his intellect became impaired ; he
talked irrationally and was confused ; the man asked him
if he knew what he was talking of, when he felt entirely
lost The man saw him home, when his speech left him,
and continued so for two days, only returning upon the
application of a blister to the nape of the neck, and the
administration of a purgative. J saw him in the beginning
of March, when he complained grefttly of the pain in his
chest, attended with tightness, and accompanied l>y difficult
respiration, cough, and sweating ; considerable elevation of
shoulders during inspiration, and attended with pretty high
action of4 the circulatory system. Upon placing the ear
over any part of the right side of till chest, a hissing noise
was distinctly heard (caused, 1 presume, by the air rushing
into a hollow cavity.) He was bldd to six ounces, blood
was cupped and buft'y ; had a blistif applied to his chest,
and took 5iss. of liq. pofassae in the course of the day,
with a view to mollify any tubercular formation, with half
a grain of squill and digitalis four times a day. In the
course of six days the sweating became very troublesome,
although the other symptoms had considerably lessened in
their severity.

vol. v. no. 29. 3 D

402 Original Communications.

'to

He now took two drachms of diluted sulphuric acid, with
twenty drops of laudanum, in the course of the day.—
Another patient, who was hectic from consumption, and
under the use of the acid and laudanum, had a severe attack
of colliquative diarrhoea, notwithstanding which she con-
tinued one drachm of the acid. On the fourth morning
after, the diarrhoea ensued, she was seized with griping in
her bowels, unusually violent, with an inclination to go to
stool, when she emitted nearly one pound of blood, which
coagulated ; after which she recovered rapidly, the diarr-
hoea entirely ceased, the sweating subsided, the cough and
spitting gradually abated. (However, this must be attributed
entirely to a natural effort of the system.) From this di-
gression, I must advert to the other patient, who continued
.the acid and laudanum for three weeks ; when the cough
and pain had become so severe, attended with puriform
.expectoration, that it was necessary, in consequence of the
existing irritation, to extract blooa, which was done to Jiv.
Two days, however, only elapsed, when he lost his speech
a second time, while walking in the street ; he returned
•home ; appeared pale and cold, with \i\s mouth drawn to
the left side. In the course of a week he lost the use of
the right side, but retained the feeling. Three weeks after-
wards he had a fit of suffusion of the face and eyes, drow-
siness, accompanied by sickness ; after which the phthisical
symptoms subsided, the cough being oniy occasionally
troublesome. A blister was applied to the nape of the
neck, and renewed a second time without advantage; he
was confined to his bed till the latter end of August, during
which time the bowels remained regular and appetite good.
In fact, little characterised these months, excepting pain in
.moving the right arm, which was apparently exquisite.
Towards the latter end of August he became severely
affected with cholera, which continued for twenty-four
hours ; it at length however yielded to opiates, but the
accompanying diarrhoea continued, attended with tenderness
all over the abdomen ; moreover the right iliac region, where
five leeches were applied, succeeded by a blister. Chalk
aud opium were administered without effect ; I proposed a
small bleeding, but the friends objected. An opiate injec-
tion produced a little quietude, not only in the bowels, but
of the whole system ; the relief being temporary, the diarr-
<hcea continued, the cough became considerably aggravated,
the appetite failed, sleeplessness . ensued, until the skin was
literally constricted upon his very bones j when finally,
nature drew a veil over his existence.

Mr. Mitchell's case of Calculi in the Vesicula, $c. 403

Autopsy.— Upon removing' the skull cap and dura mater,
a thin coating of lymph was effused underneath the
arachnoid — the pia mater was injected with blood — the
ventricles and base contained not less than eight ounces of
serous fluid, although the man remained sensible to the last.
The left ventricle had acquired a greyish appearance — the
anterior lobe of the left hemisphere was softened, so much
so, indeed, as entirely to obliterate the anterior cornu of
the left ventricles, the medullary matter of which swam in,
flakes upon the serous fluid. Upon removing the sternum
and true ribs at their cartilages, the right lung was found,
firmly adhering to the ribs, through the medium of the
pleurae ; each stroke of the knife, upon which, and the
adhering portion of the lungs, exposed fresh collections of
matter. One very large abscess had burst, and the matter
iasinuated itself at the lateral origin of the diaphragm ; the
left lung contained numerous tubercles, from the size of a
pin's head, forming1 a regular series to that of a walnut,
without any regular formation of matter.

The lower part of the jejunum, and the whole of the
ilium had a dark appearance, so likewise the lower portion
of the ascending part of the colon, the villous coats of
which were unusually vascular, a degree of deposition ele-
vating its villous coat preceding its absorption, forming
ulceration, was continuous throughout the whole course of
the ilium ; the mesentery was extremely vascular, and its
glands considerably enlarged. The cceoum, caput coli, had,
besides deposits, four large ulcerated places, thickened at
their edges ; two large ones, as in the lower part of the
colon, within two inches of the c cecum, one as large as a
shilling. The transverse arch and descending portion, was
perfectly free from vascularity, deposit, or ulceration. The
right vasicula seminalis, contained more than two hundred
stones, which, I presume, depended upon the inactive state
of the genital system, by which the secreted semen became
viscid, gorging up the passage, or so much so, to find an
entrance into the passage ; and the animalcule, which Lee-
wnhock discovered, by the aid of a microscope, no doubt
formed a nucleus for the earthy deposit, showing the vast
number contained in a small quantity of semen, when its
thinner part becomes absorbed. Six of these animalcule I
once observed without the assistance of a microscope, being
the third sensible emission of a young man, unacquainted
with the nature of a discharge ; the second of which pro-
duced nausea and vomiting ; I saw the third upon the cover
of a book which he brought me. I had no doubt as to its

404 Original Communications.

nature, and upon strictly questioning him, I soon found that
he had procured his semen by artificial means, for which
he received a severe censure. The small gelatinous emi-
nences, which I conceived to be the animalculze, swam in,
and were surrounded by a pale, thin, milky fluid. Upon
the peritoneum, as it lies over the upper part of the sacrum,
and is reflected from the anterior surface of the rectum upon
the posterior of the bladder, there were numerous glandular
eminences, and from the fact of them being repeatedly met
with, as well as elsewhere, it falls favourable to those phy-
siologists who have deemed glands as essential to secretion
under every circumstance.

Lamb's Conduit-street, Oct. 16, 1830.

II. — Mr. Foote, Jun. on Intermittent Head-ache.

J. B. set. 24, married, tall and pale, of the sanguineo-
lymphatic temperament, of general good health and regular
habits. Exposed himself to cold by sitting without fire,
with wet feet and damp clothes the whole day, after a
thorough drenching in " the pitiless storm."

On the 26th August, 1830, he complained of severe head-
ache, increased by stooping, and accompanied by an in-
tolerance of light, exposure to which considerably aggra-
vated the pain. It is situated at the top of the head, over
the brow, and in the eyes, with a sensation of heaviness iu
the head and eyes ; the scalp hot, the eyes glistening, in-
flamed and suffused with tears : pupils highly dilated and
did not contract on the approach of light : his vision was
also in some degree affected : tongue white and furred ;
complained of pain on pressure on the region of the stomach,
and on the lower margin of the liver : pulse quick and hard
(100) : bowels open.

A bleeding ab ractiio was directed; but he would not allow
it to be performed. In consequence the following medicines
could only be given : —

$>• Ext. colo. c. gr. x. Hyd. submur. gr. ii.

P. antim. gr. ii.
Mft. Pil. ii. nocte sumend.

Magn. sulph g. mane summend.

27th a. m.— The medicine has not yet operated, and the
pain is much increased, as also the heat about the scalp •
pain in the stomach, the photophobia, &c.

Mr. Foote, Juii. on Intermittent Head-ache. 305

- He now consented to be bled, and twenty ounces were
abstracted from the arm, when he fainted. On recovering,
be said that the pain, though much relieved, was not en-
tirely gone ; in consequence a few more ounces were allowed
to flow, and that not succeeding in removing the pain, eight
leeches were applied directly to the temples four to each,
which, after bleeding some time, removed it completely.
Soon after the leeches fell off, the aperients began to act,
and he. considered himself as cured ; but that not being relied
on, small doses of the tartarized antimony were admi-
nistered occasionally throughout the day, keeping up a slight
degree of nausea.

28th, — A fresh attack of pain, heat of the scalp, &c.
has again occurred. At eight in the morning, the same
hour as yesterday, the coincidence of the hour of the attack
induced some questions ; by his answers to which it was
discovered, that the head ache, aversion to light &c. had
occurred for four mornings previously at the same hour,
it was now considered as a genuine intermittent, and to be
treated as such ; but the pain being excessively severe, and
as he earnestly wished to be relieved from it, six leeches
were applied : they bled freely, and speedily removed the
pain. Afterwards

|V. Liquoris arsen. gtt. xii.
Aquas, distill. Jiv.
Sp. lavend. c. 3*s.
Mft. Mist. sum. 3 tiam a partem, 7 hor.

29tb. — The pain recurred this morning as severe as ever,
but at seven instead of eight : bowels not open since the
preceding evening.

Habeat pil. purg. statim sumend.

He bad likewise a lotion, composed of the strong acetic
acid and rectified eether, to sponge the forehead with.

When the pills had operated, which they speedily did,
the pain was much relieved ; and had entirely disappeared
by ten, in so. much that he again considered himself cured,
and craved for something more substantial than his anti-
phlogistic regimen allowed him.

B^. Lig arsen. gtt. xviij.
Dec. cinchon. Jiv.
Sp. lavend. c. 5ss.
Mft. Mist. 3 tiam partem, 12 ma, 1 na mer.
et 7 mis horis sumend.

30th. — The pain has again recurred this day one hour pre-
vious to the former attack,, namely, at six in the morning;
but it is not quite so severe. The pills, as yesterday,

406 Original Communications.

again removed it, and near the same hour, when the follow-
'mg mixture was administered:—

5t% Sulph. quin». gr. ix.
Aq. m. vir. Jiv,
Acid, sulph. dil. gtt. zv.
Tinct, aurant. 5j.
Mft. Mist. sum. 3 tiam partem,
1 ma mer. et 5 tia noris.

3Jst. — The pain did not occur until half past seven, and
was very trifling in comparison with the other attacks. It
went off at nine, thus lasting only an hour and a half. The
mint water was changed for the inf. aurant. c. as it did not
sit easy in the stomach.

Septs 1. —Nearly well.

III. — Inquest on the Body of Miss Cashin.

To the Editor of the London Medical and Surgical Journal.

Sir, — I trust that you will deem the best answer to the notion of
my inability to have conducted such an examination as that of the
body of Miss Catherine Cashin will be found in the opinions of a few
celebrated anatomists and pathologists, under whom I have had the
honour of studying, or with whom I have the pleasure of having
studied. The opinions, of which the following are extracts, were
obtained when I was a candidate for the situation of curator to the
museum of a public body. Dr. Alexander Monro, of Edinburgh,
observes, " It affords me much gratification to bear testimony to
your zeal and progress in the study of anatomy, so that I think yon
well qualified for discharging the duties of the office to which you
aspire." Dr. Knox, of Edinburgh, with whom I studied for some
time in his private dissecting-room, says, " I with much pleasure,
and independent and wholly - uninfluenced by personal motives,
declare you to be exceedingly well qualified to hold such an office,
and that there are very few persons to be found possessing either
your abilities or industry." Mr. Charles Bell, in writing to Mr.
JBrodie, states, "His education has been very complete, his attainments
•are of the first order, and such as must make him very useful to a
new institution. You may Bee his preparations and his drawings, by
which you will perceive that he is excellently well calculated to form
or add to a collection, as well as to make it useful to the students."
Mr. Bennett, the professor of anatomy in the University of London,
writes the following opinion : " I have had the pleasure of intimately
knowing Dr. Alexander Thomson since the opening of the university,
where he has been a most zealous student, and 'can, therefore, with
-confidence bear testimony to his undoubted capability to fill the
office he aspires to in King's College. I have met, both at home and
.abroad, m my capacity of teacher, many young men, who probably

Letter from Dr. A'. Thomson. 407

may excel Dr. Thomson, each in some particular department, but
never hare I known one whose information and acquirements were
so comprehensive and extended. With* such attainments I deem
Dr. Thomson peculiarly well adapted to perform the duties of a
curator, an office, which of all others in a medical school, requires
in the individual holding it an education of the highest order. I can
testify particularly to Dr. Thomson's knowledge of anatomy, and
from the specimens of preparations made by him, I believe him to
possess a very superior taste and tact in that very difficult depart-
ment." Dr. Granville, who has watched me more or less through
life, observes, " I have found him anxious for knowledge, assiduous
in his enquiries, original in many of his researches, and dexterous as
well as skilful in dissecting, making preparations and taking draw-
ings of the various parts of those animals, which engaged most of his
time and attention. His scientific qualifications are in perfect
accordance with his desire to advance natural history and the
science, which teaches the structure of man; all which circum-
stances added to his great zeal and natural bias for philosophical
investigations, render him well qualified for the situation of a curator
of an anatomical museum of natural history in general." Mr.
King, well known for his anatomical powers, late of Aldersgate-
street, writes to me. '* This I can affirm, that I never saw a post
mortem examination better conducted than what I saw you engaged
in. I mean that of the body of Miss Cashin. I saw enough to con-
vince me you stand, or ought to stand, among the first men in our
profession." Dr. Clark, of Cambridge, no mean anatomist, certifies,
" that Mr. Alexander Thomson, of St. John's College in this Uni-
versity, has lately passed the medical examination with great credit
to himself; and that in the anatomical department thereof, whieh
came under my own more immediate observation, he distinguished
himself in such a way, as to allow me to state without reservation,
that I consider him well qualified to discharge the office of Physician
to the London University Dispensary, with honour to himself and
benefit to the establishment." Mr. James Syme, the celebrated
surgeon of Edinburgh, and my old teacher of anatomy, writes me
thus ; " You possess the advantages of excellent talents, extreme
fondness for your profession, and opportunities of studying it, in all
its branches, that fall to the lot of few of its members. It will
afford me great pleasure to hear, that you have succeeded in obtain-
ing the situation which is at present the object of your wishes, and
so for as my recommendation can go, I most freely give it." I will
trouble you with only two more opinions out of the hundred which I
laid before the Council of King's College, but which I have since
withdrawn, because I will never belong to any institution which has
not liberality inherent in' its constitution. I shall now give you the
opinion of a gentleman, who is known never to say more than he
thinks of any man, and never to restrain himself from expressing a
bad opinion he may entertain of any man. Few men, therefore,
escape the lash of his tongue, still fewer the shrug of his significant
•boulder----. I mean Dr. D. D. Davies. /• In my own department

4fc)8* Original Communications.

of instruction at the university, I can safely, say that no student, vho
attended my lectures at the same time with yourself, gave more
pertinent answers to my questions in the class-room examinations,
nor furnished at other times more various and substantial evidence of
a full and perfect comprehension of my principles and precepts. I
am moreover aware, that your general character in the university
has been that of an ardent and successful student. Your devotedness
to the study of pathological anatomy seems to me to give you a
peculiar claim to notice, as a candidate for the office of curator of a
museum of anatomy. I shall be most happy to hear of the success
of your application." Lastly, Sir, let me lay before you the opinion
of the accomplished and scientific Dr. Hope, of St. George's Hospital,
one of my old fellow students : " I have been acquainted with Dr.
Alexander Thomson since the year 1822, and can bear testimony to
the extraordinary zeal with which he prosecuted his professional
studies while in Edinburgh. He distinguished himself particularly
for his profound and exact researches in physiological and morbid
structure, for the beauty and fidelity of his delineations of disease,
and for the prominent part which he took in the debates of the
Royal Medical Society on practical as well as scientific subjects.
Since his return to London I have seen him prosecuting clinical
studies with his wonted ardour, and I have great pleasure in ex-
pressing it as my opinion, that he is calculated to become a dis-
tinguished member of his profession, and an ornament to any public
institution to which he may be attached." Such, Sir, are some of
the golden opinions, that from twelve to fourteen hours honest
labour daily for thirteen continuous years, in three universities, has
procured for me. They must disarm my enemies of the force of
their sarcasm, as they remove the foundation for a belief in my ig-
norance and incompetence. With regard to my youth, it is my
proudest ornament and greatest consolation, because with God's
blessing my years shall only add improvements to my mind, and
confirm in me the strong love of truth for the sake of humanity, which
my virtuous mother early taught me to consider, as the grace and
ornament of brilliant talents, the best apology and safeguard for
those that are inferior. I must acknowledge your urbanity and
gentlemanly demeanour to me, and thank you sincerely for this op-
portunity of vindicating my honour.

Alexander Thomson.
70, George-street, Euston Square.

We publish with pleasure an authentic account of Dr. Alexander
Thomson's detail of the necrotomic appearances of the body of Miss
Cashin ; and also subjoin a very complimentary testimonial from the
jury in that gentleman's favour. To this we add a few extracts from
the testimonials of some of the most eminent professors of anatomy
and surgery in this empire, in proof of the zeal, industry, and ability

Examination of the Body of Miss Cashin. 409

with which he has pursued his studies. We cheerfully insert these
documents to Bhew the profession, that we have had no sinister motive
in commenting upon his evidence ; and we shall as readily admit
communications from any of the other medical witnesses on whose
evidence we animadverted, if requested to do so. Before the words
we now indite will appear, the trial of the accused will have taken
place, of which we shall give a special report, and it will then be seen
whether our remarks and predictions were right or wrong. At all
events we are conscious of. having acted fairly and impartially, and
of having had no object in view, but the promotion of the dignity
of our profession and the interests of humanity.

Dr. Alexander Thomson's account of the autopsy of the late Miss
Cashin: —

'• On examination we found the body well proportioned, plump,
and in good condition ; the hair of a dark brown. Anteriorly over
the whole of 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 swollen and puffy, feeling
when pressed as if containing air. The lower part of the face and
tipper lip covered with semi fluid-blood, which was discharged from
the nose in the act of removing the body from the coffin. The
featur. s were well formed, and the nose prominent and straight, lips
thin and mouth distorted to the right side ; the nails grown to a
considerable length but straight. Breasts full and plump ; abdomen
tense and tumid , and face of true proportion ; body equally well
proportioned at the back. The back and shoulders of a greenish hue,
excepting a patch of about nine inches long and six and a half broad,
and diagonally of about seven and a half inches irregular at the
margin, denuded of cuticle and of a black colour, intenaing towards
the centre, and reddening towards the margin, and a little beyond
the margin towards each shoulder. The spot was equi-distant from the
acromion process of each shoulder, and spinous process of the occi-
pital bone. The surface of the sore was hard and dry ; the true skin,
for the scarf skin or cuticle had been removed double the thickness
of that beyond the patch, indurated and semi-cartilaginous, offering
great resistance to the knife. The cellular substance, fasciae, and
muscles blended into one hard mass, from which they could with
•difficulty be separated by dissection. The cellular substance, fascia
and muscles of the remainder of the back and posterior half of the
lateral parts of the thorax and abdomen, minutely traversed with
vessels carrying red blood, and the fat of these regions of a reddish
colour. The cellular tissue of the back and loins infiltrated with
teram. The anterior mediastinum healthy in appearance, but dis-
tended considerably with air. The cellular membrane in the course
of the phreoie nerve also distended with air ; the left cavity of the
thorax contained about an ounce and a half of sanious serum, but
neither it fas costal, diaphragmatic or pulmonary portion was traversed
by iieafclu containing red blood. The lungs of this side readily

Vol. v. ko. 29. 3b

410 Original Communications .-

fcto

collapsed, and expelled, the whole Of the air, and appeared of a dull
greenish blue hue exteriorly, and Interiorly of a purple dark port
wine hue, apparently from venous congestion. This lung had at its
superior part a small adhesion connected with a cicatrix of the lung,
arising from an old attack of bronchitis; this cicatrix contained,
however, two small cavities, filled with puruknt fluid. The lungs of
the right side white, internally they were of the same hue and
appearance as those of the left ; were everywhere in close adhesion
with the mediastinum diaphragm and thoracic parietes through the
medium of their pleura, which was connected by re&aat but organised
adhesive bands, traversed minutely by longitudinal and parallel
vessels, carrying red blood to the costal, diaphragmatic, pericardial
and mediastinal pleura. The lobes of this lung were adherent to
one another by more ancient adhesions ; and' at its upper part it
contained a cicatrix similar in form, appearance, structflrV *nd
magnitude, which was about that of a walnut, to the cicatrix of the
left lung, but containing no recent purulent matter. Neither hfttg
contained any tubercles, nor do I believe from their appearance evw
had, for the bronchial glands were in a perfectly healthy state, and
the cicatrices noticed were evidently the result of abcesses of some
earlier period of life, which had been long entirely obliterated. The
bronchial tubes of both lungs, and the whole of the trachea was
minutely injected with red blood, but in no case did there appear
ulcerations of their mucuous membrane, while the hue of the blood
was so dark, and the blood itself so recently decomposed, that it
would be impossible for me to say more than that I do not believe it
to have been arterial blood, because there was no matter efiused
into the bronchial tubes or trachea, the surface of which was nearly
dry. The pericardium, though opaque, was entirely free from any
appearances of recent inflammation, although it contained about
three teaspoonsful of sanious serum. I must, however, observe, that
the foregoing observation applies chiefly to the capsular parts of the
pericardium, for there were some small stellulae of red vessels on
that part investing the heart itself, and some unusual injections of
that portion of it which surrounds the heads of the great vessels,
viz. of the aorta and of the pulmonary artery. The valves of the
heart were perfectly natural in every respect, but the whole of the
lining membranes of the heart were much and deeply stained with
the blood, which in all the cavities of the heart, was in a state of effer-
vescence and decomposition. The substance of the heart was un-
usually pale and yellowish buff in hue, and the whole more flaccid than
usual. This substance contained no injected vessels, but a few bloody
petechias. '1 he abdominal cavity contained two or three teaspooaa-
full of sanious serum. The peritoneum was not, however, tra-
versed by red vessels in any part except in the region of the
mesentery, where it was considerably inflamed. The stomach was
externally of a red hue as if stained with blood, contained internally
about half a wine glassful! of dark greenish brown foetid viscid
mucus, and had its mucous membrane most minutely and densely
studded with stellulae of red vessels, particularly in the cardiac per-

Examination of the Body of Miss Cashin. 411

lion of its greater curvature* The same appearance was observed
in the first three inches of the duodenum. No other- trace of inflam-
mation was found in any part of the intestinal tube, which was
opened and very carefully and minutely examined, from one end to
the other. Indeed the branches of the mesaraic arteries, after reach-
ing the intestinal tube, were remarkably destitute of blood. The
whole of the surface of the ilium was covered with thick, pappy, reddish,
translucent, and somewhat viscid mucus ; the latter part of the ilium
and the colon and rectum contained a considerable quantity of soft,
natural, healthy looking feculent matter. It is worthy of remark,
that the whole of the intestinal canal was distended with flatus, and
had its coats more attenuated and translucent than I ever remember
to have seen in any case that I have examined.

Account of the Examination of the Brain, Muscles of the Back,

and of Spinal Marrow.

The deep seated muscles of the back were in a soft and pappy
state. The external coat of the spinal marrow was universally of a
reddish' brown hue, which was partly removed by washing in water.
No minute vessels carrying red blood were traceable in it, so that
this colour might arise either from a stain or from inflammation.
About four inches of that part of this coat, which covers the hinder
half of the spinal marrow, lying immediately under the centre of the
sore of the back, was very much thickened. Between the thinnest
layer of this coat, and the free serous or arachnoid coat, were found
several small bands of recent adhesive matter. The remaining mem-
branes, particularly of the posterior- half of the spinal marrow,
were ako highly coloured, perhaps from a stain. No trace whatever
of disease was found within the cavity of the head.

Letter from the Jury to Dr. Alexander Thomson.

London, 2d September, 1830.

Sib, — Allow me, in the name of myself and my fellow jurymen,
to requst your acceptance of our testimony, in opposition to' the
malicious, false, and despicable attack made upon you in the
" London Medical Gazette" of last week. We beg you to receive
onr thanks for your minute and careful examination of the body of
the unfortunate Miss Catherine Cashin, for the patient and clear
manner in which you explained to the jury the meaning of every
technical term which. you employed, and for the unhesitating and
open manner in which you answered all questions, from whatever
person they came, for the deep interest, you have taken in this case,
and for your whole conduct during the inquest, which we shall not
soon forget.

We have the honour to be, Sir,

Yours respectfully,

(Signed by the Jury).

4l2 Original Communications.

IV.-— Observations on Forensic Medicine. By M. Rays,M.D.

There are many bodily imperfections which are not suffi-
cient to deprive married persona of mutual succour. The
principal end of conjugal union is the establishment of a
contract, by which the parties promise the exchange of mu-
tual succour, and many of the ordinary infirmities are not
a sufficient motive to prevent consolation being given by
those affected. Marriage is defined a civil and religious
contract between male and female, by which they engage
to live together in mutual love and friendship for the purpose
of procreation. Some diseases are aggravated by marriage,
as inveterate scrofula, epilepsy, confirmed phthisis ; and as
these and other diseases may be communicated to the off-
spring, they are considered by many as impediments to
matrimonial union. Afifain, rachitis is ofteu transmitted to
infants ; and this rachitic predisposition in the female, pre-
disposes her to spinal ana pelvic deformity, and it. too often
happens in such cases, that the female, the day she hopes
to be a mother, is consigned to the tomb. Mat.ia and
other forms of mental imbecility, are impediments to the
marriage contract. It is necessary for this compaet that
there should be capacity to contract, and the consent of
both parties. The various requisites for conjugal union,
are seldom duly considered by society ; in fact, few persons
trouble themselves about them. The age, constitution, or
health of the parties, are scarcely ever considered, though
highly important. All physiologists agree that early or
premature procreation is objectionable on many accounts,
from the imperfect developement of the parties, the small-
ness of the pelvis, which exposes the woman to protracted
suffering1 during parturition, and too often to loss of life.
It is universally known to all practical obstetricians, that
females, who become mothers at an early age, purchase
the honor of maternity at a very dear rate, ouch persons
are liable to numerous disorders during gestation, the pelris
is unable to support the gravid uterus, it is. too small for
the passage of the infant, consequently parturition will be
laborious and protracted, and finally must be completed by
artificial means; while the degree of pressure on the im-
portant organs of the pelvis, produced by parturition;
causes great suffering and danger to the woman, and may
be followed by deplorable disease, or death itself. It is
also generally admitted by the most eminent writers, that
the present mode of female education is highly injurious to

Dr. Ryan on Forensic Medicine. 413

health, predisposes to spinal curvature, and consequently
to pelvic deformity, thereby rendering the object of pro-
creation highly dangerous to the other sex. Writers on
spinal diseases have very fully illustrated this position.
Again, greet injury is inflicted on the natural develope-
ment of females, by the custom of tight lacing, the func-
tions of the thoracic and abdominal . viscera are impeded,
the developement of the mamma* and nipples is prevented;
these parts are removed by absorption from pressure, the
lactiferous ducts are almost obliterated; the nipple is un-
developed > and therefore lactation is impeded, and the
natural food- of the offspring greatly diminished. Dugee,
and other foreign writers, allude to unnatural excitement
of the generative organs, and contend that masturbation is
the cause of rickets and of various chronic and incurable
diseases. In the male sex, it is productive of the worst
consequences, and often causes impotence and sterility.
The female is unfit for the purpose of procreation until
after the twelfth or fourteenth year, or until menstruation is
established ; for at an earlier age the sexual organs are
undeveloped, there is no venereal desire, and sexual inter-
course is painful. Hence - the cruelty and barbarity of
violating female children of tender age, which shall be
farther explained in the description of rape*

The male is also incapable of performing his part in the
mysterious process of procreation until after puberty, and
according to the law of this country before the fourteenth
year. He is not qualified to enter into matrimonial engage-
ments until the completion of the twenty-first year.

There is no subject which distresses married persons so
much as want of family, or leads to so much domestic
feuds and unhappiness, and finally to the nullification of
marriage. It is necessary for the medical jurist to be fully
informed of all the causes which disqualify both sexes for
the object of procreation. All disqualifications for matri-
monial union may be divided into two classes ; 1, those
caused by defect of mental power ; 2, those caused by de-
feet of sexual organisation. The disqualifications are there-
fore moral and physioal, and are expressed by the terms
impotence and sterility. These terms are often used synony-
inouslyj though widely different. Impotence consists in the
incapacity for copulation, or in the impossibility of exercis-
ing toe venereal act ; sterility consists m the aptitude of the
organs for procreation, without the power of reproduction.
Thus a person- may be impotent, but not sterile and vice
vena. Some writers apply the term impotence to the male,
and sterility to the female, but such a distinction is arbi-

414 Original Communications.

trary and unscientific, the female may be impotent from
malformation, and the male sterile, from excessive venery.
We may observe here, that sterility does not afford a just
plea for the nullity of marriage. We have now to consider
the manifest causes of impotence in both sexes, physical
and moral.

, Physical manifest, natural or accidental impotence,
of the male.— The causes of manifest impotence of the
male, are absence of the penis or testicles. There must be
total loss of the penis, as the slightest penetration into the
vagina is sufficient for procreation. (Blundell, Richerand,
Hurd, in Lond. Med. & Surg. Journ. vol. iv.) The absence of
the testicles from the scrotum, is no proof of their non-exist-
ence in the abdomen ; unless the penis be small, the voice
puerile, the beard absent, the form delicate, and the whole
physical and moral constitution feminine. It is well known
that the testicles may not descend into .the scrotum, and be
fully developed in the abdomen, and perform their functions
perfectly, and according to some writers, much better than
m the natural situation. The removal of one testicle by
castration or disease, is no impediment to . procreation.
(Astley Cooper, Marc. Diet, des Sc. Med.) When both
testicles are diseased, their secretion is injured or destroyed,
and impotence is the consequence. Both testicles may be
removed by. castration, yet procreation be effected, as the
vesiculae seminales may contain a sufficient quantity of semen
for one or two prolific emissions, after which the person will
be impotent. But such persons,, and also, eunuchs, have
erection and emission, which consists of the prostatic, fluid,
the mucus of the seminal vesicles and urethra.

The urethra may open above . the pubes in monsters,
(Duncan and others), and in such cases the individual is
impotent. Mahon and many other jurists, contended that
individuals were impotent who where affected with hypospas-
dias ; that is, when the urethra opens through any part of
that canal from its orifice to the scrotum. If the opening
be so placed that it may enter the vagina, impregnation, will
follow. Frank relates a case in point. He knew a father
.so affected, transmit it to his. son, and even to three gene?
•rations. Another individual had three- sons. Bull, de la
Faculte de Medicine, 1810. Morgagni, Petit-Radel, Saba-
tier, who was hypospasdiac, Gauthier and Richerand have
observed analagous facts. Diet. . de Sc. Med., art. Hypos*
pasdias.

Sometimes the urethra opens along the dorsum peois ;
this constitutes epispasdias. It is evident that the reasoning
-employed in the preceding case, is applicable to this.

Dr. Ryan on Forensic Medicine. 4J5

Dimensions of the' penis, extraordinary thickness and
length, are considered by some writers as causes of impo-
tence. Fodere is of opinion that the respective organs may
be so disproportionate, as never to be adapted to each
other ; and the physical inconveniences are such as to ex-
pose the female to great injury and danger to her health.
It must be admitted, however, that thickness of the penis,
which excites great pain in some women, procures volup-
tuous sensations in others, and that the vagina is capable of
great dilatation, which may be effected by gentle and gradual
efforts, and reduced to a state capable of receiving the virile
member. Though extreme length of the penis may pro-
duce contusion of the os and cervix uteri, it cannot be
deemed a just cause of impotence, because, by certain
precautions, this danger may be avoided, unless there is
great difference between the age of parties. Diminutiveness
or shortness of the penis is no proof of impotence, for the
reasons already stated. Obliquity, tortuosity or bifurcation
of the penis, stricture of the urethra, phymosis, paraphy-
mosis, or excessive length of the fraenum, cannot be con-
sidered absolute causes of impotence, as they can be reme-
died by surgical operations. Large scrotal hernia? cause
recession of the penis, and render coition impracticable ; but
in some cases relief may be afforded. The same observa-
tions apply to large hydrocele. Sarcocele or scirrhus of
testicle does not cause absolute impotence, as it may be
removed by operation ; and one testicle remaining is suf-
ficient for procreation. The testicles may disappear by
disease, (Hamilton, Larrey, Fodere,) or by the use of
iodine. Three conditions are necessary on the part of the
mate for copulation — erectio et intromissio penis, cum
iembiis emis stone. Impotence in men depends on defect
of soiws one or more of these conditions ; erection, intro-
mission and "ejaculation of the spermatic fluid. The causes
of impotence are more commonly observed in man than in
the other sex; and this is easily accounted for, by the
greater part the male has to perform in nuptial congress.
This is evident from the phenomena which give the virile
member the form and disposition proper for erection, the
introduction of the organ, and the ejaculation of the
semen, effected by a violent ttad complicated action, which
requires a> concurrence of many indispensable conditions,
as the organs not only contract spasmodically to effect the
expulsion of the male fluid, but all the body participates in
this convulsion at the moment of emission, as if nature at
this* instant forgot every other function. The causes of im-
potence in tnan arise from two sources, from malformation

416 ' Original Commmnications.

of the genitals, or from want of action in them; but in
females, impotence can only depend on malformation,
natural or acquired, as the organs nave little to do in the
act of copulation, they being merely auxiliary to it.

The causes of want of erection may be divided into phy-
sical and moral. The physical causes depend on defects of
the body, as paralysis of the penis, curvature of the spine,
frigid and apathetic temperament, The moral causes are
such as act powerfully on the imagination, and suddenly
produce an atony of the genitals, or induce an inactivity in
organs properly developed. The genital organs, says M.
Virey, offer two states during life, in the young and old,
which are the frozen zones of existence, the intermediate
state is the torrid zone of life. The infant has nothing to
give, the old has lost all. This doctrine, though generally
correct, admits of exceptions, as children have been pre-
cociously developed even before the fourth year, examples of
which I have cited in my work on Midwifery ; and our
author described a boy, aged seven years, a native of the
department of Lot, who was as fully developed as an adult,
and who made the most furious comic attacks on his female
acquaintance, and absolutely deprived one of them of that
which she could never regain. On the other hand, a French-
man, aged ninety -nine, married a tenth wife, and was a father
at 102 (Bosquet), and Thomas Parr, married at 120, and
performed his nuptial duties so well at 140, as to make him
forget his old age. He was even compelled to appear in a
white sheet at one of our churches, for an amour, in his
150th year. He outlived nine kings of England. (Elliotson.)
But in general, the power I of procreation continues from
puberty to the 65th year. Immaturity of age, or senescence,
may be put down as the first causes of want of power of
erection. Among such causes, we must reckon a frigid or
apathetic constitution, a total insensibility to sexual desire,
and this is said to be an aggravated or profound lymphatic
temperament. Descourtliz describes persons of this tem-
perament in these words : — " The hair is white, fair and
thin, no beard, countenance pale, flesh soft and without
hair, voice clear, sharp and piercing, the eyes sorrowful
and dull, the form round, shoulders strait, perspiration
acid, testicles small, withered, pendulous and soft, the sper-
matic cords small, the scrotum flaccid, the gland of the
testicles insensible, no capillary growth on the pubes,
a moral apathy, pusillanimity ana fear on the least occasion,
are symptoms of anapbrodisia, or impotence, or sterility ;
-and any one having the majority of these signs, is incapable
of copulation or generation. PropositionssurrAnapbrosidie.

Dr. Ryan on Forensic Medicine. — Impotence. 41 7

A habitude of chastity is another opponent to erec-
tion, such as in the ancient fathers of the desert, and in
those, who by fasting and other forms of church discipline,
extinguish those feelings implanted by nature, but in their
opinion contrary to that purity which should distinguish
those who have made vows of chastity. The organs of
such persons decay like all corporeal organs, whose functions
are not exerted. Long continued debauchery will cause
impotence, whether with women or by musturbation. Every
practitioner has met with cases of both these kinds. The
impotence, . says Pinel, caused by the latter excess, reduces
youth to the nullity of premature old age, and is too often
incurable. Drs. Gregory and Parry have forcibly commented
upon this baneful habit, as also many other distinguished
writers. Long watching, great fatigue, mental or corporeal,
want of nutriment, excessive evacuations, sanguineous or
otherwise of blood, bile, faeces, saliva, menses, scorbutic
cachexia, marasmus, peripneumony, hydrothorax, anasarca,
malignant fevers, diseases of the brain and spinal marrow,
whether from external injuries or poisons, and numerous
other diseases, are temporary causes of impotence. Sexual
desire is suppressed by acute diseases, and returns after
convalescence. Zacchias and Beck relate numerous cases in
proof of this position. We see this, further illustrated
during the convalescence after fevers, when erection often
occurs. Some diseases stimulate the generative organs, as
calculus in the kidneys or bladder, gout, rheumatism,
hemorrhoids, leprosy, and other cutaneous affections. Ex-
cessive venery is a frequent cause of want of erection and
impotence. . I have been consulted in numerous cases of
this description, especially after marriage. And this is a
frequent cause of want of family in young married per-
sons.

The abuse of narcotics, saline refrigerants, acids, acid
fruits, "iodine, camphor and nitre, are causes of impotence.
Of all causes cold is the most powerful. Thus in the Polar
regions, there is neither love nor jealousy.

Moral Causes. — There are no facts which so evidently
prove the influence of the moral over the physical state of
man, as the phenomena of erection. A lascivious idea will
arise in the midst of our gravest meditations, the virile
organ will answer its appeal, and will become erected, and
fit for the functions which nature has confided to it. But
another thought arising, will instantaneously extinguish with
the most frigid indifference, all our amorous transports.

This statement is well exemplified by the effects of the

Vol. v. vo 29, 3 f

418 Original Commmnications.

'to

passions. Chagrin, inquietude, and debilitating1 passious,
prostrate the whole economy, jealousy, and profound medi-
tations, impede the faculty of procreation. Thus at the very
moment when enjoyment is about to be commenced, too
eager desire, the trouble which seizes on too ardent an
imagination, the excess of love, the fear of not being loved,
timidity, respect, doubt of capability, the fear of being
surprised, the shame of excessive modesty, on being in the
presence of witnesses, antipathy, the sudden knowledge of
some physical defect in the female, aversion from filth,
odour and pre-occupations of the mind, are sufficient to
oppose erection, and to abate it most suddenly. But who
can enumerate all the moral causes capable of impeding
or destroying erection ? A sigh, doubtfully interpreted, a
recollection, an equivocal word, are sufficient to destroy
the illusion, and congeal the most violent passion. A newly
married man has become suddenly impotent, on discovering
his bride was without a hymen ; and a debauchee has as
suddenly become anaphrodisiatic, on finding the membrane
perfect. (Diet. Des. Sc. Medicates.) And thus with a literary
man, a philosopher, or those who have a ruling idea, which
excites the brain more than the sexual organs. The fear
of being impotent is the most frequent and powerful cause
of this condition. Thus the cases related by the immortal
Hunter, and the absurd impressions of former times as to the
influence of his Satanic majesty, and his worthy colleagues
the witches. Men supposed there was no physical power
when the moral state had consumed their desires, ana they
were impotent, as long as they supposed themselves so.
Such is the power of the moral over the physical state of
man. How many impotent persons of this class were cured
with bread pills by Hunter ; and how many are annually
cured by mere placebos ? In remote ages, men allowed the
illusions of the imagination to have a most extraordinary
power over their minds and bodies. This was most remark-
able in the subject before us.

Thus we cannot easily comprehend how the power of
rue, or St. John's wort, could prevent a man properly de-
veloped, from performing his nuptial duties, on his bridal
day ; nor how the pronunciation of a few obscure and un-
intelligible words could have a similar effect. These words
were to be written on paper with the blood of a bat, sewn
up with a needle, which was used in making the shrouds
of the dead, and then the charm was to be tied round the
neck of the new married man. (Venette— also les Secrets
du Petit Albert.) To cure these enchantments, the church
prescribed prayers, and the doctors physic. Mr. Hunter's

Dr. Ryan on Forensic Medicine. — Impotence. 419

|>lan was best. He ordered timid bridegrooms to refrain
rom any venereal combats for a week, no matter what might
be their desires, and then to try their prowess. This cure was
effectual, and many of his patients succeeded sufficiently as
to remove all unfavorable impressions of impotence ever
afterwards. They casually took some mild form of medi-
cine, and a few drops of tincture of opium each night,
during the period of preparation.

Impotence natural, manifest or accidental in woman. —
It has been long held, I think erroneously, that the genera-
tive organs of the female are more complicated than those
of the male ; and therefore, that the causes of impotence
are more numerous and less apparent in the other sex. If
we examine the genital organs of both sexes anatomically,
we will find them equally complicated, and possessing an
equal adaption or arrangement of parts, as well as an
identity of structure. Thus we find the structure of the
penis, very similar to that of the genital fissure and vagina,
the double fold of prepuce the cavernous structure, its per-
formance of a part of the geuito-urinary functions, the
opening's of the vesiculae seminales and uterine tubes, the
vesiculae seminales and uterus, the testes and ovaries, the
spermatic cords and the uterine tubes. We also find the
diseases of one sex as numerous as those of the other, and
those who doubt the assertion, need only refer to jthe works
of Chopart, Titley, and others, on diseases of the genito-
urinary organs of the male, for ample proof of the position.
I need scarcely observe, that diseases of the vasa deferentia,
vesiculae seminales, the pressure of tumours, hydatids, &c.
on these parts, diseases of the prostate gland, urinary
calculi, diseases of the urethra, fistulas in perineo, diseases
of the bladder, penis and scrotum will be found as numerous
as those of the generative system of the other sex. Besides,
it would be inconsistent with the wisdom and beneficence of
Providence, that one sex should have more to do in the
perpetuation of the species than the other.

The causes of impotence in woman, are malformations or
diseases of the organs subservient to procreation. Some of
these causes are apparent, others obscure. The apparent
causes are obliteration of the external sexual organs, both
soft and hard, absence of the vagina and uterus, and great
deformity of the pelvis, with numerous diseases of the
external and internal genitals. The vagina and uterus have
been found to consist of a dense fleshy substance, (Mor-
gagni, Mott, Fodere) and the vagina has been partially
closed by such substance, (Pare, Kuysch, Fabricius, Phy-
rick, Fodere.) In my woVk on Midwifery, I have said,

420 Original Communications.

" the vagina may be absent, (Haller, Vicq. d'Azyr. Joutti.
des Scavans, Boyer, Caillot, and Willaume,) unusually
small, impervious from adhesion, tumours; or a fraeoum
passing above the hymen, or it may be filled with a fleshy
growth. If too ^narrow, it may be dilated with a bougie or
a tent sponge ; and when unattended to, must be divided
by incision, to admit the passage of the infant. It has
closed up after conception. There is sometimes a great
congenital confusion of parts, so much so, that it would be
tedious, if not impossible, to describe them.. In cases of
extreme narrowness, impregnation may take place, and (he
canal be gradually dilated during parturition. I have seen
four cases of cohesion of the labia externa, at the age of
puberty, so complete, that only a small probe could be in-
troduced at the superior commissure, The vaginal canal
may be totally or partially obliterated, and iu such cases
an operation is impracticable, and impotence absolute."
The vagina has opened into the bladder, (Sue) rectum,
anterior parietes of the abdomen, and pregnancy has oc-
curred in the two latter cases. Morgagm attests that of the
abdomen, lib. v. epist. 67 ; and the last is given in the
Annates de Med. ae M ontpellier, which led the celebrated
Louis to propose the following question to the casuists :—
" an uxore sic disposita uti fas vel non, judicent theologi
morales ?" Barbant cites two examples of pregnancy of this
kind. Die. des Sc. Med. art. Impuissance. Orfila contends
such malformation is a cause of impotence, for though
coition is not physically impossible, it is contrary to the
laws of morals and of nature. The Royal Court of Treves
annulled a marriage in such a case. In cases of vesico-
vaginal, recto-vaginal fistulas, and amplification of the va-
gina from laceration of the perineum, inflammation and
ulceration may occur and impede sexual intercourse, but
such cases could not warrant a divorce, as they occurred
after marriage. Excessive straitness, or partial occlusion of
the vagina, are not impediments to procreation, as fecunda-
tion may occur, if the spermatic fluid be applied inside the
labia, as already mentioned. Besides, fecundation has
happened, and the hymen perfect. Ruvsch, Pare, Smellie,
Hildanus, Mauriceau, Boudelocque, Naegele, Nysten. Jour.
de Med. de Corvisart, and Leroux. Prolapsion, and some
forms of ulceration of the vagina, are only temporary causes
of impotence. Cauliflower tumours of the clitoris or nymph®
may be temporary causes of impotence, as also tumours in
the vagina. Manual of Midwifery, p. 55. Bums. Trans.
Dublin College of Phys, 1824, v. 4. Ed. Med. and Sur.

Dr. Ryan on Forensic Medicine. —Impotence. 421

* • «

Journ. 1805. Leucorrhcea is one of the most common
causes of sterility.

The uterus may be absent, (Columbus, Schlegel, Mor-
gagni, Meyer, Renauldin, Hamilton, Bousquet, Theden,
Engel, Lieutaud, Caillot, Ford, and Breschet) I might

Juote numerous writers who describe the cavity of the uterus
ivided by a septum, but it is not stated whether or not
procreation was impeded. Many authors have also described
partial or total obliteration of the uterine cavity, among
whom are Bichat, Lallement, Segard, Gardien, &c. The
uterus may be double, .that is, there may be two uteri.
Haller, Purcell, Med. Facts, vol.. 3. . Mem. Med. Sci. v. 4.
Lond. Med. Journ. 1782, v. 3. Diet. des. Se. Med. T. 6.
Duges, Journ. de Progres, v. xxii. A vicious direction of
the os and cervix uteri, or complete occlusion of the former,
are irremedial causes of sterility. The whole of the causes
of impotence and sterility in females, may be arranged
under three classes ; 1, those depending on the organs which
receive the male fluid, namely, the genital fissure, the
vagina and uterus ; 2, malformation or diseases of the organs
that transmit it to the ovaries, and reconvey the embryo to
the uterus, and these are the fallopian or uterine tubes ;
3, the malformation or diseases of the ovaries or organs,
which supply the germ for fecundation.- Inflammation,
ulceration, scirrhus, cancer, ossification, calcareous deposit
or tumours in any of these organs, may be the cause of
sterility. In fact, any disease of the female genitals,
attended with much constitutional disturbance, may be held
a temporary cause of sterility. Tumours of various kinds,
callosities, cicatrices, adhesions, from disease or mecha-
nical violence, displacement of the uterus, prolapsus, pro-
cidentia, retroversion, antiversion, lateral obliquity, and
the various disorganizations incident to muscular, serous
and mucous tissues, when present in the female organs, are
causes of sterility. In the last volume of this Journal, is
an account of two singular cases of procidentia uteri; in
both impregnation was effected through the natural orifice,
though permanently fixed without the genital fissure for
years. I have also published cases of dysmennorrhoea, in
which pregnancy occurred. In the disease called irritable
uterus, so well described by Gooch and others, a cure may
he effected. In absence of the ovaries and uterine tubes,
there can be no conception, or in dropsy, or enlargement
of the former, or in occlusion or adhesion of the latter to
the uterus, pr adjoining parts. There are some cases of
constitutional sterility, which are inexplicable ; for example,

422 Original Communications.

those in which a wom$ui has had no family for years, and
at length becomes a mother.

The principal moral causes of impotence are hatred, dis-
gust, fear, timidity, an excessive ardour of desire, divers
ramblings of the imagination ; in a word, every passion
strongly excited, that is to say, all cerebral action so strong
as to diminish that of the genital organs, which require for
cohition great exaltation. Impregnation may happen under
such circumstances. Fodere is of opinion that complais-
ance, tranquillity, silence, and secrecy are necessary for pro-
lific coition ; it is arrested as if by. enchantment, by noise,
dread, fear, publicity, jealousy, contempt, repugnance,
slovenliness, by love too much respected, and by every
thing that can illumine the imagination.

Many of the causes of impotence in both sexes may be
removed, but many are beyond the reach of art. It has
been lone1 maintained, that the powers of the mind have
great influence in promoting and impeding the process of
procreation. Much may be said for and against this posi-
tion. . In discussing this ouestion in the work so often re-
ferred to, I have said—" ^n order to have coition effectual,
there is a mutual relation necessary — a union in mind and
pleasurable enjpyment as well as ia body, and unless this
union of love be mutual, conception will seldom, if ever
happen ; for it has been lone* observed, that frigidity and
reserve in either party, will defeat procreation — a want of
love being a certain cause of barrenness. Hence, in unequal
marriages, where one of the party is old and the other young,
there is scarcely ever offspring. Again, it has been observed,
that in cases 01 rape, impregnation seldom occurs.

" In order to effect procreation, there must be an ability
and fitness of disposition in the sexual organs of both par-
ties. The disproportion of the organs impede or prevent
conception. This is observed very often, when persons of
extreme difference of stature cohabit. The most frequent
cause of want of family, is too frequent intercourse ; the
male semen will be too weak, and the female will become
relaxed, have increased raucous vaginal discharge, which will
extinguish the vivifying principle of the made altogether.
Hence we see strong, young, vigorous, and amorous per-
sons remain married five, six, and seven years without
children. I know three respectable families in this. predica-
ment. I am inclined to think that the male semen is not
sufficiently strong when onjy allowed to accumulate for a
day ; in fact, all healthy persons who desire children, should
cohabit but once or twice a week, and they will be seldom

Dr. Ryan on Forensic Medicine.— Impotence. 423

disappointed in their expectations. The sexual act is not
performed well when repeated too often. Hence when boys
or extreme young persons get married, they seldom propa-
gate. It is an opinion, that the greater the quantity of
semen, the more perfect the formation, and even future
disposition of the offspring, and the gTeater the pleasure
experienced by both sexes. The first opinion is attested in
the inspired writings, Gen xlix. v. 3. Tne more the semen
is preserved, it is more powerful and ought to be retained
for a few days, in order to render the sexual congress
effectual.

" Care, thought of business, sorrow, sadness, and depres-
sing passions should be avoided, as they have & bad effect
on tne conception. This has been long the prevailing
opinion among mankind, especially among physicians, natu-
ralists, and I might add, sentimentalists too.'

On the other side, I have said, in disproving the vulgar
notions, that the power of the mother's imagination can de-
form the infant.

" Conception is independent of the mother's will and
pleasure. How many women are desirous of children, and
yet have none ; while others, not only conceive, contrary to
their wishes, but go to their full time in despite of the
various means they wickedly and designedly employ to de-
stroy the foetus. Again, the nutrition and growth of the
infant go on according to the laws of nature, whether the
woman wishes or not. It is also out of the mother's power
to choose a boy or girl — to have one or more children at a
birth — to cause the infant to be fair, dark, large or small,
weak or strong, or to give it her own or the father's features.
If then, women cannot, by imagination or will, promote or
impede conception, how can any one believe, without dero-
gating from the power and wisdom of God, that they can
disfigure the infants, and injure the works of nature ? Is it
not absurd to suppose that the mother has more influence
over her child, tnan over her own body ? The idea is pre-
posterous. If she cannot, by the strength of her imagina-
tion, make any mark on her own body, or change the
figure, situation, quantity, and number of her own limbs,
why should we believe she can do so to the body of the
infant? Is it not silly and ridiculous to think; that if the
affrighted mother apply her hand to any part of her body,
which may be done accidentally and undesignedly, this can
affect the same part of the infant ? Does she mark that
part of her own body, by such application of the hand ?"

From the preceding statements, we may, I think, deduce
the following general principles : —

424 . Original Communications.

1. To .declare either sex impotent, it is necessary that
certain physical , causes be permanent, malformations or
accidental lesions, and be evident .to our senses, which art
cannot remedy, and which prevent the faculty of exercising
a fecundating coition.

2. These causes, when rigorously examined, are few in
number. * •

3. The moral causes of impotence ought not to be taken
into consideration, as they would serve as an excuse for an
individual accused of impotence.

In this country the medical jurist is seldom required to
decide questions of impotence or sterility in our courts of
justice, but every medical practitioner may be consulted
in private, either before or after matrimonial engagements.
He may be the cause of great domestic trouble, and em-
bitter the life of male or female. He should be exceedingly
cautious in fixing the stigma of impotence or sterility on
either party. The legitimacy of children may be contested
on a plea of impotence, and such a plea may be offered
by a man accused of rape. It is therefore evident, that a
proper knowledge of the subject is necessary to the medical
practitioner.

BIBLIOGRAPHY.

PHYSIOLOGY.

1. Of the Pulse and its Modifications. By S. Jackson, M. D
Assistant to the Professor of the Institutes and practice of Medicine
and Clinical Practice in the University of Pennsylvania. — It has
been a subject of dispute whether the arteries experienced a dilata-
tion in consequence of the impulse communicated to the blood by
the contraction of the ventricles. A very slight dilatation certainly
does occur, though much less than formerly supposed, or might be
believed, from observing superficially the pulse. This point appears
to be very accurately settled by the experiments of Spallanzani,
Parry, and Poiseuille.

Three circumstances govern the pulse, of which it furnishes the
indications; 1st, the frequency or slowness, force and rythm, or
order of the ventricular contractions ; 2d, the quantum of blood
actually contained in the vessels or proper vascular system, which is
governed by the state of the capillary and areolar circulation ; and
3d, the state of the arteries.

1st. The pulse depending so much on the action of the heart,
partakes of all its aberrations from the natural state, and these de-

Physiology. Aib

' vrations are the consequence of idiopathic affections of the heart, or
of its sympathetic disorders. The last are the most common, for
the diseases of acute, and most of those of chronic irritations, ex-
tend their influence to the heart, and involve it in the morbid con-
dition.

The modifications of the pulse arising from the contraction of the
heart, are those affecting its frequency, slowness, force, and rythm
or mode of pulsation.

Frequency of the pulse is the most constant and certain symptom
of an existing irritation in the organs. Whenever the heart ex-
periences irritation, either sympathetically or primitively, its con-
tractions are quickened, and so long as a frequent pulse continues,
whatever may be the improvement of other symptoms, we should
always suspect a lurking inflammation, and endeavour to extermi-
nate it. The diminution of the frequency of the pulse, in acute
diseases, is uniformly a favourable sign, while its persistance is as
positive an evidence nearly of the continuance of the disease. In
convalescence from gastro-enteritic fevers, after the perfect reinstate-
ment of the alimentary organs in their healthy state, I have fre-
quently found the frequency and irritation of the pulse continue,
and every attempt to increase the diet or invigorate the patient by
tonics, to be attended* with febrile {excitement. The irritation of
the heart in these cases, at first merely sympathetic, had become
established permanently, and did not terminate with the cessation of
the primary irritation. It is to be overcome by local depletion from
the cardiac region, blisters to the same part, small bleedings, and
restricted regimen. If neglected, organic disease of the heart will
sometimes succeed, or the patient be cut off by dropsical effusions.

Frequency of the pulse may be combined with its force and ful-
ness, but they do not necessarily accompany each other.

The contractions of the heart, in the majority of persons, average
from sixty-five to steventy in the minute ; above that number, the
pulse is said to be ^frequent. It often mounts as high as one hun-
dred, one hundred ano} twenty, and seldom beyond one hundred and
fifty in the minute.

When the contractions of the heart are very feeble, from the emp-
tiness of the vascular system, they increase in frequency, as though
the deficiency in the quantity of the blood circulating, was to be com-
pensated by the increased velocity or the circulation. It is scarcely
possible to mistake the frequency of the pulse from this cause, for
the frequency produced by irritation. It is always attended with
extreme weakness of the pulse.

Quickness of pulse differs from frequency ; it has reference to the
*tae of each pulsation, and depends on the systole of the heart
king performed with a rapid contraction. Most commonly it ac-
companies frequency of the pulse, and is an evidence of existing
irritations. The frequent pulse of exhaustion is generally a quick
pulse.

Slowness of pulse is usually employed as opposed to its frequency
*nd expresses the fewer number of pulsation* than is usual in a given

vol. v. no. 29. 3 o

426 Bibliography.

time. Rareness or paucity of pulse would be a more correct desig-
nation, to distinguish it from slowness, as contrasted with quickness.
The diminution in the pulsations of the heart, manifests the absence
of irritation in that organ, or its declension, if they had been previ-
ously frequent. Rareness or paucity of pulse accompanies at times
a full and strong pulse, particularly in the congestions of the cerebral
organs, and is also an attendant on a small and feeble pulse, espe-
cially in chronic diseases, attended with serous effusions. It is pro-
duced by digitalis, and appears to be a specific action of that remedy,
diminishing the irritability of the heart, and consequently the number
of its contractions.

Slowness of pulse, as opposed to its quickness, has relation to each
pulsation. It arises from the same causes as rareness of the pulse, a
state of ab-irritation or asthenia of the heart or mobile organ of the
circulation, and sometimes of the softening of its parietes.

A strong or forcible pulse proceeds from the energy of the ventri-
cular contractions. Most commonly it belongs to a fulness of the
vascular system, or plethora, and manifests excitement and vigour in
the heart. It attends on hypertrophy of the left ventricle.

A feeble pulse marks, in most instances, a low state of excitement
in the heart, and indicates exhaustion of the vascular system. It may
be accompanied with slowness or frequency . In carditis and pericar-
ditis the pulse is said to be feeble, which then proceeds from the dis-
ability of the ventricles to contract, like other muscles, when they or
their sheathes are in a state of acute inflammation.

The last modification of the pulse emanating from the heart, relates
to its rythm, or mode of action. In this respect, the pulse may be
equal or regular, unequal or irregular, and intermittent. In a regular
or equal pulse, all the pulsations are similar ; a pulse is unequal or
irregular, when the pulsations do not correspond to each other in fre-
quency, quickness, and force ; a pulse is intermittent, when, after
several pulsations, there occurs a momentary repose. These con-
ditions of the pulse proceed from different modes of contraction of
the ventricles. The irregular and intermittent pulses belong to
organic diseases of the heart, and occur also in acute diseases, from
sympathetic disturbances in that organ, which, I am disposed to
believe, are only excited by irritations of the digestive organs. At
least, I do not recal pulses of that character in the diseases of other
organs, except of the heart itself. The irregular is a more un-
favourable than the intermittent pulse. I have known instances
in which an intermittent pulse was natural to the individual ; it con-
tinued for years, and during the enjoyment of good health.

2d. The capillary system modifies the pulse, as to fulness or
emptiness, by determining the quantity of blood contained in the vas-
cular system, and regulates, in these respects, the state of the direct
circulation. This last supplies the capillary system, which attracts
from the arterial and withholds from the venous vessels the propor-
tion of blood it requires, determined always by the state of its
excitation — the vascular or direct circulation is governed, as to
repletion or vacuity, by the state of the capillary circulation in the

Physiology. 427

different organs. Fullness or emptiness of pulse are, then, indica-
tions of the condition of the capillary circulation. These states of
the pulse are produced, however, under particular circumstances, and
in a manner requiring to be noticed.

When a limited extent of the capillary system is engorged with
blood, as occurs in irritation and inflammation, the circulation of the
congested part, is sluggish or suspended, and the portion thus
affected, ceases to admit further supplies for the time, from the artery
conveying the sanguine humour to it. The amount of blood which
previously passed into the capillaries, is now accumulated in the
artery, and passes into the veins exclusively by the direct communi-
cation, existing between those vessels. They are consequently replete
with blood — the artery, completely distended, is full and hard, and
it more perceptibly manifests the momentum of the heart's con-
tractions. This 1 regard as the correct explanation of the full,
strong pulse, felt in the arteries supplying an inflamed part, as in
the radial artery, in very acute inflammation of the hand.

Inflammation of the brain or meninges with light congestion, pro-
duces the same effect in the carotid arteries ; and to a greater extent,
the same circumstance is observed in the extreme congestions of the
brain, as in apoplexy. In these last cases, the pulse of the whole
vascular system, is full, strong, and often slow. The degree and
extent of the congestion, which occupies the external as well as in-
ternal capillaries of the head, arrests the capillary movements, and of
course the demand of these organs receiving in a natural state, as is
estimated, an eighth of the whole circulating fluid, while the general
torpor of the capillary system throughout the economy, which attends
on this disease, diminishes, in some degree, the call made on the cir-
culating fluid. The vascular system, in consequence, acquires a
repletion of blood, the vessels are distended, the pulse full and strong,
and as no irritation exists in the heart, its contractions are slow.

Precisely the reverse iff the effect on the general or vascular cir-
culation and pulse, of irritation in the extensive membranous tissues
rich in capillaries, and in capacious organs of highly vascular struc-
ture, producing in them profound congestions. The quantity of
blood these organs and tissues are capable of containing, and which,
under the influence of irritation they abstract and withhold from the
vascular system, is so great as to reduce the general circulation to a
state of extreme exhaustion. A small deficient current flows through
the arteries and returns immediately by the veins. The heart in a
state of asthenia, contracts with feebleness on its half-distended
cavities, and the pulse is scarcely to be perceived, and sometimes is
entirely absent, when the volume of blood is not adequate to bring
the elasticity of the arterial coats into action.

In the commencement of irritations of the internal viscera, espe-
cially of the digestive or alimentary organs, before reaction, or the
irradiation of the irritation into other organs has ensued, the capillary
and areolar circulation of the external surfaces is diminished, the
capillary circulation concentres towards the seat of irritation, where
the- blood accumulates, and is detained until it is dispersed by the

428 Bibliography:

establishment of reaction. This concentration of the circulating' or
nutritive humour in a portion of the capillary system, forms the cold
stage of fevers, and is the essential condition of visceral congestions,
which have formed so prominent a feature of late in some systems,
though their mode of production was not understood. Its direct
effect is to abstract blood from the vascular system, equivalent to a
depletion, and the quantity of blood of which the vessels are deprived,
is proportioned to the intensity and extent of the concentric move-
ments of the capillary circulation, and degree of congestion induced;
it is often equal to the abstraction of many pounds of blood. Hence
arises, in this state, the weak, feeble pulse, a sign of debility in the
contractions of the heart, and emptiness of vessels.

The same result, as to the vascular circulation and pulse, is pro-
duced by extensive irritations of the cutaneous surface, determining
sanguine congestion of its capillaries. This state exists in the erup-
tive fevers, or exanthemata?, when of a high grade, and which are
then attended with a weak, empty pulse. Scarlatina, when of in-
tense character, as in its malignant form, is a remarkable illustration
of the fact. The disease, in this state, exhibits the skin from the
head to the feet of a deep red, demonstrating the actual presence
of red blood in the skin, in a quantity entirely unnatural. The in-
ternal mucous tissues, in this malignant form of the disease, is shown
by dissection to be in the same condition. Here then is presented
the ocular demonstration of the permanent congestion of the cu-
taneous capillaries, the detention of a large quantity of the circulating
fluid in them, and its consequent deprivation from the vascular
system. Now in this form or stage of scarlatina, the pulse is always
deficient in fulness and force, and in the highest grades of the disease,
the pulse is reduced to such extreme exility, it is scarcely distin-
guishable.

This feeble, empty pulse of scarlatina maligna, has been supposed
to be the consequence of extreme debility of the vital powers, and
to require the sustaining energy of stimulants and tonics. I have
never witnessed from their employment, more, even when lavishly
administered, than a transient effect on the circulation, and by aug-
menting the morbid irritation of the cutaneous and mucous surfaces,
and thereby confirming their congested state, they have increased
the vascular exhaustion, and have enfeebled to a greater degree, the
action of the heart and pulse. Cold or tepid evaporating ablutions,
used according to circumstances, by diminishing the cutaneous irri-
tation, relax the capillary congestion, the blood resumes its natural
course into the vascular system, which fills up and expands, end the
pulse acquires fulness and firmness. I have seen, in scarlatina, the
pulse, as ablutions were employed or discontinued, become alternately
full and firm, or empty and feeble. In rubeola or measles, when
malignant, and in confluent small-pox, the exhaustion of the vascular
system, and extremely small and feeble pulse, are produced in this
same manner.

This principle, which I consider as of the highest importance in a prac-
tical view, when fully appreciated, has a very extensive application ;

Physiology. . 42$

and it places in a very clear light, the important fact, that a patient,
in irritations of great activity, is threatened at the same instant with
impending dissolution, from opposite conditions of the organs — that
is, from extreme feebleness and exhaustion of the vascular circula-
tion, and violent congestive irritation in the , capillaries of the ce-
rebral, pulmonary, or abdominal viscera, suspending their functions.
It exhibits also the necessity, under those circumstances, of resorting,
at the same instant, to a compound and opposing treatment, explains
the objects to be attained by it, and the manner in. which it is to be
directed.

3d. The arteries modify the pulse, when they are themselves in a
pathological state, to which they are subject, as well as the other
organs, oi the economy. Acute inflammation, as in arteritis, causes
firmness in their coats, and the pulse is then hard. The inception
of ossification renders the pulse obscure, and when it is complete,
the artery losing its elasticity no longer responds to the shock com-,
municated by the heart, and the pulse is lost. The coats of the
arteries, in some instances, are softened from a species of infiltration
of fluid into their interstices, which lessens their elasticity and im-
pairs their power of reaction.

The calibre of the artery has an influence over the pulse. I have
seen, in a case of dilatation of the heart, all the arteries preterna-
torally small, and which prpduced a remarkably small pulse. Undue
enlargement of the arteries is not uucommon. The pulse, in a nor-
mal state of the circulation, is then large and full, and under excite-
ment, is exceedingly deceptive. It appears to indicate profuse and
repeated bleedings, but fails with rapidity under sanguine depletion,
assuming a peculiar yielding and flaccid sensation, as though the
vessel contained a gaseous or exceedingly tenuous fluid.

The pulse in many individuals is very feeble ; it is scarcely dis-
cernible. They enjoy, notwithstanding, excellent health. The
energy of life does not depend on the force and velocity of the vas-
cular or direct circulation, but on the activity of the capillary cir-
culation. . Persons who are prone to obesity, have usually a small
and feeble pulse. It is a common explanation of the fact, to attri-
bute it to compression, on .the arteries from the accumulation of
adipose matter. This is not correct ; the arteries and whole vascular
system in such persons, is not developed to the same extent as in
others, and the vascular circulation is more inactive.

The pulse, is in some instances entirely absent, without interfering
vith health. . This circumstance occurred in the mother of Dr. S. of
this city. The pulse disappeared during an attack of acute rheuma-
tism, which did not appear to retard her recovery, and it never
returned during her subsequent life. She was active in mind and
Wy, and possessed unusual health. In no part of the body could a
pvlse be detected. I attended her during a part of the time of
her last illness, which was an acute inflammatiqn of the intestines,
but no pulse existed. She died while I was absent from the city,
sad an examination was not made to elucidate the. cause of tins
remarkable phenomenon. _. ,

430 Bibliography.

A great variety of pulses have been described by writers, who
have drawn between them fine lines of discrimination, and attempted
to establish a particular pulse for every disease, and for every critical
symptom, the occurrence of which, it was believed, could be pre-
dicted with certainty, or whose existence could be announced merely
liy the pulse. By the late Professor Rush, the pulse was regarded
a& a perfect nosometer, measuring with nearly absolute precision the
state of the whole economy, and the grade and character of every
morbid condition.

These exaggerated views of the importance of the pulse, originated
before the circulation was discovered, and the production and nature
of the pulse was known. They were subsequently maintained by
erroneous opinions of the character of the circulation, its active forces,
and the structure and office of the vessels. The direct circulation
alone was understood, the capillary, and interstitial or parenchyma-
tous were not comprehended, and the heart and large arteries were
believed to be the sole causes of the circulatory phenomena. But if
the doctrine of the circulation we have advocated, founded on the
analysis of the organs and mechanism of this function, be adopted as
correct, it must be clear, that the pretensions claimed for the poise,
as a universal diagnostic standard, must be considerably reduced.
As a positive indicator, it characterises only the action of the heart,
and the degree of repletion of the vessels. The state of the capillary
circulation, and consequently of the organs of the economy generally,
is not manifested directly by the pulse, which in the determination
of this point, is of secondary importance. For this purpose it is to
be taken in connexion with the symptoms exhibited in the dis-
turbances of other functions, and compared with them. The heart
sympathising in most cases in the morbid affections of all the im-
portant organs, and the circulating fluid being influenced in its
distribution by diseases of intensity, the pulse serves to give the value
of the other symptoms, and to render their nature manifest ; and it
thus furnishes secondarily and by comparison* signs indicative of the
condition of the capillary circulation, and the character of the patho-
logical state of other organs than of the heart.

From this examination, it then results, that the pulse is not a
general nosometer, but, as a standard of disease, is principally con-
fined to the affections, either primitive or sympathetic, of the heart,
and of the direct circulation. When, as frequently occurs, the heart
and the direct circulation, from a jmralysed or quiescent state of the
sympathies, do not participate in the morbid disturbances of the or-
gans, the pulse mils entirely in presenting any positive indications of
the state of those organs or the nature of the affection.

The forces regulating the direct and the capillary circulation being
distinct, and the offices of the two being totally different, they are
often placed in a state of antagonism, and exhibit phenomena of
opposing characters. The pulse in these circumstances, while it
faithfttUy marks the precise condition of the heart's action, and the
state of the circulation, would betray us into fatal errors, if it were
consulted in order to determine the condition of other organs. In

Miscellanies. 431

the congestions of the abdominal and thoracic viscera, the functions
of those organ/3 are oppressed with a load of blood, while the heart
is barely kept in action from the extreme deficiency of that humour
in the vascular system. In the close also of diseases of acute in-
flammations, widely diffused throughout the economy, important
organs are pressing on to disorganisation, demanding local depletion,
and other sedative measnres, with revulsive operations, while the
action of the heart is fainting from debility, and requiring to be sus-
tained by diffusible stimulation. These opposite indications cannot
be revealed by the pulse. They are to be determined by other signs,
and a reliance on the pulse, in the manner that has been taught by
high authorities, as a guide in estimating the condition of the eco-
nomy, and in directing remedial measures, will lead to wrong con-
clusions, and a practice often fraught with mischief.

MISCELLANIES.
MEDICAL JURISPRUDENCE.

Extraordinary Inquest at Hampton, from Observer, Oct. 3.

2. Yesterday (Oct. 2) an inquest, under extraordinary circum-
stances, was held at Hampton, before Mr. Stirling, to inquire into
the cause of death of Frances Clarke and her unborn child. The
death took place about two months ago, and a considerable degree
of excitation has existed for some time in the neighbourhood, owing
to a rumour that her death was caused by the unskilful treatment of
Mr. Bowen, a medical gentleman who attended her in her confine-
ment. A great number of medical gentlemen attended to give their
opinion on the subject. Mr. Wakley was also present.

The body was removed from the grave, and placed on a tomb-
stone, round which a canvas tent was erected. It was inspected by
the jury, and was not in such a state of decay as had been ex-
pected.

Ann Ellam deposed, that near three months ago, she was sent
for by deceased, between five and six of a Sunday evening. She
went, and at the desire of deceased, went for Mrs. Chilman, the
midwife. Mrs. Clarke had been taken in labour about four o'clock
that morning : was very bad indeed, and all that night her cries and
screams were dreadful ; towards morning she was very bad, and said
she must die. Witness went to Hampton for Mr. Davis, who was
from home, but his assistant, Mr. Bowen, came about half-past ten,
and remained about half an hour ; he returned about nine at night
with instruments, which he used ; about seven o'clock on Tuesday
morning, at Mr. Bowen's desire, they sent out for a boot hook,
which he used with Mrs. Clarke, and at a quarter past ten Mrs.
Clarke died ; when witness asked Mr. Bowen if he thought there
was any hope of the labour being over, he said, yes, very soon.
Mr. Taylor was sent for, to which Mr. B. did not object, but he
refused to write a note for him ; Mr. Bowen was using the instru-
ments at the time — he used them with very great force, so that the
perspiration poured, off him ; he placed h^s feet against the bed and

432 Medical Jurisprudence.

pulled with great force ; when asked how he was going on* said that
when he wanted skill, he would send for it, and if they could find
out any one that could do more than he could, they might send for
him ; he afterwards insisted on assistance being sent for, when the
hook Mr. Bowen was using gave way ; there was a sound as if a
stick had broken, and the child's arm came off. Mr. Taylor sent
an answer that he would come, if Mr. Bowen would only write a
note for him ; Mr. Bowen was very cross ; I never received such
rough treatment before.

Sarah Chilman, a midwife, sent for a doctor in proper time, and
was glad to get her own neck out of the halter ; she proposed to
Mr. Bowen to send for Mr. Taylor, but he said, if Mr. Taylor came,
he would leave ; the deceased wished to have Mr. Taylor, and said
he had been with her before, and brought her through it.

Mr. George Jewel, surgeon, and teacher of midwifery, stated,
that he was present at the examination of the body that morning;
he considered the removal of the arms, under the circumstances,
perfectly justifiable ; the instrument called a blunt hook might have
been proper to apply, and a boot hook was a good substitute, (both
"hooks were here produced, and very nearly resembled each other.)
Assuming the facts to be as stated in evidence, he conceived that
the use of instruments was fully justified. Judging from the ap-
pearances and evidence, he should say that the practice of Mr.
Bowen was correct.

Mr. George Taylor, surgeon, of Kingston, stated, that he never
saw Mr. Bowen before that day ; there was no sufficient evidence to
warrant the assertion that the practice of Mr. Bowen in the case
was erroneous ; unless under very extraordinary circumstances, wit-
ness should not have taken off the arms.

Sir Andrew Halliday, of Hampton Court, Physician to their Ma-
jesties,* stated that he had bad a conversation with Mr. Bowen on
the subject, in consequence of the reports he had heard, and Mr.
Bowen had fully satisfied him he was not to blame.

The Jury expressed themselves satisfied with this evidence.

The Coroner called the attention of the jury to the evidence given
by a professor of the obstetric art, to the difficulties frequently
attending labour cases — for example, the Princess Charlotte of
Wales, who could command the first advice in the kingdom, fell a
victim in such a case. The jury, after consulting for about half an
hour, returned the following verdict : — •• Died by the visitation of
God, and we are of opinion, that the medical attendant is not in
any respect to blame/ '

During the examination of the witnesses, several persons in the garb
of gentlemen, some of them medical men, interrupted the proceed-
ings by impertinent observations. It is astonishing that they were
not silenced by the coroner, or if incorrigible, as the report states,
that they were not turned out of the room. Medical, men who display

• This is erroneous. Sir Andrew is not physician to their Majesties. — Ed.

Medical Jurisprudence. 433

{arty spirit, act in open violation of the received principles of
ethics, degrade their profession, and impede the administration of
justice.

Assuming the above report to be correct, this inquest is one of
interest to all those engaged in the practice of obstetricy. It gives
rise to many serious reflections, and affords a salutary lesson to
practical obstetricians. For the medical jurist it is one of import-
ance. We shall therefore offer a few comments upon it.'

The disinterment of the body after a period of three months,
for the purpose of judicial investigation, though required by law,
.could be of little, indeed of no use, in such a case as this. If the
pelvic viscera were injured by pressure of any kind, the effects of
such could not be discovered after such a lapse of time. No man
living could testify with positiveness upon the subject. The evi-
dence before us is inconclusive and imperfect, and of course un-
satisfactory. It does not appear what was the habit of body, the
temperament or constitution, or age of the deceased — how many
children she . had had, or what was the presentation, whether
shoulder, side, arm, arms, &c. It is clear, however, that the. arms
were removed, and must have presented one or both, or must have
been brought down, for that purpose. It does not appear whe-
ther opium was given, or any attempt made to turn, though it is
clearly manifest to any man of judgment or experience, that turn-
ing ought to have been attempted and performed, before the ope-
rator was justified in dismembering the infant. Had opium failed
to tranquillize, the parturient action which was violent, the lancet
should have been employed, and the patient bled nearly to syncope,
or if strong and plethoric, to complete fainting, when turning could
be easily performed. The immense force employed in extraction
was not warrantable, according to the opinions laid down by the
best obstetric writers, of this and foreign countries. Making every
allowance for the purturbation of mind of the operator, he ought
to have recollected the after consequences, and that though he might
succeed in effecting delivery, the recovery of his patient was not to
be forgotten. Too many young practitioners lose all sight of after
consequences, and consider the employment of instruments the
grand point, quite forgetting that if any injury be inflicted by them,
the woman will most probably die in a few days afterwards ; and,
instead of gaining reputation by the operation, their characters
suffer very considerably. Whether Mr. Bowen followed the usual
course of practice in this case, cannot be learned from the evidence.
But one thing can be learned, that his peevishness and refusal to
write to the practitioner in whom his patient had confidence, and
desired, was highly culpable. It was contrary to the maxims
inculcated in every standard work on midwifery, and on the ethics
of our profession. It is well known to obstetricians of experience,
that the presence of a stranger, and of one in whom the patient has
no confidence, for if she had in this case, she would not have de-
sired other assistance, is highly prejudicial to the progress of natural

Vol. v. no- 29. 3 h

434 Medical Jurisprudence.

* .

labour , and placed the practitioner in an unenviable situation in such a
case as that before us. We have known and recorded two cases in
which the females lost their lives, in consequence of the behaviour of
medical men, and soley from fear, but it is unnecessary to dwell
upon a point that no man can dispute.

The next part of the evidence which deserves attention, is that
of medical witnesses. Mr. Jewel considered " the removal of the
arms under the circumstances perfectly justifiable." It is unfortu-
nate that he did not state the circumstances, as we are totally at a
loss to surmise what they could be, unless in embryotomy. Indeed,
we know of no circumstances, unless embryotomy, which could
justify such a proceeding ; they have never been mentioned during
our long perpetual pupilage under Dr. Hamilton, nor have we ever
stumbled upon them in the course of our obstetric researches, which
we have given some proof, are not the most limited. No man could
condemn, in more forcible terms, the removal of the arm, than
Dr. Hamilton, and for the sound reason that its removal could not
change the position of the infant ; and this is the opinion of the
best obstetric writers. In such cases the operation of turning ought
to be performed ; and if impracticable, which may happen, though
rarely, if the proper measures be employed ; then the thorax ought
to be eviscerated in the manner described in our work on midwifery,
and delivery effected, which may be done successfully, as we have
accomplished and already recorded. But the arm or arms need not
be removed for the reasons already assigned. The French and
American writers are also of this opinion: But it does not appear
from the testimony of the case before us, whether or not the infant
was extracted — we should think not from the facts stated ; and if
this be the case, we are not much surprized that the good people of
Hampton should have displayed " a considerable degree of excita-
tion" on the occasion. It is very extraordinary that this inquest
should have been delayed for two months ; if it was necessary at
all, it should have been held at a time that the morbid appearances
of the body, if any, could be accurately described. But if Mr.
Davis be one of the court attendants, and there is a gentleman of
that name one of them, then the (lordian knot is cut. We do not
by any means insinuate any thing against Mr. Davis, whether court,
or no court attendant, for from all we have heard of the gentleman,
who is, we believe, surgeon to his Majesty, he is a most honorable
man, and an ornament to his profession. What we mean to say is
simply this, that in case Mr. Davis, the empl6yer of Mr. Bowen,
is attached to the court, the people in the neighbourhood, however
excited they might have been, might have considered their remon-
strances useless. This was a false view, for if his most gracious
Majesty, or his amiable and beloved consort heard of the affair,
there was no doubt from their philanthropy and benevolence, but
an inquiry would be instituted. We shall offer no remark upon the
cause of death in this case, nor upon the verdict of the jury. We
are glad that a member of our profession was honorably acquitted ;
and we trust, should he see our remarks, that he will remember

Medical Jurisprudence. 435

•

that the case is one for fair and impartial criticism ; and moreover
Alt oar observations are conjectural, so far as the inquest is con-
cerned. The case is one which shews that the absolute necessity
of employing medical men of sound erudition and extensive ex-
perience, as witnesses and coroners ; men who would sift the affair
to the bottom, and not present to the profession such an imperfect
statement as that before us. For strong reasons we shall not dwell
upon this topic any longer. The only other point worthy of re-
mark is, the allusion to the Princess Charlotte's melancholy fate. It
is to be regretted that some one present did not inquire of die worthy
coroner, how it happened, that the heiress to the British sceptre,
the expected successor to Elizabeth and Ann — she who possessed
the wit and energy of the one, and the wisdom and gentleness of
the other — the young, the fair, the cheerful, the symetrical, the
healthy, the enobled, the exalted, the wealthy, the admirable and
beloved Princess Charlotte, had not the benefit of farther advice, or
the best advice in the kingdom. She, " who was all the heart
wishes, or eye looks for in woman," adorned with all that earth or
heaven could bestow to make amiable, the pride and hope of Bri-
tain, in the spring of life, " fell a victim," says the worthy coroner,
" in such a case." It needed no ghost from the tomb to communicate
this information ; but much more important information is wanted,
which, happily for the wicked, cannot be revealed by tb$ dead. A
time, however, will yet arrive, when the secret will be revealed to the
whole human family. Perhaps it may be in the bosom of the coroner,
and the medical men present neglected the interests of the profes-
sion, in not inquiring what was the cause of death in her Royal
Highnesses case, and also the death of her of her innocent
helpless infant. They could all have assured the coroner, that women
of fine form, in the prime of life, in good health, and especially
whose families were remarkable for their longevity, seldpm, if ever,
fall victims " in such a case," We should not have touched this
topic had our remarks applied to the living, and those to whom they
do apply, are no longer sensible to praise or censure.

Whatever is, is right. This world 'tis true,
Was made for Caesar — but for Titus too.

DISSENSIONS IN THE LONDON UNIVERSITY.

From the foundation of the London University to the moment we
write, we have been, and still are its zealous though feeble advocates.
We cherish the noble principles upon which it is founded ; and we
deeply regret that dissensions of no ordinary character should have
arisen in its halls. The medical profession has been anxiously waiting
far a detail of these dissensions, which has not as yet been afforded.
Such a detail is not more interesting to medical men than to the
public at large. In giving an authenticated account of the disputes
and turmoils of this institution, we have no motive, no object to
serve by such a narrative, We cannot be accused of partiality

436 Miscellanies.

towards the writer, whose public conduct on a late occasion, called
forth our severest animadversion. Though we regret in common
with the profession that medical men should interfere in politics, yet
we must freely admit the high professional attainments of Dr. Thom-
son, and the harsh and unwarrantable manner in which he has been
treated by the Council and some of the Professors, and the imperious
and indignant manner with which the most distinguished students have
been assailed by a junta of the Council. It is manifest that the
complaints of the students ought to have been attended to, and if
just, ought to be redressed, for surely the Council must be aware, that
when students discover any incapacity in their teachers, they can
never derive instruction nor shew that respect and attention due to
their Professors. The appointment of Professor Bennet is the
clearest proof of the justness of the students' memorial ; and tbe
Council acted unwisely and indecorously in branding the students
with such opprobrious epithets, as " impudent, factious, ignorant,"
and at the same time being compelled to comply with their wishes. It
will be seen by the following narrative, that our observations are
warranted, and it is to be regretted that an institution, whose motto
is " Patens omnibus scientia," and which we hoped to see the first
in the world, should be the theatre of discord. We by no means
admit, that students should intermeddle in the management of the
University ; but from the facts before us, they acted with strict
propriety in respectfully remonstrating with the Council, and their
remonstrance should have been met without delay, indecision, or
shuffling. The Council ought to be fully aware, that many who
entered the University had completed their anatomical studies else-
where, and also that some of the best anatomists in Europe were
among their own professors, and therefore that* the students were
enabled to discover any imperfection in teaching this branch of
medical education. We have further to observe, that we cannot
approve of the strong language of many parts of the subjoined docu-
ment, for the suaviter in modo is as important on the present occa-
sion as the fortiter in re. We have also to mention* that we
disapprove of the publication of some letters which were never
intended for the public eye, and can be only justified by the ter-
giversation of the writer towards the individual to whom they were
addressed. In republishing the memorial to the Council, we have to
inform our readers, that it has been printed, published, and circu-
lated throughout the country, and even under such circumstances it
should not appear in our pages, were it not indespensibly necessary
to complete the chain of facts set forth in this communication. The
public and the profession are anxious to learn the cause of the dis-
sensions in the University, and have an undoubted right to be fully
and fairly informed upon the subject. We sincerely regret the
situation in which the Council and some of the Professors appear,
and reiterate our declaration, that a sense of public duty alone
induces us to insert this communication, however well authenticated
its details have been by tbe gentlemen who have entrusted it to our
care. It is necessary for the Council, the students, and the public,

Miscellanies. 437

that a correct statement of the causes of the discussions Bhould be
published.

To the Editor of the Medical Gazette.
A SOP FOR CERBERUS !

Si*, — It is indeed a melancholy truth, that the London University
has been divided by dissensions among the Professors, by discontent
among the pupils, and by the determination of four members of
Council, who have been taking upon themselves to elect professors
obnoxious to the students, to oppose all the -wishes of those pupils,
from whom alone they derive their credit and support. At the con*
elusion of last session, during which the murmurs of discontent
against the ignorance and indifference to science of Professor Pat-
tison, had been gradually swelling upon the ear, Eisdell, who gained the
gold medal in Dr. Grant's class, and who had peculiarly distinguished
himself above the other anatomists of the school by his accurate and
extensive knowledge of developemental anatomy, sent a protest to
the Council, complaining of Professor Pattison's total neglect of this
very important branch of anatomical science, and also of the general
deficiency of his lectures in regard to the new facts in anatomy and
doctrines in physiology. Dr. Davis observed, " that that fellow
Eisdell, ought to be expelled immediately," an observation of which
Professor Parrazzi has naively remarked, " that it was far more
Austrian than English." Mr. Pattison told Eisdell that " he was
disappointed in his character." The medical professors, however,
in a body were delighted ; for, they had long been acquainted with
and deplored the total inadequacy of Professor Pattison to fulfil with
credit either to himself or to the institution, the arduous duties of
the anatomical chair. The Council, however, though they were by
no means unacquainted with the serious objections urged by the
pupils against Professor Pattison, although these objections recalled to
their minds the discussions, which had occurred at the commence*
ment of the institution in regard to the propriety of choosing this
gentleman, after what had transpired at Glasgow, in preference to
Messrs. C. Bell, Bennett, Mayo, and King, the other candidates
for the chair of anatomy ; and the fact, that Mr.- Pattison, after a
somewhat severe discussion, had been admitted by the casting vote
of the Chairman of the Council, while they rejected with disdain the
silly proposal of one of the professional (proh pudor) members of
their body, instantly to adopt the suggestion of the haughty and
tyrannical Davis, wrote to Eisdell to inform him, that " they could
not institute an examination into the conduct of a Professor upon the
representation of one pupil."

At the same time, however, Eisdell was given to understand
tuvately, that neither the medical faculty as a whole, nor the Coun-
cil were averse to the inquiry, though they wished to have more
plausible ground for its institution. Thus encouraged, and believing
the ONE, owing to these private hints, to be emphatic, what could
Eisdell do but consult with his friends? He consulted with Mr.

438 Miecellames.

Henry Cooper, who agreed with him* but hesitated to hazard his
name to a document that would drag him before the public. He
also asked my advice, and I recommended him to institute a general
inquiry into all the circumstances of the case, and if he found the
active and industrious portion of his fellow students coinciding with
him in opinion, to draw up a memorial, to be signed by all of
•them, and forthwith presented to the Council, requesting an inquiry
into the conduot of Professor Pattison. This advice I gave him on
the, very day I left town for Cambridge, the day of the distribution
of prizes to the medical classes, to undergo my examination for my
degree of M.B. I remained three weeks in Cambridge, during which
period I had no communication with any student of the London
University.

. On my return I found that my advice had been adopted as soon at
given, and that a memorial had been signed by all the medalists,
excepting two, viz. by seventeen of the men who had been crowned
with the honours of the University, many of whom had also at-
tained honours at the close of the preceding session, while of the
remaining two, one has since declared, that « he will never do any
thing at variance with his own immediate interest;" the other
signed most cordially the letter, for sending which I was first ex-
cluded from the University. v

Three weeks, then, had elapsed since the sending in of this me-
morial, and three weeks more were allowed to elapse before any
notice was taken of it, because the coup d'etat portion of the Pro-
fessors, and we have such a body among them, much resembling in
their humble delinquencies, the depraved and despotic counsellors of
Charles, urged their party in the Council (of course you are not sur-
prised to hear of parties in so heterogenious a mass, of milk and
water Aristocrats and Whigs, as .constitute the Council) to protract the
investigation, till such time as the students should have been sum-
moned by their parents to the hospitable shelter of their homes.
These men well knew that if this were not done, the profession
would laugh at the force of presenting men with medals, and thus
calling the attention of the public to their uncommon talents and
superior acquirements, and then neglecting their representations or
insulting them, by retaining as their teacher a person* the ignorance
of whom had been most loudly complained of by those very pupils,
who. had taken honoursin his own class. There was also another and
a deep design, which was] to protract the period < of investigation
beyond the annual meeting of the proprietors, lest these should attach,
in the honesty of their hearts, and in their deep desire for public
improvement, more importance to the document than certain mem-
bers of the Council had done, particularly Dr. Birkbeck, who was
instrumental in procuring the election of Professor Pattison, and
whose reputation, therefore, was implicated in proving the man he
had urged so strongly upon the notice of that body, in spite of the
moral and other objections urged •against him, to be unjustly at-
tacked, free from ignorance, replete with science, repentant far his
moral delinquencies, and the -object of a malicious conspiacy.

Miscellanies. 439

Thus, then, this public meeting of the proprietors stole a march, by
the policy of these gentlemen, upon the indignant pupils, and in its
result furnished new matter to fret the old sore, as well as to open a
Mw one ; for, Dr. Birkbeck, full of his projects for varnishing the
chsitoter of his friend, in spite of the universal' desire of the Coun-
cil to pass by this business in silence, was ill-advised enough not to
only to bring Professor Pattison on the tsph; but, by eulogizing him
to the skie*> to try and bring a sort of reflective praise upon himself,
for having almost insisted upon the election of so great and admira-
ble a man, in spite of the moral scruples of the prudish dames of the
Council. I am told by those that were present, that, as soon as he
broached this topic, a blank astonishment and panic paleness, sat
upon the face of all the Council, but particularly on that of the War-
den ; while the frowns and contortions of Mr. Brougham's counte-
nance, in his effort to stop the eulogistic zeal of the worthy Doctor,
were so- frightful that they absolutely paralysed the energies of Drs.
Thomson and Turner, who had determined severally to answer his
observations. Had Dr. Birkbeck told the truth, that is the whole
truth, no ill could have arisen from his speech, but either intention-
ally, or through a culpable ignorance, seeing that he was one of the
Council, he stated that this learned and amiable importation from
America had been charged with inefficiency ; but in a very impudent
manner by one student only, and that an ignorant student, meaning
Bisdell. Now, long ere his speech was made, the Council were in
possession of the complaint, signed by all the medalists ; and more*
over, nothing could be more dastardly in Dr. Birkbeck than this
attempt to raise his friend's reputation upon the ruin of Eisdell, who,
so far from being an ignorant man, is highly respected by all his fel-
low pupils, and by all the Professors, who know him, on account of
his good acquirements, his industry, and his perseverance, of all of
which he gave most splendid evidence, when he succeeded in beating
Mr.* Phillips, one of the present demonstrators, and Mr. Blackmore
and Mr. Garner, both excellent anatomists, in their contention for
honours in Dr. Grant's class of comparative anatomy. The know-
ledge of these facts, the deep conviction of the injustice of the
attack upon Eisdell, the indifference of the Council to the statement,
which had been almost solicited from the medalists, the designed
protraction of the period of investigation, disgusted the students, and
led many of them to retire to their summer destinations, leaving the
matter in the hands of those, who were left behind. Some of them
indeed, who had no intention of returning to town, but yet felt a
sort of lingering desire to see their alma mater flourish, remained a
few weeks longer, but to no purpose. In the mean time the Profes*
•ora took every occasion to blame the supineness of the medalists, to
make complaints personally to various members of the Council, to
cultivate the dissatisfaction of the pupils. Thus, it is well known,
that Drs. Thomson and Turner, and Professor Parrazzi, had many
conferences with Mr. Brougham and Lord Auckland upon the sub-
ject, and stated explicitly to these gentlemen the absolute necessity
of the removal of Professor Pattison, for the success and welfare-of

440 Miscellanies,

.the school* Mr. Bell had already tendered his resignation, and bad
^explicitly stated, or had been understood to state, in his valedictory
lecture, that " unless one teacher was removed from the school, he
should not again , have the. honour and pleasure of addressing his
pupils/' . Moreover, Mr. Bell took care to inquire sedulously of every
pupil, who went to him for a certificate, what they thought of the
prospects of , the school, and by .every one was informed that there
were two% requisites to its ultimate success — a more scientific Profes-
.spr of Anatomy and an Hospital. To such a height did this profes-
sional desire for change arrive, that several Professors declared une-
quivocally, publicly, privately, and unreservedly, that they would leave
.the institution if Pattison remained;, and one went so far as to say
.tp the Clerk in the robing room, before all the menials of the insti-
tution, that unless Professor Pattison was dismissed, he, the Clerk,
might consider his five shares as in the market. It was impossible
for the pupils, who were visiting in the Professors' families, not to
perceive the feelings so congenial to their own; and, as they could
not remain longer in town, those, who had remained expressly for
the purpose, waited upon me in a body, and requested me, in their
absence, to .watch for them the progress of the business, to give them
early information of whatever might be doing, and to insist, by every
honourable and. upright means, on the division of the professorship
of anatomy, or the entire removal of the present Professor. To
aid ,tme in this respect, they left with' me the statements of the
reasons of their objections, with a request to send them in, as soon as
called for by the Council. I accepted this commission, not because
I knew any thiiig of the merits of the case, but because having been
presi4ent of the Medical and of the Literary & Phil : soc :, of both of
which I was one of the founders, I felt that the students, who were
my individual friends also, had a sort of claim both upon my ser-
vices and on my kindness, while 1 knew, from my intercourse with
the Professors, that the inquiry was most anxiously desired by them,
and by no means obnoxious to the more sensible and thinking por-
tion, of the- Council, No sooner had these men left town than the
Council -appointed a cqmmittee of investigation, who sent for the in-
dividual statements of every one of the seventeen pupils. I imme-
diately sent to the Warden those which had been left in my posses-
sion ;.. and the result was, that the committee determined on examin-
ing personally as many of the seventeen as could be assembled by a
certain day. Only four, however, could be found in or near town, and
of these four, it unfortunately happened that all, with the exception of
Eisdell, were first years, pupils,; and could not therefore be so much
depended upon aa those, who were more advanced in their studies.
Some discrepancy is said to have been found in the statements of
these four, which were, confined, by desire of the Commissioners, to
mere matters of neglect, as they very conscientiously observed that
they were wholly unqualified to enter into matters of science.

The Commissioners, however, satisfied of the negligent and imper-
fect nature of the course that had just been delivered, made their
report accordingly ; and the Council prepared a reprimand, which is

,.>

Miscellanies. 441

stated to Have been so severe that not even Professor Pattison could
have retained his chair under it. Upon this being intimated to the
friends of Professor P. he acquiesced in their advice, that he should
divide his labours with Mr» Bennett. * The Council consented,* after
this proposal being made, to the suggested arrangement, and to moU
lify the language of their intended reprimand. Hence sprung the
arrangement, which was converted among the Council and Profes-
sors, and nothing more would have been done by the pupils, had
Professor Pattison at once divided the professorship upon the return
of Mr. Bennett from the Continent, whither he had been for the pur-
pose of recruiting his health, and where his kind hearted family had
taken care that he should not be harassed by the turmoils of the in*
stitution. Professor Bennett, to whom I now took care to mention
the wishes of the pupils, was desired by the Council to meet Mr.
Pattison. in order to make arrangements for the division of the pro-
fessorship. Several meetings took place, without leading to any re*
suits, Professor Pattison having wished to make Mr. Bennett a
*' Supplemental professor," as may be seen in the following letter to
myself: —

" My dear Thomson, — I have substituted from my epistle to you
from Boulogne,* a certificate of my opinion of you. I fear it is too
weak ; I feel that you deserve that 1 should say more, bnt I am de-
terred from doing so, by apprehending that more from so humble a
personage as myself might be construed into too much. However,
I shall re- write it if you wish. Pattison and I are still at issue ; he
proposes to make me a " supplemental" Professor, at whioh I kick.
We are to arrange it, if possible, to-day with Lord Auckland. Your
father caused me to disappoint you yesterday, so you will excuse me.
This evening I shall let you know how the affair goes. In the mean
time say nothing, I pray you.

" Yonr's sincerely, J.»R. Bkwnktt."

* The epistle from Boulogne contained a request to me to offer
myself for one of the demonstratorships at the London University,
instead of seeking for a situation in King's College ; it was, as you
see from the foregoing, removed, because Mr. Bennett, who had not
heard of the disturbances while in France, was informed by me that
I should not offer myself for the situation, but was shewn to many
of my friends, who know that it not only solicited me to offer my-
self, but promised me the utmost support of the writer. (A con-
vincing proof this of my ignorance and want of connexion with the
institution, as stated in last week's Medical Gazette.) If Professor
Bennett is angry at his letters being published, he must remember
th# the " galled jade will wince," that when men conspire with
one another to gain an end (as the Professors have done) and then
dfcert their tool, through a grovelling fear even of Mr. Brougham's
thunder, he can only defend himself by turning king's evidence.

Vol. v. mo, 29. 3 i

442 Miscellanies.

•', At last, an arbitration was consented to, as may be gathered from
the following, —

Wednesday.
" My dear Thomson, — A thousand thanks for the pamphlets;
you shall have them to-morrow, as I have not time to read them.
I have nothing to tell about the affair — It is ut antea. To-morrow,
Thursday, two friends from each meet, to try and settle the business.

" Yours, &c. J. R. Bennett."

So, Sir, you see I am not the only person, who felt a thousand
pleasures in. seeing the pamphlets, for re-publishing which my mo-
tives have been called those of the foulest malignity. In fact, these
pamphlets had been circulated freely enough among the Council, had
been the cause of the exertions among the Professors to rid them-
selves of their companion — were sent to Mr. Bennett, not by me,
who had never till then seen them, but by Alexander Shaw ; let me
ask for what purpose ? Was it to facilitate the pending negociation ?
Or was it an oblique missile, thrown slyly into the enemy's camp,
with a hint from the physiological castle ? At any rate, Mr. Bennett
did permit me to take a copy, and I now possess the original. More-
over, Mr. Bennett never objected to this pamphlet being re-published,
till he had stooped to shake hands with Mr. Pattison, and had donned
■his new plumes, although he did not wish it to be known that I had
■first found this pamphlet, of which I had often heard, and that pri-
marily from Parrazziat my father's table, at his, Mr. Bennett's house.
In feet he was " male Pertinax-" I shall here, once for all, state, that
my reasons for re-publishing that pamphlet was not to recal the Pro-
fessor's alleged adultery, but to show that, even in A merica, hehad
been accused of ignorance, of a gross system of prevarication, and of a
silly attempt to arrogate to himself the discovery of Colles's Fascia.
I must however, call upon all honest men, who love the safeguards of
British virtue, and upon all parents, whether they would not hesitate
in placing their sons under a man of talent, however splendid, whose
. character was publicly believed to be tarnished by a breach of one of
the most direct of God's laws, one, on which society rests its comforts,
and founds its existence ?

The Arbitrators met, and abruptly parted; and Mr. Bennett's
friend recommended him to have nothing more to do with such a
man. Mr. Bennett informed me of this in the following epistle : —

" Dear Thomson, — I had hoped within the last few days, that
some arrangement would have been made between Mr. Pattison and
myself, in order to adjust present difficulties; I have now, however,
in reply to your enquiry on the part of the pupils, to state, that I see
no prospect of any arrangement being made, whereby any change
will take place in the delivery of the Courses of Anatomy, In met,
things must go on as before.

" Yours ever, J. R, Bennett.

M July 29.— To Dr. Alex. Thomson."

Mr. Bennett further informed me, " that he had been to Mr*
Coatee, and desired him to insert his name as mere demonstrator/

Miscellanies 443

the arbitration between Mr. Jones Quain, on the part of Mr, Ben-
nett, and Dr. Conolly on the part of Mr. Pattison, having been
broken off, because intruded upon by Professor Pattison, who was not
quite prepared at that time, at least, to voluntarily solicit his friend
Mr. Bennett, whom he had accused of giving his gold medal to
Mr. Phillips, because he was his house pupil, to accept of half of his
burdbnsomjs Professorship. Is it true then that the Professorship
was divided at the solicitation of Professor Pattison ?

Finding from this communication that all hope of arrangement had
been finally broken off, I proceeded to fulfil my commission for draw-
ing up a strong memorial to the Council, embodying all the most im-
portant charges contained in their separate statements, and demanding
the dismissal of Professor Pattison, of which a copy is subjoined to the
two following epistles, which are copies of two of the statements,
and from which it will be seen that I have scarcely expressed, in the
memorial, so much as I was authorized to do :

Second Letter of Mr. Eisdell to the Warden.

May 5th, 1830.

Si a, — I have to acknowledge the receipt of your letter, commu-*
nicating the decision of Council on mine of the 30th April, and
regret the necessity of having again to address you on the same
unfortunate business; but, as the Council have thought proper to
decline, without assigning" any reason, proceeding in an enquiry,. I
am led to conjecture, either that they doubt the veracity of my
statements, and therefore think them unworthy of notice, or that
the charges I preferred against Professor Pattison were not sufficiently
specific to warrant their acting upon them. If the former were the
case, I beg now to state, that I can bring forward students, now in
the University, who can bear out my statements, and relieve me from
the imputation under which I might otherwise lie. If the latter be
the case, I proceed now to bring forward some specific imputations;
by which his ignorance will be exposed and his inability displayed ;
and if I am not myself able to substantiate these facts, there are in
in the University individuals who can : —

i. Upon a student asking him what nerves pass through the rectus
externus oculi, he was unable to afford the information.

2. In demonstrating the peritoneum, he maintained the foramen
of Winslow to be a hole in that sac.

3. When speaking of the motions of the wrist-joint, he says, that
pronation and supination are performed there.

4. He states the carotid artery and the nerves passing through
the cavernous sinus to be bathed in the blood of that sinus..

5. He brought into the theatre the heart of a frog to illustrate a
double circulation.

6. He neglected to give us the most interesting details of ana-,
tomy, viz. the developement of different organs. In fact, when
lecturing on the brain, from some of his remarks, he exposed his
ignorance of the researches of Tiedeman and others, on the
foetal brain ; at least some few of his expressions conveyed to
my mind as, well as to the mind of an eminent professor, who
was present, that such was the case.

444 Miscellanies*

' Other exposures might be made, had I stored my mind /with his
mistakes. But, Sir, I consider them things in themselves most
trifling, except as connected with the evident want of science, which
his lectures constantly display. The anatomy he teaches. is .'such as
may be found in Fyfe's compendium, and there has been* general
deficiency throughout his whole course. He began this tiery oaur$e
with promises innumerable, but he has not performed them* to the
satisfaction of the class. In fact, he did not demonstrate the
viscera till the last week of the session, and then in a most superficial
manner.

The number of the class usually in attendance, and the nature of
that class being chiefly of junior students, evince the estimation in
which he is held.

I should hot have troubled you with this communication, un-
pleasant, irksome, and anxious task as it is, did I not feel assured
that if I were now to sacrifice public good at the shrine of public
feeling, I should be doing an injury to the University of London, as
well as to its eminent Professors and Students, and I believe that if
this affair be not privately settled, there will be a public call for it,
which would do great injury to the institution itself as well as to the
gentleman most intimately concerned.

For the reason I have chosen to address you privately, I have sot
hesitated to avow my name. .

I am, Sir, your obedient servant,

N. Eisdkll.
To L. Horner, Esq.
Warden of the London University.

Tranby, near Hull, June ,19th, 1830.

My dbas Thomson, — I am much obliged to you for having given
me information on a subject, about which. I began to feel rather
anxious, as well as for allowing me an opportunity of adding my
testimony to that of my fellow students in this important affair.

I do not think I can add to your stock of evidence any individual
instances of deficiency or negligence, as from my constant commu-
nication with Eisdell, while in town, he is already in the possession
of all these facts. Indeed I .have been witness of very few. • I can,
however, substantiate the following :— his constantly using the mis-
nomers, ductus communis choledactus ; his having made that canal
open at the superior angle of the duodenum ; his giving a confused
description of the peritoneum ; having gone over the stomach, liver,
spleen, pancreas, and duodenum* in three-quarters of An hour, re*
peating the demonstration twice.; constant misnomers wherever teo
Latin names occur together, as membrani tympani, scali vestibuli, &c
&c. (of great importance to a student: in his examination); not
knowing the nerves which pass between the heads of the extern^
rectus ; describing the carotid artery and the nerves of the orbit, a»
bathed in the Mood of the cavernous sinus.

These are a few instances which have fallen under my ownobsef'
vation, and of which I have distinct recollection. After all* I cajmot

Misctllantesi A4&

• -V

kelp thinking, that these charged might seem to an unprofessional
jury, frivolous and vexatious, and that we must mainly depend upon
more general accusations, well authenticated by the more respectable
and numerous body of the students. Such charges as the; following
I shall be very ready to sign my name to.

That the demonstrations given by Professor Pattison are. vague
and desultory, the relation of parts to one another being almost
wholly omitted, and the external parts, to which they may be re-
ferred, entirely neglected ; ' that the intimate structure of most of t lie
organs is not given at all ; their developement never alluded to ; that
notwithstanding engagements entered into by Professor Pattison with
the students to assist and superintend, out of the lecture-room • as
well as in it ; he is seldom about the premises, except during the
hour of lecture, and scarcely ever seen in the dissecting-rooms ; that his
attendants consist almost entirely of junior students, and that their
average number daily is not more than fifty* while Mr. Bennett is
attended by all the seniors in the school, and seldom musters fewer
than 120.

You will see that I have written down these charges hastily, but
I have not thought upon them the less on that account- You are at
liberty to make use of my name as ready to substantiate any charges
which will embody any or all the foregoing ; but there are, of
course, many others to which I cannot personally vouch.

The report of Bell's resignation will do us much injury ; and if
your father and Turner follow his example, and start a private
6chool, I should imagine we are dished, &c. &c.

Yours truly,

Henry Cooper.

To Alex. Thomson, M. B.

Memorial from those Students of the University of London, who
wish for the Dismissal of Professor Pattison.

To the Council of the University.
Lords and Gentlemen of the Council,

As the charges already preferred against Professor Pat-
tison, on account of his negligence, deficiency, inaccuracy, and evi-
dent want of scientific knowledge, have not received the attention,
which we had anticipated, and, which their importance demands, we
fed bound to express our opinions in a more public and decided man-
ner than we have hitherto done. We Have to lament, indeed, that
some of ns from motives of delicacy, lest Mr. Pattison's reputation
might so severely suffer, as materially to injure his prospects, been led
to adopt a greater degree of privacy than appearB to have been desir-
able; for, had we known' that publicity would have been given to this
ainur by Mr. Pattison and his friends, we should not have been so
delicate and tender of his interest; - And, we feel confident that, .bad
Mr. EisdelTs intentions been made known to the whole class, previ-
ott to their separation, every senior student, as well as the majority
of the juniors, would have readily attested the statement, which has

446 Miscellanies.

been made by Mr. Eisdell, and corroborated by seventeen of his
iiellow-students.

Although we appear before you in the character of complainants,
we are not blind to the ample and magnificent arrangements,
which you have so carefully provided for our instruction, in-
deed, of all the medical professors, Mr. Pattison is the only oni,
who has disappointed our expectations, cast a damp over our spirit*,
partdyzed our exertions, and rendered us thoroughly dissatisfied*
We neither met him at the dissecting table, nor at the dispen-
sary, as, from his fair and ample promises, we had a right to
expect. We have paid freely all that you demand, and we expect
that you will provide, that your public and blazoned pledge of giving
much ampler instruction, on a better plan, shall be fulfilled. It is a
bona -fide contract between us, and that contract has been broken
by Mr. Pattison. He has, in fact, given us nothing, which, as a
Professor of Anatomy, he ought to have done ; he has neglected the
physiological linking of anatomical facts, and omitted. to allude to
regional, functional, developemental, comparative and morbid ana-,
tomy.* What can his lectures be, then, but a dry detail, which we
can more successfully and infinitely more accurately acquire for our-
selves in the dissecting-room ? They are almost wholly confined to
mere descriptive anatomy, and here he is so superficial and careless
in his demonstrations, as to mil infinitely below Mr. Bennett in the
clearness of his illustrations, and in the accuracy of his details. —
Were we to assemble instances of his negligence, they would soon
fill our paper, and tire your attention, l&nough has been already laid
before you ; suffice it therefore to remind you of a few instances. —
What can be said in excuse for his dividing one hour, and only one,
between the absorbent system (including lacteals and absorbents),
and a flowery, and therefore useless valedictory address, while the
former is one of the most important parts of the human economy. -

The most important parts of anatomy have been neglected. Thus,
of the alimentary canal, the mouth, buccal cavities, teeth, pharynx,
and oesophagus, were never mentioned ; the stomach was superficially
treated of, and its connections and relations imperfectly illustrated.
Of the intestinal canal, the differences between the duodenum, je-
junum, ileum, colon and rectum, were not clearly indicated; and
the organization of the whole was neglected. The assistant chylo-
poetic viscera, with the exception of the lobes of the liver, were
scarcely touched upon. The relation of the abdominal viscera,
for the physician of the highest, and for the surgeon of no light im-
portance, occupied the attention of this splendid anatomist exactly
half an hour. Is not this robbery ? or, is it the quackery of ana*

* Which departments he kindly and condescendedly requested
Mr. Bennett to lecture upon, as • • supplemental Professor." The
Council cannot be so ignorant of science as not to know that these
subjects are the only abstruse parts of anatomy, and alone demand
clearness- of head. - • •*

Miscellanies. 447

tomieal teaching? Must we eke out a certificate' by dragging
our attention through such a course ?

Into poults of science, we understand , and with sorrow, that the Com-
mittee, for the investigation of the conduct of Professor Pattison, have
refused to enter ; hut, why ? Why, when we charge him with unusual
ignorance of old notions, and total ignorance of and disgusting indiffer*
ence to new anatomical views and. researches, do you prevent us from
vindicating this charge ? It is on these accounts, and on these chiefly,
that we call, and that loudly, and with no friendly voice, for his dis-
missal. He teaches that the ductus communis choledochus enters into the
^superior angle of the right quadrature of the duodenum — that pronation
and supination are performed at the wrist-joint — that the peritoneum,
instead of being a sac having an hour-glass contraction, the maxi-
mum of which contraction forms the foramen of Winslow, consists
of two true, uncontinuous, sacs, and, that the foramen of Winslow
is a real orifice in the peritoneum* Moreover, in making diagrams
of the peritoneum, he could not demonstrate how its inflections were
made. He has been asked more than once what nerves pass through
the two origins, or rather the bifurcated origin of the external rectus
muscle of the eye, but he has never yet given an accurate answer.
He asserts that the brain is not developed part by part, but all at
once — that %the nerves and the carotid arteries, passing along the
margin of the cavernous sinus are bathed in the blood. We fearlessly
assert, that there is no anatomist in Europe, who would not reject a
pupil he was examining for such blunders, and yet, forsooth, we are
to be told of Mr. Pattison's splendid attainments — splendid certificates.
Splendid, indeed, because signed by a splendid lawyer and some
American and unknown names — splendid, because Dr. Davies has
been most busily 'canvassing for opinions in favour of Mr. Pattison,
and has over and over again asserted to the discontented pupils that
there is no anatomist in Europe like this Mr. Pattison ! But Ame-
ricans, and lawyers, and Dr. Davis, cannot, combined in one phalanx,
packed into one fasciculus, praise such latinity as falls from the
worthy Professor, who commonly talks of the scali vestibuli, mem-
brani tympani, ductus communis choledoctus.

We need not however, urge fresh arguments for the truth of the
accusations made against Professor Pattison ; facts, indelibly im-
printed on the mind of every pupil, and, in their hearts, a " monu-
mentutn sere perennius," call but far too loudly against him. No
senior pupils attend his class, except to save appearances, and when
they do, they retire to the remotest corner of the theatre. Of the
yaCvaiA fifty only, and sometimes only thirty, of the one hundred and
eighty, who fee him as the head of the school, usually attend him,
'while the majority of both classes indiscriminately absent themselves
from his examinations. And why ? truly, because he is ignorant,
or, if not ignorant, indolent, careless, and slovenly, and, above all,
indifferent to the interests of the science.

We urge you, therefore, to remove Mr. Pattison, to seek for some
**AL ax atom 1st for our teacher, no .man supported by certificates
from interested lawyers, or transatlantic and unknown names, no man,

44S Miscellanies.

who will not give up his whole time to the cultivation of the science, nd
man, who will plan cabals, no man, who will be afraid of the strictures of
his pupils, no man, who will promise what he never meansta perform,
no man, who will be afraid of the demonstrator being his rival, no
man, who will take a mean advantage of his situation as examiner to
brand his discontented students, no man, who will lecture upon a
case as recovered, which may die the next day, no man, who will not
be frequently in the dissecting-room, ardent in his pursuit of know-
ledge, eager to promote the interest of the institution,- determined,
by his industry, to bind us more strictly to our alma mater, and
truly philosophical in his views of anatomy ! Should you, however,
•neglect our prayer, we warn you that we shall publish this very appeal;
*shall lay bare the deep and unanswered malignity of the mis-state-
ments attested by Dr. Birkbeck; the mean, party-spirited, wilful
duplicity by which he, as the supporter of Mr. Pattison, tried to
make the proprietors believe that one student only charged that
gentleman, and that an ignorant student. Could Dr. Birkbeck, a
member of the Council, a. canvasser for Mr. Pattison, the head of
the party against our Warden, and the cultivator of these cabals,
could he say that he was ignorant of the seventeen pupils, including
the great majority of the medalists, who in a phalanx, charge Mr.
Pattison with a palpable dereliction of duty, and urge his dismissal ?
If so, why is he retained in the Council ? Did he know of these
facts, why then did he hide them ? — because he had an end to serve?
Why, then, we boldly ask, is he retained a proprietor of the in-
stitution ? Why has his mis-statement regarding Eisdell's ignorance
— an insult, which we all consider personal to ourselves — not been
officially contradicted ?

Is this the manly government you promised us? Is this the
liberality which distinguishes you above the hitherto favoured in-
stitutions of our land ? Is this " Patens omnibus Scientia?"

Once more, and for the last time we urge you, by your pledges

voluntarily given to the public, by your desire for the success of

'your school, by your Slopes of beginning the next session amicahly,

by your determination to benefit our country, by your. love of virtue,

honourable feeling, industry, and moral worth, by the honours

'which you have showered bountifully on ourselves, to dismiss this

• inefficient, careless, indifferent Professor.

Signed by Alexander Thomson, M.B.
On the part of the seventeen Medalists not in town.

fN. Eisdkll.
Signed also by< F. R. Taylor.

(jE. Srkwaro.

Immediately on this being read by the Council, Dr. Hogg, 'the
Apothecary of the Dispensary, with- whom I was boarding, was sent
for, and desired by the Chairman,- Mr. Milne, to tell me their de-
cision, " that Dr. Alexander Thomson be dismissed from, and
prevented visiting the Dispensary forthwith/' I, of course, instantly
left the Dispensary, but wrote several times, and sent friends to
procure some written order of the Council, which had desired my

Miscellanies. 449

exclusion from their institution. This, however, I was constantly
refused, and, having been informed that the only members present
were Messrs* Milne, Sturch, and Wilson, I presume that there was
no written document, as .these gentlemen could not form a quorum
of the Council All I could now do was to send in a protest to the
CoineuV in which I. individually demanded the dismissal of Professor
PittiftQu, on account of a .very disgraceful surgical operation, which
he performed in my presence, and which I described in that protest..
That 1 was -not justified in doing so, on account of my not being in
any way-qeoneoted with the institution* as stated by the Editor of.
the " Medical Gazette," will best be answered by the following
extract from my protest, not. to mention my. belief as expressed, in i
the ". Lancet," that I was a, matriculated student, and my having
attended during the whole of the last session the lectures of Mr:
Bennett, Dr. Turner, Dr. Thomson, and Mr. Lindley. "I had a.
right to expect from you at least moderation, because my character
is as yet untarnkhed, because I have done all I can to promote the ,
interest* of the institution. 1 have opened almost every body that
has been -examined for the Dispensary ; I have given instruction, to
the pupils on morbid anatomy, and on its connections with pathology,
which has not. been attempted, by any one officer of the institution.
There have been but few acute cases, which required visitation, at
their own homes, that have not fallen under my care, and. but two
or three of these have . died, while more than one, who has been .
given- up by the physician, has been restored to health and brought
to thank him, with a happy and cheerful countenance. During the ,
two months, in which I saw the portion of the patients, who ought to .
have been seen by Dr. Canolly,* several patients, who bad .been months
under cure, one indeed thirteen, were dismissed recovered, and when..
I handed over these patients to that gentleman, there was not one,
who* was not convalescent.

These are facts* which modesty requires- a man under ordinary .
cnetnnstances to veil, but for the truth of which I appeal to the
physicians themselves, to the apothecary, and individually to the
pupils, and to the patients* from many of both of "which latter classes
I now- possess letters, thanking me for my kindness and attention,
But this is not all. Who that has not been paid for it has added to
your museum but myself?. I have given full fifty valuable pre-,
parations, the spirit for preserving which I have paid for at a great .
and unusaal cost, from the strength required, out of my own pocket.

.til) I ■« ■■ I lit

* Dr. ConoHy resigned his situation in the Dispensary, for the
ostensible reason, that he was required to sign his name in a book at
every visit, a requisition which, while all sensible men must ap-
prove of the check it is calculated to exert upon the attendance,
both of the Pupils and of the Professors, (some1 of whom had pre-
viously grossly neglected their duty) he considered inconsistent with
the character of a gentleman. The Council, however, made him
resume his situation, or resign his professorship. He chose the lesser*
evil, and the Council consented to rescind the obnoxious resolution.

VOL. v. no. 29. 3 6

450 Miscellanies.

I have gone to every part of London to open bodies, and I have
brought you the spoil. But this is not all. I have presented to you,
through Dr. Grant, a large and unexampled collection of flint fossils,
which took me three whole years to collect, another of Madrepores
from Torbay, together with upwards of a hundred specimens of the
shell of the Pholas, in a state of perfect preservation. I presented
you also with many fossil bones from Newmarket Heath. But this
is nothing. I have now to ask you, who framed and gave the first
spirit to your Medical Society, to your Philosophical Society ? Who
framed the laws of these societies ? who was one of the first presi-
dents of both these institutions ? Lastly, I spent two whole weeks
in arranging your medical library, when you could get nobody else
among your officers able, or, if able, willing to work unpaid for
the good of science. Moreover, I have still a further claim upon you
in being the scientific editor of the first two numbers of the Uni-
versity magazines, where all the scientific articles, including that on
a " General Judgment," were the production of my own labour.
Finally, I have laboured in most of your classes, and gained the
esteem and the highest recommendations from all your good medical
Professors ; and I have in public and in private devoted my pen, my
heart, my tongue to your service. In Cambridge, I have endea-
voured to make them believe that you have no want of religion,
but wish to strengthen its bulwarks, by preparing the mind to appre-
ciate the value of the evidence collected in its favour, and I have
gained you friends in every quarter by my utmost efforts ; and for
these services, which, considering my age and opportunities, are,
I hope to be considered, not small, you have seized upon the first
moment to make me an example, an odium, a beacon for your
students!

The receipt of this protest was. never acknowledged, although it
contained actionable matter, although it contained a most severe
attack upon Mr. Pattison. If the Council still refuse redress to the
pupils, still remain a star chamber, a Polignacian Council, I must
publish it, for truth is like the miry elf that comes up from the
furthest deeps through the spiracles of the cumbrous mass that hides
her. ' I heard nothing more publicly of the business until a few days
before the Introductory Lecture, when, upon going to the University,
I was prevented entering by the porter. I asked him if he had re-
ceived any written order, and he said no. I now went to Mr. Coates,
the locum-tenens, and asked him when the Council planned this new
indignity, and whether he had not received orders to send me a
written communication on the subject. He said' that the order for
my exclusion was passed at the same time as that for my dismissal
from the Dispensary, that there was no written record of either, that
he had .not previously put the latter part of the sentence in force,
because HE did not think it necessary, and that he had only now
had recourse to it, because he was afraid I should make a disturbance
at the Introductory Lecture ; which means, of course, that he was
quite conscious that I had been illused, and that if he were in my
place, under such usage, he thought he should make a disturbance ;
and so this petit dictateur did not think it necessary to condescend

MitceUanies. 451

to let me know his dictation in writing. This is tie march of in-
tellect or the diffusion of useful knowledge !

I took no further steps till October 5th, 1830. When, at Fro-
feasor Bennefs suggestion, I sent the following communication to
the Warden : —

October 5th, 1830.

Dkab Srs, — Professor Bennett informs me, that some person has
stated to you, that I have kept away pupils from the University of
London, or diverted them to other schools. I shall feel obliged to
you for the name of the slanderer; for the statement is false. I
wonder you can encourage such a report ; for it implies that you
think I have considerable influence with the pupils. It is at least
your interest, as one of the coup d'etat school, to pretend a perfect
indifference both to myself and to my acts. While I have my pen
in my hand, let me ask you, whether the Council desired you to tell
the Porter to keep me out, without any notification of their wish
being made to me in writing. It is a strange thing to expel a
freeman, by putting words in the mouth of a hireling slave.

I am, Sir, your obedient servant,

Albxandbb Thomson.

To Leonard Horner, Esq.
Warden of the University.

1 immediately received the following letter from the Warden :—
My dkab Sib, — I have just received your note, and shall be
happy to see you, if you will favour me with a call, any time to-day,
between two and four o'clock. You will find no obstacle to your
admission to the gate or elsewhere. You can come direct to the
Council Room.

Yours very truly,
University, Leonard Hobnbb.

Wednesday, 6th October.

So at last, my Loan is obliged to write, however cautiously. I
met him in the evening, when he refused to tell me from whom he
had heard the report, that I intended to make a riot (was it an in-
vention of his own ? or a Jesuitical apres gout ?) stated that there
was no written order for my expulsion. In fact, that it was his own
act; that after my assurance he should recal his order, but that he
must require me not to go to Professor Pattison's class. I told him
that I would make no conditions. He then requested me not to
enter Professor Pattison's class-room, a request with which I wil-
lingly complied ; the more as I had heard from one of the Professors,
that he had told Professor Pattison that I intended to visit his class,
and that this worthy gentlemen turned quite pale, and seemed very
apprehensive. Wishing, however, after consulting my friends, to
have the Warden's recantation, in black and white, I wrote him as
follows, on

October 9th, 1830.

Dixft Sib,— I have been reflecting upon your communication,
which appears to me so extraordinary and contradictory to that

452 Miscellanies.

made by Mr. Coates, that I beg you to answer my last note in
writing. I understood you to say, " that you had been informed by
somebody that I intended to make a riot at the Introductory Lecture.
delivered by Professor Conolly, and that you, following your duty
and taking care ' nequid caperet detriment respublica,' had thought
proper to order my temporary expulsion ; and that in my case, as I
had been very troublesome, you did not deem it necessary to pay me
the common courtesy of communicating with me in writing, and
therefore gave your orders direct to the porter." Am I, or am I not
right in my conception of the communication of the Warden of the
London University ?

Your obedient servant,

Alexander Thomson.
P. S. I hope you will answer me in writing. Truth needs no
evasion !

After this, Sir, to which, by the bye, I received no answer, I
packed away my papers, and as my intimate friends well know, had
made a determination never again to allude to the disturbance?.
Accordingly I went, by permission, to my friend Mr. Bennett's lec-
ture, which I take this opportunity of saying, I have not heard
equalled in the whole course of my studies. After lecture, some
conversation between myself and a Mr. Wilson took place in regard
to an academical dress. The students agreed with me, that it would
be inconvenient, unnecessarily expensive, and, after all, an invidious
distinction. I was going, however, on the same evening, to the
Medical Society, when the porter again informed me, that I was
excluded. I was astonished, and requested permission to be allowed
to enter the society, promising to return in a quarter, or, at farthest,
in half an hour, for the purpose of apprizing them of this, new in-
dignity. The porter kindly granted my request. I went to the
room of the society, told them what had happened, and asked them
to meet me at the University Hotel upon the morrow, with the view of
hearing the letters and documents which had led to my expulsion.
I then, after having been insulted (as Mr. Horner acknowledges)
by a listening, eaves dropping menial's intruding himself into our
society, and haranguing the pupils on the excited state of my feel-
ings) left them to their deliberations. At the advice of my friends,
I next morning once more wrote to the Warden a letter, of which
the following is a copy: —

October 11th, 1830,

Sib, — I have again, notwithstanding your protestation of friend-
ship and sorrow for your former coercive measures, been insulted by
being forbidden the building by your hireling. Inconsequence of which
I have again asked the advice of my friends, Professor Bennett, Mr.
Thos, Wakley, Editor of the Lancet, and Mr. L. Estrange, a general
practitioner in our neighbourhood. By their advice, notwithstanding
your studied evasion of written communication, once more I write
to you to demand from Leonard Horner, Esq. that courtesy, which
one gentleman has a right to expect from another, viz, an explana-

Miscellanies. 453

tion of the reasons, which led him to send to me a repulsive message
by & servant verbally, and not in writing. Also to enquire what
may have caused you again to issue the obnoxious order, after pledg-
ing yourself to me, to Professor Bennett, and to Professor Smith,
that it should be withdrawn.

Mr. Bennett suggests that my having spoken to-day in his theatre
may be the cause of your ill-tempered and hasty reversion of your
pledge. That you may be certified on this point, I shall repeat my
observations. A gentleman, whose name I do not know, but whom
I have since heard called by the nick-name of Mr. Pattiton's Uga-
ment, proposed that a deputation should wait upon the Council, for
the purpose of asking permission for the students being distinguished
from those of other schools, by the badges of a silk gown and tasselled
cap. I immediately asked him — " Does this proposal, Sir, emanate
from a "Professor or from yourself? because I beg to assure you that
at Cambridge it is thought a great grievance to be obliged to wear
these trappings, to which no one, who is not obliged, will submit.
Moreover, I trust that in the present day the only distinction, which
medical pupils of one school will seek from those of another may
henceforth be placed solely in the depth of acquirement, the cultiva-
tion of natural talent, the manly independence, and the gentlemanly
and scientific deportment, which ought to characterise every member
of our profession in particular." Such, Sir, was the purport of my
address, which I humbly submit cannot be construed, even by malice,
policy, or Jesuitical feeling into an offence against good discipline,
good manners, or decent society.

I regret that among my numerous papers I have lost that contain-
ing the last part of this letter. Suffice it to say, that in the morning
I received the following notice from the pupils : —

Dear Thomson, — I have great pleasure in informing you that a
notice, the copy of which I send, has this morning been posted about
the University ; and 1 have the honour to request your attendance at
the time and place appointed.

Believe me, Yours very sincerely,

Chablbs Rob. Brbb.
NOTICE.
The students of the medical school in the London University are
particularly requested to meet at the London University Hotel, this
evening at six o'clock, when a subject, which materially regards their
interests, and the welfare of this Institution, will' be brought before
their notice.

Charles Rob. Bbxb.

B. Coppebthwaitb.

N. Eisdbll.

Wm« Calvbbt<

Wm. Evans.
Three of the gentlemen, whose names are signed to this notice,
Waited however upon me in the morning, by the request of the War-
den, who wished me to accompany them to him. I did so, and he
>afbrmed.me in their presence, that the reason of my second exclu-

454 Miscellanies*

sion from the University was, his having been informed by two pro*
feasors that I had intended to make a riot in the medical society. All
my friends assured him at once that he had been misinformed* and of
their knowledge of my intention not to have recurred to these mat-
ters, while I again assured him, that if he would give me the names
of the two informing Professors, I would bring all the papers and
correspondence that minute, and burn them in the presence of him-
self and of the students. This, however, he refused ; but after a
long parley between himself and the three pupils, he consented to
allow me to lay all the documents before the pupils, and to explain to
them my conduct in the anatomical theatre, immediately after Mr.
Bennett's lecture. I leave it to the students to say whether 1 said
any thing that was not true of any Professor ; I leave it to them to
say whether I used unnecessary violence, and whether, after an hoar
and a half's dead and silent attention, they did not rend the air with
their deafening shouts of applause ; whether they did not deeply feel
that my motives had not been personal — that their good had alone
actuated* me — that I had been made a tool of the Professors, wmle
fulfilling the commission of my fellow pupils — that I had been basely
and ungenerously deserted by these Professors — that I had been
unnecessarily insulted by the Council — that I had been traduced by
a faction of three Professors — and that, in my person, every pupil bad
been excluded from a patient hearing before the Council ! For this
Council had never' inquired into my motives, into the reasons of my
connexion with the pupils! They condemned me unheard— they
were at once my accuser and my judge ! ! ! And yet, Sir, these are
the cream of the men, who are die boasted and boasting advocate* of
freedom of speech, of thought, and when free from licence* even of
action ! ! ! The motto over their gate is " Patens omnibus scientia ;"
their Jesuitical reservation is " at least so long as they are good
boys, that is so long as they complain of no Professors, point out no
abuses, and allow members of the Council to traduce the character
of their fellow pupils !! ! "

For what has since transpired I refer to the Lancet; and am your
obedient humble servant,

Alexander Thomson, M.B.

Of St. John's Col. Camb.— of the Univ. of Edinburgh —

late of the Univ. of London, and late Pres. of the Med.

and of the lit. and Phil. Soc. in the Univ. of Load.

Copy of Letters inserted in the Lancet of Oct. 30M. 1830.

University of London, Oct 14.
Dear Sir, — We have great pleasure in enclosing Hie resolutions
agreed upon at the meeting yesterday, with only two dissentient
voices, and remain,

Dear Sir, yours very truly,

N. Eisdell, Chairman.
T. Howttt, Secretary.

Miscellanies. 455

At a meeting of the medical students of the London University,
held in their common room, on Wednesday the 13th of October,
1830, it' was resolved, that

1. This meeting views with anxious concern the unmerited dis-
pleasure of the Council, lately manifested toward their fellow student
Dr. Alexander Thomson.

2. Dr. A. Thomson having fully laid before the students of the
University, every particular of his late conduct in connexion with
that institution, and submitted to their perusal authentic documents
in support of his statements, this meeting begs respectfully to in-
timate to the Council its unqualified approbation of the motives
Dr. Thomson acted upon in the transactions alluded to.

3. The students are fully aware of the deference they owe to the
ordinances of the Council, but cannot view, without apprehension,
the summary measure which has been put in force in the case of Dr.
A. Thomson, viz. his extraordinary expulsion from the University.
They conceive it to be a public institution, established on a system
of enlarged and scientific usefulness to society ; and, they think
themselves called* upon to enter their firm protest against the dis-
missal of a pupil from its class-rooms, without his having violated
any knowb law, any hearing of evidence, or even an official notice
of his dismissal. They are convinced that a proceeding so arbitrary,
irregular, and unjust, is incompatible with the best interests of the
University, and subversive of the liberal principles, to which it owes
its foundation and support.

N. Eisdell, Chairman.

Many of my fellow pupils have called upon me, and informed me,
that double the number of names would have been appended, had a
communication not been made from the office, stating that I was
not a matriculated pupil. As soon as I heard of this, I sent the
following letter to the Warden : —

Sia, — Having received a very gratifying communication from
ninety-six of my fellow students, approving of my conduct in regard
to Professor Pattison, and having been informed by many others of
them, who have not appended their signatures to this document,
that they have been restrained, by. a communication from the office
affirming that I am not a matriculated student, from appending their
names to this document, the whole tenour of which they otherwise
approve ; I beg to express to you my surprise at such information,
and to inform you, that the moment I heard of it, I went to the
office and tendered my money for a library ticket, which was refused.
I assure you, that I have been attending the University under the
belief that I was a regularly matriculated student ; for, when I feed
Dr. Davis for his lectures, he informed me publicly, in the presence
of his class, that his share of the money at least would be remitted
to me from the office.* This money I have never received, although I

• There is an agreement among the Professors that tbey will receive no money
from their colleagues' sons. But the Council do not sanction this agreement, and,
therefore, the sods are obliged to purchase a library ticket each year, as no one is

456 Miscellanies; *

}m*e more than once Applied to Dr. Davis far it. I concluded, there-
fore, thai ibis money was left for me at the office, where I wished it to
remain, as my matriculation fee. Under this belief I attended many
of the lectures last year. Again, Sir, I wish to ask of you whether,
as a gentleman permitted by the Council, through courtesy, to attend
lectures in their institution, they give you authority to prohibit
mf entrance without ' sending me' any written document, and
through the mouth of the porter? Again, Sir, I wish to know
whether you can expel tne from, or prevent me entering, the Me-
dical Society, of which I was the founder, as well as the frame? of
its laws, and am still an honorary member, having paid alL my fees.
If I, an old pupil by your acknowledgment, am excluded in this
manner, of what use is it to me to have paid all my fees to that
society ? . An answer to, these queries will pblige

Your obedient servant,
(Signed) Albxa^oir Thomson.

October 15th 1830. .

To those Pupils of the University of London, who have signed the

Protest to the Council in favour of Dr. Ales. Thomson*
: (xentlbmbn, — Allow me to return you my thank* for the kind
interest you have taken in my welfare ; I wish you had rather
had moral courage enough to have insisted upon your own rights,
and then you would have been insulted by the Council,* who after
reading your testimonial, sent me a letter., of which the following is
a copy: —

Copy of the Warden's Letter to Dr. Thomson.

University of London, Oct. 15. 1830.
Sib,— I have laid your letter of this date before the Council, and
I am directed to transmit to yon the following resolutions of the
Council passed this day : —

'* That Dr. Alexander Thomson be not permitted in future to
come within the precincts .of the University, and that the Warden
do give the necessary orders for carrying this resolution into effect.
" That a copy of the preceding resolution be transmitted to Dr.
Alexander' Thomson .

I am, Sir, your very obedient servant,
Leonard Horner, Warden/'

permitted to buy a library ticket who- does not Intend to enter to a course of lecture?,
to pay th;t part of the fee which goes to the University chesl.

• It is better, however, to observe to you, that not more than six members of
Council met on this occasion* a? I am credibly, informed by two pf the Professors.
Dr. Birkbeck and Mr, Stutch were I am also told, of the number.

Dr. Gordon Smith is preparing for publication a Syllabus of his own Lectures,
and an Abstract of Professor Chausater's work on Judiciary Anatomy.
- List of Books, i o our next,

AH Communications and Works for Review are to be addressed to the axt of
Messrs. Underwood, 32, Fleet Street; or to the Editor, at his Residence, 61,
Hatton Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL,

No. SO. DECEMBER 1, 1830. Vol V.

CRITICAL REVIEW.

I. — Dublin Hospital Reports and Communications in Me-
dicine and Surgery. Vol. V, 1830. — {continued.)

We have given an account of the valuable contents of this
volume in our last, and now proceed to notice them in
detail.

The first paper is " a Clinical Report of cases in the
medical wards of the Meath Hospital, during the session of
1828 and 1829, by Robert James Graves, M.D. M.R.I.A.,
King s Professor of the Institutes of Medicine, &c, and
William Stokes, M. D., Lecturer on the Practice of Medi-
cine, &c.

The first section is " on diseases of the arterial system —
arteritis/9 illustrated by a case of " gangrene and paralysis
of the right lower extremity, arising from disease of the
femoral and iliac arteries. It is as follows, and is ably
detailed :-—

" Patrick Magrath, aged 44, of a strong habit, was admitted on
the 7th of Feb. 1829, labouring under loss of power of the right lower
extremity.

" For the last six months this man had been exposed to severe
hardships. In the beginning of Dec. 1828, he was first affected with
alternating sensations of cold and burning heat in the toes of the
right foot. The same sensations, soon after, were felt in the leg,
accompanied with formications, and diminished power of the limb.
Pains in the foot next supervened, and in the course of a month the
part became cold, and was totally deprived of sensation.

" On the day of his admission he had attempted to walk to the
hospital, when the pain suddenly extended to the calf of the leg with
violence. From this time he lost all power of motion in the leg.

" The constitutional symptoms since the beginning of this disease
▼ere prostration of strength, anorexia, and constant thirst.

vol. v. no. 30. 3 H

458 Critical Review.

" On admission his intellects were perfect, and the temperature of
the body, with the exception of the affected limb, natural. The pain
had extended to the thigh during the night ; pulse 96, small and soft.
On examining the limb we found its temperature to be about 58« of
Fahrenheit, and observed some oedema at the ankle and foot. There
was complete loss of sensation from the middle of the thigh to the
toes ; the patient could rotate the thigh slightly, but no other volun-
tary motion of the limb was possible. The femoral artery appeared
like a hard cord ; it was painful on pressure, and no pulsation could
be felt in the vessel. We further discovered, by the assistance of the
stethoscope, that pulsation' was wanting in the external and common
iliac arteries on this side, while that of the left iliacs was plainly
perceptible.

" From these observations we came to the conclusion, that the
right common and external iliacs, and the femoral artery, were in a
state of permanent obstruction, which would account for the state of
the limb.

" Warmth was applied to the limb, and opiates exhibited. In the
course of the night the limb became of the natural temperature, the
cedamatous swelling extended to the hip, purplish patches appeared at
the ham, and the thigh became painful on pressure. Leeches were
applied in abundance, and opium freely administered. On the 10th
the thigh was more swollen, and presented many vesications ; con-
siderable tenderness; temperature 88°. He died the following
morning.

" Dissection. — No emaciation; the right lower extremity swollen
and of a purple colour.

" The brain, lungs, and abdominal viscera, were carefully ex-
amined, but nothing remarkable was observed, except that all these
parts were unusually exsanguinepus. A few crude tubercles were
found at the superior portions of both lungs.

" The heart presented the left ventricle in the state of active aneu-
rism, with some thickening and opacity of the aortic valves. The
ascending portion and arch of the aorta were perfectly healthy, nor
could any disease be discovered in the carotid or subclavian arteries,
but in the innominata we observed some red patches where the lining
membrane was thickened and softened. The descending aorta whs
healthy to within sixteen inches from its bifurcation ; here a slender
red fibrinous clot was found stretching nearly to the bifurcation ; be-
neath this clot the lining membrane was of a deep red colour, thick-
ened and soft.

" The right common iliac, when viewed externally, appeared dis-
tended and livid ; the left apparently healthy. On slitting down to
the bifurcation, we found that the former vessel was completely plug-
ged up from its origin by a dark clot, which extended to the external
and internal iliacs, and also engaged the gluteal and obturator arte-
ries. The same disease was found in the femoral and profunda, and
extended to the origin of the anterior and posterior tibial arteries,
which vessels, including the peroneal, presented a similar appearance
as far as they could be traced.

The Dublin Hospital Reports. 459

" Along the course of the diseased vessels, the lining membrane
of the artery was found soft and thickened. It had a somewhat villous
appearance, and greatly resembled an inflamed mucous membrane.
In some portions the clot was separated from the vessel by a layer of
dark coloured puriform matter, in others it was adherent. The clot
in the tibial arteries was not red, and much firmer than in the femo-
ral and iliac arteries.

(< In the left common iliac we found the lining membrane of a deep
red colour, and the vessel contained some portions of coagulable
lymph. The external iliac, and femoral arteries of this side were
perfectly healthy.

" No disease whatever could be detected in the veins of the
affected limb.

" A large portion of the vasti and rectus muscles was hardened,
and deprived of colouring matter. The cellular tissue cedematous ;
periosteum red but not softened."

Two other cases are detailed — one of aneurism of the
abdominal aorta, the displacement of the heart, double
pulsation of the heart — sudden death. Dissection was not
allowed in this or the succeeding one, of aneurism of the
ascending aorta ; and as the diagnosis of these cases must
have been difficult, obscure, and unsatisfactory, we pass
them by unnoticed. The following interesting comment is
offered on the case of Magrath : —

" In the highly interesting case of Arteritis, it would appear,
that the disease had first commenced in the extreme branches of the
arteries of the foot, and had gradually extended from below upwards.
The symptoms are in favour of this opinion ; the numbness and
alternating sensations of heat and cold occurring first in the toes, and
afterwards engaging the foot and leg ; the extension of the pain up-
wards, and the coldness of the foot, existing at a time when the thigh
preserved its natural temperature, all point out that the obstruction
did not, in the first instance, commence in the larger trunks.

" But the appearances on dissection furnish a still more satisfac-
tory evidence of the truth of this opinion. The consistence of the
clot decreased from below upwards. In the lower portions of the
arteries of the leg it was extremely firm and pale, while in the femo-
ral and iliac arteries it was soft and red. Here also the lining mem-
brane of the vessels shewed marks of recent disease, not observable
in the arteries of the leg, namely, redness, softening, and puriform
exudation. The existence of redness and softening, with the pre-
sence of a*voagulum in the lower portion of the aorta, and in the left
common iliac, make it highly probable that here was the latest effect
of the disease ; and that had the patient lived longer, the aorta itself
would have become obstructed.

" The occurrence of coloured clots adhering to, and derived from
the inflamed portions of the aorta and left common iliac, in which the
current of the blood had flowed freely, is worthy of notice, and seems

460 Critical Review.

to suggest the idea, that the fibrinous coagulum found in inflamed
arteries differs from that of aneurisms! sacs, and is not altogether
derived from the coagulation of blood arrested in its course in conse-
quence of the obstruction. Indeed, it is highly probable that the
exudation of lymph from the inflamed internal tunic of the artery, is
the first cause of obstruction to the flow of blood through the diseased
vessel. In the smaller trunks it must very soon fill up the calibre of
the artery ; in the larger the continued clot probably results from a
double source, exuded lymph and coagulated blood.

" In this case the extreme coldness of the limb pointed out, in the
first instance, that the circulation was obstructed. Coldness occurs
in some cases of paralysis from disease of the nervous system, but it
is slight : here the temperature of the affected limb was thirty de-
grees below the natural standard. This great coldness, and the
slight and but little extended oedema observable on the admission
of the patient, shewed that the obstruction existed in the arterial
rather than in the venous system, and this was borne out by the
absence of pulsation in the femoral artery, as observed by the touch,
and in the iliacs by auscultation. The latter observation, which we
believe to be the first of the kind, was made with great ease and cer-
tainty. Having traced the pulsation of the aorta with the stetho-
scope, we followed the course of the vessel to the umbilical region,
where the pulsation could be distinctly heard passing to the left side
in the direction of the common iliac. This, however, was altogether
wanting in the course of the right common iliac ; and as no tumour
existed in this situation, it was plain that the absence of pulsation
denoted obstruction of the. right common iliac artery.

" One of the most interesting circumstances in the case, is the
occurrence of inflammatory action in the cellular tissue and skin of
the affected limb* It is evident, that as long as the current of blood
into the limb took place through the natural channels, the circulation
was diminished in proportion as the arterial ramifications became dis-
eased; the extreme parts being first affected, and afterwards the
whole limb. During this state of things, the want of feeling and
coldness kept pace with the progress of the arteritis.

" But when the inflammation had caused a total obliteration of all
the arterial trunks leading from the common iliac of the affected side,
nature appears to have made an effort, by means of anastomosing
branches derived from the healthy arteries of the opposite side, to
restore the circulation in the limb in the same way as happens in
cases where the common iliac has been tied. That this effort was
successful may be inferred from the restoration of warmth and sen-
sibility to the limb ; and it is worthy of observation, that in this and
similar cases, where a collateral circulation has been just established,
the danger to be apprehended appears to arise, as in frost bitten parts
too suddenly restored, not from a deficient, but an over active circu-
lation in the affected extremity, which manifested evident symptoms
of inflammation, such as heat, pain, tenderness, ctdema, vesications,
and superficial gangrene. The latter we consider in our case to have
been evidently the consequence of inflammation, and it is probable

The Dublin Hospital Reports. 461

that the gangrene observed in other cases of arteritis arises from the
same cause, and not, as Aridral seems to think, from a deficient
circulation, as he compares it to gangrena senilis, from ossification of
the arteries.

" If this view of the subject be correct, it evidently points out the
impropriety of continuing the application of warmth after we observe
that the collateral circulation has commenced, for the same reason
that such applications are improper or even dangerous in the case of
frost-bitten parts. Gentle warmth is in such cases at first advan-
tageous ; but when the restoration of the circulation has commenced,
our efforts should be to moderate, not increase it ; a suggestion that
may-prove useful after the operation for aneurism.

" In the advanced stages of this disease the diagnosis is not difficult;
there is paralysis, but this has not been preceded by symptoms of
cerebral or spinal disease, and the intellects remain undisturbed. To
this, the feeble pulsation, or its complete absence in the arteries of
the limb, are to be added, and ho difficulty will be experienced in
recognizing the disease.

" In its early stages the diagnosis is more difficult. Here, how-
ever, an accurate comparison of the temperature of both limbs, and
the force of the arterial pulsations, may perhaps lead to a discovery
of the disease soon after its commencement, and thus enable us to
arrest the progress of the inflammation. At all events the disease
might be checked, if not cured, so as to allow the anastomosing ves-
sels time to take on the supplementary action."

In the comments on the semeiology of the cases which
we have omitted, the most important statement is, the dis-
covery of the aneurismal condition of the aorta by the
stethoscope. There cannot be more able advocates of aus-
cultation than the authors before us ; and we must add, that
their reports are some of the best and most satisfactory
that we nave ever perused. They account for every symp-
tom with a degree of physiological accuracy seldom dis-
played by most of the moderm pathologists. They are
intimately acquainted with the most recent doctrines of
this and foreign countries, and evince acute discrimination,
the most faithful observation, sound judgment, and exten-
sive research.

Our authors next proceed to describe painful swellings
of the lower extremity, occurring from inflammation of the
saphena vein, after fever, and in the puerperal state, all of
which they consider analogous. These cases, with their
comments, deserve serious consideration, and throw much
light on the pathology of phlegmasia dolens. We give
them in full.

" Painful swelling of the left lower extremity. Inflammation of the
**pbna vein. Symptoms of intermittent fever. — During the month of

462 Critical Review.

Feb. 1829, when several cases of ague were in the house, a man
named Andrews was admitted, complaining of rigors, followed by a
hot and sweating stage, which came on every second day ; these he
stated had been preceded by continued fever.

" Considering the case as an example of tertian ague, we ordered
the exhibition of sulphate of quinine in six grain doses daily. In a
few dayB the type of the fever was changed to that of quotidian, but
still, during the intervals, the patient was nearly free from fever —
We now made a more accurate examination, and found that the left
leg and thigh were extremely painful and swollen, a circumstance
which the patient had concealed. Any attempt to extend the limb
produced intolerable pain, chiefly referable to the ham and calf of the
leg. The limb was extremely tender on pressure, particularly along
the course of the saphena vein, which in its whole extent could be
felt like a hard cord. No change could be observed in the tempera-
ture of the limb.

" The opposite leg appeared healthy. The saphena was indurated,
but not painful on pressure.

" We now omitted the quinine, applied leeches freely to the af-
fected limb, and at the same time exhibited calomel and opium. This
treatment proved successful, and the patient was discharged in three
weeks with the perfect use of the limb. The saphena having been
restored to its original state, that of the opposite side, however,
remaining unchanged. .

" Painful swellings of the lower extremities. — Eliza O'Donnel, aged
21, was admitted on the 3d of June, 1829, with symptoms of gastric
fever, and severe pain in the right side under the margin of the ribs.
Thirty leeches were applied to the painful part, and aperient medi-
cines exhibited with relief.

" On the 6th, convalescence appeared to have commenced, the
menses flowed scantily, and altogether, though great weakness ex-
isted, her situation was satisfactory: On the 7th, however, without
any obvious cause, we found that she had been kept awake the whole
night by a violent pain in the calf of the left leg, which was swollen,
extremely tender, hotter than natural, and tense, but was not at all
red, neither did it pit on pressure. The tenderness, every where
great, was excessive along the course of the saphena vein, which felt
cordy throughout its whole extent. Some tenderness was complained
of in the pubic region, with scalding on micturition ; pulse 108,
hard ; tongue brown and dry ; great thirst.

" Twenty leeches were applied along the course of the saphena;
three grains of opium and ten of calomel, divided into six pills, were
given in the twenty-four hours, and a hip bath at night. Next day
she was greatly relieved, and in a few days her mouth was evidently
affected by the mercury, and the pain subsided in the limb, which
had decreased considerably in size, was less tense, and pitted on
pressure.

" In this case a decided tendency to a recurrence of the affection
was observed, and the pain, tenderness, and swelling returned several
times, but in a less severe form, and generally yielded to the appli-

The Dublin Hospital Reports. 463

cation of leeches and stupes. Hie pain in one attack was greatest
in the calf of the leg, in another at the instep, and in a third at the
middle of the thigh. The disease in the left leg, after continuing
with intermissions for three weeks, subsided, leaving, however, the
limb considerably swollen, and the patient in a state of emaciation
and exhaustion.

" On the 28th of June, a nearly similar train of local symptoms
commenced in the right leg, attended with so much constitutional
irritation and debility, that we were apprehensive of the result.

" The violence of the symptoms, however, subsided after the ap-
plication of twenty leeches, and the use of remedies hereafter to be
mentioned, so that, although her convalescence was tedious, the local
symptoms had disappeared before the middle of July.

" It is worthy of remark, that when leeches were applied during
the swollen state of the limb, a very large quantity of serous fluid
flowed from their bites before any red blood made its appearance. —
Daring this state of the limb, the swelling too was by no means uni-
form, varying from day to day as to the situation it chiefly occupied,
and not unfrequently to the touch simulating most perfectly, the fluc-
tuation caused by an abscess immediately under the integuments.
The suffering from pain and want of sleep during the whole course
of the disease was extreme, and so soon reduced her strength, that
the exhibition of stimulating and tonic remedies was found neces-
sary eight days after the commencement of the complaint, and were
continued, combined with narcotics and the use of stupes, until she
had so far recovered, both from the constitutional and local disease,
that we were able to pass to the use of mild diuretics and the appli-
cation of bandages.

" In this case the leg first attacked had not perfectly recovered
when the other assumed the diseased action. In the right leg the
corded and knotty state of the saphena vein, and the tenderness
along its course, so remarkable in the left, did not exist.

On the subject of the painful swelling of the limb, as observed in
the case of Andrews, we shall remark, in the first place, that it is a
striking example of the danger that may arise from neglect of accu-
rate examination in any case however simple in appearance. If we
had not ultimately discovered the disease in this instance, the worst
consequences might have resulted. We shall mention another case
briefly, which illustrates the importance of general examination.

" In a female patient much debilitated by fever, convalescence
had but commenced when she complained of want of sleep from
severe pain in the calf of the right leg. . At this time we were not
familiar with the disease. On examination of the limb, the skin was
of the natural colour, and it did not appear increased in size or swol-
len in the least. Narcotics were exhibited, but without benefit, and
on the following day, the pain being very severe, and occupying a
small spot on the leg, a moxa was applied. Next day, on taking
down the bed clothes, the left leg was accidentally uncovered, when
we were at once struck with the great difference of size of the two
extremities. The right, which we had supposed of natural size, was

464 Critical Review.

nearly twice as large as the left, which was emaciated from the long
continuance of the fever. It was plain, that in consequence of not
comparing both limbs, we had mistaken the swelling of the right leg
for its natural state, lost much time in the treatment, and employed
a painful and useless remedy. The patient ultimately recovered, but
the moxa produced a very troublesome ulcer.

" These cases are good examples of the practical value of diagnosis :
so long as we had an erroneous idea of their nature the remedies em-
ployed were injurious, but as soon as the real nature of the disease
was discovered, the measures adopted were followed by complete
success*

" The intermittent fever in the case of Andrews, may be com-
pared to that depending on urinary disease. There is a point of irri-
tation in the system which appears to produce the rigors ; and to
cure the fever, we must remove its exciting cause. In this case, as
in that of urinary intermittent, the exhibition of bark aggravated the
symptoms, and we have had several opportunities of observing that
this symptomatic intermittent, although it be reciprocally cause and
effect, is exasperated by the above treatment. We have seen it in a
lady who had lately been confined, in whom there was a tenancy to
the formation of mammary abscess. Quinine was exhibited in large
doses for several days, and great aggravation of the symptoms of
intermittent followed.* In a case of phlegmasia dolens lately treated
in the hospital, the woman had daily rigors, followed by a hot and
sweating stage. In' both these cases the treatment which proved
successful was local bleeding, and the use of draughts repeated daily,
consisting of the ammoniated tincture of valerian, opium, and sul-
phuric ether. Indeed in the last mentioned case, whenever this
medieine was omitted, the rigors returned ; this happened three or
four times. The patient ultimately recovered.

" An accurate observation of numerous cases, both of phlegmasia
dolens occurring after delivery, and of painful swelling of the extre-
mities appearing during or after fever,t has satisfied us of the patho-
logical identity of the two diseases. In both cadema occurs, unat-
tended by redness, but accompanied by increase of heat, with great
tenderness and pain, and followed for a considerable time by impaired
motion of the limb.

" In both diseases the swelling and other symptoms are frequently
not confined to any one portion of the extremity, but extend uni-
formly over the leg and thigh* In both diseases, however, we have
also often observed, that the pain, heat, and swelling, occupied par-
ticular parts of the limb, wjiile the rest was comparatively free from

* In another patient we observed well marked tertian ague supervene during
the administration of large dote* of sulphate of quinine. In a case of arthritic
rheumatism in a person previously healthy, an imprudent attempt at curing the in-
termittent by still further increasing the dose of sulphate of quinine, indoosd a fatal
pneumonia . in this case more sulphate of quinine had been exhibited antecedent to
the appearance of the tertian fever than would have been sufficient to cure three
ordinary agues.

f Dr. Tweedie, Edinburgh Medical and Surgical Journal. No. 97.

The Dublin Hospital Reports. 465

disease. Thus in some cases a portion of the thigh was intensely
engaged, while the leg and foot remained free, and after some days
the diseased action seemed to change its place, and successively
attacked the other portions of the limb, without, however, any pre-
cise order in the mode of succession. In consequence of this, our
treatment has been directed to different portions of the limb, accord-
ing to the situation of the disease ; and we constantly found that the
degree of swelling in the part attacked was proportioned to the ac-
companying heat, pain, and tenderness. In some cases we have
observed this affection to be attended by a cordy and painful state of
the saphena vein, proving that it participated in the disease ; but as
this state of the vein, where it did occur, was in some cases subse-
quent to the disease of the other parts of the limb ; and as in the
majority of our cases of phlegmasia dolens, and in the painful swel-
ling of the extremity after fever in the male and female subject, no
such affection of the saphena occurred, we think that the latter cannot
in justice be considered as the cause of the disease. The occasional
occurrence of the swelling in the inferior portion of the. limb in the
first instance, and its erratic nature, militate against the idea that the
disease proceeds from an affection of the large venous trunks ; and in
two instances we have seen the disease desert its orginal seat, and
concentrate itself in the knee joint, producing obstinate inflammation
of the part, which in one case, that of a male after fever, terminated
in anchylosis, and in the other, that of a female who laboured under
phlegmasia dolens after delivery, the same unfortunate result was
with difficulty arrested.

" As the latter occurrence, and many obvious considerations, leave
little doubt concerning the inflammatory nature of the disease, it
remains to be considered what are the parts engaged. To us it would
appear that the subcutaneous cellular tissue is primarily affected,
sometimes generally, at others partially. It is not unusual to meet
vim cases either of general or local anasarca evidently of an inflam-
matory origin, accompanied by pain and heat, but unattended by
redness. The external and vascular layer of the corium remaining
nninflamed, will account for the absence of redness in this disease,
as well as in the inflammatory anasarca.

" The cellular tissue seems to follow the same law as serous mem-
branes. Moderately inflamed, it effuses an unusual quantity of its
natural secretion, serum. When the irritation is more intense, the
effusion is also altered ; it contains more animal matter, approaching
in its qualities to coagulable lymph, and sometimes it is of a puri-
fonn nature. It is to be remarked, that suppuration has occasionally
been observed in phlegmasia dolens when very intense, but usually
the effusion appears to be the result of an intermediate degree of
uflammation between that which produces puriform and merely serous
effusion. The swelling is consequently more apt to produce, by
means of the coagulable matter contained in the effusion, considerable
bardnesa arising from the consolidation of the cellular tissue. A
state of parts not observed in the beginning or termination of the

Vol. v. no 30. 3 i

466 Critical Review.

disease, when the inflammation is more moderate, which we have
frequently pointed out to our pupils both in phlegmasia dolens and
the painful swellings of the extremity after fever. Did space permit,
further arguments might be adduced from considering the pathology
of Barbadoes leg, and the disease termed berri berri in Ceylon.*

" Concerning the treatment, the local antiphlogistic plan preserved
in with assiduity, the use of stupes, and after the disease has con-
tinued for some time, the liberal use of narcotics, have appeared to
be the best means of subduing the disease, when in its acute form :
when more than usually obstinate, these means must be accompanied
by bandaging, tonics, and diuretics ; and when the knee is attacked*
frequent leeching, blistering, and the use of the inclined plane.

" The utility of salivation appears to us questionable. In one
case we obtained no advantage from the liberal exhibition of iodine.
We have been informed by an experienced practitioner, that in seve-
ral cases of phlegmasia dolens, he has observed marked advantage
from the repeated application of blisters to the affected limb; a met
evidently not inconsistent with our view of the pathology of the
disease.

" Since the above pages were written we have met with a remark-
able case, in which this peculiar swelling of the lower extremity
coincided with an inflammatory state of the vein.

" A young man of a strong habit was employed for two succes-
sive days in working in a ditch, and was consequently obliged to
stand in water above his knees during that time. On the following
day he became affected with lassitude, vertigo, and general weak-
ness, and complained of severe pain in the right thigh. These
symptoms continued for seven days, when he was admitted into the
Meath Hospital.

" On admission his countenance was anxious and depressed ; the
tongue furred; thirst; headache; urine scanty, turbid, and high
coloured; pulse 96; skin mottled with petechia?. In addition to
these general symptoms his respiration was observed to be laboured
and unequal, with some cough ; face very livid. But his chief com-
plaint was a severe pain in the upper and anterior portion of the
right thigh, which was greatly aggravated by motion or pressure.
He had also severe pain in the left hypochondrium, increased by in-
spiration or cough.

" At this time no swelling whatever of the limb could be detected;
but in the course of two days the upper portion of the thigh became
evidently swollen, the part being extremely tender, elastic, but not
at all red. • The pain of the side continued, and extensive bronchial
and pneumonic inflammation was detected. General bleeding, and
very free leeching to the limb, was employed. The blood was not
inflammatory, and no relief was experienced by the patient. The
swelling of the thigh increased ; calomel and opium were freer/ ex-

* Dub. Hos Reports, vol. iii. Ridley on Berri Berri*

The Dublin Hospital Reports. 467

faibtted, but without any effect. The typhoid symptoms increased,
and the patient died on the fourth day after his admission.

" On dissection we found the right lower extremity swollen, and
tease in its superior portion, while the leg and foot were slightly
anasarcous. The sac of the pericardium contained some sero-
purolent fluid, and that portion covering the auricles and great ves-
sels was vascular, and in many places covered with coagulable lymph.
Both lungs were in a state of extreme sanguineous congestion, with
commencing solidity in their postero-inferior portion, and general in-
flammation of the pleura, as shewn by a reticular exudation of coa-
gulable lymph, which occurred in greatest quantity in the most
inferior portions. The bronchial mucous membrane was universally
red, and the tabes filled with frothy mucous. No disease could be
detected in the lining membrane of the heart. The right ventricle
contained a fibrinous coagulum of the usual appearance. The. gastro-
intestinal system appeared remarkably healthy, except in the great
extremity of the stomach, where the mucous membrane presented a
dotted red colour. The spleen enlarged, flabby and pale, was found
in a state of purulent infiltration, bearing some resemblance to the
long in the third stage of acute pneumonia.

" The vena cava contained a few portions of a substance of a
granular appearance, friable and of a yellowish colour. These did
not adhere to the vessel, which otherwise appeared healthy. In the
external Qiac vein, however, we found, just above Poupart's liga-
ment, a large concretion of a similar nature, nearly plugging up the
vessel, and extending into some of the minute collateral branches.
lTke> lining membrane was red, and in one point adhered to the coa-
gulus. No puriform matter could be detected. The femoral and
popliteal veins were healthy, as also the arteries. The cellular tissue
of the limb was pale and oddematous.

" It cannot be denied that this case is strongly corroboranwe of
the opinion before entertained, and lately insisted on by Tommasini,*
that the phlegmasia alba dolens is in reality owing to phlebitis.

" Here we find a young man previously in the enjoyment of good
health, after a long continued exposure of the lower extremities to
cold, becoming affected with symytoms of fever, and a violent pain
in the upper part of the thigh. These are succeeded by others indi-
cative of obstruction in the circulation of the limb, and of visceral
inflammation, and in a few days the patient dies, with general pleuro-
pneumony, pericarditae, and splenitis ; and in addition to these the
vein is found in an unequivocal state of inflammation and obsruction.
It would, however, be unphilosophical to form certain conclusions as
to the disease in question from a single case. We have put our ex-
perience of the disease now on record, and leave to our readers to
form their own opinion."— -p. 42.

Though the reasoning offered in this extract seems very
plausible, we can by no means admit it conclusive, as we

* See Journal Hebdomad. No. 61.

468 Critical Review.

have repeatedly shewn in our last volume, that phlebitis
of the femoral and pelvic veins is not followed generally
by swelling of the extremity. This will be seen by refer-
ring to our reviews of Mr. Arnott's and Dr. Lee's papers,
in the Med. Chir. Trans. 1830 ; of M. Dance's and M. To-
nelle's — papers which have not been mentioned by our
authors. But whatever may be the pathology of phleg-
masia do lens, all agree in the mode of treatment. In oar
original essay on the subject, we differed from the talented
Dewees, as to the use of narcotics* -and we are pleased to
have the able physicians before us coincide in our opinions.
The remainder of the report of Drs. Graves and Stokes,
comprises an account of diseases of the chest and abdo-
men, which we shall notice in our next number.

II. — Medico-Chirurgical Transactions. — Vol. XVI. Part I.
London, 1830. pp. 235. Two Plates: Longman & Co.

This volume contains some interesting papers, and in some
measure maintains the character of its predecessors. The
contents are as follow:— 1. Case of aneurism of the external
iliac artery, for which the femoral, and subsequently the
aorta, were tied. By J. H. James, Esq- — II. An account of
the removal of a tumour situated on the cheek. By James
Barlow, Esq. — III. A case of ununited fracture of the thigh-
bone, cured by the application of a silver wire, between
the fractured extremities. By Dr. Somme, of Antwerp.—

IV. An account of a concrete oil existing as a constituent
principle of healthy blood. By B. G. Babington, M. D.—

V. Case of phlegmasia dolens, caused by inflammation of
the veins or the lower extremity, excited by malignant
ulceration of the cervix uteri. By William Lawrence, Esq.

VI. Case of extensive inflammation, and obstruction of the
veins of the right inferior extremity of a phthisical youth,
accompanied by a swollen state of the limb. By T. H. Hol-
berton, Esq. — VII. History of a case of stammering, suc-
cessfully treated by the long continued use of cathartics.
By JohnBortork, M. D. — Vfll. On the pathology of hoop-
ing cough. By James Alderson, M. D. — IX. A further in-
quiry into the comparative infrequency of calculous dis-
eases among seafaring people, with some observations on
their frequency in Scotland. By A. C. Hutchinson, Esq.—
X. Practical observations on the healthy and morbid con-
ditions of stumps. By George Langstaff, Esq. XL A case

Medico- Chirurgicdl Transactions, 469

of aneurism of the external iliac artery, in which a ligature
was applied to the common iliac artery. By Philip Cramp-
ton, M. D. — XII. On the glanders in the human subject.
By John Elliotson, M.D. — XIII. An account of the dissec-
tion of the parts concerned in the aneurism, for the cure of
which Dr. Stevens tied the internal iliac artery, at Santa
Cruz, in the year 1812. By Mr. Richard Owen, Surgeon.

In our next we shall notice these valuable papers in de-
tail, and are happy to add our testimony in favour of their
importance generally. We may merely observe, that the
most valuable to the practical surgeon, are those by Mr.
James, of Exeter, and Dr. Crampton, of Dublin, which
prove that the aorta and common uiac artery may be tied
with little difficulty, so far as the operation is concerned.

III. — A Demonstration of the Nerves of the Human
Body. Part I. The Cervical and Thoracic portions of the
Sympathetic, and the Nerves of the Thoracic Viscera.
By Joseph Swan. Plates. Folio. London, 1830 : Long-
man and Co.

IV. — Neurology of the Human Body. By Borremans,
revised and adapted to the English Nomenclature. By
T. King, late House Surgeon to the Hotel Dieu, Doc-
teur en Medicine de la Faculte de Paris, Member of the
Royal College of Surgeons in London. London, 1830.
Folio. Ten Plates : Feuillet Dumus and Co. Leicester
Square.

V.— Analytical Anatomy of the Great Sympathetic Nerve.
ByP./MANEC, M.D. P. London, 1830. One Plate,
Folio : Feuillet, Dumus and Co.

The zeal and indefatigable industry of Mr. Swan, as a phy-
siologist and a minute anatomist, are universally known to
the cultivators of medical science. The various produc-
tions of this author on the nerves, have been duly estimated.
He was perhaps induced to undertake the tedious dissec-
tion of that part of the nervous system alluded to above,
as a candidate for a prize offered by the Royal College of
Surgeons ; and the splendid preparations presented by him
to the college, obtained for him the unanimous approba-

4JH) Critical Review.

tion of that body, and the approval of the profession at
large. ••'.-•

The fasciculus now before us represents the cranial, cer-
vical 'and thoracic portions of the great sympathetic nerve ;
add ei^ht plates are devoted to its accurate illustration
Each view is shewn by two plates, with a difference in the
shading ; the second is a correct outline of the former, with
letters and figures referred to in the letter-press description.
It would be foreign to our purpose to enumerate the origin
and course of the cerebrospinal nerves, more especially as
the succeeding plates represent them more fully. These
plates are very accurately executed, and so far as they ex-
tend, are highly valuable. There are, however, two ob-
jections to the work. The first is, the unnecessary number
of plates to illustrate the same subject ; and the second, the
great expense, which is nearly three times that of the second
work on our list, and eight times that of the third, though
either is far more complete and useful. The sum of two
guineas is much too high for a partial delineation of the
nervous system, and should the succeeding numbers be
equally expensive, the work will be placed beyond the reach
of a great mass of the profession.

Mr. King's plates, when united, represent the body of
an ordinary sized adult. They not only delineate the whole
nerves, but almost all the tissues of the body. They are
invaluable to the student of descriptive anatomy, and con-
sequently have had a large sale, which was greatly aug-
mented by the lowness of their price, which is fifteen shil-
lings plain, or thirty shillings coloured. The author has
published a description in sixteen pages, octavo, and with
such a manual the student can acquire an extensive know-
ledge of the relative situation of parts ; especially of the
muscles, blood-vessels, and nerves. We strongly recom-
mend these plates to all those engaged in the study of de-
scriptive anatomy, and to junior practitioners. If placed
on canvas, they would be a great ornament to the surgery.
Mr. King is also enraged in preparing plates of the arteries,
of the same size. We wish him every success.

Manec's plate illustrates the origin of the cerebro-spinal
nerves and their inosculations. There is an accurate de-
scription in letter-press on each side of the figure. In one
plate, and one view, there is a complete delineation of the
great sympathetic, and at an expense of a few shillings-

Swan, King and Manec, on the Nerve. 471

When we consider the immense importance of a knowledge
of the cerebro-spinal nerves, in explaining the functions,
sympathies, derangements of the different organs, and the
action of medicinal agents upon the living system, we can-
not too strongly recommend the attentive study of this
plate to our junior friends. Without an accurate knowledge
of the various subjects which it embraces, directly or col-
laterally, no man can comprehend the innumerable chain of
symptoms of disease, nor the therapeutical views which
influence the scientific practitioner. This plate well de-
serves a place in every medical library.

ORIGINAL COMMUNICATIONS.

I. — Clinical Reports of the Richmond Hospital, Dublin.
By John Swift, Esq. M.R.C.S. London.

Case I. Trichiasis. — Miles Brennan, aged forty-three, ad-
mitted on the 28th of September, with entropia of both
upper eyelids, chronic conjunctivitis, an opaque and thick-
ened state of the membrane investing the front of the
cornea, and considerable intolerance of light. The disease
had originated about six years ago, from inflammation of
the meibomian glands and tarsal conjunctiva, and had for
the last three months prevented him from pursuing his
occupation as a shoemaker.

30th. Dr. M'Dowel operated on the left eye, by pinching
up a fold of skin corresponding in extent to the inverted
ciliae, and sufficient to produce the requisite eversion ;
through this he passed three single ligatures of strong silk,
one at each extremity of the fold, the third in the centre,
and having tied them firmly, fixed the ends on the forehead
by adhesive straps ; a wetted coinpress was then laid over
the eye and retained by a bandage.

On the 10th of October, the ligatures were detached by
ulceration, and the success of the operation was evident,
as the ciliae retained a sufficient degree of excision, and the
cicatrices were not yet entirely healed. A poultice was
ordered to remove the scabs, which formed in the situation
°f the ligatures. On the 14th the incrustations were re-
moved, and the cicatrization of the parts completed. The
hairs remained permanently everted, the skin of the upper
Md, which before hung. loosely, is thrown into horizontal

472 Original Communications.

folds, and the conjunctivitis and dimness of the cornea
disappearing rapidly.

On the 6th of October, the right eye was operated on
in the manner recommended by Mr. Guthrie, by removing
with the scissors an eliptic fold from the upper lid, and
dividing the tarsal cartilage at each extremity ot the inverted
hairs. The ligatures being passed through the lips of the
wound, formed by the excision, were fixed to the forehead
in the manner before described. The patient complained
very much of the comparative severity of this operation.
The former operation has the advantage of being less pain-
ful, of greater simplicity, and equally effectual.

Case II. Thomas Reilly, aet. 49, admitted on the 6th of
October, with entropium of the left upper eyelid, of six
months standing. Four years ago, he had catarrhal in-
flammation of the lids from lying on a damp floor, followed
in two months by inversion of right upper eyelid, severe
conjunctivitis and opacity of the cornea. About three
months ago, excision of about three-fourths of the tarsus
and ciliee, was performed by Dr. Jacob, with some relief.
A few hairs near the punctum lachrymale, which were left
behind, became inverted, and continued to keep up irrita-
tion in the organ. These have been restored to their proper
direction by a single suture, applied as in the former opera-
tion. Mr. Guthrie's operation was performed on the left
eye with success. The ligatures have been applied in ano-
ther similar case with decided relief, since the above was
written.

Case III. Iritis. — Return of inflammation while under
the influence of mercury. Bridget Cullen, aged forty, had
been in hospital for about a month, with idiopathic iritis
of the right eye, for which she had leeches twice applied,
a blister to the nape of the neck, and took calomel and
opium. She left hospital on the 7th of October, (her
mouth still tender) and on the same night was attacked with
iritis of the left eye, for which she was re-admitted on the
9th. The usual symptoms were present, viz. severe pain
in the eyeball and forehead, lachrymation, intolerance of
light. Sclerotic vessels injected, of a pink hue, and run-
ning in straight lines towards the cornea, round which they
inosculated, forming a vascular zone, considerable irregu-
larity of pupil, the iris being1 retracted towards the i oner
and upper part of the eyeball. Eight leeches were applied
to the inferior palpebra, the extract of belladonna smeared
round the orbit, and Sj.of the folio wiug mixture to be taken
three times a day. ft, olei terebinth* mucilag. acacia? aa.

Mr. Swift on Clinical Reports. 478

5j. aquae puras menthffi aq. piper aa. Jiij. syrup, cort. au-
*ant. 5iv.

lltb. Pain still severe ; three leeches to the inside of the
lower lid ; a blister to the back of the neck.

13th. Considerable relief from the leeches; complains
principally of soreness in the eye ; a blister behind the cor-
responding ear ; continue the mist, terebinth.

18th. Pain, intolerance of light, and lachrymation nearly
gone— vascularity of sclerotic subsiding. States that the
turpentine has produced slight nausea and headache, but
no other perceptible effects.

26th. Pain and vascularity of the eye removed ; pupil
can be fully dilated by belladonna ; two points of adhesion
to the lens nearly destroyed ; vision daily improving.

Cask IV. Amaurosis. — James Kilty, a healthy labourer,
aged twenty, was. admitted on the 27th of September, with
amaurotic symptoms, the right eye being principally af-
fected. The pupil was considerably dilated, and exhibited
but little sensibility to light. He stated, that at the time
he Jicst noticed the impairment of vision (last June), he had
been employed in mowing, and felt pain and heaviness in
the eyeballs and head while stooping at his work. He bad
also about the same period an attack of cold, and pains in
the liinbs, which lasted for a fortnight. He first observed,
on looking at objects, a cloud before his eyes, and after-
wards motes and rings of a dark colour, which expanding,
broke up, and were succeeded by similar spectra. The
flame of a candle appeared considerably magnified, and of
a bright red colour. His sight is better in the shade than
in a full light, and from six to ten in the morning, than
during the rest of the day. Latterly he has been getting
worse, and can scarcely make his way through the streets.
His appetite is good, and he has never laboured under any
intestinal derangement. No pain in the eyeball or head.
Ordered to take submur. hydrag. gr. ij. opii. gr. ss. ter die.
and to have a seton inserted in the nape of the neck.

Oct. 22d. Mouth affected ; vision considerably improved ;
can discern minute objects at considerable distances ; thinks
the left eye is as well aa ever ; right eye not well, but much
improved.

Case V. Gonorrhoea! Ophthalmia.— Margaret Murphy, a
married woman, aged twenty-two, admitted on the 19th
of October, with purulent discharge from the conjunctiva,
pain, intolerance of light, impairment of vision, and tume-
faction of the eyelids. She has been labouring under go-
norrhoea for the last two months, but is not aware of hav-

Vol- v. no. 30. 3 JE

474 Original Communications.

ing applied any of the matter to the eyes. The disease
first appeared in the left eye with severe pain, great redness
and profuse lachrymation. In two days afterwards the right
became similarly affected, and she went to Jervis Street
Hospital for advice, where she got mercurial pills, and a
wash to inject under the lids. She was bled in three or four
days after, once from the temporal artery, to the amount of
eight ounces. She became a patient of Dr. M' Dowel's on
the 19th. She was ordered to continue her pills, and have
the conjunctiva brushed with a camel hair pencil, dipped in
a twenty grain solution of nitrate of silver.

21st. The solution had given her considerable pain, but
was followed by marked improvement ; to be repeated ; to
omit her pills, as her mouth has become affected.

23d. No discharge from the eyes ; pain, intolerance of
light and vascularity removed ; sight improving ; mouth
stdl sore.

28th Discharged cured.

Case VI. Disunited fracture of the femur treated by the
seton. — Michael Flood, a healthy young man, aged twenty-
eight, residing in the country, where he was employed as a
labourer, came into hospital on the 18th of January, with
a false joint, formed at the junction of the middle and
lower thirds of the femur. He stated that about two years
and a half since, he had his thigh bone broken by a horse
which he rode falling on him. The fracture was simple, but
very oblique, and the shortening of the member consider-
able. In some short time after the accident, he went into
one of the provincial hospitals, where the limb was kept in
the extended position on a softish bed for two months.
When allowed to get up, he found that the first time he
attempted to bear his weight on the limb, the fractured
portions were not united. He was again confined to bed in
the same position for three months, at the end of which
no union had taken place, and he was permitted to walk
about on crutches, and discharged, after twelve months
confinement in hospital, with a false joint. He had been in
Stevens's Hospital subsequently some months, and had glue
bandages and splints applied, and was put under the in-
fluence of mecury with some benefit. A seton was passed
between the fragments, which was followed by considerable
inflammation and a copious discharge. At the end of a
month it was removed, a complete union having taken place,
and in a few days the patient began to bear gently on the
limb, and was discharged cured, about six weeks after his
admission. He returned again on the 10th of July, with

Mr. Swift on Clinical Reports. 475

the limb flexible, in the situation of the fracture, and unable
to sustain his weight. He stated that being discharged, he
employed it very much in digging and walking, being, as
he expressed himself, so proud of his recovery, that he
thought he could not use the limb often enough. By the
aid of rest, full diet, a glue bandage, splints along the
limb, and the iodine lotion, the thigh is becoming gra-
dually firmer. He is at present walking about with the
assistance of a stick.

5, SackvQle Garden, Summer Hill.

II. — Case of Hydrophobia, from the bite of a dog that
had exhibited no signs of rabies, arising at an unusually
early period, and terminating fatally in four days.

[The child was attended by Mr. Frankum, Surgeon, of
Lisson Grove, while the case was drawn up, and the ex-
amination conducted by Alexander Thomson, M. B., 70,
George Street, Euston Square.]

Read to the Westminster Medical Society, Oct. 30, 1830.

The mother informs me, that at about half-past eight,
p. m. of Wednesday, 16th June, her child, a boy of about
seven and a-balf years of age, was playing before a stable
door in Lisson Grove, into which a groom, who was return-
ing from the country with a nosegay in his hand, was about
to enter, when her boy, having begged in vain for one of
the attractive flowers, was suddenly bitten by a dog that
rushed out upon him, immediately upon the opening of the
stable door. She, at the earnest solicitation of some of her
friends, washed the wounded parts cautiously with brandy,
and then conducted him to the bouse of Mr. Coucher,
Surgeon, of Church Street, Lisson Grove, who was not at
home.

Half-past nine, p: m., exactly one hour after the accident,
Mr. C. being still engaged at a labour, his assistant attended,
and rubbed the wound well over with lunar caustic. The
child, however, became drowsy earlier than usual ; retired
to rest at about half-past ten, p. m., but had not been in
bed more than half an hour, before he became excessively
hot and feverish, in which state, harrassed by incessant
restlessness, and tossing himself about in various directions,
he remained till about half-past eight, a.m., when the

476 Original Cokmumcations.

mother again sought for Mr. C, and finding that he had
not returned, asked for an aperient powder.

After having taken the powder, the boy insisted upon
putting on his clothes ; became, when he had dressed bun-
self, tinconimonly lively, and appeared to be in better
spirits than usually, singing, dancing, and playing, but
soon afterwards became languid, which inducea his mother
to send for Mr. Frankum, Surgeon, of Lisson Grove, who
furnished me with the notes, from which, with the mother's
statement, the remainder of these remarks are drawn up.

June 17th, l,p. m. Mr. F. found the poor boy in bed,
though apparently not very unwell, with a wound on the
inside of the right leg, at a small distance below the knee.
It had evidently been cauterized, and was not complained
of as a source either of pain or of irritation. The boy, in
answer to the inquiry after his health, said, " Very well, I
thank you, Sir," in a somewhat languid tone. The rest-
lessness of the past night was attributed, not without reason,
to the influence of the fright. The pulse was frequent, but
not hard ; the respiration slightly accelerated ; the skin
bedewed with a moderate perspiration, and the wound
roughish on the surface. The boy had been dozing during
the whole of the day, and seeitoed to consider every move-
ment an annoyance. Mr. F. suspecting that the wound had
not been very carefully dressed, ordered a blister, rather
larger than a dollar, to be applied over it; and a diet con-
sisting of tea-sop, gruel, and barley water to be employed
with,

fV. Hyd. stibmur. gf. ij.
Pulv. antim. gr. i. til.
Ft. Pulv. j. Mitte rj.

Sumr. quartft qu&que hor& unus.

. At about half-past eight, p. hi. he passed a tolerably na-
tural, though scanty rriotion ; throughout the night con-
tinued to doze, and to be annoyed by any attempt to move
him; and became, as the night drew on, intensely hot and
feVerlsh, In about twelve hours the blister had risen well*
and at twelve, a. m. dti Friday, 18th, was removed, and
replaced by a warni bread and water poultice.

Friday, 18th, I, p. m. Mr. F. found him still cheerful,
readily answering questions, and stating that he felt quite
well, but continuing to breathe in a sofoewhat hurried man-
lier, as if from a sense of oppression. He had rather doeed
than slept during the past night, and had had no evacuation
of the bladder or rectum since half-past eight last night.

Dr. A. Thomson's Case of Hydrophobia. 477

The poise, though compressible, varied from 96 to 100
beats Id a mittute ; the tongue was rather dry and slightly
loaded ; the body was entirely free from preternatural
warmth, and the skin was moist. At about two, p. m. he
took f^itj. of castor oil in a draught, and had continued to
take the powders at tegular intervals. At about seven, p. m.
the bowels had not yet been opened ; the face, hands, and
limbs became exceedingly cold ; the whole body wsLs bathed
in clammy perspiration ; the hands swelled and became pur-
ple. He had been much troubled by thirst from the com-
mencement of the attack, and had drank plentifully of tea
and of toast and water, but had no appetite, and had
therefore taken no solid food. At this time he took another
draught, containing fjiij, of castor oiL The bowels were
not, however, relieved during the night, which was one of
great restlessness atid irritability to the little sufferer. To-
wards Saturday morning the restlessness, the irritability,
and the doldness increased.

Saturday morning. The bowels held not been relieved
daring the night, and the patient became uncommonly rest-
less, refused medicine, food, and drink of all sorts, and
violently opposed its administration by clenching the teeth.
An injection of salt, dissolved in warm water, was adminis-
tered at about ten, a. m., and in less thdn a quarter of an
hour was followed by a copious discharge of feculent
matter and of urine. At this period his mother put his
feet, which were Very <$o\&< into hot water, and kept them
there for about ten minutes. Mr. F. now returned to visit
him. Before twelve m. the bowels had been two or three
times Well evacuated, and the patient about this period
began to be drowsy, and stated, though reluctantly that
he Was quite well, (his mother says be never complained of
pain). The pulse Was weak and fluttering, and the skin
covered with a c lata my perspiration. Wine and water, beef
tea, &c. Were ordered, and offered to the boy, but refused.
At about two, p. m. his mother > after much persuasion,
succeeded in getting him to take one spoonful of mutton
broth. At about three, p. m., he began to be draWn forcibly
backwards, to utter piercing cries, aud clench and gnash
the teeth ; he had been in convulsions of a similar kind,
but not so violent ever since taking the broth at two, p. m.
but the mother at first attributed them to efforts at vomit-
ing. These convulsions much increased in frequency and
violence until four, p. m. when he was again visited by
Mr. Frankum, who found that every effort to produce de-
glutition of fluids, whether by artifice, or by the endeavour

478 Original Communications.

of the boy himself, was instantly followed by a violent
paroxysm of convulsions, in which the head was violently
retracted, the muscles of the face and neck were fright-
fully contorted, the back so bent or curved, that the abdo-
men formed the prominent part of an arc. Some bottles,
containing boiling water, were now applied to the feet ; and
some tent wine offered to be introduced into the mouth,
only produced a return of the convulsions. By each of the
paroxysms, which lasted through several minutes, the
strength of the patient was much reduced. About eight,
p. m. Mr. Franxum again visited the little sufferer, iu
company with Dr. Conolly. Similar paroxyma had con-
tinued to recur every five or ten minutes. The child, was
becoming very feeble and languid, so that these gentlemen
gave up all hopes ; after which the poor little child bein*
in a state of collapse, during which the breathing could
scarcely be traced for the space of half an hour, and at
the end of which period he died, without a groan or strug-
gle. The child had taken no medicine or fluid since half
past four in the morning, with the exception of the
spoonful of mutton broth, which gave rise to the first con-
vulsions. He had not passed urine or faeculent matter since
twelve m. The following observations of Mr. Frankum on
the case I think valuable : —

" Candour," he observes, " obliges me to Confess that
I was by uo means prepared to expect so unfavourable a
result. There were no symptoms in the child of a striking
or direct, no positive inflammatory character. He was dis-
turbed, and somewhat restless — free from pain, and jet
apparently oppressed with an uneasiness not to be de-
scribed. He had received but a very superficial injury, and
the dog appeared in such a perfectly healthy condition, that
hydrophobia was the least to be expected ; and were it not
for the peculiar nature of the fits, the difficulty of deglu-
tition, and the extent of disease afterwards discovered in
the dog, amounting to a confirmed incipient state of rabies,
I should at the present moment be quite at a loss to account,
in a satisfactory manner, for the death of the child in so
short a period ; as'it ft, I do not hesitate to declare my con-
viction, that it was unquestionably produced by the in-
fluence of a morbid poison, introduced into the system by
the bite of the dog, and that its early appearance, ana
unusual characters, were owing to the susceptibility and
condition of the child's constitution at the time the mischief
was done."

Dr. A. Thomson's Case of Hydrophobia. 479

MOBBID APPEABANCES, 24 HOUUB AFTER DEATH.

The body was that of a child of remarkable beauty, with dark
hair, regular well formed features, good proportions, and plump and
well formed limbs, with no blemish whatever on the body, except the
narks of the. cupping instrument of old date, on either side of the an-
terior of the thorax immediately below the clavicles, and the remains
on the left knee, to the inner anterior aspect of the limb, close to the
insertions of the sartorius and gracilis muscles of a blister of about
the size of a crown piece. Within the margins of this blister were
observable, two semicircular black marks, with the concave parts
opposed to one another, which I understood at the time, arose from
the marks of the teeth of the dog, the wounds from which had been
well rubbed over with lunar caustic, soon after the accident. On cut-
ting through the integuments around this blistered part, and dissect-
ing it off, we perceived considerable extravasation between the subcu-
taneous lobules of fat, which themselves appeared to be rather redder
than is usual. But no evidence of deep laceration, or of inflammation,
no mark of bruise or deviation in colour or in texture, could be traced
on the subjacent superficial fascia. The wound, or injury therefore,
was not deep or extensive ; and would readily have admitted of the
excision of the whole of the wounded part, without danger to the in-
dividual. We cannot dwell however too seriously on the fact, that in
this case little more than laceration of the cuticle was sufficient to
permit of the entrance of the seeds of this horrible disease, for we
draw this inevitable conclusion, that it is proper in all cases, however
alight the wound, however doubtful the state of the animal, to ex-
cise the part fully and freely at first ; to cauterize the cut surface
may afford additional security, and can be accompanied but by slight
chance of danger.

The theca spinalis was found externally unusually dry, and the
veins of Breschet comparatively empty ; but when the theca came to
to be minutely examined, it was found that while it was much in-
jected with florid blood, yet its posterior half was much more so, not
only in its fibrous but also in its serous membrane, which was beau-
tifully covered with stellular ramifications of microscopically minute
vessels. This half of the theca of the spinal column was also very
much thicker than the other, quite opaque, and in several places ad-
herent by its arachnoid lining to the true arachnoid of the spine. In
the upper part of the theca, however, near the region of the respira-
tory nerves, the anterior half of the theca was also very much in-
jected. Between the theca, and the arachnoid coat of the spine was
a considerable quantity of limpid serum, about two drachms alto-
gether. The arteries of the posterior column particularly of the up-
per third cauda equinas column, and of the superior third of the an-
terior column, were much more injected than is natural. This was seen
by Mr. Hinde and others. The chord itself, as well as the medulla ab-
longata and pons varolii, were of a remarkably firm and hard consist-
ence. The integuments of the head did not appear to be remarkably

480 Original Communications.

injected, The dara mater adhered firmly to the cranium, and was
very much injected, particularly in its arachnoid layer throughout.
The true arachnoid presented no traces of inflammation. The veins
and sinuses were remarkably full of black blood, which even in the
veins was coagulated. This state of veins prevailed in every part of
the encephalic mass, even within the ventricles, in which though the
plexus choroides was destitute of arterial blood, its vein was re-
markably turgid. The arteries throughout the brain were ah* oat
empty, and exceedingly small, a fact which Mr. Frankum and Dr.
Conolly both perceived. The cerebrum and cerebellum had both lost
their elasticity, and yielded unresistingly to slight pressure of the fin-
ger. The ventricles, however, were remarkably dry, and contained no
fluid whatever. The cerebro spinal axis, even until we came to the
medulla oblongata,, had lost its consistence, and all the encephalic
nerves were peculiarly tender at their origins.

The chest, when cut into, presented the left lung adherent to
every part of the parietes of the cavity, by means of its pleural in-
vestment to the diaphragm, to the mediastinal pleura ; the connecting
bands, though strong, were all recent and traversed by longitudinal
vessels, passing from the lung to the parietes of the cavity, or vice
versa paralelly arranged, and containing florid blood. The right lung,
which adhered by a recent band to the upper part of its cavity, had
between its lobes several bands of a recent formation, and densely
crowded with longitudinal red vessels, collapsed, owing to its parie-
tal attachments upwards, and floated upon about a pint of scrum, re-
sembling the washings of recently cut muscles. The pleura of this
side costel, mediastinal, diaphragmatic, and pulmonary, was intensely
inflamed, and dashed here and there with petechial spots.

The pericardium occupied a space of about three times the usual ex-
tent, expanding nearly equally round its own region; when cut into, was
found distended by a large quantity of greenish translucent serum,
containing in it ragged flocculi, of coagulable lymph, very much thick-
ened and coated in every direction, with a sort of flocculent deposit
of coagulable lymph of about l-8th of an inch in thickness, not only
on its free or capsular surface, but over its cardial portion. This ar-
tificial membrane adhered, however, very firmly to every part of the
capsular and cardial part, and connected these two surfaces together
by small transverse bands of irregular and ragged coagula. When
this artificial deposit was elevated from the pericardium, whether of
the capsular or heart, that membrane was in both cases found to be
most densely injected, and covered with irregularly distributed pete-
chia?, and sent several fine and delicate stellula? of vessels here and
there into the new membrane. The cellular tissue connecting the
pericardium, with the mediastinal pleura, was most remarkably in-
jected and thickened, so as to render the margin of a section of these
two membranes together about 1 -6th of an inch in thickness. The cel-
lular tissue was, however, far more intensely injected in the course of
the phrenic nerves, the substance of which also had a fleshy appear-
ance from the intensity of the injection of its vessels. The substance

Dr. A. Thomson's Case of Hydrophobia. 481

of the heart itself was of a paler hue than usual, the cellular tissue
between the muscular fibres appearing to be thickened, all its cham-
bers contained dark coagulated blood; its lining membrane was
universally injected with red blood, its tricuspid and mitral valves
were denser than usual, and the lining membrane of the aorta was
also in the loculi of vesalius round the orifice of the coronary arteries,
covered with fine and delicate stellula of red vessels. This last ap-
pearance was so peculiar tand of such rare occurrence that I displayed
it to several friends, Dr. Hogg, Mr. Hinde, Mr. Huddlestone, &c:
I never before met with it, although, I think I remember to have
heard Dr. Mackintosh, of Edinburgh, describe such an appearance.
There were no apparent pustules or vesicles, such as have been
observed by some, under the tongue, but the vessels at the side of its
inferior surfaces were more than ordinary turgid with red blood, its
anterior was covered with a dense dry fur, of a brownish hue, the pos-
terior part, together with the tonsils, velum pendulum and pharynx,
were considerably injected, but particularly the latter. The mucous
folicles scattered over the base of the tongue, and around the glottis,
together with those, constituting from their denser approximation ; the
tonsils were remarkably turgid, so as to present the appearance at
first of tubercles with ulcerated apices, but upon nearer inspection
proved to be clogged and turgid, with an opaque viscid secretion.
The oesophagus was considerably inflamed throughout, and about its
middle part, sent of a small fistulous orifice, that passed into an in-
durated and suppurating bronchial gland ; from this part downwards
the inflammation became more and more intense, till on the central
part of the mucous membrane of the stomach, it arrived, at its maxi-
mum, and adhered, giving rise to a few extravasations in the form of
petechias. The stomach in fact was of one nearly uniform scarlet
hue, throughout the surface of its mucous membrane, but more par-
ticularly towards its cardiac end. This inflamed state of the stomach
by isolating the gastric glands, enabled us to see them with unusual
facility. They are collected irregularly, and arranged with nearly
equal proximity round the cardiac and the hyloric orifices, gradually
becoming more scattered in proportion as they are distant from these
orifices, till .at last they may be traced passing in lines of single glands
longitudinally along the prominent part of the longitudinal ridges of
the stomach, from one orifice to the other. This beautiful and un-
usual appearance rarely to be seen, may be traced in the preparation
preserved in the London University Museum. These are I suppose
the glands of Brunner, but I could discover no qttmeuux order, such
as that in which they are said by Cloquet to be arranged, as it is true
as asserted by that author and by the Dublin dissector, that they are
more numerous, or as the latter asserts chiefly confined to the greater
and smaller curvatures of the stomach ; for the truth of this state-
ment, I refer to the preparation in the University Museum. I ought
not to omit observing that Mr. Mayo, in his physiology, describes an
arrangement of these glands, approximating more nearly to the truth
than that of Cloquet and others. He observes " the glands of the

Vol. v. no. 30, 3 l

482 Original Communications.

stomach are largest and most numerous near its orifices. At the con-
junction of the oesophagus with the stomach, they form a distinct
thickening, from three to four lines in breadth." See the Phys. p. 160,
second edition, 1829.

The nerves of the tongue, the glosso pharyngeal, the descendens
noni, the lingual nerve, the lingual branch of the fifth, were all of a
fleshy colour in the region of the pharynx, owing to injection with
blood. The margin of the glottis, the two faces of the epiglottis and
the whole of the interior of the pharynx, were in a high state of in-
flammation, particularly the surface of the cricoid and of the aryte-
noid cartilages. The laryngeal surface of the epiglottis was consi-
derably swollen, owing to turgescence of its mucous follicles of the
same kind, as that which has been related of those of the base of the
tongue. The mucous membrane trachea also, and bronchial tubes
throughout their ramifications as far as they could be traced, were in-
tensely injected, and in common with the larynx were remarkably dry,
as if destitute of the natural secretion. The cellular tissue surround-
ing the tongue, larynx and pharynx was considerably injected, as was
also the thyroid body. The pneumo gastric nerves were not of a
very red colour, till it approached the thorax ; but as they passed the
clavicles, became intensely red and remarkably injected ; this con-
tinued throughout their course within the thorax. I have already al-
luded to the high state of injection of the phrenic nerves. The bron-
chial glands were most of them very much enlarged, indurated, yel-
low in colour, in some instances of a cheesy consistence, and several
in a state of suppuration. Between these, which had apparently been
some time in passing into their present state, the left pneumogastric
nerve, in its course to the arch of the aorta, had been very much com-
pressed and flattened, and its fibres as it were separated one from
another. The substance of the lungs, but particularly of that of the
left side, was in a state of high recent inflammation, of the first stage.
There were no remnants whatever of ancient disease to be traced in
tbe lungs, saving a small cicatrix at the upper part of that of the left
side, which lay immediately beneath the attachment of the pulmo-
nary to the costal pleura, already mentioned as seen in that quarter.

In the abdominal cavity, the liver appeared remarkably bright and
florid, its peritoneal investment being much injected. The gall blad-
der was full of dark- coloured bile. The whole of the intestinal tube
beginning from the stomach downwards ; was very much inflamed,
both in its mucous and serous coat. The duodenum however, the
latter end for about a foot length of the ileum, the colon and the rec-
tum, were remarkable for the intensity of the injection of their mucous
membranes. The mesentery, however, with the omentum majus and
gastero-hepatic omentum, were more injected than any other parts
of the peritoneum, saving that which covers the diaphragm.

The kidnies were in a very high state of injection, such as is rarely
seen, and the mucous membrane of their pelvis and of the ureters,
was intensely inflamed, and here and there dashed with petechial
spots. Finally, the bladder was remarkably distended.

Dr. A. Thomson's Case of Hydrophobia. 483

remarks:

I think it certainly fair to conclude that all the parts more imme-
diately connected with the nerves devoted to respiration, or sympa-
thizing with these, were in a very excited and inflamed condition,
while it may certainly be seen in the preparation of the spine of this
child, preserved in the University Museum, that there is more injec-
tion at the upper part of the spinal column, from which the respira-
tory system of nerves take their rise, than elsewhere. It may also be
noticed in the same specimen, how much more the theca of the pos-
terior column, as well as its other membranes, was inflamed or injected
than those of the anterior, a circumstance which may be fairly pre-
sumed to account for the enormous susceptibility of the whole of the
surface in this remarkable disease. That the prior part of these ap-
pearances were found also in the dog, and with one or two others,
led Mr. Youatt, now well known to the profession for his ingenious
and accurate papers and lectures on this subject, as well as for the
extreme urbanity with which he invariably communicates his infor-
mation to those who wish to give it, as his decided opinion that had
the dog been suffered to live, all the ordinary symptoms of rabies
would have developed themselves in rapid succession.

Morbid appearances in the dog a few hours after death.

The master of the dog, although he had been conjured by Mr.
Youatt not to kill the animal, did however hang it on the morning of
the 23d. The dog having hitherto displayed none of the ordinary
symptoms of hydrophobia, and indeed no symptoms of disease at
all, we were all anxious to ascertain what morbid appearances would
be found. The pharyngeal third of the superficies of the tongue was
injected and marked with a red blush. The papillae of the same por-
tion were more enlarged than is usual. The mucous membranes of
the inferior surface of the epiglottis, along its median line of the mar-
gins of the rima glottidis, of the interior of the larynx, and more par-
ticularly of that part covering the body of the cricoid cartilage, of the
whole of the trachea, and of its larger ramifications, of the superior
part of the pharynx, of the inferior half of the oesophagus, of the
whole of the stomach, of the first portion of the duodenum, and of
the whole of the rectum, were intensely studded with minute red
vessels. In the stomach and rectum indeed, the studding was so
dense, that the whole superficies bore a dark red hue, which presented
the most minute and beautiful ramifications of vessels arranged in a
stellular form. The maximum of intensity occurred about the centre
of the greater curvature of the stomach, where, in addition to the
blush, were to be seen several extensive patches of effused blood
underneath the mucous membrane. The serous coverings of the
stomach and rectum were likewise intensely inflamed. In the pha-
rynx, at the upper part, the mucous membrane was considerably in-
jected, but was less and less so in descending the oesophagus, till
about the middle third of this pipe, from which spot it became more

484 Original Communications.

and more influenced, till it reached the maximum point already men-
tioned, as occurring about the centre of the stomach. The stomach
contained a considerable quantity of gnawed bones, some fragments
of straw and of hair matted together into a ball, all of them en-
veloped in a thick, viscid, dirty, blackish, brown, disagreeably
scented, liquid. The rectum contained some softish, crude, yelkm-
colouied foeculent matter. The mucous membrane of the bladder
also was spotted over with stellular blushes of minutely injected
vessels.

The lungs were remarkably florid, and had their own pleura on
both sides minutely injected, but particularly that of the left side. —
The lungs themselves were engorged with florid blood, being through-
out of a bright red colour, and had here and there on their surface
opaque and milky spots, about the size of a pea, consisting of coagu-
lable lymph, effused between the pleura and cellular sheath of the
lobules of the lungs. The costal pleura of the left side was most
intensely studded with vessels carrying red blood, and elevated here
and there from the subjacent parts by patches of effused blood, from
the size of a millet seed to that of a sixpence ; and on the diaphrag-
matic and. pericardial part, by small patches, flat, white, wavy, and
as thick at their margin as in their centres, of a consistence resem-
bling fibro, cartilage, varying in size from that of a millet seed, to
that of a half crown piece, confluent in some instances into an irre-
gular plate. Besides these, the whole of the mediastinal and diaphrag-
matic portions of pleura on this side were studded with minute vas-
cular spongy bodies, resembling organized granulations, sometimes
scattered and distant, but, along the margin of the diaphragmatic in-
sertion at the side, accumulated into a mass so as to resemble both ex-
ternally and internally a recent fungus, of florid granulations, and
constituting a medium of attachment between the pleura of the ribs,
or of the side and that of the diaphragm. The mediastinal pleura
was certainly more injected over the course of the phrenic nerve
than elsewhere, the pericardium was not inflamed, even in its me-
diastical part ; the heart itself was in no way unsound in its ap-
pearance, except in having its systemic auricle, together with the
vessels leading to it, and the pulmonic ventricle, and pulmonary
arteries, gorged to distention with black blood.

The dura mater and brain presented no unusual appearance, nor
did the medulla oblongata, or any part of the cerebro spinal axis, ap-
pear remarkably injected. The spinal marrow was not examined,
because Mr. Youatt had other engagements. None, who had pre-
viously seen dogs that had died under hydrophobia, examined, failed
to recognize the marked resemblance of the appearances found in this
case to those they had previously observed. Dr. Connolly, Professor
Pattison, Mr. Frankum, Mr. Youatt, and myself, left the theatre
with the conviction, that had the master had humanity enough to
have followed the earnest intreaties of Mr. Youatt, we should have
seen the animal pass through all the stages of this dreadful malady.

Dr. A. Thomson's Case of Hydrophobia. 485

Prevention of Hydrophobia after the wound.

This case is one of those which dearly points out the invariable
necessity of excising the part, however Blight may be the abrasion,
for here it was very slight, and the utility of the same operation,
whether the dog have or have not demonstrated symptoms of rabies,
because, as in this case the seeds, as well as the power of communi-
cating or transplanting these seeds may exist, without giving, at
least in the present state of our knowledge, any evidence of their ex-
istence ; for even Mr. Youatt observed none in the dog previous to
his death. Acting upon this principle, I have formed the determina-
tion of never undertaking the care of a patient, who has been bitten
by any dog, at least during the months of June, July and August,
unless the patient will consent to submit to excision of the wounded
parts. The pain of excision is slight, and if the cut surface of the
pert be very well rubbed over with lunar caustic, not of long duration,
while the wound resulting from it is soon healed, so that even sup-
posing the dog not to have been mad, little inconveniencie is suffered
by the patient, while great security will accrue, provided it have been
performed in time, supposing the worst happens. I have already
guided by these reasons, excised parts since the date of this case,
without much inconvenience to the patients, both from the arm of a
man and of a boy at the London University Dispensary. I did not
in either case wait a moment to enquire into the abate of the dog,
which in neither afterwards turned out to be rabid. But in both I
felt indifferent after the operation to what might have been the state
of the animal.

Proposed regulations in regard to dogs, with a view to the pre-
vention of hydrophobia.

1st. — To require all dogs found abroad, without an owner, during
the months of June, July and August, to be shot, or otherwise de-
stroyed by the police.

2n<L — To require under a fixed penalty, all dogs taken abroad by
their owners, during these months, to be muzzled with a basket or
wire gauze muzzle.

3rd. — To require all dogs, that may during these months have
bitten any person, whether they may or may not have already ex-
hibited signs of rabies, to be taken by the police, or by their
masters to a veterinary surgeon, licensed for the purpose, and to be left
under his care at a fixed rate, until such time as tbey shall be de-
clared by him to be harmless.

4th. — To exact a given penalty from any master, whose dog may
be found to be in a rabid state.

These regulations even would offer but slight security, and the
last would almost appear tyrannical ; but, as this disease if it do not
arise from, is certainly promoted by, a want of due attendance to the
health of this useful domestic animal, such a regulation might tend
to suppress the malady.

70, George Street, Euston Square.

[ 486 ]

III. — A. Case of Tubercular Disease affecting the Perito-
neum, with the result of the post mortem examination, and
observations. . By A. oLakb, M.D. Member of the Royal
College of Surgeons, and Surgeon to the 7th Regiment
of Dragoon Guards.

Regimental Hospital, 7th Dragoons, Canterbury.

Acting troop serjeant-major James Gourlay, of the Seventh
Dragoon Guards, a man of sober habits, and the bilio-san-
guineous temperament, aged 37 years, 18 of which he passed
in the service, and during the greater part of that time in
the capacity of paymaster s clerk, commenced the duties of
a troop serjeant-major about five months ago; in conse-
quence of which it became necessary for him to repass the
ordeal of drilling indispensable to the formation of an effec-
tive dragoon ; such as riding for several hours a-day with or
without stirrups, &c. &c. Previous to this change in his
pursuits, he led a very sedentary life, and latterly seemed
much disposed to obesity, but did not complain of ill health.
About three months ago, having then gone through two
months of his drill, he applied to me in consequence of a
painful sensation of weight, which he experienced io the
region of the spleen, and attributed to the exercise of riding.
On examination, I was unable to discover any unnatural for-
mation in the part alluded to, which may have been owing to
a considerable deposition of fat, which existed in the abdo-
minal parietes. I notwithstanding recommended to the
commanding officer, that the riding part of his exercise
should be dispensed with for a fortnight ; and as the biliary
secretions seemed defective, and the bowels sluggish, be
took blue pill, bitters, with alkalies, and occasional purga-
tives. Under this treatment he improved rapidly, and was
enabled to resume all his military duties, which he continued
to perform until the middle of September ; at this period the
left side became again painful, and he was attacked with
dysentery. I was not then present with the regiment, but
the gentleman who performed my duties prescribed castor
oil, effervescing draughts, enemata and external fomenta-
tions, as the symptoms indicated, without obtaining much
relief; a consultation was then held, at which an expe-
rienced physician assisted, and it was determined, in addi-
tion to the remedies already in use, to try the effects of calo-

Dr. Blake on Tubercular Peritoneum. 487

mel and opium, pushed so as to affect the system speedily,
and also to employ the warm bath, together with mercurial
and stimulating frictions, to the affected side. Under this
treatment, the symptoms mitigated somewhat, and the bowels
were quieted, but costiveness ensued, while the stomach con-
tinued irritable. He also continued to suffer from uneasiness
in the left hypochondrium, but no direct inflammatory symp-
toms manifested themselves. At this period also, the abdo-
men began to tumify, as if from the presence of a mixture of
air and serum ; this additional swelling precluded altogether
the possibility of examining, in a satisfactory manner, the
subjacent viscera. On minute investigation, however, the
hand, when pressed on the abdominal parietes, seemed to
come down upon a hard substance, situated to the left of the
umbilicus, in nearly the situation of the stomach. When I
saw this patient on the 19th Sept. I found him in the state
above described, and learned that he had admitted having
been without an alvine evacuation for nearly ten days, pre-
vious to his having reported his indisposition , and likewise
that he had suffered uneasiness for several days from the
pressure of his sword belt on his left side. He also stated
that he had been annoyed by a dry short cough, which he
fancied depended on the state of his stomach, for some years
past. He at the same time endeavoured to palliate the. im-
propriety of his conduct, in not having reported his illness
sooner, by alleging his anxiety to become qualified for the
rank to which he aspired. Although the nature of his dis-
ease did not indicate actual inflammation, I was induced to
bleed him, wishing to act on the safe side, and with a view
to observe the effects of the loss of blood on the symptoms
generally; I did not however allow more than 12 ounces to
flow, as its loss did not afford any relief, and its quality pre-
sented no marks of existing inflammation. Stimulating and
mercurial embrocations were then applied to the abdomen,
and the mercurial treatment recommended by Dr. Chisholm,
of Canterbury, who was kind enough to afford me in this
case the benefit of his long experience, was continued. Our
efforts were also directed towards allaying the irritability of
the stomach, and inducing the return of natural alvine eva-
cuations. To accomplish these ends, effervescing draughts,
hydrocyaraic, acid, opium, laxatives and purgatives, includ-
ing croton oil, antispasmodics and emollients, were seve-
rally resorted to, but with little better effect. The irritability
of the stomach increased daily; and at the same time the
nature of the matter ejected from it gradually degenerated

488 Original Communications.

in quality from that of ordinary food, until it assumed more
decidedly the character of the black vomit of the yellow
fever, which it latterly resembled in every respect. At this
period the patient was harassed by an intense burning sen-
sation in the stomach, accompanied by most distressing sin-
gultus, more particularly when he lay on either side, or in
the horizontal position. This latter symptom was in some
measure relieved by the occasional administration of magne-
sia, opium, alum, and the mineral acids, employed in turn;
but they did not succeed in removing it altogether. A large
quantity of mercury was used in this case, both internally
and by friction, but yet the gums were scarcely affected, nor
was the effusion in the peritoneal cavity apparently dimi-
nished. It did not, however, increase much until within
two days of the fatal termination. Nor were the extremities
at any period affected with oedema. During1 the course of
the disease, the pulse was quick and irritable throughout,
after reaching 120 in a minute; but it did not possess any of
the characters indicative of membranous inflammation. The
tongue also was but little loaded, and its edges were gene-
rally red, and remarkably clean. The bowels, when not
under the influence of purgatives, continued obstinate; but
the nature of the alvine evacuations, when attained, differed
very materially from the matter ejected from the stomach, in
as much as they did not possess that resemblance to cof-
fee grounds, which the latter so exactly presented. On
the contrary, until within the last three days of existence,
the stools were bilious, and comparatively natural. At this
period the irritability of the stomach appeared to subside,
while the bowels became suddenly relaxed, and the evacua-
tions assumed all the appearance of the matter termed black
vomit. About this time likewise, the distension of the abdo-
men diminished, and the hard body already spoken of could
be distinctly traced in the direction of the transverse colon.
It communicated to the fingers the precise feeling which the
acute edge of an enlarged liver would afford ; indeed, the
fingers seemed to pass under its edge in so natural a man-
ner, that it was impossible to imagine the tumour to be pro-
duced by any other body.

As nature became exhausted from the want of nutrition,
general debility and relaxation ensued, the absorbents seemed
to lose their power, and serous exhalations accumulated
within the cranium and abdomen, inducing symptoms indica-
tive of pressure on the brain, namely, strabismus, loss of
vision, stertor, coma, and finally death — a consummation

Dr. Blake an Tubercular Peritoneum. 489

devoutly to be wished for, in this most distressing and
incurable affection. The fatal event took place on the J 8th
instant.

The post mortem examination was made 24 hours after
death, in presence of Drs. Cbisholm and Carter, and Sur-
ffeano Ren wick and Sicard, of this city.

The body generally appeared to have undergone consider-
able emaciation, while the abdomen was distended as if from
ascites. There was not, however, the slightest appearance
of oedema in the extremities. On percussion, the abdomen
yielded a well, marked tympanitic sound, so as to render
problematical the presence of much water in it; but a hard
substance extending across the abdomen, and resembling
exactly in situation and feel the anterior edge of an enlarged
and indurated liver, was. distinctly recognized by all present.
On opening the abdomen by the usual crucial incision, we
were surprised to find that notwithstanding the tympanitic
sound elicited by percussion, no air escaped, while at least
two gallons of a serous fluid rushed out with some violence.
After which the real nature of the disease was disclosed.
The indurated substance, which we had felt .occupying the
situation of an enlarged liver, was found to be a tuberculated
mass, of cartilaginous hardness, and presenting the appear-
ance of what Air. Abernethy terms " tuberculated sarcoma,"
having an indurated and knotty structure, while its summit
was covered with red and granulated coagulable lymph.
This almost carcinomatous formation was fully an inch in
thickness, and in .some parts four inches in breadth ; it occu-
pied the base of the omentum in its whole extent, and was
closely attached to the arches of the colon and stomach. —
At the pyloric orifice of the latter viscus, this substance
stretched across to the liver, and nearly obstructed altoge-
ther by its pressure, the passage of its contents into the duo-
denum ; and in the course of the colon below the anterior
edge of the spleen, a circular band was also observed to
surround, and strongly constrict that intestine.

This disposition to tubercular formation, although it seemed
to have its principal seat in the omentum, was likewise to be
found wherever the peritoneum extended ; thus its entire sur-
face presented a beautifully stellated appearance, being
literally studded with small white tubercles, of a cartilagin-
ous hardness, similar in structure to the subcutaneous tuber-
cle described by Surgeon Wood, in the Edinburgh Medical
and Surgical Journal, for the year 1812. The surface of the
liver, stomach, and the abdominal surface of the diaphragm,

Vol. v. no. 30. 3 if

490 Original Communications.

were not free from these diseased productions; and the
mesentery, in its entire course, was prodigiously thickened
and indurated by their presence, so much so as to impede
the vermicular or peristaltic motion in the intestines, and
thereby deprive them of the necessary means of propelling
their contents through them, in a direction oftentimes con-
trary to the laws of gravitation ; hence their apparent loss
of tone in this affection. On examining the coats of the
8 to mac h, they were found to be much thickened from inter-
stertial effusion of coagulable lymph ; and its mucous lining
was dark coloured, soft, and easily detached ; the whole of
the intestines, but particularly the ccecum and appendix rer-
miformis, were also much changed in structure, being thick-
ened and indurated. The liver presented a shrivelled, olive
appearance externally, and its interior resembled a nutmeg
in colour ; but its parenchyma did not seem to be materially
altered. The gall bladder was much distended, with black
and nearly inspisated bile. The remaining viscera of this
cavity were not diseased.

The thorax presented nothing very remarkable; no tuber-
cles were discovered in it. These parasitic excrescences
seemed to have limited their habitation altogether to the
extent of the peritoneum. The lungs of the right side, how-
ever, were observed to be adherent to the pleura costalis, ex-
hibiting the effects of inflammation of some very ancient date;
and the intercostal spaces were found to be remarkably wide,
owing no doubt to the efforts which nature would have made
to enlarge the cavity of the chest, in proportion to the incur-
sion made on it by the abdominal contents. The head was
not opened, owing to the time which the other parts occu-
pied in their examination.

A preparation, showing the diseased productions alluded
to, has been made and deposited in the Military Medical
Museum, established at Chatham, under the patronage of
Sir James M'Grigor.

REMARKS.

Cases, which very closely resemble the one just detailed,
may be found in the works of Morgagni and others. Baillie
also, in his Morbid Anatomy, speaks of scrophulous masses,
adhering to the peritoneum, and likewise of cancerous tu-
mours adhering to that membrane, but no author that I have
Tead has described this affection with so much accuracy,
both with regard to its nature and symptoms, as Dr. Baron,
of Gloucester. The symptoms and result of his dissections
related in the cases contained in his work on " Tuberculated
Accretions of serous Membranes/' so exactly coincide with

Dr. Blake on Tubercular Peritoneum. 491

the details of the present case, that I am induced to con-
sider the profession under considerable obligations to this
author, for having its attention so particularly directed to a
species of disease which evidently presents symptoms in a
remarkable degree peculiar to itself; and although we may
possess the melancholy assurance, that when the disease has
once attained a certain height, there is little or no hope of

C eventing a fatal issue, it is both useful and satisfactory to
( enabled to form a just prognosis in such cases, and by
early attention to the diagnostic symptoms to discover the
real nature of the disease at its origin, at which period alone
remedial treatment can be prescribed with any hope of suc-
cess. After this we must rest satisfied with the administra-
tion of palliatives, with a view to sooth the extreme suffer-
ings, which are but the tedious precursors of death.

The case detailed in the preceding pa^es appears to me to
have been of very long standing; and it is more than. pro-
bable that had not ambition laid hold of the subject of it, and
induced him, at his comparatively advanced age, to change
his habits suddenly from those of a paymaster's clerk to
the active life of a cavalry recruit, he might have been
alive still. The perpetual and violent jolting which riding
exercise must have caused, no doubt tended to render the
growth of the diseased parrs more rapid than it otherwise
would have been. This disease seems in its first stages to
be productive of but little inconvenience, for as long as the
parasitic tubercles, which are situated exterior to the viscera,
though behind the peritoneum, do not influence mechanically
the functions of chylification and digestion, their presence
occasions no uneasiness. As soon, however, as they begin
to impede these important functions, either by their bulk and
general attachment to the intestines, or by making partial
pressure on some of the viscera, a consequent train of symp-
toms is developed. The mere effect on the intestines of
being so surrounded and fixed by these tubercular masses,
as to have their peristaltic or vermicular motion impeded, is
quite sufficient to prevent them from having the power of
propelling their contents in a course, as I have said before,
which is oftentimes in direct opposition to the laws of gra-
vitation ; hence costiveness follows, and very soon after
sub-acute inflammation of their mucous linings may be ex-
pected as a natural consequence. Excrementitious matter is
not meant to sojourn beyond a given period within the sys-
tem ; after which its presence Decomes a source of irrita-
tion and subsequent inflammation, and ultimately of all the
symptoms met with in cases of this nature.

492 Original Communications.

I must here offer my support to the assertions of Dr,
Baron, that the sensation of weight and burning heat,
referrible to the stomach, or what he emphatically terms
the feeling of " broiling heat" in that part, may be regarded,
when taken in combination with other symptoms, such as
vomiting matter, resembling coffee grounds, &c &c. as a
pathognomic sign of this disease ; and its presence will aid
us materially in our diagnosis in these cases, which must
be extremely perplexing- to those who have not had expe-
rience on this subject, and more particularly so, if they
should happen not to have ' read Dr. Baron « book with
attention. I have not ventured to attempt an explanation
of the origin or peculiar nature of these- productions, which
in this case, when examined individually, resembled exactly
in structure the sub-cutaneous tubercle of Mr. Wood, already
alluded to. Dr. Baron considers them to have a hydatid
origin, and recommends a consequent plan of treatment,
for which I must refer to his Work on the subject.

With regard to his Methodus Medendi, however, I must
say that I perfectly coincide with him in the plan he recom-
mends. I also think his views of the cause of the disease
ingenious, and probably correct ; but I do not feel myself
capable of giving a positive opinion with regard to it.

It only remains for me to beg the indulgence of my rea-
der, for the perhaps unnecessary length of these details and
observations, which the severity and unrelenting nature of the
disease alluded to in them induced me to write.

Canterbury, 25th Oct. 1830.

Note by the Editor. — Dr. Blake need not make any apology for the
length of his interesting communication, or the scientific explana-
tion he has given of the symptoms of the disease. His account is
accurate, concise, yet comprehensive, and bears ample evidence of
the cautious and judicious practitioner. His long and great expe-
rience in the army, during a period of 26 years, and in opposite cli-
mates, and his original views on delirium tremens, prove nun to be a
man of a thinking mind, and of faithful observation. It affords us
much pleasure to notice contributions from army surgeons, which are
generally characterised by the most scientific and sound practical
views ; in fact, the clinical reports of our military surgeons are much
more graphic and scientific than those of civil practitioners ; and this
is easily accounted for, by reference to the excellent regulations of
Sir James M'Grigor and his colleagues at the head of the Army
Medical Department*

[ 493 ]

IV.— Mr. Myers on Neuralgia.

Miss G- set 30, of a sanguine temperament,, applied to me, labour-
ing under a violent neuralgia of the light side of the face, along the
course of the branches of tie fifth pair of nerves ; she had been under
the care of a physician, and had tried a great variety of remedies, but
without success ; for upwards of twelve months, prior to my seeing
her, she described the pain as a kind of electric shock or fluttering
sensation, her countenance was anxious, puke 100 and irregular,
slight pain in the epigastrium, furred tongue, bowels relaxed, menstru-
ation natural, no mfiammation or alteration of structure of the parts
affected, perspiration natural* By the urgent solicitation of the pa-
tient, who imagined that the pain originated in consequence of a
diseased tooth, I was induced to extract it; but finding no relief, 1 or-
dered her to take the following piBs,

IV Ext cinchon, gr. xxxvj. eulph. quinin. gr. xviij. miscse fiat,
mass, et divid. in pil x^j.< capiat »gra. ij. ter in die' habeat, pil
hydrarg. gr. iv. alter nocte sum.

When I called next day, she was much the same as before ; I de-
sired her to continue with the same pills, at the same time giving her
this anodyne draught §^— P.. ipecac, comp, gr. <x* tr. opii. m. xxx,
ay. 5ii, aquas Jii.

Passed a better night than before, having slept two hours, but still
there remained a great deal of constitutional excitement, pulse 96,
much weaker than before. I ordered her milk diet, allowing to take
a glass of white wine daily, desired her to continue her pills and ano-
dyne draught, and in addition ordered her to take an aperient draught,
with senna and salts, in the morning. She continued these means
for upwards of seven days, without any mitigation of pain or removal
of symptoms ; the bowels more regular than before. I then thought
of trying the carb. ferri. I immediately gave her the following pow-
ders and mixture, ordering her to discontinue her other medicines ;
§r pulv. cinam, gr. iij. pulv. oapsici, gr. £ carb. ferri. 9ij, the fiat
pulv. cujus sumatj; 6 quaque hora. 5^ tr. aurant 3iij> tr. hyos-
oam 5n\ tr. cinchon 5i» aquae 3ivssK tit cujus sumat, J part post
pulv. I called next day and found she had passed a pretty good
night, but in other respects no better ; she had three motions of
a very black colour, at which she appeared very alarmed, but after
having satisfied her on that point, I advised to continue the same me-
dicines omitting the p. capsici and cinam, and increasing the carb
ferri gr. x, sing dos, c mist ut antea.

She continued these means for three days, and then told me, that
she had a great pain and uneasiness about the anus, which 1 found
to be haemorrhoids ; she had found a relief from the neuralgic pain,
and wished to continue her medicines ; she could now masticate her
food without being put to that excruciating agony she before endured,
while exercising that process ; 1 then ordered her to apply a lotion to
the piles, composed of alum Jss, bruised, galls, $i, to be boiled in a

494 Original Communications.

pint of water, and strained when cold, to be used, and of Lac
sulph. in $i> of which she was to take a table spoonful, every night
and morning. She continued these remedies as well as the pulv. et
mist* for one week, when to my surprise she called upon me, it being
the first time she had been from home for upwards of three months,
and said that she was much better ; her pulse was 80, her tongue moist.
I said she had better continue the same remedies, and reduced the
dose to 80 grains of carb. ferri, and gave the following pills, imme-
diately ; ext coloc comp gr. vij, pil hydrarg gr. iij, p. capsici gr. m
in pil ij, st sumend ; these pills produced two or three copious, dark
coloured motions, and she felt relieved from the pain in the epigas-
trium* piles disappeared, and the racial neuralgia nearly well ; pulse
now was 80, complain of throbbing of temples, and nausea produced
by the carb. ferri; ordered to continue the same medicines for one
week, which she did, and was then all but well, when she complained
of palpitation of the heart, which might be seen and heard, quite dis-
tinctly. I gave her the following pill, which had the powerful ef-
fect of relieving her; — ^. ext. hyosciam gr. ij, pil hyd. gr. j, p. di-
gitalis, gr. £, conf 8, s, fiant Pil iij, h, s, sumendse.

She continued taking the carbonate in doses of 100 grains, four
times a day, for three weeks, when she expressed herself as being
perfectly cured, and has had no return, although three months since.

V. — Medico-legal questions, relating to Ambiguity of
Sex, and to Utero- gestation. By M. Ryan, M. D.

Ambiguity of Sex. — Hermaphrodites. — There may be
malformation of the genitals in both sexes, but there is no
example of one individual possessing the perfect organs of
both. Again, the organs may not resemble those of either
male or female. There is no truth in the statement, that
hermaphrodites have married and propagated, the obstetri-
cian is aware of the physical impossibility of a full grown
infant passiug through the male pelvis. It is evident that
hermaphrodites must be impotent and sterile. The ancients
were of opinion that such persons might propagate ; even a
canonist went so far as to maintain one individual could
propagate within himself or herself — " tanquam mas gene-
rare ex alio, et tanquam fcemina generare in se ipsa.1* There
is no case on record of a perfect hermaphrodite, and no
truth whatever in the assertion that such class of beings
can propagate the species. I can see no difficulty in sup-
posing that persons of both sexes, with malformation of the
genital organs may marry, when I recollect the curious and

Dr. Ryan on the Signs of Utero- gestation. 495

well attested fcase of a female who dressed in male attire,
and assumed the name of James Allen, married another
female, and lived as a husband for several years without
detection. This ease happened in London last year, and
was discovered when Allen died, and on dissection was
found to be a well formed female. Blackstone says, " a
monster having deformity in any part of its body, yet if it
hath human shape may inherit, and every heir is male or
female, or hermaphrodite ; that is, both male and female,
and shall be heir according to that kind of sex which doth
prevail, and accordingly it ought to be baptised. The same
is observed in cases concerning tenants by curtesy." As the
brain is generally perfect in monsters, and the mind perfect,
it is clear that such persons ought to inherit property.
When two perfect bodies are united at the chest or back,
as in the cases of the Siamese youths, lately exhibited in
this city, and the Hungarian sisters, exhibited in 1723, it
would be difficult to determine primogeniture, or right to

property.

Utero- gestation. — Pregnancy.

This is a subject which requires great attention from the
medical jurist, on account of the numerous relations it has
to civil and criminal proceedings. It affects the honor of
husband and wife — it arrests the administration of justice
when offered as a plea for reprieve — it aggravates an as-
sault when abortion occurs, which - renders the crime a
felony ; it may be pretended, and deception attempted on
the medical attendant, and others ; or the female may accuse
the person of causing abortion, it may be concealed, and it
may affect the honor and property of parents and children,
as m its protracted state, whicn involves legitimacy.

For the better understanding of this important subject,
it will be necessary to describe the signs of conception and
pregnancy, including spurious, extra-uterine, false, pre-
tended and concealed utero-gestation, superfoetation or se-
cond conception, abortion, natural and provoked, duration
of pregnancy, recent delivery, survivorship of parent or
offspring, viability of infant monsters ; and lastly, prolicide,
foeticide, infanticide. These and all other meaico-legal
questions relating to obstetricy, I have fully discussed in my
work on Midwifery, a plan adopted by foreign writers ; but as
yet neglected by the writers of this country. I shall notice
them as concisely as possible on the present occasion.

496 Original Communications.

Signs of ordinary pregnancy.-— The signs of pregnancy
may be divided into rational and sensible. The first result
from the influence of the uterus on the moral and physical
systems of the female, and these are disorders and derange-
ments of the organic functions or vital properties. The
second result from the developement of the uterus, and the
presence of the foetus in that organ.

Rationed signs. — It is a vulgar opinion professed by Hip-
pocrates and Galen, that a fecundating copulation is ac-
companied by more vivid enjoyment than an ordinary coition.
The following signs usually occur after conception :— there
is a change in the moral and intellectual faculties, in the
temperament and constitution of the female ; the eyes lose
their vivacity, their brilliancy, and become languid ; the
eyelids are surrounded by a blackish, livid or leaden colored
oirole; the nose is elongated, the mouth is smaller, the
countenapce is changed, the voice is stronger, the neck
fuller, transpiration more odorous, the character more de-
cided, and the passions more violent ; the menses are gene-
rally suppressed, the mammae are firmer, more sensible and
more developed, sometimes secreting a thin, whitish serous
fluid ; the nipple is more" prominent, the areola is enlarged
and of a browner colour. Immediately after conception,
the female experiences unaccustomed sadness, a tendency
to fainting or complete syncope, horripilations, colic, and
a vermicular motion in the uterus, which extends to the
abdomen, borborygmi, and rigors. There is sometimes
anaphrodisia, sometimes increased1 salacity. The pulse be-
comes more frequent, weaker, or fuller and softer, the
temperature is increased, the transpiration is more abun-
dant, the urine is more copious, turbid and cloudy, the
secretions are increased, there is often ptyalism, the hepatic
functions are disturbed, and there ' are spots and ephiledes
on the face and skin. The taste and digestion are depraved,
anorexia, n&usea, inappetence and vomiting supervene, the
female desires innutritious or disgusting foods, as chalk,
cinders, putrescent animal food, vegetables, fruits, acid
drinks, and vinegar, &c. This inappetence and depraved
taste, are followed in a few months by a keen, voracious
appetite, but towards the last month of pregnancy, the
digestive functions become deranged, as the stomach is so
confined by the gravid uterus, that it can contain but a
small quantity of aliment.

The moral state is subject to numerous changes, some
women, naturally gay arid amiable, become sad, melan-
choly, and unsociable, and vice versa. Many diseases ap«

Dr. ftyan on the Signs of Utero- gestation. 497

1>ear, others disappear, as hysteria, chlorosis, chorea, epi-
ipsy. The whole of these signs are seldom observed in
all cases, and are doubtful and uncertain. If all are present
they afford strong proof of pregnancy, but never that posi-
tive certainty whicn enables us to give decisive evidence
before magistrates.

Sensible signs. — These signs consist in augmentation of
the abdomen, in the active and passive movements of the
foetus, in the perception of the foetal and placental pulsa-
tions by means of auscultation, in the evidence afforded by
the touch or vaginal examination, or ballottement, as to the
state of the os and cervix uteri in the different stages of
gestation, and the developement of the uterus. The most
certain of these signs are the touch or ballottement, and
auscultation. The touch consists of the introduction of the
finger into the vagina, and the application of the other hind
above the pubis, the uterus will be felt enlarged, and if
gentle percussion be applied above the pubis, the foetus will
be made to strike the finger, which cannot happen unless
there be a foetus and a fluid in the uterus. However, the
sign is not always conclusive, for it has existed in extra-
uterine fcetation. The sign can only exist about the fifth
or sixth month, and has led to mistake even at the approach
of parturition. (Capuron Malad. des Pem. p. 72.) The re-
sults of auscultation exist, in some degree, when the foetus
is dead, and also in extra-uterine fcetation. The changes of
the neck and body of the womb enable us to distinguish
pregnancy from hydropsy, tympanites, hydrometra, hyda-
tids, moles, polypi, &c.

The spontaneous motions of the foetus take place about
the fifth month, but some women never perceive them dur-
ing the whole period of gestation, others imagine them pre-
sent, when there is no conception. Nervous and hysterical
women very frequently make the last mistake. The sponta-
neous motions of the foetus and quickening, are not infal-
lible proofs of pregnancy. Auscultation has been called
into action to enable us to decide this point. M. Le Ju-
meau de Kergaradec has applied the ear and the stetho-
scope to the abdomen, and discovered the double motion of
the foetal heart, and also the pulsation of the placenta,
which was synchronous with the maternal pulse. It is to
be recollected, that the first must change with the infant,
and consequently must be heard in different parts of the
abdomen, at different examinations. Dr. Kenedy, of the
Dublin Lying-in Hospital, has written in favour of auscul-
tation, in the Dublin Hospital Reports, vol. v. 1830.—

Vol. v. no 30. 3 n

498 Original Communications,

M. Velpeau has tried it in a great number of cases in vain.
Traite Elementaire des Accouch. 1829. Dr. Fergusson, of
Dublin, thinks it an unequivocal proof. Dub. Med. Trans.
vol.1, 1830. From the preceding considerations, thefol*
lowing conclusions may be drawn : —

1 . That the foetal and placental pulsations, when disco-
vered by auscultation, are positive proofs of pregnancy.

2. That in all cases before the fourth month, the diag-
nosis is extremely uncertain.

3. That during the five succeeding months, better evi-
dence is afforded by the progress of uterine develop-
ment.

4. That there is no infallible sign of pregnancy, except
that afforded by auscultation.

Previous to the application of auscultation, it was held
by the following authorities, that there was no infallible
sign of pregnancy in the early months :— Hamilton, Burns,
Mahon, Fodere, Capuron, Far re, Male, Beck, Smith ; Edin-
burgh Med. & Surg. Journ. J 823, vol. 19. Med. Chir.Rev.
1824. Med. & Phys. Journ. 1825. For exact references,
see my work on Midwifery.

Dr. Beck concludes, that it is impossible to decide on
pregnancy before the sixth month, but this opinion is refuted
by subsequent experience. We may derive advantage from
attending to the signs of the different epochs of pregnancy,
which are afforded by the developement of the uterus.
During the two first months the diagnosis is extremely
obscure, and cannot be attempted with any degree of cer-
tainty. At the end of the third month, the fundus uteri is
developed, directed towards the sacral concavity, round,
gaping, and thickened ; the limbs of the foetus may be often
felt through the abdomen. At the end of the ninth month,
the uterus becomes depressed under the epigastrium, the
orifice of the uterus is more easily felt, rounded and often
open, the head of the infant can be readily felt. In women
who have had former pregnancies, the uterus does not
ascend so high as in first cases, as the abdominal muscles
have been relaxed, and it therefore inclines more forward.
In diagnosticating, in cases of doubtful pregnancy, we
should not forget to bear in mind the appearance of the
abdomen in ovarian dropsy, and here a careful history of
the symptoms will enable us to arrive at a correct conclu-
sion. I have frequently known young women affected with
let the hand be immersed in cold water, and suddenly ap-
plied to the abdomen of the female ; and in cold weather,
let the hand be immersed in warm water and applied, when

Dr. Ryan on the Signs of Utero- gestation. 499

the motion of the infant will be distinctly felt. I have often
acted on these suggestions with success. It is also to be
remarked, that the cervix uteri begins to diminish in length
at this period, as well delineated by Gooch and Meygrier.
At the end of the seventh month, the uterus approaches the
inferior margin of the epigastric region. The abdomen
affords a dull fluctuation, which differs from that of ascites ;
percussion affords a dull sound, which is distinguishable
from tympanites or meteorism. At the end of the eighth
month, the uterus is in the epigastrium, the cervix nearly
od a level with the superior margin of the pubis ; at the end
of the fourth month, the uterus is in the hypogastrium, the
spontaneous motions of the foetus are perceived by the
mother, and the diagnostic styled ballottement, is afforded
to the obstetrician. At the end of the fifth month, the
uterus touches the inferior boundary of the umbilical re-
gion, and the cervix uteri is elevated in the vagina. At the
end of the sixth month, the uterus is felt at the umbilicus,
and as this part projects, the motion of the foetus may be
felt by the practitioner. We can now avail ourselves of
auscultation. Morgagni proposed the following plan for
discovering the motions of the foetus. In warm weather,
this disease, to have all the appearances of pregnancy ;
the general health suffers little, and sometimes not at all ;
the catamenia are regular — the usual symptoms of preg-
nancy are absent, and upon close inquiry, it will be found
that pain commenced in the ovary, and the tumour was first
in one side. In this, as in all other cases, a knowledge of
disease will alone enable us to diagnosticate correctly. This
knowledge is to be obtained by reference to the best sys-
tems of obstetricy, and by actual experience. It would
far exceed the limits by wnich I am circumscribed, were I
to describe the various diseases which may be mistaken for
pregnancy. I mu6t refer the reader to the standard works
upon this subject. After a luminous description of the
diagnosis in the case before us, and all its difficulties,
M. Velpeau concludes, " but it is dangerous to forget that
there exist causes without number (of deception), and that
before the tribunals one ought never to give a decisive judg-
ment, without having previously acquired a mathematical
certitude of the fact upon which he pronounces/' This is
the received opinion of the present time.

Dr. J. C. Fergusson has published five cases of concealed
pregnancy in the Dub. Med. Trans. 1830, in all of which
he was enabled to discover the pulsations of the foetal heart
and bruit of the placenta. He says, " I conceive it to be

500 Origiuat Communications.

sufficiently established, that either a placenta or foetal heart
being heard, constitutes infallible evidence of pregnancy ;
evidence upon which a medical man may, if required, con-
scientiously and positively swear to the fact, which I believe
all admit, and our legal records show, could not be done
under ordinary circumstances. * * * * The absence of
these phenomena amounts, if not to positive, at least to
presumptive proof of the contrary.'* I cannot agree with
these conclusions, because many practitioners may not be
sufficiently dexterous with the stethoscope to detect; the pul-
sations ; and as further evidence is required to warrant the
latter conclusion. It is very manifest, however, that aus-
cultation ought to be employed in doubtful cases of utero-
gestation.

In cases of extra-uterine fetation, should the Caesareau
operation, or rather gastro-hysterotomy be performed, the
infant cannot inherit property according to the laws of this
country. (Blackstone.) This is the only medico-legal point
connected with the subject. A point of much importance
to be decided is, whether twins be the result of one coition,
or of super fetation. The decision will affect primogeni-
ture. The question has not been discussed by any British
writer on forensic medicine except myself.

Svperfcetation. — Physiologists are at issue upon the ques-
tion of superfcetation, or that it is possible for a pregnant
woman to conceive a second time. According to Aristotle, a
female was delivered of twelve infants, and another of twins,
one of which resembled her husband, the other her lover.
Some writers maintain that superfcetation is possible during
the two first months of preg.ancy ; the majority hold it
possible during the first few days after conception, before
the uterine tubes are closed by the decidua. This is the
received opinion, though cases are on record which justified
Zacchias and other jurists, to conclude that superfcetation
might occur until the sixtieth day, or even later. Nothing is
more common than to see a full grown infant born, and
another of the second, third, fourth, fifth, or sixth month
expelled immediately after. I need not cite authorities upon
this point, as obstetric works abound with examples. But a
few examples may be given. Dr. Maton published an ac-
count of a woman who was delivered of a full grown infant,
and in three calendar months afterwards of another, appa-
rently at the full time. Trans. Coll. Phys. vol. iv. A woman
was delivered at Strasburg, the 30th of April, 1748, at teu
o'clock in the morning ; in a month afterwards M. Leriche
discovered a second fetus, and on the 16th of September*

Dr. Ryan on Superfoetation. 501

at five o'clock in the morning, the woman was delivered of
a healthy full grown infant. Manuel Complet de Med. Leg.
par Briand. Degranges, of Lyons, attests a case, the woman
was delivered at the full time the 20th Jan. 1780 ; in three
weeks afterwards she felt the motions of an infant, and her
husband had no intercouse with her for twenty- four days
after delivery. On the 6th of July, (five months and six-
teen days subsequent to delivery) she brought forward a
secoud daughter, perfect and healthy. On the 19th Jan.
1781, she presented herself, and both infants, before the
notaries at Lyons to authenticate the fact. Fodere, vol. 1 .
These cases prove the posssibility of superfoetation, four,
five, and six months after conception. . This may be pos-
sible, as menstruation has occurred during pregnancy, (Mau-
riceau, Deventer, Heberden, Francis, Hossack, Dewees,
Capuron, Mayo.) Buffon related a case of a woman in
South Carolina, who brought forth a white and a black
infant, and on inquiry, it was discovered that a negro had
entered her apartment after the departure of her husband,
and threatened to murder her unless she complied with his
wishes* Dr. Mosely relates a similar case. A negress, of
Guadeloupe, brought forth a black and mulatto, having had
intercourse with a white and black man the same night.
Another negress produced a white, black, and a piebald
infapt. A domestic of Count Montgomery produced a white
and black child at one birth, (Velpeau.) Gardien relates
a similar case on the authority of M. Valentin. A mare has

troduced a foal and a mule, she having been impregnated
y a horse, and in five days afterwards by an ass. In
treating of this subject, in my work on Obstetrics, 1828,
1 made the following remarks : —

" Another argument, which I have never seen, occurs to
me from analogy, which deserves mention ; namely, that
each dog will produce a distinct puppy — this no one can
deny ; for the offspring will resemble the different males
that fecundate the bitch in succession. If a number of
healthy vigorous men were to have intercourse in succes-
sion, immediately after the first conception, I think impro-
bable and possible, that similar superfoetation would hap-
pen. I am proud to say, that Dr. Elliotson is an advocate
of superfoetation. He explains Buffon's case this way.
Magendie is of the same opinion. Medical men must
bear in mind, that women have had three, four, and five
children at one birth. Various cases of infants of different
sizes being expelled in succession, are recorded in our own
periodicals. Medical and Physical Journal, v. 22, p. 47. —

502 Original Communication*.

v, 24, p. 232. Medico-Chirurgical Transactions, v. 9. Phi-
losophical Transactions, v. 60.

u One of the Pennsylvania newspapers in 1827, recorded
the ease of an Irish lady, who in eighteen months had at
three births twelve living1 children, all born prematurely.
She and her husband were healthy fresh looking people,
and only two years married. This case is not recorded as
yet, in any of the American Medical Journals ; but if it
prove to be authentic, it will be the most extraordinary case
of fecundity recorded in any country. Cases of twins, tri-
plets, quadruple and quintuble births, are of very rare oc-
currence ; but of these more particularly hereafter.0 Dr.
Golding, of this city, delivered a woman of six infants
during the year 1829.

• I am happy to add, that Professor Velpeau, of Paris, is
of the same opinion. He says, " In according all pos-
sible authenticity to these observations regarding their ex*
actitude as demonstrated, the idea which prevails in phy-
siology on generation, permits an easy explanation. Two
ovules can be fecundated one after the other, in a woman
who accords her favours to two or more men, the same day,
or in two or three days afterwards, that is to say, to the
moment when the excitation of the first coition causes the
effusion of coaguable lymph into the uterus, to form the
caducous membrane (decidua.) These ovules may not
descend through the uterine tube at the same time, and
may be differently developed. But he thinks superfoetation
impossible after the decidua is formed, op. cit. The closure
of the os uteri after conception, does not take place for
some days, weeks, or months (Dewees), but if the male
semen be absorbed from the vaginal surface, and conveyed
directly to the ovary, as in the elephant, cow, sow, (Gert-
ner) such closure is no objection. Twins have generally
but one amnois and placenta, but in cases of superfoetation,
each infant has its own membranes and placenta. 1 once
attended a female who was delivered of one infant on
Monday, the parturient action ceased, and on the following
Thursday, the membranes presented, and she was delivered
of a second infant. There was no haemorrhage, and the
placentae were united. My friend, Mr. Whitmore, sent me
a similar union of the placentas a short time ago. Whether
we suppose superfoetation or twins, the medical practitioner
ought to notice which was born first, male or female, when
the disposal of property or title depends upon the decision.
The question is, which was born first, not which was con*
ceived first. Admitting superfoetation to be possible, and

Dr. Ryan on the Duration of Pregnancy. 508

it caDDot be denied in the early weeks of gestation, we
cannot decide paternity, unless perhaps, when one infant
is black or brown, and the other white ; but if both males
were of the same colour, the decision might be difficult*
unless some physical mark on the infant existed in one of
them. The following conclusions are admitted in cases of
pregnancy. It is now decided that a female may become
pregnant, and be ignorant of it until the time of labour*
(Foderi, and Sanders of Edinburgh). This may occur in
cases of idiots (Desgranges), when the female is in a state of
stupor, either from inebriation, narcotics, coma, syncope,
or during sleep. Foder6, Orfila, Beck, Hebenstreit, and
author's work on Midwifery.

Duration of Pregnancy. — Legitimacy.— Hippocrates,
Aristotle, Galen, Pliny, Avicenna, Mauriceau, Kiolan, La
Motte, Hoffman, Schenk, Haller, Benin, Lieutaud, Petit,
Levret, Louis, Astruc, &c., maintained that pregnancy
usually terminates at the end of the ninth calendar month,
but might be protracted to the tenth, eleventh, twelfth, and
some of them said to the fifteenth.

It is also decided by a preppnderating majority of the
profession, in all countries, that the term of utero-gestation
is not uniform ; in other words, not invariably limited to
nine months. This position is strongly attested by the
analogy afforded by the inferior animals, for it appears by
the extensive observations of M. Teissier, on the gestation
of heifers, mares, sheep, swine, and rabbits, that all these
animals exceed their usual periods of delivery. Trans.4 de
I'Acad des Sc. Paris, 1817. Further evidence is afforded
by the vegetable kingdom, in which we observe in the satire
field, on the same tree, shrub, &c. different parts of vege-
tables arrive at maturity with more or less celerity. Petit
informs us that many faculties of medicine, forty-seven
celebrated authors, and twenty-three physicians and sur-
geons, concluded pregnancy might be protracted to the
eleventh or twelfth month. He cites a case on the autho-
rity of Schlegel, in which pregnancy was protracted to the
thirteenth month ; the child was admitted to be legitimate,
on account of the probity and virtue of the mother, which
induced her shopman to marry her, and she bore two chil-
dren by him, each at thirteen'months. Tracy, a naval phy-
sician, relates a case at the fourteenth month. Dulignac, a
Freuch surgeon, positively asserts that his own. wife quick-
ened at four months and a-half, apd on two occasions she
went to the thirteenth month and a-half, and on the third,
to the eleventh month. Desormeaux relates a case of a

,504 Original Communications.

mother who had three children, who was maniacal, and
whose physician, after all means had failed, recommended
pregnancy. Her husband had intercourse with her once in
three months, of which he kept an exact account. She was
closely watched by her domestics, and she was extremely
religious and moral ; she was delivered at nine months and
a-half (Velpeau.) The last author attests a case which
went to 310 days.

The medical evidence in the Gardner Peerage cause,
tried before the House of Lords, in 1825 and 1826, throws
much light upon the subject. It is right, 'however, to ob-
serve, that witnesses spoke from their personal experience,
lost all sight of physiological science, and of the numerous
opinions of ancient and modern writers, that " one and all
have shewn an extraordinary ignorance on the principles of
evidence, will be conceded by every one who examines
carefully their testimony. But it may also be doubted whe-
ther the question admits of better evidence than has been
already proved, or at least arrived at, by them and their
professional predecessors." (Dr. Duncan, Edin. Med. and
Surg. Journ. 1827, v. xxvii.)

1 have condensed this evidence in my work, so often re-
ferred to, as follows : —

" The majority of the medical men, examined in the
Gardner Peerage cause, were in favour of protracted preg-
nancy, as Drs. Granville, Conquest, Blundell, Hopkins.
Hamilton, of Edinburgh, and Power. Dr. Granville proved
that his own wife went to three hundred and six days,
even admitting pregnancy to have occurred the day before
the interruption of menstruation ; and there hundred and
eighteen days, if from the middle of two of the last and
expected periods. Dr. A. T. Thomson, who attended her,
was of the same opinion, that the child was ten months old
at birth. Dr. Granville knew other cases of two hundred
and eighty-five, two hundred and ninety, and three hundred;
and one doubtful at three hundred and fifteen days. Dr.
Conquest knew two or' three cases at the tenth month.

His patient was a most sensible woman, who bad been the
mother of six children, and had engaged him and the nurse
to attend her at a certain time ; went five weeks after, and
four. with the next. She had other children afterwards, at
the ninth month. Dr. Merriman knew cases, at 280, 285,
303 and 309 days, and thought the Gardner case possible ;
Drs. Blundell and Hopkins, 285 ; Dr. Power, eleven months;
Dr. Hamilton, ten calendar months; and Dr. Collins, of
Liverpool, published a case of eleven months soon after*

Dr. Ryan on the Duration of Pregnancy. 505

wards, which occurred two years before. Edin. Med. Journ.
April, 1826, v. 25. This is most worthy of perusal. I
know a delicate woman, who menstruated the last week in
February, 1826, quickened in July, and engaged me to
attend on her in November. She had spurious pains in No-
vember, December, and January, 1827, and was delivered
on the 28th of February, 1827 ; nearly twelve months from
her previous indisposition. I had most serious business
from home in November, but by her entreaties deferred my
journey in that, and even the next month, and of course I
then daily expected her delivery ; yet she went two months
later. The infant was a girl and of the ordinary size, and she
and all her friends thought she would be undelivered from her
protracted pregnancy ; yet her labour was only of two hours
continuance and perfectly natural. I shall ever have cause
to remember this case, as I nearly lost some property by
deferring my journey to attend upon it. It was a first preg-
nancy. I most solemnly declare, that the case was a true
one, and not fabricated to support any particular opinion.
This is the longest instance of protracted pregnancy, which
has hitherto been recorded in British medicine. Another
argument in favour of generation is, that children often grow
more in one year than in seven years before, which would
prove the developement may not be the same in the womb.
The following accoucheurs were produced against the doc-
trine of protracted pregnancy, on the Gardner Peerage
cause. Dr. Charles Clarke, who m twenty cases, never
knew one exceed the term of nine months. His evidence
does not controvert the opposite side of the question. Dr.
Blegborough had practised extensively for thirty-four years,
and never knew pregnancy exceed the ninth month. Mr.
Pennington contended for forty weeks and three or four
days ; and Drs. D. Davis and Gooch were of the same
opinion. It is a strange but positive fact, that these gentle-
men who came forward to prove pregnancy to be immutable
and definite at a certain period, all admitted it might ex-
ceed nine months, by four or six days ; hence the justice of
Dr. Duncan's critical sneer at their evidence. In the case
under consideration, the claimant Jadis, otherwise Gardner,
was born eleven months after his father went abroad, and
his mother had cohabited with Jadis, the father, soon after
Lord Gardner had been absent. On his Lordship's return,
he obtained a divorce against her, and married again ; and
the offspring of the second marriage, on claiming his father's
title, was opposed by Jadis, who, at the adult age, took

Vol. v. no. 30. 3 o

506 Original Comrnunicdjion**

the name of Gardner ; and under these circumstances, and
contrary to the medical evidence of the majority of the
obstetricians, the House of Lords decided against him.
The evidence in favour of the legitimacy of Jadis was
founded on too few cases, to warrant a perfect confidence
in it, or to settle the question of protracted pregnancy.
The Edinburgh Medical Jurist justly concludes, by stating
that there was not a single new fact advanced by the me-
dical men, in elucidation of the subject at issue ; and the
reviewer smiles and " wonders at the want of knowledge of
the witnesses who appeared to be unacquainted with the
nature of legal evidence ; and neither their evidence, nor
that of the other side, was sufficiently accurate, in not being
deduced from physiological science ; which, however, in
the present state of medical knowledge on the question,
could not perhaps be more accurate. On the whole, the
weight of the testimony was in favour of the advocates of
protracted pregnancy ; but the mother having cohabited
with another, proved her incontinence ; which fact influenced
the House of Lords against the legitimacy. After all, the
-subject remains as obscure as before, and will require much
more scientific medical evidence to decide it one way or
the other."

Dr. Dewees relates a case of a lady, whose husband was
absent on account of, embarrasment of his affairs. He re-
turned one night clandestinely, had intercourse with his wife,
whose menstrual period was expected within a week and
occurred, yet she was delivered in nine months and thirteen
days from the coition. Work, 1825. The question of pro-
tracted gestation, and more especially the Gardner Peerage
case, was discussed at the Westminster Medical Society, in
Dec. 1829, when Dr. Granville adduced the following au-
thors in favour of the affirmative side of the question:—
Among the ancients, Hostius (Horstius), Sylvius, Harvey,
Mauriceau, Levret, Lieutaud, Heister, Delignac, La Clo-
ture, Benedictus, Petit, Smellie, and W. Hunter. Among
the moderns, are Osiander, Fodere, Schoreider, Lentos-
seit, Spregnel, Adelon, Bardt. Capuron, Orfila, Burns,
Desormeaux, Dewees, Hamilton, of Edinburgh, and Mer-
riman. I have already mentioned many others. On the
occasion in question, Mr. Chinnock related a case of a
female who menstruated Oct. 14, and had intercourse with
her husband on the 29th. She was delivered on the 20th of
February, a space of two hundred and ninety eight days
tfter the connexion, but labour commenced three days pre*
viously. I mentioned the cases narrated in the extract from

Dr. Ryan on the Duration of Pregnancy. 507

my work inserted above ; and Dr. Ley and Mr. North took
the same side of the question. The whole of the society
were of the same opinion, with one or two exceptions.
Lond. Med. & Surg. Jour. 1830, v. iv. Med. Oaz. 1830,
vol. v. There is no doubt but the weight of medical autho-
rity, in ancient and modern times, are in favour of pro-
tracted pregnancy ; but in the present state of science it is
impossible to assign the exact limit. The law of this country
assigns no limit to utero-gestation ; the law of France
limits it to three hundred days or ten months, and allows
legitimacy to be contested after this period. (Velpeau.)

Abortion.

In judicial investigations relative to abortion, medical jurists
are required to decide the following questions: — 1. Has
there been abortion produced ? 2. Is abortion natural or
provoked ? 3. Has the foetus quickened ?

Signs of abortion. — To determine whether abortion* has
taken place, we must always examine the product of abor-
tion, and also the female who is said to have aborted. If
we do not see the substance expelled, we cannot give a
satisfactory, much less a decisive opinion.

Examination of the embryo or foetus. — During the two
first months of utero-gestation, we must be extremely cau-
tious and take care not to confound the foetus with a mole
or false conception, or with a sanguineous concretion or false
mole. At this period, the embryo is enveloped in a capsule
formed by two membranes (the chorion and the amnois),
united to a spongy mass (the placenta), more voluminous
than itself. The first of these membranes is torn, and
allows the second to escape in the form of a membraneous
sac, to which is attached a clot of blood. On opening this
sac, a quantity of fluid escapes, and the embryo will be
found in an organized condition. It is a gross mistake in
many works on obstetrics, in which it is stated, that the
foetus cannot be recognized at this period. I have a pre-
paration which shews it perfectly formed at two months and
a half. There is also an illustration of the embryo at the
forty-fifth day, in an organized form, in the excellent plates
of Meygrier. We seldom see the substance expelled in early
abortions, as it is generally destroyed by the female attend-
ants ; and every obstetrician must have been embarrassed
by this circumstance, and must have seen cases of supposed
abortion, in which the expelled substance was a clot of

508 Ortginal Communications.

blood. Hence the necessity of washing such substance,
when any doubt exists, in order to determine whether the
substance be blood, a mole, or a real conception. We should
also remember the frequency of catamenial obstruction for
two or three months, and how often women suppose them-
selves pregnant when they are not so. In such cases the
want of coagulation in the menstrual fluid, proves it not to
be blood. In the cases before us it is absolutely necessary
to know the appearances of the foetus at the different
periods of gestation. The embryo is visible at the fifteenth
day (Meckel) , and the ovum is six or eight lines in diameter.
It is piriform, elongated, curved, round, enlarged at one
extremity, which is the head, and attached to the membrane
at the other extremity, having a white cord, which is the spi-
nal marrow. (Velpeau.) Towards the end of the first month,
the extremities begin to appear in the form of round tuber-
cles, and the umbilical cordis sren attached to the intestine;
the liver is large and fills the aodomen. In the course of the
second month, the head is equal in size to nearly half the body ;
the eyes are seen as two black spots ; the nose, nostrils, and
the ears are apparent ; the arms and legs begin to appear ;
the toes and fingers are distinctly observable ; there are
many points of ossification in the frontal and maxillary bones,
the clavicles, ribs, and os ilium. The rest of the osseus
system is in a state of cartilage. The penis and clitoris
)roject, and the sex may be determined. The embryo is
ittfe less than two inches long, and weighs nearly an ounce.
At three months, the foetus is about four inches long, and
weighs nearly three ounces. It is impossible to mistake it
at this period, and therefore it is unnecessary to describe its
developement any farther.

The law of this empire is extremely defective on abortion,
for it abounds with the greatest absurdities. Its intention is
humane and excellent, but it is based upon erroneous phy-
siological principles. It enacts, for instance, that the em-
bryo ft not animated until after quickening, that is, until
half the period of utero-gestation has elapsed, though the
foetus is alive from the very moment of conception. I have
described its developement before the period of quickening,
which I need scarcely observe, could not happen if it were
inanimate.

Again, a jury of matrons is to decide whether a woman be
pregnant or has quickened, questions which the whole faculty
of physic, in every part of the world, could not determine
in trie early months of pregnancy. It would be as wise to
~;ut a jury 0f infants to determine these questions. The

Dr. Ryan on Abortion. 509

law also enacts it felony to procure abortion before quick-
ening, and subjects the person who does so by any means,
or even advises it, to transportation for seven or fourteen
years ; and to death, if after quickening. Every man must
applaud this philanthropic legislation ; but it places the me-
dical practitioner in a most dangerous predicament. Thus
in thousands of acute diseases, where life is in the greatest
danger, treatment must be employed which may produce
abortion ; and is the practitioner to allow his patient to die
without the benefit which his art affords ? In some cases
of uterine haemorrhage, the life of the female can only be
saved by extraction of the infant. Yet this is producing
abortion in the eye of the law. Again, if the woman is
so deformed, that a full grown infant cannot be born at the
full time, that is, at the termination of the ordinary period
of utero-gestation, without a fatal operation, is the medical
man to allow the female to be placed in this predicament
when he can save her life, and that of her infant, by indu-
cing premature delivery ? If the infant arrive at the full
term of utero-gestation, it must be destroyed by nature or
by art ; and by the latter to save the life of the mother.
As the statutes now stand this is felony; but a talented
legal writer observes, " it may be presumed the operator
in such cases only commits justifiable homicide, and not
the crime of abortion." (Cabinet Lawyer.) Surely the ope-
rator can be influenced by no clandestine or sinister motive,
in endeavouring to save the lives of the parent and offspring.
But to resume the medical part of the subject. We should
examine the woman, to ascertain whether abortion has
really happened. It is impossible to determine this point
during the first two months of pregnancy, as the foetus is
too small to leave any trace of its passage. When it occurs
in the last months of gestation, the usual signs of delivery
will be present, which will be described hereafter. The
expulsion of moles, hydatids, or other morbid growths,
should not be lost sight of, and should be carefully ex-
amined. The phenomena presented by the abdomen and
external genitals, can only be valuable in proof of abortion,
when conjoined with the following circumstances :— 1. When
there is a certainty of pregnancy, and a comparison made
hetweeu the developement of the foetus and the period of
gestation. 2. When the pregnancy is so far advanced that the
changes in the os and cervix uteri are appreciable. 3. When
examination is made, immediately after the abortion has
taken place.

5W Original Communication*.

The practitioner shook! bear ia mind the immense number
of causes which produce abortion; and therefore ought to
be extremely cautious in making a judiciary report in such
cases. Many ef these causes are peculiar to the woman, as
excessive sensibility, and too great contractility of the neck
of the uterus, rigidity of the fibres of the body of the
organ ; or laxity or flacoidity of its neck ; habitual delicacy
of health, menorrhagic disposition, or debility of constitu-
tion ; all acute, and a great number of chronic diseases,
fevers* continued and intermittent, inflammations of the
various organs, peritonitis, gastritis, enteritis, cystitis, hysteri-
tis, rheumatism, pleuritis* variola, scarlatina, haemorrhoids,
convulsions, pertussis, chronic catarrh, colic, cholera,
diarrhoea, dysentery, constipation, gonorrhoea, leueorrhcea,
tcirrbus,* cancer, retroversion, polypi,t dropsy, and va*
rious diseases of the uterus, hydramntos, hysteria, moles
with the foBtus,J &c. The diagnosis of these diseases
is easily established. When abortion depends on rigi-
dity of the fibres of the uterus, it recurs at later periods in
successive pregnancies, as the uterus gradually expands ; but
when abortion is caused by laxity of the neck of the organ,
the laxity increases in each pregnancy, and the abortion
happens^ earlier. Among the ordinary or hygienic causes,
may be enumerated violent mental emotions, the impression
of strong odours, the fright caused by thunder, noise of
artillery, sight of extraordinary and. frightful objects,
errors m diet, stimulating food and drink, abuse of spiri-
tiioos liquors, too much exercise, as walking, riding, danc-
ing, running, the agitation of carriages or other vehicles,
accidental falls, or blows on the abdomen, wounds, tight
clothing, immoderate laughter, abuse of venery, surgical
operations of any kind, even the extraction of a tooth, &c
Sometimes* abortion depends on the death of the foetus,
fromd ebility, ill cured syphilis, monstrous conformation, dis-
eases of the plsucenta, scirrhus, calculus, hydatis, its im-
Cintation over the neck of the uterus, &c. Again, we
ow that a peculiar constitution of the atmosphere will
produce abortion, as an epidemic. (Hippocrates, Fodere.)
All powerful medicines, as emetics, purgatives, mercury, Ac.
may cause the premature expulsion of the foetus. Venesec-
tion has been employed to produce abortion, but it seldom
or never succeeds. A woman has been bled forty, and

* Bonetus. f Levret. J Morgagni.

Dr. Ryan on Abortion. 511

another ninety times, and yet arrived at the full period.
(Mauriceau.) This remedy is successfully employed to pare-
vent miscarriage, and haa been repeated «mS tvufin
a case with success. Emetics ana purgatives soften fail to

Koduce the desired effect, and the latter often destroys the
male by inducing abdominal inflammations. Emmena-
gogues also fail in most cases. Various herbs are employed
by the vulgar, mentha pulegium, sabina, secale cornufcum,
artemisia rubra, &c. and unfortunately with effect. , But
we must conclude that there is no medicine or abortive
means, which always produce abortion, and nothing but
abortion ; there is none which does not endanger the lives
of the mother and infant. Irritation of the cervix utem by
mechanical means, and piercing the (membranes, justify toe
truth of the remark, " Soepe, *uos utero qum necat, ipsa
ferity " Every woman who attempts to promote abortion,
does it at the hazard of her life."- (Hartley. ) There is no
drug which will produce miscarriage in women who are not
predisposed to it, without acting violently on their system,
and probably endangering their lives." (Male.) "It has fre-
quently'occurred," says Dr. G. Smith, " that the unhappy
mother has herself been the sacrifice, while the object in-
tended has not been accomplished."

When called on in 'courts of justice, to report on an
abortion, supposed to be provoked or criminal, we should
duly consider the causes already enumerated, the circum-
stances which preceded it, whether the female has denied
her pregnancy, procured abortives, used drastic medicines,
applied to various practitioners without acknowledging 'her
real condition, and a variety of other inquiries, which will
suggest themselves to every well informed practitioner, be-
fore we can decide that she premeditated the <crime. If the
woman had died, we should examine the uterus to discover
wounds, and also the abdominal viscera, as it often happens
death is produced by enteritis or peritonitis, though 'the
uterus may have been punctured a few hours before death.
This was the fact in a case tried at the Old Bailey, during
the last year; the medical witness for the prosecution
ascribed the cause of death to the punctures, which were
not inflamed ; but the witnesses for the prisoner to enteritis.
According to the law of this country, the exhibition of any
medicine, for the purpose of causing abortion, renders tbe
accused liable to a prosecution for felony ; and therefore
those young* men who vend medicines, ought never to commit
themselves l>y vending the most harmless medicine to appli-
cants in the case undier notice.* Should the female acknow-

512 Original Communications.

ledge that a certain apothecary sold, her medicine for the
purpose, he could have no witness to disprove her allega-
tions, and consequently must incur the greatest danger to
his liberty or life. Too many young men forget that the
crane of abortion is the destruction of a human being;
and hence they incautiously supply medicines, in general
harmless ones, without the slightest recollection of the
perilous situation in which they place themselves. I trust
that this caution may be useful to my junior readers.

Medical jurists designate criminal abortion, foeticide,
that is, destruction of the foetus in utero ; and apply the
term infanticide to the destruction of the new born infant.
Both terms are included in the word prolicide. Before we
consider this part of our subject, it is necessary to describe
the phenomena of parturition, and the viability of the
infant.

Of Delivery,,

The medico-legal questions relative to delivery are, 1. Do
signs exist by which , we can determine that a woman has
been recently delivered? 2. At what period afterwards
can wefind traces of delivery ? 3. Can a woman be delivered
unconsciously ? 4. When the mother and infant are found
dead, which was the survivor?

Signs of recent delivery.— The signs of recent delivery
are observable in the sexual organs, uterus, abdomen, the
lochial discharge, state of the breasts, and secretion of milk.
In the first days after delivery, the labia majora et minora
are dilated, red, tumified, and often inflamed, the vulva is
open, the fourchette . is partially or completely torn, the
orifice of the womb is so dilated as to admit the introduc-
tion of one or two fingers into the cavity of the organ;
the posterior lip is elongated and thickened ; both lips are
much thicker than during pregnancy. The womb itself is more
voluminous, can be felt above the pubis, or may be felt
enlarged by placing oi.e hand on the hypogastrium, and a
finger in the vagina. The size and flaccidity of the abdo-
men, its wrinkled condition, the lochia and milk, are signs
of recent delivery ; but all may be present after the expul-
sion of a mole or other morbid growth in the uterus.
The lochial discharge has a peculiar odour, and when pre-
sent is a good sign, but it is liable to be suppressed from
a variety of causes, and is entirely absent in some natural
cases. Any one of these signs is not conclusive, and does
not prove recent delivery, but taken collectively, and above

Dr. Ryan on Delivery. 513

all, if we can learn the history of the pregnancy or anterior
condition of the woman, we may arrive at a correct conclu-
sion. We can only arrive at a proper conclusion during the
first six or eight days, for at the end of ten or fifteen days,
it is impossible to decide the reality of delivery. It is now
decided that a woman may be delivered without her know-
ledge if completely intoxicated, if stupified by narcotics,
a ease which I have recently witnessed, if attacked with
apoplexy, syncope, delirium or idiocy ; and this fact ought
never to be forgotten when we are called on to decide ques-
tions of infanticide. Another question of great interest is
to determine the survivorship of the mother or infant, when
both are lost in parturition, for in some cases, if the infant
survives the mothers the father inherits the property he had
by his wife, and if the mother, the property passes to her
own family. This is the law of tenant by courtesy. It is
impossible to decide this question unless some person has
been present at the delivery. It was decided by the Court
of Exchequer, in 1806, that the motion of the lips of the
infant proved its vitality. (Smith.) It is now universally
known to judiciary physiologists, that a still born infant may
be resuscitated an hour after birth, and one case is recorded,
in which the infant was pronounced dead, and placed in a
corner of the apartment, and at the next visit, which was at
the end of twenty-four hours, it was found alive.

It is almost unnecessary to allude to the substitution of a
dead child for a living, as such cases are of rare occurrence:
Women have shewn dead children, to appease the
wrath of their husbands, who accused them of sterility.
Male's Forensic Med. p. 211. Capuron, p. 110. Beck,
. 99. A woman has substituted a living for a dead child,
or an account of the appearances of the womb after death,
during the first month, the reader should consult Burns,
p. 326. The law only requires, that the medical witness
shall prove whether the signs of conception were present or
not. An infant must be found, in order to bring the charge
of infanticide. A woman may be delivered unconsciously,
if labouring under coma, or the effects of narcotics. Fodere,
vol. 2, p. 10 ; and a woman, who died before delivery, was
placed on the bier for interment, when the child was born,
op. cit. 11. These are exceptions to the general rule, namely,
that healthy women must be conscious of labour. Dunlop
records an extraordinary instance of a lady having a child,
though she and her husband did not think she was pregnant.
Edition of Beck, p. 107. Again, a woman without assist-

vol. v. no. 30. 3 P

514 Original Communications.

•»

ance, may have her child so suddenly on the floor, in the
street, or water closet, as not to be able to prevent its
death.

Circumstantial evidence on the incidents of time and
place, of situation and character, most generally guides the
decision.

With regard to the death of the child before or after
delivery, it is a question that may be agitated in civil and
criminal cases ; as when the succession to inheritance is
mooted, or when a pregnant woman has been maltreated,
and her child supposed to have died in consequence.

The life of the infant is inferred from the good health
of the mother, the progressive increase of the abdomen,
and the motion of the foetus. But healthy females may
bring forth dead children ; delicate females have produced
healthy children, and the increase of the abdomen may
depend on moles, hydatids, dropsy, &c. while the motion
of quickening has been caused by flatulence. A woman
may suppose she feels the motion of the infant, during
delivery, yet a putrid infant may be produced. Various
causes may act on the mother, and destroy the infant, as
unhealthiness of habitation, mode of dress, want of food,
or improper use of it, violent exercise, too great labor,
violent passions of the mind, venereal excesses, intemper-
ance, haemorrhage, convulsions, syphilis, small-pox, falls,
wounds, and accidents, inordinate evacuations ; in fact, all
the causes of abortion, which were enumerated. Pressure in
difficult labors, may destroy the infant ; improper use of
instruments, fainting and diseases of the placenta, will pro-
duce the same effect. Yet the child may recover in despite
of most of these causes.

The following signs occurring during pregnancy are
indicative of the death of the infant — want of motion in the
child ; the womb feels as if it contained a dead weight,
which rolls according to the position of the woman ; the
navel is less prominent, the milk disappears ; the breasts
are brown, flaccid, the mother experiences a sense of lassi-
tude and coldness, accompanied with head ache and nausea.
If actually dead, and long retained in the womb, putrefac-
tion sets in, the membranes become black, and foetid dis-
charges take place. Maceration of the body, presence of the
meconium, spots on the skin, violet or brownish blue colour
of the lungs, the mass sinking partially or entirely in water,
weighing about the seventieth part of the body, and the
mouth and throat being filled with a glary sanguinolent
fluid.

Dr. Ryan on Delivery. 515

Many of these symptoms are equivocal. The foetid
discharges and state of the skin and bones cannot be de-
pended on. If the medical examiner be called immediately
after birth, he can distinguish these symptoms ; but he is
seldom called so early, and in general not for many days
afterwards. The skin will exhibit marks of putrefaction,
and will be of a purplish brown or red colour. The um-
bilical cord is livid, soft, and easily torn. The cranium
and thorax are flattened, the sutures of the head are dis-
united, the brain is almost fluid, and has a foetid odour.
If the death take place after birth, there will be characters
of viability and complete developement, signs of external
violence, fractures, cruises, perhaps omission of the liga-
ture on the cord, developement of the pulmonary vessels ;
the arterial and venous canals are straightened or obstructed,
lungs spungy, rose colour, swimming in water, also after
compression of them ; but this happens, if filled with gas,
by putrefaction ; but if the gas escape by compression, the
lungs will sink ; the lungs weigh about the thirty-fifth part
of the body. The lungs of an infant already dead, if in-
flated by the trachea, will preserve the air, as if respiration
took place ; but they will not weigh more than compact
lungs. From the fourth to the eighth day after birth, the
cord desiccates and falls off, there is a slight desqua-
mation of the epidermis, a yellow colour of the skin, dis-
appearance of thrombus, ecchymosis, or inflammation, and
oedema of different parts ; on pressing the breasts of either
sex, a serous fluid appears. From the eighth to the thir-
tieth day after birth, the navel will be healed, the foramen
ovale, arterial, venous, ducts and umbilical vessels will be
obliterated by adhesion, the sutures will be more solidified,
and the fontanels diminished.

Prolicide, Foeticide, Infanticide,

Medical jurists have employed the word prolicide, to de-
signate the destruction of the offspring, and divided the
subject into foeticide, or the destruction of the foetus in
utero, and infanticide, or the destruction of the new-born
infant. I have already stated the law on this subject,
9 Geo. 4, c. 31, which makes no distinction between the
murder of an infant not viable, that cannot live, and one
that is viable. A woman who destroys her infant not likely
to live— for example, soon after conception, is assuredly
less criminal than one who destroys it at a later period>

5H> Original Communications.

which, if left undisturbed, may become fully developed, and
arrive at maturity. The first commits an act upon an im-
perfect being, which has not acquired the perfection neces-
sary to durable existence — she acts almost on a dead body,
rion homo est, qui non futurus est, the other acts upon a
perfect being, which nature destines to occupy, a place in
the class of her family and of society. If the death of a non-
viable infant is less criminal than abortion, the punishmeot
of infanticide ought not to be inflicted, for this is inflicting
the greatest punishment for the lesser crime. But as the law
stands at present, the researches which the medical practi-
tioner has to make in cases of infanticide are as follow : —

1. After having ascertained the external appearance of
the infant, its volume, length, and respective proportions
of its different parts, it is necessary to determine whether
there exists any original defect of conformation, or any
pathological condition which could induce the death of the
infant at the moment of birth, or whether it has not been
destroyed by pnessure during a laborious parturition.

2. After this examination, we should inspect the internal
organs, and decide whether respiration has been complete,
ana consequently whether the infant has been born alive.

3. To determine how long a period has elapsed since
the infant was living ; and what was the cause of death,
whether natural or violent.

4. To determine whether the woman to whom the infant
is attributed, is really the mother.

The most important of these inquiries are the following :—
Has the infant died before delivery ? Has it died during
delivery ? Has it died at the moment of birth, in conse*

Suence of deformity of the mother, or congenital disease?
u the first place, we are duly to consider the various cause*
of abortion, and the signs which indicate the death of the
foetus in utero. The former have been already enumerated ;
the latter are, the cessation of the motion of the foetus,
the perception of it in different positions by the motions of
the woman, the tumefaction or diminution of the breast-
signs which are extremely equivocal. But if during' delivery
the foetus is not felt to move, the waters are black and
foetid, the scalp soft, placid, wrinkled, and easily excoriated,
if the cranial bones are more niobile than ordinarily;
there is much reason to suppose that the foetus has been
deprived of life for some time. After delivery, the proofs
of the death of the foetus having taken place some days
previously, are the flaccidity of its limbs, desquamation of
the cuticle, the skin purple or brown in certain parts, a

Dr. Ryan on Prdidde, Feetitide, Infanticide. 517

serous or sanguineous infiltration of the subcutaneous cel-
lular tissue, especially of the scalp ; the umbilical cord soft,
flaccid, livid, easily lacerable, the thorax flattened, and its
viscera in a state which shews that respiration could not
have happened.

If the infant has been destroyed by pressure, by a pre*
mature rupture of the membranes, there will be tumefac-
tion of the superior part of the head from uterine pres-
sure, the head is deformed, and the brain will be found
apoplectic ; or the last sign may depend on compression of
the umbilical cord, either by being round the neck or body
of the foetus, or by compression of the parts of the parent.
On the other hand, if the foetus has died from haemorrhage
during1 labour, in consequence of detachment of the pla-
centa, rupture of the umbilical cord, the body will be of a
livid pale colour, the sanguineous system will be empty and
collapsed, and if there is* rupture of the cord, its extremity
will be jagged or irregular.

It would far exceed my limits, were I even to enumerate
the various defects of conformation of the wotdan, or mal-
formation of the foetus, which may destroy the life of the
latter. I can only advise the practitioner to exert his know-
ledge of anatomy, physiology, and pathology, in any case
on which he may be caUed upon to give his opinion. He
should most cautiously consider the defects of conformation
and , pathological degenerescences, and which may impede
the functions of respiration. Though it will be seen here-
after, that the proofs afforded by respiration are inconclu-
sive, aad that too much importance has been ascribed to
them.

Let us examine the degree of certainty of an infant being
bom alive, which is prevented by signs afforded by the
anatomical examination of the foetus. Daniel considered
that the thorax was amplified by respiration, and this he
determined by measuring the cavity before and after respi-
ration. (Comment, de infantum nuper natorum umbilico et
pulmonibus.) But the conformation of the chest is subject
to too much irregularity, to enable us to arrive at a satis-
factory conclusion. Plocquet laid great stress upon the
position of the diaphragm, whether depressed towards the
abdomen, or elevated towards the thorax; but artificial
respiration will affect these positions as well as natural.
The size of the lungs affords no positive evidence. Schmitt
has seen them fill the chest before respiration, and so much
compressed after that process had continued thirty-six hours,

518 Original Communications.

as to render it difficult to decide whether respiration had
been established. Besides, there may be uterine, vaginal,
and extra- uterine respiration before the complete expulsion
of the foetus, and death occur after the birth. The rosa-
ceous colour of the lungs may or may not exist, and is
subject to great variety, so that no dependance can be
placed on this sign. It may exist in the foetus long before
maturity. The obliteration of the umbilical arteries and
vein, of the foramen ovale, and of the ductus arteriosus,
evidently prove that the infant has been born alive. But
this change does not happen at the moment of birth, nor
sooner than two or three days, and often not before the
first or second week ; and consequently this evidence, in
most cases, is of little value.

Plocquet instituted experiments to ascertain the weight
of the lungs before and after respiration, in comparison
with that of the whole body, and concluded that the weight
was 1 : 70 before, and 2 : 70 or 1 : 35 after respiration, The
accuracy of these conclusions is denied by Chaussier, Orfila,
and Schmitt, of Vienna. Daniel proposed to immerse the
lungs, before and after respiration, in a vessel of water, to
the side of which a graduated scale was attached to mark
the elevation of the fluid. He said that the condensed lungs
would occupy less space than after respiration ; this is true,
but more delicate instruments are required for the execu-
tion of this experiment, before we are justified in adopting
it in the practice of legal medicine.

Schreger proposed the immersion of the lungs and heart,
the large vessels being tied, in water so far back as 1682 ;
and concluded that when they sunk, no respiration had
taken place, and if they floated, respiratory function had
been established. This is what is called the hydrostatic
test, or pulmonary docimacy, upon which no reliance is
placed in any part of Europe at the present period. Nu-
merous objections may be made to this test ; 1, the infant
may respire before birth; 2, it may respire and be de-
stroyed before birth ; 3, an infant may be alive, and may
not have respired ; 4, the lungs may float before respira-
tion ; 5, the lungs may not float after respiration. The
infant may respire before birth, and be born dead. (Hun-
ter, Marc, Siebold, Capuron, Osiander, Sabatier, Mabon,
Hutchinson.) There may be intra-uterine respiration. Trans.
Royal Soc. of London, vol. xxvi. Edinb. Med. and Surg.
Joum. No. 73. Hufeland's Journ. 1823. The foetus may
be asphyxiated, or remained enveloped in its membranes
and be alive, without respiration. (Buffon, Schurig, Le

Dr. Ryan on Prolicide, Foeticide, Infanticide. 519

Oallois.) A delicate immature infant may respire, and yet
the lungs will sink in water; and the infant may be born
with pneumonia, pulmonary engorgement, or hepatization.
(Billiard.) In the two first cases, the air cannot arrive in
the bronchial vesicles, and consequently respiration will be
incomplete. In the last, we often find the subcutaneous
cellular tissue of the mouth and limbs gorged with san-
guineous effusion, which induces some persons to suppose
violence has been employed. Billiard has pointed out this
error. The lungs may float before respiration, from putrefac-
tion, (Orfila,) emphysena, (Chaussier,) or insufflation. (Mor-
gagni. Dr. Bernt, of Vienna, has put an end to the ancient
hydrostatic test, and proposed a new one in its place, which
is equally objectionable, in consequence of the complica-
tion of his instruments. (Progtamma quo nova pulmonum
doscimasia, hydrostatica, proponitur. Vienna, 1821.)

It is a matter of great importance to determine how long
it is since the infant was living ; or how long it has been
dead. If the skin be soft, and covered with the white
unctious matter, which is seen at birth, if the stomach
contains but a small quantity of mucous, the large intes-
tines are filled with meconium, and the bladder with urine :
it is probable that life had ceased at or immediately after
birth. If on the contrary, the stomach contains any alimen-
tary substance, and the intestines any matter except meco-
nium, it is certain that the infant has lived for some time.
I have already described the change in the vessels peculiar
to the situation of the foetus. I may mention, however,
that the umbilical cord remains soft and humid for fifteen
or sixteen hours, and begins to desiccate about the fortieth.

To determine how long the infant is dead, we must con-
sider the state of putrefaction, and all circumstances which
hasten or impede it. Warmth and humidity promote de-
composition, and already putrifies more rapidly in running
than in stagnant water, or in humid earth, than in an argil-
laceous, sandy or chalky soil.

The next question is, what has been the cause of death.
This is often involved in impenetrable obscurity, as lesions,
purely accidental, frequently present the appearances, of
crime. We should endeavour to determine those that are
accidental or involuntary, and those that are criminal.

Death of the foetus from involuntary causes. — I have
already enumerated the most of the causes of the death of
the foetus in utero, and may now caution the young practi-
tioner to bear them in recollection, for otherwise he may
commit the most serious errors in giving evidence on the

52Q Original . Communications.

question . under. notice. Let him remember that diminution
or deformity of the pelvis, are preternatural presentations of
the foetus, may cause elongation of the head, tumefaction of
die scalp, fractures of the cranial bones, blackness of the
face, congestion of the brain, ecchymoses of different parts of
the surface of the body, fractures of the limbs and various
other lesions, which may be readily mistaken for the result
of external violence. Again, the twining of the umbilical
eord round the neck or the compression of the os externum,
may induce cerebral congestion, as well as .marks of strangu-
lation. If the appearances on the head are caused by exter-
nal injury, they will often exist in situations on which no
pressure could have been made. We must always bear in
mind jbhe presentation ; and by so doing we can often distin-
guish natural lesions from injuries.

In those cases in which the neck is compressed by the cord, *
there will be no excoriation, or exoriation of the cuticle.
When there is rupture of the cord during labour, there frill
be fatal haemorrhage, but if accident happens after birth,
that is, after exposure to the air, fatal haemorrhage will not
result. If the cord be lacerated by violence, its extremities
will be irregular, but the flow of blood will cease. The in-
fant will not be destroyed by b&morrhage, unless the cord is
divided with a sharp instrument. Should the infant have
been destroyed by detachment of the placenta, the pale waxy
colour of the foetus, the discolouration of the viscera, the va-
cuity of the heart and large vessels, explain the cause of
death. The infant may be expelled suddenly, and falling on
the floor or on any other hard substance, the skull may be
fractured, and the cord torn. Such cases are related by
many obstetrio writers. I have narrated three examples,
and others are attested, by .Hamilton, Chaussier, Heake,
Klein, Pasquier, Meirieu. Jour. Univ. des se.Med. 1820
and 1823. M, Klein collected a hundred and forty three
observations on this point, and asserts- there was not one in*
fant in the kingdom of Wurtemburg, whose skull was frac-
tured, all recovered. Many fell upon the pavement, two of
which were affected with momentary asphyxia.- Though the
cord was lacerated, there was no fatal Haemorrhage. When
sudden expulsion of the infant is alleged as the cause of
death, it is necessary to examine all circumstances anterior
and subsequent/ to compare the dimensions of the pelvis, and
the volume, of the infant's head, to consider the duration of
labour, the position of the woman when the, infant has escaped,
the height of the fall, the substance with which the head
came in contact, and finally, the state of the umbilical cord

Dr. Ryan on Prolicide, Foeticide, Infanticide. 521

which ought to be ruptured at the placenta or umbilicus, but
not in the middle. The extremity of which ought to present
the sign of laceration.

When an infant perishes at the moment of birth, by choak-
ing of the air passages, and is afterwards thrown into water
or into the water closet, it may be supposed it has been de-
stroyed by submersion or drowning. Every practitioner is
aware that infants have been precipitated into the latter situa-
tion, and that it is extremely difficult to distinguish whether
the fluid in the ail* passages be mucossity, liquor anmii, or an
extraneous fluid introduced. When the fluid contained in
the trachea is frothy, we cannot positively affirm that the in-
fant has respired, as insufflation would produce the same ef-
fect ; or a morbid secretion of gas, or the evolution of air by
decomposition. If on the other side, the fluid is limpid and
free from air bubbles, we can affirm that the infant has not re-
spired, but this is no proof that it was dead at birth, or at
the moment of submersion/ The rigid examination of the
physical and chemical properties of the fluid, will alone en-
able us to determine its real nature.

BIBLIOGRAPHY.

PBACTICK OV MEDICINE.

i. Red Bronchocele. — Real bronchocele, M. Larrey says, con-
skis of one or several tumors filled with air, which during its forcible
compression in the upper portion of the trachea, the larynx, or the
mouth, has produced small hernia? of the mucous membrane ; these
tumours rapidly increase in size, so as not unfrequently to exert a
Violent pressure on the vessels of the neck. They are situated in
front, or at the sides of the larynx, between the hyoid bone and the thy-
roid cartilage,, or between the cricoid cartilage and the first tracheal
ring, and are invariably produced by violent exertion. The most
characteristic symptom of this kind of bronchocele consists in the
disappearance of the tumor under compression. In Egypt we fre-
quently observed this kind of bronchocele in the blind, who are very
numerous there, and who are employed by the priests to chaunt at
the top of the minarets. It generally happens, that after two or three
years, such persons became totally unfit for this office, on account of

Vol. v. no. 30. 3 q

522 Bibliography.

»
the occurrence and subsequent increase of these tumors. Since*
M. L.'s return from Egypt, he has had the opportunity of observing two
cases of bronchocele in two subaltern officers, who had for a consi-
derable time been employed as military instructors. One of them
had near the larynx two tumors, which were free from pain and cre-
pitus on pressure. They were of equal size and globular form, and
the skin by which they were covered was rather tense, but without
any morbid alteration. Both individuals had almost entirely lost
their voice, being unable to make themselves understood by words,
except whilst forcibly compressing the tumors. They were also
obliged to breathe with their mouths "wide open. In consequence of
the continued pressure on the vessels of the neck, the jugular veins
had become enlarged, and they suffered greatly from congestion
within the head. The application of bladders filled with ice, and of
graduated compresses with camphorated spirit and liq. amnion.
acetat. greatly reduced the size of the tumors, but did not prevent
their reappearance on the least exertion. — Clinique Ckirurgicale.

SURGERY.

2. Case 'of Fungus Hamatodes. By Thomas Sewell, M. D. Pro-
fessor of Anatomy and Physiology in the Columbian College, district
of Columbia. — The following case of fungus hsematodes occurred in
the practice of Dr. M 'Williams, of this city, the same gentleman
whose name I have introduced in a former communication published
in this Journal. By the courtesy of Dr. M'Williams, I had an op-
portunity of examining the case and marking its progress during the
life of the patient, and was afterwards requested by him to make the
post mortem examination, and draw up an account of its history.

The subject of the case was a Miss W , of this city, abort

twelve years old, healthy, active and intelligent.

In Nov. 1828, while in the enjoyment of her usual health, she was
attacked with slight pain and lameness in the- left thigh. On ex-
amination a hard tumour, the size of a walnut, was discovered on the
inside of that thigh, situated one-third of the distance from the hi]'
to the knee-joint. This was deej>-seated and extremely obscure,
being under the thickest part of the fascia lata, but by strong pres-
sure it was found to be moveable "and disconnected with the bone.
From the time of the first examination of the case, the tumour con-
tinued to increase rapidly in size, and was attended with an almost
constant, heavy, obtuse pain, which was also extended to the knee
and ankle-joints, accompanied with an uneasy sensation in the whole
extremity, producing a frequent desire to extend the limb and to
change its position. The pain was always more severe and constant
in cloudy and damp weather ; but at other times would occasionally
remit for six or eight hours together. At the end of six months, the
tumour had acquired such a size as to disfigure the limb and to pre-
vent the patient standing or walking, and the pain was more severe,
and accompanied with a sensation of great heat or burning.

Surgery. 523

• During the last eight months, all the symptoms became aggra-
vated. The tumour increased with greater rapidity than before — its
surface became irregular, and exhibited a glossy appearance, inter-
spersed with livid patches and superficial vessels greatly enlarged,
and when handled, presented in different parts very unequal degrees
of firmness, at some points appearing soft and yielding, as if suppu-
ration had taken place ; at others, imparting to the touch a sensation
of almost cartilaginous hardness.

Ten days before her death, a rupture of the tumour took place,
accompanied by a copious discharge of acrid foetid sanies, and con-
tinued without at all impeding its growth.

She died on the 22d of Jan. 1830, fourteen months from the com-
mencement of the disease.

It should be remarked, that during the continuance of the disease,
till within two days of its termination, the appetite was good ; large
quantities of nutritious food were taken and digested without diffi-
culty ; but as the parents justly observed, all the aliment she received
seemed to be expended in the development of the disease, rather than
in the nourishment of the body.

The treatment of the case consisted principally in topical applica-
tions; but these had not the slightest influence in arresting' the pro-
gress of the disease, or alleviating the sufferings of the patient. *

The morning after the death- of the patient, the following exami-
nation was made :—

The body was found in a state of great emaciation. The leg and
foot of the diseased limb were oedematous and considerably swoln. The
tumour, as to formr size, and colour, is accurately delineated in the
accompanying drawing. It involved the whole thigh, and extended
down over the knee-joint, measuring in length fifteen inches, in
diameter twelve inches, and in circumference three feet. By a hori-
zontal section about one-third of the tumour was removed, by which
its internal structure was clearly brought to view. On careful exa-
mination, it was found that every tissue which entered into the struc-
ture of the thigh, had undergone an entire change in organization,
and had assumed all the characters of the morbid growth, except the
facia lata, and this was greatly thickened. On the anterior part of
the thigh a large cavity was found, containing about twenty-four
ounces of fluid resembling olive oil, its walls thick and cartilaginous,
with osseous depositions. On the posterior part of the thigh, corre- *
spooding with the cavity just described, was a hard tumour, several
inches in diameter, apparently composed of condensed cellular sub-
stance, with cartilaginous structure and osseous matter. This, togc- .
ther with the cavity already mentioned, constituted about one-fourth
of the tumour. The remaining three-fourths resembled in colour and
consistence, the medullary substance, of the brain, irregularly inter-
mingled with cortical matter.

This mass was intersected by numerous membranous septa, formed
Probably originally of cellular substance. There were also numerous
^uses running in different directions, containing viscid sanies, and-

324 Bibliography.

their walk formed of a dark-coloured membrane, apparently Hie
inter-muscular fascia, much thickened.

The shaft of the bone was also extensively diseased. It was en-
larged, spongy, and flattened, and had many small spicule projecting
from it. It was fractured about four inches from the head, which I
was informed happened after death, in attempting to more the limb.
The extremities of the bone were sound, and the structure of the hip
and knee-joints not in the slightest degree changed by the disease,,
although the tumour enveloped both. — Amer. Jour. Med. Sciences.
. 3. On Strychnine. — These affections are often ascertained with
difficulty, and, therefore, cases may be viewed as such, though ari-
sing from structural derangements of the interior of the organ of
vision. In these, as in others arising from severe or long continued
internal inflammation and other causes, strychnine, I apprehend, can
be of no possible service. The same thing may be said of amauroas
depending on clots of blood, or tumors which press upon the optic
nerves. Where again, as is frequently die case, the disease is owing
to the absorption of the medullary portion of the nerve, it must be
allowed that nothing can be expected .from it or any other medicine.
In fine, in my opinion, it is only in cases of paralysis of the optic
nerve, and those arising from congestion, that strychnine can be ad-
vantageously employed ; and I think the preceding examples, and
those already published by Mr. listen* Mr. Guthrie, and others, must
decidedly prove its efficacy in them. It is not immaterial to observe
that in such cases its beneficial operation is considerably aided by the
previous use of mercury, possibly either by exciting the nervous sys-
tem, by rousing the energy of the capillaries, or by increaaing the
powers of absorption, or by all three conjointly. Thus, in No. 5.
strychnine failed until mercury had been employed ; but on its appli-
cation, and then only, vision was improved ; and in cases Nos. 7 and
9, its decided effects followed the use of that medicine.

I cannot positively say whether the effects of strychnine are lasting,
but I believe it in most cases to be so if properly used. I may safely
assert also, that in no case in which I have tried it has vision been
injured, where the disease existed in one eye only, or where sight was
not entirely destroyed. In no case did any constitutional evils arise
from its use* I am inclined also to believe, from one or two instances,
that it was beneficial in removing opacities of the cornea, probably
by its highly stimulating property occasioning rapid absorption.

In delicate persons, or where- the system is affected by mercury, I
ought to add, the strychnine should be commenced in small doses, e.
g. not exceeding a quarter of a grain, and increased daily -until it
produces sensible effects on the constitution, such as headache,
pricking pains over the body, or tremors, when it should be discon-
tinued, and on resuming it, the dose should always be considerably
reduced.

Where unpleasant symptoms arise, I can suppose that camphor in
large doses, or an opiate enema, suited in strength to the violence of
the symptoms and the constitution of the patient, or, as recommended

Surgery. 525.

by M. Lembert, the application of morphine in small doses, sprinkled
on the blistered surfaces, will be found to give relief ; but in no in-,
stance have I judged it necessary to employ any of them.

Several of the cases here detailed were attacked with erysipelas,-
which strychnine seems prone to occasion ; but they were invariably
relieved by simply rubbing about a drachm of mild ointment or cold
cream over the diseased surface every four hours. — Edin. Jour.

4. Impaction of a Foreign Body in the Ear, producing Infiamma-.
turn of the Brain, and terminating fatally, by Mr. Ingleby. of Birming-
ham.— Master — , four years and a half old, the son of a medical
gentleman late of Birmingham, was observed by the nurse maid in the
afternoon of Monday, 4th June, repeatedly thrusting his finger forci-
bly into his left ear, and on interrogating him, he replied that he had
put something into his ear, but could not tell when, nor what it was.
1 saw him immediately upon this declaration, and attempted to ex*v
tract the substance with various kinds of forceps, for about fifteen mi-
nates, but without avail. I could distinctly feel a metallic Ixxiy,
lying, as I believed, upon the tympanum. Mr. Wood, on my failure,,
employed with very great care and gentleness, every expedient that
he could devise, but ineffectually. The boy was then put to bed.
Various local remedies were applied : fomentations, poultices, lint
and warm oil, and the ear syringed with tepid water. A dose of ca-
lomel was also given, he was very restless during the night, .and
started frequently while asleep.

Tuesday, 10, ▲. m. — The boy appeared tolerably well and cheerful;
the calomel had operated. The internal ear was somewhat swollen,
and there was a considerable sero-aangumeous discharge from. it. A
mild aperient medicine was ordered, and the local applications con-
tinned. It was deemed expedient to make no farther attempt at ex*,
traction at this period.
6, p. ii. — Same as in the morning.

Wednesday, 10, a. m. — The same as yesterday. At twelve o'clock
he became sick, and vomited once ; he refused food ; he became
thirsty, ami general listlessness prevailed ; the pulse remained good ;
his walk seemed unsteady. In the evening, his head dropped on his
shoulders somewhat suddenly, and from that time he lost all com-
mand over progression. The right side of his body seemed to be
more particularly affected.

Thursday morning. — Dr. Male and Mr. Jukes were called in. The
state of the patient was now very alarming. During the night he had
entirely lost the power over the rigfct side, and become very comatose*
He now lay in a state of partial stupor, with the eyes half closed, and
a cadaverous countenance. Pulse irregular and about BO. Discharge
from the ear continues as before.. Mr. Jukes attempted the removal
of the body without success.

At noon he was attacked with violent convulsions of both sides.
Mr. Hodgson being called in consultation at this period, attempted to
extract the body, but unsuccessfully. Opium by the mouth and per
*wun was prescribed, and in the evening, a hot bath and purgative
Ejection. Pulse very intermitting and irregular.

526 Bibliography.

Friday, 5, a. m. — General and intense spasmodic action. A con-
siderable quantity of purulent matter has been discharged, both by
the nose and mouth, which continued oozing till 7, a. m. when be
died.

I examined the body in the presence of Mr. Hodgson, Mr. Jukes,
Mr. Freer, and others. On removing the calvarium and dura mater,
the vessels generally were much injected, and the substance of the
brain was studded with, vascular points. There was . considerable ef-
fusion between the membranes, and a deposit of yellow lymph at the
base of the brain, similar to what is observed in hydrocephalus acutus.
The plexus choroides were peculiarly turgid with blood; The exter-
nal ear and integuments being divided and dissected back, the inter-
nal ear was removed, by taking away a triangular portion of bone. A
piece of metal, having a shining silvery appearance, now presented
itself to view. It could not, however, be extracted, although it "was
very moveable ; for being below the ridge to which the membnuia
tympani is attached, the projection (processus auditorius,) presented
an insuperable barrier to its removal. It appealed difficult to account
for the presence of this body in such a situation. When extracted by
asectiou, it proved to be a piece of lead, weighing 3jj. portions simi-
lar to which were in use at a workshop in his father's yard, and the
child was seen in the shop a week prior to the detection of the acci-
dent. Hie oseicula auditus were missing, except one which was found
loose in the cavity of the tympanum. The membrana tympani was
also destroyed, with the exception of a small ragged margin.

Observations. — The peculiar situation of the foreign body, and the
impossibility of extracting it until a section of the internal ear was
accomplished, accounted for our abortive attempts to extract it during
life — moveable as it not only appeared, but was actually found to be
on dissection. I am quite of opinion that the lead had been an entire
week in the ear, and was only detected when the body first began to
feel uneasiness. The sufferings of this little patient appeared to be
most intense. To the friends and attendants, the scene was truly dis-
tressing, one of the most heart-rending it has ever been my lot to
witness. — Mid. Rep.

6. Mr. Syme continues his valuable reports of the Edinburgh
Surgical Hospital in the October number of our northern contem-
porary. He commences his report by stating that the Royal College
of Surgeons of Edinburgh recognize the hospital and his clinical lec-
tures (indeed we should be greatly surprized if they did not do so),
and that the sources from which he derived 800/. for the support of
the hospital, were fees for his clinical lectures, 400/. — board of two
house surgeons, 200/. — and cash paid out of his own pocket, 200/.
What a contrast does his generous conduct present, when compared
to that of the hospital surgeons of London and Dublin, who not only
do not expend a shilling in support of the institutions to which they
belong, but hoard up the immense sums which they derive from
students. The report comprises a period of three months, during
which 545 cases of surgical disease have been presented for relief,
and ot these 82 have, been admitted into the house. The first case

' Surge? y. * 527

detailed is that of a man, aged 30, bad constitution, whose elbow
joint was excised ; the operation was performed with that ability and
dexterity which characterise the narrator. The patient sunk five
weeks afterwards.

" On dissection the abscess of the hip was found to extend
upwards amoiig the muscles as high as the lumbar region. There
was an extensive abscess between the ilium and iliacus interims
descending into the groin. There were old adhesions between
the pleura pulmonalis and costalis on both sides, but especially on
the right. Upon the centre of the anterior surface of the left lung
lymph had been recently effused to a considerable extent, and about
eight ounces of sero-purulent turbid fluid lay in the pleura of the
same side. The lungs in several parts were indurated or hepatised,
and in some places suppuration had taken place so as to form depo-
sits of the size of a walnut. On the surface of the brain the vessels
were more turgid than usual, and in some places there were small
ecchymo8e8. Great part of the wound was healed, but the ex-
tremities of both the humerus and ulna were exfoliating.

" This unfortunate man, whose thin emaciated care-worn appear-
ance indicated an age not less' than fifty, though it really was no
more than thirty, was certainly, as the result showed, a most un-
favourable subject for operation. - At the same time this is the only
one of ten cases of excision of the elbow-joint which has terminated
fatally ; and 1 sincerely believe, that any operation, however slight,
which had the effect of at all disturbing the constitution, would have
given rise to equally disastrous consequences. This extreme ten-
dency to disordered action could of course be learned only when it
was too late."
The following cases are highly interesting : — *
" David Forret, set 28, from Cupar-Fife, recommended by Dr.
Scott of Cupar,- on account of a diseased elbow- joint, of which he
gave the following account : ' Nine months ago he began to be
troubled with a gnawing pain at the back of his right elbow, as
if between the ulna and humerus. There was then no swelling ; the
motion of the joint was somewhat impeded, but did not increase the
pain. In January, he observed a small tumour, about the size of a
bean, .a little above the internal condyle, which broke two weeks
afterwards, and has continued to discharge ever since. Up to this
time he had not been incapacitated from working, the pain which he
felt being only moderate, and ascribed to rheumatism. But four
months ago, without sustaining any injury, the joint inflamed, be-
coming red, swelled, and excessively painful, so as to render the
slightest motion intolerable. He was blooded and leeched repeatedly,
by which means the activity of the disease was subdued, and shortly
afterwards another opening made its appearance on the outside of
the olecranon. The constant discharge, gnawing pain, stiffness of
the joint, and general exhaustion consequent on this severe and pro-
tracted disease, have made him extremely anxious to obtain relief,
and willing to submit to any measures necessary to afford it. He is
thin, pale,' and evidendy much reduced by his sufferings.'

528 Bibliography.

" This case evidently required either excision or amputation.
My friend, Mr. Webster, Surgeon of the 4th Dragoon Guards, who
saw the patient on his admission, and who had not at that time
witnessed the operation of excision, declared that he would have do
hesitation in amputating the arm; Though there was evidently very
extensive disease of all the soft parts, I did not consider this any
objection to excision, and, accordingly performed the operation in
the usual manner, that is, by making a transverse incision from die
ulnar nerve to the external tuberosity of the humerus, close to the
olecranon, and then one upwards and downwards at both of its ex-
tremities. All the bones entering into the articulation were very
much diseased, the cartilage being abraded and the surface carious.
The synovial membrane, being very much thickened and gelatinous,
was cut away as far as possible, one small artery of the integuments
was tied, and the edges of the transverse incision were stitched
together; but the extreme softness of the diseased integuments
rendered it impossible to close the longitudinal ones in this way, a*
the threads instantly cut their way out. Caddis and a bandage were
then applied.

" The patient has done extremely well ; the swelling of the joint
is now almost gone ; the discharge has almost entirely ceased ; and
lie has the prospect of being soon dismissed cured.

" Elizabeth Johnston, set. 16, from Falkirk. In the first of these
Reports, I mentioned the case of this girl, who entered the hospital
last summer on account of a diseased elbow-joint, which exhibited
the most formidable appearance of any that I have yet met with, but
which, nevertheless, was completely cured by the operation of ex-
cision. She returned home, and remained perfectly well, using the
arm for all ordinary purposes until December last, when, after
exerting herself too much, her wrist swelled and became painful.
Tartar emetic ointment was applied, and afterwards blisters ; but an
abscess soon formed, which opened, and has continued to discharge
ever since. A probe introduced into the sinus, which is situated
over the lower end of the radius, enters a large carious cavity of the
bone, and can be pushed downwards into the wrist-joint.

" As amputation appeared the only resource, it was performed oo
the 24th June above the elbow, by the method of double flap. She
recovered most favourably, and is now well.

" The elbow being dissected, afforded a specimen of the union
which is established between the bones in such cases. When the
integuments and muscles were dissected off, the appearance presented
was wonderfully little different from that of a natural joint, owing
.to a great mass of fibrous ligamentous-looking substance which con-
nected the bones together. This connecting medium, which was
above an inch in length, and perfectly flexible, did not constitute any
thing analogous to an ordinary articulation, and more resembled the
structure that usually exists in the false joints that result from frac-
ture of the bones. My friend and pupil, Mr. Charles Bell, made a
sketch of the preparation, which gives a very good idea of its ftp-

Surgery* 529

pearance, and which, therefore, I have caused to be engraved to illus-
trate this description." — p. 226.

Mr. Syme next describes hip disease, knee disease, ankle disease,
elbow and shoulder disease, and employs these terms in preference to
the more scientific nomenclature of the German school, as some ma-
tured contemporary has accused him of pedantry, for having used one
of the German terms on a former occasion. We must observe that
the accuser is one of those who delights in progress of moving back-
wards, and we are surprised at a surgeon of Mr Syme's eminence,
to be influenced or deterred by such a silly piece of absurdity. Why
should not British surgeons improve their nomenclature as well as
others, or why should they allow others to advance in this particular,
at least a century before them ? The terms proposed by Rust of
Berlin, for the diseasesin question, are as follow : — spondil-arthrocace,
or vertebral disease, cox-arthrocace, or hip disease, son-arthrocace,
or knee disease, om-arthrocace, or shoulder disease, olecran-arthro-
cace, or elbow disease. We too have been accused of pedantry, for
proposing a more correct nomenclature for obstetricy, which is now
adopted in France and Germany, and very generally in this country.
What classical scholar would not prefer the word obstetrician, to
accoucheur midwifer, or to the barbarism, physician man midwife,
which, as yet is employed by some old fashioned obstetric lecturers,
and practitioners in this metropolis, or gynaecology for midwifery,
gynaecotomy for anatomy of the female organs of generation,
gynaecophiosology for the functions of these organs, parthenosology,
for the pathology of these organs in the unimpregnated state, ge-
nescology or anthropogensy for procreation, embrysology for the de-
velopement of the foetus, encyonosology, for diseases of pregnancy,
tocology, for parturition, eutocia, for natural parturition, dystocia,
for preternatural parturition, chiragoticia for manual parturition, and
organikotocia, for instrumental parturition ; cochianoaology for puer-
peral diseases, and paidonosology for diseases of infants and children.
Dr. Blundell approved of the term obstetrician, while the Reuv. Me-
dicate, Francaise et Etrangere noticed the whole classification in these
words : —

" M. Ryan vient de faire en Angleterre, pour les. accouchemens,
ce que M. le professeur Duges et M. Tarvenier, avaient fait en France,
pour le meme branche de 1 art et pour la Chirurgie **** ce professeur
pour supplier a quelques cunes qui existaient dans les ovrages du
meme genre, publie avant le feien, s'est attache a faire connaitre les
maladies des organes de la generation, celles qui se developpent pen-
dant la grossesse, apres r accouchement et enfinles affections propres
a 1' enfant nouveau ne\ Aux mote generalement, usites M. Ryan a era
devoir substituer des expressions nouv elles, telles que gynoecotomie,
&c. &c. qui forment autant de chapitres dans lesquels il examine a
fond toutes les questions quis'y rapportent. Le manuel d'accouche-
ment de M. Ryan est un livfe destine, a devenir classique, aussi
croyons-nous devoir le recommander aux etudians de Paris et de
Montpellier, qui veulent etre aucourant des progres de cette partie

Vol. v. no. 30. 3 a

530 Bibliography.

de la Chirurgie, chez nos confreres d'outre Mer." Such a testimony
from foreigners must be gratifying to the author, and humiliating
to the few, who have accused him of pedantry, not only on that oc-
casion, but in introducing so many new terms of the foreign schools
into this periodical. Why should not British medicine keep pace
with science in other countries ? Are we to stand still while all other
nations are in rapid motion ? Certainly not; and we trust the scien-
tific part of our profession, will be no longer tramelled by antiquated
usage, and miserably defective nomenclatures

6. Tumour on the Lumbar Vertebra, by Mr. WaMron, Surgeon,
Bath. — About the middle of April, 1829, I was requested to see
Master Peckover, a boy 12 years of age, whom I had attended two
months before, in an attack of acute hepatitis ; his complaint yielded
to the usual means of general and local blood-letting, blisters, aperi-
ents, &c. ; but the highly inflamed state of his blood, jaundiced hue of
skin, morbid state of alvine evacuations., and tenderness in the re-
gion of the liver, bespoke the severity of his attack, and indicated, in
a person at his early period of life, an unusual degree of disease in
that viscus. I was now consulted in consequence of a swelling hav-
ing made its appearance on the lower part of the spinal column, be-
tween the third and fourth lumbar vertebra ; it was about the size of
a small hen's egg, but little sensible when examined by the touch,
and accompanied with pain and uneasiness in the back and loins ; it
did not dilate upon coughing. At this period, the boy's general state
of health was. good : I at once suspected this to be a lumbar abscess,
but not being decided in my opinion, I determined, at all events, to
act with caution. I directed a calomel powder to be taken twice
a week at bed time, and the following drops to be taken : — |£r Liq.
calcis mur. Jis. Tinct. ferri mur. Jss. misce fiant guttae. Capt
Hi xxx. bis quotidie a calice vitreo aqua;. The following lotion to be
applied to the swelling : — fy Liq. ammon, acet. J>iv. Liq. plumbiacet.
3ij. Aq. distillat. 5xij- misce ft. lotio constanter applicanda. This
jplan was continued, but not with the utmost regularity, till the 1st of
September, when the father of the boy having, a few days previous,
learnt from me, that I considered the swelling in question to be capa-
ble of removal by the knife, viz. that it was an encysted tumour; un-
known to me, he took the boy to Mr. Hicks," of this town; this gen-
tleman having expressed a wish to meet me on the case, we met, and,
in his own words, I will give his views of the case. " He defined
the tumour to be an impulse of matter, and prescribed blisters to pro-
duce absorption, with exhibition of internal remedies to improve the
constitutional defect. At the time Mr. Hicks saw the boy, the tu-
mour was three inches and a half long, and in width about three
inches ; the integuments were perfectly healthy and free from all dis-
colouration ; he suffered no pain, and his general health was good.
The tumour was firmly attached to the fascia of the tendon covering
the latissimus doisi muscle. Mr. Hicks continued his plan till the
7th of November, when ulceration having taken place in the integu-
ments, he pursued the following plan ; Mr. Hicks did not follow up

Surgery. 631

.the efforts of nature, but selected the soundest part of the tumour,
into which he thrust an abscess lancet, and evacuated its contents.
He next directed thin tea-chest lead to be applied, with a view, as he
stated, to obliterate the remaining cavity, and produce adhesion.
After making trial of this plan for nearly three weeks, without success,
the boy was brought back to me, to be placed entirely under my care,
and in the presence of Mr. Soden, Mr. George Goldstone, and Mr.
Ormond, I laid the tumour open to its full extent, and exposed a cyst,
not merely of condensed cellular membrane, such as is found in chro-
nic abscess, but thick and distinct, and capable of secreting its own
fluid in very considerable quantity. It became necessary, after three
weeks, to dilate a sinus which still remained, and kept up a discharge
and prevented the granulating and healing of the wound. This
being done, and the wound dressed with warm digestive dressings,
the whole of the cyst sloughed away, the parts granulated, and are
now, April 25, 1830, wholly healed.

Observations. — This case, which I have now briefly related, having
caused some little conversation with regard to its treatment, I would
observe that it is the opinion of the three respectable surgeons whom
1 consulted, when the boy was brought back to me, that the tumour
in question was an encysted one, and ought to have been removed at
an early period by the knife ; any further comment on the nature and
treatment of these swellings, would be quite superfluous, as the sub-
ject is fully treated of by surgical writers, and generally understood by
every well informed surgeon, Mr. Hicks' plan of treatment is most
assuredly novel, and as such I have stated it. To what extent it
will be followed by my professional brethren, time will prove.

7. Case of Ozena cured by the use of Chloride of Lime. By
W; E. Horner, M.D. Adjunct Professor of Anatomy in the Univer-
sity of Pennsylvania. — The acknowledged difficulty of curing ozena
or chronic purulent discharge from the nostril, makes this disease in
the estimation of experienced surgeons one of the most untractable
that they are called upon to treat. Mr. Boyer, after most extensive
opportunities, admits that it is absolutely incurable, and this opinion
is sustained by other persons of equal celebrity, among whom I may
mention Dr. Fhysick. Under these circumstances, even a partial
observation of a remedy entirely successful, may be considered
worthy of attention, and subsequent trials will tend to establish how
far it may be relied upon in cases generally.

In October, 1828, Luke Johnson, a black man, aged about thirty,
of good constitution, was brought from Virginia by his master to be
placed under my care for ozena. At this period there was a large
discharge of intolerable foetid matter from both nostrils, most abund-
ant in 3ie morning after waking ; his nostrils were then filled with
it, and on blowing them, immense quantities would be discharged,
part being in a fluid purulent state, and the remainder dried into
tenacious yellow plugs ; during the night much of this matter ran
into his throat, and by its offensiveness produced severe sickness of
the stomach, and sometimes a loss of appetite the next day. The

532 Bibliography.

discharge also existed during the day, but as he could then keep his
nostrils clear of an accumulation, he suffered less at that period.
He occasionally had headaches, especially when the quantity of
the discharge diminished.

The following statement in a letter dated Sep. 16, 1828, from
his attending physician, the late Dr. Spence, marks the progress of
his complaint, and the mode of treatment which had been resorted
to : — " Luke Johnson has for a long time laboured under a distres-
sing pain in the head, and particularly in the frontal sinuses, with
a discharge of offensive matter from his nose. He has not long
been a patient of mine ; all the remedies he has used have been
unavailing. About three years since he first complained of pains in
his head, which he ascribed to sleeping in a damp cellar. A short
time before I took my last trip to your city, (August, 1828,) I was
consulted on his case. He then complained of severe pains in the
frontal sinuses, accompanied with a discharge of very offensive
matter from both nostrils. He had taken a variety of medicines,
chiefly, I believe, of a purgative nature, without benefit ; and he
was a good deal reduced in flesh. As he had a thick mass of hair
on his head, I directed it to be cut off, applied blisters to his fore-
head, and put him on an alterative course of mercury combined
with a small portion of opium. When his gums became affected,
I advised him to leave off the mercurial pills. This course he had
commenced before I left Dumfries, and since my return he has
informed me his mouth has been sore ; the blister has drawn well,
but without affording him relief. He also used a weak solution of
sulph. cupri as a detergent wash, which he thought beneficial, as it
caused a free discharge of pus from his nose ; for when this die
charge is checked he is almost distracted. He is a man of great
veracity, and assured me he never had had any syphilitic affec-
tion."

De8paring in this case of the efficacy of the usual routine of
practice, I determined to begin at once with the application of a
solution of chloride of lime. Dr. Fhysick's advice being also taken,
with his characteristic candour, he acknowledged the inefficacy of
such remedies as he had been in the habit of using, and he readily
acquiesced in the plan of treatment proposed. I accordingly began
by putting about a tea-spoonful of the chloride of lime in a wine
glassful of water, and I injected each nostril with the clear solution.
This process was repeated twice a day for a week. During this
time it produced no important diminution of the discharge, but it
made the patient more comfortable by correcting the foetor. At the
expiration of the week, Luke went home with directions to perse-
vere in the treatment. The sequel will be seen in the following
communication to me from Dr. Thomas M. Boyle, dated Dumfries,
Virginia, April 13, 1830.

'• On my return home, in conformity to your request I called on
your patient, negro Luke Johnson. He stated that by the use of
the chloride of ume, as recommended by yourself, his nasal afrec-

Surgery. 583

tion web entirely cured in December last; Since then his general
health, which before did not suffer much, has been remarkably
good."

I may further state, that since the occurrence of this case, the
chloride of lime has been used with evident advantage, in another of
a year's duration, where the affection is confined to one side ; but
the treatment has not progressed far enough for a positive and satis-
factory result. In this case the application of the lime by snuffing
is followed instantly by a discharge of several drops of serum ;
afterwards, pure transparent mucous is secreted abundantly for the
day. attended with frequent sneezing and all the local symptoms of
influenza, with a perfect arrest for the time of purulent discharge.
The nostril is caused by the application to bleed frequently ; this
circumstance has made me hesitate in the regular application of the
remedy. I have also prescribed it in a very severe case of three
years duration, and on both sides, but of the result I am not yet
informed.

As cases of ozena do not frequently occur in the practice of an
individual, I trust that this suggestion of chloride of lime as a
remedy will be candidly tried, by others, and their experience com-
municated. We have some accounts of its being used successfully
in caries of the bones of the nose, which will be an additional
incentive to a fair experiment of its value, in chronic purulent dis-
charge from the nostril. — American Journ. of the Med. Sci. May,
1830.

8. Case in which a Foreign Body remained ten years in the Bron-
chia before causing death. — As an instance how long foreign bodies
sometimes remain in the bronchia before causing death, M. Dupuy-
tren related the following case : — One of his friends, a robust young
man, whilst playing with some children, amused them by throwing
up a ten-sous piece, and catching it in his mouth ; at last, during
the moment of inspiration, the coin fell into the trachea. Violent
painful cough, accompanied by a peculiar noise, immediately en-
sued, especially when the foreign body was, during expiration,
thrown up towards the glottis ; when it was not moved, as it some-
times happened, for several hours, respiration was but slightly
affected. The patient being continually in hopes that the foreign
body would be thrown up through the glottis, decidedly objected
to an operation, and in this1 state continued for five years, during
which time he was much inconvenienced by cough, suffocation, &c.
After that period, however, the foreign body appeared to become
fixed, and for some time the patient felt almost quite well. Symp-
toms of phthisis, however, gradually succeeded, and terminated his
life ten years after the accident ; the piece of money was found in
a tuberculous excavation. — Lancette Francois.

9. Strangulated Hernia, new mode of reduction. — Mr. Geoghe-
§an, an experienced surgeon in Dublin, has addressed a letter to
Mr.Abernethy, in which he makes some critical remarks on the
modern practice, and endeavours to disprove its correctness. He

534 Bibliography.

published a paper upon the subject in* the Edinburgh Medical and
Surgical Journal, in 1811, vol. vii., which waa unfairly censored
in the opinion of our author. The experience of later writer* con-
firms his views. The principal feature in his treatment of stran-
gulated herniae, is the application of cold for an hour, which
« evidently controuls inflammatory action, and abates sensibility,
a very material preparation for manipulation, and for the ulterior
operation.

. " In the original publication, I have quoted verbatim the advice
of Munro, Pott, Bell, Cooper, and Lawrence, on the taxis ia
strangulated hernia, a manipulation as described by them, in my
judgment not adapted to the cure of the. disease on principle—
and calculated to aggravate it, to a dangerous extent, indeed so aa
to- occasion the obliteration we have been discussing."

Our author enumerates several cases which required operation,
according to the opinions of many highly talented surgeons, and
were relieved by the application of cold. Sir Astley Cooper, in
his lectures in The Lancet, offers a sharp comment upon the pas-
sage—" that cold applications are useful in removing strangulation,
and gives instances of their success, but that it is ah absurdity to
attribute this to diminishing the volume of air, and that if cold had
such a. power, it would do no good, nothing could "be gained by it,
that the principle is erroneous, diminishing can do no good, whilst
pressure is the same, it is of no use to empty the gut of its eon-
tents, &c &c"

- " The authorities, arguments, and facts stated, I hope will con-
vince Sir A. Cooper, that the principle and practice he impugns,
are better founded than he imagined, and that if, as he observed,
he suffers such a calamity, which I hope may never happen, he will
avoid the practice he proposes for himself, namely, in the first in*
stance the taxis for about fifteen minutes, then bleeding, tobacco
enema, and if they fail, operation speedily, and that he will reverse
the order of proceeding, and defer the taxis until bleeding and the
enema had been used, then danger from handling will be lessened,
and we know that the taxis increases inflammation when it fails ; he
would be still safer, I am satisfied, were cold applied first for an
hour, it evidently controuls inflammatory action, and abates sensi-
bility, very material preparation for manipulation, and for the ulterior
operation. When cold succeeds, the tumefaction disappears as per
saltern with (a hissing noise caused by exit of the contents,) not
paullatim as the fingers are erroneously employed to accomplish.

" The reasoning and facts advanced in this paper, and in my pub-
lication, and much observation, perfectly satisfy me, that the in-
dication of cure, and the manner of fulfilling it, as universally taught,
are at variance with all principle, not adapted to the cure, highly
dangerous, and ought to be abandoned, and the indication substituted
of abating inflammation, and removing tubular obstruction, which is
often effected by local and general remedies, as I have already

Surgery. 535

detailed, without handling the part, and should they prove ineffec-
tual, the sensibility will he lessened so as to admit of manual
efforts with more safety. These efforts should be conducted
differently from the usual manner, their object being different,
namely, the return of the contents of the hernia, not the hernia itself.
This is to he effected by embracing it with the band or hands, ac-
cording to its size, and gently squeezing, so as to act upon the con-
tents without disturbing the hernia much, or removing it from its
situation. If the contents obtain exit through the obstructed part of
the intestine, the strangulation will yield ; then the intestine being
reduced to a smaller size than the aperture, can be replaced with
ease ; it is manifestly its bulk that constitutes the resistance ; a point
of incalculable importance on which to anchor. Should this practice
fail, the hernia will still be within the reach of operation, and those
fatal consequences arising from strangulation within tine ling, after
the replacement, can never occur."

MATERIA MKDICA.

10. A second edition of Dr. Reece's Essay on the effects of Lobe-
lia Inflata has just appeared, in which he adduces the testimonies of
eminent physicians of America, Glasgow, &c. He observes, " It
may be proper to add, that of the cases in which the oxy-syrup or
the ethereal tincture has been exhibited, neither of them failed to
afford the most essential relief ; in some, removing every symptom
of the malady in a few minutes. In order to ensure its fall or
specific effects on the malady, the dose of either preparation should
be gradually increased till it slightly nauseates the stomach.

" The author has added a concise account of the Chirayita herb,
the celebrated Indian remedy for indigestion arising from morbid
sensibility or nervousness of the stomach, attended with disorder
of the liver, a predisposition to gout, &c. which has lately been
administered in this country with great success in nervous or irrita-
tive affections of the digestive organs, after other stomachics and
the blue pill had failed/'

The profession is indebted to Dr. Reece, for the introduction of
some valuable medicines into practice, and from the high testimo-
nies in favour of these before us ; we strongly recommend them to
the notice of the medical practitioner.

11* Ascites cured by the external application of Digit dis.-^M. Rai-
sin has cured two cases of dropsy by friction with the tinctures of
digitalis and squills. One of these patients was attacked at the
same time with quartan fever and gastritis — in the other the dropsy
had resulted from abdominal inflammation. The state of the gastric
passages would not permit any of the stimulating remedies proper
to excite the secretion of urine, to be taken. M. R. had recourse
to the intraleptic method, which produced an abundant flow of
urine, and the ascites disappeared after a treatment of from two to
three months.

536 Bibliography.

M. Dan de la Vanterie has obtained a similar effect from the long*
continued application of the fresh leaves of digitalis bruised, to the
thighs and lower part of the abdomen. — Amer. Joum. of Med. Set.

12. Ergot of Rye as a Febrifuge. — Dr. Mehlhausen, of Deutsch-
Eilaw, recommends, in the 29th Vol. of Rust's Magazine, the ergot
as a remedy for intermittent fevers* In seven cases in which be
employed this remedy, five were cured. It must be confessed with
no great success. He gives the remedy in the dose of ten grains!
repeated three times in the two hours, which immediately preceded
each paroxysm. — Op. cit.

13. Arsenic in large doses. — We have received a communication
from R. Dakin, M.D. of Columbus, N. J. in which he states, that
he has employed, at the suggestion of Dr. Budd, of Mount Holly,
N. J. arsenic in large doses, as a remedy for intermittent fever, and
with great success. He gives it in the form of pill, in doses of
one-fourth of a grain, four times a-day — in one case he says he
gave as much as five grains in three days. He says that he has
never seen any serious injury result from these large doses.— Ame-
rican Joum. of Med. Sci.

14. Taste of Sulphate of Quinine. — M. Schweinsberg states in
Geige's Magazin fur Pharmacie, for Oct. 1829, that the best mode
of correcting the bitterness of the sulphate of quinine is not to mil
it with syrup, but with an aromatic powder. The sulphate of quinine
is so intensely bitter that a mixture of one part of this salt with one
hundred and sixty parts of sugar is still sensibly bitter ; but if one
part of the salt be mixed with ten or fifteen parts of powdered vale-
rian, fennel, aniseed, orange peel, &c. the mixture possesses scarcely
any bitterness.

CHBMI8TRY.

15. Analysis of Copaiba. — M. Gerber, of Hamburgh, has ana-
lysed the pale yellow copaiba, and obtained the following results :—
Volatile oil, 41 ; a brown resin insoluble in cold petroleum, 2.18;
a brittle yellow resin soluble in cold petroleum, 51.38; water,
5.44.

When the copaiba becomes old, it undergoes some changes,
according to M. G. ; a part of its volatile oil appears to be trans-
formed into a brown resin : thus the analysis of old copaiba fur-
nished with the following results: — Volatile oil, 31.7; soft brown
resin, 11.15; brittle yellow resin, 53.68; water, and loss, 4.10.—
Apotheker, Archives des torn. xxx.

16. Purity of Balsam Copaiba. — The best test of this, according
to M. Gerber, is the caustic ammonia, which furnishes at once a
clear solution, whilst the solution with potash does not become clear
until after some time. The addition of a very small quantity of
fatty oil, renders the ammoniacal solution immediately cloudy and
thicker. — Ibid.

[ 53T ]

MSDICAI* POLICE.

17. Respect shewn by the French Government to the Medical Pro-
fession.— An '• ordonnance" has just appeared conferring the decora-
tion of the Legion of Honour on MM. Rostan, Biett, LaUemand, An-
dral/fr, Chomel, and Barruel. Not many months ago several medi-
cal men in Paris were created Barons. The document above-men-
tioned is followed by a report from the Minister of the Interior to the
King, from which we subjoin an extract. " Medicine is at once the
noblest of the sciences, and the most useful of professions — neverthe-
less it offers but few resources to those who practise, or to those who
teach it. By the very nature of their pursuits physicians seem to be
in some degree excluded from the ordinary paths of ambition. It is
therefore just that the government should bestow upon them a large
share of the honours awarded to merit."

ARMY MEDICAL DEPARTMENT.

18. Aiterationsto the following effect have taken place in the Army
Medical Department : — All former rules and regulations respecting
the titles, rank, periods of service and pay of the medical officers of
the army have ceased; and the following are to be in force; — The
rank of Apothecary to the Forces, and that of Hospital Assistant
have been abolished ; the title of Physician to the Forces has also
been discontinued, instead of which, that of Assistant Inspector has
been established. The army medical officers are to be distinguished
by the fallowing ranks and titles ; Inspector General of Hospitals,
whose pay will be from 1/. 16s. to 2/. varying according to length
of service ; Deputy Inspector General of Hospitids, daily pay, vary-
ing under some conditions, from 1/. 4s. to 1/. 10s ; Assistant In-
spector of Hospitals, daily pay, from 19s. to 1/. 4s. ; Staff Surgeon,
daily pay, from 14s. to 1/. 3s. ; Regimental Surgeon, daily pay from
13s. to 1/. 2s. ; Assistant Surgeon, daily pay from 7s. 6d. to 10s.
The amount of pay between the highest and lowest terms, is in
proportion to length of service, which is fixed at the following
gradation ; — above 25 years actual service the highest pay, above
20 and under 25 years, above 10 and under 20 years, under the
lowest pay.

MBDICAL JUEI8PBUD1JTCE.

19. Agreeably to our promise, we subjoin a correct and original
report of the medical evidence at the trial of the notorious St. John
Long, which will be found more comprehensive than that of any
of our contemporaries. We think it unnecessary to insert the evi-
dence of the other witnesses, which differed in no respect from that
given at the inquest. There is much room for criticism upon the
medical evidence, but we leave the reader to compare it with that
given at the inquest. Had the witnesses been properly cross-
examined by the prisoner's advocates, no small discrepancy would

Vol. v. no 30. 3 n

538 Medical Jurisprudence.

have appeared, which, with the comments of Mr. Justice Park,
would have turned to no trivial account for the benefit of the ac-
cused. A worse defence was never made ; in fact, there was no
defence at all. On referring to page 259, it will appear that the
medical evidence was discrepant at the inquest, and, on perusing it
below, it will be found perfectly accordant. Again, the treatment
employed in Miss Cashin's case was the most inert, a feet that
would have afforded some palliation of the prisoner's crime. The
fact was, the prisoner had no fears upon the issue — he was intoxi-
cated with the support and patronage he received from the aristo-
cracy and gentry — an influence which had no small effect in a
quarter in which it ought to have had none. It had no effect,
however, on the honest and intelligent jury, who, to their eternal
credit, contrary to the judge's charge, brought in a verdict of guilty.
They could not have done otherwise, for it was as clear as the
meridian sun that the deceased lost her life by the gross ignorance
of the prisoner. On the announcement of the verdict, the surprise
of Mr. Justice Park, and of the nobility and gentry who sur-
rounded him, was extreme, it was confusion — worse, confounded.
The sympathy for " the gentleman at the bar," a convicted felon,
was great, and his sentence was delayed, which finally was decreed,
a fine of £.250, and thus ended the farce of " killing no murder."
In one short month the prisoner is found guilty of another man-
slaughter, and in consequence of the great public indignation, he
evades justice, though appearing at large under the eyes of the
civil authorities. Had he been a poor man, he would speedily find
a place in Newgate. It is clear, however, that his iniquitous career
is at an end, as it is beyond all doubt he can make no defence in
the case of Mrs. Lloyd ; and we are inclined to think that the
vox populi, will not be lost on the next judge who will try his

vOOCa

Trial of St John Long, at the Old Bailey, Oct. 30.
Before Mr. Justice Park.

20. B. G. Brodie, Esq. I am a surgeon. I went on Monday, be-
tween five and six o'clock, to the house of Mrs. Roddis, and saw
Miss Cashin — she was confined to her bed ; I examined her person,
and found her back very extensively inflamed — the whole of the
inflamed surface must have been as large as the whole of a common
plate, and in the centre of the inflamed part there was a spot as big
as the palm of my hand, which was black, dead, in a state which
we call slough or mortified— she was also suffering from incessant
sickness ; I was informed that nothing whatever would remain on
her stomach — I prescribed some medicine for her, merely to allay
the sickness — nothing further could be done at that time ; I ordered
a poultice to be applied to the back — I believe it had been poulticed
before ; I desired it to be continued — I thought her very ill indeed,
though I did not at that time regard her to be in such very imminent
danger as she was.

Medical Jurisprudence. 539

Q. Had you any means of judging how tbe place on the back
had been produced ? A. I should think some very powerful stimu-
lating liniment had been applied to the back ; I called at the house
on the following afternoon, and found 'she had died in the morning —
in her state I should think it quite absurd to administer a tumbler
of port wine — it was impossible it could stay on her stomach*

Cross-examined by Mr. Gurney. Q. When you arrived at the
house, and heard the young lady was dead, I believe you were per-
fectly astonished ? A. I did not expect her to die that day ; I do
not know that I expressed great astonishment — I saw the body ;
mortification had extended in the course of the night very rapidly
indeed — I did not examine the entire body.

Q. Is there a system among some of your profession of curing
disease by counter-irritation? A. It is very common; a blister
causes counter irritation.

Q. Will not the things which are made use of as counter irrita-
tion have different effects on different persons ? A. Yes, they will ;
I have known cases where a blister will not disturb the system of
one person, and produce very great disturbance in another ; the
bad appearance in this wound would not alter after death.

Mr. Phillips, Q. Are there many means which may be used by
professional gentlemen to check counter-irritation, if it proceeds too
rapidly ? A. Yes, there are, and they require to be used with
discretion,

Q. Would you think it right to apply to a person in perfect
health, stimulating liniments, which would produce such a slough
and sore as you saw on this lady's back ? A. Certainly not, and
I doubt very much whether any stimulating liniment, in com-
mon use among the profession, would produce the same effects—
the same extensive mischief; I mean by that to include the consti-
tutional and local effects ; the sickness and vomiting were as much
the effects of what had been done as the mischief — if the liniment
had not been applied to the back, there would not have been the
sickness nor the mortification.

Court. Q. Upen your judgment and experience, if a lotion of so
powerful a stimulating nature as to produce the effect you observed
on the person of the patient, was applied to a person of her sex
and appearance, being then in perfect health, was such an applica-
tion likely to produce a derangement in the system, and to produce
disease and danger ? A. I think it would, and it has fallen to my lot
to see another case, exactly similar, since.

Q, Is there much difference in the constitution of persons, so
as for the effect to be different, according to the constitution ?
A. There is — it depends on the constitution, the thickness of the
skin, and other things ; it is not uncommon to apply stimulants to
the chest, blisters, for instance — I never knew stimulants applied
where there were no symptoms of consumption ; I did not know
the young lady before — when I saw her there was a black spot of
mortification in the centre of the wound, which extended during the

MO Medical Jurisprudence.

night : the black spot itself was as large as the palm of my hand ;
wine would have been proper to administer if the stomach would
bear it.

Q. Why you say it was improper is on account of the stomach ?
A. The question put to me was whether a tumbler of wine would
be proper ; mulled port wine, administered in a proper quantity,
would not be improper, if the stomach would bear it — I was not
present at the post mortem examination ; the appearances I saw on
the back were quite sufficient to account for death — I can say
nothing about what produced these appearances, except from what
I was told by Mr. Sweetman, Mrs. Roddis, and others in the
house ; I did not examine the back after the body was opened — 1
saw a portion of the dead skin, which was taken from the back.

Dr. Alexander Thomson. I am a bachelor of medicine. I at-
tended at Mrs. Roddis' house, and saw the body of the deceased
there, stated to be Catherine Cashin, on the Sunday morning after
her death ; I examined the body, and the wound on her back-
producing a memorandum) this was not made by myself.

Q. Give us an account of the appearances of the body, as well
as you can, without referring to that ? A. I will endeavour to do
so, but it is not usual for medical men to recollect these things —
we commit them to writing. I have heard Mr. Brodie's evidence,
and concur in every thing he has stated, most certainly ; I went to
the tomb where she was buried ; I saw the same body there, as for
as I could possibly ascertain — it had similar appearances to the
body I had seen ; I had sewn up part of it — it had the sewing
up which I had made, and also the incisions I made.

Mr. Thomas King. I attended the examination of the body of
the deceased, at the Roman Catholic Chapel, Moorfields, on the
, 24th of August ; Dr. Thomson, and various other surgeons were
present — there was a piece of dead or disorganized skin, which we
call an eschar, (which Mr. Brodie calls slough) between the shoul-
ders, nearly the size of a crown of my hat ; the parts beneath the
skin were gorged with serum.

Q, What did the appearances you saw on the back seem to you
to have been produced by ? A. If I was to hold a piece of hot
iron about a quarter of an inch from the skin, it would produce
such an eschar — we examined with a view to discern if there was
any latent disease ; we discovered none whatever — I examined the
brain and spinal marrow ; the muscles were in a tolerably healthy
state — they were in a state I should expect after laying some time
in the tomb.

James Johnson, M.D. I attended at the tomb, and was present
at the examination of the body — the limbs and breasts were plump
and fleshy, and so was the body generally ; there was no appear-
ance whatever of disease, except where the wound was inflicted —
not of disease which could have preceded the infliction of the
wound ; I believe there was no disease existing previous to that —
there was no evidence of it whatever ; I examined the brain — it was
perfectly sound, and the spinal marrow was perfectly sound.

Medical Jurisprudence. 541

Croes^exainined by Mr. Sergeant Andrews. Q. Was. this on the
Sunday After her death ? A. On the 24th, the Tuesday week.

Mr. John Hogg. I am a physician. I examined the body of
Miss Caahin, with the other gentlemen, in the tomb at Moorfields
Chapel — I observed the appearances on the back very particularly ;
I have heard the evidence of the other, gentlemen — I differ a little
with Dr. Johnson's description of the spine, bnt I* agree in the
description of the wound on the back ; I Should have supposed it
was produced either by fire or gunpowder-— it had that appear-
ance.

Q. Can you conceive any state in which, in a healthy body, the
application of any thing which could produce such a sore could be
of service. A. Certainly not.

Court. Q. What do you not agree with Dr. Johnson about I
A. It struck me the sheath of the spine was discoloured opposite the
external wpund—^the inference 1 should draw from that was,, that
there must have been very great constitutional . disturbance en-
suing.

Q. Did ydu not state before the Cdroner, that not having been
present at the first examination, it was difficult for you to ascertain
cause of death ? A. I said so, and that violence done to the ner-
vous system was sufficient to cause death, particularly to a nervous
young lady.

Henry Goodeve, M. D. I attended at Moorflelds Chapel, and
assisted in the examination of the deceased — I observed the wound
on the back ; I could discover nothing but what must have arisen
from that wound, that could have caused her death — I examined the
brain and every thing \ I looked at her breasts and limbs — they
seemed, as far as I could judge, as if she had been a very healthy
person ; I would not have inflicted such a wound myself.

Prisoner's Defence (written.) My Lord and Gentlemen of the
Jury, — 1 am perfectly sensible, that in the situation in which I
stand, 1 should not benefit my case by the use of eloquence, even
if I possessed it ; I will, therefore, in few words, state simply and
truly all the facts I know respecting the unfortunate young lady
whose early death occasions the present inquiry. In August last,
Miss Catherine Cashin came to me, with her mother and sister, the
latter of whom was deeply affected with a pulmonary complaint,
and had, as they informed me, been given over by her physicians ;
the deceased was supposed to be afflicted with the same disorder,
and was, by her mother's desire, put under my care for examination
and cure ; the means I used, and the mode of treatment I adopted,
were those, by which, in the course of the last four years I have
been enabled, under God, to restore to perfect health a great num-
ber of persons of the first respectability and of high rank, after
their cases had been declared hopeless, and they had been given
over by some of the most eminent medical men of the present day ;
if the course of treatment by me in the case of the deceased hap-
pened to mil, it was a dispensation of Providence, which human

542 Medical Jurisprudence.

means could not avert — it was such a failure as frequently occurs to
medical practitioners of the first repute ; I utterly deny that 1 have
in any way been accessory to the death of Catherine Cashin— had
I no human feeling, no religious principle, my interest would pre-
vent me from purposely doing or negligently hazarding any thing
which could produce evil or even danger. In conclusion, Gentle-
men, I will add one observation — I know that whilst this case was
under discussion before the Coroner, and even since, the public press
has been employed in endeavours to create a prejudice against me—
even since the bill on which I am now being tried has been found,
the sulntance of it, with comments, has been laid before the public ;
I am sure I need not entreat you not to judge or decide from such
statements — I know you will be governed by your oath, and by that
alone ; but I intreat you, if possible, to dismiss from your memory
any thing you may have read or heard on this most distressing sub-
ject. Gentlemen, I now leave the case in your hands, with hope
and confidence ; an intention to do evil no one will impute to me,
and it will be for you to decide whether a medical practitioner, be
his skill what it may, shall be criminally answerable for a fetal
event, which he could neither foresee nor avert. I am to be tried,
not by any fancied system of justice, but by the law of England,
constitutionally administered — to that law I make my firm and so-
lemn appeal ; you, Gentlemen, will have it explained by the learned
Judge, and on his wisdom and your conscience, I place my firm
reliance. — Verdict — Guilty. Fine £250,

MISCELLANIES.

21. DISSENSIONS AT THE LONDON UNIVERSITY LETTER FROM

PROFESSOR CONOLLY TO THE EDITOR.

University of London, November 15th, 1830.

Sir, — I am sorry to be obliged to occupy any portion of your pages
with what merely relates to myself; but I think it proper to inform
you, that the account, given in a note at page 449, of your Number
for the present month, of my reasons for withdrawing from, and sub-
sequently resuming, my duties at the University Dispensary, is alto-
gether incorrect.

I do not wish to revive the memory of the only personal difference
with the Council in which I have ever been involved, and which has
now for some time been entirely set at rest'; but I am called upon to
add, that the assertion, in the same page, that the Council of the
University offered me the alternative of returning to my Dispensary
duties, or of resigning my Professorship, is utterly without foundation.

I am, Sir, your very obedient servant,

J. Conolly.

NOTICES TO CORRESPONDENTS.

22. We received a communication from Mr. Whitmore, in which
he states he had not attended the female, whose case we published
under the title of " Extraordinary instance of reproduction." We
have made inquiry, and find Mr. W. is quite right ; but he attended
immediately prior to the period mentioned.

Miscellanies. 543

In reply to " A Reader of the Medical and Surgical Journal/' we
beg to state, that we have fearlessly exposed the intrigues against the
medical attendants of His most gracious Majesty, while a Royal
Duke, and further to add, that with the exception of " The Lancet,"
no other Journal has noticed the subject. It would serve no useful
purpose to resume this topic, as the professional odium attached to
it can never be wiped away. We in common with all independent
members of the profession, deplore the existence of such conduct in
this enlightened age, and more especially that splendid services to
humanity, science and the fame of our country, should have been re-
warded with neglect and apathy ; but we can perceive no redress, no
source from which condign punishment can reach those guilty of
such unprofessional and base behaviour.

23. Mr. C. Bell has resigned his professorship in the London Uni-
versity This Institution is now placed on a firm basis, by the ele-
vation of Mr. (now Lord Brougham,) to the office of Lord Chancellor.
It will have a charter.

LITERARY INTELLIGENCE.

Dr. Epps will shortly publish an Account of the life of John Walker,
M J), late Director of the National Vaccine Establishment.

Mr. Curtis, Surgeon Aurist to His Majesty, has in the press a new
edition of his Treatise on the Physiology and Diseases of the Ear.

Communications have been received from Drs. Montgomery and
Cusack, of Dublin, Mr. Gregory and Mr. Swift, Dr. Tuthill, of
Halifax, Nova Scotia, Mr. Whitmore, Mr. Foote, Mr. Mitchell, Dr.
Stoker, Dr. Conolly, Dr. Alexander Thomson, Mr. Edward Browne,
and a Constant Reader.

BOOKS RECEIVED DURING THE MONfH.

1 . Dublin Medical Transactions ; a Series of Papers by Members of the Associa-
tion of Fellows and Licentiates of the King aud Queen's College of Physicians in
Ireland, 1830. p.p. 88. 8vo. Three plates. Dublin. J. M. Leckie.

2 Elements of Surgery. By Robert Listen, Fellow R. C S. in London and
Edinburgh, Ac. &c. 1831. 8vo. pp. 318. London. Longman and Co. Adam
Black, Edinburgh.

3. Medicine no Mystery ; being a brief Outline of the Principles of Medical
Science, designed as an Introduction to their general Study as a Branch of a liberal
Education ; 2d edit. By John Morrison, M.D. and A.B.T.C.D. 1834. pp. 165.
London, Henry Washbourae ; Millikin and Son, Dublin.

4. Cases, illustrative of the Efficacy of various Medieines administered by In-
halation, in Pulmonary Consumption, in certain morbid States of the Trachea and
Bronchial Tubes, attended with distressing Cough, and in Asthma. By Sir Charles
Scudamore, M.D. F.R.S, &c. Ac. 1830. 12mo. pp. 113. London, Longman
tad Co.

5. Pathological Observations, Part Third, on Typhoid, Inflammatory and
Symptomatic Fevers, with an Appendix, consisting of Cases to illustrate the Nature
and Treatment of Diseases. By William Stoker, M.D. Hon. Fellow of the King
and Qoeen's College of Physicians in Ireland, &c. &c 8vo. pp. 133. 1830. Dub-
lin, Hodges and Smith, and Millikin and Son.

6. A Practical Treatise on General or Partial Debility, either original or here-
ditary, or from Age, Dissipation, Residence in a tropical Climate, &c. ftc. or the
most effectual Means of preventing and curing Organic Disease, &c. by Diet, Ex-
ercise, and the Round Leaf Cornel, where a Tonic Remedy is necessary. By
S. H. Robinson, M.D. and others. Highley, London.

544 Miscellanies.

7. Disptitaoo Medica Inauguralis de Cyaanchft Tracoeali, Samuel Malins, An*
glua. Edinburgh 1830.

•#* A well written and able theses.

8. A Practical Treatise on the Anti- Asthmatic Properties of the Bladde<-podded
Lobelia ; with Directions, &c. By Richard Reece, M.D. Fellow R.C.S. &c Ac.

9. Cases of Cancer Uteri; with Observations. By W. F. tfoatgomerv,
A.M. M.B. M.R.I. A. £c.

10. Report of the WeJMey Female Institution. By Samuel Cosack, A.B.
M.B. Ac.

11. Farther Remarks on Hernia, io Explanation of the Nature of Strangulation,
and of Obliterated Intestine, and in Defence of View? and Suggestions towards
Improvement in the Treatment. By E. Geoghagan, M.R.C.S. &c. in a Letter to
John Aberneth) , Esq. Hodges and Smith, Dublin.

12. Case of Ovarian Disease of % remarkable Character. By W. F. Mont-
gomery, A.M. Two plates. Dublin, J. M. Leckie.

13. Description of a very remarkable Malformation m a Fcatns, in which nearly
all the Abdominal Viscera and the intestinal Canal were external to the Body. By
W. F. Montgomery, A.M. &c. Dublin, J. M. Leckie.

14. Report of the Coombe Lying-in-Hospital. By Richard Reed G cegory, Mem-
ber R.C.S. in Ireland, 4c

15. An Address introductory to a Course of Lectures on trie Principles an)
Practice of Physic, delivered before the Members of the City of London Medical
and Chirurgicai Society, By James Baker, Surgeon.

. 16. Lectures on Anatomy, interspersed with practical Remarks, Vol Second.
By Bransby B. Cooper, F.R.S. &c. 1830. pp. SOB. 8vo. S. Highley, London.

%• These Lectures are concise, minute, and excellently well written, and when
complete, will be exceedingly popular with students.

17. Appendix to a second edition of a Series of Observation* on Strictures, ft*
By R. A Stafford. 6vo. pp. 156. Loudon, 1880.

18. A Treatise on Pulmonary Consumption ; its Prevention and Remedy* By
John Murray. Small 8vo. pp. 136. Londbn, 1830.

19. Practical Remarks on the Nature and Effects of the expressed Oil of the Cro-
ton Tiglium, Ac. By Michaul J. Short, M.D. 8vo. pp. 64, 1830.

20 Remarks on the Disease called Hydrophobia ; Prophylactic and Curative.
By John Murray, F.S.A. &c. &o. 8vo. pp. 96. Longman & Co., 1630

2. A Short Tract on the Formation of Tumours, and the Peculiarities that Jare
met with in the Structure of those that have become Cancerous : with their Mo«le of
Treatment By Sir Everard Home, Bart. 8vo. pp. 96. Longman, 1830.

The various Periodicals, domestic and foreign, have been duly received.

ERRATA IN VOL. V.
Page 135, for " morbid anatomy," read " average mortality;" (< due charges,"
read " few charges ;"* " rubefacients," read " sorbefacients."

148, for " Dr. Real," read " Dr Reade."

*— 156, four lines from top, for " formerly," read " finally."
— — 164, twelve lines from bottom, for " quora," read " quinia."
— - 299, for "judicial anatomy," read "judiciary anatomy."

— 250, six lines from bottom, for "do means," read "no means."
356, for " Medical Logical," read " Medical Logic*

»»

All Communications and Works for Review are to be addressed to the care of
Mature. Underwood, 33, Fleet Street; or to the Editor, at his Residence, 61,
Hatton Garden.

%• Title and Index in our next.

INDEX,

VOL. V.

Page

Abdomen, excision of, for removal

of Foetal Bones - - - 172

Abortion, causes of fc - 510

Acites, cure of. by digitalis, exter-
nally - . " ' 5Sb
Accoucheur, Laws relating to - 315
Affection of the Heart, Mr. Dobson

on - - - - 306

Ague, Endermic cure of - - 164

American Journal, North, Reply to 82
Anatomy, Judiciary Remarks on - 220

, Morbid Vademecum of - 67

, Pathological value of - 191

Aneurism, Hunter, Guthrie, and

Waidrop on - 00

Animal Fluids and Solids, Dr. Stoker

on - - - - 110

Aneurism of the Heart and Aorta,

relieved by Moxas - - 73

Apparatus, extraordinary Obstetric - 67
Apothecaries' Company, regulations
of - - - 339

, abuses of - 227

, duties of,

towards Physicians - - 238

, unqualified
—- ■ i, penalties

against - 815
■, fees for at-
tendance, legality of - 321

', Irish Laws

- 329

- 636

relating to
Arsenic, large dose of
Argenti Nitras, use of, in Diseases

of the Eye - - -276
■, uses of, in Leucorr-

ha* - - 283, 289

■ , use of, in Gonorrhoea 290

Army, Medical Department, rules of 537
Artery, internal Iliac Ligature on - 73
Arteries, irregular distribution of,

Dr. Green - - 65
, Mr. Guthrie on - 99

Page

Asylum lunatic, defects of - 98

Attendants, Medical, of his late Ma-
jesty, intrigues against - - 852
Authors, medical Right of 332

Autopsies of French Kings - 160

Bath Warm, use of, in Delirium
tremens ...

Beale, Mr. on Deformities
Belladonna, use of, in Pertussis

-, use of, in Phthisis and

Neuralgia

-, Iritis -

162

338

ib.
ib.
85

Bell, Mr. Charles, Resignation of -
Bites of Serpents, efficacy of Mur.

of Soda in ...

Blake, Dr. on tubercular peritoneum 486
Blane, Sir G., Biography of - 836

Blood, preservation of* - 259

Bodies, Dead, Exhumation of, Law

on - - 335

Bones, Discharge of, per rectum et

vaginam ... 337

Botany, Mr. Castle on 339

Bright, Dr., Harvian Oration by - 75
Brodie, Mr., Evidence of - - 961

Burne, Dr., on Contraction of the

Intestines - - - 158

Caesarean Operation, Cases of - 300

Calculi, numerous, in Vesiculae Se-

minales, Mitchell Mr. on - - 401
Cancer, Pathology of Dr. Hodgkin

on - - - - 397

Carbutt, Dr., on Cure of Ague, by

endermic method - - 260

Carmichael, Mr., on 01. Terebinth

in Venereal and other Diseases of

the Eye - 281

Carson, Dr., on Animal Heat 247

546

INDEX.

Page

Cashin, Miss, Inquest on, Dr. Thom-
son on ... 406

Inquest on, Reply to

the Editor on the Medical 'Evi-
dence - 342
Castle, Mr. on Botany - - 388
Characters, Anatomical, of some

Adventitious Structures - - 397
Chevalier, Mr., on the Efficacy of

Quinine with Purgatives - - 75
Cheselden's improved Operation of

Lithotomy, Yelloley Dr., on - 400
Children, Genital Discharges of - 20
Chlorine, Use of, in Phthisis - - 891
Cholera, Searle Mr., on - - 177

Chorea, Cure of, by Cold Bath— M.
Dupuytren's Method - - 70

,"Dr. Ryan on - - 7 1

Cinchona, new Substitute for, Dr

Hancock on - - - 79

Coffee, Dandelion Root substitute

for - 176

Cold Bath, Use of, in Chorea - - 71
College of Physicians, Power of, to
suppress Quackery - 283 264

— , in Dublin - 326

College of Surgeons, power of - 322

in Dublin, power of - 328

Company of Apothecaries, new Re-
gulations of ... 339
Conduct, Profession in public and

private Practice, Remarks on 189

Onnolly, Dr. on Insanity - 92

Conquest, Dr., on Puerperal Inflam-
mation - - - 1

Consultations, Medical Importance
of - 141

— — , Propriety -of Apothe-
caries at ... 147
Consumption, Chlorate of Potass in 297
Copaiba, purity of 536
Copland, Dr; on Rheumatism of the

Ovaria - - - 08

Coroners, Medical, Contest for - 264

■ , Failure of - 353

, fees for attending, in Ireland - 329

Costello, Mr., on Lithotrity - - 76
Croton Tiglium, Short, Dr. on - 252

, Use of, in Hepatitis,

Gastroenteritis, Tetanus, Constipa-
tion, and Hydrocephalus externally
as an irritant - . 258

Court, Medical Appointments, Ex-
posures of the Intrigues of - 352
Cure of Nevus Maternus, by Vac-
cination, Mr., Marshall on 53

Dandelion Root substitute for Coffee 175
Deformities, Mr. Beale on - 80

Page

Delirium Tremens, warm bath in - 162
Derangement Mental, Mr. Footeon 129
Dewees, on Practice of Medicine - 89
Discharge Purulent from infantile

genitals - . ... 20
Diseases Chronic, Dr. Philip on 109
Disease, Symptoms of, inexplicable

by morbid appearances - - 189
Dislocations, treatise on - 261

Dispensaries, gTeat utility of - 140

— — abuses in - - HI

Dissensions in London University - 435
Distribution irregular of arteries,

Dr. Green, on # - - - 165
Divorce, Law on - - - 331

Dobson, Mr. on the Spleen - • 849
— , on affection and action of

the heart - - - - 305

Drop, Black, poisoning by - -128
Dropsjr, Pathology of, Dr.* Stoker, on 134
Drnggists and Chemists, rights of - 315
Dublin, Faculty of - - 326, 329
Duelling, Danger of attending, by

Medical Men - - - - 333
Dupuy, Dr. on the Autopsies of the

Rings of France - - - 150
Dupuy tren's Account of the wounded

during the Revolution in Paris - 335
Dysentery, Cure of, by Acetate of Lead

and Opium - - 250

Dysmenorrhea, Pregnancy in - 313

Ear, foreign body in, death - 525

Ecchymoses, on new bora children 516
Editor's Rejoinder to Dr. G. Smith 342
Eisdell, Mr. Defence of . 435

Elephantiasis, Dr. Tidy on - 165

Elliotson, Dr. on Diseases of the

Heart 380

■ on Pipirine in Ague - 70

Empirics, Petition of, J. D. Wil-
liams, Esq. against - -351

punishment of, by College

of Physicians - - - 175

Endermic Method, efficacy of 164—950
Ergot of Rye, efficacy of, in haemorr-

-388

-536

- -554

Ethics, Dr. Ryan on - - 136

Evidence Medical, at the inquest on
Miss Cashin, strictures on - 262

■ — rules of giving - - 344

Excision of poisoned wounds, new

proposals for - 73
Eye, 01. Terebinth, in Diseases of 139
, Venereal Diseases, Mr. Law-
rence on - - 269

, in ague

Errata in Vol. V.

INDEX.

547

Page

Eye, Diseases of, Gonorrheal, and
Syphilitic, Mr. Lawrence, on - 271

F.
Faculty, Medical etiquette of - 228—231

■ piety of - - 266

Fawdington, Mr. on Seton in Nevus 251
Fees of the Faculty, exorbitance of 223

of Physicians, Laws of -

Femur, disunited fractuie of, treated

by Seton -

Fevers, various theories of

Dr. Tweedie on - -

— — not inflammation

Hospital Dublin, Dr. O'Brien's

Report of ...
Mortality of, in London, Man-
chester and Dublin
— — , efficacy of blood letting in
Fevers puerperal, uterine phlebitis

- 74

474
209
200
201

174

208

205

Mortality of, in Paris, in 1829 17

■ treatment of -
puerperal, Dr. Conquest on -

■ cause of, M. ToneDe on
Fischer, J. J. Rev. on the cure of

156
1
9

Hydrophobia, by table salt
Fistula lachrymalis, new operation

for -

Fluids and solids, Dr. Stoker on

Foetus, malformation of, in which
nearly all the abdominal viscera
were external to the body -

. in utero, death of, from ill

cured syphilis -

developement of

- 49

148
100

- 390

28
507
signs of death of, before and
after delivery - - 514

Foeticide, signs of - - 515

■ objections to 517

causes of involuntary 519

Foote, Mr. on Intermittent head-ache 404
on poisoning by the Black

Drop

on Mental Disturbance

Formulae, unchemical defence of, by

Dr. Paris -

Fractures, treatise on -

of thigh, use of Seton, in

401
129

127
251
474

France, Royal Institute, proceedings

of ... 74

Fungus nematodes, formidable case

of .-. • 522
Medical Faculty of, fees of 226

Gangrene of lower extremity from
disease of the iliac and femoral ar-
tery - - - 457

Gannal, M. on inhalation of chlo-
rine in consumption - - 293

Page

Gastrohysterotomy, recovery from 172
Generation, organs of, diseases of 413
General Practitioners, society of 31 1, 352
Geo. IVth, Autopsy of - - 129

Geoghagan. Mr., on Hernia - 583

Gestation uterine, medico, legal ques-
tions relating to . . 435
Gonorrhoea, simple, produced by

numerous diseases - - 21

— — — — — secondary symptoms
from, Mr. Travers on - - 22

cure of, bv Mercury - 24

Gonorrhoea and Syphilis, identity
of, not a specific Disease - 20, 22

Nitras. Argent, best

Cure for - - - - - 290

— Arthritic Form of - 278

Graves, Dr. on gangrene of the leg,
phlegmasia dolens, from phlebitis,

457, 468
Green, Dr. on Irregular Distribu-
tion of Arteries - - - 65
Guthrie, Mr. on Arteries - - 99

Haemorrhages, Cure of, by Secale

Cornutum - 338
— from large Arteries,

Suppression of, by natural efforts

or slight pressure
Halford, Sir H., Exposures of, in

Court Medical Appointments
Hancock, Dr., on Cinchona
Handy v. Hension, Decision of
Hart, Mr., on the Action of the

Heart

Harty, Dr., on Purpura Hsemor-

rhagica -
Hawkins, Mr., on Hydrophobia -
Head-ache, Intermittent, Mr. Foote

on ----- -

Health Public, Offences against -
Heart, Diseases of, Dr. Elliotson on 880
— , Affection and Action of,

Mr. Dobson on - 305, 385

, Action of, Corrigan, Stokes,

and Hart on 384

Heat, Animal, Dr. Carson on - 242

- 104

352

321

- 384

174
75

494
333

Hermaphrodites, Law on
account of

330
404
533

Hernia, new mode of reducing
Hodgkin, Dr., on Anatomical Cha-
racters of some adventitious Struc-
tures -
Home, Sir E., on Tumours and

Cancer -
Hospital Reports, Dublin Reviews of 457
Hospitals, great utility of 140

Hospital, Norwich, Report of - 164

- 397

265

548

INDEX.

Page

Hospital, Opthalmic,St. Petersburg*),
Report of - 81

Surgical Edinburgh Re-
port of . . 525

— — ■ Richmond Dublin Reports

471, 474

, Royal Westminster Opthal-

mic, Report of ... 182

Houlton, Mr., on Protraction of Ve-
getable Life - - - 79

Hunter, John, correct Pathology of
Aneurism by - - - - 99

Hydrophobia, Mt. Murray and
Youatt on - 68

, Mr. C. Hawkins on - 75

, Mr. J. Kirby on - 880

~, Dr. Thomson's dissec-
tions in 479, 498

— » suggestions for the pre-
vention of 485

Hyosciamus, use of, in iritis . 280

I.
Iliac Artery, Disease of, Gangrene

from . 457

Impotence, Causes of - - - 413
Infants, Genital Discharges of - 80
Infant, Syphilitic, Cure of, by mer-
curialising the goat which suckled

it 257

— — , Death of, before and after

Delivery, Signs of . .514

Infanticide, Causes of .515

, Objections to Tests of .517

, Causes of involuntary . 519

Inflammation, Puerperal, Dr. Con-
quest on - - - - -1

, M. TonneUe on 9
Inglebv, Mr., case of fatal otitis, by 525
Innoculation for Vaccination, bar-
barous mode of performing 74
Inquest, extraordinary, at Hampton 431

— on Miss Cashin - - 261

Insanity. Dr. Conolly on - - 92
Insurance Life, Case of disputed,
on discrepant evidence of Sir E.
Home and Mr. Cline - - 268

Intermittents, Cure of, byPiperine 70

— — — , by endermic

method ..... 164

—■ — , by ergot of rye 536

- > Cause of, by inflamed

saphena . 457

Intestines large, Contraction of - 156
Iodine, efficacy of, in enlarged Ova-
ry and Uterus - - - 288
Ireland, State of Profession in
Irish College of Physicians and Sur-
geons, Laws of - 326, 829
Iritis, Syphilitic, Mr. Lawrcncs on 279

Page
, Depletion and Mercury in-
dispensable in - - - - 279
— — , Recurrence of, during mer-
curial ptyalim . . 473
Iron carb. no mode of preparing 388

Jackson, Dr., on Absence of the
Pulse .247

, on Varieties of Pulse - 424

Jewell, Mr., on Leucorrho?a 282

Johnson, Dr. James, depletion in
Cholera first proposed by - - 1SI

Journal. Medical and Surgical, Lon-
don, Address to its Readers • 83

, North American, recla-
mation of, Rejoinder to - - 82

Jury, complimentary Letter from, to
Dr. Thomson ....

411

King, Mr., on Neurology . 470

Kirby, Mr , on Hydrophobia . 110

L.
I^tbia Pudendi, Disease of - - 419
Labour, induction of, justifiable ho-
micide . .509
Lachrymal Sac, New Operation on 148
Lacing, Tight, injurious effects of - 413
Larrey, M. on Bronchocele 521
Lawrence, Mr., on the non-identity

of Syphilis and Gonorrhoea - 26
. , on the Venereal Dis-
eases of the Eye - - -269
, Traite sur !es Mala-
dies des Yeaux - - .373
Laws relating to the medical pro-
fession . . 312
Lead, Action of Water on - - 175
Lee, Dr , on Uterine Phlebitis and

Phlegmasia Dolens - - .400
Legitimacy, Laws on - 382, 502

Leucorrhcea, identity with Gonor-
rhoea - - " - - - 19
, Nitrate of Silver in - 282

■ of Infants - - 20

> , Pathology of - - 287

Liberty of the Press - - 358
Ligature Distal, to Aneurism, fal-
lacy of 102

■ on Internal Iliac, Dr.

Cramp ton on - - - 468

, Mr.

James on -

on the External Iliac, Dr.

Stevens on

Libel, Law on - - - 332

Life, Vegetable, Protraction of - 79

Literary Property, Protection of - 332

INDEX.

549

Page

175

631

ib.
47

260

Lightning, singular Effect of
Ume, chloride of in ozena
Lithotritv, Mr. Costello on -
Liver, Diseases of, use of Nitro-inu-
riatie Pediluvia in

, Cartilaginous State of -

Lives of Medical Men, insurable - 832
Lobilia inflate, use of, in asthma 585
Long, St. John, Killing no Mnrder

', Noble Dupes, Sup-
porters of trial at Old Bailey 537
Longevity, Cases of 885
Lnes ana Gonorrhoea, identity of 20, 22
Looatic Asylums, Defects of - 96
Luogs, Insufflation of - - - 73

Macbraire, Dr. on Nosology - 206

Machine, singular obstetric - 67

Machinery, specimens of, for de-
formities .... 39
Mackenzie, Mr. on diseases of the

Eye 861

Malformation, singular case of - 391
Manec, M. demonstration of nerves,

by . 470

Marriage, disqualifications for - 412
Marshall, Mr. on the cure of naevus

by vaccination - - - 53
Man-midwifery, notice of - 53

Matrons, jury of, absurdity of in

cases of abortion . 508

Mayo, Mr. H. on Menstruation

during pregnancy - 501

Martinet, M. on Therapeutics - 91
Medals proposed by Sir G. Blane - 358
Memoir of Sir G. Blane - - 856

Medical Men, laws relating to -314

■ remuneration of - 318

■ • beneficial distinctions

225

119
192

- 233

among -

Medicine, Academy of, in Paris, ac

count of
Medicines, action of on the body

' complication of

quack, immense revenue

from -

Medicine Forensic, Dr. Ryan on 233, 412
■ Practice, Dewees and Mar.

tineton - - 89

Malpractice of, Laws on - 315

Medicines, gratuitous, administration

of, violation of no law by 315

Medicine, state of, in England 813, 325
in Scotland - - 326

— in Ireland - - 327

in France - 537

Page
Menstruation, protraction of - 336

Mercury, use of in Gonorrhoea 31

specific for Syphilis - 35

Milk, of a syphilitic woman, effects

upon foetus - - ib.

Mil tfoil, use of in many diseases - 117
Mitchell, Mr. case by - - 401

Moles, remarks on - 497

Montgomery, Dr. on Ovarian dis-
ease ... 336
on Monstrosity - 390
Murray, Mr. on Hydrophobia - 66
— — on Consumption - - 117

Nevus, Mr. Pawdington, on - 207

cure of, by vaccination - 52

Nerves, tumours of ... 267

■ ■ demonstration of 469

Neuralgia, use of belladonna in - 388

■ Mr. Myers* case of - - 498

Neurology, Mr. King, on 470

Nosology, Dr. Macbraire on - - 216

O'Brien, Dr. on Fever - - 174
Offences against public health, law
on 833

Oil of Croton, Dr. Short on * - 252
■ danger from, in stric-

ture of the intestines - - 161

— — — turpentine in diseases of the
eye ----- 281

Ophthalmia. Mr. Lawrence on - 309

Purulent, Mr. Macken-
zie on - - . . 862

of infants - 863

Gonorrhoea!, depletion

in .....

While blood can be

procured - 274

Danger of this practice 273

Mr. Swift on 473

Opium, singular effect of 335
Organs, sexual, of the male
diseases of

— of the female -

Ovarian, diseases of

enlargement of, cure of

- 414

- 419
. 886

- 288
—— - rheumatism, cure of - 59

Ozena, cure of by chloride of lime 531

Paralysis of leg from disease of fe-
moral artery ... 457
Paris, Dr. on unchemical formula: 127
— on the effects of water on lead 175

550

INDEX.

Page
Pattison, Professor, charges against 445
Pertussis, cure of, by belladonna 388
Phlebitis uterine, cause of Puerperal

fever - 9

Phthisis, cure of, by belladonna - 838

bvcholrine - - 291

— - chlorate of potas - - 297
Pharaiacopseias Supplement to -117
Phlegmasia dolens, Dr. Lee on - 400
— Dr. Graves and Stokes on 464

109

285

280
840
384

320
321

3S6

70
297
891
337

ib.

407

503
368

687

130
155
247

Philip, Dr. on Chronic Diseases
Physicians College, Meeting of

Moral Statutes of

— — Licence of
— conduct towards Apothe-
caries - .

powers of

privileges of
■ remuneration of, law on

— — character, protection of •
— — — Irish, laws relating to -
Piorry, M. on Insufflation
— — on the appearances of the

tongue -
Pipirine, use of in agues -
Potas chlorate, use of in Phthisis -
Potter, M. on Consumption
Pregnancy extra-uterine

■ symptoms fallacious
— — symptoms, real discovery
of by auscultation .

duration of

Press, Medical, Liberty of
Profession in France, respect shewn

Puerperal Fever, Conquest, Dr. on
— — — — M. Tonnelle on
Pulse, absence of
— modifications of, Dr. Jackson on 424

Q.
Quackery in London, shocking

effects of . . 260

Quacks, trials of . .351

Quinine, substitute for . 74

Correction of, taste of . . 538

, efficacy of, with purgatives 75

Rape, law relating to . . 884

Read, Dr. new theory of Vision, by 148
Reece, Dr. on Lobelia Inflata in

Asthma .... 535

Remuneration of Physicians . 320

■ of Surgeons . 321

of general practitioners

of Apothecaries

Reproduction , extraordinary cases of 212
Respiratory Organs, remarks on 78

Page
Respiration, physiology of . 81

— — extra-uterine and vaginal,

proofs of .... 518

Rheumatism of the Ovaria . 58

Royal Society, report of . 76

Roupell, Dr. on piperine in Ague 70, 136
Ryan, Dr. on Duties of Medical Men

in questions of Infanticide , 516

— , Proofs of the Death of the
Foetus in Utero - - -516

, impossible to enumerate
Causes of 517

• , Tests of Daniel, Plocquet,

Schreger . . .517

— — , Fallacy of Hydrostatic Test 518
— — , on the involuntary Causes
of Death of the Foetus in Utero,
and during Parturition . . 519

, Dr. on Medical Ethics 39

, on the state of the Profes-
sion .223
— , on extraordinary Reproduc-
tion . . .812
— — , on Forensic Medicine — im-
potence . .412
— — , on Chorea . 71
— , on the Laws relating to the
Profession in the United Kingdom
, on Medical Evidence . 412

, on the Rights, Privileges,

and Immunities of Medical Men 813
— , on state and Forensic Me-
dicine . . 329

— , on protection of medical
character . .321
, on the state of the Profes-
sion in Scotland . . 326

, in Ireland . . 327

, on cases in which Medical

Evidence is required — liability ef
witnesses— duties due to society
and profession — reprieve—divorce
— legitimacy — duelling — public
health — rape — defloration — un-
natural offence . 330, 835
-, on disqualifications for mar-

riage — impotence and sterility,
various causes of, physical and
moral - - -413

, on reproduction — pregnancy
— signs of pregnancy — doubtful
sex — stethoscopic proof of preg-
nancy decisive . , 333
— — , on ambiguity of sex .494

, account of latest writers on 500

, on superfcetation, proofs of

. on duration of pr**gnancy—
legitimacy .503

, on abortion, causes of 510

— — , on delivery . . 513

INDEX.

551

Page

Ryan, Dr., on prolicide, foeticide,and

infanticide - • • 515

Rye ergot, febrifuge, effect of . 686

— , use of, in haemorrhages 388

Salicme, substitution of, for quiuiue
Sapbena vein, inflammation of,

causing ague . . 450

Sarsaparula, efficacy of, weakened

by Heat - - - 269

Scapula, Fracture of 464

Scirrhus. Pathology of - 308

Sclerotitis, Gonorrhceal, Remarks on 277

, may be combined with

Rheumatism ' - - 278

Scrotum, elephantiasis of - - 165

Searle, Mr., on Cholera - - 177

Secale Cornutum, use of, in Hae-
morrhages • - 338

, in ague - - 586

Seton, use of, in disunited fracture

of femur
Serpen: s' Bites, Cure of, by Table

Salt, Rev. J. J. Fischer on
Short, Dr., on Croton Tiglium
Short, Dr. on Strychine
Smith, Dr, Reply to the editorial
Remarks on the Medical Evidence
at the Inquest of Miss Cashin - 342
Society of General Practitioners, Ac-
count of - - - 811

of Metropolitan General

Practitioners - - 352

Prospectus of 79

474

- 49
252
524

-■ ■ ■ ■ J * tvwvvviivs w«

•, Royal, London, Paper on
Utbotrity, illustrated by Cases, by
Mr.Costello -

Medido-Botanical, Meet-

tags of, Lectures by Drs* Glendin-
ning and Whiting, and Mr. Houl
ton - - - 1

Soda, Muriate, efficacy of, in Ser-
pents' Bites and Hydrophobia - 49
Solids and Fluids, Dr. Stoker on - 100
Spider's Web, sedative effect of • - 256
Spillan's, Dr., Supplement to the

Pharmacopoeias, by - - 117
, on Action of Medi-
cines on the Living System - 119
Spine Deformities of, Mr. Beale on 34

, Mechanical Cure of - 86

Spleen, Mr. Dobsou on - - 248

•, Reservoir for the Blood after

Chylification - - - 244

Staphyloraphy, Cases of, by Mr.

Hon* - - - - 73

Sute of the Medical Profession in
Dublin, by Unus Quorum -306

Page

Statutes, Moral, of Royal College of

Physicians, Dr. Ryan, on - 80

Sterility, Causes of 413

Stethoscope, Use of, in Diseases of
the Heart - - 388

, in doubtful Cases of

Pregnancy - 407

Stoker, Dr., on Solids and Fluids - 100
— — — . on Dropsy - - 134

on Use of Millefolium in

Dropsy, Rheumatism, and Cuta-
neous L)ii

Stokes, Dr. Clinical Report of the
Meath Hospital, by

Strychine, use of, in amaurosis

SuperfoBtation, evidence of

Subjects, Anatomical and Artificial

Suppuration of the Joints, from Ab-
sorption of Pus, in Variola

Surgeons, Royal Colleee of, Power
of, to suppress Quackery

, Fees of, and Charges for

Medicines, Legality of -

— , Laws relating to
Irish, Charter of

110

457
584

500
66

- 242

821
822
888

Swan, Mr. Demonstration of the

Nerves, by. . • • 469

Swift, Mr. Clinical Report of Rich-
mond Hospital, Dublin, by 471
■ "■ on trichiasis •

■ onentropium . . 472

— — on iritis during mercurial
ptyalism • • ib.

- — on amaurosis • 478

on gonorrhceal opthalmia . ib.

. on disunited fracture of the

femur, treated by Seton . 474

Syme, Mr. on Excision of the Joints 585

Syphilis in an Infant, cured by mer-

curealising the goat that suckled it 257

and Gonorrhoea, identity of 22

in infants and in foetus « 28

Terebinth. 01. use of, in Diseases of
the Eye . .138

Therapeutics, Dr. Norton on . 01

Thetford, Dr. on the Cure of en-
larged Uterus by Iodine . 888

Thomson, Dr., Detail of the Morbid
Appearances as given in evidence
at the inquest of Miss Cashin . 408

•, Letter, complimentary from

Jury • *H

, Testimonials of . 406

-, Rejoinder to Observations

on his conduct at the inquest of
Miss Cashin -406

552

INDEX.

Page

ThomsonjrA. T., Professor, on the

Cure of enlarged Ovary . 288

Tiglium Croton, use of 262

Titley, Dr. on Ephantiasw Scroti • 165
Tongue diagnosis, from appearance

of . .Si

Tonelle, M. on Puerperal Fever of

Paris in 18*10 . .9

Tonics, effects of, on the digestive

apparatus, and circulatory system

Toy, Dr. Gastrohysterotoray, by 172
Transactions, Dublin Medical 385

, Medico Chimrgical,

Vol. XV. Part 11. .394

Travers, Mr., on the Pathology of

Venereal Affections . 19

Tumours and Cancer, Sir E. Home

on . • . • 265

Turpentine, oil of, solidification of 237

University, of London dissensions, in

85, 176
Expense of Education

, 35S

Mr. Bell's Resignation

•a v - •»<• 8ft'*

Memorial of Students
to, council of . . 445

Urethral discharge of in Infants 25

Uterus, adhesion of to the abdomen ;
gastrohysterotomy .172

, Enlargement of, Cure of by

Iodine s : • .288

Page

Wjetable Life, protraction of, rnrious

example of* by Mr. Houlton 79

Venereal affections, pathology of . 19
Venesection, use and abuse of in

Gonorrheal Opthalmia 273, 456

Vertebrae lumbar, tumour of . 5S0

Vision, new theory of . . 148

, restored by iigfatuing . 175

WakJey, Mr. Candidate for Ceroner 2M

Warden, Mr. on chronic and ano-
malous disease of the Liver w . 47

Wardrop, Mr. Operation ,for Aneu-
rism by, fatal objections to . 102

Water, powers of, in dissolving Lead 175

Web Spider's, sedative effect of -258

Willcock, Mr. on the Laws relating
to the Medical Profession . 233

Williams, Mr. petition of, against
Empiricism . . • 351

Witnesses Medical, Strictures on the
Inquest of Miss Casbin • SSO

— — — , Confidence in, in anvn-
mense number of civil and crimi-
nal proceedings . . 329

, liability of .330

-, cases In* which* their evi-

ihli %

dence is required

Wounded at Paris in the late Revo-
lution, account of . . 336

Wounds poisoned, excision of new
proposals for . . 73

Vaccination, barbarous mode of
inoculation for . . 74

, Universal Support of
Vademecum of morbid Anatomy 67

Vaginal Discharge of Infants . 20

Yellowly, Dr. on Cheselden's im-
proved lateral operation of Li-
thotomy . 400

Yeux maladies des traitl pratique,
par le Dock Lawrence, traduft
par C. Billard, D. M. .379

Youatt, Mr. on Hydrophobia . 08

OVTHRIS, PRINTBR, 15, SHOE LANE, VlKICT *T8YCT

THE

LONDON

MEDICAL AND SURGICAL

JOURNAL ;

CONTAINING

REVIEWS OF ALL NEW WORKS, ORIGINAL COMMUNICATIONS, AND EXTRACTS
FROM ALL THE MEDICAL PERIODICALS, DOMESTIC AND FOREIGN.

EDITED BY

MICHAEL RYAN, M.D.

Qmerere Veram. Hokacb.

VOL. VI.

FROM JANUARY TO JULY, 1881.

LONDON:
PUBLISHED BY RENSHAW AND RUSH,

356, STRAND, NEAR EXETER HALL.
1831.

LONDON :
Qtmiftll, 15, SHOK LAN!, FLKIT STRBH.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 81. • JANUARY 1, 1831. Vol. VI.

CRITICAL REVIEW.

I. — Dublin Hospital Report* 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 Kespiratory 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 u Diseases of the Respiratory Organs" in the 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. VI. NO. 31. M

2 Critical Review.

fy Tart, antimon. gr. vi. Aq. cinnamomi. $v. Syrupi, mucila-
ginis, a a 5i. 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 feet
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 Lsennec, 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 17th 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 Fn
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
hied 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
Bound, 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 pneumonia

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, we 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 Lsnnec, 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 Laennec 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 rehiedy 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 generally find, 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. We 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 iuflammation'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 f«ve# 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.

" 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 solidification* 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 was owing to the benefieial 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 Laennec, that in all cases of pneumonia the
bronchial mucous membrane is necessarily engaged in the affected
portion of die 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 pleurae. 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
petechia?, 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 turgeacence 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 affection 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, fcetor 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 fcetor 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 finders, 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 thd* 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 met, 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 Ithese
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 singularly
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 cf 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 met 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 would give in forming our diagnosis, and the protracted
and gradual inspiration either prevents or renders very indistinct

Vol. vi. no. 31. 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 exertiou 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
neglected, particularly on any exacerbation of the complaint.

The Dublin Hospital Reports. 1 1

" 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 added 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 examination ; 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.
Hie same observation applies also to percussion ; and the met 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 met, 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-

Eiratively small scale, when compared to the extensive
ying-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, we 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 graut,
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 mueh 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 Blender — 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, we 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. J ndeed, we can five 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,
M'Keever, 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.

buttons to science, and to all we say, " amicus Socrates,
amicus Plato, s£d magis arnica scientia." Having 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 farmer, so that we must give it in detail, as it attests
very practical points of considerable importance. The ooly
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 meaical 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
known 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
ako 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 perinaeum, 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 with, 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,
who 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
&&& 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-
rox9 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 was 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 convulsionsjwhile dressing for dinner, and in the course of twelve
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 scammonyby 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

daring 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 band 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 hcur-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.
Ih 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 thiiat,

vol. vi. no. 31. n

18 Critical Review.

redness of tongue, or white coating with florid papilla 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 everr in-
stance, the disease was so extensive as to engage all the soft parts
in the neighbourhood of the os uteri, evidently shewing thpt
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 lover
- extremities, loss of appetite, debility, and sallowness of the counte-
nance. They were treated with alterative doses of the pH. hydrar-
gyri, followed by mild saline purgatives combined with bitters;

The Dublin Hospital Repdrts. 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 upon 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 vesicae aad vaginae 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 turned towards
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.

20 Critical Review.

" In three instances, where it was employed in half drachm doses,
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.
Fains, 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.
Dashwood, 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
hourjs 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 Ios3 of blood, and was in a favoura-
ble condition till the seventh day, when, apparently 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. Th*

The Dublin Hospital Reports. 21

pain in the parts mentioned preceded the external symptoms of inflam-
mation, hut in a short time the joints affected became red and swollen.
The calf of the affected leg participated in the tumefaction.

" 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
*& 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 alk
covered with silver wire, as sold at the music shops. Bilk is con-
ceived to he 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 si
the place where the tumor was separated, and aH the farmer 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 ease 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
Hgature, in cases of polypus, is worse than useless, he conceiro
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 taming 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;

" 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 Boft; 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 simftar 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 Review.

on the point of death ; the face bloodless, extremities cold, poise 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 being 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 who 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 was 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 other.

" Some of the cases of prolapsus uteri were of very long standing ;
in no instance however was there any difficulty in the reduction of
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 shivering?.
pain in the abdomen, &c. She appeared as if quite run down 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
Medico-Chirurgical Society of London. 8vo. pp. 235.
Two Plates. Vol. 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. He 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
tbe ligature, and the tumour had decreased one inch. From
this day the tumour began to increase, and on the 12th had
equalled its original size, and pointed at its lower and outer
part. On the 24th the integuments were tense, shining and

Eainful, and the patient looked very ill. A consultation was
eld, at which it was determined to tie the aorta. The

Vol. vi. no. 31. b

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 was 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. T 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 aneurismdl nee-
dle through, and succeeded ; but when it reached the other aide 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

Medico*Chirurgical Transactions. 27

became flaccid) at the same time the patient complained of deadncss
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 tbe 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 of 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, was 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
Poupart's 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, Al.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, 1 828, 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 was
divided into two parts, in the line of Poupart's ligament.

28 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 nam. 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 mouths previously, but continued
at his duty until the 20th of May. He was treated aotiphlo-
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 Colles, 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 back 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 yellowish 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 below it. Nothing could be more easy

Medico- Chimr.gical Transactions. 29

than to pass a ligature xonnd an artery so ,situated. The* fane finger
of the left hand was passed under die artery, which with a little
management was easily separated from the vein ; and on the finger,
(which served as a guide,) a common eyea* 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 * 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 twenty- 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 die 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 roll 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 97°, 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, thrilfvery perceptible, no pulsation of the femoral
artery* the ligature came away — blood cupped and buffed*
v. s. ad. Jxij. 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 bad 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 popUteal aneurism was 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, —

" 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 pressing1 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

Medico-Chirurgical Transactions. 31

difficulties, however, might have been avoided, by getting1
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, <f whether,
under any possible circumstances, a surgeou 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 now 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 I have described in this paper, a ligature
could with great ease be passed round the abdominal aorta,
without interfering with 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 all 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. By
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 was the artery affected. The Woman

32 Critical Review.

was curecl of her disease, lived for ten years, and died of
a pulmonary complaint.

We shall uow 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.

The second is by Mr. Barlow, of Blackburn, on the suc-
cessful removal of a medallary 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. The 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 profuste haemorrhage and profound syncope,
that the patient (who was a female, aged 66), 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 oefore 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, whieh 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. — Cases illustrative of the efficacy of various medicines,
administered by inhalation in Pulmonary Consumption, in
certain morbid states of the trachea, and bronchial tubest
attended with distressing cough, and in asthma. By Sir
C. Scudamore, M.D. F.R.S. &c. &c. London, 1830.

We opened fhis 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 mase so gorgeous an appearance in thejtitle page ;
aud 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, " tnere
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 be
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, wnen the law shall compel bim 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. Jonn Long,
should he yet again be spared to his agonized friends, expli-
citly to disclaim all connection with any other house, except
m consideration of value receiv$d.

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-
ore 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. r

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, he speaks 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 bis glass bottle
in the sarcasm, which he has already levelled against Dr.
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 8 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. Scudaroore 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 all the
commentaries that criticism may offer. But we cannot help
thinking that the ungracious task which 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 tempora, o mores.

V. — Lectures on Anatomy, interspersed with practical
remarks. By Bransby B. Cooper, F.R.S. Surgeon of Guy's
Hospital, Lecturer on Anatomy, &c. &c: London, 1830.
Two Plates, Royal 8vo. Vol. II. 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 with 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 bow
lectureships are filled 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 be 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 kuow ledge 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 dicidealy 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 be
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 Ho Hard'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 ]

\l— Elements of Surgery. By Robert Liston, Fellow
of the Royal Colleges of Surgeons in London and Edin-
burgh, Surgeon to the Royal Infirmary, Lecturer on
Surgery, &c. : London, 1831. 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 Hargravb,
A. M. IVJ. B. T. C. D., Member of the Royal College of
Surgeons in Ireland, Lecturer on Anatomy, Physiology,
and Operative Surgery, &c. : Dublin, 1831. 12mo. 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 preparatory 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
be 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.

tics 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 bums. 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 prw-
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 tbe
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 b
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
tne best possible companion for the Dublin Dissector. It
ought to De 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. — First Principles of Medicine. — By Archibald Bil-
ling, M. D. Fellow of the Royal College of Physicans, Lec-
turer on the Theory and Practice of Medicine, and on
Clioical 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 see'ms 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 lxmdon 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 raedica 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 tne 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 positiou, 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 however 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 cto, 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 law, 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 power of
protecting and regulating the rights and interests of its mem-
bers, and die 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 sanc-
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

Dr. Billing on First Principles of Medicine 41

to these observations, it affords us much pleasure to state,
that- Dr. Billing has rendered the student cf medicine an
essential service, by this interesting and instructive volume?.
We strongly recommend, not only the perusal, but the
study ot it, to the student and young practitioner, and even
lo 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 wo enter-
taiu 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
bones — recovery. — By Richard Tuthill, M.D. Assistant
Surgeon to the 52d Regiment, Halifax, Nova Scotia.

Daniel Caiaaghan, est 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 driveu 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 the anterior part of the parietal, and the adjoining part of
the frontal bone; the former was attended with considerable
laceration of the scalp, 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-

Vot. vi. no. 31. n

42 Original Communications.

tance of half an inch from one another, and immediately af-
terwards he wrs 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 often 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 Fa den, at 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 was
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 were 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 ira*
subdued, and his natural senses were restored. A short rime
after the operation had been performed, the brain put on a

Dr. Tuthill on Fracture of the Cranium. 43

morbid action, and portions protruded, varying 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 protusion 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 were 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 heu's egg, protruded, muttering delirium began in the
evening1, 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 tne cerebellum. No other morbid appearances
were discovered.

44 Original Communications.

III. — Case of Cesarean operation.— By John Sttouno, Esq-
Halifax, Nova Scotia, communicated bj Dr. Tuthill.

Sarah Munn, aged 42 years, of the height of four feet only*
although the head, neck, and trunk, a9 low down as the os thorn,
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 seveu
yeajrs, was married in the year 1822 ; in the month of July,
] 823, 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
vertebra 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 was 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 severs 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, m
the year 1826.

In the month of May, 1828, she informed me that she was
again pregnant, and I endeavoured to persuade her to permit

Mr. Stirling on Cesarean Operation. 45

me to use mechanical means to produce abortion, which ahe
declined.

About three months afterwards, she had an attack of pneu-
monia, which yielded to the usual mode of treatment, aince
which time she has enjoyed pretty goedhealth, with the excep-
tion of some febrile attacks occasioned by the pain andirrttat ion
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 t be osuteri was loose and 9oft,Mgh up above the
brim of the pelvis, and. about one and half inches in diame-
ter, the belly was pendulous, being projected wholly before
the os pubis, pulse 90. On Monday, at two, p. m. the os
uteri wasnearly dilated, the membranes gave way, andthe 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 farts
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 madical practitioners was
called at seven o'clock, p. no. when it was the general opi-
nion, that an attempt to extraot the child by embrynlcia
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 tod been
opened in the morning by a dose of castor oil, and at four,
p. m. an euema was thrown up, which emptied the large intes-
tines. The room was heated to about 900, the patient placed on
her back near the foot of the bed, and a broad swathe fixed
loosely under her. The operation was commenced by an inci-
sion, Deginninga 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 hare 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 ibe
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 wsis 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 abort 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 quantitv.

Dec. z3. — 1(3, 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, rave 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 ; duriug the
night there has been a considerable discharge of bloody
sanies from the lower part of the wound, 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 from bowels, 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. *»•
has not vomited since noon, pulse 140, thirsty, feels inclined

Mr. Stirling on Casarean Operation. 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 nignt, 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 fsecal 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 Soft Parts

removed. not removed.

In. In.

Short diameter from projection of
sacrum to the symph. pubis 2. 1-1 2th l£

Long diameter of ditto .... 3^ 3 6-8ths.

Projection of sacrum to the point of

the os coccyx 24 1 J

From ischium to ischium . . . . 4J

From arch of the pubis to the re-
motest part of the sacrum in the hol-
low • . . 2§ 2£

From superior spinous process of the ilium
to the other 8J

Whole height of the body . . . 4ft. £inch.

6th Oct. 1830,
Halifax.

}

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.)

Joan K&tftKSY, aged 70, of active habits, and enjoying good health,
was admitted on tke fomrth 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 metacarpophalangeal 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 tbe
metfian serve, which supplies the outer side of tbe thumb, and then
proceeds up the fore arm j pain periodical, and brought on by trifling
causes j soreness- felt on pressing the spines of the second and third
cervical vertebra?, and over the roots of the brachial plexus, The
principal uneasiness referred to the limited spot oa tbe 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
m 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 ulnark 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.

7 th.— 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 vertebras, which are tender on pressure. Habt. ext
ricutse, gr. ij. opii granum in pil. 6 tia. horis.

9th.— Slept better last night, and feels less pain.

I lth.— -Attacked on the preceding night with severe paroxysms of
coughing, attended with difficult expectoration, perspiration, and
tendency to syncope. Emplast. vesicat. thoraci. R. mist cainph.
Jvi, spirit, aether, oleosi Ji. sumt. g ter die.

12th. — Passed the night badly ; cough and weakness, as on the
last night ; the blister had fallen off his chest. Hab. empl. vesrist
inter scapulas — enema terebinth — fovr. pedes.

Mr. Swift's Clinic Reports. 49

14th.-M\ilmonary 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, Bj* a apulv. ipecacuanha;, gr. x in pill x ij divid .
atimat,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.

... . ■ ,

JamsbLaitbbnt, aged thirty-eight, admitted on the 4th of August,
witii considerable enlargement of the spleen, extensive disease of the
cervical and axillary glands, acute mflammation 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,
oedema 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
feats 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: \faile 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 hypochondriunu 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,
magnesia? usto J$j ; sumat Jj ter die. 5j °f the ung. hydrarg. fort, to be
nibbed 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
rapped on the knee.

Uth. — Right knee relieved by the cupping ; complains now of the
left, and of severe pains in the ankles ; gets no sleep at night. 5i»s

▼ol. VI. no. 31. G

50 Original Communications.

of tinct. opii to be added to his oolchicum mixture, taut
anodyn. h. 8.

15th. — No diminution of the spleen ; diarrhoea, with griping ; severe
pains in the knees and ankles ; great prostration of strength. Haost
olei ricini tinct. opii m. x. x— omit ung. hydraxg.

23d — Pains as before; diarrhoea still continues. Haost. rhd
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 diarrhea
almost immediately.

11th. — Has been placed under Dr. M'Dowel's care, who ordered
to have the left knee, which was swelled and very painful, copped
to Jx, 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; alight
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 sinistra.

17 th. — 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— Extimct cicntie, gr. ij. o. n. et m — to omit
his other medicines.

20th. — Diarrhoea checked ; pains in the knees better; sleeps badly;
to repeat his medicineB 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

[i-ung. hydriod. potassse, 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; stiimes
nearly gone ; moxa to be applied over tie inflamed tumour, near the
clavicle.

18th. — Going on well ; inflammation arrested by the moxa, tamoa?
in the splenic region " much lessened."

yi.—Vesico-vaginal Fistula, successfully treated by actual

Cautery.

The patient, a young married. woman, was delivered of her fin*
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 liberated 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 aas 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. — SypUoid Gonorrh€ea,aPapukjr eruption, Chare. — Peter Gaffhey,
aged twenty, was admitted on the seventeenth of September, with,
papular eruption, disease of the lympjhatic 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 urinse. 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 aa soon as the eruption was fully
established. He had also, about ihe 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 t
flcabs, 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 lymphatic glands improved ; he left hospital on the

20th of October.

52 Original Communication*.

VII. — Case of fatal Peritonitis in the last month of Utero-
gestation. By Samuel Malins, MJ). 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 chesty
and from whom she had received some aperient powders. The com-
mencement pf 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 foil
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 tune
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.MaliD8 on Fatal Peritonitis during Utero- gestation* $3

enema, without any mitigation of the pun. The parent 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 pf 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 fmtus 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
epigastrium 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 lor
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, ajja. 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 hippoeratic, 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 thia
condition, tiU the supervention of low muttering delirium and con-
vohuona 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 miaolfcs, or where it is expanded over the uterus and

54 Original Communications.

reflected, around the large and email 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 hgaments and ovaries were disorganized and ma 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 parietesofthe
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 decldua, 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 mption of the epigastrium.
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 widen the
abdominal uneasiness and soreness had been calm, when not tfeduced
by her forced and unnatural exertion, pretty constant. The i*e of
this woman, it should have been noticed, was 83, and she had three
children living. Her habit of body was delicate and weak ; afitf
the: digestive' functions bo 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'
case, that the inflammatory process- wae proceeding during the whole :

Dr.Malins on Fatal Peritonitis during Utero-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 1 1s 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 fron\ 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 die possibility of a latent or sub-acute inflammatory
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 fe preference to any other period ! for the knowledge of neither
the pattafet herself, nor of her friends could supply us with any
unusual chwanstance to be adopted for, or tortured into an exciting
cause. ^ . .

Rejecting the possibility of inflammation existing so lor ^ without
evidences of its presence, by more than transitory Abdominal
pains, how, it may be vfeked, 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 certainty 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 was 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 tit the brim of the pefrfe,
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*
tun*, both of which were unjustifiable, by forcible dilatation of the
oa 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 writera, in all' countries ; and still more ob-
jectionable for the extraction of a dead infant. Again, was not gas-
trotoiny 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 degtee. 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 fetal
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 0/
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 rubefacient— 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 folly justified by the evidence afforded by

Dr. Malms on Fatal Peritonitis during Utero- gestation. 57

the dissection. Jt 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, and its 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. 4661 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
candidua imperti, si non, his utere mecum."

vol. IV. no. 31. i

[ 58 ]

VIII. — Hydatid of Liver and Gall Bladder.

London Hospital. — Enlargement of the liver extending
into the pelvis, hydatids, fistulous opening from the
gall bladder into the bronchia.

Sarah Manning, «t 35, widow, had never borne children, was
lately admitted into the London Hospital under the care of Dr.
Billing ; had complained for three yean 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 aide 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
gall duct into the duodenum was not obstructed. The other
viscera were healthy.

Dec. 18th, 1830.

[ 59 ]

IX. — Medicolegal questions, relating to Infanticide.

By M. Ryan, M.D.

Death of the fcetus from voluntary causes. — The new-
born infant inay be the victim of external violence wilfully
inflicted upon it, and it may- also perish by 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.
Jt is difficult to determine what thermometrical degree of
heat or cold would destroy life in these cases, but if we
find the bod v 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 ratal haemorrhage ; but this i* 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 salve 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,
the 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 nnfrequent,
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 vertebra. — When death is
produced by luxation of the cervical vertebrae, the ligaments
of the vertebra), will be torn, the spinal marrow will be
bruised or torn ; ecchyroosis, 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
facte in mind, in determining questions of infanticide from
such injuries.

Torre f action, 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 1 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 born 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
as 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 froenum linguae, the

62 Original Communications.

ecchymoses of the neck, the marks of injuries upon the
chest, and in the interior of the month, 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, mnd the similarity of the fluid feud
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 primipartius. 1
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 k
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 iti 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
laud 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 thi3 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 casein 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 tethe 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 eaHy as the third
day in warm weather (Beqk*)« r>.„

It ii 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 Jungs 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, Bxperimentorum
Doceraatiam .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 Browne, F.L.S. Surgeon to the Parringdon 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 fcet, 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-
versity 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 jperceive 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 vest satisfied
wkh 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 knowledge. This the world will expect* this year
profession has a right to demand from you ; for h affords yon 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, hide-
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 ef 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 making 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 0/
natural knowledge is implied in the very name of the physieisn.
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.
1 am not aware that the philosophy of the human mind has yet

Mr. Browne's Lecture on Natural Philosophy. o7

been made a separate article of medical education, but the reference
which must be made to the subject in die 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 " quern Deue
vqjtperderej 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 pi 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 natuwi
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 ufe 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 P
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 suUimary pur-
poses— die 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 hie
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 wiU 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, lira*
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, ft 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, *e
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 cunge, 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 ra|>id 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 Rother-
hithe, will yet, at no distant period, be carried to a triumphant
termination, in despite of the untoward circumstances which. hav.e
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 criaracter, 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 ^level 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
kl 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 rampart*
were left undefended, the Romans entered the city, surprized and
subdued the inhabitants, and slew the philosopher in his study, is
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 be was 50
transported with the feelings excited by his discovery, that he
instantly sprung from the water, and rushed home unmindful of his
nakedness, exclaiming, Bop?**, Evpn**, 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
pi Syracuse, with a quantity of gold, for the purpose of making a
crown, purloined a part Qf 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. Soch
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 j 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. Id &e first tfee genius of Wollaston has provided tk

Mr. Browne's Lecture on Natural Philosophy. 7\

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 chemical 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 ohanges
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 f 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 die 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 physios, chemistry and life. But although some of the vital func-
tions require the aid of chemistry for their illustration, there are others
in which physical and vital action only is concerned, as in the perform-
ance of muscular motion, and some of which are referrible to natural1
philosophy alone. 1 would recommend the study of these to you, in
the eloquent language c4 Dr. Arnott, as far more effective than any
persuasion which 1 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 Bibliography.

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 bejaware
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 1 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 die 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 forour mathema-
tical and philosophical instruments, it cannot be denied, thatitisat 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
took 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, alasl 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 do
not understand. Would you learn the extent of the benefits which
may be conferred upon suffering humanity by this means ? 1 refer
you to my esteemed colleague Mr. Costello, who has had the boaow
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 Prance, and thus saving the patient from the honors 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 eaU 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 calcinating 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 subjecta
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 parte 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 whicn 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.

SURGBRT.
HOSPICE OB LA PITJB.

2. Cancer of the Nose— Extirpation.— G , aetat. 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 watched4 the cm*
for some time, M. Liafranc, who was of opinion that it was *

Surgery. 75

ease 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.

HO PITA L BBAUJON.

3. Fracture of the Neck of the Thigh-bone 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 alight 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 faeces, 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. Hie fragments were about three lines
distant from each other ; the extenuu fragment being drawn upwards
and outwards.— Xa»c. Franc.

HOPITAL OB LA PITIB.

4. Lithotomy. -+&—- -, setat. 60, of a feeble constitution,- had,
daring the last nine years, been labouring under symptoms of stone
in the bladder. Being admitted at the hospita) under the care of M.
Velpeau, lithotrity had been tried, but without success ; the stone
being very mrge, 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 oral
form, two inches and a half %i 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 Mad-
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.

Midwifes t.
Hotel Dieu.
5. Obliteration of the Vagina. — Angel. Andre, aetat.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 nymphae, 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 ;'f 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 1 Oth 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 oat by
the injection of warm water, a further examination of the parte 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

uteri 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 canuk 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
iii 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 modern

78 Miscellanies.

walks on Botany and Materia Medica, Hyoadanas Niger I assert
is a biennial plant, and is in a fit atate for medical purposes in the
second year only of fa duration, when in flower, or according
to the excellent general rale of the Royal College of Physicians
" postquam {lures expassifuerwt; tt mUsqwam semma wtwrtssmti"—
The leaves at this period differ very mock from those of the first year,
their season ia generally from tie beginning to the end of Jane,
they are caulme, sessile, very clammy, and foetid, containing a large
proportion of extractive matter. 'Hie leaves of the first year are
plentifully brought to market in August and September ; they are
radical, petiolated, having very little clamminess, or footer, 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 Buffered 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 1 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 dandelidh, 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 EECBIVBO DURING THE MONTH.

1. The Works of Willis* Cullen, M.D. Professor of the Practice of Physic iri
the Univereiiv 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 Medlca Edited by John Thomson, M.D.
P.R.S. L. And £. Lecturer on the Practice of Physic, consulting Physician to the
New Town Dispensary, and late Regius Professor of Military Surgery in the Uni-
versity of Edinburgh. la 9 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 equaUea.

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 Formula) 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 Formulas 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 formula 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 ;
ana on Clinical Medicine ; and Physician to the London Hospital, &c. &c.
London. 1881. 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, Ac. 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-
torer 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
AveriU's 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, Ac &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.8t.
Longman and Co.

7. The Dublin Hospital Reports and Communications in Medicine and Sorger? .
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. 1 881. 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 sen?e, 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. 8vo. 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 bnt
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. 18S-J
8vo. pp. 44. Simpkin and Marshall.

*«+ These LectuTes'abdond-Vkh important information.

If. The London University Calendar for the Year 1831. London. 1S3I.
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 religions
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 Annual*
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 Letler-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 ;" i€ cochianosology," ****
" lochianosology ;" "cunes," read "lacunes;" " ovrager," read
" ouvrages." In article " On Signs of Utero -gestation," in our lasi,
page 4S8, 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, &>
Hatton Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 82. FEBRUARY 1, 1831. Vol. VI.

CRITICAL REVIEW.

I- — A Supplement to the Pharmacopoeia, and Treatise on
Pharmacology in general, including not only the drug*
and preparations used by practitioners of medicine, but
also most of those employed in the chemical arts ; to-
gether with a Collection of the most useful Medical For-
mulce, 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 Book of Formula
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 Formulce 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.

II. — ^4 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 Pharmacopoeia of the Veterinary College,
patent medicines, perfumery, paints, varnishes and simi-
lar articles, kept in shops, with their compositions, imi-
tations, adulterations, and medicinal uses, being a
general book of formula and recipes, for daily reference

Vol. ti. no. 32. *

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 Queen's Col-
leges of Physicians, &c. ; and William F. Montgomery,
A7M.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 Ihomson, 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 we 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 worthy 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
3j. as an 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
Kasori, Borda, 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 ; — <f Prussic
acid is a tonic and antispasmodic," oxalic acid is refreshing
and slightly diuretic, in doses of ffix. to tnxx. 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 Review.

been measured by the minim glass, and also the first tine
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 $j. into 5ij.
of water, in fistulas, venereal sores, scrofulous, ulcers, &c. f
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, hematuria, and inflammation of
the bladder and urethra, which ought to' be treated with
warm bathing, fomentations, and emollient drinks.9' Those
engaged in medical practice, scarcely ever observe effects
requiring warm bathing or fomentations. Among the many
good qualities of digitalis, it is prescribed " 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 siphilis and
cutaneous disorders." The dose of hydriodate of potas is
stated, but no disease is mentioned. " Liquor opii sedati-
vus is imitated by mixing 3iss. of opium with Jvx. of pare
water, and 1\. 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

Ren nie'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 lungs, 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 tjie 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 with 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
potasses 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. " 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 corriutum 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 5j. 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 Reviem.

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, " 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 whicn he so often alludes in the work before us,
is replete with errors ; in some parts we have observed the
3 for the 3, 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 homes, confections and cos-
serves, syrups, inspissated juices, extracts, powders, pills,
electuaries, ointments, plasters, extemporaneous prepare-

Barker and Montgomery on Pharmacopoeia. 87

lions, and miscellaneous "preparations, is consigned to Dr.
Montgomery. Dr. Barker, as an experienced physician,
and Professor of Chemistry, in Trinity College, Duolin, 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 me 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 lie 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 18*24.
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 . with die first
portions of vaporized compound. For this reason we ore directed to
reject the first portion, or of the whole fluid employed one tenti jart,
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 en-
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 molt ; for which reason
the vinegar of wine is directed W 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 paifc 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 tree from cmpyreuma : it was therefore thought ad-
visable to increase the propoirional quantity to be d» stilled over, leav-
ing a smaller residue in the retoic, and rendering 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 be detected by the addition of water impregnated
with sulphuretted hydrogen, and by a solution of sulphate of soda :
the first' of these reagents producing a brownish coloured precipitate
of sulphuretof lead1, the second a white precipitate of sulphate of
lead. Irbn 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 eaiths and with the oxide of lead; but with
protoxide of mercury, a salt of sparing solubTty.

" Viriegar is often adulterated by means of sulphuric acid. This
may^ be detected by the addition of a baiy tic spit, which will afford a
precipitate insoluble in nitric or muriatic acid. This impuilty 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 bar y Lie 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-
dissolved 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. u

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
oi 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 tia.

" 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 cylinder;
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 sol-
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 unfirequently 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 bolls 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 carbonateof
lime or dry carbonate of soda required to neutralize a known weight
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 3
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; ofpotassse acetas, sodas acetas,
hydrargyri acetas, plumbi subacetatis liquor, and in the preparation
of the compounds included hi 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-*
ftammatory 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
act 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*
barbs of Edinburgh.

" Its fumes disengaged from nitre by strong sulphuric acid, are
apposed efficacious in destroying the contagious effluvia of typhus or

92 Critical Review.

other febrile diseases. Dr. Gaimichael 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 nitroi"* 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
f Ames can scarcely be brought *nto contact with clothes shut up in
drawers or boxes, or with the interior of Deciding, and to such arti-
cles contagion is supposed, and with a high degree of probability to
adhere. 1 hat 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
poweiA'1 action, and completely alters their chemical qualities. But
although we should concede to nitrous fumigation the power of di-
minishing contagion, its superiorly over ventilation and cleansing is
by no means estab'/shed, 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 tHs practice should be preferred to ex-
cision, expexience rone crn decide, for on its first application it may
accelerate the abFciption of the poison, and in this respect prove
rather injuiious tb^a serviceable." — p. 52.

The following remarks on prussic acid are highly im-
portant : —

•* Prussic acid.— Take of cyanuret of mercui/, ?i ounce, muriatic
acid, by measure, seven drachms, water, by measure, eight ounces.

" Distil into a refrigerated receiver, eight ornccs 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 d "stil-
led water, as 99S 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 retoit, and as the residual liquor cook, de-
posits its usual spicular crystals. The changes which take place in

Barker and Mon toraery on Pharmacopoeia. 93

lis instance, and the atomic quantities transferred, are represented
in the following scheme : —

Materials.

1 Mercury

2 Cyanogen

= 200
=* 52

2 Chlorine
2 Hydrogen

= 72
= 2

1 Bicyanide of Mer-
cury

= 252

2 Muriatic Acid

« 74

Products.

2 Cyanogen
2 Hydrogen

= 52
= 2

1 Mercury

2 Chlorine

= 200
= 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 gre.

*' Ail experiment was made in which equal weights of cyanuret
(bicyanide) of mercury and muriatic acid were employed. The
prussic aoid 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*
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 leas 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 red
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 nea-
sure, of this add, 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
prosaic 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 an 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.

" U$es. — Pharmaceutical. It is not applied to any pharmaceutic
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 prescriber 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 cemcs 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
exeited 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 bail-
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.

" Base. — 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 formula?
for the preparation of tartarized antimony, and proves
sattisfoetorily tbat the Dublin method is preferable to every
other. Hi« comments on this article occupy six pages, *nd
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 hare
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. Tbe
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, ft
is decompounded by infusion or decoction of bark ; and Orfila recom-
mends this also as an antidote to its effects. Dr. Duncan tried vith

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, hut in general
much below this quantity, its action is sedative ; hut in these large
doses it should he 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 -
num. The decomposition which takes place in its solution in conse-
quence of the absorption of carbonic acid from the atmosphere, may
he 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. ho. 32. o

98 Critical Review.

votary of science, he has avoided all personality, and merely
contented himself by defending the principles maintained
in the pharmacopoeia, which he assisted in preparing.

He lias displayed no special pleading, but a truly sci-
entific view of every subject he nas 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
Lis 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 opiuions of his venerable predeces-
sor, Dr. Percival, will be exceedingly agreeable to bis 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 Cassar what belongs to Caesar. We have not the
honour of Dr. Per rival'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 Dest
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 Geoftroy, 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, h appears that it is not
identical with the jatiophic 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 die 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 rail 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 $u.

Aqua? distillatae Jss. 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 some diluent." A drop may be given on a lump
of sugar : but where there is no dislike to oil, one drop of croton ofl
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 takeil 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 liis 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. Gaventou 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.

■• Do$e. — FYom 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.

" 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 may 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 HiatilKng 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; externally 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 rail; 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. Gheyne, in his essay on gout, recommends it
as a specific in sciatica; a commendation which, unfortunately, expe-
rience has shewn it does not merit.

" 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 unmixed," vol. ii. 687-8.

" In puerperal fever its administration internally, and its applica-
tion externally to the abdomen, has been found in many instance*
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. Colles, as an useful applica-
tion to wounds received at the dissecting table.

Barker and Montgomery on Pharmacopoeia. 103

" Oil of turpentine is a valuable application to scalds or burns in
their 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.

" 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.

" 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 Himinianing 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 1 10 to 40 by the use of digitalis, taken by gradually increased
doses to the extent of six grains in the day. The 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, we should immediately discon-
tinue the medicine, as its further administration under such ciraum-

104 Critical Review.

stances, will almost certainly give rise to a train of the most alarm-
ing symptoms, terminating in death.

" Trje 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.

TiActur 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 aimed 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 ;
bat 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, t 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,
1 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. wo. 32. p

106 Critical Review.

gave five ounces of the tincture in the course of the day in a cue of
tetanus.

" After surgical operations a full opiate is generally given, and
with good effect ; it soothes the pain, calms tfce 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 retraining 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 : —

£f. Tincture Opii Jss.
Olei Olivarum 3 i*
Vitelli Ovi. q. s. ut fiat linimentom.

" The quarter of this to be rubbed on the thighs or legs twice or
thrice a day.

" Opium is often appEed 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 railing asleep ; this habit he continued
for twenty-four years, and had begun with a grain ; but Dr. Smith
Bays, 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
OQstLveness, succeeded by diarrhoea and flatulence, with loss of appe-
tite and a sottish appearance ; the teeth decay, the memory rails,
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, Huf eland, 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. I 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 th*e 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, orAy fourteen were infected; and that when he
afterwards used a stronger preparation of the drug, every one escaped
the disease. KoretT, 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 betaken 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 Sdemmering, 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, may be added that of Hufeland, who says
in the Journal de Practischen Heilkunde, Nov. 1825, that " it gives

Barker and Montgomery on Pharmacopoeia. 109

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.

1 10 Critical Review.

" Dupuytren, after a continued use of belladonna internally far 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 ;—

fy Extracti Belladonnas drachmas duaa
Oerati Simplicis unciam. — Gommisce.

•*' 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 o^ 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."

" 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 »
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.

Time oor 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. Andrei'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 with 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-
drul 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 loctl
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. Andrei'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 precediug 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 Vademecum 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 to
statement is well attested by the following observations :—

M. Andral on Pathological Anatomy. 113

" Of the alimentary canal in the healthy state. — There has Seen
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 met, certain circumstances under the influence
of which the alimentary canal, though free from disease, may yet

voIm vi. no. 32. a

1 14 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 met, 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 while 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 die 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 pariete8 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 increasng
colour from the venous blood ; now, what takes place in the skin most
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 Boerhaave did long ago, we prevent by a ligature the
circulation of the blood in the trunk of the vena porta?, 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 thai,
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 porta?, 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, whether 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 cons*;

M. Andral on Pathological Anatomy. 115

quence of Borne 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. Jn feet, there is not one of these appearances that
may not be produced by a simple injection from a hyperemia either
mechanical or passive ; and he would be strangely mistaken who
should imagine that the dotted redness, for instance, more necessarily
announces an active hypenemia, 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 now, under
the influence 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 bodies, 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 exiat 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 jart
now proved, presents various degrees or shades, like the redness from
congestion, 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 1ms,
however, very seldom happens, except in experiments on animals
that are strangled, and kept in the vertical position for several boms
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 simikr
has ever been observed in the horses killed by pithing, or by knock-
ing on the head ; and, in the human subject, the detennination of tbe

M. Andral on Patholbgical 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 tike 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
mis 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, I, on certain con-
ditions relative to the body itself; such as the kind of death* the

118 Critical Renew.

nature of the distant that prodneed it, &e. ; and, 8. on certain
evternal cffcumstances, especially on the thermometries! and bygio-
metrical states of the place in which the body is. Aocordingrf ,
when, in Banner time* ire open bodies that have been kept, since
death, in warm bade, and in rooms of a temperature at least at high
as the external air, it is naoal to find, so soon aa after four and
twenty hours* very evident marks of transudation in the alimentary
canal ; in such eases, for instance, I have often found all the mem-
branes of the gnat 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 die canal, and
mix with the fluids contained. 1 have ascertained this to be the
ease in most of the bodies I had occasion to gramme in the very
warm summers of 1825 and 1826."— p. 21.

The stomach ma? have its pariatea diseoloured 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 Mood 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 tiuge
produced, which cannot be removed by ablution. Our
author deduces the following inferences from this part of
his investigations :—

" To sum up ; the gastrointestinal 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-
remia 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 differeut gases in the alimentary canal
at the moment of death ; 7, on the developement of other gases, it
a longer or shorter period after death; when putrefaction takes
place ; 8, on the combination of the yellow matter of the hue with
different parts of the gastro-inteattnal mucous membrane; 9, &&
lastly, on the accidental introduction into the alimentary canal of

M. Andral on Pathological Anatomy. 119

different colouring principles that may stabi in internal surnice, and
thus produce a colour more of 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 j
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, tioat cseteris paribus, the
colour of the gastrointestinal 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 die 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 gastrointestinal
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-
niach, we may allow the mucous membrane to be of the natural

KO Critical Review.

thickness, when, on making an incision in it, taking cue not to cat
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 tins
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
slowly. 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 follows from these facts, that the post mortem softening of the
gastro-intestinal mucous membrane does not occur until the potre-

M. Andral on Pathological Anatomy,. 121

fiction is pretty far advanced, and after the usual period of opening
bodies in most cases. It would appear, then, that we should hot con?
aider 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, (torn. 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 that viscus 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
eontradict 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 (hem we often find
witboat 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 thrfce 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 Andrei's

Vol. vi. no. 32. a

12$ Critical Review.

Pathological Anatomy, and we think he will agree with us,
in considering it a most valuable contribution to medical
science. It is a work which stands a splended 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.

V. — Medico-Chirurgical 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 wire pasted
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 wire was passed through the canula, so
that both ends were 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 wjre 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
hone had completely united. The limb was kept in the
fracture box six weeks longer.

Medito-Chirurgical Transactions. 123

The fourth paper is, " 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 _2_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 Do lens." By Wil-
liam Lawrence, Esq. F.R.S. &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

disease extended in both these vessels beyond the aitaaiijanB where ftey
had been divided, but its inferior limits were not ascertaifled j the
right spermatic vein was closed in its lower .half. The coats of 4he
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 was elearly a ease of cruritis, 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, 1820.

The sixth paper is on t€ 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
common iliac contained lymph, the same was observed at the
union of the left internal iliac, with the former vein ; the
remainder of the vessels was healthy. The left external iliac
was healthy, except at its lower portion, where it was com-
pletely blocked up by coagnlum, adherent at one part only.
The coagulum was found to extend along the two upper
third* 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 wan 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 Cougb.
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. slow in -lb**
operation. Calomel and James's powder are also useful

Medicare hirurgical Transactions. 125

He throws no new light on the subject, and even omite
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 infrequeocy 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- m
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 town* ;
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, " Practical observations on
the healthy and morbid conditions of Stumps.9' 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. EUiotson. Two cases* were admitted into St.
Tnomas'9 Hospital, of typhoid fever, purulent discharger
from the noatrrlgr, abscess in different parte of the extremities,
pustules on the alae 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 sat* an ac-
count of " a ratal 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 belie?e in the
possibility of contagion in such a case, he was referred to Mr.
Trover'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.

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, " at the same time, it will yield strong presumptive
evidence." " 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 strong 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,

Pr. 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 : —

I .—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

Sreat degree of caution is necessary in every case, before a
ecision 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, weight, 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 every 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 Orisrintu Commuuicmtiotu.

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 a topi,
or refresh his memory from it ; whereas be cannot use fj<x>pj
•neither case, especially io this country. The nextfartof
our duty is to examine the external parts of the body, and here
also the appearances are to be recorded.
'. Autopsy- Di&section.~-Medical jurists are not agreed upon
the method of dissection, in cases of infanticide. Dre. Ifeek
and Smith think it most convenient to commence the dissec-
tion with the mouth and cavities leading to the chert.
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,
nod 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
vender its anterior surface prominent* It is right to observe,
mohbther the mouth be open or closed, if the tongue be pro-
truded, or turned back into the Sauces. An incision is then
Id be made from the lower lip to the upper extremity of the
nteraum^ and another along the lower edge of the inferior
•nax^llarybone, the integuments are to be dissected back, and
all onarks 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-
giattss be natural, and u there be fluid in the larynx or trap
•chea?*~-tbe abdomen is next to be examined, an incision is to
be made from the sternum to the spine of the ilium on each
side, flie 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
he permeable or obliterated. The sine of the liver should be
•noticed, its large vessels tied, and the organ be removed
^nd weighed; but previous to its removal, the gall bladder is
Jo 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. \ 29

fully examined. We should further observe whether the in-
terstinal canal contains meconium, faeces 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 maybe 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 and brownish, 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 witn 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 Communication*.

can be easily separated in this manner. We are now to aaeeN
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

Eerusal of the statements made in the course of this work,
ut 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 in 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 Berot 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

Dr. Ryan on Infanticide. 131

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, \ftoat 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
aeqaktal of the accused ; he should confine himself solely
to the duties of his profession, and strenuously avoid putting,
what lawyers call " leading questions/9 or intimidating the
aecused, 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 eases, leaning to the side of
mercy.

In the, foregoing dissertation I have only discussed the
principal points which claim attention, in cases of infanticide ;
ae 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,
willbe 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 known to require ex-
pression in this place.

Medico-legal questions, relating to violation of

Women.

In a preceding article I 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 aa
follow : — 1, Are there certain signs of defloration 1 2, Can ws
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.wqraan can be
violated without her knowledge ? And 4, whether pregaaney
can follow violation f

1 32 Original Communication^.

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 bv 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 leucorrhcea, 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, ieacorrhcea, 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,ferendel, Severin, Pineau,&c.)
Indeed women have been in labour, and the hymen perfect
(Mauriceau, Ruysch, Pare, Meckel, Walter, Baudelocque ,
Smellie, Capuron, Neegele, &c.) It is therefore no infallible
sign of virginity, nor is its absence alone a positive proof of
defloration. The carunculse myrtiformes were loug 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 ail 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 virgipity, 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 nave 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 ift 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

£lace, the signs are very evident. The laceration of the
ymen (if it exist), the presence of its remains covered
with clotted blood, the contusions of the labia, majora, and
minora, of the clitoris, and carunculce 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 leuoorrheic
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 oenent.
But it is to be recollected that many women will not content
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,
ana may cause laceration or contusion of the external
genitals ; and who does net know that these excesses ha? e
brought on delirium, and who is ignorant of the deplorable
effects of onanism. (Briand.) Again, women hare injured
the organs for the purpose of accusing an innocent man of

cases of defloration we must consider the

tape. (Fodere.)

In all
strength, and state of mind of both parties. When
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 womae
may accuse a delicate man, on boy, or one who is impotent.
It i* held by most jurists, that it is almost impossible ; stall
events exceedingly doubtful that one man can violate an
adult female. (Mahon, Farr, Fodere, Capuron, Beck,
Briand, &c.) The exceptions to this rate 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 career, &c, or the organ may be so small as
to cause no pain on its introduction into the vagina. Zac-
cbias 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 oe 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 tne crime is alledged to have been
perpetrated, that is, if it appears from the third to the eighth
day, and, above all, if tne accused is affected with the dis-
ease. Every well-informed practitioner is aware that gonor-
rhoea or syphilis cannot manifest itself immediately after

Dr. Ryan on Violation of Women. 135

congress, lAd 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 oractice 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 gfcnital organs of both sexes, from the
period of infancy upwards, may arise from causes purely
physical, chemical, Of 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
symptomB 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 lost 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 previouely to the supposed offence. In a case in
which I was consulted, and winch is recorded in the LoncL
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 ou 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
eatamenial or lochial evacuations, the introduction and long
retention of a bougie in the urethra, irritation in different
pacts of the alimentary canal, constipation, certain aliments*

136 Original Communications.

and medicines, as new beer, asparagus, &c. — in a wonl, dis-
eases of organs which strongly sympathize with the genito-
urinary system may cause simple gonorrhoea. Cases are
recorded m which gastro-enteritis, diseases of the respiratory
system, coryza, 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 tbe
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 were 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 casein
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 Mayor to request five phy-
sicians to examine the child separately, without knowing the
application to each other, and they all agreed that she only
laboured under a simple mucous discharge. (Manuel Me-
dico-Legal, &c.)

The following case is related by the revered Dr. Percival,
in his admirable Ethics :—

" Jane Hampson, aged four, was admitted an out-patient
of the Manchester Infirmary, Feb. LI, 1791. The female
organs were highly inflamed, sore, and painful ; and it was
stated by tbe mother, that the child had been as well as
usual, tdl the preceding day, when she complained of pain
in making water. This mduced the mother to examine the
parts affected, when she was surprised to find the appear-
ances above described. The child had slept two or three
nights in the same bed with a boy fourteen years 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 attending 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, th*y 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, nymphae 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 datk spot, ooserved by
Dr. Smith only on the thigh. The examinations of the me-
dical men were made at different times. The case was
frievously mismanaged for the prisoner ; the only evidence
m his favour was Dr. Smith's, which was contrasted with that

vol. VI. no. 32. ' T

188 Original Communications* .

of the two medical witnesses for the prosecution. The
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 nymphffi, orifice of the vagina, and the meatus
urinarius, are ujian 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 «t
such an appearance, and she suspects her child of having
acted in an improper manner ; and perhaps, not quite dstr
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 unfortuaateh
not be aware of the nature of the complaint I am speaking of,
and he says, * Good God ! your chifd has got a clap.' (A
laugh.) A mistake of this kind, gentlemen, is no laughing
matter; and, though J am glad to make you smile some-
times, and like to join, you in your smiles, I cannot doit 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

uis xnee laieiy : xne cniia innocently replies, • sio <xw,
mother; nobody has, I declare to you/ The. mother Jfea

Dr. Ryan on Ftotation of Women. 199

sayfe, •' Ob, don't tell me such stories ; 1 Will flog y oh, if you
de*' And* thus, the ehild is driven to confess what never hafH
pened, ia orde* to>sa«e herself from being chastised : at last
she says, * Soch a one bas taken me on his lap.' The person
is. questioned, and firmly denies it ; but the child, owing to
the mothes'e threats* persists- in what she ha* said. The ntea
is brought into a court of justice ; a surgeon, wbo is ignorant
of th* natuve of the discharge I am now speaking about,
gives his evidence; and the mart suffers for that which be
sever 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, ' What a hor-
rid villain, must he be for forcing a child to such an unnatural
crime, and communicating to her soeh 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, who had
a gonorrhoea on her. I went, and found that she* had a free
discharge from the preputiuin cHtoricbs. I said .that there
was nothing so common as this. There was considerable in*
ikmeoation, and it had even proceeded to ulceration, which I
told him would soon give way to the use of the liquor ealcis
with calomel. ' Do you tell me so V (be replied ;) why,
suspicion has fallen on one of the servants ; but he will not
eeafeesk 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 k a heat of the parts, slight inflam-
mation, and. this sometimes increase*, and goes on to ulcera-
tion. Tbi& disease sometimes, occurs in children at the time
of cutting their teeth.1' — Lectures on Surgery.
- Dr. Deweesy the eminent professor of midwifery, in the
Ubkersity 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, " We occasionally find that very young chil-
dren haw a discharge from within the labia of a thin acrid
kind, or of a purulent appearance. When this occurs ia 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, whether by spermatic,
leucorrhceal, gonorrhoea!, lochial, mucous and salival fluids.
The evidence afforded by this table, is far from being posi-
tive, and I therefore omit it.

Third questiou. — 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 was of course unconscious
of it during 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 has had chil-
dren, whose sexual organs are dilated, may be violated dur-
ing sleep ; but a virgin could not be deflowered without her
being awoke. Drs. fiecjt, Gordon Smith, Bartley, Fodere,
and Capuron, doubt the possibility of a married woman being
violated during sleep.

Fourth question. — Can violation be followed by concep-
tion? It has been long decided in the negative, as it was sup-
posed that women who were 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 foregoing1 observations, it is evident that medical
science does not furnisn 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
case will be stronger attested by any other marks of vio-
lence. However, great caution is required in these cases, as
depraved mothers nave 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 an 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 ]*nsdowne's Act,
9 Geo. 4, c. 31, contusions are classed with wounds, and
under this statute we have to comprehend, ecchymoses, con-

148 Original Communication*.

mission or lost of power of organs, distortions, disloca-
tions, fractures, burns^ wounds of fire arms, and wound*
in general.

Contusion is an. injury, and sometimes a wound, inflicted
by a hard, blunt instrument, without loss of suhstanct, or
wound of the skin, but with laceration of the cellular tisane
and extravasation of blood, either diffused or congested, to
a<oeLhilar extent : if the skin be divided, it m designated a
eoatosed wound.

JEocAymona, or blackness, is an extravasation of blood by
rupture of capillary vessels ; aod hence it follows conta»
siou* but it may exist as in eases of purpura hemorrhagica,
semrvy, and other- morbid conditions without the latter ; and
we often see persona arise from sleep with numerous eechy~
mosee, which are sugillationfl, and called by the vulgar,
" de*d men's pinches. •'

When ecchymosis is caused by injury, it generally ap-
gleavs kfc a* short time, or in a few hours, but sometimes not
lea daysw The part appears red and bluish, then black or
lead colour, violet aad yellow, and is marked most in the
centi*. Its progress and duration will, be modified by age
and eonstitttiKHfr

It may be produced ia deep seated organs, as in the
muaelea of the thigh, &o. 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 appest before ten or fifteen days. Again, the viscera
io the chest, abdbmen and pelvis, may be ecchymosed from
external injury, though the integuments are discoloured
It is easy to distinguish ecchymosis from lividity, consequent
to acute 01 chronic exaathematoua diseases, vesication, in-
flammation or gangrene, by 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 ofteo
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
ewt the effused blood, but ablution will not remove &e
changes effected by gangrene.

It too* often happens that ecehymoees- are confounded
with cadaverous liviakies, which are more or less extensive,

Dr. Ryan on Violation, of Women. 143

q£ 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 lab while it has been becoming cold. These also

Spear where pressure is made by the cloths, and from
eir resemblance to the injuries caused by flagellation with
rods, are called by the French vergetures. A more ap-
propriate term is, cadaverous lividity or sugillation. These
are frequently observed in the most dependent parts of the
lungs and abdominal viseera. Professor Andral'e 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,
progress to putrefaction, &c. They cannot be confounded
with ecchymoses, as there is no effusion or infiltration of
blood in the cellular tissue.

The term commotion or concussion, is the shaking -of an
organ by a blow. or fall, more or less remote, which causes
inaction of an organ. Thus a blow or fell on the head, feet,
knees, or body, causes concussion of the brain, whieh-may
be followed by slight stunning, by hemorrhage 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. paralyses 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, haemorrhage, 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 oa the epigastrium. The medi-
cal witness was raiorant of the. danger of contusion on this
part, and the Judge jeprimanded him very severely for not
having opened the foody. 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, mkexe a man received a blow < on the stomach from
a lri*nd* wbioh caused instant death.

144r Original Communication*.*

Distortion is a serious injury followed by engorgement,/
which will not be dissipated for weeks or months, accord-
ing to the habit and constitution of the sufferer. Sometimes
there is stiffness of the joints ; sometimes relaxation of the
ligaments, which is to be ascribed to a scrofulous or ricketty
disposition.

Luxations are generally, free from danger, though they
may be followed by paralysis and atrophy from the injury of

a nerve.

Fractures, if simple, are not dangerous, but if compound
or comminuted, especially in or near joints, they are serious
and often fatal. I am greatly surprised at the French jurists
who give a table to shew the period at which fractures will
be consolidated, as every man of science must be convinced
of the inaccuracy of any fixed period for consolidation will
be completed sooner or later according to the age, constitu-
tion ana state of health of the patient.

For example, the same kind of fracture will be united in
twenty days in an infant, in thirty or forty in an adult, and in
fifty or sixty in an aged person, or perhaps not at all. Every
well-informed practitioner must* agree with me in opinion,
that a gouty, scrofulous, cancerous, or venereal habit, mol-
lities or frigilitas ossium, will modify the period of ossifies*
tion in fractures, and pove the fallacy of all fixed periods.
The valuable remarks of the distinguished and erudite au-
thor of the Surgical Dictionary upon these points, amply at-
test the truth of this position.

Burns, present three degrees of intensity ; 1, where there
is irritation or slight inflammation of the skin ; 2, where
there is vesication ; 3, where there is disorganization of the
skin, cellular membrane or more deep-seated parts.

In the first and second case there is little danger, unless
the injury is extensive, or occupies parts endowed with great
sensibility ; in general both are cured in a few days. In the
third case there is great danger, as the degree of constitu-
tional irritation is considerable and often proves fatal to
young and middle aged persons, and to those advanced in life
by profuse suppuration or gangrene. Even these cases may
terminate favourably, but with great deformity.

Gunshot wounds, are ' generally dangerous, but here also
we must be guided in our prognosis by the habit and con-
stitution of the patient. In the works of Hennen, S. Cooper,
Guthrie, Larrey Thomson, Ballingall and all others—
we learn that the bravest men have lost their lives
on the field of battle, by prostration of the vital powers/

Dr. Ryan on Homicide by contusion and wounds. 145

who were only graced 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 fistula?, 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, or 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 occipitofrontal 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 erysipelatoris 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
Sreat.

Incised wounds of the ICalp, 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. wo. 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 doys 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. 1 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 be had committed, and the certainty
of exfoliation taking place sooner or later, as the bone vat
denuiied, 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, aud she became subject
to epilepsy. The old surgeons considered wounds of the scalp
.aud fractures of the skull highly dangerous for three weeks,
and never declared the patient out of danger until after the
lnpse 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 datigerous. 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.

Wovnds of the Face. — Contusions and wounds of the
eyebrows and lids are generally free from danger, tboi&fa
they may cause blindness. Penetrating1 wounds of the globe
of the eye, of the optic nerve, and causing1 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

ductile of great personal injury. Contusions and fractures
of the nose are attended with little danger, and total ablation
of the Organ is no longer ah 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 Juurnal, 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.

Womaids 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 w«>und on
tbe anterior surface* of the neck may divide the phrenic nerve,
aud 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 ou 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 jurist s>
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 wiere saved by ligatures. The section of the prin-
cipal nervous trunks, such as the great sympathetic and tenth
pair, are mdrtal, 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 ia
all parts which they supply, and often by death. Lastly,
the cutting instrument may pass between the cervical verte-
bra 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 indv.ee 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 (hremathorai),
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 requites
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 th$se 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 vertebra, 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
Kkewise 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, jpulmonary vessels, vena?
cava?, vena azygos, and thoracic 4uct, 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 then* 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 Teasels, 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 Dy a mortal paralysis. Effusion
of bile, blood, urine, food or feces, is fetal, 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.

Wounds 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 veaieulas 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
uiiimpregnated 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
tbe foetus. The organ may be inflamed and gangrenous, com-
plicated with pentonitis 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. Malinsr
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

15ft Original Communications.

the fetal injuries inflicted by ignorant male obstetricians, by
manual and instrumental operations in difficult parturitions,
are unfortunately too notorious, of late, to require further
oomment.

Within the last year medical men in this country and in
France, have been found guilty of manslaughter, and very
justly, for the rashuess and violence! of their operations were
more >characteris tic of illiterate savages*, or of the darkest
ages, than of men acquainted wkh 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, arid as to the consequences of contusions and
lacerations of her organs and their fatal results* they were
totally forgotten. .

Lesions of the. eatreinMe*. — Contusions, dislocations,
fractures ana 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, protuse 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 bodv, &c.

II — Mr. Searle on Cholera — Reclamation.

[We readily insert this reply to our Review of Mr. Searle'a v/oik
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— whka
ever the reader may chuse to designate it — to prefer the principles **
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

Mr. Searle an Cholerar—Reclamation. 151

felt offended; then admitted the justice of our remarks, an^ftfelty
became our friends. Even Mr* Searle has made one! step-in tins
march of reconciliation, when he partly admits the justice? of 'our
remarks. He must be well aware of the utter impossibility tar an
independent journalist to please authors and pubEshejs. 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 df
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 6i 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.7— En.]

To the. Editor of the London Medical and Surgical Journal.

Sia, — 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 ni 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 unphiloeophical) 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 incorruptible 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.

158 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. Seade
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 4>e happy to
meet you in an open, candid discussion ; which, at this particular tune,
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. Hub 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, at
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.

Mr. Sear le on Cholera — Rtclamation. 153

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 bpurgin, 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 notiBjed 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 ia con-
ceiving the tiling, 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 hate 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 Organs

VOL' IV. no. 32. x

154 Original Communications.

more particularly exposed to its operation, indeed, we nay 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 aerial 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. Has
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 substance*
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 respirm-
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
dilitatdon ; 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 skjn, 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."

Mr* Searle on Cholera — Reclamation. 155

" 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 1 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 met 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 firet» 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, vitality 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 met, that a capillary
tabs 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
ha* 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, by removing both brain and spinal marrow."

" That there can be little doubt of the origin of the nervous or
electrical fluid 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
•pinal marrow ; from whence it is again transmitted by the nerves, at
the pleasure of volition, in the several actions of muscular contrac-
tions ; excites the sensorium to the various operations of the mind ;
and the organs of sense to their respective functions ; or is transmitted
by the par vagum to the great secretive processes of the stomach and
other organs to which these powers are transmitted ; and hence, the
intimate connection and remarkable sympathy existing between 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 torpifying or arresting the
chemical functions which take place in the general capillaries 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 effects ; 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 die
effects of some narcotic poison than of disease."

" Another argument that may be adduced in favour of my views,
is, the fact 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 mephitic 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 implied. The experiments of Bichattoo, on the respira-
tory function in animals may be adduced, as bearing upon the subject,
who concludes his numerous experiments by observing. — We con-
clude then in general terms, and without attempting to determine
how this takes place, that the heart's action ceases, when the chemical
phenomenon of the lungs are interrupted ; because the black blood
which penetrates its muscular fibres, is not capable of keeping up
their 'action.'* And, the same he says of the brain, and finally
observes, " The circulation of black blood carries to every part de-
bility and death, the organs ceasing to act, because they receive no

Mr. Searle on Cholera — Reclamation- 157

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
die circulation the most remote from the heart's influence ; which
obtains to by tar the greatest extent in the mesenteric, gastric and
splenic veins, forming the roots of the vena porta? ; as the propelling
action of the ventricle ceases in the arteries, and the suckuig power
of the auricle's dilitation has to operate through the additional and
protracted route of both the hepatic veins and vena portss. 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 theBe 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 aero-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 00 often
exemplified in cases of debility, on the patient's removal from the
recumbent to the erect position ; and particularly from the sudden loss
°[ 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."

158 Original Gonumtmeatiens.

" In a ratio with die 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, mine, &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, idiosyncrxcy,
state of the individual at the time of attaeki 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 capillary 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 every 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-
flammation."

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.

Mr. Settle on Cholera**— Reclamation. 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 Boird 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*'
auction 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 Brbussais 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 denned 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-

160 Original Communications.

led by these tiw madam ea, and * grater or km inti «Hj of the

We stall now present the reader with the symptom of tat
frequent form of the disease, oar second species, or cholen
as we hare thought proper to denominate i£m preference
to spasmodica, as spasms are by no "■*»*** luiifutialy present, where*
I believe, is always so."
The patient is iwraiDy suddenly seized with girtdiirm, sorbo-
rygma and purging ; or the latter, with a sense of weakness, mi
symptoms of indigestion have been for some boars, or eves dtp
deration; these are folio wed by vomiting, which with the evacuations
from die bowels soon assume the conjee or barley water-like appear-
ance, anflOBcdcd by great ytt wl ration of strength, tremor or twitching
of the extremities — abas clonic spasm; a sunken ghastly coante-
nance, ringing noise in the ears, cold damp akin, feeble pane, md
precordial oppression. From the sense of pracordml oppresses,
heat sooner or later becomes developed, and the patient cornpfam* of
inward burning, attended with great thirst and maatiablr desire for
cold water; the irritability of the stomach is now usually increased,
and there is extreme restlessness. The pulse becomes now stop,
frequent and wiry ; while the extremities are cold, and m general
damp. With the developement of this partial excitement, task
spasms or cramps usually set in, oommffnangin the feet and legs, tad
gradually increasing, or extended to the upper extremities, and oca-
aionally involve the muscles, also of the belly and cheat. Ibeex
hansting influence of these spasms, or sense of inward angaist
singly or conjointly, is soon succeeded by collapse. The stemad
and bowels, which continued before irritable, now retain whatever »
pouredin them ; the spasms cease* the skin is livid, covered with coU
sweat, and the fingers shriviEed ; the eyes are suffused with blood,
or covered with a dense film, half open, inanimate, and countensate
death-like ; coma and dyspnoea ensue, and life gradually leaves its
frail tenement without a struggle."

" Nothing, perhaps, can be of more practicable consequence dm
to note accurately the various stages of acute diseases from their coav
mencement to their termination ; for unless this be done, the daspetei
may be endless about the modes of treatment, which must cones-
pond to the leading phenomena of each stage, Tbis erudite and jast
observation of Dr. Armstrong is particularly applicable to the disease
under consideration ; and it has been the want of its observance tint
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 : — R*
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, fat the
first instance oppression, bounded by the tonic spasms, or other
symptom denoting the partial or topical excitement of the flecsad

Mr. Searlt 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 sweat."

" The indications of treatment resulting from thus viewing the
disease, are obvious — to remove the fhet 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 particularly evacuating; bearing
in mind at the same time, the nature of the disease, that die 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 oi 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 : — °

" Hie immediate cause of the disease, being, torpor of the ge-
neral capillaries of the system, by which the chemical changes in
the blood are but 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 operation, I believe to be,
specific on these vessels ; this is mercury, (or 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.'1

" 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 tjiem
to increased action i 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 direst influence on this organ, by its absorption from the
stomach and btfwels 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. T

160 Original Communications.

fied 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 hare 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
precordial oppression. From the sense of precordial oppression,
heat sooner or later becomes developed, and the patient complains of
inward burning, attended with great thirst and insatiable desire far
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
pouredin 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 stages 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 : — R>e
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 die
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 m 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 sweat."

" The indications of treatment resulting from thus viewing the
disease, are obvious — to remove the fhst 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 particularly 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 disease, being, torpor of the ge-
neral capillaries of the system, by which the chemical changes in
the blood are but 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 optTation, I believe to be,
specific on these vessels; this is mercury, lor 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.'1

" 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 tjiem
to increased action ? hence its renowned deobsturent powers, and its
operation on the glandular system in increasing the various secretions.
Its more obvious rfect on the hepatic function, is probably owing to
its primary dirtdt influence on this organ, by its absorption from the
stomach and btfwels 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

162 Original Communication*.

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 contraindication
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 mesenteric 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 pulae admit* of it ; as it
is a remedy judiciously resorted to, that general experience leaves
most ample testimony in favor of ; and which is mdst obviously indi-
cated with the intentions specified. But in saying time much in its
favor, I must add, my most solemn protest, not only against its indis-
criminate employment, but in any one awe, usque ad deHquram,
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 ot
opium in this disease ; this becomes next the subject of consideration,
arid 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 on 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 alio been the subject of its attack more than once during that
time. And I may notice, recovered from it, whioh 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 Srarlr."
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 urinarhis in women.

It has not, I believe, been hitherto conjectured that some of those
tumours which arc kruwn occasionally to occupy the pelvis and ob-
struct parturition, have a similar origin. This met 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 sag'
gests the propriety and safety of the treatment by free incision.

I have carefully examined the liodies of two women in whom 1
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 lacunae,
which had thereby become dilated into a cyst, and distended by a
gelatinous fluid. I was enabled to 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 which have been described by the author*
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 & 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, Paris, 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 feet wits wanting. But in others the
histories of the cases show that they could not have been ovaries; but
they leave the nature of the tumour in complete 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 with membranous flakes, and
became thereby collapsed ; others, during an attempt to lift them
above the brim of the pelvis, disappeared 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 perinseum. In this doubtful state of our
knowledge concerning the nature of tumours which are not of unfa-
quent occurrence, which, when they do occur, occasion so material
an impediment in the process of parturition, 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* 105

Mrs. Hollingsworth came to me in April 1832, 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 be 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 die 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 1 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 shte 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. 4 Sur. J.

8UBGEBY.

2. Operation for restoring the Cohtmna Nasi, fiy 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 I was
consulted by Mr. M., then aged 16, on account of deformity occa-
sioned by loss of the cohtmna 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 Bubject. 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
tosaues, was then deprived of its prolabium, and elevated, without

146 Bibliography.

twisting, »o that it* oral margin was placed in contact with the nv
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 toe
point of the nose and the upper part of the new columna. The nw
edges in the wound of the up were brought into accurate appoeitka
by two points of twisted suture, as in the operation for harelip.

The pins and Kgafcures were removed after a few days, and adhe»
4do* was found to he completed. The lip, which before was too foil
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 sHp was also perfect ; and by supporting this part by t
small round compress, and carefully plugging the nostrils, so as to
distend the aim, the patient's appearance was totally changed. The
point of the nose could not fall downwards; the al» 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
columns. The patient, instead of being constrained by horrid de-
formity to confine himself to his house and surrounding grounds, was
able (bo mix in and enjoy society, without its being observed that say
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 aasuined the same colour, and apparently the same structure,
as the-smrrounding skin,

Case II.— Anna Riley was admitted into the Royal Innrmay on
the 10th of August 1828. There was very copious and foetid dis-
charge from the nostrils; the triangular cartilage and oohimna nasi
were completely destroyed ; and the inner surfaces of the alae exten-
sively ulcerated. The point of the nose had become quite fiat 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 abort
eighteen months ago, labouring under how*. The aim of the note,
the upper part of the lip, and the inner surface of the nostrils pre-
sented one continuous surface of angry ulceration. The columna salt
and part of the cartilaginous septum were destroyed, and the point
of the nose was flattened and depressed. The discharge frost the
ulcer was acrid and highly offensive, and the countenance was very
mueh 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, hut without essct

S*rgery. Wf

" In the Infirmary means vm taken to improve he* general
health, and the sore was touched occasionally with spirit of torpeffl"
tine. Under this application the ulceration seemed to be arrested tar
some time, and the aspect of the sore began to improve ; but the
benefit was temporary, and the liniment, having lost its inttUttntft
over the irritable surface, was disused. A sohitfon 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 sum
was brought into a healthy state, and the process of reparation c*m-
menced. The topical remedy which all along proved of most ser-
vice, and under the use of which the parts were ultimately brought td
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 hi the
same manner as in the preceding cases, and adhesion wae completed
in both the nose and lip in two or three days* The columna was
supported by compress and bandage, and the alas were kept distended
by dossils of lint*

Ulceration has not returned ; and the margins of ake, 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 bo when osdema leaves
the part.

Case IV. — In the summer of 1827, I performed the Indian opera-
tion for restoration of the nose on Charles Thome, 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 tb»
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 wag 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
hh& a new columna (the third he had had) from the upper lip* hav-
^ 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.

Cass 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
*«nt to Brighton, where he was seized with violent pleurisy. Early .
ul 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.

Mm 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 symptom* 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
tjll 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 hones
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 hied,
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 thktame 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 nfctallic 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 alas 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 alas. 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 die parts than dosmb
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
factory. — Edinburgh Medical and Surgical Journal.

(Literary Intelligence, Books for Review, &c. in oar next.)

All Communications and Works, for Review are to be addressed to the cave of
Messrs. Underwood, 32, Fleet Street; or to the EdUor, at his Residence, 61,
Hilton Garden.

.*
i

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 38. MARCH 1, 1831. Vol VF.

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 preceding 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. Colles, 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 far 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 df 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 pr 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.

41 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 faeces ; 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 evacuations are devoid of faeces ; a feculent stool is passed
perhaps once in two or three days ; the faeces 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-
namm, 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 fistulse.

" 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 to sym-

The Dublin Hospital Reports. 171

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 faeces 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 mils, thirst be-
comes very urgent, emaciation proceeds rapidly, hectic fever becomes
fully formed, though more marked by profuse night 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, which 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 few 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 with mucus, and certain feelings of uneasiness : on

1 72 Critical Review.

examination by the finger, a thickening and slight projection of the
gat 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 ; but 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 akin, 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 pome 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, tie 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 very 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.

The Dublin Hospital Reports. 173

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 or 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 be 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.

44 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, ware 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 they 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. 1 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 receiTc
an impression from the projecting ridge of the sacrum ; for it is by

The Dublin Hospital Reports. 175

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 feces 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 feces 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 bine 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 feces 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, " ten inches
up the scrotum, 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 tnalorum, as certain interested individuals lead
the public to believe, is a species of knavery which merits
the indignant reprehension of every scientific practitioner.

Dr. Colles next describes " vascular tumours of the rec-
tum," or, what are denominated " hemorrhoidal 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 tbe
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

The Dublin Hospital Reports. 177

mode of operating and suppressing haemorrhage is extremely
judicious : —

" The following mode of operating I have found to he 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 win 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 haemorrhage, 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 we 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 " Ob-
servations on the Mucous Membrane of the Rectum.1' 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 thai
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 hear in
mind the existence of these folds, that he may not mistake them fa
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/9 by Thomas
E. 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

The Dublin Hospital Reports. 179

Author, employed numerous remedies, with only temporary
relief; Dr. Colles was consulted, and also Mr. Fitzpatnck, 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

Ethology pronounced the case " neurose intestinale."
*. 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, ad 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, aa large as a shilling, was exposed on its posterior surface,
a little above the origin of the cceliac 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 oi
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 vertebrae 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 1 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 was 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 produced 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

The Dublin Hospital Reports. 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, " il/aui vous bien palper
monsieur,9' 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
111 women in private practice with the forceps or lever,
never observing any unpleasant result.

" None of the mothers died — none of them had their perineum
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 born 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 facte." — 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, Mil lot, 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. 183

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 be 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 met, 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 ; sad,
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 die 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 mintings, convulsions, great ex-
haustion, fever, &c.

" To assist delivery under such circumstances, two classes of in-
struments have been devised ; 1 st, Those by which extraction may
be effected without injury to either mother or child ; 2dly, Tho*t
by which 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 k
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 ; tar 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.
The 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 delivery with the perforator a*?d 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 injury 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 born 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 firet 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 perinaeum (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.

<f 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. no. 33. B B

IB6 Critical Review.

When convulsions supervene, Dr. Beatty strongly insists
upon the necessity of first trying the forceps, which does not
occupy so much time as the perforator, and should the at-
tempt fail, it is easy to have recourse to the latter. That
this principle admits of practical application, the folio wiog
case testifies :—

" In the year 1814, a gentleman, residing eighteen miles from
Dublin, called on me, to request I would accompany him with all
expedition to see his wife, who had been suddenly seized with labour
of her first child, attended with convulsions before he left home.
We reached his house in about five hours 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 be low in the pelvis, and the os uteri dilated. Without removing
her I introduced the forceps, and in a few minutes succeeded in
extracting a female child alive. The mother was now removed to
bed ; the convulsions ceased in a short time ; her senses were
restored, and the recovery was as speedy as if no untoward circum-
stances had occurred. I may observe that the gentleman had no
more children, and the child then born is now alive, and heiress to
his large estates ; a consolation of which he must have been de-
prived, had I rashly employed a destructive instrument. If I bad
experienced much difficulty in this case, I would have thought
myself justifiable, nay, called upon, to sacrifice the child, but cer-
tainly not until I knew it was unavoidable ; and I state it to show
that in the worst cases, the milder means may be resorted to with
considerable prospect of success." — p. 19.

Our author further informs us, that since 1804, he has
used the crotchet but three times, during which period the
majority of his 111 forceps cases occurred, and he con-
cludes with these impressive words —

" In conclusion I will observe, that nothing short of the most
imperative necessity can warrant the use of the destructive instru-
ments, and no case can be considered as demanding them, until
every means by which both mother and child might be saved have
been put into requisition, and fairly tried. Let us ask with Dewees,
what is to be feared from a proper application of the forceps ? Is
their mode of action such as to do injury to either mother or child,
when well directed ? Certainly not. Then there is nothing to be
apprehended from their structure, application, and mode of action,
since they neither cut nor contuse mother or child when well
directed. They neither create unnecessary pain, nor inordinately
augment that which may be present ; but are truly calculated, in
the language of Dr. Denman, to supply the insufficiency or want of
labour pains. If this be so, and it is admitted by Dr. Denman

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
papep, 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 " 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 all 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 trie 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 gastrototny 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,
aqd 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 prostratiou might extinguish life. Pew 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

Culsation of the foetal heart, or placentary noise, generally
oth, 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

E laced in a chair, and no part of the dress removed. He,
owever, 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 beard 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 bad 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 heematemesis, in which the gas-
trointestinal mucous membrane was blanched, but the fiver
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 contaiued a fetus
of about two months, the sac had burst, the intestines were
inflamed, 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
oase favours the doctrine of seminal absorption from the
vagina, as stated by Gartner and others.

Dublin Medical Transductions. .191

The next paper is on " Hydrophobia/' by Dr. Purdcra.
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,
[ere unusual difficulty was experienced, which was found
to arise from the presence of the head of a second infant,
occupying1 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. Colles, the
other by Mr. Crampton, the Surffeon- 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 shews these
are not against the possibility of the occurrence of the
disease.

HI. — 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 Outline* of
Mr. Mayo, the Translation of Blumenbach's Physiology by
Dr. Elliotson, and of Magendie by Dr. Milligan.

" My apology is, that it appears to be important for a teacher of
any branch of scienoe 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, far
the sake of the medical students of this school. My objects in writ-
ing them have been, first,, to state the tacts which appear to be ascer-
tained, and the inferences which appear to be fairly dedacible 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 is
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 scienoe, 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

" 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 many 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, note* 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 ths 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. 188

The work consists of seventeen sections, arranged as follow :
1. Preliminary observations. — II. Of the laws of vital con*
tractions.— *II I. Of the circulation.— IV. Of the composition
and properties of the blood. — V. Of nutrition, exhalation,
and secretion in general. — VI. Of absorption. — VII. Of the
properties of the textures and secretions formed from the
Mood 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 — XL Of
digestion.— XII. Of the external sense, common sensation,
smell and taste, sig ht, 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 XVI II. 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 be treats in an able, concise, and simple
manner, as appears by the following extract:—

** 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
tar as is yet possible, of all that takes place in it, different from what
takes place in the dead body. Afterwards we explain t)ie 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
vl explanation of which mots 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

" The word life, as commonly used, does not denote an indivi-
dual met, 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»
psopriation 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 g eneration,— and terminates by death.

vol. vx. ko. 33; c c

194 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, tat
manifestly inconsistent with, the mechanical and chemical laws tint
regulate the changes, and have been inferred from the observation of
other departments of nature. In so far as we can ascertain this to
be 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, die 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, car 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 lets
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 fact*.

" Setting aside both these hypotheses, we hold that all physio-
logical inquiries are intended only, to ascertain the conditions, wader
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, Ac. Of such
first principles in science we can give no other account, than that
they depend on the will of the Avthor of Natubb ; but the deter-

Dr. Alison on Physiology. 195

minatkm 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.

" Hie 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; 1. 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 Critical Review.

and all the vital functions, as occurring in man, may be illustrated
by the corresponding functions, at least in the different division* 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 be will
agree with us in op;nion, 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 tbe pleasure of no-
ticing the promised volume on pathology and therapeutics,
and we know few so well qualified to execute the task as
Dr, Alisou.

IV — A Manual of Surgery, founded upon the principles and
practice, lately taught by Sir Astley Cooper, Bart. $t.
and Joseph H. Green, Professor of Surgery, in ike
King's College, $c. Third edition considerably en-
larged, containing many additional notes from the writ-
ings of other distinguished surgeons. Edited by Thomas
Castle, P. L. S. of the Queen's College, Oxford, &c.
London 1831. 12mo. p.p. 515. E. Cox.

This work is published with the express pertnjssian of Sir
A. Cooper and Mr. Green, and is a compendium of tbe lec-
tures on surgery, delivered by these eminent teachers. Mr.
Castle has compressed the opinions of lecturers, and added
some important extracts from tbe beet 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 met
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 bauds of surgical
students* It has a large sale, and it well 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-
ology. London, 1830. 8yo. 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 seleet 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.

44 The personal I is confessed a permanently being ; every indi-
vidual acta as if he wane one and identical; and such he k invari-
ably considered by others, notwithstanding the admitted feet, 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 fcatal existence, modifies and controls them
during the succeeding stages of life, and allows them to eome 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 Rrovidenoe 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 organisation ; 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 onoe prompts us to enquire, (and surely it is an
interesting subject of enquiry) whether they do not exhibit incon-

198 Critical Review.

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 oar senses exist
before we have acquired any experience, we have sufficient grounds
for questioning another assertion, which is frequently pat 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 exhibit* 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 ; Borne 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 die bee builds is always
placed vertically, that of the wasp, horizontally. Moreover, the
cells are all constructed on strictly geometrical principles ; far 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 tie largest possible area
in proportion to the quantity of matter employed." If they were
cylindrical, vacant spaces must exist between each three contignoiB
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 things 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,— hbo 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. 86.

VI. — The Life of Sir Humphry Davyt Bart. L. L.D. late
President of the Royal Society 9 &c. 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, J 831.

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 a, without feeling all his noblest impulses, — all his
propensities to industry, iuvigorated ana quickened. —
Viewed then through the medium of such a description as
is given to us by a writer like Dr. Paris, one who, from nis 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 rounder of his own fortune.

200 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. Parts 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 persona 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
grained nim 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 sons
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 sttmalus
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, whion 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 earburretted 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 tie 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

202 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 persoual 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 lively, 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 Albemarle-street was as much fre-
quented by the countesses of bon ton as Fop's Alley in the
Opera House 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, which 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 meriU
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
of 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 electricity
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 will 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 j 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.

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 aecay. 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 flxygen 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
m 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
ana the copper no longer coalesced, and the latter remained
perfectly tree 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 nave 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 didit
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, 8vo.

Dr. Paris's Life of Sir Humphry Davy. 205

and bis 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

tierson crossing his knife and fork at dinner in his presence,
t 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 gTeat discovery which we have to notice, and
indeed that by which he is most extensively known, and by

20$ Critical Review.

whioh he will b$ longest remembered, is hie invention of the
eefety 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 tube?
were of certain lengths and diameters, he proceeded to examine the
limits of such conditions, and by shortening the tubes, dmunisbiDg
their diameters, and multiplying their number, he at length aimed
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 ffi
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 do
recondite or mysterious cause, but simply upon their cooling powers.
which must always be proportional to the smallness of the mesh, and
themas8 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 01 the French philosophers. In bis 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. 207

for Davy. Dr. Paris is very eandid on these points, and
endeavours to excuse his hero with infinitely 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, ad 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 excellencies*

" 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.
' 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 ha* 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 bis labours to the world— end for the most
splendid of which the philosopher never received any state
reward or acknowledgment beyond the sterile dignity of a

fatent of .baronetcy. In giving an account of his death,
>r. 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 Btock 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.

" 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 Roe da
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 be
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 Humphry Davy. 20ft

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 our
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. set. 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 nigh 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. e e

£10 Original Communication*.

The general health improved amazingly ; bark, dilated
•ulphurio 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 power, the eye acquired a pearly appearance,
the skin became of a yellow hue, ultimately shrivelled and
Contracted — the non-naturals were 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 was inflated, forming a bag
larger than an ordinary clenched hand, which Dr. Parr
assigned to absorption, in consequence of having1 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. 811

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-
dria! 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 Communication*.

[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 willing assent to the principles which yon
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, wnich
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 1
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 few 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 Choleras 213

We agree with him, that the spirit of modern reviewing k
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 Rbes, Esq.

Warren, ®t 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 would 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 5i. of the secal. cornut.
in decoction in two doses, with the same effects as attended

214 Original Communication*.

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

5 [rite suspended, the patient being now (10, p. m.) very rest-
ess 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. fV T. Hyos. 3ij. spr. aether, nit. 5iss. m. camph.
Bviii. m. cap. coch. 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, I 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, IJr L. opii. Bedat. mxii.
mis. camp. Jiss. wi. 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 3ss. of ol. ricini in
each, one immediately and the other in an hour if necessary ;
and should the bowels not be opened, to take Bss. of ol.
ricini and another half in three hours if necessary.

Mr. Rees on Chronic Peritonitis. 215

4th, a. M. Has bad the glysters, and has taken the ol. ricin.
without giving- rise to alvine evacuations. Has been very
restless all night, say she is weaker. Abdomen is painful
od pressure, pulse 140, regular. Has vomited some black
adhesive fluid. Urine was drawn by the catheter.

&. 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 heen 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 snort 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 part. 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 coecum 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.

Mb. 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 die bosom of every family.

Mr. Marshall on Vaccination. 217

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 aa 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
aH 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. b t

218 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 consequent iat 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-efficient 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 Com 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 proofe, 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 ;
while 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, I 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 Bhapes, 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 1 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 case 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 piin-

220 Original Communications. ~

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 haw
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 i9 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 varwk
into vaccina, bred through the medium of the constitution of the

Mr. 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 tfie 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 then: 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 Original Communications.

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 era
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 Tiros
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 sot
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 siagk
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-

Mr. Marshall on Vaccination. 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 nnimnlq 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,
bo 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 €ows iy

Small-pox Inoculation.

After surmounting numerous impediments and anxious delays, aris-
ing from objections made to the proposition of trying the experiment
upoa 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 mOk,
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 npon
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 be 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 nomenclature 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 {**
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. 225

bIbo bound by a rope above the tarsus or bock; this mode of
precaution is called bobble, 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.

Bat further trials have been mads 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 bo 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. o Q

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 met is corroborated by the teeming instance* 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 yean
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 rather 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 *as
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 »w
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 lavs
of nature, which, by surpassing the instinctive faculty of man, bids
defiance to pathological explanation. A whole family of an EngU*°
baronet, have been long known to be liable to secondary and here-
ditary attacks of small-pox ; from motives of delicacy the name i*
suppressed, which was 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. 22?

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
fay 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 /rom ocular Observation, which go
far to enforce the necessity of forming a plurality of Vaccine
Vesicles.

Sbvebal 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 Original Communications.

reiterate vaccination in numerous instances, to correct die 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, 1 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 tar 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 practise 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-*
dieted 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 Worthy Montague, and Viscountess Strangford.

With a view of informing the reader, who has not seen my former
publication 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 m
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 Wortiey 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 mitr-
ing the deadly attributes of natural variolous by inoculation, *hkf
is fully described, in vol. ii. fifth edition, 1805, of her Ladyships
works., For the amusing intelligence of the reader, a compen#o«
abstract follows. By the pressure of modern works, and the lapse «

Mr. Marshall on Vaccination. 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, bo fatal and genera}
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 nntshell 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. Hie 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
cventB 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 bamshed,in one
day, the mistaken objections made by his subjects against the

232 Original Communications. -

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 die
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 Svlject of the Decadency of Vaccinatum, toydier
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
vims 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

Mr. Marshall on Vaccination. 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 met, by
such reasoning, those patients, it would be fair to suppose, who were
vaccinated with its infant lymph, 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 Communications.

-tion. I performed the operation daring the summer of 1830, upon
the iubvus 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. Tbi*
merciful result has been also recently testified by surgeons of acknov-
ledg »d 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 contents toothers;
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 the 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 Nora* Maiemus, 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 I At present, therefore, it strikes the author, that the cose
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
he asked, while the cow is always amenable to mild cow-pox by
vaccination, all the year round, how ib 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 wert 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, 1631.

V. — Judiciary Examination of Wounds.
By M. Ryan, M. D.

According to the law of this country, the surgeon mast
describe the length, depth and situation of wounds, abo state
whether they be mortal or not. He is to examine the orga*
hie 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 gau-

Srene in a hernia, or rupture of a varicose vein in the leg.
l 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,
bis 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- 237'

their excitement of strong emotions in Che sufferer, may cause
death. We 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, " do unto others as
you would they should do unto (you." 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,
sit 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 lire-

fular person to undertake a cure and allowed to die. Sir
I atthew Hale thinks this an error, and Judge Blac ketone

238 Original Communications*

sides with the former; Mr. Justice Bayley holds it man-
slaughter— Willcock on the laws relating to the medical
profession, p. 227. 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 hare 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, e?ery
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, ecchj-
mosis, wound, fracture, dislocation, carefully examined, and
we must take care not to confound cadaverous lividity with
eccbymose8. If the body is that of a female, we roust ex-
amine the mammas, abdomen and reproductive organs, in
prder 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 tne 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 after
death ?

240 . Original CommrnmcaHons.

In describing wound*, I have endeavoured to point est
the diagnosis between ecchymoses and cadaverous tividity-*
a point of the greatest importance*

W hen 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 momenta 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 time.

When a wound is made some hours after death, its lips ait
retracted as if inflicted during life, but its lips are pale, not
tumified, without any trace of blood ; the cellular tissue ■
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 aO the
characters of a wound inflicted in the last moments of life
Much stress has been laid on the presence of Wood 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 anunals,
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 1 A careful examination of the
situation of a wound, 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 bands of the deceased are abo
wounded, it is evident resistance had been made, and murder

fenerally proved, though there may be some exceptions.
n general a suicide inflicts wounds on the anterior surfaces
of the face, chest, and abdomen, and almost always in as
oblique direction from right to left: those made by aa
assassin are from left to right ; but though this difference is
conclusive with some jurists, I think it tar 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 as far too nice to be de-
pended upon.

Before we arrive at a final conclusion, we must consider
the age, physical and moral constitution, the season and
constitution of the atmosphere, &c. In general, suicide h

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 long1 delibera-
tion. It is proved by late writers, that this dreadful acfis not
so much influenced by climate as was formerly imagined,
and that it is as oommou 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 be
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-
Eared with the returns entered into the commissioners*
ooks, 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 1&00, 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 ji 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:
tne suicides of Paris, Berlin, and Copenhagen, as drawn
from tables collected by Dr. Burrow3 for this purpose,
being, in proportion to tne relative population of London ,
as 5 to 2 for the first, 5 to 3 for tne 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 duriug the last twenty
years.— Letter to Lord Robert Seymour, 1829.

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 diarrfcasa
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 hi*
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 remind 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 a 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) intq their body,"

244 Bibliography.

These worthies ought to be henceforth designated, "TieWmMm
of Nottingham."

PRACTICE OF MKDICIKK.

4. State of Medicine t* Turkey. — •« This gentleman vu bom it
Zagori, a district not far from Ioanina, fanous throughout the Levant
for its breed of itinerant quacks. Hie male population conssto
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 idem of their
wealth may be formed from their houses, which are well huut,
spacious, and the best famished 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 bat them-
selves. They are then taught reading sufficiently to decipher the
pages of their nrr*****', or manuscript, « containing a selection of
deceptive formula), 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 entrure in docto
nostro corpore ; and he then prepares to leave Zagori. The Zagoziots
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 signer dottore. He never eaten
a town but mounted on a gaudy-caparisoned horse, dressed in long
robes, with a round hat and neckcloth; never opening his month but
ex cathedra, his movements are performed with due professional
gravity, and he is at all times attended by his satellites. 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 die 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 die
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. Ihue 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 hfe 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 Gag.

8UB6S&Y.

5. — Case of Fungus Heematodes of the Thigh, cured by Amputation.
By William M'Dowall, -Surgeon, Kirkcudbright. — William Carson
is a lad of about 23 years of age, in the village of Twynhohn, 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 \ 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
but 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 tOl 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 oqze 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 riot 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

346 Bibliography.

recovery from the faint ; bat by cordials and applying heat to biefcet
he gradually recovered. The sac and wound seemed to get clean, ud
began to fill up with new granulations. The matter got better ; bk
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 continue 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 dus 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 bad passed into the situation just
mentioned, where it was cut out with difficulty. As soon as it wis
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 tone 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 is
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 hsematodes had proceeded.
The whole of the muscles near the knee joint were turned into
cellular substances and had lost their action, and there was toy
little motion of the joint. The cavity of the joint seemed to be

Surgery. 247

sound, but the thigh bone above die knee on the inside where the
piece of bone had exfoliated was in a curious state a long way up.

MATERIA MBDICA.

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 85 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
leucorrhoea. Fiat vena? sectio ad 5*vi. 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, There is no dis-
charge. Jfc tinct. opii ntxx. mist, camph. Jiss. 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 1 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, Jss. 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 pert of the belly and right Qiao region ; pressure gives pais.
Ap. hirud, xii. part, affects, fr Liq* ammon. acet. $as. ^
nitrat. 3i. Liq. antimon. tart. 3^®- Aq. menth. $iv. as. m. Sumtt.
coch. mag. iii. 4tis. horia.

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, Jsb. statim. Hie
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 <k the
present year. ~

June 13th. — I was sent for from Malvern, about three o'clock,
r. it. 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 muck
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 ; anil it
seems worth while to note tile occurrence of two children born at so
early a period of pregnancy, and both of them thriving 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 theae.—Midland Med. Rep. Feb.

MEDICAL JURISPRUDENCE.

8. Trial of 8L John Long, for Manslaughter. Before Baron Bayly,
Justice Bosanquet and Baron BoUand. Old Bailey, February 19.

The indictment against the prisoner charged him " with havi&f,
on the 6th October, 1830, committed an assault upon Mrs. Cotia
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 mfUunraatory,
corrosive, and dangerous liquid which was applied to the chest aad
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 : ia
consequence whereof she lingered to the 8th of November loilov-
ing; when she died."

The deceased was forty-eight years of age, and had bo complaint
except .globus hystericus* The husband had first seen the pal-

Medical Jurisprudence. • 240

soaer at the inquest of Bliss Cashtn in August, and deemed it right
to have bis 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 ezcrnciating pain, and the prisoner said " that
every thing was well and goiug 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 bis 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 7th,
8th, Oth 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 coW ; 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 whenever
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
ease 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
jnoisture ; 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
cheat, the cellular membrane under the skin was partly destroyed,
and there was a considerable discharge from the whole would*
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
poaltices. 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. x K

250 Medical Jurisprudence.

was not necessary to produce it tor the disease in the timet or far
any disease. On cross-examination , Mr. G. admitted the known
injurious effects produced by blisters, bad apprized the sister of
deceased of ber danger, did not recommend a consultation, at the
family were satisfied with bis ability.

On re-examination, witness said, though he apprehended danger,
he bettered he understood the treatment perfectly, and after the
body was examined, he saw no reason to think he was mistakes;
the injury was not similar to that produced by common blisters.
The simple dressing was calculated to reduce inflaiuiaatisn ;
rubbing would have increased, and would not in any way hate
benefitted the treatment.

Mr. Vance corroborated the testimony of last witness; wassailed
on 21st October, when Mr. Lloyd described the patient as sssferisg
from extreme soreness in her mouth and throat, and attributed it
to the inhalations of Mr. Long ; there was a sloughing nicer oa tat
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. Campbell's 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 infiammaboa
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 tbe prosecution.
. It was contended on behalf of the prisoner, that there was so
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 witk
what he did not understand, unacquainted with principles, venter*
ing to prescribe for the sick, incurred a heavy responsibility, and
indisputably, in some cases, was guilty of manslaughter* That, if
a man were to say laudanum is an exceedingly good meensjae, so
see could question his assertion ; but were he to administer s tea-
icnpful of laudanum, was there any man in his senses wosM say
that such a person was not guilty of manslaughter? Sorely then,
the person who would so deal with that valuable medicLie, 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 every 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, bad neglected previously to

Medical Jurisprudence 251

aake himself acquainted with its properties. The consent of the
latient in the present case, did not prevent it to he an offence
igainat criminal law.

The prisoner was then called on for his defence ; the principal
>oints of which were the following : that when he ceased to attend
rf re. Lloyd, there was no mortification ; the flesh was red and
iealthy9 and no injury appeared for eight days afterwards. . He
cnew nothing of any blister ; how could the medical men state the
:ause of death, without the examination of the head and spine, the
;ase was not his but Mr. Campbell's; and the only remedy
employed to cure mortification was spermaceti plaster. He could
tfaow by the testimony of hundreds of witnesses, that his process of
nhaliog, is attended with the most complete success ; he prescribed
'or the deceased on the Sunday, and she was taken out of his
lands on the Tuesday, and then her death attributed to him.
Uould it be supposed that he, who had cured so many hundreds,
ihoald all at once be deprived of his skill, and should be accused,
ivhen having prescribed but once, not only of a total failure, but
>f a felonious intention ? Mr. Campbell followed a particular line
>f practice, evidently absurd and insufficient, and why should he be
responsible for the act of another ? He could produce gentlemen
>f known learning and character, who would prove he had sufficient
knowledge to prescribe as he had done ; be had cured consumption,
liver complaint, diseases of the hip-joint, small-pox, insanity, and
* number of other maladies, and he never lost a patient, except
those who had been previously in the hands of regular practitioners,
rhis proceeding originated with the physicians and surgeons of this
Metropolis, though he had spent more money on his education than .
my 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 Ood 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,

SOB Medkal Juri*pruA*U€.

and also whether he bed shewn snakiest eUU and knowledge!*
estimate the effect* ef such a remedy upon the individual eoustite-
tic* of Mrs. Lloyd ; if they thought that he had betrayed pen
Ignorance, gross rashness, or wut of thought, they aunt find bin
guilty* It wm clear enough, that subsequently to tte application
Of the remedy, he wae not guilty of any negligence ; bat tfee qaestisn
wan, whether in the first instance, he wae rash, ignorant and anakft*
ful. The learned jadge then gave an historical acooant^f tfceevi*
dence* and told the jury, that if they should he of opinion that the
death of the deeeaeed took place from the wound, they must give the
terdkt against the prisoner! but they must he fully wntiwfad that
the death arose from that alone. If, however, they entertninedasy
doubt About it, then they woald giro the benefit of that doubt to the
prisoner ; they should also consider, whether the Tomody applied
was of an improper nature to administer, for if if war* not, tea
the prisoner could not be charged with any bad intent ; if tbsy
were of opinion that the prisoner was rash in making the appttcs*
tion, then he had been guilty of a felonious act ; the two points,
therefore, he begged to remind them of were, had the death sf
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 whet
wae the exaet stale of the wound when taken under the, care of
Mr* Campbell, and how it had been in the early stages of the tran-
section ; if, on due consideration of all these circumstances, the
jury had a perfect conviction produced in their minds that theft
wae a want of care and improper rashness in using the application k

Cstkro, and that the use of that was the cause of Mrs. Lloyd's
th, then the prisoner was liable to be found guilty, nod ought
to be found guilty ; but if they did not feel that full Goavietiee,
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

— *ef **#<!?•
A more extraordinary rerdict than this was never retained in s

court of justice. A clearer case of manslaughter, according to the

la^r 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 rerdict 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 is

existence. The deceased lost her life by the infliction of the injury

or by the treatment pursued ; the medical witnesses proved the

MtjirtL J*fiiptu4**0e; 298

latter to be judicious, *nd therefore she toe* her life by the injury.
Ab to the defence made by the prisoner himself, it was allassertien ;
and the medical part of at the grossest nonsense ever uttered*. The
very words, terms and phrases used by this rash and audacious
quaek, 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*, towel ; of curing incurable diseases ?

The presumption aud impudence of this man is unequalled iu
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 1 in allowing him
to resume his vocation ; but had he been a poor, illiterate* half
starved mechanic, he Wr>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, LongV innocent
liniment applied to their scalps as early as possible, lest at a fu-
ture sessions they perchance mightagafcxbe 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 bf 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 4.
and any candid, honest and scientific member of our profession,
most arrive at this conclusion*' If Mr* Long pursued a- practice*.
not indiscrimtnate,.net dangerous to human life, we should never
waste a line about him. We should consign him, with his innumerable
brethren in this metropolis, to silent contempt. We shou\d 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*
Bat when we see a man cause a painful ulcer of the magnitude ia
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 sueh 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 1600 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 condom
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 core all diseases by one
remedy. He of coarse 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 nart becomes disorganised, 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 rations other morbid changes, known to the educated
practitioner ; and it would be as sensible of Mr. Long to aasert he
could substitute a new lung for a diseased one, as to any lie 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.

MISCXI.LAKIX8.

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 Gag.

10. King's College. — We have at various times reported prugieas
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,
TSsq. 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, »
rierw considerably abated. The greatest exertions have been wed
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 rick
from the healthy, were insisted upon, have been strictly enforced

Miscellanies. 255

among the operatives; and the mare effectually to cany them into
effect, a temporary hospital, to which all access was shut out, except
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 107 7 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 cnmtt.—- 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 9th 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 Mi*edkm£*9t

AO0K8 BSOBIYSD DUUVO TBI MOOTS.

1. Outlines of Physiology, with an Appendix, containing Heads of Lectures oe
Pathology and Therapeutic*. By William Pukeney Alison, M. D. F.R.S. E.1V
femr ot the Institutes of Medicine in to University of Edinburgh, FiWiwih.
ISSi. 8vo. pp. 152. Blackwood.

*2. A Manual of Analytical Chemistry. By Henry Rose* Professor of Cbemtey
at Berlin. Translated from the German, by John Griffin. London. 18S1. to.
pp. 464. TOgg*

* Physiology of the Pojtns, liver, and Spleen. By George Calvert Hsliani,
M. D- Lecturer on Physiology, and Joint Lecturer of the Practice of Physic in (he
Sheffield Medical Institution. London. 1831. Svo.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 Tamer
Tnackrah. London. 1831. 8vo. pp. 126. Longman and Co.

6. Appendix to the Second Edition of a Series of Observations on Strictures,
Ac Ac. By R. A. StanVd* Esq,

6. Artenoloey of the Hnsnan Body. By Borrtmans ; revised, and aotstri w
the English Nomenclature, by T. King, Professor of Anatomy and Sugar.
London. 1830. 8vo. pp. 15. Fenillet, Dumus snd Co.

7. Medical Zoology; or Illustrations and Descriptions of the Animals sad
Minerals employed in Medicine, and of the Preparations derived from them; am-
prisms; their generic sad speciste diaraciers; English, provincial and ftfSfa
appellations; a copious list of Svoonymes; natural hikory; physical*
and medical properties and uses ; including also a popular and scientific I

account of
animal, mineral, atmospheric and gaseous Poisons"; with figures coloured fron
Nature, intended to serve as a oofrtimiatioo sx supplement to the Anther**, isd
other works on " Medical Botany," and Materia Medka. By John Stephanos,
M.D. F.R. S. London. 1831. Published monthly by Wilson.

8. A few Observations en the Subject of MedicW^CcmipositMm, with a view to
the establishment of. an improved* form of Aperient PiU, for domestic piunsmt;
addressed to dyspeptic Invalids, Amateurs in the Practice of Medicine, and the cos-
sinners of popular Pills, styled " Antibihous;** and recommended to the afieanoa
of country clergymen end benevolent ladies, who interest themselves in the wdfcre
ef their poor andaifiscted srarirbonrs; to which are added, some leniaiha npsaim
St. JohnLong's principiesaf Practice ; the whole accompanied by mnveJOwenjaV
' natory notes. London. 1830. 8vo. pp. 32. Miller.
' 9. The Companion to Post Mortem Examinations; illustrated by six piss*
London. 18S1. Sve. pp. 94. Rose. Wntte, &c

10. Illustrations of Mr. S. Cooper's Surgical Dictionary, pabhsned montyf
containing four lithographic plates, with letter-press descriptions, and reference)*
the text. London. 1830. Longman and Co. ~

11. The Nottingham Dispensary ; its necessity, origin, objects «nd hsmry;
historical and statistical inqniries into (he NotthtgnatnGeneral Hospital, StJhsp
Medical Estedblishment, and other provisions for the sick poor ef NolnngB»j
their resources, expenses, supporters, privileges and government; the nejnreesf
extent of their assistance, and other useful information ; a correct narrative oftbe
proceedings relating to the proposed Dispensary; full parficukrs ojf fheexdon®
of die Medical Faculty from Its Committee; correspondence ; &e meetiogs aw
resolutions of the Medical Profession; and other proceedings arising from*?1
measure; opinions and comments, Ac &c.; the whole drawn ne> from aiatsote
sources. By Thomas Jowett, Surgeon. Nottingham. 163L 8ro. (f • t*
Bennett. &c.

1*2. A Letter to John Bell, on the Dissection of his Body. By Gracdras. ft**
8vo. pp« 19. London. . Eccles, &c.

All Communications and Works for Review are to be addressed to the cj* J»
Messrs. Underwood, 3», Fleet Street; or to the Editor, at his Residenci, «,
Hatton Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 84. 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 Iving. 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/1
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 sirap]^
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

VOL. VI. no. 34. i L

258 Critical Review.

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,
ana will add to his high literary and professional reputation.
Had he written but this volume, ne would ha ye ranked
among the best topographical writers of the day, for bis
descriptions " of men, manners and countries/' are seldom
equalled, and scarcely surpassed.

In justi6cation 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, be 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
be 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-
otjions, 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 winch 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 bat
universal compact. One of the best remedies, then, for irritability of
temper, is a tour of this kind. A few hundred pounds would be well
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 depress**
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-— cesium non animum mutant. Yet, from two or three
instances which 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 any

260 Critical Review.

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 melancholies 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 isobtunded,
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 mil 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 traveller?
here, many of whom were females and invalids ; yet none suffered

Dr. Johnson on Change of Air. 261

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.

" 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 hygiometrical 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 viewB
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 were three or four invalids with us,- whose lives were

262 Critical Review.

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 pin-
sue our journey.

" Now these and many other facts which I could adduce, offer
inoontestible proof how much the morbid susceptibility to transitions
from heat to cold — from drought to drenching* — 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 axe 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 ail 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 sir,
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 poiati
of earth and ocean. But we know, from observation, that there are

Dr. Johnson on Change of Air. 263

great differences in air, as for as its effects on the human frame are

concerned. Hence it would appear that the individual, confined to

one particular air, he 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 be safely applied to change of air. ' Eo magi? 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, " 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 : — II. 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-

264 Critical Review.

rate than retard the fatal event — and takes away the few chance*
that remain of final recovery.

" If this be a correct estimate (it is at least an honest one) uf
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 Mends
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 thi*.
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

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 iuto convul-
sions on contact with a perfume.9' In disorders of the
digestive organs, comprising indigestion, bilious, stomach

VOL. vi. no. 34. m u

266 C / Uical Review.

affections, our author thinks a journey to Italy of advantage,
but he will neither assert confidently, nor peremptorily deny,
whether a permanent residence be beneficial.

Such are sortie 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.

1L— The Effect* of the Principal Arts, Trades and Pro-
fessions, and of Civic States and Habits of Living* tm
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, sad
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, when
reform will and must be effected in our profession — when
the vile absurdities of three centuries* date, will be coo-
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 bv 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 immediately at home, we observe the wonders
which science and art have effected. \Ve 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 Eke 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
L#eeds 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 P 1 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
moan* 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-teuths of the survi-
vors, cannot be a subject of indifference. S€ Assuredly/'
says he, " an examination into the state of our manufac-
tures has lonjr been demanded, alike by humanity and by
science.9' 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 bis
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 the 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 an Health and Longevity. 269

" Batchers 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 Bfe." — 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
jeen higher. They are subject to disorders of the diges-
ive 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 alf 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 coarse, have great
and continued exertion ; bat the kind is objectionable. TTieir posi-
tion on the saddle is bad, and they use the arms unequally ; hence
curvature of the spine. They are moreover said by Margagni to be
particularly subject to aneurism of the aorta. Hie drivers of chaise
and hackney coaches have more moderate and equal exercise ; bat
their position subjects them to popliteal aneurism. Hiey, as weS
as postilions, suffer from irregular living, and the habit of frequent

§ station. They are subject to disorders of the head and the stomach.
till 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, fn 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 alt drivers are exposed,
are thought to produce rheumaifism and inflammation of the longs.
I conceive, however, that these diseases would rarely occur to
abstemious men. It is intemperance which gives the susceptibility to
such maladiee ; and it is intemperance winch produces much greater,
the fatal affections which we have just mentioned. I scarcely need
add, that the whole class is snort-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 congested1, and the secretions consequently impeded.
The mult 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, mifl-
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 an excess of car-
bonic acid, and say a " 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 j>er 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
ad rice of the medical poet is lost: —

Fly the rank city, shtm its turbid air,
Breathe not the chaos of eternal smoke
And volatile corruption, from the dead,
The dying, sick'ning, and the Eying, world
ExhaTd, to stilly 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
ind impure atmosphere, tailors are placed first.

" Sitting all day in a confined atmosphere, and often in a room
oo crowded, with the legs crossed and the spine bowed, they can-
lot have respiration, circulation, or digestion well performed. Ihe
mployment, we must admit, produces few acute diseases. But
isorders of the stomach and bowels are general, and often obsti-
ate. Pulmonary consumption is also frequent. Some of the men
tate their liability to pains of the chest ; but the majority make no
Dmplaint. It is nevertheless apparent, even from observing only
le expression of countenance, the complexion, and the gait, that
le functions of the stomach and heart are greatly impaired, even
i those who consider themselves well* We see no plump and rosy
ilors ; none of fine form and strong muscle. The spine is gene*
Uy curved/* — p. 16.

Not one of the workmen employed in Leeds attained the
e of sixty. The evils attendant on the employment, are

272 Critical Review.

in many cases greatly aggravated by bad habits, as the**?
people who are physically depressed, often seek comfort
from ale and ardent spirits. Oar 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
* 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 Loo-
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 be
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 storing' straw

Mr. Thackrah 0n Health and Longevity. 2?3

bonnets. It induces cough, and finally pulmonic disease.
This gas might be absorbed, in a great measure, by plac-
ing1 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 veutila-
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 aft
least from the ukuiaturaJ position of that column.

" Weavers have a confined atmosphere, and, though the limbs are
fully exercised, the trunk is kept comparatively fixed, and the chest
is not expanded. Ttiis stooping however, is somewhat diminished
by the mode of casting the shuttle with a string, instead of the4
hand. When 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 front the frequent defect of proper nourishment. The weavers
of stuffs have low wages, and are often out of employ. There axe
more old men in the occupation of weaving than in most others."—
p. 2L

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-
B*e— a posture second only to that of tailors. The abdominal
TBcera, a*d especially the stomach and liver, are compressed. Lads'
>ut to this employ, often suffer so much from headache and general
ndftspefliiaoii that they are obliged to leave it ; and men who have
teen able to bear it for years, lose appetite and strength. Digestion
nd ci*c&ftatta& are so much impaired, that the countenance would
Mirk ft shoemaker atoost as well as a tailor. We suppose that,
xma the reduction of perspiration and other evacuations, m this
nd similar employments, the blood is impure, and consequently the
roaplexion darkened. The secretion of bile is generally unhealthy,
ad bowel complaints sire frequent. The capacity of the. rang* in the
[dividual examined we found to average six and one-third, aad the
rcuimferenee of the chest thirty-five inches. la the few shoe-
*kev» who live to eld qge> there is often a remarkable hollow Si
te fettseol the breast bone, occasioned by the pressue of thelast.

VOL. VI. 270. 34* v v

274 Critical Review.

Are shoemaker* subject to popliteal aneurism? Morgagni
this ; but 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 die 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 die relief of this
as well as other employments, which we have yet to ctmwHm* ; bat
to prevent repetition I shall make some general remarks on tins sub-
ject at the close of the paper.

" Curriers and leather-dressers are subjected to no injurious

rt, except the bent posture in the process of " shaving." This
ts the head. Hie 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. Hiese, 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. Hie 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 aa a cement.
Hie 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. Tfaackrab on Health and Longevity. 275

these workmen, indicates a reduction of health and vigour, life is
not abbreviated in a marked degree:

" Qockmakers 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.

" 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
2preat, and young men of scrofulous constitution are particularly
iable to sink under the employ. Smiths are subject to high tempe-
rature, and frequent changes of temperature, but with no obvious
njury. They are rarely affected with rheumatism and catarrh.
Che employment subjects the. eye to the annoyance of smoke,
nd to excitement from the glow of the heated iron. But our
Examination of the smiths in this neighbourhood does not prove
hem subject to ophthalmia; nor does it show that vision is impaired
►y the excitement of the retina. When smiths are ill, the cause is
lost frequently intemperance. They do not however arrive at great
ge. We could hear of but one old smith in the town of Leeds.

" Cabinet-makers are generally healthy, though employed within
oors. The labour is good ; and there is no hurtful accompaniment,
rith the exception of die dust, which is produced by sawing certain
inds of wood.

" Patten-makers are subject to no other inconvenience from their
tnploy , than the bending posture required in cutting the sole or clog.

" House-servants, from their confined situation in a smoky town,
re rarely in full health. We find them often affected with disorder
f the digestive organs and of the head ; the latter particularly fre-
lent. Girls from the country soon lose their ruddy complexion,
id suffer more than the natives of the town. Kneeling produces in
msemaids a swelling of the buna, near the patella, which produces
uu&iderable inconvenience, though seldom serious disease. Foot-
en, who stand long behind carriages, are said to be frequently
Fected with hydrocele.

Waiters at inns, irregular and dissipated in their habits, are
inerally unhealthy. They die comparatively young.

276 Critical Review.

HI. — A Brief Statement of the Progressive Improvement
of the Health of the Koyal Navy, est the end vf the
eighteenth and beginning of the nineteenth century;
together with practical illustrations, and a narratiu of
some historical incidents connected with the subject. Bj
Sir Gilbert Blank, Bart. M.D. Physician to the King,
&c. &c. London, 1 830. 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 hare not been pub*
lished.

Any one acquainted with the naval history of this country
for the last fifty years, must reflect with 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 wae
effected by Sir Gilbert Blane, Bart, by whose exertioaf
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 cob*
ferred on science and humanity hy this humane and talented
physician, of whose career we gave an imperfect sketch is
a former number. The first essay before us was presented
tp 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 fix»t admiration of his demoted
subjects.

These tracts are highly instructive, a&d exceedingly
interesting. They cannot he perused without imnrsww*
the reader with the most favourable opinion of tie hem
and heart of the author; for an ardent love of science, of
country, and of humanity, is displayed through every pagt>
which is calculated to make a deep impression upen the
minds of every class of readers. We hasten to illustrate
6ur statement by a few extracts.

" In the course of the year 1780, my first year of son***
physician to the fleet on the windward station, I found iron ■?
own returns and from ftMmining the records of the hospitals, that

Sir G. Blane on the Health ofthv Royal Navy. 872

the tjannel Joss of lives from dowse prerous to on* arrival, end

some *ime after , had been at the rate of Me inteyen; nerlraetlttf

alajrining rate of mortality imputable fc> the prevalence ef 6he p*cu?

liar epidenaic of the cjyhnafe, for time were tten iwy few cases ef

yellow fever ; and a* the principal causes of it were such es seemed

to me tote removable by practical and attainable means, 1 won

anxious to state these circumstance* at the source of authority* I

found that in a fleet, of whieb the complement of men was 12,109,

the inoxtality in one year had amounted to l»*lft» besides $59 yen*

dered unservieeahle, a number awe than equal to the cquigftnent af

three ships of the line. When this is duly weighed by a cffQsjfkrats

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 heme to our feelings, no case

could be conceived mere 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 amlion in the
West Indies would become the great theatre of war. itwasthenL
made such representations as brought about a total ekauge in the
state of health of the fleet.

" In a memorial to the Board of Admiralty, I stated the causes
of disease to consist in :—

t4 1st. The neglect of cleanliness, ventilation, and dryness in the
interior economy of ships.

" 2ncQy. The Want of the supply of an article, which had been
found, by the most uueqnivooal experience to be infallible in pre*
venting and caring 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.

" 8rdly. 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.

" dthly. 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.

"• tithiy. The want of a gratuitous supply of medicines, as well
aa necessaries to the surgeons, in order to enable them to cure as
many as possible without sending them to

278 Critical Review.

" 7tfa* As hospitals are* to a certain degree, indispensable si the
-principal stations, especially for the relief of ships in 'which con-
tagions 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 lint
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 die recommenda-
tion of wine, and of being an eye witness of its almost incredible
benefit in the new reinforcement which accompanied the admiral oa
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 ™t««n«i 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 ™frMwt»i pro-
tection required that when the channel fleet has been constrained to
return into port in so short a time, another naval farce, 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 ss
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 Gamperdown, 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 Nekon ; aad
that of the same great commander on the 2d of April, 1801, at
Copenhagen ; that of July, 1801, under Sir James Sanmarex; 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
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 Ins 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, hfe majesty was pleased to grant
him a pension for his services.

S80 Critic*! Review.

absolute will they place their tore* and limbs ; it is in their character
to tie anthmkiiig and careless of. their own welfare and interest,
ttquioaaj to be tended fike children, and, like children, are entitled
to ai parental tenderness from the country they protect and the
officers they obey." — p. 29.

Scurvy has been prevailed, subdued, and totally rooted
out, by the general Use of lemon iaiee, since L795» and hat
inaanined no, and fevers ate. entirely extinguished.

Thane improvements hafte extended to the nerval services
of aft countries, and entitle their author to a plane among
the best friends of science and of mankind.

IV.— The Life of John Walker, M. D. Graduate of the
University of Ley den, Licentiate of the Royal College
of Physicians of London, and late Director of tie
Royal Jennerian and London Vaccine Institution*.
By John Epps, M. D* Graduate of the University of Edin-
burgh, Lecturer on Materia Medica and Cbemjatry, Di-
rector of the Royal Jennerian and London Vaccine Insti-
tution*, &o» &c. London 1831, 8vo. pp. 343. 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 majikind 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,
mere especially as it Contains hie literary, political and reli-
giotts opinions, which would he misplaced hi a journal of
wis description.

His biographer and successor baa dene 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,

Johk Efts,

Dr. Epp»'s Lift of Dr. John Walker. 281

To those who knew the Doctor, that is the whole profes-
lion in London, a few anecdotes of him cannot be void of
nterest. Dr. Walker was born in the borough of Cocker-
nouth, in July, 1759. His parents were humble and indus-
rious, and took great care to procure the blessings of edu-
cation. While at the grammar school with his fellow
ownsman Dr. Woodville, it appears he had no great love for
earning or the learned, as the following anecdotes amply
estify :—

" While there, Walker exhibited that vagariousness of disposi-
ion, which formed a constant feature in bis life. At his tasks he
vas the idlest of boys ; at his amusements the most active. His
[uilty looks, on repairing to school after an holiday, sufficiently
vinced that the whole time bad been spent in play. When obliged,
towever, he could write with considerable expedition his Latin
hemes, which were so well finished as to obtain for him considerable
•raise. Frequently he went to his master's desk four or five times
1 the day to repeat his lesson in Virgil or Ovid, depending, espe-
ially after his master's dinner, upon the soporific influence thence
rising. Cultivating this dependence, he learned generally only two
r three of the first lines, and a few at the end of the lesson,
lefore completing the few he knew, the master began to nod.
Toung Walker kept his eye fixed upon the sleeper, keeping up, at
he same time, a humming sound, without articulating a syllable,
01 the master, giving a greater nod than usual, awoke, when the
poung rogue repeated the last line of his task and went to his seat*
Vhen the honest pedagogue was sufficiently on the alert, the defic-
iency was detected, and Walker flagellated, was sent to bis form."
-p. 5.

Having received a limited education, he became weary of
he pursuit of his father, which was that of a blacksmith, and
determined to go on board a privateer in the Bay of Dublin.
)n his arrival in the capital of Ireland, he was astonished at
be splendour and elegance of the public buildings, a full
nd faithful account of which is given in his Universal Gazet-
eer, published in 1795. "The attentions and familiar man-
era of his new acquaintances made him feel very soon at
ome." He failed however to accomplish his object in
oing" to sea, and was greatly reduced in circumstances,
rhen chance threw him in contact with an engraver, named
Ssdale. With this worthy man he remained for four years,
nd in the year 1780 published Walker's Hibernian Magazine.
le had the use of a good library with his friend, and readily
vailed himself of its advantages, devoting all bis leisure

TOI*. VI. no. 34. oo

282 Critical Review.

hours to acquiring the knowledge of Greek, Latin and
mathematics.

He now determined to become a schoolmaster, and bared
the difficulties which at first appeared insurmountable to this
accomplishment of bis wishes, by adopting the axiom, " pos-
sunt, quia credunt posse;" inother 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 st
the auctions in Dublin, which are always numerous. On
leaving these marts of literature, he often wished he coold
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 was doomed to endure. Influenced bj
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 alter bis
labours were over at 5 p. m. and slept until midnight, wben
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 1 7§2, he was able to publish
the quarto edition of his works. Here we must mention s
curious feature in his scholastic discipline ; he had no corpo-
real punishment, very little coercion, and so far did be 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, be
gave up his school to Mr. John Foster, author of the
" Moral Essays," and repaired to the great metropolis of the
world. He now entered himself a student at the medical
schpol, Guy's Hospital, where he became acquainted with
Sir Astley Cooper and others, who have since attained coo-

Dr. Epps's Life of Dr. John Walker. 283

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, " 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, as 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

£84 Critical Review.

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 hia huma-
nity and generosity," 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 waa 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 Facha at
Rosetta, a town situated on the western branch of the river Mile,
about twenty -five miles N. £. of Alexandria, he received arrests*,
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 tins
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.

Dr. Epps's Life of Dr. John Walker. 285

The Doctor* too, not being a vindictive creditor, pocketed the low,
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, wnich was found effectual in
arresting the lavages of the small-pox,' those soldiers escaping it
who submitted to his operation, and doing their duty as usual;
whiJe 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 mils 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 of

286 Critical Review.

the millions of public money squandered upcn 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
Giseh, 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, »
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 lateral
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 tongne,
that he was " Ingiese"— 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 " Ingiese," 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. Hie 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

Dr. Epps's Life of Dr. John Walker. 287

philosopher failed to profit by it. He pursued his tour
through the interior or a daugerous 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 he larking 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. *

" '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

Elague ; the poor must be prevented. It is absurd, and John Wal-
er could see it so." — p. 70.

The time allotted for the performance of quarantine having
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

288 Critical Revfow.

friends were musing, in lather a melancholy mood, on their absent
objects of affectum. This cast of melancholy had arisen from tie
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 pensuejBtate, a loud single knock at the door
was heard. For fear, no one answered it* save the balking of the
dog. After some delay, the servant determined to look out of the
window, when a voice utteired — " A letter under the knocker P'
The letter would have received tfce dews of night, had not an old
servant, who was often employed in the shrubbery, shortly after
requested admittance. When admitted, he, with all the language
of astonishment written on bis race, said that a strange-looking ao,
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 take advantage of the man's arrival, to go to the frost
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 bis tour, and again the
brow cast aside its mantle of care to put on that of peace."— p. 71-

He commenced bis 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, aodvras
finally obliged to resign. The London Vaccine lustitnti**
was established, over which he was again elected as cow
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, asapDeaisfrom
the correspondence inserted in the volume under notice. The
description of the Doctor at the vaccine stations, is faithfully
and graphically ffiren, with the exception ot his personal
appearance, which we shall add to complete the picture.
He was a thin spare person, far advanced in years, dressed »

Dr.Epps's Life of Dr. John Walker. 289

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 wliich 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, gaveashort, 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 die 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

VOL. vi. no. 34. p P

290 Critical Review.

Ettle one," and forthwith drew his lancet, to gather the rick kkr,
the produce of what he called his " vaccine roses." The sown* of
the terrified child, the complaints of the excited mother, and tfe
apprehension written on the countenances of al}, did not intimidate
the courageous soul of the director. He finished his operation, sod
then, laying aside the frown of offended authority, and patting 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 Astyansx, Andro-
mache and Hector's child, cried, when his brave father, hetaeted,
took him in his arms. Dr. Walker's lank and long physiognosff.
his broad-brimmed hat, and his tout ensemble, were sufficient to all
forth the greeting of a scream, when he offered the welcome, even of
die kindest feeling. The cries of the children (for children bone
imitative beings, when one commenced, the rest jomed) were, toae-
times, to those not aware that children often cry from imitatwo with-
out being hurt, truly terrific. Dr. Walker was used to it, and, con-
sequently, regarded not tears, or cries, or screams, or threats, aD «f
which he had dairy to meet with.

" He, it may readily be conceived, could not be interfered vtt,
occupied as he was sometimes with the vaccination of perhaps fifty or
sixty " little Londoners" at one station. Towards the eonchsos of
his life, if any one disturbed him in the regularity of his pfess, &
vexed him very much. Sometimes a medical man would speak to
him about something not at all important, and break the course of kis
proceedings. " Cannot thou keep thy peace ? I wiB attend tote
last" — was the result of the disturbance, and tiie offender bad fte
misery of looking foolish until every one else was supplied.

" The vaccination for the day was often concluded by a fects*.
after which the mothers went away, saying, "What a erosi oU
man!" " What a strange man!" ,€ What a curious old fellow!" "I
will not go again — Buch a cross old stick !" and raaay singular vslgv
remarks. However, the mothers did go again; fortheie was abat-
ing something in the "old Doctor," as he was called, that enticed than
back ; and also, then they had the satisfaction of hearing eipreasw.
with the greatest confidence, by the director, •* Thy child is safe.

" The medical men, who came for supplies of matter, he alwsj5
kept to the last, unless wanting their lancets charged, and ^enJlt
was absolutely necessary that they should present the lancet properly
opened and properly guarded (that is, so fixed that the ichor w«®
put upon the lancet, could not be wiped off). If not so gives, be
would return it, often not saying a word* If a servant brought ft*
lancet unarmed, he usually told him, " Go to thy master, sad teflon
to send me his lancets properly, and then I will supply him." If anyo*
ventured forward before his turn, he was sure to be supplied h*j|-
Many young students who had not yet received sufficient rebuffs is life
to teach them humility, came into the stations with all the import

Dr. Epps's Life of Dr. John Walker. 291

arrogance of conceit, saying, " I want these lancets armed," " Dost
then ?" with a peculiar expression of dignified contempt and jrity
combined* " stand back there!" was all the Doctor said. On some
of these occasions, when Dr. Walked had to do with sneh 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, m other words, *as 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. Walker was to be met with at 215, Strand; at a quar-
ter past nine, 337, Strand; at half past nine, at 2$, Haymarket ; at a
quarter to ten, a. m., 27, Lisle-street; at ten, a. m., at8, Broad-street,
Btaomsbury; at a quarter past ten, at 144, High Holborn ; at half past
ten, at 63, High Holborn. Front that station he weni 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 td 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
t 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.

" 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 tne 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

292 Critical Review.

year after year, watched, with the care . of a parent, die cause of
which he was so experienced an advocate ; who was willing to fans
nothing bat 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 <kj*
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
poisouing of the siek 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 ; but 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.— fly
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 Physioldgy 6/ the Fat us, $c. 203

. Id an exceedingly well written introduction, be
" 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 met, 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

204 Critical Revitvo.

occupies the place of experiment, facta are disregarded in mn eagtr-
neu to establish some favourite hypothesis ; and the instructive voke
of sage experience is not heard amufet the loud exclamations of noisy
partizans, contending for the troth of new theories, and ever varying
doctrines. The ancients were generally More practical, the modems
are more theoretical ; trie former way» therefore^ be sometimes safely
followed, (he latter seldom: kit H Womld l« dangerous to refy
imptieftly on either; tile ideas ol the one being often erode and rial*
colons, those of* the other visionary or imjterfect. It has beeri justly
asked* with reference to the present Backward state of medical
science-- What has inedleine 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 Ms
moral habits ; in developing his sensitive principles ; and in unlock-
ing'aH the hidden sources of internal enjoyment ?"— p. 18.

Ho adverts to the law which held it a serious crime -to

Suestkm the correctness of the philosophy of Aratotleyor
is 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 existing1 dogmas in medicine have
oeen 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 Abernetby. 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 oh medicine than on the other
sciences; to compose a work, even of a very hsmbie kind, on
natural or moral philosophy, requires superior intellectual
powers, strengthened by rttueb 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 existing1 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 throw? him into the shade This

Dr. Holland on Physiology of the Foetus, %c. 295

is a faithful picture of modern medical writers. Our author
adduces further facts ia illustration of the retardment 6f m*r
dical science, and the difficulties to be encountered by its
cultivators. He say*—

" In investigating the operations of nature, the inquiring mind k
perplexed by studying them through the medium of Ifeese ever vary-
ing systems, which involve the most important subjects of medical
sad physiological inquiry in almost impenetrable obscurity. There
axe 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-
etepast theories, dashing 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 eudnswe
mttentiomio espenmewt*"~-^ W.

He exaaiiae* the claims of the mxmt eminent physiologists,
of Hatter, Biehat, Richerand, Magendie, and points out their
defects with great candour and impartiality. He offers satis-
factory evidence that these illustrious men anrived 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 Chink, 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 CritictU Review,

one mind, or to admit of generalization. No system of medicine an
indeed, be formed with advantage, tQl its principle* are aim
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 Medkme 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 tk
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 tint
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 b&
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 Foetus, $c. 29?

He commences the body of his work with an examination
of the physiology of the liver and spleen, and after admit-
ting the difficulties of the subject, adverts to the opinions of
Dr. Stukely, published pin 1723 and of Moreschi of Pavia,
in 1803, " that the spleen is an organ appropriated to the
digestive function, supplying1 blood according to its de-
mands.*9 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 eompliment 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 SirE. Home,Malpighi and AssoIlant,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. vx. 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 ease." He thinks
the office of the spleen is not as yet discovered. We are
much surprized at nis 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. I have already endeavoured
to shew, that padsions, 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, baneral
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, $c. 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 part of the ancients supposed, that these organs
woe 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 nirther 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 abdoT
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 tQ 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 actum 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 onr next.

VI. — 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 is
the German schools. The translation of his worx 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 lor 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 pert 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 toe 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 tie 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 further to facilitate reference, an index has been
added to the work.

902 Critical Review.

Hie description of the practical contrivances employed in aniiy-
tical chemistry, is almost entirely passed oyer. For the introdnctkn
of most of these contrivances, and for the greatest improvenesb
they have received, we are indebted to Beraeliua* He has accoatefy
described them in the fourth part of his system of chemistry, with
the translation of which (into German) Professor Wohler is oov
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. xiL

ORIGINAL COMMUNICATIONS.

I. — Observations on Spasm of the Colon. By Fsux

W. Lyon, Esq* Surgeon.

I HAVB presumed to offer the following remarks on a dis-
ease, which I conceive to be spasm of the colon, in conse-
?uence of its more general cause (or at least that which
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 oo,
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
buffering, nausea and vomiting* are sometimes present, but
the latter is less frequent : out of ten or twelve cases I saw
last year, I believe 1 met with it in only one, and in this it

f>Toved inconvenient rather than distressing ; neither was it
61 lowed 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.
acybala), 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, which 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 Commmmiiation*.

rated faces. The object* I had, therefore, in view, were to
relieve the spasm* and to proaure free evacuations of the
bowels, which were accomplished by the exhibition of
aperient medicines combined with opium, each as the fol-
lowing:*^

^ Magnes. sulph. 3ies.
Infus. semis* 5xi.

Tinct. opii. xnj. viii. in., f. haustus tota quAque
hori sumendus.

This I have usually repeated, nntil the stools put on s
natural appearance. If, however, the disease had condoled
some time, and the bowels were relaxed, the evacuation!
being mucous and bloody, I have usually substituted sasill
doses of castor oil, (3iss. or 5ii.) mixed with the mucilage
of gum arabic, for the infusion of senna, and sulphate of
magnesia, repeated at intervals cf six or eight hours, until
the stools became healthy, and the following powder os
go^ng to rest :—

£r Hydrarg. cum cretA gr. v.

Pulv. ipecac, compositi gr. viii, v\. f. pulvis.

These modes el treatment I have always found attended
with success, and as soon as seybata have ceased to appear
in the evacuations, the pain and other unpleasant symp-
toms have left the patient : I then usually order some slight
hitter infusion, with small doses of the sulphate of mag-
nesia, to restore a proper degree of tone to the bowei*,
and a strict caution to the patient of the necessity of pro-
curing daily evacuations for the future.

2SJ, Dean Street, Soho,
March 6th, 183U

X ■« '» ■ ■ w^»»— — — p^^— ^ »^ ^

tl.-L-Rttpture of the Liver — Ignorance of Lawyer
Coroners. By Dh. Tuthill.

Pour cases, in which death was produced by rupture of the
liver, spleen, and an intercostal artery occasioned by vio-
lence. Reported by • Richard Tu thill, 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 hare

,Dr. Tuthill on Rupture of th$, Lber. 305

Jbeen very ill ; upon reaching her bouse I found that the had
died a few minutes previously, in eonsequenoe of severe
blows inflic'ed upon the body by her husband. Sixteen
hours afterwards I examined the body in presence of two
medical gentlemen. The liver was torn to the deoth of an
inch or more at the inferior and posterior part of the trans-
verse fissure ; the right 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 ht-
lle 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 nis 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 nave 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 Seen sworn I recapitulated the above statement,
respecting the appearances of the body and the cause of
death, and I waa submitted to the following examination by
the council for the defendants— -What are the (unctions of
-the liver? Is not the liver attached to the stomach by an
clastic 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 die act of vomiting? Does net rum produce in this country
a peculiar disease, not generally known in England ? The
learned gentleman bad in view the delirium nervosum ebrio*-
aitatis, and be 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 wail as rum. Was the liver altered in its appearance— was
k so changed, as to render it the more easily to be torn by
any preternatural excitement of the neighbouring parts ? It

' vox., vi. no. 34. a a

306 Original CommufiuxUiofu.

will appear evident from the nature of the above questions,
that an answer in the negative must have been ghrea 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 sof-
fines 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
shouldnot 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 couldnave produced the inward
appearances, and that such violence as the witnesses had
described would have been sufficient."

On the 1 3th October last, James Small, sat 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 uot discovered until after death.
About ten minutes after it had happened, he became feint
and lay down* he complained of uneasiness about the pre*
cordiav accompanied with dyspnosa, which gradually m*
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 reeeived 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 Au*. Stirling,
the medical gentleman in attendance, was requested to state,

Dr. Tuthill on Ruptur* of the Liver. 307

what he had seen without any examination. A verdict1 of
accidental death was the issue.

When stationed at Sierra Leone in 1827, 1 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 oyer 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 inio>
the abdomen took place, and death ensued in the course pf
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 bad 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
where 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 he have a knowledge of the structure
of the human frame, and of forensic medicine, can he

i'udge of those alterations to which the various parts of the
luman 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 ffchese important points, sub*

{'ects which none, generally speaking, are acquainted with
>ut 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, '

17tbDec. 1830.

308 Original Commun ications.

III. — Observation* on Homicide by Asphyxia.

By Da. Kyan.

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, oy

fases unfit for allowing the necessary oxygenation of the
lood in the lungs, or haanatose, as hydrogen* nitrogen, car-
bonic acid, or deleterious gases, ■ as carbonic oxide gas, sul-
phuretted hydrogen* nitrous aeid g*s, sulphurous acid gas,
amtaoniacal gas, chlorine, &c« Asphyxia tnay be momen-
tary, and respiration may be restored ; but when it is pro-
longed, it is fetal. Various injuries and diseases may produce
it, as division of the spinal marrow, formation of (also mem-
brane in the larynx or trachea, and syncope, &c.; bat with
these causes the medical jurist can hate 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 bsematoae of the
blood. This fluid passes through the lungs without any
change, it possesses the characters of venous blood and a
unfit for sustaining life ; the brain suspend* ten actio*, ths
muscles lose their nervous supply and cease to contract, the
chest becomes immoveable, the blood accumulates in the
lungs, and as the arterial ib mora 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 sou*
eases apoplexy or syncope may occur from fear ait ths
moraeut of immersion, ana death will not be caused by want
of respiration, but in general asphyxia is the ca tree of death,
whether by deprivation of air or by passage of water into the
bronchi.

In those destroyed bv submersion, the iaoa is red and
tumid, the pupil dilated, the eyelid putty open, -the eyes
glassy, the tongue projected beyond the lips, a frothy fluid
escapes from the mouth and noetrHsv the skin of the trunk
and extremities is remarkably pale/ the trachea, and some-
times the bronchi contain an aqueous sangviuoteftit froth,
according to Louis, Goodwin, Berger, Qtafe, and others,
and this is formed during life (Worry), as it cannot be pro-

Dr. Ryan *m Homicide by Aiphyxia. 809

duced by inftnersion of a dead body ; and is only a secondary
cause or death, according to Orflla. Tlie cheat and epigas-
trium are swelled, the fingers are deprived of akin, there is
earth under the nails varying according to the soil of the
bank near the water ; the brain is engorged, the epiglottis is
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 race
will uot be present, should the submersion be effected rapidly
and have caused syncopal asphyxia, or anger or drunkenness
might induce it. The external appearances of the body will vary
according td 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.
He 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 oache-
xiee. The engorgement of the brain is still more uncertain,
and may arise from a variety of causes. The condition of
die lungs and elevation of the thorax arise from various
causes. The presence of water, Or any other fluid in which
the body hes been found in the stomach, is a strong proof J
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 nimself 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
eectiymose* on the neck or wrists, or traces of poisoning, we
may suspect assassination, and in the former we must be
careful in distinguishing eochymoses from cadaverous livi-
dity, in the manner already described in treating- of wounds.
We can generally distinguish wounds inflicted before and

310 Original Communications,

after death, though a person may fall against a ftone ind
receive a wound m the water which can scarcely be distin-

Euiehed from one inflicted before immersion. When new
orn 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 od 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 4he vertebra, 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 bis
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 ecchymosesis
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 stiao*
Slation may be caused, and this sign be absent, or it may be
ep-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, bv the redness
and prominence of the eyes, which appear as if starting from
the sockets ; there is the livid engorgement of the tongse
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 tie
former. The lividity of the face and congestion of the brain
may exist, but disappear before the autopsy, or may be pro-

Dr. Ryan on Homicide by Asphyxia. 311

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 lungs 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 strangulatiop, except discoloratiou 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. Suoh 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 vertebra may occur in volun-
tary as well as criminal suspension. Orfila, Chaussier,
Pfeffer, Ansiaux. Orfila, however, concludes, that in general
sjuch 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

SIS Original Communications.

foreign to mjr purpose to introduce io this place all the
causes of euietae.

Asphyxia by Suj^oeatian^SviSocaAon is different from
strangulation, it being produced by the introduction of some
foreign body into the throat, or larynx and pharynx, winch
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 mow,
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 bard, they
will produce ecchymoses, excoriations and lacerations, fa
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 is
4he 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 ui
in forming an opinion.

Asphyxia by non-rsspirable eases.— Two divisions of
gases are 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, ana kill, by ceusing'a defect of
oxygen producing the same morbid appearance as result
from asphyxia by want of air : these are nitrogen, hydro; ea,
protoxide of nitrogen, carbonic acid, carbonated hydrogen,
.oxide of carbon, poisoning by charcoal. These and fol-
lowing gases 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 Chrtsti-
son divides gases into irritants and narcotics. The irritant
gases are nitric orfide 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 oride,
nitrous oxide and cyanogen.

Nitrogen gas.— TW\b g&s is found in cellars, in which
substances are placed, which have a strong affinity f<*
oxygen, as oils, &c. and sometimes ill privies. The signs

Dr. Ryan on Homicide by Asphyxia. 313

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-
bustion of charcoal, common fuel, or in cellars, from fer-
mentation of wine or malt, and from lime kilns, from coal
pita, 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 tjian 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 are

vol. vl. no. 34. s $

314 Original Communiemtioks.

bright, the tongue is swelled, the epiglottis is raised, fa
veins of the brain and lungs are congested with very Mack
blood, the stomach and intestines are ted, the mucous ttr-
feces are ecchymoeed, the blood remains fluid, and all 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. Chriatison thinks it
positively poisonous ; but it has been injected into the' veins
and produced slight effects, such as feeble nrusfcular action,
which disappeared spontaneously in a few day$. (Nysftea).

Asphyxia, by deleterious gases. Sulphuretted hydrogen,
ts 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 fnuscular
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 Mood.

After the death, the mucous membranes of the hose and
bronchi are lined with a thick bluish tmicosity, the Mood
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. Hie muscles have lost their contractility, ail
the soft parts are easily lacerable, exhaling a fetid odoar,
and speedily becoming putrified.

Asphyxia, produced vy gas evolved in privies and dr&hu.
This is the hydro-sulphate of atamonia, mixed with arrest
quantity of air, is composed of twenty-four parts in 100 of
nitrogen, one or two of oxygen, four of carbonic acid and
subcarbonate of ammonia. It is destg*nated 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
Jang-uinolent fluid in the mouth, constriction or 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
ttiorbid appearances are sftnlfer to thotfe dbserved by salphu-

Dr. Ryan on Hemicidt ty Asphyxia. 81$

retted hydrogen or hydrosulphuric Mid gas. This was said
to to (be cause of the fatal cholera at Clapham, which is
4en^4 by Christison.

Asphyxia, by sitlphuroys add gas, nitrous hydrochloric,
a/mmowual* qrsenical gases, hydrogen, carburetted hydro-
gen, muriatic gas, and chlorine. — AU these gases are irritant,
inducing cough, suffocation, vivid pains in the chest, some-
time* hemoptysis, 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 mapy 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 tfie 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 De °f
interest to the medical jurist.

Homicide by combustion*— The medical liirist is gelo-om
called on to pronounce an opinipn on a body destroyed by
combustion, as murder is afldom perpetrated by burning.
•The records of legal medicine afford but few illustrations of
homicide by combustion. When such cases occur, medicaf
evidence may be required, as stated in jthe remarks upon
Jmrns or torrefaction. It is now admitted on the continent of
Europe, though disbelieved in these countries, £hat spon-
taneous combustion is possible, though its caupe is as yet
inexplicable. It is aaia to occur most commonly to aged
females, who have long indulged in the abuse of alcoholic

flotations. Generally speaking, some matter of ignition, as a
iehted candle, a pipe, &c. has been found near 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 Communications.

contained in the cellular substance of our 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 mictions fetid
humidity, such as results from the combustion of hydrogen
gas. It rarely happens but some of the bones of toe limbs
remain, but the trunk is consumed, probably as it is con-
nected with the large cavities, and on aecount of the laxity
of the cellular tissue, and the evolution of hydrogen gas is
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 fire 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 foeculent matter in the bowels, the gull 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.

[ 317]

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 falfil 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 Original Cowtrnpnieation*.

Rachel, the wife of Jacob, died in giving birth to a son, akboagi
assured by the midwife that she need not feav. The second aDosoa
is contained in the latter verses of the 38th chapter of the sane
book, and presents the description of a rare occurrence in the practice
of midwifery. It is a case of twins, and one of them presenting by the
arm, on which, to distinguish it at belonging to the first bom, tat
midwife tied a scarlet thread; but the arm afterwards receded— the
second child came down, and was eventually expelled first. Fran
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 Pfaaroah,
by whom they had been oonynanded to kill all the male children, tint
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 was 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 grift
premature labour, terminating fatally, was brought on in the wife
of Phinebas, 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 ia
misapprehension of danger. The last citation from the holy writings
to which allusion must be made, refers to the treatment of the
umbilical cord, the division of which, 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, where we read of
the comparison of Jerusalem to a wretched infant, whose navel
declared to be uncut on the day of its nativity, that the
express mention of omphalotomy occurs ; and the inference
from it has been, that the Jews were in the habit of dividing, bat
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 niention of salting and swaddling, that If the eord
was not secured by tying, at least other means were had leeoui*
to -for trtopping the pffiiMAn of blood. Since also Ezekiel wrote ia
the year of the world 3840, at a time when the Jews had been in
frequent and durable intercourse with other nations, it cannot be

Dr. Mattes'* iMtvduetory Denture. &l4

tare than probable that section, though then in use. Was the mode
of separation that bad 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 met, that male practitioners are never alluded
to, either in the Old Testament, or in the writings of the Jewish
historian, Joaephus ; 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,
aurfets, chiropodists, &c. — in the next, the Egyptians are known, by
the monuments and relics which they have left behind them, as well
wi by the testimonies of the earliest profane historians, to have
mbeen 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 ait of medicine

320 . Original Communications.

-were distinctly exercised ; that the people were learned, policed

and sagacious; and from their frequent communication with &
country in which they could aee 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 fat
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 tnorbis muliervm, de ex$ec~
Hone fcctus mortui, and de super/cetatione ; 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 neok of a narrow-mouthed flask. Em-
bryotomy, or the extraction of the child piece-meal, he directs to be

Dr. Mai in's Introductory Lecture. * 321

performed whenever it is so swollen that it cannot pass, or the mal-
preaentation 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 haemorrhage 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 Anirnalivm, 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

Vol. vi. vo. 84. t t

322 * Original Communications.

obstetric subjects. Though for the most part a copyist of Hiefft-
crates, Celaua has modified and deviated from his precepts in several
important particulars. He advises that the feet of the child shook
be brought down in those cases of transverse presentation where
they can be more readily seised than the head, and observes that ex-
traction by the feet can be effected without much difficulty. Cekst
gives judicious directions for dilating the os uteri when requisite, fa
conducting the extraction of the placenta, and for performing embry-
otomy. In describing the proper modes of using tfee crotchet or
hook (two kinds of which he describes) he notices that convusnoes
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 oommeneement 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 654 set
write till after the period of Gelsus, and it is nearly certain that his
was the first book written specially on midwifery. Hie only other
work which contests the honour of priority with it, is that ete efcrae*
pudenda muliebri of Soranus Bphesioh, a writer who lived in the
reigns of Trajan and Adrian, in the second century* Mosshisa
ventures to recommend delivery by the feet with less reserve thsa
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 ite performance, for with
the exception of knee and breech presentations, he first attem|Hed to
reduce all others to that of the head, before resorting to eataaetun
by the feet. And this plan is now adopted and recommended by
several professors in Germany and Prance.* Mosohion spsatn af
parturition rendered difficult by disease and deformity of the iaJaat'i
body, by presentation of the head in a wrong position, amffey
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 wont 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 sad
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.^

Pliny, who was destroyed through his imprudent curiosity during
the great eruption of Mount Vesuvius in the first century, is

* Flamant, Ossiander, Siebold and others.

t Moschion has likewise given us a description of the chair or stool which
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. Malm's Introductory Lecture. 323

fltesManed, not because he was a physician, or said any things new on
efcatetric subjects, but from his stating among his paraphrases or
copyings of the writers on midwifery who preceded him, that from
tike circumstance of children presenting by the feet being so seldom",
or witii so much difficulty born alive, they were called by the name
of Agrippte, as if ogre parti. Hence PHny thought that such positions
should be always rectified.

The medical writer nest 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 hie 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-^partioularly of the. noted midwife Aspasia, and of Phi-
romenus— that his writings are interesting. iEtius treated uterine
bsBsnosrhage by styptic injections, astringent pessaries, and ligatures
round the lianbs { 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 Gelsus and Moschion, with
icflpect to pedal presentations and delivery. From Aapasia,
whoSssKppoetod.to have lived before the time of Hippocrates, and to
have been&e mistress of several Persian monarch*, 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,
besjdss minute directions for the management of puerperal women.
Of Phflumeuus, it is reported that he always in cases of locked
head, endeavoured to turn before resorting to the performance of
embryotomy— -that one ef the instruments employed by him in this
operation was a forceps, armed with teeth for comminuting and
extracting portions of brae--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.

Faufos Aginata fbilowsnextin chronological order to iEtius, 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 CoMMtunieation*.

lived in the fourth' or seventh century* Dr. Friend mcKnes u>*e
latter epoch, and to place his residence at Alexandria, since le*nag
and learned men were already at that period banished from Europe;
while Le Clerc considers that it was in the fourth cenimy 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 oar
modern term accoucheur was applied-— the Arabians calling him or
obstetrix, or obsietricus, 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 Paulas are for the moat 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 somenasagackni
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 die 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 wefl
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
midwives, answering to the terms grandmother,* female physicks,
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 Soto
— *' 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,

f Mffiai, uiTpo/UMiti, tprpwai, of*p*k&oju.Q>

Dr. Malin'S Introductory Lecture. 385

wdd to teach their employers, as we learn from Plato; the art of pro-
ereating 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 umbilical 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 bis Epigrams.
Hystericam yetulo se dixerat esse marito ;
Prutinus accedunt medici, mediceeque reoedunt.

906 Original Communications.

theTtJatbnof tteetymubgyofta

is for the unt port w*U founded and correct. Butthov^eetimsJsi
from necessity, -and prescribing from custom and prejudice for me
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 met that
they were addicted to wine, rash, and not worthy of being ^aitrustsd
srith the important charge of at least a first confinement.

Sans pol ill* tomnlenta eat muUef et temenria :

Nee talis digna, cai committal primo partu muliereaa.

Andriat, Ad 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 nark
Sges, that similar usages obtained amongst them.
. In proof of such having been the ease, 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 demaxtded more
anatomical skill, and physical, as well as moral resolution, than
females can in general have possessed ;— end the foot 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
nractioe of midwifery, in eases 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 Livie, the wife of the emperor Augustas,
to whom, after she had suffered a long time from lingering labour,
the court physician, Antonius Mlfsa, 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. Halm's Introductory Lecture. 327.

o> tairgeon (for th$ distinction df office ift* the prtrfesston wW not in
those times established) who was called upon in eases baffling-
female skill, is clear, from the term " me&cue»" always used by
Cdsus, to denote die individual to whom his direction* 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 eouse*
quence of the. ineffioacy and uuskilfclness of the midwivea, the .
Athenians— that ingenious and polished people* whose name, even
in the present day, is held to be typical of all that is elegant, intesV
leetual and reflned-r>enaoted a law, prohibiting females and slave*,
from studying or practising any of the branches of medichsev 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) pnefecced to perish in giving
birth to tbeir ofispring, 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 Agnodfee, was led, after removing hex hair and?
assuming male attire, to attend the lessens of an obstetric teacher*
HierophUus, in order that she aright gain sufficient skill ter admi-
nister to the sufferings of her sex, in their hour of travail an£
difficulty. So extensively was she sought after* that the absent
cheum, finding their interests to be greatly injured, and suspecting
something to be wrong, caused her to be charged before theureopa*)
gus, with being an eunuch and. corrupting men's wives* Brought to
trial on this accusation, she discovered her sex to the court,, eo?
which the accoucheurs became still more virulent and urgent for her
punishment, and this would no doubt have been severe, but km the*
intervention of the most distinguished ladies of ton* 'efty* ' wAo*
pleaded so eloquently and pertinently in her behalf, that she wast
not only liberated, but the obnoxious law was sJsfrreBoindeji, and free
permission thenceforth given to females, be4h<to/fiie£tise'the obttetrfer
art, and to treat all the diseases peculiar to the female eonasitutisavr
After this time, the male and female practitioners acted concunentlyir
the former being oonsulted in all probability only when their service*/
were indispensably required* .

The state of midwifery among the Greeks bjh! Jkunens liarangr
thus been considered, let us transport our imaginations to its' cenlbv
tion among their sucoessors in science and literature, the Arabians'; fori
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 Communication*.

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 coo-
signed to ruin, that the Huns emulated their sacrilegious and ferockxB
deeds, and that all the barbarians conspired to sweep away every
vestige of intelligence and trace of human dignity from the race 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. Hie
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 mat
heaven-born knowledge, which aims at uniting mankind in firm and
fraternal bonds of harmony and lore.

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 pie-
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 »
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 mil, the head
is to be opened, and its bones comminuted in the customary way.

(To be contimed*)

[ 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.

MBDICINB.

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. v 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, folly sub-
stantiates our good opinion. We usually direct two drachms of
turpentine to eight ounces of gum arabic mucilage, with which the
patient is required to gargle frequently in the ooume of the day. We
have, however, in some cases, employed the undiluted turpenbae
with die same happy effects. It usually occasions; at fust, consider-
able smarting, which, however, is of only temporary duration, sad
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
of burns and scalds.

We will say nothing of the modus operandi of the medicine in i
of salivation, but will merely recommend a fair and impartial trial of
it as a remedy for that distressing affection. — America Jomrmmlofikt
Medical Sciences, Nov.

3. Case of Colioa Constipata removed by mutation. By John King,
juti. Surgeon, Irvine. — The importance of inflation as a remedy lor
obstruction of the bowels, appears to me not to be sufficiently appre-
ciated at the present day. It was first recommended by Hippocratee
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 aa 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 e&siao
and immersion, freezing lotions, pounded ice and snow ; not to men*
tic* emetics, purgatives, and mechanical distention by warm funds,
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 feast
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. 831

but on account of the danger there is of greater exhaustion being
produced by it. I take Hie liberty of giving one case, as I conceive
it amy give some idea of the power of inflation.

in September, 1829, I was requested to visit Mrs. O. est. 26, of
father 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-
draehm 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. W hen
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 inclining 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 bam, 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 opmmenced being wrought.
As soon as the air entered the rectum, the effect was immediate and
satisfactory ; the countenance lost ite anxiety, the eye brightened,
and the patient said she felt quite relieved. A gurgling noise was
beard 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 ftve years ago, with the iatsl 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-
fid 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 Bibliography.

continued until die little sufferer tank. la 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 men
powerful means, than fluid injections, et caetera. 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 flees,
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 officiausness of his pbjr*
aician*" — 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 fbl-
. lowing comments : —

" Since the above cases and remarks were composed, the work of
Sir Charles Scudamore, on consumption, has fallen into my hand*.
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
Buch 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 die great risk of receiving injury instead of
benefit, I have avoided the introduction of formula 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 bis residence, in Wimpole -street, than
as a praiseworthy offering upon the sacred altar of medical science,"
—p. 388.

Medicine. 383

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, hiorth
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 1 827, 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 ;
thatfhe 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 beet 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

884

tinotareof iron three timet a day v ni sufficient quantity of wafer,
and to have a gallon <af cold water dashed en the periwaim and acta
nuramg e^ evening. He ipaaioved rapidly under the sweetmeat,
having wet hie bed for the last time on the 18th of October, art
having done it for the previous eleven nights. The cold water, on
which I had placed aome reliance as a tonic was not used at all; a
waa omitted at first from causes $at were not satisfactory to me, and
as he had become so much better when I was informed of it, the
employment of k was not pressed. The urgency of making water
gradually lessened, . and the power of retention improved, so as to
become natural in both respect?. Although he was entirety restaxed
in so short a time, the treatment was continued three months alto-
gather, as the incontinence was congenital, and he baa remained ever
since free from his distressing majady.

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
xhus gfcbrum or sumach, an ounce of the leaves to the pint of water,
the dose half an ounce three times a day, afforded gxent relief, add
almost cured the disease. His object waa to give tone to the urinary
system. Should this plan succeed in other bands, it will be a great
improvement in therapeutics.

scaaaar. -

6. Treataumt of Ununited Fractures by &fo».-~Dr. JJays, ©uetf
the talented editors of pur much esteemed contemporary, the Americas
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 fel-
lows: " 1 hftliftve it nifty tw» flftid +W tVmrg pre hro nr frfrr»» f^rfyM—

recorded, jn which, after some weeks and months confinement, with
a good deal of pain.tand danger, the union has been effected in this
way, but in other cases the introduction qf the seton haa failed."

" We confess ouraelves at a loss how to notice this summary and
contemptuous jfaipjwsaj of a methoal .of treating ununited factum**
and one which, contrasted with the ,/w*a/a/, and aometune* fetal
operation for which it was proposed as a substitute, it appeals to us,
can hardly be too highly extolled.

The apparent accuracy with which the lectpras are given in the
Gazette, seems to forbid our ascribing ao material a mis-statement to
an error of the reporter — the high character Mr. Lawrence hat
hitherto sustained for fairness and candour, .equally prohibits the
imputation .of intentional misrepresentation on ius pan, and yet kis
impossible to suppose that Mr. L. who is distinguished for extensive
erudition, should be ignorant of cases published in the Medko-Chirur-
gical Trapsactions of London, the Edinburgh Medical and Surgical
Journal, the London Medical Repository, the Medico^Dhiragjcal
ftevie*, the London Medical and Physical .Journal, the fcojadoB

Surgery* SBS

Medical and Surgical Journal, the Dublin Hospital Reports, Charles.
Bell's Operative Surgery, and Cooper's Surgical Dictionary, in which
no less than thibtexh different cases of ununited fractures notes*-
fttif treated by the *eton are related. Be the case, however, as k 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 snail give a brief
wrmmary 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 cf Excision of the db&w joint.— Mn, Eogers, aft. 46,
November, 20, 1829. The left elbow-joint is increased hi 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 oon»
dyle of the humerus, die third over the external, and the fourth over
the anterior part of the joint, beside* the tendon of the omens
muscle. The motion of the joint is exceedingly limited, and she
cannot !move fa or attempt to shut the hand without great pain.
Her health has fallen much off within the test 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 ; fls the soft parts were not much diseased; and an
the caries appeared confined to the extremities of the bones, I
thought it a fair cane to try excision of the elbow-joint, and was
happy to -find that 8ir Oeorge Ba&ingafl had the same opinion.

On the 26th November, the Operation was performed in the foU
lowing manner. s— An ineision was begun on the back of the arm,
about tihree inches above the joint, and carried in a straight fine to
about two inches below it, over the point of the olecranon process
to the edge of the uhsa, taking care to avoid the ulnar nerve. At
each extremity of this ineision a transverse one was made about two
inches long, and the nap on the radial side was dissected hack,
exposing part of the humerus, radius, and ulna. The fiap on the
inside was next made, taking ease 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
act appear sound. The insertion of the braokiaUs muscle was not

390 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 memos
was made by the saw, so as to include three-fourths of the articuk-
tion, and extend about two inches up the shaft of the bone, and in*
elude 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 pais,
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 Btraight 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 joist
has increased within the last three months, and that it is en!
improving. The connection of the radius with the humerus does not
appear so firm as that of the ulna.

To Sir George Balling all, I feel myself under many obligations,
not merely for his attention in this case, but for bis valuable adrice
and assistance in a great many others. — Edin. Medical and Strgkd
Journal.

8. Cases of Lithotrity, or examples of the stone cured without ««•
sion. followed by a description of the first symptoms of the &m&
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 fall
justice should be done to its merits. We accordingly read witfl
attention, the different documents of the controversy which arose os
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 Cniale to
this truly valuable invention, the admirable simplicity and efficacy of
the instruments which this gentleman, and his really scientific pnp"«
employ with such signal success, and the emptiness of the pretension*

Surgery. 337

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, sis 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

▼ou ti. wo. 34. x x

338 Bibliography.

cases of flat calculi, occurring in tbe vast number of patients whoa
they have relieved ? Have all the flat calculi been reserved for
M. Heurteloup? Oh, fortunate briseooque, thus to hare yoor
triumph* 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 insrrmnfnt We
pity these men. All the flat stones are for Heurteloup and ba
brisecoque.

But, supposing, as M. Heurteloup will have it, that fiat calcofiai*
refractory to comminution by any other instrument thap the briie-
coque, still the whole question, with regard to the invention of da*
piece of mechanism, presents itself again. M. Heurtdoop ray
quietly, and with becoming modesty, asserts in his pamphlet, tint be
is the sole inventor of it. Now, however much our confidence in hk
statements may have been shaken, we might, on account of the bold-
ness with which he has persisted in this claim, have admitted it, bat
that we find in a work published on Lithotrity, pp. 41-42, by Dr.
Civiale, ere yet M. Heurteloup was a lithotritist, lie 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 tvo
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 aa
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 sender 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 lithotnt*.
This canula serves as a sheath, and bears at one of its extreaiitiei,
the wheel destined to move the blades together or separately, accord-
ing to the effect intended to be produced." Here, then, is a on**
pierre, with which M. Heurteloup must have been acquainted beta
he made his own, and differing in no essential from any of the doe*
brisecoques that have been constructed by Amuesas, Riga), Coloav-
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 tbe
ordinary or three-branched lithotrite; and further, that from tbe
absence of a central piece, he could not accurately ascertain tbenatai*
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. Caetle,
he admits, that five operations or applications of Civude's instrument,
were made without any result. Five fruitless sittings I ! 1 We find
nothing like this in Costello's or Civiale's numerous cases. Now* »

Surgery. 339

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
mstranYent ; 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, but far different
in tiie 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 were 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 were, 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

•40 Bibliography.

be very wrong, seeing that the whole performance is addressed tut
to the world at large, than to men of science. For instance, it v
stated, that stones of a certain size, are seldom destroyed by mesas'
of Civiale's instrument, and that, in flat smooth stones, it can never
effect a cure. To this, the two hundred cases of Messrs. Cirnk
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 ii
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, m» mp*.
These assertions prove abundantly, that this performance was not
intended to throw any additional light upon the subject of lhhotritr,
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 die Society for the
Diffusion of Useful Knowledge is invited to take advantage of so mncft
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 infianunatory affection
of the testis, in the last case detailed, it is stated that the testis bad
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 »
not uttered in ignorance, then it is dictated by a disposition to attri-
bute to his own great tact, the avoidance of unfavourable consequence
whenever they happen not to occur. From the exhibition of such
vanity, we turn away with feelings bordering on disgust, and we call

Surgery. 341

on Mr; CtaeteUo, 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.

MI8CBLLANTK8.

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 New 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 sftendid institution, the London Univer-
sity. When we consider that die Lord Chancellor, and of course the
present ministry, eve the patrons and beat friends of that estabEsh-
meat, and find it disfteult to mcorporate it, from the opposition of
rival institutions, what chance can the proposed college have of
success in obtaining the like privilege ? Besides, it most not only
encounter this opposition, but the hostility of all the medical cor-
porations.

Were tbeprospecta of the intended college in the most favourable
position, the influence of the medical corporations alone must blight
them ; and ire 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. Tliese 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 undassically 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 Publm
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,
immediately proceed to Lincom'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 wul
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 wOl
only reflect upon the subject, that the proposed College cannot pos-

Miscellanies. 949

siblys ucceed. It has opponents, who never wifl*Uow it a legal foun-
dation. Let its Mends follow the judicious a/too* of the Chairman,
to endeavour to reform the old institution, but let them not indulge m
the vain hope of demolishing all the medical institution* 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 had courage to attempt ;
but in which reform or improvement in existing institutions, and not
their suppression was defended. In offering these] 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 ?" 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.

1 1. London University. — We are happy to inform our readers upon
the best authority, that the Government has determined to advise
and recommend bis 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.

MC Miscellanies.

LITBEABT IHTBLUGSKCK*

. 12. Dr. Uwins is preparing for the press a treatise on Mbjttal
Dekangbmsnt, 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 Coarse of Medical Jurisprudence, delivered in
the London University, on Friday, Jan. 7th, 1831. By A. T. Thomson, M.D.
P. L. S.1 Professor of Therapeutics, Jfcc. &c. London. Taylor.

2. Address of Earl Stanhope, President of the Medico-Botanical Society, for
the Anniversary Meeting, Jan. 10th, 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. 1881. 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 Stn-
dents of the 6lasgow Royal Infirmary. By M. S. Bachanan, 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 toe
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 10th of February, 1830, with the Report and List of Officers and
Members, 8tc. Ac.

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 oar next Number.

Books Received in Exchange.
The American Journal of the Medical Sciences, for Nov. 1680
The North American Medical and Surgical Journal, for Oct. 18|0.
The Medico Chirurgtcal 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 of the French, which perhaps, may be accounted for by the state of WL&a
of our Contemporaries.

0. The best Surgical Plates we can recommend to Tyro, are the excellent ilint-
trauons of Cooper's Surgical Dictionary, now in course of Publication by Mr.

AU Communications and Works for Review are to be addressed to the care of
Ha^'Gara^*0*1' ^ FIeet **I"St' °r *° *" Edito^, U his Re**nce» w

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 85. MAY 1, 1831. Vol VI.

CRITICAL REVIEW.

I. — Physiology of the Fatus, 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, 8vo. pp. 229. Long-
man and Co. — (continued.)

Dr. Holland commences his physiology of the foetus with
" an account of the various opinions concerning its nou-
rishment ;" but a few, of these however, are detailed. He
S'ves extracts from the works of Hippocrates, Galen, Harvey,
arwin 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, thkt the uterus generates a fluid similar to galva-
nism. He next quotes the views of Geoffroy-St.-Hilaire,
from tble series of this Journal in 1824; next, the doctrine
of Buffbn 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. wo. 35. Y T

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 »mmn»
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 aU
the physiological reveries upon this and other parts of my subject:
but I cannot help inserting a few more upon this point. Lobetem
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 : whOe
Schurigius, David, Roederer, Scheele, Winslow, Heroldt, Bedard,
and Geoffroy-Saint-Hilaire believe it to enter the trachea and bron-
chi, and to be there elaborated for the purpose of nutrition. Hie
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
omphalomesenteric 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

Dr. Holland on Physiology of the Foetus, $c. 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 Gynecology, 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-
litf , but fluids which are appropriated to the purpoees of organize-
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 Rcvifw.

the uterus possesses are perhaps as essential to its growth u the
warmth commnnicated to the egg during incubation. When the
vital actions have proceeded so far in the organization of the fate,
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 folly established the embryotic is changed into
fatal life, and the latter is exclusively nourished by the arterial
blood of the mother"— p. 70.

This explanation of fetal 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;
and , about the sixth or eighth day, in bitches, by Prevort
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, abort
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 fetus 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 Accouch. 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 tljfli the
amniotic fluid, which he very strangely denominates the
amnios, nourishes the fetus, 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

* Adeion, Physiologic de) 'Homme, vol. IV. p. 846.

Dr. Holland on Physiology of the Foetus, $c. 349

cutaneous veins of the foetus. This was also the opi&ion
of Lassaigne, which was long since satisfactorily refuted by
Gbevreul. Our author observes—

•

" That the amniotic fluid contains a respirahle gas, is a fact
proved, according to the statement of Geoftoy-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
akin, which act like so many trachea*. 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 festal life to its com-
pletion; and therefore, it is improbable to suppose, that a pure
oxygenating principle could exert any influence under such circum-
" - 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 become*
arterial blood, air is received directly from without, and whatever i*
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 foimed. But how. can the
placenta improve the qualities of blood, without oxygen, and the con*
currence of those organic adaptations which characterise 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 S. Home seem*

350 Critical Review.

to imply, that air only is received from the mother. " The foetal
blood," he Bays, is close enough to that in the vessels of the utena,
to have the air communicated to it." It has 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 placental 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 die
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 k
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 bj a
molecular action in the placenta, which though inexplicable may be
still correct. He thinks it may be compared to the capillary sptan
after birth : to what takes place in secretory organs, and in the long
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 die
lungs between the atmospheric air and the venous blood. Howerer
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 hemorrhage con-
sequent to their rupture. It is really, astonishing that a physician »
intimately acquainted with obstetrics, and every branch of medical

Dr. Holland on Physiology of the Fwtvs, $c. 351

science, as Professor Velpeau is, could seriously suppose such a doc-
trine."—p. 86. Dr. Ryan, ut supra.

The last hypothesis noticed by our author is Dr. 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. Parti. 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 duct* manifesting unequivocal traces of it, "in
general/' Dr. Lee says, " the hepatic and common ducts of thelber
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 m
pressed out upon a plate of glass without mixing with the tiled
the gall-bladder." Dr. Lee examined above twenty foetuses, and
yet, in two only, found a sufficient quantity to be pressed oat 1900 1
piece of glass !

" 4thly. If the liver be an organ which secretes albumen far the
support of the foetus, how, I would further ask, is its nutrition to be
explained in those cases of maloonformation, in which die organ is
entirely wanting.? Many instances of this kind are on recent Mr.
Brodie relates a case, in which no liver could be found ;* others ire
mentioned by M. Mery,f Dr. Le Cat,} and Dr. Qaik.§

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:—

«c

4«

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.

" Sdly, 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 110
direct communication between the u terns and foetus. He
holds the absorption of the maternal blood by the umbilical
vein, and that of the foetus by the uterine veins. In fert-
ile has not added a single new idea to this disputed point
of physiology. He compensates for this deficiency by *
most ingenious view of the causes " 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, tri
which are intimately related to the views already proposed, concern-

• Lotkk PUt. Tram; Part I. 1800.

t Htstoto <fe F Academic Rotate Jes Sciences, 1720.

1 Ibid, 1740

Lond. Phil. Trans. 1703.

Dr. Holland on Physiology of the Foetus, Sfc. 353

ing 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 the 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. vx. vo. 34. z z

364 Critical

out, and the ooolest receive, until they have attained a safest
degree of heat. It is, therefore, manifest that as long «tkW
foetus remains in the uterus, it will be of the same tempentaB m
the mother. If this explanation is considered satisfactory, it i
obvious that the conclusion of Magendie is fallacious, viz. that "tk
foetus must possess some means of Iftnmming the tempemtDR til
does not exist after birth." — p. 128.

The remaining chapters are on " the origin of the liquor
amnii and meconium ;" " the nutrition ana peculiarities of
the foetus;" " the brain, spinal cord, stomach, liver, pan-
creas, and intestines not essential to foetal life ;" " of the
functions of the liver, supra-renal capsules, thymus and
thyroid glands in the foetus;" " the mode of nourish***
in the oviparous and ovo-viviparous* animals, and on the
influence of the mother's imagination on the devekpemeot
and constitution of the foetus. '

The whole of these subjects are ably, discussed, sad At
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 wul
be highly interesting to the physiologist. It will add to the
well-earned reputation of the author.

II.— The Effects of the Principal Arte, Trades end Pro-
fessions, and of Civic States and Habits of Luring, »
Health and Longevity. By C. Turner Thicks**
London, 1831. Longman and Co. Leeda, Baines & Co*-
(continued.)

Ws 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 artnj
or kneeling posture, and with the body bent over to thegrestetf«j
gree. They work in an unnatural atmosphere* and with art**
light. They are exposed to changes of air, and occasianaHyJ^
work with their feet in water. Perspiration at other times '9t0$?\
as to cause them to be almost naked. They generally work fro© m
a. m. to four or Ave p. m. and take little food while in the m»*7
Colliers are generally spare men, Hie spine to almost ttayicart**
-and the legs are often bowed. The skin, of course, iskadea*1™

Mr. Thackrah on Health and Longevity. 355

dirt; and when this is removed, die 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 oarburetted 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 pita at the age of six or seven, and are employed
in opening the trap-doors, driving the horses, propelling the trucks, &o*
amd finally, when of sufficient age, they become colliers. Sickness
avid vomiting sometimes»affect persona 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 5 bat 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
siaw 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 tot
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 day*
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 parv
tift} effect . A more promising plan is recommended in Keea'a Cydo-
t, Ait. WeHL—o. 99.

• Sat m the Edinburgh Medical Journal, vol. 88, s short but interesting paper
by Mr. Watson, ef Watriock Head, on a ease of this kind Headache, giddiness*
tingling of the year*, vomiting, tremor, with extreme debility, succeeded to the par*
Mor general jaeunibilrt?, which the gas had produced. These or four mdirideals
appeared afterwards in a state of intoxication.

&>G Critical Review.

Mr. Thackrali next considers " employments wkiek pro*
duce dust, odour, or gaseous exhalations." He adverts to
operatives whose employments connect them with animal
ajid 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, arc
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 tie
not accustomed to it, does no evident injury to those who inhale
it daily.

" Bricklayers, and particularly their labourers, are exposed to line
dust. This frequently excites ophthalmia and cutaneous eruption,
but not internal diseasef.

" The remark applies also to lime- workers and leaders of lime.

" Plasterers and whitewashes, 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 ammoniacal gas evolved from the glue ; but I doubt it*
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 odonTr
and in the stoving department to an increase of temperature, let
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, produce*
disorders of the head, the air-tube, and the stomach." — p. 33.

• I stale of course what we observed : but the number of starch-makers hi I*sj*
is comparatively small. Merat says that if the odours be in great quantity, iwj
produce cough, difficulty of breathing, paleness, and emaciation.

f We hear an adage in the mouth of the workmen, that " bricklayers aodp«**
tcrers' labourers, like asses, never die."

Mr. Thackrah on Health and Longevity. Zbf

Our author next describes employments m 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-
temperance, 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.

&5S Critical Reviem.

" Buckram-aULBuftaturers art exposed to the odour of the gbe.
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, ant
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
titie fourth 76 ; and these individuals have been at the employ froo
an early age.

" Tallow-chandlers, subjected to an offensive animal odour, enjoy
health, and attain a considerable age. During die plague in London
it waa remarked that this class of men suffered much less tan
others.

•• Tanners, it is well known, are subject to disagreeable odom
They work in an atmosphere largely impregnated with the vapovof
putrifying skins, and this combined with the smell of lime in one
place, and of tan in another. They are exposed constantly to vet
and cold. Their feet are scarcely ever dry. Yet they are re-
markably robust ; the countenance florid ; and disease almost in-
known. Tanners are said to be exempt from consumption; and the
subject has of late been repeatedly discussed in one of the medial
societies of London. We have carefully inquired at several to-
yards, and could not hear of a single example of this fannidtbk
disease. We do not find M 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 proces.
Persons, however, in advanced life, yet healthy, are found in other
occupations, who have before been for many years in the tan-ytnh,
and have not apparently suffered from the long continued expeewe
to their offensive odour. Hence we may infer that this employ,
while it invigorates the constitution in youth and middle age, doet
not sensibly shorten life ; does not, in other words, give tenponiy
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 media!
police, however, we see no occasion for their exclusion from the
town.

" The observations under this head apply also to slaughter-mea,
but their employ was mentioned with that of the butchers."— p. 17-

" Employments producing a dust or vapour, dsddedlf
injurious"

" Corn-mfflers, breathing an atmosphere loaded with the partkiei
of flour, suffer considerably. The mills indeed are neceamrOy
exposed to the air, — the number of men is comparatively small, tad
the labour is good. Yet millers are generally pale and sickly; most
feaye the appetite defective, or labour under indigestion ; many ire
annoyed with morning cough and expectoration; and some are
asthmatic at an early age. The average circumference of the cos*

Mr. Thackrah on Health and Longevity. S5t)

in ten men, whom we measured, was 36 2-5th indies ; and the
quantity of air thrown out by a foil expiration was somewhat lest
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 die 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
140°. 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 ot 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 speaks lust men-
tioned, but are not annoyed by that of common timber. The

360 Critical Review.

removal of wood-dost would not, I conceive, be difficult. A car-
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 is
lifting weights ; they are exposed also to vicissitudes of the weather,
they are addicted to intemperance. We promptly find the effect)
of these circumstances on their physical state. From their exertkn
in the open air, their face has colour, and the figure is muscular and
robust : inhaling dust, the bronchial membrane is often in a stateof
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 Jambs 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 pag*.
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 Bdelity. It b*s
a great sale, and it well deserves it. It is a beautiful spe-
cimen of typography ; the wood-cuts are executed in *
superior style; the descriptions are simple and scientific;
and the work, upon the whole, is interesting to the general
and medical reader.

r sci ]

IV. — Introductory Lecture, delivered at the Hull General
Infirmary, Nov. 12, 1830. By James AldBrson, M.D.
Fellow of the Royal 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 drown
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
>ught to be regarded, but as a happy means of benefiting his fellow
creatures, of administering comfort, and of prolonging life. And in
he long and laborious process of qualifying for the performance of
ts duties, there are many branches of tedious and difficult study to
>e encountered, many where doubt and obscurity might almost dis-
ourage him, had he a less important object in view.

" The value of medical science, even as a branch of general
dacation, is strikingly Bet forth by one of our first moral philoso-
hers, who, in speaking of the early studies of a still greater man,
ears this testimony to its importance : — " No science," says Dugald
itewart, " could have been chosen more happily calculated than
ledicme, to prepare such a mind as that of Locke, for the prose-
ution of those speculations which have immortalized his name v
te complicated, fugitive, and often equivocal phenomena of disease*

voxh vi. no. 35. 3 a

362 Critical Review.

requiring in the observer a far greater portion of discriminator
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 tk
upright medical man is, a desire to benefit his feflow-creataresto
his profession ; unremitting diligence to attain the utmost height d
scientific truth and practical information, is the means by which be
acquires power to pursue this purpose ; and a careful cultivation <*'
all the charities and courtesies of life enables him to give mil nbe
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, n
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 harried,
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 ism**
active in drawing from the resources he already possesses, will abff
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 m
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 ail 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."

Aksnsidk.

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 bleeseth him that
g^ves and him that takes ;" and we may be thankful that we belong
to a profession which affords such constant opportunities for its

" 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.

K4 Critical Review.

" ' And here," says the elegant and moral author of DeVoe,
" let ut not refuse to pay a tribute to this most amtthU profession,
which it deserves beyond all others ; that it contributes (and imfad
cannot be exercised in perfection without it) to the moral happiras
as well as the bodily sanity of mankind. Other professions fat
their evident importance ; and from requiring all the great virtue,
are rewarded with wealth and honour. But none like this, wiwk
itself into an intimacy with the secret heart of man, and tks
obtains his confidence and acquires his lore. Indeed it must be so,
since half our diseases spring from mind ; and the cure of tk*
depends more upon benevolence, kindness, and discretion, than
upon medicine itself. Hence we may, I think, observe, that vkik
the distinguished in other professions are more outwardly hanamet
the friend of the sick room is most personally loved.' " — p. 30.

V. — Du Degre de Competence dee Medecins dans le$ quti-
tions judicaires relatives aux Alienations Mentalet, &
des Theories Physiol giques sur la Monomanie Homicide,
etc. ParELiAS Kegnault, Avocat a la Cour Royalede
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, $c. 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, €t any man of sound judgment is as com-
petent as M. Pinel and M. Esquirol, and has, moresier, 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 question* «&*
mitted to them, they too often substitute the ambitious ig-
norance of the schools for the natural Jig-fat of reason' —
Journ. Univer. des sc, Med. t xl. m. Juillet, 1826. "?**
passage," says our author, " full of force and truth, woaw
dispense with my entering further into the question, u

M. RegnauU on Mental Alienation. 969

several physicians had not believed that ibis concession at*
tacked their right and skill. M. Georget, however, opposed
this doctrine in very strong terms, ana is in turn attacked by.
our author. " The sophistical reasoning'/' says the former,
" 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 wasalsq
condemned by the profession in America as appears by our
northern contemporary." — Amer. Med. ana Sur. Journ«
1828. M. Regnault 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 eminent 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 bis
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 ithis 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* let. The
disorders of the mind, of the thought, which constitutes
delirium (deure). 2d. The disorders which supervene on
the organic 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 end 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 Reviei.

especially to madness, so as to indicate it infallibly, then we
must have recourse to the physician, who, as we hare
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-acbe, 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 which 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 roan can re-
cognise it by its extravagance and by its fury. If there ii
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, hare
each raised their systems according to the ruling ideas;
some in the bile, the blood (the black bile, clots of blood
from piles), or the mucous pituite; some in the soul, in the
vis naturae 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 : " the prelude of the invasion
and of the return of the attacks of madness may be v«T
various ; but it seems that in general, the first seat, of mad-
ness is in the stomach and intestines, aud 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. S6T.

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 being the effect of madness, whilst all
physicians have regarded it as the cause of the disease.
Let lis apply these reconciliations to other affections depen-
ding on madness. Many physicians have considered suicide
as a variety of mental alienation ; admitting for an install
that it is really a disease, I wonld 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 buiaiy organs.
Bete 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 moie
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 (foli& raisonnante). How can we form an idea
of reasoning madness when madness is only the absence of
reason ?

*' M. Esquirol," he says, rc appears to have perceived A«
ridicule of this term, When he proposed the word 'mono-
mania." This writer says the species of monomania take
their name from the object du 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 die
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 ana pusillanimous spirit.
In vain I seek for traces of madness. The Brachmans
who passed entire days standing on one foot, in the burning*
sandsr, 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. EsquiroPs
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.

VOL. VI. no. 35. 3 B

370 Critical Review.

The publication of the murder committed by. Henriette
Cornier, caused several other women to commit similai
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.

This 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 convulsion*.

From these reasonings, our author will not admit em
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 soch
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, wd
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. 371

other 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, " 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.
Falret. 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
fdunded, 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. Bat 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. Hegnault 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 venffence,
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 arrived
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 then* 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 parteof 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 herespok
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 cat
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, bat we
are even unable to demonstrate by such testa the existence of any
one of them. It unfortunately happens that the delicate orgama-
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 to
by the observation of certain effects on the body, and the application
of the general reasoning employed above, that physicians were &*
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 physical
believe to be engendered by exhalations from the soil being infinitely
diversified in character, that difference can only be attributed to i
corresponding difference in the causes from which they flow.

" If the principles just stated be admitted as correct, and ve
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 pecs-
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 soil 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 Tixy,
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 m
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 are most apt to vary. Widely diffused over the gtobe,
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 syrnp-

Prevalence of Dysentery in Scotland. 375

toins, in Holland and Italy — still more rapid and intractable along
the shores of Africa, at Batavia, and the mouths of the Granges — 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 rail 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 believed
in by practical meteorologists. Their observations have not

376 Critical Review.

indeed afforded results so certain as to be subject of ealadi-
tion, but they are generally admitted to be founded hi fed,
and if so, there must also be a corresponding rotation of dmm.
This idea was suggested by Sydenham, who professes himself, how.
ever, unable to determine its accuracy. " Hand equidem satis soo,
an diligentius examen (quali rite instituendo viz unius hominis kw
aetas par esse videatur) nos edoceret, epidemicorum alios contmni
qu&dam serie, ceu facto circulo, alios semper excipere." It miy
appear presumptuous in us to offer any opinion as to a point, w/hich
this greatest of ail medical philosophers, upon a field of discask*
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 doling 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 my
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, viB
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 we, hi
this country, to receive a visit from the Indian cholera, which, after
having travelled oyer land from Hindostan, is now approaching die
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 a
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 sew even in India, but more accurate
researches have shown that opinion to be erroneous, and we have bo
doubt, similar researches, if there are documents on which to fcand
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 livi4 face of plague may be again seen in the
land, we hold • to be perfectly possible, and if from the ravages d
war, or any other cause, the country were to relapse into its prisa*
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 he
inconsistent with the observed analogy of nature in our western
hemisphere.

[ 386 1

ORIGINAL COMMUNICATIONS.

I. — Dr. Malins'8 Introductory Lecture.
(Concluded from page 328 J

Thr 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 tibia 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 mam 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 mil 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 mil 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. vx« no. 35. 3 d

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 i
book, " De Arte Obstetricia," by a celebrated female, Trotnla, wbo
lived some time in the thirteenth century. A book on the disease
of women, dedicated by its author, Priscian, to an eminent midwife
named Salviana, appeared in the eighth century, and these two an
the only works relating to our subject, which appeared ia 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 bak
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 were 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 irt
Lake authors on every other subject, these on midwifery now begm
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 noW
in this sketch of the history of the art.

It was at this early period that, according to the authority of
Haller, the Caesarian 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 midwiferj. He
taught that the head presentation alone was natural, and that m
every other case the child, after being when necessary turned,
should be brought into the world by the feet. The credit, howerft
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 nad
not sufficient discernment to detect, or what is more likely, sufficient
courage to expose ; for at the time he wrote the prevalent notion*,
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 tp,
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 1565.
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 Caeearean. 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\ Ghiillemeau, and at a later period, Mauriceau hesitated, from
experience of its fatality, to sanction its recommendation.

Ghiillemeau 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 femrnes.

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 abode. 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 ? Hie 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 Comrnumcwtion*.

expelled dead. la the fetter instance, however, ewe and efect ir
eonfbnnded, for the death of the child rather rente from, thane*
duees, the unnatural duration of the process. Harvey beM
likewise that aaper-fbatetioii was possible, and that uteio-gestttai
might be protracted beyond the term of nine months ; andhtkat
medical man of distinction who nratiaed midwifery mtakeoasrf

Between 1650 and 1700, lived several eminent accoachcwi as
at home and abroad. In France, Msnricenu, Ctaasst and fa
were the principal.

Manrieeau'a writings wese fuller than any which had atwdf
appeared, especially on the diseases of females, and centos any
-excellent suggestions and observations. He invented aa aatoiaai
to txtmet the head of the fcetus after it had been eseaei ad
emptied, called a " tire-tfcte," bat was ignorant of the fees*
He erred too, fadeaounctiigtheCanMU'eanc
fetal one, bnt oh the whole is to be deemed an iOntnaas ass?
in the obstetric art.

Clement was employed secretly to attend the mistresses of U*
the Fourteenth in their accoocbemena ; to the first of wbkahew
sxmduoted blind-fold, while the king was concealed among nefaed
<emlains, and the face of the lady enveloped in a net-woa\ sf ha.
The cftrcumstance of these ladies employing Clement, priaci|*iy
contributed to bring male practitioners into fesbion-*tbe coal
hastened to imitate the examples of those who presided enr fe-
ttle rest of the nobility and gentry were swayed by a practice *&
-earn* so powsjfattyjeeommended to them, and the boargeos a*
dtaens could be hot too happy in adopting or humbly oeajiaf«I
of the usages of their betters. The name of jfeeswekariw**
invented to designate this class of practitioners, whom ft***1*?
immraaliy the mode to employ. The contagion of toe enisle
soon spread in£> neighbouring countries, and the custom, bo***
whimsical or trifling in its origin, or resisted and opposed ie*
progress, is now generally established, conferring, beyond all doe*
great and daily benefits on the community.

Pen, who comes last in order of the French praititkinearfj*
17th century, is notable for his aversion to too frequent dip*
interference during parturition — for his opposition to obstetric ops*
tkms in general, and for his just discrimination of spurious fas J*1
Uterine pains.

. In England during the latter half of the 17th centarj, tte**j
famous and successful obstetricians were theChnmbedias, &&*?*
three sons, who enjoyed very extensive practice in Leaden, os*
being in possession of a secret method of expediting *****£*
difficult cases, which afterwards turned out to be thetoep* 0*
of the brothers translated Maurieeau's work, and in a note *PPa*~
to the fetter's description of hk " tire-tete," declares that ah W
possessed a better contrivance for the purpose of ssfffdyasjtkj*'
pension of the natural efforts in the expulsion of the bead, *****
this was, remained unknown till Chapman described <** ^

Dr. Maiina'a introductory Lecture. 319

-in 1783. Dr. Denman thought tiieir instrument rather a lever mm
theiorcepe ; but the discovery of the original inodels about fifteen
yean Binee, in a chest concealed beneath the floor of a closet hi a
mansion were Chamberlin resided in Essex, has shown bis supposition
to be incorrect. • It may be remarked that male practitioners were
^employed as early in Boghmd aaan France, and dart therefore 4he
usage dkl notecase tone recemansended as a Ibragn novelty , as has
been observed in ridicule and depreciation; The mtioduetion of
French manners and customs in >hia court, by Gharlea the second, m
consequence of a partiality derived atom long residence on tto conti-
nent, may have had gome influence in causing its .adoption; bat a
more efficient reason must be assigned in the extension of hocory and
the progress of refinement and inteiMgance, winch, by rendering
females more sensible and susceptible of the precarious and hazar-
dous condition, in which parturition and its sequences place them,
would lender 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 oonsideratiottwere Culpepper, who published a 4< Directory
for Midwifes*" Woofoeridge, Hie tide alone of whose work I have
been able to find, which is *• Cpecalum Matrices Iibemicum ;" a Dr.
Salmon, who had a share in the composition of theianuuous woik
wow so generally Imown and 'circulated among Hie lower order as
Aristofiefc : WiUoughby, one of whose customs was to affect to
liberate an impacted festal head, by pressing outwards the os ooccygis
dffldanaaosavriag with two fingers on the back of the pelvis ; Thomson;
nnd Jerman, physician to Charles the second.

The chief practitioner of this period an the continent, not French,
woe' the celebrated Dutoh anatomist, Ruyseh, who expresses himself
awverely on the conduct of those madwives who precipitately
extracted the placenta. He advises that its expulsion should alinost
aawayabe left to nature.

In briefly mentioning the aathoreon midwifery after the periods
already oonskutned, I wiH confine myself still more closely to the
distinguished among them, rejecting thoee of ordinary eminence, in
order that the toffieusueas of the recital may be as much aa possible

In 1701, appeared at Leyden, the work of Deventer, exhibiting,
as itB 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 aa well- as best authority on the subject, and that m despite
of the sneers of the experienced Smelbe.

Lamotte waa a French country practitioner of great modesty and
excellent judgment, woe was largely engaged in midwifery practice
during forty yearn, and published in 1718. He turned in difficult

.390 Original Communications.

cases of head presentation when practicable, and so averse was be
to the use of instruments, that for thirty years he had reamse 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 hsmm-
hage after delivery, was contained in a pamphlet published in 1722
(but never extensively known), by Dasse, a surgeon-accoucheor 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 stunnhsof
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, sod
wished to rectify all inalpresentatioos and accelerate all lingering
cases solely by manual means.

De Goiter, 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 wexe, according to his knowledge, mur-
dered. Haller says of Chapman, that he was " vir bonus, Candida*,
qui neque minis aibi 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 into*-
tion of its nature, a point to the unravelling of which no cine exists,
he must participate in the honor of having been among the fii* to
devise and apply that description of instrument.

Sir Fielding Oulde, 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 " terrebia occulta,
the disqualifying qualities of which are smaHness and weakness.

In 1747, a Dutch surgeon-accoucheur communicated to the pro-
fession the account of an instrument very famed in Holland, whica
had been secretly used, and never divulged by its inventor, Rood-
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 suapk
lever, though of very different construction and dimensions to that
now in use.

Dr. Mai ins' s Introductory Lecture. 391

LevTet, 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 was
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 with —
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

39£ Original Communication*.

the orifice of the <cw» an idea thai in ou own tinmfcs
been assumed aa original and propounded so oBtfatetiwriy fay
Dr. Power.

SmeHie's opponents ware not limited to his medical brethren, fcr
in 17(0, a moat violent diatribe agjainet him and all other accou-
cheurs, was issued by a Mrs. Nieol. the follies and iaipertiaeficia
of which proved a complete antidote to the. effect intended to be
produced; and though at the time the book was extolled at pro-
digiously clever, and was translated into French, it is now unbeml
of, and unknown.

Aa the practice of midwifery since the time of SmeDk, hat tan
principally in the hands of the medical profession, writings on k after
this date, become more numerous and frequent. To enumerate these,
would be a tiresome task; hut to indicate the new suggestions they
contain, to point out their merits and defects, and to give even toe
succinct account of them that has been presented, of the elder write*
on the art, of those who assisted is 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 dreanttcribed
by prejudice and ignorance, and restricted by a spurious sad ens
cruel moral code ; to lay before you. gentlemen, equally brief par-
ticulars of the improvements of more recent and living authors, vwld
be, aa well as an unwarrantable trespass on your patience and tine,
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 me lew)
of an ennobling, because an inestimably useful pursuit. Sarin]
brought the account of it down to the period of its admission saw*,
the legitimate objecta of preliminary pursuit, and of itonracticessnaj
become to many members of the profession an affair of primary *****
tkm and care, I am not solicitous to continue its history up to u*
present moment. A reference, however, to the existing conditina,
and some of the more recent triumphs of the art, and a slight daw*
stratum of its dignity and utility, will be neither superfans* aw
misplaced.

Passing, then, over the names of the illustrious and jndiww
William Hunter, of whose discernment and industry we poncn
such splendid relics; of the sophistical and ingenious, but misjudging
Osborne ; of the benevolent, eandid, and cautious Detunan; of Rigtyt
whom fruitful experience and. well-directed labour enabled to worthily
fill up an important void in obstetric literature; and lastly, of the
nwn^to^yaejisitiveandfiiiiB^nrlymt^lpctiisI Goooh. whose preiaetet
mas science must erer denature; passing over, I say, this *8*J*
bright and honoured namea, and arriving in the midst of taeh'rinji
coming to consaner the art as it actually is known and taught, east
is the spectacle this branch of medical science exhibits ? Wast sn
ha claims on the philanthropist's applause, the legislature's protection,
the possession of public esteem? It may be unhesitatingly afirffl^

Dr. Malins's Introductory Lecture. 393

that he who is merely a well-wisher to the progress of human improve-
ment, will he 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 mriating 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
ire 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-
n unity. To remove the accumulated rubbish of ages, flanked and
"ortified by hereditary and almost intuitive prejudices, and by clear-
ng it away, to reduce the practice of an art to clear and definite rules,
eqtiires no ordinary merit and no common capacity. The efforts and
abours of most of the professors of midwifery, during the last half
entury, have been directed to the simplification of its practice ; to
lie abolition of absurd and pernicious customs ; and to the diminu-
ioxx of necessity for instrumental aid. They have comprehended

Vol. vi. no. 35. 3 b

394 Original Communications.

nature, whose intentions, when salutary and beneficial, the older
practitioners did but too frequently thwart and oppose ; they faro in-
culcated that knowledge, and by precept as well as example, recom-
mended a close study of the natural operations, injudiooody dis-
regarded, because they were natural and simple, not only as the sorest
means of understanding and appreciating deviations from them, bet
also as affording the best lessons against that omaonsoea and
meddlesome intrusion, which are so often practised, and as generiSr
resented by some untoward and ty»Tft«nng occurrence. If , as b
universally agreed upon among the reflecting and honest, the pro-
duction of reform in other sciences and on other subjects, involTes
numerous points of difficult and delicate consideration, and reqaro
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 haying effected a salutary change in the practice
of midwifery be depreciated ? Why should the honour of bring
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 vita
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. That patriarchal 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 belong*.

The sound opinions, the results of mature reflection and peisaal
observation, which characterize the writings of professor Barns, ire
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, inn
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 effusion*, 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 bat
negative improvements; for the reverse obtains, and the factwfc
otherwise. Physiology and surgery have shed two of the most brilM
rays on obstetric subjects, and have supplied, from their ferule and
constantly enlarging sources, remedial means which it has been the
office of the obstetrician to apply successfully to the alleviation &
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 itsaid.

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 fronl
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 fata)
and deplorable termination.

396 Original Communication**

II.— Remarks on Obstinate Intermittent. By Mhhcw,

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 hoars, and induced much debility ; a blister
was applied to the left hypochondrium, and kept discharging
twenty-eight days ; the Dowels 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 wis
seized with a fit ; his body was much convulsed and bis 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 haa 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-
acne, 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 is their
action, but generally constipated. I ordered him 3ii com-
pound infusion of gentian, with Jij infus sennas, to be takes
at two draughts during the day. On the next evening be
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 ne had at Antwerp. I directed he should tale, just as
the cold fit was coming on, a draught, composed of fire
grains of camphor, one drachm of T. opii, and Jij. Aq. cn>
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 bad
the effect of producing re-action very quickly, and he slept
well, 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 bead 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 neat 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 rod 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
as only taken a few aloetic pills since the loth. My object
in sending to you this case is not from any value I attach to
it " per se," but to prove the system may be brought under
the influence of mercury, " maupre," 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 Communication*.

termination 1 Cynanche traobealis is also a disease, in wink
the use of mercury has been ably advocated, and I thai
justly, if there was time to «arry its powers into the system;
indeed die arguments brought by its opponents are ehiefy
relative to the period necessary to bring the system under
its influence; a powerful one m its favour in this disease,
its property of preventing the formation of fibrine, its use n
tins 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 fair
times in twelve hours, a better effect than aVesioatoiy will be

Sroduced, therefore nothing could be lost by its trial in this
tsease, and benefit might rationally be expected to accrue,
A fear of rendering this paper too prolix has prevented m?
enlarging on many parts, but I trust enough is advanced to
excite the attention of practical readers.

III. — Mr. Mitchell on Stricture of the Urethra and

Gall Ducts.

lb the Bdkor of the London Medical and Surgical Jomrmt.

Sot, — By inserting the enclosed observations on stricture
in your valuable periodical, if of sufficient importance, yon
will oblige, your most obedient servant, .

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 tt
least what I hare 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 month;
during the course of which and for some time prior, bad
suffered immediately upon evacuation of the urine, seme
grasping and painful contraction in the perineum : he was of
a costive habit, and troubled occasionally with irritation in
die neighbourhood of the anus; when constipated paiaia

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 examine*
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 be 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 peraneum 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 tl^e cancelled
structure of the bones. The ductus communus choledochus,
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 most be
excused for assigning* constriction of toe vesical fourth of
the urethra; to be inae pendant 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 affo, 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 commencement was forked, bat ai
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 oneabofe
the middle size, after retrograding, one entered with some
difficulty; and with as much, removed in consequence of i
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 wherei 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, haemorrhage, corrosion,
and inflammation of the sensible lining of the urethra, fis-
tulas, 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 opiate

Mr. Mitchell on Stricture of the Urethra. 401

and the warm bath to allay inordinate and excessive 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 mucoud 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

VOL. VI. no. 35. 3 F

402 Original Communications.

veins. It is scarcely necessary to mention, that all poisooi
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 nerra,
as incontrovertible -proved by Morgan and Addison.— {Ewoy
on the Action of Poisons, $c. 1829.) These experiments
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 toe
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 ve ssels which con-
tained them.

General Indications of the means of detecting prison-
ous substances. — There is no subject which requires such
minute precautions as the discovery or detection of poison,
from their varied combinations with the fluids and lolids
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 toxicologic.
To the first illustrious professor we are indebted for a clas-
sification of poisons which is now generally received, aod b
as follows : —

1, Irritants; 2, narcotics; 3, narcotico-acrids ; and, 4,
septic or putrefiants. This arrangement . is adopted bt
Christison, and differs from those proposed by Paris and
Beck, and is decidedly the best.

Class I. Irritant Poisons. — The poisons comprised m
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
mouth, throat, gullet and stomach, the pain is acute
extends to the abdomen ; it is increased by drinks and the
respiratory movements, the heat is acrid and corrosifSt &
breath is foetid, nausea is often an early symptom, there u
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 bowel?

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, ana 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 blistenng, 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 ana bowels, spontaneous rupture of the stomach
and duodenum, bilious vomiting and cholera, effects of drink-
ing cold water, hernia or rupture, melaena hsematemosis,

404 Original Communication*.

colic, iliac passion, and inflammation of the neritouem
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 orgtu,
followed by gangrene (Haller.) Ices or iced water in hot
summers, produce similar effects. (Bull, des se Med. ?. 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 bl-
owing diagnosis in cholera: — the sense of acridity in the
throat never precedes the vomiting"; there is no saoguinoleot
vomiting, and in this country " death within three days is
very rare indeed." Death from irritant poisons is seldom
delayed 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 hare
been reported to him. Idiopathic gastritis may perhaps
exist, but inflammation of the stomach is usually caused b?

Soisons, and the burning in the throat, if present at all
oes 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 ramollisement, 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. Ecfin. Med. and Sur. v. vl
It appears from the testimony of Christison, that perfora-

Dr. Ryan on Homicide by Poisoning 405

tion of tug alimentary canal by worms, colic? , melenp., ileus
and obstructed hernia, can scarcely, be confounded with
effects of poisoning.

Irritant Mineral jtoisons. — The poispns of L thief class are
sulphuric acid (vitriolic acid , vitriol, and qil of vitriol.)
Nitric acid (aquafortis) 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 hajs happened pf late years that
infants have been destroyed. by. tne barbarous practice of

Eouring sulphuric acid into the mouth ; and the countenance
as 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 thq stomach,
and the pain is much more intense than in ordinary. gastritis.

The matter vomited is brownish, olack, 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 \ apd 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 dpys, 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. Christ ison thinks that death naay 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.

Earchment, or of a burn, or of vesication. The mucous mem-
rane of the mouth is generally hardened, whitish or yel-
lowish ; the pharynx is in the same state or very red, the
gullet is often fined with a dense yellow membrane, the
subjacent tissue is brown or red. The muscular coat of tk
mouth, throat, and epiglottis is sometimes exposed, and oc-
casionally the gullet is unaffected, though the moathaal
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

f taste of disorganized tissue, blood, and mucous. The py-
orus is contracted, the mudous 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, takinr
it for granted he is informed on the physical and chemical
properties of the acids in a pure and diluted state. Tho*
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. 407

Sulphuric Acid. — The process is simple, for the detection
>f the acid in alimentary matter. The suspected matter is
o be boiled for a few minutes, and after filtration, sub-car-
>onate of lime added ; the mixture agitated when sulphate
>f lime is obtained, which is to be dissolved in boiling
nrater, and tested by a salt of baryta, the product is to be
:alcined with charcoal, and this gives a sulphur, from which
sulphuretted hydrogen will be evolved by a few drops of
litric or hydrochloric acid. (Sedillot, 1830.) Dr. Christison
lescribes this process more minutely when diluted.

When diluted, it is to be tested with litmus and tasted.
\n acid having thus been proved to be present, a little nitric
icid is to be added, and subsequently a solution of the
litrate of baryta. If a heavy white precipitate falls down,
t can be nothing else than sulphate of baryta, because no
tcid 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-
ng this test care must be taken to employ nitric acid entirely
ree of sulphuric, — an admixture which the common nitric
icid of the shops almost always contains.

The test now mentioned is alone sufficient to indicate the
»resence of sulphuric acid, combined or uncombined. But
is the duty of the medical jurist is to supply not only satis-
actory evidence, but also the best evidence which his science
kffbrds, it is advisable in a criminal case to establish the
tature of the precipitate still farther by the following pro-
jess: —

" Collect the precipitate on a filter, wash, dry, and remove
t. Then mix a little of it (not more than two grains) with
i small proportion of dry charcoal powder; and subject the
nixture for two or three minutes, in a covered platinum
poon or in a fold of platinum foil, to the flame of a spirit-
amp enlivened with the blow pipe. A portion at least of
he sulphate is thus converted into sulphuret of baryta. To
>rove this, put the powder with a little water in the bottom
>f a small glass tube, add a little hydrochloric acid, and then
lold within the tube, without touching the matter below, a
)it of white paper moistened with acetate or nitrate of lead.
Sulphuretted hydrogen gas is disengaged, which will darken
he paper, and likewise often betray itself by its singular
>dour. ' — (Christison.^

This process is to be applied for the detection of stains,
he cloth or other solids being boiled, &c.

Nitric acid. — The process proposed by Christison for

408 Original Communications.

detection of nitric acid when mixed with food, consists of
neutralizing the acid with potass, evaporating to dryness,
and ascertaining by the addition of sulphuric acid and the
application of heat, whether nitrous fumes are evoked.
Sedillot, who is one of the latest and best French writer*,
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 crystal*
of nitrate of potass will be obtained. Dr. O'Sbaugbesv,
an able analysist and jurist, objects to these tests, and
after a satisfactory exposure of their fallacy, proposes ao
entirely new re-agent, namely, morphine, which, vrheo
brought into contact with nitric acid, in the minutest quan-
tity, immediately produces a brilliant Vermillion colour. The
mode of experimenting requires attention. " 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 sarface,
when the characteristic tint is instantly produced.9* (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 it*
peculiar vapour, and by the white fumes formed by its
mixture with animoniacal 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.*9 (Christison.)

Dr. O'Shaughnesy objects to the test of amraoniacal fas.
as he says it will produce a similar result, though of a les*
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 «▼*

Dr. Ryan on Homicide 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 Ghristison, 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, vomiting1, 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. (Ghristison.) 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, while 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 stalrch, and this again is, by some
inexplicable digestive process, transformed into the nvdrio-
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 wa&
found in large quantities.

" Again, the hydriodic acid once formed, is rapidly elimi-
nated through the several excretory channels. In fort;
minutes we nave found it in the urine, in which, in the doj^
just alluded to, it was detected occasionally for five days;

voi*. vi. no. 35. 3 q

410 Original ( ommunieations.

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, do
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, ana 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 is 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 b,
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 tne urine, the simple adnV

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,

fives a white precipitate, which is with difficulty soluble in
ydrochloric 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 : —
"lb 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

Sreviously with any alkali, for then they act with greater
elicacy. 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 sulphutes. The insolubility of the
oxalate of lime in hydrochloric acid, on the other hand, dis-
tinguishes the precipitate from the tartrate, citrate, carbo-
aate, and phosphate of lime, which the test might throw

412 Original Communications,

down from any solution containing 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 op nil a
larger quantity of that acid is added.

" 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 add.
This test does not precipitate the sulphates, hydrochlorate,
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 js-ais-
solved on the 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 supplemented
test of fulmination, is to distinguish the oxalate of siWer
from the numberless other white precipitates, whict 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 e?en
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 pf oxalic acid, free or jCombined, many fluid which
does not contain animal or vegetable principles.

" Of the modifications which are rendered, neeesaaiyhj
the admixture of such principles, none are of any cobs*
quence, except those acquired in the case of an analysis of
the contents of the alimentary canal or matters of vomitine*
Here a word or two must be premised on the changes which
the poison may undergo, in consequence of being mingW

Dr. Ryan on Homicide by Poisoning 418

with other' substances in die stomach or intestines.' Them
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 promt!
that oxalic acid has not any chfemical 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 aoid or
the gelatine. Consequently oxalic acid, so far as it con*
cerps 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 pu»e 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 we magnesia
and chalk. Each of these forms an insoluble oxalate, so that
if either .bad 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 sfco*
roach, 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 aoid is then to be neutralised with potass,
and the whole filtered. If magnesia or chalk has been

given as an antidote, the insoluble matter is to be separated
y 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, while 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 pka
for this purpose, but have found none to answer so well as
precipitation with the muriate of lime, so as to procure u
oxalate of lime, which, after being well washed, is to to
decomposed by boiling it in a solution of carbonate tf
potass, as before. An oxalate of potass will again be found
in solution. The excess of alkali is finally to be neutralised
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, subcarbonate of potass. — These substance*
attract moisture from the atmosphere and deliquesce ; they
turn the syrup of violet green, and litmus paper blue, ana
are saturated by acids. Watery solutions of them are not
decomposed by subcarbonates of soda and ammonia; hj«
drochlorate of platina causes a yellow precipitate, composed
of potass, oxide of platina and hydrochloric acid.

Nitrate of potass % nitre, salt petre. — When this sabstanc*
is thrown on ournipg 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 hj
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 nitrons ackl otB
be evolved. The morphine test mentioned, when speaking
of nitric acid, is the last that has been proposed, and
perhaps the most certain.

Soaa, 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,
deuto chloride, bichloride corrosive sublimate, is the com-
monest preparation of mercury employed as a poison. Tbe
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 muriaticacid,
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

lie protoohloride of tin strongly attracts more chlorine,
hereby removing one atom of it from mercury, and reducing
be latter to a protochloride (calomel) which is also deprived
f 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
olatised in the form of thick irritating fumes, which tarnish
opper. If the mercury, mixed with potass, in a glass tube,
hut at one end, and sublimed, the mercury will appear in
be form of globules on the sides of the tube, if a watery
olution of the corrosive sublimate is mixed with potass or
Ime water, a yellow precipitate occurs, a white one by
iquid ammonia, a black one by the soluble hydrosulphates,
nd finally, the ferruginous hydrocyanate of potass causes a
vhite deposit, which soon becomes yellow, then more or
ess blue, from the formation of Prussian blue. If a plate
f copper is immersed in a mercurial solution, it becomes
overed with a slight coat of the metal, when oxymuriate
f mercury is mixed with animal or vegetable substances in
olution, and the re-agents produce no effect ; ether should
>e added, the mixture agitated, filtered and distilled with
:entle heat, when a residue will be obtained, which, mixed
nth water, affords a pure concentrated solution. A fourth
>art of ether should be added, which has the power of
bstracting the salt from its aqueous solution. After agita-
ion for a few minutes, and allowed to rest for thirty seconds
>r more, the etherial solution rises to the surface and may
>e removed ; it is then to be filtered, evaporated to dryness,
ind the residue treated with boiling water, which afforded
he evidence already mentioned, on being tested with pro-
ochloride of tin. This preparation of mercury may be de-
ected in vomited matters, by drying them in a sand bath,
nixing them with a solution of potass in alcohol, and cal-
:ining them at a red heat, when the metal will appear in
globules in the neek of the tube.

The following mercurial preparations — the sulphate, sub-
litrate, red precipitate, acetate and cyanuret, when mixed
vith organic matter, may be decomposed, and the mercury
teparated by boiling with fused or caustic potass for an
lour, an excess of nitric acid is to be added, which preci-
>itates caseous and albuminous matter ; filtration is then to
>e concentrated by evaporation. If a slip of gold, bound
•ound with a harpsicord wire, be plunged into the fluid, an
imalgam of gold and mercury will be formed ; this is to be
icraped off and sublimed in a glass tube, when globules
of mercury will appear.

416 Original Cowmmnieatums.

When the corrosive sublimate is applied to a wood
or ulcer, it is absorbed, and causes inflammation of the
heart, inducing brownish black patches on its internal nea
brane, as well as on that of tne intestinal canal. Wh«
taken into the stomach, it produces greyish white patch*,
which do not result from any other poison. The best anti-
dote is white of egg, 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
eyanuret have induced death, but are seldom employed.
Dr. Cbristison'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 evert
medical practitioner.

Compounds of aflrmtc.— Metallic arsenic has an iron-
grey colour, is fragile and brilliant, when recently broken.
It oxidates in air, water or alcohol. When exposed to atr,
it becomes rapidly tarnished, and forms a black powder.
It sublimes at 356°. Parh. and in close vessels it condenses
Unchanged ; but in open air it rises in white fumes, with an
alliaceous odour, ana becomes white oxide, which consists
of one atom of metal and two of oxygen, or of thirty -ei*ht
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 orpimeut, 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 arid.

'• 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° Fa.hr. it is sublimed, and con-
denses unchanged in minute octabadres. 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. Ryari on Homicide by Poisoning. 417"

t quickly causes in the part. In this opiniou we altogether
coincide. The arsenious acid of the shops is soluble in
toiling water in the proportion of 115 to 1000 parts,, and
wenty-nine parts are retained on cooling ; temperate water

Sain takes up, in thirty-six hours, 112-5. The solubility of
e acid in water is impaired considerably by the presence
if various organic materials, such as mucous, albumen, or
istringent matter.

t: The arsenious acid forms salts with the various salifiable
rases, of which the most remarkable are the arsenites of
ilver, copper, lead, lime, potass and ammonia, all of which
nay be prepared either Dy bringing the arsenic acid into
lirect contact with the base, or by decomposing a salt of
he base (such as the muriate of lime, nitrate of silver*
icetate of lead or sulphate of copper), by means of a soluble
leutral arsenite. Arsenious acid, added by itself to one of
bese salts, produces no decomposition, since its affinity for
he 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-

fical importance, namely, the pure orpiment and the impure
ing's yellow, 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'Shaughnesy, 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-

VOL. VI. no. 35. 3 H

418 Original Communicatnm*

tate3 on cooling. It is very soluble in water, and an adfr
tion of hydrosulpburic acid, which causes a precipitate of
yellow sulphur of arsenic, which is entirely soluble v am-
monia. The ammoniacal deuto -sulphate or copper, enw
a green precipitate. On boiling this acid with potass, i
yellow precipitate takes place by nitrate of silver. Wta
white oxide of arsenic is mixed with vegetable and ami
matters, the following processes are recommended for ill
detection : —

A small quantity of these substances is to be boiled fa
fifteen or twenty minutes, filtered and tested with- the Tama
re-agonts already mentioned. The hydrosulpburic add ar
soluble hydrosulphates, to which a few drops of nitric acid
aire added, are the best tests, as the yellow sulphate of
arsenic is detected with difficulty; when audi auspected
matter is much coloured, it will not be easy to recogme
the precipitates ; and then a concentrated solution of chlo-
rine should be added, and by this means the arsenioot w3I
be converted into arsenic acid, which is very soluble. Oi
filtering the liquor, we are to observe if it |*ive a white
precipitate with lime water or baryta, a whitish blue with
acetate of copper, a brick red with nitrate of silver. If that
liquor is boiled with hydrosulpburic acid, the yellow sajphar
of arsenic is formed.

When the liquor obtained by the first operation contain
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 wiH destroy die
animal matter; the excess of acid is to be saturated wii
potass, a few drops of hydrosulpburic acid gives a precipi-
tate of yellow sulphur of arsenic.

The contents or the stomach may contain anentona add
in a solid or fluid state ; when solid it may be mechanically
mixed, and subside on simple deoantation. 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 oi&*te
of potass with two of supertartrate of potass, and cs^
limed in the manner mentioned by Dr. Chrtstison in the csb»
sequent extract ; the second part should be boiled ia d*
tilled water until dissolved, and a drop or two of the selsticB
placed on three different watch crystals ; nitrate of a3vtr
should be added to oae, when a yellow precipitate sues
place ; sulphate of copper and ammonia to the second, wh«
a deep green deposit occurs ; and sulphuretted hydrog*

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 wheji 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
^rawing out the wick with a pair of forceps. A little water,
disengaged in the first instance, should oe 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
ef *he 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.

[ 430 .J

BIBLIOGRAPHY.

ANATOMY.

1. On preserving Anatomical Preparations in Spirit*. .By Alex-
ander Wataon, Eaq. M.R.C.S.E., &c. &c. — After enumerating the
Tarious causes by which an evaporation of the spirit employed takes
place, Mr. Watson proposes, in order to obviate these inconvenience, to
have glass-stoppers accurately ground to fit the preparatioa-bottla;
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 property 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 »
inserted, and melted wax poured over it afterwards; it likewise
appears a cheaper method than the one at present employed—
Edinburgh Med. andSur. Joum. April.

8UBGBBY.

2. Sixth Report of the Edinburgh Surgical Hospital, from AwpA
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 wis
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 :— '' l*
In effusion into the surrounding soft parts, and gradual ossification t»
a layer of these exterior to the bones. 2d. In effusion into &
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 toe
ossification of their periosteum, " by cutting them through long1'

.Surgery. 421

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 (he
crepitation is quite distinct ; it usually ceases very suddenly, and the
limb all at once gains a degree of firmness sufficient to support its
3wn weight : when such fractures are dissected within the first two
Mr three weeks, the ends of the bones are found quite separate,
rhese facts, Mr. S. thinks, are quite opposed to the idea that the
process consists entirely in a deposit between the broken portions,
n which case the mobility should cease gradually.

He gives two dissections of fractures in the early stage.

Case 1. Catherine Adam, set 52, oblique fracture of the right
:high, 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
sfrusaon 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
>arietes composing it were in some parts connected with the very
;dge of the bone, but in others they became adherent to it at a (Us-
ance of an inch or more from the extremity, leaving a space to this
jxtent uncovered, and apparently denuded of periosteum. When
sarefully examined, this exposed portion was ascertained to be
covered by a thin layer of gelatinous substance, which did not
xMsess the toughness or other characters of a membrane ; and the
*espectxve surfaces of the bone had a covering of the same kind.
Hie medullary membrane was very vascular, and more distended
Iran usual.

In examining the structure of this bag, I endeavoured to ascertain
which of the natural tissues entered into its formation, and in what
>arts of it, if any, ossification had commenced. On tracing the
periosteum from the sound bone, I found that where the bag adhered,
iiat membrane became thick and evidently continuous within its
walls. It seemed probable that where the membrane had been stripped
>ff the bone, as already mentioned, it might assist to form, in some

421 Bibliography.

aeaaH pert, the eec in qneetien ; tthetgreat fwrtmt of which, bavtar,
WW CMihiiitly oonAtifcated by the neighbouring teua, wfastM
tttB^iappenBd tobe,mus*le, tendon, fat, or ovular substsace, d
being induced to the same appearasne internally, by raBeabsayi
the surface, and the same coiristenoe, by the interstiti&l efemai i
dtgaeusatte natter.

(Qn'intnxhiemg my;nnger into the bag, ao as to feel if the* m
ally indications of ossification, I pcieeived same small gtaawstsasb
of bone, which, when minutely exaraied, presented a atriktai
i, and .were ascertained to be in; the 8uh«tanoe.oftbeap-
When examined in the same way -near fa ea>
nezion with the bone, it was found to contain much ilarger mam
peescssmg osseous fhinness. In order to ascertain the piece* sett
aati origin of which, I carefully dissected the membrane where &f
existed, and then found that they lay completely imbedded lritsm it,
hmvmg «tx>Yeriag from it on botii sides; also that they did aotai-
here tor the bone, being separated from it hy*thin layer of the nee-
basse, ao as to admit of a 'slight degree of motion; bat tt these
parts, the-ahafb itself had begun to shoot out a growth of. new boot"'

lit would appear from this, that not only ^arteries aapjdyisg to
periosteum and the bone itself, can take on- that action, bat tike**
the arteriesnof the aurroonding parts. This dissection is a/iust im-
portant and highly inteieBtuig one, andia^heenidesaribedaeipc-
finned itrith Mr.ioVs well known skill and attention.

As we hare devoted so much space to- tins ease, wecan«lypw
an extract of the ease which fblkrw*c~Mary - Donalcbsn, *t 70.
A compound; and comminuted fracture of the left leg, dosetod*
ancle. Theipatient was admitted on the 27th September, <n tfe
nfith of October the cure appeared complete, and on 4c 5th d
hfovantber she was discharged cored. About tan days after***
she'died, and Mr.* S. procured persuasion to examine the leg. ft*
hones on being freed 'from the muscles appeared nearly astml
hot after maceiation the tibia appeared composed of thirteen p«a»
which ooBstitutedifnerely-a skeleton,* the central eawty tastnhg
recant. On examining the internal surface, oasincation wt» «••
sored to. nave been going on all over h, and Mr. S. has no <&#
it would hare become solid in time. The>fibula 'presented «■**

Mr.rS. promises to return to the subject again at the fintcsp*-
tmrity. We expect it with impatience, as every met of such SB*8*
is ofcgreat rehie, to determine this-point.

Four additional cases of excision of elbow joint are added, e*n»J
fiiuiteen in all ; three were successful : in the fourth, the din****
which tit was performed was very extenaire. Ainpntaaon wpi fc»v
done, but-the patient died the day after.

Urinary Cakuims.—The next subject treated of, of oopngaeaK.
is this disease.

2n*Mr.'S.'s last report, he mentioned a case of stone that *****
iniprivate. practice, in which he extracted two large stood fa»**

Surgery. 43*

jurethia. Some uneasiness remained aftet the operation, suppaaedto
*e eaiiaed- by a stricture of the urethra which< existed, more especially
is 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 Ustea to any suggestions against the skill of the
surgeon.

As it is impossible to ascertain die existence of the calculus pre-
vious to the operation, and as it frequently happens thai 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 aeons*
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 imtation 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 he
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. hmd been for same time mdupenesble.

On the 6th Sir G. Balhngall 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*
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 imtation counterbalances the irritation of the operation.

424 Bibliography.

But the previous irritation was excessive, while that from the open*
tion was comparatively mild, from the facility with which it to
performed ; and hence the function might be thrown into disorder,
and produce death. He is not, however, certain of this, and le&rc
it to the practical reader to explain as best pleases him.

Cancerous Sores of the Face. — When they can be eradicate!
should be removed freely with the knife, as owing to the loosenes d
the surrounding integuments, cicatrization readily ocean. Some
cases are given in point. A case of lacerated wound of the vagina
k 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 ow
sincere thanks for the excellent paper we have just perused.

3. New operation for stricture. — Mr. Stafford observes:—" 1
have myself now operated on upwards of forty cases of perma-
nent stricture of the worst description, without a single failure, to
no instance, has there been a false passage made, nor has thecnltin?
through the contracted part either caused pain, haemorrhage, inflam-
mation, or any other unfavourable symptom ; the hardened stricture
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 is
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 pover
of the bladder.

It cannot but be gratifying to the profession to know, that altbougk
the employment of these instruments is not necessary in every case d
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 trifina incou^-
nience. I say trifling 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 core has
been completed. — Appendix to Work on Stricture.

4. Browne on Tracheotomy, in cases where a foreign hods &* a
one or other bronchus. — In the greater number of cases, the foreign
body is in the right bronchus, which according to Cloquet, is more *
continuation of die trachea than the left, and is also larger, and a lit-
tle more forward.

From Mr. Key's experiments, which have been repeated by fr
Browne, it would appear, first, " that a shilling could be forced, fr

Surgery. 425

the distance of an inch, into the right bronchus, but not at off into
the left : while a sixpence passed freely into either bronchus, but
Farther within the rigid;: secondly, if a long slender forceps was
paased into the trachea, without giving it any particular direction, It
went invariably into the left bronchus : and lastly, that bones, six-
peneea, &c. ootid 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 & great measure,
counterraeted. '

The irritation produced by these foreign bodies most frequently
caused pulmonary consumption, and the patient's death : though
ctaeasionally cases, have been recorded* in which, after suffering for
yean from ajfausa* disease of the chest, the patients have expelled
the irritating cause : but these must be regarded as exceptions to the
general jrule, 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. flrowne draws these conclusions from his observations.

1. That the existence of foreign bodies in one or other bronchus
can be ascertained by tile use of the stethescope : by the seat of the
pain, and other uneasy sensations : and by the previous history of die

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 aa 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 thereaearehea of the learned doctor to be directed to that par-
ticular branch of surgery, in exploring which Mr. Key has led the
way.

On exammation after death, the bone was found in the right brcb-
chusyjdose to the bifurcation.

in the present number, there are several cases illustrating the use
of acapuncturation : one of that painful affection termed tic doulou-
reas, 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. Jam*. April.

vol. vx. ho. 35. 3 z

426 Bibliography.

MATBB.IA MBOICA.

5. Observation and reflections on the employment of stryckmhtu
the treatment of paralysis. By E. Geddings, M. D. Charleston,
S. Carolina, &c. — The able author has paid a just compliment to tk
talents of that distinguished physician Fauquier, for the me 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 mak,
aged 50. He was placed under Dr. G's care in Jury 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 bra
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 Ji. 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, bat
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 Elaterhun. By Mr. Monies. — Having made
an infusion of fifty grains4 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 potass*,
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 ^IV^VuM
By experiments it appears not to exert any purgative effect on
animals, but in doses of a tenth, twelfth, or even of a gJTfo^TFth of a

Chemistry. 427

grain (when acidulated) has been found to exert a powerful effect on
the human system.

Mr. M's formula is as follows :

£r ^Elaterinae gr j., alcohol Ji. acid nitrici gtt. iv.
Solve : sumat a 5 ss. ad gtt xl. in aquae
cinnamomi 3ss.

From Edinburgh Med. and Surg. Journ. April.

MIDWIFXRY.

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 nevbb produces pain in either the mother o^ 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, fetal haemorrhage.

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 isretter than cure," recommends should be given
from the second day, gradually increasing its dose until the day of

4$8 Bihliegrvpjiy^

fonzes is past. Dr. ft. p*moaes, instead rfa Egata*?, $# __.
of tne actual cautery. This, we presume, would cause a* mata*-
ritation ; and besides burn down half the houses in lfmfka\, Mess-
ing to the present practice of dividing the chord ; and, of coast,
searing it (Unless we wished the child t# die *f haemorrhage) underfe
bed-clothes. In concluding, we advise the Doctor to " tak tent**—
Edinb. Med. and Surg. Jour*. April.

8. Ergot m MvtorThagit.—Dx. John Bellinger, ed ChaifesuK
S. C. informs us that he has tried the ergot in one case of meaor-
hagia, as recommended by Marshall Hall, and that the hsemoniage
was increased, and the sufferings of the patient greatly aggravated
by the treatment. — Amer. Jour. 0/ Med. 8ei. Nov. 1830.

9. Com of Cmsaream Section. By Dr. Mc.Kibbin. — Anne M.
set* £6, apparently well formed, seised with labour pans tor the fet
time, on the evening of Sunday the 27th September 182$. On
examination on Monday, the left side of the pelvis was found to be
occupied by a large exostosis, tiling up the hollow of the aacnna,
and extending forwards to within a quarter of an inch of the left isms
of the pubis, on the right side, the diameter at the widest part was from
14 to If of an inch, and the long diameter from pubis to right sacro
ihac synchondrosis, was calculated at frosn 9j to 4 inches. Ife
patient entered the Ballast Lying-in-Hospital, on the Tuesday even-
mg, when on consultation, the Oafeavean section was decided an, as a
was evident, that emkryukia would prove a* dangerous to the mother
as the Cesarean section, while by this last operation there was t
chance of saving the child, of whose death doubts were entertained:
accordingly the operation was performed by Br. 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.--
JBdm, Med. and Sur. Journ. April.

Thus adding another to tfre list of unsuccessful cases of th» ope-
ration by British practitioners ; its unsuccessful ternunation is evi-
dently owing to delay, when the patient has been so for exhausted
by the continuance of labour, as to be incapable of withstanding sues
a severe operation : in the present instance, however, the delay m
attributable to the friends, and not to the medical men.

MISCELLANIES.

raojsaao* PAinsoff .

10. To the Editor of the London Meiical (fyeft?.— Sue. I are
read from time to time with no little surprise* and not without incre-
dulity, the accounts you have given of dUtwbances in the Anatomi-
cal Theatre of the London University. \ suppose, however, it a
best to be surprised at nothing. It will only oe fair if I admit, at
once, that I am in' spine degree interested in the reputation of the
professor of anatomy, from having been, his pupu ip, u^laagow fifteen

cor sixteen yaars *£*. ** I !»▼* Kfrfaga PftnnWU ird l»m to he an
accomplished anatomist, I am •eoesaaiiry alow in mj belief of his
recently differed incompetency.

Uvwn 1819, tfl w *ot mistaken, that Mr. Fattiaon, am the
de*th of AU&ft Burns, whose demonstrator he feed been and intimate
friend* aucoooded to the vacant «bahr in College Street. I am able
to speak with eenfidenee respecting the estimation in which he was
held dqring tb?ee fiupcfpaive cewaea of lectures, of ail tmmQsa each,
wbioh he delivered in the winters of 1814, 15, and 16- Hie daaa*
room accommodated, but with aome difficulty, 128 pupils. I well
remember that there never was one seat unoccupied in a single lec-
ture. My impression ia, 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. $* demonstrations on (he
neck and face are not Jikely to be forgotten by those who had than
the privilege of witnessing them.

Mr. fattjson's manner as a lecturer waa inferior tfo t&attf hja;
opponents, Afontejjth was a handsome man,, with a graoefa} ga£-
very; white the other, professor Jeffrey, is (or waa) one of thfl hes$
looking rn,en \ have seen, and remarkable in his phya^ojogicaj, dia^
courses— a branch to which he devoted top much of his cojarse— rfor
dignified ana most attractive eloquence, pattpon spake with * lisp*
and his delivery waa peculiar and somewhat innnotonous, tat* t*PGtk
in the past tense, for 1 have not seen him for more than fourteen
yoars— his language waa sufficiently fluent, distinct, and impressive :
and those who were attentive to die matttr which he so zealously
uttered, aa all the students I believe were, had no fault to find with
the manner.

Mr. Pattison ia 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 has recent incompetency as a lecturer. Sixteen years

ago students were lessnrecocloua 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 oluhe, it ia

true, but it was for literary and scientino purposes. They wete then

too simple to think of forming " Committees/' in order to control

and soanage the affairs of 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

480 Miscellanies.

ignorance, and who trimmed the midnight lamp that they na^t
satiate their thirst for that honourable knowledge, which, in the cue
of several, with whom I am proud to claim acquaintance, has con-
ducted them to eminence in their profession, and no leas to deserve!
estimation as members of society. This simplicity of theira — tin
dawn of intellect, in comparison of the noon-day intelligence of on
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. 6. 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. 8. 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 wonderful 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 Medal. — The Hunterian Society offer their medal of tea
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 *u1
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 reports from all quarters* and
hopes the love of humanity and science will stimulate the medical

Miscellanies. 431

ittendants on hospitals to transmit him regular reports, which he will
irrange 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
)ur hospital physicians and surgeons, are too indolent and lazy to
rive 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. Abemethy. — It is with unfeigned feelings of
regret that we record the death of the justly celebrated and renowned
mrgeon, J. Abemethy esq. ; of whose talents and important contribu-
ions to science, as well as of his great popularity, it is obviously
mperfluous to speak. We trust that some of his eminent disciples
wall place his character in a just light before the profession and pub-
ic. He expired at Enfield on the 18th ult.

17. Library of the Royal College of Surgeons. — This splendid
ibrary is now open to the members from 10 a. m. to 5 p. m. except
>n Saturdays, when it closes at 1 p. m. Catalogues may be had by
nembers or articled pupils at the cost price; The council, have
icted 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
>een rumoured, that Mr. Horner resigned in consequence of reduc-
ion of his salary. This is incorrect. He has voluntarily relin-
quished £200 a year of his salary, and resigned, as he was deprived
>f that influence and authority which were deemed necessary to a
iue and efficient, exercise of the duties of Warden, and the main-
enance of proper discipline.

19. National Vaccine Establishment. — Copy of the last report from
he National Vaccine Establishment to the secretary of state for the
tome department.

To the Lord Viscount Melbourne, secretary of state for the home
lepartment, &c &c. &c. — My Lord, it has required all our industry
jid zeal to supply the numerous demands which have been made
ipon us for vaccine matter from all quarters of the Empire since our
BLSt report.

We have furnished the means of protection to the army and navy,.
o every county in England and Scotland, to Ireland, to the colonies,
nd moreover to several of the capitals of Europe; and nearly 12,000
f the poor of the metropolis and its immediate neighbourhood have
een vaccinated in the course of the last year.

Whilst this affords an undeniable proof of the great diffusion of
accination, and is a strong argument for the value of this institution,

43J Mistetlanies .

ft diminishes our satisfaction to be obliged to confess, that, if fti?a-
meat should determine that enough had now been done to estabEi
tife superior merit of vaccination above every other security agaiss
die danger of small pox, and that it should be left henceforward &
the discretion and good sense of the nation to continue the practia
from the resources of individuals, such a determination would find t&
country unprepared and unprovided with the means of defence, s&i
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 farther supply far themselves. But it would seen, hum
the incessant applications which oofitiirae to be laade to mo, other
that our warnings are not sufficiently attended tov or what we beheve
to be the met, from the replies constantly made to us, it ia imprac-
ticable to keep up a continued supply any whefe but ia the capital,
where numerous appointed vaccinators assist and aaypuri 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 HALFOBD,

President of the Royal Coll. of Physicians.

Robert Bret, M. D. Censer.
George L. TuthUl. M« D. Censor .

ROBT. KEATE,
President of the Royal ColL of Surgeon*.

JOHN P. VINCENT.
Vice President of the Royal Coll. of Surgeon*-

Ckmi. Bme9 M. D.< Registrar.

National Vaccine Establishment,
14th March, 1831.

20. The March of Intellect. — A respectable correspondent assures
us, that at the corner 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 Luci*a,fave ! novus tngreditur tua templa sacerdos.

Miscellanies. 4S3

22: Defence of ike professional skill of Mr. St. Join Long, con-
dieted felon and illiterate mtadk.-^Bf Francis H. Ramadge, M. D.
Oxon. Fellow of the Royal College of Physicians, Lecturer on "Medi-
drie, Ate. &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 by such a dis-
reputable line' of conduct. No, it is a fellow who, par excellence x is of
a superior caste, one of the elect, one of the by -legal heads pf 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, an4
gross injustice of placing fellows above licentiates, above men, who
are with few exceptions their 'superiors, in talent, in science, and in
public ertiinatian, If proof were^pquiwi of, the truth pf j*». #ate-
meat, it is only necessary tot refer .to the list of fellows and licentiates,
where we find there is scarcer^ a fellow, .Paris and ElKoteon
excepted, whose name is known' in the annals of medical science*
while Jthe lame of the medical, literature of this empire is. almost
entirely maintained by the lfcentiates-rrby the aforesaid minus docti
and alieni homines t who are not allowed to enter their own college
without special invitation from /the illustrious and renowned fellows*
Bat. 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 aU
regularly qualified graduates unite, and an opportunity will an
spxbbily AjroansD theu ; and petition the new parliament against
the imbecilitycf the College of Physicians, and the unlimited ravages
of quackery, and medical reform .must kdep 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 lelldws and licentiates is eon*
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. vz. no. 35. 3 k

434 Miscellanies.

. We cannot express our surprize at the defence of Long, by m
respectable or scientific physician or surgeon, of a man who has bees
proved, beyond all possibility of doubt, to be utterly ignorant of i
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! " I 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 Bchool where I lectured four years ago (without any per-
sonal acquaintance with you at the period) purchased dead homes,
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 hit
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 oar
author by the scientific and infallible Mr. Long, requesting his opi-
nion on the practice of that enlightened personage in the cases of die
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 Halfbrd. 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 thii
displayed by a respectable member of any of the medical corpora-
tians 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 world.

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 yon
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 pdssibly 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.

organ, .through a diminution of which, deaths prcaajpradly
examples of which are at times seen in cases of spasm occunpf
through gout seizing the stomach, a violent blow upon tiat
organ* &c. t .

" To me, who have had for" more tflfifc eleven yerfrspasf,**
equalled opportunities of treating, and where death has falsa aire
of investigating, numerous anectioro -of the chest, Td6 not exag-
gerate when I sa^ that i lhaVe opened 'more thaar a thoo&alkd IT""1 '
of consumptive persons akme. It has -always appeared to tofe,
t^e same opinion has been entertained by .the principal
continental pathologist, that the iinperfect|y fonnedj^catri
of ^ifejcn was found in ^he summit of each lung in Miss
(plough contrary to the statements made by sgme^edlpal m
examined the body of the deceased), had $een formed from tabcr-
callous matter (the presence of which constitutes 'cohsujntpuSa).
yt^ic^ having undergone a softened state, and in thia way faiag
exj)ectorated, allowed the cysts which reniained to heal up like say
ordinary abscess. I have numerous specimens in my mnsjeuni, shew-
ing the progressive changes which tubercles undergo, until 'their
.place becomes supplied with condensed1 cellular membrane.

" With an observation or two more, I shall conclude jiar remarfa
upon the morbid appearances whioh were found at, tbe exjmatkB
of six days from the time of Miss Cashin's death* by which mess*
her disease was attempted to be satisfactorily ascertained.

*\ The appearances in the chest, .abdomen, and about the spine,
might easily ^e rnet with in any individual, who hayjt died of very
little or no apparent injury whatsoever, "pie deep-seated jnuseka i
the back, as every person who has had .the treatment of fiver, jar-
ticularly in neglected cases, can bear testimony, are auaceptiEfe eft*
undergoing more, extensive disease, by gangrene and actual inpr&fc-
cation, than the medical witnesses 'against you wished the puhfr'to
believe, and yet in this case these might not have been , the jirow-
inate cause of this , young, lady's1 ^eath, nor have been fbjhnrm by
fatal injuries of the spinal marrow, or its investing: jnemhninfEt.
Hence- it/ollows that even if the symptoms of the patient hadj^w
of a more aggravated nature than they are described to ^iave beep,
still, in my opinion, she might have lived. The natural jgravitattqa
of the uujds to the back, combined with a trivial previous ixjitaSqa.
would produce most of tjhpse which were regarded as signs ojt niqat
extensive .mischief. In common fairness, a much, greater stress ougit
po have been Jaid upon the rapid decomposition whic^i was every
where going on* In fact, had f had as an impartial person a sjuore
in the post mortem examination, it would have been nay bonnets
duty to have warned the friends of the deceased, to have placel
un^er existing circumstances^ but a very .moderate reliance on die
,§xpec$ed results, of "such an investigation, ..J&dejc any ./iWinrtfa
of heahh for some time,, no matter from ybat cause produced* 1
hftye every reason to believe that new crops of tubercles would ban

ppeared, and most probably, sooner or .Jater ^axe temina^edJier
xlstence. * ■ : [

It &jyp0Gurs> by this attract that th& above named' practitioners,
very one- of whom is much better known to the medical public
ta(n< their critic (for afl have' contributed more, or less to science},
o ttdt know- sloughing or gangrene from abrasioirof the cuticle.
Lgain, tikis is the mist time that prams and purple grapes hare been
iacovered, whioh - is rattier singular, when Mr. Long is so well
cqnainted with the causes of disease. We refer tb our report
f the trial fcr the most incontrovertible evidence of the -fact, tjiat
he practice of Long, m treating the eschar on the back, was the
aoet injudicious, dangerous and ratal The gravitation of the blood
o the back, might cause cadaverous lividity, but not ecchvmosis*,
ft abrasion of the cuticle, which could only be induced by putre>-
actioti, which had not taken place. We challenge our author to
iddtute the authority of one medicolegal writer in opposition to thfe
►pinion. If there was merely abrasion of the cuticle, why tal^e sb
nuch trouble to explain the signs of the most extensive mischief ?

We mUBtpass over the unequafled opportunities1 of opening dead
yodies, by merely observing, that it is certainly marvellous sjtch
LhonWhave occurred in a city where the aid of Mr. Long was to
ie procured, Whiob cotUd :infalliblyprevent such a tremendous mof-
xfllty. -Our air&or disposes of Mrs. Lloyd's case, fa making it 91-
nanaged erysipelas: here again he contradicts Mr. Brodie and$fr.
(Tancef. 'J?be following piece of ethics deserves attentive perusal :»-**

" A few years ago some of my pupils informed me, that Jkigji
operations for the stone were jpexformed at St. George's Hos-
pital, ly J^r. prooje ; the events were most unfortunate ; an^, f.
jelieve, commented upon pretty freely, by more than one anato-
jucal lecturer in this metropQha, and tjie failures were ascribed to
2ie want of necessary precautions in guarding the cellular xoembxanf
it the smjunii; of the bladder from destructive urinous infiltration, by
iia^upgaoQunter opening infenorly, as advised by that successful
^per^tor, fox the same ctfsease, &lr. Carpue. fhp precocious Reduct-
ions of Mr. Brodie on points of experimental physiology, axe. many
?f them, as I have myself ascertained, o^uite .fallacious; and jtae
few recently published facts, by a Physician ajvfi Surgeon of Guy,s
rlosplta^. shew clearly, at & events, How mucfy mistaken he has
been on the iiction and ejects of morbid poisons jn the snij$al
ceconomy." ' " '

Mr. Brodie never performed the high operation for lithotomy, and
neter reejonwefcted ^ 24th wit-

Massing over a case which' was supposed to be similar to that of
the late Jang, and mistaken by two royal physicians and a Univer-
sity professor, and its real nature, discovered by pur author, we arje
next favoured with the following fraternal and benevolent exposure
of meoUcal abuses : —

438 Miscellanies.

49 Judging from a conversation I had with you, lor tht tint tar
after the inquest upon Miss Cashin, you induced me to think tasta
professional merit, under the present corrupt system of patronet
witnessed in the various responsible appointments to our unites-
ties, colleges, court, hospitals, infirmaries, &c. was overlooked, y*
had no chance of fair competition ; and as nearly one-half the nse&
cal profession are unlicensed, and practise under the names of as-
geons, accoucheurs, chemists, &c. you saw no reason why jus.
should not act as a medical practitioner, having early had a taste fss
medicine, and also, to my knowledge, having, in an anatramcal
school, where I lectured some four years ago (without any persona]
acquaintance with you at that period), purchased dead bomes, at &
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 Las-
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 now unrfer-
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 hadesdored
from the medical profession, and you seemed to think, as I dompelt
that had you not been very fortunate in gaining the confidence of the
public, you never would have been the victim of their envy sad
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 tbat
more than one day in the week should be appointed by themarfva
.for seeing their unfortunate out-patients, and also more than one dty
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 thousands
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 prot6g£ of an old influential medical -main,
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 t6
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 Miscittanit*.

an account of the " monopoly of the faculty, their too eztesre
and improper employment of poisonous medicines, the size of &
irritation, (! ! !) erroneously and unjustly called a wound.9 Mi.
Brodie's unscientific treatmemVof Miss Cashin, disgraceful preju&a
of the faculty, fatal Operation by1 Mr. Broctie, abuse of Mr. Lct-
rence, and Mr. Copland Hutchinson, for enormous scarifications is
erysipelas, abuse of the medical attendants of the Duke of Yo.4,
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 inevitably1 ruin his character vim 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 so now, will be of little use to him. as it will he said k
is influenced by personal feelings, more especially should the CoHes?
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' he afforded d
the gross partiality and insolent behaviour of the managers of this
Institution.

S3.' Aptkecarie* Cempmmy v. J2y«».— The report of, tWa tymi^aintl.iytwacmti^o reaebsi
«■ too late for' notice this month. We are. delighted that the partial conduct erf tke*
Inftoleut pharamaopolfetB were eenswtfd by the Judge, «ad tfeeir vevdftot set add* tej a*
King1! Bench.

LITBaABV UTT5XI4GBKC*.

In the Rress.1— *A Manual of State and FWensic Medicine, com*
piled, from the best medical and legal works ;. comprising.*-:-!, Tfef
ethics of the mbdical professiari, ancient and modern, moral statutes
of the British universities 'tod colleges ;— ?-H, » The charters and sta-
tutes relating' to phyaieiamr, surgeons; apothecaries, ybstttiiuni*.
ehemists, druggists, > andi empirics ins rthe British dosniaioiis^li
The* rights, privileges, and immunities of . the faculty .^-IV. Tfef
civil' and *crnniiialr cases .in 'whkh medical evidence is required;
V, AH medicolegal questions** witb the latest decisions ; being »
Analysis of a Course ofLedtuves on; Medical Jurisprudence, animalfr
delivered in London, and intended ae a conpendkan for the use at
barristers, solicitors, magistrates, coroners, and medical practitioners.
By Michakl Ryan, M. D. Member of the Royal College of Pfer-
sicdans in London; Lecturer on Practice of Medicine and Medical
Jurisprudence, at the Medical Theatre, Hatton Garden, near Sl
Bartholomew's Hospital, etc. &c.

Mr. Wallace, Surgeon to the •Charitable Infirmary, and to the
rnnrmary for Diseases of the Skin, Dublin, will shortly publish the
History afid Treatment of Venereal Diseases of th^Skun, inckdmc
the Primary Symptoms and Eruptions ; illustrated by DetineaooDs
as large as life, and coloured after nature.

Aft Communications and Works for Review are to be addressed t» ibe ctr? d
G". Underwwd, 39, Fleet Street », or to the Editor, at hie raaidUsBce^ <1, Ha***
Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

■ ■■■ ■ «^f»«

**mt.

afsesattsemm*

No. 36. JUNE 1, 1831. Vc*. VI.

CRITICAL REVIEW.

I. — Elements of Medical Jurisprudence. By Thbqooric
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 ConsidSrte
dans ses Rapports avec la Legislation Actuelle, ouvrage
particulierement destine a MM. les Medicins, Avocats,
et Juris. 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 parm
ticularly intended for Physicians, Advocates, and
Juries. By C. Sedillot, M.D. of Paris. Paris, 1830,
18ino. pp. 511. Crochard, Rue de Sorbonne. London,
J. B. BaiUiere.

Theme 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

Vol. vi. no. 36. 3 l •

442 Critical Review.

very little trouble indeed in the execution of his task. We
deem it right to give this information to those who posses
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 legal 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 be
is much too concise, and not sufficiently explicit. He prefixes
the law to each article, in imitation of M. Briaod, in his more
diffuse and excellent Manual of Legal Medicine, 1888, 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. uf 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 topio introduced, and we should
illustrate this statement by extracts, had not the greater nart
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
q 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 or that
before us, but the introduction of Medical ethics, and of all
the laws relating to the medical profession in this empire
will 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 oy 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, tbe Uni-
versity of London, appointed a professor of medical juris*
Erudence, we have every reason to believe it would not have
een required at all.

i. » ■ .11

HI.— 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-
clock, 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 iu

444 Critical Review.

4erms of the highest respect, still- it is superseded by the
productions of Averill and Hargraye. 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 evideoce 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.— -4* 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-streeL

Tub 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 tertperament, then the symptoms of indigestioa ;
thirdly > the influence of the former upon the latter. In
describing the common symptoms of indigestion, Dr. Mayo
etamines the opinions of Paris, Philip, Johnson, 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 write** have respectively undertaken the history of Indiges-
tion. In the three feeble writers, tritcfte wtwfa justly enjoy the highest
present refutation on this subject, Br. Paris, Dr. Wilson Hrilip, sod
Dr, Johnson, I find but little reference to temperament or constita*
tion, ssany ground of pathological distinctions. Dr. Wilson Philip

Dr. Mayo oh Indigestion. 445

furnishes a very masterly, description of the disease. He has looked
&t 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
t>e 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
xiecessary 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 riertous
and bilious, and to ascertain the nature of the disease on which they
depend.'

%4 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. PhiHp 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 grvfen by Philip, and the ordinary features of the
dyspeptic patient, as pdurtaayed by Dr. Johnson. This will form a
useful basis for the more immediate subject of this Bssay, 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 roust remind our 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 bv the profession and the publics which is
a strong proof, of t£e high estimation in which it is held*.
On the other hand it is to t>e recollected, that a very small
portion of the profession assent to the divisions of dyspepsia,
maintained by Dr. Philip. Br. 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.

fV Ext« colocynth, comp.

rhei aa gr. xv,

Pil. hydrargyri 9ss,
Pulv. ipecacuanhas gr. ij,
Saponis Venetianse gr. iij,
Olei caryophyllor gts. iij,
H\. ft. pil. x. capiat i. ij. vel iij. hori 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, axe 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 aa
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 an
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 met 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 so
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 Rtviev.

the tame thing ; and it wffl be difficult, by any reasoning, to mfc
good the supposition, that small portions of aloes, of rhubarb, d
ipecacuanha, or of compound extract of colocynth, have generalir s
more unwholesome purgative effect, than cabbages, potatoes, asd
turnips. Of this point I feel certain, that the state of the mtestrati
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 tfee
bilious temperament. In the latter case, digestion may be very wdl
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 numoralism must of course he 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 om*s
probandi lies with Dr. Johnson. In describing- the treat-
ment of melancholy, combined with bilious indigestkw,
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 favoQrite 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, hot 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 obUnmn§ wmriskment 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 mis state has, in most cases, continued
long before the mind obtains attention as a seat of disease.

" The risk of depletory measures, as tending to convert this se-
condary affection into an almost mcurable 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 mtsoty. This
caution is the more required, hi regard to our present subject, because
melancholia or hypochondriasil, when a primary disease, and not
the sequel or advanced stage of dyspepsia* hears on the whole man

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 :—

" 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
bis 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 faecal 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 was, 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 for 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 diarrhcea, 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 immemste
dyspeptic symptoms linger, by delaying the process that would
afford them relief.

" The relief of dyspepsia by spontaneous diarrhcea 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 faeces often constitutes a sequel to this diarrhoea. And
here a difference in the treatment required deserves to 1»e noticed.
In the bilious temperament it may be assumed as a principle, tint,
until the faeces 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 far a
repetition of such medicines. The return of an adequate secretion
may often be Becurely 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 tie
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 diarrhea*
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

" 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 nervouBnes*

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 cf great indurance,
while the asthenic is easily exhaustible.

" Now these two forms of the serous, or phlegmatic temperament
differ remarkably in the treatment, which 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 abeoratehr
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 me
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 wOl 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 fopd 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,
bis 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 tons les Accouchemens contre
Nature reduite a la plus grande simplicite, et precedee
du Mechanisme de I 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 oar
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 ma?
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 horum magi*
accipe.

Of the Management of Preternatural Labour*.

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 iliacus 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 iliar spine.

Size, from before backwards. — The size o\ 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, more generally it is elip-
tical.

Dimensions. — The superior strait is measured by four
diameters, viz. an anteroposterior ', which 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 ot the situation
of the psoas and iliacus muscles ; so that in reality it pre-
sents to the obstetrician a diameter of four inches. Tb*
oblique diameters are about four inches and a half.

Inclination.— When the woman is standing, the superior
strait is not situated horizontally, but it* posterior part b
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 concaie,
and presents transverse lines which mark the points of union
of the different pieces of which the sacrum and coccyx ar?
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, aud present the sciatic
hollows, converted into foramina by ligaments of the same
name; a square surface which answers to the cotyloid
cavity ; ana 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 anterioposterior
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.
Anteroposterior diameter. — From the middle of the sym-
phisis pubis to the middle of the sacrum, measures about fire

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-verteDral 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
Vol. vi. no. 86. 3 *r

458 Critical Review.

iutimate knowledge of these different parts not being neces-
sary for the explanation of the mechanism of natural laboor,
we shall therefore at present confine ourselves to that whkb
relates to their form and size.

Of the Head of the Fmtus.

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 tod
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 Fatal Head.

The fluetal head has five diameters and two circum-
ferences.

Of the Five Diameters.

The first extends from the occiput to the dun, isd*
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 occipitofrontal. 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 bead to the
basis of the cranium. Its extent is three inches and a baft

The fifth extends from the mastoid process °f mjT
to that of the other, and thus measures the breadth of the

• The author should have added— or in pedal presentations,— &>•

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 crauium is incapable of diminution.

Movements of the Head on the Trunk.

The head 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 pf
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 iU
anterior and posterior walls.

1st. The largest diameters of the foetus exceed the extent
of the smallest diameters of the pelvis cf 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.

2d. The largest diameters for delivery, at the superior
strait, are the oblique; whilst at the inferior strait, the

Seatest is the antero-posterior ; it follows, therefore, that
e 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 fire
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 right sacro- iliac symphisis. The posterior sarhce
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 occiprt*'

Dr. Hatiit 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

1)ubis, and the face in the hollow of the sacrum. Then the
argest 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

five to them the same rotatory motion as to the head,
he 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.

Secpnd Portion. Principal Relations.

The occiput answers to the right cotyloid cavity, and the
face to the left saoro-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 heaa 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 oa
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 toe head
escapes through the genital fissure, the forehead resting oo
the posterior commissure, and the different points of the lace
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 rigtit thigh, and the
(ace 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. 466

strait, tbey 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 Dehind, 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. — Principal 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 oolique diameters of the
pelvis. In these positions., the foetus is disposed in sach <a
manner that the thighs are bept 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 by 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 which the leit hip is soon placed under the pubis

464 Critical

and the right in the hollow of the sacrum. (This rotatorr
motion does not take place when the pelvis of the mother b
of a certain size* and in that case the breech goes oat
obliquely).

The hip, which is behind, receiving the whole contraction
of the womb, comes out first, whilst that which is in frost
serves to it as a point of support. The breech, after having
eseaped, 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 is
the curve of the sacrum, and the occiput under the arch of
the pubis.

Tne chin then traverses the whole extent of the cum
of the sacrum, of the coccyx, and of the perinaeum, 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

. •

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 Tweak 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 perinaeum, 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, when 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.

Vox. vi. wo. 86. 3 o

466 Critical Review.

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
forwurds 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 fatal
looks backwards and to the right, and the anterior forward)
and to the left.

fourth Position. Principal 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 fetai
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,

* 9 4

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 raisea, 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 Co the
right sacro-iliac symphisis. The posterior region of die
foetus is directed forwards and to die left, and the anterior
backwards and to the fight 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-iiiac 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-iiiac symphisis, and the posterior part of the thighs
to th$ 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
sacroiliac symphisis, and the posterior of the thighs to the
rijght cotyloid carily. 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 enraged 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

E laced under the arch of the pubis. The hip which is
ehind 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 axillae 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, aud 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,
P. 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

Srievances of the members of the College of Surgeons,
efends " 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 om
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. 46ft

. ' *" 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 ?" 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.
Put 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

4T0 Critical Review.

ptodact certificates of taring attended ketnres on anatomy* phyn-
alogy, chemistry, materia medica, botany, practice of medien,
medical jurisprudence, comparative anatomy, midwifery, and that
daring that time they have attended a public hospital. 9. Thsi
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
dosed chamber, without the aid of books.

«* 8. There shook! be a class of honorary members of the General
Council, men of distinguished merit in provincial towna, the army,
navy, or colonies.

" 9. That general practitioners who have given up the practice
fef 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 onrj
have undergone the examinations of the first class, but should have
given public proofs of their capability to teach by delivering a lee*
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 ignoranct
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 aU 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 method
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 ef its cha-

Mr. Green on Surgical Reform 471

meter and purposes, they could not be divided. Instead, therefore,
of any partial alteration or regulation, I should advise that ova
faculty of medicine be constituted, with such powers and admimstra*
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.

" 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 £he profession.

" Lastly, from the colleges or institutes qf medicine, surgery,
midwifery, and general practice, might be formed a medical convor
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 he
obliged to have their licence for their several callings. And if the
government would render the benefit complete, and national, tfcey

473 Critical Review.

would root up the detestable upas-tree of quack and patent ragdjriaci
And thus, Sir, we might at length see a profession flourishing* k
this country, the motto of which would be Distinction witkmt
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 atterlj
impossible that the present defective anomalous and anti-
quated condition of tne medical corporations in this empire
can be longer tolerated. Reform must take place, bat
those who live by monopoly and corruption, will, like tbe
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 anion 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 is
all the advantages which the commerce of tne world confers
upon her, the Queen of cities, tbe 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 tbe
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 tbe
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 8 object 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 Arkendale, 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
" fetiing," seems to be equally innoxious.

" Turning, boring, and grooving wrought iron present nothing re-r
markable. But the turning of cast iron is so laborious, that the
men can scarcely bear it for the whole 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 terminating,
when men pursue the employment for years, is bronchial ex tubercular
consumption. The frequency of these fatal diseases is easily ex-
plained. The sensitive membrane lining the airtube and airoells 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

Vol. vi. no. 36* 3 r

474 Critical Review.

a predisposition to the tubercular form of the disease. The
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, asd
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, by 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 partidef
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 oo
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 38-5-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
enly from the duet they inhale, and the consequent bronchial irri-
tation.

" Hie 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. Hie mortality among ma-
chine-makers is not the result of intemperance ; for the men, in the
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 fife?

Mr. Thackarh on Health and Longevity. 47 S'

Magnetic mouth-pieces, which attract the particles of iron inhaled in
respiration, and thus greatly diminish the quantity which would enter
the air-tube, were many yean 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 fTfl""nipg 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. Gould 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 3ie 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 hak
of the head changed to green." — p. 55.

Braziers are subject to noxious exhalations from the sol-
der, but tbeir 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
tbey burn. Tinners are subject to inconvenience from the
fumes of soldering.

Plumbers are exposed to the fumes of volatizett 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 were it not for the tur-
pentine. If this be true, some other article ou^ht 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 which they worked, and by ob-
servance of cleanliness, more especially in manual ablution.

" 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, end exposed consequendy to
abominable evolutions of sulphuretted hydrogen, say they are wefl
and hearty. The manufacture, however, bong of a comparatively
recent origin, does not afford us the opportunity of seeing its rail
and ultimate effects.

Mr. Thackrah on Health $nd% 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 occupation*
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, whiah
produces constipation, colic and palsy. Intemperate paen
suffer most severely. The use of lead iu glaring might be
discontinued, or the process might be effected by a machine.
It is wellascertaioecf that the glaze of common earthenware
is soluble in animal oil, and more copiously in acid fruit*
when assisted by heat; and there is every treason 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-
sion in a solution of sulphuric acid, whieh is employed in
the process of " felting." Their nails and fingers are ex*
coriated and sore.

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 dweHs 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.

4Y8 Critical Review.

44 Whether we examine the agency of moisture on men in the ope*
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 die 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 feet, they are fa* mne
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 b
generally careless of protection, — at the paper-maker, one hour per-
spiring at the strong labour of the press, in an atmosphere of wans
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 comphinti

• If a man safer to-day from headache and sickness, the effects of yestenky's
debauch, he ascribes them to the cold he took in returning home. If bis bows
be irritable from the annoyance of undigested aliment, he has " taken cold.** If
be suffer from an epidemic, he is sure it arose from " sitting- with his back to aa
open window." If he have an attack of gout, it was from " going oat m a hasy
day." Nay, the unhappy victim of hereditary consumption, ascribes his illness
to "sleeping in a damp bed/' This subject is sorely important in Pievtatfivg
Medicine. If we err in the causes of disease— if we attribute onr 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, h
not likely to correct that dietetic fauk, which has occasioned the disorder. He was
ascribes the affection of the head, which from its recurrence and severity threateat
to produce at length serious disease, to his standing in the warehouse without as
hat, or some such petty exposure daily committed with impunity, will not sorely
be disposed to forego that excessive application of mind, which is really the came
of the cerebral excitement.

Old Parr, we are informed, was in the habit of sleeping in wet sheets as ha
cure for a cold.

Mr. Thackrah on Health and Longevity. 4/9

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
lias 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 ' 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
jexciting 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
Crushing .cloth. See j>age 63, That this vapour should affect

480 Critical Review.

principally the stomach and bowels, is a circumstance which ve
should not have expected.*' — p. 69,

. Our author next examines the health of those exposed to
a high temperature, or to great variation* 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 possev
this work. It is replete with information, equally valuable
to the one as to the other. It re6ecfs 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 100° The
heat of the oven is about 180°. These men are subject te
disorder of the stomach, to cough, and rheumatism. The
two 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 eomplain of Jan*
goor, ' 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 labouriag
.classed, and must terminate-our present notice : —

" The high degree of temperature/ which the Iranian body caft
sustain without injury, is surprising. I scarcely need refer to the
well-lcnown experiments of BXagden and ftnuybe, Tfflet, &c

Mr. Thackrah on Health and Longevity. 461

" 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 Iangour. The complexion is rendered pale ; and the
digestive functions are impaired.

" 2. Persons exposed by their labour to great and frequent va-
riations of 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. Hie drinking

Vol. vi. no. 36. 3 Q

482 Original Communications.

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.
7\> his Excellency Prince Lieven, SfC. $c. $c.

Sir,

Having 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 bad 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 I 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. 1 beg to refer to
1>p. 50, 51, of the accompanying pamphlet, on the crotontig-
ium oil, published by me dunng 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-
Soeia, two ounces and half of compound tincture of car-
amoms 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 vaiious. 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-
hausen, Esq. Russian Consul General at London.

March, 23, 1831.

" The Medical Board at St. Petersburg!), I am informed,
have found in your pamphlet, besides the remedies therein

484 Original Communications

stated, different useful and new observations, which, in tht
opinion of said board, will deserve the attention of the
medical men who will have to treat the cholera.9'

[It affords us much satisfaction to notice the flattering
manner in which the Russian Medical Board has speken of
Dr. Short's Essay, a production of which we spoke in just
terms of praise m a former number of this Journal. The
testimony of a physician who has extensively observed die
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 Ttglkim.
—Ed.]

II. — Dr. Blake on the Injurious Effects of Belts and

Stays.

A paper on the danger of the custom so generally adopted
of compressing1 the abdomen, by means of a belt or stays*
as tending to the production of Herniae. 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 natious, 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
mv mind, disposes in an eminent degree to the production
of this loathsome complaint ; I mean she 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 oy 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 apnea,
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 upe still
more universal, and a mistaken supposition that the support
given by a belt to the abdomen diminishes the liability to na-
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 th?
degree of compression applied to the waist.

Cavalry soldiers are also constantly exposed to this cause
of hernia, owing to their heavy swora 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 Qpopet'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, now much the application of a tight belt or
stays, « embracing the abdomen, must tend to destroy the
equilibrium between the two 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 natur&lly 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 hernias. " Gutta cavat lapi-
dera non vi sed seepe 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 substituting1 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
hira 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 on, 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 pnUie
service over which they preside. Hie opinion of such an
able medical officer of the army as Dr. Bteke, is entitled to
attention and respect.— Ed.]

IIL— Report of the Royal Westmtnstbs Ophthalmic
Hospital. By Ma. J. Foots, Jan.
Purulent Ophthalmia.

This disease (the evil effects of which, under the treatment
at present pursued by medical men, are constantly exempli-
fied by unnappy infants, who have lost one or both eyes,
being Drought to this hospital at a period of the complaint,
when it is no longer in the power of surgery to afford tbem
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 tne 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«

auently employed by practitioners, more especially those of
1e 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 works 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, Jim. 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 01 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
sy ringing 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 cornea? are much diseased, being
ulcerated and ruptured.

Vol. vi. no. 36. 3 r

490 Original Communication*.

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 milk washes, and so forth. ~

The child's health is pretty good, bowels open.

App. hirud. j. cantho extern, sing, ocnli.

Lotio. aluminis ter quaterve die usurpand.
Pnlv. alter, ss. nocte et mane sumend.

23rd. The leeches, applied last night, bled so freely, that
they 8ent 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 aluminifl 2 d& horft post applicationem ung. et tunc omai
horft 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 oy 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.

29tb. 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.

Qr Quins, sulph. gr« ss.

Sacch. pur. gr. v.
Ft. pulv. bis die sumend.

Cured.

Mr. Foote, Jim. 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 hen 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.

Casell. — Purulent Ophthalmia: from Leucorrhoea. 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 leucorrhcaa.

The discharge was previously well syringed out, and then
the ung. arc\ nitr. applied, and freely diffused over the whole
of the eye by rubbing the lids.

Pulv. alter, as. nocte et mane sumend.
9th. Is going on well.

Habeat lotionem alumnus
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 Ortginal 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 mafic.

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
eonorrhcBa, 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.
|V Calom. gr. j

Sacch. gr. iij. m. ft. pulv. j. nocte et mane Bumend.

28th. The right eye appears to have improved under the
application of the ointment: discbarge 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 like wise 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 eyes :
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, Jun. on Purulent Ophthalmia. 493

The ointment was applied, and the use of the lotio
aluininis directed ; but the mother never brought it baqk.
— H.

Case IV.—Gonorrhceal ophthalmia.

Ellen Nicholson, eetat. 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 hay never
perceived any discharge from the vagina, or felt soreness
about the genitals, though her husband has since told her
that he haa a gonorrhoea, of which he is still uncured.

When admitted to-day, there was great inflammation of
the conjunctiva of the ball, with cheilosis, 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 " 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 lachiymation. Id 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
Eain, attended with considerable discharge ; the left eye
ecame 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 ; cornesB 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.

1 lth. The left eye is nearly well ; the right very much
better : there is no longer any tumefaction, and the pain has
disappeared : discbarge very slight from the right ; none
from the left.

App. ung. nigr. dextr. tantum.
Hep. pulv.

13th. Discharged, cured.

Case VI. — Pustular inflammation from injury.

Mary Kennedy, aetat. 14. Admitted 8th June, 1890.

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 food 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.

JV pil. hy<L gr. iij. nocte: sulph. magn. 5 as. mane.

June 12tb. No very great improvement : large red vessels
running across the conjunctiva : great pain iu the head.

Mr. Foots, Jun. on Ophthalmia from Lime. 495

Rep. ung. nigr. — Hirud. ij. node applic.

Pulv. cal. gr. iv.

Pulv. jalaps, gr. z. — M. ft. pulv. statim sumend.

14th. Some improvement is manifest

Rep. ung. et hirudines. — Pulv. jalap, c. 9j. 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.

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.

£r 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, atat. 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 ltd enormously
swollen ; vision gone ; no pain in toe head : a poultice was
applied last night.

C. C. ad Jriv. tempori
HI. hydiargyri 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.

Br hyd. submur. gr. ij.

P. opij. — gr. \> ft. pil. ter. die sumend.

23d. Inflammation much lessened: pain in the eye en-
tirely gone : vision still indistinct : very little lachrymattoa.

Rep. pQ.

Of this case the notes were no longer taken ; the mouth
was rendered sore, and he gradually recovered, When be
was dismissed, the cornea was clear and vision good. — EL

Case IX. — Albugo : cured by insufflation.

William Sanson, aetat. 53. Admitted May 6th, 1830,
with a large albugo, covering ne&rly the whole of the cornea,
of a milk white appearance, resembling lime.

Insufflator pulv. saceh. c cal. in ocol.

1 1th. A great deal better.

, Iteretux mwifflatio.

. . 13th. Improving ; says he sees much better : the albugo
does not cover one-third the space it did.

Rep. insufflatio 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, aetat. 49. . Admitted April llth, 1631,
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. 497

This complaint (the amaurosis) commenced on Saturday
week; she now complaint; 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. $j.

ant. tart. gr. ij«— h< s. s.

The gutt. via. 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 un£. 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 asr well as fett ;
the dr6ps 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.

fWe afe much indebted to Mr.- Foote, Jun. and bis zealous
leagtres 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 esteerted 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 auditor* of such teachers
seemed quite astounded, when we referred them to the
various ophthalmic institutions for melancholy proof of the'
fallacy of sutii an erroneous assertion. — Ed.]

Vol. vi. no. 86. 3 s

499 Original Communication*.

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 gentlj
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 op
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 U
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 flax,
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 nest 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. Ryu 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 tnat 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.

mu%d .with recently ignited charcoal, and , reduced in a
tube- .. .

'* We feel confident that this «method will succeed in ex-
perienced bands i|i many instances in which the complex
precipitations of animal matter by die 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 them before the reader : —

Yr 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 elude 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. Christ i sou 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 30on deposited. If Xhe precipitate tie green, we hue to
seek for two metals in it, arsenic and copper. The first is
recognised easily, t>y mixing the powder with charcoal and
dried .carbonate .of soda, and beating 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 ho rax, 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. Ryt\\i on J$<micide by Poisoning. 'jfi£

For directions qn tbe use of the blowpipe, tf*e the&tticle
on lead.

" If the deposition frpm the alkaline solution (be yallow,
it should be veduoed 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 become* blackened, both experiments .indicating that
the yellow precipitate is the sulpburet of arsenic.

" The arsenical poison may also have been the alternate
of potass. Orfila nas besides very recently asserted, that
the arseoious acid is liable to be converted into the arse-
nate 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. Christian's

Elan, should, therefore, before transmission gf sulphuretted
ydrogen, be touched with nitrate of silver, which in nay
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 eropyreuma, will occur in. the reduction ; a diffi-
culty which, as vet, we have not been able tp overcome.

" How far the additional step of examining the solids
is actually necessary in this country, it may be difficult to
determine. Pr. Puncap has seen oae case of poisoning by
Scbpele's green, which be 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, Cbristise&'s analysis are
altpgetW. neglected." — Lancet, 1831, vol i.

Sedillot informs up that there are two sulph.urets.of arsenic,
the orpiment and realgar, from which, if heated with potass,
mettdhc arsenic will be obtained by sublimation. MM-
Geizer .and Rejmaa, digest the mixture for some time with
liquid ammonia, it is then filtered, and hydrochloric acid
added in excess. If a yellow precipitate oqquns, it is an
indication pf arsenic; .but when there is no precipitate, we
cannot pronounce negatively ; the fluid js to be evaporated
to dryness, mojre ammonia is added, and the admixture is
/saturated as before with hydrochloric acid ; on adding a
few drops pf bydrosulphuric acid, a yellow precipitate taxes
place, if arsenic is present.

Arseniotts of potass, soda and ammonia, when projected
on live coals, .volatilise in the form of arsenic acia. Mixed
and heated with charcoal, metallic arsenic will be obtained.

M8 Original Communication*.

Action of arsenic, and the symptom* it excite* in sum.—
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, ks
effects may be purely narcotic. It may destroy fife, and
leave no mark of disease to account for death. It prom
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.
Cbristison 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 caooot
be answered but vaguely. The quantity is not as yet deter-
mined ; and of course a great deal must depend on the stale
of health, age, habit, diet, in a word, on concomitant cir-
cumstances. Hahnemann thinks four grains will prove fetal
in twenty-four hours. Cbristison has related a fatal esse
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 witk
arsenic : —

" The symptoms of poisoning with arsenic may be ad-
vantageously considered under three heads. In one set of
oases 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
distinot disorder of the nervous system. When such
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 fife 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 eli-

Dr. Ryan on Homicide by Poisoning. 508

mentary canal are succeeded or become accompanied about
the second or fourth day or later by symptoms of irritation
in tbe 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 (OrfilaJ. 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 twitching* 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 aphthae, delirium supervenes, and death closes the
scene. In some cases the person expires calmly, in others

504 Original Communication*.

with convulsions* When the sufferer survives for days or
weeks* the' body may be covered with eruptions of various
kinds, sometimes resembling small«pox, petechias, miliaria,
&c. In some oases a remission of ail suffering take* 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 many of them may
be absent, others leas violent, and that they are not all
present in every case. In a former number of this Journal
(Med* Repository t vol* ii.), Dr. Yelloly* of Norwich, re-
lated the case of a lad aged sixteen, who died in
hounrfronv having* taken half an ounce of the white oxidi
he never oomplamed of.psria,. though gastrointestinal in-
flammation was indicated by sfokness, vomiting- and purg-
ing. Another extraordinary circumstance in tab 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 artenic 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 symptom* of narcotism are
prominent.. In these cases, though half an. ounce of arsenic
maybe found in the stomach, tuts organ will be healthy.
Yet the* patient' has been -destroyed ia eight hours. The
poison is supposed to act oa remote organs, of course by
nervous sympathy. Morgftgni, Chaussier, Orfila and Chris*
tison cite examples of poisonmg 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 arnfts 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, 1 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-
tieoiij 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 pn all topics
and not to load his memory by references.

•

I 505 ]
BIBLIOGRAPHY.

PHYSIOLOGY.

1. — On the Structure and Motions of the Heart, and on the IndU
cations of the Pulse. By Dr. Burne. — Dr. Jfarne 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. Bw considers, from his own ex-
periments of the rabbit, and from experiments by Hallo*, by Dr.
Knox also, in the heart of the sharks 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 of the poke may be represented by me
following designations : — It may be strong, weak, hard, soft, wiry,
sharp, harsh, grating, jarring, vibrating, falling back, fleeting; or
fall, 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* fet-
tering.

Bach of these terms designates some notable peeuaiarity of me
puke ; and as they are numerous, and as most of them cannot he
measured except by the sensation produced in the mind, is miknm
that the accuracy of this measurement must depend on the anH oi
mdmduak, 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 me
stethoscope, requires the ear to be educated; and aa education of*
the touch is necessary to a correct judgment of the puke.

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 puke ; because the pulse is one of the most pro-
minent signs in disease, and one of the most certain indications is
the treatment. Without the assistance of the pulse, we cannot ad*
vantageously, or even safely, employ blood-letting, which ia 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; me
heart, the volume of blood, and the artery ; and as these causa
always operate, it follows that every given puke must have several
characters. Thus, the same pulse maybe 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 »
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, alow,
equal, unequal, regular, irregular, hesitating, labouring, intermittent,
fluttering.

Those which depend upon the volume of blood are, full ami amalL

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*
pressibk.

The puke, in health, beats about 72 strokes in the minute, or there-
about, and the number varies a little in the course of the day sad
night, being rather more than 72 in the evening, and leas than 72
before rising in the morning. Its natural character k, equal, regu-
lar, soft, and of moderate strength and volume.

Physiology. 407

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 hemorrhagic 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 .lohn 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-ehterite," that its action iB 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

£08 Bibliography.

full hope of rescuing at least some of his patients from an almost
certain death." — From the Revue Medicate, Francois* et Etramjere.

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.

8. 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 die
skin is induced in the living system, and the fluids are carried m
greater abundance to the extreme vessels on the surface of the body.
These facts authorize the watchful practitioner to look nponhot
climates as the cradle as it were, of the majority of all contagkms,
as well as of the most dreadful cutaneous diseases; hence lepra,
elephantiasis, &c. 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. 890.

" Numerous diseases depend upon particular occupations. Scurry,
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 flai-
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. 909

" 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. Pleuropneumonia 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. Univ. 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.

410

Hie liver proved to be entirely free firom decay. It
one third more than the usual bulk* but not sensibly morbid. The
total surface of this viscus exhibited a group of eminences about the
ske of garden peas, individually distinct. On the concave surface
they were more remarkable. They represented the small pox, in die
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 comsatM
pulp or parenchyma, and were all covered bythe delicate, peritoneal,
tunic of the liver. The colour of the liver and eminences was
natural.

BtTRQEftV.

6. Remarks on Morbus Coxarius, with an account of Dr. P. S.
Physick* s method of treating this Disease. By J. Randoph, MJX
&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 k
found to be in a state of ulceration. The author then notices the
opinions of Messrs, Brodie and Ford, which we need not insect
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 m^iyflim, end
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 s
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, SI 1

be carefully wpdded, in order to prevent it from excoriating the akin,
and it must be retained in its proper situation by mean* of- two
rollers, one of which should be attached to the upper-end of the splint,
so aa to secure this part to the thorax and hips, whilst the other is
applied to the splmt 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
temove it until sometime after attthe 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 ill 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
esperieneee so much relief from pain, that he is extremely unwilling
it should be taken off, even for a short time.

" It way 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. 300.

7. Gamer by Navus twice excited, four timet cauterized] and
finally cured by methodic compression. — M. Recamier, one of the

editors of the Revue Med. Franc, et Strang, relates a singular case of
nstvus* 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. Q*re of Gonorrhoea and Leucorrhaa by Iodine. — A man, aged
28 year*, wis treated in the ordinary way for a gonorrhoea without
success. He was ordered 12 drope of tinct. iodinae, m. n. and cured
in eight days.

H1& wile took 8 drops twice a day in cold water, and was cured of
leueorrhcsa in ten days. — M. BrogHa inAnnaH Universali diMedicina
Genua?*, 1831.

9. Treatment of Neuralgia. — When thia 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. — Heldenbrond in some work.

10.— Dr. Buchanan's Surgical Report from the Glasgow Royal In-
firmary, for the Summer of 1630. — Among other case*, Dr. B. de-
scribe* a ease of change in the colour of the skin, from the internal
use of the nitrate of «ilver% He conjecture* 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
fleam engine moulder, and six daye of the week, like his neighbour*

512 Bibliography.

as to complexion, to be thug 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 sank
of virgin beauty, whose bodily and mental constitution, it may be,
hflft been in a similar condition to that of Hattrjck, 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 credit, 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 varices
tribes of human beings, so amusingly and eloquently detailed by
Le Cat, nor do I mean to inquire (as Mr. B. Cooper ha* 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 thefotm of
blue pill, was my first empirical attempt, and this I proposed to sty-
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 infn-
enced by the nitrate of silver, when internally adnxiniatered, bat
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 deiangement 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 1 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, sr 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 with the same result. I need scarcely say that their
use was problematical, as was .that also of huge doses of sulphur,
and the external application of nitric, muriatic, and nitro-muriatic

Surgery. 513

aofcb. These all, it maywell be said, were empirical remediee ; but
what medicine exhibited for the removal of any internal disease, is
not, in some measure, of thia nature, from the most sovereign ape-
ojfics for intermittent*, as arsenic and quinia, to the heterogeneona
and difwordant nostrums for gout, phthisis, and dyspepsia, which
have disgraced the pharmacopoeias both of modem and ancient times .
. In the West ladies, it is often remarked, that the akin of the
oeprQ, when blistered extensively and severely, assumes a dusky hue*
and, in some instances, is even changed into a dirty white colour ;
following out thia observation, I first tried, on his arm, the effect of
powerful vesication bv cantharidea, and thereafter had a solution of
chlorine applied to the vesicated surface ; but still, after cicatrisa-
tion waa accomplished, there could not the slightest difference be
detected* between the sound and lately blistered portion. The pa-
tient havinff become tired at so manv successive failures to alter nia
outer man, resolved to submit to no more experiments, unless I
could give him some better grounds to expect a change ; thia I at
once declared 1 could not, entertaining, aa I did, the opinion, that
hie black foce 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 waa the external application of thia me-
tallicaalt, upon which he had been experimenting, and that, like most
of my other medical friends, he had never seen, for leas treated, an
artificial mulatto. He suggested at the same time, but with his
usual caution* aa 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 anxioue
tpgive thia last application a full and fur trial; for this purpose I
dipped a thick piece of caddis in ammonia, and clapped it over
the whole check; the patient bore it moat manfully, and though
vesication waa 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
JfedkalJeurfial. Mag. .

11.— 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 Anderaonian 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
thia let us take a complete dislocation of the radius and ulna back-
wards. The immediate injury done to the ligaments and muscles I
meed not specify : the ultimate connexions are nearly the following.
Posteriorly, the ends of the ulna and radius form cellular connexions

Vei. iv, no. 845. v .

514 Bibliography.

with the posterior muscles of the ana/ and anteriorly the condyle*
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 firs* date of tlte in-
jury, or soon afterwards, in consequence of the absorption of the
intervening soft parts, the bones come into actual contact, and when
so osseous matter is effused, and anchylosis is the result. Hence
the well known feet, that joints- of this description are very son
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 ameer
which it has been thrown. J

1st. When it comes in contact with a mere point of bone away
from its original socket,- the articular surface and the point on winch
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 |n nimmiil
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 cbricfe.
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;

Surgery. 615

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. ■ • . , • ' - * . ■* . t

' In attempting the redaction of old dislocations, we must be guided
by the nature of the joint (gingiymoid joints sooner become anehylosed
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 dnlocti-
•tiohs of the shoulder into the axilla, when the artery has followed
.the bone, andean 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 traduction: '<

Manner cf* 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 stable 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 . * .
r T 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
Mend and pupil, Mr. Qraham. - 'Each ot 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: i - : • .!.•'*.

v > 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 saime
plain with the table. Gare must be taken that the centre of the
tablebethe centre of the oircjto of- which the rod is a segment. •'• To
prevent the rod from yielding to the extending > power; itnrastbe
attached to the wall by abort rods so curved, that the point of attach-
ment be on itaoutskb. . The hook of the pailey will thus pass with-
out interruption along the rod. • .:> ~ * ■ -

By this shnple and ci)eap contrivance the. direction of the limb

* >*■,

cstepdiag power. The objection to this m the rrsintanr u which the
friction of the iron surfaces would probably oppose to naouaaj fhe
books. Were the surfaces smooth and oiled. I do not suppose that
ibe ferae could be to greek ee to reeiet thecmortsof ewer two

Ms. (Gtaumm proposes a mere scientific but
the principle of which k tomovetljc pelvis on the thigh instead of
the thigh upon the pelvis. Thm is acooinpliahed by naaaaa trf a
table fixed to the ioor by a central point, with a revolving body Khe
a femoewtating table. On this thepetient is kid; thssotsmi janet
oppoeite to that to be reduced is made the central point, end fined
over the centre of the table* He la them sUapperi down hi the
manner recommended. The table b very eaeBynaypedL and a very
alight turn makea a great change on thai angle fended by the
and pelvis. It might be possible to eenefaana a table of '
with the cToellent operabag table which Mr. ~ "
contrived.

By way of adjuvant, Dr. L. reoonnaende
neaa and relaxation, by means of tartar emetic or tobsraa. fib
demno bleeding at first, but recommends it at the latter part; forme
purpose of increasing relaxation and warding off inAaAmation.

Before concluding with Dr. L.'s paper, we must beg to osfe same
lemarks on the off-hand manner in which h* fat* rid of M.Fmaboti
excellent paper, published in the Rep. Gee* far 1637. He
ledges he has a*t*r seen its sad can merely speak Irons an
he perused in the paper of M. Marx, a paper professedly
favour of attempts at reduction, while hi. Flaubert's
against it.

Notwithstanding Dr. L. aster beheld the paper, be
objection indirectly to accuse M. F. of net deemiing all
stances of the cases described in the first* the pcOntalia
shorthesd of biceps, and the axillary artery torn across: the
patient died. In consequence of the sbrwtien ewe? meeV of exd
not being mentioned, he declares roundly, nay* he sake if it
doubted for an instant, thai tbprimt tees ttlfael fMm
by too sudden and powerful exertions. Alas! for the
if the magnate*, if the hospital physicians and surgeons*
themselves, wbet must We eatpeet from the mmorts? If the gnat
men, who, it is but four to suppose, cannot have any u
motive, especially when the bread ocean sell
act in so improfoiskaaA, so unjust a mano
from our juniors in the profession, who ha)
mad .to eminence, and who can. only hope to gala the miauml, by
industry or else covertly andrwmininy their pnifremtmnl faffethren.
This is the fast tune We have heard of a pater having been reviewed
without being even see* ; we hope it win be the bat.

Then quoting another case on the same ajutfeoaty* ha adds, what
tntgeofc, net tomMlf ignvrm* tf the first jKitrifUes s/a»jrt's/iesfss,

Surgery. 51 7

would force a dislocated humerus of seven or eft/At »e»b (only seven
at the utmost) by Ids own shewing, but we presume the eighth was
added for die sake of the tautology) standing into its piece, after
seven or eight minutes extension. He is here again wrong on his
own statement ; two attempts were made, and, of course* with aa in-
terval between them, surely quite long to tear ceUmiar cemuvitme of
aeven weeks' duration; hardly seven weeks* me the connexions aa-
eufedLy did not take place on the very day that the accident
happened.

Our author has been - umreesomekiy severe, more than severe, un-
just, toM. Flaubert and he must not complain of our notioe. Our
motto is, JUSTICE TO ALL.

The writer of these remarks is acquainted with M. Flaubert,
and witnessed some of the eases and their reduction, which he has
described. He can aver, and fearlessly also, despite Dr. Laurie and
JnV 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, m more
famous man to his pauper patients. M. F. ie and has been far
several years, surgeon to a larger hospital than any in London; ft
contains above 1,200 beds. And we hswefreqwenthf seen the hos-
pital so crowded, that double rows have been obliged to be laid.

M. F. beam a great reputation in Rouen, both for ins humanity
add bis skill : it i* needless to may, that he is in consequence much
beloved. On one occasion, -we recollect perfectly well, a deputation
f rem the garrison, waiting on him to tinuric Mm for his humanity to
some soldiers (uhe hospital being ihilitaiy as well as civil) in a severe
and dreadful accident which befel them. It was in the year 1897.

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 ie excellent, and were it not fertile great
blot We have noticedV it would bear the palm.

We fear that the medical profession wiRbe 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 dpfrmwoA, which We are making in the eyes of the un-
professional puhhc i but can we wonder at it, when detraction,
calumny,, scurrility, and all the ignoble passions characterize a large
portion/ of the feeuky 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 winch he will
observe an account of a ease entitled " Hernia punctured by mistake
for hydrocele, death, inspection,'' and this by a surgeon who resides
within five miles of Glasgow. Dr. M. 8. Buchannan, who published
the report, refrains from disclosing the name of* this enlightened
Ssculapian, and evinces more sense, judgment, and professional
etiquette by so doing, than by calling him a murderer, as Dr. Laurie

5 1 8 Bibliography.

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 wiU discover, that " to err is hamaiL
to forgive divine.''

12. Case o/AMHary Aneurism, in which the Subdaomn Artery wm
■successfully secured in a Ligature. By Valentine Mott, M J>.

William Hmes, aged twenty-eight, of Smithville,
to New York, August 24th, 1830, 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 ther 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, I directed him to keep quiet, to be hied, and to take

some purgative medicines; and fixed on Monday, the 30th, for tyiag
the subclavian artery.

- At 11 -o'clock, a. v. he 'was placed upon the table, with the
shoulders elevated and inclined to the right side. An obhqoe in-
cision was made/ two inches in length, through the integuments tad
platisma myoides muscle, and' coi responding to a middle line of the
triangular interval formed on the inner side by the scalenus nrasde,
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 ceDular
tissues were put aside, and the artery readily exposed as it passes
from between thesoaleni muscles. After detracting the artery a little
of the filamentous tissue with a knife rounded at the point, and cut-
ting only at the extremity, a ligature r was conveyed around it, from
below upward, by the American nccule, and the artery tied a Bttfe
without the scalenic muscles. :

'No other ligature was required; "The patient lost less than two
, tecUspoonsfol of blood. The operation lasted about fifteen minutes,
and was performed, -with the assistance of Dm. Vache and Nosacka
in the presence of Drs*£arro*r, Kissam, Rogers, and WmVs. The
wound* was closed. by two stitches and adhesive straps ;*the arm
was immediately wrapped in cotton wadding ; no dtnihmtion of tem-
perature took place. * • •' -

8, p. m; Found the patient comfortable; says he has leas pain ia
. 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. salph. morphine, -which was given to allay the pais
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 ; skm 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.1
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 7 th. Everyway comfortable; right radial pulsates regu-
larly, though more feeble than the left.

• . 9th. 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.

.11th. Dressed the wound, which looks remarkably well; every
thing appears very favourable. t

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 dayB should have been required for ite 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.— iJmeriaui Journal of the Medical Sciences;
Feb. 1831. .

13. — Illustration* to Mr. S.. Cooper' a Surgical Dictionary.— Tbc\i
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 Bibtiograpky.

Though nomiMtty iltosfratioas of the Surgical Dtetkuwy, tibese nut
redly 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 student*. We
wish the author that success which he so watt deserve** and con-
scientiously recommend his work to every class of our readers.

14.— TV Surgical Anatomy of tke Principal VtmeU »/ tke Head.
Publhhed by John Wilson, binees Street, Soho.— This is an ex-
ceedingly well executed delineation of fata arteries and venae of the
toad, fece, 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, said faiiiHfstvs
the labours of the dissector, in this important piece of human ana-
tomy. It reflects great credit on its author.

15.— View* of tke Pehris, skewing the astern/ SUt, Ferns, mmdB*-
lations of tke Bladder, Uretkra, Rectum, Uterus, 4c. 4c. m tke Infant
am4 in tke Adult, take* from Preparation mad* for tke Museum of tke
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 iUnstrnte the
relative situation of the pelvic viscera in the make, female, sad in-
fant, and will be referred to with advantage in the anatosByaad
pathology of these important Viscera. The Uthotomiat and obste-
trician will find them well worthy of notice.

16.— Observations an Distortion* of tke Spine, witk a few Remarks
on Deformities of tke Legs. By Iionel Beate, Member of theBnysl
College of Surgeons, &c. 8vo. pp. 102. — This is an Appendix to
the author's work on Deformities, which is now out of print hi
reviewing that excellent work a few months ago* we spoke of it. ss
we do of all works that come before us, as it deserved; andrtsAns
us satisfaction to find our high opinion of it now amply iiinfjinm d
The essay before us is replete with instrnetfve information on the
vnjoous subjects enumerated in the title. We have no apace, at thai
late period of the month, to make extracts ; but we assure our junior
readers that this production is worthy of their attention, If it eon-
tsined nothing more than the section on deiinniftses of lege of wtxstty
children* and the judicious advice for the management of these
alarming though harmless complaints, it ought to have a peace fat
every medical library. It contains a good account of sfanal irrita-
tion, hmammation, and curvature, with cases in illustration. We
shall notice it fully m our next.

17.— The Art of Cupping; aeing a brief History of tke Optra-
tie*, from at* origin to tke pratent suae; utitk a Desariaamm of As
various Instruments employed, &c. 4c By George Frederick Knsav
Cupper at the Westminster Hospital,. Central Infirmary, &c. &c—
The young practitioner will find this work of great service, mom
especially if he is not a praotboal cupper, and even the establishes
pradtitsoner will peruse it with . advantage ; of course we speak of
that part of the work which relates to cupping itself: we

Surgery. 521

«peak ao well of 4hat 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 tat present, and 'it requires facts to prove
its utility before it is recommended, to cup in cases of anasarca,
bubo, .cephalalgia, catarrh, hernia humoralis, hydrocephalus, nodes,
phfhisis, 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
jireaorihing 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 MthAmting 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 fiat
.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 m 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 Buch 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 glasaand admit Air. The
large scarificator should be used behind the ear, and on the r fae** ;

Vol. vi. no. 36. xi

522 Bibliography.

the oval glass and the temple scarificator are but. The

most favourable for cupping on the throat, is the recumbent, win

the head bent towards one side.

" Those who calculate the pain incurred in cupping by
with a cut finger, are very much deceived : in met, there is rates/
any pain felt in this part of the operation, nor is any
suffered from it afterwards.'*

This is not always the real circumstance of the case. We
from personal experience, that when cupped in the contrary directing
to the fibres of the muscles on the chest, whenever the arm was
moved, the pain was very severe, resembling the drawing' of afafister,
as also when cupped on the deltoid. Upon the whole, we fmsaoaipce
this a highly useful publication. It contains every infonnatioa mat
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.

HATERIA MKDICA.

18. On Peruvian Bark. Dr. Carpenter, of Philadelphia. In thai
paper Dr. C. describes a species of bark from Maracaibo, which
is much superior to the Carthagena bark, coiitaming ' more man
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 qf tie Medical &eanaces, at
supra cit.

19. On the Utility qf Strychnia in certain forms qf anwuwii*
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* m my opinio*,
the most likely means of removing the defeat, more especially if it
be of recent occurrence. But it will, in many instances, be found
necessary to institute a most rigid examination, before deckling 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; bat it will be
readily admitted that if this examination be not conducted in the
most careful manner, it will be impossible to dracrinunafce, 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 investigatian, be viewed, at
otherwise than a rash. and criminal procedure; a procedure which k

Materia Medica. 524

likely to destroy the power of vision for ever, than to yield any
prospect of relief.

The manner of employing it is as follows: — Race 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 die second dressing, which
should be, as nearly as possible, twenty-four hours afterwards;
twenty-few hours between each dressing is a proper and necessary
interval; cover the blistered surface with a piece of linen very thinly
spread with ung. oetacei, 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 employ-
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.

ThU 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 1 — Mid. Med. 4 Surg. Rep.

MIDWIFERY.

SO. Accidents caused by allowing a pessary for years in vagina
related by M. Ricord. — The unfortunate subject of this case was
aged 01 years, and had a pessary passed in 1825, since which time
it had remained. M. Iisfranc divided the perinteum, in order to
effect extraction of the instrument : death ensued, and there existed
cancerous vegetations and gangrenous perforations in the bladder and
rectum.— Jbtira. Univ. et Hebdomadahre de Med. Chir. Pratiques,

This esse 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 i»> that we have lecturers on all branches of

624 Bibliography.

medical science in London, who promulgate as ridiculous opinions as
students of three months' standing. This defect is at length per*
eeived 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 puipuse
of cleaning it ; that the speaker had known a casein which one was
worn for three years without removal or inconvenience. Now any
medical practitioner, of the most ordinary comprehension, most; 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
in a shorter period than two or three years. It must be
to dwell farther on a matter so obvious. The negative assertion
one of these false facts with which the faculty is so redolent at the
present period. — En.

21. Signs of Pregnancy before the fourth month. — M. Bescaaa
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 Prmssic Add. By
W. Thomas Clark. — It is of the highest importance that a medua&e,
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 - - - I 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. 525

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 pf 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 boeufs." We think the cyanide of1
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 not 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 ]

S3. Expuision<^ Ih.Remuxdgefrtm the London M
The Medical Society of London, the oldest and one of the mo*
respectable in this metropolis, expelled Dr. Ramadge, for his advocacy
of Long, the Quack, and his abase of the medical profession. We
have been informed, upon the best authority, that the College of
Physicians will adopt a similar proceeding.

•

24— J*. MamadgsU Rfply to ike Edkarial JELemar&s on kit Djace
of Loaf the Quack. — his almoat unnecessary tomakeaaragkooB*
meat on the following letter, which is no reply whaawsr to our
strictures on the impropriety and unprofessional conduct of say n-
anactable physician or surgeon, in defending such an illilrratehqmbcg
as this empiric* . The London Medical Society has confirmed ow

£*nion, which indeed moat be that of every respectable member of
profession. We have no wish to prolong this painful dgcnanm,
but may inform Dr. Ramadge that we know notch more about it
than he imagines. It appears he did not send the letter totbefo-
aVn/Hnm; but any. man of common sense must see it wee intended
for the public eye. He next endeavours to escape iromhhsamBtun,
that there was only abrasion of the cuticle in the eschar on the lack
of Miss Catkin, though it waa proved in evidence by Mr. Bmfe
Mr. King, and others, there waa a sore or eschar the aseof ta?
mould of a hat, oar of a supper plate, and a large slough m the
centre. Dr. R. labour* under a mistake, when he supposes uehro
not seen an acoonnt of the autopsy. He will find it at length n oar
fifth volume. As to the extracts quoted by him, we have wo*
denied nor contradicted them.; and our only regret is, that beta
whom they applied should descend from his high station to briar
them to his aid in defending a notorious and incorragibleQasek. We
leave the reader to form his own opinion on the value of the Al-
lowing very polite letter : —

To the Editor of the London Medical and Surgical Journal.

Sir,<-~As it ia impossible for me to reply to the numerous unmanly
and mendacious attacks made upon me in some of the medical jour-
nals, -and in your* 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 ts not true that I sent any letter to Mr. \&%
through the medium of the Sunday Tones. The letter in question
was addressed by me to Mr. Long in answer to one in wbiea be
appeals to me as an honorable man to give a candid opinion on the
cases of two ladies who had previously been under his caret bat wbo
died in the hands of Mr. Brodie and Mr. Vance. It first appeared
in Mr. Long's last publication, and from thence found its wsyio*
the newspapers.

In the next place, it is not true that Miss Cashin had no disease «
the' lungs, or never was jxrasumptiYe. In proof that the eoDtmry**
what you state is the feet, I beg leave to refer you to the reports

527

t)s6' post-mortem eiammation by the medical witnesses, wfai<^ docu-
ment yoado not appear to have seen, aa well as to my letter insetted
in the London Medical Gazette of the 14th of this month. You, ore
pleased to assert that there was no abrasion of the cuticle from the
effects of putrefaction, which last you say had not takes placet
This is false ! The* commencement of the report runs thus? "An*
teriorlyover the abdomen and thighs the* skin peelkig, apparently
from die effects of decomposition. The skin of the neck, shouldexs;
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 ail 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 58, 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*
(binary, Greville-street. I am deeply indebted to the kindneBs of
that able pathologist ; the result of whose labours I 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
enougn of the subaltern members 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 hk 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,
21tf May, 18M, - Your oBedt serv*,

Ely Place. P. H. RAMADGE, M. D.

528 Miscellanies.

25.— London University.— Dr.Elliotaon has been appointed Pro-
fessor of Practice of Medicine in the London University ; and it is
•aid that Mr. Quairi, the distinguished anatomist, of Aldezagate-
atreet School, wiilbe the successor to Mr. Bennet. Hiere 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 prafes-

LI8T OV BOOKS RECEIVED DT7EING THS MONTH.

1. Illustrations of Mr. & Cooper's Surgical Dictionary, published monthly.
Parts VIL-VIII. IX. X. XI. and XII. each containing Poor Lithographic Plates,
with Letter-press Descriptions and References to the Text. London, Longman
and Co. 8vo. 1880. See onr present number.

2. Views of the Pelvis, shewing the natural site, form, and relations of the
Bladder, Urethra, Rectum, Uterus, &c. Ac. in the Infant and in the Adult, takes
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 (5. Underwood, London; and Maclachlan and Stewart,

Edinburgh. 1829, 4to. Noticed in this number.

8. 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 or&a
to the present time ; its Utility ; minute Rules for its Performance ; a List of ma
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 Westoua-
ster Hospital, the Central Infirmary, &c &c. Dedicated, by permission, to at
Physicians, Surgeons, and Pupils of the Westminster Hospital. London, T. ami
6. Underwood. See our present number.

9. Leotiouefl Celsianea et Gregorian* ; or Lessons in Celsos and Gregory, con-
sisting of Passages from those Authors syntactically arranged, with copious Obser-
vations explaining the Difficulties of Construction, and a Lexicon of (be 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 *e
Classics, and Medical Latin. Wilson, London. 1£mo. 1881. .

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 coring of
Tooth Ache, by the Use of the Anodyne Cement, &c. &c. Abo statin? file
Improvements in fixing Artificial Teeth, and a Description of the Sciliceoos Pearl
Teeth, and Teeth Renovator ; with Testimonials from their Majesties^ Physicians
and Surgeons. By Joseph Scott, Dentist London, Stmpkin and Marshall. 8ro.
1831.

NOTICE TO CORRESPONDENTS.

We have been informed that Dr. O'Shaughnessy is not the author of the Gem*

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.

EEEATA IN OUE LAST.

Page 370— 80th line from top, for " rite," read "series."

373— 2d line from bottom, between "distinct'* and "regarded," insert

" been."
1 402— 3d line from bottom, for " sanguilent,'* read " sangiriuolent.9*

405— 7th line from top, for "cadine," read "iodine."

4M— 16th line from bottom, for " citrate," read " tartrate."

— - 4416—160) line from top, after " blister," add a comma.

All Communications and Works for Review are to be addressed to the rare of
Messrs. Reushaw and Rush, (near Exeter Hall,) 856, Strand; or to the Edttsr,
at his Residence, 61, Hatton Garden.

INDEX.

VOL. VI.

Page
A.

Abbbnstrt, Mr. death of 43 1

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. . . . 267
Alderson, Dr. introductory lecture

by 361

Alison. Dr. outlines of physiology

by..... ........ 191

Alienation mental, M. Regnaulton 864
Albugo, case of, by Mr. Foote. . . . 496
Amaurosis, case of, by Mr. Nice . . . 406
Amaurosis, case of strychnine, in .... 521

Anatomical atlas, by Weber 829

Anatomy, Mr. B. Cooper's lectures on 35
Anatomy, Dr. Quain's lectures on. . 197
Anatomy, Mr. Heurteloup's know-
ledge of 828

Anatomy, Mr. Paxton on 360

Anatomy, surgical of the head 520

AndraPs 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 81

Annual Medical, by Dr. Reece .... 247
Antimony, tartrite of, large doses

of, in pneumonia 2, 507

Antimony, tartrite, use of in neu-
ralgia ; 6U

Aorta, ligature on, by James and
Grampton 25, 27

Page
Apoplexy of lungs, value of ste-
thoscope in 188

Argenti nitras, colour of akin from . 61 1

Arsenic, effects of as a poison 416

Arteriology, Borreman's, bv Mr.

King : 329

Asbestos, M. Aldini's dress of .... 264

Asphyxia, Essay on by Dr. Ryan. . 309
Atlas, anatomical, by Weber ...... 829

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. 82

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

bv coition 187

Beck's Jurisprudence, byDr.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 286

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 606

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 . . J96
Cautery actual, cure, of vesico-va-
ginal fistula, by 50

530

INDEX.

Page
Cerebri Fungus, by Dr. Tuthill ... 49
Cesarean operation, bv Mr. Stirling 44

by Dr. M'Kibbin 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 . . . 510
Clarke, Mr. on new mode of pre-
paring prussic acid 594

College, King's, appointments at 254, 430

of Surgeons, regulations of,

relating to their library • . • 431

Colles, Dr. on diseases of the rectum 170

on vascular tumors 176

— — hemorrhoidal excrescence. . 11
Colica constipita, cured by inflation,

by Mr. King *. 390

Collins, Dr. on lacerated uterus, Ac 187

on extra uterine fattation 190

Colon, transverse, found in the chest 11
Congenital incontinence of urine, by

Dr. Duo..' 33S

Consumption, Sir C. Scudamore
on the cure of, by inhalation ...» 33

Cooper, Mr. B. on anatomy 35

Coster's Manual of Surgery) by Fife 44S
Cornea, sloughing of, from lime,

by Mr. Foote, junr 495

Crampton, Mr. on tying the com-
mon iliac 97

Cranium, Fractures of, by Dr. Tuthill 41
Croton, Oil, efficacy of in inter-

mittents 396

Cupping, Art of, by Mr. Knox . . 590
Cusack, Dr's. Report of the Wellesley
Lying-in Hospital 19

D.
Davy, SirH. 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

Dupnytren's, operation for obli-
teration of vagina 76

Dysentery, causes of, by Dr.

Buchanan

Dyspepsia, Dr. Mayo on ... • .... 446

Elaterium, analysis of 496

Elements of Surgery, by Mr. Listou 37
Elliotson's, Dr. Appointment to the

Chair of Medicine in the London

University 4186

— — ^— on Glanders in human

subjects 125

Emetic tartar in pneumonia 1 , 507

Emetic tartar in neuralgia. 1, 511

Enlargement of the Spleen, Mr.

Swifton 49

Epps, Dr. Life of, Dr. Walker, by 289

Ergot of rye in menorrhagia 428

Excision of the elbow-joint, Mr.

Syme on 33$

Expulsion of Dr. Ramadge from the

London Medical Society 526

Femur, fracture of neck, 6cc 75

shaft, cared

by wire seton &?

Ferguson, Dr. J. C. on pulmonary

apoplexy „ . . . 1*

on anomalous labor 191

Fistula, vesico-vaginal, cure by setae/

cautery .,......•• 30

cases from pessary 52S

Recto-vaginal, by same .... 523

Foetation, extraordinary case of . . . 25ft
Foetus, Physiology of, Dr. C. Hol-
land on .....T?.. 299,345

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 499

— — — leucorrhosa. 491

gonorrheal ophthalmia 493

— — mucopurulent ....... 49S

— — pustnlar inflammauoa .. 494

■ ophthalmia from lime. . 499
— — — sloughing of conjunctiva

from lime 495

albugo, cure of 486

Fosbroke, Dr. versus Mr. Darwin. . 843
Fractures of crainum, Dr. Tuthill on 4*

■ femur and pelvis . . 75, 12
Fungus cerebri, Dr. Tuthill on ... • 4?
Fungus haematodes, Mr. Barlow on 8
Fungus nematodes, cured by am-
putation ftf

INDEX.

531

Page

trail-bladder, hydatids of ....... . 58

Geddings, Dr. on ol. terebinth in

salivation • . . 329

— on strychnia in

i>aralysis 426
anders, in man cases of, by Dr.

Elliotson 12ft

"Gonorrhoea syphiloid, Mr. Swift on 51

cure of, by iodine .... 511

"Gonorrheal ophthalmia, Mr. Foote,

Jan. 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.
Hemathorax, Dr. R. Tnthill on . . 804
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 . • 884
■ 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-

krahon 266, 854, 472

of the Royal Navy, Sir G.

Blaneon 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 Civi ale's instruments 887

knowledge of anatomy 838

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, 845

Hospital, Dublin Reports, review of 12
Hospitals, Dublin Reports of, 1,24, 48
Houlton, Mr. on the effects of cold

on plants 74, 75

Honston, Dr. on valves in the rectum 178

Page
Houston, Dr. on views of the pelvis . . 520
Hunterian Society, Prize Medal of 480
Hutchinson, Mr/ on calculous dis-
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 leucorrhcea 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 488

Johnson, Dr. on change of air .... 257

King, Mr. on arteriology 329

King, Mr. J. on colica const ipata 830
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 anj chronic cases of 9
Law, Dr. on gangrene of the lungs 189
Lawrence, Mr. on phlegmasia dolens . 1 28
Leucorrhoea cure of by iodine .... 51 1
Lithotomy, lithotrity, Velpeau on . . 75
Lithotrity, claims of Civiale, Costello

and Heurteloup to 836

> Heurteloup's success in . . 338

Lisfranc, M. on cancer 74

List on, Mr. on surgery 37

on restoring the columna

nasi •• 165

Liver, hydatids of, Dr. Billing on. . 58

rupture of 804

London College of Medicine 341

■ Hospital Reports from 58

532

INDEX.

Page
Long, St. John, Report of trill for

manslaughter 348

Longevity in Russia •• 430

Langs, hydatids of 58

Lying-in Hospitals, Dublin, Rept». of 12
Lyon, Mr. on spasm of the colon. 909

M.
M*Dowell, Dr. cure of vesicova-
ginal fistula, by cautery 50

Mac Kibbin, Dr. on the Cesarean

operation 428

Malins, Dr. on peritonitis during

gestation ...• 52

lecture on midwifery 317, 885
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

1 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

Naevus, cure of by compression. ... 511
Neuralgia cubito-iigital, 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

Old Dislocations, Dr. Laurie on. . . 513

Critical strictures on .... 516

Oleum Crotonis Tiglii, remarks on .. 396

Operation of physical causes on

health, &c

Operative Surgery, by Mr. Hargrave 38

Coaler's, by Dr. Fife .... 443

Ophthalmic Hospital (Westminster)

Report of....

Ophthalmia purulent, Mr. Foote Job.

— — — from gonorrhoea 490

— — — feacorrhcea .... 491

muco-purulent 403

— ^— pustular 491

from lime • 495

O'Shaughnessy, Dr. on poisons... 40S
Otto, Dr. on congenital incontinence

of urine 333

Outlines of physiology , by Dr . Alison 191

P.
Paracentesis Cranii, bv Dr. Conquest 255
Paralysis, Dr. Gearings on stry-
chnia in 438

Paris, Dr. Life of Sir H. Daw, by 199
— — Hospital Reports of, 74, 75, 76
Pattison, Professor, defence of .... 426
Paxton, Mr. on human anatomy. . . 360

Pelvis views of • 599

Percussion, discovery of tubercles

by m

Peritonitis fatal, by Dr. Malins ... 5ft
Chronic, duration of, Editor

on 55

Mr. Reesoa 21$

Peruvian Bark, new species of ... . 521

Pessaries, injuries caused by 523

Pharmacopoeias, Mr. Gray on the.. . SI

■ Mr. Rennie S3

' Drs. Barker, and

Montgomeny on 96

Phlegmasia Dolens, Mr. Lawrence

on 123

Phthisis, in last stage, cure of .... 249

Dr. Hastings on SS3

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-
emetic . .1 ........ ..... 1,507

Poisons, action of, on the economy,

Dr. Ryan on I. 409

Poisons, on the detection of, 408

— — irritant symptoms of 403

— • autopsies by 403

mineral, symptoms of 406

INDEX.

539

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 . . 624

-Chronic peritonitis in 213, 521

Preparations, anatomical mode of

preserving ..• • 420

Productiveness, extraordinary case of 356
Prussic Acid, new process for pre-
paring 524

Pulmonary Apoplexy, Dr. J. C.

Fergusson on 188

Abscess, Dr. Gilroy on . . 426

Pulse, Dr. Burne on the 605

Purulent Ophthalmia, Mr. Foote,Jun.

on ....1 489

Pustular Ophthalmia 494

Q.
Quain, Jones, Dr. on Anatomy, &c. 197

R.
Ramadge, Dr. Defence of Saint John

Long, by 433

expelled bv the London

Medical Society .. ." 626

reclamation of 526

Recamier, M. on Cancer 511

Reclamation, of Mr. Searle 150

Rectum valves in, discovery of 520

Reece, Dr. Medical Annual, by. . . . 247
Rees, Mr. on chronic peritonitis .. 213
Reform Medical, Mr. Green on. . . • 468
Regnault, M. on mental alienation. 364

Remarks on morbus coxarius 510

Rennie, Mr. on the pharmacopeia. 83
Respiratory Organs, Diseases of . . "
Richmond Hospital, Report of, by

Mr. Swift 48

Rivinus, Dr. on the operation of

physical causes 508

Rosens chemistry by Griffin 300

Rupture of the liver, &c. by Dr.

TuthiU.. 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 185

violation, whether ever

followed by conception 141

on unnatural offences ... 141

Pace
Ryan, Dr. on homicide ........... 148

— on wounds, &c . . •• 144

— on the judiciary examina-
tion of wounds 236

■ on homicide by asphyxia . 308

■ by poisoning, 401, 496

S.
Scudamore, Sir C. on consumption. 33

Searle, Mr. reclamation • 160

■ on cholera 212

Sedillot, M. on state medicine 442

Seton. use of in ununited fractures

122, 834
Short, Dr. on cholera in Russia ... 462
Society, Hunierian Prise Medal of. . 430
Somme, Dr. on ununited fracture • . 122
Spasm of the colon, Mr. Lyon on 802
Spleen, enlargement of, cured by

iodine 49

Stafford, Mr. by operation for stric-
ture 424

Stays, effects of, in producing hernia 464
Stevens, Dr. on tying the internal

iliac 31

Stethoscope, failure of 509

Stirling, Air. on the Cesarean 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

— — Quarterly Report 420

— 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.

Niceon • 496

Terebinth ol. in salivation 329

Tetanus infantum, Dr. Hancock on 427
Thackrah, Mr. on health and lon-
gevity 266, 354 472

Townsend, Dr. translation of An-
drei's pathology, by 96

Tracheotomy when a foreign body is

in the bronchus 424

Trades and professions diseases caused
by 266, 354, 472

634

INDEX.

Page

Tubero-carunculoid liver 509

Tuthill, Dr. on fractures of the

cranium 41

— — on f ungus-cerebri 42

— — on ruptu re of the liver, &c . 304
Typhus Fever at Warwick Bridge . . 854

• • ••

398
216

U. V.
Urethra Strictures of, cure of
Vaccination, Mr. Marshall on
Vaccine Establishment, annual re-
port of 431

Velpeu, on lithotomy and ltthotrity . 75
Violation Female, medico-legal*
questions on 132

W.
Walker, Dr. Life of, by Dr. Epps S90
West's, Dr. translation of Andral's

pathology 86

Warden, of the London University,

resignation of 4S1

Wounds, medico-legal questions

on 142, 150

■ hidiciary examination of,

by Dr. Ryan 235

Utero-gestation, phrenological sgn

of ". 5S4

University of London, proceedings of

TBI AND.

. t

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