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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. M.R.C.S. L. & E.,

MEMBER OF THE ASSOCIATION OF FELLOWS AND LICENTIATES OF THE ROYAL
COLLEGE OF PHYSICIANS IN DUBLIN ; LECTURER ON PRACTICE OF
MEDICINE AND MIDWIFERY, AT THE MEDICAL THEATRE,

HATTON GARDEN, NEAR ST. BARTHOLOMEW’S HOS¬
PITAL ; AND ON OBSTETRIC MEDICINE, AT
THE MEDICAL SCHOOL, ROYaL WESTERN
HOSPITAL.

Quffirere Verum. Horace.

VOL. XU.

FROM JULY TO DECEMBER, 1829.

LONDON:

PUBLISHED BY THOMAS AND GEORGE UNDERWOOD,

32, FLEET STEEET,

1829

LONDON :

PRINTED BY C. SMITH, WHITE LION COURT,
WYCH STREET, STRAND.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 13. JULY 1, 1829. Vol. JII.

CRITICAL REVIEW.

I. — The Study of Medicine. By John Mason Good, M.D.
F.R.S.L. Mem. Am. Phil. Soc. and F.L.S. of Philadel¬
phia. Containing all the Author s final Corrections , and
Improvements. Third Edition, with much additional mo -
dern information on Physiology , Practice , Pathology , and
the Nature of Diseases in general . By Samuel Cooper,
Surgeon to the Forces, King’s Bench, and Fleet Prisons,
Author of the Dictionary of Practical Surgery, Honorary
Fellow of the Academy of Natural Sciences, at Catania,
&c. &c. In Five vols. 8vo. London, 1829.

A new edition of the splendid and unrivalled work before
us, has been long and loudly called for by the profession ;
and has now appeared from the pen of the most distin¬
guished writer on British Surgery. “ The Study of Medi¬
cine,” was universally acknowledged by all eminent medical
men, to be the most learned and perfect system of practical
medicine that has hitherto appeared in this country. There
is no other British work on the subject which can be com¬
pared to it in point of learning, extent of research, or pro¬
fundity of copious, accurate, and varied information. It is a
model well worthy of the imitation of future writers.

The language is classical, correct, and, in general, agree¬
able ; the style clear and precise ; and the knowledge it con¬
tains infinitely more comprehensive and accurate than in
any other work on practical medicine extant. This elabo¬
rate work, however valuable, is by no means complete, nor
can it be ever expected, that any one individual will be
able to accomplish so desirable an object. Yet it must be
fairly considered, the most faithful and extensive abridg¬
ment of the science and practice of British medicine. The

VOL. Ill, NO. 13, »

Critical Review.

industrious student and anxious practitioner have here an
inexhaustible fund of useful information, and we apprehend
that every real cultivator of medicine will cheerfully avail
himself of such an inestimable advantage. The lamented
and indefatigable author has revised the whole work, and ap¬
pended all the information that had been elicited by the
combined efforts of the cultivators of medicine in this and
in other countries, to the period of his decease. The ques¬
tion then naturally presented itself, who was the most com¬
petent person, to superintend the publication of a work so
diversified and comprehensive ? On examining the names of
the numerous distinguished writers in this country, no one
appeared to hold a more prominent place in the republic of
medical literature than that of the author of the Surgical
Dictionary — a writer who, in the extent of his research, and
the judicious concentration of the multifarious contents of
his invaluable work, stood nearest to the author whose
place was to be supplied. We know of no other writer, me¬
dical or surgical , better qualified than Mr. Samuel Cooper,
to edit such a work as Dr. Good’s Study of Medicine. It
may appear objectionable to a certain portion of the profes¬
sion, which we believe to be rather small, that a physician
should not have been selected to edit a medical work. But
we apprehend the age of medical sectarianism is far on the
wane, and is rapidly progressing to well-merited oblivion.
The unnatural and unscientific subdivisions of the healing art,
into sects, was never generally recognized by the members
of the profession, in any age, and owes its revival, to the
darkest period of the annals of science ; and never was, nor
never will be, sanctioned by the public. We believe, with
Mr. Abernethy, that “ medicine is one and indivisible and
in this belief an overwhelming majority of the profession, in
this and every other country, fully concur. We believe
too, that our most eminent surgeons prescribe in fifty cases
to the one in which they operate ; and hence, we do not
clearly comprehend how they canhot understand the nature
and treatment of medical, as well as surgical diseases ; or
what is the real line of demarcation between physic and sur¬
gery. The imaginary distinctions between physic, surgery,
pharmacy, and obstetricy, or midwifery, have long ceased in
the medical schools of Europe and America, and can scarcely
be said to exist in this country at present. The greatest
improvements which have recently taken place in the sci¬
ence and art of medicine have been effected by surgeons ;
hence we cannot perceive the validity of the objection that
an eminent surgeon should be the editor of a medicai work.
Drs. Cullen, Hunter, Good, and many others who have at-

Dr. Good’s Study of Medicine.

tallied the highest eminence as physicians, and whose works
have added splendour to British medicine, were first sur¬
geons and general practitioners. There was a time when
the education of a physician was much more extensive than
that of a surgeon, but that time has ceased, and the course
of education now required by the constituted examiners of
physicians and surgeons in this kingdom, is slightly, if at
all, different. We merely offer these few remarks in justifi¬
cation of the opinion maintained in this article.

The present edition of the work before us is both enlarged
and improved by the important additions of the author, and
the valuable annotations of his editor. Much attention has
been bestowed on the body of the* work, and several facts in¬
corporated with the text by Mr. Cooper, whose chief emenda¬
tions, however, are made in the surgical articles. The general
arrangement and original contents of this valuable produc¬
tion are unchanged. We cannot express the high opinion we
entertain of this work more strongly than in the words of its
learned editor, “ if the general tenor of his book be good ;
if, indeed, what seems to me to be the fact, it be so excellent
that no other modern system, on the whole, is half so valu¬
able as “The Study of Medicine,” its imperfections will be
indulgently disregarded by every liberal critic, and its genu¬
ine merit warmly admired/’ Advertisement, p. vii.

The author divides his work into the following branches: —
1* Physiology, or the doctrine of the natural action of the
living principle. 2d. Pathology, or the doctrine of its mor¬
bid action. 3. Nosology, or the doctrine of the classification
of diseases. 4. Therapeutics, or the doctrine of their treat¬
ment and cure.

We shall here insert the heads of the “ table of classifica¬
tion,” or order of nosology, for the advantage of those stu¬
dents who have not seen the former edition of this work ;
which appeared in 1825. We deem this necessary, as many
students and young practitioners rest contented with the
systems of Cullen, Gregory, and Thomas, works excel¬
lent so far as they extend ; but only containing a fifth part
of the information in the “ study of medicine/’ Dr.
Good has described the nature and treatment of various dis¬
eases, which are omitted by the former systematic writers.
He divides diseases into the following classes : —

Class I. CCELIACA.

Diseases of the Digestive Functions.

Class II. PNEUMATICA.

Diseases of the Respiratory Function.

Class III. HAEMATIC A.

Diseases of the Sanguineous Function.

Critical Review*

Class IV. NEUROTICA.

Diseases of the Nervous Function.

Class V. GENETICA.

Diseases of the Sexual Function.

Class VI. ECCRITICA.

Diseases of the Excernent Function.

The classification before us, is much more natural, classi¬
cal, and scientific than any preceding one ; and it embraces
almost every disease incidental to the organs of the body.
It may be considered objectionable from the introduction of
new names ; but it has one unequalled advantage, that of
presenting a continuous account of the nature and treatment
of the most important diseases of every organ. Each class
of disease is preceded by a physiological account of the
functions of the respective organs; and next we have the his¬
torical description of the nature and treatment of the diseases
of each organ. We now proceed to notice the first article
in the work — the Physiological Proem to Class I, Coeliaca,
or Diseases of the Digestive Functions . In this interest¬
ing account of digestion, Mr. Cooper has given a compressed
yet copious exposition of the most recent opinions upon the
subject, and has made many valuable additions to the text
of the author. It is not our intention to occupy the pages
of this Journal with the conjectural doctrines of the un¬
stable science of physiology ; and we therefore decline the
promulgation of opinions which are highly speculative, and
serve no useful practical purpose, we may observe, however,
that the opinions of Leuret, Lassaigne, Tiedernann, Gmelin,
Prout, Children and Graves, are faithfully recorded ; as also
the latest account of the function of the liver, use of the
bile, functional connexion between the lungs and liver, na¬
ture of the pancreatic juice, supposed offices of the spleen
and omentum, physical properties of the chyle, and the uni¬
versal sympathy of the stomach, with the various organs of
the body. The author next proceeds to describe Class I.
Order I. Enterica, diseases affecting the alimentary canal,
which he defines as follows : “ Disquiet or diseased action

in some part of the passage for the reception and detrition
of food.” The present order embraces the following genera :
I. Odontia, misdentition ; II. Ptyalismus, ptyalism ; III. Dys¬
phagia, dysphagy ; IV. Dipsosis, morbid thirst; V. Limosis,
morbid appetite; VI. Colica, colic; VII. Coprostasis, costive¬
ness ; VIII. Diarrhoea, looseness ; IX. Cholera, cholera ; X.
Enterolithus, intestinal concretions; XI. Hekninthia, worms;
XII. Proctica, proctica. The genus I. Odontia, misdenti¬
tion, is thus defined, cc pain, or derangement of the teeth, or
their involucres ;” and is divided into the following species ;

Dr. Good s Study of Medicine.

K Odontia dentitionis, teething. 2. O. dolorosa, toothache.
3. O. stuporis, toothedge. 4. O. deformis, deformity of the
teeth. 5. O. Edentula, toothlessness. 6. O. incrustans, tar¬
tar of the teeth. 7. O. excrescens, excrescent gums. In de¬
scribing the first species, or O. dentitionis, teething, the
author has given a concentrated account of all the opinions
of his predecessors, in which he derives much support from
the editor. This section is both interesting and important,
and deserves cautious perusal by the young practitioner. It
affords the most extensive view of the phenomena of denti¬
tion, and of the treatment to be employed in the diseases
incident to that process. The usual research is displayed
both by the author and the editor in the compilation of the
article under notice ; and yet a fact relative to the subject,
which is even unnoticed by both, and indeed by all other
writers we believe, has lately fallen under our observation, and
which is the following. A gentleman, aged eighteen, had
lost the first set of teeth at the usual period, from the sixth
to the tenth year, but their places have not since been sup¬
plied, except by the canine or cuspidati of the lower jaw.
There is no effort made by nature to supply the deficiency,
the gums are thin and soft, and yet the process of mastica¬
tion is wonderfully perfect and unattended with any incon¬
venience. The general health is good, but the habit is spare
and rather delicate. Perhaps in this instance teeth may be re¬
produced at a future period of life, as in the numerous cases of
persons from the thirtieth to the hundredth year, as record¬
ed in the article under notice. We have deemed it right to
give the preceding classification of the author, as a fair spe¬
cimen of the manner which he has adopted throughout the
entire work. In the ordinary works on the practice of medi¬
cine, we have little information on the various phenomena of
dentition ; and therefore the student or young practitioner is
too frequently unacquainted with the subject. A few ex¬
tracts from the section on teething, are well worthy of in¬
sertion.

Class I. Cogliaca — -Ord. I. Odontia — Sp. 1. Odontia Den¬
titionis — teething — irritation from cutting the teeth.

(( Dr. Cullen did not allow dentition to enter into the list of dis¬
eases 5 but this is to suppose the process of teething to take place
at all times, instead of only occasionally, with perfect ease, aud
without irritation of any kind. Whenever it occurs in this man¬
ner, there is, undoubtedly, no disease, and so far Dr. Cullen is cor¬
rect. But in a very large number of cases, perhaps, in refined
and intenerated society, in the larger number there is not only
disease, but, in many1 instances, disease of an alarming and fatal
character 5 strikingly severe in its progress and complicated in its

Critical Review.

symptoms. The organism of the teeth , indeed, is peculiarly distin¬
guished by the following feature : that there is no other part of
the human structure so brief in its duration, and none, with the
exception of the uterus, so signalized by pain and inconvenience
during its progress. Yet their mechanism, notwithstanding
these evils, is most admirable. No effort of human wit has ever
been able to improve upon it, even in imagination, and no organ
is more strikingly impressed with marks of supernal goodness and
intelligence. [The human teeth differ from those of animals in
being all of one length, and having no considerable interspaces be¬
tween them. Another of their peculiarities is the perpendicular
direction of the lower incisors. In animals, these teeth slant back¬
wards, and the jaw also slopes backwards directly from the alveoli,
so that the full prominent chin is found only in man, while in ani¬
mals it seems as if it were cut off. In man, the obtuse tubercles of
the grinders are very particular, not resembling the flat crowns with
rising ridges of intermixed enamel, belonging to herbivorous ani¬
mals, nor the cutting and tearing grinders of the carnivora.] Ed.

“ There are three periods of life in which dentition, or the
breeding and cutting of teeth, uniformly take place : in infancy,
in boyhood, and adult age. Besides which, we meet with in¬
stances occasionally of a reproduction of teeth in advanced life.
Each of these formations is accompanied with cirrumstances pecu¬
liar to itself ; and, when attended with pain, or morbid action of
any kind, affords a distinct modification of the present species of
disease, and consequently lays a foundation for the four following
varieties : —

a Lactentium.

Milk teething.
b Puerilis.

Permanent teething.
c Adultorum
Adult teething.
d Senilium.

Climacteric teething.

Cutting the milk, or shedding teeth.

Cutting the second set, or permanent
teeth.

Cutting the adult or wise teeth.

Cutting teeth in advanced life or old
age.

“ The teeth of man, as indeed of most mammalia, are composed
of two distinct sets, differing both in number and structure ; the
first, or smaller set, consisting of ten for each jaw, which are cut
between the [sixth and twenty-fourth month after birth ; the most
common period of their first appearance, however, being the com¬
mencement of the seventh], shed between the seventh and four¬
teenth year, and from the period of their protrusion called milk
teeth j and the second, or larger set, consisting of fourteen, fifteen,
or sixteen for each jaw, for they occasionally vary in number,
which are cut progressively, upon the shedding of the first set, be¬
tween the seventh or eighth, and the seventeenth or eighteenth
year; and which, from their continuing till old age, except in
cases of accident or disease, are denominated permanent teeth.
The farthest grinder on each side, however, is seldom cut so early
as the eighteenth year, generally after the twentieth, and some-

Dr. Good’s Study of Medicine. 7

times not till the thirtieth ; on which account, these teeth are de¬
nominated dentes sapientice, or teeth of wisdom.”

Mr. Cooper has added an interesting account of the pro¬
cess by which nature accomplishes dentition, and has ap¬
pended some pages to the original text, in which he gives
copious extracts from the works of MM. Serres and Meckel.

. " The rudiments of all the first set, and of four belonging to each
jaw of the second set, are produced in the foetus, and may be dis-
tinctly seen when it is about four months old : M. Serres declares
that he has traced them, and even the teeth, at three. (The jaw
of a new-born^ child contains a number of cells, separated from
each other by imperfect bony septa. By removing the external or
internal plate of the jaw, the contents of these cells are exposed.
Ihey consist of membranous bags, named the capsules of the
teeth, enclosing the rudiments of the bodies of these organs, and
certam soft vascular substances, termed the pulps, on which the
bodies of the teeth are forming. The bone of the body of the
tooth is the part firsfr formed ; the enamel is added to this: and
the fang appears the last in order. The pulp, which, according to
Meckel grows up from the bottom of the capsule, about the fourth
month of foetal e^stence, accurately resembles in shape the body
of the tooth which is to be formed on it. It is a soft vascular sub¬
stance and its vessels are most numerous in that part which is co-
vered by the portion of tooth already formed. The capsule is a
whitish membrane, but very vascular on its inner surface. It in¬
cludes the pulp, round the basis of which it adheres, and the ru¬
diments of the imperfect tooth. On its outer surface it adheres
firmly to the gum ; so that, if we attempt to tear the last-men¬
tioned part away from the jaw of a foetus, the capsules and their
contents wdi come away at the same time. These membranes

tainpd" Th Cmely r°i the b°ny cells in which they are con¬
tained. 1 he office of the capsule is that of secreting the enamel •

in its cavity is a small quantity of fluid. The ossification com¬
mences by the formation of the cutting edge of the incisors, and
the grinding- bases of the molares. The bony substance being de¬
posited on the pulp, as on a mould, the rudiments of the teeth are
necessarily hollow ; and the bony layers first formed are those

b?- m c„0IJtact with the enamel when it is deposited.
As the formation of the tooth advances, the pulp is gradually sur-
rounded, till the whole is covered by bone, except its base. 7

The adhesmn of the pulp to the newly-formed tooth or bone
s very sligh , and no vesseJs can be discerned going from one to
the other, it is, however, most strongly attached round the thin
astic edge, which is the last part formed. When the bone has
covered all the pulp, it begins to contract a little, and becomes
somewhat rounded, making that part of the tooth which is called
he neck , and from this place the fangs begin. The formation of
fangs makes the bodies of the teeth ascend through the sockets
and afterwards through the gum, which is absorbed in conse¬
quence of the pressure of the tooth.

Critical Review.

"The pulp has originally no process answering to the fang; hut,
as the cavity in the body of the tooth is filled up by the ossifica¬
tion, the pulp is lengthened, and the fang forms over it. The lat¬
ter part grows in length till the whole body of the tooth is pushed
through the gum, the socket at the same time contracts at its bot ¬
tom, and grasps the neck or beginning fang, adheres to it, and
rises with it. Thus the alveolus is raised with the fang, and the
fang does not itself sink or descend into the jaw.

“ If two or more fangs are to be formed, the process is rather
more complicated. When the body of a molaris is completed,
there is but one general cavity in the tooth, from the brim ot
which the ossification is to shoot, so as to form two or three
fangs : if two only, then the opposite parts of the margin of the
cavity shoot across where the pulp adheres to the jaw, meet in the
middle, and thereby divide the mouth of the cavity into two open¬
ings, from the edges of which the two fangs grow. It is a cu¬
rious circumstance, however, that at the very time when the pulp
is restricted to the crown of the tooth, the number of future fangs
is already denoted by that of distinct branches given off by the den¬
tal vessels *. When the surface of the tooth first appears through
the gum, its body is yet more hollow than that of a perfect tooth,
and the fang is only in tan incipient state. In proportion as the
tooth rises through the gum, however, the hollow is gradually
filled up, and the fang is lengthened. When the bone of the body
of the tooth is somewhat advanced in its formation, the enamel
begins to be deposited on its surface from the vessels of the cap¬
sule. This deposition commences on the masticating surface of
the tooth, and thence extends towards the root. The enamel if
complete when the fang of the tooth begins to be produced, for
at that time the body penetrates the gum, and thereby lays open
the capsule, which at this period is found to have undergone great
alteration in its texture and appearance. Instead of the soft vas¬
cular surface which it exhibited while the deposition of the ena¬
mel was going on, it is now dense, and almost tendinous, with
very few blood-vessels. When the fang begins to grow, the cap¬
sule also becomes connected to it, and forms its periosteum.

The author then proceeds to describe the symptoms which
attend the production of the second set of teeth, and here he
introduces the opinions of the best writers on the subject.
We cannot devote further space to this article, but strongly
recommend it to the perusal of every class of the profession.

[To be Continued.']

II. — An Account of some of the most important Diseases pe¬
culiar to Women. By Robert Gooch, M.f). One Vol.
8vo. London, 1829.

From the immense number of recent writers on obstetricy,
we scarcely had expected the publication of another original

* Meckel, Manuel d’Anat. tom iii, p. 343.

Dr. Gooch, on the most important Diseases of Women . 9

work upon the subject. In our review of the excellent ele¬
mentary treatise on parturition, by M. Velpeau, in our Num¬
ber for May last, we have given an historical sketch of the
rise and progress of obstetric medicine, and enumerated the
principal writers on the subject, both ancient and modern.
From this account it appears that the principles and practice
of midwifery have been as extensively cultivated as the other
branches of medicine. On referring to the long list of obste¬
tric writers during the last thirty years, we find the names
of many who have treated of all the diseases of the other
sex. Hence we have been struck with surprise at the title of
the volume before us. We were firmly convinced that the
works of Drs. Hamilton, Denman, Clarke, Hunter, Burns,
Merriman, Capuron, C. M. Clarke, Gardien, Meygrier, De¬
wees, Blundell, Clocquet, Ashwell, &c. &c. &c., have left no
necessity for ic An Account of some of the most important
Diseases peculiar to Women/’ On perusing the contents of
the work under notice we saw no reason to change our
opinion. We expected to have found a fuller account of the
female diseases than had hitherto appeared ; in this expecta¬
tion we have been much disappointed, for the author has
given a description of a very few, out of the number described
by his predecessors. The contents of Dr. Gooch’s work are
as follows : — Chap. I. The Peritoneal Fevers of Lying-in
Women. Chap. II. The Disorders of the Mind in Lying-in
Women — Thoughts on Insanity, as an object of Moral Sci¬
ence. Chap. 111. Ihe mode of distinguishing Pregnancy
from the diseases which resemble it. Chap. IV. Polypus of
the Uterus. — Of Polypus of the Uterus attended by unusual
circumstances.— Of Excrescences from the Uterus, which
are liable to be mistaken for Polypus. Chap. V. Of the Irri¬
table Uterus. Chap. VI. Of some symptoms in Children er¬
roneously attributed to Congestion of the Brain. Appendix.
Is the Plague a Contagious Disease ?

We cannot give our consent that these are the most im¬
portant diseases peculiar to the human female. We consider
cancer uteri, the ulcus exedens, uterine hydatid, the various
displacements of the uterus, other diseases of the puerperal
state, as convulsions, puerperal irritability, intestinal irritation,
constitutional irritation induced by hemorrhage, phlegmasia
dolens, sloughing of the genitals, and diseases of the ovaries,
deserve equal attention as those described by Dr. Gooch.
We regret that an author of such high talent and great ob¬
servation should have omitted them ; and we hope that he
will supply this deficiency in a future edition. Indeed, we
think such is his intention, for we find in the concluding pa¬
ragraph of the preface a declaration tantamount to this—1 “ If

VOL. 111. NO. 13.

JO Critical RevieiC.

the profession should approve of this volume, and Providence
prolong my life, I may probably (as I possess materials) at¬
tempt similar accounts of other diseases of women and child¬
ren.” We believe the profession are generally aware of the
eminent character which Dr. Gooch has attained as lecturer
on Midwifery at St. Bartholomew’s Hospital, and as a prac¬
tical obstetrician to the London and Westminster Lying-in4'
Hospital, and that he has been for many years most exten¬
sively employed in the practice of obstetric medicine. He
has had the best opportunities of acquiring a practical know¬
ledge of this branch of medicine, and has already afforded the
strongest proofs of an accurate and faithful observer of dis¬
ease. The observation and experience of one so highly qua¬
lified, must have great weight with the practitioners of mid¬
wifery. We therefore submit his observations and the result
of his experience, with great confidence, to the notice of our
readers.

We have attentively perused the author’s account of pe¬
ritoneal fever, a term he proposes for puerperal fever, and
which, by the bye, we rather think untenable, and hoped to
have derived much new information on the nature and treat¬
ment of that fatal disease ; but we must state, with great
deference to so high an authority, our hopes have not been
realized. In our estimation he has not exceeded the descrip¬
tion of Drs. John Clarke, Burns, Douglas, or a host of others.
Here we must express our regret that the invaluable essays
of Dr. John Clarke are out of print, as they contain a most
faithful history of puerperal diseases, and especially of that
under review. Like all his distinguished predecessors. Dr.
Gooch has admitted that puerperal fever is contagious, and
has given a most able critical review • of the discordance of
writers on the subject; but subsequently he adopts the
opinion, that the disease is peritoneal inflammation. He has
detailed numerous cases in proof of this opinion, of which
we shall take due notice, and some of which, we apprehend,
admit of serious doubts. Had he perused the recent accounts
of the pathological appearances, published on the continent,
we think he would hesitate in arriving at his conclusion.
He is, and he is not, an advocate for the monopathology of
the disease. It appears astonishing to us that many of our
most eminent practitioners, writers and teachers, seem to be
unacquainted with the recent discoveries in the different
branches of medical science, and that they do not keep pace
with the rapid progression of improvement. Perhaps exten¬
sive practice deprives them of sufficient leisure for study.
Hence it is that the observations of many, however excellent
and original they may be, are far behind the real state of

Dr. Gooch, on the most important Diseases of Women. 1 1

science, and may have been long since anticipated by others.

These observations apply to a great majority of every class
of our profession. T.he elucidation of the pathology of puer¬
peral fever, made by the French in 1824, and the Germans
in 1819, unnoticed by all the late medical writers in this
country except the periodical, and the editor of this Journal*,
proves, beyond all doubt, the correctness of the opinion en¬
tertained by the greater number of eminent obstetricians in
this and other countries, that the disease designated puer¬
peral fever is not peritoneal inflammation, and that the treat¬
ment successful in .the one, is doubtful if not useless in the
other.

The opinions of the profession are, and have been, so dis¬
cordant as to the nature and treatment of the fatal child-bed
fever, that we hope to be pardoned for the length of our re¬
marks on this formidable malady. From some intercourse
with our medical brethren, both in public and private prac¬
tice, we are convinced that nine-tenths of the present prac¬
titioners confound many of the puerperal diseases with that
under notice, and hence the necessity of giving a full exposi¬
tion of the symptoms, diagnosis and treatment of the disease.
We firmly maintain that the real puerperal or peritoneal fever
is an epidemic, distinguished by symptoms widely different
from peritonitis, and not to be encountered in every-day
practice. We cannot agree with those who think every
slight pain in the abdomen of puerperal women, accompanied
with a rapid pulse, is puerperal fever. In fact, daily obser¬
vation enables us to assert, that there are no diseases inci¬
dental to humanity more frequently mistaken than those of
the puerperal state. The recent necrotomic discoveries in
the bodies of those destroyed by puerperal fever, substantiate
the opinions of some of the most eminent obstetricians who
witnessed the ravages of the disease in hospitals, and who
considered it very different from simple peritonitis. The
following hospital physicians were of this opinion : Drs.
Young, A. and J. Hamilton, of Edinburgh, Drs. Kirkland,
Hunter, Lowder, Jo. Clarke, of London, Mr. White, of Man¬
chester, Drs. Clarke, Labatt, Douglas, and others, of Dub¬
lin; Drs. Roux, YeJpeau, of Paris, and Drs. Mastocheck,
Raimann, Hartmann, Boer, Shiffner, Zesti, Bellitzky, of
Germany. It is very clear that common peritonitis has
never appeared as an epidemic or contagious disease, while
all the medical obstetricians to lying-in hospitals, in every
country, have ascribed such powers to puerperal fever.
Having premised thus much, we now hasten to insert the

* Manual of Midwifery. By.M. Ryan, M.D. 1828. pp. 317-334.

12 Critical Review.

opinions of the able author before us, and to append such
remarks as fair and liberal criticism may warrant.

Dr. Gooch has divided his remarks on peritoneal fevers
into two parts. 1, an historical account of the opinions of
his predecessors ; 2, his own observations and opinions on
the subject.

The first chapter of the work is devoted to the considera¬
tion of the peritoneal fevers of lying-in women. The author
proceeds as follows : —

“ The most fatal disease to which lying-in women are subject
is known under the names of puerperal or child-bed fever, puer¬
peral peritonitis. Its essential symptoms are pain and tenderness
over the abdomen, with a rapid pulse*. It begins a few days
after delivery, with pain in the abdomen j shivering succeeded by
heat and a quick pulse. As this disease advances the milk be¬
comes suppressed, the belly tumid, and the breathing short.
When it terminates fatally, it does so commonly about the fifth
day, 'but often in less than half that time On opening the abdo¬
men, the morbid appearances are not uniform ; but the most com¬
mon and remarkable are a copious effusion of lymph and serum
on the surface and in the cavity of the peritoneum. Thus it is a
fever essentially complicated, with an affection of the peritoneum.
A better name than puerperal fever* or puerperal peritonitis, would
be that which I have placed at the head of this paper, “ peritoneal
fever,’’ for it would express the fact, that an affection of the peri¬
toneum is an essential accompaniment of the disease, without de¬
fining what that affection is, because it is not uniform. A remark¬
able circumstance about this disease is, that it is much more pre¬
valent in some seasons than in others. In populous towns and
cities it occasionally appears at any time, but the cases are few in
number, mild in degree, and, if detected early, and treated pro¬
perly, generally recover. Sometimes, however, it becomes extra¬
ordinarily prevalent. In a lying-in hospital, in which there is
commonly so little illness that the office of physician is almost a
sinecure, cases of this disease sometimes become so numerous,
that the physician linds it impossible to do his duty without visit¬
ing the hospital at least twice a day. In populous places so many
cases occur, and so many of them are fatal, that the practitioner
of midwifery goes about his task with unusual anxiety ; and even
in a thinly peopled country, where the death of a lying-in woman
is almost an unheard of event, fatal cases have occurred in rapid
succession, spreading terror among the pregnant women in the
neighbourhood. Another remarkable circumstance about this
disease is, that when it is most prevalent it is most dangerous.

* Dr. Lowder adopted a very good method to form an accurate definition of
this disease. He read all the different authors of character who had written on
the subject, and noted down all those pathognomonic symptoms which they
agreed were necessary to constitute the disease, and on comparing these with
his own experience, he found them to be very few : — fever, intense pain of the
jhead, and internal pain of the abdomen. — Lowder' s MS. Lectures.

Dr. Gooch, on the most important Diseases of Women . 13

Each case is much more difficult of cure than when it occurs
seldomer. The practitioner finds that, although the group of
symptoms resembles what he was formerly accustomed to, he has
now to deal with a disease far more obstinate and destructive, and
his usual remedies are not successful as formerly j he loses case
after case in spite of his best efforts. When it has been thus
raging for a considerable time, it at length subsides 3 the cases
become less frequent and less severe j the practitioner finds his
treatment becoming more successful, partly because experience
has taught him to detect it earlier, and to treat it better, but pro¬
bably, also, because the disease has itself become milder. There
is still another remarkable circumstance in the prevalent or epide¬
mic form of this disease. It is not uncommon for the greater
number of cases to occur in the practice of one man, whilst the
other practitioners of the neighbourhood, who are not more skil¬
ful or more busy, meet with few or none. A practitioner opened
the body of a woman who had died of puerperal fever, and conti¬
nued to wear the same clothes. A lady whom he delivered a few
days afterwards, was attacked with and died of a similar disease j
two more of his lying-in patients, in rapid succession, met with
the same fate : struck by the thought that he might have carried
the contagion in his clothes, he instantly changed them, and met
with no more cases of the kind. A woman in the country, who
was employed as a washerwoman and nurse, washed the linen of
one who had died of puerperal fever ; the next lying-in patient
she nursed died of the same disease : a third nursed by her met
with the same fate, till the neighbourhood, getting afraid of her,
ceased to employ her. The disease has occurred in some wards
of an hospital, the others being free from it ; but after ventilating,
cleansing, and painting these wards, they became as healthy as
the others. Facts such as these have long led to the suspicion
that the disease might be communicated from one lying-in woman
to another, in the clothes of the practitioner or nurse, or the fur¬
niture of a tainted chamber. From the little I have already said
about the symptoms of this disease, and the morbid appearances
discovered after death, it is clear that it essentially consists in
fever, with an inflamed state of the peritoneum j but fever
may vary, not only in degree, but in kind, or (as it is com¬
monly called) in type ; and inflammation may vary, not only
in degree, but also in kind or type. Hence, in investigating
the nature of this disease, one of the first questions is, whe¬
ther it is strictly uniform, differing only in degree in different
cases, and requiring only different degrees of the same treatment ;
or whether it differs so much in kind or type, that the mode of
treatment which is necessary in some cases, is destructive in
others. The latter is the conclusion to which we must inevitably
come, at first sight, in tracing the history of this disease in the
works of those who have written about it. This I propose to do
through the last half century, not for the useless purpose of raking
up old and obsolete opinions, but because it is unsafe to draw in¬
ferences, except from a wider survey of facts than the experience
of a single individual, or of a single epidemic, affords.”

, Critical Review.

Dr. Goocli gives a brief account of the puerperal fever
that prevailed in this country.

“ He tells that it was prevalent in Derbyshire and the adjacent
counties, between 1765 and 1775, and was described by Dr. But¬
ter, of Derby. His opinion was, that bleeding ought never to be
used in this disease, unless when complicated with inflammation,
and even in these cases bleedings of three ounces were sufficient :
that the best remedy was ten grains of rhubarb and ten grains of
cordial confection every day, till the stools became natural ; and
that this mode of treatment never failed. He gives several cases,
all of which recovered. In 1787, that is about ten years after Dr.
Butter wrote, a puerperal fever was prevalent and fatal in London,
and Was described by the late Dr. John Clarke. It generally began
on the second or third day after delivery, and terminated fatally in
a week — sometimes as early as thirty-six hours. Its essential
symptoms were pain and tenderness of the belly, with a rapid
pulse. A s the disease advanced, the milk became suppressed, the
belly large, the breathing short, the pulse quick and weak. The
appearances on dissection were those of inflammation in some
parts of the viscera of the abdomen, but this was never extensive,
and sometimes there was none. The effusions of inflammation,
however, were very abundant*, they often amounted to several
pints, and appeared to be pus and lymph mixed with serum. The
surfaces of the viscera were coated with lymph, but the peritoneum
underneath was not red. The interstices between the viscera were
filled with masses of lymph, which formed a cast of their shape.
Of the patients attacked with this disease, more than two-thirds
died. Bleeding was injurious ; leeches to the abdomen were use¬
less ; emetics were hurtful ; bark and cordials, though indicated
by debility, were inefficacious. Dr. Clarke suspected that the dis¬
ease might be occasioned by the purge which is always given to
lying-in women on the second day after delivery ; but glysters
were not more successful. Now compare the accounts which Dr.
Butter and Dr. Clarke have given of the results of their practice.
The former seems to have lost none of his patients, and found a
daily dose of rhubarb and cordial confection a never-failing re¬
medy; the other lost more than two-thirds of his patients, and
nothing seems to have done any good. JVhat can explain this con¬
trariety of statement ? A perusal of their pamphlets at once solves
the mystery ; they are talking about two different diseases. That
described by Dr. Clarke was a genuine puerperal fever, accompa¬
nied by an affection of peritoneum, which occasioned the effusion
of lymph and serum : that described by Dr. Butter is quite differ¬
ent. Its ordinary duration was from ten days to five or six weeks.
Whoever is familiar with the tremendous disease which I am con¬
sidering, and knows that the patient is either dead or safe at the
end of a week at longest, will instantly perceive that a disease so
protracted cannot be the same ; and a perusal of Dr. Butter’s cases
leaves no doubt on the subject. It was a slow remitting fever, not
attended by any affection of the peritoneum. Its chief symptoms

Dr. Gooch , on the most important Diseases of Women . 15

were sleepless nights/great depression of spirits, a quick pulse,
one or two exacerbations of fever every day, and a very disordered
state of the alimentary canal. I have repeatedly seen it, but never
as an epi emic, and though it lasts a long time, I believe it never
kills. Dr. Butter imagined that this fever, which he never failed
to cure, was the same disease which he describes as so fatal in
London.

“ Dr. W. Hunter used to say in his lectures — : Of those at¬
tacked by this disease, treat them in what manner you will, at
least three out of four will die. Upon examining the bodies, the
uterus, the viscera, and every other part of the abdomen are found
to be inflamed. . There is a quantity of purulent matter in the ca¬
vity of the abdomen, and the intestines are all glued together.
We tried various methods, (bleeding, refrigerants, stimulants, ini-
thridate), but every thing failed.’ Richter, speaking of the child¬
bed fever, says, f I have often seen the child-bed fever, and al¬
ways treated it successfully. I have also seen cases, both near and
at a distance, in which the fever was treated differently from what
I am accustomed to treat it, and the patients died. I therefore
think that I have a right to offer my opinion about the nature and
treatment of this fever/ One would, at first sight, suppose that
Richter had committed some error, like that of Dr. Butter ; but
the following remarks must remove this suspicion : — ‘ It is plain,
says he, f that it is not every fever"which attacks a lying-in wo¬
man which is to be called child-bed fever. Its principal symptoms
are debility ; swelling of the abdomen ; colic-like pains \ pains in
the abdomen on external pressure \ pain of the head, especially in
the forehead. The disease is commonly fatal in a few days. On
dissection, the viscera of the abdomen are found inflamed, suppu¬
rating, gangrenous. The means for preventing the disease, or, if
it has already begun, for curing it, are timely evacuations by
purgatives

“There can be no doubt that Hunter and Richter both meant,
thus far, at least, the same disease — that is, the child-bed fever
attended by inflammation of the peritoneum, and which if not
cured, kills in a few davsu But what shall we say to their very op¬
posite experience \ the one whatever he did, lost three patients out
of four, the other by the gentlest aperients, never failed to cure
the disease. Richter, at the time he wrote this statement, must
have been sixty years of age. The inexperience of youth, there¬
fore, will not explain it, and it is explicable only on the supposi¬
tion either that old as he was, he had never seen the epidemic
puerperal fever, or that if he had, the epidemics which he had seen
were singularly mild. The reader will feel curious to know
the mode of treatment which in Richter’s hands was so successful.
On the first symptoms of child-bed fever, he gave a purge two
days successively, each enough to operate three times ; on the
following days, smaller doses were given, enough to operate once.

* Mcdicinische und Chirurgische Bemet'kungen von L>. A G. Richter, b. ii.
s. 60.

Critical Review.

or at most twice ; and this plan was continued till all symp¬
toms had ceased. Dr. Lowder, who about thirty years ago, lec¬
tured on midwifery at the medical school of Guy’s and St. Tho¬
mas’s hospitals, and who was esteemed by the best judges of
those times as an excellent practical physician, gave the following
account of this disease: — "That the pathognomonic symptoms
were pain of the abdomen, pain of the head, and fever j that it
terminated fatally in a space of time between forty-eight hours
and one week ; that the appearances on dissection, were redness
of the peritoneum, adhesion of the intestines, effusion of serum,
mingled with pus and lymph.’ He thought that the inflamma-
mation was erysipelatous, and the fever typhoid. When the in¬
flammatory symptoms were distinct, he permitted a few ounces of
blood to be drawn, but if the symptoms were typhoid, bleeding
was positively injurious. He mentioned it as the assertion of
many medical men, that all the patients who were bled, died.
Whenever the fever was typhoid, he recommended bark, and
mentioned two cases, apparently hopeless, which recovered by
taking daily a gallon of the decoction. Among the London physi¬
cians, Dr. Denman was the chief believer in the inflammatory na^
ture of puerperal fever, and in the safety and absolute necessity of
bleeding, provided it was used early and actively. There can be no
doubt he meant that puerperal fever, of which peritoneal inflammar
tion is an essential part ; and if I understand him rightly, he be¬
lieved that whenever the peritoneum was affected in that way
which terminates in the effusion of serum and lymph, it was always
with that form of inflammation which bears, and requires bleed¬
ing. His mode of treating the disease seems to have been this:
first, at the commencement of the disease, by a full bleeding from
the arm, and if the effect of it was beneficial, by another bleeding
after a few hours. If the constitution of the patient was feeble, he
preferred cupping or leeches to the abdomen. Next by an emetic of
ipecacuanha, or tartarized antimony, so as to procure full vomitings
and after this had subsided, if the disease was not extinguished,
the emetic was to be repeated. These emetics generally produced
not only vomiting but sweating and purging , if not, sulphate of
magnesia, dissolved in thin gruel, was given every few hours, till
it produced several stools. Having succeeded in procuring these
evacuations, he gave a full opiate. The rest of the treatment con¬
sisted in a saline aperient every morning, and an opiate every night.
Puerperal fever was epidemic in Aberdeen more than two years,
between 17S9and 1792, and was described by Dr. Gordon, a phy¬
sician of that place. He states, that the essential remedy waS
blood-letting, employed early and freely ; that when he took ten
or twelve ounces away the patient generally died, but when he
took twenty-four ounces away at once, and during the first six
hours of the disease, the patient commonly recovered.

From the foregoing account of the experience and opinions
of different physicians, who had opportunities of observing puer¬
peral fever, what inferences are we to draw ? Supposing that
each observed accurately the disease which he witnessed, and that

l)r. Gooch, on the most important diseases of Women. 17

no mistake was made in the formation of his opinion, the inevit¬
able conclusion is this j that puerperal fever, by which I always
mean that fever which is accompanied by an inflammatory state of
the peritoneum, is not one uniform disease, but may occur under
different forms — that sometimes it is mild, as to be curable by the
gentlest aperients, and at other times it is very obstinate and fatal.
That in this latter form it sometimes consists of acute inflamma¬
tion of the peritoneum with inflammatory fever, which bears, and
is curable only by, early and active depletion, sometimes of inflam¬
mation, and fever of low type, in which depletion is useless and
even pernicious,’’ p. 16.

Dr. Gooch next relates the successful treatment employed
by M. Doulcet, in the cure of the disease, in 1782. This
consisted in the exhibition of fifteen grains of ipecacuanha,
and after its effect, a potion was exhibited, composed of two
ounces of oil of almonds, one ounce of syrup of marshmal¬
lows, two grains of kermes mineral. The same remedies
were exhibited daily, until the symptoms of the disease had
subsided. This plan was said to be most successful in every
case, and its success depended on its being given at the mo¬
ment of attack. The loss of a few hours, however, was not
always irreparable, the practice was employed by various
physicians in this country, with different results. “Dr.
Walsh said it was infallible; Dr. Denman that it was emi¬
nently useful ; Dr. Lowder that it disappointed him ; Dr.
John Clarke that it was injurious ; and it soon fell into dis¬
use. Was it ever fairly tried in this country ? that is, not
after the disease had established itself for several hours, but
at the moment of attack, and with the portion of almond oil
and kermes mineral,” p. 18. Our author proceeds in his
narrative, by inserting a long extract from the work'of Dr.
Boer, of Vienna, detailing his successful practice, which was
said to consist of some antimonial preparation, the nature of
which he did not choose to divulge. The above account was
published in the year 1790, and again in 1806, but the in¬
fallible puerperal powder was kept a profound secret. The
author next alludes to the works of Drs. Armstrong, Gor¬
don, and Mr. Hey, but the opinions of those writers need
not be detailed in this place. We may briefly remark that
these authors consider puerperal fever, peritoneal inflamma¬
tion ; and that free depletion is the only means of cure.
Such are the authors and their opinions enumerated by Dr.
Gooch, in his history of puerperal fever, and which occupy
forty pages of his work. This terminates Part I, of Chap.
I. Part II, Chap. I, is devoted to the personal observations
of the author, and a detail of fifteen cases with many very
judicious remarks on the various remedies recommended for

VOJL. HI. NO. 13.

Critical Review .

the cure of the disease. Before we can notice this part of
the work, we must add a few remarks on that just con¬
cluded.

Though Dr. Gooch’s history of peritoneal fevers, is one
of the most extensive extant, we cannot hold him guiltless
of various important omissions, which leaves his narration
quite incomplete. He might, perhaps, be excused from in¬
troducing the opinions of the ancients, which we think in¬
excusable, and much more so his omission of the names of
many of the writers since the middle of the last century.
Though we have already devoted too much space to our re¬
marks, we cannot refrain from attempting to supply the ob¬
vious deficiency. It appears from the works of Hippo¬
crates, Avicenna, Raynalde, Platerus, Sennertus, Riverius,
Willis, Sylvius, Mauriceau, Sydenham, Boerhaave, Strother,
Hoffman, De la Motte, Burton, Smellie, Tissot, Van Swie-
ten, Astruc, Cooper, Denman, Hunter, Johnson, Millar,
Manning and Kirkland, that puerperal fever was caused by
a suppression of the lochia, retention of the milk, inflamma¬
tion, or some other disease of the uterus. In the year 1746,
considerable light was thrown on the pathology and history
of the disease, by M. de Jussieu, in the Mem. de 1’Acad.
de Sciences of Paris. He described the usual symptoms,
headache, pain on pressing the abdomen, lochia unnatural,
breasts painful, and sometimes the chest affected. The dis¬
ease was most common to the poor, and especially to those
delivered at the Hotel Dieu, and was most fatal in the month
of February. On dissection, the uterus, intestines, and, in
some cases, the stomach, were found inflamed, and the ova¬
ries in a state of suppuration. The uterus in some cases
contained grumous blood. “ Lymph (du lait caille) was
attached to the external surface of the intestines, and a se¬
rous milky fluid was effused into the abdomen and cavity
of the pleura, the lungs were gorged with a milky putrid
lymph.” The first account of any epidemic disease among
puerperal women was that of Peu, 1794.

It appears from an essay published by Dr. Clarke, of Dub¬
lin, in the Edinburgh Medical Commentaries, for 1796,
i( that the puerperal fever was epidemic in London, from the
I2th of June to the end of December, a fact also stated by
Dr. Leake.” The disease was also epidemic during the sum¬
mer of 1761, 1769, 1776, 1771 ; it also appeared in the year
1773, in the lying-in ward of the Royal Infirmary, of Edin¬
burgh, and is thus described by Dr. Young, then professor
of midwifery in the university of that city. “It began about
the end of February, when almost every woman, as soon as
she wras delivered, or perhaps about twenty-four hours after.

D. Gooch, on the most important Diseases of Women . 19

was seized with it $ and all of them died, though every me¬
thod was used to cure the disorder. This disease did not
exist in the town. I found that the women in the lying-in
ward did not recover so well last year as formerly, but
scarcely any died. It was this made me think there was a
local infection, and determined me to shut up the ward till
it could be removed. This I did after losing six women.”
It appears by a report published in Paris, by a committee
appointed by the Royal Acad, of Sciences, 1786, “that an
epidemic disease prevailed among lying-in women in 1 774,
which committed the greatest ravages, and re-appeared
every winter till the year 1781, and still prevails more or
less in cold seasons.” M. Tenon who communicated these
facts to the committee, stated that all women seized with
the disease, were destroyed, and that seven in twelve were
attacked. cc The puerperal fever,” continues Dr. Clarke,
“ first visited the Lying-in Hospital of Dublin, in the year
1767 ; and from the 1st of December, to the end of May, of 360
women delivered, sixteen died. The disease re-appeared in
1774, and of 280 women delivered, thirteen died. From the
year 1774 to 1 787, this fever was unknown as an epidemic
in Dublin. From the 17th of March to the 17th of April,
128 women were delivered, eleven of whom were seized with
the symptoms of puerperal fever, and seven died. In No¬
vember 1778 the disease appeared a fourth time ; during
this and the two succeeding months 350 women were de¬
livered ; seventeen were attacked by this fever, and fourteen
died.” The disease re-appeared in the Dublin Hospital in
1801, 1812, 1813, 1815, 1819, and 1820.

From 1771 to 1777, Drs. Hulme, Leake, Kirkland, Man¬
ning, and Mr. C. White, published their works on puerperal
fever. Dr. Hulme undertook to represent the nature and
cause of this disease in a new point of view, to illustrate his
opinion by dissections, and to point out a rational mode of
cure, which had been confirmed by his own experience. He
concluded, that “ the disease was of a nature peculiar to it¬
self, and it was distinguished by the following symptoms :
an acute pain and great soreness over the lower part of the
abdomen, attended with a fever and a pain in the forehead
soon after delivery : he said it was most likely to be con¬
founded with after-pains, milk fever, miliary fever, the iliac
passion, flatulent colic, inflammation of the uterus, aild
cholera morbus : he pointed out the diagnosis. In six
cases of dissection he found “ the omentum and intestines in¬
flamed and mortified ; the abdomen«contained putrid sanies,
foetid air or pus : the uterus was perfectly sound : he re¬
commended saline aperients and diaphoretics for the cure :

Critical Review,

lie gives it as his opinion that there are eases in which
blood-letting is highly necessary, and others in which it is
highly improper. The best criterion® to judge by, are the
pulse and period of the disease/’ He differed in opinion
with regard to the disease from all who had written before
him. Dr. Leake also disputed the right of the discovery,
and proved he had inculcated the same opinions three years
previously. He opposed the opinion of Van Swieten and
Levret, that an obstruction or a critical metastasis of the
milk, or lochia! discharge was the cause of child-bed fever :
he proved that the fluids found in the cavities of the ab¬
domen and thorax were the result of inflammation, and de¬
nied the-accuracy of Hoffman’s conclusion that the disease
was caused by inflammation of the uterus. The proximate
causey he considered, was inflammation of the omentum and
intestines. He mentioned, that early and copious bleeding,
regulated by the pulse and habit of the patient, was the only
remedy which gave a chance for life. In four cases of dis¬
sections he found inflammation, suppuration, and gangrene
of the omentum and intestines : the uterus appeared in a
sound state. Dr. Kirkland differed with both those writers,
and published his treatise as a useful supplement to their
works. He was of opinion that uterine irritability, accom¬
panied with inflammation, was the cause of child-bed fever.
He did not deny that inflammation of the abdominal viscera
might be the cause, but it was not always so ; he thought
that bleeding and purging could not be used to their
full extent, because they render the patient less capable of
undergoing the remainder of the disease. Mr. White and
Dr. Manning considered the fever of the low and putrid
type : such was the discrepancy of authors as to the cause
of this disease, which, perhaps, led Mr. Hunter to offer his
opinion on the subject— He thought that the disease
pilled puerperal fever would be more properly denominated
inflammation of the peritoneum*, because that is the part
principally affected.” He affirmed that the substance of the
uterus, the abdominal viscera, the muscular and villous
coats of the intestines in general, remained sound, and,
when inflamed, that the peritoneum was first affected. He
does not deny that puerperal women may labour under fe¬
vers peculiar to themselves, and that such fevers may kill f
but he is convinced, from what he has seen on dissection,
that “ the disease most frequently fatal to them is merely
an inflammation, and that the febrile symptoms are like
those after the amputation of a limb, owing to an injury
done to a particular part, and not to, any specific disease.”
Med • Common. 1775, v. iii. p. 322. It appears from the

Dr. Goodly on ihe most important Diseases of Women. 2i

account of dissections performed at Vienna in 1819, that the
os uteri was first affeeted with inflammation and gangrene,
and it appeared to spread from this point as from a focus.
The essay of Dr. John Clarke on child-bed fever was pub-
lished in 1788, but was not generally known to the profes¬
sion when that of his talented namesake appeared in the
Medical Commentaries in 1790. Each essay was an original
production, and both correspond in most points. Dr. John
Clark republished his production, with additional observa¬
tions, at the period just mentioned.

This is the fullest and most accurate account that has ap¬
peared of the disease in this country, and we are unable to
perceive why it has not been laid under more contribution
by the author before us. Dr. Clarke described the seasons
in which he and others had observed the disease, and ar -
rived at the conclusion that any particular state of the
weather had no influence in causing the disease. We have
also attempted to prove the same fact with respect to
typhus fever, and have given an account of the constitution
of the air in the epidemic fevers of this country, from the
most remote period to the present time . — Manual of Mid¬
wifery, p. 319.

We have already extended this article beyond the usual
limits, that it would be impossible for us to extract the nu¬
merous important observations of Dr. Clarke. We believe
his opinions are faithfully noticed in' the excellent work of
Dr. Burns. The last point in our critical indictment against
the author before us, is his omission of the pathological re¬
ports, and mode of treatment recently pursued on the Conti¬
nent. This we shall also endeavour to supply, after we have
submitted the personal observations of Dr. Gooch. The
history, symptoms, and morbid appearances discovered on
dissection, and detailed by our author present nothing novel-

The cases which were so numerous in the seunhealthy seasons,,
had the common symptoms and course of puerperal fever. They
began a very few days after delivery ; the leading symptoms were
diffused pain, and tenderness, with some swelling of the abdomen,
a quick pulse, which was generally at first quick and vibrating-
Sometimes it was small, but still it was hard and incompressible j;
the skin was hot, though not so hot as in other fevers ; the
tongue was white and moist, the milk was suppressed. As the
disease advanced the belly became less painful ; but more swelled,
and the breathing short ; towards the end, the pulse was very fre¬
quent and tremulous, and the skin covered with a clammy sweat ;
even in this state the tongue continued moist, and the mind clear,
and death took place generally about the fifth day. On opening
the abdomen which was often as large as before delivery, the
intestines were found distended with air, the peritoneum was

Critical Review .

red in various parts, its surface was covered with a coat of lymph,
the intestines adhered to each other, and the omentum to the intes¬
tines. Coagulable lymph was deposited on various surfaces, espe¬
cially in the depressions between the convolutions of the bowels and
on the omentum, on both which parts it often lay in large masses :
the cavity of the peritoneum contained several pints of a turbid
fluid, apparently serum mixed \yith lymph. In the uterus the
morbid appearances were generally confined to its peritoneal co¬
verings, which was coated with lymph, on removing which the
membrane was found naturally red j but in some cases the disease
had penetrated deeper into the uterus, the substance of which
was sometimes infiltrated with pus, and sometimes contained
small abscesses, the size of a nut ; the inner surface of the uterus,
especially at the fundus, often appeared black and ragged, as if
gangrenous. The enlargement of the abdomen depended entirely
on air in the intestines ; when there was no air there was no en¬
largement, even though the peritoneum contained several pints of
fluid. The first time I noticed this was in the body of a young
woman who had died with all the symptoms of puerperal fever,
excepting the tumid belly. When the body was lifted from the
bed on to the board on which it was to be opened, the belly, in¬
stead of being tumid, was sunk and hollow, and we began to think
her case had been mistaken, but on opening the abdomen, we
found several pints of turbid fluid. The disease began very sud¬
denly. After being quite well, feeling no sense of illness, or at
least making no complaint, the patient was at once seized with
chillness, or shivering, and pain in the belly, and the pulse rose to
130 but sometimes the attack was more gradual. For many
hours, or even for a day or two, there were pain and tenderness
in one part of the abdomen, then in another, with long intervals,
in which there was no pain any where ; and during all this time
the pulse would remain quiet, or not quicker than eighty or ninety.
In short the disease would have an incipient stage, but this was
not a common occurrence. I soon found that I had to deal with a
very fatal disease. When I saw the patients after it had been
going on for two or three days, or even longer (which was no un¬
usual circumstance among the out-patients,) I seldom or ever
saved them 5 the sunk countenance, the small weak pulse, of 140
or 160, the tympanitic belly, the short breathing, and sometimes
the clammy sweat^all indicated a fatal disease, past the reach of
depletion, even if it ever had been fit for it ; and cordials appeared
to promise the only chance of recovery, but they were seldom or
ever successful. Wine mixed with gruel, or egg for diet, and
diffusible stimulants for medicines, were almost signals of a fatal
termination. I was soon satisfied that the disease was incurable
in this stage. Within the hospital I used to see it earlier, some¬
times within a few hours of its commencement, although even
here this was not always the case ; for we had not yet learned
how soon the curable stage passed over, and how vitally import¬
ant it was to begin the treatment at the very beginning of the dis¬
ease. Besides this the patients of a lying-in hospital, are slow to

Dr. Gooch, on the most important Diseases of Women. 2.‘$

►

confess themselves ill. They look upon pains of the belly as no¬
thing but after pains, and dread the active remedies which a con¬
fession of illness brings upon them ; even after the confession, the
nurses are often dilatory in communicating them, and thus many
hours used often to pass before 1 was called to the case, notwith¬
standing the activity, intelligence, and rare humanity of Mrs.
Wright, the matron. There was another frequent cause of delay.
In a very large proportion of cases the disease began in the night y
the patient would go to bed complaining of nothing, and be waked
in the night or at day-break, by pain in the belly and chillness,
but the night-nurse thought it unnecessary to disturb any body,
and I lived two miles from the hospital. Whenever puerperal
fever is prevalent in a hospital or neighbourhood effectual means
ought to be taken to obviate these causes of delay. When I saw
the patient very soon after the attack, I found a great group of
symptoms to what I had witnessed in the latter stage \ the pulse
was not so quick, about 120 or 130, it was generally full and vi¬
brating, or if small, it was hard and incompressible 3 the skin was
hot, the belly was slightly full and tense, and very painful and
tender 3 so that the patient could neither bear to have it pressed
nor to turn from one side to the other in bed. These symptoms,
especially the character of the pulse, looked like an inflammatory
disease, for which the remedy was depletion 3 the appearances dis ¬
covered by dissection, corroborated this notion ; remedies of an
opposite kind had been tried unsuccessfully. Dr. Denman’s and
Dr. Gordon’s account of the subject afforded encouragement for
the trial of depletion, and I was still further encouraged by the
experience of Dr. Maton. We therefore resorted to general and
local bleeding and purging. The blood drawn from the arm
formed a crassamentum, which cupped and buffed in the greatest
degree ; the patients expressed relief from this treatment. It was
soon clear that bleeding and purging did more good than any re¬
medies we had tried, and our success in the treatment of the case
was decidedly increased. We were in this state of opinion and
practice, when the publication of Dr. Armstrong’s treatise render¬
ed us more bold in the use of our remedies, and induced us to em¬
ploy depletion, with more activity. I now found that, provided I
saw the patient within a few hours of the attack, I could generally
arrest the disease. The mode of treatment was as follows : a vein
was opened in the arm, with a wide orifice, so that the blood
flowed in a full stream, and it was allowed to flow till the patient
felt faint 5 the arm was then tied up, and her head was raised so
as to encourage the fainting for many minutes. As soon as the
faintness had subsided, she took from ten to twenty grains of calo¬
mel in a tea-spoonful of arrow-root, and afterwards half an ounce
of sulphate of magnesia, dissolved in beef tea, or thin gruel every
other hour, until several copious evacuations were procured from
the bowels. When the patient had thoroughly recovered from her
faintness, from ten to twenty leeches were applied to the painful
and tender parts of the abdomen. When the leeches had fallen
off, a bag, long and broad enough to cover the whole abdomen, was

Critical Review.

stuffed with a poultice, which was spread so as to form a cushion
an inch thick, this was laid hot over the whole abdomen, and re¬
newed so often as to keep up heat and moisture. If the patient
complained of the weight of the poultice, the bag was stuffed with
scalded bran. We found this application of infinite value, not
only as a means of encouraging the bleeding of the leech-bites,
but also as a perpetual fomentation. In the treatment of acute in¬
flammation in the vital organs, the customary practice is to consi¬
der local bleeding as a milder means of effecting the same object as
general bleeding, and to postpone it till the stage of the latter wras
over. To me it appears that they are calculated to effect two dif¬
ferent objects, both of which are necessary at the beginning of the
treatment ; the one to reduce the violence of the general circula¬
tion, the other to empty the distended capillaries of the part. As
long as the pulse is quick, full, and hard, it is in vain to take blood
from the affected part $ if we could completely empty its gorged
capillary vessels, they would be instantly gorged again, whilst the
heart and large arteries are injecting them with so much violence.
On the other hand, after having reduced the force of the general
circulation, the capillary vessels often remain preternaturally in¬
jected ; this I conclude from the fact, that the patient is often not
relieved till local blood-letting has been used, and then is relieved
immediately. Hence, as soon as the patient has recovered from
the faintness occasioned by bleeding from the arm, leeches ought
to be applied without delay. I waited until the purgative had
operated fully, that I might know what impression the combined
operation of general and local blood-letting and purging had pro¬
duced on the disease, before deliberating about the employment of
a second blood-letting. The common effect of these remedies
was this, as long as the faintness lasted in the slightest degree,
the pulse- remained soft, and often slower, and the pain was much
less, or ceased altogether ; but an hour or two after the bleeding ;
when the circulation recovered, the pain returned more or less,
and the pulse regaineid much of its hardness or incompressibility.
This state continued until leeches bled freely, and the purgingacted
repeatedly and copiously. The state in w’hich the patient was found
after this, determined me whether or not to employ a second
bleeding. My two chief guides were the state of the abdomen
and that of the pulse. If the abdomen was still painful and ten¬
der, and the pulse retained any of its hardness or incompressibi¬
lity, or if the pulse was small and weak as to forbid a general
bleeding, a vein was again opened in the arm, and the blood al¬
lowed to flow till faintness was produced, which was encouraged,
as after the first bleeding ) on the contrary, if the pulse was small
and weak, if the pain was gone and only soreness remained, 1 pre¬
ferred a repetition of the leeches. Mere soreness without pain,
and with a feeble state of the general circulation, is more surely
relieved by local than by general blood-letting ; and the best
mode of employing it is by relays of leeches j as soon as the ori¬
fice of one set have donfe bleeding, to apply a fresh set, till the
soreness and tenderness are gone. The rest of the treatment con-*

Dr. Gooch, on the most important Diseases of Women .

sisted in purging during the day by calomel and salts, the constant
application of the bag of poultice of bran, and leeches to the abdo¬
men till all the tenderness was gone. The active treatment, which
will determine the fate of the patient, should be begun and ended
during the first day 3 when employed later it is under great disad¬
vantages, and with very diminished chances of success. When !
consider the extent of the membrane which is affected, and the rapi¬
dity with which the effusions of inflammation are sometimes poured
out, so far from wondering that the curable stage passes over soon,
it is to me a subject of wonder that the disease should ever be
cured after it has lasted twelve hours. The more I have seen,
read, and thought of this formidable disease, the more strongly I
am impressed with the belief that whatever may be the proper
mode of treatment, it is not fairly tried unless employed in the
early hours of the disease. I think it useless to trouble the reader
with a number of cases, which would greatly lengthen this paper,
without any adequate advantage. But I will relate a few instances,
as specimens of the disease, and the way in which I used to treat
it during several seasons in which it was prevalent between the
years 1812, and 1820.” pp. 41-50.

In this narrative of the symptoms and treatment of peri¬
toneal fevers, we find nothing different from what has been
already advanced upon the subject. The author ascribes
every form of puerperal fever to peritonitis, and yet he has
denominated the disease peritoneal fever ; ancT he has lost
sight of the distinctions of former writers. We cannot as¬
sent to the plan of applying “ to the painful abdomen, when
leeches had fallen off, a bag, long and broad enough to cover
the whole abdomen, stuffed with soft poultice, which was
spread so as to form a cushion nearly an inch thick.” We
have never seen a case, even of common peritonitis, in which
the weight of such an application could be endured. Neither
can we admit that every case in which there is pain in the
abdomen, or an acceleration of the pulse, is to be considered
real puerperal fever. Yet there were no stronger proofs in
many of the cases annexed by the author. We are a good
deal surprised at Dr. Gooch’s mode of relating his cases.
There are deficiencies and omissions, which depreciate the
clearness and precision of the detail. The age of the patient
is only given in one out of fifteen cases 5 there is 110 mention
made whether the disease was epidemic 3 in fact, the whole
symptoms, were pain in some part of the abdomen, with or
without rigor, and an accelerated state of the pulse. We
are not surprised that depletion and purgatives should have
been successful. The oil of turpentine was exhibited in four
cases unsuccessfully 3 but as an external rubefacient, it was
used with considerable benefit. The fifth case was decidedly
neither peritonitis nor puerperal fever. The patient was a

VOL, Ill. NO. 13.

Critical Review.

lady, twenty six years of age, habitually thin, and long sub¬
ject to pains in the pelvis. On the second morning alter
delivery, being perfectly easy, she took a purgative of salts
and senna , which operated plentifully several times, attended
with severe griping, and gradually the abdomen became
painful and tender all over. The pain was without inter¬
mission, and the tenderness so great that she could not bear
the slightest pressure ; the skin was cool, the pulse 80, and
soft. The case was cured without depletion, by opium and
fomentations. We find by the sequel that the author did
not consider this peritoneal fever ; and we are therefore at a
loss to perceive why it was detailed as such.

Case VII. was one of violent after-hemorrhage, in which
it was necessary to exhibit pure brandy. It occurred in
private practice. Three days afterwards the patient was at¬
tacked with a severe rigor, and violent pain in the abdomen,
which was painful and tender, the skin hot, and pulse rapid.
The medical man in attendance sent an express for Dr,
Gooch, before whose arrival, thirty ounces of blood were
abstracted. The patient expired before his departure. We
fully agree with him in opinion, that if, instead of blood-let¬
ting, opium and fomentations had been used, the result
might have been more fortunate. Surely few obstetricians
attached to lying-in hospitals would acknowledge this a case
of peritoneal fever. Case VIII. was one in which depletion
was also used, before the arrival of our author. The patient
was hysterical, and on the third day after delivery the prac¬
titioner was called out of his bed, and found her complaining
of great pain and tenderness over the whole abdomen ; the
pulse was quick, small, and weak, and the skin temperate.
She was bled to syncope ; five grains of calomel, and soon
after a dose of salts and senna , were exhibited, but the latter
was vomited. Two hours after the first bleeding, the pain
not having been relieved, she was bled again to fainting :
twelve leeches were applied to the abdomen, and three grains
of opium exhibited. On the arrival of our author, u her face
was ghastly ; it was difficult to keep her from fainting ; skin
cold and clammy ; pulse quick, small, and fluttering, and
could scarcely be counted. Dr. Gooch took off the leeches,
and endeavoured to revive her by warmth and cordials, but
she died in the evening, about thirty hours from the begin¬
ning of the pain. The body was opened next day. The pe¬
ritoneum was healthy, but pale, there were between one and
two ounces of colourless serum in its cavity ; the abdominal
viscera were all healthy, but pale ; the uterus was contracted
in the ordinary degree/’ Dr. Gooch observes, that the treat-

Dr. Gooch, on the most important Diseases of Women. 27

meat should have been the same as in the last case. Was
this peritoneal fever ? We think not.

** These cases (says our author), opened to me a new view of
the subject 5 they taught me that a lying-in woman might have
permanent pain and tenderness of the abdomen, with a rapid pulse>
independent of acute inflammation of the peritoneum, or any other
part ) that these symptoms may depend on a state which blood¬
letting does not relieve, and which, if this remedy is carried as far
as it requires to be carried in peritonitis, may terminate fatally ;
and that the most effectual remedies are opiates and fomentations.
Most of the patients who were the subjects of these attacks, were
women who in their ordinary health were delicate and sensitive ;
the attack sometimes seemed to originate in violent after-pains,
gradually passing into permanent pain and tenderness, resembling
inflammation, or in the painful operation of an active purgative }
but it could sometimes be traced to no satisfactory cause} the pa¬
tient had had a common labour, and had experienced no unusual
cause of debility or irritation. The pulse in all these cases, al¬
though quick, was soft and feeble } this, together with the pre¬
vious constitution of the patient, were my chief guides ; when I
could trace it to any irritating cause, such as a griping purge, and
when blood had been already drawn without relief, and without
being buffed, I saw my way still clearer. When I doubted, I ap¬
plied leeches to the abdomen.

The cases which I have related, and others similar to them,
were speedily and completely relieved by the remedies which I
have rnentioned. There seemed to be nothing dangerous in this
form of disease, provided the nature of it was not mistaken, and
improper remedies not used 5 yet it so strikingly resembled peri¬
toneal inflammation, that it was invariably taken for it by the
practitioners who witnessed it, all of whom possessed at least that
average quantity of sense and knowledge, on which the public
must extensively depend. These cases, though sufficiently nume¬
rous to attract my notice, and produce a strong impression on my
mind, were, nevertheless, only occasional occurrences. I had never
seen them in numbers at the same time ; they occurred at com¬
paratively long intervals, and at times when there was no preva¬
lent disease among lying-in women 5 they resembled sporadic
diseases, both in the rarity of their occurrence, and in the facility
with which they were cured. At the hospital I saw two or three
cases, in which, after the ordinary symptoms of puerperal fever
had terminated fatally, and the body was opened, the usual mor¬
bid appearances were not found } nothing appeared but a mode¬
rate quantity of fluid slightly stained with blood. In the winter
of the year 1824, puerperal fever was prevalent and fatal in Lon¬
don and its neighbourhood. I saw this disease repeatedly in con¬
sultation, and heard of it among my medical friends. Several in¬
stances occurred of its prevalence among the patients of particular
practitioners, whilst others, who were equally busy, met with few
or none.”— p. 75.

Critical Review .

How .can Dr. Gooch reconcile the first paragraph in this
extract with his opinion, that inflammation of the perito¬
neum is the cause of fatal puerperal fever ? All signs of this
peritoneal inflammation may be present, cc independent of
acute inflammation of the peritoneum, or any other part ;
and that these symptoms may depend on a state which
blood-letting does not relieve, and which, if this remedy be
carried as far as it requires to be carried in peritonitis, may
terminate fatally ; and the most effectual remedies are opi¬
ates and fomentations.” Assuredly such symptoms may be
caused by intestinal irritation, and ought to be carefully
borne in mind by the great majority of those practitioners,
who resort to the lancet in every case of abdominal pain in
the puerperal state. The cases IX., X., XL, and XII.,
though fatal, left no vestiges of the disease, neither were the
symptoms those of acute peritonitis. The cases XIII. and
XIV. presented all the symptoms, but none of the usual ap¬
pearances, of peritonitis on dissection. The author next
details the following important clinical facts : —

u In the winter of 1827 and 1828, cases of peritoneal fever were
very common among the in and out-patients of the Westminster
Lying-in Hospital $ and a journal was kept, and an account of
them published, by Mr. J. A. Hingeston, who was then residing
as house-surgeon of the hospital *. These cases were all attended
by pain and tenderness of the belly, with a rapid pulse j the pain
remitted, the skin was moist, and the pulse full and compressible.
Most of them were cured, without the lancet, by keeping the ab¬
domen covered with a large, thin, hot linseed-meal poultice, and,
giving ten grains of compound powder of ipecacuanha, repeated
till the pain was gone. If the bowels were constipated, a purgative
was previously given ; if they were not so, the purgative was post¬
poned till the pain had subsided. In one case, the dry skin and sharp
pulse, indicating that the affection of the peritoneum was acutely
inflammatory, twenty ounces of blood were drawn from the arm j
ten grains of compound powder of ipecacuanha, with two of calo¬
mel, were given, and calomel alone was repeated every six hours ;
twelve leeches were applied to the abdomen, and afterwards a lin¬
seed-meal poultice. The gums became sore in twenty-four hours,
and the patient recovered ; but after the bleeding she had frequent
faintings for several hours, and ‘ life was reduced to a low ebb.’ A
striking contrast this to the way in which bleeding to double this
extent was borne in the peritoneal fevers, from 1810 to 1820. Mr.
Hingeston thinks that these cases, which are cured by opium, are
the first stage, a lower degree of that acute inflammation which
requires the lancet.

For the following particulars I am indebted to Dr. Ferguson,

* See London Medical Gazette, No. XI.

Dr. Gooch, on the most important Diseases of Women, 29

one of the present physicians to the Westminster Lying-in Hos¬
pital : —

“ During the late autumn and winter there has been much sick¬
ness for so small a hospital. To say nothing of the out-patients,
sixty-two in-patients were admitted between September 11, 1823,
and February 20, 1829 $ of these, twenty-eight (that is, nearly half
the number) had peritoneal fever ; and of these, seven died, that
is, one in four. A large proportion of them were cured at once
by ten grains of the compound powder of ipecacuanha, every three
or four hours for three doses, and a hot linseed-meal poultice over
the whole belly. Sometimes this treatment removed the pain, but
not the soreness ; but this was generally removed by the applica¬
tion of leeches. As soon as the symptoms were subdued, the
bowels were opened by a mild purge ; when these remedies failed
the case was a bad one. It may be said, by the advocates for
blood-letting, that these bad cases might have been saved, if they
had been blooded and purged early and actively ; but in those in
which the lancet was used, however early, its effect was discou¬
raging. The patients fainted after losing a few ounces, the blood
bore no marks of inflammation, and the remedy was followed by
great and immediate exhaustion j even leeches, when applied in
considerable numbers, and when they bled profusely, in some cases
seemed to occasion great exhaustion. But in the cases which I
have related from my own experience, the lancet was used as early
and actively as the warmest advocate for depletion could wish.
Case No. 6 was blooded without relief, and was immediately re¬
lieved by opiates and fomentations. Cases 7 and 8 were blooded
immediately onfhe attack of pain, the former to thirty ounces at
once, the^ latter twice to faintness, besides leeches, calomel and
senna mixture, and they immediately and speedily sunk under the
remedies. Of the four cases which occurred to one practitioner.
No. 10 was blooded immediately after the attack, in the evening,
and the bleeding was repeated the following morning. The case
No. 13 began during the violent operation of a purgative j the pa¬
tient was blooded to faintness about fourteen hours after the at¬
tack, the blood was not buffed, and she never rose out of the ex¬
haustion which followed. In the case related by Mr. Dalrymple,
the patient was blooded freely five hours from the attack, and the
effect was similar.

" In Dr. Farre’s remarks, introductory to his Journal, he states
that, f at the east end of London, not far from the river, this dis¬
ease (puerperal fever) proved still more fatal during the month of
March, 1825. One surgeon informed the editor that he had lost
seven, another four, in all of which the disease was treated at the
instant of its formation by active blood-letting. A physician-ac¬
coucheur, who attended in consultation many of these cases, stated
to him, that out of thirteen cases eleven died ; that all which had
been bled died ; and that the only two which recovered had not
been bled, having been treated by turpentine.’ ”

The author has remarked, during the last few years, that

Critical Review.

the most malignant and fatal form of peritoneal fever may oc-’
cur aand yet leave few or no vestiges in the peritoneum after
death.” p. 96. What then becomes of the new opinion, that
fatal child-bed fever is nothing but peritonitis ? Dr. Gooch
thinks there are several varieties of peritoneal inflammation,
from a pale peritoneum to that which is highly vascular ; he
is convinced by the experience of the last few years, 66 that
those who maintained the peritoneal fever to be always of an
inflammatory type, and always to be cured by bleeding and
purging, are not borne out by the reasoning employed, nor
confirmed by subsequent experience.” p. 98. He is also con¬
vinced that remedies have not a fair chance of success unless
employed during the first hours of the disease, whatever may
be the nature of the case or epidemic. The chief remedies
are, 1st, bleeding and purging; 2d, emetics of ipecacuanha;
3d, opiates internally, and poultices externally to the abdo¬
men ; 4th, mercury given to affect the constitution ; 5th,
oil of turpentine. Such are the opinions of the able and ju^
dicious author before us. We have accused him of not lay¬
ing the works of recent writers under contribution ; and to
perfect the account of the formidable and usually misma¬
naged disease under consideration, we shall briefly advert to
the latest and best accounts on the subject.

We have already cited the authority of many of the obste¬
tricians of the asylums dedicated to obstetric medicine, in
this and other countries, all of whom considered the disease
epidemic, and of a peculiar nature, and indeed the reports of
such hospital practitioners further confirm the opinion. Ah
attempt has been made during the last twenty years to refute
the observations of the brightest ornaments of obstetric me¬
dicine. But these attempts have made no impression, on the
minds of men of sober and faithful observation. Facts are
stubborn things, and can never be obliterated by the visionary
conjectures of a few individuals. It is now the custom to
despise the opinions of the last century, but every man of re¬
search must smile on comparing the ancient and modern
histories of disease. In former times, the short and happy
method of fabricating cases, to support the reveries of hypo¬
thesis and delusions of theory were unknown in the profes¬
sion. Facts, and facts onlv were recorded. Wo are led in-
to this train of thought, when we contrast the preponde¬
rating testimony of those who maintain that the real puerpe¬
ral fever is a different disease from simple peritonitis, with
that of the very few respectable practitioners who maintain
the opposite opinion. We are very well aware that every
puerperal pain is now considered child-bed fever, and we are
as firmly convinced that three-fourths of the diseases of the

Dr. Gooch on the most important Diseases of Wornen. 3>l

puerperal state are mistaken, and the patients sacrificed by
the ill-founded and preposterous opinion as to puerperal fever,
almost universally prevalent. The greater number of those
who advocate the new opinion are men who met the disease
in private practice, and not in the lying-in hospitals, as Mr.
Hunter, Cruickshanks, Bichat, Pinel, Gordon, Armstrong,
Hey, Blundell, Campbell, Mackintosh, Ashwell ; but Walter,
Johnson. Forster, Capuron, Dtiges, Conquest and Gardieu
are, perhaps, exceptions.

On the other side we have men connected with lying-in
Institutions, who had the most extensive opportunities of ob¬
serving the fatal disease, all , unanimous in opinion that it
differs from peritonitis. In this phalanx we have William
Hunter, Hulme, Leake, Jussieu, Villars, Fontaine, Ponteau,
Peu, Tissot, Le Roi, John and Joseph Clarke, Young, A. and
J. Hamilton, Denman, Labatt, Douglas, Walsh, Stoll,
Doublet, Doulcet, White, Manning, Haighton, Lowder,
1 Brenan, D. Davis, Dewees, Gooch, and numerous others on
the Continent and in Great Britain.

The various opinions respecting the nature of this com¬
plaint may be reduced to the following: 1. That it is a
disease sui generis , and peculiar to puerperal women only.
2. That it is accompanied with putrid, bilious, or typhus
fever. 3. That it is an inflammation of the peritoneum and
abdominal viscera. 4. That it is an inflammation of the ute¬
rus and its appendages. 5. That it is peritonitis in the pu¬
erperal state. 6. That it is sporadic, epidemic and conta¬
gious. The best nosological distinction which we have seen
is given by Dr. Douglas, of the Dublin Lying-In Hospital*.
Dr. Douglas observes, “ The present discrepancy of opinions
with regard to the nature of puerperal fever, whether it be
inflammatory or putrid, or nervous disease, is attributable to
a want of proper nosological distinction of the disease gene¬
rally known under the name of puerperal fever. There are
three different species: synochial puerperal fever; gastro-
bilious puerperal fever ; epidemical, or contagious puerperal
fever. “ In- the first species, which is inflammatory, attend¬
ed with fever, copious blood-letting, and other sedative and
evacuant remedies, viz., antimonials, purgatives, enematay
fomentations, &c., are the best remedies.

“ Within the second distinction I include those cases
wherein the disease dods not so rapidly assume, or at least
manifest, a decidedly inflammatory character ; not, as in
the former, commencing with a bounding, incompressible

* Dublin Hospital Reports, v. ii. p: 145

82 Critical Review.

pulse, but with a pulse frequent, hard, and contracted, as is
usually observed in synochus,or the common epidemic fever ;
neither are the symptoms of abdominal inflammation so
early evolved ; yet such inflammation does exist, and pro¬
gress when not checked, although more slowly and more
obscurely than in the former. The tongue is here loaded,
as in common bilious fever ; whilst in the former it is usual¬
ly white or cleanly florid, with sometimes a glazed appear¬
ance. The treatment here should likewise commence with
blood-letting, but in more moderate quantity ; immediately
after which, ten or twelve grains of calomel should be ad¬
ministered, and followed in a few hours by an ounce of cas¬
tor oil, combined with some other briskly purgative medi¬
cine. These medicines, unless given in large doses, will
produce but little effect in this complaint ; and it is of para¬
mount importance that the mucous surface should be effec¬
tually acted upon early in the disease in all cases, and more
particularly where the morbid action of the peritoneal cover¬
ing is under a kind of panic from the blood-letting, and be¬
fore that inflammatory action can re-organize its broken
force. Often, by such prompt treatment, will the disease
be arrested in limine. Should it, however, advance, whe¬
ther in increased or subdued violence, purgative medicines,
varying in kind, must be daily administered, assisted by
enemata, fomentations and topical blood-letting, ike.

“ That form of disease which I arrange under the third
head, is the really contagious or epidemical fever ; and al¬
though agreeing with the others in the great leading symp¬
toms, inflammation, pain, tumefaction, and tension of the
abdomen, yet, differing from them in many material charac¬
ters. The sensorium seldom is here in any degree disturb¬
ed; whereas, in the others, it is so frequently, and even
sometimes is excited to high delirium. The pulse here is
usually, from the moment of attack, soft, weak, and yield¬
ing, and, in quickness, often exceeds 160 ; whereas, in the
first species, it is full, bounding, and often incompressible ;
and, in the second, small, hard, and contracted, and in both
moderately quick. The eye, instead of being suffused with
a reddish or yellow tint, as in the others, is here generally
pellucid, with dilated pupil. The countenance, instead of
being flushed as in the others, is here pale and shrunk, with
an indescribable expression of anxiety, and expression alto¬
gether so peculiar, that the disease could, on many occa¬
sions, be pronounced or inferred from the countenance
alone. The surface of the body, instead of being, as in the
others, dry, and of high pyrexial heat, is here usually soft
and clammy, and. of heat not above the natural tempera-

Dr. Gooch , on the most important Diseases of Women . 33

ture ; and not only is the skin cool with clammy exudation,
but the muscles, to the impression of the finger, feel soft
and flaccid, as if deprived of their vis-vita by the influence
of the contagion. Indeed, there is such prostration of mus¬
cular strength and depression of vital principle, from the
very onset of the attack, that I must suppose the contagion
to act on the human frame, probably through the medium
of the nervous system*, in a manner analagous to that of
the contagion of the plague ; and, perhaps, the African plague
does not commit greater havoc among an equal number of
infected persons than puerperal fever in this country, nor is
puerperal fever less quickly fatal than the plague itself.

Of the methodus medendi , in the third species of puer¬
peral fever, noticed by Dr. Douglas, we shall let that experi¬
enced practitioner speak for himself : — 6 Without pretend¬
ing to detail any of the various modes of treatment which I
may have seen pursued, either successfully or otherwise, I
would here recommend the practitioner to commence by ad¬
ministering ten grains of calomel, combined with two grains
of powdered opium, in the form of bolus or pills ; likewise,
as early as possible, a briskly purgative enema. After the
operation of the enema, a number of leeches, from two to
four dozen, according to circumstances, should be applied
to the abdomen ; and the abdomen should afterwards be
covered with flannel cloths, wrung from warm water ; and
not only at this period, but frequently through the whole
course of the disease, should such fomentations be used.
Three or four hours having elapsed from the time of admi¬
nistering the calomel and opium, three drachms of pure oil
of turpentine,, with three drachms of syrup and six drachms
of water, in the form of draughts, should be swallowed, and,
after the lapse of another hour, this is to be followed by an
ounce of castor oil, or some other briskly purgative medi¬
cine. In some instances, the oil of turpentine and castor
oil may be combined in one draught ; but I generally prefer
giving the turpentine as here recommended. Some of these
remedies, occasionally assisted by others, suitable to the pe¬
culiarities of the case, are to be used as the circumstances
may indicate ; but I would not be disposed to repeat the in¬
ternal use of turpentine oftener than twice, in any case
whatever. In several cases, particularly where the debility
is very considerable, the blood-letting may be altogether
omitted ; and in these cases a flannel cloth, steeped in oil of
turpentine, should be applied to the abdomen, and allowed
to remain on for the space of about fifteen minutes. The

** Contagion and all poisons act through the nerves.— Addison and Morgan on
Poisons, 1829.— Ed. * 1

yor, in. no. 13.

Critical Revie w.

external application of turpentine, without either its inter¬
nal use or the aid of blood-letting, I have frequently expe¬
rienced to be entirely efficacious in curing puerperal at¬
tacks ; and although I have hitherto omitted to speak of
turpentine for the cure of the other varieties of this disease,
yet I would not feel as if 1 were doing justice to the com¬
munity if I did not distinctly state, that I consider it, when
judiciously administered, more generally suitable, and more
effectually remedial, than any other medicine yet proposed,
I can safely aver I have seen women recover, apparently by
its influence, from almost hopeless conditions, certainly
after every hope of recovery, under ordinary treatment, had
been relinquished.” — Such are the opinions of a physician
who was attached to one of the largest Lying-in Hospitals in
Europe ; and the testimony of such a man should have due
weight with those monopathologists who have recently ap¬
peared in the field of controversy. We shall here introduce
documents relative to the malignant puerperal fever in
Vienna, from August to November, 1819.

These documents are of the most authentic description,
and were extracted from a Report to the Government of
Lower Austria, by medical men of the highest eminence.
They consist of, 1st, a description of the disease and its pro¬
gress, by Dr. Raimann, director of the General Hospital of
Vienna, and professor of Clinical Medicine. 2d, History of
the disease from the beginning of August to the middle of
November, by Dr. Boer, professor of Midwifery. 3d, Re¬
port of the appearances observed on dissection, by Dr. Bi-
ermayer. 4th, Report of the Committee appointed to inves¬
tigate the subject. — Report of the dissections. The bodies
of 56 puerperal women were examined.

ff In all were observed many livid blotches over the whole body,
and rapid putrefaction soon after death ; in most of them imme¬
diately, so that in a few hours the bodies could scarcely be
opened.

“ In all there was a bloody discharge from the mouth and nos¬
trils.

. “ In all the belly was more or less greatly distended, except in
two, who had been delivered a considerable time before death.

The parts of generation were every where more or less swol¬
len, discoloured, reddish, and foul y four were syphilitic.

Marks of blood-letting appeared in thirteen ; of leeches on
the abdomen in seven ; of blisters alone in seventeen j and of both
cupping and blisters in twelve.

“ In the head, the organs were always turgid with blood ; the
ventricles generally contained more than the usual quantity of se¬
rum ; in other respects there was nothing worthy of notice in re¬
ference to this disease.

Dr. Gooch, on the most important Diseases of Women. 35

“ In the trachea there was generally found a sanguineous fluid,
and its internal surface was reddened.

“ The lungs were always in the greatest state of expansion, tur¬
gid with blood, frequently adhering or united by effused lymph to
the pleura, which was generally, but not in all, slightly red.

f< In the cavity of the thorax and pericardium, there was inva¬
riably more than the usual quantity of bloody serum ; the pericar¬
dium in no case morbidly changed, nor the heart externally, but
its substance, without exception, more flaccid and tender than ill
the healthy state. Its internal surface, particularly the valves,
chiefly of the right side, of a deep red, often of a black colour ;
the mass of blood generally fluid.

In the abdomen there were only two cases in which there was
no unnatural fluid, i.e. in those cases which had been delivered a
considerable time before death. In all the rest there was found from
one to two quarts of turbid, very fetid fluid, mixed with portions
of coagulated lymph, and sometimes purulent matter ; the latter
appearance was observed in those cases where powerful antiphlo¬
gistic means had been employed, and which had survived longer
after delivery.

“ The peritoneum, omentum, and mesentery, exhibited, in five
cases only, no appearance of redness ; in the rest it was always
somewhat more or less red, particularly towards the pelvis , and
they were often agglutinated with the adjacent parts.

“ With the exception of two cases, the stomach and intestines
were always much distended with air, and their external surface
more or less red. Lumbrici frequently appeared in great numbers,
not only in the small, but also in the large intestines, in the sto¬
mach, rectum $ and, in one case, in the nostrils.

“ The liver and spleen were always similarly affected ; they were
much more pale, flabby, and tender than in their healthy state ;
-easily broken down with the finger, similar to the degeneration of
the uterus, and filled with somewhat fluid blood. These appear¬
ances were seen even in those two cases where the abdomen was
not distended, nor contained fluid, and in which the intestines were
healthy. The gall-bladder was always much filled with dark bile.
The pancreas always healthy.

“The kidneys, in most of the cases, were flabby and tender.
The ureters always somewhat enlarged, and red. The urinary
bladder always contracted.

“ The internal parts of generation were every where covered
with yellow coagulated lymph, except in the two cases, in which
no fluid was found in the abdomen ; and in those cases in which
strong antiphlogistic means were used, there was frequently a
thick yellow purulent fluid often externally on the neck of the
womb. The ovaria and fallopian tubes were always more or less
swollen, red and tender.

“ The uterus, in all cases little contracted, was more or less red
externally, even in those where the delivery had taken place long
before, and the abdomen was not otherwise in an unhealthy con¬
dition. The substance or body of the uterus was always flabby,

* \

.Critical Review*

tender, easily broken down by the finger; in two cases, full of
small holes or cavities filled with stinking blood. In two cases,
the uterus, on account of the tenderness, of its substance, had
burst during delivery, at its neck ; in the one case, the rupture
was four inches in length ; and, in the other, one inch and a half.
The cavity of the uterus was found filled with foetid air several
times, particularly in the syphilitic women. Its internal surface
appeared generally covered with offensive cineritious ichor or mu¬
cus, only seldom with offensive viscid blood. Beneath this, it was
always red, discoloured, often as if slightly eroded or ulcerated,
the internal membrane very much eroded, and destroyed. Thus,
in a woman of eighteen years of age, who had been delivered three
weeks, in whom the abdomen was not distended, nor contained
fluid, and there was nothing diseased in the abdominal cavity, ex¬
cept the liver and spleen being flabby and tender, the uterus was
entirely ulcerated on its .internal surface, like the internal surface
of one of the large intestines, when covered with ulcerations.
She died on the twenty-ninth day. On the fundus of the uterus,
there generally remained particles of the placenta and membrana
decidua , in the form of putrid shreds. The colour of the cervix
of the uterus was constantly darker than the rest ; and it always
was darkest, and penetrated into its substance, at the mouth of
the womb, which was likewise much dilated, and often as if de¬
stroyed with loss of substance, often cracked, as if rent* The va¬
gina was generally preternaturally. red. Such were the facts care¬
fully abstracted from the whole fifty-six dissections.”

A committee was appointed to investigate the nature and
progress of this dreadful disease, who arrived at the follow¬
ing conclusions :—Thht in the earliest stage of the malady,
the os uteri was gangrenous, and in all the cases the suffer¬
ers first complained of pain in that part. The lochia disap¬
peared immediately, or in a few hours, the mammae became
empty, loose, and flabby. Symptoms of uneasiness were ex¬
perienced in some cases before delivery, which fact corrobo¬
rates the opinions of Drs. Joseph Clarke, Douglas, J. P.
Frank and others, that the disease might occur before deli¬
very. The causes of the disease could not be ascertained,
no contagion was traced, but the committee entertained
doubts on that subject. The treatment was antiphlogistic,
consisted of general and local bleeding, calomel, all the cele¬
brated remedies, cataplasms to the abdomen — all proved un¬
successful in the whole of the cases. Even pregnant women
removed from the institution, and placed under the chief
physicians, met the same fate. The symptoms, progress,
and fatal termination of the disease completely accord with
the descriptions of British writers, hut no English author has
so fully described the pathology of the disease. Sad and
authentic us. this, report is, it clearly proves the opinion of

Dr. Gooch, on the most important Diseases of Women . 3 7

our own hospital physicians, that the real puerperal fever,
and puerperal peritonitis are different diseases.

Having given the most extensive and indisputably authen¬
ticated account of the pathology, we proceed to add the
most recent and successful mode of treatment. M. Velpeau,
published an essay on the use of mercurial frictions in puer¬
peral peritonitis, Rev. Med . Janvier 1827. After adverting
to the opinions of Willis, Sauvages, Burserius, Frank, and
many others, he details his own observations, which corro¬
borate the melancholy reports of his predecessors. He had
seen thirty-nine cases in hospital and nine in private practice,
and two only were saved, though the antiphlogistic treat¬
ment was energetically employed. The various modes of
treatment recommended by Hulme, Leake, Butter, Manning,
Walsh, Clarke, Hull, Hamilton, Denman, Armstrong, Gor¬
don, Brenan and Sutton were all tried, and all failed. The
practice of Broussais was also resorted to, and from fifty to
two hundred leeches applied to the abdomen, and yet from
forty to fifty cases proved fatal in spite of all treatment pur¬
sued. So unsuccessful was every mode of treatment, that he
was convinced that if the disease be once established, neither
general nor local bleeding could arrest it, and, on the contrary,
often rendered it much worse. The mercurial frictions, so
strongly recommended by the surgeon of the public hospital
of Antwerp now only remained, and our author and M.
Bourgon put the plan into execution. Three cases, of the
most malignant character were treated by leeches and 3ij.
Ung. Hyd. rubbed over the abdomen every two hours, and
after the second friction every three hours. The amendment
was astonishing, and complete recovery took place. M.
Roux also witnessed the treatment. Those practitioners think
themselves authorized to draw the following conclusions from
the facts they observed : —

6C 1st, That puerperal peritonitis once completely esta¬
blished, and abandoned to itself, is almost invariably mortal.

2d, That it remains yet to be proved that sanguineous de¬
pletion alone is adequate to the cure of'the disease.

3d, That the writings of Hamilton, Gordon, Vanden-
zande, incontestably prove that by means of calomel, in large
doses, many cases of puerperal peritonitis of the most severe
kind. have been saved.

4th, That mercurial frictions over the abdomen, made at
short intervals, promise considerable success, and that this
ought to draw the attention of the profession to this point of
practice.

5th, That by means of mercurial frictions patients have
been rescued, as it were, from the brink of the grave, and,

38 Critical Review.

consequently, that this remedy should be tried, however late
in the disease.

6th, That the friction should be continued without fear,
until the mouth become affected, and, in most cases, for
some time after all the symptoms have subsided.

7th, That it would probably be advantageous to enjoin the
internal administration of calomel, warm baths, and warm
temperature.

8th, That the facts observed by the authors, without being
.sufficiently numerous or conclusive, are yet such as may en¬
courage, authorize, nay, compel practitioners to prosecute the
enquiry.” From this and the German Report we learn much
instructive information. According to the one, there is no
doubt but the uterus is the organ first inflamed ; and ac¬
cording to the other, mercurialization is the chief and only
remedy*. Reflection on this information has led us to make
the following remarks in our work already alluded to. It is
rather surprising that local bleeding has not been more gene¬
rally employed. Leeching and cupping might be applied to
the groins, hypogastric region, and the former to the labia
and vagina. Again, why not apply cold to those parts, and
also to the vagina and uterus. Cold injections, or pound¬
ed ice might be introduced into the vagina, and applied to
the orifice of the uterus, to that part which is first affected.
The only objection to the use of cold would be the presence
of the lochia, but this could not obtain, for the application
of cold to the uterus would cause further contraction of that
organ, and so far from suppressing the lochial discharge,
would most probably increase it. Mercury might be exhibited
in scruple doses, as recommended by Boyle, Cartwright and
Musgrave, and if the mer. ointment were applied in the ax¬
illae, its effects would be more speedily produced. The oil of
turpentine should be used, both externally and internally, as
recommended by Dr. Brenan ; (i the dose from two to four
drachms, and continued to the extent of two ounces, and
the remedy to be applied to the abdomen as a rubefacient.”
— Manual of Midwif. p. 331. Dr. Isaac A. Johnson has pub¬
lished six cases, in each of which he exhibited half an ounce
of turpentine and the same quantity of castor oil every hour,
until the bowels were freely purged, and then continued the
medicine at longer intervals, and ail terminated successfully.
— Philadelphia Med. Journ . Dr. Payne, of Nottingham,

* M. Olivier read a treatise on Puerperal Peritonitis cured by Mercurial
Frictions, at a late meeting of the Society of Practical Medicine, in Paris. He
thinks general bleeding should precede the mercury, and he thinks mercury has
no specific effect, on the disease, but acts as a derivative upon the salivary glands.
— Lancette Francaise , Mai 7.

Dr. Gooch, on the most important Diseases of Women . 39

most strongly recommends the oil of turpentine, and has al¬
ways found it successful. — Edin. Med . and Sur. 1822. v. 18,
p. 538. He never used depletion of late years. In a sub¬
sequent essay he informs us that the disease was epidemic
in the winter of 1822. “ Not any of those who were ill of

the disease, to whom I was called, were bled, either generally
or locally, and every one of them recovered. Augmenting
the intestinal secretion, appeared very speedily to put a stop
to the complaint in every instance.” — Op. Cit. 1824, v. 22,
p. 59. Dr. Dewees, the eminent American obstetric writer,
has lately recorded a case of real puerperal fever, which was
observed by two other practitioners. The antiphlogistic plan
was strenuously pursued, but without success. The case
was considered hopeless, when 30 minims of oil of turpentine
were exhibited every hour, sinapisms applied to the legs,
and an ounce of mercurial ointment rubbed on the abdomen
every night, with an enema, containing one drachm of lauda¬
num. This practice was continued for three successive days
— the patient recovered. — Amer. Journ. of Med. Sc. Aug.
1828.

We cannot conclude this article without adverting to the
opinions of Dr. Hamilton, the justly celebrated professor of
midwifery in the University of Edinburgh, to whose valuable
instructions we have been much indebted for our information
in obstetric medicine. Dr. Hamilton observed, in his lec¬
ture on puerperal fever, that the lochial discharge was not
suppressed in any of the epidemics that occurred in Edin¬
burgh. He quoted the manuscript notes of Dr. Young, and
the work of Dr. Hull, in corroboration of his assertion. This
symptom he considered pathognomonic of the disease, and
he denied that the cases related by Dr. Armstrong and Mr.
Hey, in which the discharge was suppressed, were eases of
the real puerperal fever ; he considered that puerperal fever
and peritonitis were distinct diseases, and this opinion he
still maintains ; and we have already shown that a vast ma¬
jority of those who have observed the disease in hospital prac¬
tice have arrived to the same conclusion. He also mentioned
cases of the disease having been communicated to private pa¬
tients by the medical and ordinary attendants ; fully detailed
every mode of treatment proposed, and declared that all were
^ineffectual. Such was the result of his great experience in
1820, and, we are inclined to think, such it is at present.
One other remedy has been proposed in the treatment of the
disease, which is the application of cold to the abdomen, and
this is strongly recommended by Loeffler, and other foreign
physicians of great repute, but we believe has not, hitherto,
been tried in this country. Such are the principal facts that

Origi na l Commun icuti ons .

have been recently observed in the disease denominated Ma¬
lignant Puerperal Fever, Puerperal Peritonitis, and Perito¬
neal Fevers — facts that should have been alluded to by Dr.
Gooch and the other recent writers on midwifery in this
country. We have deemed our duty to adduce them, be¬
cause they throw much light on the real nature and best
treatment of one of the most fatal diseases incidental to hu¬
manity.

[To be Continued.)

ORIGINAL COMMUNICATIONS.

I. — Observations on the Anatomy Bill. — By Chirurgus.

In the subsequent remarks on this bill, I wish it to be dis¬
tinctly understood, that nothing can be further from my in¬
tention than to reflect on the conduct of any individual. In
common with the profession, I feel deeply indebted to Mr.
Warburton for his readiness and anxiety in endeavouring to
remove the great impediments which obstruct the foundation
of medical knowledge — the study of anatomy. On many
occasions he has been the friend and promoter of medical
legislation ; and had he been allowed to proceed according
to his own judgment and discretion, the extraordinary bill
for the encouragement, or rather the prevention, of the
study of anatomy, which has just passed through the House
of Commons, would never have assumed its present objec¬
tionable form. This bill, like all others, is the production
of the whole collective wisdom of the nation, and cannot be
ascribed to any one individual. Having premised thus much,
I now proceed to examine, very briefly, the features of this
measure, and to notice its immediate effects on the study of
anatomy. The penalties inflicted on teachers of anatomy
by the intended bill, are so numerous and oppressive, that
no respectable anatomist would run the risk of encounter¬
ing them. There could not have been a more complete
measure devised, for the total suppression of the study of
anatomy in this country. The first section enacts, that the
punishment for exhumation of the dead, after the passing of
the act, will be six months’ imprisonment, with or without
hard labour, and two years’ imprisonment for the second
and every subsequent offence. So far, so good. The bill
then empowers the Secretary of State for the Home De¬
partment to appoint commissioners, the majority of whom
shall not be medical men, to grant licenses to anatomical
teachers ; so that it appears non-professional men are con¬
sidered the best judges of the talents and competency of

Observations on the Anatomy Bill, 41

such teachers. This is legislation with a vengeance. These
commissioners are to grant licenses annually to anatomical
teachers, at an expense of five pounds for each ; and all
monies so received are to go into the National Treasury. It
appears, then, that the darling object of taxation was not for¬
gotten, and that it might be even derived from the hallowed
source, the remains of man after dissection. On referring
to the list of lecturers in London, I find those of anatomy
amount to fifteen ; so that the immense sum of /5/. an¬
nually, would be added to the Treasury. A visitor is to be
appointed by the Secretary of State, and “ is empowered to
inspect, at all times , the licensed schools of anatomy, and to
examine, on oath, the keepers of the same, who are bound
to comply, under a penalty of 50 1, ; and such visitor is to
be paid reasonable expenses for his trouble,” of course by
the anatomist. What an enviable station that of teachers
of anatomy will be under the new bill. The commissioners
are to make rules and orders for the regulation of anatomi¬
cal studies. It is to be presumed that a future enactment
will give like powers to* non-professional men to regulate
the studies of physiology, pathology, and therapeutics, and
the other sciences, astronomy, natural philosophy, chemis¬
try, &c. Lord Tenterden strongly opposed this sapient
section of the act ; and the Council of the Royal College of
Surgeons, and the Professors of the University of Edin¬
burgh, have petitioned against it. “Every licensed teacher is
to bury, or cause to be buried, each body after dissection, in
a separate coffin, at his own expense, twenty-one days after
the receipt of such body, with rites of Christian burial, or
with such other funeral rites as accord with the religious
creed of the deceased, or are customary in that part of the
kingdom, under a penalty of 50/.” for each omission. This
section clearly establishes the validity of the opinion deliver¬
ed by Mr. Guthrie, in his recent lectures at the Royal Col¬
lege of Surgeons, that medical men should be represented
in the Houses of Parliament. If medical men were present
on. the introduction of this clause, they would' probably sug¬
gest the utter impossibility of collecting every part of the
body after dissection, and also mention that such things as
museums existed, and that many of the best specimens of
human disease were procured by dissection. They would
also remonstrate with the Honourable House as to the un¬
reasonableness and severity of the duty about to be imposed
on the teachers of anatomy, namely, that they should form
a part of the funeral procession of all dissected bodies, and
procure “the rites of Christian burial, and such other fune¬
ral rites as accord with the creed of the deceased,” which,

Original Communications ,

of course, embraces “ the thousand and one” different reli¬
gious persuasions of this age of intellect, and this country
of civil and religious freedom. They might also explain the
hardship of anatomical teachers being obliged to incur the
expenses of the undertaker, the parson, the parish clerk*
and the grave-digger. In a word, they might inform “ the
collective wisdom” that no eminent teachers could, or would,
comply with such unreasonable and unjust injunctions. In
sober truth, were this bill to pass into a law, the study of
anatomy would become so enormously expensive, as to ex¬
clude nine-tenths of our medical students from the possibi¬
lity of acquiring a proper knowledge of the profession. The
remaining penalties of the act are, “ 50/. for receiving a body
without a licence, 50/. for receiving it without the certificate
of the person entitled to dispose of it, and 50/. for not en¬
tering in the book of registry, the receipt of such body.”
All these penalties are to be recovered before a magistrate
in a summary way, who is to issue a warrant of distress
against the goods and chattels of the persons convicted ;
half the penalties to go to the clerk of the commissioners
for expenses, and the other half to the next public hos¬
pital.

The person convicted is to give bail for the amount, or in
default, to be committed to prison for three months ; he may
appeal to the quarter sessions, by giving fourteen days no-
tice, and the decision of such court is to be decisive. Such
is the tenor of the anatomical bill, which I am convinced
will never be carried into a law. There is no doubt but some
provision must be made for the regulation of anatomical dis¬
section by the legislature, in next session of parliament. I
perceive that the bill has been withdrawn from the House of
Lords, at the suggestion of the Archbishop of Canterbury,
but from the feeling which prevailed among the peers, and
from the support which Lord Calthorpe, the mover of the
measure, received from the Duke of Wellington, Lord Grey,
the Marquis of Lansdowne, Lord Goderich, and other noble
lords i a legislative enactment may be certainly expected
during the next session. The Duke of Wellington said
4C he approved so strongly of the object which the noble
lord had in view, and of the principle on which the noble
lord professed to proceed, that, if the measure had been
discussed, it was his intention to have supported the se¬
cond reading, and to have done all in his power to amend
the bill in the committee. (Hear, hear.) Why he was
glad that the bill was to be postponed was, that he was
aware of the opposition that would be raised to it, and of
the quarter from which that opposition would come ; and

Observations on the Anatomy Bill .

knowing, too, how much influence that opposition would be
likely to have upon the country, he could not help feeling
that it was extremely desirable that such effects should not
accompany the measure, if it passed into law. He was de¬
lighted, therefore, that the bill was to be postponed, and
although he could not take upon himself the task of bringing
forward a measure on the subject, yet he would willingly co¬
operate with any noble lord who should bring forward ano¬
ther measure, even upon the principle of this bill, to get rid
of the horrible evils which wrere produced by the present
system, (Hear, hear.) Unless they could increasegthe number
of subjects for dissection, they would do nothing.55 It is to
be hoped that the next bill will neither be so unjustly op¬
pressive on the teachers of anatomy, nor so outrageously
offensive to the feelings of the poor. No doubt it is a diffi¬
cult matter to legislate on the subject, but surely the profes¬
sion or the public ought to be satisfied. I cannot assent to
the opinion that the repeal of the law relative to the dissec¬
tion of the murderers, is the great panacea for public preju¬
dices ; in fact, people in general seldom bestow a thought
upon such dissection. It is the general opinion of many well-
informed jurists, and of a large poi'tion of society, that
the law in this respect is too mild, that its provisions should
be enlarged, and that the bodies of all who suffer death by
the hands of the public executioner, and those who termi¬
nate life by suicide, should be subjected to dissection. This
is the impression of those who have paid most attention to
the nature of crime and punishment. Earl Grey, Lord Ten-
terden, and Lord Calthorpe have maintained this opinion ;
and the Marquis of Lansdowne the contrary, for “ he has ex¬
pressed his intention to move next session, for leave to bring
in a bill, to abolish the law which consigns the bodies of
murderers to dissection.55 But it has been urged by a certain
part of the public press, that it is unjust to expose the bodies
of the poor, exclusively to dissection. This is not the fair
view of the subject. In fact the bodies of the rich are most
extensively dissected. The bodies are not exposed in dis -
secting-rooms, but nevertheless they are dissected. Are not
the bodies of the king, queen, princes, and princesses em¬
balmed, and can they be embalmed without dissection ? Are
not the bodies of the nobility, commoners, baronets, knights,
clergy, physicians, lawyers, esquires, gentlemen, tradesmen,
artificers, and labourers, daily dissected or examined after
death, and at the express desire of the relatives of the de¬
ceased ? It is therefore evident, that the bodies of the poor
are not exclusively exposed to dissection. The bodies of the
poor are dissected, and owing to the many disadvantages in
which they are placed, their bodies are more easily obtained

44 Original Communications.

than those of the upper orders of society. The poor, how¬
ever, are the persons who derive most benefit from dissec¬
tion ; for they must inevitably apply to the young medical
practitioners, who give gratuitous advice, and whose know¬
ledge of operating must have been derived from dissection of
the dead, or must be acquired by practice on the living. On
the other hand, the wealthy can always procure the best ope¬
rators. If the future students be debarred from acquiring a
proper knowledge of anatomy, and this would have been the
case under the late bill, the poor and lower classes will be
the greatest sufferers. It is highly amusing to peruse the
sapient proposition of a few newspaper editors and others,
“ that anatomy can be learned from books, plates, casts, and
surgical operations, performed on pasteboard.” This cant
is a flimsy placebo for popular prejudices, and reflects little
lustre on the public press of the present period. If those
worthies were affected with diseases which required capital
operations, I apprehend they would prefer the human to the
pasteboard anatomist. If those men would only condescend
to reflect on the natural decay of the body in the grave, the
progress of putrefaction, the ravages committed by insects
and vermin on the human fabric, if they could recollect the
fate of the bodies slain in battle, the exposure of them to
birds and beasts of prey, and the consignment of them in
one chaotic heap to the earth, and the fate of those which
become the food of the inhabitants of the deep, they would
cease their stupid and selfish opposition — their miserable
pandering to the prejudice of the multitude. Let them only
represent the true state of the case, let them fairly explain
that dissection consists in an examination of the important
organs of the body, which may require operation, and that
such examination is ten thousand times less revolting than
the process which the body has to speedily undergo ; and,
finally, let them honestly represent to the public that dissec¬
tion is indispensable to medical practitioners, that without it
the lives and limbs, the health and comforts of every class of
society cannot be preserved, and then popular opposition to
anatomy will completely cease.

II. — Physiology , Phrenology , Materialism , Immateriality of
the Mind. By The Editor.

Of created spirits there is one which we can know by the
light of reason as well as by revelation, namely, the human
mind. In this paper we shall treat of the mind, or soul, of
man, and prove that it is not material, and that it does not
depend upon the development of the brain, as the phrenolo¬
gists and materialists have vainly endeavoured to establish.

Phrenology , Materialism , Immateriality of the Mind. 45

The subject may be divided into five parts ; 1st, of the ex¬
istence of the mind ; 2d, of its nature ; 3d, of its faculties ;
4th, of its operations; 5th, of its destination. 1st, of the
existence of the human mind. Three things are required to
be answered under this head ; does the mind exist ? how
does it exist ? and where does it exist ? Before we can
answer the first question directly, we ought to define or de¬
scribe what is the mind or soul of man. We understand by
mind or soul an immaterial and active spirit, distinct from
the body, possessing peculiar faculties and operations. That
the mind exists, is evident from an inward sense implanted
in the breast of every rational being : we think, we judge,
we discourse, we understand, we will ; but a material sub¬
stance, such as our body, is not capable of these operations.
Therefore, there exists in us a substance distinct from the
body, whose office is to think, discern, judge, understand,
and will ; and this mind or spirit can be nothing else than
the soul, according to our definition.

The second question is, how does the human mind exist ?
The mind constitutes an especial part of the person of man,
for he cannot perform his operations without their being re¬
ferred to it ; but whether it exists united hypostatically with
the body, or whether it is derived from it, or is independent
of it, is not so obvious to our senses. This question may be di¬
vided into three sections. In the first we shall shew the close
union which exists between the mind and body of man ; in
the second, we shall investigate in what that union consists ;
and in the third, we shall inquire whether the mind and body
preserve the distinction of their nature in that union. 1st
Section — Of the intimate union which exists between the
mind and body. A mutual dependence in operations exists
between the mind and body, for without this connexion the
mind could not perform its functions of thought, judgment,
perception, and volition — a fact demonstrated by daily expe
rience ; for if there be disorder of the nerves or corporeal
organs, the intellectual faculties of the mind will be impaired,
or even be suspended. In all the vicissitudes of the body,
the mind is influenced in the exercise of its faculties ; in like
manner the body depends upon the volitions of the mind in
its motions, and the performance of its functions ; and there¬
fore the mind and body are intimately connected, and affect
the functions of each other. If the union be destroyed, the
mind cannot comprehend the ideas and cognitions which
come to it by sensation; it will become destitute of the
knowledge of all physical things and their relations, in ac¬
quiring which, it has need of impressions produced by ex¬
ternal objects on the organs of the body. Therefore, by its

46 Original Communications,

union with the body, its powers of cognition are much am¬
plified. If the body were separated from the mind, what
would it be but an inert heap of matter, wanting motion,
volition, and life ; it would be entirely unfit to provide for
its conservation $ it would be incognisant of wThat is harm¬
less and hurtful ; but, assisted by the mind, and directed by
the government of its will, the body moves and acts, avoids
all things noxious, and selects those beneficial, as if it were
exclusively endowed with a peculiar vitality and intelligence.
Therefore the mind and body are perfected by union. 2d
Section — Of the union between mind and body. Much dis¬
pute has taken place between philosophers concerning the
nature of this union. This is not the place to enumerate
and confute all the extravagant opinions on the subject ; but
we may briefly allude to the leading ones. It was said, that
mind acted physically and immediately upon the body,
moved it, and rendered it obsequious to its will ; and that
the body acted reciprocally upon the mind, and exerted in it
Ideas and sensations which correspond with impressions de¬
rived from external objects. This was the sy sterna influxm
pkysici. To this it is replied, that the mind being immate¬
rial, and the body being material, their properties are differ¬
ent, and therefore the doctrine is repugnant to the nature of
;both, and cannot be admitted. The next doctrine was that
of Le Clerc, entitled sytema mediatoris plastici , which taught
that a principle, different from mind and body, and distinct
from both, existed, which produced the functions of both. —
Biblioth. Chome , tom ii, p. 144. This principle should be
material or immaterial, and obviously cannot possess the

functions of mind and matter. The system of Lobentz is

• <

next in order, and was called the prestibility of harmony.
According to this doctrine, there is no real connexion be¬
tween mind and body, no real and mutual dependence in
operation, but a mere analogical correspondence of opera¬
tions between them, from divine ordination. Mind and body
are automata according to this theory, but still different, so
that man would have no free will, and would be rendered
irresponsible for his actions, contrary to revelation. Besides,
the doctrine disallows connexion between mind and body,
a connexion that is observed by daily experience. The next
system was proposed by Maiebranche, and denominated, the
doctrine of occasional causes . It, teaches, that mind and body
are in turn occasional causes of the operations of each other.
This is the most feasible of all former opinions ; it contains
nothing contrary to the divine attributes ; nothing that does
not accord with the nature of mind and body. It leaves man
Iprd and master of his own actions. The last theory is that

Phrenology r Materialism, Immateriality of the Mind. 4J

named moral influx. The patrons of this system maintain,
that the body suffers various impressions from the action of
physical objects on its organs, which are the occasional
causes of ideas and sensations in the mind, and that the
body concurs in other mental operations as an instrumental
cause. That the mind, in procuring the various motions of
the body, acts according to its own volition as an efficient
cause, not physically but morally, not otherwise than that
the Deity exercises his will in producing the motions of all
bodies, and the mind, by virtue of its volition, affects the
body variously, to which it is conjoined. Some contend that
the mind, on account of its excellence, has the power itself
of causing the motions of the body ; but the volition of the
mind cannot cause motion in a paralytic limb. Therefore it
is from the gratuitous concession and ordination of the
Deity, the mind has its power. The mind commands, go¬
verns, and directs the body, and is responsible for its ac¬
tions. The mind cannot act or do but what is spiritual, nor
the body but what is physical ; and therefore the distinction
and rights of each are preserved. If the physical harmony
of the body be disturbed or deficient, the mind will be dis¬
turbed in its ideas and sensations. It is equally as demon¬
strable, that the mind requires the assistance of the body for
its operation. Those born and wanting a particular sense,
never can comprehend the sensible qualities which corres¬
pond to the impressions of that sense ; for example, those
born blind can form no idea of colours, nor one born deaf of
sounds. This leads us to the third section, or the distinction
between mind and body.

It may appear supercilious and unnecessary to many of
our readers, that we should proceed to discuss a subject
which has been acknowledged and supported by the most
eminent metaphysicians, from Aristotle to the present pe¬
riod, including Luther, Melancthon, Paracelsus, Ramus,
Descartes, Locke, Bacon, Hobbes, Gassendi, Gallileo,
Kleber, Milton, Leibnitz, Berkley, Malebranche, Le Clerc,
Hartley, Hume, Reid, Oswald, Beattie, Stewart, Brown, &e.
&c. ; but all these distinguished philosophers are now op¬
posed bv the materialists and phrenologists, and their dis¬
tinction between mind and matter is to be laid prostrate and
exploded. Such is the quixotic philosophy of the nineteenth
century. It is quite necessary to preserve the young prac¬
titioners and the medical students of the day from the bane¬
ful infection of this philosophy, and for this reason alone we
offer a few remarks upon the subject. Reason and religion
teach 11s that the mind and body differ. Real philosophy
has long established the same conclusion. Theologians and

48 Original Communications .

metaphysicians define them differently. They agree that
“■■the mind is simple, active, and intelligent/’ “ the body
material, inert, and destitute of all intelligence.” They
inform us, that the identification of mind and body is con¬
trary to reason, to philosophy, and to revelation. In this
opinion the medical profession almost universally concurs.

The phrenologist and the materialist assert, that the fa¬
culties of the mind are functions of different parts of the
brain ; the theologians, the physicians and metaphysicians,
hold the opposite opinion. If the faculties of the human
mind depended on, or were the result of, organization, man
would be irresponsible ; his passions and propensities would
be as involuntary as hunger, thirst, or any other function of
the body ; and it would be derogatory to the attributes of
the Deity to impose laws for his observance, or to promise
rewards or punishment, when man was not free to act. That
philosophy which assails the attributes of the Supreme
Being is fallacious ; that wild hypothesis which is in open
opposition to the principles of revealed religion, can have
few disciples in an age so distinguished for the universal pos¬
session of knowledge. The really learned in our profession
are in no danger of being infected by the poison of infidelity,
nor are they to be captivated by illusive speculation. It is
unnecessary to enumerate the unanswerable objections to
materialism and phrenology in this place, as they have been
so recently and so frequently before the profession. For a
complete refutation of both, we refer the reader to the Edin.
Med . and Surg . Journ ., 1822; to Stone's Evidences against
Phrenology , 1829; to “ Thomas’s Metaphysico-Physiologi-
cal Essay upon the Nature of the Triple Alliance of Corpo¬
real Organization, Animal Life, and the Life of the Under¬
standing,” in the Lond. Med. and Phys. Journ ., 1828. Mr.
Thomas, after adducing the most unanswerable arguments
against materialism, concludes in these words, “ the doctrine
of the materiality and mortality of the soul should for ever
be exploded, as totally false and unworthy of ail regard, as
subverting the fundamental principles of all religions, as in¬
troducing civil anarchy into the political economy of legisla¬
tion, as substituting disorder for harmony, despair for hope,
and eternal darkness for everlasting light.” The most
learned and talented members of the profession, with scarcely
an exception, have arrived at this conclusion.

If materialism tended to promote the happiness of society,
to assist our hopes, to subdue our passions, to instruct man
in the happy science of purifying the polluted recesses of a
vitiated heart, to confirm him in his exalted notion of the
dignity of his nature, and thereby to inspire him with senti-

Phrenology , Materialism , Immateriality of the Mind. 49

ments averse to whatever may debase the excellence of his
origin, the public and the medical profession would be deeply
indebted to the phrenologists. But the tendency of phren¬
ology, however disguised, is to make mind a secretion or
function of the brain, and thus to deny the immortality of
the soul. Unbelievers, in general, wish to conceal their sen¬
timents ; they have a decent respect for public opinion, are
cautious of affronting the religion of their country, fearful of
undermining the foundations of civil society. Some few
have been more daring, but less judicious, and have, without
disguise, professed their unbelief and again retracted their
opinions. In denying the immortality of the soul, they deny
the authenticity of the Bible; they sap the foundations of all
religions; they cut off at one blow the merit of our faith, the
comfort of our hope, and the motives of our charity. In de¬
nying the immortality of the soul, they degrade human na¬
ture, and confound man with the vile and perishable insect,
and overturn the whole systems of religion, whether natural
or revealed. In denying religion, they deprive the poor of
the only comfort which supports them under their distresses
and afflictions, and wrest from the hands of the powerful and
rich the only bridle to their injustice and passions ; and
pluck from the hearts of the guilty the greatest check to
their crimes — that remorse of conscience which can never be
the result of a handful of organized matter — that interior mo¬
nitor which makes us blush in the morning at the disorders
of the foregoing night, and which erects in the breast of the
tyrant a tribunal superior to his power. Such are the con¬
sequences naturally resulting from the principles laid down
in* phrenological writings. It is no intention of ours to
fasten the odium of infidelity on any portion of our profes¬
sion ; but it surprises us that men, whose understandings
have been enlightened by the Christian revelation, and en¬
larged by the study of medicine (the most extensive and va¬
ried of all human sciences), should broach tenets which
equally militate against the first principles of reason and the
oracles of the Divinity ; and which, if true, would be of no
service to mankind. Of what benefit to humanity would be
the establishment of phrenology? We answer none; butj»
on the contrary, the greatest injury. If any man be so un¬
happy as to work himself into the conviction that his soul is
a function or a secretion of the brain, and of course must
perish with it, he would still do well to conceal his horrid
belief with more secrecy than the Druids concealed their
mysteries. In doing otherwise, he only brings disgrace upon
himself, for the notion of religion is so deeply impressed on
our minds, that the bold champions who would fain destroy

VOL. III. NO. 13.

Original Comm unications.

it are considered by the generality of mankind, and our pro¬
fession, as public pests, spreading disorder and mortality
wherever they appear ; and in our feelings we discover the
delusions of a cheating and unmedical philosophy, which can
never introduce a religion more pure than that of the Christ-
tians?, nor confer a more glorious privilege on man than that
of an immortal soul. In a word, if it be a crime to enter¬
tain such a doctrine, it is consummate folly to boast of it.

hence this eagerness to propagate systems, the tendency
whereof is to slacken the reins that curb the irregularity of
our desires and restrain the impetuosity of our passions ?
It must proceed from a corruption of the human heart, averse
to restraint, or from the vanity of the mind, which glories in
striking from the common path, and not thinking with the
multitude. In vain are the phrenologists informed by the
anatomist, that he can find bile in the liver, urine in the kid¬
neys, but none of the faculties of the mind in the brain. In
vain are they told that after death, when volition has ceased,
that the motions of the muscles can be excited by galvanism,
and that though muscular motion be restored, he cannot recal
volition, or the other mental faculties ; rather a strong proof
that motion and volition are not exactly the same thing.
These and ten thousand other proofs are lost on the phren¬
ologists. They set up the proud idols of their own fancies
in opposition to the received opinions of their profession,
and in opposition to the oracles of the Divinity ; and, in en¬
deavouring to display absurdities in the Christian religion,
fall into much greater. To them we can with due deference,
and without disclaiming our title to good manners, apply the
words of St. Paul to the philosophers of his time — i( They
became vain in their imaginations ; professing themselves
wise, they became fools.

Let the patrons of the revived and long-refuted philosophy
persuade their wives that their souls die with their bodies ;
let them instil the same doctrine into the minds of their
children ; let the doctrine become generally received — un¬
faithful wives, unchaste daughters, rebellious sons, and ge¬
neral confusion and anarchy will be the blessed fruits of their
philosophy. To those philosophers the words of an able and
learned prelate very forcibly apply — e£ The Bible has with¬
stood the learning of Porphyry and the power of Julian, to
say nothing of the manichean Faustus ; it has resisted the
genius of Bolingbroke and the wit of Voltaire, to say nothing
of a numerous herd of inferior assailants ; and it will not fall
by your force. You have barbed anew the blunted arrow's
of former adversaries ; you have feathered them with blas¬
phemy and ridicule ; dipped them in your deadliest poison ;

Successful treatment of Puerperal Peritonitis. 51

aimed them with your utmost skill ; shot them against the
shield of faith with your utmost vigour ; but, like the feeble
javelin of the aged Priam, they will scarcely reach the mark,
will fall to the ground without a stroke.5' — Dr. Watsons
Apology for the Bible.

The doctrine of materialism is not more discordant with
the principles of revealed religion, than with the opinions of
the greatest men who have ever adorned the science of me¬
dicine ; men who were, and still are, as great ornaments to
the literary world in general, and medical literature in par¬
ticular, as they are useful to mankind.

III. — Cases of Puerperal Peritoneal Inflammation, Cured

by the 01. Terebinthince, combined with Ol. Ricini.

By Geo. G. Warden, Esq. Surgeon.

To the Editor of the London Surgical and Medical Journal.

Dear Str — I beg leave to forward you an account of a case
of puerperal inflammation, cured by Ol. Terebinthinae, given
immediately after the abstraction of blood. For the know¬
ledge of the above practice I feel greatly indebted to you, and
I do not hesitate in affirming, that had I been fortunate
enough to have been acquainted with the beneficial effects of
the Ol. Terebinthinae when puerperal fever crept into my
practice fifteen months ago, the disease \tould have been cut
short, and I might have saved the lives of those patients who
fell a sacrifice to the most dreadful malady that can affect
females. I am, Dear Sir,

Yours, &c., Geo. G. Warden.

Stepney, June 15.

On the 5th inst. at eight o’clock, a. m., I was called to at¬
tend a Mrs. Etteredge, aged 20, of James-street, Limehouse*
Fields, who was about to be delivered of her second child.
The infant was born before I arrived. The placenta was re¬
tained for an hour or more, after the birth of the child, dur¬
ing which period the uterus was contracting, as the pains
soon became very sharp. There was an adhesion of the pla¬
centa on the right side of uterus, which I separated, and the
expulsion took place immediately. On visiting my patient
at 5 o’clock p. m ., she complained of the after-pains being
very violent. Sent her an anodyne draught, and ordered
warm cloths to be applied to the region of the uterus ; the
pulse was regular, tongue moist, and a gentle diaphoresis.
On the morning of the 6th I was sent for, when I ascertained
she had been shivering all night. At intervals the breathing
was sery difficult, pulse varying from 120 to 130; tongue

Original Communications.

brown and dry ; anxious countenance ; extreme tension arid
tenderness over the abdomen; lochia suppressed; fluidity of
the breasts, and a total carelessness in the behaviour. 1 im¬
mediately opened a vein in the arm, with a free orifice, and
took twenty-four ounces of blood, and sent her two drachms
of the Ol. Terebinthinee, and Ol. Ricini, to be taken im¬
mediately. Six o’clock, p. m the bowels had been freely
acted upon ; pain and tension not so great ; had had some
sleep; pulse 110; repeated the Ol. Terebinthae and Ol. Ri-
cini. 7th. The patient has passed a good night, slept well ;
pains and tenderness much abated; pulse 90; tongue moist ;
return of the lochia ; complains of thirst. Sent her a sa¬
line mixture ; three or four spoonfuls to be taken every four
hours. 8th. Tenderness and tension entirely gone ; a free
secretion of milk and lochia; pulse 80, but complained of
thirst. Repeated the saline mixture. 9th and 10th. Going
on well.

I have had two or three cases, where symptoms of perito¬
neal inflammation had commenced after delivery; one, in par¬
ticular, after a premature birth of a foetus at the five and a
half months, to all of which I gave the Ol. Terebinth, which
seemed to me to produce, if 1 may be allowed the expression,
a magical effect in correcting the progress of the disease.

IV. — Medical Jurisprudence. By A Reformer.

The charge of Baron Hullock, in a recent case, has given
the most violent blow to the medical corporations of this
country which they have yet received. Any man may prac¬
tise physic, surgery, and midwifery, and should patients die
by dozens, he is not liable to a criminal indictment ; he is
only liable to a civil action. There cannot be a better exem¬
plification of the incongruity and the glorious uncertainty of
the law than this exposition. The laws of our medical cor¬
porations enact that medical practitioners shall receive a pro¬
per education, and shall be examined as to their competency,
previously to their initiation into practice. But the common
law, as expounded by the learned Judge, virtually abrogates
the statutes and charters, though subsequently conferred on
the members of the medical profession. It would be well if
the principles of the common law, which were founded upon
reason, justice, and the welfare of society, would not be so
totally forgotten by the legislature in its enactments, nor
by judges in their expositions. The principle that every man
may practise medicine, and be irresponsible for his temerity,
is a just one, if no proper advice can be procured ; but it is

Medical Jurisprudence.

to be recollected that there is no hamlet in this country, in
which a medical man cannot be found, and, therefore, there
is now no necessity for sanctioning empiricism. Besides,
this is inapplicable in the metropolis of Great Britain. The
toleration of quacks in this country is one of the greatest
public evils ; it Is the ruin of thousands of human beings.
Empiricism was so considered three centuries since, when
the laws that incorporate the well-educated medical men
were granted, and, as the preambles set forth, solely for the
protection of the public, and the suppression of quackery.
The charters and statutes then conferred are yet in force,
and are nugatory, according to the exposition of the com¬
mon law, to which allusion has been made above. The cor¬
porations of physicians, surgeons, and apothecaries are use¬
ful, or they are not. If they be useful, they ought to be pro¬
tected 5 if they be unnecessary they ought to be abolished.
We shall not now stop to inquire whether these corporations
have been advantageous to the public or the profession, but
certain it is, that the acknowledged irresponsibility* of those
who choose to practise medicine in all its branches, will not
tend to increase their ranks. It is obvious to every man, that
the immense number of our medical students leaves no reason
to apprehend a scarcity of the faculty ; in truth the supply
is much greater than the demand, and the profession is over¬
crowded to a degree that is decidedly ruinous to its members.
Therefore there is no want of medical men, nor need the
public be subjected to the prey of temerarious and unprinci¬
pled empirics. If the profession were represented in parlia¬
ment it could never have arrived at its present degraded con¬
dition. It was never intended by the legislature, that the
rights of the whole profession should be monopolized by a
few individual members $ but such is the corruption of hu¬
man nature, that men of the most enlarged minds and the
most exalted station will sacrifice general good at the shrine
of self interest. Hence arise the bad feeling and the great
disorders which disgrace the dignity of medicine at the pre¬
sent period ; hence it is that party exists to such a degree,
and hence it is that reform is so indespensible.

In this country we have nine medical corporations, and
each has peculiar rights and privileges. It was just and
right that England, Ireland, and Scotland, when distinct na¬
tions, should each have a corporation of physicians, surgeons,
and apothecaries $ but since their union into one nation, the
necessity of such corporations has ceased. It is rather su¬
perfluous to assert that the principles and practice of medi¬
cine are the same in these countries, though men qualified in
the one part cannot practise in the other. Yet it is extraordi-

54 Original Communications.

nary with what pertinacity each corporation maintains its
privileges, and how men, already qualified, must submit to
re-examination and expense, as if they had never belonged to
the profession. Is this policy just or equitable, when the
countries are united ? And though the United Kingdom is
blessed with so many medical corporations, there is no coun¬
try in Europe, in which so large a proportion of irregular
practitioners exists. If a census of the profession in the
United Kingdom were now taken, more than one half of
those who are considered duly qualified, would be found with¬
out the pale of legal qualification. Had the corporations
acted honorably, the whole of the members would freely co¬
operate with them, and prevent the inroads that are made
on the really qualified portion of the profession. But if re¬
form be proposed, and if the government of the country appeal
to the corporations, the strongest opposition will be humbly
offered by them to improvement, and, for reasons best known
to themselves. “ Those superannuated institutions/’ says
the editor of Hr. Percival’s Ethics, “ are mill-stones and
dead weights hanging about the profession, which, however
well adapted to it three centuries since, are now little superi¬
or to mere vehicles of diploma mongering, and of perverted
and illiberal views.” This is a faithful picture. Had these
institutions endeavoured to suppress empiricism — had they
acted liberally towards their own members, they would then
obtain the attention of the government and the applause of
all regular practitioners. Then, indeed, would they have
served the profession, and not expose those who have obtain¬
ed the legal qualifications to the competition of men who as¬
sume their titles. Thus would they serve the cause of hu¬
manity and science. Constituted as those corporations now
are, and acting as they have all invariably done, they are the
chief cause of the abuses which degrade the profession, and
of the, injury which regular practitioners experience. Were
the heads of these institutions to petition the legislature, and
fully detail the imperfect state of the laws relating to the me¬
dical profession in this country, there is not a shadow of
doubt but the defects would be remedied, and the safety of
the public health be rendered more secure. But such an ap¬
peal would lead to reform, would destroy monopoly, and
would partition the loaves and fishes of the profession ; for
there are such things in medical Institutions as well as in
ecclesiastic. It is in vain to expect any efforts for improve¬
ment from monopolists. The reformation of abuses can only
be effected by an independent exposure of such abuses
through the medical, and, if possible, through the public,
press. For five and twenty years the medical press has ad-

State oj the Medical Profession .

verted to the necessity of reform, but to little purpose, as
the members of the legislature never peruse medical works,
and are generally ignorant on the subject. Medical reform
can never be effected, until the public and the members of
the legislature are aware of the necessity. This can only be
accomplished by frequent meetings of the members of the
profession, and by the publication of their complaints and
proceedings, in the public Journals. If the defects and
abuses which exist in the practice of the medical profes¬
sion wTere generally known to the public, they would be
speedily corrected 3 until they shall be known, reform can¬
not be accomplished.

V. — State of the Medical Profession.

TO THE EDITOR OF THE LONDON MEDICAL AND SURGICAL JOURNAL.

Sir — It is with much pleasure 1 perceived the recent notice
from the Society of Apothecaries in London, relative to the
exposure of those who practice pharmacy without having
complied with the provisions of the act of parliament, in¬
tended for the proper regulation of the practise of pharmacy
in England and Wales. It is obvious to every man, that
the licentiates of Apothecaries’ Hall, have hitherto been in¬
fringed on by an immense number of persons who have no
qualification, and who not only dispense and retail medicines,
but compound prescriptions, and prescribe for every form of
disease. I need not expatiate on the injustice of allowing
such practices, nor prove the great injury inflicted on soci¬
ety, by men who have received no professional education.
The law is sufficient to prevent such usurpations, and only
requires to be enforced, to protect the rights of those who
have complied with its provisions, and the regulations of the
Society of Apothecaries. It would not be a matter of diffi¬
culty to ascertain who are, and who are not, properly qualifi¬
ed 5 nor would it be impracticable to publish a list of the licen¬
tiates in the public papers, in a succession of advertisements,
and also to print it in such form as to have it circulated
among the profession, through the medical periodicals. The
College of Surgeons should adopt the same proceeding, and
thus the regular practitioner would have some means of con¬
vincing his patients of the incursions of those who may as¬
sume the titles, and usurp the rights of men who are duly
qualified. Besides, it is very easy to fine those who com¬
pound prescriptions, and no difficult matter to detect them.
As matters now exist, the general practitioner is not the

56 Original Communications .

compounder of prescriptions, he has merely to depend on re*
tail, and his private practice, for the support of his family.
The chemist and druggist have become the apothecary, in
open violation of the provisions of a certaifi Act, and under
the cognizance of a Society which was instituted for the re¬
gulation and protection of the Apothecaries. Again, the
sale of drugs is nearly destroyed by patent medicines ; and
the incorporated guardians of the profession of pharmacy,
have never attempted to remove this evil. They have never
petitioned the Government for the prevention of quackery,
nor have they, nor the other heads of the medical profession,
respectfully remonstrated in consequence oi the direct insult
offered them, by the toleration of quack nostrums. They
have never informed the public nor the legislature, that edu¬
cated medical men are the most likely persons to discover
the effects of medicines : and that patent medicines are
palmed upon society by ignorant and illiterate individuals.
If pusillanimity prevent an appeal to the legislature, justice
and humanity ought to induce an appeal to the public, and
the evils of quackery and villany be fairly exposed. I am not
factious or querulous, but I fearlessly maintain, that the
promised rights, which I naturally expected as a member of
the College and of the Hall, have no existence, and that
those who have never been educated have had as many ad¬
vantages, and much more, than those who qualified, and re¬
ceived diplomas in surgery and pharmacy. As the profes¬
sion is now constituted, a man cannot select a worse mode of
life, than that of a general practitioner, and the ranks are
daily augmenting, as if fame and fortune awaited the acqui¬
sition of a testimonial. What a delusion ! It would be really
much better for a man to embrace any other mode of pro¬
curing a livelihood than become a general practitioner, as
matters are now managed in this country. Ihe young prac¬
titioner expects an instant influx of business, but a few weeks
experience will convince him to the contrary. He is opposed
by the chemists and druggists on the one side, and by the
hospitals and dispensaries on the other. His in-door prac¬
tice is destroyed by the former, his out-door as completely by
the latter. The middle and lower classes of society, who
form the patients of the general practitioner, will apply to
the chemist for advice and medicine, or to the hospitals and
dispensaries, where there is immediate attendance, and so
forth, without any expense. How many general practi¬
tioners are oppressed and ruined by these causes ? How
long shall matters thus continue ?

I am, Sir, Yours, &c.

A General Practitioner.

times of Poisoning by Morphine , Opium and Brucine . £>7

MONTHLY SYNOPSIS OF PRACTICAL MEDICINE.

Royal Academy of Medicine — May 12.

1. Cases of Poisoning by Morphine , Opium , Brucine. By MM.
Orfila, Marc, and Mestivier. — Physiological Experiments on Pulmo¬
nary Insufflation. By. M. Piorry. — M. Orfila related the case of
a young* doctor who swallowed, at 6 o’clock, a. m., twenty- two
grains of acetate of morphine, dissolved in water, and received no
assistance until 4 o’clock, p. m., when M. Orfila was called to see
him, and found him cold, in a profound coma, and with a trismus
that prevented the power of deglutition. He had a most intense
pruritus or itching of the skin \ the pupils were feebly dilated. M.
Orfila thought it right to note this circumstance, because he said
in his work that, in poisoning by opium, the pupils are sometimes
dilated and sometimes contracted ; and eight days ago he saw
such contraction in a case in which an ounce and a half of lauda¬
num had been taken. The pulse, in the case under notice, was
from 120 to 125 j respiration precipitate and stertorous occa¬
sional convulsions; loss of intellect. He considered the patient
was to perish, as it was too late to administer an emetic, either by
the stomach or by the veins. Venesection, to the quantity of six
cupfuls, was performed, and during the flow of blood the tem¬
perature of the body increased a little ; this was the only amelio¬
ration that could be obtained at the moment. The rest of the
treatment consisted of sinapisms to the feet ; frictions strongly ammo-
niacal to the inside of the thighs ,• an irritating enema with six grains of
tartarized antimony ; acidulated drinks, alternated with a strong infu¬
sion of cofee. The injection was returned immediately 5 there was
a difficulty of swallowing the drinks ; the rest of the treatment
was executed. .At 10 o'clock at night the patient recognised M.
Orfila, and spoke feebly 5 the following morning was very well $
speech had returned 5 and the fourth day afterwards was entirely
recovered.

M. Mestivier lately saw a case of poisoning, by two ounces and
a half of laudanum, and found on dissection as much pulmonary
congestion as in pneumonia ; a fact noticed before by Orfila.

M. Marc related a case of poisoning by brucine, which was fol¬
lowed by insupportable trismus j and he thought M. Orfila should
have injected the stibiated tartar through the median vein. M.
Orfila replied, that he had regarded the case as hopeless, and that
such an attempt was useless, and that such injection into the veins
was far from being dangerous ; it required a certain hability which
every one did not possess. M. Marc cited a case in which a piece
of tendon of veal was arrested in the oesophagus, and nearly pro¬
duced suffocation. The injection by the vein excited vomiting
very promptly, and expelled the foreign body.

M. Piorry announced that he had made numerous experiments.

VOL. III. NO. 13.

■I

Synopsis of Practical Medicine .

and among them, that the insufflation of air in the lungs of rab¬
bits does not cause death, as is generally imagined. In such case
or where the trachea is open for the introduction of a canula, the
blood penetrates the aerial conduit, becomes frothy, and that this
froth is, perhaps, the cause of asphyxia*, that the insufflation of
the digestive tube by the rectum or stomach, is a remote cause of
death, by preventing the descent of the diaphragm ; that insuffla¬
tion does not produce inter-lobular emphysema of the lungs $ that
when it is extreme and kept up, the pulmonary surface is lace¬
rated, the pleura elevated, and sub-pleural emphysema formed ;
that the pleura of rabbits will be torn if the insufflaton be conti¬
nued 3 but that in sheep and man this membrane resists a long
time ; that in three cases out of five the insufflated rabbits did not
present pneuma-thorax 5 that pulmonary crepitation is a morbid
phenomenon ; that it does not accord with the opinion of M. Pre-
dagnel, as to the presence of inter-lobular emphysema, but upon
an abundant froth formed in the air passages at the approach of
death 3 that the pulmonary crepitation in dead bodies corresponds
in degree to the quantity of pulmonary froth ; that this froth is
the material cause of death of the greater portion of those who die
of asphyxia. M. Piorry established these facts conjointly with M.
Bose, by numerous experiments and multiplied researches on dead
bodies. This establishes the distinction between asphyxia by sub¬
mersion, if quick or slow, with or without froth. And M. Piorry
thinks, that in persons who have been submerged without agony,
it is good before insufflation be resorted to, to hold for a few in¬
stants the trachea inferior to the thorax, for the purpose of allow¬
ing the escape of the water contained in the air passages. In
omitting this precaution, the water becomes frothy by insufflation,
and death is rendered more certain. M. Barthelemy said that pul¬
monary emphysema was not so dangerous as was supposed 3 for
horses have the whole or part of the lungs emphysematous, and
vet live for a lone; time. — Lancette Franeaise.

Society of Practical Medicine — May 7*

2. Antidotes for the Poisonous effects of Hydrocyanic Acid. — MM.
Cottereau and Valette had poisoned dogs with prussic acid, and
recovered them by applying a lotion of chlorine (du chlore) to their
noses. M. Orfila had witnessed the experiments j and M. Gillet
had seen the same effects produced by liquid ammonia applied to
the forehead.

3. Observations on Pruritus Vidvce. By Dr. Ruan. — The subject
of this case had been lately married, but did not become preg¬
nant for some time after, she first complained of strangury, for
which the usual remedies were resorted to, and at length was at¬
tacked with such an itching about the pudenda as made her mise¬
rable. Purging, with various articles, diuretics, drinking largely
of mild diluting fluids, with a free use of opiates and rest, pro¬
cured some mitigation of her sufferings, but nothing like a cure
was effected until the balsam of copaiva was used. This, in doses
of twenty drops three times a day, acted like a charm and she was

Observations on Pruritus Vulvce.

completely relieved. She has two or three times since had slight
attacks of strangury, for which the balsam has been used with
immediate advantage. I did not meet with another case like this
until June, 1825. In this instance the patient was far advanced
in pregnancy, and the strangury was by no means an urgent
symptom, but the itching was so intolerable, that although a de¬
licate young woman, she could scarcely refrain from scratching in
my presence. It did not occur to me to use the balsam until I
had tried bleeding, purging, diuretics, and opiates freely and re¬
peatedly, together with various applications to the part. She also
washed the parts with lead water, and with borax dissolved in
water ; it was applied finely powdered. Lime-water, warm milk
and water, and poultices of bread and milk, were tried. Indeed, I
may say, every thing I could think of, or that was suggested to
me by some of my medical friends, was resorted to without any
advantage. I had somehow lost sight of the balsam, but at length
it was brought to my recollection, and again answered perfectly.
My patient was cured by it directly ; and I now considered myself
in possession of a very important, if not an infallible remedy for a
distressing disease. But the very next case, which occurred in
September, 182 6, shewed the fallacy of this opinion. This wo¬
man, like the last, was near her confinement ; the balsam failed
entirely, but she was relieved by washing with a solution of borax.
My fourth case was that of a woman about seven or eight weeks
after delivery. Her confinement had been -protracted for such a
length of time by various complaints, and she was at last attacked
with this very troublesome one, which set at nought all the reme¬
dies I had before made use of ; but she was relieved by carbonate
of soda, in small repeated doses. My fifth patient was delivered
in July last. She was a woman of delicate health 3 suffered from
a tedious labour, and did not receive all the attentions her situa¬
tion called for. She had repeated attacks of fever during her con¬
finement, and, in the third week the distressing complaint came
on, with strangury, which called for the repeated use of the ca¬
theter. In addition to the remedies that had been tried in the
preceding cases, an infusion of the common laurel was used as a
wash, at the suggestion of a medical friend, but without effect.
She could be kept in tolerable comfort only by the constant appli¬
cation of bread and milk poultices, and large doses of laudanum.
I now had recourse to the lapis caliminaris, and had the part
dusted with it, but she complained of this producing smarting and
pain. Being desirous of trying it further, I mixed it with an .equal
quantity of powdered starch. She now bore it without complain¬
ing, and the itching gradually subsided. She continued the use of
it for a week or two. This was the only case in which the parts
were inspected by me. The swelling about the meatus urinarius
was so great, that I was obliged to use a very small catheter, and
the difficulty of passing this gave me a fair pretext for this exami¬
nation, which discovered no other mark of disease than what
might be attributed to the violent scratching. Having given this
short account of these cases, I refrain from any observations upon

Synopsis of Practical Medicine.

them, but I shall be much gratified if I succeed in drawing inform¬
ation from my fellow members. — North American Med. and Surg.
Journ., Oct. 1828.

4. Important Recommendation for the recovery of Persons Drown¬
ed. By MM. Magendie and Dumeril. A report made to the
Academy of Sciences, April 20th, 1S29. This memoir was the
production of M. Leroy, and was submitted to the examination of
the above named physiologists. The author announced, that air
if forced into the trachea of certain animals, caused sudden death.
The examiners confirmed this assertion. These facts are highly
interesting, because many authors recommend inflation of the
chest with the mouth, with the syringe, or bellows. The exami¬
ners agree with the author, that air forcibly blown into the lungs,
will lacerate the delicate tissue of these organs, pass into the ca¬
vity of the pleura, press on the lungs and impede considerably the
function of respiration. This is easily proved, by injecting air
through an intercostal space, by a canula. The tissue of the lungs
in dogs is dense, and hence these animals are less injured by in¬
sufflation than others. MM. Dumeril and Magendie have shown
by experiments on dead bodies, that the insufflation of air through
a tube introduced by incision into the trachea, will rupture the
tissue of the adult lungs, and the air will pass into the cavity of
the pleura j with the infant, the lung is more dense, and opposes
such resistance as not to be ruptured by insufflation. The re¬
porters assert, that not more than two-thirds of the drowned per¬
sons, who were assisted during the last five years in Paris, were
restored to life 5 and they think insufflation of air in the usual
manner, is one of the causes of want of more success. They agree
with the author, that the chest and lungs are passive during arti¬
ficial respiration, but active in natural respiration and hence the
author proposes to imitate nature, by placing fine needles on the
attachments of the diaphragm, and in passing a current of galvan¬
ism through that muscle to excite its contraction. By the action
of the diaphragm, air will be introduced. The reporters are con¬
vinced of this fact, from experiments made on drowned animals,
all of which were revived, if submersed under the period of five
minutes duration. But they are not quite certain that the reco¬
very was to be attributed to the galvanism ; it may be possible,,
but it would be imprudent to affirm it. As a galvanic apparatus
may not be always at hand, the author proposes a very simple
proceeding, which consists in putting in action the elasticity of the
ribs, their cartilages, and the parietes of the abdomen ; in fact, in
making moderate pressure on the abdomen and thorax. When
the thoracic and abdominal cavities are compressed, the vitiated
air of the lungs is expelled, the pressure ceasing, the ribs, dia¬
phragm, and abdominal parietes return by their elasticity to their
former situation, the chest is dilated, and air is aspired. By this
manoeuvre, the blood, stagnant in the vessels of the abdomen and
chest, is put in motion towards the heart and lungs 5 the contrac¬
tility of the diaphragm put in play, is excited, the convulsive con¬
tractions of this muscle become more regular and life re-appears.

Case of Tic Douloureux . 61

By this method, and by heat and frictions to the abdomen, Mag-
gioni of Padua, restored an infant that had been half an hour
under water.

This plan appears to the reporters likely to be employed with
success, from the facility with which air is introduced into the
lungs, and expelled from these organs. It is a powerful reason,
which ought to render us very reserved in using insufflation of air
in the lungs. The reporters, however, are of opinion, that unless
persons be seized with syncope, who remain longer than five mi¬
nutes under submersion, or be affected with syncope at the mo¬
ment of submersion, recovery cannot be expected. They do not
speak decisively on this point. They think insufflation of air, as
practised by common people, highly dangerous. The reporters con¬
clude thus : 1st, that it is desirable, that the ordinary treatment,
and especially pulmonary insufflation, should undergo some modifi¬
cations. 2d, that this insufflation can, in certain cases, be usefully
replaced by the means proposed by M. Leroy, which require no
medical knowledge, no particular apparatus, no loss of time, and
are accompanied with no danger ; and, finally, that this memoir is
worthy of insertion among those of learned correspondents. The
conclusions of the report have been adopted by the Academy. Dr.
Bernard has offered some reflections on this memoir, and the re¬
port, in the public paper denominated La Globe, of the 25th of April.
He asserts that the practice has been known a long time, and
adopted more frequently than the reporters imagined. It was de¬
scribed by all writers of the last century, especially by De Haen,
in 1771, and it was the common practice of the watermen of Paris,
in 1772, by which they restored many drowned persons to life,
sometimes after a quarter of an hour’s submersion. M. Bertrand
details the experience of a friend, of the highest veracity, who re¬
suscitated dogs by this method, and also the human species. —
Lancette Franpaise .

College of Physicians — June 1.

5. Case of Tic Douloureux, by the celebrated Locke. — A literary
curiosity of great interest was laid before the meeting ; a case de¬
tailed by the celebrated Locke. This curious document was ob¬
tained by Dr. C. M. Clarke, from Lord King, and presented to the
College. The original MS. was laid upon the table, and consisted
of a French almanack, bound up with a number of leaves which
had been originally blank, but which were filled with various notes
and memoranda in the hand-writing of Locke, and among others
the ease in question.

It has often been doubted whether Locke ever practised as a
physician, but the question is now set at rest. In Lord Grenville’s
pamphlet, entitled “ Oxford and Locke,” he remarks, that "in the
printed life of Locke, commonly prefixed to his works, we are
told that he applied himself, at the University, with great dili¬
gence, to the study of medicine, f not with any design of practis¬
ing as a physician, but principally for the benefit of his own con¬
stitution, which was weak.’ ” His lordship goes on to observe,
that no such motive is ascribed to Locke by Le Clerc, from whom

62 Synopsis of Practical Medicine .

our knowledge of his private history is principally derived ; nor,
indeed, is the supposition at all probable. Le Clerc, however, as¬
serts “ that Locke never practised physic for profit, though he was
highly esteemed by the ablest phvsicians of his time.' In proof
of this, we need onlv quote the following passage from Syden¬
ham : — “ Nosti preterea quam huic meae methodo suffragantem
habeam, qui earn iutimius per omnia perspexerat utrique nostrum
conjunctissimum, Dominum Joannem Locke ; quo quidem viro,
sive insenio judicioque ac-ri et subacto, sive etiam antiquis, hoc est,
optimis moribus, vix superiorem quemquam, inter eos qui nunc
sunt homines, repertum iri confido, paucissimos certh pares. ’

Lord Grenville savs, that the assertion that Locke had never ac-
tually practised, is ‘’unquestionably erroneous; and the case
which we subjoin proves the correctness of his opinion.

Locke was called to see the Countess of Northumberland, who
was the Ambassadress at Paris, Dec. 2, 1677- The case was evi¬
dently one of tic doloureux. It is entitled Convulsio, and the symp¬
toms are thus described : Acute pain over the right cheek up to
her ear. In the intervals, pain in the teeth. She was warned of
the approach of the fits, by a throbbing she felt in the lower jaw,
where she had a tooth drawn the previous summer. The fits had
been preceded bv three or four days of ordinary tooth ache. There
was no swelling, or inflammation ; no flux of rheum ; no external
swelling; no indication for bleeding ; besides which, that remedy
had been tried some months before, without effect.

" It being night,” says Locke, “ I thought at present there was
nothing to be done but to give her ladyship present ease by some
topical application.’’ He thought first of a blister, but paused till
he had made some more general evacuation. He therefore ordered
an opiate embrocation to the gums, which gave her much relief.
On the following day (for the case is related in the form of a
journal) be again deliberated about the propriety of the exhibition
of an aperient, but the extreme cold weather made him conclude in
the following manner. “ I apprehended that a purge, w'bich I
thought very necessary, would be dangerous in such a season, be¬
cause, if weak, it might cause disorder with very little or no eva¬
cuation ; if strong, in so delicate a constitution I could not tell
how to venture ; besides that, I feared she might take cold in the
working, which might increase the mischief.”

The result of his prudent caution was, that he prescribed a drop
of aethereum terebinthinae on a little lint, which she applied to the
gap whence the tooth had been extracted, but it did not allay the
pain, and he then ventured upon the purge, and gave a mercurial
one, which “ wrought very well seven or eight times.”

After the operation of this medicine, he prescribed an opiate
draught, and during the following night she enjoyed some sleep.
With occasional exacerbations, the fits upon the whole began gra¬
dually to abate in severity. He describes most accurately what
we all know to be the truth in this cruel disease ; how various
blight causes bring on the paroxysm of pain ; bow touching any
part of the affected side of the body (even the foot of that side).

Observations on Insanity.

talking, or opening her mouth to eat, brought on the twitches of
pain. He reasons upon this strange nervous affection very sen¬
sibly, considers what the original mischief was, and how far the
extraction of the tooth had to do with the increase of the malady,
and concludes that the root of the mischief lies in some harm done
to the nerve connected with the tooth. The tooth itself, when it
was drawn, was found to be a sound one, and its extraction so far
from a remedy, that it increased the violence and frequency of the
fits. Locke continued in attendance till December 16th, a space
of a fortnight, when he pronounced the lady ambassadress “ quite
well.”

On Monday, Dec. 20th, he writes in his MS. — Memorandum :
that my lady ambassadrice’s gums itched vehemently after the
pain was gone, and did so for several days after j and used to do
so for several years before any tooth wras drawn.”

6. Observations on Insanity. By Sir H. Halford. — After the above
had been read. Sir Henry Halford stated, that, in consequence of
having understood that there was no paper for the present evening
(for Locke’s case had only just been received), he had hastily
thrown together some observations on insanity. As there was
sufficient time left, he would read them to the meeting.

Sir Henry observed, that, in the closet scene in Hamlet, the
following words occur : —

“ - - Extacy !

My pulse, as yours, doth temperately keep time,

And make as healthful music ; ’tis not madness
That I have uttered ; bring me to the test,

And I the matter will reword — which madness
Would gambol from.”

The circumstance to which the learned President particularly
alluded, was the expression “ I the matter will reword and he
proceeded to relate the following case in illustration of the just¬
ness of Shakspeare’s test.” He was called, last January, to a
gentleman then in a state of mental derangement. A short time
previous to his illness, he had sent for his solicitor, and given di¬
rections about his will. He stated his intention of adding 500 1.
a-year to his mother’s jointure, and of' leaving various legacies ;
adding, that his friend, the solicitor, was to be residuary legatee.
The solicitor, in the most honourable manner, told him that he
could not consent to the last part of the arrangement, unless, at
the end of six months, he continued of the same mind upon the
subject. In the interval he was attacked with mental excitement,
for which he was attended by Sir Henry Halford and Sir G. Tut-
hill. One day, on asking him how he did, he appeared calm and
collected, and answered that he was very ill, and only anxious to
settle his affairs and make his will. Next day he repeated the
same expressions, in a tone and manner which induced his attend¬
ants to comply with his request, and the solicitor was sent for,
who brought with him a will drawn up according to the instruc¬
tions he had formerly received. This was read over to the gentle¬
man, and being asked, after each clause, if such was his meaning,

04 Synopsis of Practical Medicine.

he distinctly replied — yes, yes. The will was then executed, being'
witnessed by his physicians. On going down stairs. Sir Henry
observed upon the unpleasant circumstance of the medical at¬
tendants becoming involved in a deed which was likely to become
the subject of litigation, and proposed that they should return to
him, and apply Hamlet’s test, by ascertaining whether he could
“ reword” his will. With regard to several of the clauses this
was the case; but he stated that he had left one individual ten
thousand pounds, whereas he had only left him five thousand ;
and on being asked to whom the residue of his fortune was to go,
he answered, “ to the heir at law, to be sure !” Being asked who
was the heir at law, he replied that he did not know. Thus, said
Sir Henry, he could not tf reword” his meaning, but “ gaipbolled”
from the matter.

The author then adverted to the fidelity of the pictures drawn
by Shakspeare, so justly characterized by Johnson as the poet of
nature. He also alluded to the writings of the ancient poets, as
containing many descriptions which might be recognized by an
attentive observer. He had himself seen two of the cases men¬
tioned by Horace, illustrated to the very life. One, a man of high
rank, supposed himself present at a theatrical entertainment, and
Sir Henry had heard him urging Garrick to exert himself in the
part of Hamlet, which he supposed him then to be acting. The
other case was that of a gentleman of large fortune, who possessed
himself of every thing he could get, but parted with nothing. He
was brought from the Court of King’s Bench, having refused to
pay for a picture which he had bought, and which was valued at
261500. Sir Henry told the jury, that if they would go to the
gentleman’s house, in Portland Place, they would find .3650, 000
worth of property ; among the rest this very picture, with baby
houses and baubles strewed over his dining-room.

The paper was listened to with great interest, and this was in¬
creased by the very animated manner in which it was read by the
learned President.

Hunterian Society. — May 27, 1829.

7. Dr. F. Ramsbotham related a case, which, though not sin¬
gular, was interesting, inasmuch as it showed what nature could
effect in cases of extra-uterine foetation. The woman is set. forty-
six, and has had three children. In July 1819, she became preg¬
nant the last time. The enlargement was most perceptible in the
left side. No motion had ever been perceived in the foetus. At
length uterine pains came on, with a sanguineous dribbling, and
the discharge of some pieces of solid matter. A secretion of milk
in the breast ensued, and continued for some time. In a few
months she became regular, but she lost flesh and sunk in strength,
and derived no benefit from the means ^employed. At the end of
1827, she ceased to menstruate. In April 1828, the excretions
from the bowels became foul and offensive, and the tumour began
to diminish. About this period, bones began to appear in the
faeces : a thigh-bone, vertebrae, bones of the skull, &c. Three
weeks ago the bones ceased to pass ; the motions have become

Remarks on Secale Cornutum 9 Ergot of Rye . 65

natural, and the woman is pretty well. The doctor adverted to
six other cases that had fallen under his care : in three, death oc¬
curred from rupture of the sac in another, the child died at eight
months, from the mother’s having a fright — she carried it till ten
months, and died : the foetus was found putrid. In another, the
whole foetal bones passed per anum, and the woman recovered.
In the sixth case, the foetus had been retained twelve years, and
within this period the doctor has twice attended the "woman in
confinement.

Mr. Macmurdo related a case of lithotomy, in which the opera¬
tor, on introducing the gorget, observed that it passed the calcu¬
lus. Instead of being in the bladder, it was found encysted in the
membranous part of the urethra. It was the size of a large wal¬
nut, flattened, with two cornua. It was supposed to have escaped
from the bladder, when small, and to have become imbedded in
the membranous part of the urethra. The symptoms of stone
had been very slight. Mr. Macmurdo also reported an instance
of extirpation of the thyroid gland. It had been greatly reduced
by iodine, and then remained stationary. The woman’s health
had been impaired by the remedy, and she entreated the removal
of the gland. She appears to be doing well.

Dr. Hodgkin said, that he attended the meeting for the purpose
of mentioning that he had learnt, since he directed the attention of
the Society to the subject of retroversion of the valves of the aorta,
that M. Bertin had previously described the same occurrence. His
words are, “ Nous avons vu les sigmoides dejetees et en quelque sorte
renversees vers les parois de Vaorte. Cependant nous avons observe
aussi une disposition inverse pour ces dernieres, conime si pendant la
systole de sang les avait resoulees vers la cavitd ventriculaireN

Dr. Ramsbotham described a case of polypus uteri, in a young
unmarried woman. The peculiarity of the case consisted in the
frequent retraction of the tumour within the uterus, so that at
times it could not be felt.

Mr. Cooke reported a very aggravated form of urticaria febrilis.
The swelling of the limbs and face, and the pain of the joints, were
extreme, and the eruption was much more vivid than ordinary.

FOREIGN SOCIETIES.

8. Remarks on Secale Cornutum. , Ergot or Spurred Rye. By R. M.
Houston, M.D. — Dr. Houston’s remarks are intended to prove that
the secale cornutum exerts a poisonous influence upon the child,
and its use is followed by many unfortunate results. — “ My own
experience,” he observes, “ with the article convinces me that it
is a most dangerous and destructive drug. In making this de¬
claration, as well as the statements that follow, I do it under the
fullest sense of the great responsibility which every man ought to
feel when giving testimony upon a subject which involves the
lives of many of his fellow-creatures and it is this feeling, toge¬
ther with the firmest conviction that the medicine is now doing
incalculable mischief, that impels me to the task of laying this'

VOL, III. NO, 13,

66 Synopsis of Practical Medicine.

paper before you — Dr. Houston then details the vast pre¬
ponderance of still-born to living infants in the practice of Drs.
Church, Holcombe, Ward, Hall, Moore, Hossack, and other
American practitioners. Dr. Holcombe asserts, that “ it has
caused several fatal demonstrations, and, from what he has seen
and heard, that more children have perished by the injudicious
use of the ergot during the few years which have followed its in¬
troduction into the practice of this country, than have been sacri¬
ficed by the unwarrantable use of the crotchet for a century past.”

“ The injudicious use,'’ means the exhibition of 'scruple doses,
which are recommended by all our most judicious writers. The
only explanation of its fatal effects are given in an extract from
Dr. Hossack’s letter to Dr. Hamilton, 6f Edinburgh. It is thus :
“ I believe its operation, when sufficient to expel the child in
cases where nature is, alone, unequal to the task, is to produce so
violent contraction of the womb, and consequent convolution and
compression of the uterine vessels as very much to impede, if not
totally to interrupt, the circulation between the mother and
child.”— Our author does not concur in this opinion, but thinks
that the bad effects of the medicine are produced by the powerful
and constant compression of the placenta between the firmly con¬
tracted uterus and the solid parts of the lightly compressed child,
so that there is a total suppression of the important functions
which this organ is known to possess before birth. It is likewise
•possible that some mischief may be caused by compression of the
child’s brain for a longer than ordinary period, from the perma¬
nent contraction of the uterus not suffering the head to recede at
regular and ordinary intervals, so as to relieve this condition by
the natural elasticity of the parts.” Dr. Houston endeavours to
reconcile the exposition of his opinions to those of the most emi¬
nent practitioners in his country, and this he does by asserting
that they have little opportunities of seeing bad cases, as their
practice is among the affluent. On the whole, he does not think
the ergot invariably dangerous. This paper was read before the
College of Physicians, in 18*28. — North American Medical and Sur¬
gical Journal, Jan. 1829.

We are much surprised on perusing the above remarks, as we
believe the most eminent men in Europe, as well as America, do
not assent to them. Many writers in this country and on the Con ¬
tinent, and most of the eminent obstetricians in this city, are at issue
with the remarks before us. On this side of the Atlantic, the ergot
is not exhibited unless in natural labour, where the head of the in¬
fant has descended into the pelvic cavity, and where the admeasure¬
ment of the pelvic outlet is natural. In such cases we apprehend

* In no other place in the United States, nor, perhaps, in the woild, is er¬
got so much praised, and by so. distinguished men, as in Philadelphia ; and in
no other of the principal towns in the United States, as far as their bills of
mortality have come under my notice, is the number of still-born children in
so large a proportion to the whole number of deaths. Indeed, this item in our
hills of mortality has become so glaring as to attract the notice of the most
cursory reader of our newspapers. Comment is unnecessary.

Redundancy of Organs in the whole of a Family. 67

the remarks of Dr. Houston are perfectly inapplicable. In this
country the ergot is administered, in divided doses, in the form of
decoction, and its effects carefully watched, and never allowed to
become violent; and the formula generally in use is ^j. of the ergot,
and 3 i i j * of water, slowly reduced by boiling to one half. The dose
a table-spoonful every quarter of an hour, until the effect be pro¬
duced. In our own practice we add milk and sugar to the decoction,
which addition renders it more agreeable to the patient. \Ve have
given it thus in many cases, and never have observed any bad
effect on either patient or offspring. The result of the observa¬
tions of many recent writers, and of many of our most extensive
practitioners, detailed in the proceedings of our medical societies
in this city, are in direct opposition to the remarks of Dr. Houston.
As a further proof of the efficacy of the remedy, we may mention
that our surgical instrument manufacturers very loudly complain,
t( that the sale of obstetric instruments, has almost ceased during:
the last year, in consequence of the efficacy of this new medicine.”

9. Observations on Pathology , Anatomy and Physiology . By Dr.
Holl. — Redundancy of Organs in the whole of a. Family.— A healthy,
well-formed woman gave birth to four infants, offering anomalies
in conformation, and to two others which were well formed ; the
third infant was a male, had six fingers on each hand, the super¬
numerary one attached to the base of the little finger, the second
and third toes of both feet were confounded together. The meta¬
carpal bones of two toes of the fourth infant, also a male, formed
an acute angle, but were not confounded, and the same deformity
existed in the fifth infant, which was a female. The sixth infant
was a female, and had six toes on both feet ; those on the right foot
are distinct; the metacarpal bones of the fifth and sixth toes of
the left foot are disposed like those of the fourth and fifth infant ;
the first phalanges of these two toes are united. — Meckel: Archiv.
fur Anatomie und Physiologie , 1828. No. 2, p. 177-) Bulletin des Sci¬
ences Med, Avril, 1829.

10. Malformation from defect of plastic force. — A well-formed
man, of a feeble constitution, a valetudinarian, and unmarried, is the
father of three infants, by different women, all of whom were
healthy and well-formed ; the first infant was a delicate female,
deprived of the auricular cartilages ; the second was a male, very
feeble and a hypospasdias, the urethra opening on the inferior sur¬
face of the penis ; the third infant was still-born, and had hare-lip
and cleft palate. Without doubt, the father was the cause of these
wants of development. The author institutes a comparison be¬
tween the phenomena of electricity, and those of the generative
system, and he concludes, that generation is to be considered an
electrical act, founded on the different polarity of both sexes, the
positive electricity predominating in the male and the negative
electricity in the female. The author describes another case, in
which the father had a variegated iris, and all the children that re¬
sembled him had the same deformity.

Another case is related, the particulars of which were as fol¬
lows : — A healthy man married a female, in whose family strabis-

68 Synopsis of Practical Medicine .

inns was hereditary, and some of whom had deafness. The firs*
infant was deaf and dumb, a male j two daughters had no disorgani¬
zation } the fourth boy was deaf and dumb, the fifth boy was
well-formed, and the sixth male was deaf and dumb.

11. On the Functions of the great Sympathetic Nerve , and its Im¬
portance in Pathology. By Professor Langenbeck. The learned
author considers the nerves of sense, as those of vision, smell, and
hearing, have need of another order of nerves, which do not pos¬
sess sensibility of themselves and are merely an accessory appa¬
ratus. Such are the ciliary nerves to the optic, and such the fifth
pair to the olfactory nerve : the great sympathetic presides over
the functions of vegetative life, but it is directly connected with
all the organs of sense, and it is necessary to attribute to it an ac¬
cessory part in the sensitive functions. It forms a sort of conduc¬
tor between vegetable and animal life. Phe author applies these
views to the pathology of the eye, and especially to amaurotic
amblyopia, and amaurosis. This malady is often a constitutional
affection, which manifests itself sympathetically in the eye as if an
organic affection. The author demonstrates anatomically, how
the eye sympathises with parts more or less remote, through the
sympathetic nerve $ it accounts for the action of the iris, and re¬
futes the opinion thut the excitation is produced by light on the
retina, and propagated by the optic nerve to the iris ; and, in fine,
the author thinks that light excites directly the ciliary nerves of
the iris. The dilatation of the pupil by belladonna explains this
action of the ciliary nerves, and if fomentations or gargle be em¬
ployed, the effects depend on the great sympathetic and its irra¬
diations in the iris. The nerves of the retina and optic nerve are
of no importance in the motions of the iris, the irradiations of the
great sympathetic nerve, which establish the connexion between
the eye and other organs more or less remote.

Amblyopia and amaurosis are sympathetic and idiopathic. Laeh
species offers different modifications, which depend on the struc¬
ture of the retina and optic nerve. The retina receives the ramifi¬
cations of the central artery, which are accompanied by neives con¬
tinuous with those which accompany the trunk of the artery.
This vascular and nervous apparatus presides over the vegetative
life of the retina 5 the capillaries of the central artery ot the re¬
tina are to the eye, what the cerebral vessels are for secretion and
reproduction of the substance of the brain. Ihe vitality of the
visual organ is organic and animal 5 derangements can be pro¬
duced in one and the other mode of vitality ; and in each of these
derangements we can admit a fundamental principle, a reciprocal
relation between the vascular and nervous systems. Both systems
are confounded in one, and the excitation of the one influences the
state of the other. In admitting both these principles of vitality
we can divide amauroses into four classes. 1. Sympathetic amau¬
rosis, determined by organic vitality. 2. Sympathetic amaurosis,
determined by the nervous system. 3. Idiopathic amaurosis de¬
termined by organic vitality. 4. Sympathetic amaurosis, deter¬
mined by the nervous system. M. Langenbeck regards as apper-

Fracture of the Neck of the Thigh-bone,

taining to the first class, amaurosis caused by derangement in the
abdominal circulation, by abdominal plethora, orgasm, venous,
turgescence, suppression of the menstrual or hemorrhoidal dis¬
charges,, this which happens in the last months of utero-gestation,
and in hypochondriacs. The disease induced by those causes
comes on slowly, and is to be treated by low diet, small abstrac¬
tions of blood, but copious depletion if there be passive congestion
or dilatation of the veins 5 temperance to be observed, sulphur and
cream of tartar if the congestion be not active, sulphur and guaia-
cum with Richter’s pills, if there be obstruction. Amaurosis
with epilepsy, clonic and tonic spasm, hysteria, does arise from a
simple dynamic or vital origin. The treatment is that of epilepsy
and the other diseases.

Amaurosis caused by plethora and attended with headache, sensa¬
tion of pressure in the eye, and excessive sensibility to light, pre¬
sents the iris in a state of paralysis. Amaurosis may be caused by
hemorrhages, excessive menstruation, salivation, excessive sper¬
matic evacuation and may likewise be induced by the suppression
of coryza, in gouty and rheumatic subjects, and by the repercus¬
sion of cutaneous eruptions. The disease may commence by acute
inflammation of the retina, or by a chronic phlogosis with an exu¬
dation, and with an exaltation or diminution of the vitality of the
iris. The antiphlogistic plan must be pursued in such cases, and
mercury employed if there be any exudation. Arthritic amaurosis
commences with a violent inflammation of the fibrous parts of the
globe of the eye, and is soon propagated to the vascular mem¬
branes ; the disease terminates by an exudation on the iris, with
inflammation of this membrane, occlusion of the pupil, hypo-
pium, or an affection of the capillary sanguineous system of the
optic nerve. Purgatives, especially the saline, mercury, and arti¬
ficial ulcers on the skin, are the best remedies. If amblyopia, of
amaurosis be caused by gastric irritation, the treatment must be
directed against such irritation. If these diseases be caused by
mechanical violence to the sub-orbitary region, there is first, irri¬
tation or inflammation in the capillary system of the sub-orbitary
nerve, and those are propagated to the ophthalmic ganglion and optic
nerves. If amaurosis arise from organic disease of the brain or cra¬
nium, the optic nerves, and retina are affected directly, and also in¬
directly by the irradiations of the great sympathetic nerve. — ( Neue
Bibliothekfur die Chirurgie und Ophihalmologie , Tom. iv. p . 729).

FOREIGN HOSPITAL PRACTICE.

Hospital Beaujon.

12. Fracture of the Neck of the Thigh-bone ,• power of elevating the
limb , and of locomotion remaining . — A female, aged sixty, was ad¬
mitted with the right inferior extremity two inches shorter than
the other j the foot turned outwards, transverse mobility, and
projection of the great trochanter. In fact, all the signs'which left
no doubt of fracture of the neck of the thigh-bone. Crepitation
had been heard by M. Blendin, nevertheless the patient walked

70 Synopsis of Practical Medicine.

with a crutch, but without difficulty, or pain of the fractured
member. The injury had not been treated before her entrance
into the hospital. The woman was placed in bed, but there was
no means resorted to, nor was the limb even placed in the in¬
clined plane. This was not the only example of' such treatment.
A similar case occurred some time since, and the patient was al¬
lowed to rise and walk about daily, and left the hospital with the
limb considerably shortened. — Lancette Francaise , No. 83, Mai 12.

Hotel Dieu.

13. Explosion of a Pistol in the Mouth ; lacerations of the soft
parts , and Fracture of the inferior Maxillary Bone. — A young sol¬
dier was admitted on May 8th, who had attempted to commit sui¬
cide. He fired a loaded pistol through his mouth. He was im¬
mediately conveyed to the hospital. He asserted that he did not
fall or lose his senses after the injury. It was impossible to dis¬
cover the course of the ball} the inferior maxillary bone was frac¬
tured on the median line ; there was an horizontal laceration of
half an inch at the right labial commissure, and two other lacera¬
tions of three or four inches at the left half of the upper lip } the
lips were tumefied. During the application of the dressing, which
was very simple, the patient perceived a heavy body fall from the
pharynx into the oesophagus. He was ordered to lose three cups
of blood. May 9th. Moral good ; pediluvium, venesection from
the arm } the lips are thick and livid ; pain very acute towards the
right maxillary condyle ; the patient answers all questions, and
speaks very intelligibly. The moment has not yet arrived to unite
the wounds of the soft parts, or to adjust the fracture. In this
case it is to be borne in mind, that the extremity of the pistol was
placed in the bucal cavity, and that the explosion produced two
distinct effects. The sudden dilation of the gas formed, by the
combustion of the powder, the impulse communicated from a pro¬
jectile, as it is impossible that the ball had fractured the jaw and
lacerated the lips ; it ought to have taken a direction backwards
and more oblique. We think all the injury observed externally
was produced by the violent shock of the air and of the gas, deve¬
loped at the moment of the explosion. It appears that suicides,
by a fatal instinct, apply their lips exactly on the circumference of
the pistol, and then the gas, having no exit, re-acts upon the pa-
rietes of the buccal cavity, with a violence which depends upon the
quantity and qualily of the powder. Such is the explanation of
M. Dupuytren. No tooth was injured 5 the mucous membrane,
on the internal surface of the maxillary bone was untouched. The
slight force of the ball is easily explained by the shortness of the
barrel of the pistol. The progress of this case is favourable. —
Op. Cit. p. 331.

14. Vesico- Vaginal Fistula . — This disease was induced by labo¬
rious parturition, and the actual cautery has been applied three
times (! !) since March 2S. A fourth cauterization was applied
on the 28th of April. The fistula contracted, and the urine gra¬
dually passed through the urethra. A complete cure was esta¬
blished. — Op. Cit. }). 332.

On the Efficacy of Camphor in Puerperal Mania. p\ w

If a catheter were continually left in the bladder in this case,
and the urine allowed to escape through the urethra, a plug being
placed in the vagina, as recommended by Dr. Cumming, of Glas¬
gow, a cure would be as speedily effected ; a mode of treatment
we have found efficacious in two cases during the last two years.

In one of those cases, the extremities of our four fingers readily
passed through the fistula, and the patient had not slept, accord¬
ing to her account, for six weeks. The tampon or plug, when
properly introduced, and placed against the aperture, prevents the
urine from escaping into the vagina, and producing irritation and
inflammation, and at the same time allowing it to collect in the
bladder, and pass off by the catheter. The instrument should be
open, and fluid allowed a constant escape, so that the parietes of
the bladder might be almost in contact, and thus the edges of the
fistula would approximate more closely, and the reparatory process
of nature would be more expeditious. Any obstetrician who has
seen this painful disease must shudder at the idea of the actual
cautery.' — Ed.

La Charite.

15. Crural Hernia. — A female, aged fifty, of a feeble and deterio¬
rated constitution, was admitted under the care of M. Roux, who
for a number of years laboured under epiploic or crural hernia, as
it was presumed. A private practitioner had attempted to reduce
it. The tumour was voluminous, indolent, and clammy, and pro¬
duced no inquietude. On examination, it was supposed that a little
serosity was contained in the sac, or that the intestine had spha¬
celated, and allowed a certain quantity of stercoraceous matter to
escape. There was little pain in the tumour, but the patient could
not bear the slightest pressure on the abdomen. The sac was di¬
vided, and contained omentum only, which was pale, indolent,
without any trace of congestion ; it was returned into the abdo¬
men. M. Roux considered the operation could not produce bene¬
fit, as he feared it w'as performed too late, and that the portion of
the intestine first affected was in a state of ulceration or inflamma¬
tion ; the operation was performed on the 4th of May, and the
patient died upon the 6th.

Autopsy. — On opening the abdomen, all the viscera were bathed
in a thick purulent serosity the mass of intestines exhibited nu¬
merous traces of recent inflammation ; the reduced omentum was
red and tumefied ; it is evident that peritonitis had been intense
and almost general ; the intestinal tube was distended with gas.

— Op. CiL Mai 14.

16. On the Efficacy of Camphor in Puerperal Mania. — The form of
disease in which Dr. Berndt exhibited the medicine is accompanied
by inordinate sexual propensities, or even actual nymphomania — a
symptom which he thinks characteristic of idiopathic puerperal
mania. We seldom observe this symptom in this country. He
relates four cases in which the camphor was most effectual. He
administered four grains every hour by the mouth, and in one case
gave eighty-eight grains in this manner. Twenty grains were in-

0 72 Synopsis of Practical Medicine .

jected into the rectum. Drs. Haslam Cox, Halloran, and Bur¬
rows, condemn the use of camphor in maniacal affections. The
cases of Dr. Berndt are related in the Journ. dcr Practischen Heil-
kunde , Nov. 1828.

17. Case of Caesarean Operation in which both the mother and child
were saved. — The operator in the following interesting case was Dr.
Muller, physician at Lowenberg in Silesia. He was called in July,
1822, to visit a woman who had been two days in labour, and
whom he found it impossible to deliver on account of the defor¬
mity of the pelvis. She was thirty-three years old, only three feet
tall, deformed in many respects, the legs and arms being dispropor¬
tionately short, the fore-arms, thighs, and shins somewhat crook¬
ed, the pelvis flat from before backwards, the chest well con¬
structed. The gravid uterus projected very much. The whole
body when he first saw her, was bathed in perspiration, and she
complained less of labour-pains, than of insupportable and conti¬
nual rending in the lower pelvis. The pulse was very frequent
and small ; and the waters had been discharged for twenty-four
hours. On examining per vaginam it appeared that the superior
outlet of the pelvis was of the form of a fissure, the length of
which from the union of the os ilium and os pubis of one side to the
other was four inches, and the breadth at each end between one and
a half, and one and two thirds of an inch; at the middle, between the
prominence of the sacrum and symphysis pubis not above two inches
and a sixth. The prominence of the sar.rum gave the outlet the
form of a heart posteriorly, and the shape of the anterior margin
corresponded with that of the posterior. The os uteri had disap¬
peared as usual, and was close upon the upper outlet of the pelvis.
The soft integuments of the child’s head were pressed as far for¬
wards as the outlet would admit of, but the head was not wedged
in. The integuments were elastic, and the mother declared she
felt the movements of the child.

“ Natural delivery was manifestly out of the question ; and de¬
struction of the child’s head, although practicable, was fraught
with danger to the mother, and besides could not be immediately
resorted to because the child was alive. Yet there was no time to
be lost, as the woman’s strength was greatly exhausted, and far¬
ther delay exposed her to the risk of speedy death. The Caesa¬
rean operation, then, appeared to be the only resource of art that
remained.” The patient readily gave her consent j and Dr. Mul¬
ler, after the preparative evacuation of the bowels and bladder,
proceeded to perform it in the following manner. At the first in¬
cision he cut through the integuments down to the tendinous ex¬
pansion of the linea alba, beginning an inch below the navel and
ending an inch above the symphysis pubis. A small aperture was
next made into the abdomen near the navel, the fore and middle
fingers of the left hand were introduced into it, and the scalpel
being then passed between them, the fingers and instrument were
carried downwards till the requisite opening was completed.
This was nine inches in length. The uterus now pressed forcibly
forward, and many large vessels could be seen under its glisten-

Case of Caesarean Operation. 73

mg surface. A part of the uterus was pinched, up, and an inci¬
sion, as long as that in the integuments would allow, was made
through its parietes where they were most free of vessels. Very
little haemorrhage followed the wound, and care was taken to
sponge all the blood away so long as it continued to flow. As
soon as the incision was completed, the child pressed outwards
with its feet on. the operator’s left hand, and was immediately re¬
moved without difficulty. It was alive, healthy, vigorous, and
weighed seven pounds and a half. The navel string was secured
in the usual way, and the placenta soon afterwards was removed
by introducing the hand previously cooled in water. During this
part of the operation pressure was made upon the abdomen, to
prevent the entrance of air into the cavity. The wound was now
united by adhesive straps and covered with charpie ; a fustian belt
was then put on and tightened. At the lower angle of the wound
an opening an inch in length was left without straps for the dis¬
charge to flow through. Meanwhile the uterus was felt contract¬
ing in the usual manner and formed a ball in the left flank.

A good deal of blood issued from the vagina after the removal
of the placenta, and again after the dressing of the wound was
completed. The patient was directed to remain in the supine
posture, and care was taken to make every arrangement before
the operation to insure perfect quiet for some time alter it. In the
evening there was some fever, but no pain j and during the night
she slept none. Next day the fever had increased, the pulse was
very frequent, the thirst inextinguisable, the pain of the lower
belly severe and constant, and she had snatches of sleep disturbed
by startings ; but during the night she slept well. During the
third day the fever and pain were moderate, the abdomen a little
swelled : in the evening the fever increased \ at night she had
little sleep. On the morning of the fourth the fever was again
moderate. The wound, which had suppurated, was dressed. In
the evening the usual febrile exacerbation occurred, with increased
swelling, but little pain. The straps having become loose, they
were carefully removed, and fresh ones applied. The edges of the
wound were hot, swollen, and florid. The secretion of milk had
commenced. At night the patient slept well. On the morning of the
fifth there was no fever, but it returned violently at mid day, with
smarting of the wound, and increased swelling of the abdomen.
The fever moderated, however, in the evening, the lochia began
to flow, and the patient again slept well. On the sixth the abdo¬
men was greatly swollen, the purulent discharge great, the pain
considerable, the lochia more abundant. In the evening her appe¬
tite improved, and soup was allowed. The dressings were changed.
On the seventh there was little or no fever, her appetite was
good, the pain and swelling had abated, and the lochia was more
abundant. The wound was dressed, and it was found that two
inches of it next the umbilicus had healed. From this time the
suppuration continued so profuse for some days that frequent
dressings were required daily. The abdomen progressively dimi¬
nished in size 3 the fever was inconsiderable j the appetite strong.

VOL. III. NO. 13

/4 Synopsis of Practical Medicine.

On the eleventh, tonics were administered, the treatment having
previously been confined to the occasional administration of a
clyster. On the twelfth the milk receded, and the pus had be¬
come less abundant, and of firmer consistence. On the! sixteenth day
there was not above an inch of the wound open ; the pus was healthy
and moderate in quantity ; and the patient was able to sit up a little
in bed. On the twenty-second, she was allowed to leave her bed
for a short interval ; but her debility was very great. For ano¬
ther week she continued to improve } but for a few days after that,
in consequence of her having removed to an uncomfortable lodg¬
ing, and been restricted to an insufficient diet, the wound, which
had nearly healed, became inflamed, and a black, fetid, tough,
slimy fluid, was discharged from the belly. A change of quarters
and diet, together with the use of cinchona, restored her former
favourable state of progress; and on the forty-third day the wound
was completely closed. Some weeks afterwards the surface broke
out again, but in no long time it was finally healed up ; and four
years after the operation, Dr. Muller saw her in good health, which
she said had not suffered any interruption after the healing of the
wound. The child died of convulsions when three months and a
few days old. — (Magazin far die gesammte Heilkunde, 1828, xxviii,
i. 146.)

18. Delivery of a Foetus through the Abdominal Farietes. — A female,
thirty-three years of age, feeble in constitution, and of middle sta¬
ture, in the advanced stage of her first pregnancy, fell from the
height of a story on a stair. After recovering from the fainting
fit, which was the cause of her fall, she felt violent pain in the
lower belly, and had considerable uterine hemorrhage. These af¬
fections were removed by antiphlogistic treatment ; but left her
in a state of extreme debility. Four weeks after the accident she
* was seized with severe contracting pains like those of labour ;
and on manual examination, it was found that the os uteri was
puffy and open. The apparent labour, however, did not make any
progress. There was at the same time a copious discharge of sam
guinolent mucus, constant sickness, extreme prostration of
strength, hurried pulse, general paleness, and uninterrupted per¬
spiration. The patient had never observed any movement of the
foetus after she met with the fall. Several days having been
passed in these unfavourable circumstances, an inflammatory tu¬
mour suddenly appeared in the region of the umbilicus, accompa¬
nied with most acute pain and an intolerable sense of burning.
The passages continued moist, but the os uteri did not increase in
openness. Seven days after the false labour-pains appeared, the
tumour opened and discharged a moderate quantity of fetid pus.
In the course of the same day, when the aperture had attained the
diameter of an inch, the hip of a foetus presented itself. This was
in so advanced a state of putridity, that it was easily separated
from the body ; but it was with difficulty extracted from the open¬
ing. The thigh and foot followed, and after them the chest, of
which the ribs, sternum, and clavicles, were successively removed
with a pair of lithotomy forceps. The arms were next extracted.

Five Children at a Birth.

/•>

■then the bones of the head, after being broken down with the
crotchet 5 and, in short, every bone of the foetus was withdrawn
from the same opening. A slimy membrane, and a light, spongy,
cheesy mass in small portions of various sizes, consisting evi¬
dently of the placenta and membranes, were in the last place sepa¬
rated. During the progress of this extraordinary delivery, which
lasted two hours, the uterus contracted occasionally with consi¬
derable force. The patient suffered much from the irritable state
of the abdominal aperture. The sore was dressed with dry lint,
after an injection had been used of tepid water and chamomile in¬
fusion, which passed through the vagina . The lochial discharge
flowed partly through the natural passage, partly through the aper¬
ture in the abdomen. Under the use of generous diet, the patient,
notwithstanding her unpropitious condition, gradually recovered.
The discharge, which had at first, and for some time, an insup¬
portable stench, gradually lost its odour ; the wound in nine days
had closed so far as only to admit a quill ; and the secretion of
milk receded. The patient’s appetite and sleep continuing good,
and her mind calm and cheerful, her farther recovery proceeded
with rapidity j in six weeks the opening was healed up altoge¬
ther, and she was able to resume her household occupations in
her usual state of health. Dr. Muller, to whom this singular case
occurred, has appended a few remarks on its nature, and endea¬
vours to establish that it was not an instance of extra-uterine ges¬
tation, but of ordinary pregnancy ; that the accident must have
excited inflammation and suppuration of the anterior surface of
the uterus ; that this disorder passed by continuity of surface to
the abdominal parietes, and gave occasion to the false passage.
This certainly appears the only rational account that can be given
of the progress of the case. The complete recovery of the patient
in such disastrous circumstances is certainly, as the author ob¬
serves, a most extraordinary instance of the restorative powers of
life. “ Nature, too, has her Csesarean operation !” — ( Magazin fur
did gesammte Heilhunde, 1828, xxviii. i. 157- )

19. Five Children at a Birth.— A. Russian peasant, who had
twins on a former occasion, was delivered of five children in No¬
vember 1826. She gave birth to a daughter on the 9th, 10th
12th, and 13tli respectively, and to a son on the 16th of the
month. The infants were each about eight inches in length ; the
Son was born dead • the daughters died on the sixth day the mo¬
ther was well at the end of the month. — North American Medical
and Surgical Journal, Oct. 1828.

In the year 1827, we have been called to a case in which one
child was born on Monday, and a second on the following Friday.
There was no hemorrhage or untoward symptoms during the in¬
terval ; the placentae were united the infants were born alive,
but died in a week : the parturition was natural. A medical friend
has assured us that he had attended the wife of a soldier, who
had travelled by the stage-coach thirty miles three days after de¬
livery, and on her arrival at the end of her journey she complained
of swelling of the abdomen, which, on examination, was found to

# 76 Synopsis of Practical Medicine.

be a second infant. The labour was natural, and she suffered no
inconvenience during her journey. We regret we cannot publish
the name of our friend. — Editor.

BRITISH HOSPITAL PRACTICE
Bath Hospital Reports.

20. Fracture of the Skull, with Hernia Cerebri, treated by Mr.
Norman. — August 19, 1828, Ann Lacey, aged twenty, fell from
the window of a third story, on her forehead and chest. Previous
to her admission into the hospital, she had vomited a large quan¬
tity of blood, and had been bled from the arm to sixteen ounces.
She was insensible ; her pulse 130, and very small. Two small
wounds above the right eye penetrated to the bone, and were di¬
lated j a fracture was felt passing through the upper part of the
orbit, and apparently extending backwards into the basis of the
cranium. Numerous small portions of the lower part of the
frontal bone, and of its orbitar plate, were removed, leaving the
upper and posterior part of the eye exposed. Some small pieces
of brain were observed in the wound, having made their way
through a lacerated opening in the dura mater. The edges of the
wound were easily closed by means of sticking-plaster. After
the operation she was uneasy and restless ; pulse quick, small,
and variable. In the night she was delirious, and the skin had
become hot.

20th, at Noon. — Pulse 144, full, and bounding. She had scarcely
swallowed any thing ; but the bowels had been moved by an in¬
jection. She may be roused when spoken to, but does not answer
questions. Bled to sixteen ounces. A purgative.

21st. — She was more sensible when roused, and answered ques¬
tions, though imperfectly. The blood taken was buffed and cupped.
Pulse 136, and full, with throbbing of the carotids, flushed face,
and hot skin ; tongue furred. The wound was dressed, and a
small portion of brain found projecting at the bottom, through the
opening in the dura mater. Pressure was made upon it by a small
compress of lint placed within the wound, and fixed by sticking-
plaster. Bleeding to ten ounces. Antimonials and saline.

22d. — She had a tolerable night. The skin cooler, and tongue
moist. Pulse 100, and soft ; bowels open ; blood taken yester¬
day buffy. The protrusion of brain into the wound is less. Pres ¬
sure re-applied in the same manner.

2,3d. — There was little alteration. She was sensible when
spoken to, and occasionally expresses her wants. Pulse 100, and
soft. • -

24th.' — She has slept much since yesterday, and is less sensible.
Pulse 120, and full, with considerable throbbing of the carotids.
The forehead and eyes were so much bruised and swelled, that it
had been previously impossible to ascertain the condition of the
iris on either side $ but it was found this day that the left eye
could be opened, and that the iris moved freely when exposed to

Fracture of the Skull , with Hernia Cerebri.

light, the quantity of brain protruding into the wound increases.
She was purged, and lost eight ounces of blood, which was buffed^

25th— She was less sensible, and much inclined to sleep • pulse
106, with less throbbing of the carotids. The quantity of brain
protruding has increased considerably notwithstanding the conti¬
nued application of pressure.

26th and 27'th.— All the symptoms became more aggravated.
Pulse 140, and upwards, small and contracted. Insensibility and
great restlessness, with continued protrusion of the brain into the
Wound. — She died on the 28th.

Examination. — Besides the pieces of bone which had been re¬
moved at the time of her admission, the walls of the right orbit
were fractured, and much shattered at the upper and posterior
part. The fracture extended posteriorly unto the base of the cra¬
nium as far as the body of the sphenoid bone, and, laterally, com¬
pletely across the upper and posterior part of the left orbit. In
this latter situation the dura mater was separated from the bone
by the accumulation of a considerable quantity of coagulated
blood. There was a little healthy suppuration in the wound, and
the quantity of brain protruding was much less than during life.
It had made its way through two lacerations of the dura mater, of
which one was very minute, and the other less than an inch in
length. The protrusion was actually cerebral matter, pulpy, and
semi-purulent on the surface. The part of the brain connected
with it, viz. the anterior part of the right hemisphere, was toler¬
ably firm, and, when cut into, presented numerous bloody lines or
striae, probably vessels, converging towards the point of protru-*
sion. Precisely at that point, the arachnoid, covering the surface
of the brain, adhered accurately^ the corresponding part of the
membrane coating the dura mater, in such a manner as to prevent
all communication between the external wound and the cavity of
the cranium. The pia mater at the base of the brain was thickened
and vascular ; there was considerable gelatinous effusion into the
cellular substance connecting it with the arachnoid, which was
slightly opake. The pia mater was elsewhere more vascular than
natural, but there were not any marked evidences of considerable
inflammation within the cranium.

21. Fracture and Depression of the Skull, without Symptoms of
Pressure, treated by Mr. Norman. — William Wilmott, aged sixty,
was admitted August 18, 1828, having fallen a height of fourteen
feet in a quarry, and struck his head upon the angle of a block of
stone. He was quite sensible, his skin cold, his pulse small and
weak. A small wound at the upper and posterior part of the pa¬
rietal bone bled freely and communicated with the bone. The lat¬
ter was fractured and depressed ; an oval piece, about an inch and
a half long, and half an inch wide, being indented, one side re¬
maining on a level with the rest of the skull, whilst the other was
depressed a quarter of an inch. Being firmly wedged in this si¬
tuation, it could not be elevated nor removed until Hey’s saw had
been employed to divide it completely along the edge that was not

Synopsis of Practical Medicine.

depressed. When it had been removed, it was found that the
fracture extended much farther in every direction in the internal
than the external table of the skull, and several fragments of bone
were removed. The dura mater was unhurt, and there was not
any extravasation of blood between it and the bone.

19th. — He had a restless night, and had suffered much pain in
his head. Purged and bled to eighteen ounces.

20th. — The wound had in a great measure closed by adhesion,
though there was a copious discharge of watery fluid from the
surface of the dura mater. He complains much of pain in the
back part of his head, and that the light hurt his eyes. His pulse
70 j tongue moist.

21st. — He makes the same complaints, and had a restless night.
Pulse 68. The iris moves freely in each eye. He is perfectly sen¬
sible. Bled to sixteen ounces. The pain in the head and want of
sleep at night continued to be the principal symptoms, gradually
subsiding, however ; his pulse at the same time being rather slow,
viz. from 58 to 64 in a minute.

On the 25th he lost six ounces of blood, in consequence of an
increase of pain. The wound healed slowly, a thin clear discharge
continuing for some time from the surface of the dura mater.

He remained in the house until October 9, when he was dis¬
charged with the wound healed, and in good general health. The
pulse continues slow, probably its natural state ; but he still com¬
plains of giddiness in the head, and weakness of vision.

22. Case of Ununited Fracture of the Femur, cured by the introduc¬
tion of the Seton. — The subject of the following case was admitted
into the hospital under the care of Mr. Henry Lyford, with a frac¬
ture of the right os femoris. The boy stated that the fracture had
been produced (so long ago as eleven months) in consequence of
a fall from a tree. A surgeon was called to his assistance at the
time of the accident, and adjusted the fracture in the usual mode :
at the expiration of eight weeks, the bandages and splints were
removed, when he found that he was quite as unable to move the
limb as at the very first moment of the accident. The dressings
were re-applied, and continued (with the exception of their being
occasionally renewed) up to the present period. On examination,
an oblique fracture was discovered, rather above the centre of the
femur, at which part there was a very considerable degree of mo¬
tion, so much so, that the disunited portions of bone could be
made to form an obtuse angle, and that without pro ucing the
slightest pain or inconvenience. The foot and leg quite oedemat-
ous, and much everted, the limb one inch and a quarter shorter
than the opposite extremity, and incapable of being elongated by
extension. There appeared to have been an unusual degree of con¬
stitutional languor and inactivity, manifested by a very slow and
feeble pulse, extreme coldness of the hands and feet, pallid coun¬
tenance, dry skin, and impaired appetite, with constipated bowels.
Ordered a large blister to be applied on either side of the thigh,
contiguous to the fracture 5 meat diet ; a pint of porter daily ;
the bowels to be kept open by equal parts of the mercurial pill

Case of Ununited Fracture of the Femur, /9

ami extract of aloes, and three spoonfuls of the compound mixture
of steel to be taken three times a-day.

Sixth day. — The vesieations produced by the blisters are entire¬
ly healed 3 general health much improved 5 ordered to continue
the medicine and diet as before, and to repeat the blasters.

Twelfth day. — The blisters have totally failed to produce any
effect, by way of exciting ossific inflammation 5 the fractured
portions of bone can be made to move on each other with as much
facility as on the day of the patient’s admission, notwithstanding
his general health appears very materially improved. Mr. Ly-
ford, therefore, determined to-day on introducing a seton between
the broken ends of the bone.

Operation. — An incision of one inch and a half being made
through the integuments on the inner part of the thigh, at the
mesial edge of the rectus muscle, the parts underneath were com¬
pletely divided down to the fracture 3 a long round seton needle,
somewhat resembling a packing needle, armed with a piece of
tape, well oiled, was then introduced between the fractured ex¬
tremities of the bone, and protruded behind the vastus externus
muscle, through the skin, at the dorso-lateral part of the thigh.
No hemorrhage ensued. The wounds being closed with adhesive
plaster, the patient was removed to his bed, and placed on his
back, his leg and thigh being supported on a double inclined
plane.

Fifteenth day. — Wounds dressed the first time since the opera¬
tion 3 the incision on the inner part of the thigh quite united, ex¬
cept at the place where the tape is inserted 3 the discharge, though
healthy, very scanty. No inflammation, or febrile symptom, has
supervened. Ordered to continue the same diet, with the porter,
as before the operation, and to take decoction of bark one ounce
and a half, three times a day.

Eighteenth day. — Wounds dressed 3 the quantity of discharge
materially increased 3 some degree of pain produced on pressure
immediately over the situation of the fracture 3 no accession of
fever. Continue the medicines and diet.

Twenty-fifth day. — The patient has passed a very restless night,
accompanied with frequent rigors, considerable pain in the thigh,
which is much swollen ; the pulse 100, tongue white and dry 3
the discharge from Ihe seton copious and extremely fetid 3 the
wounds on each side of the thigh encircled by an erysipelatous
blush. Ordered : — Calomel pill five grains, to be taken directly,
with an aperient draught 3 and at bed-time, gum opium gr.j. The
seton to be withdrawn, and the thigh to be poulticed with bread
mixed in the poppy fomentations. Low diet.

Twenty-sixth day. — The irritative fever has much subsided ;
pulse SO, and soft 3 tongue moist 3 the bowels have been freely
acted on 3 the pain in the thigh much relieved 3 the tumefaction
diminished 3 the discharge as copious as yesterday, but not so
fetid. Continue the poultice 3 take a wine glass full of the saline
mixture every five hours.

Thirtieth day . — -Since the last report, the constitutional symp-

Synopsis of Practical Medicine .

toms have gradually disappeared. Pulse, tongue, and skin, natu¬
ral j the wound on the dorso-lateral part of the thigh has com¬
pletely healed ; the discharge from the other very scanty, but
healthy j a high degree of inflammation, however, has taken
place between the fractured portions of bone $ the slightest move¬
ment of the limb, or any part of the body, being felt most acutely
at the seat of fracture. The limb was now made perfectly secure
and steady, by the application of a many-tailed bandage, with
splints.

Fortieth day. — The wound, which has been dressed every se¬
cond day, has now entirely closed.

At the expiration of two months from the time of his admission,
he was discharged cured j the limb, however, being one inch and
a quarter shorter than natural, compelled him to walk with a par¬
ticular kind of gait.

23. Pressure on the divided Extremities of Arteries. — Mr. Smith,
sen., surgeon to the Bristol Hospital, has published a very valuable
paper on this subject in the Provincial Medical Gazette , under the
unostentatious title, A Letter on Blood-letting.” He observes,
“ Pressure is the common resort as a remedy, but the manner of
its application renders, cceteris paribus, the practice successful or
the reverse. In general an immense bundle of lint is clumsily
tied on, so that a jet of blood separates the lips of the wounded
vessel. Thus it happens, that an interposing body, being once
established, union seldom takes place ; the orifice enlarges, and
all the ordinary and well-known phenomena ensue. I allude to a
puncture of the artery solely, without any wound of a vein, and
not to cases where the former is pierced through the latter.

About two years ago a messenger came to me, in the greatest
state of alarm, informing me that his fellow-apprentice had mis¬
taken the brachial artery for a vein, and opened it with a lancet.
I arrived in about a quarter of an hour after the accident. The
man had lost a large quantity of blood, but the hemorrhage had
been checked by the application of a tourniquet. I cleaned the
arm and the orifice, and accurately closed the latter, placing over
it a small button-like compress, secured by good adhesive plaster,
and over that an ordinary well-regulated pressure. I. then slacken¬
ed the tourniquet, the man was sent to bed, and his bowels well
cleared. In two or three days, his pulse being active, and his
system in a state of excitement, he was copiously bled ; but no¬
thing was done to the arm for a fortnight, at the expiration of
which time the pressure was removed, and no tumour appeared.
A strap of adhesive plaster, moderately tight, was continued as a
support, and, as nothing was subsequently heard of the patient,
he most probably was not afterwards inconvenienced.

On the 15th of April, I was called suddenly four miles into the
country, to see a stout, healthy workman, whose brachial artery
in the right arm had been mistaken for a vein, and opened by a
lancet. I reached the spot about two hours and a half after the
accident j the hemorrhage had been very profuse until a tourni-

Pressure on the Divided Extremities of Arteries . 81

tjuet was applied, when it was checked. The instrument had.
been screwed so tight that the man was in great torture, com¬
plaining loudly, his arm being exceedingly swollen and livid. I.
treated the case in the same manner as the last, and then gradual¬
ly loosening the tourniquet, the circulation was restored, and the
pain, by degrees, left him. On the following day the arm had re¬
sumed its natural appearance, and the case continued to go on so.
well, that on the 19th he walked in to shew himself to me. From
time to time the bandage was moderately and cautiously tighten-;
ed, and on the 2d of May every thing was removed. No tumour
existed, nor any unnatural appearance j a strap of adhesive plaster
was placed round the arm as a measure of precaution, and the
man enjoined not to use it roughly. I have since seen the gentle¬
man in whose surgery the accident happened, and Jearn that the
man experiences no uneasiness.

I might relate other cases in my own practice, or that of my
friends, of the same kind, amply sufficient to shew that well-
regulated pressure will generally succeed in preventing the forma¬
tion of aneurism. Doubtless, occasionally, it will fail and we
have had many cases of fjrachial aneurism sent to the infirmary
from various quarters, in some of which, very likely, pressure had
been properly applied. One of them being attended with rather
curious circumstances, may not be unwortiiy of record.

The patient was a schoolmaster, twenty-four years of age, of
very irritable temperament, residing on the other side of the Severn.
When the accident happened, the operator was aware, by the
colour and jet of the blood, that the artery was opened, and bound
a large quantity of lint on the orifice. The blood, however, forced
its way into the cellular membrane, and the arm became engorged
with it. As the external wound soon healed, it was hoped that
all would do well ; but -shortly afterwards a pulsating tumour be¬
gan to appear, which, in about six weeks, (when he arrived at the
Infirmary, and was placed under my care,) was as large as a hen’s
egg. The day after his admission was appointed for the operation
of tying the brachial artery above the aneurism. One of my
brethren happening to have a finger upon the tumour at the time
I made the incision through the integuments, informed me that
the pulsation had instantly ceased ; it was likewise gone from the
wrist ; in the other arm the vessels pulsated strongly, and the
man was by no means, under the influence of syncope. I continued
the operation, and passed a ligature round what was considered to
be the artery, but as there was not the slightest pulsation, we de-.
termined to let it hang loose for the present, and to endeavour to
restore the circulation. For this purpose, the arm was plunged
into hot water, renewed from time to time for an hour; but our
efforts were unsuccessful. The lips of the wound were now ap¬
proximated a little with adhesive plaster, the ligature being left
as before, and the man covered up warm, and placed on his bed
by the fire of the consultation-room, which opens into the opera¬
tion theatre. All this occupied the space of time between one and
half-past two. The man went to sleep, and was pretty com-
vol. in. no. 13.

Synopsis of Practical Medicine.

fortable, but the pulsation did not return till about seven o’clock,
when it was pretty strong, both in the tumour and at the wrist 5
and I had the satisfaction to find that a pull at the ligature checked
it immediately and effectually.. Assured, thus, that all was right,

I made a knot, and tied the artery. The wound was then treated
in the ordinary way, and my patient had a good night, and suf¬
fered but little.

In nine days the ligature came away without a drop of blood,
the wound was rapidly closing, and I flattered myself that all was
well. Shortly after, however, he became attacked with erysi¬
pelas, spreading from the affected arm over nearly the whole of
the trunk of the body, which occasioned suppuration in the cellu¬
lar membrane of the limb, and sphacelus of some portion of its
integuments, and considerably undermined his general health.
When he was getting out of this, on the thirtieth day from the
operation, there was a sudden and immense flow of blood through
the wound where the vessel had been tied, which, in all probabi¬
lity, would have proved fatal but for the accidental presence of a
pupil. It was now judged expedient to amputate the arm, which
I did immediately, a colleague commanding the artery by pres¬
sure, as there was no room for the tourniquet. The poor fellow
bore it with more fortitude than I had anticipated, and, after the
operation, said, “ Well, sir, now I hope I shall get well.” In this
hope, you will readily believe, I heartily joined, and 1 had, indeed,
the pleasnre of seeing him daily recovering for a fornight or
more, when he was suddenly, and without any ascertainable cause,
seized with convulsions, and, in half an hour, a period was put to
his sufferings.

Upon examining the limb, we discovered that the brachial ar¬
tery had ulcerated at the spot where the ligature had been applied.
The aneurismal tumour was reduced to the size of a filbert.

Allow me to add a case connected with the subject, though of a
different description.

A young woman, in opening an oyster, plunged a sharp knife into
the palm of her hand. She became immediately deluged with blood,
and a neighbouring surgeon was called to see her. He enlarged
the wound, and endeavoured to find the bleeding vessel, but failing,
after many trials and a great loss of blood, told the friends that it
would be necessary to perform an operation upon the arm. Of
the propriety of this, he was incapable of convincing them, and I
was sent for. I found that, upon the removal of the compress
tied round the hand, the wound became instantly a pond of blood
escaping profusely. By pressing a single finger in various direc¬
tions, I at last hit upon one spot which commanded the he¬
morrhage. Exactly over this I placed a firm ball of rolled lint,
the size of a small nut, with as much precision as possible, and
there secured it with superincumbent firm dossils, leaving the
sides of the wound separated, and the compress between them ;
'wer all a roller was carefully applied, and the hemorrhage ceas-
c Being afraid to meddle with it prematurely, I kept the hand
• I'm"' t0°^ evaporating lotions ; and, at the expiration of

Case of Bulimia ) or Canine Appetite.

a fortnight, the plug was discharged, covered with healthy pus.
In a few days the wound granulated, and the patient got perfectly
well, with the action of the fingers very little impeded.

24. Case of Bulimia, or Canine Appetite. By Dr. Porter, of Port-
sea. — The subject of this case was a pale, emaciated man, aged
nineteen. His pulse was small and frequent ; tongue furred
skin cold and pallid ; eyes glassy j enlarged abdomen ; appetite im¬
moderate urine, with a sweet smell and taste. His food consisted
of 261b. 8oz. of solids and spoon victuals, his drink amounted, by
weight, to 221b. 12oz. ; excrements, 4lb. 8oz. ; urine, 28lb.

Was not this a case of diabetes ? It is uninteresting to detail
the daily reports, as they present nothing unusual. The case ter¬
minated fatally.

Necrotomy forty hours after death.— -After describing the appear¬
ances in the chest, we are informed nothing particular was ob¬
served in the stomach or pylorus, except that the stomach and
alimentary canal were pale. The pelves of the kidneys were more
capacious than usual.” Many disgusting facts are related of this
man’s voracity, many even revolting to nature. He would pilfer
all sorts of food, clean or otherwise, even from the dunghill or
hog-tub. He was once found making a luxurious repast on the
carrion of a dead horse, nor would he quit this bonne bouche till
compelled by blows. At another time he stole a sheep’s head and
pluck from a butcher’s shop, and while the owner was pursuing him
he contrived to eat the whole of it. The butcher, struck with the
fact, and supposing hunger and want had induced the lad to com¬
mit the theft, took him charitably into his house, and supplied him
with boiled and broiled mutton, till, astonished at the immense
quantity he devoured, he at last drove him out, declaring to the
crowd assembled on the occasion, that f the chap would eat a
whole sheep.’ At the house of a reverend gentleman., he devoured
a very large turkey, besides bread, potatoes, and other vegetables.
On another occasion he ate five pounds of fat bacon and forty-two
pounds of potatoes in the space of ten hours. During his confine¬
ment in gaol, for stealing a watch from one of the canal barges,
for which offence he was afterwards transported, the surgeon or¬
dered him three men’s allowance j and one day, while in the in¬
firmary in the gaol, he consumed twenty-one pounds of bread and
forty pints of water in six hours, as also the parings of thirty
pounds of potatoes. Even while in the convict hospital ship,
where ample allowance was made of good food, as per Hospital
Journal, he would extinguish the light at night, and pilfer every
mess which he had previously turned his eyes on and in the night
of October 4, he stole a jar of smelts just put into salt, and ate the
whole raw, weighing about six pounds.” — Prov. Med. Gazette.

&5. Beport of the Comparative Salubrity of several Counties hi
England. — The following observations relating to the salubrity of
different districts in England, are founded on extracts from the
Parliamentary Returns made before a Committee of the House of
Commons. The counties in which the mortality was above the
average, were Middlesex, where it was 1 in 36 ; Kent, where it was

Synopsis of Practical Medicine .

1 in 41 ; Warwickshire, where it was 1 in 42 j Cambridgeshire,
where it was 1 in 44 ; Essex, where it was also I in 44 5 Surrey,
where it was 1 in 45, the East Riding of Yorkshire, where it was
1 in 47 Lancashire, where it was 1 in 48: Of these eight coun¬
ties, four are subject to agues, namely, Kent, Essex, Cambridge¬
shire, and the East Riding of Yorkshire, comprising all the coun¬
ties of that description, except Lincolnshire, in which the mortality
was below the average j for it was 1 in 45, the average being 1 in
58-7- The smaller degree of mortality in this last is no doubt
owing to the great proportion which the dry and upland part of
this country bears to the fenny districts. That there is a great
difference in the mortality in these, is proved by their respective
returns. The mortality in the town of Boston, for instance, which
is situated in the fens, is 1 in 27 whereas that of Stamford, which
is in the dry upland division, is 1 in 50.

It may be asked, whence arises the greater mortality of the
other four counties, of which the rate is above the average. With
regard to Middlesex, it is imputable, no doubt, to the various cir¬
cumstances adverse to health, peculiar to the metropolis, such as
the more intemperate habits of life, and, perhaps, still more, the
unfavourable influence of the air of this great city, particularly on
young children. It is worthy of remark, however, that London
has of late years been improving in salubrity 5 for it appears by
the bills of mortality that the burials invariably and considerably
exceeded the christenings till a few years before the close of the
last century ; whereas, since that time the christenings have ge¬
nerally exceeded the burials. This may in part be ascribed to vac¬
cination ; but it cannot be entirely owing to this cause, for the
decrease of burials took place some years before that admirable
discovery. The first year on the records of the bills of mortality,
in which the births exceeded the burials in the metropolis, was
1790. The great diminution of mortality among young children,
so as to amount now to little more than one half of what it was as
late as the middle of the last century, has already been adverted
to. In farther proof of the improving health of London, it is
stated in the Parliamentary Report, that the annual mortality in
1700 was 1 in 25 ; in 1750, 1 in 21 ; in 1801, and the four pre¬
ceding years, 1 in 35 and in 1810, 1 in 38. The increased mor¬
tality in the middle of the last century has been imputed to the
great abuse of spirituous liquors, which was checked about that
time by the imposition of high duties. The other causes of supe¬
rior health seem to consist in a general improvement in the habits
of life, particularly with regard to ventilation and cleanliness, a
more ample supply of water, greater abundance and better quality
of food, the improved state of medicine, and the better manage¬
ment of children. The high proportion of mortality in Surrey is
no doubt owing to its containing a portion of the metropolis, con¬
sisting of a population of 170,000, which is more than one-half of
the whole county.

The high rate of mortality in Warwickshire seems at first sight
the most difficult to be accounted for, the air of that part of the

On the Salubrity of several Counties in England. 85

kingdom being very salubrious. It is no doubt owing to the town
of Birmingham being situated here, for it comprises two-fifths of
the population ; and the mortality of the average of the last ten
years is 1 in 34. The mortality in this town is greater than in
Manchester, Leeds, or Norwich. The operations in metal have
been alleged as the cause of this j but it is much more probably
owing to the want of attention to cleanliness and ventilation, par¬
ticularly with regard to the streets, which are very narrow and dirty.

With regard to Lancashire, where the mortality is somewhat
above the average, the number of large towns and extensive ma¬
nufactures affording a greater proportion of artisans to rural inha¬
bitants than in any other county, except those in which the metro¬
polis is situated, is certainly the cause of this ; for the air is very
salubrious, and the greater quantity and cheapness of fuel is ex¬
tremely friendly to life, health, and comfort. It is probably owing
to this advantage, that the inhabitants of this county, particularly
the females, have become noted for their well-formed persons and
comely countenances, forming a contrast with those of Bucking¬
hamshire, where the fuel was extremely scanty and high priced,
before the late extension of the inland navigation, so that the la¬
bouring classes suffered peculiar hardships from this privation, and
are of a stature so inferior, that the militia-men are, by Act of Par¬
liament, admissible at a lower standard than in the rest of England.
The report of Manchester, which is the second town in England,
in point of population, forms an exception to the rest of Lan¬
cashire ; for the mortality there, on the average of the last ten
years, was 1 in 58 ; and in 1811, 1 in 74- But that of Liverpool
was 1 in 34, on the average of ten years ; and 1 in 30 in 1811. In
the former town we have another pleasing picture of the progres¬
sive improvement of health; for it is stated, by the late Dr.^Per-
cival, that in 1757, the annual mortality of Manchester was 1 in
25-7 j and in 1770, I in 28 ; although at the former period the
population was not quite one-fourth, and at a later period not one- '
half the present amount. This improvement of health is clearly
imputable to certain regulations of police, particularly with re¬
spect to ventilation, recommended and introduced by the above-
named benevolent, enlightened, and active physician. The like
progressive amelioration of health is deducible from these public
documents, with resped; to the whole kingdom, and which, in all
probability, we shall, on a future occasion, lay before our readers.

26. Feigned Diseases of the Heart. By Dr. Quarrier.— -The most
formidable species of simulation which I have had to contend
against, has been the production of apparent organic disease of the
heart, introduced into the Royal Marine Artillery, by George
Chapman, who had been brought up under a veterinary surgeon,
and had acquired a knowledge of the effects and noxious qualities
of certain deleterious drugs. This practice was productive of some
alarming consequences for a considerable period ; some were per¬
manently injured, haying actually produced the disease which they
intended to counterfeit ; and some others succeeded in obtaining
their discharge, notwithstanding the vigilance of the naval officers

86 Synopsis of Practical Medicine.

at Haslar, where they were treated, and the strictest inspection
on my own part. While this man remained in the hospital, we
were surprised to find an unusual number of cardiac affections,
more particularly in the surgical wards where he was placed.
Some who had gone into the hospital with slight gonorrhsea, or
syphilitic affections, had no sooner recovered from their original
disease, than faintness, vomiting, and the utmost degree of ner¬
vous irritability assailed them, leaving palpitations, and a variety
of dyspeptic feelings. Every curative means was adopted by the
physicians and surgeons of the hospital, but with partial success ;
I say partial success, for some of them became tired of medical
discipline, and got well speedily ; but the rest continued until
Chapman had been sent out, when they got spontaneously well, a
considerable debility only remaining. Chapman deserted in a few
days after being sent from Haslar. He was taken, after an ab¬
sence of some month's, was punished, and sent again to Haslar
hospital for cure ; when a fortnight had not elapsed, before two
cases of cardiac disease occurred in the ward where he was, and
in men who had never exhibited the slightest symptom of such
an affection. The symptoms assumed considerable variety of form,
with strong epigastric pulsation ; and we could not doubt that
means had been resorted to so as to produce this curious affection :
vbut we were foiled in our various attempts at searches and sur¬
prises, and in discovering the particular means adopted to produce
such anomalous symptoms. Chapman was again discharged
cured, and very soon deserted a second time. He was taken in a
remote part of the country, and succeeded in inducing the staff-
surgeon of the district militia, who had examined him, to report
his total incapacity for service, in consequence of organic disease of
the heart. He had taken his medicine, and no one, unacquainted
with the peculiar symptoms, and the expression of countenance,
induced by the helleborus albus, could detect a person so practised
in the art of simulating disease as Chapman was. He had found
it profitable, and sold his powders to the seamen and marines at a
considerable price, as well as receiving a gratuity upon success.
The helleborus albus was the principal ingredient, and the powders
were calculated either to produce a sudden and severe illness for
the immediate occasion, or to gradually undermine the tone of
the stomach and digestive organs, producing every appearance of
dyspepsia, attended by great nervous irritability, and violent and
continued palpitations ! This drug, however, is most uncertain in
its action, and it is constantly adulterated in the shops • the
smaller doses, therefore, at times, produced the most violent
symptoms, and frequently deterred the person from persevering.

It is fortunate that the adulteration was so great; for it will
excite the astonishment of physicians, to know that two scruples,
and sometimes a drachm, and even a drachm and a half, of this
most noxious drug, were given as a full and effectual dose.

27. M. Vatel on the Pulse of Animals.— M. Vatel in his valuable
work on Veterinary Pathology, gives the following table of the
standard pulse of different animals : —

Extensive Wound of the Heart.

f‘ In a state of health, the pulse of domestic animals offers very
great variation, with respect to the frequency of its beats. That
of the ordinary horse makes from 32 to 38 pulsations in a minute;
ass, from 48 to 54 ; ox and cow, from 35 to 42 ; sheep, from 70
to 79 ; goat, from 72 to 76 ; dog, from 90 to 100 ; cat, from 110
to 120.’

28. Extensive TV ound of the Heart , in which the patient survived
one hour and a quarter. Necrotomy. — William Beckett, bricklayer’s
labourer, setat. twenty-five, native of Winchester, was brought to
the hospital, having been precipitated from a ladder on the top of
a house, in the vicinity of the town, on some wooden railings,
which had perforated the upper part of the abdomen, causing a
wound about two inches and a half in extent, through which a vast
quantity of the small intestines had protruded. A surgeon being
sent for at the moment of the accident, reduced the intestines,
applied three sutures to the wound, and directed the man to be
conveyed to the hospital. On his arrival he was found to be in a
very exhausted state, with great coldness, not only of the extremi¬
ties, but of the surface of the body generally : the pulse at the
wrist or carotid artery could not be felt — respiration very labori¬
ous and interrupted ; extreme jactitation, so much so as to re¬
quire three or four persons to retain him in bed ; complete insen¬
sibility ; the pupils dilated permanently. On bis admission he
was immediately enveloped in warm blankets, bottles of hot water
applied to his extremities and stomach, and small quantities of
hot brandy and water administered every ten minutes, which he
swallowed not without some considerable difficulty. These en¬
deavours were, however, entirely fruitless; the surface of the body
still retained its death -like coldness, as well as its convulsive
movements ; the respiration, became gradually less frequent and
more feeble, and he expired in rather more than one hour and a
quarter from the time of the fall.

Necrotomy. — The body was examined six hours after death. On
tracing the wound, which had been made by the top of the rails,
On which he had fallen, it was found to have extended through
the diaphragm, immediately underneath the sternum, into both
ventricles of the heart, and through the septum ventriculorum, leav¬
ing a large ragged opening of one inch in length in the parietes of
each ventricle, by which the blood Jiad escaped from those cavi¬
ties into the chest, which contained rather more than two quarts
of that fluid perfectly uncoagulated. The small intestines, in
many places, were in a complete state of introsusception. With
these exceptions, the body presented a most healthy appearance.

Refections. — This case, in one point of view, is highly interest-
ing, and of much practical importance, inasmuch as it clearly
manifests, that a very considerable injury of the heart may be sus¬
tained without causing that immediate dissolution which is com¬
monly supposed uniformly to arise from wounds of this important
and vital organ. We have on record numerous instances of rupture
of this viscus from disease, occurring principally, if not entirely,
amongst persons at an advanced period of life. In ten patients.

88 Synopsis of Practical Medicine.

who lost their lives from this organic lesion, it was observed,
eight died instantly ; one at the expiration of about two hours j
and another at the end of fourteen. The longest period which a
person has been known to survive after a wound of the heart is
forty-eight hours, exemplified in the case of a soldier, on duty at
Haslar hospital, who had a bayonet plunged into the right auricle.
On examination after death, it was found that a coagulum had
formed, and completely filled up the wound ! but in an effort to
evacuate the bowels, a second hemorrhage took place, and he was
found dead, sitting on the night chair. — Provin. Med. Gazette .

29. Death of Sir Humphrey Davy. — This justly celebrated che¬
mical philosopher, paid the debt of nature, on the 30th of May,
at Geneva; His health had been long impaired by his scientific
pursuits. The highest honours of the city were paid to his re¬
mains, which were accompanied to the tomb by the magistrates,
officers, and all the scientific inhabitants. Posthumous eulogy
was never bestowed on a philosopher more deservedly. He was
the most distinguished chemist of the age, and his splendid disco¬
veries formed a new era in the science which he professed. The
results of his discoveries, his works, papers, and lectures are so
well-known that allusion to them in this place, would be a work
of supererogation ; but we may briefly remark, that his discovery
of real elements of chlorine, of the composition of the alkalies, of
the safety lamp, and of many phenomena of electricity, effected a
fundamental change in the science of chemistry. British science
has lost her favourite son, and her patrons will for ever bear in
memory the name of the illustrious philosopher, whose indefati¬
gable exertions and great discoveries have conferred such import¬
ant benefits upon humanity.

30. Informers against General Practitioners. — It is not generally
known to the young practitioner, that the law in this country, in¬
flicts a fine of five pounds on those who vend any quantity of pa¬
tent medicine without a stamp. Under the designation of patent
medicine, are included all drugs which may be used in the same
manner as the quack nostrums : for example, soda, or ginger
beer powders, lozenges of all sorts, mixtures, pills, ointments,
&c. &c. A general practitioner was lately fined five pounds, for
selling materials to make a soda water draught, without affixing a
proper stamp. The informer is entitled to half the penalty. It is
also necessary to procure an annual license at the stamp office,
which costs two pounds, in order to vend chemicals.

NOTICE TO CORRESPONDENTS.

Want of space prevents our acknowledgment of Communications, Works of
Review, Correspondence, and the insertion of the London Hospital Reports ;
all of which shall appear in our next Number,

, Communicatious and Works for Review to be Addressed to the Editor, at
Messrs. Underwood’s, 32, fleet Street.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 14. AUGUST 1, 1829. Vol. III.

CRITICAL REVIEW.

I. — The Study of Medicine. By John Mason Good, M.D.
F.R.S.L. &c. &c. Third Edition , with much additional
modern information on Physiology, Practice, Pathology ,
and the Nature of Diseases in general. By Samuel
Cooper, Surgeon to the Forces, King’s Bench, and Fleet
Prisons, Author of the Dictionary of Practical Surgery,
& c. &c. London, Underwoods, 1829.

[Continued from page 8.)

In our last Number we described the usual process by which
teeth are formed ; and now proceed to submit the descrip¬
tion of the attendant symptoms, according to the author
before us. He observes —

“ The immediate cause of irritation in the present instance is the
pressure of the teeth in the gums ; and the degree of irritation de¬
pends upon the peculiar temperament of the child. As the teeth
push forward, the superincumbent gum wastes in consequence of
absorption, and is at last cut through, and the tooth makes its
appearance. This pressure is not, however, uniformly exerted
through the whole course of teething, but is divided into distinct
periods or stages ; as though the vital or instinctive principle,
which is what we mean by nature, becomes exhausted by a cer¬
tain extent of action, and then requires rest and a state of inter¬
mission. The first active stage of teething is usually about the
third or fourth month of infancy ; and constitutes what is called
breeding the teeth, or the production of their bone from the pulpy
rudiment, buried in the gum, and formed during foetal life, which
at the same time shoots downwards, and gives to every tooth a
neck and fang. The first and most usual symptom of this change
is the looseness with which the infant grasps the nipple, and the
frequency with which it lets go its hold, accompanied with fret-
fulness and crying, and succeeded by a copious discharge of saliva,
the salivary glands partaking of the irritation of the gums. Next
the uneasiness of the gums is found to be relieved by the pressure
of any hard substance upon them, which benumbs their excited

no. ,14.

VOL. in.

Critical Review.

sensibility ; and lienee the child is pleased with having its gums
rubbed with the fingers, a -coral, or a gold ring.

“ This last is, perhaps, the oldest method, and, it may be the
best ; for the experiments of Dr. Chrestien, of Montpellier, who
has of late endeavoured to revive the old preparations of gold, as a
part of the materia medica, show sufficiently that this metal, in
very slight quantities of some of its simplest forms, is peculiarly
active, and a powerful exciter of those secretions which have a
tendency to diminish irritation and subdue inflammatory action.
He has proved before a committee of the Royal Academy of Sci¬
ences, at Paris, that friction of the tongue and gums with not more
than four grains of powder of gold produces sometimes a copious
ptyalism, sometimes abundant alvine evacuations, and sometimes
profuse perspiration. M. Auzebi, however, dissuades from the use
of friction by the finger or any other means, from an idea that the
gum will hereby become more callous, and consequently more
difficult to be cut through. But so far as I have observed, this
idea is not supported by facts. In many respects M. Lallemand
has since confirmed Dr Chrestien’s observations.

te If the irritation become very considerable, the gums swell,
the child grows still more fretful, and starts in its sleep or, on
awaking suddenly, there is heat, thirst, and other concomitants of
pyrexy, with, perhaps, dulness or drowsiness ; the bowels are af¬
fected, which is a usual symptom, and a rash appears on the skin,
usually the red-gum, and if the irritation extend to the muscles
of* the chest, there is a dry and troublesome cough. It is the
opinion of Dr. Withers, as given in his treatise on asthma, that
a cough, during dentition, never takes place but from primary af¬
fection of the respiratory organs : yet I have often seen this effect
produced as evidently from mere sympathy, as increased flow of
saliva, or looseness of the bowels. In abdut ten days or a fortnight
these symptoms subside ; and though the infant may, occasion¬
ally, be teased with slight paroxysms of uneasiness, it generally
passes on without much inconvenience till the arrival of the second
stage, or period of cutting the teeth, which we may expect to
take place between the seventh and the close of the ninth month,
though sometimes this does not occur till a few months later.

“ This is the usual progress ; but here, as in many other organs
of the system, we sometimes meet with a singular precocity of ac¬
tion, and at other times with as extraordinary a hebetude : and
hence, while it is no uncommon thing for an infant to be born with
several of its milk teeth already cut ; a fact which has, in various
instances, occurred to myself, and is specially noticed by Helwig
and other writers. Sometimes, however, the milk teeth are
found to be extremely tardy in their appearance, and in one in¬
stance are said not to have protruded till the child was ten years
old. [According to Meckel, the appearance of teeth at birth is
particularly frequent in such infants as have not been born till after
the usual period. Ed.]

** It is an observation of Mr. Fox, that these premature teeth,
which are generally the central incisors of the under jaw, are no¬
thing more than the upper parts or crowns of teeth without the

Dr. Good’s Study of Medicine .

apparatus of fangs ; that they have, consequently, a weak attach¬
ment to the gums, soon get loose, and produce a considerable in¬
flammation in the mouth of the child, as well as great incoveni-
ence to the mother : and he recommends, accordingly, that they
be immediately extracted. Speaking generally, this account is
correct ; but as there are instances in which teeth of this prema¬
ture growth are possessed of fangs and are perfect, it is better to
wait before we extract them, till some inconvenience arises which
may call for their removal

“ It is somewhat singular, that the natural growth of the first
set of teeth does not seem to be varied, at least, according to any
general rule, by the degree of strength of the infant ; for weakly
children often cut their teeth even more rapidly than those in ro¬
bust health, though the reverse is perhaps more generally the
case 5 and hence the stimulus of irritation in the process of denti¬
tion very nearly keeps pace with that of healthy vigour.

“ At this time the gum is often extremely sensible, and, instead
of being eased by the pressure of a hard substance, cannot endure
the slightest touch. At the base it is florid and distended, but
paler and whiter at the edge or upper part, and when the tooth is
on the point of protrusion, seems covered with a flat and whitish
blister. The other symptoms are a repetition of those just de¬
scribed, with a scabby eruption about the lips or head, erythema-
tic inflammation behind the ears, and occasionally spasmodic
movements of the mouth and jaws, convulsions, or epilepsy.”

The author next describes the treatment in the following
words.

“The grand point is here to moderate the local irritation. A
diarrhoea or full discharge of saliva does this naturally, and hence
these are favourable symptoms. And if the former be too violent,
or accompanied with griping, it should be merely corrected by
magnesia or prepared chalk. If the bowels be confined, we must
employ cooling laxatives 5 and the discharge of a small quantity
of blood from the gums in the first stage, by lancing them, will
often afford effectual relief. If the symptoms of oppression or
spasmodic action be severe or incumbent, as drowsiness, diffi¬
culty of breathing, stertor, or irregular motion of the jaws, an-
timonial emetics and leeches should be had recourse to, and occa¬
sionally repeated 5 after which, blistering will be found useful be¬
hind the ears or on the back. And when the bowels have been
thoroughly emptied, the use of anodynes may be allowed, and will
generally prove highly serviceable ; though they should be em¬
ployed with judgment, and never entrusted to nurses. Hyoscya-
mus, in most of its forms, has often succeeded here as well as in
adult tooth-ache, when judiciously administered.

In the second stage, or when the teeth are on the point of pro¬
trusion, the lancet will often afford immediate relief, not by a dis¬
charge of blood, for the upper part of the gum is now become so
thin and wasted that little or none will follow, but by giving a di¬
rect opening to the tooth, which will frequently make its appear-

Critical Review,

ance in the course of a few hours. In this stage, however, if we
cannot at once cut down directly upon the tooth, the lancet had
better be withheld, for we shall be certain of giving pain, though
very uncertain of affording relief.

“It is singular that the use of the lancet should be objected to so
generally. The tooth is imprisoned by a membrane that sur¬
rounds it on a full stretch, and that is in a state of inflammation*
Lancing the gum, or rather the inflamed membrane below the
gum, takes off the tension, and sets the tooth tree. The pain is
slight and transient, and by no means to be compared with the
permanent uneasiness which the operation undertakes to relieve.
It has been conceived, that a tough indurated cicatrix will be
formed if the divided edges of the gum should unite after the lan¬
cet has been applied. Yet in the spongy texture of this organ no
such effect is found to follow ; but, on the contrary, the recently
united edges of the gum, as in all other parts, far more easily give
way to the process of absorption than they would otherwise have
done ; by which means the passage of the tooth is facilitated.

“ As the erythematic inflammation, which occasionally takes
place behind the ears, proves often useful as a revellent, it has also
been found sometimes serviceable to imitate it by a friction with
savin ointment, or other rubefacients. But I cannot advise that this
or any other eruptions, wrhen produced naturally, should be suffered
to run their course without restraint : for I have often known
them become a worse evil than the original disorder. In this case
they should unquestionably be exchanged for some other more
convenient discharge.”

The author concludes this chapter with a description of
the process of permanent teething, adult teething, climac¬
teric teething ; enumerates many extraordinary instances
of the last species in persons of 90, 100, and 120 years of
age. This chapter is well worthy of the serious perusal of
the junior members of the profession. The next disease de¬
scribed is Gen. I. Sp. II. Odontia Dolorosa, toothache ;
and this description occupies twenty-five pages, and con¬
tains an account of all the facts hitherto published on the
subject. Like every other part of the work, it evinces the
great research, judicious discrimination and faithful obser¬
vation of the author. It is an invaluable fund of informa¬
tion, and its perusal is indispensible to those who devote
themselves to the management of dental diseases. The five
succeeding species are equally valuable. III. O. Stuporis,
tooth-edge. IV. O. Defonnis, deformity of the teeth. V.
O. Edentula, toothlessness. . VI. O. Incrustans, tartar
of the teeth. VII. O. Excrescens, excrescent gums. The
author lays down two causes for tooth- edge ; 1, from jarring
noises; 2, from vfellicative or acrid substances; and he ex¬
plains their action in the subsequent scientific manner.

f In many cases the teeth sympathize with the ear, on an ex-

Dr. Good’s Study of Medicine.

posUre to harsh, dissonant, or stridulous sounds, as the grating of
a file, the creaking oi a door on its hinges, or of a swinging1 sign
in the street. '

“ The same effect is produced whenever the teeth are vellicated
by smooth substances, as a piece of silk or velvet, or exasperated
by acid or other acrid materials.

“ To explain these effects, it is necessary to observe, in the first
place, that a close reciprocity of feeling is at all times maintained
between the teeth and the tympanum of the ear, by an union of
their respective nerves 3 as one of the branches of the seventh
pair, destined to supply the tympanum, anastomoses with the
lingual branch of the fifth, which sends offsets to the tyeth ; by
which means the latter become indirectly an organ of sound as
well as of mastication. It is for this reason, among others, that
deaf persons open their mouths to catch up speech they cannot
otherwise hear ; and that, as already observed, in cutting the wise
or adult teeth, the tympanum not unfrequently endures more pain
than the gum or membrane by which the tooth is covered ; and
hence, the tuner of a musical instrument is often in the habit of
applying his tuning-pipe to his teeth, as soon as he has put it into
a state of vibration, to determine more accurately upon its pitch.

“Now, as the last action is a source of pleasure to the teeth
from the vibrating tone proving agreeable to the ear, we can
readily see why tones or sounds of any kind that are hateful to
the ear should be hateful also to the teeth.”

This explanation satisfactorily accounts for the many pain¬
ful diseases which appear contiguous to the ear, during den¬
tition and violent toothache, and teaches the young practi¬
tioner the inutility of attempting to cure such diseases with¬
out removing the primary cause. The observations on
deformity of the teeth, toothlessness, tartar of the teeth, and
excrescent gums, are highly interesting, and will amply re¬
pay the reader for his perusal. The author next proceeds
to Gen. II. Glass I. Ord. I. Ptyalismus, which he divides
into two species. P. Acutus, salivation. P. Iners, dri¬
velling. All the causes of this affection are enumerated,
but those which claim medical attention are the following.
P. hydrargyratus, mercurial salivation. P. sensitivus, mouth¬
watering, produced by the sight, smell, or thought of agree¬
able food. P. mellitus, accompanied with a sweet or muci¬
laginous taste. The descriptions of the author, and the ad¬
ditions of the editor throw great illumination on these sub¬
jects y and contain all the opinions of their predecessors.
The next chapter is devoted to Sp. II. P. Iners, drivelling*
or slavering which is referred to the following modifications ;
I, that of infants ; 2, of old age ; 3, of dotards or idiots. The
succeeding chapter embraces Geri. Ill, Cl. I. Ord. I. Dyspha¬
gia, dysphagia, which is thus defined. “ Pain or obstruction
in swallowing, without inflammation, and most commonly

Critical Review.

without impeded respiration.” It is divided into five species,
1. Constrictive; 2, atonic ; 3, spasmodic or nervous; 4, uvu¬
lar; 5, lingual. The description of the symptoms, causes,
and treatment of these species, is the most perfect that has
hitherto appeared in any work on practical medicine in this
country. The accounts of the disease in the popular sys¬
tems, are exceedingly imperfect, and indeed some of those
works are silent on the subject. We believe there are many
men in practice who could scarcely define the disease, and
much less its causes and treatment. There is much curious
information in the succeeding chapters on morbid thirst —
a disease also unnoticed by other systematic writers. The
next, chapter includes Gen. V. Class I, Ord. I, which is
Limosis, morbid appetite, and is divided into the following
species. L. Avens, voracity. L. Expers, long fasting.
L. Pica, depraved appetite. L. Flatus, flatulency. L.
Emesis, sickness, vomiting ; and L. Dyspepsia, Indiges¬
tion.

The usual luminous description, which distinguishes
every part of the invaluable work under notice, is pre-emi¬
nently displayed in the detail of the nature and management
of the diseases comprehended in the genus Limosis. Here,
again, is much instructive and novel information, such as
is not to be found in the class books of our schools. The
explanations of the phenomena of this Protean class of dis¬
orders, and the mode of operation of the various remedies,
are truly scientific, and cannot fail to instruct ordinary read¬
ers. Those who have paid great attention to the diseases to
which we allude may find nothing novel in the pages of the
work before us ; but we conscientiously aver that they ap¬
pear to us to contain more extensive and valuable informa¬
tion than even all the monographs and systems of former
writers. We are far from thinking that the “ Study of Me¬
dicine contains a complete account of the disorders and
diseases of the digestive organs. It certainly does not, nor
is there any work, domestic or foreign, that does. We still
want a treatise that will embrace a perfect account of the in¬
fluence of the faculties of the mind on the digestive functions,
that will explain the influence of the moral powers on these
functions, or what our neighbours so aptly designate the
power of the morale on the 'physique.

Of all the recent works on this class of diseases, that of
Dr. Johnson1 accords nearest the views we have formed and
advanced, and next in order is that of M. Barras2. The
productions of Mr. Abernethy, Drs. Philip, Uwins, Paris,

* Essay on the Morbid Sensibility of the Stomach, &c. &c. 5th edition.

1 raitd sur les Gastralgies, et des Enteralgies, &c. troisierae edition, 1829.

Dr. Good s Study of Medicine . 95

Mr. Cooke, are also highly valuable, but there is still ample
room for some able writer, who might take the axiom of Mr.
Hunter for his theme3, and consider all the bearings of the
subject. He might even take a more extensive view, and bor¬
row his text from the father of physic — “ ut terra est arbor-
ibus, ita sit ventriculus animalibus. Unaquseque vero corporis
pars altera alteri, cum hinc nil illinc perruperit, statim mor-
bum facit, venter capiti, et caput carnibus ac ventri, et re-
liquae omnes eadem ratione quern admodum venter capiti et
caput carnibus ac ventri* *.” Mr. Abernethy, in his bookon
the constitutional origin of local diseases, has proved that
the digestive organs have much to do in causing many local
diseases; and Mr. Cooke has shewn how various diseases of
lemote parts will affect the digestive organs, and derange
their functions. Thus he has ascribed dyspeptic symptoms
to vaiious souices, as affections of the mucous membranes
chronic peritonitis, . affections of the kidneys, liver, pancreas'
influence of the brain, nervous system, and mind. He also
describes the effects produced on remote parts and on the
mind, by derangements of the digestive functions— on the
head, mind, muscular and nervous systems, genital and
urinary organs, mouth, nose, lungs, heart, lymphatics, skin,
and m producing fever. Dr. Uwins has given a more length¬
ened detail of the causes of idiopathic and symptomatic dys¬
pepsia. His commentary on the diseases of'children, refera¬
ble to the derangement of the stomach, is excellent, and
this part of the subject was unnoticed by other recent writers.
Ihe excellent treatise of Dr. Johnson is the last that has ap¬
peared, and contains many views unnoticed by former wri¬
ters. In common with our contemporaries, we think the
profession and the public deeply indebted to Dr. Johnson
foi his ingenious and original views, and particularly for his
able elucidation of the effects of mental influence on the di¬
gestive functions, and his valuable diagnosis between dis¬
orders and diseases of the digestive organs.

It is to be regretted that the observations of recent
writers on dyspepsia, were not more fully introduced in the
genus Limosis, in the Study of Medicine ; but yetitis to be
recollected, that no writer, however great his industry and
research, can be expected to peruse all the works that daily
proceed from the press, and without such perusal he cannot
intioduce all the opinions which are advanced on the nume¬
rous diseases described in the voluminous work under no-

3 “ The stomach sympathizes with every part of the animal, and
sympathizes with the stomach.”

* Hippocrates De Locis in Homine.

every part

Critical Review .

tice. No man could undergo such an herculean task. We
find our Gallic neighbours are obliged to associate to effect
it. But who are the writers in this country that have
evinced so much research, indefatigable industry, and judi¬
cious discrimination as Dr. Good and Mr. Samuel Cooper ?
Certainly not one. We ardently wish some of our able
writers would associate, and arrange a systematic work on
the plan of the Diet, des Sc. Medical., of our neighbours ; or
prostrate that tottering barrier which has separated medicine
from surgery, and produce a general system of physic and
surgery. They certainly manage these matters better in
France, and hence they have many dictionaries of medicine
and surgery, and now a splendid work which embraces
both *. The one branch is no longer dependent on the
other, there is now equality, the study of both is indispensi-
ble and inseparable, and is only opposed by a few monopo¬
lists, who advocate anile and absurd distinctions in the
large cities. While physicians and surgeons are jealous
about distinctions, the general practitioners, who combine
the practice of both, enjoy the advantages of both, and leave
the disputants ample leisure for the full enjoyment of their
nominal titles and sapient distinctions. It is evident to
every one, that the division of the healing art into physic and
surgery, is arbitrary ; and that the art is but one, and in
this way was it viewed by Hippocrates and all the ancient
writers (if we except a few casual sectarians), to the middle of
the twelfth century, when it was divided by ecclesiastical
Influence. To suppose that external disease will not dis¬
order the internal organs of the body, is one of the greatest
absurdities that the mind can imagine. The works of Aber-
nethy and others, named in this article, indeed all surgical
and medical works, refute that absurd opinion. But accord¬
ing to the constitution of the medical profession in this
country, Mr. Abernethy, and every other surgeon, are guilty
of a high misdemeanour in publishing such works as the in¬
valuable treatise on the constitutional organ of local dis¬
eases — such works should alone emanate from pure physi¬
cians. But enough of this topic. Though the disorders and
diseases of the digestive organs have been amply described
in this and other countries of late years, we cannot help
observing, with due deference to modern writers on the sub¬
ject, that we have not perceived a single opinion advanced
by them, on the symptoms or causes of these maladies which
does not exist in the works of Hippocrates. We shall not

* Nouveau Elemens de Pathologie Medico* Chirurgicale, ou Traits th^orique
et practique de Medecin et de Chirurgie. Par MM. L. C. Roche, et L. J, San¬
son, 1829.

Dr. Good’s Study of Medicine.

now stop to prove this assertion by introducing extracts
from the writings of that unequalled and wonderful genius,
as any one who chooses may convince himself of the fact.
It must be admitted that the opinions of many writers on
dyspepsia, are certainly original ; but it must be as freely
admitted, that had. these writers referred to the works of the
ancients, they would have discovered the slender claim their
own opinions had to originality.

Medicine has been ever proverbially famed for the insta¬
bility of its principles, and never was there a period more
remarkable for the vacillations of theory than the last quar¬
ter of a century. The most opposite theories have appeared
and disappeared. At every period in the progression of me¬
dical science, some particular organ has been considered the
origo et causa morborum omnium . The viscera of the head,
chest, and abdomen have been put in successive requisition,
as the causes of all diseases. The external surface of the
body was not omitted. The present period is no less distin¬
guished for its theories. The cerebrists can understand no
cause of disease, but nervous irritation or nervous influence,
and its ubiquity through the fascinating circle of sympathy.
The pulmonists were all but extinguished in this country,
until revived by the marvellous discovery of auscultation.
Both these sects are placed in the back ground of late by
the hepatists and stomachists ; for hepaticism and gastricity
are the orders of the day. If we see a child dying of denti¬
tion, remittent fever, hydrocephalus, or any disease, the
mischief is placed in the digestive organs. If we see per¬
sons labouring under chronic headache, determination of
blood to the brain, epilepsy, mania, amaurosis, phthisis,
functional or organic affections of the heart, gout, rheuma¬
tism, neuralgia, calculus, ulcers in any part, in fact any dis¬
ease, the cause is said to exist in the digestive organs. A
German physician, who visited this country about thirty
years since, expressed his surprise aat the scarcity of gas¬
tric diseases, as well in reality as in the heads of physi¬
cians.” Should that writer be still alive, he must perceive
there is now no lack of gastricity in the heads of the faculty
in this country. He will observe that the gastro-mania of
the Continent has become a desperate epidemic, and bewil¬
ders the heads of physicians in this country to a most extra¬
ordinary extent. Were he once more to visit us, he would
experience a new cause of surprise, when he should discover
that pulmonary consumption, our national scourge, has lost
all its terrors, and is now forgotten, while his favourite gas¬
tricity, triumphantly supplies its place in the heads of the
faculty. In describing the gastro-enteric maniacs of France,

98 Critical Review.

M. Barras observes* “if we are to believe them* the stomach
is a kind of powder machine* which is exploded by the most
trifling spark, and by means of the most opposite nature.
Nay* it takes fire spontaneously, according to their account*
like a stack of damp hay — and gastro -enteritis* acute or
chronic* continued or intermittent, regular or irregular, spo¬
radic or epidemic, contagious or non-contagious* usurps
almost the whole nosological chart, under the denominations
of plague* typhus, small-pox* measles, scarlatina* fevers of
all types* cholera morbus, gastralgia bulimia* hypochondri¬
asis* &c. &c. In short, it is a perfect Proteus, with all kinds
of shapes at command — a complete hydra, whose heads give
employment to the whole of the faculty, and are reproduced
as fast as they are lopped off.” This satire as fairly applies
to the gastro -maniacs in this country. That the functions
and combined agency of the stomach, liver, and collatitious
viscera are important and extensive* no man can deny ; but
that they can be illiinitibly extended and exclusively ap¬
plied as the cause of every human disease, is so manifestly
absurd* as to require no serious refutation. That these func¬
tions are frequently disordered is equally obvious; and this
fact, together with the gastro-mania so unusually prevalent*
induces us to analyse the leading opinions of the profession*
in this and other countries, as to the causes and treatment
of this class of diseases. These reasons we trust, will be a
sufficient apology for the prolixity of our preliminary obser¬
vations.

The author of the work before us, refers the proximate
cause of dyspepsia, “to debility of the stomach* intestinal
canal and the collatitious viscera, as the mesentery, the
spleen, the pancreas* and, especially, the liver ; and* under
whatever form and from whatever cause the disease occurs*
there is a considerable degree of languor and debility,” vol
i, p. 192. This was the opinion of Hippocrates and Cullen.
The French pathologists ridicule this theory, and maintain
that indigestion, apepsia* bradyspepsia, is the form under
which acute and chronic gastritis, and gastro-enteritis, very
often appear ; and is the constant effect of these inflamma¬
tions, and is the sign of all the irritations, which suspend* sym¬
pathetically* the action of the stomach and duodenum. The
.English physicians ascribe it to atony or an asthenic state of
the stomach; but this is the same as the ancients* who attri¬
buted it to coldness of that organ. But in France it is said to
depend on gastritis, duodenitis or chronic gastro- duodenitis*
often accompanied with an alteration of tissue *. We have

* Diet. Abr<*g6 des Sc. Med. Article, Indigestion, 1823, p. 527.

Dr. Good’s Study of Medicine.

already alluded to the work of M. Barras, who ascribes the
proximate cause of gastralgia, a form of dyspepsia, to irrita¬
bility or irritation of the nerves. The greater part of Bri¬
tish writers, as Abernethy, Philip, Abercrombie, Paris,
Uwins, Cooke, Johnson, Armstrong and many others, have
arrived at the same conclusions as our Gallic neighbours.
But we cannot admit that all those writers exclude debility
of the stomach and collatitious viscera, as an occasional
proximate cause. Thus Dr. Johnson observes, in his detail
of the injurious consequences of repletion or intemperance ;
“ any organ that is over-exerted in its functions is sooner or
later weakened — -nay, the remark applies to the whole ma¬
chine. Nothing is more common than to see men of origi¬
nally good constitutions, broken up prematurely by inordinate
labour, whether of mind or body. The debility thus induced,
whether of a part or of the whole machine, is invariably ac¬
companied by irritability. The former has been recognised
in all ages as the parent of the latter. In this way a mor¬
bid sensibility may become established in the digestive or¬
gans *.” He further states “ on reviewing the foregoing
phenomena there is not one of them, which does not indi¬
cate debility and irritabiilty of the stomach and bow¬
els.” We are rather surprised at Dr. Johnson’s declaration
in the last Number of our esteemed contemporary, the Med.
Chir. Rev. where he states, that “at all events it is not simply
debility” which is the proximate cause of dyspepsia, as laid
down by Dr. Good. Assuredly debility, either local or gene¬
ral, may exist without irritability. Or, rather, there may be
diminished sensibility of a certain organ without irritability.
Is not this exemplified in a paralytic limb ? We find Dr.
Johnson has admitted this position in his excellent work,
and also in the last monthly number of his journal (p. 93)
although he subsequently observes, “ the antiquated doctrine
of debility has carried millions to their graves, and driven
tens of thousands inad. It led to the farrago of stimulants
and tonics, when the stomach was in a state of irritability
as well as debility , instead of low and unirritating diet and
tranquillizing medicines.” There is no doubt but debility
and irritability may exist in the stomach at the same time, but
we cannot admit that they bear the relation to each other of
cause and effect. They may or may not be present at the
same time in dyspepsia. Again, many eminent physiologists
maintain a vast difference between decreased sensibility of an
organ and irritability, and the German and French writers
attribute the proximate cause of the disease under notice.

* Essay on the Morbid Sensibility of the Stomach, 5 Ed. p. 20-23.

100

Critical Review.

to defective or increased sensibility of tlie stomach Bn€
sensibility and irritability are two different functions ; they
are, perhaps, simple modifications of one fundamental sourcef.
It is, therefore, evident from these premises, that defective
sensibility of stomach may exist independently of irritability,
and this defective sensibility differs not, perhaps, from debi¬
lity of the parietes of that organ. But we fully agree with
those who rank nervous irritation as a common cause of dys¬
pepsia, and we believe inflammation of the stomach and ali¬
mentary organs, or disorganization of them, is the effect and
not the primary cause of the disease J. Every one is aware
that the disease may continue for weeks, months, and years,
and on dissection no traces of disorganization can be found §.
The functions of the stomach may be disturbed without any
appreciable lesion of structure, and who can affirm in such
cases the disturbance is the result of irritation? “Thus,
Andral and Lerminier, Dr. Philip and many others in this
country, attribute the first stage of indigestion to nervous
irritation. On the other side, we find Dr. Paris describing
“ those causes that may operate in depressing or paralyzing
the muscular powers of the stomach, and of these, undue
distension is, perhaps, the most common, and, at the same
time, the most powerful. This may be proved not only from
ample observation on the stomach, but by the analogy of
other cavities ; and particularly when the bladder is over
distended with urine, or the rectum by faeces. It is, there¬
fore, comprehensible how greatly the muscular fibres may
become permanently debilitated by the repetition of such an
excess/’

This writer distinguishes the symptoms which indicate
mere loss of tone or weakness of the gastric juice from those
indicating inflammation of the stomach, or duodenum, and
from those indicating organic mischief. Mr. Abernethy
considers “weakness and irritability of the affected parts
accompanied by a deficiency or depravity of the fluids secre¬
ted by them are the causes of disorders of the digestive
functions || .” Dr. Uwins concludes “that indigestion pri-
marily»consists of muscular spasm, membranous irritation
and nervous uneasiness ; that the ingesta not duly acted on
by the muscular fibres of the organ, and not duly influenced

* Smidtman, Summa Obs. Med., &c. Berlin, 1826. Barras, Traits Gastral-
gies, &c. 1829. ,

+ Diet. Abr6g6 des Sc. Med. Article Irritabilite. 1824.

X Med. Ch. Rev. 1827, v. vi, p. 27.

§ Dr. Philip and others. Clinique Medicale, &c. Maladies de l’Abdomen,
par G. Andral, fils. Paris, 1827.

|| Surgical Works, 1817, v. i. p. 61.

101

Dr. Good’s Study of Medicine,

by the secretion from its membrane, become more or less
subject to laws which influence matter not under the agency
of vital principle ; that the consequences are fermentation,
flatulent swellings and eructations ; and that the resulting
uneasiness or pain is attributable rather to organic sensibi¬
lity of the stomach and adjacent parts than to inflamma¬
tion

These discordant opinions should have been noticed in
the work before us. The author of the Study of Medi¬
cine, after having ascribed the proximate cause of the dis¬
ease to debility, details the connexion which exists between
the adjacent viscera and the stomach, and the functions,
which these organs perform. He explains the influence of
respiration upon the chyle, and the connexion existing be
tween the stomach and the lungs; and accounts for dyspep¬
tic phthisis. He next describes the causes of the disease,
and divides them into local and general.

"The common causes of this imbecility, whether confined to
the stomach, or co-extensive with the associate viscera, may be
contemplated under two heads, local and general ; under both which
they are still further resolvable into the two opposite extremes
of deficient and excessive stimulation ; and, consequently, into a
divergency of any kind from that medium of excitement and acti¬
vity upon which health is made to depend.

"The local remote causes are, a too large indulgence in seda¬
tive and diluting substances ; as tea, coffee, and warm. water, or
similar liquids taken as a beverage j or an equal indulgence in
stimulant and acrid materials, as ardent spirits, spices, acids, to¬
bacco- whether smoked or chewed, snuffs, a daily habit of distend¬
ing the stomach by hard eating or drinking ; or a rigid abstemi¬
ousness, and very protracted periods of fasting.

"The general remote causes are, an indolent or sedentary life,
in which no exercise is afforded to the muscular fibres or mental
faculties. Or, on the other hand, habitual exhaustion from in¬
tense study, not properly alternated with cheerful conversation •
becoming a prey to jthe violent passions, and especially those of
the depressing kind, as fear, grief, deep anxiety, immoderate libi¬
dinous indulgence ; and a life of too great muscular exertion.
Perhaps the most common of this latter class causes, are late hours
and the use of spirituous liquors.”

We cannot help observing that this list of causes is much
too limited, and we think much more might be included.
We have already expressed our regret that the writers of
this country almost lose all sight of the vast influence of mo¬
ral causes on the digestive functions. The French writers
are pre-eminent on this point. They contend that the pro¬
cess of chymification does not solely depend on the action of

* Treatise on Indigestion, 1827, p. 243.

102

Critical Review.

the parietes of the stomach, but partly upon the function of
mastication. They describe the action of dividing the food in
the mouth, how the animal liquids of that cavity may be in¬
creased or diminished by certain aliments, how deglutition is
promoted or impeded by the quality of the food, how these
circumstances influence and stimulate the stomach, and there¬
fore that gastric irritation is the chief cause of dyspepsia.
Dr. Johnson has exactly arrived at the same conclusion.
They consider there as four species of the disease. 1. Indi¬
gestion by the action of improper food on a sound stomach.
2. That arising from a sympathetic action of an injured or¬
gan on the stomach containing nutritious aliment. 3. That
caused by proper food on the stomach when primarily de¬
ranged. 4. The disease when caused as in the last species,
the stomach being secondarily diseased. The first species
is caused by primitive irritation in most cases, the second
arises from the same cause consecutively, and the third and
fourth from primary irritation. In all species the small and
large intestines are said to be also irritated.

Pinel, Johnson, and many others attribute dyspepsia to
repletion in every case, and so have the ancients. On ano¬
ther occasion we have given the opinions of some of the an¬
cients in these words. “ The chief and evident rule in diet¬
etics consists in moderation, for we observe that most dis¬
eases are relieved by depletion. The immortal Hippocrates
recommended that a person in health ought never to take
food to satiety/’ Plato said (i that intemperance was the
nurse of physicians, and that the stomach destroyed more
than the sword.” Galen asserted cc that the ancients la¬
boured under fewer diseases, because they had lived more
frugally than the people of his time.” Nothing is of more'
importance to the bilious or dyspeptic, than the proper and
complete mastication of the food, which will render it more
easily affected by the solvent powers of the stomach *.” M.
Barras gives the following etiology of the disease. The
most common causes are, the abuse of spirituous liquors —
stimulating medicines ; emetics ; drastic purgatives ; poi¬
sonous substances ; the presence of foreign bodies in the
alimentary passages; too stimulant diet; excess at table;
ices and cold drink when the body is heated ; vicissitudes of
temperature ; especially from hot to cold ; particular tempe¬
raments, as the sanguineous, which dispose to the phlegma-
sise, suppression of hemorrhages, or other accustomed eva¬
cuations ; repercussion of cutaneous diseases ; rheumatic

* Essay on the Chemical Composition and Medicinal Effects of the most cele¬
brated Mineral Waters, in Europe and America. By M. Ryan, M.D., &c. &e.
Second Edition, 1828, p. 43.

Dr. Goods Study of Medicine. 103

tind ai thritic metastases ; contusions on the stomach and

owels. Such are the causes of chronic gastro-enteritis,
and the following are said to induce gastralgia : a nervous
and irritable temperament ; sedentary habits ; desk work,
and mental exertion ; all the passions when in excess, as
jealousy, ambition, envy, and disappointments, losses and
vexations of mind, certain professions, and trades, venereal
excesses, hot and moist atmosphere ; too spare a diet in
other diseases ; long fasting; too much liquid and slops:
excessive tea drinking; in a word, every thing which can in-
01 mateiy exalt, directly or indirectly, the nervous sensibi-
lty or susceptibility of the stomach. The present edition of
the Study of Medicine, should have equalled this etiology
oi a disease so common, and should have far exceeded the
multifaripus empirical productions of the day, entitled trea¬
tises on indigestion, I he diagnosis between functional dis¬
order and organic disease was necessary to be mentioned •
at least it should have been attempted. The remaining por-
tion of the article on dyspepsia is devoted to the treatment
° ^ lt?c"sease anc^ occupies twenty-four closely printed pages.

. the remedies hitherto employed are enumerated, and
their action clearly accounted for. The author proceeds

tflub • " IJ

“ Under what shape soever the disease may present itself, the
hrst thing to be enjoined is a relinquishment of whatever cause
has laid a foundation for it ; we must next palliate the symptoms
that aggravate and continue the disease ; and, lastly, we must re¬
store the debilitated organs to their proper tone ; or, in other
words, we must corrector remove what is called, though not very
precisely, the proximate cause of the malady.

The patient must, in the first place, be convinced of the neces¬
sity of putting himself under a new rule of conduct, and be deeply
impressed with the idea, that though he may have continued his late
plan of life for a considerable period of time, without having sen¬
sibly suffered for it, yet, now that he is suffering, nothing but his
conforming to another plan will remove his present complaint.

bevere and long continued study, protracted, as I have often
known it, through ten hours a-day, for many months, without any
relaxation or interchange of pursuit, must give way to the exer¬
cise of riding or walking, and this not occasionally, but daily . and
to the still better cordial of cheerful conversation. The last is of
very great importance ; and without it, even exercise itself will be
of little avail : for the mind, accustomed to a certain track of in¬
tellectual labour, will otherwise relapse, even while riding or walk¬
ing, into the same habitual course, be dead to the most fascinat¬
ing prospects around it, and become exhausted by its own ab¬
straction. And it is to characters of this kind, perhaps, more
than to any other, that the amusements of a watering-place pro¬
mise ample success ; where the general bustle and hilarity, and

104

Critical Review .

the voluntary forgetfulness of care, the novelty of new scenes,
and new faces, and new family anecdotes, and the perpetual rou¬
tine of engagements that fill up the time with what would othei-
wise be trifles and frivolities, reverse the mischievous order and
monotony of the past, break the sturdy chain of habit and associ¬
ation, and give leisure to the worn-out sensory to refresh itself.

"Where the same effect has proceeded from a town-life of fa¬
shionable follies and dissipation, nothing is more common than to
recommend a like change of residence. But in this case, though
it mav be a change of residence, it is not a change of life j and
hence it is too often made without any benefit whatever. A total
retreat from the world, the unbroken seclusion of a remote ham¬
let the sober society of a few intimate friends, simple meals and
early hours, instead of close and heated rooms, crowded and
motley routs, costly feasts, and midnight madrigals, are what
are specially called for in this instance, but are not always to
be met with in the resort of a wateriug-place. In such as are
still distinguished for their quiet and unfrequented shores, where
all is rude and simple, and spruce squares and long-drawn parades
have not yet put to flight the scattered and irregular cottages of
former times, these advantages may still be obtained. But it is
rarely that patients, who are suffering from a life of dissipation,
will consent to relinquish the higher attractions of our gayer and
more public retreats, for what they are apt to esteem the dulness
of an unfrequented coast, till it is of little importance whether
they go any where or remain at their own homes.

“ In like manner, the habitual use of hard eating and drinking
must give way to a wholesome plainness of diet ; though I am
afraid that not a little mischief has often ensued from rigidlycom-
pelling a man who is suffering from a long habit of the former, to
abandon this habit at once, and run to an extreme abstemiousness.
Nothing can be more injurious. Even in full health, the animal
frame, though it may be brought to any extreme by degrees, very
ill brooks abrupt changes; and I have often seen where such
changes have been attempted in an enfeebled constitution, that
they have introduced worse complaints than they have been in¬
tended to remove. The use of tobacco is not, in our own day,
employed very often to such excess, whether in smoking or chew¬
ing, as to become a very alarming cause of dyspepsy : but I have
known instances where the former has been suspected, though
perhaps unjustly, of having been the cause of this complaint, and
where an abrupt prohibition of its entire use has introduced a dan¬
gerous atrophy. , ...

(< is certain, however,i that a free use of tobacco under either

or any form has produced very severe dyspeptic affections, and con¬
sequently, in such cases, it ought to be relinquished by degrees.
Nor is it difficult to conceive by what means tobacco thus acts ;
for like opium, it is a stimulant readily producing a narcotic
effect, or, in other words, rapidly exhausting the sensorial power.
In chewing, a considerable portion of tobacco is conveyed to the
stomach along with the saliva: in smoking, a somewhat smaller

105

Dr. Good’s Study of Medicine .

quantity is conveyed in the same manner ; and, in both, the sali¬
vary glands are excited to a great waste of secretion •, which can¬
not take place without impairing the chymifactive process indi¬
rectly, as the introduction of the tobacco into the stomach, impairs
it more immediately. The areca, or Malabar nut, though a good
bitter, when chewed for a long time is well known to impair it in
the same manner. Even in the form of snuff, tobacco has not
unfrequently been found to produce the same result ; partly per¬
haps from the paresis of the olfactory nerves, in which the sto
mach participates by sympathy, and partly from the portion of
tobacco that is constantly passing into it from the nostrils. “ I
have found,” says Dr. Cullen, “ all the symptoms of dyspepsia
produced by snuffing, and particularly pains of the stomach oc¬
curring every day. The dependence of these upon the use of
snuff became very evident from hence, that upon an accidental
interruption of snuffing for some days, these pains did not oc¬
cur ; but upon a return to snuffing the pains also recurred ; and
this alternation of pains of the stomach, and of snuffing having
occurred again, the snuff was entirely laid aside, and the pains did
not occur for many months afterwards, nor, so far as I know, for
the rest of life.”

Dr. Cullen tells us in another place, in proof of the same fact,
but in proof also that the habit is sometimes variable in its influ¬
ence, that he knew a lady, who had been for more than twenty
years accustomed to take snuff, and that at every time of day ;
but who came at length to observe that snuffing a good deal be¬
fore dinner took away her appetite ; and that even a single pinch
taken at any time in the morning, destroyed almost entirely her
relish for that meal. When, however, she abstained entirely from
snuff before dinner, her appetite continued as usual, and after din -
ner, for the rest of the day, she took snuff pretty freely without
any inconvenience.”

The older writers accounted for the injurious effects of
snuff, by its action on the olfactory nerves, and their sym¬
pathy with those of the stomach, or by its immediate passage
through the pharynx into the stomach, an occurrence well
known to immoderate snuff- takers. Dr. Good thinks that
whatever disagrees with the stomach ought to be avoided.
The second intention is to palliate urgent symptoms. Di¬
rections for the use of emetics and gentle stimulants are
next recorded. The author observes

f‘ A spare diet, however, though often recommended, is rarely
found of service, and very generally adds to the disease: for as the
stomach and bowels have been accustomed to the stimulus of
food, and a certain degree of impletion, if this be not maintained,
the atony will be increased, the natural function still further im¬
paired, and all the symptoms of uneasiness be aggravated. A
moderate proportion of exeitement and impletion is hence imperi¬
ously called for j and our discretion is principally to be exerted in
determining the nature of the viands and the degree of impletion

VOL. III. NO. 13 p

106 Critical Review

which will best agree with the stomach, and which it may most
easily master.’’

This doctrine is at variance with that of the principal
writers on indigestion in this and other countries. Mr.
Abernethy, Dr. Johnson, and a host of others, maintain that
a spare diet is indispensable to a cure — and wre fully agree
with them. If the disease be caused by repletion, as most
'writers properly assert, the cause must be removed or the
effect will remain. The author describes the utility of alka¬
lies and acids, mineral and vegetable, but he by no means
satisfactorily accounts for their success. Dr. Johnson, how¬
ever, has cut the Gordian knot, and explained the enigma.
(i In some cases the discharge of clear -water from the mouth
was ascertained to be owing to the presence of an extremely
acrid alkali which strongly effervesced with and neutralized
acids. We should therefore ascertain whether it is owing
to the presence of an acid or alkali in the stomach

The remaining part of the article consists of an account
of the various bitters, tonics, and peptic precepts. The
author has devoted seventy-seven pages to the description
of limosis, or dyspeptic complaints, and has displayed much
research and judgment, but we certainly contend the writ¬
ings of recent authors should have been laid under greater
contribution. Upon the whole, the article, with all its omis¬
sions, is the best that has hitherto appeared on the disease
in any systematic or monographic work in this country.

{To be Continued.)

II. — An Account of some of the most important Diseases pe¬
culiar to Women. By Robert Gooch, M.D.

(Continued from page 40.)

The next class of diseases treated of by Dr. Gooch in his
valuable work, is entitled “ Disorders of the Mind in Lying-
in Women,” and occupies ninety pages. He does not pur¬
sue the usual path in his descriptions, but introduces a
number of interesting and instructive cases in elucidation of
his opinions. We have already devoted so much space to
the review of the volume before us, that our remarks must
be brief, and we must, therefore, refer our readers to the
work itself. Besides, the author has so far exceeded all
former writers in the extent of his observations on the ma¬
nagement and treatment of puerperal mania, and so admir¬
ably compressed and connected them together, that it is per¬
fectly impossible to detail them in fewer words, and as they
occupy twelve pages, it would be impossible to transfer such

* Essay on the Morbid Sensibility of the Stomach. Fifth Edition, p. 88.

Dr. Gooch, on the most important Diseases of Women. 107

extensive matter to our review. This part of his produc¬
tion is a most valuable addition to obstetric medicine, and
will be perused with interest and advantage by every class
of practitioners. The author published an essay on puerpe¬
ral insanity, in 1819, in the Trans, of the Coll, of Physici¬
ans ; and he now has added the result of his experience dur¬
ing the last ten years. “His chief object is to relate his own
experience of the disease.” He tells us that the disease oc¬
curs most commonly after delivery, or during nursing. It
may arise from mental agitation, and come on suddenly, but
“ in other cases in which no such cause occurred, and the
disease arose spontaneously, its approach was more gradual,
several, or even many, days elapsing during which nothing
more was observed than a pulse rather quick, restless nights,
and a something quick and peculiar in the patient’s man¬
ner.” Mania, or rather melancholy, may occur several
months after delivery. In some cases we are told “there
was an incipieat stage in which the mind was wrong, yet
right enough to recognise that it was wrong.”

The author relates an excellent case of catalepsy which
occurred in the puerperal state, and is one of great interest.
He also quotes the manuscript lectures of Dr. Hunter, on
prognosis. That eminent practitioner was of opinion, when
mania was accompanied with fever, it generally proved fatal,
but without fever it generally terminated favourably. He
knew nothing of singular service in the cure of this disorder.
Dr. Gooch observes, “ none of those with a slow or mode¬
rately excited pulse, died; some, which were attended with a
quick pulse recovered.” p. 123. Dr. Haslam whose opi¬
nions are entitled to the greatest credit from his great expe¬
rience and observation in mania, remarked at a meeting of
the London Medical Society, this session, that of all forms
of mania, that of the puerperal state most generally termi¬
nated well. Our author describes the prognosis of the affec¬
tion under consideration, in the following words : — ■

“ There are some other circumstances to be taken into the ac¬
count of the prognosis : the form of the derangement, and the
period at which it occurs. Mania soon after delivery is more
dangerous to life than melancholia, beginning several months
afterwards. Nights passed in sleep, a pulse slower and firmer,
even though the mind continues disordered, promise safety to life.
On the contrary, incessant sleeplessness, a quick, weak, fluttering
pulse, and all the symptoms of increasing exhaustion, portend a
fatal termination, even though the condition of mind may be ap¬
parently improved. In the cases which I have seen terminate
fatally, the patient has died with symptoms of exhaustion, not
with those of oppressed brain, excepting only one case.”

108 Critical Review.

But we have no satisfactory documents to determine its
duration.

“ Unfortunately vve have no such documents taken under satis¬
factory circumstances. The records of hospitals contain an ac¬
count of cases which have been admitted, only because they were
unusually permanent ; they are the picked obstinate cases, and
can afford no notion of the average duration of the cases of all
kinds ; the cases of short duration, which last only a few days, or
a few weeks, which form a large proportion, are totally lost in the
estimate of a lunatic hospital.”

According to the experience of Dr. Gooch, mania does
not return after future labours. He thinks it is most com¬
mon to those in whose family disordered mind had already
appeared. His patients in general were of susceptible dis¬
positions, very nervous, long subject to depressing passions,
or were suddenly assailed by some cause of mental agitation,
hut in some cases no such circumstance had occurred. It
appeared soon after delivery, or during nursing, in persons
unaffected before or afterwards. “ There is therefore some¬
thing in the state of the constitution induced by lying-in or
nursing capable of producing the disease in predisposed con¬
stitutions.” p. 127- The worst form of mania we have
ever observed in females, was in one who was, after weaning
her child, and not pregnant; it was induced by mental agita¬
tion, in consequence of her fears for the safety of her hus¬
band, and after two years it proved fatal. Dr. Gooch is of
opinion that unusual excitement of the nervous system is
the real cause of mania. He next proceeds to speak of the
pathology of the affection in these words : —

“ But experience and reflection lead to very different conclu¬
sions ; they teach us that a disorder of the mind may be connected
with very opposite states of the circulation, sometimes with in¬
flammation or active congestion, for which depletion is the short¬
est and surest remedy ; sometimes with an opposite condition of
the circulation, which depletion will only aggravate. Cerebral
excitement does not necessarily depend on inflammation or con¬
gestion, nor is depletion, however moderate, necessarily the pro¬
per remedy. Cerebral excitement is often aggravated by deple¬
tion ; and in some cases, as I shall have occasion to relate, abso¬
lutely brought on by it. Now the question, what is the morbid
state of organization on which puerperal insanity depends, must
be determined in the usual way.”

He introduces cases in proof of his opinions. In Case VI,
there seems to us a degree of contradiction. u The next morn¬
ing every one recognized puerperal mania. In this state
she continued several weeks, during which it w^as often ne¬
cessary to put on the straight waistcoat, in order to keep her

Dr. Gooch, on the most important Diseases of Women . 109

in bed. In less than a month she was convalescent from
her mania, and for a week or two it was supposed that she
was out of danger ; but now her abdomen began to swell,
and she died dropsical, in the eleventh week after delivery.5’
Case VII was cured by sedative liquor of opium. Case VIII
was induced by great exhaustion, and terminated fatally.
“The body was opened the next day by two very experi¬
enced anatomists. The veins throughout the body were re¬
markably empty — the heart contained little blood — the lungs
and liver were singularly pale. Within the head there was
the same deficiency of blood in the veins of the pia mater,
and in the sinuses ; under the arachnoid membrane was a
little serum. On slicing off the hemispheres the bloody
points were unusually numerous.55 Case XX was not treat¬
ed by our author, but we introduce it as we apprehend few
obstetricians would have adopted the same remedial mea¬
sures.

I had no concern in the treatment of the following case, but
being in the house where it was, to see another patient, I was
taken by her medical attendants into her chamber, where I found
her sitting up in bed in a straight waistcoat, with a flushed cheek,
a dull eye, and occasionally uttering unintelligible words ; her
pulse was much above,. 100, but I did not count it, and her attend¬
ants remarked that it was getting hard. She did not look at all
like a person within six hours of her death, so that I was much
surprised to hear that she died that evening after being blooded to
faintness, which took place when she had lost about eight ounces.
I received the following account of the case from those who at¬
tended her.

“E. B., twenty-three years of age, was delivered of her first child
on the 30th of December. On the evening of the day of her deli¬
very, she had a rigor, succeeded by heat of skin, and constant pain
at the lower part of the abdomen, increased by pressure. The
pulse was 130, and weak. An injection was given, a large poul¬
tice was applied over the belly, and she took ten grains of the
compound powder of ipecacuanha. Her bowels were opened by
the injection j she slept well during the night, and the next morn¬
ing, the 31st, the pain was gone, but the 6oreness remained. The
next day, 1st of January, she complained of tightness of the head,
her tongue was furred, her skin hot, her pulse 120, and weak ;
her bowels had been moved several times the day before. She
now took five grains of calomel, her head was shaved, and six
leeches were applied. At two o’clock on the same day she was
visited again j her eyes were bright, her face was flushed, her skin
hot. She spoke indistinctly, and her mind rambled ; her pulse,
which in the morning was weak, was now thought to be getting
hard, and she was ordered to be blooded from the arm till she
fainted. Two grains of calomel were ordered to be taken every
two hours. She was blooded at three o’clock in the afternoon.

Critical Review .

As the blood flowed, the pulse became so quick it could not be
counted ; hence, when she had lost eight ounces, it was stopped,
although she did not feel faint. At six o’clock, when the attend¬
ant went to give her the calomel, she had scarcely any pulse. At
eleven in the evening the pulse could not be felt. She looked
deadly pale, the crassamentum of the blood was flat and red, with
little serum $ her mind wandered, but she knew her mother and
relatives, who stood at the bed-side. Attempts were made to re¬
vive her by cordials, but she sunk rapidly, had a cadaverous smell,
a cold skin, and died at four in the morning. The body was exa¬
mined eleven hours after death. In the abdomen the viscera were
healthy, the peritoneum also ; the external and internal surface
of the uterus, as also its substance, were examined, and found
natural. There was about half a pint of reddish fluid in the peri¬
toneum. In the head the sinuses were thought to be rather more
loaded than natural, the dura and pia mater rather thicker than
usual ; there was no unusual effusion any where. The plexus
choroides appeared unusually palej the substance of the brain
was firm, and on slicing it no bloody points appeared.”

The only proofs of mania in this case were, ce a flushed
cheek, a dull eye, and, occasionally, a muttering of unintelli -
gible words.” It was obviously an example of intestinal irri¬
tation, and had the treatment consisted of brisk purgation
by the ol. ricini, and ol. terebinth., followed by opiates, ano¬
dyne fomentations, and a moderate use of cordials, it might
have terminated very differently. It is not usual in cases of
mania, to be able to administer so much medicine as on this
occasion. Case X was first puerperal convulsions, followed
by mania. Dr. Baillie thought the patient would recover —
she died in three days afterwards. There was no vestige of
disease found on dissection. The author offers many judi¬
cious comments in these cases as follows : —

“ What inferences are we to draw from the foregoing cases re¬
lative to the question for the solution of which I have related
them, namely, what is the morbid condition of organization on
which puerperal insanity depends ? Let the reader reflect on the
leading points of these cases. In No. I, the disease occurred in a
pale lady, without any heat of skin, or much quickness of pulse,
and was not relieved by the loss of blood. In No. Ill, it occurred
in one whose constitution was drained and enfeebled by nursing.
In No. IV, it occurred in a pale woman, habitually hysterical, sub¬
ject to bear dead children from want of power to afford them life
for nine months *. In No. V, it occurred in one who had been
drained by flooding. In No. VI, in one in whom, for urgent rea¬
sons, the circulation had been reduced to the lowest ebb consist¬
ent with life. In No. VII, in one who had been living very low

* Ill cured syphilis is a much more frequent cause of dead children, from the
sixth to the eighth month, than the cause assigned by the author. — £d.

Dr. Gooch, on the most important Diseases of Women . Ill

for a week, with such marked symptoms of the irritation of debi¬
lity, that at first sight I thought it was the close of some disease
that had been overlooked. It was speedily relieved, not by cup¬
ping and purging, but by the tranquillizing and sustaining power
of opium. In No. VIII, the disease was treated, though with all
possible prudence and moderation, as an inflammatory estate of the
brain, by leeches, cupping, purging, and low diet, yet the patient
died, not with symptoms of oppressed brain, but with those of
exhaustion 5 and on examining the body the whole venous system
was found extraordinarily empty of blood. In No. X, the patient
fell, as if shot, under the stroke of the lancet, and on examining
the head there was found no effusion, and empty blood-vessels.
In No. XI, the disease came on after puerperal convulsions, a dis¬
ease generally, but not always, depending on cerebral congestion,
and after one of those enormous bleedings commonly practised in
these cases j and no morbid appearances were discovered after
death in the brain. These cases, if fair specimens of puerperal in¬
sanity, lead straight to the conclusion, that the disease is not one of
congestion or inflammation, but one of excitement without power.

The diagnosis is clearly pointed out, and this is well worthy
of our consideration. The state of the alimentary canal is then
alluded to. “ The alimentary canal is generally disordered
in its secretions — the symptoms which indicate this are a
furred tongue, an offensive breath, and, above all, dark and
offensive stools. These symptoms exist in very different de¬
grees in different cases ; in some they are scarcely percepti¬
ble, in others they exist in a most remarkable degree ; in these
latter cases they seem to be the link on which the disease
hangs, for as soon as they are removed the patient is well.

The moral and medical treatment is detailed in such a
clear, concise, and compressed manner, that we cannot ana¬
lyze nor yet insert it in this place from its great extent.
It proves the author to be a man of great observation and
judgment, and throws great light on a subject so much ob¬
scured by discrepant opinions. The author appends a sec¬
tion entitled “ Thoughts on Insanity as an object of Moral
Science,” whidi Is well worthy of attentive perusal, and
consideration. In this article he displays much judgment,
evidently the result of serious and repeated reflection.
Among many valuable observations, he remarks “ the cure
of insanity is sometimes effected by a method both moral in
its nature and moral in its operation 5 thus, patients have
been relieved from their hallucinations, and restored at once
to complete sanity by a well- contrived incident, a well- ex¬
pressed argument, or a well-managed conversation. A case
which clearly proves this position, was detailed in a former
page, in which a lady labouring under mania, who supposed
her husband was dead, was restored by his appearance and

112

Critical Review.

conversation. Case X, p. 169. Insanity is sometimes a
moral disease, p. 183. The same effects are brought about
by the same means in affections whose origin is confessedly
physical.

“ If a person low spirited from ill health should suddenly re¬
ceive some joyous news, he would, for a time at least, be restored
to the hilarity of health ; would forget his low spirits in his bright
prospects ; the physical would yield to the mental impulse. A
more striking example sometimes occurs in delirium ; a person
in the height of fever, who if left to himself would stare vacantly
and talk incoherently, will sometimes at a loud question wake up,
answer collectedly, be himself for a short time, and then relapse
into his former incoherence. Here is a mental cause removing,
by a mental operation, a state of mind avowedly physical. From
such facts what are we to infer ? not that insanity is a moral dis¬
ease because it is sometimes benefited by moral treatment, but
that though the unnatural state of the mind arises from a diseased
condition of the body, there are times and states in which the
mind begins to regain the capability of being acted upon in the
natural way by its natural mental objects.”

In alluding to the opinion of the physical nature of insa¬
nity, our author observes that it does not favour the doctrine
of the materiality of the soul. The author declines entering
into this question, but briefly observes : —

“I may be allowed, however, to remark, that the whole danger
rests on this proposition, that if the diseases of the body disorder
the faculties of the mind, then the faculties of the mind must be
the functions of the body. But where is the proof of this ? dis¬
ease in the liver impairs digestion j is digestion a function of the
liver 1 defects in the cornea confuse the perceptions of the retina j
is vision a function of the cornea ? It is plain, therefore, that dis¬
ease in a part may disorder actions which are not the functions
of that part. The mind is affected by the state of the stomach, of
the liver, of the uterus j we know therefore- that it may be affected
by the state of organs with which it communicates, but of which
no one pretends it is the function. It may be said that the mind
and these organs can never be seen apart and' that although it
is not supposed to belong to them in the same way as a function
belongs to an organ, we have no proof that they can exist se¬
parately : true, but take another instance. A hand shattered by
the bursting of a gun will produce fever and delirium ; let the
limb be removed at the proper period, the constitution regains its
tranquillity, and the mind its powers : it is clear, therefore, that
the mind may be affected by disease in a part not only of which it
is not the function, but from which it may be separated ; that such
is the construction of the living body, that one thing may affect
another with which it has only a temporary connexion j where
then is the danger of the principle, that the diseases of the body
disorder the faculties of the mind ?• Whoever has convinced him-

Dr. Gooch, on the most important Diseases of Women. 11S

self by other considerations of the immortality of the soul, will
find no difficulty in this principle, and so far from shrinking from
it, will rather see in it a reason for believing that, f in a separate
state of existence, it is highly probable that the soul works clearer,
and understands brighter, and discourses wiser, and rejoices loud¬
er, and loves nobler, and desires purer, and hopes stronger than it
can do here.’ ”

Here are a few solid blocks, which we opine, will not be
too readily “cut through” by razors of the phrenologists.
The author next considers insanity as an object of legal me¬
dicine, and offers remarks evidently founded on reason and
extensive observation. The next chapter of the work be¬
fore us is on “ the mode of distinguishing pregnancy from
the diseases which resemble it.”

There are some interesting cases in this chapter, and the
plates representing the natural appearance of the os uteri,
and its changes during pregnancy, will facilitate the acqui¬
sition of knowledge with those who are liable to be consulted
in such cases, and, especially, in a forensic point of view. But
we have found no information in Dr. Gooch’s remarks, that
does not already exist in most of the works on medical Juris¬
prudence, especially in those of Beck and Paris. The next
essay is on polypus of the uterus, and is much more valu¬
able and instructive than the last. Several plates are given
of the disease, and also of the improved instrument which
the author has discovered for applying ligatures. The next
chapter is “ on irritable uterus,” a disease hitherto unde¬
scribed by writers : the author describes it in these words:—

“ The disease which I have ventured to call the irritable ute¬
rus, is a painful and tender state of this organ, neither attended
by, nor tending to, produce change in its structure. It is now be¬
tween fifteen and twenty years since I began to notice this disease,
and since then I have seen several cases every year. At first it
puzzled me much j I had not seen it described in books. I took
it for chronic inflammation, which would end in disorganization,
probably of a malignant kind ; but experience, whilst it taught me
that it was a very intractable disease, taught me also that it was
not a disorganizing one. I became familiar with its obstinacy,
and less apprehensive about its result, for I know cases which have
lasted upwards of ten years, in which the structure of the uterus
is as unaltered now as it was at the beginning of the disease, as far
at least, as can be determined by examination during life. Al¬
though I often find it still an intractable disease, and wish I had a
shorter and surer mode of cure to communicate, yet I think it worth
describing, that practitioners may recognize it when they meet
with it ; that they may know what they are to expect in obsti¬
nacy, and what they need not apprehend in the result ; what will
do harm, what will do good, and the mode of treatment which,

VOL. II. no. 14. £

114 Critical Review .

however unsatisfactory to the medical attendant and his patient,

will slowly, but ultimately conduct most cases to recovery.”

The disorder may continue for years, and finally disap¬
pear. It is compared to the irritable mamma described by
Sir Astley Cooper, and its symptoms and causes are thus de¬
tailed by the author.

“ To embody them in one view, let the reader fancy to himself
a young or middle aged woman, somewhat reduced in flesh and
health, almost living on her sofa for months, or even years, from a
constant pain in the uterus, which renders her unable to sit up and
take exercise 5 the uterus, on examination, unchanged in structure,
but exquisitely tender ; even in the recumbent posture always in
pain, but subject to great aggravations more or less frequently.
The causes to which this disease has been attributed, and after the
application of which it has occurred, are generally considerable
bodily exertions at times when the uterus is in a susceptible state.
In one patient it came on after an enormous walk during a men¬
strual period j in another, it was occasioned by the patient’s go¬
ing a-shooting with her husband not many days after an abortion j
in a third, it came on after standing for several hours many suc¬
cessive nights at concerts and parties 3 in a fourth, it originated in
a journey in a rough carriage over the paved roads of France j in
a fifth, it was attributed either to cold or an astringent lotion, by
which a profuse lochia was suddenly stopped, followed by in¬
tense pain in the uterus 5 in a sixth, it occurred soon after, and
apparently in consequence of, matrimony. Although, however,
the disease followed, and was apparently excited by these several
causes of irritation, yet the patients had previously manifested
signs of predisposition to it 3 they were all sensitive in body and
mind, many of them had been previously subject to the ordinary-
form of painful menstruation. The disease seemed to consist in a
state of the uterus similar to that of painful menstruation, only
permanent instead of occasional.”

The mode of treatment is briefly described in the follow¬
ing passage, but then commented on at much length, and
modified according to circumstances. “The remedies for
subduing pain, are the horizontal posture, narcotics, warm
hip baths, occasional local bleeding, to which may some¬
times be added mercury and counter-irritants/’ The author
gives us cases of the affection, which are highly instructive.
It is most common to irritable nervous and hysterical wo¬
men, and in many'- instances may be mistaken for painful
menstruation. The pain, however, may occur before or
after menstruation. We strongly recommend the perusal
of this chapter to our readers. Chapter V, is entitled “ a
peculiar form of hemorrhage from the uterus.” Dr. Gooch
remarks that hemorrhage may occur though the uterus be
contracted as ordinarily, and that the uterus may be bulky

Dr. Gooch, on the most important Diseases of Women . 115

and no hemorrhage. He thinks e£ if the force of the circula¬
tion was extraordinarily great it would be able to overcome
the ordinary closure of the orifices, and that thus a profuse
hemorrhage might arise although the uterus was contracted
in an ordinary degree," p. 345. He relates cases in proof of
this position. In a case of violent hemorrhage after the ex¬
pulsion of the placenta, the following plan was adopted,
which we apprehend few men would be disposed to employ
at the present period.

“I had been talking on the subject, with Dr. Rigby, at Nor¬
wich, who told me that in hemorrhage from the uterus, after deli¬
very, he had found La Roux’s remedy the most effectual, and that
it had unquestionably enabled him to save several lives which
must otherwise inevitably have been lost. I took several hand¬
kerchiefs, soaked them in vinegar, and passed them one after the
other into the vagina, so as completely to fill it ; this effectually
prevented all external hemorrhage ; I no longer felt the blood
pouring over my hand the uterus began to harden, and my pa¬
tient complained of pain $ the colour came into her face again,
and her faintness she said was gone. These favourable appear¬
ances, however, lasted but a short time ; the pains ceased, the ute¬
rus grew soft and seemed to swell, the pulse became thread-like
and weak, and she turned ghastly pale. It was plain that, though
I had prevented the blood from escaping externally, it was flowing
into the uterus in great quantity, and that I had only converted an
external into an internal hemorrhage. Feeling herself sinking,
she screamed out she should never see her children again, and en¬
treated that she might see her husband, and take leave 6f him be¬
fore she died. The next instant I thought she had realized her
fears, she sunk into the pillow pale and senseless, her face became
distorted, and her limbs convulsed.

“ My belief now is, that when hemorrhage occurs after the re¬
moval of the placenta, the quickest way to stop it, is to introduce
the left hand closed within the uterus, apply the right hand open
to the outside of the abdomen, and then between the two to com¬
press the part where the placenta was attached, and from which
chiefly the blood is flowing. When the hand is introduced merely
as a stimulant, there is an interval of time between its arrival
within the uterus and the secure contraction of this organ, during
which much blood is often lost. By directing the hand to the
very vessels from whence it issues, and compressing them as I have
described, this quantity is saved. If I may judge by my feeling,
the blood stops, in a great degree, even before the uterus con¬
tracts : the hand acts first as a tourniquet, then as a stimulant.

It is true we cannot tell with certainty where the placenta was at¬
tached, and consequently where the pressure should be applied ;
but as it is generally attached to or near the fundus, if the pres¬
sure be directed there, it will generally be right. Besides, after
the child is born it is often several minutes before the placenta
separates and descends $ if, during this interval, we pass up the

116

Critical Review.

finger along the chord and observe at its entrance into the uterus,
whether it turn towards the front, the back, the right or left side,
or straight up to the fundus, we shall form a tolerably exact idea
of the spot to which the placenta has been attached in this indivi¬
dual case.”

The secale cornutum would have produced much better
effects under the circumstances. Mr. Brown, of Blackfriars
Road, related a similar case at a late meeting of the London
Medical Society, in which he had the. aid of Dr. Blundell’s
advice. The lady was subject to after-hemorrhage, and last
year was saved by the operation of transfusion. The labour
had ceased after the head had descended into the cavity of
the pelvis, the ergot of rye was exhibited and repeated a
second and a third time, the infant was speedily expelled,
the uterus immediately contracted and no hemorrhage what¬
ever took place. The placenta wTas expelled soon after the
infant.

The last chapter is on some symptoms in children erro¬
neously attributed to congestion of the brain;” and con¬
tains many judicious remarks. To this is appended a paper
which the author published in the Quarterly Review, and
which he has inserted as it may possibly be the only one
he will put to press. He sincerely hopes that this pa¬
per led the government to leave the quarantine laws un¬
touched. We have endeavoured to give a fair and impartial
review of Dr. Gooch’s work, and taken leave to comment on
those parts which we deemed open to criticism. We cannot
conclude our remarks without expressing the high opinion
we entertain for the talent and observation of the author, and
think his work well worthy of a place in every medical
library.

III. — The Influence of Climate in the Prevention and Cure of
Chronic Diseases , more 'particularly of the Chest and Di¬
gestive Organs , comprising an Account of the Principal
Places resorted to by Invalids in England and the South
of Europe ; a comparative Estimate oj their respective
merits in particular diseases ; and General Directions for
Invalids while Travelling and residing abroad. With an
Appendix , containing a Series of Tables on Climate . By
James Clark, M.D. Member of the Royal College of
Physicians of London, &c. &c. &c. London : T. and G.
Underwood, pp. 328.

From the time of the illustrious Hippocrates to the present
period the influence of climate on the mind and body of man,
and in causing and preventing disease has been duly consi-

117

Dr. Clark on the Influence of Climate.

tiered by physicians and philosophers. By the term clitnate,
is understood the temperature, the situation, the cultiva¬
tion, the habits and state of civilization of any country. As
vet we have no work, foreign or national, that embraces a
complete account of the influence of climate in the different
degrees of latitude upon the human body. On another occa¬
sion, we have given a superficial outline of such a work, and
attempted to describe the apparent varieties of mankind on
the face of the globe, and accounted for them by referring
them to the well-known and indisputable influence of the
multifarious powerful causes comprehended in the term cli¬
mate. We have said, “ his gentibus humanse varietatibus
breviter, expositis, proximum est, ut quae sint earum causae,
quique effectus in hominum corpora derivati, e caelo, situ,
solo, cultu, moribusque populorum inter se diversis flux-
erent, exploretur The excellent work under notice only
embraces a part of the subject — the effects of climate in the
cure of disease — but it fills up a blank in our medical litera¬
ture, as we have had no volume that contained an account of
climate in the different parts of this kingdom. Dr. Clark
has taken the trouble of making minute inquiry, and person¬
ally experienced the vicissitudes of temperature in this and
other European countries. He has, therefore, drawn a com¬
parison between the south of Europe and of England. This
work is divided in two parts. 1. On the general physical
characters of the milder climates of the south of Europe
and of England. 2. On the principal diseases which are
benefited by a mild climate; and these are consumption,
disorders of the digestive organs, of the larynx, trachea, and
bronchi, asthma, "gout, chronic rheumatism, general deli¬
cacy of constitution in childhood and youth, premature de¬
cay at a more advanced period of life and disordered health
from hot climates.

In speaking of consumption, the author very judiciously
observes : —

“ I feel convinced that by adopting such a system of manage¬
ment, from early infancy, as I have laid down in the following
pages, a great improvement might be effected in the general
health of many among the higher and middle classes of society in
this country. The children of delicate, and even of diseased pa¬
rents, might, by proper care, be reared so as to overcome, in a
large proportion of cases, their hereditary disposition to disease.
The ultimate effect of this in diminishing the vast and increasing
extent of hereditary diseases, need not be pointed out.”

We fully agree with Dr. Clark that his work may be con-

* Tentamentum Medico-Physicum Inaugurate de Genero Humano, ejusque
Varietatibus. Auct. M. Ryan, p. 25.

118

Critical Review,

sidered a manual to the physician in selecting a climate for
his patients, and a guide to the latter while no longer under
the direction of his medical adviser. Such a work was want¬
ed, and the author has displayed great research and judg¬
ment in its arrangement, and well performed the immense
labour required for its compilation. We fully subscribe to
the following very valuable observation :

I hope it will be found that I have succeeded in throwing
some light on the obscure subject of the influence of climate on
human health, and on the application of it to the treatment of dis¬
ease. I would also hope, from the the minute manner in which I
have described the characters of the different climates frequented
by invalids, and the care with which I have indicated the nature of
the diseases benefited by them, that I have gone far to correct
many of the erroneous opinions which have hitherto existed on
these subjects. However this may be, I do at least anticipate
this good effect from my labours — that, for the future, those pa¬
tients only will be sent abroad whose cases afford a reasonable
prospect of benefit from such a measure ; and, that the practice of
hurrying out of their own country, a class of invalids, whose suf¬
ferings can only be thereby increased, and their lives shortened,
will no longer be sanctioned, but that such persons may be allowed
henceforth, to die in peace in the bosom of their own families.”

This opinion reminds us strongly of the remark of an in¬
imitable writer who has spoken so feeelingly . on the many
advantages of this country, and concluded his elegant ex¬
postulation in these expressive words : “ Where, then, my

dear countrymen, are you going V* Well might such lan¬
guage be applied to many unfortunate and dying patients,
who repair to foreign climes for advantages they possessed
at home. In our present article we shall notice the first
part of the work before us, and defer to a future number the
remaining part of the volume.

Part I. General Influence of Climate. . The author makes
a few introductory remarks on this topic, which cannot be
better expressed than in his own words.

“ Although the power of different climates to produce as well
as to alleviate and cure diseases, is well established as a matter of
fact, yet, perhaps, there is nothing in general science more unsa¬
tisfactory than the manner in which we are able to explain this
influence; and certainly there is nothing in physic more difficult
than to direct successfully its application. Much of this arises
from the natural difficulties of the subject, but much also from our
neglect of careful observation. And yet when it is recollected
that the problem of physical climate still remains unsolved by na¬
tural philosophers, it need not be matter of surprise that the phy¬
sician should find it no easy matter, nay almost impossible, to
give a satisfactory explanation, when the subject becomes compli-

119

Dr. Clark on the Influence of Climate.

cated by the addition of such elements as organic life, health and
disease, with all the intricacy and complexity of their combina¬
tions. f When we study the organic life of plants and animals,’
says Humboldt, ‘ we must examine all the stimuli or external
agents which modify their vital actions. The ratios of the mean
temperatures of the months are not sufficient to characterize the
climate. Its influence combines the simultaneous action of all
physical causes 3 and it depends on heat, humidity, light, the elec¬
trical tension of vapours, and the variable pressure of the atmo¬
sphere. In making known the empirical laws of the distribution
of heat over the globe, as deducible from the thermometrical vari¬
ations of the air, we are far from considering these laws as the
only ones necessary to resolve all the problems of climate. Most
of the phenomena of nature present two distinct points, one which
may be subjected to exact calculation, and another which cannot
be reached but through the medium of induction and analogy.’
No one can be more sensible of the truth of these remarks than
myself 3 and, indeed, I have cited them to show, that, although
the utmost diligence has been used to determine the physical
characters of the different climates, more especially as regards tem¬
perature, (unquestionably the principal element of climate) such
is the imperfect state of our knowledge on this subject, that in
this, as well as in my endeavours to trace the relations between
different climates and the human body in health and disease, I have
been obliged to content myself, in a great measure, with simply
detailing the unexplained results of experience. It will be my en¬
deavour, however, in the following pages to state, as far as the
data with which I have been able to furnish myself enable me —
first, the physical characters of the different climates $ secondly,
the experience of the effects of these 3 and, finally, the characte¬
ristic, or, if I may so express myself, the medicinal qualities of
each particular climate, as deduced from the combined results of
the two preceding sources of information.

“ The influence of climate in the prevention and cure of diseases
is, for many reasons, a subject of peculiar interest to the inhabit¬
ants of this country. To the inclemency of our seasons we are
justified in attributing some of our most fatal diseases 3 and many
others, of great frequency, if they do not derive their origin im¬
mediately from our own climate, are at least greatly aggravated
by it. Among this number may be ranked pulmonary consump¬
tion, and some other fatal diseases of the chest 3 scrofulous affec¬
tions 3 rheumatism 3 disorders of the digestive organs 3 hypochon¬
driasis, and a numerous train of nervous disorders, &c. For the
prevention of some, and the cure of others of these diseases, a
temporary residence in a milder climate is the best, often the
only effectual remedy we possess.”

After many other valuable remarks, the author concludes
his opinion in these words : —

“ It may suffice to mention here, in reference to this fact, inter¬
mittent fevers, asthma, catarrhal affections, hooping cough, dys-

120

Critical Review.

pepsia, hypochondriasis, and certain nervous disorders ; all these
diseases are frequently suspended, and often entirely cured, by
simple change of situation, after they had long resisted medical
treatment ; or they are found to yield, under the influence of such
a change, to remedies that previously made little or nd impression
upon them.”

The author reasons from this that a complete change of
climate, with the circumstances connected with it, should
produce still more important results in ameliorating the ge¬
neral health, and in preventing and curing diseases : and in
this expectation he thinks himself borne out by experience.
But he remarks, the remedy has been too often resorted to
either as a last resource or forlorn hope, and has been mis¬
applied in cases wherein it might have been of essential ser¬
vice. Patients have often been sent abroad without proper
directions as to the situation most suited to their complaints ;
without a proper knowledge of their circumstances, which
alone could render the best selected climate beneficial to
them. The remedy is thus brought into discredit ; but the
author observes

« My own experience, the result of extensive observation, satis¬
fies me, that, for the prevention and cure of a numerous class of
chronic diseases, we possess in change of climate, and even in the
more limited measure of change of air in the same climate, one of
our most powerful remedial agents j and one, too, for which, in
many cases, we have no adequate substitute.*’

We are next informed of the great importance it is to the
citizens of London to change their residence occasionally,
even though unattended by any disease. This fact is so well
known, and is so influential upon the minds of every class of
persons, as to require no further elucidation. The author
next points out the great necessity of caution in the choice of
climate, a caution too much neglected by many practitioners.
He also felicitously points out the advantages to be derived
from travelling, and their great efficacy in improving the mo¬
ral and physical constitution of mankind. The author next
proceeds to describe the climate of this country in the. fol¬
lowing words : —

ENGLAND.

“ Before travelling beyond sea in search of a climate that may
prove beneficial to his disease, the invalid will naturally inquire
what resources, in this respect, the limits of our own island afford.
And I am inclined to believe that England possesses advantages
which have not been made so fully available in this way, as they
might have been 3 and that many invalids, for want of discrimina¬
tion in applying the proper climates to the diseases to which they
are most suited, have gone abroad in search of that which they
might have found almost at their own doors.

Dr. Clark on the Influence of Climate .

121

LONDON.

“ In taking our departure from London, as, for obvious reasons,
the most important point in our survey, it is necessary to ob¬
serve, in the outset, how much of the peculiarities of its present
climate it owes to artificial circumstances. Under this head we
must take into account the effects of a crowded assemblage of so
many living beings, and the multifarious processes ministering to
their existence the countless operations of art ; the influence of
buildings, &c., in augmenting and diffusing warmth, by reflec¬
tion, by radiation, and in other ways. Besides these more direct
effects, the more indirect influence of perfect draining and of pav¬
ing, in contributing to maintain a dry state of the soil and of the
atmosphere, ought not to be forgotten.

“The mean annual temperature of London is 50° 39; , being one
and a half degrees above that of the environs, with the exception,
perhaps, of the warmer parts of Brompton and Chelsea, which are
acknowledged to be peculiarly sheltered.

“This difference of temperature between the metropolis and
surrounding country, as the physician ought to know, is very un¬
equally distributed throughout the year, and throughout the day.
The excess of the city temperature arrives at its maximum in Ja¬
nuary, at which time it exceeds that of the environs by three de¬
grees ; but the difference throughout the whole of the winter, is
less than it is in the summer. In the spring months, the tempe
rature of the environs becomes nearly equal to that of London, and
in the month of May it rather exceeds it. The excess of the city
temperature is greatest in the months of January, September, No¬
vember, and August j and the relative degree of excess is in the
order stated. That accurate observer, Howard, further shows,
that this excess of temperature of the city “ belongs, in strictness,
to the nights; which average three degrees and seven tenths
warmer than in the country ; while the heat of the day, owing,
without doubt, to the interruption of a portion of the solar rays
by a constant veil of smoke, falls, on a mean of years, about a
third degree short of that on the plain.”

We cannot help remarking in this place that the author
has given a very superficial account of the temperature of
London, and, also, that he might have made many more ge¬
neral observations on our ever varying climate. The vicis¬
situdes of season should not have been entirely omitted. It
is well established that the climate of this country was in
early times far more genial than it is at present. A writer
of the thirteenth century tells us that “ a continued fall of
showers throughout England for three days, terrified many.T
In ancient times, according to Mr. Bagford, there were vine¬
yards in Hatton Garden, East Smithfield, and St. Giles’ ;
and the many vine streets in Westminster, Bloomsbury,
Lambeth, and the borough, seem to have derived their name
from the same source. The change which the climate has

VOL. III. NO. 14.

1 22 Critical Review.

undergone, seems to have chiefly taken place daring the last
century. Charles II, whose diurnal peregrinations about
the metropolis afforded him ample opportunity of correct
observation on the subject, was wont to say, that there
never was a day in which it rained so incessantly, that a
person could not take a dry walk out of the twenty-four
hours. The inhabitants of London, however, have less rea¬
son to complain of the deterioration of the climate than per¬
haps any other part of this country. The usual range of the
thermometer in this city is from five to ninety-five degrees,
according to Fahrenheit’s scale. Even in the coldest wea¬
ther, the medium of the twenty-four hours, on a long aver¬
age does not fall below the freezing point.. These and many
other facts connected with the subject ought to have been
introduced by our author.

SOUTH COAST OF ENGLAND.

The principal places on this line of coast described by
Dr. Clark are Hastings, Brighton , Chichester , Gosport,
Southampton, and the Isle of Wight. From want of more
general data the author’s observations can only apply to
these places correctly. The mean temperature of this coast
is one or two degrees above that of London in winter, and
the same ratio below the heat of the metropolis in summer.

The general character of the climate from Worthing to
Southampton, is said to be humid and heavy, and many
parts of the plain are subject to aguish complaints,” p. 24.
The author exempts Hastings, Brighton, and the Isle of
Wight from the character given of the southern coast, and
treats of them separately.

HASTINGS.

The description of the climate of this watering-place is
taken from Dr. Harwood’s interesting work. The author,
however, observes : —

“In its effects on disease, the climate of Hastings corresponds
with that of the south coast generally j it is, however, according
to my experience, unfavourable in nervous complaints, to persons
subject to headache, and to languid or relaxed habits. For per¬
sons also who have suffered from ague, I should consider Hastings
as a very doubtful residence. There is a degree of closeness and
confinement in the atmosphere of the lower and more sheltered
parts which is unfavourable to the former class of invalids j and
agues are not unfrequent about Hastings.”

BRIGHTON.

We extract the following valuable hints from the volume
before us on the climate of this long favoured place.

“ In the case of invalids who are of a relaxed habit, and who

123

Dr. Clark on the Influence of Climate.

suffer from diseases connected with this state of constitution, and
are injured by a close or humid state of the atmosphere, and for
whom a dry, mild, elastic air is necessary, Brighton, during the
autumn, claims the preference over every other place on the coast
with which I am acquainted. The early part of the spring is the
worst season at Brighton, its exposure to the north-easterly winds
rendering it an unfavourable climate at this season, to all persons
disposed to^ pulmonary or other diseases accompanied with much
general or local irritation. As examples of such, I may mention
affections of the trachea and bronchia of the dry irritable kind, and
dyspepsia arising from an irritated state of the stomach.

For the greater number of veletudinarians who frequent the
southern coast, it is probable that the autumn and beginning of
winter may be passed with the greatest advantage at Brighton 3
January and February at Hastings 3 and that some sheltered situ¬
ation in the interior, is preferable to any part of the coast in the
spring.”

ISLE OF WIGHT.

Dr. Clark details the description of Dr. Lempriere of the
climate of this island, and then makes some valuable re¬
marks.

“ On this part of the coast,’’ says Dr. Lempriere, (i we have a
climate as favorable to the invalid as any part of England can
afford. This is proved, not only by thermometrical observation, but
also by the state of vegetation during the colder months of the
year, when the myrtle, geranium, and many other exotic plants
flourish luxuriantly in the open air 3 and that even in seasons
when the severity of the frost has destroyed the green-house plants
in the north side of the island, although placed in sheltered apart¬
ments. Snow is rarely seen, and frosts are only partially felt
here.

4t The mildness of the climate, the dry nature of the soil of Un¬
dercliff, and the extent to which it is sheltered from cold winds by
affording ample space for exercise, are great advantages to inva¬
lids threatened with pulmonary disease, or others to whom exer¬
cise in the open air, in a mild climate, is desirable. In this re¬
spect, it is probably superior to any place in this line of coast.
The principal objections to it, as a residence for invalids, are the
scantiness of accommodations, and its distance from medical ad¬
vice.”

SOUTH WESTERN COAST.

The temperature of the south coast of Devon is three or
four degrees warmer than that of London, and, in sheltered
places, in winter, so much as five degrees.

“ As regards the continuance of the same temperature, the south*
western has a remarkable superiority over the southern coast ?
amounting nearly to three fourths of a degree 3 which is a very
considerable difference, when we reflect that the whole amount of
variation of successive days scarcely exceeds three degrees.

t( Different places on the south-west coast possess these general

124

Critical Review.

qualities in a more eminent degree, accordingly as they are more
or less sheltered from the north-east wind. Of these Torquay,
Dawlish, Exmouth, Kingsbridge, and Salcomb, in the South Hams,
(the Montpelier of Huxham) deserve to be particularly noticed.
But many other sheltered spots may be found along this coast, as
about Lyme Regis, Plymouth, and other places.”

TORQUAY.

<x The general character of the climate of this coast, is soft and
humid. Torquay is certainly drier thau the other places, and
almost entirely free from fogs. This drier state of the atmo¬
sphere probably .arises, in part, from the lime-stone rocks, which
are confined to the neighbourhood of this place, and partly from
its position between the two streams, the Dart and the Teign, by
which the rain is in some degree attracted. Torquay is also very
remarkably protected from north-east winds, the great evil of our
spring climate. It is likewise well sheltered from the north-west.
This protection from winds, extends also over a very considerable
tract of beautiful country, abounding in every variety of landscape 3
so that there is scarcely a wind blows, from which the invalid will
not be able to find a shelter for exercise, either on foot or horse¬
back. In this respect, Torquay is much superior to any other
place we have noticed. It possesses all the advantages of the
south-western climate in the highest degree, and with the excep¬
tion of its exposure to the south-west gales (one of the evils of
this coast) partakes less of the disadvantages of it than any other1
place having accommodations for invalids. Of the places on this
coast frequented by invalids, Dawlish perhaps deserves the prefer¬
ence after Torquay 3 it is less dry, and more exposed to easterly
winds, than the latter place Exmouth is tolerably well sheltered,
but damp and subject to fogs. Sidmouth, as will be perceived by
a reference to the tables, possesses very little of the characteristic
qualities of this climate. It is to open to the valley of the Sid, and
exposed to currents of cold wind from the mountains, whence this
stream takes its rise. It is therefore inferior to all the other places
as a winter br spring residence. It may, however, be an agreeable
summer or autumn watering place.

“ The climate of the coast of Devonshire is found very benefi¬
cial in various forms of disease. I have known it serviceable in
chronic affections of the throat, trachea and bronchia, proceed¬
ing from irritation, ora low degree of inflammation of these parts,
and attended with a dry cough, or with little expectoration 3 like¬
wise, in an irritable or morbidly sensitive state of the stomach,
and in hypochondriacal affections, the consequence of such a state.
In dysmenorrhcea, and all nervous sympathetic affections depend¬
ant on that disorder j in a highly sensitive state of the nervous
system, and in most diseases of general irritation, advantage may
be expected from this climate. On the other hand, it certainly
exerts an unfavourable influence on nervous headaches, and on all
nervous complaints arising from relaxation or want of tone of the
nervous system 3 it is injurious also in pure dyspepsia, when the

125

Dr. Clarl v on the Influence of Climate.

tone and sensibility of the stomach are below par, as indicated by
pale lips, a pale clammy state of the tongue, and languid circula¬
tion , and it wdl be found no less unfavourable in menorrhagia
in leucorrhoea, and all diseases accompanied with much General
relaxation of the system, or with much discharge from the af¬
fected organs.”

PENZANCE.

Dr. Clark has introduced Dr. Forbes’ description of the
climate of this district, and added his own observations.
The difference of temperature between London and Pen¬
zance is very remarkable.

“ Ihis will be aptly illustrated by observing that the difference
between the mean temperature of the warmest and coldest months
in London is twenty-six degrees, while at Penzance it is only
eighteen degrees ; and that, whilst in London the mean difference
of the temperature of successive months is 4°.3 6', it is only three
degrees at Penzance. On examining the progression of "tempe¬
rature for the twenty-four hours at these two places, we find that,
in winter, it is during the night that the greater part of this differ¬
ence of temperature occurs ; Penzance being nearly, on an aver¬
age, six degrees and a half warmer than London during the night ;
and only little more than three degrees warmer during the day.
This distinction ought to afford matter for the physician’s consi¬
deration. But this equal distribution of heat throughout the year
at Penzance, which we have compared so advantageously with
that of London, is still more striking when compared with that of
the south of Europe. Madeira is the only climate which we have
examined that is superior to Penzance in this quality.”

The author has given a minute account of the variations
of temperature, in the different seasons, and then enume¬
rates those diseases said to be alleviated by residence at this
place. He quotes the opinion of Dr. Forbes, that Cf little
is to be expected from it in consumption,” if once esta¬
blished, but he thinks its influence beneficial in affections of
the mucous membrane of the lungs accompanied with dry
cough and little expectoration, in tracheal and bronchial
diseases of the same character, and in asthma. The climate
is injurious in a relaxed state of the general system, in in¬
creased secretion from the bronchial membrane, and haemop¬
tysis.

WEST OF ENGLAND.

In this tract of country, the author considers the vicinity
of Bristol and Clifton to afford the most eligible winter and
spring residence for invalids. From the testimony of Drs.
Nott and Chisholm, he thinks ce there appears sufficient evi¬
dence of this spot being the mildest winter, and, more espe¬
cially, spring residence in the west of England,” p. 55. The

1*26

Critical Review.

author concludes his observations by comparing the differ¬
ent climates now described, and the diseases in which they
are beneficial.

‘f The whole of these places, as we have seen, are considerably
warmer during the winter and spring than England generally, and
much warmer than the colder parts of it. Indeed, as I have shown,
and as a reference to the tables on climate will further prove, there
exists as much difference between the temperature, and its distribu¬
tion, in the south of Scotland and south of England, as between the
latter and the south of Europe. Now, as the influence of tempe¬
rature on the living body is, in a great degree, relative, an inhabit¬
ant of one of the coldest parts of our island would, it is reasonable
to believe, feel the influence of the climate of the south-west of
England (as far at least, as regards temperature) as much as an
inhabitant of the latter would that of the south of Europe. An in-
, valid, therefore, from the northern parts of England, or from
Scotland, will find in the places we have pointed out, a milder
climate during the winter and spring, that is to say, he will be ex¬
posed to a less degree of cold, and for a shorter period ; and he
will, in consequence, be enabled to take much more exercise in
the open air, than he could have done at home.”

In speaking of situation in consumptive cases, Dr. Clark
observes : —

“ The selection will, I believe, lie among the following places,
as winter and spring residences — Torquay, Undercliff, Hastings
and Clifton ; and perhaps, in the generality of cases, they will
deserve the preference in the order stated. But I wish to be un¬
derstood as speaking with much diffidence on this subject.

*' In diseases depending upon, or connected with, much gene¬
ral or local irritation ; in chronic inflammatory affections of the
throat, trachea, and bronchia, accompanied with little secretion or
expectoration j in indigestion, arising from a heated and irritated
state of the stomach, and in the nervous and hypochondriacal
affections originating in such a state ; in dysmenorrhcea, and in
dry irritable cutaneous diseases, the coast of Devonshire affords
the most favourable winter climate. In cases of the kind referred
to, in which it is desirable that the invalid should remain station¬
ary during the whole year, the Land’s-end would perhaps be pre¬
ferable to the coast of Devon.

“ In chronic diseases of the trachea and bronchia, on the other
hand, which are attended with copious expectoration and dysp¬
noea ; in dyspeptic disorders of a more purely nervous character,
and where there is a relaxed state of the system, or a tendency to
copious mucous or sanguineous discharges, the climates of the
south west of England and the Land’s-end are unfavourable. It
is indeed difficult to find any place in our island, the climate of
which is very suitable for such cases, during the whole of the cold
season. Brighton is, I believe, the most favourable residence
during the autumn and early part of the winter. The climate of
this place is generally mild and equable, and the air comparatively

Mr. Wallace* on Pneumonic Inflammation. 12 7

dry and elastic at this season. But during the later part of the
winter, and still more in the spring, Brighton is cold, being ex¬
posed to all the severity of the north-east winds, Hastings is*
then considerably warmer and more sheltered. The neighbour¬
hood of Bristol and Clifton affords a good spring residence in the
affections which we have noticed ; but the distance from the south
coast will render such a change in general unadvisable, as well as
inconvenient. Invalids labouring under the chronic affections
mentioned, and who cannot absent themselves from London dur¬
ing the whole season might go to Brighton during the autumn
and early part of winter, remain in town in the winter, and go to
Clifton in the spring y or, should this be inconvenient, Chelsea
and Brompton afford sheltered spring situations, which might be
found suitable.

“ When we are better acquainted with the climates of the
warmest and more sheltered parts of Sussex, of Surrey, and Hamp¬
shire, a better and more convenient arrangement, I have no doubt,
may be made for such patients. On the present occasion, how¬
ever, it was with difficulty I could collect materials for determin¬
ing with some accuracy the characters of the principal places in
this country resorted to by invalids ; and this, I hope may be re¬
ceived as an apology for the meagre account of them with which
I have been obliged to content myself. It is right, moreover, to
add, that my experience of the effects of these climates on diseases
is still too limited to enable me to speak of their remedial quali¬
ties in the same decided manner, which I feel warranted in doing
respecting most places frequented by invalids in the south of
Europe.” - (To he continued .)

ORIGINAL COMMUNICATIONS.

I. — 'Observations on Pneumonic Inflammation * occurring after
Immersion of the Body in Water . By James Wallace*
Assistant-Surgeon* R.N.

In the course of my nautical life, I have had occasion to ob¬
serve the frequent occurrence of pulmonic complaints after
immersion of the body in water, and conceiving that a due
attention to these accidents may be the means, in some
cases* of mitigating, perhaps of preventing altogether* such
an unfortunate occurrence, I beg to put the profession* espe¬
cially the nautical part of it* in possession of the little infor¬
mation which I possess on the subject. Sea-faring people,
from their habits of life* are generally robust, and well cal¬
culated to bear fatigue of every description. They are, from
their youth inured to toil* and to hardships of various, kinds,
which confers on them a strength of fibre* and a general
vigour of system* considerably above the generality of men *

128

Original Comm uni cations.

and with this accession of corporeal strength, they undoubt¬
edly possess a corresponding immunity from disease. They
are frequently stinted both in their food and their sleep 5
they are shifted rapidly from one climate to another ; they
are exposed to every inclemency of weather ; they are sel¬
dom clothed according to the exigencies either of season or
climate ; and yet we find them, in the majority of cases,
healthy, and attaining, not unfrequently, even to old age,
without experiencing any serious ailment. Hence the word
c hardy/ as applied to the sailor, has become proverbial.
Yet, for all this, the sailor is subject to a multitude of dis¬
eases, and with all his strength, he sickens and dies like his
fellow men. Nor ought we to presume too much upon his
strength, seeing that it does not always avail him, but we
ought to watch him as carefully, and be as much on the
alert either to prevent, or combat when they have attacked,
his different ailments, as if his system were on a par with
that of the more delicately brought up landsman.

All the world knows that, when a person gets damp or
wet, there is a considerable risk of injury to health, and that
certain precautionary measures are necessary in order to
avoid after-illness. Experience teaches us that not only se¬
rious diseases of the chest, but also diseases of other parts
of the system, are frequently brought on from such causes,
and even the most ignorant are aware of the necessity of
getting rid as quickly as possible of their damp or wet ha¬
biliments, and bringing the body back to its natural state of
warmth. But I do not think it has yet been particularly
noticed, at least it has not been insisted on, that violent and
even fatal inflammation of the lungs is very apt to follow
accidental immersion of the body in water (that water, and
the surrounding atmosphere, being at a certain temperature)
and I do not think that medical men, generally speaking,
are so much on their guard, or so watchful of such cases as
they ought to be.

It is some years since my attention was first directed to
the present subject. The first case which I particularly no¬
ticed was that of a boy, who fell from the deck of a ship into
the water at Portsmouth harbour. He was speedily picked
up, stripped of his wet clothes, dried, and put to bed. He
was at this time labouring under the usual symptoms of de¬
pression from the application of cold. He was shivering ;
the skin wTas cold and shrivelled ; the face pale and shrunk¬
en ; the pulse scarcely to be felt ; respiration hardly observ¬
able ; the articulation difficult. In a short time reaction
began, and in the course of a few hours, the heat of skin
was so great, the pulse so full, and the respiration so hur-

Mr. Wallace on Pneumonic Inflammation. 129

ried and impeded, that it was deemed advisable to detract
blood. He was greatly relieved by the bleeding for a time,
but by and bye, the pulse again rose, the breathing became
impeded as before, and he now complained of considerable
pain in the chest. He was in fact seized with acute inflam¬
mation of the lungs, which quickly ran on to suppuration,
and in a few days he died.

The second case occurred at Lisbon. A sailor, in rather
a chilly evening, tumbled from the deck of his ship into the
Tagus, but was, like the boy, quickly taken up and put to
bed. As soon as reaction had fairly set in, the loaded state
of the lungs became most apparent. He breathed with
great difficulty, and with considerable noise ; there appeared
to be violent spasmodic action of the whole respiratory ap¬
paratus ; he sat erect ; the countenance was anxious ; and
the pulse full and thrilling. He was bled largely from the
arm, with instantaneous relief. He slept tolerably well for
the rest of the night, and though for a day or two after
there were threatenings of increased action, yet he quickly
got well.

A third case occurred soon afterwards in that of a marine,
who also got into the river, while attempting to step from
a boat into his ship. He also had an attack of pneumonia,
and though the more acute symptoms were soon subdued,
yet it was for some time doubtful whether he would reco¬
ver ; he had a threatening of phthisis for some time, but
ultimately did well.

A fourth case was one of the same kind; but in this case, as
in the one first mentioned, death was the result. The man fell
into the river in a cold night, and two days after was seized
with inflammation in the chest, which in a short time proved
fatal. This man, however, had previously been the subject
of severe pectoral disease.

I might multiply cases, for I have known others closely
resembling these, but these will be sufficient to prove that
after immersion of the body in water (under certain circum¬
stances) there is a liability to congestion in the lungs, and
that, therefore, it is incumbent on the medical attendant, in
• all such cases, to watch narrowly the state of his patient for
a time.

It is known to every body, at least to every body ac¬
quainted with medicine, that if by any means we depress the
vital energies of the system for a time, as soon as the depress¬
ing cause is removed, reaction begins, and this reaction is
generally in proportion to the previous degree of depression.
By the application of cold to the extremities in the winter,
and the consequent reaction (increased too often by the in-

VOL. III. NO. 14.

130

Original Communications.

cautious application of heat), we have chilblains and other
inflammatory affections of the feet induced ; but when the
cold has been more intense, and the part has become actu¬
ally frost-bitten, then it is only by the greatest care that we
can manage so to moderate the after-action as to prevent it
from terminating in the death of the part. By the applica¬
tion of a certain degree of atmospheric cold to the surface,
to the bronchise, and other mucous membranes, we have
common catarrhal symptoms induced ; but if the cold ex¬
ceed a certain limit, and especially if any impropriety is
committed during the stage of excitement, instead of ca¬
tarrh, we have pleuritis, pneumonia, rheumatism, or seme
other disease not less acute in its character. When a per¬
son falls, or receives a blow, so as to produce a sudden im¬
pression on the nervous system, we have the vascular sys¬
tem immediately sympathizing, and both the circulation and
respiration become greatly lowered; but in a short time
symptoms of increased action appear, and the strong pulse
and full breathing clearly indicate that now there is a greater
activity of circulation than previous to the accident. But
when the shock has been so great as to produce insensibi¬
lity, or a state nearly approaching to it, then the reduction
of circulation is still greater— the heart’s action may be im¬
perceptible^ — but when reaction does begin, it may never¬
theless run so high as to destroy life. And in the same
way when a person plunges into water, at the common tem¬
perature of the sea, a sensation of cold and sinking is pro¬
duced, and the heart’s action is sensibly diminished, which,
however, is quickly followed by an agreeable glow of heat,
and a stronger pulse than before. But if the water is much
under that temperature, or if the body is kept in it for too
great a space of time, then there is a degree of depression
induced, which is incompatible with health ; and, as in the
former cases, life is endangered by the after-excitement.

There indeed appears to be a remarkable similarity in the
effects produced by concussion of the body, and the immersion
of it in water; with this difference, that in the former case the
onus of the excitement falls upon the brain — in the latter,
upon the lungs. We have the same immediate symptoms of
depression, and the same increase of vascular action, after a
time, and the same tendency to the lesion of most important
organs in both cases. It has not been the custom to watch
with the same care the patient who has suffered from immer¬
sion as he who has suffered from concussion, but I conceive,
looking at all circumstances, that we would be right in put¬
ting them on the same footing. The lungs are about as es¬
sential to life as the brain, and, I believe, we have about as

Mr. Wallace on Pneumonic Inflammation 131

much danger to apprehend from inflammation within the
thorax as within the skull. If we are anxious about the state
of the brain after concussion, we cannot be much less anxious
about the state of the lungs after immersion of the body in
water, seeing that, in the latter case, as well as in the
former, congestion is likely to ensue, and that in both cases
the danger to life is pretty nearly balanced. There may, in7
deed, be a slight degree of difference in the danger of these
two cases, but it is not such a difference as ought to weigh
much with the. practitioner, or throw him off his guard ; on
the contrary, he ought to watch with the same diligence, and
be as prompt and active with his treatment in the one case
as in the other.

It is not improbable that, occasionally, in the accidents now
spoken of, the symptoms of depression may proceed, in part
only, from the application of cold; they may, also, in fact, be
the product of concussion. It is natural to suppose that, when
a person falls into the water from a height, the system will
receive a considerable shock, quite independent of the ac¬
tion of cold, and therefore we might expect that in such
cases we would have the head suffering as well as the lungs.
I have observed, too, that those people who, in bathing, are
fond of jumping into the water from an elevated part, are
more liable to after-headache than those who walk quietly
in. But I cannot say that I have observed any very se^iou^
affection of the head following these accidents. The patient,
it is true, generally complains of headache during the stage
of re-action, but the head, we know, suffers somewhat in
all cases of vascular excitement. The lungs, I believe, even
in these cases, are the organs demanding our chief atten¬
tion.

It is but fair to state that I have seen numerous instances
where persons have been immersed for a considerable time in
the water, and yet have sustained no injury. Nay, I have
known them, in spite of every remonstrance, obstinately keep
on their wet clothing after they had an opportunity of part¬
ing with it, and yet escape with impunity. But this by no
means invalidates what has previously been said. Inflam¬
mation of the brain does not always follow concussion, and
hair-breadth escapes are common in all things. It matters
not although it might be proven that even the majority of
those who may be exposed to such accidents come off with¬
out injury. If it has been ascertained that even a few have
suffered — if it can be shewn that even liability to injury ex¬
ists, then we must proceed on the probabilities of the case,
and so put in force either a prophylactic or a curative mea¬
sure, as may be necessary.

132 Original Communications.

What, then, are the remedial measures which we ought to
have recourse to in the accidents under consideration ?
They are few and obvious ; so obvious, that they must rea¬
dily occur to every one acquainted with the general treatment
of disease. It has already been stated that the symptoms
following immersion of the body in water, are closely allied
to those following concussion, and I apprehend that the
treatment which is applicable in the one case, is also appli¬
cable in the other — keeping in mind, that our attention in
the first case is to be especially directed to the lungs, in the
second to the brain. When the body is taken out of the
water, it ought to be speedily stripped of its clothing, dried,
and laid in bed between blankets. If there be much torpor,
besides the warm covering, we may employ friction, both to
the trunk and extremities ; and this, I believe, is all, or
nearly all, that wTe can do in the first stage. Sailors at this
time are very apt to seek spirits, and their messmates, un¬
less a strict watch is kept on them, are not slow in applying
them, but if it be prejudicial to stimulate when there is a
tendency to phrenitis, it cannot be less so when there is a
tendency to pneumonia. All that we ought to do is to pre¬
vent the farther subduction of heat, which is best done by
covering the body well up, and in a moderate time the natu¬
ral warmth is restored. When the second stage has set in,
if no impropriety has been committed in the previous stage,
and if we can produce a free perspiration, the lungs will, in
general, be safe. The pulse may be full, but it will be soft,
the breathing will be free, and a day or two’s rest with low
diet, will put the patient out of all danger. But if the pulse
should become full and hard, the breathing hurried, and im¬
peded, the countenance anxious, and the skin remain hot and
dry, wre ought at once to take away blood in a full stream,
and in considerable quantity. One full bleeding, timeously
had recourse to, may effectually put a check to all the alarming
symptoms. But if the symptoms of over-action should re¬
turn, we must again return to blood-letting, and we must
again repeat it, without fear, as often as may be necessary.
It may be necessary, also, to have recourse to topical blood¬
letting, such as the application of cupping-glasses to the tho¬
rax, along with digitalis, tartrite of antimony, saline pur¬
gatives, and the other means best suited for the reduction
of vascular action. If, after all, the ailment should termin¬
ate in suppuration, the treatment best adapted for that
stage must be assiduously put in force, wrhich, however, it
would be needless to detail here.

Of course, when the accidents happen to those who have
previously laboured under pulmonic complaints, or who are

Dr. Ryan on Hysteralgia and Intestinal Irritation . 133

known to possess a constitutional tendency to these ailments,
the risk of after-inflammatory action will be considerably in¬
creased, and, if possible, we must be even more watchful of
these than of common cases. In such cases, although no
serious symptoms may appear for some days, yet, as they
frequently come on afterwards, we ought not to lose sight of
the patient, or think him altogether safe, until after the
lapse of some time.

These observations, as I have already stated, I have chiefly
brought forward with the view of calling the attention of me¬
dical men, practising at sea, to the object, and I should hope
that those whose experience may enable them to judge of the
correctness or incorrectness of my remarks will, at some pe¬
riod or other, favour the profession with their opinions.

Chatham, 29th June, 1829

II. — Case of Partial Adhesion of the Placenta by Cellular
Membrane — Hysteralgia and Intestinal Irritation— -‘Reco¬
very. By Michael Ryan, M.D.

Mrs. B. jet. twenty-two, of rather a full habit and sangui¬
neous temperament, was delivered of her first child on the
22d ult. ; the labour was natural but tedious, it having con¬
tinued for twenty-four hours. Mr. Loveless, one of my pu¬
pils attended the case. The placenta was not expelled at
the expiration of two hours, but there was no hemorrhage ;
and on examination it was found partially lodged in the va¬
gina, the foot of the funis, however, could not be touched.
The uterus was fully contracted and there were no after-
pains. On endeavouring to extract the placenta with the
finger and thumb, a good deal of pain was experienced,
which induced Mr. Loveless to desist, and request my at¬
tendance. I repaired immediately to the patient, and found
the symptoms as just stated. The uterus felt fully contract¬
ed through the abdominal parietes, and on instituting the
usual vaginal examination, I found the greater portion of the
placenta loose in the vagina, the root of the funis could not
be touched, and the os uteri was firmly contracted on the
placental mass. With much difficulty the fingers were gra¬
dually insinuated between the placenta and the os uteri, and
cautious traction employed, which produced unusual pain,
and obviously proved that an adhesion of some kind existed
between the uterus and placenta. The whole hand was
slowly and cautiously introduced through the os uteri, and
the fingers very carefully insinuated in the ordinary manner
for the separation of the adherent placenta. In separating

134 Original Communications .

the adhesion, I experienced more difficulty than is usually
encountered, it was slowly accomplished ; the uterus finally
contracted, and expelled both the hand and secundines.
On examining the placenta, it was found entire, and the ad¬
herent portion was very firm in structure and covered with
well organized cellular membrane. The funis was attached
to the extreme edge of this portion. There were two coa-
gula which were estimated at four ounces, attached to the
detached surface of the placenta. No after-hemorrhage.
The infant was very large, which shews the development of
the uterus and secundines must have been in a similar con¬
dition ; and also accounts in some degree for the unusual
deposition of cellular substance and placental adhesion.
The patient had been extremely healthy during the whole pe¬
riod of utero-gestation. 23d. Seven, p.m. The patient makes
no complaint, lochia natural, urine passed freely. She has
passed a good night, but this morning complained of occa¬
sional pain in the left iliac region, which extended through
the abdomen and stomach. While her attention is engrossed
in answering questions considerable pressure on the abdo¬
men induced no pain, nor did it affect the uterus except in
the situation just mentioned. Pulse 80, soft, and rather
small ; tongue white and moist ; no appetite ; no nausea or
vomiting; no headache or heat of skin; mammae flaccid; lo¬
chia sparing ; little urine ; bowels confined. Was ordered a
draught composed of castor oil, four drachms ; oil of turpen¬
tine, one drachm. Fomentations of decoction of poppies
and chamomile to the abdomen ; the catheter to be employed
in the evening if necessary. The apartment is oppressively
warm, as a fire cannot be dispensed with. Six, p.m. Pain in
abdomen much increased since last visit; complains of a
sensation as if a large ball moved from the uterine region to
the stomach,^ from side to side, and this only at inter¬
vals ; pulse 104, not strong, sharp or hard ; bowels opened
four times, motions scanty, no febrile symptoms with the
exception of the state of the pulse; no pain or tenderness
on pressing the abdomen, unless during the paroxysm;
lochia very sparing; urine voided in considerable quantity.
To have a draught of castor oil, six drachms; tine, of opium,
twenty-five minims ; peppermint water, one ounce. Fomen-
tion to be repeated. Nine, p.m. Pain more violent at inter¬
vals, shooting through the sides and abdomen ; skin hot, has
not taken the draught ; pulse 126, soft and easily ^ com¬
pressible.

Twelve ounces of blood were abstracted with difficulty
when the flow ceased, no relief produced ; draught exhibited,
with ten minims more of the tine, opii; soon after which she

Dr. Ryan on Hysteralgia and Intestinal Irritation. 135

felt relieved in some measure. She had a mixture of a solu¬
tion of acetate of ammonia, nitrate of potass and camphor,
every fourth hour. 24th. Eight, a.m. Slept well and is much
relieved; no pain in the abdomen; slight soreness remains
in the left iliac region ; tongue cleaner; bowels opened twice,
dejections brownish and foetid; lochia very trifling; mammae
more tumid; no secretion of milk; no discharge of urine.
Thinks herself free from complaint. Blood slightly cupped,
not buffed. About six ounces of urine drawn off by the
catheter. , , ? - '

Some of the gentlemen attending my lectures, visited the
patient, as I considered her case a well-marked exainple of
hysteralgia, (so well described by Dr. Burns) combined with
intestinal irritation, and not dependent on inflammatory
action. Two, p.m . Was requested to see the patient as
soon as possible, as the pain had returned more violently
than before, and had awoke her from a sound sleep. On
my arrival, I found her writhing with agony, screaming
loudly from the severity of the pain, pulse very small and
rapid; no tenderness on making gradual and steady pressure
on the abdomen. Exhibited forty minims of tine, opii in
a table spoonful of brandy and warm water ; detracted six
ounces of blood from the arm with difficulty; ordered the
fomentations to be repeated, and introduced the; catheter as
she felt a desire to evacuate the bladder, and extracted four
ounces of urine. These measures afforded no relief what¬
ever. The abdomen was then fomented with flannels wetted
with oil of turpentine. This application was continued for
half an hour, when partial vesication was produced, and
caused such severe pain, that the former suffering no longer
existed. She was now more vociferous than ever, and had a
fit of syncope. A napkin wrung out of cold water was ap¬
plied to the naked abdomen, and kept constantly moist with
the same fluid, which, in about ten minutes, diminished her
sufferings, but she refused to continue its application fur¬
ther. A paroxysm of the former pain recurred with vio¬
lence; at a quarter past three, forty minims of tine, opii were
exhibited in half a glass of brandy and water. This fit con¬
tinued for half an hour, when she became more tranquil, and
appeared drowsy, the pulse became fuller and slower. I
took advantage of this calmness and examined the state of
the os uteri which was not hotter than usual, and bore consi¬
derable pressure without any pain ; on introducing the finger
through it, I discovered a piece of membrane imbedded in a
clot, and a piece of placenta, about an inch in extent, were
hooked into the vagina, and extracted. A severe rigor oc¬
curred which, was followed by copious perspiration, and at
four, p,m., she felt no pain whatever; the pulse was full and

136

Original Communications.

soft, 110. She pressed heavily on the abdomen and uterus
with perfect freedom. Five, p.m. Has had no return of any
pain; is in a profuse perspiration. Seven, p.m. As at last visit.
Half past nine, p.m. Has had no return of pain in the uterus
or abdomen ; pulse 120, smaller, soft and compressible ; ex¬
periences a sense of soreness in the uterine region on chang¬
ing her position only; tongue less white and moist; thirst;
lochia increased; mammae more tumid; perspiration profuse;
abdomen soft but tympanitic* To have a draught composed
of castor oil, six drachms ; peppermint water one ounce and
a half. Mr. Loveless and Mr. Heath were present at this
visit. Eleven, p.m. Has had no return of pain — symptoms
as at last report. Requested to hear from the patient early
next morning.

25th. Eleven, a.m. Mr. Loveless, Mr. Bayliffe, and Mr.
Glissan accompanied me to visit the patient. She has slept
well, feels no pain even on steady pressure on the abdominal
and uterine regions ; pulse 88, soft and fuller ; tongue
cleaner; mammae fuller; lochia sparing; discharge of urine
natural; bowels opened twice; dejections yellow and foetid;
makes no complaint. Eight, p.m. Slight return of pain ;
which is of a griping kind ; bowels opened several times ;
dejections yellowish, and less foetid, the last slightly tinged
with blood ; perspiration ; thirst ; distension of the bosom ;
pulse 100, soft and full ; tongue cleaning ; no pain on press¬
ing the abdomen ; uterus pained on coughing ; lochia still
sparing. To have diaphoretic mixture and twenty-five mi¬
nims of tine. opii. The apartment is very warm, though door
and window are opened constantly. 26th. Eleven, a.m. Has
passed a good night, no return of pain ; occasional griping;
abdomen less tense ; dejections natural. Pulse ninety-six ;
skin cool ; milk secreted ; tongue much cleaner ; lochia still
sparing ; to have an anodyne draught to relieve her tor¬
mina. She was quite well on the 27th.

This was evidently a case of hysteralgia, and intestinal
irritation ; the first so accurately described by Dr. Burns ;
the second, by Drs. Granville, and Marshall Hall. The
suddenness of the attack, the periodicity of the pain which
was erratic, the state of the pulse, the absence of rigor, nau¬
sea and vomiting, clearly proved the nature of the disease,
and left no doubt of its dependence on nervous irritation,
and not on inflammatory action. The treatment was adopted
according to this view of the case. The bleedings were re¬
sorted to, more for the purpose of allaying irritation, than
under the apprehension of inflammation, and certainly
should have been carried to a greater extent, had not the
veins been very small and the patient much opposed to de¬
pletion.

Hatton Garden, July 30th.

BIBLIOGRAPHY.

GENERAL REVIEW OF FOREIGN AND BRITISH MEDICAL JOURNALS.

MEDICINE.

1. Remarks on Otorrhcea Purulenta. By Dr. Burne. — Otorrhoea
is a chronic discharge from the ear, and may proceed from the or¬
gan itself, or from suppuration in some neighbouring part. The
discharge may consist of mucus or of pus j the purulent discharge
is not unfrequently preceded by the mucous, and both are the
consequence of inflammation. The mucous otorrhoea is met with
in children particularly, and is seldom of serious consequence ; it
generally yields to treatment, or subsides at the age of puberty.
The purulent otorrhoea, on the contrary, is deep-seated and dan^.
gerous ; and it is this which forms the subject of the following
observations.

It is inflammation of the mucous lining of the tympanum which
generally gives rise to purulent otorrhoea 5 and the construction of
the part opposes the discharge of the matter, the simple retention
of which is the cause of serious mischief.

Inflammation of the tympanum manifests itself by severe pain
deep in the ear, which rapidly increases, and affects the whole side
of the head. The pain extends in the direction of the eustachian
tube, and of the mastoid cells, and is aggravated by the slight¬
est noise or motion. The cavity of the tympanum is soon filled
with a muco-purulent secretion, which having no outlet (the eu¬
stachian tube being obstructed by tumefaction) produces a most
distressing sense of tension. To these symptoms, delirium not
unfrequently succeeds, and all the sufferings continue until the
matter has worked itself an outlet.

This it may do through the membrana tympani, or by the eu¬
stachian tube, or through a fistulous opening in the mastoid pro¬
cess. Of these, the first exit is by far the most common. After
several days of severe suffering, the perforation of the membrana
tympani is effected, and a copious discharge of matter takes place,
which is immediately succeeded by a subsidence of the symptoms.
In some instances, the matter is said to discharge itself by the eu¬
stachian tube, but from Dr. Burne’s experience, this does not take
place until the inflammation has been relieved by the spontaneous
perforation of the membrana tympani. In this case, the discharge
will continue both by the meatus externus and the eustachian tube,
simultaneously.

The purulent otorrhoea does not always begin in such an acute
form as that above described. It is often produced by inflamma¬
tion travelling from the throat along the eustachian tube to the
tympanum, which happens particularly in eruptive diseases, and
hence the date of the otorrhoea is frequently referred to the period
when the patient had the small- pox or scarlet fever.

When the matter has found its way through it into the mastoid
cells, it cannot be evacuated except through a carious perforation.
From the form and situation of the tympanum, the matter lodges

VOL. Ill, no. 14.

138

Bibliography .

in it as in a well, and gives rise to a train of formidable symptoms,
which constitute the second stage of the disease.

The continual lodgment of matter from the cause above detailed,
now begins to operate injuriously on the containing parts. The
perforation of the membrana tympani giving access to the air, the
retained matter is decomposed, and its irritating qualities in¬
creased, by which the lining membrane is exulcerated, and the
bone exposed.

The parts which first suffer are the mastoid cells, in which the
matter is pent up : the slow advance of the caries is indicated only
by obscure signs, so that the bony structure of the ear is under¬
mined before we are aware. For a considerable period there is
little else complained of than an obscure pain, and the sense of
hearing is blunted.

As the caries advances, the mastoid process becomes tender on
pressure, and the integuments about it puffy ; and at length, the
perforation of the bone being completed, the matter escapes, and
forms an abscess underneath the integuments. The abscess does
not burst readily, but extends itself upwards, behind the ear ; but
there are examples in which it descends under the stylo-mastoideus,
and points low down in the neck 5 it never extends backwards.

The caries of the mastoid cells does not confine itself to this out¬
ward direction, but next affects that part of the temporal bone
which forms the posterior wall of the mastoid cells ; the bone is
here naturally thin, and when carious, presents a worm-eaten ap¬
pearance. Through these carious perforations the matter pene¬
trates, detaches the dura mater, and gives rise to more decided
cerebral symptoms. Should the patient survive, the caries will go
on to ravage the internal ear 5 and in this way all the sinuosities
and cavities, and bony fabric of the ear, are destroyed ; and the
petrous portion and mastoid process present one large carious ex¬
cavation.

In the course of this general devastation, the portio dura and
facial nerve are involved, which give rise to neuralgic pains, con¬
vulsive twitchings, and, lastly, to paralysis of the side of the face.

When the perforation has taken place internally, the dura mater
being now exposed to the irritation of the secretion from the ear,
inflames and suppurates, and becomes detached, by the matter,
burrowing between it and the skull. In this stage the patient is
sometimes carried off by meningitis ; at other times, the destruc¬
tive process will go on to cause ulceration of the dura mater, and
of the other membranes, and lastly of the brain itself.

It is at one of these periods of inflammation of the brain that
the practitioner is called in, and his first impression of the com¬
plaint is, that it is an idiopathic meningitis ; between which and
the present case it is so far important to distinguish, that the
blood-letting required to save the patient in the one instance
would destroy him in the other.

In the inflammation of the membranes of the brain in cases of
otorrhoea, there is a deep-seated, severe throbbing pain in the mid¬
dle of one side of the head, with great tenderness of scalp on the

Dr. Burne’s Remarks on Otorrhcea Purulenta. 139

same side, so that the patient cannot lie upon it 3 the suffusion of
the face is not marked, nor is the expression of the eye vivid, and
though there is delirium, it is little active 5 the symptomatic fever
is not ardent in proportion to the urgency of the local signs, and
there is a marked exacerbation of the febrile state at night, while
it is moderate in the day.

As, after a puriform discharge from the tympanum is once es¬
tablished, the subsequent mischief results from the retention of
the matter, the chief indication is to prevent such retention. This
can be done only by washing out the tympanum by injections $
because, notwithstanding the eustachian tube may be pervious,
and its inclination favour the natural discharge of the matter, its
canal grows so narrow as it approaches the tympanum, that it
offers an insufficient outlet in its sound state 3 and when tumefied
by the diseased secretion, it is nearly closed, and in very many in¬
stances obstructed altogether. Little can be expected, therefore,
from the natural evacuation of the matter by this canal.

The membrana tympani being perforated by the ulceration, ad¬
mits the use of injections by the meatus externus, by which means
the tympanum may be cleansed without much difficulty j but the
formidable obstacle to a cure is the lodgment of matter in the
mastoid cells, the opening to which is, it will be remembered, at
the upper part of the tympanum, so that when matter has once
flowed into them, it cannot evacuate itself, nor be dislodged by in¬
jections through the meatus externus. There is only one means
which suggests itself for the effectual removal of the matter thus
retained, and that is, perforating the mastoid process by any fit in¬
strument, so as to form a free external communication with the
cells through which injections may be passed. In this way it would
be practicable, by injections forced through this artificial commu¬
nication.. as well as through the meatus, to prevent any lodgment
of matter either in the cells or tympanum, and thus do away the
cause of the disease. Should the membrana tympani not have
been perforated by ulceration, and the discharge have taken place
only by the eustachian tube, the artificial perforation of the mas¬
toid process would offer equal advantages, the injections then
passing directly from the cells through the tympanum, and down
the eustachian tube into the pharynx, and all the parts of the ear
would be thus relieved from any lodgment of matter.

Before having recourse to injections care must be taken to as¬
certain the exact stage of the disease, because they cannot always
be used with safety. So long as the caries is confined to the ear,
there need be no hesitation in administering injections 3 but when
it has penetrated the skull, they are inadmissible, lest any part of
the fluid should be forced within it, the consequences of which
might be fatal. The character of the symptoms will point out
the extent of the disorganization, and inform us correctly whether
it has reached the brain. While the disease has not extended be¬
yond the ear, the sufferings are referred to this organ by the pa¬
tient, the pain being deep-seated in the ear, and radiating from it
over the side of the head 5 but as soon as the dura mater and brain

140 Bibliography.

are involved, the symptoms of cerebral affection predominate, the
complaints being now all directed to the brain. This diagnosis
will be a safe guide, and should be borne in mind.

When the disease attacks the internal parts, every means must
be adopted to encourage a return of the discharge, as fomentations
and poultices to the side of the head ; and blood-letting must be
employed only so far as to keep down the inflammation.

2. Remarks on Ischuria. By Dr. Hastings, of Worcester. — On
the 9th of April, 1814, M. H., aged twenty-three, was admitted
into the Worcester Infirmary. Within the last week she had been
exposed to cold, whilst menstruating. For the first day or two
she only suffered from slight fever ; but soon afterwards the se¬
cretion of urine became deficient, and she had difficulty in pass¬
ing it. On the evening of her admission she complained of pain
and tenderness over the whole of the lower part of the abdo¬
men, and in the loins j there was vomiting, and a disposition to
convulsion. The lower part of the abdomen was much distended.
Ten ounces of urine were drawn off by the catheter ; after which
the pain was relieved. She had purgative medicines. The next
morning the bowels had not acted. She had severe head-ache, as
well as abdominal pains ; she had passed no water, and had been
delirious during the night. She was cupped on the back, had a
blister applied, and took cathartic mixture every four hours till
the bowels moved freely ; after which she went into a warm bath.
On the 25th, there was much vomiting, pain, and distention
of the abdomen, but she passed a little urine. On the 27th, a
bloody discharge appeared at the umbilicus, after which the ab¬
dominal pain and tension were relieved. She also passed some
urine by the urethra. The bloody discharge from the umbili¬
cus, and the other symptoms, continued very much the same till
the 2d of May, when there was a discharge of an urinous appear¬
ance and smell from the umbilicus. She had passed no urine by
the urethra for three days. The catheter was introduced, but no
urine found in the bladder. This discharge of urine from the um¬
bilicus continued till the 5th, when the catamenia appeared, but
quickly vanished. From the 7th to the 9th, there was no dis¬
charge of urine from the umbilicus, nor was there any passed by
the urethra. On the 10th, in the morning, six ounces of urine
were drawn off by the catheter; and in an hour after, two quarts
of urine, of the same appearance, gushed from the umbilicus.
This was followed by much relief of the abdominal pains. The
discharge of urine from the umbilicus continued for three days,
and was accompanied with great improvement of the general
symptoms. On the 17th, the catheter was introduced into the
bladder, and no urine was found. In an hour after this two quarts
of urine passed from the umbilicus, and soon aftewards great re¬
lief was experienced. From this time to the 25th, there was little
variation, but the young woman suffered during that interval very
much from vomiting, and daily passed urine from the umbilicus.
The catheter was passed every day, and no urine was found, but
the bladder contracted strongly on the instrument. On the 26*th,

Case of Perforation of the Stomach . 141

for the first time after many days, four ounces of urine were drawn
from the bladder. Each succeeding day this quantity was now
increased, and the quantity passed by the umbilicus was diminished.
The bladder was regularly emptied every day by the catheter for
more than a month after this date, during which time the abdomi¬
nal pain and vomiting subsided, and there was no discharge from
the umbilicus. Early in July she began to pass some urine, and
the power over the bladder was gradually restored. She was dis¬
charged in the middle of July in tolerable health.

4% This curious case of ischuria is well worthy of consideration.
The remarkable sympathy observable between the brain, the sto¬
mach, and kidneys, is common to all cases of this description, and
is so obvious as not to require any further comment. The very
remarkable feature in the case, is the occurrence of the urinary
discharge from the umbilicus many days after the ischuria had
been noticed. Such instances, although rare, are not without pa¬
rallel in the annals of medicine. Shenck relates two instances of
this kind. In the one, a male, the urine was discharged in conse¬
quence of an obstruction at the neck of the bladder, f tanquam
mictione ex umbilico,’ for many months, without any detriment
to health. In the other, a female, and more resembling the one
now related, ‘ cum suppressa per multas dies fuisset urina, tandem
per umbilicum urinam profudit.’ — Shenck Obs. Lib. iij. de Urina,
p. 4S9.

The interesting question is to determine in what manner the
urine is conveyed to the umbilicus in these instances. The ura¬
chus offers itself as a mean by which the discharge may be deter¬
mined to that part, and it seems probable, that in the case of me¬
chanical obstruction related by Shenck, at the neck of the bladder
that a channel of communication was formed by the urachus, be¬
tween the bladder and the umbilicus. But in the case we now
remark upon, there had been no urine secreted into the bladder,
long before its appearance at the umbilicus, nor was there for
some time after > and the first discharge from the umbilicus was
not of an urinary, but bloody nature. We must, consequently, I
think, regard the' urinary discharge in this instance as vicarious,
and as proceeding, probably, from the peritoneal surface. This
view seems confirmed by the great abdominal distention which
took place for some time previous to the discharge from the um¬
bilicus, when it was invariably found, from introducing the cathe¬
ter, that the bladder was empty, and that it contracted on the in¬
strument.”

Dr. Hastings adds, that the young woman was again admitted
into the infirmary, in May, 1827, for paralysis of the lower extre¬
mities, from which she recovered by appropriate remedies. The
urine, for a time, was drawn off by the catheter, but there was no
return of the former disease. — Midland Med. and Surg. Reporter.

3, Case of Perforation of the Stomach. By Dr. Marshall Hall. —
The little girl whose case I am about to describe, had been sub¬
ject, from a very early period after its birth, to attacks of bron¬
chitis.

142

Bibliography.

Early in April it became affected with pertussis. The symptoms
of bronchial and pulmonary inflammation called for the abstrac¬
tion of blood ; and three, and then two leeches were applied to
the chest on two successive days, with other remedies usual in
such cases. This was followed by exhaustion with reaction, the
countenance varying, being sometimes pallid and cold, and some¬
times flushed, and the pulse frequent and jerking. Soon after the
second application of leeches, there were also frequent fits of con¬
vulsion, for which a cold lotion was applied to the head j and the
warm bath was used frequently. The hydrargyrum cum creta was
administered, with a mild nutritious diet. There was no sickness,
no diarrhoea.

After a variable state of things this little patient sank and ex¬
pired, having lingered eight days.

Permission could not be obtained to inspect the body until the
fifth day after death. The morbid appearances were then care¬
fully noticed by Mr. R. Welbank and myself.

The general surface was extremely pallid, but there was little
or no emaciation.

The bronchise were clogged with mucus, and the lowest lobe of
each lung was hepatized-

On looking into the right cavity of the thorax, a small portion
of venous blood was observed. The source of this was carefully
traced. A small part of the pleura immediately adjacent and
above this spot, extending upwards over the convex surface of the
vertebrse, was found perfectly removed by erosion ; the subjacent
veins had been opened by the same process, and their blood had
escaped the nerves were left entire, as it were beautifully dis¬
sected. Proceeding with the examination, there was found at a
part which corresponded with these appearances, an opening that
penetrated into the oesophagus ; and through this opening, a por¬
tion of the contents of the stomach flowed on raising this organ.
At the same moment the rest of the contents of the stomach es¬
caped into the abdomen, through a large orifice at its most depen¬
dent part.

On further examination of the state of the oesophagus and sto¬
mach, the mucous membrane was found uniformly reduced to a
gelatinous mass \ the textures constituting the former were pierced
by an irregular opening of a size less than that of a pea ; the pe¬
ritoneum covering the latter was destroyed to a considerable ex¬
tent. But there were no appearances of disease about the edges of
either orifice.

The head was not examined. The other viscera presented no
unnatural appearances.

The case thus briefly detailed leads to some remarks of great
interest.

1 . It cannot be doubted that in this case the perforations of the
oesophagus and of the stomach resulted from the action of the gas¬
tric juices after death. This appears to be proved by the eroded
state of the adjacent parts. This fact may therefore be regarded
as established by the present and similar cases.

143

Case of Watery Effusion of the Brain .

2. It is equally certain that there is one special disease or dis¬
order of infants which leads to similar results, as stated in the in¬
teresting and valuable paper of Dr. John Gairdner, in the Trans¬
actions. of the Edinburgh Medico-Chirurgical Society, Vol. i. p.
311.

3. It is a point of the utmost importance to state in the account
of post mortem appearances, at what precise period after death
the examination was made ; and it might be useful sometimes to
make the examination at two distinct periods, taking care not to
disturb the parts at the first. It is quite plain, that, had the pa¬
rents of the little girl whose case has been given earlier, consented
to an examination of it, some of the appearances which have been
described would not have been observed.

4. It would be interesting to make a series of observations on
rabbits and other animals, with a view of determining the circum¬
stances which favour or oppose the erosion of the stomach by the
gastric juice. The observations made by Dr. W. Philip, in the
third edition of his singularly admirable work on the Vital Func¬
tions, pp. 131, 132, appear to be too general on this point.

5. We might possibly employ the gastric juice in the minute
dissection of the nerves, since this texture appears to resist the
action of this agent, whilst that of the other parts is destroyed by
it. The fact itself is mentioned by M. Cruveilheir, in his Mede-
cine Pratique, Cahieri. p. 143. — Edinb. Med. and Surg. Journ. July.

4. Case of Watery Effusion in the Brain, &;c. By Dr. Shearman.
Some time ago I published a small volume, wherein I declared my
intention to be, <c to controvert the doctrine of water in the brain
being a distinct specific disease, and to oppose the prevalent opi¬
nion of the proximate cause of the watery effusion being inflam¬
mation.’’ Since that time similar opinions seem to have been en¬
tertained, more especially as to the latter part of the quotation,
by men of extensive attainments and considerable reputation, par¬
ticularly by Dr. Monro, in his book on the Morbid Anatomy of
the Brain ; and, therefore, it may be thought that the doctrine I
had previously advocated, will, under such auspices, obtain that
general acquiescence, which so humble and obscure an individual
as myself was inadequate to enforce. Nevertheless, as one parti¬
cular point referred to in my little treatise seems to have passed
unregarded, viz. the frequent occurrence of watery effusion in the
brain, as a concomitant or effect of proper idiopathic fever, (in
addition to its being an accidental symptom in all other infantile
diseases) I deem it not altogether useless to illustrate the truth of
this proposition by a case which lately came under my care, from
which I deduce, that this effusion was not the consequence of any
preceding inflammation in the membranes of the brain, but arose
as an accidental occurrence in a weakly and scrofulous constitu¬
tion, predisposed, therefore, to a great degree of irritability of
those membranes.

Richard Milsom, aged three years, of a weakly constitution, and
of a scrofulous appearance, was brought, November 6th, to the
West London Infirmary, with symptoms of hydrocephalus. His

144

Bibliography.

head was constantly in rolling motion, accompanied with convul¬
sive twitchings in his limbs. His countenance had an idiotic ex¬
pression \ and he was incapable of recognizing his mother or sur¬
rounding objects. The pupils of the eyes were greatly dilated ;
and the child appeared unable to see, a near approach of the hand
of a bystander to the eyes not producing any motion of the eye¬
lids. The pupils, however, slightly contracted on the approach
of the light of a candle, but not otherwise. The bowels were ra¬
ther constipated, but there was neither hardness nor tension of the
belly ; pulse nearly natural. He had not spoken for many days.
The account given by his mother was, that he was attacked a fort¬
night previously with febrile symptoms, accompanied by purging.
These continued for a week, at the end of which time she disco¬
vered in the morning, that the child was unconscious of her pre¬
sence, and incapable of seeing, and exhibited all the other symp¬
toms now present. Applicetur abdominis lateri dextro Empl. Can-
tharidis. Sumat statim pulverem aperientem ex Hydrarg. Subtnur.
gr. i. 2, quaque hord.

November 9. — Blister had drawn and discharged freely. Twelve
of the powders had been taken, but at rather longer periods than
prescribed. Bowels well open 3 urine copious. The child is now
conscious of his mother’s presence, and of surrounding objects,
and can see perfectly well. The rolling motion of the head and
the convulsive twitchings have ceased. He was ordered ten drops
of diluted sulphuric acid, and of vinegar of squills, every four
hours ; and four grains of rhubarb and of magnesia, with one of
calomel, every night.

November 13. — The child is still improving. Contin. Medicam.

November 20. — No symptoms remain. The medicines were
ordered to be continued for a short time, with the addition to each
of the powders at night of three grains of Ferrum tartarizatum.

What might have been the view any medical practitioner would
have formed in the first days of this affection, and what remedies
he would have employed, is uncertain. The disease was com¬
pletely left to its unrestrained course. What would have been
the treatment adopted at the end of the first week, when the ap¬
pearances of affection of the head were so unequivocal, is again
uncertain, for no medical attendance was sought for till a week
after that. When I first saw the patient, I considered the case
to have been one of proper infantile fever, during the course of
which, or at the period of its termination, increased exhalation
took place in the cavities of the brain, owing to the irritable state
of its membranes and increased circulation in its vessels, so fre¬
quent a circumstance in weakly and scrofulous constitutions. I
see no evidence of inflammation of the brain or its membranes
having taken place during any time of the progress of the dis¬
ease 3 no prominent symptoms of the head being particularly af¬
fected manifested themselves in the space of the first week 3 and
the sudden accession of those denoting effusion of* fluid would
seem to be the effect of that state of the system, whatever it was,
to which the previous symptoms were owing. If it be maintained

Periodical Hemicrania .

145

that these febrile symptoms themselves were nothing* more than
symptoms of inflammation of the brain, viz. that they consti¬
tuted hydrocephalus acutus in its first stage, it will be necessary
to explain why this inflammatory disease should have terminated
in perfect recovery, without the use of any counteracting means,
whilst almost all severe cases of a similar kind, when large bleed¬
ings and antiphlogistic measures have been employed, terminate
fatally. Lt appears to me, that nature, when left to herself, will
frequently bring proper idiopathic fever to a favourable termina¬
tion, whereas, when he efforts are interrupted by active and violent
interposition, she is commonly rendered unequal to the task of
accomplishing her end. The fever in the case related, not having
been interrupted by artificial means, appears to have terminated in
seven days by crisis, at which period a great increase of the vari¬
ous secretions usually takes place. In this predisposed subject,
increased exhalation into the cavities of the brain also took place.
It would have been important to ascertain whether the urinary dis¬
charge was here in due quantity, for, as I have elsewhere hinted,
the exhalation in the brain and the secretion by the kidneys appear
to be vicarious to each other. It is unnecessary, however, to pur¬
sue the subject farther. I shall only add in conclusion, that if
hydrocephalus acutus, were, as is maintained, an actual inflamma¬
tory affection, it ought generally to yield to those active measures
which are commonly resorted to in its treatment. The want of
success in antiphlogistic remedies to conquer any given disease,
when the same disease will yield to other and opposite remedies,
is a strong argument against that disease being one of inflamma¬
tion. My opinion of the non-inflammatory nature of hydroce¬
phalus acutus, is strengthened by the result of other cases of this
affection, in what are called its first and second stages, which have
come under my management, wherein success has followed the
means employed the means employed in accordance with the prin¬
ciples I have already advocated. — Op. Cit.

5. Dr. Dewees on the Practice of Physic. — Dr, Dewees, of Phi¬
ladelphia, is preparing for publication a System of Practical Medi¬
cine. We understand it will be strictly a practical book, divested,
as far as possible;, of theoretical disquisitions, and will contain the
result of nearly forty years’ experience. The industry and talent
evinced by Dr. Dewees in all his former publications, lead us to
look forward to this promised work with the expectation of find¬
ing in it much valuable matter, especially to English physicians,
who must feel anxious to instruct themselves in the pathological
and practical views of their trans-atlantic brethren.

6. Periodical Hemicrania, terminating by the evacuation of a Cal¬
culus through the Nose. By Dr. Axmann. — A female, aged fifteen,
complained of pain in the region of the left and frontal sinus,
which extended to the same side of the head. It recurred daily, at
ten, a. m. and continued to five, p. m. Sometimes the pain was
excessive, affecting the left side of the face, and inducing tume¬
faction around the eye. The left nostril was dry. During the

vol. in. no. 14.

146

Bibliography.

paroxysms, the girl suffered from nausea and vomiting. The dis¬
ease continued two or three weeks, and recurred all the year, ex¬
cept January and February, Menstruation appeared in the seven¬
teenth year. She married at twenty-one, and during her preg¬
nancy the disease disappeared. During fifteen years she bore
eight children, and generally enjoyed good health, except at the
end of the third pregnancy, when headache was violent Three
years from her last delivery, the menses diminished, and in March,
1823, the headache returned with violence. In the summer, she
visited the baths at Kissengen, and derived much benefit. In
March, 1825, she was consoled by the passage of a calculus from
the left nostril, of the size of a bean, and this was effected by a
pinch of snuff. During the succeeding months and the following
year she evacuated several Calculi, which were followed by a dis¬
charge of fetid pus, and this effect was produced by sternutatories.
Since 1826 the woman is perfectly well. The calculi were ana¬
lyzed by M. Geiger, and found to consist of albumen, mucilage,
and fibrin *, fat and osmazome, in the proportion of 0.35 ; phos¬
phate of lime 0.8 j carb. of lime 0.325 ; carb. magnesia 0.125 ;
and traces of soda, muriate of soda, and oxyde of iron. — Heidel-
berger Klinische Annalen.) Arch. Gen. Mai.

7. Treatment of Sciatica, and other Cases of Neuralgia. M. Mar¬
tinet has succeeded in curing fifty-eight cases^out of seventy-one,
and has relieved fifteen others by the internal and external use of
oil of turpentine. It was given in draught or electuary, combined
with magnesia. — Nouv. Biblioth. Med., Mai.

8. Febrile and non-febrile periodical Affections — M. Raisin, of
Caen* considers intermittent fevers, and other periodical affections,
not to be febrile, to be identified, and he relates the following case,
in proof of his conclusion. A man, aged thirty-two, was subject,
for many years to violent cramp, which usually continued for
twelve hours. On one occasion, the disorder was so violent, that
he was obliged to give way to piercing cries, and wished for death.
Opium afforded slight relief for some hours, but next day and
night the fit returned, and remained for six hours and a half. It
reappeared in like manner for the six succeeding days, and an the
seventh day he took sulphate of quinine, which afforded immedi¬
ate relief. In the case of a child, aged four, who complained of
acute pains in the abdomen ( enteralgia intermittente) every night,
which disappeared in the morning, and was unrelieved by anti-
spasmodics, a grain of the quinine was exhibited every third hour,
and the pains ceased to return. Our author relates a case of inter¬
mittent cephalalgia, attended with turgescence of face and injection
of the conjunctiva, in which bleeding and pediluvia were used in
vain. The quinine cured him effectually. — Rev. Med.

9. Nitrate of Soda in Dysentery . — M. Meyer informs us that an
epidemic dysentery prevailed in 1822, in which he found the ni¬
trate of soda a most valuable remedy. Six hundred patients were
restored by its use. The proportion of deaths was two in a hundred.
He administered, daily, from half an ounce to an ounce of the
soda in eight ounces of gum water. It acts as a refrigerant, is
gently purgative and diaphoretic.

Memoir on the Use of Stibiated Tartar in Rheumatism . 147

10. Memoir on the Use of Stibiated Tartar (Tart. Ant.) in large
doses in Acute Articular Rheumatism. By M. Dance. — The author
relates twenty cases, which were treated in this manner at the
Hotel Dieu, the dose of the medicine having varied from four to
eight grains every hour, or every other hour, and continued from
the period of eight days to two months : the total quantity exhi¬
bited varied from twenty-four to a hundred and ninety-four grains.
In Case 1, the patient had taken seventy-eight grains in seven
days. Case 2, a hundred and twelve grains were exhibited in
eight days. The effects were frequent vomiting and super pur¬
gation during the first few days. Case 1 disappeared in four
days ; 2 in six days ; 3, in a few days ; 4, in five weeks ; 5, in a
month ; 6, relieved in a few days, but not cured for six weeks ;
?, in a month (the patient took a hundred and fifty-six grains in ten
days) ; 8, cured in eight days, but fever occurred, and pains con¬
tinued for six weeks (a hundred and fifty-six grains in ten days) ;
9, slight relief, remission of pains, exasperation of symptoms,
violent cholic, and prolongation of the disease (seventy grains in
six days). In 10, 11, 12, 13, 14, 15, 16, 17, and 18, no relief was
procured. 19, sixty-two grains were given in eight days, and
produced gastro-intestinal phlogosis (enteritis), which was cured,
as also the disease ; and of the medicine forty-two grains in six
days. The 20th case was followed by tension of the stomach, in¬
testinal irritation and pneumonia; cure dubious. The 21st case
was combined with pericarditis, thirty-four grains in three days,
numerous alvine discharges each day ; slight amendment the first,
and death on the third day. Autopsy, softening and wasting of
the mucous membrane of the stomach and colon ,• an abundance of
mucus in the small intestines. The 22d case was combined with
acute hydrocephalus , the disease had continued ten days ; great
relief the first, and death on the second day ; fifteen grains given;
autopsy, as in the last case. The 23d case was pneumonia, which
had continued five days ; death on the second day ; fourteen grains
exhibited, which produced repeated vomiting and alvine evacua¬
tions ; autopsy, as in the last cases. From this report the author
thinks it unfair to conclude, definitively, as to the success or utility
of the remedy, because various circumstances may influence the
results, such as a particular susceptibility of the patient, duration
and activity of the disease, its complications and modifications,
and the dose and vehicle in which it is exhibited. The principal
phenomena which occurred during this medication, were the fol¬
lowing : 1, Some of the patients, especially the women, had such

an irritability of the digestive organs, that it was impossible tp
expect any benefit from the small doses of the emetic (14 15, and
17). 2, Others experienced symptoms of violent cholera morbus
(12). 3, Others, after having borne the medicine for some days,

were seized with violent vomitings, tormina, and acute colic
(No. 8 and 9). 4, Others would not bear an increased dose with¬
out the occurrence of similar accidents (15 and 19). 5, Others

had continued the remedy from six to eight days, but then con¬
tracted a repugnance, an insurmountable disgust to the emetic po-

148

Bibliography.

tion, and refused to continue it, as it infallibly produced vomiting y
(1L and 16). 6, Finally, it was remarked, if the remedy were

discontinued for a day or two, the same or similar doses, pro-
duced the same effects as in the commencement of the treatment y
(13 and 17), M. Dance agrees with Rasori and others, as to the
efficacy of the remedy in inflammation, but observes, contrary to
the prevailing opinion, that the remedy is seldom borne. He de¬
nies its mild effect on the chest, and has seen it produce colic,
pains in the bowels, and general irritation. Arch. Gen. de Med.
Mai. Dr. Loudon, of Leamington Spa, has lately called our at¬
tention to the claims of Dr. Marryat, of Bristol, as to the exhibition
of large doses of tartar emetic in inflammatory diseases, without
producing any bad effects, but a complete cure of the disease. Dr.
Marryat published his work on Therapeutics in the year 1790, in
which will be found very ample directions on the use of this re¬
medy in fever. This was about ten years previous to the experi¬
ments of Rasori and Tommasini in Italy. “ Any fever may be
soon extinguished, &c. Medico-Chir. Rev. July, p. 25*2.

We are indebted to our valued contemporary for this infor¬
mation. Ed.

SURGERY.

11. Dr. Ballingall’s Clinical Lectures. Edinburgh Infirmary. —
Gentlemen : In commencing a retrospect of the fifth course of
Clinical Leetures, which, as the senior attending surgeon of the
house, it has become my duty to conclude, I would, in the first
place, direct your attention to some of the accidents and acute
cases which you have had an opportunity of witnessing during the
last four months.

Of the acute cases, the fractures of the limbs have, upon the
present, as upon former occasions, constituted a large majority ;
of simple fractures 1 find that there have been treated, on my side
of the house, twenty-six cases, all of which have either terminated
successfully, or are in the progress of cure, with the exception of
that of William Fernie, set, sixty-two, who was admitted on the
3d of January, with a fracture of the neck of the femur. This
man was brought from Kinglassie, in Fifeshire, where he had met
with the accident about ten days before. His limb was immedi¬
ately placed in Boyer’s splint, and was extended to the same
length as its fellow on the opposite side ; but, although the old
man complained of no inconvenience from the apparatus, it was
soon perceived that ulceration had taken place on the sacrum
to a considerable extent. This induced me to remove the splint,
and place the patient on his side. Here again a gangrenous spot
appeared over the trochanter of the right thigh, and the patient
was subsequently turned to the opposite side ; my object now be¬
ing to obviate the effects of pressure and the extension of the gan¬
grene, rather than to look for any successful treatment of the frac¬
ture. The ulceration, however, continued to extend, and the
patient’s strength to sink, notwithstanding the liberal exhibition
of animal food, porter and wine, until the 4th of February, when

Dr. BallingalTs Lectures on Surgery. 149

he died, six weeks after the receipt of the injury ; and I regret to
say that the body was immediately removed to Fife, without af¬
fording us an opportunity of examining the state of the broken
bone. -

In the cursory observations which I have had occasion to lay
before you on the subject of fractures, I have always inculcated
the necessity of giving your attention to the general principles on
which fractures are treated, observing, that the variety of these
accidents is so endless as to render it a matter of impossibility to
be previously acquainted with the specialities of each individual
case. My views of the treatment of fractures of the neck of the
femur I explained to you from one of my printed Lectures, and I
would now only observe, that the result of the foregoing, as well
as of some other cases of the same kind which I have witnessed,
has made me lately disposed to question whether we would not
do well, in many cases of fracture of the neck of the thigh bone,
to be satisfied with the simple treatment recommended by Sir A.*
Cooper : to place tholimb in a relaxed position, with a folded pil¬
low under the knee-joint, and to take our chance of such a cure
as nature may be pleased to afford us, rather than, by confining
the patient in a coercive apparatus, to run the risk of inducing
ulceration or gangrene j the progress of which, in advanced life,
or in broken constitutions, it is so little within our power to con¬
trol.

Of the cases of compound fracture occuring during the present
course, that of Margaret Thomson, set. seventy-four, who was
admitted on the 3d of November, having both bones of the fore¬
arm broken, terminated fatally with symptoms of effusion into the
thorax, four days after her reception into the hospital.

A case of compound fracture of the leg presented itself in the
case of John Hamilton, set. fourteen, who was under treatment
in the early part of the season, in whom the cure was consider¬
ably advanced previous to the commencement of the course, and
who was eventually dismissed cured on the 21st of December, after
a confinement of upwards of twelve weeks. The only other case
of compound fracture which has been under my care during the
present session was that of Alexander Kerr, set. twenty, whose
case was of a very severe and dangerous character, and of which
the following particulars are recorded : “ Admitted, October

6th. — The whole left leg is very much swelled, tense, and painful.
About an inch and a half above the ankle, there is a small wound
upon the anterior surface of the tibia; and the skin above the outer
malleolus is very much contused, and fluctuates from the effusion
of blood beneath it ; when the foot is forcibly moved, an indis¬
tinct crepitus is felt. About eight o, clock this morning he was
overturned in a cart, the edge of which fell against the lower part
of his leg, whilst the weight of the horse was resting against the
shaft. Limb was placed on MfIntyre’s splint, and the spirit lotion
applied.’’ Took an anodyne draught at bed-time, and a dose o.
oil on the following morning. The spirit lotion was continued to
the leg, and an antimonial solution administered internally from

150

Bi bliography.

time to time. On the 8th, gangrene began to appear, and the
following report was entered :

“ Slept ill 3 pulse 108, very full and strong 3 bowels once re¬
lieved j tongue slightly furred 3 skin upon the outer side of the
leg is evidently gangrenous, and that upon the inner side consi
derably discoloured. An incision was made through the former,
some serum was discharged, but the wound bled very little. He
was bled to twenty ounces.

“ Eleven o’clock. — Pulse 132 3 gangrene does not appear to
have spread on the outside, but the skin upon the inside is more
extensively discoloured. — V. S. ad Jx.

“ 9th. — Slept a little j pulse 112, not so strong 3 skin hot 3 less
thirst 3 bowels once relieved yesterday 3 gangrene has not spread
at all upon the outside of the limb, and there is some healthy pu¬
rulent discharge from the incision made yesterday 3 on the inside,
the gangrene has certainly spread a little. Last blood drawn nei¬
ther buffed nor cupped.”

The fermenting poultice was applied to the leg, and the antimo-
nial solution continued internally. His feverish symptoms now
began to subside, and on the 11th it was reported that “ his pulse
was 100 3 skin cool, tongue less furred, appetite returning 5 gan¬
grene had ceased to spread, but the sloughs had not begun to se¬
parate.”

It now became obvious that we should not be compelled to am¬
putate by the extension of the gangrene, but, when sloughs came
to be detached, and both the tibia and fibula were laid bare to a
considerable extent, with a copious purulent discharge, and rather
profuse sweats, I was greatly inclined to amputate the leg 3 and,
had not some of my colleagues entertained a more favourable
opinion of the case than I did, it is probable the operation would
have been proposed to him.

There was great encouragement, however, to persevere in our
attempts at a cure, from the prosperous state of the man’s gene¬
ral health, as well as from his youth and apparently vigorous ha¬
bit. The extensive sore, which nearly surrounded the lower part
of the limb, became covered with florid and healthy granulations 3
the discharge rapidly diminished ; and on the 21st of December,
he was discharged cured, a trifling exfoliation having previously
taken place from the fore part of the tibia.

Of compound fractures I have hitherto said but little in these
lectures, nor do I now propose to enlarge 3 for, although in the
two cases just mentioned you have witnessed a successful termi¬
nation under the treatment adopted, yet they are, upon the whole,
a class of accidents, the results of which have been to me the least
satisfactory of all that I have had occasion to treat in this house,
and are not co-incident with my experience of them in other situ¬
ations. Had these results been the consequence of one uniform
mode of treatment, I should naturally have concluded that that
treatment was erroneous. But, when 1 look back to the mode of
dressing the wounds, sometimes by a piece of lint soaked in
blood, and allowed to form an incrustation over them ; sometimes

15i

Dr. Ballingall’s Lectures on Surgery.

by covering them with a paste of gum or a pledgit of simple
dressing, and sometimes by bringing their lips into accurate appo¬
sition with adhesive straps : when I look again to the different
positions in which the limb has been placed, either closely enve¬
loped in splints, lying less constrained in a fracture box, or simply
resting on a pillow, sometimes in the bent, sometimes in the ex¬
tended position j and when I look also to the various means taken
to subdue the violent inflammation and high symptomatic fever
accompanying these injuries ; by general or by local bleeding, ac¬
cording to circumstances 5 very frequently by the use of cold eva¬
porating lotions to the seat of the injury, and sometimes by the
use of anodyne fomentations or cataplasms : I cannot admit that
the unfavourable results which I have so often had occasion to
deplore, have been attributable to any bigoted prejudices or ex¬
clusive partialities in the mode of treatment.

In my remarks upon this subject, I took occasion to observe
that we are greatly in want of a work on these accidents, from
some surgeon of varied and extensive experience. I say varied
experience, because it appears to me that we are often led, by the
irresistible force of habit, to give our attention too exclusively to
one mode of treatment. I remember to have heard an hospital
surgeon assert that he never expected to lose another case of com¬
pound fracture, by following up the practice, which seemed to
him to be a new one, of closely enveloping such fractures in
splints and bandages, without undoing them for weeks together.

ut it. is not rom those who take such a limited or exclusive view
of this matter that we are to expect such a w'ork as I could wish
to see, but from those who are capable of discriminating between
those cases (perhaps numerous ones) in which the above practice
is advantageous, and those in which it is not only injurious, but
absolutely insufferable.

before quitting this subject, I would beg leave to mention that

u*rei are tWO P°*nts treatment of compound fractures, upon

which my own observation has led me to form a very decided
opinion, and to offer you a remark which may possibly prove use¬
ful hereafter. I have, I think, too frequently seen a reluctance to
use the saw in removing the protruding extremities of the bone
when these were either difficult to reduce, or of a sharp and spicu-
lar form and I have, I think, sometimes seen the closure of the

external wound attempted by means too forcible and too long
continued. &

Among the more severe accidents requiring amputation which
have occurred during the present cfcurse, that of Robert M‘Gre-
gor, set. fifteen, deserves particular attention. This lad was ad¬
mitted late on the evening of the 28th of January, and the follow¬
ing notice of his case entered in the journal: “ Had his right
arm drawn into the machinery of a paper mill, at five p.m. The
arm was torn off from the body about the middle of the humerus.
I he extremity of the bone projected out from the muscles. The
laceration extends on the inner side of the arm into the axilla, de¬
stroys the inferior margin of the pectoralis major and latissimus

152

Hi bit ography.

dorsi museles. The skin, for a short way on the back of the sca ¬
pula is destroyed, and also a considerable part of the clavicular
portion of the deltoid. The artery is seen pulsating about three
inches from its end, which is closed by coagulated blood. No
hemorrhage had taken place j his extremities were cold, and pulse
feeble.”

The operation at the shoulder-joint, was performed by Dr.
Campbell, who succeeded me in the active duties of the house. A
single Hap was made from the deltoid, which completely covered
the wound ; four vessels were secured, and an opiate adminis¬
tered. The patient had a good night after the operation, and no
untoward circumstance occurred until the night between the 1st
and 2d of February, when a secondary hemorrhage took place,
which is thus noticed in the journal : “ About ten, p. m. there

came on a considerable hemorrhage from a small vessel, which
was tied $ and, about half past two this morning, the ligature
came away from the axillary artery, and hemorrhage ensued.
The vessel was immediately secured j a considerable quantity of
blood was lost. Pulse about 130, stronger than yesterday even¬
ing. An anodyne was given. — Cont. H. Anodyn. cum T. Opii,
gtt. xxxv.” For several days after this the patient appeared to be
in considerable hazard : some sloughing took place from the edges
of the w’ounds, with a copious discharge of ill conditioned matter ;
his pulse varying from 125 to 150, with occasional rigors and pro¬
fuse sweatings. He was treated chiefly with the free exhibition
of opiates, beef-tea, and small quantities of wine occasionally ; the
wound being dressed daily with resinous ointment.

On the 7th, he is reported to have taken “ ten ounces of wine
since yesterday morning $ about midnight, having had no sleep,
fifty drops of Tr. Opii were given, and he slept soundly for seve¬
ral hours j one natural stool ; pulse 128, of moderate strength 5
tongue clean 5 feels much better. — Habeat Vin. rub. Jxij., et
Haust. Anodyn. p. r. n. An egg for dinner daily.’ From this
period, the cure went on progressively, the lad’s looks improved
daily, while the wound assumed a more healthy appearance ; the
discharge gradually diminished j and he may now be considered
as out of danger.

In my comments upon this case, I considered it as illustrative
of three important points : the spontaneous cessation of the he¬
morrhage, in cases where limbs have been torn from the trunk ;
the question of primary and secondary amputation ; and, lastly,
the mode of performing this operation at the shoulder-joint. In
illustration of the first point, I showed you the portion of the hu¬
meral artery which was removed along with the remains of the
arm, the internal coat of which was in some points slightly lace¬
rated, while the external coat was over-stretched, and a consider¬
able portion of it filled with eoagulum. I referred, for further
illustration of the state of arteries after accidents of this kind, to
a case detailed in the nineteenth volume of the Edinburgh Medi¬
cal Journal, by Mr. Lizars ; and to a very valuable paper, contain¬
ing indeed all the information which we possess on this interesting

153

Dr. BallingallV Lectures.

subject, by Professor Turner, in the Medico-Chirurgical Transac¬
tions of this place. By the kindness of this last-mentioned gentle¬
man, I was also enabled to show you some drawings, exhibiting
the state of arteries in accidents of this nature \ where in some
cases, we find their internal coats completely torn through, and
corrugated, or coiled up, as it were, within the vessel, so as to
prevent the effusion of blood.

On the subject of primary and secondary amputation, we now
possess a series of valuable observations, from the time at which it
was made the subject of a prize-question by the French Academy,
in 1756, down to the present day ; when the advantages of pri¬
mary amputation, are, I believe, admitted by every practical sur¬
geon, who is now enabled to add to his own experience that of the
French army surgeons, as detailed in Baron Larrey’s writings ;
that of the English army surgeons during the peninsular war, as
detailed by Mr. Guthrie and Dr. Hennen ; and that of the naval
surgeons, as detailed in Mr. C. Hutchison’s work. One of the
most striking illustrations of the successful issue of primary am¬
putations, is contained in an extract from a report made by Dr.
Burke, inspector of hospitals to his Majesty’s forces in Bengal,
which has been made public by my friend, Mr. Annesley, in his
splendid work on the Diseases of India. Dr. Burke states that “ of
eighty cases of amputation,” performed at Bhurtpore, in Upper
India, “ the whole recovered in fourteen days.”

We must not, however, expect to meet with the same propor¬
tional success in the amputations performed in civil hospitals : at
least, I am entitled to say, that the contrast between the success
of primary and secondary amputations, during the time that I have
served in this house, has by no means resembled that which I was
accustomed to see and hear of in the army. F , these different
results in military and in civil hospitals, many reasons, might, 1
think, be assigned ; some of them more satisfactory than those
mentioned by Sanson, who, in a recent paper upon this subject,
has noticed the fact, but has, I . think, failed to give a very lumi¬
nous or satisfactory explanation of it.

In speaking of the operation at the shoulder-joint, I remarked
that, although this operation has undergone many modifications,
to some of which the names of Morand, La Faye, Le Dran, Lar-
rey, Lisfranc, Broomfield, Alanson, and others, have been attached,
yet these may all be resolved into two modes of proceeding, either
by forming a superior and inferior, or an anterior and posterior
flap. I have myself operated in both ways, but not sufficiently
often to enable me to institute any fair comparison as to the best
mode of operating : I may, however, be permitted to remark that,
in a very large proportion of the cases requiring amputation at the
shoulder-joint, the soft parts are so lacerated as to leave us no
choice, but to compel us, as in the present case, to form the flaps
as circumstances best will admit. We are now well aware that
the apprehension of an uncontrollable hemorrhage, which alarmed
our predecessors, and made them slow to adopt this operation, is
altogether unfounded , the bleeding may always be controlled by

VOL. III. NO. 14.

firm pressure above the clavicle by the hands of a steady assist¬
ant and, in fact, this compression, as my distinguished predeces¬
sor, Dr. Thomson, observes, has been found <f easier in pructice
than it appeared to be in speculation.’’ It is necessary, however,
to remark that, at the moment of cutting through the axillary ves¬
sels and nerves, the patient is apt to give an involuntary Start, and
may throw the fingers of the assisant off the artery ; an accident
which once happened to a gentleman assisting me in this rtpera-
tion, and by which I nearly lost my patient. I was for a moment
completely blinded by the discharge of blood into my eyes from
the open axillary artery.

Another case in which primary amputation was thought advisa¬
ble during Ahe present course* Was that of Charles Cuthbertson,
set. seventy-one. This old man was admitted on the 18th of De¬
cember, with a comminuted fracture of the radius and ulna, at
their carpal extremities, and an extensive lacerated wound of the
left wrist. He had also received a severe contusion in the lower
part of the back, with a fracture of some of the ribs. Although,
as I stated to you in the theatre, at the time of operation, I enter¬
tained little or no expectation of this man’s recovery, I determined,
after a few moments’ consultation with my colleagues, to remove
the arm a little below the elbow. It was obvious, however, at
the first dressing that no prospect of union existed : the lips of
the wound, instead of presenting that wholesome turgidity and
tension which presents itself in a healthy stump, were flaccid,
somewhat livid, and apparently tending to gangrene ; the smaller
vessels, if I may use the expression, had not taken up, but had
poured out a quantity of grumous blood, which flowed through
the dressings ; at the same time the patient began to complain of
oppressed breathing and symptoms of inflammatory action within
the thorax ,* so that he had to contend with all those difficulties
which you may suppose to exist in the case of on old man labour¬
ing under acute inflammation within the trunk, and gangrene in
in one of the extremities. Amidst a choice of evils, the abstrac¬
tion of a limited quantity of blood was tried, but without any
good effect, and the patient died during my temporary absence in
London, about eight days after the receipt of the injury. No re¬
port of the dissection appears to have been entered in the register j
but I am told that the whole of the ribs on the right side, with the
exception of the two inferior ones, were found fractured, and
some recent deposition of lymph on the pleurse.

This case I am induced to mention, not from any very instruc¬
tive lesson to be gathered from its progress, much less for any
thing very unexpected in its event, but as a caution against an
accident whic h occurred during the operation. While passing the
knife through the forearm, from the radial to the ulnar side, for
the purpose of rorming a posterior flap from the extensor and su¬
pinator muscles, its points slipped between the bones, which ren¬
dered it necessary to withdraw it, and to pass it more carefully
behind the ulna ; this was, perhaps, owing partly to my own in¬
advertence to the exact position of the bones, but partly, I believe.

155

Dr. NicoFs Case of Recto-Vaginal opening.

also, to the connexion between the lower extremities of the radius
and ulna having been broken up, so that in pressing the knife close
to the back of the radius, with the view of obtaining a sufficiency
of muscular subtance to form a good flap, the parallelism of the
two bones was in some measure destroyed, the radius was pressed
forward, and the interosseous space thus presented to the point
of the knife.

12. Recto-Vaginal opening , treated by Dr. Nicol.— Although
cases of lacerated perineum will sometimes occur under the most
skilful management, the kindly disposition of the parts to heal,
especially when aided by judicious after-treatment, most common¬
ly preclude those calamitous consequences to the unhappy sufferer
of which the following case furnishes an example.

Mrs. B. aged twenty-four, a little woman, was delivered of her
first child in the latter end of 1827* after a tedious labour. The
case was conducted by an ignorant country midwife ; and the pe¬
rineum was lacerated to a considerable extent. Ulceration and
loss of substance followed ; her recovery was tardy, and after a
long confinement, the feces continued to be voided principally per
vaginam. A natural delicacy prevented her from applying for
surgical assistance until very lately, when, upon examination, I
found the parts had healed up, leaving an aperture capable of ad¬
mitting the finger to pass into the rectum, and distant nearly two
inches from the perineal margin of the os externum. Through this
opening, the relaxed folds of the rectum protruded forwards into
the vagina, forming a tumour about the size of a walnut, and the
feculent matter kept up a continued excoriation of the passage. By
drawing the perineum towards me and reducing the gut, I found
it could be retained or confined in its proper place; with the ex¬
ception of a very small portion towards the lower edge, which, by
adhesion to the vaginal surface, continued irreducible.

The bowels were freely evacuated, and she was placed on a
spare liquid diet. The vagina was kept distended by means of a
lithotomy forceps, a clumsy expedient, but the only dilator then
within my reach.

The gut was reduced and the perineum kept tense by drawing
as formerly, towards me. The aperture was sufficiently exposed,
but it was not until the scalpel, curved scissors, and several other
instruments were tried in succession, that I discovered the diffi¬
culty of reaching the parts and paring the edges as I could have
wished under snch circumstances. A duplicature of the vagina
fell down between the blades of the forceps and obscured my ob¬
ject. The rectum would frequently resume its place in the vagina,
notwithstanding my attempt to keep it reduced by means of
sponges, bougies, &c. introduced by the anus.

After several tedious and trying attempts I succeeded at last in
denuding the edge of the opening of its coverings, with the excep¬
tion of the upper extremity, and this I succeeded in abrading by
means of a round-pointed scalpel. A couching needle, with a long
stem, previously perforated near the point, curved to the extent

156 Bibliography.

of an inch, and bent at a right angle, was armed with a ligature,
and used to bring the edges together, which was effected by means
of four stitches, with comparative ease.

The aperture thus obliterated presented a puckered appearance,
and it was evident that, notwithstanding every possible care to
bring the cut edges together, they were not throughout in appo¬
sition, as might be expected, therefore this operation failed.

Adhesion took place, however, to a small extent towards the
lower part, and afforded sufficient hope of ultimate success. By
this partial adhesion, also, the irreducible part of the rectum had
now disappeared.

Unwilling to risk a second failure by using instruments on which
I could not satisfactorily rely, I procured a dilator, long curved
scissors, lancet-pointed curved bistoury, and strong needle. The
dilator answered my purpose completely. I could see the parts
perfectly? and cut with comparative facilty between the blades as
far as free access went, while their breadth, and the curve of the
instrument upheld sufficiently the vaginal fold, so annoying in my
former attempt.

At this time I resolved to cut more freely, and passed the bis¬
toury through the loAver edge, as if I wished to transfix it to the
back part of the rectum, including nearly as much of the vaginal
surface contiguous as was considered necessary, and carried it up¬
wards. The yielding nature of the parts permitted too much to be
included in this section, profuse hemorrhage followed, further
progress was arrested, and it became necessary to use the sponge
plug, and put the patient to bed.

A few days thereafter, 1 proceeded in my third attempt, passing
the bistoury after the manner already mentioned, removing the
membranous covering to the extent of nearly half an inch along
the left side of the opening, and leaving it attached at either ex¬
tremity. I made a similar attempt on the right side, but the situa¬
tion of the parts rendered it impossible, save by piece-meal. In
this way, however, I detached part after part, snipping off with
the curved scissors what the bistoury had partially separated, and
succeeded in removing the cicatrices and mucous membrane sur¬
rounding the opening, to the extent of fully half an inch, without
anv impeding hemorrhage.

In the removal of the upper part, which 'was attended with great
difficulty, I found the small hook used in eye operations highly ad¬
vantageous in facilitating the access of the scissors, where the bis-
tourv was inadmissible. Satisfied that this stage of the opera¬
tion ’was perfect, I brought the parts together with four stitches,
introduced by means of the stouter instrument, constructed after
the manner of the couching needle used in my first operation.

Although the shut aperture had the same puckered appearance
as formerly mentioned, there could be no doubt but that the de¬
nuded surfaces were now in contact. Perfect adhesion took place,
and although alvine matter was observed to pass in very small
quantity per vaginam some days thereafter, it was found to have
made its way through the suppurated holes of the ligatures.

Mr. Law’s Remarks on Spina Bifida. 157 '

T-hese speedily healed up, and she is now rid of an affliction which
must otherwise have rendered her life miserable.

Many of my readers may feel disposed to think that I have been
more minute in my details than the merits of the case demanded,
especially as at first sight the operation may be considered of
easy accomplishment. The difficulty, however, of this and of
another similar operation, viz. that for cleft palate, will be esti¬
mated on making the attempt.

Cases such as the present, I apprehend, are frequently to be met
with among the poor, in those districts where labour is conducted
by ignorant, homebred country midwives. In the earlier part of
my practice, I recollect to have met with two cases, where the
sides of the openings, which were large and of long standing,
were covered with long and ash-coloured vegetations, and studded
with hydatids. The constant irritation and consequent profuse
sero-mucous discharge proved fatal. I have recently been in¬
formed that the Dublin Lying-in Institutions abound with similar
cases.

Being of opinion that these openings are caused more by loss
of substance from extensive ulceration than by imperfect union of
the lacerated parts, and as their edges will consequently be much
attenuated, I teel satisfied that paring them alone, and attempt¬
ing to bring them in contact, will assuredly end in a similar dis¬
appointment with that experienced on my first operation. To
insure success, a considerable portion of the surrounding surface
must be removed, and the parts thus bared must, as it were, be
folded together The ligatures should be passed right through to
the rectum, including enough of substance to prevent their work¬
ing out too soon, and inserted so close to each other as to produce
complete mechanical obliteration, otherwise, whenever the gut
is distended with flatus, it will certainly make its escape between
them, and lessen the chance of adhesion.

Perhaps the introduction and retention of a small elastic gum
catheter in the rectum might be useful in obviating the conse¬
quences of such defects.

When the perineum lias been once lacerated, subsequent lacera¬
tion is much move likely to happen. Last winter I was called to
a case of protracted labour, where the patient had married late in
life, and on two former occasions the perineum was lacerated. I
found the vagina so contracted by the cicatrices, as to be forced
before the head of the child in a semilunar fold, stretching across
and obstructing fully half the passage. It was peculiarly interest¬
ing to mark the difference in the structure obedient to the law of
nature from that which resisted it. Perceiving delivery to be im¬
possible without another laceration, I divided this intervening fold
with a scalpel, and it was speedily accomplished without either
hemorrhage from the section, or any other unpleasant conse¬
quence. — Edinburgh Med. and Surg. Journ. July.

13. Remarks on Spina Bifida. By Mr. Law.— I had occasion to
treat a case of this disease some years ago, along with another
surgeon, but with such unpromising aspects almost from the first,

158

Bibliography .

that any detail of its complete failure could hardly be read with in¬
terest. When the capsule at the part was emptied each time, there
was an evident draining of the fluid previously prominent at the
fontanel, flaccidity taking place at the distended sutures of the cra¬
nium.

The case, however, I propose now to describe, was so near a
successful termination, and was reversed so very unexpectedly,
undergoing its changes in an unusually short period, that I con¬
sider it well worth attention. The child was a male, rather more
than two months old when I first saw it ; and the disease of a he¬
mispherical form, two inches in diameter, was in the usual situation
on the lower part of the lumbar region. This was about the 20th
of September \ and a few days after, when the mother agreed to
have it punctured, I proceeded to do so with a lancet. The in¬
strument was pushed into the most prominent part near the mid¬
dle, and on this occasion seemed to enter a membranous capsule,
distinct from the outer skin j the swelling was more than half
emptied of a thin watery fluid mixed wtth blood, which appeared
to flow from the divided edges. A little patch of adhesive plaster
was put on the opening, and a fold of linen and flannel with apiece
of pasteboard, quilted with tow, in a circular form, bound over
the part with a roller, The child did not seem much affected by
what was done. Three days after, the pasteboard being removed,
the swelling was found of its original size, when the water was
again drawn off at a new opening, and the pasteboard applied as
before. In three or four days it was again done, but I changed
the pasteboard for a piece of circular eork, which having a slight
projecting rim on the edge of the surface applied to the tumour,
and a strap of adhesive plaster across, remained more steadily on
the part. After the first occasion, I twice made the openings
more to the side of the tumour, lest I might bring on ulceration
where the integument was so thin as to be almost vesicular 5 but
after a few applications of the cork compress this precaution be¬
came quite unnecessary, as great thickening took place at this
part.

It was seldom now necessary to puncture, simple tightening
of the roller over the compress answering every purpose The
tumour had become flat, projecting scarcely one-fourth of an inch
from the surface, not hanging pendulous, as in one of Sir A. Coo¬
per’s cases, and was in its exterior so thick and unyielding as
to afford no space within for a fluid, which, if any now remained,
must have been quite beneath the level of the surface. A too
frequent evacuation of the feces (which in themselves seemed all
along healthy) had ceased, and even a constant discharge of urine,
which at first gave bad hopes of ultimate success, had been quite
corrected. The skin in general, became mottled, like that of most
healthy infants, and, in short, the case proceeded in every respect
with prospects beyond what could have been anticipated.

Nothing seemed now remaining to be done but to preserve for
a short while the ground that had been gained. About the third
week in October, however, some increase reappeared in the part ;

Scirrhous Enlargement of the Testicles . 159

the fluid discharged was thick ; and at the next opening, on the
24th had become purulent. Still, however, let it be observed, the
little patient seemed unaffected constitutionally, and I was much
surprised on the 26th, to be informed of its death, with no other
precursor than that about forty-eight hours before, when its clothes
were changing something was heard to snap or give way about
its person, compared in sound to that caused by the fracture of a
nut. From this time the mother Said, in her homely idiom ff it
was much distressed with the nerves 5” but I cannot say that I
could perceive any remarkable change, or such a one as to induce
me to remit the treatment.

On dissection I found, exterior to the spinal sheath, a distinct
cavity where the pus had lodged ; but whether communicating
with that canal bv a small opening, I cannot, from a trifling in¬
jury, done in clearing out the matter, be quite certain. There was
a slight appearance of extravasation beneath the cyst, but f did
not, in dissecting, perceive any fracture of the ligaments of
bones, if such took place when the snap was heard, and which
might have let the purulent matter in upon the Spinal cord. Some
considerable injury, however, may have taken place at this time.

I took a passing view of the abdominal viscera, which seemed
healthy.

On further reflection, I am inclined to think, I ought not to
have continued the pressure when I found pus discharged from
the puncture. The absence, still, of all bad symptoms rendered
it probable that there did not then, at least, exist any connexion
with the important part beneath j but the fear, on the other hand,
of allowing the protrusion of the former watery bag, at what
might now have been an ulcerated aperture, a trust in the law of
the system, that matter, when formed generally, tends to the
surface, and a hope that the cavity in which it existed might di¬
minish at each discharge, made me, in choosing between two
evils, believe it safer to keep the part reduced as it was, rather
than expose it to the irritation of mechanical friction, which it

must have undergone from its situation on the exterior of the
body.

In similar circumstances, that is, if the treatment unexpectedly
produced the suppurative action, the inflammation proceeding be¬
yond the mere desirable adhesive thickening, I would be apt to
leave nature, in this stage, more to her own course ; but the ac¬
count .of my error, if such it was, may prove beneficial to others
on a like occasion.

Mr. Law sen. saw the case several times along with me.— Edin.
Med. and Surg. Journ. July.

14. Scirrhous Enlargement of the Testicles to an enormous size . — -
M. Lesson has published a case of this description, which he had
seen at the isle of Taeti, in the Archipelago, (Pacific Ocean) and
asserts that the disease is common to the natives ; it is designated
ha-u-roa, or eura. The subject of his case was a Spaniard, who
had been affected for four years. The scrotum was immensely
enlarged, the penis buried in the tumour, and a sinuous opening

160

Bibliography.

appears in the centre leading to the urethra. The tumour mea¬
sured at its distal extremity, five feet six inches in circumference,
two feet eight inches at its pubic attachment, and its length from
the pubic to the distal extremity, was two feet eight inches. The
surface of this gigantic tumour was generally sound, but was ulce¬
rated inferiorly, and gave out a fetid odour. The cutaneous veins
were enlarged. The man was of an athletic constitution, and his
digestive functions and general health were good. He was indiffer¬
ent about his condition, and jested about Lis sad position. The
kind’s uncle, who visited the narrator, laboured under the same
disease. — Ann. de la Med. Physiol. Par M. Broussais, Avril.

We have been told by a gentleman who has travelled through the
Brazils, that the natives are affected with an enlargement of the
scrotum, which extends to about a foot in length. The disease is
attributed to certain ingredients in the water. — Ed.

M. Broussais has extracted a passage from the American South¬
ern Ret., which is exceedingly agreeable to the vanity of his
countrymen, inasmuch as it is very much the reverse to the profes¬
sion in* this country } and be far exceeds his duty as a reviewer in
commenting on it. It is as follows: The French anatomists

and physiologists, and of late years, the physicians, are so evi¬
dently superior to those of London and Edinburgh, that the jea¬
lousy of the anatomists and physiologists of Great Britain, makes
them shut their eyes to the discoveries of the Continent, which
leave them half a century behind the positive knowledge of the
day.” This is a great truth, quoth M. Broussais, and on this and
everv thing else our neighbours shut their eyes. “ Ce est la une
grand verite mais a laquelle, plus qu' a tout autre, nos voisins
s'empresseront de fermer les yeux.‘ The French physicians su¬
perior to the British !! Really our transatlantic contemporary
must have formed a most extravagant idea of the vanity and gulli¬
bility of our neighbours. He either jests, or is extremely igno-
rautof the vast difference that exists between the active and effi¬
cacious practice pursued by our countrymen, and the inert and
useless practice employed by our neighbours. We freely forgive
M. Broussais for his oblique political comment, which we think
mis:ht be spared in a scientific review, and which we can perceive,
though our e\es be so hermetically sealed and such sightless orbs
was caused by national jealousy and wounded pride. The profes¬
sion in this country has certainly shut its eyes against the vivid
litrht of the nouvelle doctrine medicale, and against many other visi¬
onary doctrines, of which the desperate fecundity of our neigh¬
bours is so exuberantly prolific. Hinc illee lachrymce. This caustic
reviewer is eminently calculated to estimate the state of medical
science in this country, for he only happens to mistake the Edin¬
burgh Review, for the Edinburgh Medical and Surgical Journal , in
his last Journal, p. 445. He is not more complimentary to the
journals of his own nation. The Journ. Held, and La Ciiniq. are
absurd 3 the Lan. Fran, a tissue of nonsense, the talented Reca-
mier, ce terrible practicien. M. Broussais is not the only trench
journalist who displays great ignorance as to the state of medical

Experiments on the Use of Metallic Ligatures. 165

science in this country, we daily see the names of the British prac¬
titioners mistaken for those of America, and vice-versa. These are
the men who are a century before us. — Ed.

15. Experiments on the use of Metallic Ligatures. By Dr. Levret*
Dr. Jones, in the course of his interesting experiments “ on the
process employed by nature in suppressing the hemorrhage from
divided and punctured arteries, and on the use of the ligature,”
arrived at a very striking result 5 one that seemed likely to lead
to an important innovation in the application of the ligature. He
found that if a ligature be drawn around an artery with a degree
of force sufficient to divide its internal and middle coats, the sub¬
sequent inflammation and effusion of coagulable lymph produced
its obliteration, and the ligature might be removed, and the wound
healed by the first intention.

Had these conclusions been found by subsequent inquirers to be
correct, we might have considered it a degree of perfection in the
use of the ligature, beyond which we can never hope to proceed ;
but unfortunately, others who have investigated this subject, have
arrived at conclusions somewhat different, and have found that
although an evident contraction of the calibre of the vessel was
the almost invariable result of an application of the ligature, as re¬
commended by Dr. Jones, yet its complete obliteration was sel¬
dom observed.

Mr. B. Travers imagined that the cause of failure in these cases
proceeded from a too speedy removal of the ligature, before the
sides of the vessel had time to contract the slightest adhesions,
and improving upon the idea of Dr. Jones, has advised that it be
suffered to remain on the vessel for a short time, until adhesions
should be established between the opposing sides 3 by which means
he hoped to secure invariably the desired result.

To ascertain the truth of this reasoning, he instituted a number
of experiments upon inferior animals, and actually realized the re¬
sults which he had anticipated. Since the publication of his pa¬
per, the practice he recommended has been extended to the hu¬
man subject, and in some cases has been attended with the hap¬
piest effects 3 in others, however, it has failed entirely, and has
even been productive of the very worst consequences. The length
of time necessary for the ligature to remain on the vessel, the in¬
conveniences which result from a wound kept open forty-eight or
seventy-two hours, and the doubtful effects of the ligature unless
suffered to remain on for that period, are obstacles which must
always prevent this practice from being adopted. It therefore re¬
mains for future inquirers to discover some means by which that
direful malady, aneurism, can be alleviated, without those unplea¬
sant consequences which invariably attend the present mode of
operating, if indeed such a result be attainable.

Some years ago Dr. Physic suggested the propriety of an ani¬
mal ligature, thinking that it would be removed by the absorb¬
ents 3 the external wound might therefore be closed, and all the
bad effects produced by the ordinary ligatures thus obviated. We
cannot say positively what has been the result of this practice, but

VOL. m. no. 14

believe that the animal ligature is not used so much as its import¬
ance demands.

The same gentleman has likewise suggested the use of leaden
ligatures, with the view of obtaining such results as were hoped
for from his animal ligature, or the temporary one of Dr. Jones,
To this he was led by a knowledge of the fact> that bullets, buck
shot, and lead would remain in contact with almost any tissue of
the body, without producing irritation or unpleasant consequences,
and that for an indefinite period. So far as I know, a trial of this
ligature has never been made ; with a view, therefore, to ascertain
its effects, I have instituted a number of experiments, the results
of which I will now relate.

Experiment 1. — On the 16th of May, 1828, I laid bare the right
carotid artery of a dog, and, after separating it carefully from its
accompanying nerve and vein, I passed under it a lead wire, and
tied it firmlv. Both ends of the wire were then cut off with a
pair of scissors, and the sharp points bent down with a common
dissecting forceps. The wound was now drawn together with a
few stitches of the interrupted suture, and over these were laid
some adhesive strips. This animal was not confined, but suffered
to run at large : when I examined him several days after, I found
the stitches ulcerated out, and the wound open j it had filled up
from the bottom with granulations 3 but the edges of the skin
were separated to a considerable distance : with light dressings it
healed entirely by the 5th of June.

June 2,8th . — I killed this animal and dissected with care the
neck. A small cicatrix existed in the skin ; the lead was found in
the situation in which I had placed it, by the side of the vein and
nerve, perfectly encysted ; the artery at this place had been re¬
moved entirely for the space of half an inch.

Both ends of the vessel, caused by this removal of its central
portion, adhered by loose cellular substance to the surrounding
parts, which appeared to be in a perfectly natural state. The end
towards the heart was not at all increased or diminished in size ;
it was sealed up for three-eighths of an inch in extent, by an or¬
ganized substance, resembling a coagulum of blood in colour, but
not in consistence, it being much firmer. The end towards the
head resembled the one just described, in all particulars 3 the sub¬
stance, however, which filled its extremity was of greater extent,
and occupied the whole space up to the next branch, which was
rather more than half an inch.

Not the slightest trace of inflammation existed in the neigh¬
bouring parts, on the contrary, they appeared perfectly natural.
The lead itself was enclosed in a dense cellular substance, which
formed for it a complete cyst.

Experiment 2. — The right carotid artery of another dog was se¬
parated from its contiguous parts, on the 17th of May, and a lead
wire placed around it, as in Experiment 1. The lips of the wound
were kept in contact with sutures and adhesive strips. I exa¬
mined it three days after, and found that it had united by the first
intention, in the whole of its course, except in those points in-

'Experiments on the Use of Metallic Ligatures . 163

eluded by the stitches ; these I cut loose, and dressed it simply
with adhesive strips. When I looked at this dog again, I found
that from the itching of the wound, the animal had scratched off
the dressings, and broken up the new adhesions; I washed it care¬
fully to remove the dirt, and dressed it with simple dressings. It
healed kindly, and was entirely well on the 6th of June, at which
time I killed the dog, and made) a careful dissection of the parts.
The cellular substance here was much thickened and indurated,
forming a strong bond of union between the nerve, vein, and ar¬
tery. The two former were in their natural condition ; the artery
was pervious in its whole extent, to within three-eighths of an inch
of the wire ; at this place the calibre was entirely obliterated ; a
firm substance, resembling bruised muscle, filled its cavity ; be¬
tween the ligature and the head, the artery was impervious, and
much diminished in size, having the appearance of a mere cord,
not exceeding one-fourth the original dimensions of the vessel.
The lead preserved its situation around the artery ; it had become
entirely encysted, and not the slightest remains of inflammation
existed.

Experiment 3. '-—•I cut down on the left carotid of a third dog, on
the 29th of May, and proceeded as in Experiments 1 and 2, differ¬
ing in no respect, except in dressing the wound : I used no
stitches, but merely adhesive plasters.

June \st. — I examined the wound, and found that it had united
through its whole extent, but as I supposed the union not to be
very firm, the strips were re-applied, and suffered to remain on
until the 5th, when they were removed altogether.

June 27 th. — The animal was killed and a minute examination
made. The lead wire was found around the vessel, which was im¬
pervious for an inch or more, as in the former experiments. The
surrounding parts healthy.

Experiment 4. June 9th. — The dog which was the subject of
the last experiment, having entirely recovered from the first ope¬
ration, now became the subject of a second, which was performed
on the carotid of the opposite side. This was conducted exactly
as the preceding ; the wound united by the first intention without
the least difficulty ; no constitutional symptoms manifested them¬
selves. On the 27th, at which time this dog was killed, an exa¬
mination was likewise made of this side of the neck ; the appear¬
ances corresponded exactly with those of the preceding experi¬
ments.

Experiment 5. August 5th. — I performed a similar experiment
on the carotid of another dog. I killed him on the 3d of Septem¬
ber, and found that the appearances differed in no respect from the
foregoing. The lead having answered my expectations so well in
these cases, I felt a great inclination to ascertain, whether that
substance alone possessed the property of remaining in contact
with the living tissues, without exciting irritation or any unplea¬
sant consequences, or whether similar results might not be ob¬
tained by using the other metals. I accordingly continued the
subject, using gold, silver, and platinum, instead of lead.

104

Bibliography .

Experiment 6. August I2th>—The right carotid of a dog was
separated neatly fom its surrounding parts, and tied firmly with a
small gold wire ; the wound was kept closed with adhesive strips,
and by the third day had united firmly. September 2d. — The dog
was killed, and I examined his neck j I could perceive no differ¬
ence in the appearances exhibited here, from those produced by the
lead.

* Experiment 7* October \3th.—l exposed the left femoral artery
of a dog, and placed around it a gold wire. 15 th. I examined this
dog, and found that from his restlessness he had removed the
dressings and had torn open the wound j I replaced them, and he
recovered in a short time. 30 th* I examined the subject of this
experiment, and found that the results corresponded in every par¬
ticular with those above related.

Experiment 8. October 1 6th. — The above experiment was re¬
peated on this dog ; the wound healed very kindly by the first in¬
tention, &c. 30 th. 1 found the result to coincide with the last in

all particulars ; there was a slight appearance of ecchymosis
around this ligature, which no doubt would have been removed in
a few days more, only fourteen days having elapsed between the
operation and the examination of the result.

Experiment 9. October 5th. — I passed around the carotid of a
dog, a piece of silver wire, and united the wound by the first in¬
tention, which had taken place on the 9th, at which I examined it.
30 th. I found that the silver had become encysted, and had left no
remains of irritation.

Experiment 10. October 5th. — The same experiment on another
dog. 30 th. The results the same.

Experiment 11. October 13 th. — l passed a silver wire around
the right femoral artery of a dog. 1 5th. Wound healed. 30 th.
Wire encysted. No traces of inflammation remaining.

Experiment 12. August 29 th. — I cut down on the left carotid of
a dog, and passed around it a platinum wire. 4 his animal made
his escape, and I did not see him again until the 16th of October,
when I examined his neck j the wound had united so nicely that
its former situation could scarcely be recognized ; the cellular
-substance beneath was slightly thickened and indurated j the ar¬
tery was obliterated for an inch and a half, or two inches } the
middle portion resembled a small cord, around the centre of
which, I found the platinum wire enclosed in a mass of condensed
cellular substance, which formed for it a cyst ; the inside of this
cyst was smooth, and adhered closely to the platinum j no traces
of inflammation remained.

Experiment 13. October 1 5 th.— Another dog was subjected to
an experiment resembling the above in ail particulars. 3 Oth. I
killed him and found no other difference in the appearances, than
that the cyst which enclosed the platinum, was not so perfectly
formed ; it, however, existed.

Experiment 14 th. October 1 6th. — This experiment was con¬
ducted precisely as the two last : the appearances upon examina-

Experiments on the Use of Metallic Ligat nres 165

tion were the same, This dog was the subject of Experiment 7,
and was examined on the 30th of October.

Experiment 15. June 15 th. — -I enclosed the humeral artery of a
dog in a ligature made of a single stran of silk, previously waxed.
In applying the ligature, I drew it barely tight enough to place
the opposite sides of the vessel in contact, without dividing the in ¬
ternal and middle coats. Both ends were then cut off, and the
lips of the wound placed in apposition : it did not unite, however,
by the first intention, the dressings having been removed by the
animal ; it was now dressed in the usual way, and soon healed per¬
fectly by granulations. On the fourteenth day after the operation,
I made a dissection of the parts : the artery was filled with a firm
coagulum, both above and below the place of the ligature, which
prevented the possibility of hemorrhage, so firmly did these eo-
agula adhere to the parietes of the vessel. The ligature was found
in the centre of a small abscess, loose and detached from the sur¬
rounding parts ; the artery was ulcerated through, the ends being
separated a short distance.

Experiment 16. August 15th. — I repeated this experiment on the
femoral artery of another dog ; the wound was united by the first
intention. Sept. 2 d. — Upon dissection, an abscess as large as a
pea, was discovered immediately under the skin and above the
artery ; the loop of silk was found in its centre, and offered no re¬
sistance when I attempted to remove it.

Experiment 17. — I passed under the femoral artery of a dog a
piece of gum elastic, previously stretched and rolled to render it
of a proper size, and tied it with a single knot. This operation
was performed on the 15th of August j the wound united by the
first intention. Sept. 3d. — An examination was made of the result
of this experiment. The ligature was found encysted ; the inner
side of the cyst was uneven, and not in close contact with the
gum elastic ; from its appearance, I thought that pus had existed,
but was now absorbed ; the artery was obliterated to the next
branch, both above and below.

Experiment 18. August 20 th. — The same experiment repeated
on the right carotid of another dog. 23d. Perfectly united by the
first intention. 1 Sept. 2d. — The gum elastic was found contained
in an abscess as large as half a nutmeg $ the artery was imper¬
vious both above and below the ligature, and ulcerated through at
the place of its application. • < ;

Experiment 19. September 1st. — The experiment with gum
elastic was repeated on the femoral artery of another dog, and the
wound united in the usual manner. This dog was the subject of
Experiment 12 5 consequently I had not an opportunity of examin¬
ing him until the 16th of October, when he was again caught.
The cicatrix in the skin was to be seen plainly. On making an in¬
cision at this place, I perceived a small lump, about the size of a
pea, immediately under the skin, and at the lower angle of the
wound. I opened this and found it contain the gum elastic liga¬
ture, surrounded by a small quantity of yellowish-looking pus j
the vessel was removed for the space of an inch and a half, both

166 Synopsis of Practical Medicine.

ends obliterated. Just above the place of tne ligature, several
small arteries, not distinguishable in the healthy condition of these
parts, were observable, and appeared to be spent upon the conti¬
guous muscles.

Experiment 20. August 25th. — I cut down on the left femoral
artery of a dog, and tied it firmly with a grass ligature, such as is
used for fishing- lines. 2“th. It had healed by the first intention.
September 2d. — The grass was found encysted, but the inner side
of the cyst was moist and uneven, and did not appear to embrace
the ligature closely ; no appearance of inflammation.

Experiment 21. August 25th. — The same operation performed
on another dog. September 3d. — It was examined and found to
correspond with the twentieth in every particular.

From the experiments now detailed, we may, I think, conclude,
that the plan of tying arteries with lead and the other metals,
is free from danger, and may be productive of some peculiar ad¬
vantages •, more experience, and a greater number of experiments
are necessary to establish this point thoroughly, and it is to be
hoped that some one fully competent to the task, will prosecute
the subject. — Amer. Journ. Med. Sc.

MONTHLY SYNOPSIS OF PRACTICAL MEDICINE.

FOREIGN HOSPITAL PRACTICE.

PIotel Diec.

16. Syphilis — Paralysis of the Facial Nerve — Cure . — A girl, aged
sixteen, of a healthy constitution, contracted gonorrhoea in No¬
vember. 1S28, for which no treatment was adopted. Six weeks
after she arrived in Paris : at this time there was a tumor upon
the left frontal protuberance. The day after her arrival, during
the night, without any previous pain or any accidental cause, she
experienced a numbness in the left cheek; the whole of the face
on this side was stiff and insensible, and in the morning she per¬
ceived that her mouth was strongly drawn towards the right side.
There was also a slight stifFness of the tongue, and her speech was
embarrassed ; no other symptom existed. Upon the first attack,
she had been bled twice in the day from the arm, and on the suc¬
ceeding day leeches were applied to the anus. From this treat¬
ment no benefit was obtained, and two days after the patient was
admitted into the Hotel Dieu.

The gonorrhoeal discharge still existed, and the exostosis of the
os frontis was very apparent. Neither the head nor stomach was
affected. The motions of the tongue were free and natural ; the
difficulty of speaking evidently resulted from the immobility of
the cheek and lips. An emetic was given on the two succeeding
days, and on the third she was bled from the arm, but no alteration
occurred. The anti-syphilitic treatment of M. Dupuytren was
now commenced, consisting of pills of an eighth of a grain of
the deuto-chlorate of mercury, half a grain of opium, and two

Sudden protrusion of the whole Intestines, Qc. 16/

grains of extract of guaiacum. Three of these pills were taken
each day, together with decoction of sarsaparilla and sudorific
syrup.

Eight days after the appearance of the paralytic affection on
the left side, the same symptom suddenly manifested itself on the
right, and the face of the patient, when she awoke, was no longer
drawn to one side. There was now a complete relaxation and a
perfect immobility of all the features. The eyelids could be only
half closed, and the tears flowed over the cheeks. The lips re¬
mained open, and were agitated like two curtains by the expired
air. The tongue was not affected. The power of motion had
alone suffered, for the skin and the mucous membranes retained
their sensibility. The patient did not suffer, and her naturally ex¬
pressive countenance had now a serious cast, which oddly con¬
trasted with her cheerful disposition of mind. She sometimes
laughed heartily, but she appeared as if she were laughing behind
a mask, and, from a knowledge of this fact she was much annoyed.

The treatment was regularly continued, and a blister was ap¬
plied on the left cheek, near the ear, and several others successively
on the same part of the right side of the face. A large seton was
placed in the neck, which produced considerable pain ; suppura¬
tion was not established from it for a month, until when its bene¬
fit was not apparent.

At the expiration of two months, the mobility of the cheeks was
gradually recovered. The patient no longer slept with her mouth
open. The power of closing the eyelids wTas, by degrees, restored,
and the tears no longer flowed over the cheeks. It is to be ob¬
served that none of the senses had ever been affected. Both taste
and smell had remained perfect ; neither had the sensibility of the
skin been diminished or altered. The general health had not been
disturbed } the appetite wras good throughout the attack. At the
commencement of the disease, however, the patient disliked to eat,
because the food, on account of the immobility of the cheeks,
collected in the mouth, and she had not the power of forming it
into a mass, or of swallowing it. She lately became accustomed
to this state, and her tongue, fingers, and various instruments,
were made to perform the duty of the buccinator and labial mus¬
cles. The muscles of the face very gradually regained the power
of assisting in respiration, or of depicting any mental emotion.
The patient had been observed to sneeze without presenting that
peculiar expression of the face which naturally accompanies the
act. When she gaped the jaw dropped, but neither the lips nor
the countenance indicated in the slightest degree, the sensation
which is connected with gaping. There can be no doubt that if
dyspnoea had arisen from any cause, the nostrils would have re¬
mained motionless, instead of assisting in that painful expression
which is so often evident in asthmatic subjects.

After remaining four months in the hospital, the patient went out
in the following state : The exostosis on the frontal bone had dis¬
appeared, the gonorrhoeal discharge had ceased, and the general
health was good. Her round and cheerful face expressed with

168

Synopsis of Practical Medicine .

vivacity every moral and physical sensation. Her laugh was still
rather odd, for the motions of the lips did not appear to correspond
with the rapidity or extent of the motions of the diaphragm and
ribs. She masticated easily, and had the power of collecting her
food into a mass for deglutition. With a slight effort she could
completely close the eyelids, but the tears frequently flowed over
the cheeks. The seton was kept in, and there was every reason
to believe that in a few months the patient would retain only the
remembrance of this singular affection.

17. Exostosis of the Superior surface of the first phalanx of the
Great Toe. By M. Paillard.— This disease was described in the
Journ. Hebd. from which the preceding extract has been made, and
is said by the editor to have been unnoticed by former writers.
He has erred in arriving at this conclusion, as the disease has been
well described by Mr. Liston, in the Edin. Med. and Surg. Journ.
1826, v. 26. p. 27.

The operation performed by M. Dupuytren, of removing the tu¬
mour by a circular incision, in preference to amputation of the toe,
has been anticipated by Mr. Liston, who in future cases was
obliged to perform the removal of the joint in consequence of a
return of the disease 5 an operation, he observes, which is quite
effectual, and more neatly, quickly, and easily done than the di¬
vision of the bone. The amputation of the whole bone appears to
me preferable to any attempt at excising the diseased part only,
as being less painful, more certain, and productive of as little in¬
convenience.’’' — Ed.

18. Ligature on the distal side of an Aneurism. — M. Dupuytren
lately applied a ligature on the axillary artery in a case of aneurism
of the subclavian 5 the patient died on the ninth day after the ope¬
ration, but not in consequence of the operation. The tumour had
considerably diminished, cold lotions and ice were applied, slight
hemorrhage took place, the pulse became quick and frequent,
blood-letting was resorted to four times, the hemorrhage had
ceased, debility and general uneasiness supervened, and death
closed the scene. The whole of the subclavian artery was found
aneurismal, it was distended considerably in front, and contained
numerous clots at this part, and several layers (the nature of
which is omitted), the axillary vein near the ligature was black,
softened, and fungous, and easily torn, and numerous large
branches (of what artery or vein ?) were filled with clots of a grey¬
ish colour.-— La Cliniq. Lan. Fran. Journ. Hehd.

We have seldom perused a more confused account of a dissec¬
tion than this. — :Ed.

Hopital Beaujon.

19. Melanie Cancer of the palm of the Hand. By M. Jadelot. The
subject of the disease was a man aged forty-six, of a sanguineous
temperament and robust constitution 5 he was admitted into the
hospital March 28, 1829 About seven years previously he per¬
ceived a blackish spot on the palm of the hand, similar to an ec-
chvmosis, and it appeared without any evident cause. Nitrate ot

169

Melanie Cancer in the Palm of the' Hand.

silver was applied, and a saiiious suppuration ensued. From that
period to the year 1828 he underwent a variety of treatment. Two
tumours now appeared : one was spongy, and discharged a sani-
ous matter, the other was covered with skin and was attended
with lancinating pain. An arsenical paste was applied, which re¬
moved these tumours. Early in February a new tumour was
formed, and was attended with lancinating pain, which was aggra¬
vated by the arsenical paste,- which induced him to seek admission
into the hospital. The following description is added. The tumour
occupied the whole of the palm of the right hand, is irregularly cir¬
cular, ulcerated in the centre, and discharged a fetid ichor : the rest
of the tumour was hard and circumscribed, and the pain was lan¬
cinating. MM. Marjolin and Blandin determined on amputation,
which was performed May 5, at the radio-carpal articulation. On
examining the diseased mass after removal, it was found to con¬
sist of two distinct tumours. The cutaneous veins were distended,
and the cellular tissue was discoloured. The larger tumour pene¬
trated the palmar fascia, the anterior annular ligament and the
fibres of the adductor pollicis minor. Several small tumours pe¬
netrated deeply the metacarpal interosseous spaces, and affected
the flexor tendons, the vessels and nerves of the four fingers. The
tendons of the index and middle fingers were implicated. The
tumour on the dorsal surface was the size of an orange, blackish,
lardaceous, and decidedly melanotic. The patient was discharged
cured, June 3.— Journ. Hebd. Juin 13.

BRITISH HOSPITAL PRACTICE

BRISTOL HOSPITAL.

20. Sudden Protrusion of the whole Intestines into the Scrotum.—
John Marsh, aetat. 50, labourer, was brought into the hospital,
having been knocked down and completely run over by a cart
laden with bricks. His scrotum, on inspection, was found to be
of most enormons size, extending two-thirds downwards between
the thighs, and measuring in circumference seventeen inches. Its
colour of a jet black ; and its texture, from over distension, so ex¬
quisitely thin, asito threaten immediate rupture from the slightest
manipulation. The abdomen perfectly flaccid, and nearly empty.
Immediately over the umbilicus existed a large transverse ecchy-
mosis, indicating the exact course of the wheel over the belly.
The patient was incessantly vomiting, accompanied by the most
urgent retching, extremities cold, the body bedewed with profuse
clammy perspirations, attended with syncope. On being placed
in bed, the viscera were returned to their natural situation without
much difficulty, merely by elevating the Ipps, depressing the
shoulders, and applying moderate and careful pressure with flan¬
nels moistened in hot poppy fomentation j the facility of reduction
depending on the large opening through which the viscera had
passed, together with favourable and relaxed state of the patient.
One grain of opium was now exhibited, with the view of allaying
the irritability of the stomach, and the abdomen fomented, as well
no. 14.

170 Synopsis of Practical Medicine .

at the scrotum, with poppy fomentation 3 bottles of hot water ap¬
plied to the feet.

Four o'clock, p.m. — Sickness still continues unabated. Abdo¬
men exceedingly tender, so as to confine the patient entirely to his
back. Extremities warm from the application of the bottles con¬
taining hot water. Pulse feeble. Ordered — Repeat the opium
pill ; to use a tepid bath for ten minutes 3 and in one hour after,
a common glyster to be exhibited. The scrotum to be constantly
suspended.

Second Dcaj. — Sickness has subsided. Has passed an easy night
without much sleep ; still unable to move the least in bed. Glys¬
ter has operated twice. Expresses great comfort from the bath.
Pulse 90, and feeble. Skin temperate 5 countenance not so anx¬
ious. Ordered — Castor oil, six drachms, to be taken directly. I'o
repeat the bath again at bed-time.

Third Day. — The castor oil has operated twice copiously. Has
passed a very restless night. Intense pain in the abdomen on
pressure 3 slight tension 5 nausea 3 pulse 100, and wiry 5 skin dry 3
tongue white" The scrotum somewhat reduced in size, though
perfectly black. Ordered — Thirty leeches to be applied to the
abdomen directly ; tepid bath as before 3 blister to be placed over
the belly at bed-time 3 and to take three spoonfuls of the follow¬
ing mixture every four hours sulphate of magnesia, one ounce 5
water, half a pint j make a mixture.

Fourth Day. — Bowels have been relieved five times 3 the evacu¬
ations very fetid and dark. Pain on pressure nearly removed j the
tension entirely. Has slept at intervals during the night 3 blis¬
ter has produced extensive vesication. Pulse ninety, and soft 3
skin perspirable 3 tongue white. The thighs partake of the same
discoloration as the scrotum. Ordered— Effervescing saline mix¬
ture, two table spoonfuls, to be taken every five hours 3 the bath
at night ; and the scrotum to be kept wet witkthe spirit lotion.

Sixth Day. — Has continued to improve in every respect. Quite
free from pain, except when endeavouring to turn in his bed.
Pulse eighty-six 3 skin natural 3 tongue moist 3 complains of
great flatulence. The lotion has had the effect of corrugating and
contracting the scrotum, which is still extremely black. Ordered

_ Infusion of cloves, one ounce 3 aromatic spirit of ammonia, half

a drachm 3 to be taken twice or thrice daily. Diet a small quan¬
tity of animal food.

Twelfth Day. — Quite convalescent 3 has been capable of sitting
up in his bed for some hours, the precaution of applying a double
truss having been previously taken. He was discharged cured in
three weeks from the time of the accident.

Since this patient has left the hospital, I am informed he is sub¬
ject to occasional diarrhoea, which is extremely violent, and re¬
duces him very considerably before it can be checked. He is
compelled to wear his double truss both night and day, otherwise
the viscera descend immediately into the scrotum in very large
quantities. He was never afflicted with hernia prior to this unfor¬
tunate occurrence* — Prov. Med. Gazette.

Amputation of the Penis.

171

ST. BARTHOLOMEW’S HOSPITAL.

21. Amputation of the Penis.— Lewis Tyson, seta t. sixty, a band-
box maker, of a spare habit, grey-haired, and emaciated, was ad¬
mitted into Lazarus Ward, under the care of Mr. Lawrence, May
7, with carcinomatous ulceration of the penis. Is a married man,
has not been diseased, or ever got any blow on, or injury to, the
parts that he is aware of. His attention was first called to the
disease about twelve months ago. It then appeared in the form
of a cluster of small pimples under the fore-skin ; they increased
in size, and ran into one, and for the last three months, the whole
has been a mass of ulceration discharging profusely. There is
now a deep excavation, with everted edges and hardened base, on
the under surface of the corpora cavernosa ; a fungous substance
shooting forth from under the prepuce, indicating us it would
seem, that the glans and prepuce are both included in the disease.
Ordered to have the bowels cleared, the extract of conium to be
administered, and leeches and poultices applied to the parts.

On Saturday last, at about a quarter to one o’clock, he was
brought blindfolded into the operating theatre, to undergo the
operation of amputation. When, after being seated on the table,
Mr. Lawrence took hold of his hand, and asked how he felt, he
replied that he was very indifferent, that he was of a very weak
constitution, and begged that no more should be removed than
was absolutely necessary for the cure. An assurance to this effect
having been given by the operator, he immediately proceeded to
the removal of the parts. Taking hold of the diseased portion with
the left hand, and extending the organ, with a scalpel he made a
circular incision at about one and a half or two inches from the
pubic arch. Then after slightly dissecting the integuments up to¬
wards the pubes, with three cuts of the scalpel he separated the body
of the penis. A considerable quantity of blood was lost, six liga¬
tures were applied, and the operation completed in twelve minutes.

After the patient was taken away, Mr. Lawrence observed, that,
from the dissection, it appeared the glans and prepuce were not
involved in the disease, as he had expected to find ; the scirrhous
mass issued from under the surface of the corpora cavernosa, tra¬
velling along the prepuce to the orifice of the urethra, and nothing
short of the operation that had been performed, could have been
expected to afford any relief.

18th. Slept well during Saturday night, and, until to-day, has
been comparatively free from pain, since the operation. The urine
has passed away freely. A cold wet cloth has been kept over the
wound. It is very painful to-day.

19th. Slept last night, but not so well as during the two pre¬
vious nights. Complains much of soreness and smarting pains.
There is a slight ulcerative process set up on the surface of the
wound. Pulse quiet. Tongue clean and moist. — Lancet.

GUY’S HOSPITAL.

Lithotomy. Performed by Mr. B. Cooper.— On Tuesday,
June 9th, Mr, Bransby Cooper performed the operation of litho •

172 Synopsis of Practical Medicine.

tomy on a child apparently about five years of age. Mr. Coopef
stated previously, that although the child was unhealthy, and an
unfavourable subject for the operation, it would not be proper to
delay the operation longer, in consequence of the urgency of the
symptoms. The child being laid on the table, and bound in the
usual manner, Mr. Cooper introduced the straight staff, and hav¬
ing (with his two colleagues, Mr. Key and Mr. Morgan) ascer¬
tained the presence of a stone, the operation was commmenced in
the following manner : — An incision was first made with a com¬
mon double-edged scalpel, to about two inches in length on the
left side of the raphe, extending obliquely backwards, dividing the
integuments and superficial fascia. Mr. Key holding the staff in
his right hand, another incision in the same track, but not quite
so long as the first, was the next step. Several smaller incisions
were then made, and the finger and scalpel were observed alter¬
nately passing into and out of the wound with some apparent dif¬
ficulty 5 the point of the scalpel at length found its way into the
groove of the staff. Sir Astley Cooper’s knife was next intro¬
duced, and the scalpel withdrawn. The operator then laid hold of
the staff, and depressing it considerably, carried forwards the knife
into the bladder ; no gush of urine followed, which could be per¬
ceived by those who were at some distance from the operating
table, but a great deal had passed by its natural course during the
former part of the operation, previously to the opening being
made through the perineum into the bladder. Having withdrawn
the staff, &c., the short forceps were introduced into the bladder,
but the attempt to extract the stone proved of no avail. Alter¬
nately they were removed, and the fore-finger introduced, and the
operator seemed to evince some degree of impatience, until at
length the long forceps were used, when a very large stone/ o.
an oval shape, was extracted, seven minutes and a half occurring
from the time of the first incision. — Op. Cit.

ST. THOMAS’S HOSPITAL.

23. Genital Irritation— Impotence. — The following case of irrita¬
tion of the genitals and impotence, and severe pajn at the occiput,
was admitted into Edward’s Ward, February 13th, 1825. (See
Case Book for 1825.)

John Martin, setat. thirty- six, ill one year and a half ; married,
and has three children. Complains of pain at the occiput,
from which it darts through to the forehead, and is exceed¬
ingly severe when lying on his back. Vertigo; quite impotent
for three months 5 no tentigo, but a constant discharge from the
urethra, and a copious oozing almost every night ; numbness of
hands and feet at first waking ; great depression of spirits and
strength; sometimes makes a large quantity of urine at others very
little. The same variation as to the appetite ; always cold, never
sweats ; frequent and terrific dreams ; very costive ; two epilep¬
tic fits last summer, preceded by vertigo.

A seton to be put in the nape of the neck ; sulphate of mag¬
nesia, half an ounce ; infusion of gentian, two ounces ; a dose
three times a-day. ; : •

Curious Cure for Traumatic Tetanus. 173

22. A blister to the forehead, to be kept open with savin oint¬
ment.

March 5. Repeat the blister ; continue medicines.

8. Calomel, four grains twice a-day.

II. Had an epileptic fit. Cupped on the occiput. Continue
the medicine.

19. Mouth sore, very little pain at occiput.

April 9. Still no pain of head tentigo yesterday for the first
time since admission.

14. leit quite well, and left the hospital, being' very desirous to
return to his wife. — Op. Cit.

24. Curious Cure for Traumatic Tetanus. — We take the follow¬
ing extract from a review of Dr. W. Reid’s work on Tetanus and
Hydrophobia, in the American Journal of the Medical Sciences.
We were not ourselves aware of the fact stated : —

ffIt may be proper, as a matter of curiosity, merely to allude
to an extraordinary practice among the inhabitants of the Tonga
or Friendly Islands, in the South Facifig Ocean, among whom we
are told traumatic tetanus prevails to a great extent. It consists
in producing a considerable degree of irritation in the urethra, and
a discharge of blood from that part by the introduction of a reed
of proper size for some distance into the canal ; and, when the
case is very violent, by passing a cord along the urethra through
the perineum, the two ends of which are occasionally pulled to
and fro, inducing great pain and a copious hemorrhage, with
much swelling and inflammation of the penis. By Mr. Mariner,
fiom whom we derive the account of this strange and unpromis-
ing practice, it is stated that he witnessed two cures of confirmed
tetanus from it. Every fact relating to the treatment of this disease
is interesting, and, without advising this precise mode, it may
suggest a principle capable of improvement. It was, indeed,
somewhat on this principle that Dr. Brown, of Lexington, many
years ago, proposed exciting strangury as a cure, and bore some
evidence to its efficacy.”

25. Lithotomy. — Of eighty-three operations by the lateral me¬
thod, performed by M. J. M. Viricel, at the Hotel Dieu of Lyons
eighty were successful.— Revue Medicate.

26- Prevention oj the Poisonous Effects of Hydrocyanic Acid. By
M. Herbst. This practitioner had instituted many experiments
with hydrocyanic acid on dogs ; and most speedily combatted its
poisonous effects by cold affusions applied to the head and spine.
The poison appears to act vividly on the nervous system, and to
abolish sensibility,- — Journ. Complemen. du Diet > des Sc. Med. Mars.
M. Broussais is of opinion, should it produce accidents analogous
to tetanus, the cold affusion ought to be tried. — Annates de la Med.
Physiologique , Mai.

27. Influence of Season and Physical Causes on Conception. Ba¬
ron Cuvier made his report on a paper, transmitted to the Royal
Institute of France by M. Villerme on this interesting subject.

] J4 Synopsis of Practical Medicine .

The author alleges there are most births in the six months of win¬
ter and spring in the following order, February, March, January,
April, November, September. Of consequence the greatest num¬
ber of conceptions take place in the six months consecutively but
without much regularity, commencing between the winter sol¬
stice and vernal equinox, and which finish between the summer
solstice and autumnal equinox, that is to say during the sun s ap¬
proach to our hemisphere and its elevation on our horizon. Ihis
general fact demonstrates solar influence, and that of light and heat
united upon the process of propagation. Marsh effluvia are inju¬
rious to conception, and this is observed more particularly in au¬
tumn. His researches on marriage have led him to this remark¬
able conclusion, that few women conceive in the first week of their
union. Times of famine and of fasting exercise the same influ¬
ence on conceptions, and both one and the other are causes of di¬
minution of the population. — Institut . Juin 4, Journ. cle Chew,.
Med. %c. Juillet.

28. Foreign Body presumed to be in the Ear for many Years.— A
child, between ten and eleven years of age, was brought to the Ho¬
tel Dieu by its parents, who said a kernel of a prune had passed
into the left ear, and had remained there for many years. There
is a degree of paralysis on the left side of the body, with strong,
painful and tetanic retraction pi the whole side. The child cried
on stretching the limbs. He has strabismus of the lett eye. The
external ear was examined with care but no foreign body was dis¬
covered. The general and local state of the patient rendered it
doubtful as to the presence of a foreign body in the ear; and M.
Dupuytren thought it was more probable that there was disease
of the brain, consisting of a tumour or some other state, difficult, if
not impossible, to be discovered. A seton was applied to the
neck, mild purgatives were given to obtain a salutary derivation
to the intestinal canal. This treatment at first appeared to miti¬
gate the symptoms. General convulsions soon manifested them¬
selves, the muscles of the left side were more severely affected,
involuntary evacuations set in, and the patient died. May 16, alter
a sojourn in the hospital ot three months.

Necropsy. — The cerebral aspect of the cranial bones presented
no appearance of disease, the membranes were healthy. . The sub¬
arachnoid tissue was infiltrated, and the lateral ventricles were
full of serosity. In the right optic thalamus a tumour was found
the size of a pullet’s egg, round, red, and rough, with various as¬
perities. On being divided it was greenish and homogenous, filled
with various spaces containing serosity. The organ of hearing
was sound and contained no foreign body. The splanchnic vis¬
cera were healthy. — Journ. Hebd. Juillet 4.

29. A New Species of Inguinal Hernia— This case occurred in the

H6pital Beaujon, required operation, and death ensued. On dis¬
section, a bridle ran across the hernial sac which caused the. diffi¬
culty of reduction.- — Op. Cit. r*dto Imh. , tn\*

There is nothing novel in this appearance. It has been de-

Cancer of the Zygomatic Fossa. 175

Scribed some years since by Sir Astley Cooper, and others in this
country. — Ed. awouot gimc|a i>«£

30 Cancer of the Zygomatic Fossa. — M- Lisfranc presented the
section of chirurgery on June 25th, the head of an individual,
from whose zygomatic fossa he removed a cancer. In three days
afterwards patient died from the cerebral affection caused by the
division of the fifth pair of nerves at their escape from the cra¬
nium. — Op. Cit .

31. Mortality among Leeches during Storms.— That atmospheric
changes have a remarkable influence upon leeches, is a well es¬
tablished fact. In 1825, M. Derheims, of St. Omer, ascribed the
almost sudden death of them to the approach of, or during, storms,
to the coagulation of the blood of these creatures, caused by the
impression of the atmospheric electricity. This opinion, which
at the time was the result of theory, he confirmed, in the month
of March last, by direct experiment.— Bull. Univ.

frf* l * 3 4 5f °(l ^ie Society °f Apothecaries. Rex v. Hatto. — The defendant
had pleaded guilty to an indictment preferred against him for imposing upon the
Examiners of the Apothecaries’ Company, by a forged certificate as to the com¬
pletion of the period of his apprenticeship. The prosecutors did not press
ioi any severe measure of punishment. The sentence of the Court was six
months imprisonment in Lincoln gaol. We are glad to see the Apothecaries’
Society so cautious in granting their testimonial, but at the same time must ob-
serve that the like caution ought to distinguish them in protecting their Licen¬
tiates from the ruinous encroachments made on them by chemists and drug¬
gists, who are virtually the apothecaries in this metropolis, in open defiance to
a statute which could be enforced before the next magistrate. An excellent but
veiy expensive education is required of the qualified apothecary, and the rights
which belong to him ought to be protected.

BOOKS RECEIVED DURING THE MONTH.

1. Study of Medicine. By John Mason Good, M.D. F.R.S.L. Mein. Am. Phil.
:oc. and r.L.S. Philadelphia; containing all the Author’s final Corrections and
Improvements. Third Edition, with much additional modern information on
Physiology, Practice, Pathology, and Nature of Diseases in general. Bv Samuel
Cooper, Surgeon to the Forces; King’s Bench and Fleet Prisons; Author of the
Dictionary of Practical Surgery, &c. &c. &c. Five Vols. 8vo. London, 1829,
u nderwood. Reviewed in the last and present Number,

^c^ount °f some of the most important Diseases peculiar to Women.
By Robert Gooch, M.D. London, 1829. Murray.

3. The Influence of Climate in the Prevention and Cure of Chronic Diseases ;
more particularly of the Chest and Digestive Organs, comprising an Account of
the principal places resorted to by Invalids in England and the South of Europe-,
a eompaiative estimate of their respective merits in .particular Diseases, and ger
neral directions^ for Invalids while travelling and residing abroad. With an
Appendix, containing a series of Tables on Climates. By James Clark, M.D.
i eoo ei" °* t^ie R°yal College of Physicians of London, &c. &c. Underwood

4. An Essay on the Connexion between the Action of the Heart and Arteries,
and the Functions of the Nervous System, and particularly its influence in ex¬
citing the involuntary act of Respiration. By Joseph Swan, London, 1829.
Longman and Co.

5. Answer to “ Observations on the Phrenological Development of Burke,
Hare, and other atrocious murderers, &c. By Thomas Stone, Esq. &c.” By
George Combe.— Anderson, Edinburgh ; and Simpkin and Marshall, London,

176 Books Received, Notices to Correspondents, i fc.

6. A Rejoinder to the Answer of George Coombe, Esq. on the Phrenological
Development of Burke, & c. By Thomas Stone, Esq. President of the Royal Me¬
dical Society of Edinburgh, 1829.

We have attentively perused both these pamphlets, and pronounce, impartially,
the author of the rejoinder the victor. Mr. Stone is one of the most formidable
combatants that has yet entered the lists of the anti-phrenologists. In fact no
one can read this and his former production, “ Evidences against Phrenology,”
and remain a phrenologist.

7. Dictionnaire, de Medecine et de Chimrgie Practiques. Par MM. Andral,
B£gin, Blandin, Bouillaud, Bonvier, Cruveilhier. Cullerier, Devsrergie, Alph.
Duges, Dupuytren, Foville, Guibourt, Jolly, Lallemand, Londe, M.agendie. Ra-
tier, Rayer, Roche, Sanson, Tome Deuxteme. A Paris, Chez les Libraires Edi-
teurs Gabon, M^quignon, Marvis. J. B. Baillihre, 1829. T. 2.

This is the fourth Medical Dictionary published in France during the last seven¬
teen years It is purely practical, and is therefore a better work than the Diet.
Abr6ge Des Sc. Med. It appears quarterly, and its price is very moderate. It
will be completed in 15 vols.

8. American Journal of Medical Sciences, May 1829.

9. North American Medical and Surgical Journal, October 1828, and Janu¬
ary 1829. *

10. Bulletin des Sciences Med. Avril, 1829.

11. Lancette Francaise.

12. Cerebro-Spinal System in Man ; together with the Origin and Primary
Division of the Nerves, which arise from it. Translated from the French of M.
Manec, M.D. By Luis Vicente D’Affonseca. London, 1829. Underwood.

13. Address of Lord Stanhope to the Medico- Botanical Society.

14. Oration delivered before same Society. By Mr. Frost.

15. An Essay on the Phrenology of the Hindoos and Negroes, By James
Montgomery, Esq. London, Lloyd and Co., Harley Street.

16. Strictures on Mr. Montgomery’s Essay. By Gordon Thompson, M.D.
Lecturer on Physiology, and on the Nature and Treatment of Diseases at the
Sheffield School of Medicine.

17. Observations on the Treatment of Small-Pox. By Alexander Stewart,
A.B.T.C.D. Assistant Surgeon 2nd Dragoons.

NOTICE TO CORRESPONDENTS.

The Editor of the Medical Gazette has requested of us, and others of his bro¬
ther Editors, to correct a blunder which he made in his report of the proceedings
of the Royal College of Physicians, and which we copied in our last Number,
page 70. It turns out that there was no will executed by the man who laboured
under insanity, as the testator could not reword the document. “ The Editor
regrets his having fallen into this mistake the more, as, from all reference to the
source whence the report was taken having been by some accident omitted in
the several Journals alluded to, they may incur the discredit of a blunder to
which they have as little title as to the article which contained it.” We beg to
assure our contemporary that, we are not so ambitious as to claim any title
whatever to such an important article, which, by the way, should not have had a
place in this Journal, had we not contrasted the Proceedings of the Medical So¬
cieties of this Metropolis, with those of Paris, in our last publication. We cer¬
tainly had acknowledged the source from whence the article was taken, which
was accidentally omitted by the printer ; but we promise he shall be more cau¬
tious in future. There is no better axiom than Suum Cuique.

All Communications and Works for Review to be addressed to the care of
Messrs. Underwood, 32, Fleet-street; or to to the Editor, at his residence, 61,
Hatton- Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 1 o. SEPTEMRER 1, 1829. Vol. III.

CRITICAL REVIEW.

I. — The Study of Medicine . By John Mason Good, M.D.
F.R.S.L., &c. &c. Third Edition , with much additional
modern information on Physiology , Practice , Pathology,
and the Nature of Diseases in general. By Samuel
Cooper, Surgeon to the Forces, King’s Bench, and Fleet
Prisons, Author of the Dictionary of Practical Surgery,
&c. &c. London, Underwoods, 1829.

( Continued from page 106.)

Having concluded the description of Limosis or Dyspepsia,
Dr. Good proceeds to consider the numerous other disorders
and diseases of the digestive ogans, included in Class I.
Order I. Enterica, Gen. vi. Colica, which is subdivided into
the following species; 1. C. Ileus, Iliac Passion; 2. C. Ra-
chialgia. Painter’s Colic; 3. C. Cibaria, Surfeit; 4. C. Con-
stricta, Constrictive Colic. Gen. vii. Corprostasis, Costive¬
ness ; 1. C. Constipata, Constipation; 2. C. Obstipata,
Obstipation. Gen. viii. Diarrhoea. — 1. D. Fusa, Feculent
Looseness; 2. D. Biliosa; 3. D. Mucosa; 4. D. Alba ; 5.
D. Lientaria ; 6. D. Serosa ; 7* D. Tubularis, Tubular
Looseness. Gen. ix. Cholera. — 1. C. Biliosa; 2. C. Flatu-
lenta ; 3. C. Spasmodica. Gen. x. Enterolithus, Intesti¬
nal Concretion. — i. E. Bezoardus, Bezoar; 2. E. Calculus;
3. E. Scybalum. Gen. xi. Helminthia, Worms. — 1. H.
Alvi ; 2. H. Podicis, Anal Worms; 3. H. Erratica, Erra¬
tic Worms. Gen. xii. Proctica. — 1. P. Spasmodica, Spas¬
modic Stricture of the Rectum ; 2. P. Callosa, Callous
Stricture of the Rectum ; 3. P. Tenesmus ; 4. P. Marisca,
Piles ; 5. P. Exania, Prolapse of the Fundament.

The next diseases described are those of the abdominal
viscera, and are as follows. Order II. Splanchnica, affecting
the collatitious viscera. Gen. i. Icterus.— I . Choloeus, Bi¬
liary Jaundice ; 2. I. Chololithicus, Gall-stone Jaundice ;

VOL. III. NO, 15. 2 A

178

Critical Review.

3. I. Spasmodicus ; 4. I. Hepaticus ; 5. I. Infantum. Sf.
ii. Melsena. — 1. M. Clioloea, Black or Green Jaundice; M.
Cruenta, Black Vomit. Sp. iii. Cholilithicus, Gall-stone ;
1. C. Quiescens, Quiescent Gall-stones; 2. C. Means Pass¬
ing Gall-stones. Sp. iv. Parabysma, Visceral Turgescence.
— I. P. Hepaticum ; 2. P. Splenicum ; 3. P. Pancreaticum ;

4. P. Mesentericum; 5. P. Intestinale ; 6. P. Omentale; 7* P«
Complicatum, Turgescence compounded of various organs.
This completes the nosology of the diseases of the digestive
organs and of Class I. The description of the various dis¬
orders of function, and organic diseases in this part of the
work are distinguished for that perspicuity, discrimination,
judicious selection of facts and arduous research, which are
so pre-eminently displayed in every article in the Study of
Medicine. It is perfectly impossible to pronounce which
disease is best described, all are so excellently executed and
instructive. The chapter on worms, presents many curious
and important facts, and clearly proves that they are taken
into the body, and not produced by spontaneous or equivocal
generation, as is generally imagined. The mass of evidence
afforded on this point, is incontrovertible and conclusive.
The extraordinary cases of constipation and obstipation de¬
serve attentive perusal, and shew the superior power of na¬
ture over the resources of science. There is also much va¬
luable information in the chapters on diarrhoea, cholera,
alvine concretions, diseases of the liver, gall-stones, and vis¬
ceral turgescence. The observant practitioner will here find
information highly valuable in the treatment of many dis¬
eases of daily occurrence, though undescribed in the popular
systems of practical medicine.

The author next proceeds to Class II. Pneumatica, Dis¬
eases of the Respiratory Function. Order I. Phonica, affect¬
ing the vocal avenues. Gen. i. Coryza, Running at the
Nose. 1. C. Entonica ; 2. C. Atonica. Gen. ii. Polypus.
1. P. Elasticus ; 2. P. Coriaceus, Cartilaginous Polypus,
Gen. iii. Rhonchus, Rattling in the Throat. — 1 . R. Stertor,
Snoring. 2. R. Cerchnos, Wheezing. Gen. iv. Aphonia.
1. E. Elinguium ; 2. E. Atonica; 3. E. Surdorum. Gen.
v. Dysphonia. — 1. D. Susurrans, Whispering Voice ; 2. D.
Puberum ; 3. D. Immodulata, Immelodious Voice. Gen. vi,
Psellismus, Dissonant Speech. 1. P. Bambalia, Stammer¬
ing ; 2. P. Blgesitas, Misenunciation. Order II. Pneumo-
nica, affecting the Lungs, their membranes or motive power.
Gen i. Bex, Cough. — 1. B. Humida ; 2. B. Sicca; 3. B.
Convulsiva, Hooping Cough. Gen. II. Laryngismus, Laryn-
gic Suffocation. — 1. L. Stridulus, Stridulous Constriction of
the Larynx. Gen iii. Dyspncea, Anhelation. — 1. D. Chronica,

Dr. Good s Study oj Aledicine. 179

Short Breath ; 2. D. Exacerbans, Exacerbating Anhilation.
Gen. iv. Asthma.— 1. A Siccum ; 2. A Humidum. Gen y.
Ephialtes, Incubus. — 1. E. Vigilantium, Day- mare ; 2. E.
Nocturnus, Night-mare. Gen. vi. Sternalgia, Suffocative
breast pang. — 1. S. Ambulantium ; 2. S. Chronica. Gen.
vii. Pleuralgia, Pain in the Side. — 1. P. Acutus ; 2. P. Chro-
nicus. This brings us to Class HI. Haematica. Diseases
of the Sanguineous Function. Order I. Pyrectica, Fevers.
Gen. I. Ephemera, Diary Fever — 1. E. Mitis; 2. E. Acuta ;
3. E. Sudatoria, Sweating Fever. Gen. II. Anetus, Inter¬
mittent Fever. — 1. A. Quotidianus ; 2. Tertianus ; 3. A.
Quartanus ; 4. A. Erraticus ; 5. A. Complicatus. Gen. iii.
Epanetus, Remittent Fever. — 1. E. Mitis; 2. E. Malignus,
Autumnal, burning, asthenic. Remittent, Yellow Fever; 3. E.
Hecticus. Gen. iv. Enecia, Continued Fever. — 1. E. Cauma,
Inflammatory Fever : 2. E. Typhus ; 3. E. Synochus. Or¬
der II. Phlogotica, Inflammations. Gen. I. Apostema. — 1.
A. Commune; 2. A. Psoaticum; 3. A. Hepaticum; 4. A. Em¬
pyema ; 5. A Vomica. Gen. ii. Phlegmone. — 1. P. Commu¬
nis ; 2. P. Parulis, Gumboil; 3. P. Parotidea; 4. P. Mam¬
mae ; 5. P. Bubo ; 6. P. Phimotica, Phimotic Phlegmon.
Gen. iii. Phyma Tuber. — 1. P. Hordeolum; 2. P. Furuncu-
lus ; 3. P. Sycosis ; 4 P. Anthrax. Gen. iv. Jonthus,
Whelk. — 1. J. Varrus, Stone-pock; 2. J. Corymbyfer, Car-
buncled Face, Rosy Drop. Gen. v. Phlysis. — 1. P. Paro¬
nychia. Gen. vi. Erythema. — 1. E. (Edematosum ; 2. E.
Erysipelatosum ; 3. E. Gangraenosum ; 4. E. Vesiculare ;
h. E. Anatomicum; E. from dissection; 6. E. Pernio ; 7. E.
Intertrigo, & c. Here we shall conclude for the present, and
resume our author’s nosology in our next Number, commenc¬
ing with Gen. vii. Empresma, Visceral Inflammation. The
physiological proem to Class II. Pneumatica, contains a full
account of the phenomena of respiration, and is much more
comprehensive than in the preceding edition of the work.
The most recent opinions on this part of the animal econo¬
my are faithfully detailed. The work is equally excellent on
the physiological proem to Class III. Haematica, Diseases of
the Sanguineous Function ; and here we must introduce the
author’s opinions on the nature of fever.

<f No complaint is so common as fever ; none in which man¬
kind, whether professional or laical, are so little likely to be mis¬
taken, and yet none so difficult to be defined. In reality, no
writer seems to have been fully satisfied with his own definition j
and it is not extraordinary, therefore, that he should seldom have
given satisfaction to others. The difficulty proceeds from the
complexity of the symptoms that enter into the character of a fe¬
ver ; the contrariety of many of them to each other in different

180

Critical Review .

stages of it 3 and the occasional absence of some that, in other in¬
stances, appear to constitute its leading features. “ Febris,” says
Professor Frank, ‘ certorum potius morborum umbra, qustm ipse
morbus est.’

“ The nosologist has also two other difficulties of considerable
magnitude to contend with in laying down a clear and perspicu¬
ous survey of fevers 3 and that is, their division or collocation,
and their generic names. But, as I have already pointed out these
difficulties, and the means by which they are attempted to be re¬
medied under the present arrangement and nomenclature, in the
running commentary to the order before us in the volume of No¬
sology. I shall beg to refer the reader to the observations there
laid down, and shall subjoin only one or two additional remarks
upon the same subject.”

Dr. Good notices two facts which have been often observed
by many eminent practitioners, namely, that the heat and pulse
are not always augmented in fever, and that the hot may
precede the cold fit. He thinks it beyond the power of lan¬
guage to provide for these extraordinary and anomalous in¬
cidents by any definition whatever. He adopts an excellent
principle in laying down the genera of fevers. It is this :

“ In dividing fevers into distinct genera, I have taken the line of
demarcation from the character of their duration, as limited to a
single paroxysm 3 as composed of numerous paroxysms, with in¬
tervals of intermission or perfect apyrexy 3 as composed of nume¬
rous exacerbations, with intervals of remission, or imperfect apy¬
rexy 3 and as composed of a single series of increase and decrease
with a mere tendency to intervals of remission, without perfect
apyrexy at any time. Other nosologists have drawn their generic
distinctions from other circumstances 3 as their disposition or in¬
disposition to putridity 5 their inclination to a sporadic or an epi¬
demic character 3 the vigour and violence, or weakness and debi¬
lity, of their action 3 or, in the language of Dr. Darwin, the nature
of their influence on the sensitive or irritative fibres of the animal
frame. The most obvious mark, however, and that which has
been most generally approved, is the character of duration assumed
in the arrangement before us. To all the rest there are greater or
less objections, which, as 1 have already examined them in the
comment just referred to, need not be repeated in the present
place.

“ Regulated, therefore, by the principle before us, fever admits
of the four following genera : —

I. EPHEMERA.
II. A NET US.

III. EPANETUS.

IV. ENECIA.

DIARY FEVER.
INTERMITTENT FEVER.
REMITTENT FEVER.
CONTINUED FEVER.

“ To each of these belong several species, and to most of the

species several varieties, as will be noticed in their respective
order.’’ • . ? 1

Dr. Good’s Study of Medicine. 181

We fully agree with the author that the deviations from
the ordinary nomenclature which he proposes are founded in
every instance upon a principle of correctness and simplifica¬
tion, and consequently calculated to disentangle rather than
add to the incumbrances of the reader, and to facilitate his
progiess in the labyrinth before him. He next comments on
the scholastic terms of remote and proximate causes, and
refers to the proegumenal or predisponent, and protocartic
or occasional ; and he seems to adopt those which have
been chiefly studied of late, particularly in the case of fever.

u " ^hat only/ says Gaubius, f deserves the name of a physical
cause, which so constitutes the disease, that, when present, the
disease exists 5 while it continues, the disease continues -} when
changed or removed, the disease is altered or destroyed.’ It is
this which constitutes the proximate cause, and is, in fact, the
essence of the disease, the actual source of all its effects. The
he mote cause is that which directly produces the proximate ; as
a specific virus in syphilis, or a specific miasm in influenza, or
epidemic catarrh.”

We cannot refrain from inserting the concise and graphic
sketch of the various speculations which have arisen from
the term proximate cause. The author observes :

‘Fevers, then, in respect to their proximate cause, have been
conjectured to originate from a morbid change, either in the com¬
position of the blood, or in the tone or power of the living fibre.
The first view has given rise to various hypotheses, that rank un¬
der the common division of the humoral pathology. The second
has given rise to other hypotheses, appertaining to the common
division of the fibrous or nervous pathology.

The hypotheses derived from the one or the other of these
sources, that are chiefly entitled to attention, are the following •
of which the first two belong to the former division, and the Re¬
mainder to the latter.

f‘ I. That of the Greek schools, founded on the doctrine of a
concoction and critical evacuation of morbific matter.

“ II. That o‘f Boerhaave, founded on the doctrine of a peculiar
viscosity, or lentor of the blood.

III. I hat of Stahl, Hoffmann, and Cullen, founded on the doc¬
trine of a spasm on the extremities of the solidum vivum, or living
fibre. °

“ W. That of Brown and Darwin, founded on the doctrine of
accumulated and exhausted excitability, or sensorial power.

m“ V* To which we may add that fevers have, by some physiolo¬
gists, as Dr. Clutterbuck, M. Broussais, and Professor Marcus
been identified with inflammation ; and their proximate cause
been ascribed to increased action in some particular organ.”

The author gives a description of the various theories
from the time of Hippocrates to the present period, and oc¬
cupies twenty closely printed pages in his luminous disser-

182

Critical Review .

tation. Every man desirous of full information on this im¬
portant subject ought to peruse this inestimable essay, and
especially the sectarian, who ascribes fever to a specific
cause, or to a certain organ. The author concludes his va¬
luable and elaborate review of all theories of fever in the
following words, which ought to have due consideration from
all theorists.

“The result of the whole, as observed at the outset of this in¬
troduction, is that we know little or nothing of the proximate
cause of fever, or the means by which its phenomena are immedi¬
ately produced. In the language of Lieutaud, applied to the sub¬
ject before us, they are too often &tra caligine mersae ; nor have
any of the systems hitherto invented to explain this recondite in¬
quiry, however ingenious or elaborate, answered the purpose for
which they were contrived.”

Vivi perve nimus, “is it come to this ?” do we know no¬
thing of the nature of fever after an investigation of nearly
3000 years, and in this age of intellect and theory ? The
fact is so, and it would be well to remember it. Those prac¬
titioners who have had the greatest opportunities of observ¬
ing fever have arrived at this conclusion. Our author hav¬
ing disposed of the proximate cause of fever, next consi¬
ders the remote, and lays great stress on human and marsh
effluvia. He is a contagionist, and thinks the denial of
contagion hardly worth attending to. “Such speculations
may be very ingenious and very learned, and find amusement
for a leisure hour in the closet, but they will rarely travel
beyond its limits, and should they ever be acted upon would
instantly destroy themselves.’' This is mere gratuitous as¬
sertion, but in strict accordance with the opinions of the
largest portion of the profession. It was the most popular
side to take, but is one that never has been proved. We are
surprised that Dr. Good and his learned commentator should
dispose of the subject of contagion in a single passage, a
doctrine which has had the most beneficial, or, rather inju¬
rious effects on mankind for many ages. A few words on
the question — is typhus, common fever, plague, or yellow
fever, contagious — may be of use to our junior readers.

It had been generally, but never universally admitted, that an
invisible something , arising from the bodies of those labouring un¬
der fever and plague, and applied to the bodies of healthy persons,
causes,the same diseases in them. This was called contagion by
Some, and infection by others. If this opinion were true, fever
and plague could never cease to prevail, while the diseased were
attended by the healthy; but every day’s experience disproves such
a foolish assertion. We know, on the contrary, that medical and
ordinary attendants had ministered the rights of humanity and sci¬
ence to the diseased, even during the worst epidemics, and yet

183

Dr. Good s Study of Medicine .

were never affected by the disease. If this doctrine of contagion
were admitted, we should admit another not more plausible — that
the first human being who appeared on this earth, had the conta¬
gion inherent in him ; for, according to the modern contagionist,
the diseases under our consideration can alone arise from their
occult and invisible something , emanating from the body of the
sick, and applied to the body of the healthy. Such, however, is
the attested opinion of a large majority of physicians, before a
Committee of the House of Commons of this country, on a late
occasion ; and such is the solemn opinion of the British legislature
on the subject. But let us subject this conclusion to scientific in¬
vestigation, to experience, and faithful observation. Let us sub¬
mit to the test of history, and compare the results. We are ready
to admit that diseases, really contagious, have existed from an
early period of human history j for we find them recorded in
the earliest history of the world— the Sacred Volume. We find
the leprosy mentioned in the Pentateuch j but can find no mention
mode of contagious fevers. Before we proceed further, it may be
right to explain more fully what is meant by the contagion. The
meaning of this word is as diversified as there are writers on the
subject. Some attach to it the signification already stated j others
the reverse. Some say that contagion and infection are synoni-
mous j others maintain that contagion is the poison that generates
disease, and its operation is infection. Many assert, that conta¬
gion is diffused through the air ^ others call this difference infec¬
tion, and hold that contagion is a something which is produced by
the sick, and which can only affect the healthy by actual contact.

Contagious diseases are divided into two classes, acute and
chronic, febrile and non-febrile, endemic or sporadic, and epidemic.
Dr. Hosack, of New York, divides them into three classes 1*
Those that arise from actual contact only, as itch, venereal, sib-
bens, yaws, elephantiasis, leprosy, hydrophobia, and vaccina. 2.
Those which arise from contact through the medium of the air, as
small-pox, chicken-pock, measles, hooping cough, scarlatina,
and malignant sore throat. 3. Those which arise solely through
the medium of the air, as plague, typhus, yellow fever, and dy¬
sentery. Others add to this class, ophthalmia, phthisis, catarrh or
influenza. Let us now return to the ancient history of pestilence.
The earliest plague we read of in profane history, is attributed to
the agency of intense heat. Apollo, incensed at the insult offered
to his priest, afflicts the Grecian camp with pestilence ; and Ho¬
mer represents its first attacking mules and dogs. Iliad, B. I.
See also Ovid, B. 7 y and Lucretius, B. 6. Not a word is said
about the importable nature of plague by these writers — a remark¬
able discrepancy between the ancient and modern opinions on the
subject. We find also * that the primitive Irish, who were de¬
scended from the most illustrious and ancient nation in the uni¬
verse, namely Scythia,’ and whose ancient history is now duly
appreciated by all men, were frequently visited by plague, during
a succession of ages ; but the disease was never ascribed to the
contact of the healthy with the sick. Hippocrates wrote his

184

Crii-ica i Ret tew.

book on r the e~ : .* asanv centuries sunset net cm . atm maity at¬
tributed these visatataons to the influence of toe Etmosotiere. Ce-
so*. Aretseus and TrA .at were of toe so toe opicioa. Tnneym ides .
Galen and Lucretfas ns sorted : an: o mpne was contapm -5 Thu¬
cydides described the plagce of Athens very Ltto.rE.te y nno Livy
described the nestle nee of Rome, loo its extsnaon to t oe inferior
animals. Contazoon of fevers is said to arose d~T*"IXIZ 1 vnri-UUS OX'l"

ol: c

site causes, am mots it
which arise from a specif, source,
emnvium of healthy persons. wi>en eoumoen in a
and when deprived of pure lot. It os starec tn be

. f ^ . -- ^r.ss :* . to

o>tner uiseases.

the

HUTTO W FOLSE,

penerated sr the

sick, nod er the same circa ms tan ce \jsk; it is snm to t*e :u-
dooed by the eSevmsn of putrifymp b t>c -es . am lastly, by tn-
ordinate extremes of temperature by data. mnempernnee, ant uk

causes of cebilirv. TA = need scarce! v observe, teat no: one cf

* *

these causes eat induce the con tap, to. c ' any really contain otos
cosense. That fevers arose from snob causes, no naan can tor a
momeu: com: : bn: then, what beeoaaes of toe anemone ** jf ac¬
tual costae: only prnducinp mem : Toe history of epidemics m
every apt aoo nan to . confirms one truth of one former posn-nn
am os equal, y opposed to the latter

On pemsinp the morks of m partial nisiioriaa* wa fno pesti-
lence La* occurred tinder everr drrersrrv of atmospheric t ionssi-
tnde, an-d this ba5 been the case :n every country m w ; m epide¬
mics have appeared.

The st at omen: otv i? say* Mr L-arkon in ms ununsweruo ,e
Essay on the non-com tapiousu-es * of P.apno on :ne Ton torn MeA:-
cai and Physics] Journal, that oesnlience is p monputeo ay con¬
tact Tent — is no: i f ueneec oy temierumre — oo*ey* no onanpe cf
season — and o* perfectly anaf etteo and unchecked by any conch -
don of the atmosphere. Compa-e tnese assertions v-o too fact*

eTer rain* fall dnmtp the sultry beats of July an o An pa an In mat
country the vitiatioB of the air is occasioned by those in: to ease

swarms or locusts - a oh infest it tne o-ntrefatricn of widen .*
heightened by the excessive .n temperance of tne climate .n winch
vkaen: rain* fail at one season of tbe year for firrse or foo r
months torexher. In euumerutmz t* cunses I siwobd have nn-
ticed, that numerous swarms of insects her* rrepaen:iy been ob¬
served to be tne precursors of plapne. procnomp it ot taant:t.p tne
air in their dissolution So tboroupbiy were tne Epyptians im¬
pressed with this fat:, tea: Cicero- informs us on at they worshipped
tbe cord Ibis, for tbe serr.ee :t c d them on devoermp meat ■am¬
bers of wm ped serpents, which were wafted by the w-iad from tne
vast desert* of Lyo .a : thus reederiap :oem mocaous oy pee- cat¬
lap toe no from Lurtiaz tv tbeor oite amen ivmz o*r tae_r pes¬
tilent v ape- a r winen aeac. Tne Araoiao p; ysimnne- whe Lved aea”
these countries, declare, that p>esuiieo-oes are ororom t by tmseaswn-
aijie LumiDity, bv beat, arm want of winns To show mat hi
course may be checked by the staxe of tbe air, ament to tne fol¬
lowing- facts — At bnrymu. tne plazwt cumstat' iy teat cs anoar tut

'Dr. Good’s Study of Medicine. 185

$4th of June; dry and clear weather then succeeding to the un¬
wholesome damps that annoy the country during the spring
Whatever infected goods, or whatever infected persons, are landed
during the winter months, plague never spreads , Here, then, it is
evident that it is not propagated by contact alone ; that it’ does
obey change of season, is affected by temperature, and checked by
the condition of the atmosphere.

Extreme heat was long considered a prominent cause of con¬
tagion. Yet Prosper Alpinus informs us, that the great] plague of
Egypt entirely disappeared in a season of great heat ; and this
fact equally applies to the pestilence of Smyrna and Aleppo. At
Constantinople, great cold is considered the cause of plague • and
the plague of London, in 1664, was meat violent in December.
Dr. Rush was of opinion, that great heat was inocuous, if agitated
by winds 5 but if the season were hot, dry, and serene, then dis¬
ease might be expected. The venerable Bede informs us, that the
yellow plague which ravaged these countries in 667, commenced
in a summer which was uncommonly dry. On the other hand, the
plague of 10S6, which attacked half of the people of this country,
commenced in summer, which was more rainy and tempestuous*
than had been experienced in the memory of the oldest man in
England. Saxon Chron. Lingard. The fatal plague of 1348, which
was as destructive as any recorded in history, commenced its fatal
career in the summer of that year : and this kingdom was deluged
with rain from June to December. Sydenham has left us a most
minute account of the fevers or plagues that appeared in this
country, from 1650 to 1691, and under the most opposite states of
temperature and season. Again, the formidable fever that de¬
stroyed 80,000 persons in the sister country, in 1740, was preceded
by a wet summer and autumn, and a winter with a frost of seven
weeks duration. The next epidemic fever of Ireland commenced
in 1800, and was preceded by a very warm dry summer ; while
the autumn, during which it prevailed, was very humid. The
next epidemic occurred in 1816, the summer of which year was
unusually wet ; there were 142 days wet in succession. The
summer of 1817 was wet and cold ; the spring of 1818 was wet
and cold, but the summer was hot and dry. During these years,
fever or typhus, as it was called, ravaged the whole country, spar¬
ing neitiiei age, sex, or condition, but was most prevalent amon<r
the lower and middle classes. The numerous valuable reports of
the disease, unanimously contain this lamentable fact, that the fe¬
ver attacked 800,000 persons, of whom 40,000 perished. All the
medical writers of that country cordially agree, that famine and
want of employment, and the consequent want of the means to
procure food, fuel, and clothing, privation of every kind, depression
of mind and body, have always caused epidemics in that country.
No matter what may be the nature of the season, whether unii-
sually humid or dry, both of which states deteriorate and diminish
the food of the lower classes, fever will be the concomitant. Eu-
minc and fever bear the relation of cause and elfect in Ireland.
Thus the summer of 1821 was remarkably humid ; and the fever

VOL, 111, NO, 15.

2 l)

186

Critical Review .

of 1822 immediately followed. The fever of 1824 was ascribed
to the influence of warm moist weather ; the fever of 1826 was
attributed to an unusually warm and dry summer ; from March to
June, not one day was wet, but all dry and warm. From these
facts, it is obvious that the greatest diversity of atmosphere may
exist antecedent to, or combined with fever ; and that the conta¬
gion or cause of fever, cannot depend on any particular state of
temperature, as the contagionists imagine. It must also be ad¬
mitted that no other contagious disease, except fevers, can be in¬
duced under the most varied states of temperature. In truth, the
existence of the contagion of fever, according to the modern opi¬
nion, has never been proved, but assumed, for the sake of hypo¬
thesis. The modes of its introduction into the system are dis¬
puted ; in fact the conjectures are as multifarious as the authors
who have written on the subject. Some assert^ that actual con¬
tact is necessary to its imbibition ; others that a near approach is
sufficient ; a third set, that it is necessary to respire the infectious
breath ; a fourth, that the saliva of the healthy person is infected,
and must not be swallowed ; a fifth and numerous set maintain
that the atmosphere around the infected person is tainted to the
distance of many vards : and a sixth set contend, that the poison
is absorbed through the pores of the healthy. By some we are
told that the influence of the subtle emanation is immediate — ex¬
tinguishing life with the rapidity of lightning ; by some others*
that some hours must elapse — in some cases weeks, months, and
years. Such is a fair example- of the congruence of the contagious
philosophers, with regard to the properties and qualities of their
subtle fluid. Dr. Hodges informs us, in his account of the plague
of London, that * the deadly quality of pestilence vastly exceeds
either the? arsenical minerals, the most poisonous animals, or the
killing vegetables (hemlock, or the rattle-snake, are nothing to it)
nay, pestilence seems to be a composition of all the other poisons
put together. It is more active than lightning, and in the twink¬
ling of an eye carries to a distance, putrefaction, mortification,
and death.’ We are told, with the most imperturbable gravity,
that the very nature of the contagion was subjected to chemical ana¬
lysis ! ! ! f The breath of an infected person was received on a
piece of glass, and was found to consist of an innumerable multi¬
tude of strange, monstrous, and frightful animals ; such as snakes,
and serpents and dragons, and devils, frightful to behold;’ But we
are gravely told by a writer on the last plague of London, f not to
depend on this analysis ; for he has reason to suppose the experi¬
ments were defective, on account of the instruments not being suffi¬
ciently delicate and accurate.’ Indeed ! We may here observe, that
Mr. E. Davy recently collected a large quantity of the air which sur¬
rounded patients labouring under typhus, and subjected it to the
chemical analysis, and he found it as pure as common atmospheric
air. So much for the snakes, and serpents, and dragons, and devils^
frightful to behold. The modern contagionist has improved on the
doctrines of his predecessors, who thought fever and plague were
produced by the united energy of various physical causes. Some

187

Dr. Good’s Study of Medicine.

were of opinion, that contagion was derived from stellar influence,
from the malignant aspect of the heavens, or the evil conjunction
of the planets ; others, that it was shook from the horrid hair of
comets 5 some, that it was of supernatural origin — the truest
opinion others, that it descended in airs from heaven, and more,
that it arose in blasts from hell. Again, it was ascribed to the fall
of meteors, and to the projection of bails of fire into the heavens,
from the bowels of the earth. Dr. Hodges said, it arose from the
corruption of the nitrous part of the air. Sydenham supposed it
to be caused by a peculiar pestilential condition of the atmosphere.
Mead was of the same opinion. Maclean observes, 'from the records
of epidemic and pestilential diseases, it would appear that they have
their stated periods of recurrence 5 and their periods are such as are
most remarkable for the vicissitudes of the atmosphere ; that they
become general only in those years in which the vicissitudes are
extreme, and do not occur in seasons when degrees of heat and
cold, however intense, are equable ; and that they uniformly cease
with the establishment of an equable state of the atmosphere,
whether hot or cold,’ Dr. Rutty has left us a faithful record of
the diseases of Dublin, for a period of forty years, and states,

' that dry weather was peculiarly productive of fever in that city,
as also wet and cold summers.’1 Having said thus much, we now
proceed to examine the doctrine, ' that the contagion of plague
is importable.’ Here also are we surrounded with contradictions
and absurdities, and can only ascertain the truth by referring to the
pages of history. .....

Dr. Hodges remarks in his Loimologia, e that the plague was
imported from Holland to this country in packs of merchandize $
and if any one please to trace it further, he may be satisfied by
common fame, that it came thither from Turkey in bales of cotton.’5
We have, then, the authority of common fame, that plague is im¬
portable — an authority on which our modern philosophers would
place little reliance, in arriving at their conclusions. Yet very
strange to say, we have no better proof even in these times. Before
we prove this assertion, we may be allowed to quote the opinion
of Bacon, as to the reliance men ought to place on common fame.

" Men of learning,” says that great philosopher, "are too fre¬
quently led, from ignorance or credulity, to avail themselves of
mere rumours or whispers of experience as confirmations, and
sometimes as the very ground- works of their philosophy, ascrib¬
ing to them the same authority as if they rested on legitimate tes¬
timony ; like to a government which should regulate its measures,
not by the official information of its accredited ambassadors, but
by the gossipping of newsmongers in the streets. Such in truth
is the manner in which the interests of philosophy, as far as expe¬
rience is concerned, have hitherto been administered. Nothing is
to be found which has been duly investigated — nothing which has
been verified by a careful examination of proofs — nothing which
has been reduced to the standard of number, weight, or mea¬
sure.” What an admirable commentator on the contagionists !
In further illustration of the absurdity of confiding in common ru-

188

Critical Review.

mour, in philosophical or physical investigations, we select a pas¬
sage from a great modern philosopher — from Dr. Reid’s work on
the Mind. He says, f that upon a great number of miscarriages
being accidently succedent to the arrival of a white cow in a
country village, where such a prodigy had never before been seen,
the rustic philosophers (not a whit more sagacious than the con-
tagionists) readily discovered in the white cow the fons et origo
malorum, and never allowed themselves to rest until that ill-starred
animal was expelled the vicinity.’ Thus Sir A. B. Faulkner, in
his late work on the Plague of Malta, gravely informs us, f that
the manner in which the plague was introduced into Valetta, from
the San Nicolo, was confidently stated in Malta to have been by a
piece of linen, part of the cargo, which was purchased by Borg, a
shoemaker.’ Here, again, is common rumour, and again the gos¬
siping of newsmongers in the streets, as a proof of the importable
nature of plague. In fact, our author was unable to prove that
the disease arose from actual contact ; nay, even his orderlies had
free intercourse with the infected, contrary, of course, to orders;
yet only one man in a whole regiment became diseased. Our au¬
thor was also obliged to admit, that the disease appeared in differ¬
ent parts of the city, and could not, in many instances, be traced to
the shoemaker’s family, which he he has designated the foils et ori¬
go malorum. In his evidence before the Committee of the House
of Commons, he stated, he doubted f whether himself was attacked
with the disease, but he believed not.’ The plague had not appeared
at Malta for 130 years before 1813, although plague-ships had
visited the island frequently during the period ; and not one of the
crew of the San Nicolo, was infected on the voyage back, although
the plague had raged for a year before and after, in different parts
of the Levant. Much stress has been laid on the absence of dis^
ease in the island for 130 years, and then its appearance, on the
arrival of the infected vessel ; but the arrival of the vessel was a
mere coincidence, and the disease might have appeared sponta¬
neously, as it has in thousands of other districts, where no trace
of contagion could be suspected.

We have thus submitted the most positive evidence, which
was afforded by general and medical history in every age, that
plague, yellow, and common fevers, arise from an immense variety
of causes 3 and not from specific contagion, or a virus produced
by the bodies of the sick, and applied by actual contact to the
healthy. We defy the most sceptical contagionist to refute a
single statement which we have advanced in support of this opi¬
nion. We have shewn that the doctrine of actual contagion was,
and is, founded on common fame, ‘ on the gossippings of the
streets,” and cannot be supported by medical science. Like a
thousand other absurd and unscientific theories, which have infa¬
tuated the medical profession, and are now exploded, the doctrine
of contagion is rapidly progressing to oblivion. This doctrine is
only maintained by a small minority of the medical of the medical
profession, at the present time : and we have little doubt of its
complete rejection before the expiration of the present century.

189

Dr. Good’s Study of Medicine.

We say a small minority of the profession, because most of those
who have been educated within the last quarter of a century, dis¬
believe in this doctrine altogether. Society will benefit much by
its annihilation *, that perpetual fear which destroyed thousands
will cease, and the sick will no longer be deprived of that sympa¬
thy, and attention, and assistance, which took place to a lament¬
able extent, during former epidemics : when men, intent only on
their own safety, "fled from the care of the infected, and slighted
every call of honour, duty, and humanity. We have already proved,
that many escaped epidemic disease in this and other countries $
and we shall demonstrate, in the succeeding remarks, that many
persons are perfectly insusceptible of the attacks of fever. We
have also stated the fatality of fevers, and proved that they re¬
quire the closest medical attention ; a fact, which will be further
elucidated in these observations. We have shewn, that one half
of all the deaths which occur among mankind, are ascribed to fe¬
vers. We shall now proceed to consider the nature or causes of
Pyrexioe, or febrile diseases.

Fever has been universally considered a general disorder of the
whole body, and not confined to any particular organ. This opi¬
nion has been admitted by the most eminent physicians of ancient
and modern times, by Sydenham, Huxham, Rutty, Hoffmann,
Boerhaave, Pringle, Cullen, Gregory, Duncan, Kellie, Home,
Welsh, Alison, Cheyne, Barker, Crampton, Harty, Percival, Sto¬
ker, Grattan, Toomy, O’Brien, Heberden, Fordyce, Jackson, Wil-
lan, Baillie, Parry, Bateman, Armstrong, &c. &c. most of whom
had the most extensive opportunities of observing the disease ; and
this is still the most general opinion. Fever is said to affect the
whole system, the different viscera of the head, chest and abdo¬
men, the trunk of the body, the limbs, skin, muscles, membranes
in the chest and abdomen, the nervous system, the mind, volition,
the circulation of the blood, and the different secretions ; in fact,
all the functions and organs of the body. It does not affect the
various organs equally, uniformly, or simultaneously j but in ge¬
neral attacks one or more organs more particularly, according to
the predisposition of the sick. Fever is, therefore, said to be a
general disorder of the system. This, we say, is the general opi¬
nion, although objected to by a few eminent physicians of the pre ¬
sent time, who maintain that fever depends on local disease in a
particular organ ) and they have disagreed as to the organ supposed
to be affected. Thus Clutterbuck, Mills, Marcus and Plocquet
maintain that idiopathic fever is not a general disease of the sys¬
tem, but is caused by inflammation of the brain. Peio asserts, it
is caused by congestion in the brain. Broussais contends, that
it depends on inflammation of the stomach and bowels, which he
designates gastro-enteritis ; and Bretonneau is certain it arises from
inflammation in the glands of the intestines. Each of these theorists
maintains his opinion with a degree of tenacity, that is quitefanatical.
Such is an example of the congruence of the modern theorists on
fever. Of these doctrines, that of our countryman. Dr. Clutter-
buck’s, is most ably and ingeniously supported, and therefore dc-

190

Critical Review .

serves especial notice. The other dogmas, although of more re¬
cent origin, are now discarded. Dr. Clutterbuck asserts, * there
are no idiopathic fevers, without local inflammation as their cause,
and that they all depend on inflammation of the brain, and on this
cause only. The peculiar functions of this organ, as sensation,
voluntary motion, and intellect, are constantly disturbed in a
greater or lesser degree in all fevers, which disturbance proves
that disease of the brain makes an essential part of the character of
the disease.” We know, however, of no other author, who main¬
tains that disordered action and inflammation are one and the same.
He asserts, that the distribution of the blood during the cessation
of life is such, that no vestige of inflammatory action can be found
in the brain, although inflammation in that organ shall have de¬
stroyed the individual. This will not hold good when any other
organ has been inflamed, for evidence of such disease will be found
on dissection. We also know that hundreds of patients may la¬
bour under fever, and not complain of headache, nor any of the
ordinary signs of inflammation of the brain ; and hundreds of
thousands of fever patients have done well, although neither ge¬
neral nor local bleeding had been employed. Fortunately for so¬
ciety, the lancet is not generally employed in fevers j for it must
obviously destroy many of those debilitated persons who recover
the disease, inflamed brain, without its employment. We are
sorry that so able and talented a physician as Dr, Clutterbuck
should be blinded by the zeal of a theory, that is so generally op¬
posed by the brightest ornaments of the profession. We should
not allude to it on the present occasion, had it not been promul¬
gated so extensively through the medical press, and is calculated
to mislead many who will not take the trouble of referring to the
best and numerous treatises on the subject. Of all the theories of
fever which have been proposed, we think Dr. Cullen’s the best
and most ingenious ; but it must be recollected how ignorant we
are of the proximate cause of fever. We think the Cullenian doc¬
trine leads to the safest and most successful practice ; and this we
assert on the authority of extensive observation and repeated expe¬
rience. We cannot concur in the opinion as to the proximate
cause of fever, but readily agree with the history of the different
stages and symptoms of the disease.”

Dr. Good informs us that miasmata may arise from va¬
rious sources, though these of exanthems are distinct and
specific, those of marsh and human effluvia are not equally
so, as Cullen imagined, yet in a future paragraph we are told
they are probably so. The author describes the insalubrious
effluvium which arises from the decomposition of all dead
organized matter, illustrates his remarks by allusion to the
burial grounds in France, the Malaria on the Guinea coast,
44 in these instances accompanied with a stench, which itself
may be injurious to the health.” p. 88.

“ How far the decomposition of dead vegetable matter, though
its effluvium prove thus injurious to the health of man, may alone

191

Dr. Good’s Study of Medicine.

be capable of exciting fever of any kind, may, perhaps, admit of a
doubt ; for in the bogs or peat-mosses of Scotland, and still more
those of Ireland, the inhabitants are exempt from agues, though
the ooze extends in immense tracts.

t( The decomposition, however, to which, on the present occa¬
sion, we are chiefly to direct our attention, is of a mixed kind $ for
the marsh and oozy soil of countries, that are closely or have been
long inhabited, is necessarily a combination of animal and vege¬
table matter.

u If this decomposition take place slowly, as in cold or dry wea¬
ther, and more particularly in a breezy atmosphere, not the slight¬
est evil is sustained during its entire process. And hence, in or¬
der to render it mischievous, and particularly in order to render it
capable of producing fever of any kind, it is necessary, that it
should be assisted by the co-operation of certain agents, many of
which we do not seem to be acquainted with, but which, so far as
we are capable of tracing them, appear to be auxiliary to the ge¬
neral process of putrefaction, as warmth, moisture, air, and rest or
stagnation.

** The simplest and slightest fever, that is produced under the
joint influence of these powers, is the intermittent : and we find
these produced where their joint influence is but feeble, and where
it exists, perhaps, in its lowest stage, as in the favourable climate
of our own country ; where we are not frequently overloaded with
equinoxial rains, and have not often to complain of a sultry sky,
or a stagnant atmosphere. Even here, however, we perceive a
change in the character of the intermittent at different seasons $
for, while in the spring, it usually exhibits a tertian type, in the
autumn, we find it assume a quartan. And as these can only be
contemplated as varying branches of the same disease, we have
thus far, at least, reason to regard it as produced by a common
febrile miasm, modified in its operation by a variation in the re¬
lative proportion which its auxiliaries, known and unknown, bear
to each other during the vernal and autumnal seasons ; coupled
perhaps, with some degree of change, produced by the same sea¬
sons in the state of the human body.

“ If from our own country, we throw our eyes over the globe,
we shall find in every part of it, where the same causes exist, that
in proportion ats they rise in potency, they produce a fever of a
severer kind, more violent in its symptoms, and more curtailed in
its intervals, till we gradually meet, first with no distinct intervals,
and at length with no intervals whatever ; and hence perceive the
remittent progressively converted into intermittent and continued
fevers. And that here we have still the same miasm merely mo¬
dified in its operation by the varied action of its auxiliary powers
on the constitution of the individuals it attacks, is a clear as the
former case 5 because in many attacks we see different indi¬
viduals, touched by the very same influence, exhibit all the va¬
rieties now alluded to, and intermittent, remittent, and continued
fev ers cc-existing in every diversity of violence ; commencing
with either of these forms ; keeping true to the form with which

192

Critical Review.

they commenced ; or changing one form for another. Such, as
remarked by M. Devize, was the course of the fever at Philadel¬
phia in 1793 and such, according to M. Berthe, that of the
southern provinces of Spain, in 1800 : and such was peculiarly
the fact in the highly malignant yellow fever of Antigua in 1816,
as admirably described by Dr. Musgrave.”

Dr. Good has next given an excellent account of the dis¬
crepant opinions relative to the contagiousness of yellow
fever which we are sorry to be obliged to exclude from want
of space. He reduces the origin and laws of febrile miasm
to the following corollaries.

“ 1. The decomposition of dead organized matter, under the in¬
fluence of certain agents, produces a miasm that proves a common
cause of fever.

“ 2. The whole of these agents have not yet been explored ;
but so far as we are acquainted with them, they seem to be the
common auxiliaries of putrefaction, as warmth, moisture, air, and
rest, or stagnation.

“ 3. The nature of the fever depends, partly upon the state of
the body at the time of attack 5 but, chiefly, upon some modifica¬
tion in the powers or qualities of the febrile miasm, by the varying
proportions of these agents in relation to each other, in different
places and seasons. And hence, the diversities of quotidians, ter¬
tians, and quartans, remittent and continued fevers, sometimes
mild and sometimes malignant.

« 4. The decomposition of the effluvium, transmitted from the
living human body, produces a miasm similar to that generated by
a decomposition of dead organized matter, and hence capable of
becoming a cause of fever under the influence of like agents.

« 5. The fever thus excited, is varied, or modified, by many of
the same incidents, that modify the miasmatic principle when is¬
suing from dead organized matter ; and hence, a like diversity of
type and vehemence.

'«■ 6. During the action of the fever thus produced, the effluvium
from the living body is loaded with miasm of the same kind, com¬
pletely elaborated as it passes off, and standing in no need of a
decomposition of the effluvium for its formation. Under this form,
it is commonly known by the name of febrile contagion. In many
cases, all the secretions are alike contaminated ; and hence febrile
miasm of this kind seems sometimes to be absorbed, in dissection,
by an accidental wound in the hand, and to excite its specific in¬
fluence on the body of the anatomist.

“ 7. The miasm of human effluvium is chiefly distinguishable
from that of dead organized matter, by being less volatile, and
having a power of more directly exhausting or debilitating the
sensorial energy, when once received into the system. Whence
the fevers generated in jails, or other confined or crowded scenes,
contaminate the atmosphere to a less distance, than those from
marshes and other swamps ; but act with a greater degree of de¬
pression on the living fibre.

193

Dr. Clark on the Influence of Climate.

"8. The more stagnant the atmosphere, the more accumulated
the miasmic corpuscles, from whatever source derived ; and the
more accumulated these corpuscles, the more general the disease.

“ 9. The miasmic material becomes dissolved or decomposed in
a free influx of atmospheric air : and the purer the air, the more
readily the dissolution takes place; whence, e contrario, the fouler
as well as more stagnant the air, the more readily it spreads its in¬
fection.

“ 10. Under particular circumstances, and where the atmo¬
sphere is peculiarly loaded with contamination, the miasm that
affects man is capable also of affecting other animals.

‘'ll. By a long and gradual exposure to the influence of febrile
miasm, however produced, the human frame becomes torpid to its
action, as it does to the action of other, irritants : whence the na¬
tives of swampy countries, and prisoners confined in jails with ty¬
phus contamination around them, are affected far less readily than
strangers ; and, in numerous instances, are not affected at all.

“ 12. For the same reason, those who have once suffered from
fever of whatever kind hereby produced, are less liable to be in¬
fluenced a second time ; and, in some instances, seem to obtain a
complete emancipation.”

The doctrine of crises is next examined, and much light
thrown on the subject. We need scarcely observe, that the
opinions on this part of the inquiry, are as discrepant as in
any other, but the author inclines to adopt those of the an¬
cient sages of our profession. He next proceeds to describe
the various kinds of fever, which shall be noticed in our next
Number. \_To be Continued .]

II. — The Influence of Climate in the Prevention and Cure of
Chronic Diseases , more 'particularly of the Chest and Di¬
gestive Organs : Comprising an Account of the Principal
Places resorted to by Invalids in England and the South
of Europe ; a comparative Estimate of their respective
merits in particular Diseases ; and General Directions for
Invalids , while Travelling and residing Abroad. With an
Appendix , containing a Series of Tables on Climate. By
James Clark, M.D. Member of the Royal College of
Physicians of London, &c. &c. &c. London : T. and G.
Underwood, pp. 328.

( Continued from page 127.)

Dr. Clark confines his description of climate in the south
of Europe to the west, south-west, and south-east of France,
including Pau, Montpellier, Marseilles, Aix, and Hyeeres,
Nice, Villa Franca ; Italy, Genoa, Florence, Pisa, Naples,
Sienna, Lucca, Rome, Switzerland, and Madeira. He de-

VOL. HI. NO. 15. 2 c

194

Critical Review .

scribes the temperature, localities, endemic diseases, and
sanative effects of each of these places. It is impossible ter
do justice to the author, unless by a transcript of his opi¬
nions, for condensation is impossible, nor do we think it the
province of a reviewer to transfer the whole of a work to the
pages of his journal. The work before us is so extremely
interesting and instructive, that it must have a place in every
medical library, and this conviction is our apology for not
introducing the description of the climate of the south of
Europe, which occupies much more space than we can spare
for it at present.

The second part of the volume is devoted to the descrip¬
tion of the diseases benefited by climate, as disorders of the
digestive organs, consumption, disorders of the larynx, tra¬
chea and bronchi, asthma, gout, chronic rheumatism, gene¬
ral delicacy of constitution in childhood and youth, prema¬
ture decay at a more advanced period of life, and deranged
health from hot climates. Our author considers too much
benefit is prematurely expected from climate, both by pa¬
tients and their medical advisers, and he respectfully re¬
quests their attention to the following very judicious re¬
marks : —

“ In the first place, I would strongly advise every person who
goes abroad for the recovery of his health, whatever may be his
disease, or to whatever climate he may go, to consider the change
as merely placing him in a situation the most favourable for the
removal of his disease ; and to bear constantly in mind that the
beneficial influence of travelling or of sailing, and of climate, re¬
quires to be aided by such a regimen and mode of living, and by
such remedial measures, as would have been requisite in his case,
had he remained in his own country. All the circumstances re¬
quiring attention from the invalid at home, require to be equally
attended to when he is abroad. The necessity for such attention
may differ somewhat in degree, but that is all. The same care as
to regimen, exercise, &c. that would have been necessary at home
will be equally so abroad. If in some things greater latitude may
be permitted, others will demand even a more rigid attention. It
is, in truth, only by a‘due regard to all these circumstances, that
the powers of the constitution efen be enabled to remove, or even
materially alleviate, a disease of long standing, in the best possible
climate.

“ It may appear strange to some of my readers, that I should
think it necessary to insist so strongly on the necessity of attend¬
ing to things, which are so self-evident, and so consonant to com¬
mon sense ; but I have too often witnessed the injurious effects of
a neglect of them, not to deem such remarks called for in this
place. It was often, indeed, matter of surprise to me, during my
residence abroad, to observe the manner in vvttich. invalids seem to
lose sight of the very object for which they left their own country.

195

Dr. Clark on the Influence of Climate .

This appeared to me to arise chiefly from too much being expected
from climate. Every invalid who goes abroad must make up his
mind to submit to many sacrifices of his inclinations and pleasures,
if he expects to improve his health by a residence on the continent.

The more common and more injurious deviations from the
system of living, which an invalid should adopt, consist in errors
in regimen ; exposure to cold, over-fatigue, and excitement in what
is called sight- seeing 5” frequenting crowded and overheated
rooms, keeping late hours, &c. Many cases have fallen under my
observation, in which climate promised the greatest advantage, but
where its beneficial effects were counteracted by the injurious
effects of these causes.”

He next makes some pertinent observations on tra¬
velling : —

In order that the patient may derive advantage from his jour¬
ney, or at least that his complaint may not (as often happens) be
increased by it, some preparatory measures will generally be re-
quisite before he sets out. Travelling is exciting to most people;
and to those who have chronic inflammation of any organ, how¬
ever latent or obscure, it very often proves injurious, particularly
during hot and dry weather. Almost every one in health is sen ¬
sible of the excitement arising from travelling. The appetite is
generally increased on a journey, while the secretions and excre¬
tions are much diminished. The speedy consequence is a degree
of excitement of the whole system, generally and not inaptly
termed by travellers, e a heated state. What in health amounts
only to a slight degree of excitement, easily removed by a few
days rest, and the employment of a few common cooling remedies,
often proves of serious consequence to the invalid who labours
under, or is even disposed to any inflammatory affection. The
local disease, in whatever organ it may exist, seldom fails to be
aggravated, under such circumstances ; as is sufficiently indicated
by a general febrile state, or the occurrence, or increase, of symp¬
toms more immediately connected with it.

" When, therefore, the patient’s disease is of an inflammatory
nature, or threatens to assume such a character, his condition
should be well examined before he sets out. There should, if
possible, be no vascular excitement at the beginning of a journey.
If any local inflammation exists, measures should be taken to re¬
duce it by proper regimen, by r^gt, by tepid bathing, &c# ; and
local or even general bleeding may be requisite in some cases.
Simple congestion, or an otflerloaded state of the vascular system,
general or local, will also require to be diminished. In short, be¬
fore one step of the journey is taken, every thing like excitement
or plethora should be removed, as far as the nature of the case
admits.

“ Having his system in a proper state when lie sets out, the
invalid should endeavour to keep it so during the journey— by ad
hering to a mild, light diet, taking care not to overload the sto¬
mach even with the mildest food, by abstaining from wine and

196

Critical Review

spirits of every kind, and by maintaining the regular action of the
bowels. The latter object is best effected, not by strong and irri¬
tating purgatives, but by laxatives, such as castor oil, electuary of
senna, or of cassia, manna and mild lavemens. Purgatives of the
more drastic kind, under which I comprehend nearly the whole
class of pills, generally irritate the bowels, increase the disposition
to constipation, and often induce heemorrhoids ; a frequent conse*
quence of neglected or irritated bowels while travelling. To these
means of maintaining the system in a cool state, I may add the
use of tepid bathing, which should not be omitted where it can be
conveniently procured, and when there are no objections to it
from the peculiar nature of the patient’s disease. When used at
the proper temperature and with the necessary precautions, it is
free from danger, and will generally prove very useful in obviating
the exciting effects of travelling. The temperature may be from
ninety-four to ninety-seven degrees of Fahrenheit's thermometer,
according to the feelings of the patient. The forenoon, or rather
just before dinner, is the best period for taking the bath, and from
twenty minutes to half an hour the proper time for remaining in
it. By adopting the general regimen mentioned, and by travelling
only such distances daily as the invalid’s strength can bear, resting
for a day when he feels it necessary, he will not only avoid the in
jurious effects frequently produced by travelling, but will often
find his condition improving as he proceeds on his journey, and
will, probably arrive at his winter residence in a much better state
of health than when he left his own country. And this, I may ob¬
serve, is a rare occurrence in the usual mode of conducting a long
journey : for even when no positive increase of disease is the con¬
sequence, the traveller has frequently sufficient cause to regret his
inattention to the precautions above mentioned ; as there is often
induced a degree of general excitement, and a deranged state of
the secretions, &c., the injurious effects of which are felt by a de¬
licate constitution during a considerable part of the winter. The
invalid thus not only loses the benefit which he might have gained
by the journey, but that also, in part, which he would have ob¬
tained from his winter residence. If the invalid is wise, he will
keep these things in mind. It is the duty of his medical adviser,
as I have stated, to prepare him for his journey, by reducing any
excitement which may exist in his system, and by removing any
other morbid affections with which the principal disease may be
complicated, and which often form insurmountable obstacles to re¬
covery. And, having his system thus prepared, the invalid should,
on his part, endeavour to maintain it in the same state by a strict
adherence to the prescribed regimen. If, during his journey, his
pulse should become frequent, his skin dry and hot, or if he has
thirst or a dry tongue in the morning, or "if his nights become
restless, he may feel assured all is not right. He is over-excited
either by too full a diet, by too rapid travelling,! by exposure to a
hot sun, or by the bowels being overloaded. In the generality of
such cases, a few days’ rest and the use of some such cooling
measures as have already been pointed out, will restore the system

Dr. Clark, on the Influence of Climate . 197

to its previous state • and the invalid may then pursue his journey,
taking care to avoid whatever he has reason to believe excited him
before.”

The reader must perceive the impossibility of rendering
this very important information more concisely than in the
language of the author. The observations on diet* regimen,
clothing, and selection of apartments, deserve attentive pe¬
rusal.

Dr. Clark thinks we have much more to learn as to the pa¬
thology of dyspepsia, which is the first disorder he describes
after his preliminary observations. He considers disorders
of the digestive organs the most important of any to which
mankind is liable ; and he hazards another opinion which is
much more questionable.

I am convinced, however, after close and careful observation,
that the mind is more generally influenced by the state of these
organs than by that of any other ; and even that through this me¬
dium are made the most frequent inroads upon the integrity of the
intellect,”

The mind is certainly very much influenced by the de¬
rangements of the stomach, but we apprehend it is much
more so by those of the brain, with which it is decidedly
more intimately connected. The pathological views of our
author are also liable to objection. He ascribes the morbid
conditions of disorders of the digestive organs to two states :
u 1, an irritated state of the mucous Surface of the stomach
of an inflammatory character ; 2, a highly increased degree
of sensibility of the nerves of the same part accompanied
mostly with a loss of tone of the whole viscus.” The for¬
mer he calls gastric, the latter nervous dyspepsia.

i( Excesses in diet, are, according to my observation, the most
frequent cause of gastritic dyspepsia ; whilst intense and long
continued mental exertion, a sedentary life, a fluid relaxing diet,
and constipated bowels, give rise, most commonly, to the nervous
form of the disease. The manifest difference in the pathological
character of these two morbid states show, in a striking manner,
the error of applying the same mode of treatment to all cases of
disordered stomach.”

There surely may be irritation independently of inflamma¬
tion, as we daily see in gastrodynia, gastralgia, and spasm
of the stomach. The author gives a minute history of the
symptoms of both forms of the disease, and, according to his
observations, those of the gastritic are more permanent than
of the nervous form of the disease. This conclusion is cer¬
tainly doubtful, for who is it who has not seen dyspepsia
continue severe for years, and yet leave no disorganization
whatever. Dr. Clark, however, is of a different opinion.

198

Critical Review .

In protracted cases, the disorder is seldom confined to the
stomach : it is gradually propagated to the mucous membranes
of other parts ; to the intestines, to the throat, to the trachea, the
bronchia, kidneys, bladder, urethra, or uterus j and often from the
mucous membranes of these organs the irritation is transferred to
the glands more immediately connected with them, to the liver,
testes, mammae, &c.*’

He is also of opinion that “ mercury never cured a single
case of dyspepsia, but has produced incalculable mischief,
more especially in delicate constitutions, and in young chil¬
dren. It produces temporary relief, but if long continued,
fixes the disease on the mucous surface of the digestive or¬
gans ; and thus excites an irritation in the whole nervous
system that is never entirely removed. This is more espe¬
cially the case in the nervous form of dyspepsia, and in per¬
sons naturally of a very sensitive nervous system.” p. 191.
What will the advocates of blue pill say to this ? Mercury
is too often pushed to an improper extent, but we certainly
cannot agree with our author that it never cured a case of
dyspepsia. It is of course unnecessary in the early form of
the disorder, but daily observation convinces us of the effi¬
cacy of the remedy when the secretion of bile is deranged.

“ During my residence on the continent, I met with many vic¬
tims to the abuse of mercury in its various forms, among the inva¬
lids who annually came to Italy — sent abroad, in too many in¬
stances, after the constitution was reduced to such a shattered
state that no climate or mode of life could materially improve.
Indeed, I may safely affirm, that among the numerous cases of de¬
cayed constitutions, which I met with among dyspeptic invalids,
the larger proportion had suffered more from calomel and drastic
purgatives, than they would have done, I believe, from the disease
if left to itself. Calomel is a valuable remedy when used with
judgment and discretion, but it is one of the most destructive
agents of the materia medica in the hands of persons ignorant of
its real operation. When the nature of dyspeptic complaints is
better understood, mercury will not be employed, more especially
in the nervous form of the disease, once in a hundred times so
frequently as it is at present.”

The secondary diseases produced by dyspepsia are enume¬
rated by our author.

“ We often find that the diseased state of the stomach, in place
of being propagated to the internal surfaces of other organs, is
translated to other systems. It is thus that we find it producing
various affections of the skin and of the nervous system. Among
the last may be mentioned different convulsive disorders, tic
douloureux, paralysis, amaurosis, deafness, loss of smell, loss
of voice, asthma, palpitation, &c. ; and, in the more exquisite
degrees, I believe, in some cases, it ultimately leads to dis¬
eased structure of the brain, and, as a consequence to pertna-

I)r. Clark on the Influence of Climate. 199

went epilepsy, to palsy, to apoplexy, or to confirmed mania. In
other instances, it induces functional, and even organic disease of
the heart. Gout is well known to originate in an irritated condi¬
tion of the digestive organs 3 and rheumatism also frequently de¬
pends upon this state. Many of these symptomatic disorders
simulate idiopathic affections of the same kind, so perfectly as to
be often erroneously treated as such.”

On the other hand, we know diseases of every other organ
in the body will produce dyspepsia, as we exemplified in
our review of Good’s Study of Medicine, in our last Number.
Among the remedial measures for the various morbid condi¬
tions, whether in their primary or secondary forms, there is
none, we are told, which affords a fairer prospect of relief,
than a change of climate, and this can be accomplished even
in our own island.

“ In recommending such a change, however, to the dyspeptic
invalid, the peculiar disorder of the stomach must be attended to.
The two opposite states of the disease, noticed above, require dif¬
ferent climates. The patient with well marked gastritic dyspep¬
sia, should not, for example, go to Nice, nor to the south-east of
France. In cases of this kind, Pau, or some other part of the
south-west of France, or even Devonshire, would be preferable.
Rome and Pisa are the best places in Italy for such a patient. On
the other hand, when nervous dyspepsia predominates, and there
exist languor and sluggishness of the system, as well as of the di¬
gestive organs, with more settled lowness of spirits and hypo¬
chondriasis — a state of mind rather of a sombre desponding cast,
than of an angry, complaining character — and when the pulse is
slow, and the feelings blunter, Nice is to be preferred to all the
other places mentioned ; and in the same cases, Naples will ge¬
nerally agree better than Pisa or Rome.”

To insure the advantages derived from the best chosen
climate, the urgent symptoms must be removed or alleviated
before the patient commences his journey, and the nature of
the disorder and principles on which he is to regulate him¬
self ought to be explained to him, and strictly observed by
him. Above all it should be impressed on his mind that he
is not to expect too much from climate, and that he must
sedulously avoid the causes which brought on his complaint.
By this moral and medical discipline a winter spent in a fa¬
vourable climate cannot fail to prove highly beneficial to the
dyspeptic invalid, and a well applied course of mineral waters
the following summer, will, in many cases, be of the great¬
est service in restoring the impeded functions of the abdomi¬
nal viscera of the skin. After this, the patient may return
with a degree of bodily health, and of mental energy, to
which he has long been a stranger, and may continue to* reap
the fruits of his perseverance and self-denial, so long as he

200

Critical Review.

shall avoid the exciting causes of the disease, p. 197. The
author next describes the length of time necessary for a re¬
sidence in a certain climate, and this will depend upon the
state of the disease whether slight or protracted.

** In the first class, in which there is a degree of gastric irrita¬
tion, the climate of Rome will prove one of the best in Italy, and
that of Nice, one of the worst. On the other hand, where the ner¬
vous system is chiefly affected — where there is a greatly embar¬
rassed abdominal circulation, with a disposition to mental despond
ency, Rome will not in general, agree. The climate of Nice in this
case will be more suitable. Even the selection of a residence in the
same place is not a matter of indifference to very sensitive invalids.
One will feel himself better in an elevated situation, another in a
lower and more sheltered one. The high and low are more con¬
fined situations of Rome and of Naples, afforded me many oppor¬
tunities of observing the different effects of locality on such per¬
sons, and satisfied me of the necessity of attending to this circum¬
stance, in selecting a residence for them. But dyspeptic patients,
who pass the winter in Italy, need not in general be confined to
one place j they may visit during the season the principal cities in
the south of Italy and if this is done with prudence, the succes¬
sive changes may prove beneficial to their health : although the
climate most suited to the particular character of their complaint
should be selected as their principal residence. Generally speak¬
ing, Rome will be the best residence in Italy in gastritic dyspep¬
sia, especially during the spring.

“ To all these patients the spring proves the period of the great¬
est excitement ; and they who are disposed to the more acute kind
of stomach affections, must be more particularly on their guard
ugainst whatever can excite the digestive organs at this season.
The same degree of stimulus that is tolerated in the winter, will
prove injurious to them in the spring.

“In mucous irritations, whether of the digestive or pulmonary
organs, I had every year occasion to remark the increase of excite¬
ment that occurred during the spring months. At this season
there are great and often rapid alternations of temperature, which
are extremely exciting to sensitive invalids. A powerful sun, fre¬
quently accompanied with sharp winds during the day, alternates
with cold nights. This may be said to be the character of the
spring generally j but in the south of Europe it is particularly so,
and this circumstance renders the climate injurious in the more
acute degrees of gastritic dyspepsia.”

Dr. Clark gives a minute account of the regimen neces¬
sary for dyspeptics, but this is so well known, that we need
not repeat it. He is a staunch advocate for the use of mine¬
ral waters, and means to favour the public with a work on
the subject. The efficacy of mineral waters in the allevia¬
tion and cure of many diseases, is not generally understood
by practitioners, though there cannot be a better form in
which their medicinal agents can be taken into the stomach.

201

Dr. Clark on the Influence of Climate.

Our author recommends those of Ems, Vichy, Plombieres,
Cauterets, Carlsbad, Spa, Piedmont, San Lucia, and Geiss in
Switzerland. On another occasion we have given an alpha¬
betical list of the principal mineral waters in Europe and
America, wherein will be found a description of thousands
of others *, applicable to the diseases under consideration.
The author concludes his disquisition on dyspeptic disorders
by the following corollaries : —

tf 1st. Dyspeptic complaints are chiefly referable to, and have
their origin in, two leading pathological conditions of the stomach
— the one of an inflammatory, the other of a nervous character.

“ 2d. These two states require two different methods of treat¬
ment, and are benefited by climates of a different character ) a soft
and mild climate, such as that of the south-west of France and of
England, being more suitable to the inflammatory form ; and the
drier and more exciting climates of the south-east of France and
Nice, more beneficial in the nervous and congestive form.

“ 3d. In complicated cases of dyspepsia, which are the most
frequent, the method of treatment, both generally and as regards
climate, must be regulated chiefly by the morbid condition which
is the more predominant, and which influences the constitution
most evidently. When a secondary series of disorders has been
induced, these, as well as the hereditary disposition of the patient,
must also be taken into consideration, in selecting a fit climate.

4th. Mineral waters are very valuable remedies in chronic dis¬
orders of the digestive organs, and will frequently effect cures after
climate and suitable regimen have failed to do more than relieve.

5th. The advantages to be derived from change of air> climate,
mineral waters, &c., depend, in a great degree, upon the proper
application of these agents to the nature and degree of the disor¬
der, and upon the regimen followed by the patient during their
operation.

Finally, No change of climate, or other remedy, can be made
permanently beneficial, while the exciting causes of the disease
continue to be applied.

With respect to the influence of climate in consumption,
our author thinks we must not depend on the measure singly,
still it is a valuable remedy under certain limitations. After
all that has been written on the disease, he thinks our prede¬
cessors who flourished ten and twenty centuries ago, were as
successful in the treatment as we are, and under this convic¬
tion he takes a brief view of the nature, causes, and progress
of the disease. He considers it impossible to prevent con¬
sumption.

* An Account of the Natural History of Water in its simple aud combined
States, and of the Chemical Composition and Medical Uses of all the known
Mineral Waters, being a guide to Foreign and British Watering Places. By M.
Ryan, M.D. &c. ; also in Lond. Encyclopaedia, 1828, v. 28.

202

Critical Review.

“ The utmost, I fear, that we can reasonably expect in the pre¬
sent state of the art, when tubercles are already formed, is to re¬
tard their progress, and to prevent their Successive formation j
and even our best directed efforts in this way are chiefly of a nega¬
tive kind. Some, indeed, are sanguine enough to believe that tu¬
bercles may be absorbed. But of this we have no positive proof}
and there is too much reason to fear, that, when once formed,
they are little influenced by any remedies hitherto discovered, but
advance, with more or less rapidity, through their different stages,
and ultimately terminate in the destruction of that portion of the
lungs in which they are imbedded ; and which, in a frightful pro¬
portion of cases, ends in the destruction of the patient. Yet the
expulsion from the lungs, by expectoration, of the softened tuber¬
culous matter, occasionally leads to the permanent cure of the
disease} and in the opinion of some of the best pathologists of the
present day, this is the only way in which a cure of tuberculous
consumption is effected. But such fortunate cases bear a ratio so
extremely small to the number of fatal terminations, that they can
hardly be considered as controverting the truth of the position —
that tubercles may be prevented, but are scarcely to be cured.”

Dr. Clark reasons forcibly as to the formation of tubercles,
and contends that they exist independently of inflammation.
He objects to the general opinion which regards inflamma¬
tion as the source of all the evil 5 and considers the removal
of it as the only principal means of preventing the further
progress of the disease. He observes “ his views are in ac- *
cordanee with those of some of the best pathologists of the
day, both English and Foreign.” p. 231. Our author offers
the following hypothesis on the formation of tubercles.

“ The immediate process by which tubercles are produced is in¬
volved in much obscurity. It may be a peculiar action of the
extreme vessels, totally unconnected with inflammation or even
increased action, at least, we have no proof that any such increased
action takes place. Their formation is just as likely, for any thing
we know to the contrary, to be the result of a morbid diminution
of action — a supposition, by the way, which the pathological phe¬
nomena observed in many consumptive subjects seem rather to
support. The vessels of any organ may deposit the matter of tu¬
bercle in the place of that which should be secreted to maintain
the healthy organization of the body j such deviation from the
natural action depending, probably, as well on the morbid state of
the fluids, as on a depraved action of the vessels, both originating
in a cachectic state of the system generally.”

Dr. Todd is of opinion that tubercles are depositions of
coagulable lymph of a deficient degree of vitality, produced
by a peculiar depravation of the function of assimilation, the
consequence of a general disorder of the constitution. Ac¬
cording to this opinion, no dyspeptic could be free from tu-

Dr. Bateman on Cutaneous Diseases . 203

bercles, but every one knows the reverse to be the case in
general. The author considers the disease hereditary and
accidental — rather a curious opinion. His description of
the causes and symptoms of consumption present nothing
novel. We are informed that no one climate or situation is
best in all cases, but he recommends the south of France
and Italy, and the best of all he thinks Madeira, p. 266. He
considers chronic consumption almost invariably complicated
with, and in a large proportion of cases chiefly induced by,
disorder of the digestive organs — an opinion denied by Dr.
Paris and others, who assert there is no such disease as dys¬
peptic phthisis. Dr. Clark points out the best situations
for persons labouring under different degrees of consump¬
tion, and he asserts that change of air and climate are most
beneficial in irritation of the mucous membrane of the air
passages — of the larynx, trachea, and bronchi. He thinks
gout, chronic rheumatism, asthma, and the states of debility
in infancy, and advanced life, very much improved by change
of climate. Dr. Clark’s book will be consulted with advan¬
tage by invalids, as well as by professional readers, and may
be fairly considered a work of reference for both. The work
displays very considerable observation, and adds very much
to the reputation of the author.

HI. — A Practical Synopsis of Cutaneous Diseases * according
to the arrangement of Dr. Willan; exhibiting a concise
View of the Diagnostic Symptoms and the Method of Treat¬
ment. By Thomas Bateman, M.D. F.L.S. Physician to
the Public Dispensary, and Consulting Physician to the
Fever Institution. The Seventh Edition, Edited by An¬
thony Todd Thomson, M.D. F.L.S. Member of the Royal
College of Physicians, and Professor of Materia Medica
and Pharmacy in the University of London, &c. &c. Lon¬
don, Longman, and Co. 1829.

The editor of this work informs us, in his advertisement, that
he u accords with every sentiment of the author on the sub¬
ject of nosological arrangement; and believes that it is not
by the loose manner of imparting information, which has of
late years prevailed in the medical writings, that a correct
knowledge of the healing art can be communicated to the
uninitiated, and the boundaries of the science of medicine
extended.” There is much force in this remark, but still
we must remember that a correct knowledge of the healing
art cannot be communicated to the student by an arbitrary
aiid imperfect nosology,, as that of the work before us is decid-

204

Critical Review*

edly admitted to be. It is a matter of surprise that a writer
of such ability as Dr. Thomson could be satisfied with the
classification of Dr. Bateman — in which all consideration of
the constitutional or local origin of cutaneous diseases is
forgotten. This objection has been reiterated by the medi¬
cal press on many occasions, and more especially in the re¬
view of Mr. Plumbe’s excellent work on the subject. Ample
experience and some observation, both in the practice of pub¬
lic charities and in private practice, have convinced us that
the chief object to be obtained by the practitioner, which is
the most successful treatment, will be best attained by at¬
tending to the simple information, whether the disease, no
matter of what species, depend on a constitutional or local
origin, or whether it be accompanied by fever or not. The
knowledge of this fact, will lead to more scientific and suc¬
cessful practice, than the random employment of remedies
according to this or that form of eruption. The arrange¬
ment of diseases of the skin, according to their external forms,
without any reference to their origin, whether constitutional
or local, is certainly not calculated to facilitate the acquisi¬
tion of knowledge to the uninitiated, nor to lead to the safest
and most judicious mode of treatment. The classification of
Mr. Plumbe is much less objectionable than that of the au¬
thor before us. The following arrangement of cutaneous
diseases would lead much more readily to the indications of
cure than any other that we have seen. Febrile, non- febrile
constitutional, local, dermal, epidermal, phlegmonous, and
erysipelatous. The plan of treatment we have found most
efficacious, is founded on this classification. It is simple
and can be described in a few words. If the disease be ac¬
companied with fever, the ordinary treatment for the latter
is employed, with the exception of cold ablution. Moderate
purgation is chiefly relied on, and small doses of calomel
and antimonial powder are repeatedly exhibited. The same
treatment is equally valuable in non-febrile cases, and, gene¬
rally speaking, it is unnecessary to make any local applica¬
tion, if persevered in for a few days. The digestive organs
are to be closely attended to, and if disordered, are to be re¬
lieved by the invaluable plan proposed by Mr. Abernethy.
If the disease assume a phlegmonous or erysipelatous form,
it is to be treated on the ordinary principles of surgery.
Local applications are seldom necessary, but if required they
will seldom fail, after ablution or the removal of all scabs
and scales, a precaution so seldom attended to by most
practitioners. The chief object to be obtained in the em¬
ployment of external remedies, is the immediate application
to the diseased surface. These indications of treating cuta-4

Dr. Bateman on Cutaneous Diseases . 205

neons diseases lead to more successful practice than mere
attention to nosological disquisition.

We need scarcely remind our readers that Dr. Bateman’s
arrangement is discordant with Dr. Cullen’s. He excludes
variola, varicella, pestis, miliaria, urticaria, pemphigus, and
aphthae from the exanthemata. In his preface he comments
with much severity on the classifications of his predeces¬
sors, and with some reason, but it remains to be proved
whether his own arrangement is less liable to objection.
Dr. Thomson has adopted his nosology and added the syno-
nymes of each genus and species, and has made further im¬
provement by giving more distinct definitions. He has like¬
wise appended lists of works at the end of each genus, which
may be consulted by young practitioners, and has construct¬
ed an atlas of plates, for . the delineation of the author’s
works, and on a plan which he hopes will render it acces¬
sible to every class of students. This has been a great desi¬
deratum. “ It contains almost all that really relates to the
diseases delineated in Dr. Bateman’s plates, with the addi¬
tion of several original representations. To give them the
character of demonstrations, the different stages of the erup¬
tions, and other peculiarities necessary to be pointed out,
are marked upon the plates. By this plan the troublesome
method of examining plates by means of letters and figures
of reference is avoided ; and without lessening in any de¬
gree the beauty of the representation, the utility of the plates
is greatly enhanced.”

The atlas has not yet appeared, but is promised immedi¬
ately. Dr. Thomson has added much valuable information
to the text, and distinguishes it by inverted commas, and
appended many valuable notes which are marked with his
initial. The nature of this work does not admit of analysis,
but we may observe it is the best class-book for the student.
The present edition is much improved by the additions of
the highly talented editor, who has given the improvements
of the more recent writers on the subject. However defec¬
tive the nosological arrangement may be, and it is perhaps
as perfect as the present state of knowledge admits, the
work is indispensable to every class of medical practitioners.
The execution of this edition adds very considerably to the
well-earned reputation which Dr. Thomson has previously
acquired by his former very valuable publications. He has
detailed several anomalous and obstinate cases, and has
drawn much from the older systems of materia medica, and
proved the efficacy of many obsolete remedies.

206

Critical Review*

IV . — Medico Chirurgicai Transactions 'published by the Me¬
dical and Chirurgicai Society of London . Vol. XV. Part
I, 8vo. pp. 264. London, Longman, and Co. 1829.

The present volume of the Transactions of the Medical and
Chirurgicai Society, contains, like all its predecessors, much
valuable information. The contents are as follows : — 1. A Pa¬
thological Inquiry into the Secondary Effects of Inflamma¬
tion of the Veins. By James M. Arnott, Surgeon. II. A Con¬
tribution to the Pathology of Phlegmasia Dolens. By Ro¬
bert Lee, M.D., &c. III. Analysis of a quantity of Fluid
drawn off from Hydrocele of some years standing. By J.
Bostock, M.D. F.R.S. IV. On the Use of Subcarbonate of
Iron in Tetanus. By John Elliotson, M.D. F.R.S. V. An
Account of a case of Aneurism by Anastomosis of the Fore¬
head, treated by the application of Ligatures. By B. C.
Brodie. F.R.S. VI. Two Cases of Fracture of the Thigh-
Bone, taking place without any violence, in which a diseased
state of the bones appears to have been the predisposing
cause of the fracture, and concurring with cancer in the
breasts of both patients. By T. Salter, Esq. F.L.S. VII.
Observations on the Local Diseases termed Malignant. By
Benjamin Travers, F.R.S., &c. We shall endeavour to give
a concise account of each of these important papers.

I. A Pathological Inquiry into the Secondary Effects of
Inflammation of the Veins. By J. M. Arnott, Esq. — This
paper is divided into two parts : 1. An inquiry into the cause
of the severe constitutional irritation consequent to phle¬
bitis. 2. An inquiry on the origin of abscess in parts re¬
mote from those injured. In elucidation of the first part of
his investigation, Mr. Arnott has detailed the most interest¬
ing cases hitherto published in the united kingdom ; and
after much reflection on them arrives at the following con¬
clusion as to the cause of constitutional irritation, (C that the
entrance of pus in the circulation is the principal cause of
the alarming and fatal consequences of phlebitis, a similar
influence being perhaps also possessed by any inflammatory
secretion from a vein,” p. 61. We think this conclusion
extremely doubtful, if not wholly erroneous, when we consi¬
der the very valuable and unanswerable opinions of Dr. Ad¬
dison and Mr. Morgan, that all poisons act through the me¬
dium of nerves. They have demolished the whole theory of
the action of poisons through the circulation, and proved
that all, as well as the remote causes of disease, contagion,
miasmata, infections, &c. act through the nervous medium*.

* An Essay on the Operation of Poisonous Agents upon the Living Body
By J. Morgan, F.L.S. and Thomas Addison, M.D. London, 1829.

Medico- Chirnrgical Transactions. 20 7

Mr. Arnott acknowledges the resemblance which exists be¬
tween the introduction of a pus into the circulation, and the
diseases arising from the inoculation of a morbid poison.
Had he perused the essay to which we have referred, and
which appeared some months previous to the work under
notice, we are inclined to think he would not have arrived
so readily at his conclusion. Mr. Arnott does not even stop
here, but ascribes the formation of abscesses in remote or¬
gans subsequent to great surgical operations, to the absorp¬
tion of pus into the veins. He quotes Velpeau and Monteg-
gier, on this point, and he converts the following passage of
Mr. Guthrie’s to his side, without the slightest relevancy,
for it is much more in favour of sympathetic action and irri¬
tation.

Mr. Guthrie thinks remote abscesses after amEputation
depend “ on the alteration which takes place in the san¬
guiferous system, in consequence of amputation, and the
suppression of the discharge causing fever, and a determina¬
tion to, and irritation in, a particular part Mr. Arnott
has not been able to name one eminent surgeon in this
country who refers such abscesses to the absorption of pus,
or who has not spoken of the irritation and suffering which
the patient had undergone previous to such secondary collec¬
tions of matter. And yet he observes, u in the statement
which has been now made, I have not alluded to the theory,
which attributes the formation of these abscesses to a dis¬
turbance of the nervous system, the opinion itself being so
purely conjectural, and the operation of the cause so unde¬
fined and unintelligible as to render this unnecessary. In
fact the only view of the subject, supported either by evidence
or argument, is, that which considers the origin of abscesses
and inflammations on remote situations after injuries, as con¬
nected with the absorption into the circulation of punilent
matter from a wound,” p. 67. Now this is mere assertion ;
let us consider the proofs. Mr. Arnott relates thirty-seven
cases of secondary abscesses occurring chiefly in the thora¬
cic and abdominal viscera, and in four only of these was
phlebitis present. Then we ask him, how account for the
other thirty-three cases ? that is the question. But he has
also forgotten the opinions of Sir A. Cooper, Mr. Travers,
and many others on local and constitutional irritation. He
would there have found the records of innumerable cases of
the most violent constitutional irritation from sympathy
alone, and independently of phlebitis. Has not Sir A. Coo¬
per related numerous cases of abscesses in organs remote

* Gunshot Wounds, 1815, p. 73.

208

Critical Review.

from the diseased part, which solely arose from irritation.
“Had it been asked/' says Sir Astley, speaking of hectic
fever, “ thirty or forty years ago, on what it depended, it
would have been said absorption of matter into the constitu¬
tion. Some old surgeons used to put sponges to the mouths
of wounds, to absorb the matter and prevent its being car¬
ried into the system, but it appears to have no power on the
constitution/’ vide Lect. ii-x. and passim. We would beg
leave to ask Mr. Arnott, can inflammation or abscess ever
form without nervous irritation ? We think he has been ra¬
ther unfortunate in his oblivescence of the opinions as to the
cause of constitutional irritation, entertained in this country;
and we think he would have been more in unison with the
profession in this empire, had he applied the terms “ purely
conjectural, undefined, and unintelligible/’ to his own the¬
ory. We need not notice at length the remaining part of the
paper before us, as the cases related are liable to some ob¬
jections. Few practitioners would refer abdominal and arti¬
cular abscesses consequent to inflammation of the uterus, to
absorption of purulent matter from that organ. This paper
occupies 131 pages of the volume, and we must take leave
to. observe that the whole substance of the author’s opinions
might be comprehended in a dozen pages.

The next paper is A Contribution to the Pathology of
Phlegmasia Dolens. By Robert Lee, M.D. Dr. Lee observes,
“ the cases and dissections related by M. Bouillaud, Drs D.
Davis and Velpeau*, first threw light on the real nature of
the complaint, and shewed that it consisted in an inflamma¬
tion of the trunks and principal branches of the veins of the
lower extremities, but the histories of most of these cases,
were so brief, and in many respects so imperfect, that pa¬
thologists remained in doubt whether they should be consi
dered examples of genuine phlegmasia dolens, or viewed as
analogous to those formidable attacks of phlebitis which
sometimes succeed to venesection and wounds.” This is an
exceedingly meagre account of the pathology of phlegmasia
dolens, and moreover it is a very imperfect one. In the
first place, Dr. Conquest had taught in his lectures this pa¬
thology of the disease a long time previously to Dr. Davis’s
publication f ; and again many French writers had antici¬
pated both Dr. Lee should have remembered that the
infiltration of the limb in Dr. Davis’s cases, was declared

* Not Phlegmasia Dolens. Med. Chir. Rev. 182(1, v. 3. p. 237.

+ See Report of the Proceedings of the Medico-Chir. Society, Lancet, 1824.
Vol.l, p-167.

X Rev. Med. August and September, 1824.

209

Medico- Chirurgical Transactions .

anasarcous by no less an authority than Mr. Lawrence *.
All writers agree that the puerperal swelled leg does not
pit on pressure. Again this pathology is denied by many
eminent writers in this country, France, and America, as we
shall shew immediately. Dr. Lee relates a case, however,
in proof of this pathology, the facts of which are as follows :
The patient died twenty-one months subsequent to the dis¬
ease, and the following necrotomic appearances were ob¬
served :

The whole of the left inferior extremity was considerably
larger than the right, but no serous fluid escaped from the inci¬
sions made through the integuments, beneath which a thick layer
of peculiarly dense, granular, adipose matter was observed. The
common external iliac and femoral veins and arteries, enclosed in
their sheath, were removed from the body for examination. The
common iliac, with its subdivisions, and the upper part of the fe¬
moral veins so resembled a ligamentous chord, that, on opening
the sheath, the vessel was not, until dissected out, distinguishable
from the cellular substance surrounding it. On laying open the
middle portion of the vein, a firm, thin layer of ash-coloured
lymph was found in some places adhering close to and uniting its
sides, and in others clogging it up, but not distending it. On trac¬
ing upwards the obliterated vein, that portion which lies above
Poupart’s ligament was observed to become gradually smaller, so
that, in the situation of the common iliac, it was lost in the sur¬
rounding cellular membrane, and no traces of its entrance into
the vena cava were discernible. The vena cava itself was in its
natural state. The entrance of the internal iliac was completely
closed, and in the small portion of it which I had an opportunity
of examining, the inner surface was coated by an adventitious
membrane. The lower end of the removed vein was permeable,
but its coats were much more dense than natural, and the inner
coat was lined with a strong membrane, which diminished consi¬
derably its calibre, and here and there fine bands of the same sub¬
stance ran from one side of the vessel to the other. The outer
coat had formed strong adhesions with the artery and the common
sheath. The inguinal glands adhered firmly to the veins, but
were otherwise in a healthy condition.”

M. Schwilgue has given an account of inflammation of
the crural veins and nerves, the veins in some parts having
been reduced to the consistene of an artery, and in some
places filled with pus and blood in a woman after delivery,
yet there was no phlegmasia dolens. Diet, des Sciences ,
Med. ml. 41. Meckel has related a similar case in the dis¬
sertation of M. Sasse. Drs. Hosack, Beck and Francis,
and other eminent writers of America are of the same opi¬
nion. The second case ralated by Dr. Lee was one in which

* Med. Chir. Trans. 1823. Vol. 13.

2 E

VOL. III. NO. 15.

210

Critical Review .

there was a varicose state of veins of the extremity : the wo¬
man recovered. “ No enlargement of the femoral vein could
be felt," p. 140, “ the enlargements are white and pallid,
and pit on strong pressure." This was not a good example
of the disease under notice. Dr. Lee concludes that the in¬
filtration of the cellular membrane and other diseased ap¬
pearances are merely the consequence of inflammation and
obstruction of the blood-vessels." p. 143. “It remains, how¬
ever, for future observers to determine if this venous inflam¬
mation be the only cause of the disease, or if cases do not
occur wherein the other textures are primarily affected.

I may observe that, hitherto, no instance of phlegmasia do-
lens has been met with when the glandular, lymphatic, or
cellular tissues of the limb have been found diseased without
the veins being also in a morbid condition/7 p. 144.

Numerous French writers contend that pressnre on the
sacral, crural, and pubic nerves during parturition, may in¬
duce neuritis of these nerves, and give rise to one or several
phlegmonous inflammations, which may terminate in gan¬
grene and prove fatal ; and moreover induce the disease
under consideration. Dr. Francis asserts that the disease
very frequently commences in the calf of the leg, proceeds
upwards, and may appear in both sexes, and in the superior
extremities *. Dr. Beck has seen it attack a female in her
fifty-second year f. Velpeau regards disease of the sacro¬
iliac symphysis of the affected side, the primary cause of
phlegmasia dolens ; the veins being consecutively affected J.
The swelling of the limb, whether the result of impervious¬
ness of the veins or lymphatics, or of neuritis, is the effect
and not the cause of the disease J. In one of Dr. Beck's
cases, “the pain commenced in the toes, heel, and upper
part of the foot, which on the next day ascended to the knee
and groin." Dr. Hull maintained that the disease consisted
“ in a peculiar inflammation in the muscles, cellular mem¬
brane and inferior surface of the skin, and this theory is the
best that has been offered. Dr. Lee should not have for¬
gotten the excellent remarks made on Dr. Davis’s paper by
the talented editor of the Med. Chir. Rev. 1824, vol. 1, p.
378 and seq. in which he has clearly proved the fallacy of
Dr. Davis’s conclusion. We would also refer him to the
succeeding number of the same periodical, vol. 2, p. 57>
where he will find Dr. Hosack’s refutation of the position
taken by Dr. Davis, and his complete concordance with the
opinion of Dr. Johnson. The pathognomonic symptoms of

* New York Med. Journ. No. 1.

+ Bull, des Sc. Med. Juillet, 1824,

t Op. Cit. No. 2.

Medico- CMrurgicctl Transactions. 211

the disease as laid down by Dr. Bateman, in his erudite
article on the subject in Rees’s Cyclopaedia, are very different
from those of Drs. Davis and Lee. “The swelling,” says
Dr. Bateman, “is general and equal over the whole limb—it
is much firmer and harder than in anasarca, in every stage
of the disorder. It is not so cold in any state of the disease
as the dropsical swelling, neither does it pit when pressed
upon by the finger, nor does any water issue from it, when
it is punctured by a lancet.” This is the opinion of all ob¬
stetric writers, with very few exceptions. Contrast this
description with Mr. Lawrence’s account of the autopsic ap¬
pearance already quoted. Dr. Hosack has reviewed the
whole of the theories proposed, and concludes with the fol¬
lowing corollaries.

“ 1st. That cruritis is an inflammatory disease,, not only affect¬
ing the limb, but the whole system.

“ 2d. That it most usually proceeds from a suppression of the
natural excretions, the effect of cold, stimulating drinks, and other
means of excitement.

“3d. That it is not necessarily connected with the lochial dis¬
charge, as inculcated by Trye, Denman, and indeed by Rodrigus
Decastro, of Hamburgh, in 1603, by Wiseman, in 1676, and by
Mauriceau, in 1712, who were the authors of this doctrine.

“ 4th. That the first irritations frequently appear about the calf
of the leg, and not in the groin and pelvis, as asserted by Dr.
Denman.

“ 5th. That it follows easy as well as difficult labours, and
therefore cannot proceed from the pressure of the child’s head
upon the edge of the pelvis rupturing the lymphatics, as supposed
by Mr. White. • ,

“ 6th. That it is not a disease confined to the lymphatics, hut,
as in the cases recorded by Dr. Hull, it appears in every part of
the affected limb.

7th. That it is not confined to females, but, as in the cases re¬
corded by Dr. Hull, Dr. Ferriar, Dr. Thomas, and others, it occa¬
sionally appears in males.

“ 8th. That, as in gout and rheumatism, when depletion is not
actively employed, the inflammation, after appearing in one limb,
is, in some cases, transferred to another.

“ 9th. That it sometimes appears in both limbs at the same
time.

“ 10th. That the general means of subduing inflammatory action
are the most effectual in removing the active stage of this com¬
plaint*

“ llth. That in the second stage of cruritis, in addition to the
use of general stimuli and tonics, stimulating spirituous liniments,
friction, and the roller, are most useful in restoring the circulation
and in exciting the absorbents in the removal of the swelling
which remains in the passive stage of this disease.

“ 12th. That occasionally, as in the cases related by Hull, Den-

212

Critical Review-

man, and by Zinn, it ends in abscess, and proves fatal, especially
where the antiphlogistic treatment has not been vigorously pur¬
sued in the first stage of the disease, or when it occurs under great
exhaustion and debility of constitution.”

These, and various other opinions were quoted by us on
a recent occasion *, and should not have so soon escaped the
memory of Dr. Lee.

III. Analysis of a Quantity of Fluid drawn from a Hydro¬
cele of some years' standing. By J. Bostock, M.D. F.R.S.
This paper is one of physiological curiosity, more than of
medical treatment. The author notices the researches of Dr.
Marcet, his own, of M. Breschet, Drs. Christison, Thomson,
and Turner, on nearly similar animal fluids, and retains the
designation he has formerly proposed, namely, albumino-
serous matter. He thinks the substance a peculiar one,
and that it is rather the cause than the consequence of the
disease ; the primary morbid change not being in the fluid,
but in the organ into which it is deposited, the substance
after its deposition giving rise to farther derangement
either by unduly distending the parts or by mechanically
obstructing the vessels. We possess no agent by which the
substance can be removed, nor are we acquainted with any
means of preventing its formation.” p. 160.

IV. On the Use of Subcarbonate of Iron in Tetanus . By
John Elliots on, M.D., &c. Dr. Elliotson in a former paper
(Trans. Med. Ch. Society, vol. xvi, part i,) adduced satisfac¬
tory proofs in favour of his opinion, that subcarbonate of
iron might be given in large and repeated doses, ec probably
in any quantity that does not disturb the alimentary canal/’
It may be given in any quantity, and the only objection to
its use is the unwillingness of the patient to swallow it, and
the inability of the stomach to manage so heavy a mass.
“ Neither headache, thirst, heat, foulness of tongue, griping,
nor constipation has occurred, nor been increased, if already
present. Nay, pain and heat of the head, and giddiness ex¬
isted already in some cases, and ceased during its employ¬
ment.” Our author has cured nine cases of chorea by large
doses, and without any bad symptoms, but the treatment
was continued from four to twelve weeks in some cases.
He also treated a genuine case of traumatic tetanus in the
same manner and with equal success.

“ The result of this case was highly gratifying, but did not sur¬
prise me. I had not given the remedy at random, but according
to what I conceived a fair analogy. Neuralgia, paralysis agitans,
chorea, and tetanus appear all to be affections of the nerves, or

* Manual of Midwifery, &e. By.M. Ryan, M.D. 1828, p. 335.

Medico- Chirurgicai Transactions . 21 S

those parts of the brain and spinal marrow which are immediately
connected with them. These affections are evidently not of ne¬
cessity structural, because in all, the disease often rather sud¬
denly ceases, and because after death nothing is generally to be
discovered. Neither are they of necessity inflammatory, both
because also of the latter circumstance, and because antiphlogis¬
tic measures with mercury generally fail to remove them. The
affection in each of these diseases has also this peculiarity— that
narcotics are of very uncertain utility in subduing it j so that I
was convinced, as stated in mv last paper, that we are upon a
wrong scent in our attempts to cure tetanus and hydrophobia
by narcotics, and that we should employ other remedies which
exert peculiar actions upon the nervous system.” The power
of subcarbonate of iron over neuralgia, unconnected with in¬
flammation or structural change, thus led me to employ it in
paralysis agitans, and in the first case I succeeded. I was then
encouraged to exhibit it in chorea, and my success is already be¬
fore the Society. My resolution was now taken to treat the first
case of tetanus with it that should fall under my care.

" But, besides having employed it by analogy, I could not doubt
that the remedy had cured the disease, because this gradually in¬
creased till it was taken, and even during the first and second day
of its exhibition j after which the symptoms declined in severity,
and ceased altogether in about twelve days. Instances of trauma¬
tic tetanus are generally fatal, and when they are not, they usually
decline in a very gradual manner, and terminate at the end of
some weeks. So inefficacious are opium, venesection, hot and
cold bathing, mercury, bark, wine, and all the remedies ordinarily
tried, that Dr. Parry concludes that “ the cure of acute tetanus
still remains to be sought, and since we have so little analogy to
direct our search, it will, he fears, not readily be found and Sir
James Macgrigor states, after some hundreds of cases, during the
peninsular war, affording room for extensive trials of the same re¬
medies, as well as of potass, purgatives, digitalis, and local means,
he is ‘ obliged to confess, that little or no dependence is to be
placed in any of the remedies, and that the method of cure is yet
to be discovered.’ ”

Dr. Elliotson did not detail the result of this case to the
profession, but wished to put the remedy to a further test }
and an opportunity was afforded him about three years after¬
wards in the following case.

“ Thursday, November 6, 1828. Bryan Macguire, aged 44, a
labourer, was admitted into George’s Ward, labouring under tris¬
mus and opisthotonos. The mouth could be only half opened,
and the tongue had been severely bitten in his sleep. The muscles
of the back and abdomen were rigid, the body arched consider¬
ably, and, during the spasms, the pain at the epigastrium was de¬
scribed as dreadful. The forehead was wrinkled, and the angles
of the mouth drawn up, giving an expression of extreme agony.
The pulse was seventy-six, regular, soft, and rather full.

214 Critical Review.

« on the preceding Friday he first felt a little stiffness on each
side of the lower jaw, and this had increased ever since. On the
Tuesday he first experienced a tightness with eatchings at the epi¬
gastrium, and at night could not sleep on account of his tongue
being frequently bitten $ and he sweated profusely. On the Wed¬
nesday, all these symptoms increased, and opisthotonos began.
During the whole of the last week he had been very chilly.

<< Exactly a fortnight previously to his admission, his right
thumb was jammed between two pieces of logwood. The skm at
the root of the nail, was slightly torn, and a little matter formed
under the nail, and escaped on one side. I found the thumb
slightly swollen, and tender j a small dry crust was observable at
the root of the nail, and the nail was evidently separating, but

without any pus below it. ,

<f The bowels not having been relieved for four days, I ordered
him instantly gij of oleum terebinthinse, followed by ^ss. of oleum
ricini every hour till a motion was procured ; after which he was
to take ^ij of the subcarbonate of iron formed into an electuary
with treacle, diffused in strong beef tea, every two hours. He
was allowed ifeiij. of strong beef tea daily.

Friday 7th. There had been seven stools, the first dark, the
rest yellow and healthy. The pulse was sixty, but rose during
the spasms to eighty-eight. The temperature in the axilla was
ninety-nine degrees. The symptoms were rather increased. Ihe
dose of the iron was augmented to 3iij, and a common injection ot
gruel, salt, and oil prescribed. ...

Sth. There had been four liquid stools from the injection, lne
trunk was more arched, the abdominal muscles harder, the pain
at the epigastrium more severe and frequent. The pulse was
eighty-eight, and weaker.

“ The dose of the iron was increased to 3SS* and a common in¬
jection ordered.

“ 9th. The injection had produced two or three rather lumpy
stools. The body was still more arched, and the muscles of the
thigh felt hard. The slightest thing excited an exacerbation, so
that I was compelled to request the pupils not to visit him, except
in company with myself. The mouth could only be^ opened a
quarter of an inch less even than at his admission. The pulse
was sixty-four and weak ; the respirations twenty-two.

** A pint of milk, and of porter, were added to his diet, and the

injection ordered to be administered twice a day.

“ 10th. Each injection had come away exactly in the state it
was administered, and been followed by several large dark red
balls, without any pain. This continued to be the case every day
till the dose of the medicine was diminished. To ensure the faci-
lity of their discharge, the injection was from this time employed
three times a day. The symptoms remained much at the same
point from the 9th to the 13th. I discovered that above double
the dose of the medicine was given that I intended, but as it pro¬
duced no inconvenience, and the progress of the disease was evi¬
dently arrested, I made no alteration.

Medico-Chirurgical Transactions. 215

,c 14th. He was somewhat better. 13th. Decidedly better— the
abdomen less arched and hard ; the paroxysms less severe and
frequent. I noticed by means of the stethoscope, that, during the
attack of spasm, inspiration was made with a strong sonorous
rattle, and, immediately when the spasm was over, with no more
than the healthy murmur. I could not repeat the observation, as
he never afterwards experienced an exacerbation at my visits.
From this time the medicine was not taken in the night.

“ 16th. The paroxysms were far less severe and frequent.

" 17th. The abdomen was soft, and the trunk very little arched,
and he had suffered but four paroxysms in the last forty-eight
hours. The medicine was now given only every four hours.
From this time he rapidly improved, had but one exacerbation in
the twenty-four hours, and that at night and gradually slighter ;
and was so well on the 25th that I discontinued his medicine.

“ I am ignorant whether, if even the cure was effected by the
remedy, a smaller quantity would not have been sufficient. I be¬
lieve that in most cases of disease, doses of 3i. or ^ij, two or three
times a day, answer every purpose. But knowing as I did, that
indefinite quantities are generally borne without inconvenience, and
that large doses sometimes succeed after small ones have failed,
and having a terrible disease to treat, which renders the system
callous to many agents, and requires the full force of remedies to
subdue it, I did not feel justified in trying whether less would ac¬
complish the end. Among the large number of cases of tetanus
upon record, I have read one only in which iron was exhibited,
and then, together with many other means, the sulphate was given
in doses of five grains every two hours, to a negress twelve years
of age, for four days. She recovered *.

“ Should iron prove a remedy in tetanus, I am aware that some
cases will be too rapid for its action to be exerted, and that in
others the degree of trismus will prevent its sufficient exhibition.

t: But I dare not assert that these two cases were cured by the
medicine, and I never before published upon the powers of a re¬
medy, till long and careful experience had satisfied me that my
results would be confirmed by all those who employed the re¬
medy in the same manner, and under the same circumstances of the
same diseases in which I had employed it.”

Dr. Elliotson met another case, February 4th, 1829, the
patient aged fifteen : the iron was only exhibited on the
fourth day and the boy died on thefifth. Dr. Elliotson thinks
the result is not unfavourable to the use of the iron, as he
has already stated his opinion that it does not exert any be¬
neficial influence in less than two or three days; (e he hopes,
therefore, the profession will pursue the enquiry into the
powers of iron in the disease.” We hope so most ardently,
and cannot conclude our notice without expressing the great

* Memoirs of the Medical Society of Loudon. Vol. VI. 1805, p. 77, et seq.

216

Critical Review.

benefits most probably that shall arise from the recommen¬
dation of the talented and scientific author.

V. An Account of a Case of Aneurism by Anastomosis of
the Forehead , treated by the Application of Ligatures. By
B. C. Brodie, F.R.S.— -This paper is so exceedingly interest¬
ing that we submit it in the words of the author.

“ The disease which Mr. John Bell has described under the name
of aneurism by anastomosis is, according to my experience, of
comparatively rare occurrence. Three cases of the kind, however.,
have been already recorded in the Transactions of this Society, and
to these I am now induced to add a fourth, the history of which
will probably be deemed not devoid of interest, inasmuch as the
disease had existed form any years, gradually increasing until it had
reached an alarming extent, and after other methods of treatment
had been employed to no purpose, was ultimately cured by a very
simple operation, founded on the same principle with that, which
Mr. White and Mr. Lawrence have recommended in cases of the
vascu^r naevus of infants.

Miss - , in the year 1809, being then about five years of age

received a severe blow on the forehead, in consequence of her hav¬
ing run against the corner of a bed-post. Soon afterwards a
small pulsating tumour, not larger than a pea, was observed at
the part on which the blow was inflicted. For many years the
tumour remained nearly stationary, and as it produced no incon¬
venience, it excited but little attention. In the year 1821 it had
manifestly increased in size, in consequence of which a surgeon
in London was consulted, who attempted to cure the disease by
pressure. For this purpose compresses were applied over the tu¬
mour, secured by a tight bandage round the head. Under this
treatment the patient suffered from a constant and severe pain,
and so far was it from being of any service, that as soon as the
pressure was left off, the tumour seemed to grow more rapidly,
and the pulsation in it became stronger than before. From this
time also there were frequent attacks of intense head-ache, which
were to be relieved only by blood-letting.

« After this no local treatment was resorted to, until the year
1824, when the tumour having increased to a still larger size, ano¬
ther attempt to restrain its growth by pressure was instituted un¬
der the direction of Sir Astley Cooper, but with no more favour¬
able result than formerly.

“ In the end of June 1826, the disease having made still further
progress. Sir Astley Cooper was again consulted, and by him a
ligature was applied, (at four different times) round each of the
four principal arteries by which the tumour was supplied. The
result of these operations was, a slight diminution in the size of
the tumour, and some relief from pain j but even this favourable
change was of short duration. In the course of the winter of
1827, the tumour again grew larger, and the painful sensations re¬
turned with redoubled violence, attended with a constant sense of
weight over the eyes, and excessive depression of spirits. Occa-

Medico - Ckirurgical Transactions. 217

sionally there were paroxysms of pain still more violent than what
was usually experienced, and followed by a state of extreme lan¬
guor and exhaustion.

<c Miss remained precisely in this state, except that the
tumour continued slowly to enlarge, until the 9th of October
1828, when she arrived in London, after an absence of many
months, and I saw her in consultation with Dr. Robertson, of
Northampton. The tumour was now bigger than a large double
walnut, occupying a spot on the right side of the forehead, imme¬
diately below the margin of the hairy scalp. When the fingers
were applied to it, they received an impression as if it was com¬
posed of a mass of tortuous vessels, and a strong pulsation was
perceptible in every part of it. The skin covering the tumour was
thin, and on some occasions, as in coughing, when the vessels
were unusually distended, it appeared as if on the point of burst¬
ing. When the scalp was shaved, large and tortuous arteries were
to be seen, even from a considerable distance, passing into the ba¬
sis of the tumour, in every direction, from each temple, from the
orbit of the right eye, and over the crown of the head from the
occiput. Pressure being made on the two temporal arteries at
the same instant, the pulsation of the tumour was perceptibly, but
not greatly, diminished. There was a constant sense of weight
and pain in the forehead, and the latter was very much aggravated
by pressure on the tumour, especially on a particular spot towards
its upper edge.

“ The sufferings of the patient were such, that she was willing
to submit to any plan of treatment which might afford her even a
chance of being relieved. On considering the subject, it appeared
to Dr. Robertson and myself that there was no reason to expect
advantage from any further attempt to obliterate the arteries by
which the tumour was supplied with blood, nor indeed from any
operation which had not for its object the complete extirpation
and removal of the diseased structure. Rut the attempt to ac¬
complish this object by means of the knife, would necessarily be
made at the risk of a most alarming hemorrhage, and the applica¬
tion of the actual cautery or of caustic would not only be uncer¬
tain as to the result, but, if carried to a sufficient extent com¬
pletely to answer the intended purpose, might occasion such
injury to the bone and periosteum, as would be productive of
much subsequent inconvenience, if not actual danger, to the pa¬
tient. Under these circumstances. Dr. Robertson immediately
assented to the proposal which I made, that I should endeavour
to extirpate the tumour by means of ligatures, so applied as to
produce the complete strangulation of it at its base. There seemed
at any rate to be no more effectual, nor any safer method of pro¬
ceeding, but even with respect to this, it was impossible not to
experience in the first instance, considerable apprehensions as to
the loss of blood, which might take place on the separation of the
slough. These apprehensions were, however, greatly diminished,
if not altogether removed, in consequence of the conviction which
we felt, that the unusual dilatation of the principal arteries of the

VOL, III, NO, 15, 2 F

218

Critical Review.

scalp, was to be regarded as the effect, and not. the cause, of the
morbid growth of the smaller vessels, and as being likely to sub¬
side immediately on the tumour being destroyed.

“ A further consultation having been held with Mr. Keate, and
afterwards with Sir Astley Cooper, and both these gentlemen hav-
ing agreed in opinion with Dr. Robertson and myself, I proceeded
to perform the operation, on which we had determined, on Wed¬
nesday, the 15th of October, in the following manner.

A long steel needle, the length of which was about double the
diameter of the tumour, was passed between it and the periosteum,
penetrating the skin on each side. By means of this needle the
tumour was raised as much as possible, and a second needle was
introduced in the same manner, but beneath, and at right angles
to, the first. A very strong silk ligature was then bound several
times round the base of the tumour, below the needles as tight as
it could be drawn. The tumour immediately assumed a purple
colour, as if in a state of strangulation. The operation occasioned
great pain both at the time and afterwards ; but from the instant
of. the ligature having been applied, the peculiar sufferings occa¬
sioned by the disease were at an end.

“ In the evening, the pulse being strong, the skin hot, and the
pain caused by the ligature very severe, some blood was taken
from the arm.

“ October 16th. The pain was somewhat abated, the tumour
had assumed a dark colour, and had begun to shrink.

•f October 17th. The tongue was furred, the pulse hard and fre¬
quent, and the skin hot. More blood was taken from the arm.

“October 18th. All the arteries entering the tumor had either
ceased to pulsate or pulsated less strongly than before, with the
exception of those at the upper part. Concluding from this last
circumstance that the strangulation was not every where complete,
and that a still greater degree of compression was necessary, I
armed one of the needles with a strong double ligature, then drew
it through, and having removed the needle, tied the ligatures one
on each side.

“ October 20th. The other needle was armed in the same man¬
ner, and by means of it another double ligature was passed through
the base of the tumour, and tied like the former one.

“ October 22d. The slough had begun to separate at its edges,
and all severe pain had ceased. The pulsation at the arteries at
the upper part was greatly diminished.

“ October 26th. The slough came away without the smallest
hemorrhage. Dry lint, with strips of adhesive plaster over it,
was applied to the ulcerated surface.

“ In the course of a few days the ulcer had assumed a healthy
appearance, and had begun to granulate.

“ The appearance of the ulcer was very carefully watched, and
two or three times the nitric acid was applied to some spots on its
surface, in which there was an appearance that led Mr. Keate and
myself to suspect that there might be a disposition to reproduce
the original disease. The sloughs made by the nitric acid soon

Medico- Chirurgical Transactions. 219

separated ; the sore continued to heal, and the pulsation of the
arteries in the neighbourhood to diminish.

“ December 2d. The cicatrix was completely formed, and no¬
thing unusual was to be observed except that between it and the
eyebrow there was a slight appearance of fullness, manifestly de¬
pending on the skin at this part having been for a long time much
distended, and having not yet returned to its original dimensions.
There was no more pulsation in the arteries, which had formerly
been so much enlarged, than in those of the other side of the fore¬
head, and the patient was free from pain and all other incoveni-
ence.”

VI. Two Cases of Fracture of the Thigh-bone taking place
without any violence, from a diseased state of the Bones , and
concurring with Cancer in 'the Breasts of both patients. By
T. Salter, Esq. F.L.S., Surgeon, Poole. The subject of the
first case, was a female, aged eighty-two ; who had been
afflicted with cancer of the breast, for many years. The fe¬
mur gave way suddenly below the trochanter, while <£ she
was standing at her drawers taking out some linen.” She
died in six months afterwards, but no re-union had taken
place; ua post mortem examination was not permitted/’
We are greatly surprised at the use of this shred of medical
dog latin, post mortem dissection, as if there were an ante
mortem autopsy, or necrotomy ; we have certainly much
room for adopting the nomenclature of other nations.

In the second case the woman was aged fifty-six, and had
laboured under a scirrhous tumour of the left breast for seve¬
ral years. The fracture occurred three inches below the
trochanter major, no re-union took place, and on a necroto-
mic examination, the femur was so soft, that it could be
divided by a knife throughout its whole extent. The frangi-
bility of bone in cancerous subjects, has often been noticed
by former writers, but as the practitioners of the day are
content with referring to modern works, the author was jus¬
tified in recording it. We think he is quite correct in his
cautious opinion as to whether the frangibility of the bones
is to be ascribed to carcinomatous or other disease in the
system.

The last paper in the present volume is one on Local Dis¬
eases , termed Malignant. By B. Travers, F.R.S. ; which in¬
cludes an admirable description of a disease for a long time
unnoticed, namely, cancer ; and this account is so extremely
accurate, concise, yet comprehensive, occupying sixty-eight
pages, that we cannot devote sufficient space for analysis of
it in this Number. The essay contains a vast mass of valu¬
able information, and an imperfect account of it would be an
injustice to our readers as well as to the justly eminent
author. — We shall notice it in onr next.

220

Critical Review .

V. — Address of Earl Stanhope, President of the Medico-
Botanical Society , at the Anniversary Meeting , January

An Oration} delivered before the Medico-Botanical Society
of London, at the commencement of its Ninth Session ,
Tuesday , October ‘Z&th, 1828. By John Frost, F.R.S.
Edin. F.L.S. Director of the Medico-Botanical Society of
London, &c. & c. Dedicated, by permission, to the King.

While physiology and pathology are now universally culti¬
vated in this country to an extent unequalled in the annals
of science, the more useful and more important branch of
the healing art, designated therapeutics, is almost totally
forgotten. In proof of this position we need only refer to
the proceedings of our Medical Societies in this metropolis.
There is scarcely a meeting of these bodies at which speci¬
mens of the most common diseases are not presented, as if
every regularly educated practitioner was not conversant with
the appearances of organic lesion. In many instances the
pseudo-discoverer most gravely presents u a morbid speci¬
men,’' taken from a body destroyed by a very different dis¬
ease ; and, indeed, is ready to admit he has not seen the de¬
ceased during his illness, and, consequently, is unable to
describe the symptoms or treatment that had been pursued.
Of what value are such morbid specimens under such cir¬
cumstances ? We wish the Presidents of our societies would
discountenance a practice so jeune and useless. If exam¬
ples of organic disease be presented, some account ought
to be given of the symptoms, phenomena, and peculiarities
of the disease, and of the treatment previously pursued ; and
let it be recollected that the disorganizations of every part of
the human body have been described a thousand times be¬
fore, in this and other countries, and are well known to every
observant practitioner. It is infinitely more important to
hear a detail of the remedies employed, than observe the ne-
crotomic appearances. Swift never maintained a more falla¬
cious axiom than that fC the knowledge of disease was half its
cure." But the worthy Dean was not a member of our pro¬
fession, and, consequently, knew nothing of the nature of
human infirmity. Of the numerous medical societies in this
country, there is not one so completely devoted to the disco¬
very of therapeutical agents as the Medico-Botanical Society,
nor one so likely to diminish human suffering. This society
was instituted for the purpose

Of investigating, by means of Communications, Lectures
and Experiments, the Medicinal properties of Plants, their Botani¬
cal characters and Chemical constituents j

Proceedings of the Medico- Botanical Society. 221

" Of promoting the study of the Vegetable Materia Medica of
all countries 3

f< Of collecting and describing the various substances appertain¬
ing thereunto 3

“ Of improving their Pharmaceutic preparations 3

“ Of disseminating, by correspondence and publication, such
discoveries as may be made of new Medicinal Plants, and of new
uses or preparations of those which are already known 5

Of adjudging honorary or pecuniary rewards to the authors of
Such discoveries ;

(t And of cultivating Medicinal Plants.

“ The general design is therefore the extension and improve¬
ment of the Vegetable Materia Medica through the means of
Botanical inquiries, of Chemical analysis, and of Medical investi¬
gations and experiments.”

There is no other scientific society in the world enjoys
such extensive operation, as its members] are to be found
in every civilized nation on the surface of the globe. It owes
its extent and great utility to the unequalled patronage which
it possesses, and for which it is chiefly indebted to its noble
and scientific President, whose activity, zeal, and indefati¬
gable exertions in its behalf are unequalled in the history
of the Peerage of this empire. We seldom have observed
our nobility take real interest in scientific pursuits, but there
are a few brilliant exceptions — the Bacons, the Boyles, the
Cavendishes and the Stanhopes. There is no other scienti¬
fic society which enjoys such exalted patronage. Our gra¬
cious Sovereign, the munificent patron of science, has confer-
ed the distinguished mark of his royal favour on this institu¬
tion, and has condescended to add his autograph in the
signature book of the Society. This gracious condescension
of his Majesty is beautifully and forcibly described in the
classical and elegant language of the noble President in the
following words —

t( I proceed to mention an event, which forms, indeed, an
epoch in the history of this Society, and which inspired universal
joy as well as unbounded gratitude. 1 need not add that I allude
to the gracious kindness of his Majesty, in condescending to be¬
come the Patron of this Society, in conferring upon us that dis¬
tinguished mark of his royal favour, which we were so anxious and
so ambitious to receive. His benignant protection, which is be¬
stowed upon those objects which are valuable in themselves, and
tend to promote the happiness and welfare of his subjects, will, I
am confident, add energy to all our exertions, and excite an ardent
desire in the heart of every Member of this Society, to endeavour
by all |the means in his power, to deserve the patronage of our
Sovereign. The best and most acceptable tribute of our gratitude
which we can offer to our gracious Monarch, will be derived from
our zealous, persevering, and successful pursuit of the objects for

222 Critical Review*

which we were established, and by which we were recommended
to his favour j and we may be assured that we shall greatly contri¬
bute to his satisfaction, if our exertions, which are so laudable
and useful in their design, should, in their results, be beneficial to
his subjects and to mankind.

“ During the last year we have been very highly honoured, by
the condescension and kindness of the Emperor of Austria, of the
Emperor of the Brazils, of the King of Prussia, of the King of
Sweden, and of his son, the Prince Royal, in deigning to become
Members of this Society. These distinguished favours are ex¬
tremely gratifying to us, and cannot fail to be of very great service
in promoting our objects on which those Sovereigns have been
pleased to bestow so flattering a mark of their approbation. We
must also acknowledge, with sincere gratitude, the lively interest
which has been manifested for their success by their Representa¬
tives in this country, some of whom we have had the pleasure of
seeing at our meetings, and all of whom expressed their earnest
desire to facilitate our communications and to forward our views.

“ From the Report of your Secretaries, you have had the satis¬
faction of learning, that the number of our Corresponding Members,
particularly on the Continent, has been very much increased j
and we have every reason to expect from them communications of
great importance. We have received, also, an accession of 56
additional Fellows, and I rejoice to find amongst them several per¬
sons of high eminence in the Medical Profession. This Society
will always hail with peculiar joy the accession of persons who
belong to* any branch of that profession, and who must fully ap¬
preciate our objects, and are eminently qualified to promote them.
The learned and illustrious President of the College of Physicians,
for whom I entertain the highest veneration, and of whom I have
had the friendship during more than twenty-five years, as an Ho¬
norary Fellow of this Society, and though you must deeply regret,
you cannot, however, be surprised at his absence from our meet¬
ings, as you know that he is always most actively and most use¬
fully occupied in restoring health, or, where that is impracticable,
in alleviating sufferings.’,

** It may not be known to every member,” says the talented
Director of the Society, " that the signature book contains the
autographs of His Majesty, the Dukes of Clarence, Cum¬
berland, Sussex, Cambridge and Gloucester, Prince Leopold of
Saxe-Coburg; His Imperial, Royal, and Apostolic Majesty the
Emperor of Austria ; their Majesties Don Pedro, the Emperor of
the Brazils : Charles John, King of Sweden and Norway ; Lewis,
King of Bavaria 5 William, King of Wirtemberg ; His Imperial
Highness, Leopold, Grand Duke of Tuscany, and His Royal
Highness, Oscar, Prince Royal of Sweden.”

Many other Foreign Princes and Ambassadors are mem¬
bers of this Institution, all of whom evince their anxiety to
promote its invaluable objects, and have promised and sent
multiplied specimens of plants, so that in a few years the

Proceedings of the Medico-Botanical Society. 223

Society will possess the largest collection of plants in Europe.
There is a constant transmission of correspondence from the
most celebrated professors in the several countries, through
the Ambassadors, to the Society ; and his Majesty's Secre¬
taries of State for the Home and Colonial departments have
most kindly afforded every assistance, by facilitating the fo-
rign correspondence. The Society has received various im¬
portant communications on the vegetable poisons used by
the Bushmen of the Orange River; on the plants of the
Western Islands at the Azores ; on the real tree, which pro¬
duces the cusparia, or Angustura bark, which has not been
hitherto described, and other valuable papers from Persia,
East and West Indies, America, and different parts of Eu¬
rope. The Society corresponds with the Horticultural and
Societe de Pharmacie, of Paris, the Philosophical Society of
British Guiana, Agricultural Society of Berlin, &c. The
King of Bavaria has presented the Institution with an her¬
barium, consisting of more than 600 plants, indigenous to
his and the neighbouring dominions, and preparedby that
eminent botanist Professor Martius. Dr. G. Barclay has
given 1000 specimens of tropical plants ; Dr. B. G. Babing-
ton those indigenous to the Mauritius ; Dr. Hancock those
of South America ; the Royal Asiatic Society the Ceylonese
plants ; Sir James M’Grigor several hundred specimens,
which he had collected thirty years ago in the Island of Jer¬
sey, and the Directors of the East India Company have
granted duplicate Specimens of medicinal plants, which their
extensive herbarium contains ; and they have lately received
no less than twenty-three tons of specimens for this splendid
collection. u Not only," observes Mr. Frost, i( does the
Society enjoy the exalted patronage of the several Sovereigns,
but they evince their anxiety to promote your noble objects
by such signal marks of their favour ; and you will, it is to
be hopec£ possess in a few years one of the most splendid
Herbaria in Europe."

Many valuable books and manuscripts have been presented
to the Society ; the library contains the best works on Ma¬
teria Medica, Medical Botany and Pharmacy, and several of
the foreign periodicals. Many noblemen and distinguished
literary characters have been elected into the Society during
the present year. Lectures are delivered on Materia Medi¬
ca, Medical Botany, and Toxicology, by Professors chosen by
the Society.

Such is a compressed account, compiled from the Essays
at the head of this paper, of the Medico-Botanical Society of
London, and we trust our remarks on this Institution have
been fully justified by the facts we have recorded. We re-

224 Original Communications.

gret that want of space prevents us from giving further ex¬
tracts from the Address of the noble President, but we can¬
not avoid inserting the following : —

“ We never entertained either the desire or the intention of es-
tablishing new theories, which must be hazardous, which might
be dangerous, and which would deservedly expose us to the cen¬
sure of the world, and more especially of the Medical Profession.
We do not attempt or even wish to form a sort of Revolution in
Medicine, to subvert the doctrines, or supplant the practice which
we find established ; we are not actuated by such presumption,
nor do we proceed upon such principles. We have thought, and
we have still the strongest reasons to think, that the medicinal pro¬
perties of plants have not yet been sufficiently ascertained, and not
yet accurately known, and are highly deserving of a patient and
attentive examination, and of careful trials. For a proof of this
assertion, and without referring to the ancient Herbals, in which
some plants were not, perhaps, correctly defined, I need only re¬
mark that modern works of that description, and on Medical Bo¬
tany, often mention with doubt and uncertainty, the virtues that
are ascribed to particular plants, and do not notice the trials, if
any, which were made of their efficacy, and, in many cases, con¬
tain contradictory statements. This is unfortunately the fate of
many of our indigenous plants, an acquaintance with which must
be interesting, and might be important. It has also been found
by experience, that diseases had been successfully removed by
plants, which some writers, indeed, allow to be efficacious, but
consider to be possessed of different properties from those which
would be useful in such complaints. All these are proofs of an
imperfect knowledge, on which full reliance cannot be placed, and
to which further researches are indispensably requisite.”

The whole address proves the author to be endowed with
a highly cultivated mind, philosophic zeal, and an ardent
love of science and humanity. The classic composition of
the Oration, and the extensive view it affords on botanical
science are highly creditable to the literary and scientific ac¬
quirements of its author.

ORIGINAL COMMUNICATIONS.

I. — Observations on the Ladies' Lying-in Institution. By A
General Practitioner.

I have perused an article in a late Number of the Me¬
dical Gazette, levelled against those of our profession who
do not exclude the management of parturition from their
practice. I should not condescend to notice that ridiculous
tirade had the editor not thrown out some gentle hints, that
it is the production of a certain “ woman hater,” whose lu¬
cubrations have often amused the profession and surprised
the public. One would suppose that the universal sanction

Observations on the. Ladies' Lying-In Institution . 225

of a custom, by an enlightened age, ought to have some
weight with those incorrigible noodles, who so foolishly op¬
pose themselves to the great bulk of our profession. It is
really surprising how men, who have never witnessed the
difficulties and dangers incidental to the nativity of our spe¬
cies, will presume to offer opinions on the subject, as if the
profession and the public would consider them of the least
importance. This anile opposition to any portion of the pro¬
fession is uncalled for at the present time, and is a remnant
of that ridiculous sectarianism which as yet debases the
practitioners of this country. The exclusion of the considera¬
tion of the functions and diseases of any organ in the body
from the knowledge of the medical practitioner, prevails in
no civilized country in the world, except this. The anti-ob¬
stetricians (to use a term you have so felicitously introduced)
should publish a solemn profession of faith, a public denial of
the expediency and utility of sanctioning the existence of
such terrific 'animals as the men-midwives amongst us.
They should also clearly prove the non-existence of preter¬
natural parturitions, and the- gross frauds of pretending to
accomplish the nativity of our offspring by manual and in¬
strumental operations, when nature cannot effect it. They
must not fail to convince the physiologists of the great ab¬
surdity of investigating the phenomena of reproduction and
the uninteresting changes consequent to the process, prov¬
ing, of course, the utter folly of the most illustrious culti¬
vators of medical science, who have endeavoured to discover
in every age, the mysteries of nature in the perpetua¬
tion, development and nativity of the human race, and the
mitigation or removal of the numerous fatal diseases conse¬
quent to maternity. Sheer nonsense all this, quoth the
pures of our respective medical corporations. We have never
allowed our wives, daughters, or female friends, during par¬
turition any medical assistance, even though they are
stretched upon the rack upon which nature has laid them. It
is the lowest degradation to the faculty to abridge or alleviate
their agony, though the greatest of human suffering. We,
the pure physicians, (the degenerate sons of the immortal
Hippocrates, who foolishly practised every branch of the
healing art) do not defile ourselves by the contamination of
parturition and its derangements ; we confine ourselves to
medical diseases, in fact, to the maladies of all internal or¬
gans of the body, except the uterus and its appendages. It
is our exclusive province to inspect the variegated contents
of the close-stool, and regale our olfactory nerves with the
delicious odours thereunto belonging. Still, “ we are the
purest of the pure/' ^And so are we/’ quoth the chirurgeons.

226 Original Communications.

“ we are not defiled, as others, by our digital explorations in
that useful organ, the rectum, implete with the salutiferous
residuum of digestion ; feees black and yellow are indis¬
pensable.” “ We will prescribe for the diseases of the
female genitals without any examination, or any idea of the
nature of the malady, as long as you please,” exclaim the
former ; “ and we will perform any operation on the same or¬
gans,” quoth the latter ; “ but none of us,” say all, “ can
listen to the calls of nature, or obey the dictates of humanity*
by affording immediate relief to that sex when afflicted with
the greatest of mortal suffering, whom God and Nature, have
commanded us to protect and cherish.” Such is the ridicu¬
lous practice enforced by the bye laws of the self-elected
managers of the healing art in the metropolis of the greatest
city in the world. They all refuse to examine students in
obetetrics, though well aware that every young practitioner
must practise midwifery in these times. One would think
that the lives of parturient women and their innocent ofL
spring were of no value, or that the sacrifice of a few thou¬
sands of them is a salutary check to the over-population of
the nation. There is no doubt but that the present Examiners
in London, have immortalized themselves by their refusal to
recognize the functions and diseases of the organs subser¬
vient to the perpetuation of our species in the other sex, as
a part of the medical education, and at the same time re¬
quiring students to produce certificates of attendance (which
is never given), there being no risk of examination. This is
in strict accordance with the regulations of the Ladies’
Lying-in Institution, and must afford our continental and
trans-atlantic brethren just grounds for accusing us of being
half a century behind the present state of medical science.
If the practice of midwifery be unnecessary it is a great
piece of injustice to oblige medical students so fee lecturers
.on obstetrics ; and especially as such lectures are scarcely
ever attended. Why should they be attended when there
is no examination at the Hall or College ?” This leads me to
ask, what has become of the Obstetric Society, and when is
that body to receive the Charter so long promised by the
Government ? Another examining body of medical men, or
a reformation of those already in existence, is absolutely ne¬
cessary — but the latter is the more desirable. The first reso¬
lution I would suggest to the Obstetric Society, is this :
Resolved, that the members of this Society shall never afford
aid to the wives, daughters, friends or relations of that part
of the profession, aptly styled pares , who so obstinately op¬
posed the recognition of obstetric knowledge as a branch of
medical education.

Dr. Ryan on Delirium Tremens . 227

H. — On the Nature and Treatment of Delirium Tremens*
By Michael Ryan, M.D. %

The term delirium is said to comprehend all the aberrations
of the mental faculties, and announces a disorder of the
cerebral functions. This morbid state may be continued,
intermittent, or remittent, idiopathic or symptomatic, acute
and chronic. These distinctions are of little importance as
to the origin of the disorder, for in every instance it depends
on the same organ. It is not difficult to prove that the en¬
cephalon is the seat of delirium, whether dependant on func¬
tional or organic derangement. In fact, fall the phenomena
that characterize delirium must be referred to the brain, as
the organ destined to execute the intellectual functions. But
in what does the cerebral lesion, which produces delirium,
consist, does it occupy the whole or a part of that organ ; is
it analogous to irritation, vascular congestion, inflammation,
atony, collapse, or in conditions diametrically opposed to
these ? It is imppssible, 1 apprehend, to answer these .ques¬
tions in the present state of science. We know nothing of
the action of the different parts of the brain in health or in
disease. The phrenologists have not yet proclaimed on what
part of the brain does delirium depend, nor have they shed
the slightest light on the nature and treatment of mania.
We know that delirium may continue for months and years,
deprive the sufferer of reason, finally prove fatal, and leave
no trace whatever of its existence, which is by far the most
frequent occurrence* No doubt we occasionally find traces
of congestion or inflammation of the brain or its membranes,
but in such cases death very speedily takes place. But we
much more frequently discover that delirium is the effect of
irritation of the brain from increased or diminished action of
its proper functions, from irritation or collapse, atony, as¬
thenia, or debility. It is difficult to distinguish whether de¬
lirium, in certain cases, depends on an excited or depressed
state of the brain ; but that it may depend upon either of these
conditions is universally admitted by physiologists. All ad¬
mit that excitement and collapse bear the relation to each
other of cause and effect. I am aware that the terms collapse
and debility are considered very unphysiological by a few
modern theorists 5 but I apprehend every man of ordinary
observation must be satisfied, that without these teims he
could not explain many phenomena of disease. Delirium
manifests itself in the commencement, course, or decline of
diseases of the brain, of the viscera of the thorax and abdo¬
men $ it precedes, accompanies or follows the various de-

228

Original Communications.

rangements of sensibility or cerebral function, of the diges¬
tive, circulatory, and respiratory functions, and of all their
diseases. It will be induced by external injury on any part
of the body, and by narcotism. It characterizes the greater
part of vesanise, or mental derangements, and is often pre¬
sent in fevers, inflammations, exanthems, hemorrhages,
nervous, comatous, adynamic, spasmodic, cachexic, and local
diseases. In a word, we observe delirium in morbid affec¬
tions of the brain and its membranes, in those of the diges¬
tive organs, stomach, intestines, uterus, liver, spleen, kid-
nies, heart, lungs, in fact of every part, as every part or
organ sympathises with the brain. The diseases of all parts
will induce delirium, slight or most intense. From these
premises it is evident that delirium may arise from nervous
sympathy, that is, by the transmission of pain or irritation
in any organ through the medium of its nerves to the brain.

When we consider the intimate connexion that exists
between the cerebral and spinal nerves, we can have no he¬
sitation in admitting the ubiquity of sympathy in the human
body. Delirium is said to be caused by irritation, arising
from increased or diminished sensibility ; and from conges¬
tion of inflammation of the brain or its membranes. The
strongest evidence is in favour of the former opinion. It is
well known that in most cases of delirium, recovery happens,
which could not be expected if it were dependent on conges¬
tion or inflammation. The pathology of this morbid state is
entirely unknown, and we can only observe its results. It
was said to . depend on a disorder of the vital spirits, by an
accumulation of nervous fluid, by the anger of archseus, the
vis medicatrix natures, the afflux of certain noxious vapours,
ascending to the brain from the stomach, the spleen, the liver ;
by a depraved state of the humours, by a tension or relaxation of
the fibres, and by a lesion of the vital principle. The opinions
are entirely hypothetical and visionary, and afford no insight
into the pathology of delirium. Whatever may be the patho¬
logical condition of the brain in the state of morbid action
called delirium, of one fact we are satisfied, that it arises
from deranged nervous action in an excited or diminished de¬
gree, and from congestion or inflammation. It has long been
admitted as an axiom in physiology, that the increased ac¬
tion of any function or organ is followed by collapse or debi¬
lity, during which the natural force or power is accumulated,
to enable the affected organs to resume their healthy func¬
tions. This law is particularly observable in the nervous sys¬
tem, the healthy functions of which require a periodical state of
collapse or repose, to fit them to be resumed, and this is
well exemplified by rest and sleep. The collapse or debility

229

Dr. Ryan on Delirium Tremens.

Of the brain may be prevented by the presence of the host of
diseases already mentioned, and also by the abuse of inebri¬
ating potations, when carried to a certain extent, the cere¬
bral functions may be excited or enfeebled. In the last stage
of typhus or continued fever, a low, muttering delirium su¬
pervenes soon after the cessation of the stage of reaction or
excitement, and in such cases is the result of reaction, or
a constitutional effort, and not dependant on vascular action,
congestive or inflammatory in the greatest portion of cases!

How often do we see all the symptoms of effusion of the
brain in fevers and inflammations, and yet recovery will cer¬
tainly take place. Every man who has observed fever is
aware of this *, and hence the unanswerable proof of deliri¬
um in fever being caused by morbid action, diametrically
opposite to congestion and inflammation. During the last
year Baron Dupuytren published a paper on delirium occur¬
ring after surgical operations, which he has designated ner¬
vous delirium, and which was very speedily cured by an
injection of fifteen or twenty drops of tinct. opii into the
rectum. The Baron explains the success of the remedy, by
attributing it to want of digestion in the rectum, and to its
absorption in a pure state. This explanation is merely as¬
sumptive, for we know the injection of treble the quantity
into the rectum in uterine pains or irritation, will have often
no effect whatever.

Having endeavoured to prove that delirium may depend
on nervous irritation, I shall attempt to shew that the spe¬
cies called delirium tremens, brain fever, delirium ebriosi-
tatis, proceeds entirely from the same pathological condition,
and, consequently, is not to be removed by local or general
bleeding, as many practitioners imagine. As the popular
systems of medicine afford very imperfect information on
the nature and treatment of this form of disorder, it may not
be unimportant to condense the greater part of the opinions
that have been offered on the subject.

Delirium tremens has no place in systems of nosology. In
the ancient medical writings it has been often described very
accurately, under the names of fever, phrenitis, and mania.
Hippocrates relates an instance of the malady 'f, which
wanted, however, the tremors of the hands — a symptom
which is not always present Aretseus has nearly described

* See Dr. Allison’s Account of the Epidemic Fever of Edinburgh. Edin Med
and Surg. Journal, 1827. Andral, Clinique Med. t. 1. p. 418. Sir Astlev Coo-
per’s Lect on the Erysipelas of the Scalp. Similar Cases related in my own
work on Midwifery, p. 204. ■

+ De Morb. Popular, lib. iii. sect. ii. ASgrot v.

-Work on Fever.

+ Armstrong on Delirium Tremens.-

230

Original Communications.

it * * * *, and also Celsus f. Boiietus, Morgagni, and many others
of their times, have noticed it. Mr. John Bell has observed,
in speaking of intoxication ee it is an epitome of all the stages
of excited action and vascular congestion; but being in a
sound organ, not predisposed, it ends not in apoplexy, but in
recovery, less perfect, indeed, at every renewed debauch,
and attended, even at the best, wnh giddiness and disorders
of the head, trembling of the hands, and a disordered sto¬
mach];. And he held that brain fever and delirium tremens
very strongly resembled each other §. Ur. Hassey, in his
work on fever, described the disease under consideration very
accurately ||, and it was the demonomania of the older wri¬
ters, especially where the sufferers were intemperate. The
continental works abound with many such examples, espe¬
cially those of the 16th and 17th centuries. Dr. Alderson
published an account of a manifest example of the disease in
one of the early volumes of the Edinburgh Med. anti Surg,
Journal.^ Many other writers might be quoted, the chief oi
whom are the following : Dr. Saunders, of Guy’s Hospital,
noticed the malady in his lectures, since 1773- fhe first
perfect account of the disease was printed by Dr. Burton
Pearson, of Newcastle, which appeared afterwards in the
Edinburgh Journal** * * §§. This is the best history of the symp¬
toms, diagnosis, and, perhaps, of the treatment, which has
appeared. Dr. Armstrong followed, and published his essay
in the same Journalff. Dr. Sutton had written previously,
and first named the disease delirium treinens. Dr. Armstrong
gave it the appellation of brain fever of drunkenness, in his
excellent work on typhus, and, perhaps, it could not be bet¬
ter designated than by the term delirium ebriosum. 1 he
next essay of importance was that of Dr. Blake s, published
in 1823];];. and is one of the most instructive papers on the
malady. Dr. Clutterbuck has adverted to this form of dis¬
ease in his lectures, in the commencement of 1827§§, and
is of opinion that it depended on congestion or inflammation
of the brain. 1 transmitted two papers to the Edinburgh Med.
and Surg. Journ., the substance of which appeared in the
Lancet || || . The cases detailed in that work prove, beyond the
possibility of doubt, that the disease depends on morbid
sensibility or nervous excitement, which is induced by the

* De Morbor. Acut. Curatione. lib. i.

f Lib. iii. Insania. » ~

% Bell’s Principles of Surgery, v. ii. p. 574. § Op. Lit. p. / lb.

ii Vol. vi. p. 288. 1810.

i[ A Physical Essay on the Cause and Cure of Fever. 178b.

*★ Vol ix n 326 ft Op. Cit. p. 58-146.

St Op. Cit.’ v.’xxiii. p. 497: See also Howship on Indigestion, 1825 ; Irans*

Med. and Phys. Society of Calcutta, 1825; Med.-Chir. Rev., 182a, vote. YTf and v*

§§ Lancet, v. xi. p.*376, Nos. Oct. 1827 and Jan. 1828. |||| 1828 v. ii. p. / Jl-

Dr. Ryan on Delirium Tremens. 231

collapse or enervation consequent to inebriation, and that
the best mode of restoring the wonted functions of the brain,
is by the exhibition of the accustomed or habitual stimulus
of the patient. It must be admitted by all, that there is great
derangement of the digestive and cerebral functions, pro¬
duced by habitual intoxication. The excitement caused by
inebriety is followed by collapse, and the greater the cause the
more complete the effect. This baneful habit, indulged for
a long time, must be highly injurious to the functions of the
brain, and always produces much depression of mind and
body. When the habitual drunkard pursues his course for
several days in succession, he labours under regular mental
aberration ; nature is at length exhausted, sleep occurs, and
on waking he experiences great nervousness and depression
of mental faculties, or he is attacked with that species of
delirium which I am about to describe. In each of the
twelve cases which I have met with during the last two years,
the delirium appeared after a debauch of one, two, or( three
days’ duration, and, generally, during sleep. It appeared
to arise from a want of the usual stimulus, and was at once
removed by the exhibition of such stimulus, without any
medicinal remedy. The morbid nervous derangement was*
removed by the restoration of the ordinary sensibility in the
disordered function. The delirium consequent to uterine he¬
morrhage, the last stage of fevers of hunger, is to be relieved
upon the same principles. No medical practitioner would
propose depletion in such cases. According to my observa¬
tion, the best treatment of delirium tremens consists in the
Cautious and repeated exhibition of that stimulus to which
the patient has been accustomed, and this at any stage or pe¬
riod of the disorder. Since the publication of this opinion
in the Lancet, the subject has been discussed at the London
Medical Society, when Mr. Callaway and Mr. Tyrrell added
the weight of their authority in favour of the practice*, but
both these eminent surgeons thought it possible, though not
probable, that local inflammation might occur in some organ,
and require depletion. Mr. Tyrrell had exhibited the natural
stimulus in cases in which he believed nothing else would
have saved the patients. It is obvious that the habitual sti¬
mulus is more congenial to the system than the medicinal.
It is atonishing that this simple fact should have been hither¬
to so much overlooked.

A large majority of those who have written on the disease
recommended medicinal stimuli ; and a few have considered

* Reports of the Proceedings of the London Med. Society. Lancet, 1828. v. i*
pp, 87 119.

232 Original Communications .

depletion, followed by stimulation, the most successful prac¬
tice. I am totally at a loss to comprehend on what patholo¬
gical principle the lancet ought to |be freely used, and then
stimulation employed. I have witnessed that practice, and
can conscientiously say it had been inefficacious, and in some
instances, extremely injurious, if not fatal. Di. Burton
Pearson, in his valuable pamphlet, published in 1801, and
republished in the Edin. Med. and Surg.Journ., in 1813, v.
ix, informs us that he treated ninety-three cases of the dis-
esae (i with opium, stimuli, (wine porter, &c.) and consoling
language, and did not lose a patient. On the conti aiy, if ve¬
nesection, evacuations, rigid confinement, be employed, I
can state, from much experience, that the odds against the
patient’s existence, let him be ever so robust, are, at least,
twenty to one. This last observation, I hope, with practi¬
tioners in future, will be impressive. The disease is ol more
consequence than many are aware of, for some thousands
have lost their lives in it, purely by mismanagement. Mr.
Maxwell has cured forty patients on the same principles.

Armstrong, who first called public attention to the tract
of Dr. Pearson, observed, in the Journal just quoted, that
out of fourteen patients, treated on the same principles, three
died, two of whom were infirm old men ; the third was a
young man, who for some years before his death had seldom
been a day sober. The disease, in general, being the most
immediate consequence of inebriety. Dr. Sutton, Mr. Blake,
Mr. Playfair, and Dr. James Johnson, are advocates for this
mode of treatment. Dr. Clutterbuck is the chief person who
recommends depletion. In general, the disease comes on
suddenly, after a debauch; the patient awakes delirious,
but he may have lucid intervals, merely momentary, when
he will recognize those about him, but rapidly digresses into
his hallucination ; he thinks some great misfortune has hap¬
pened to himself or his relatives, supposes he is a murderer,
has been plundered or wounded. He thinks the apaitment
is crowded with demons and phantoms, and rapidly looks
after them. There are great tremors of the superior and in¬
ferior extremities, and hence the derivation of the name ol
the disease. The pulse is frequent and small, the face pale,
the tongue white, and there may be nausea or vomiting. Dr.
Armstrong observed that symptoms of prostration might set
in for ten days before the development of the disease, but
this was not observed by Dr. Pearson, nor in those cases
which I witnessed. The heat of the body is seldom inci eased ;
the attack is sudden; the strength remains, and thus it dif¬
fers from typhus. It is said that the disease may continue
for days or even weeks, but 1 doubt that to be the fact.

Dr. O’Reardon on Fever.

233

It generally terminates in sleep, and health on the third or
fourth day — or in death. Dr. Pearson recommended forty
minims of tinct. opii in wine or porter, and half the quan¬
tity every four or six hours, until sleep shall be procured.
In one of the cases which has fallen under my care, a quan¬
tity of opium, equal to 960 minims, was exhibited in seventy-
eight hours, without any effect, and tranquility, sleep and
health were restored by the administration of the usual sti¬
mulus. In another case to which 1 was called, the patient's
head was shaved, and a blister about to be applied, as he
was said to labour under typhus, though in perfect health two
days previously, but sleep soon followed the potation of his
ordinary beverage. I have seen four cases during this year,
two male and two female , and all very soon had sleep by the
use of the wonted stimulus. I do not recollect any writer
who has described the disease In females. The one was
about thirty years of age, the other sixty. It is highly im¬
proper to eoerce or contradict the patient, and he may be al¬
lowed to go into the open air, with one or two attendants, if
he wish it. Dr. Pearson allowed one of his patients to travel
fifteen miles, to reconcile his feelings to the innocence of a
murder ; he fell asleep three hours afterwards, and completely
recovered." Blisters and drastic purgatives are highly inju¬
rious in this disease. c* The impoverishing the system,*'
says Dr. Pearson, c< by bleeding, strait jacket, or abstinence
from invigorating remedies and diet must be highly injuri¬
ous." Mr. Blake thinks the prognosis unfavourable when
the pulse exceeds 100, but my experience enables me to form
an opposite opinion. Upon the whole I firmly believe the
exhibition of the ordinary stimulus, in repeated quantities,
is the most successful treatment of the disease in all its stages.

I shall describe the symptoms, causes, diagnosis, progno¬
sis and treatment of this disorder, in the next Number of this
Journal. ;

61, Hatton Garden, Aug. 25, 1829.

BIBLIOGRAPHY.

GENERAL REVIEW OF FOREIGN AND BRITISH MEDICAL JOURNALS.

1. Medical Report of the House of Recovery and Fever Hospital ,
Cork street, Dublin. By John O’Reardon, M.D. — The divisions
of fever designated in our classic medical works by the appella¬
tions of synocha, synochus, typhus mitior, typhus gravior or pu-
tridus, febris biliosa, febris nervosa, and febris maligna $ and
and which Pinel terms Fi&vre anquiotenique ou inflammatoire,
Fi&vre meningo gastrique ou bilieuse, Fievre adenomeningee ou
muqueuse, Fibvre adynamique ou putride, Fievre ataxique ou ma-
ligne : all these divisions are, I venture to say, mere variations of
vol. in. no. 15. h2

234

Bibliography.

one genus, that is, of the above-described general sub-inflamma-
tory condition, constituting fever: varieties produced by the diet,,
occupation, locality, temperament, habit of body, state of mind7
or nervous condition of the patient ; or by an alteration in his
biliary or other secretions, or by the period of the fever, or its
treatment, or by the season of the year, the climate, or constitution
of the atmosphere .

I must likewise include, as species belonging to the fore-mention¬
ed genus, the Peripneumonia biliosa, Peripneumonia putrida, Perip¬
neumonia maligna, Catarrhus biliosus, Catarrhus putridns, Ca-
tarrhus malignus, of some authors j as, in tracing the histories of
these diseases in the works of some of the physicians who record
them, I find them to be the ordinary kinds of fever, combined,
some with catarrh, some with pneumonia, and others with abdo¬
minal ailment.

The varieties of fever in different countries, and in different
parts of the same country, are principally to be set to the account
of diet, locality, air, and climate. The basis or general plan of
treatment ought, 1 conceive, to be similar in all countries ; save
that their varieties and changes demand corresponding modifica¬
tions in the treatment. In unfavourable situations, and very hot
oppressive climates, the progress of fever through its stages is
rapid, and must necessarily be met by appropriate activity, vigi¬
lance, and discernment.

The above view of fever, which in my mind is that of nature,
removes that obscurity and confusion which long prevailed, and
in some places still exists, in the management of fever. Though
comprehensive, it does not confound any diseases which are natu¬
rally separate. It admits and requires the utmost attention in dis¬
tinguishing the varieties and successive changes of fever, and in
discriminating the character of each disordered viscus. It indi¬
cates a rational, clear, effective, and tolerably uniform line of prac¬
tice in the treatment of fevers, and their manifold complications ;
a practice which the best modern physicians are, for these many
years back, gradually adopting, as if it were by common consent.

This practice consists mainly in the antiphlogistic plan of treat¬
ment, modified and varied according to circumstances, and espe¬
cially according to the character, grade, and period of the fever,
its complications, and the patient’s pulse and strength.

Bilious and hepatic symptoms are to be subdued by well-
known appropriate remedies, similar to those prescribed for the
hospital nurse, whose hepatic disease and recovery are noticed.
There are remedies which, so far from being opposed to, are, for
the greater part, in unison with, the fore-mentioned antiphlogistic
plan. This plan, based, it is presumed, on sound principles, is
extensive and varied in its application. It admits of the mildest
practice in mild cases, as well as of the most active and efficient
treatment in severe cases. It is suitable not only to the diseases
above mentioned, but is also applicable to the exanthemata, or
eruptive fevers, which require to be treated pretty much on the
same principle with common fever and its modifications 5 but, in

M. Broussais on Fever.

235

the exanthemata, we must be cautious to prevent the disappear¬
ance of the eruption before the proper period, and we must be
ready to obviate or remedy visceral determinations.

Under, these circumstances other indications arise, which call
forth the application of the whole medical mind. The methodus
antiphlogistica is to be employed not only in a very mitigated man¬
ner, but it must be combined with, and often superseded by,
antispasmodic, antinervous, diffusively- stimulating, and tonic re¬
medies. As, in the class of tonic medicines, cinchona holds a pro¬
minent station, I think it right to observe that this article is scarcely
ever useful, and is often injurious, in continued fever, during the
existence of a hot skin, a quick pulse, and a loaded tongue 3 cases
of gangrene excepted, where indeed the temperature is in general
any thing but high, and where cinchona, aided by camphorated
mixture, good wine, and a suitable position of the body, is an ex¬
tremely valuable curative agent. — Med. and Pliys. Journal.

2. Case of Gastro- enter o- cephalitis, attended with malignant symp¬
toms, and successfully treated. By M. Broussais. — The tenth vo¬
lume of the Annals of the Physiological Medicine contains a case of
typhus gravior by M. Broussais, which we have been tempted to
translate for the perusal of the British physician. It is every
way worthy of his serious consideration 3 a most violent form of
fever, attended with alarming symptoms, finally overcome by
means so simple, and, apparently, so inefficacious, as to astonish the
active practitioner. Could we have the courage to follow pari
passu the founder of the physiological medicine, and rely on simi¬
lar means in the treatment of our fatal forms of fever, there is rea¬
son to believe that we should less frequently have to deplore the
inefficacy of our art, and perhaps never the hurtful tendencies of
our remedies. Let the stimulators meditate on this case, and com¬
pare it with similar ones in their own hands.

The details might have been considerably abridged without de¬
triment, but I thought it better to give them in full 3 for the case
may be considered, as it regards the power of antiphlogistic treat¬
ment in these fevers, a specimen of many others scattered through
the volumes of that valuable Journal.

Henry Bethune, student of medicine, aged twenty years, of ple¬
thoric, robust and well constituted habit of body, has been occa¬
sionally subject to derangement of the digestive function, which he
usually treated with emetics. He has lived in Paris for the last
eighteen months, and had more frequent attacks of this complaint,
attended with violent headache, aggravated, no doubt, by his con¬
stant application to study. He had been for some days suffering
from this complaint, without however relinquishing his daily pur¬
suits, when on the 26th of February he took a walk with a friend,
during bad weather, beyond the city, and returned^to his lodgings
in the evening affected with fever.

The next day he was in the following state : tongue coated with
white fur, slightly red at the point and edges 3 mouth clammy,
anorexia, thirst, nausea, tenderness of the epigastrium, diarrhoea.

236 Bibliography.

pulse frequent, hard, and full, superorbital pain, sleep frequently
disturbed, contusive pains of the limbs. (Venesection 3 perfect
quietude ; abstinence 3 milk and water for drink.)

28th. Same state as yesterday, only the pulse is less tense, the
headache less violent.

March 1st. — The whole abdomen painful on pressure, flatulency,
borborygmi, with frequent liquid stools, pulse more frequent, not
so full, but harder, headache more violent 3 the patient could
scarcely support himself on his feet. An abundant epistaxis super¬
vened during the night, which sensibly relieved him. (Ten leeches
to the anus 3 emollient fomentations to the abdomen j gum water.)

2d.— The night was calmer than yesterday 3 a slight remission of
the symptoms.

3d. — Aggravation of the inflammatory symptoms 3 alvine dis¬
charges less frequent, tension of the abdomen 3 delirium during
the night.

4th. — M. Broussais is called to the patient. Redness of the
tongue more circumscribed, appetency for cold drinks, epigastrium
tumefied, tense, hot, and very painful 3 stools suppressed, urine
scanty and high coloured, with enoeorema 3 delirium at times fu¬
rious, subsultus tendinum ; pulse quick, small, and corded. (Fif¬
teen leeches to the epigastrium, five to each temple 3 refrigerant
applications to the head 3 gum-water for drink.)

5th. — Tongue dry, very red towards its point, covered with a
fuliginous coat, and the patient scarcely able to extend it beyond
the lips 3 breath foetid 3 sensible diminution of the pain and ten¬
sion of the epigastrium 3 hypogastrium now tense and painful,
borborygmi, discharges of foetid gas per anum, dysury, continu¬
ance of delirium, with loquacity alternating with muttering, car-
phology, subsultus tendinum, eyes haggard, hallucination, stupor,
continual efforts to uncover the extremities, pulse small and quick.
Towards night there succeeded to these symptoms a deep coma¬
tose state. (Six leeches to the hypogastrium 3 refrigerants to the
head.)

6th. — A very copious epistaxis came on about four in the morn¬
ing, preceded by heat and redness of the face 3 the hemorrhage
continued to flow during the day and following night. In conse¬
quence of this the patient gradually became more rational and col¬
lected 3 the countenance resumed its expression, the pulse rose,
became fuller and less frequent ; the tongue moister, and the hy¬
pogastrium more supple. (Emollient cataplasms to the abdomen 3
continuation of refrigerants to the head.)

7th. — Patient sensibly better. The tongue is less red, and its
sooty coating has disappeared 5 abdomen supple j urine sufficiently
abundant, free, and no longer high-coloured. He has had a co¬
pious alvine evacuation, very foetid, and as black as ink j (he had
swallowed a great quantity of blood 3) pulse less frequent and
hard 3 thirst very great. The arrival of the patient’s relatives
afforded him gratification, and he conversed with them composedly.
(Small enemata of cold water to be repeated two or three times in
the day 3 refrigerants to the head.)

M. Broussais on Fever.

23/

8th. — Prostration of strength, somnolency, intense thirst, desire
for cold drinks, (he asked for a piece of ice 3) abdomen has again
become painful and tense, no alvine discharges j urine abundant,
pulse again 100. (Refrigerants to the abdomen ; cold enemata.)

9th. — Same state as last evening. (Same prescription.)

10th. — Dryness of the throat 3 tongue fuliginous 3 greater ten¬
sion of the hypogastrium 3 bowels continue costive 5 frequent de¬
sire to pass urine j slight cough ; transitory delirium 3 continual
somnolency 3 eyes turned convulsively upward 3 subsultus tendi-
num. (Six leeches to the hypogastrium j emollient cataplasms to
the abdomen instead of the refrigerants.)

llth. — Abdomen nearly in'the same state 5 hardness in the left
iliac region, attributed to the distention of the sigmoid flexure of
the colon. The leech-bites surrounded with a livid areola j fre¬
quent desire to void urine, especially after drinking much 3 it is
pale and limpid 3 slight cough, pulse less frequent 3 somnolency.
(A small enema of cold water 3 emollient cataplasms to the abdo¬
men j acidulated barley-water for drink.)

12th. — Much the same as last evening. Skin dry with acrid
heat. (An oily enema given, which produced two scanty, foetid,
and black stools.)

13th. — -Copious stools during the night, of the same odour and
colour as the preceding ones. Face pale, bluish, especially about
the eyes j tongue, teeth, and lips covered with dark sordes 3 speech
difficult 3 abdomen swollen and tense 3 thirst less 3 urine scanty 3
pulse frequent and small 3 cough trifling 3 delirium transitory.
Cold applications to the abdomen.) Cough increased during the
night ; became very harassing, and without expectoration 3 respi¬
ration frequent 3 cheeks flushed 3 delirium constant 3 pulse very
frequent, small and corded 3 thirst very intense. (Twelve leeches
over the lower part of the sternum 5 emollients to the abdomen
and chest, instead of refrigerants.)

14th. — Cough and disordered respiration nearly ceased 5 face
flushed instead of being pale ; pulse less frequent and fuller 3
tongue cleaning off j thirst abated ,• speech freer 3 abdomen less
tense 5 urine not so abundant ; stools less copious j delirium tran¬
sitory 3 the patient asks for food. The subsultus tendinum con¬
tinues. {Emollient enema 3 emollient fomentations to the ab¬
domen.)

15th. — Complexion clearer} expression of the countenance more
natural j great desire for food ; he talks only of eating 5 the sordes
on the tongue and lips has nearly disappeared 3 he can put out his
tongue with facility ; abdomen supple, except in the right i n c
region 3 has had two stools during the night j pulseless frequent,
cough has ceased 3 delirium very slight. (Same prescription.)

16th.— Exacerbation during the night 3 delirium, agitation, sub¬
sultus tendinum 5 pulse frequent and fuller 3 cough, with quick¬
ened respiration 3 tongue and lips again covered with sordes 3
speeeh embarrassed ; thirst more moderate 3 the patient talks
Continually about eating 3 abdomen swollen and tense, especially in
the hypogastric region 3 costive 3 discharge of urine scanty and

238

Bibliography.

involuntary. (Twelve leeches to the hypogastrium during the exa¬
cerbation ; emollient fomentations ; enemata.)

17th. — Great prostration of strength ; face pale and dingy ; eyes
dull and sunken ; cheeks and temples hollow ; deep stupor ; lies
immoveable on his back, with constant tendency to slide down in
the bed ; arms perfectly relaxed and powerless ; takes no notice
of any thing 5 the organs of sense greatly blunted; continual
moaning; lips, teeth, and tongue dry, and covered with brown
sordes ; deglutition difficult ; refuses drink, which seems to pass
into the stomach mechanically ; cough ; respiration at times la¬
borious ; pulse frequent, small, and impeded ; heat diminished ;
abdomen sunken and flaccid ; involuntary discharges or urine ; the
body exales a strong odour of mice ; costive. (Sinapisms to the
legs ; gum-water, with a sixth part of milk for drink.)

18th. — The patient scarcely moves his legs ; the sinapisms,
though very irritating, have produced but slight redness ; pulse
almost insensible, but frequent ; cough continues ; chest sono¬
rous ; respiration slow and easy ; the patient is roused from his
stupor with difficulty ;, abdomen greatly sunken. (Sinapisms.)

19th. — Stupor and drowsiness less profound ; the patient recog¬
nises those about him, and answers tardily but distinctly to ques¬
tions ; deglutition better 3 pulse fuller and less frequent ; cough
moderated, and attended with expectoration ; voluntary discharge
of urine ; patient lays on his side ; the surface of the body uni¬
formly warm. (Gum-water with milk and rice-water, for drink.)

20th. — The night has been calm, as well as the greater part of
this day ; an exacerbation at night ; cheeks flushed ; tongue dry
and coated ; cough more urgent ; pulse frequent and full ; heat
augmented ; urine discharged involuntarily ; lies on his side ; a
large eschar has taken place over the sacrum. (Diluted gum-water
for drink; emollient enemata.)

21st. — Towards morning the somnolency ceased, and the pa¬
tient became rational ; thirst great; desire for food ; tongue moist
and cleaning off ; cough slight ; pulseless frequent. Great pros¬
tration of strength with emaciation ; urine discharged voluntarily;
bowels so torpid that the enemata are not discharged. At night
a similar exacerbation as the preceding day, with obstinate drowsi¬
ness, taciturnity, stupor, moaning, cough, subsultus tendinum ;
frequent and small pulse ; involuntary discharge of urine ; lies im»
moveable in supination. (Sinapisms; enemata; gum-water.)

22d. — During the day the same state as last night ; sinapisms
have produced no effect ; exacerbation at night. (Same pre¬
scription.) '

23d. — Same as yesterday ; at night the cough is more frequent ;
the patient seems gay and talks much ; continued emaciation ; a
copious stool obtained by an enema.

24th. — Nothing particular ; exacerbation at night. (Gum-water
for drink ; enemata.)

25th.- — Cough very frequent ; respiration accelerated ; surface
of the chest hot ; cheeks flushed ; pulse frequent ; delirium ; agi¬
tation ; refuses drink; breath foetid; urine discharged involun-

Claims of M. Civiale. the invention of Lithotrity . 239

tarily ; he continually uncovers himself, and complains of a weight
on his chest, which threatens, to suffocate him. (Emulsion for
cough ; enema ; cataplasm over the chest.)

26th. — Patient much agitated during the night ; cough fre¬
quent, and constant delirium; more calm in the morning; less
pulmonary affection ; a desire to void urine. (Emulsion ; ene-
mata ; tepid drinks.)

27tli. — Same state 5 remission during the day; exacerbation at
night. (Same prescription.)

28th. — Nothing particular ; cough relieved ; pulse soft but fre¬
quent ; the excretions very foetid, especially at night; patient con¬
tinually uncovers himself ; complains of the least weight on the
abdomen ; talks continually about eating and returning home ; de¬
lirium constant even during the day.

29th, 30th, 31st. — Same state. (Enemata.)

April 1st.' — Cough trifling ; pulse frequent, and tongue dry dur¬
ing the exacerbation ; no thirst ; great desire for food ; bowels
opened ; urine scanty and high-coloured. (Enemata ; small
quantity of decoction of arrow-root.)

2d. — Cough increased; pulse frequent ; skin hot ; cheeks flush¬
ed ; delirium aggravated ; urine suppressed ; bowels costive. — -
(Calming potion ; gum- water ; enemata.)

3d and 4th. — Cough trifling; pulse soft and small in the day ;
frequent at night ; also at this time tongue dry, and speech em¬
barrassed ; progressive emaciation ; eschar over the sacrum de¬
taching with abundant suppuration ; great desire for food; sleep
at night ; urine turbid and scanty ; less foetor of exeretions. — *
(Starch enemata ; arrow-root.)

5th, 6th, 7th, 8th. — Cough ceased ; pulse still frequent, from
90 to 95 ; emaciation extreme ; tongue coated and dry; no thirst ;
urine scanty and turbid ; lips red ; senses of sight and hearing
morbidly acute ; great desire for food ; the enemata have brought
away a small quantity of hardened faeces ; eschar detached ; the
surrounding parts inflamed, and very painful ; hips and elbows on
the point of ulcerating ; a phlegmon in the integuments of the
hypogastrium. (Enemata ; gruel, rice-cream, vegetable broth.)

9th, 10th. — Pulse not nearly so frequent; tongue moist and
clean ; speech natural ; rational ; moderate discharge from ulcer
on the sacrum ; phlegmon on abdomen opened. (Rice-cream ;
diluted milk ; small quantity of animal broth.) — From this time the
food was gradually made more nourishing, and the patient gained
sufficient strength to leave his chamber in a month, and finally re¬
covered his original health and strength, with the loss of his hair.— -
American Journal.

3. Claims of M. Civiale to the Invention of Lithotrity. By W. B*
Costello, Esq. Jermyn Street. — I have read with great and painful
surprise, a series of statements, reflecting in very unmeasured
language, on the pretensions of Dr. Civiale as a scientific man and
a moral character. I regret, exceedingly, that one gentleman
should have spoken so inconsiderately of another, and particularly

240

Bibliography.

of one who has merited so well, not only of his country and of his
age, but of the entire human family. From the long and intimate
relation in which I have had the honour of standing towards that
truly meritorious individual, having participated in the long series
of his brilliant operations, I feel bound, as well in justice as in
gratitude, to defend him from unmerited aspersion.

For the credit of M. Heurteloup, I could have wished, most sin¬
cerely, that he had rested for fame upon his own merits, and not
deemed it necessary, as an element of success, to impugn the
rights of Dr. Civiale, as the author and inventor of the operation
and instrument employed for lithotrity ; nay, more, I would fain
persuade myself that most of the inaccuracies of which I com¬
plain, have glided into print, between M. Heurteloup’s ignorance of
our language, and misapprehension on the part of your reporter,
else how could it have been stated that M. Civiale was indebted to
M. Le Roy (d’Etiolles) for the model of his instrument, or that he
had possessed himself of it surreptitiously ?

The article states that, five years ago, M. Heurteloup, indignant
at Civiale’s conduct towards M. Le Roy, first turned his attention
to lithotrity ; yet M. Heurteloup’s indignation did not, at the pe¬
riod he mentions, prevent him from inserting in the Archives Gene¬
rates, May 1824, a highly laudatory article, in which he thus ex¬
presses himself : — “The foregoing is a rapid expose of M. Civiale’s
method. . . . For my own part, hurried away by my enthusiasm at
the splendid results which M. Civiale has obtained from the re¬
searches in which he has been engaged since 1817, I have, &c.”
M. Heurteloup concludes this article by adopting the words of the
report to the Academy of Sciences, which are, “ We are of opinion
that the new method proposed by Dr. Civiale, for destroying the
stone in the bladder, without having recourse to the cutting ope¬
ration, is alike glorious for French surgery, honourable for its
author, and consoling for humanity.”

The facts of the case are as follows : —

M. Civiale, who had been previously occupied in constructing
instruments for the destruction of calculus in the bladder, ad¬
dressed in June, 1818, a memoir to the minister of the interior, de¬
manding an advance of money, to enable him to execute instru¬
ments of his own invention, for destroying stone in the bladder
without cutting. This memoir was transmitted a few days after¬
wards, under the No. 20,639, to a commission of the Faculty of
Medicine, with explanatory drawings. M. Civiale was immedi¬
ately informed by the minister of this proceeding, and on the 14h
of the same month, the Barons Chaussier and Percy were ap¬
pointed to report on the same. The instrument, even then, was
called a lithontriptor, and was executed the following year by an
artisan of Paris, with modifications and improvements, so as to re¬
semble, very closely, the instrument now in use. The reporters,
in 1824, place this fact beyond question, by the following expres¬
sion : — “ Thus we can trace back to four or five years the exist¬
ence of this method.’’

At what time, it will be asked, did M. Le Roy publish his lithon-

Claims of M. Civiale to the Invention of Lithotrity. 241

triptic instrument ? In 1822, a month after M. Amussat had shown
the possibility of effacing the curvatures of the urethra — a fact
which M. Le Roy affirms was the ground-work of his inventive
efforts, and of which he was ignorant (as he states himself) until
M. Amussat proclaimed it. Now the Egyptians seem to have
been aware of the fact 5 the Romans knew it \ it was taught by
Rameau, Lieutaud, and Santarelli, of Rome, in the last century,
and in the present it had been demonstrated by Lassus, Montagu,
Gruithuisen, Elderton, of Northampton, (I believe) and by Civiale.

From what precedes, it is evident that four years at least, inter¬
vened between the presentation of M. Civiale’s memoir, and the
publication of M. Le Roy’s instrument. The principal difference
between the inventions of these gentlemen was, that instead of
elastic branches, M. Le Roy proposed watch-springs for seizing
and fixing the stone in the bladder. Rut the application of this
instrument was impossible ; and so convinced was M. Le Roy
himself on this point, that he soon after substituted for the watch
springs, a branch pincers resembling that of M. Civiale. It is,
however, important to remark that this change of M. Le Roy’s in¬
strument, was not made till M. Civiale’s method and operations
were generally known. A passage from Baron Percy’s letter to
M. Le Roy on this subject, and published by the latter, places this
point beyond the reach of cavilling. “ I have in my possession,”
writes Baron Percy, “one of the little watch-springs, for which
you have substituted the pincers of Franco’s relation ; you let it
drop in my room when you came to show me your instruments,
with which, assuredly, you could not have performed one of those
brilliant operations of which M. Civiale made us witnesses.”

This change, however, was not a fortunate one for M. Le Roy j
for the extremities of the branches not being sufficiently curved,
it was scarcely possible to avoid pinching the bladder, in the at¬
tempt to seize the stone , and, accordingly, M. Le Roy informs
us that this accident happened in the case of a woman, upon
whom he made the first application of his instrument, in April,
1824. He tells us, “ he could not seize the stone ; that the bladder
was pinched ; that there was great difficulty to withdraw the in¬
strument ; that the patient afterwards submitted to be cut, and
that she died.” (See Page 149 of his work.)

We may now infer which of these gentlemen copied from the
other : but this is not the only fact connected with the imitation
of Civiale’s instrument. . .

M. Civiale’s first instruments had no provision for preventing
the water injected into the bladder, from flowing out during the
operation. His experiments on living animals pointed out the ne¬
cessity of remedying this defect. The same defect existed in M.
Le Roy’s instrument, to correct which he again copies from Ci¬
viale.

M. Le Roy himself could not shut his eyes to the evidence of M.
Civiale’s claims ; he avowed that he had previously assured him¬
self, by reading M. Civiale’s memoir, that M. Civiale had proposed
in 1818, a pincers with elastic branches, for seizing the stone, and

VOL. 111. no. 15. 2 1

242

Bibliography .

a stilette or perforator to reduce it. Such an avowal places M. Le
Roy in a very awkward predicament.

Now I put it to any honest man, on the facts I have stated, to
say whieh of those gentlemen is guilty of the plagiary ? Whose
is the invention of lithotrity 1 Where now are the grounds of M.
Heurteloup's indignation ?

It should not be overlooked, that the commissaries, Barons
Chaussier and Percy, who drew up their report in 1S24, were the
same who had been appointed to report on his memoir in 1818.
These honourable men did not hesitate to speak of this method as
Civiale’s, or to say that M. Civiale “ had arrived the first.”

Touching the prizes awarded by the Academy of Sciences, the
facts are as follows : — In 1824, the Academy adopted the report,
in which M. Civiale’s claims are judged. In 1825, the Academy
promised prizes for the most favourable results of lithotrity. In
1826, the Academy, not judging the moment favourable for the
distribution of prizes, distributed titles of encouragement only,
awarding to Dr. Civiale 6000 francs, and to M. J. Le Roy d’Eti-
olles, 2000 francs. In 1827, the Academy granted 10,000 francs
to M. Civiale, and a medal of encouragement to M. Le Roy, of the
value of 2000 francs. In 1828, Baron Heurteloup obtained a prize
for improvements in the instruments, on condition of his publish¬
ing his instruments together with the cases in which they had been
employed. He has not complied with this condition, and conse¬
quently, as I have been informed, the prize is in abeyance. And
here let me add, that it is incorrect to say, that the title of Baron
was conferred on him, for his merit as an operator for the stone.
This title descends from M. Heurteloup’s late father, on whom it
was conferred by Buonaparte. The only title conferred by the
French sovereign for merit as a lithotritist, was that of Knight of
the Legion of Honour on M. Civiale.

I fear I have trespassed too largely upon your columns. The
defence of Dr. Civiale has led me very far, and yet an important
part of my subject still remains.

1st. It is incorrect to state, that perforation is had recourse to,
for the destruction of small stones. When stones do not exceed
the size of a hazel nut, they are crushed at once by the united
pressure of the perforator and the claws. As to the entanglement
of the claws with the three-branch instrument, I have never seen
it happen, and I believe 1 am warranted in saying, that if such an
accident were likely to occur, 1 should have seen it. It is, how¬
ever, matter of notoriety, that this accident has happened to Pro¬
fessor Lallement, of Montpellier, whose dexterity in operating is
well known, with M. Heurteloup’ s four branch instrument. The
details of the case have been published by M. Lallement.

2d. The instrument a virgule, is far inferior to the perforator
shown last year in this country, by my friend. Dr. Pecchioli., It
is applicable to only about an eighth of the calculous patients* sus¬
ceptible of cure by this method. It is too weak for safe use in
ordinary cases.

3d. The value of the four branch pincers is exemplified by Pro-

Claims of M. Civiale to the Invention of Lithotrity. 243

Fessor Lallement’s case. The objections to it may form the sub¬
ject of a subsequent observation. The pince a forceps , formerly
called the pince servante, which comes in for so much admiration,
consists of nineteen pieces. Civiale’s instrument may not, from
its simplicity, stand so high in the estimation of some people, as
it consists only of six pieces.

4th. The brise coque was, no doubt, necessary to complete the
ensemble of the theory. I shall only make one observation on this
instrument. If the three branch instrument adapts itself without the
necessity of perforation, to fragments or small calculi, what is to be¬
come of the brise coque ? Of course it must share the fate of all the
brise coques that have gone before it, not excepting even Dr. Civiale’s.

The sense of the profession in France is shown in the simple
fact, that in March last, when Professor Baron Dubois, whose
character is sufficiently known in this country, was to be operated
upon for the stone, he gave the preference to Civiale and his simple
instruments, and when his cure was effected, he addressed, through
the medium of the medical and literary journals, a most flattering-
letter to the Professor, and in which he speaks of the operation as
one “ to which M. Civiale has irrevocably attached his name.”

The foregoing observations would never have been submitted to
the public, if the writer alone had been concerned ; but when a
man, whose talents have been of such eminent utility to science
and mankind generally, was so unfairly stigmatised as a charlatan,
it became the duty of one who has had so many opportunities of
judging of Civiale’s skill, to set the public right upon the subject,
and defend his character from unjust attacks. — Lancet.

4. Extirpation of a part of a Cancerous Mamma, one large artery
supplying the part : torsion of this vessel , immediate suspension of he¬
morrhage, re-union by the first intention. Hospital Beaujon. — Mar-
jolin and Blandin, Surgeons. — The frequent occurrence of phlebitis
after the ligation of arteries, and its fatal consequences, have sti¬
mulated our Gallic brethren to endeavour to obviate this great de¬
fect, and, accordingly, to improve what they term the hemostatic
science. MM. Thierry and Amussat have proposed to refrain from
tying arteries, but to restrain hemorrhage by torsion or twisting
the divided extremities of arteries. Experiments on animals af¬
forded satisfactory results, and M. Amussat has cited two success¬
ful cases in the human subject. He has operated on small arte¬
ries, and read a paper on the subject before the section of surgery,
on the 23d of July; in which he maintains the following opin¬
ions : 1. that the effect of torsion, or twisting, are the same on
arteries and on veins j 2. that torsion on large arteries, ought to
consist of ten half turns ; 3. twenty half turns will effect the com¬
plete rupture of the artery ; 4. after the complete or incomplete
section of the artery; the torsion ought to be made twice $ 5, after
proper torsion there is no fear of consecutive hemorrhage 5 6. the
torsion is equally effectual on the vessels of a dead body $ 7. if the
artery be ossified, it produces a rupture of it 5 8. if water be inject¬
ed through the trunk of an artery, on which torsion has been made,
the fluid will not escape at the extremity thus secured ; 9. the tor-

244

Bibliography.

sion offers all the advantages and none of the inconveniences of
ligatures, is less painful, as easy, not so tedious, and requires no
assistant j it may be applied in all cases, to varices, aneurisms,
wounds. MM. Larrey, Lisfranc, Begin, consider torsion not pre¬
ferable to the ligature, and exposes the patient to consecutive he¬
morrhage. The case which we relate is therefore worthy of se¬
rious attention.

A female, aged forty- five, was admitted into the Hospital Beau-
jon, July 24, in consequence of a tumour of the left breast. She
had ceased to menstruate for some years, but her general health
was good. About eighteen months since, she perceived the aug¬
mentation of the affected part accompanied with lancinating pain.
The external half of the breast is the seat of a bilobated, indurated
tumour adherent to the skin, especially at the inferior part j the in¬
teguments superiorly are unchanged, but inferiorly they are the
seat of three tubercles of a reddish colour, and continuous with the
deep seated tumour. The diseased part is moveable, there is no
affection in the axilla ; the general health is good. The operation
was performed on the 28th, and there was nothing unusual, unless
that a large artery supplied the tumour superiorly, which was
seized by a forceps (une pincej and twisted four times ; the hemor¬
rhage was arrested, the wound was united by agglutinative band¬
ages. The artery was the size of a raven’s quill. The forceps
used was that employed by watchmakers, which M. Blandin, who
reports the case, thinks better than that proposed by M. Thierry. —
Journ. Hebd. Aout.

We shall report the remaining history of this case, should any
untoward accident occur. — Ed.

5. On the good effects of Tartarized Antimony in solution , as an exter¬
nal application. By M. Fontaneilles.— M. Fontaneilles read a memoir
on the external application of tartarized antimony, before the Royal
Academy of Medicine, in 1813, and has since employed it in seve¬
ral cases. He recommends it as a local application in solution, in
the proportion of 5i to Oj of warm water. He applies compresses
imbibed in this solution to inflamed parts, but if the disease run
high he recommends the usual antiphlogistic treatment at the
same time. Even in abrasions of the inflamed surface he has
found it very useful, and he has seen it a good application to
wounds, but in a weaker proportion. This remedy is not benefi¬
cial in all inflammations, in some it is injurious, in incipient gan¬
grene, anthrax. It is valuable in cutaneous and internal inflam¬
mations. He has seen it beneficial when applied to the forehead
in cases of cephalalgia, to the chest in peripneumonia, and to the
abdomen in acute inflammation of the several organs contained in
that cavity, especially in those of the digestive tube, liver, spleen,
and urinary organs, in chronic diarrhoea and dysentery. He has
used it in cases of pruritus dartres, and lumbago. — Rev . Med.
Sciences, t. 2, 453.

6. Operations for New Lip and Nose. — Case I. A. Cowan, aged

orty-two. About six years ago a small ulcer appeared upon the

245

Operation for New Lip and Nose

under lip, accompanied by lancinating pain, and induration of the
adjacent parts. A shepherd applied to the sore a plaster, said to
be composed of acrid vegetable matter. This had the effect of de¬
stroying completely the whole under lip.

When admitted, on May 9th, under the care of Mr Liston, the
ulceration had ceased, and the parts were cicatrized. The patient
wore a leather bag under his chin to collect the saliva, the flow of
which caused great inconvenience ; his speech was also indistinct.

May 10th. — To-day a new lip was formed $ a piece of leather of
the size and shape of the under lip, was placed under the chin, and
a corresponding portion of the integuments was reflected upwards,
a considerable attachment being preserved. The cicatrix was re¬
moved by the knife, and the flap having been twisted round, was
adapted to the edges of the wound, and retained by six interrupted
sutures. A considerable quantity of tartar, which thickly coated
the teeth, had been previously removed.

May 16th. — The sutures have been withdrawn.

May 20th. — The flap is adherent, though somewhat swollen and
oedematous, and is supported by a compress and bandage. The
wound under the chin is cicatrizing rapidly.

June 6th. — The flap has firmly united, excepting immediately
above the attachment, at which point a probe can be readily passed
beneath it.

June 7th. — A bistoury having been introduced beneath the non¬
adhering point of the flap, was carried downwards, so as to divide
the attachment, which was then removed by a second incision.
The lower part of the flap was laid close to the chin, and retained
by a bandage.

June 20th. — The whole of the flap is firmly adherent, but is still
rather tumid. The wound under the chin is almost completely ci¬
catrized.

June 21st. — The edges of the flap, which were non-adherent in
consequence of the hairs on their surface being twisted inwards,
were pared, and a firm compress and bandage applied.

July 8th. — The wound has wholly cicatrized. The patient
speaks distinctly, retains his saliva, and his countenance is much
improved. Dismissed cured.

Case II. — E. Hamilton, aged forty-four. Three years ago a
swelling appeared on the upper part of the left side of the nose,
attended with acute pain ; a small abscess formed and was laid
open, and an irregular portion of bone, of the size of the point of
the fore finger (probably the nasal process of the superior maxillary
bone), was discharged from the abscess six months afterwards.
Two years ago she was put under the influence of mercury, with¬
out benefit.

May 30th, was admitted under the care of Mr. Liston, with an
opening the size of a shilling on upper and left side of nose, com¬
municating with the cavity of the nostril. The callous edges of
the aperture were removed with the knife ; a portion of integu¬
ment was reflected from the forehead, twisted round, and attached
by sutures to the edges of the wound, so as completely to occupy

246

Bibliography.

the aperture. The edges of the wound on the forehead were ap¬
proximated by three interrupted sutures.

July 1st. — Since the operation a firm compress and bandage has
been applied to the flap, which still continues slightly oedematous.
The wound has completely cicatrized.

July 4th. — She is now an out-patient.' — Med. Gazette.

7. Ncevus maiernus , cured by Vaccination. — Catherine Strathern,
eight months old, was brought to the hospital in the month of
September, having ansevus on the lower part of the forehead, half
an inch above the left inner canthus. It was as large as a hazel
nut, and of a dark red colour. It was observed at birth, and was
then quite level with the surface. After a month it became ele¬
vated. Having never been vaccinated, fresh lymph was inserted,
by minute punctures, both around the circumference and over the
whole extent of the tumour. On the eighth day many small pus¬
tules were visible, and by the twelfth they had coalesced, and be¬
come incrusted. On the twenty first, the scab separated, leaving
the surface underneath tender and slightly prominent. A second
crust succeeded, and to this a third and a fourth ; a perfect cure
being effected in about six weeks.

I perfectly agree with those who have made trial of this prac¬
tice, that it is indispensable to the ultimate success of the case,
that the lymph should be freely introduced over the diseased sur¬
face, as well as around its circumference. In this way, the adhe¬
sive inflammation which is excited appears to extend from one pus¬
tule to another, and in the course of a few days the whole becomes
involved in one scab.

8. Precocious Menstruation . — A case of this kind is related in
the third number of Meckel's Archiv.fur Anat . und Physiologie for
1827.' At birth this child was of an ordinary size ; but after the
first month she commenced to grow rapidly, and at nine months
was of the usual size of a child of a year and a half old. About
this time she passed from the vagina some drops of blood ; at
eleven months of age she had another and more abundant sangui¬
neous discharge, and at the same time the mammary glands began
to be developed, and hairs appeared on the mons veneris. At four¬
teen months she had a third, and at eighteen months a fourth san¬
guineous evacuation from the vagina. The whole physical deve¬
lopment of the child is precocious ; but her mental faculties are
not greater than those of other children of her age. She appears
to have no desire for sexual intercourse.

9. Absorption of the Placenta. — Dr. C. F. Naegele, Professor of
Midwifery in the University of Heidelberg, has published in Fro -
riep's Notizan some cases which seem to shew that the placenta,
when retained after the delivery of the child, is sometimes absorb¬
ed by the uterus. In 1802, Dr. Naegele was called to a lady,
who, in conseqence probably of fatigue, “ was brought to bed be¬
tween the twenty-fourth and twenty-sixth week of her pregnancy;
the child lived several hours after birth ; little hemorrhage followed,
but the placenta did not come away. The cord, which was very

247

Absorption of the Placenta.

thin, had been torn off at its insertion, as far as could be judged
from the length of it. The midwife, who was an experienced as
well as a highly respectable person, informed me that it had oc¬
curred as she passed her finger along the cord to ascertain whe¬
ther the after- birth were already separated 5 and assured me that
she had not exerted too much force in endeavouring to extract it,
in which account the bystanders also agreed. The lady and her
friends were under considerable alarm on account of the placenta
not .coming away ; and the midwife, who suffered not less anxiety
for her patient, scarcely quitted the bedside for the first nine days,
and even passed the night in her room, so that the case was watch¬
ed with the greatest attention. The lochia, which was sparing and
devoid of fetor, and with scarcely any coagula of blood, lasted only
four days. A slight attack of fever was experienced twenty-four
hours after delivery, unattended, however, with any pain of the
abdomen. The breasts did not swell, the menstruation returned
in eleven weeks, and in about three years after she bore a child at
the full period of pregnancy.

In another case, in 1811, where abortion had occurred be¬
tween the fourteenth and fifteenth week, from no assignable cause,
and with scarcely any hemorrhage and which I had an opportu¬
nity of observing with the greatest accuracy, the secundines did
not come away ; a febrile attack came on upon the third day,
which soon disappeared ; no local pain, no discharge from the parts
of generation ; the menses returned after nine weeks, and no traces
of the placenta, &c. ever appeared.

An experienced accoucheur of this place, (Dr. Gotzenberger)
has had the opportunity of attentively observing two cases of this
kind, and assured me positively that he was perfectly convinced
that no trace of the placenta had been detected, either in a solid
or in a partly dissolved state.

This circumstance having interested Dr. Naegele considerably,
he has, he says, endeavoured, of late years, to excite the attention
of several of his professional friends, and at various times has re¬
ceived from them accounts confirming the truth of his observa¬
tions, “ both in cases of premature labour, where the placenta had
been retained, as also of labour at the full term of pregnancy,
where large portions of it had remained attached, where no traces
of it either in a solid or half dissolved form had come away, and
this had occurred without any injurious consequences.”

Professor Sebastian, of Heidelberg, having lately returned from
a journey to Holland, has communicated to Dr. Naegele a most
interesting case which he received from the mouth of Dr. G. Sal¬
mon, of Leyden, where, after labour at the full period of preg¬
nancy, the whole placenta had been absorbed, and the case termi¬
nated successfully.

I am far from denying, says Dr. Naegele, the liability to decep¬
tion in cases of this sort, and am well aware how extremely difficult
it is form a correct opinion upon them. A comparison of this
with processes of a similar nature, more especially with those that
are observed to take plaee in cases of extra-uterine pregnancy, and

248

Bibliography.

also in animals, and a more elaborate discussion of the subject in a
practical point of view, which has engaged my attention for some
time, has made me vary anxious to avail myself of the experi¬
ence of others who may enjoy more extensive means for observa¬
tion than myself.

10. Extraordinary length of the Umbilical Cord.. — Dr. Schneider of
Fulde relates an instance of the umbilical cord haying surrounded
the neck of an infant six times, and on unravelling it, the infant
was resuscitated. The cord measured five feet six inches in length.
— Siebold. Journ. fur Geburtsh.

11. Case in which the Infant cried previous to its complete expulsion
from the Generative Organs. By M. J. P. Ouvrard of Angers.
The object of the author is to describe the conclusions which may
be deduced from this and similar cases connected with medical
jurisprudence. In this case the infant’s head was expelled, when
the child cried and continued to do so for twenty-five minutes,
when it ceased from the strangulation caused by the external geni¬
tals, Fie disengaged the shoulders and put an end to delivery.
He drew blood from the umbilical cord, and soon afterwards res¬
piration was re-established. He tells us .that Dr. Schmidt has re¬
lated twenty- six, and Dr. Leandei* eight cases analogous to the
present; but every obstetrician has often met with such cases.
He argues that it is wrong to pronounce positively that a child
has lived because it has breathed. In cases of the kind under no¬
tice, the child must perish, unless the shoulders be delivered by
the hand, so that an innocent woman may have a dead infant,
without assistance, and be sent to the scaffold. ‘‘The pulmonary
examination and observations on the specific gravity of the lungs
can only establish one point, which is that the child has breathed.
The author labours under a mistake on this point, for the lungs
may be diseased and swim in water, a fact which has led the me¬
dical jurists of this country to place no reliance on the hydrostatic
test *. A child may breath in the uterus, yet be born dead. The
mere -fact of respiration does not establish life, though without the
establishment of that function, extra-uterine life is said not to take
place. — Meditations sur la Chir. Pratique.

12. Lntra-Uterine Respiration. — M. Le Saurage, of Caen, has com¬
municated the following fact to the Royal Academy of Sciences of
Paris. Two days before the delivery of a bitch, the cries of her
pups were distinctly heard at the distance of ten paces.— Rev. Med.

13. Extirpation of the entire Uterus. By M. Recamier, of the
Hotel Dieu. During the last month, M. Recamier extirpated
the whole uterus, by passing ligatures through the substance
of the organ, and using such traction as brought it down within
the vagina. No untoward accident occurred. On the 4th of Au¬
gust, M. Dupuytren entertained his auditory with an account of
this difficult operation which M. Recamier has first performed in

* Edin. Med. and Surg. Journ. 1826, v. 26. Ryan’s Manual of Midwifery,
1828, p. 303.

Venereal Sore on the Mamma .

249

France. “ This is one of the finest facts,” he says, te which en¬
riches French surgery. The number of women affected with cancer
of the uterus, is so great, that if half should die of the operation, it
is rendering a service to humanity to endeavour to preserve the
other half from certain death.” M. Dupuytren proposes to imitate
his colleague, and do himself the glory of assisting him at a future
occasion, and that he will not operate, but under his auspices. —
Lan. Fran.

It would have been well if these surgeons recollected the result
of the cases in which Dr. Blundell so dexterously operated in this
country during the last year. This operation, can, perhaps, never
be successful, because in cancer of the uterus, the adjacent parts
are affected, as was the case in the most successful of Dr. Blun¬
dell’s subjects — which destroyed the woman in a year afterwards.
Besides, the uterus may be enlarged to an immense size, and weigh
ten pounds, which of course would render the operation impracti¬
cable. Two women on whom M. Lisfranc performed amputation
of the uterus, during the last month died in a few hours afterwards.

The operation of complete extirpation is as horrible as it is im¬
practicable.

MONTHLY SYNOPSIS OF PRACTICAL MEDICINE.

- —

HOSPITAL REPORTS.

ST. THOMAS’S HOSPITAL.

1 . Venereal Sore on the Mamma , from Secondary Syphilis in the
Mouth of a Child at the Breast. — A woman, set. 40, applied at St.
Thomas’s Hospital, January 9th, 1829, having an elevated sore of
a suspicious character, nearly the size of a shilling, on the left
breast, to the right of nipple. Its surface was slightly excavated
in the centre 5 smooth, having no observable granulations 5 and
the discharge from it was small, thin, and bloody — there were
great pain and tenderness, and some hardness of its base. One of
the axillary glands was enlarged to the size of a chesnut. This,
the patient stated, had been the case for nearly six weeks, at
which distance of time she also said she first perceived the sore on
the breast. The latter, from her account of its nature when it
first appeared, and from the description she gave of its subsequent
mode of increase, which were exactly those of a primary syphilitic
ulcer, was believed to be such, and even its appearance alone
would have guaranteed such an opinion.

The patient attributed the origin of the ulcer to giving suck,
for some weeks before its first appearance, to the child of another
woman, who was known to have had the venereal disease — whe¬
ther at the time the infant was born, or whether it had been cured
in her before its birth, we could not distinctly ascertain, though it
would have been satisfactory to have known ; but we should sus¬
pect the former. The child, about six weeks after birth, had ulcers
of the mouth and blotches on the trunk, and when in this condi¬
tion, it was applied to the patient’s breast.

VOL. in, no. 15, 2 K

250

Synopsis of Practical Medicine .

The aspect of the sore being so decidedly specific, Mr. Green
thought the present a favourable opportunity to ascertain whe¬
ther a sore of this kind, viz. one primarily syphilitic, could be
produced by the local application of the matter of ulcers belong¬
ing to the secondary form of lues. This, he considered, might be
brought to the test of proof by waiting the result of the case,
without the interposition of the specific remedy. Some arg. nitr.
was applied to the ulcer, and aperient medicine, with pulv. ipec.
c. given internally.

February 5th. — The woman came to-day, having iritis of the left
eye, which came on about a week ago. The sore on the mamma
somewhat resembled a wart, there being no raw surface, and, con¬
sequently, no secretion from it. Its surface was smooth, as be¬
fore, and elevated abruptly — the hardened base remained. Caus¬
tic had been applied to it twice or three times. The ring round
the margin of the cornea was very distinct. The iris itself was
but little altered in colour, and exhibited no deposit. Calomel,
gr. ij. Opii, gr.ss. M. 2dis horis.

Gth. — Pain and redness of conjunctiva having increased, leeches
were applied.

9th. — Gums and mouth sore ; iris restored to colour and move-
able ; vascularity of conjunctiva much less. Has not taken the
medicine since the night before last, when she first felt her mouth
becoming sore j she then left it off of her own accord. The sore
of the mamma not so elevated, but its surface appears raw. Or¬
dered to resume the calomel and opium.

A few days after this period we again saw the woman. Very
slight remains of the iritis, as well as of the sore on the breast,
were then apparent. All the particulars of the case being consi¬
dered, together with the occurrence of iritis, little doubt was now
entertained of the specific nature of the sore.

I his, then, we believe to be an instance, wherein a primary sy¬
philitic ulcer had its origin from the matter of secondary lues
coming in contact with a sound and healthy skin — -it being in a
situation not obnoxious to that of a primary ulcer or chancre. —
Med.-Chir. Rev.

II. Inf animation of Cellular Coat of Vena Saphena Major. — John
Anderson, jet. 11 , admitted January 24, 1829, under Mr. Travers.
He has an irritable sore, in chiel superficial, at the base of the fifth
toe, on the dorsal surface. This has existed for a fortnight, being
produced by wearing a tight shoe, and has been much aggravated
by daily exercise. About the middle of metatarsus, an inflamed
line, an inch broad, commences, and extends upwards to the groin,
along the course or the saphena major. The redness is shining,
transparent, and indicates the inflammation to be of a passive
kind 5 it is more conspicuous, for a short space, in the middle of
the leg 3 it then becomes less so for a few inches above and below
the knee, but is very distinct in the thigh. The lower tier of in¬
guinal glands slightly enlarged and tender. The inflamed line is
hardened, and has a knotted feel. The boy’s aspect is unhealthy,
and evinces debility, otherwise his constitution is surprisingly

251

Ctyise of Hypertrophy of the Heart.

little disturbed. He describes the pain as severe, but we do not
think this arises entirely from the action going on in the inflamed
parts. He has experienced no chills, and has slept well at night.
He was placed immediately in bed, with the limb supported on
pillows. Twenty leeches to be applied along the part, and a dose
of jalap and calomel.

25th. — Has passed a tranquil night — redness and tenderness in
the course of the vein considerably diminished. Bowels open.
Rep. hirudines.

27th. — The redness remains only over the tibia — the parts are
not softer, but in the groin and throughout the entire line, for¬
merly so well marked, the tenderness is sensibly lessened. The
lobulated or knotted feel to the fingers is not so perceptible.

31st. — Inflammation has progressively subsided — there is some
tenderness still, and likewise induration in the course of the vein
and at the groin.

February 7th. Convalescent — hardness not removed.

11th. — Presented 3 the affected part being a little harder than na¬
tural. /

In Mr. Travers’ opinion, the external coat of the vein was alone
implicated, though, for obvious reasons, such could not be very
distinct. In this case, there was no oedema similar to that occur¬
ring in phlegmasia dolens. — Med.-Chir. Rev.

EDINBURGH ROYAL INFIRMARY

2. I. A Case of Extraordinary Hypertrophy of the Heart. —Jane
McLean, set. 20, admitted 12th May, 1829, under Dr. Duncan.

Symptoms on Admission. — Has a frequent and severe cough, at¬
tended with a profuse watery expectoration, tinged with blood.
The respiration becomes hurried and distressing, even to a sense
of suffocation, when she inclines to the horizontal posture. The
action of the heart is heard over a larger space of the surface of
the chest than natural, and the pulsations are stronger than natural.
Palpitations are excited by trifling causes, and are generally fol¬
lowed by a fit of coughing. Pulse 100, moderately full, rather re¬
sisting, and occasionally intermitting. Has severe headache, which
is aggravated very much by coughing 3 the face is very pale 3 has
general oedema 3 the bowels are open 5 the urine is scanty.

History of preceding Symptoms, &c. About two years ago, had
fever j after which, palpitations arose, and which palpitations have
since re-appeared on any exertion. About two months ago the
cough and difficulty of breathing commenced — since then, have
continued to increase in severity. The oedema and blood in sputa
were only noticed one month ago. She was in the infirmary last
winter, complaining of headache and palpitations, and was dis¬
missed somewhat relieved.

Symptoms and Treatment after Admission, fy. Antim. tartarizatq
gr. ij. Aquee font, gviij. Tinct. opii, 3jss. Syrupi, 3ss. M. capiat
yss. tertia quaque hor& ; habeat haustum anodynum hor& somni.

13th. Had a bad night 5 vomited 3 symptoms continue. Sumat
pul v. digitalis, gr. j. onmi hor& ad sextam vicem nisi supervenirit

252 Synopsis of Practical Medicine .

vomitus. If. Spt. setheris nitrosi, %ss. Syrupi, Jj. Aquae font.
Jvj. M. capiat ^ij- ter in die.

14th. Sickness was produced by three powders ; cough less
troublesome 5 the urine scanty; pulse 100, full and regular. Su-
mat tinct. scillse, guttas xij, ter dedie ex aqua font ; habeat pil.
hydrargyri j. omni mane, et intermittantur medicamenta heri pre-
scripta. It is unnecessary to pursue the diurnal details. She lin¬
gered till the 6th of June, when she expired.

Post Mortem Examination. — There is a general oedema, but not
to any great degree. The lower part of the right side of the chest
sounds duller than natural on percussion. On elevating the ster¬
num and cartilages of the ribs, the heart is seen to occupy a much
larger space than usual, reaching from about the second rib to be¬
tween the seventh and eighth. In each side of the chest there is
about ffejss. of serum, and in the abdomen about fbsiv. The dia¬
phragm is thrust more into the abdomen than natural, and, conse¬
quently, so is the liver. The lower parts of the right lung are
much diseased ; being of a dusky red or brown colour, and per¬
fectly hepatized : the other parts are not so much altered ; for
though they are firmer than natural, the areolar structure can still
be recognized, and they crepitate on pressure. The left lung is in
no particular so changed as the right lung ; but is of a greyish
white colour, approaching, according to Dr. Duncan, to the cha¬
racter of the grey hepatization ; it is likewise more filled with se¬
rum than natural. The heart weighed thirty-two ounces, that is,
twenty-two ounces more than the ordinary weight : and it was
seven inches in length and about five inches in breadth. The
fibrous and loose portion of the bag of the pericardium is, in this
case, in all places adherent to that thinner portion which closely
invests the heart itself. This adhesion between the two layers of
the pericardium is by means of a loose cellular tissue, which is in¬
filtrated with serum. The auriculo-ventricular valves are dis¬
eased ; more especially the mitral valve, which is thickened, con¬
tracted, and has some calcareous deposition on it. The pulmonary
veins are exceedingly small. The ascending, the transverse arch
of, and the descending, aorta are smaller in caliber, and have thin¬
ner coats than natural.

II. Laryngitis — Tracheotomy. Case 2. — Mary Taylor, set. 28,
admitted May 23d, at Two, p.m. under Dr. Duncan.

Symptoms on Admission. — Complains of pain in the larynx and
trachea, which is increased by external pressure. Inspiration is
extremely difficult, causing pain in the larynx, and producing a
loud croupy sound. Expiration is free; expectoration difficult;
sputa scanty and viscid. She has a harsh and painful cough ; and
very great anxiety expressed in the countenance. Pulse 100, and
smaller than natural. Skin is moist ; bowels are open. Has a
deep ulcer on the uvula, and a superficial one on the fauces.

History of preceding Symptoms , fyc. The ulcers on the uvula and
fauces have existed for seven months. At intervals since their ap¬
pearance she has been seized with difficult deglutition, and inspira¬
tion likewise has at times been difficult in some degree, but never

Laryngitis — Tracheotomy , 253

before tbe present attack has it been distressing. For the last
fortnight she has had a soreness about the fauces,, and deglutition
and inspiration during the same period, have been painful in some
degree \ but the extreme difficulty of breathing under which she
now labours, appeared only the day before her admission to the
infirmary. It came on suddenly, and quickly became aggravated
to its present intensity.

Symptoms and Treatment after Admission.- — In the evening the
symptoms became more aggravated. Applicentur hirudines, xij.
faucibus externis et postea cataplasmata, et IL Calornaelanos, gr. iv.
Pulv. antimonialis, gr. vi. gutt. statim. sumendus.

24th. Inspiration is much more difficult and painful 3 and, dur-
ring which, the soft parts above the clavicles are sucked in. She
has slept none 3 headache is very distressing ; expectoration diffi¬
cult 3 pulse 100, rather small 3 tongue moist 3 bowels open 3
countenance anxious 5 face flushed 3 voice nearly lost. Sulph.
cupri, gr. v. Aq. font, ^ij- solve et sumat statim j post emeticum
bibat aquae tepidae, ibj. 5 emetio finito admoveatur emplast. epispas-
tieum collo 3 et fy. Hydr. submur. gr.x. Opii, gr. ij. gutt, fiant pi-
lulae vj. sumat duas omni bihorio.

25th. — The dyspnoea was relieved for some time by the emetic,
but has since returned. She sits almost upright in the bed 3 and
inspiration is much more difficult, incomplete, and painful than it
was yesterday. The obstruction is referred by the patient dis¬
tinctly to the glottis. The face is flushed ; tbe eye-balls project 3
and there is almost perfect aphonia. The pulse intermitting. As
it was evident that tracheotomy would give the only remaining
chance of recovery to, the patient, its performance was decided on,
and immediately executed.

The Operation.- — Mr. Liston commenced by making a perpendi¬
cular cut of about an inch and a half in length through the integu¬
ments over the trachea, commencing below the cricoid cartilage 3
he then slit up two or three rings of the trachea, and introduced a
curved tracheal tube, of rather large caliber, which was fixed in its
situation by means of tape passed through the rings at the exter¬
nal end of the instrument, and tied round the patient’s neck. In¬
stantaneous relief was obtained by the operation 3 for after two or
three convulsive expirations, (caused by some drops of blood en¬
tering the trachea from the wound) she breathed with perfect ease.
She got an anodyne at bed hour, which was repeated for three
successive nights. A very large quantity of mucus was expecto¬
rated for the first three days after the. operation. The ulcers of
the uvula and fauces have healed by the application of nitrate of
silver 3 but with an almost complete destruction of the former
appendage. During the process of cure a thick piece of bone
came away, which some of the surgeons think to be an ossified
portion of the thyroid cartilage. A smaller tube has lately been
substituted for the one first introduced 3 the voice is much re¬
stored, and it is hoped that the artificial opening may soon be dis¬
pensed with, and the breathing established through the natural
passages'.-*- Med. -Chir. Rev.

254

Synopsis of Practical Medicine.

3. Remarks on a peculiar Class of Diseases, resembling Inf anima¬
tion of the Pleura , Peritoneum, and other Parts, which would not
bear depletion, and were cured by Calomel and Opium. By Mr. Geo.
Newstead.

We solicit the attention of our readers to the following state¬
ment. It will be read with interest, and probably with advantage,
by those who unsheath the lancet the moment that pain is felt in
the abdomen or chest. There has been some peculiar constitution
of the air, or rather of the earth, during the last few years, which
has induced a host of anomalous diseases, imitating inflammatory
affections, and leading to most injurious practice. Such practical
facts as the following are very valuable.

A number of cases have occurred in my practice, during the
last three or four years, which, with all the external characters of
active inflammation, have not been relieved by bleeding, and, in
fact, could not bear it to any great extent. The form chiefly as¬
sumed by the disease, when I first observed it, was that of pleu-
ritis. Cold chills or shivering — uneasiness in the back and limbs,
and frequently vomiting, were succeeded by very acute pain in the
side. The tongue had the appearance exhibited in typhus mitior —
the pulse was sometimes accelerated, but very often was not dis¬
turbed in the beginning — the secretion of urine was remarkably
scanty, very high-coloured, and deposited a thick sediment. It
sometimes terminated in three or four days with profuse sweats,
and sometimes in a week or ten days by expectoration, tinged often
with blood. The pain was so urgent, and the breathing so ob¬
structed, that I did not hesitate to use the lancet ; but the first
bleeding generally put me upon my guard. I was astonished at
the small quantity which commonly flowed before syncope was
produced, and also at the slight relief of pain, even where larger
abstractions could be borne. Cases like peritonitis began to occur,
and I then found, that wrhether the patient complained of the chest
or abdomen, the pain was not confined to one part. Upon ex¬
amining those complaining of the chest, there was great tender¬
ness to the touch there, (a circumstance I never remarked in in¬
flammation of the lungs or pleura), and not only there, but upon
the abdomen, and very often down the back ; and those who said
the pain was in the abdomen, were affected, in like manner, by
pressure on the chest and back, as well as the belly. In some,
even the arms and thighs were affected •, and whatever part was
touched, they shrunk like the subject of acute rheumatism upon
handling an inflamed joint. This diffused pain upon pressure, and
the diminished secretion of urine I fixed upon as the characte¬
ristic symptoms of the disease. Although the region of the kid¬
ney was usually pointed out as the seat of the most acute pain in
the abdominal disease, and the secretion of urine was so much dis¬
ordered, there was not that frequency of making water, and pain
in voiding small quantities, which mark nephritis. The state of
the bowels was various — frequently diarrhoea came on with green
stools, or a discharge of bloody mucus ; but, as calomel was freely
given, I attributed these symptoms to its use. One young man

Newstead’s Remarks on a Peculiar Class of Diseases. 255

however, before any medicine was given, had frequent discharges
from the bowels of a thin bloody serum, without tenesmus, and
totally different from any thing dysenteric. I observed some,
where the. chest was chiefly complained of, spit up the same kind
of serum, like bloody water. The stomach was often irritable
throughout the abdominal disorder, and a green fluid was occa¬
sionally discharged. I felt an awful responsibility at first, when I
dared to treat this complaint without, or with very little, deple¬
tion for patients themselves, identifying what they felt with what
they had heard of inflammation, would ask to be bled, but I was
alarmed by the exhaustion I had seen follow, and I never, except
in two cases, ventured upon more than one bleeding, trusting
afterwards to leeches, a dozen at a time. My reliance was upon
opium and calomel, or mercurial frictions. I was partly encou¬
raged to withhold the, lancet by the state of the pulse, which was
often not above 80, and natural to the feel, when the chest, back,
and abdomen could not be touched without agony, and even the
weight of the bed-clothes was irksome ; for although I am aware
that fatal inflammation of the bowels may exist without an acce¬
lerated pulse, I fancy that, commonly, it is when it proceeds from
some mechanical obstruction, and that in pure enteritis or peri¬
tonitis, there must be a quick pulse, though the feel may be va¬
riable. The pulse did not often continue in this state — it gene¬
rally got to be 100 or upwards after two or three days, when the
febrile disorder, which seemed to me to modify and give a pecu¬
liar character to the inflammatory symptoms, had time to develope
itself. My cautious practice has been successful. Out of a num¬
ber of persons afflicted in this way, I cannot say how many, but I
can readily bring forty to my memory ; three died. Two of these
had been freely bled, and the third was a woman seventy-eight
years of age. Within the last month I have treated two cases suc¬
cessfully, even without leeches. I will give you a daily report of
one of them.

Jane Cotham, aet sixty-one, July 7, 1S29.-— Attacked suddenly
after tea this afternoon with excruciating pain all over the abdo¬
men,. and vomiting. Eight o’clock, p. m. Complains of great pain
in the abdomen, which is very much increased upon pressure ; does
not mention pain elsewhere ; but, upon examination, the whole of
the left side of the chest, as high as the axilla, and the back, are
as tender to the touch as the abdomen ; pain came on suddenly,
but she has felt chilly and not very well all day has been uneasy
and stiff in her back and limbs two or three days ; has never been
subject to any spasmodic affection ; pulse 72, with a sinking feel j
tongue pretty natural ; bowels moved both yesterday and to-day.
(Warm bath •, two grains of opium immediately. Pulv. ipecac,
c. gr. x. Hydrarg. submur. gr. ij. cum dosi mist, salin. 4 tis horis
postea. Ol. ricini, ^j. primo mane. Rub the parts affected as
much as can be borne, with camphorated oil.

July 8th, ten o’clock, a. m. — Is easier. The pain on pres¬
sure continues, however, particularly acute on the left side of the
chest, and the right side of the abdomen j cannot take a full in-

256 Synopsis of Practical Medicine.

spiration ; lias no cough $ urine said to be very little in quantity ;
no stool ; has not yet taken the oil ; pulse 72, without any sink¬
ing ; tongue furred : ordered to take the oil and a black draught
every four hours after until the bowels are opened. — Eight o clock,
p. m. Opening medicine has not operated ; does not complain
much when she is still, but the whole of the abdomen is exqui¬
sitely tender to the touch, also both sides of the chest as high as
the arm-pits ; can bear pressure now upon the back ; pulse 65 ;
tongue a little moister ; urine in very small quantity, but nothing
particular in its appearance ; has vomited after taking an opening
draught — July 9th. Has been purged freely ; does not complain
of pain ; can bear pressure tolerably well upon the abdomen, ex¬
cepting the right side, which is still tender ; has a little tender¬
ness on the right side of the chest, but shrinks from the slighest
touch on the left side ; pulse 86 ; tongue loaded with a moist fur
jn the middle ; evidently febrile action ; has continued the ca¬
lomel and comp, powder of ipecac. — July 10th. Is easier ; has
slept well ; bears pressure on the abdomen without pain, but it
feels hard, and as if the muscles were spasmodically contracted ;
some soreness to the touch all over the chest. Pulse 80 ; gentle
diaphoresis ; urine exceedingly scanty, depositing a thick sedi¬
ment ; tongue rather improving; dry and foul in the middle;
bowels open ; has vomited repeatedly.

July 11th. — Severe gripings ; constant efforts to stool, but
evacuates only small quantities of very bloody mucus ; has passed,
however, during the night, a large quantity of dark green fecu¬
lent matter, mixed with scybala; no pain on pressing the abdo¬
men; a little still on touching the left side of the chest ; chalk
mixture, with tine, opii ; three grains of opium for a suppository.

July 12th. — The griping and tenesmus abated after a dose or
two of the mixture ; returned this morning with some discharge
of blood ; used the suppository, and has been quite easy since ; no
pain on pressure ; gums swelled and tender ; pulse 100 ; urine
still very scanty. Continue chalk mixture ; to take 5ss. ol. ricini
in the morning.

July 13th. — Has had an easy night ; castor oil has produced
three good motions ; mouth very sore ; pulse 86 ; tongue begin¬
ning to clean. Left off taking medicine.

July 19th. — Has been quite free from pain ; bowels regular.
Fast regaining her former health.

Two puerperal women have been severely attacked by the
disease. One had two dozen leeches, and the other only one dozen,
very ineffective ones. Calomel and opium were given, and the
bowels were opened once or twice with ol. ricini, combined with

ol. terebinth. 5ij. — Both recovered.’’

Remarks. — It will hardly be contended that the above were cases
of genuine inflammation. They were pleurodyne and enteralagia,
rather than pleuritis and enteritis. How far these complaints are
allied to the aguish or periodical affections, now^ so very preva¬
lent, maybe a question. As Howden, in East Yorkshire, is si¬
tuated near the banks of the Ouse, there is probably a source of

257

Dr. Hastings on the Use of the Stethoscope .

malaria in that district, which may help to account for the causes
of the diseases above described. We exhort our brethren to be
strictly on their guard against excessive and indiscriminate deple¬
tion during the present reigning constitution. — Med. Chir. Rev.

4. Observations on the Use of the Stethoscope in Affections of the
Lungs, fyc. By Charles Hastings, M.D. — “ Save me from my
friends,” is an adage which frequent experience confirms. In
medicine, more especially, we have numberless opportunities
of evincing its truth,- for no sooner is any new mode of treat¬
ment, or means of investigating disease, submitted to public con¬
sideration, than its indiscreet advocates keep within no ordinary
bounds of commendation of its value. Thus it often occurs,
that when more deliberate cultivators of the science put the im¬
provement to the test of experience, they are disappointed in its
success, and consign it to unmerited oblivion.

It is my opinion, that something of this kind has happened
with respect to the new method of diagnosis of diseases of the
chest. I cannot even exempt Laennec, the illustrious discoverer
of the stethoscope, from the imputation of attaching too much
importance to the information to be derived from this source.
He obviously inclines to rest his dependence on the results to
be derived from the use of auscultation and percussion, to the ex¬
clusion of the important aid to be procured from a diligent study
of the symptoms. If such a divorce of these helpmates to each
other were ever to happen, the discovery of the stethoscope would
become comparatively of no avail, for it is only by a proper con¬
sideration of the knowledge to be procured from each of these
sources, that a correct judgment can be formed of obscure pulmo¬
nary affections.

That I may convince the reader that the strictures above made,
regarding the celebrated author in question, are not erroneous, I
will submit a few remarks relative to the phenomenon of pecto-
riloquism, which may justly be considered as amongst the most
important circumstances relating to the use of the cylinder in pul¬
monary affections,

Laennec considered that he had, in pectoriloquism, discovered a
true pathognomic sign of phthisis pulmonalis — the only sign to
be regarded as certain. There can be no doubt of its being a
sign of great importance, for this phenomenon is invariably ob¬
served when the excavated end of the instrument is applied over
a cavity of the lungs communicating with the trachea, by means
cf a bronchial ramification, and the person to whom it is applied,
pronounces audibly a given number of syllables. Thus far, then,
we may predicate with safety, that where pectoriloquism exists,
there is a corresponding cavity in that part of the lungs ; and
also that pectoriloquism is a pathognomic sign of phthisis, if the
existence of an excavation in the lungs is necessarily accompanied
by consumption ; or if pulmonary consumption can never happen
without the occurrence of a tubercular excavation ; but I am pre¬
pared to argue that excavation of the lungs may exist without the
co-existence of phthisis ; and also that tubercular phthisis very

VOL. in. no, 15. 2 L

258

Synopsis of Practical Medicine.

commonly happens, unattended by any excavation, and, conse¬
quently, that pectoriloquism is not a pathognomic sign of pulmo¬
nary consumption.

We must first inquire, does the existence of a tubercular exca¬
vation necessarily imply the co-existence of phthisis ? That, in
infinitely the greater number of persons thus affected, consump¬
tive symptoms also occur, the history of this disease, unfortunately,
but too decidedly, testifies. But are there not, I would inquire,
individuals in whom the existence of such a cavity is consistent
with tolerable health ? In whom, by length of time, the excava¬
tion is emptied of all tubercles or purulent matter, and becomes
lined with a smooth, polished membrane ? Such persons regain
their flesh, and sometimes enjoy years of health, and, consequently,
cannot be said to be affected with phthisis, although, if we con¬
sider pectoriloquism a certain sign of phthisis, they must be con¬
sidered to be so. Laennec has himself described cases of this kind,
and other authors have confirmed his observations. The two
following’ cases have fallen under my notice.

Case I. — A man of seventy years of age, was admitted into the
Worcester Infirmary, in September, 1813. He was subject to fre¬
quent vomiting, which had come on within a few weeks. He had
been generally a healthy man, but said, that when a boy, he was
nearly dying of consumption.

Various remedies were tried, but without avail. The vomiting
continued, and he lost flesh and strength. At the end of six weeks
he died.

# Examination of the Body. — Abdomen. — An ulcer of considerable
size was found in the pyloric end of the stomach, with much
thickening of the coats of the organ. The other abdominal viscera
were healthy.

Thorax. — There was very general adhesion, evidently of long
standing, between the pleura covering the lungs and lining the
ribs.

In the lungs there were several hard tubercular masses, but not
of a large size.

In the superior lobe of the right lung, we discovered a cavity
large enough to hold a walnut. The membrane lining it was in
appearance not unlike pleura; It communicaied with the bronchia.

Case II. — The other case of the same nature occurred in a wo¬
man, who reached the age of sixty. She had, early in life, been
much subject to cough, and always remained susceptible of cold.
She died of continued fever.

There was in the left lung, in this instance, a cavity with a
smooth polished lining. There were also, interspersed throughout
each of the lungs, a few very hard masses, which had apparently
been originally soft tubercles, but they had become so hard,
as to afford considerable resistance, being something like, although
not so hard as the calcareous deposit we meet with in the cellular
tissue of the lungs. The cellular membrane which surrounded
these substances, was in a sound state.

But, in addition to this cause of fallacy, in drawing a conclu¬
sion from the phenomenon of pectoriloquism, we are also exposed

Dr. Hastings on the Use of the Stethoscope. 259

to a similar one, if we neglect a close attention to the symptoms
in case of dilatation of the bronchia. This occasionally happens,
and gives rise to a similar phenomenon, although the pathological
state of the lungs is very different from that of tubercles. We are
forced, then, to the admission, that the existence of pectoriloquism
in any part of the chest, by no means necessarily implies that the
subject is affected with phthisis, and we are now also prepared to
evince, that tubercular phthisis may be present, and pass on to a
fatal issue, without ever being productive of tuberculous excava¬
tions of the lungs.

In the first Number of this Journal*, I have distinctly shewn,
that tubercular phthisis may exist without any excavation, and
that it may become slowly fatal, although the tubercles never
soften, by the gradual encroachment of these foreign bodies on
the cellular tissue of the lungs, so as to obstruct the free circula¬
tion of blood through the organ, and to cause progressive ema¬
ciation and debility. In such cases, consequently, the phenomenon
of pectoriloquism can never exist as a sign of phthisis. It is also
not very uncommon to meet with instances of consumption, where
the disease is of much more rapid course, owing to the conjunc¬
tion of inflammation of the cellular or bronchial tissue of the
organ, with numberless miliary tubercles scattered throughout the
lungs, and in some parts coalescing, and forming large tubercu¬
lous masses. In such instances, death often seizes its victim ere
any excavation has formed, and of course before pectoriloquism
can inform us of the tuberculous deposit. But although the cy¬
linder, in such instances, does not offer us what Laennec states to
be the certain sign, it is, under such circumstances, often exceed¬
ingly useful in pointing out that much mischief is progressing in
the lungs. For the absence of the usual respiratory murmur in
certain parts of the lungs, where it ought to exist, may justly
lead us to pronounce, after sundry trials of the fact, that there
exists some unnatural production in the substance of the lungs.
In this way, the attentive auscultator may be enabled to form an
opinion of the probable termination of consumption in its more
early stages, long before excavations are formed, or the symptoms
manifest any severe lesion of this important viscus. That such
knowledge is of the first consequence to the practical physician,
no sensible man will, I presume, deny. It may, in some cases,
by pointing out the necessity of early treatment, enable us to avert
the fatal issue of a disease, whose ravages annually sweep off a
large portion of the population of Great Britain. I am certainly,
from some experience, decidedly of opinion, that if our treatment
of tuberculous consumption were more early and assiduously
applied, we should not so» often have to deplore the inefficiency
of our art in this dreadful malady., I am aware that this state¬
ment is at variance with the conclusion formed by the enlightened
discoverer of the stethoscope, but, nevertheless, the observations
that I have made do not permit me to fall in with the opinion
stated by him.

* Midland Medical and Surgical Reporter, No. 1, p. 28.

260

Synopsis of Practical Medicine .

The following may be quoted, amongst others, as an instance
where the early symptoms of consumption were checked, and the
progress of the disease arrested, by appropriate treatment.

Case III. Symptoms of Consumption and Tuberculous Deposi¬
tion, terminating favourably . — M. G. aged 17, was received into
the Worcester Infirmary, under my care, in September, 1S20.
She had for some time been out of health. She was affected with
dyspnoea on slight exertion, and had a short, dry cough. Her
habit of body was spare 3 the complexion delicate 3 the eye quick
and penetrating ; pulse 100, small 3 tongue clean 3 bowels re¬
gular.

By the stethoscope, the respiratory murmur was found to be
puerile over the whole of the right side of the chest. On the left
side, in several parts, it was puerile also, but towards the upper
part of that side, there was a spot more than an inch square, in
which no respiratory murmur could be heard. Repeated exami¬
nation with the cylinder confirmed this 'result. I accordingly,
comparing the information derived from auscultation with the
general state of health, concluded, that a portion of the lung on
that side, was rendered impermeable to air, by the deposition of
tuberculous matter.

The plan of treatment was in conformity with this view. I order¬
ed a seton over the part. She was bled, and drank large quantities
of decoction of sarsaparilla with Brandish’s alkali, for a considerable
time. It gave me much gratification to observe, that the plan
succeeded in amending her general health. After remaining in
the infirmary some time, she was discharged in tolerable health 3
but the respiratory murmur had not then returned in the spot be¬
fore alluded to. I saw her two years afterwards, looking pretty
well, but I had not an opportunity of examining whether there
was still an absence of the respiratory murmur in the affected part.

In denying then, that the stethoscope does, in all cases, afford a
certain sign of phthisis, I by no means wish to impress the reader
with an idea, that it may not, even in such cases, afford him im¬
portant aid in unravelling the mystery, which often hangs over
this disease 3 but I would rather stimulate him to renewed exer¬
tions, that the discovery which has hitherto so auspiciously for¬
warded our acquaintance with the obscure affections we are now
discussing, may be improved still farther, and at length lead to re¬
sults in the highest degree beneficial to the healing art. But as it
is very far from being my conviction, that any good can be hoped
from overrating the dominion we have gained over disease, or the
value of the means by which we investigate its approaches, I .shall
relate the following cases, in which the cylinder failed to give any
accurate ideas of the change of structure that was going on in the
lungs. In the first of these, a curious combination of morbid
changes had taken place in the lungs 3 for there existed, at the
same time, chronic bronchitis, tubercular depositions to a consi¬
derable extent, without any excavation, and emphysema.

Case IV. — The subject of this curious affection was 66 years of
age. He was of a thin, spare habit, and had been ill with a cough
or several years. He had in fact, been considered asthmatical for

Dr. Hastings on the Use oj the Stethoscope. 261

five years before I saw him. During the whole of that period, he
had rather lost flesh, and in each succeeding winter and spring,
had suffered a considerable aggravation of cough, expectoration,
and difficulty of breathing. I was first called to see him in March,
1827. He then complained of distressing cough, particularly at
night, and he could not lie down in bed comfortably, for he no
sooner attempted it than he was called up by cough. The expec¬
toration was very various, but for the most part frothy 3 sometimes
the frothy was mixed with a small portion of pus-like fluid, some¬
times the pus-like matter was in great quantity, and, occasionally,
a tough mucus tinged with blood, was, after a severe fit of cough¬
ing, expectorated. The cough came on usually in fits, and was
deep and sounding. The pulse was eighty ; tongue loaded 3 stools
unnatural 3 urine pale and abundant 3 the breathing was laborious,
and the muscles of the chest were called into unnatural action.

By percussion, the chest gave a louder than the natural sound,
both on the right and left side. The stethoscope discovered an
audible rattle in several parts of the chest. It was a wheezing
noise, and did not resemble the mucous rattle of bronchitis 3 in
other parts of the chest, scarcely any rattle or respiratory murmur
could be heard. I could not, in any part of the chest, discover
pectoriloquism. The result of this examination did not much
improve my knowledge of the disease of my patient, and it cer¬
tainly did not lead me to expect that tuberculous disease had pro¬
ceeded to any great extent. The result of percussion and auscul¬
tation, rather favoured the notion of emphysema, but the state of
the symptoms was not explained by that view of the case. He
lived about a month afterwards, and his death afforded me an op¬
portunity of investigating the condition of the thoracic viscera.

On opening the chest, the lungs appeared larger than usual. On
examining them more accurately, the air vessels under the pleura
were found, for the most part, very much enlarged, and this gave
the apparent increase of magnitude to the lungs. On pressing the
lungs, the displacement of air was heard, not at all like the ordi¬
nary pulmonary crepitus. The pleura were not adherent. When
the lungs were cut, air escaped, and then there came in sight num¬
berless miliary tubercles, imbedded in the pulmonary tissue. By
extending the examination over each of the lungs, the tuberculous
bodies were every where found numerous 3 but in the superior
lobes of each lung, they were particularly so, and in several parts
they coalesced. The cellular tissue was rather inflamed and thick¬
ened. The mucous membrane of the bronchia w'as much inflamed
and thickened. There was considerable dilatation of the bronchial
vessels.

The abdominal viscera were healthy, excepting the liver, in
which organ there was a deposition of tuberculous matter.

In this case, the cylinder and percussion failed in giving warn¬
ing of the existence of a tuberculous degeneration of the structure
of the lungs, owing to the very rare conjunction of extensive em¬
physema of the organ with the miliary tubercle, on which account
no sign was afforded by the physical investigation, indicative of
the real cause, that was slowly acting so as to destroy life.

262 Synopsis of Practical Medicine.

The next case to which I shall call attention, is one where a
considerable ulceration took place in softened lungs, so as to cause
a cavity, which gave rise to the phenomenon of pectoriloquism,
whilst, at the same time, there were no tubercles in the organ.
The following is the outline of the symptoms.

Case V, — On the 19th of August, 18*35, I was consulted re¬
specting a young lady, who had been for two months in a dubious
state of health, from a very slight cough, with trifling expectora¬
tion in the morning, which had once or twice been tinged with
blood. On the morning of my visit, she had expectorated some
blood, unmixed with pus or mucus, and of a scarlet colour. Her
parents were, on this account, under great alarm, as they had pre¬
viously lost three children in consumption. There was nothing,
however, in the general appearance of the young lady, to have
given alarm to an ordinary spectator. She was" rather full of flesh,
and considered that she had rather gained than lost in that parti¬
cular during the last two months. To an experienced eye, how¬
ever, she had not a healthy look, for the countenance was rather
bordering on the cadaverous, and the eyes were dull. The hands
felt clammy, and there was an unaccountable listlessness in the
young lady’s manner. The pulse was seventy-six ; the tongue was
clean, and the bowels were regular. 1 could not trace any fever¬
ish action during the twenty-four hours. The breathing was free,
and a full inspiration caused no uneasiness. The catamenia were
regular. In short, she declared, that excepting the slight barking
cough which attacked her in a morning, when at the toilette, she
was in perfect health. She betrayed, nevertheless, much pertur-
• bation at the sight of the expectorated blood, and declared a firm
conviction that the disease was similar to that of which her rela¬
tions had died.

I examined, at this visit, the chest very particularly, and found
that percussion produced a natural sound on each side. With the
stethoscope, the respiratory murmur was heard natural on the
right side, and no indication of any excavation of the organ. On
the left side of the chest, however, perfect pectoriloquism was
heard, on the front of the chest, between the second and third, and
third and fourth ribs.

Some blood was taken from between the shoulders by the cup¬
ping-glasses, and I directed a mixture of infusion of roses and
tincture of digitalis, to be taken every four hours. I also advised
quietude and a milk diet.

In a few days, the spitting of blood disappeared, and this ami¬
able young lady described herself in perfect health again, except¬
ing that she had a slight morning cough, and trifling expectora¬
tion. She walked about without any hurry of respiration, and
seemed anxious not to be considered an invalid. It was, notwith¬
standing, but too evident, that the disease was formidable, for ano¬
ther examination with the stethoscope, established still more
strongly my conviction, that there existed an excavation in the su¬
perior lobe of the left lung. The eyes also looked peculiarly lan¬
guid, and the hands had a deadly clammy feel.

She went on with very little appearance of illness, and without

Dr. Hastings on the Use of the Stethoscope. 263

losing any flesh, till the 15th of September, on the morning of
which day, she coughed up about two tea-spoonfuls of dark-co¬
loured Mood, accompanied with a small quantity of pus-like mat¬
ter. . lhe pulse was ninety-four. The breathing was not at all
hurried, and there was not any heat of the skin. By appropriate
treatment, this bleeding subsided, and did not return till the 28th
of the same month, when a sudden exasperation of the symptoms
took place. The breathing became hurried ; the cough much
more troublesome, and a considerable quantity of scarlet-coloured
blood was expectorated. Various means were ineffectually tried
to arrest the progress of the disease. The bleeding repeatedly
occurred, and my patient died in the morning of the 8th of Oc¬
tober.

Examination of the Bodij. — No considerable emaciation had
taken place. On elevating the sternum, nothing worthy of re¬
mark presented itself. On removing the lungs, they were found
slightly adherent on the right side, but much more so on the left ;
on both sides the adhesion was high up, and in the direction of
the axillae.

The internal surface of the trachea was free from purulent se¬
cretion. The bronchia contained a small quantity of sero-sangui-
nolent fluid. On tracing the ramifications in the right lobes, the
only appearances were a rather suffused state of the blood-vessels
in some parts ; the lungs of a soft structure, and the air-vessels
throughout, pervious;

The general appearances of the left lobes resembled those of the
right ; but on the outer and upper surface of the superior lobe,
appeared a cavity large enough to admit the half of a middle-sized
orange, which had been prevented from opening into the sac of the
pleura, by the adhesion of the pulmonary to the costal pleura.
This cavity communicated freely with the bronchial tubes. Pus
was searched for, but the slightest trace of it could not be found ,*
nor was there the slightest degree of hardness in the sides of this
ulcer, indicative of the process of adhesive inflammation having
been set up. On the contrary, the appearance was that of simple
ulcerative absorption rapidly advancing.

The stethoscope here, although it forwarded my knowledge of
the case, by shewing that a cavity was formed in the left lung,
gave no real insight into its nature. Agreeably to Laennec’s
rule, that pectoriloquism is a certain sign of tuberculous phthisis,

I concluded that my patient was so affected. Proceeding on this
assumption, and being convinced that the mischief was confined
to the superior lobe of the left lung, I came to the conclusion,
that it was not impossible, as there was an absence of emaciation,
and the symptoms were not at all urgent, that it might turn out to
be one of those cases in which, from the quiet state of the symptoms,
the lining of the cavity eventually becomes polished ; but at any
rate, I could not regard it as a case in which the disease would
make a rapid progress. How vain, however, did my speculations
prove ! owing to the disorganization being of an entirely different

264

Books Received, Literary Intelligence , SfC.

nature to that which Laennec supposes the stethoscope discloses
with certainty.

The stethoscope, then, is not a certain test of tubercular con¬
sumption, as Laennec supposes it to be. Should we then cease
to employ it as a means which may materially aid our attempts to
develope the morbid changes that occur in the organs contained
within the cavity of the thorax ? Undoubtedly not. For there is
scarcely an affection of any one of those organs which may not be,
in some degree, made clear, by studying the physical signs that
are afforded by auscultation and percussion. The object, there¬
fore, of the preceding observations, is not to disparage the disco¬
very, but chiefly to show, that our dependence must not be too
confidently placed in these signs, to the exclusion of a diligent study
of the natural symptoms.

BOOKS RECEIVED DURING THE MONTH.

1. Anti -Phrenology, or Observations to prove the Fallacy of a Modern Doctrine
of the Human Mind, called Phrenology. By John Wayte, M.D., Lyine-Regis.
Sold by Baldwin and Cradock, London, 1829, pp. 97.

%* This Essay is elegantly written, and the arguments adduced place Phre¬
nology in a very low condition — in fact completely extinguish it. We recommend
this production to those who wish to learn the science of Phrenology, and its
refutation.

2. Medicine no Mystery ; being a brief Outline of the Principles of Medical
Science, designed as an Introduction to the General Study, as a branch of a
liberal education. By John Morrison, M.D. and A.B. Trin. Coll. Dublin. Lon¬
don, Hurst, Chance, and Co. 1829.

3. Pathological Observations, Part II, on Continued Fever, Ague, Tic Dou¬
loureux, Measles, Small-pox, and Dropsy ; illustrated by Cases, noted in the
year 1828, from hospital and private practice; with a preliminary dissertation
on the Irish tests of medicine ; and an Appendix on the Origin, Prevention, and
Cure of Organic Diseases of the Cranium, Thorax, and Abdomen. Illustrated
by Cases and post-mortem Examinations. By William Stoker, M.D. Fellow of
the King and Queen’s College of Physicians, in Ireland, &c. &c. &c. Dublin,
Hodges and Co. 1829.

4. Pauli Mascagnii Anatomia Universa XLIV, Tabulis aeneis, juxta Arche-
typum, hominis adulti accuratissime representata, dehinc, ab excessu, Auctoris
cura ac Studio. Eq. Andrea Vacca Berlinghieri, Jacobi Barzelotti et Joannis Ro-
sini, in Pisana Universitate Professorum Absoluta utque edita. Pisis, 1829. Lon¬
don, Messrs. T. and G. Underwood.

*** These splendid Plates are Engraved on Copper, and exquisitely coloured,
represent the whole human figure of the adult size ; and are deservedly the most
accurate delineations that have ever appeared. There is no university or na¬
tional library, but will be possessed of these magnificent engravings.

LITERARY INTELLIGENCE.

Shortly will be Published, a Practical Treatise on Diseases of the Genitals of
the Male, with a Preliminary Essay on the history, nature, and treatment of
Lues Venerea ; with an Engraving of Elephantiasis of the Scrotum. By John
Maddox Titley, M.D. .

An Introduction to Medical Botany, illustrative of the Elements and Termi¬
nology of Botany, and of the Linnaean, Artificial, and Natural Systems as con¬
nected with the Study of Medical Plants. By Thomas Castle, F.L.S. &c.

All Communications and Works for Review to be addressed to the caie of
Messrs. Underwood, 32, Fleet-street; or to to the Editor, at his residence, 61,
Hatton-Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

OCTOBER 1, 1829. Vol. III.

CRITICAL REVIEW.

I* — The Study of Medicine. By John Mason Good, M.D.
F.R.S.L., &c. &c. Third Edition , with much additional
modern information on Physiology , Practice , Pathology,
and the Nature of Diseases in general. Bv Samuel
Cooper, Surgeon to the Forces, King’s Bench, and Fleet
Prisons, Author of the Dictionary of Practical Surgery,
&c. &c. London, Underwoods, 1829.

[Continued from, page 193.)

We shall now conclude our remarks on the valuable work
before us, by submitting the author’s opinions on the nature
and treatment of continued fever. There is no subject in
medicine, on which such discrepant opinions prevail, as on
fever. Dr. Good has examined all the works which have
appeared during the last three centuries, and declares that
(i the sum of medical opinion is against the employment of
blood-letting as a general remedy.” In this article on fever,
the learned author has, however, made one great omission,
namely, he has not noticed the various reports of Irish or
Scotch physicians on the epidemics of 1817, 1818, 1819,
1822, 1823, 1824, 1825, 1826, 1827, or 1828. In a national
work of this kind, such an omission appears to be extremely
unaccountable, to say the least of it. Dr. Good is a staunch
contagionist, but is obliged to admit that typhus may arise
from the ordinary causes of fever.

Any of the ordinary causes of fever may be a cause of ty¬
phus j for, the typhoid form is often dependent upon the charac¬
ter ol the constitution into which it is received, as evincing a
great deficiency of sensorial power : and hence cold, mental agi¬
tation, excess of muscular labour, and even intemperance, which,
in a high entonic habit, might generate synocha or inflammatory
fever, will often, in a debilitated^constitution, and especially when
the debility depends primarily upon the state of the nervous sys-
VOL. III. NO. 16*. 2 IY1

266

Critical Review.

tern, and the nervous influence is recruited with difficulty, give a
typhous complexion to the disease from the first,

<<r But, though all the causes of fever may in this way give rise
to typhus, its common cause as we had occasion to notice when
treating of the remote causes of fever, is febrile miasm, issuing
from the decomposition of human effluvium, under the influence
of the ordinary auxiliaries of a close and stagnant atmosphere ;
still farther corrupted by a load of foreign exhalations from dirt
or filth of any kind, and of that degree of warmth and moisture
which must always exist where society exists, and especially
where it exists in too crowded a state. Under these general cir¬
cumstances, a very low degree of warmth and moisture is suffi¬
cient, though there must be some proportion of both. And pro¬
vided there be an adequacy of warmth, the lower the temperature,
the more certainly an individual becomes affected j not from a
more abundant generation of febrile miasm, or from its being
more volatile — for, on the. contrary, it is here perhaps less abun¬
dant, and even less volatile — but from the more depressed state of
the living power, and the less resistance it is capable of offering
to any morbid influence whatever.

“I have just remarked, that, under a depressed state of the
living power, whatever be its cause, whether a want of cheerful
warmth, cheerful passions, cheerful food, or cheerful and regular
habits, typhus is often more likely to take place, than any other
species of fever. But when febrile miasm, produced by a decom¬
position of effluvium from the living body, exists in co-operation
with these, it is almost impossible for an individual to escape j as
the miasm thus generated has a specific power — a power beyond
all other febrile causes whatever — of lowering still farther the
vital energy as soon as it is received into the system, and thus of
confirming the previous tendency to this peculiar type.

All this indeed has been observed already, though it is neces¬
sary to revert to it on the present occasion : it has also been far¬
ther observed that, when a typhus has, in this or any other man¬
ner, once arisen, the effluvium from the living body during its
action is loaded with miasm of the same kind, completely elabo¬
rated as it passes off, and standing in no need of the decomposi¬
tion of the effluvium for its formation. In many cases, indeed, all
the secretions are alike contaminated ; and hence, febrile miasm
is often absorbed, in dissection, by an accidental wound on the
hand, and excites its specific influence on the body of the anato¬
mist ; for in this way, also, typhus has been produced.”

From these extracts it appears that typhus may arise
from many different causes besides contagion, but none of
the really contagious diseases, as the eruptive fevers, can arise
from any cause but contagion, and therefore there is total
dissimilarity between the contagion of typhus and that of the
eruptive fevers. Again if the dead subject can produce the
contagion of fever, it is very extraordinary how few per¬
sons are affected during dissection. When we come to con-

Dr. Good’s Study of Medicine. 267

sider the large number of bodies in the dissecting rooms of
this metropolis, and especially of Dublin and Paris, and the
frequency of dissection-wounds, and the very rare examples
in which they prove injurious, we must pause before we
agree with the author’s conclusion in the end of the last pa¬
ragraph. We believe it requires a peculiar predisposition
in the system of those who become affected by such wounds.
To assert that the contagion of typhus u or febrile miasm, is
often absorbed in dissection,” is contrary to daily observation
and experience. If contagion arise from the body of a man
labouring under fever, we should reasonably expect it should
be produced from the general vitiation of the whole system
immediately at or after death, and more especially when pu¬
trefaction shall have commenced. But this is not the case,
there is no danger from a body destroyed by this contagious
disease, its noxious effluvium ceases with life. Such is the
doctrine maintained in our dissecting-rooms. How often
have we seen the bodies of ten and twenty persons who had
died of the worst form of typhus, many of them rapidly ad¬
vancing to putrefaction, exposed to the dissecting-knife,
and no febrile miasm absorbed by wounds or otherwise.
Another very questionable opinion has been proposed by
our author.

‘f It is also of great importance to know, that typhous miasm,
like the specific miasms of exanthems, does not render clean
clothes of any kind contagious j or, in other words, does not ad¬
here to, or harbour in them. When, however, they are not clean,
they may unquestionably be rendered contagious ; and hence,
it is probable, that the animal filth, with which they are impreg¬
nated, while it is a source of additional miasm, becomes a fomes
of that already formed, and separated from the patient’s body.’’

Animal filth then is the only source of fomites. This is a
new hypothesis, of which no proof has been afforded. The
doctrine of the contagionists is, that the effluvium arising
from a feverish patient, if applied to the body of a healthy
person, produces fever. Now let us contrast the following
paragraph with this received opinion.

A susceptibility, however, to diseases of every kind varies
considerably in different individuals j and hence many persons
upon an equal exposure to typhous contagion with others, receive
it far less readily, and, in some cases, seem to be almost favoured
with a natural immunity. As we have already remarked, that a
peculiar state of body gives a peculiar tendency both to generate
and receive typhus, we can easily conceive that, where the body is
in an opposite state, it must be much less susceptible of its influ¬
ence ; and we are thus put in possession of a general cause of es¬
cape. But there seems to be something beyond this, dependent,

268

Critical Review .

indeed, not upon the incidents of more vigorous health, or higher
animal spirits, but upon the nature of the idiosyncrasy itself.”

It appears by the medical reports of the epidemic, or ty¬
phus, which prevailed in Ireland in 1816, 1817* and 1818,
that 80,000 persons were affected, and that the medical, cle¬
rical, and ordinary attendants who must have amounted to
4 or 5000 persons, in general escaped, and perhaps not more
than 100 of them fell victims to the disease, though, in gene¬
ral, they had been depressed in mind and body, and all con-
tagionists. The late Dr. Gregory, of Edinburgh, was wont
to state in his lectures, that he must have been exposed to
fever some 20 or 30,000 times, and yet he never had the dis¬
ease. Again if the doctrine of actual contact be true, how
can we explain the exemption of medical men from the poi¬
son. Dr. Good attempts to explain this difficulty.

“ Man is so much the creature of habit, that his constitution is
in a thousand instances brought by degrees to endure poisons of
the most fatal power. This we see daily in the use of opium and
ardent spirits ; and we shall in due time have to notice something
the same kind even in plague. This adaptation of the constitu¬
tion, however, to the circumstances by which it is surrounded, is
in nothing more conspicuous than in the fever before us. Not,
indeed, in all persons — for all do not possess the same pliability
of constitution — but in those who are endowed with it. And,
hence, .one reason why nurses and perhaps hospital-surgeons es¬
cape so often without injury j and especially why prisoners,
brought into a court for trial, remain themselves occasionally in
perfect health, while their clothes are so impregnated with the
contagious miasm as to infect a whole court, and communicate
the disease to the judge or others who are at the greatest distance
from them ; of which we are furnished with melancholy examples
in the Oxford assizes of 1577) those at Exeter and Taunton in
1586, those of the Old Bailey, in 1736 and 1750 ; besides similar
instances in various hospitals and ships of war.”

This reasoning is far from being satisfactory, when we
recollect that medical students in their first attendance on
fever, escape the disease, and that the medical and ordinary
attendants at the commencement of an epidemic, especially
the clergy, are not “ the creatures of habit.” And yet very
few, indeed scarcely any, will be affected. Again the medi¬
cal officers of fever hospitals, will have escaped for many
years, but if debilitated from any cause very readily become
affected, especially if alarmed at the increase of the disease
and if at all afraid of it. Fear is the most powerful of all
debilitants, it has often destroyed life, and is a prolific cause
of fever. The best preventive on the other hand, is a dis¬
regard of the disease, a good constitution, and a good state
of bodily health. Contagionists are all fearful, they are

269

Dr. Good’s Study of Medicine.

eternally alarmed, the mind and body necessarily depressed,
and therefore are bad subjects for fever — they are generally
seized with the disease, which mostly proves fatal to them.
From an analysis of all that has been written on fever, it
appears to be universally admitted that the first shock or
impression of the disease is made on the nervous system,
and thence communicated to every function of the body.
When we consider the power of the mind on the nervous
system, we can readily conceive the great influence of fear
and the other depressing passions, in depressing the senso¬
rial functions, and consequently those in every organ. We
cannot be surprised then that those who are in constant
dread of contagion, may be attacked with fever or at least
are very susceptible of the disease. During the fever of
1818, a gentleman, who dreaded contagion very much, passed
by a man in the street who appeared to be dying of the epi¬
demic. This gentleman went home, took to his bed, had all
the symptoms of low fever, and died of the disease. One of
his medical attendants related the case, and there was no
trace whatever of contagion. The man who had lain in the
street, and whose appearance had such a powerful effect,
was dying of starvation and not of fever. The records of
medicine afford innumerable examples of fear alone having
caused fever. Dr. Good observes that “ the mild typhus
was called by Dr. Huxham, febris lenta nervosa, and .has
lienee been commonly distinguished by the name of the low
or slow nervous fever, from the great languor and dejection
of mental or sensorial power with which it is always accom¬
panied. Debility, however induced, has been found to ex¬
ist before contagion can have any effect, and it is more than
probable, indeed it is generally admitted, that enervating
causes, as cold, moisture, vitiated air, scarcity or deteriora¬
tion of food, deprivation of domestic comforts, ike. &c. shall
produce fever, where no trace of contagion can be disco¬
vered. Dr. Good has given the diagnosis between typhus
mitior and typhus gravior, but here we find nothing of no¬
velty. The following remarks are valuable.

“ The balance of the sanguiferous system is generally much
disturbed, from a greater degree of sensorial debility in some or¬
gans than in others ; and hence, the blood is determined irregu¬
larly, and accumulation, effusion, and inflammation are frequent
effects. These show themselves chiefly in the head, the lungs,
and the liver; but there is no organ in which they may not occur;
and they never can occur without danger. All the external senses
evince great hebetude, and especially the hearing, so as often to
amount to absolute deafness 5 the stupor is increased, and the
speech muddled ; while the patient appears to dream without

Critical Review.

270

being asleep, and talks deliriously ; thus evincing the typhomania
of the ancients j being often unconquerably riveted to a single
idea or train of ideas. And, as the nervous exhaustion increases,
he is indifferent to every thing, feels little or nothing, and if he
answer at all to an inquiry how he is, says he is very well.

“ Typhus fever affords a striking example of the vast change
produced in the secretions by disease. The fact is particularly
noticed by Dr. Armstrong, in his description of the state of the
tongue. In typhus fever, he observes, as the lips and cheeks be¬
come dusky during its perfect development, a peculiar secretion is
besmeared over the tongue and fauces, almost as if the fibrine and
albumen had been dissolved, so as nearly to resemble in its adhe¬
sive property, common melted glue ; the tongue itself, from the
evaporation of the thinner portions of this secretion, becomes dry,
presenting a varnished appearance, like that of a walking-stick ;
and, at a still more advanced stage, it becomes brown, and ulti¬
mately black, from an apparently carbonaceous deposit.

“ According to the same physician, in some fully developed
cases, where the tongue is glazed, dry, and brown, and the lips
and cheeks of a dusky or purple hue, the blood drawn from the
temporal artery has a venous colour. The circulation of such
blood within the arteries, he says, is connected with many of the
most conspicuous and curious phenomena of the advanced stage
of typhus. The cause of this remarkable change can be shown by
dissection to depend upon a specific bronchitis, the mucous texture of
the bronchial tubes being loaded with dark blood, and besmeared
with a copious and tenacious secretion

In the year 1814, when Dr. Stoker, of Dublin, maintained
that the blood and fluids were changed and diseased in fevers
and other maladies, he was said to broach very extraordi¬
nary doctrines, but since that period his researches and opin¬
ions have been lauded by the Continental writers, especially
the Germans, and are admitted in the above quotation. We
shall allude to them particularly in a subsequent article.
The following account of the pathology of typhus gravior is
highly important, and hence our excuse for transcribing it.

“ From the debility that prevails, even from the first, the pulse
is feeble and tremulous, the extreme vessels torpid or nearly so.

* See Armstrong’s Morbid Anatomy of the Bowels, Liver, &c. p. 8. 14, &c.
4to. Lond. 1828. According to Dr. Bnrne, the blood flows slowly from di¬
vided vessels, is blacker than usual, coagulates less firmly, rarely shows the
huffy coat, and, in the dead body, is found black and fluid. On Typhus, or
Adynamic Fever, 8vo. London, 1828, Dr. Clanny’s observations lead to the con¬
clusion, that the watery part of the blood increases in proportion during the
progress of the fever ; while the quantity of all the animal principles and salts
of that fluid is lessened ; and when the crisis has taken place, the opposite
change begins, so that the blood returns to its natural condition. Supposing
this statement to be correct, we must not fancy with Dr. Clanny, that fever de¬
pends upon the derangement of sanguification, but only that the latter is one of
its attendant changes.

Dr. Good’s Study of Medicine. 271

anti the circulatory balance greatly disturbed. Hence, we have
reason to expect, that effusion and congestion, or an irregular de¬
termination of the blood will, in many cases, be an early attend¬
ant ; and, if there be energy enough remaining in the organs thus
affected to produce any degree of re-action, that local re-action
will follow, and perhaps lead on to inflammation terminating in
suppuration or gangrene ; of which Sir John Pringle has given
numerous examples. And hence there is some ground for con¬
templating typhus, as Hr. Armstrong has done, under the three
varieties of a simple, congestive, and inflammatory affection 3 this
last being sometimes seated in one organ, and sometimes in ano¬
ther : most frequently perhaps in the brain, where Marcus sup¬
poses it to exist in every case whatever 3 and, occasionally, perhaps,
in some of the secreting membranes, through all of which it is
conceived, in every instance, to extend by Hildenbrand, the rete
Malpighi, the membrane that lines the cavity of the nose, of the
mouth and throat, the tunica arachnoidea, and the mucous mem¬
branes of the stomach, intestines, and organs of urine and genera¬
tion. It is a fact, now perfectly established, that, in certain forms
of fever, the mucous coat of the intestines is often found in an in¬
flamed, ulcerated, or even gangrenous state. The writings of
Broussais, Andral, Ribes, and others in France, leave no doubt on
this point, which has received still further illustration from the
publication of Dr. Bright, as was noticed in the consideration of
remittent fever. Besides the affection of the head and nervous
system, which seems to be connected with the first impression of
fever. Dr. Bright is convinced, that there is a secondary state of
cerebral irritation, which depends upon the mischief going on in
the intestines ; and this often shows itself after the fever has con¬
tinued for several days, increasing with the increase of the abdo¬
minal affection, and going on till it produces that general nervous
agitation, with injected conjunctiva and constant delirium, which
often closes the scene of life. These observations remind the edi¬
tor of a fact, which according to Dr. Ribes, has been completely
established by M. Scoutteten from numerous dissections 3 namely,
that the connexion between the intestinal canal and the pia mater
is so intimate, that when the former is affected with either acute
or chronic inflammation, the latter always participates equally in
the affection, with this particularity, that it only happens when
the mucous membrane of the bowels is concerned, and not when
the serous one alone is disordered. An observation made by Dr.
Alison rather corroborates the foregoing statement j as he notices,
that in the worst cases of remittent fever of children, the mucous
membrane of the bowels is inflamed and ulcerated, and that one
mode in which the case proves fatal, is by sudden conversion into
an affection of the head. The researches of Dr. Bright agree with
those of the French pathologists in fixing upon the mucous mem¬
brane of the ileum, coecum, and beginning of the colon, as the
principal seat of morbid alteration, though occasionally the same
membrane has been inflamed and irritated throughout the whole
extent of the intestinal canal. “The appearances,” says Dr.

27 2

Critical Review.

Bright, tc which are most marked in the mucous membrane of the
intestines, are those of increased action, vascularity sometimes oc¬
curring in patches of greater or less extent, without any obvious
dependence on inflammation of the mucous glands, aud occasion¬
ally extending, under some form or other,^ through the whole
track from the pylorus to the rectum ; but this vascularitv is more
generally connected with inflammation of the mucous elands,
which often appear like the small-pox on the second or third dav
of the eruption, elevated and almost transparent, with minute ves¬
sels which dip into them from the lining membrane of the intes¬
tines. They scarcely seem to go into a state of true suppuration,
but become distended with a yellow cheesy matter, and slough off 5
or sometimes ulceration takes place upon their points externailv,
without any collection of yellow matter being perceptible. The
same process, or nearly so, takes place both in the solitary and in
the congregate glands ; except that, in the latter, the appearance
becomes much more formidable, and the mischief more extensive.
The masses, or clusters of congregate glands are chiefly placed
along that part of the intestine which is furthest from the inser¬
tion of the mesentery ; and when the parts are irritated from dis¬
ease, three, four, or five considerable branches of vessels are seen
passing on the mucous membrane, from the mesenterv on each
side, towards the cluster of congregate glands.” The elands
themselves enlarge, and after some time, form a thick flafmass,
of a lighter colour than the surrounding intestine. This some¬
times increases to the thickness of a half-crown piece, and occa¬
sionally even spreads on the top, so that the surface overhangs the
base nearly the sixth part of an inch. Sometimes a dark coloured
matter, like.grumous blood, is deposited amongst the glands ; so
that the whole mass, instead of being lighter than the intestine, is
of a brown colour, elevated evenly above the surface ; but in
either case, the mucous membrane is at first only raised, and not
broken. In a little time, fissures are formed, and the whole mass
ulcerates. When the inflammation subsides, the depth of the
ulcer diminishes ; and the greater part of the glandular structure
being apparently removed by ulceration and slouching-, the edges
fall down, and the ulcer becomes shallow, sometimes leaving the
muscular fibres nicely displayed, or often exposing: the internal
surface of the peritoneal coat to the extent of a quarter or half an
inch square. This excavation is filled up by the process of granu-
. lation, which Dr. Bright says, may be seen very beautifully by
suspending the intestine, cut open, before a lamp or the bright
sunshine, and examining it with a common lens. When the whole
is healed, a scar remains visible for some time, and appears to be
covered by a true mucous membrane. These ulcerations are
stated to be quite analogous to those painful and irritating sores
which frequently occur on the lips, or lining of the cheeks3 The
space occupied by the ulcers in the intestines, is usually about
two feet at the lower end of the ileum, and freauentlv the valve
of the colon, on the side towards the ileum, is the part’ where the
disease is most advanced. A few ulcers are likewise often found

273

Dr. Good’s Study of Medicine,

in the coecum, and some are occasionally dispersed along the co¬
lon. The peritoneal coat at the back of the ulcers is generally
discoloured and vascular, though seldom actually inflamed; which
however, it is sometimes, when the tenderness of the abdomen
becomes more marked, and, after death, a sero-purulent effusion
is found, and the convolutions glued together with threads of co¬
agulating lymph. In a few rare cases, the ulceration extends
completely through the peritoneum, the contents of the bowel be¬
coming effused in the abdomen, followed by general inflammation
of that cavity and death. Together with the foregoing changes,
the mesenteric glands are usually found enlarged and vascular,
particularly those which are situated opposite the intestinal ulcers,
and which occasionally suppurate. In the remittent fever of scro¬
fulous children. Dr. Alison represents the mesenteric glands next
to the ulcerations of the mucous coat as being much swelled, and
of a dark red colour, both externally and internally. Dr. Bright’s
investigations confirm the remark of the generality of modern pa¬
thologists, as Andral, Percival, Macartney, and others, that, in ad¬
dition to the preceding morbid appearances of the intestinal canal
in subjects destroyed by fever, other organs frequently suffer as
much as the bowels, and even more, especially the brain and its
membranes, in which marks of congestion are very manifest.
Nor, says he, is it at all unusual to find the lungs altered, as in
pneumonia, and it is even more common to find them loaded with
an extraordinary quantity of blood.

"Many of the cases, in which the above morbid appearances in
the bowels were observed by Dr. Bright, seem to have been of the
remittent type ; though others were probably typhoid, as far as
can be judged from the particulars recorded.”

Dr. Ribes and others contend that typhus fever may be
unattended with any of the foregoing morbid appearances in
the ileum and valve of the coecum, and autopsic exami¬
nation has repeatedly and very generally proved the truth of
this opinion. Ulcerations of the mucous membrane of the
intestinal tube are not always discovered on necrotomic ex¬
amination. The substance of the plan of cure is as follows.
As a common rule severe bleeding and purgation are not to
be employed ; gentle aperients are to be used, but not eme¬
tics unless nausea be present*. When marks of congestion
or oppression in the brain, lungs or liver, are present, deple¬
tion is to be employed, for the patient will die without it. In
such cases stimulant purgatives, as calomel are strongly re¬
commended. When symptoms of inflamed or ulcerated
mucous intestinal membrane are evident, the plan proposed
by Dr. Bright is to be employed.

* Mr. Cooper has given Dr. Bateman’s opinion from Art. Fever, in Rees’
Cyclopaedia— which is, that an emetic, or cold affusion will give the system such
a shock iu the commencement offerer, as will arrest the febrile action.

vol. in. no. 16. 2 n

274

Critical Review .

“ When the symptoms indicate irritation and ulceration of the
mucous membrane of the bowels. Dr. Bright prescribes the hydrar¬
gyrum cum creta, and the compound chalk powder, with or with¬
out ipecacuanha ; and if the alvine evacuations are too scanty, he
gives castor oil with a few drops of laudanum. This, with fomenta¬
tions, leeches, and cupping of the abdomen, according to circum¬
stances, is the practice from which he has seen the greatest bene¬
fit result, where fevers are attended with the complication of dis¬
eased mucous membrane of the bowels.”

Dr. Good has detailed the practice of many centuries,
and the controversies that were maintained respecting blood¬
letting, and clearly shews that the weight of medical opinion
is against it as a general rule, though highly necessary in par¬
ticular cases. He proves that its expediency often depends
on the state of the atmosphere, and Drs. Bateman and Ali¬
son are of the same opinion.

“ As inflammatory fever has sometimes a tendency, from pecu¬
liarity of constitution or accidental circumstances, to run rapidly
into typhus, typhus, in like manner, occasionally meets with inci¬
dents that suddenly reverse its character, and incline it to an in¬
flammatory type. A very stimulant plan of treatment has some¬
times done this ; but, far more frequently a sudden change in the
atmosphere, from hot, hazy, and relaxing weather, with scarcely a
breath of air stirring abroad, to a dry, cool, and refreshing east or
north-east breeze : and 1 have often found a like tonic effect pro¬
duced upon a patient labouring under typhus, in alow, damp, filthy,
and suffocating lodging, upon his being removed into a large, cool,
pure, and well ventilated chamber, such as is now generally found
in our fever institutions. In this case, bleeding, which I had not
dared to risk, notwithstanding some symptoms of oppression, be¬
fore the removal, has been practicable without any risk after¬
wards, and has laid the foundation of a speedy and effectual cure ;
and I am inclined to think, that some part of the clash of opin¬
ion, which prevails upon this subject in the present day, proceeds
from a want of due attention to the different states in which differ¬
ent or even the same patients are placed by this difference in the
purity and temperature of the surrounding atmosphere $ and that
many hospital physicians, who are the warmest advocates for san¬
guineous depletion in their own fresh, cool, airy wards, would he¬
sitate upon its expediency if they were to attend their patients
throughout in their own close, heated, and miserable habita¬
tions.”

We have next some judicious observations on the inter¬
nal and external use of cold water, of bark, columbo, ser-
pentaria, contrayerva, camphor, wine, opium, antimonials
acids, blisters, diet, regimen, ventilation, and fumigation.
The last chapter on fever is on synochus, under which de¬
signation, puerperal fever is described. As we recently sub¬
mitted an analysis of all the valuable works on that disease.

Medico- Chirurgical Transactions . 275

in our review of Dr. Gooch’s work, we need not notice the
subject farther. A press of other works transmitted to us
for review prevents us from proceeding further with the
Study of Medicine, but we have given a sufficient specimen
of the present enlarged and improved edition. In conclu¬
sion we have to repeat our opinions, offered in the introduc¬
tory remarks, that this work is the most valuable system of
medicine extant. Every page of it is replete with valu¬
able information, and no man who wishes to practise medi¬
cine with satisfaction to himself and benefit to his patients,
can be without it. The very copious additions made to it
by Mr. Cooper bring it down to the present state of science,
and prove that gentleman to be as able a medical as he has
been a surgical writer. The Study of Medicine and the
Dictionary of Practical Surgery, form a medical library in
themselves — an Encyclopaedia (if we may use the term) of
British Medicine and Surgery.

II. — Medico- Chirurgical Transactions published by the Me¬
dical and Chirurgical Society of London . Vol. XV. Part
I, 8vo. pp. 264. London, Longman, and Co. 1829.

Observations on the Local Diseases termed Malignant.
By Benjamin Travers, F.R.S. — The last paper in the work
before us is on a subject of great importance, and is very
superficially treated of by Mr. Travers. After some gene¬
ral observations on chronic diseases of a malignant kind he
considers the disputed question, whether cancer is a local
or constitutional disease ? We think he has left this ques¬
tion precisely as he found it. But he shall speak for him¬
self.

“ A question of primary importance, in reference to the dis¬
eases termed malignant, is the following. Is the disease on its
first appearance malignant ? By which term I mean, not intrac¬
table, but incurable, and at the same time directly tending, sooner
or later, to the destruction of the individual. Or does the disease,
arising in circumstances favourable to the attainment of malignity,
as texture, sex, temperament, age or climate may explain, be¬
come in the course of time malignant ? The point of this inquiry
is obvious. If upon its first appearance a local affection is stamped
with the essential character of malignity, as above defined, it is in
fact a disease of the constitution, whence alone such a character
can be derived. It is conceivable that a simple local disease may
become malignant by the influence of the constitution upon it, as a
simple fever may become typhoid or putrid, but a strictly local
affection cannot be malignant. When we speak of the decided
malignity of a tumour, or ulcer, we mean to say, that it is such a

Critical Review.

276

disease of the system shewing itself in a part. When we say that
it has a malignant aspect, or resembles a malignant tumour or
ulcer, we mean that it is analogous to those in which the constitu¬
tion, sooner or later, takes such an action. We cannot well con¬
ceive of malignity, as the exclusive or innate property of a part.
A change of structure, whether of increase or loss of substance,
which not only resists every remedy, but which, being extirpated
or destroyed, is reproduced either in the vicinity or at a distance
from the original site, is certainly not, in strictness, a local dis¬
ease. But if from any local cause a sore refuses to heal, or falls
into gangrene ; if by the extension of the ulcerative process
blood-vessels are opened and fatal hemorrhage ensues ; if by the
profuseness of a secretion the patient dies exhausted ; if by the
incessant irritation of the nervous system, or the morbid actions
set up in vital organs under a protracted symptomatic fever, life is
extinguished ; the disease does in no respect imply a malignant
nature, though often so considered, malignant diseases being subject
to a similar termination. It is to incurableness from causes not
local, and consequently the disposition to appear in more than one
part at the same time, or to re-appear when the first affected part
has been freely removed, that the term malignity is applicable.

“ If a local disease were from its earliest germ impressed with a
malignant character derived from a morbific matter in the consti¬
tution, it would be so much a constitutional disease, that the re¬
moval of it could never be urged on the ground of permanent be¬
nefit. To one species of malignant disease this character is ap¬
plicable, as I shall explain hereafter.”

There seems a manifest contradiction between the former
part of this paragraph and the sentence marked in italics ;
and if the concluding paragraph be true in cancerous cases,
the following opinions are highly contradictory.

“ A scirrhous tumour may therefore be, and undoubtedly is, in
the first instance, a local and single disease. The proof of this
may be found, allowing for all the prejudices against the opera¬
tion, and all the mistakes of pathology, in the record of a thou¬
sand instances of the early and complete removal of the disease,
without threat of return during many years of the patient’s after
life j nay, the ulcerated stage is not always too late for recovery,
and under otherwise favourable circumstances the removal of the
fungating ulcer of the cancerous breast, and other parts, has been
successful. This however, has proved a fortunate exception to
the ordinary course of experience.

“ This single fact is an answer to the question, whether the
scirrhus is local or constitutional in its origin.”

It is to be presumed that the 6 scirrhous tumour” means
the malignant or cancerous kind, and if so it was indispen¬
sably necessary to quote the authorities for ce the thousand
instances of the early and complete removal of the disease
without the threat of return during many years of the pa-

Medico- Chirurgical Transactions. 277

iient’s after life,” for we know of no such facts in the records
of medicine. The weight of surgical opinion, we believe, is
opposed to this position. In all the best surgical works, we
find that malignant scirrhus cannot be so permanently and
successfully removed as the above assertion would lead us
to imagine. And again we have innumerable instances on
record proving that a malignant scirrhus may exist in a dor¬
mant state for twenty, thirty, or forty years, and ultimately
terminate in cancer — that is, that this local disease can be¬
come malignant *. Sir E. Home, Burns, Richter, S. Coo¬
per and Mr. Abernethy assert, that tumours may become
cancerous, which were not scirrhous or really carcinoma¬
tous from the beginning ; while Mr. Pearson observes “ it
has never been clearly proved that any other disease can be
converted into cancer.” Scarpa is of this opinion f*

A very general opinion, however, certainly is, that cancer is a
local disease of a specific nature, which is at present unknown,
and that in its progress, it may produce such irritation as to affect
the general health, and contaminate different organs. Another
opinion is, that a predisposing cause exists in the habit, without
which no accident or injury can induce it. If it be a constitutional
disease, it would be great folly to attempt its removal by the ex¬
tirpation of a single organ ; as well might the cure of venereal
be attempted by the removal of the diseased inguinal glands.
Cancer has been produced by external injury in persons in whom
predisposition did not exist, as in cancer of the scrotum from soot
lodging iu the rugae of that part in young chimney sweepers. It
has been said, that the frequent return of cancer after operation,
and its rapiid increase is owing to the contamination of the system,
by the absorption of a specific virus, in the advanced period of the
disease. But the only effect of absorption is on the lymphatic
glands, which intervene between the sore and the heart for be¬
yond these, the absorbed matter is changed in its nature and pro¬
perties. Tulpius imagined that his throat was affected with can¬
cer, from inhaling its effluvia ; in a more recent period Mr. Smith,
of St. Thomas’s Hospital, supposed himself diseased from tasting
the cancerous matter. Le Cat and Ponteau affirmed, that cancer
could not cause cancer, though it might induce an ill-conditioned
ulcer. Mr. North and M. Alibert inoculated themselves with
cancerous matter, but did not produce the disease.

The best judges of cancer, men who have made it their constant
study for years, affirm that they have removed the disease both in
the occult and ulcerated form by extirpation, which could not hap¬
pen if the system were contaminated. Yet how can we account for
the recurrence of the disease after the most complete extirpation
and often in a different organ ? Still it is unphilosophical and un-

* In the works of Celsus, Van Swieten, Tulpius, Hilden, Sir E. Home, Car¬
michael, &c. &c.

+ We think the following facts ought not to have been omitted by Mr. Travers.

278

Critical Review.

supported by analogy to suppose that a constitutional poison can
exist for many years without injuring the system ; and afterwards
to be wholly eradicated by the knife, which only removes a single
tumour. And it must be admitted that no internal remedies can
influence the disease ; so that if constitutional, a permanent cure
can only be effected by local application. Dr. Parkinson thinks,
that inflammation attended by accretion and its consequences, is
the cause of cancer. M. Rouzet* * * § concludes his very excellent essay
by stating there is a cancerous diathesis, and that the disease is
hereditary, while M. Lasserre + is convinced that chronic inflam¬
mation is the cause of cancer, which is not a malady, sui generis,
an essential malady, an organic vice. Mr. Charles T. Johnson |
thinks cancer is a local disease, arising from a constitutional pre¬
disposition, such as gout and scrofula, which in their effects, are
at first local. In healthy constitutions external causes will not
induce either of those diseases, while they frequently produce can¬
cer — a disease concerning which there is not the same proof of its
being hereditary, as of gout or scrofula. Nevertheless it must be
admitted that external violence in other habits, will only induce
common inflammation. That great genius, Mr. Hunter, whose
opinions have been seldom refuted, is amongst those who think
cancer local in its origin : in his opinion it was so far local, that if
all the diseased part, or that which was so contiguous to it, as to
have felt its influence, and have acquired a predisposition to the
disease, were removed, the patient would have been as exempt
from cancer in the part, as if it never had occurred. Mr. Abernethy
concurs in this opinion, but affirms, that although the patient be
thus exempt, this state of the constitution which induced it origi¬
nally, may, after a certain lapse of time, cause it to form again j or
may produce the same disease in other parts of the body, or a pa¬
tient may die of other diseases attendant on a cancerous constitu¬
tion. We are not, in our present state of knowledge, able to dis¬
tinguish any peculiar circumstances characteristic of a cancerous
constitution §.

M. Scarpa asserts, that whatever obscurity there may be with
regard to the primary origin of the morbid principles, generated
in the animal economy, still from the examples of erysipelas,
furunculi, the exanthemata, and numerous other affections, it
would appear, that germs of disease are formed, in the general
system, which not being miscible with the blood, are, by the
power of vitality, expelled entirely from it, or driven only to the
skin, or else deposited in some of the external emunctories, and
there held for a greater or lesser time in a latent or inocuous
state. The efficient cause of this disease is to be traced to no
other source than that of internal elaboration, to which every
individual is more or less, or in some measure predisposed ;

* Recherches et Observations sur le Cancer, par F. J. L. Rouzet, M.D. Pa¬
ris, 1819.

t Reflections sur le Cancer. Journal de Sciences Medicales, T. 4.

X Johnson on Cancer, 1810.

§ Surgical Works, v. 2, p. 90.

Medico - Chirurgical Transactions. 279

although exposed to the same oceasional causes as suppression of
certain evacuations, disappearance of cutaneous acrimonies, rheu¬
matism, &c. and for these reasons he does not believe it to be
proved in any way, that there are scirrhi or cancers, solely pro¬
duced by internal causes, which some authors think are less for¬
midable than that arising from external causes.

Mr. LangstafF, who had great experience in cancerous diseases,
is convinced that cancer and fungus hsematodes are no more local
diseases than those of the scrofulous class. He supposes that
cancer, fungus haematodes and scrofula, have their origin perhaps
with the formation or development of the natural parts or the foe¬
tus in utero ; and that they remain after the birth of the individual
dormant or inactive in some instances for a series of years, and in
all only require a peculiar morbid excitement to occasion their in¬
crease and destructive mass * .

Sir Astley Cooper is of opinion, that blows or injuries inflicted
on the testicle, in a constitution predisposed to cancer, might
call into action that disease, in the same manner as cancerous dis¬
ease in the female breast, often owes its origin to a blow received
on the part f.

Such are the chief facts and arguments generally brought for¬
ward, concerning the question of the local and constitutional
nature of cancer •, but they contain only a small part of the opin¬
ions which have been given on the subject.

The author of the essay under notice has said very little
on the pathology of the disease, and not a word on the di¬
agnosis, or medical treatment. He has not noticed the va¬
rious theories on the origin of incipient disorganization ; he
has merely stated the results found on dissection. When
we consider the vast number of works on cancer published
in this and other countries, and the contradictory opinions
maintained as to the real nature of the disease, we should
naturally expect a full discussion of the disputed opinions
from a modern writer. There is much room for a compre¬
hensive work on the different forms of cancer, the immediate
cause of which disease is as yet unexplained, and perhaps
unknown. The disease is of very common occurrence, and
too often so situated as to preclude all surgical operation ;
and hence the necessity of endeavouring to discover some
therapeutical means, at least of alleviating its direful conse¬
quences. With all our boasted knowledge, with all our
wonderful improvements in the healing art, we must still
how down before the ancients, and admit the justness and
solidity of their opinions. This is well exemplified in cases
of cancer, a disease as intractable as in the days of Celsus
and Aretaeus. The former observed, in speaking of that ma¬
lady, “ neque ulli unquam medicina profuit ; sed adusta pro-

* Medico-Chir. Trans, v. viii and ix.
t Lancet, v. ix. Oct. 15th, 1825, p. 130.

2.80

Critical Review .

tinus concitata sunt, et increverunt, donee occiderent, ex-
cisa etiam post inductam cicatricem, tamen, reverterunt, et
causam mortis attulerunt.” Lib. 5. c. 2/. The latter has left
the following practical precept, “ orientes avertere, et nuper
incipientis solvere opertet.” — De Cur. Morb. Diut. L. I . c.
14. This is the general opinion of modern surgeons, and of
Mr. Travers among the number ; it was his maxim in the
cases which he has related in the production before us. His
candid avowal of his failure of success in some of the cases
related does him much credit ; and must have reminded him
of the statement of Celsus. His cases are ten in number,
from which we shall extract the most interesting.

“ Medullary Tumour of the Face and Angle of the Jaw.— This is
sometimes seated in the cellular rpembrane, more frequently in the
lymphatic glands. I have seen it occupying the situation of the
zygomatic fossa, and also over the parotid gland, covering this
and a portion of the buccinator muscle. Such tumors are at first
moveable, of slow growth j little painful ; they increase from the
size of a small bird’s to a goose’s egg, when the skin is universally
adherent, erubescent, and polished; their softness and appear¬
ance of pointing leads the inexperienced surgeon to mistake them
for chronic abscesses ; if they are punctured, blood only escapes.
I have seen them situated on the hairy scalp. In this situation,
which is rare, the subjacent bone is affected by the disease, or ul¬
cerated by pressure before they reach any considerable size.

« Cancer of the Eyelids and contents of the Orbit . — This is a very
strongly characterized disease, and very uniform in its character.
It begins in the form of a hard, fretful, pimply ulcer upon either
palpebra, or one of the borders or angles of the tarsi. It is dis¬
coloured by inflammation, and sometimes itches, discharges a thin
matter, and scabs repeatedly. When it draws surgical attention,
it is an irregular sore, notching or puckering the border of the
affected lid, by removal of its substance, and creeping around the
orbit. Its progress is slow, but after some time the conjunctiva
of the palpebra becomes elevated, thick, and rigid. The ulcer at
length environs the orbit and eyeball, and a luxuriant fungus over¬
shoots, and, together with the hanging remnants of the lids, buries
the eye, so that, although the globe remains, it becomes difficult
to be seen. The pain is itching and burning. The ultimate stage
of the disease presents a horrible appearance. For a long time
the globe remains (I have even seen the cornea and humours
clear) suspended, as it were, geometrically, in the centre of the
ruin ; the malar and temporal bones are denuded, but an immense
fungous mass encircles the orbit, and in part springing from it, is
everted over the supercilium, nose, temple, and cheek. The globe
at last perishes, but seems rather to yield to its complete insula¬
tion than to the destroying process which it has so long with¬
stood. I have extirpated this disease, when, as is rare, it has
commenced in the loose conjunctiva, removing the entire con¬
tents of the orbit. The disease re-appeared upon the inferior pal-

Medico-Chirurgical Transactions . 281

pebra. I have also known it removed in the fungous stage after
the destruction of the lids, by which only a temporary respite was
obtained. The lachrymal gland is sometimes exclusively affected
with scirrhus, and in this state, previous to internal ulceration, I
have removed it. The patient remained for some years free from
disease. I have since lost sight of him.

“ Medullary Tumour of the Eyeball, and contents of the Orbit , —
This disease has been so repeatedly and fully described of late
years by the cultivators of ophthalmic surgery, that I conclude
it is well known in its leading features to most members of the
profession. The peculiar metallo-lustrous or tapetum-like ap¬
pearance of the fund of the eye is not diagnostic : this is a fact
highly important to be known.

The best diagnosis is founded on the increase of volume of
the eye-ball, or the contrary, prior to the giving way of the tu¬
nics. Even this, and loss of shape, and discoloured tumours of
the sclerotic, are, however, insufficient, as all may be produced by
disorganizing choroiditis 5 but the progressive advance of the tu¬
mour to the cornea, and the shrinking and sloughing of the latter
membrane, which happens prior to the protrusion of the fungus,
is decisive of all doubts. The hydrophthalmic enlargement, or
the direct collapse by interstitial absorption of the contents of the
eye- ball, are sure indications that the disease is not malignant.

“I have extirpated the eye affected with medullary cancer in
several instances } but I am not acquainted with any case in which
the patient, who has survived two years, has not been revisited by
the disease.

(< Cancer of the Lower Lip. — -The commencement of this com¬
mon and well-known disease is in the interjacent cellular tissue of
the mucous membrane and skin. The enlargement and induration
render it conspicuous before the villous surface of the lip cracks
transversely, and oozes a thin fluid, then ex-ulcerates aud scabs by
turns, and ultimately ulcerates deeper and fungates. The patient
is generally a healthy male, of advanced years, and accustomed to
smoking. Pus sometimes escapes on a section of the fungus, but
the stool or base of the tumour is hard, granular, or seedy ; the
skin and mucous membrane and the labial glands, now prominent
and warty, are closely compacted together and indurated. As the
ulceration proceeds, the induration extends, and the salivary glands
beneath, and the lymphatic glands, at one or both angles of the
jaw, become sympathetically enlarged and tender. The healing
of this sore is attempted to no purpose j cleansing, destroying,
the surface by escharotics, covering it by an artificial scab, are all
ill turn fruitless. The perfectly clean or new surface cannot be
brought to form skin. The operation after the manner of hare-lip
is simple, and in proportion to the loss of substance the cicatrix
slight, and the deformity little perceptible ; but there is a mode of
operating which I prefer to that for hare-lip, and slow as the pro¬
gress of the disease is, and little painful, the wisest way is to re¬
move it freely in its early stage.

VOL. m. no. 16. 2 o

282

Critical Review .

“ The mode of operating which I alluded to above, is the simple
removal, by a full crescent-shaped section, of the substance of the
lip. The commissures of the mouth should, if possible, be left —
no suture is of course, required. The contraction during the heal¬
ing process under a double-headed bandage passing over the ver¬
tex and occiput, so as to keep a little moistened lint or simple
ointment on the cut surface, shapes and adapts the lip with singu¬
lar neatness ; and what is more remarkable, the cut surface takes
a depth of colour, and a plumpness and a defined border, which
has much the appearance of the natural surface. I lately perform¬
ed this operation at the suggestion of Sir Astley Cooper, for an
elderly gentleman from Grantham, who had twice undergone the
hare-lip operation for the disease, under an eminent provincial
surgeon. Although the substance of the lip was removed to the
fraenum, it was interesting to observe how much its natural figure
and appearance were restored. The disuse of suture and ligature
obviates a very irritating and objectionable part of the treatment.

“ Cancer of the Alveolar Membrane of the Lower Jaw. — This is a
rare, but very marked form of malignant disease. I have seen it
only in aged persons. It commences at the point of reflection of
the membrane of the gum on the alveolus, or on the inner side of
the gum at the root of the teeth, where the sore mouth from mer¬
cury is commonly first perceived. Small granular eminences or
tubercles are formed, by which the membrane of the gum is raised
and thickened into a small lump. The disease begins, in my ex¬
perience, about the root of the last incisor or bicuspid, and thence
gradually enlarges backwards to the middle molar teeth. Ulcer¬
ation then ensues, the edges of the ulcer fungating and bleed¬
ing frequently it is slowly, but progressively phagedenic, de¬
stroying the soft parts, and, ultimately, by ulcerative absorption,
the substance of the maxilla, so as even to divide the bone. The
adhesive inflammation of the contiguous membrane and soft parts
during this process, and the tumefaction of the sub-maxillary
gland, give a peculiar elongation, breadth, and bulging of the jaw
on that side, which is a characteristic feature of the disease. The
imperfect opening and cleansing of the mouth, the difficulty of
taking nourishment, and the horrible fetor of the discharge —
the constant gnawing pain, with shoots darting upwards to the
temple, render this a disease of great suffering. It admits only of
palliation by the frequent use of antiseptic and detergent gargles
and lotions, as of lime-water, camphor, myrrh, borax, honey, &c.

“ Medullary Tumour of the Mouth and Fauces. — I have seen se¬
veral instances of fungoid tumour situated within the cavity of
the mouth $ in one upon the upper maxilla, extending from the
left alveolar process over the palate ; in another, from the oppo¬
site alveolar process of the lower jaw, extending backward to
the fauces and pharynx ; in a third, and of this more than one in¬
stance, growing within and around the incisores teeth, and cover¬
ing the symphysis of the lower jaw. The extirpation is attended
with very free hemorrhage, and is invariably, in my experience,
followed by the rapid reproduction of the tumour, which does not

Medico-Chirurgical Transactions. 283

break up into ulceration, but increases to such an extent as gra¬
dually to destroy the function of the parts necessary to nutrition.

“ Cancer of the Tongue. — This is not a smooth and firm rounded
tubercle, such as is often met with in this organ, but an irregular
rugged knob, in its first stage, generally situated in the anterior
third, and midway between the raph6 and one edge. It some¬
times, but seldom, extends across the middle line, although it
often extends alongside of it. The hardness is unyielding, inelas¬
tic, and the mucous surface puckered and rigid. It also gives to
the finger and thumb of the surgeon the sensation of solidity, or
of its penetrating the entire muscular substance, being perceived
equally on either surface. Sharp shoots of pain are felt through
the side of the affected organ, towards the angle of the jaw and
ear. The disease tends to run backward towards the base or pos¬
terior edge. It sometimes acquires great bulk before ulceration
takes place, so as to project the tongue from the mouth. In this
state a female patient of mine was seen some time ago in St. Tho¬
mas’s Hospital, in whom the permanent projection of the dis¬
eased organ beyond the widely distended lips was from three to
four inches. Life was sustained for a time by nutritive injections.
The ulceration often extends from the edge of the tongue to the
membrane of the mouth and gums, when the elevated and dis¬
tended membrane at length gives way, and ulceration is rapid.
The surface of the ulcer is very uneven, clean and bright granu¬
lations appearing in parts, and in others deep and sloughy hol¬
lows. The darting pain is very acute, but only occasional. There
is a dull aching always present, and as constant a spitting as in
deep salivation. The irritation is such as soon impairs the powers
of life. It happens to strong and hitherto healthy persons, for the
most part males, from the age of forty onwards. There is gene¬
rally an evening paroxysm of pain, and the nights are much dis¬
turbed by the secretion accumulating in the throat, which excites
cough. Often the patient is roused by a painful compression of
the tongue falling between the jaws. The leaden hue of the coun¬
tenance, the loss of flesh, and difficulty of taking food, although
symptoms of the advanced stage of the disease, are observed long
before the appetite or muscular powers fail in proportion. Fre¬
quent moisture with mild fluids, as tepid milk and water, or con¬
fectioner’s whey is gratefnl to the patient. Speech is much
affected and painful.

“ Towards the fatal termination of the disease, occasional pro¬
fuse hemorrhages take place at shortening intervals, and alarm and
weaken the patient, who ultimately dies tabid and exhausted, ge¬
nerally with symptoms of more extensive disease of the mucous
membrane in other parts.

Of all diseased states this is one of the most pitiable : it admits
of palliatives only, and these very ineffective. I have seen only
one case, wherein the ligature or knife had been employed, and in
'which I did not witness or hear of a recurrence. The black wash
(3ss. of calomel suspended by mucilage in ^ij- of lime water) is
upon the whole the best application. Local opiates seldom act as

284

Critical Review.

anodyne. Neither mercury, steel, arsenic, iodine, prussic add,
bark, nor any other medicine, have any permanent influence over
the disease.

“ Cancer of the Antrum.-*-? This most disfiguring and destructive
disease begins upon the lining membrane, and first shews itself in a
bulging of the cheek under and upon the malar bone. The tumour
is elevated, circumscribed and hard, and the integument has a blush
of colour. The pain is inconsiderable when the patient is alarmed by
,ihe appearance and increase of the swelling. The nostril soon be¬
comes closed on the same side, and the teeth loose j they fall out or
are extracted, and a copious oozing of purulent ichor takes place
into the mouth. The introduction of the probe by the nostril or pa¬
late, is followed by free bleeding. If the alveolus is trephined, a
fungus shoots up, fills the opening and covers the gum. Next the
palate becomes depressed, so that the arch on that side is lost, and
the eye-lids are closed, or the eye protruded j and completely
amaurotic in either case. In the mean time the external swelling
gains size, is quite immoveable, and the skin acquires a livid hue.
Small veins are seen rampant upon it in great numbers, forming a
net-work. There are commonly one or more depressions where
the bone is absorbed. These break and discharge pus. The pa¬
tient suffers a good deal of burning and darting pain. The ulcera¬
tion extends until the mouth communicates directly with the sur¬
face, and fluids escape from the wide opening in the cheek, which
is surrounded by a raised, thick, everted border of granulation; or
the openings are less direct and fistulous, in which case the tu¬
mour acquires an enormous bulk, and the roof of the mouth is
upon a level with the incisor teeth, and compresses the tongue.

“ Cancerous Fungus of the Nares and Antrum. — This is a growth
essentially malignant, to which the common lining membrane is
subject, though it is happily rare. It has no character of tubercle,
but, on the contrary, is a brittle or friable fungus, excessively vas¬
cular, growing from the whole surface of the cell. I have seen it
commencing in, and proper to the nares, but it is more frequently
situated in the antrum. It distends the parietes enormously by its
rapid growth, and although masses of it are cut or torn away, and
the cautery applied to the cleared surface, it is reproduced again
and again within the space of a few weeks.

“ Cancer of the Fauces and Pharynx. — Scirrhous tonsil, like scir¬
rhous testicle, is often talked of, but in reality seldom seen. But
the broad papillse at the root of the tongue adjoining the base of
the epiglottis, the tonsil glands, and the mucTous follicles of the
common membrane of the glottis and pharynx, are each of them
occasionally proper seats of the disease, beginning in tumour and
induration, and terminating in fungus.

“ Cancer of the External Ear. — The ear is rarely an original seat
of cancer, although not unfrequently attacked by the encroach¬
ment of an ulcer on the cheek. I have once, however, seen the
upper third of the external ear the exclusive seat of an indurated
sore, having every character of cancer, and amputated the diseased
piece. The wound healed, and the patient, I believe, remains sound.

Dr. Stoker on the Pathology of fever. 285;

u Medullary Tumour of the Internal Ear.— I have seen one ex¬
ample of this disease. The sufferings of the patient were severe
from the confinement of its situation, and the displacement of
the parts 5 and the deformity was excessive. Externally, the tu¬
mour extended from the temporal fossa to the angle of the
lower jaw ; and internally, to the posterior nares and fauces. The
mastoid cells were apparently not invaded by the tumour. The
jaw became locked, and a bleeding fungus filled the meatus audi-
torius. The same side of the head and face, and the muscles of
deglutition, were paralysed. To this coma succeeded. The pa¬
tient was nourished with great difficulty, and his death was acce¬
lerated by inanition. The post-mortem examination, to my great
disappointment, was peremptorily refused.”

III. — Pathological Observations , Part II, on Continued Fe¬
ver, Ague, Tic Douloureux , Measles , Small-pox, and
Dropsy; illustrated by Cases, noted in the year 1 828, from
hospital and private practice ; with a preliminary disserta¬
tion, on the Institutes of Medicine ; and an Appendix on
the Origin, Preventibn and Cure of Organic Diseases of
the Cranium , Thorax, and Abdomen. Illustrated by Cases
and post-mortem Examinations. By William Stoker,
M.D. Fellow of the King and Queen’s College of Physi¬
cians, in Ireland, &c. &c. &c. Dublin, Hodges and Co.
1829. *

The object of the author before us is two-fold : first, to con¬
sider the validity of the Cullenian doctrine of fever, and the
doctrine of solidism in general ; and, secondly, to prove it
imperfect and untenable, according to the result of his
own observations on fever, during a period of twenty-five
years, in which 773866 patients had passed through the hos¬
pital, to which he is one of the physicians. Dr. Stoker is
long known to the profession as a scientific physician, and a
faithful observer of disease, as his numerous works very amply
testify, and from the immense opportunities he has had of
observing disease both in hospital and private practice, from
his ardent love of science, and his sober and faithful obser¬
vation, we cannot be surprized that he should have disco¬
vered many imperfections in Dr. Cullen’s theory of fever,
and the other doctrines that have succeeded it. Dr. Stoker
has drawn his conclusions from the best of all premises,
from his observations at the bedside of the sick, and he has
found the present theories of Cullen, Brown, Darwin, Clut-
terbuck, Marcus, Plocquet, Broussais, Bretonneau, and
others, all inadequate to their explanation. It is to be recol-

$86

Critical Review.

lected, however, that Dr* Cullen very candidly acknowledged
his doctrine of fever was a modification of Hoffman’s,
and that it was not free from objection, although the most
satisfactory which he considered could be offered. But he
was soon undeceived by the writings of Brown and Darwin,
and even the most talented of his successors in the Edin¬
burgh school do not rank among his disciples. His theory
of fever approached much nearer the true one, than that of
the humoral pathologists; it embraced a certain action in the
nervous system, which, though inapplicable, was referable to
that part of the body which is primarily affected in fever as
well as in all other diseases. It appears by the subsequent
physiological researches, that all poisons, animal, vegetable,
mineral, and gaseous, act primarily on the nerves, as is in-
controvertibly proved by Morgan and Addison; and that
the sudden deleterious effects of the contagion of plague,
fevers, malaria, and miasmata, can only be explained in the
same manner ; for life will be extinguished before reaction
or excitement— -the effect of spasm of the extreme vessels of
Cullen — has time to be established. We are, therefore, justi¬
fied in concluding, that the first impression made by the
causes of fever is applied to the nervous system ; that its
functions are deranged, consequently those of circulation,
respiration and secretion ; that the supply of blood is dimi¬
nished on the surface and extreme parts of the body, the
function of the stomach impaired, and all these phenomena
are easily explicable on the received doctrines of physiology.
Thus far we can legitimately proceed, but no farther. We
consider the causes of fever, sedative powers applied to the
nervous system, producing certain phenomena, but how
these effects may cease in a single day or be continued for
one, two, or three weeks, is a perfect mystery to us. Neither
can we account for morbid appearances of the blood, of the
secretions, or the different parts of the body. Of the cause of
these changes we know nothing, nor are our modern theories
a whit more perfect than those of the sage of Cos and his
successors to our own times. Some men ascribe all these
changes to congestion and inflammation, but those conditions
are secondary, nor can they explain the proximate causes of
intermittent, remittent, continued, or eruptive fevers, or of
the hereditary diseases. Besides thousands of fever cases
do well without depletion. In the present state of science
we might be much more parsimonious of our ridicule of for¬
mer theories, of those which referred fever to the humoral pa¬
thology, to vitiation of the blood, black bile, lentor and acri¬
mony of the vital fluid, predominance of acids or alkalies,
mechanical derangement of the sanguineous globules ; for

Dr. Stoker on the Pathology of Fever. £87

even in these intellectual times, we have progressed no far¬
ther, increased vascular action being generally considered
the sole cause of fevers. Our modern theorists, like their
predecessors, seem to forget that there are such organs as
the brain and nervous system in the human body, or that
fever is at all dependent on their derangements. It is now
the fashion to refer the cause of fever to congestion and in¬
flammation in certain organs, to the brain, the stomach, in¬
testinal canal, &c., and it is really astonishing with what
tenacity these theorists maintain their opposite opinions.
In all these different theories, we find no explanation for the
periodicity of intermittents, nor for the phenomena of the
diseases already enumerated.

Morbid anatomy throws no light on the causes, but merely
on the effects of these maladies ; in a word, we are gravely
reminded of the everlasting theme in medicine, u that the
real causes or nature of these diseases are inexplicable in the
present state of science.” The ardent admirers of necro¬
tomy, are now convinced of the inutility of endeavouring to
discover the causes of febrile and other diseases by the scal¬
pel ; and they are once more very rapidly returning to other
modes of investigating the causes of those diseases, which can¬
not be explained by localizing them, or referring them to differ¬
ent organs. Dr. Stoker is the first writer in this country, who
has in some measure assailed the modern theories, and en¬
deavoured to direct attention to the condition of the fluids
in disease. In a former page we have cited the authority
of Dr. ’Armstrong, in corroboration of the validity of the
opinion, but at the same time we have shown that this mor¬
bid state of the blood is the effect and not the cause of fe¬
brile diseases. If the morbid state of the blood were alone
the proximate cause of fever, we could not account for the
frequent recoveries from that disease, often without the use of
any medicine whatever. Besides, the nervous system would
be secondarily affected, an idea that cannot be entertained
for a moment. It must be freely admitted that the func¬
tions of this system are primarily affected in all diseases,
long before congestion or inflammatory action can be esta¬
blished. The theorists have been too long unmindful of this
fact, and at length seem aware of its importance. That the
blood should be exempted from vitiation or disease, and thus
differ from all the other constituents of the human body, is a
position that never could have been really maintained by pa¬
thologists on sober reflection. This position we shall prove
from the interesting work under notice, and from other
sources of high authority. Dr. Stoker is entitled to the sole
'merit of directing the attention of the profession to this im-

288

Critical Reviciv.

portant part of pathology, but he has not afforded sufficient
evidence to prove, that the blood is more vitiated in fever than
in numerous other diseases. He has certainly collected a num¬
ber of facts which must be deemed incompatible with the ex¬
clusive system of solidism, but fully explicable by consider¬
ing the conditions of the blood. Having furnished these few
remarks, we now proceed to subject our author’s opinions to
impartial criticism, and place them fairly before our readers.
The work before us is divided into two parts : 1. An intro¬
ductory Dissertation on the Institutes of Medicine ; 2. A
Medical Report of the Cork Street Fever Hospital, in Dub¬
lin, from the year 1804 to 1828 inclusive. Dr. Stoker in¬
forms us of the extent of his theory in an advertisement
prefixed to his work, and transcribes a letter from Dr. Per-
cival, of Dublin, a gentleman, of great observation and au¬
thority, as corroborative of his opinion. Dr. Stoker com¬
mences thus :

tc Being fully sensible of the hazardous position of mediator,
which I had for some time endeavoured to maintain in the im¬
portant controversy between the Humoralists and Solidists, I
earnestly requested three years ago, in the advertisement to the
prefixed Dissertation, to know from the advocates of the rival
systems how far they would sanction the principles it asserts, be¬
fore I should present this subsequent publication, which is little
more than an addition of facts, and its practical conclusion.. To
have known what were the particular tenets received and rejected
by each, and why they were so, would have enabled me to pro¬
ceed -in the present case with some degree of certainty and satis¬
faction. The reviewers of Great Britain, however, have not been
pleased to express their opinions, and I have therefore been
obliged to take those criticisms which I have privately met with,
as the expression of the solidists in the English school. But in
Germany, where the pathological principles, which I have adopted,
have been always more favourably received, my humble efforts
have been noticed ; and in a long and able criticism upon the dis¬
sertation, by Dr. Steinheim of Altona, he has again established

his claim to my warmest thanks.

“ In reply, however, to the objections which have been urged
against the possibility of conciliation between the solid and the
humoral pathology, I would remark, that I cannot perceive the
same necessities which the reviewer contemplates, nor believe
that the truth of either of these rival systems of pathology is at all
dependant upon the issue of the question. Where is the salient
point of life?

<f If, indeed, I had considered disease and life to be either the
same or similar, I never would have ventured upon pathological
enquiry j and it may be perceived, that in collecting facts, which
I deemed incompatible with the exclusive system of solidism, but
fully explicable by considering the condition of the fluids, particu-

Dr. Stoker on the Pathology of Fever. 289

larly of the blood, my views never extended farther than the evi¬
dent signs of the commencement of disease, or interruption of
healthy or vital power ; and that, finding certain changes in the
condition of the circulating blood to be connected with such in¬
terruptions, whilst no evidence of altered structure in the solids
was yet observable, I considered them likely to influence the suc¬
ceeding symptoms. It was with such views I stated, from Dr.
Bostock’s work, what were the external characters of the blood in
a healthy state, and contrasted them with those morbid appear¬
ances which it assumes in disease 3 and on afterwards finding that
these morbid appearances differed according to the part engaged,
I was induced to remark that circumstance as a useful diagnostic
of the part engaged, and to suppose it might lead to a discovery
of the cause of the interruption in the function of that part.

“ One thing at least we must be certain of, that the two contra¬
dictory systems cannot both be true, and that neither of them is
sufficient for the physician’s guide, or the purposes of society.
This conviction, as well as that each contains much that is valu¬
able is my apology for persevering in the course I have adopted,
in which I am further supported by the following letter, which
must be acceptable to the reader, whether he considers the depth
of information it contains, or the high authority from whence it
comes — Dr. Percival of Dublin. • t.

“ In reading the publication you were so good as to send to me,
I have noted in the lower margin some detached observations

which have occurred to me. ■ .

“The existence of iron in healthy blood appears to be well as¬
certained 3 also of sulphur, calcareous earth and of different saline
substances, or at least of their constituent principles. — Good, voi.
ii. pp. 30, 32 3 2d edition.

« Now if iron, sulphur, and salts, applied externally, excite vas¬
cular action, is it not probable that the blood stimulates the ves¬
sels through which it circulates, more or less according to the pro¬
portion of these principles which it contains 3 and is not this con¬
clusion rendered more than probable by the effect of chalybeates
in chlorosis, and of sulphureous waters in cutaneous affections ?

“ But again— we know that blood may be infected in the living
animal with various extraneous bodies ; the volatile matter of aspa¬
ragus and turpentine, the coloring matter of madder, by emetic tartar
and mercury. Some of these appear to stimulate the vascular sys¬
tem, partially or generally, and by producing an increased action,
short of inflammation, to contribute to the removal of chronic dis¬
eases, particularly by increasing the perspiratory discharge. Such,
also, seems, in some cases to be the effect of a generous regimen.
But when the operation of any of these stimuli exceeds the healthy
limit, inflammation, partial or general is produced 3 and this is to
be removed, not only by diminishing the action of the vessels, but
by removing the irritating cause. When inflammation attends the
puncture of a thorn which remains in the wound, antiphlogistic
means are with propriety employed, but the main point is the ex¬
traction of the thorn.

VOL. in. no. 16. 2 p

290

Critical Review.

“ This reasoning may be applied to febrile diseases in general,
if we take into account that they are often, perhaps generally,
produced by indirect stimuli. Their first effect is to diminish the
exertion of vital power, and thus to cause an accumulation of vital
energy, which often breaks out in inflammatory action, necessary
perhaps for the removal of the morbid cause; but in sthenic habits,
exceeding the due limit, and requiring to be moderated. In this
point of view, we might consider fevers as a depuratory process, in
which the powers of life are gradually, according to a certain law
of periodical movement, excited to the expulsion of the offending
matter. This brings us back to the concoction of our forefathers,
whose doctrine, but especially whose practice, though I should be
considered as a dotard, I cannot reprobate.”

In the section on physiology, Dr. Stoker endeavours to
explain the functions of the liver much more fully than
others have done, but we must state, in our opinion very un¬
successfully ; for his conclusions are quite hypothetical.
He considers that very important uses in sanguification be¬
long to the liver and spleen, in consequence of certain
changes in the hydro-carbonous principle with which the
blood comes charged to the vena portae % thus fitted for the
changes it has to undergo in the lungs.

“ By effecting this change in the hydro-carbonous principle too,
I supposed that the liver might be deemed the chief secerning or¬
gan of fat, and perhaps of fibrin, with the assistance of the lungs,
for the supply of which, for the different parts of the body, there
is no other appropriated apparatus such as may be found for each
of the other secretions, though apparently far less important to
the maintenance of life. In this point of view the hepatic system
may also be deemed a chief source of animal heat, inasmuch as
by favouring the mutual attraction and chemical cohesion, be¬
tween elementary parts of the adipo-fibrinous matter, carried thi¬
ther by the veins, a commencement of that intimate combination
takes place, by which subsequently in the lesser, as well as in the
greater circulation, caloric, in consequence of diminished capacity
for it in the circulating mass, is evolved, according to the exigen¬
cies of life. A theory of animal heat, consistent with those of
Drs. Crawford, Skey, and De la Rive, which will be found fur¬
ther substantiated by evidence derived from observations in the
course of diseases f. The cases which afford such evidence shall
be considered more fully in the next section, on pathology ; but
those to which I would at present refef, were those of certain dy¬
senteric forms of the epidemic that prevailed last summer in this
country, in which very large quantities of dark-coloured blood
were discharged from the mesenteric and hemorrhoidal veins ;
and where the temperature of the patients, ascertained by apply-

* The Experiments of Prevost and Dumas corroborate these opinions,
t According to more recent views, the temperature of the blood depends on
nervous influence. — Ed.

291

Dr. Stoker on the Pathology of Fever.

ing the hand to any part of the surface, or to the air expired from
the lungs, was so much diminished as to feel very cold to any of
the bye-standers who made the experiment. In other cases (but
one in particular) of chronic hepatitis, the surface of the body of
the patient was cold and clammy, and for some weeks previous to
death the colour of every visible part was dark, livid, and cold ;
the most strikingly remarkable circumstance in that case (and for
which I allude to it here) was, that the blood taken some days
before dissolution from the temporal artery, on account of a sud¬
den apoplectic attack, as it flowed sultatim, had the colour not
only more like to venous than to arterial blood, but was actually
as black as ink.”

The terminations of the cases referred to, are not given,
and we are left to draw our conclusions from symptoms re¬
lated in the above extract, which from their severity natu¬
rally induce the supposition, that great debility must have
existed. In such a state, the diminution of animal heat can
be as justly referred to exhaustion of the vital power, and the
general prostration of the functions of the other organs, as to
the liver and spleen ; but we perceive no legitimate reasons
for ascribing it to any organ in particular. . We know so
little of the source of animal heat, that we think Dr. Stokei
rather premature in his conclusion. We must also remind
him of the functional connexion between the liver and lungs,
and of the evolution of caloric which is said to be effected
during respiration \ nor must we forget the disorder of the
sensorial functions in the cases which he has related. The
general disordered functions will better explain the diminu
tion of caloric under the circumstances described, than the
following explanation.

« In the former dysenteric eases, there was an evident deficiency
of combustible matter, (as Dr. Skey, I think, aptly calls it ;) and
in the latter, or hepatic disease, there was as obvious an imperfec¬
tion in the apparatus provided for kindling that combustible mat¬
ter into action ; and subsequently under the controlling influence
of vital power for evolving animal heat.

Our author endeavours to establish another office for the
liver, the formation of adipose substance, and this he sup¬
poses from the size of that organ in all animals at birt •
But we have no proof whatever that the liver, or indeed any
other organ secretes or forms fat. Our opinions on this
obscure and unknown part of physiology, are merely conjec¬
tural. The following experiment is adduced in proof ot his
opinion. A dog was suspended until the animal was nearly
dead, when blood was drawn from the vena porta, and then
from the vena cava . The blood taken from the latter was
many shades lighter in colour than that from the former,
the distinction continued for several hours afterwards, which

292

Critical Review .

accorded with the author’s opinion that an important change
is effected on the blood in the liver, before it arrives at the
heart. Dr. Colles, the Professor of Surgery in the Royal
College in Dublin, had assisted at this experiment. The
blood taken from each vein was placed separately in water
at the temperature of 160 degrees, “with the hope of de¬
taching the oily and therefore the lighter parts, and of al¬
lowing them to take their place on the surface. After some
time an unctuous and dark-coloured film floated on the sur¬
face of the water in the basin which contained the blood of
the vena cava , which continued for several hours, assuming,
however, a more friable feel to the finger, and utimately ap¬
peared more soluble in the circumambient water,” xxviii.
No such appearances presented themselves in the blood of
the vena portce. These experiments confirm the old opinion
that the liver effects some important changes on the blood,
but they afford no proof that oil or fat is formed by that or¬
gan. Indeed our author seems to agree with our opinion, in
another page. “I am desirous not to be misunderstood as
thus attempting to explain the final and chief causes of these
phenomena ; the organic affinities of the hepatic system,
conducive to the elaboration of oily, gelatinous, and, perhaps,
other substances intended for the supply necessary to the
constant waste of the solids, &c.” p. xxxviii. This decla¬
ration is strongly opposed to the preceding doctrines we
have related. The next physiological point our author dis¬
cusses, is the difference which exists between healthy blood,
and that found in disease. He quotes the description of
healthy blood as detailed by Dr. Bostock, and argues that
the different constituents occasionally predominant are to be
ascribed “ to the result of chemical affinities insufficiently
controlled by vital power.” He thinks that the morbid ap¬
pearances found in the blood must be considered symptoms
of disease, and also sufficient to excite further disorder in the
animal economy, such as has been shewn by Dr. Barry to
follow the introduction of any fluid extraneous in its nature
or properties, to that natural to the sanguiferous system.
There can be no difference of opinion on this point, for if
the blood be diseased, it cannot afford the proper support
to the different organs, and disorder or disease must be the
consequence. In all cases where the blood presents unna¬
tural appearances, we find disease in some organ or other.
Dr. Stoker having considered the functions of the liver as,
one of the great avenues of supply to the right side of the
heart, he next proceeds to that of the other, namely, the
union of the chyle and lymph in the thoracic duct.

ie The chyle and lymph, on this union in the thoracic duct, flow

293

Dr. Stoker on the Pathology of Fever.

into the subclavian vein, and are then mingled for the first time with
the blood at the right side of the heart ■, blood which had been in
some degree prepared for that purpose by the process which we ap¬
prehend it must previously undergo in the liver, thus fitting the
homogeneous contents of the right ventricle of the heart, for that
more perfect animalization effected by the agency of the respira¬
tory system j a function which I have little doubt consists of or¬
ganic affinities, controlled by vital power, as well as that of the
hepatic system. The general condition and properties, however,
of the chyle, just before it is submitted to the action of the lungs,
are all that I can advert to at present.”

Dr. Stoker makes along extract from M. Richerand’s Phy¬
siology, on the nature of the chyle, and on its difference in
composition according to the kind of aliment from which it
is produced, and then endeavours to exemplify the various
colours of the huffy coat immediately after the consideration
of physical properties of the chyle, but in fact without the
slightest perceptible analogy. He remarks that in diabetic
complaints, which there is reason to believe originate from
imperfect digestion, the blood drawn is often found co¬
vered with a whitish milky fluid, the crassamentum being of
a brighter colour than that of venous blood.

“ In simple forms of hepatic disease, on the other hand, the
buffy covering on the blood drawn, is generally of a more dusky
while throughout its whole substance, than in pneumonia, and the
external surface of it yellow -} the buffy coat also occupies a
larger proportion of the solid part of the blood than in pulmo¬
nary complaints. When, however, as not unfrequently happens
both the pulmonic and hepatic systems become equally engaged
in the disease, such distinctions cease 5 but I have often seen
them restored in the same proportion as the diseased actions,,
affecting either of those systems, were found to vary in their rela¬
tive urgency.”

The knowledge of these facts are extremely important in
a practical point of view, but we are entirely at a loss to
perceive their relevancy in the proof of the author’s theory of
humoral pathology. Dr. Stoker only maintains that <e some
diseases take place primarily in the fluids, as others do in
the solids,” p. lxi. In a most able article in the Magazine
of German Literature, for July, 1824, Dr. G. H. Gerson
gives a condensed account of the theories which have been
proposed since the time of Dr. Cullen, and exults that the
Germans never received the doctrines of solidism to any ex¬
tent, u and that the last meteor of the solidists (Broussais’
doctrine) whose elegy. Dr. Stoker has already sung in Ire¬
land, will soon be extinguished.” Dr. Gerson proceeds : —

“ ‘ *** Stoker now opposes himself to this physio-pathology of his
countrymen, and with the danger of having all that applied to him,

294

Critical Review.

which was said against humoral pathology in modern times.
Every well-intentioned person will praise him for his courageous
love of truth, (for it requires courage to speak the truth to those
who we are certain will ridicule us, more even perhaps than to those
who would stone us ;) yet it is important to examine how he has
performed his task. I must again remind my readers of a former
assertion, that the greater number of systems of medicine derive
their origin from a practical, rather than from a theoretical want,
and this is the case with this entirely new theory of the author,
novel as it is principally to England. The property of this mode
of invention, as it happened before, was, that whatever was new
differed from that which had already subsisted only by some com¬
pleting, aiding additions, as Fr. Hoffman’s, and we shall see that
this was the case with Stoker’s trials. The manner in which he
conducts his new doctrine proves this at once, for he prepares and
conducts the reader by practical cases as they occurred to himself.
This method is certainly, practised by his countrymen, and is
formed on the fundamental principles of Locke, being peculiar to
observers, who wish to deviate but little from direct evidence,
and retire quickly to it again.”

Dr. Stoker proceeds to give a compressed detail of the
various theories which have prevailed in medicine, which
we cannot find space for at present. He alludes to the great
support offered to the solidists by William and John Hun¬
ter, and Dr. Baillie, but he maintains that there are many
diseases which leave no ^traces on dissection. In proof of
his position, he details supposed cases of phthisis pulmo-
nalis, apoplexy, paralysis, threatened angina pectoris, dropsy
of the chest and pericardium, and one case mistaken by La-
ennec himself. These facts are adduced against the anato¬
mical sect of pathologists. Dr. Stoker offers the following
theory on the formation of the huffy coat of the blood, which
he has proved in his former Pathological Observations, Part
I., did not depend on slow coagulation of the fluid as was
generally imagined.

“ As the various appearances of the blood drawn in disease, can
no longer, I think, be fairly attributed to any process subsequent
to extravasation, the following explanation of them appears to me
to be natural : that one kind of these sizy surfaces, or buffy coats,
is produced from disordered chyle (the consequence of unwhole¬
some aliment or impeded digestion) not being duly prepared for
the changes it should undergo in the minor circulation, the func¬
tions of which it disturbs, and then passes into the sanguiferous
system, to be the source of morbid actions. Another kind arises
from the morbid condition of the venous blood, in its return from
the greater circulation by the vena portae, unfitting it for the pre¬
paratory process, which in health takes place in its passage through
the liver, that it may be duly qualified for the functions of perfect
sanguification, by which it was to be again refitted in the pulmo-

Dr. Stoker on the Pathology of Fever . 295

nary system for the vital purposes of the greater circulation.
These explanations appear further supported by the experiments
on the blood, instituted since mine in London and Paris. I am
therefore led to hope that they will hereafter be found of practi¬
cal utility both in the ratio symptomatum , and methodus medendi of
diseases.” *

Mr. Abernetliy partly maintained this doctrine, for he was
of opinion that imperfectly formed chyle was probably pro¬
ductive of disease or vitiation of the blood *. We think few
of our readers will receive the following hypothesis.

“The various appearances which the blood presents in idiopa¬
thic and typhoid fevers, probably arise from changes effected on
the vital fluids by morbific matter supplied to the lacteal or lym¬
phatic system by the absorbents, which entering by the thoracic
duct, I suppose has the same sedative influence which poisons
have on the pulmonary and sanguiferous systems. This view of
the subject may also assist in explaining the length of time, or la¬
tent period, between the application of contagion, or infection,
and the commencement of febrile paroxysms, or morbid actions.”

From what we have remarked in a former page, there can
be no doubt but contagion acts on the nerves, and not
through the absorbents or circulation. Having replied to
Dr. Good, who accused our author of adopting the Boerhaa-
vian doctrines of fever, which attributes the disease to the
sizy condition of the blood, he next considers the new doc¬
trines of fever — those of Drs. Clutterbuck, Armstrong,
Mills, Marcus, and Broussais, and we presume Peio, Ploc-
quet, and Bretonneau are included, for all come under the
following denunciation.

“ The new doctrines of fever, which I deem branches of solid-
ism, inasmuch as they attribute fevers generally to inflammation,
or altered structure of some vital part, and suggest blood-letting
as their common remedy, are directly opposed in principle to that
theoretic division of fevers into idiopathic and symptomatic, which
I have ever deemed natural and useful in practice.”

Our author examined closely the arguments in which
these doctrines were promulgated and maintained, as phy¬
sician to the fever hospital, and has given the result of his
observations in his work on fever, published in London,
1814.

“ In the three earliest of these Reports, evidence was adduced
in favour of the division in question, showing, from several hun¬
dred cases taken without selection, that the same tendency still
continued in idiopathic and typhoid fevers, to terminate favour¬
ably or fatally on certain critical days, as had been observed to
characterize them by Hippocrates. And in my Report for the

* On the Constitutional Origin and Treatment of Local Diseases.

296

Critical Review.

year 1811,. I added facts to prove- that fevers subject to such peri¬
odical revolutions, were frequently the consequence of exposure /.o
contagion or infection.”

With respect to blood-letting we are informed that it was
chiefly employed by Dr. Mills, and the proportion of deaths
to recoveries was 1 to 11 44, and among those treated by
the ordinary methods, as 1 to 12pn a proportion differing
from the power in no small degree, “ and justifying the con¬
clusion that the treatment of fever by small and repeated
general detractions of blood is either of little efficacy or inju¬
rious,” p. cxviii. Dr. Mills’s patients were chiefly male,
and remained in the hospital, on an average, 16f days,
those of the other physicians 1 7h a difference very slight,
but in favour of blood-letting ; but it should be recollected
that males are less disposed to remain in hospital than fe¬
males. From all Dr. Stoker has observed, he divides fevers
into three species : 1. Idiopathic fevers, comprehending

those of spontaneous and contagious origin ; 2. Inflamma¬
tory fevers ; 3. Those in which the two kinds co-exist, or
mingle together. The cases admitted into the Cork Street
Hospital, are generally of the first or third species ; and the
symptoms of the first species are thus described.

The characteristics of the first class of fevers, very generally,
are sudden prostration of strength ; failure of mental and bodily
power ; suspension or disorder of the secretions ; irregular vas¬
cular and pulmonary action, producing both inequality in the dis¬
tribution of blood, and of temperature in different parts of the sys¬
tem, and an uniform tendency to perform a certain succession of
salutary or morbid changes, in definite periods. The distinguish¬
ing features and local origin of the second class, or inflammatory
fevers, are well marked and generally known ; but when their
symptoms mingle in epidemics, with those of typhoid or idiopathic
fevers, the importance is commensurate with the difficulty of as¬
certaining their relative degrees, so as safely to decide on the
means to be employed.

“ The opinions, too, that typhus and synochus are not essenti¬
ally inflammatory, but in their simple forms are diseases of debi¬
lity through their whole course j the excitement, so observable in
their early stages, being referrible to constitutional reaction, ac¬
cord with my experience.

“ Neither has morbid anatomy appeared to me to warrant the
conclusions of those who hold the opinions of typhus fever being
an essentially inflammatory disease. In some instances, I have
observed the same partial turgescence of vessels which dissectors
report, and likewise signs of inflammatory action in various parts
of the bodies of those who died of fever the former, however,
by no means designated previous inflammation ; and I could ge¬
nerally trace the commencement of inflammatory action, which

Dr. Stoker on the Pathology of Fever. 297"

led to the latter appearance, from local diseases, that preceded or
supervened on fever, and sometimes at late stages ; but in several
cases, where I had witnessed the highest degree of febrile excite¬
ment before death, no such signs of turgescence, or of inflamma¬
tion, were observable on dissection.

“ In support of such statements, I was happy to be able to add,
in the same Report, the satisfactory testimony of two of our most
distinguished Anatomists. And besides their unquestionable qua¬
lifications, and numerous opportunities for examining the bodies
brought to their several theatres for dissection, their opinions on
anatomy have peculiar advantages of being deduced from obser¬
vations that were not influenced by preconceived theory, or by
cases selected for particular views.

“ f In the midst,’ Mr. Kirby writes in answer to my queries on
the subject, * of all the discussions relative to topical congestion, it
was impossible, however, not to remark the singular want of ac¬
cordance between the prevalent opinions and local appearances.
The brain, so constantly supposed to be the seat of inflammation,,
rarely exhibited the characters indicative of such a state. In some
instances this organ was much paler than usual j in a very few,
amongst a great number of dissections, was there any evidence of
sanguineous or serous effusion.’ And after recounting his obser¬
vations on all the other vital organs, he thus concludes : — 4 In
short, in a great majority of cases, so little did any particular or¬
gan seem to suffer, that I have wondered what could have been
the cause of death.’

With the foregoing statement, the answers of Dr. Macartney,
Anatomical Professor of Trinity College, Dublin, to the subse¬
quent queries of Dr. Barker, on the same subject, are coincident,
and appear to me further to corroborate the opinion, that typhous
and inflammatory fevers are distinct. I may, therefore, be allowed
to add the following extract trom Dr. Barker’s Report for the
years 1817 and 1818, as published in the second volume of
Transactions of the Irish College of Physicians, p. 574.

‘ He (Dr. Macartney) informs me, that having reviewed his
notes on the anatomical examination of persons who died of ty¬
phous fever, he can state, as the result of his experience, that mor¬
bid appearances in typhous fever are not those of common visce¬
ral inflammation.’ And having stated more fully the actual obser¬
vations on which this opinion was founded, he concludes thus : —

‘ Two facts deserve to be recollected: first, that the duration
of general fever and visceral inflammation are not the same ; se¬
cond, that internal inflammations are very common in hot-blooded
animals, but idiopathic fever is peculiar to the human kind.’ It
may be added, that processes of an inflammatory nature are fitted
for repairing parts that have their functions interrupted, or their
structure injured, but the effects of typhous fever have no such
power.”

The author, with that candour and good sense for which
he is so distinguished, informs us that he has endeavoured

VOL. III. NO. 16. 2 e

298

Critical Revieiv.

to come to a right decision on a question which he believes
involves the health and lives of mankind more than any
other of the science of medicine ; and by stating all the cir¬
cumstances of the case, he wishes to enable others to exer¬
cise their own judgment. Dr. Stoker quotes the work of
Dr. Kernel*, and the reports of Drs. Duncan and A. T. Thom¬
son, in proof of poisons or morbid matter causing typhus
fever, by the different modes of ingress into the circulation.
From what we have already said in our remarks on Good’s
Study of Medicine in a preceding page, it is too evident that
more recent facts are opposed to this conclusion. Dr. Sto¬
ker next proceeds to his third section, therapeutics ; and states
“ the pathological physiology which I have adopted indi¬
cates diseases in the fluids, as well as in the solids, but that
they more generally commence with changes in the former
than in the latter, and often terminate in disorganization or
altered structure of parts ; further, also, that altered struc¬
ture may lead to morbid actions, and thence to changes in
the animal fluids by functional derangement.

Before we notice the methodus medendi, we must observe
that, in our opinion, Dr. Stoker has established nothing fur¬
ther than this, that the fluids may be primarily diseased, as
well as the solids. But he has not adduced any thing
like satisfactory evidence, that the changes or vitiations of
the blood produce continued fevers. We believe that the
blood is vitiated in numerous instances of disease, but we
believe also that in nine cases out of ten of continued fever,
the first impression is made on the nervous, and secondarily
on the circulating system. These opinions are the more ne¬
cessary, prior to the detail of Dr. Stoker’s views of the me¬
thodus medendi.

“ In studying the methodus medendi, however, the first place
should be ceded to the consideration of the cause of diseases while
they are still confined to the fluids within their proper vessels,
not only because they frequently originate there, but also that it
is then that curative treatment can be most effectually employed ;
for when altered structure or extravasation lies beyond the sur¬
geon’s province, other means seldom succeed, farther than to pal¬
liate distressing symptoms.” p. cxxiii.

Dr. Stoker next enumerates the principal remedies which
he employs in the treatment of diseases, and those in ordi¬
nary use, which present nothing novel. In this place he in¬
troduces the medicines usually employed in dropsy, and re¬
fers to his former publication on fever and dropsy. The
remedies which he employs in febrile diseases, are barm or
yeast, blisters to the right hypochondrium, leeches to the
verge of the anus, tartarized antimony ; in tendency to phre-

299

Dr. Stoker on the Pathology of Fever .

nitic fevers and dropsical effusions on the brain, infusion of
green tea in coma in typhus ; alum in internal hemorrhages ;
verbascum thapsus, white mullein, boiled in milk in dysen¬
tery ; frictions with ammonia, and camphorated oil and
bandages over the abdomen, vinegar to relieve hiccup, as¬
sisted by frictions and blisters to the abdomen ; and to these
means, Dr. Stoker adds, ££ the immediate weaning of infants
suckled by mothers labouring under petechial fever ; strait
waistcoat and ankle straps. ££ Many of these remedies may
seem to a cursory observer of trifling moment, but having
often witnessed their utility, I do not hesitate to recom¬
mend them, however insignificant they may appear as inven¬
tions. ” Such are the leading points in the first part of Dr.
Stoker’s work on the Institutes of Medicine, and we think
they entitle him to great credit as a faithful observer of the
various forms of disease. He has shewn great perseverance,
indefatigable industry, deep research, and sober and faithful
observation, in his prosecution of the investigation of the
nature and treatment of diseases. Uninfluenced by the just
and high encomiums bestowed on him by the German and
French writers, he has modestly and honourably admitted
the difficulties he had to experience in arriving at his the¬
oretical conclusions, which are chiefly to be ascribed to the
present imperfect state of science. Though we have dif¬
fered from him in many of his conclusions, we have freely
admitted that he has established many important facts in
the treatment of diseases, especially with regard to the diag¬
nosis from the different appearances of the buffy coat of the
blood, which must inevitably lead a more judicious and sci¬
entific practice in the treatment of very fatal and formidable
disease. And no candid man can peruse this part of the
work, nor that which we are about to notice on the nature
and treatment of fever, but must honestly pronounce Dr.
Stoker to be a physician of high acquirements, great re¬
search, sound judgment, extensive observation, great discri¬
mination and talent.

Having in a preceding article, considered the phenomena
of fever in our review of Dr. Good’s Study of Medicine, we
are the more anxious to insert a condensed account of the
opinions of a physician so intimately acquainted with the
disease as the author before us. There is no better axiom
than audi alteram partem . Dr. Good’s account chiefly
comprehends the opinions most prevalent in this metropo¬
lis; it is, therefore, the more necessary to learn the opinions
of a practitioner who enjoyed much more extensive oppor¬
tunities of observing the disease ; and these we shall give in
our next.

300

Critical Review.

IV. — Medicine no Mystery, being a brief Outline of the

Principles oj Medical Science , designed as an introduction

to their general Study as a branch of liberal education .
By John Morrison, M.D. A.B. F.C.D.

The title of this work expresses the author’s object so clearly,
that further explanation is unnecessary. If any were wanted,
we find it afforded in the Introduction, in the following
words :

“ It has long been a subject of complaint amongst scientific and
well-educated medical men, that the public in general seems un¬
able or unwilling to draw the distinction between the physician of
liberal attainments, who founds the practice of his profession on
enlightened views of the structure and functions of the animal
economy in health and disease (which his previous education and
habits of philosophic research have enabled him to take with just¬
ness and precision), and the uneducated and illiberal retailer of
drugs and nostrums — who practises physic in the same spirit that
he pursues his mechanic trade ; whose only ideas of the profes¬
sion he presumes to follow are derived /from hearsay and prece¬
dent j who, incapable of reading in the Book of Nature (as he has
not cultivated the moral sense necessary to the perception of its
character) is only confirmed in his errors by the practice of them ;
who mistakes symptoms for causes, and in whose short-sighted
views the idea of an ailment and a nostrum are so inseparably
united, that the one uniformly follows the other in his bungling
and self-interested practice.

“It is a notorious and melancholy fact, that five-sixths of the
practice of the medical art are engrossed by persons of the latter
description, and the result is a frightful increase of human misery
in the form of chronic diseases, without even the pitiful, miserable
counterpoise of a pecuniary saving being effected by the system of
employing those “ roturiers'’ of the profession.

*' The complicated and intricate structure of the human frame —
that beautiful fabric composed of circles of systems, the nervous,
the sanguineous, the alimentary, the motive, all mutually influenc¬
ing and supporting each other, so that the smallest deviation from
healthy action in one entails disturbance of the rest, and malady
on the individual — this structure cannot support the rude handling
of the empirical nostrum-monger, without suffering from it.

" It is not in its more immediate effects, in many cases, that the
ill consequences of the interference of the gross and ignorant dab¬
bler in physic are manifested, but in the fatal injury inflicted on
the constitution, either by the very means employed to remove the
disease, or by the neglect of measures calculated to prevent the
consequences apt to result from it.

“ Instances elucidating the above observation might be multi¬
plied, ad infinitum : — for example, a delicate man coming from a
warm climate is attacked with what he calls a fit of bile, shortly
after his arrival— the apothecary is sent for: destitute of the power

Dr. Morrison on the Principles of Medical Science. 301

of discriminating disease or temperament, he applies to our invalid
the practice which he has just pursued with the bloated alderman,
who has been suffering from the effects of the civic feast — he
makes, his body f a thoroughfare for his whole shop to pass
through f emetic, blue pill, black draught, succeed each other ;
the nervous powers of the stomach are exhausted j an attack of
chronic indigestion is produced ; the constitution, already en¬
feebled, is further shaken by want of healthy nutrition, and by
irritation of the digestive organs ; gout, which was lurking in the
system, shortly afterwards makes its first attack (as it generally
does when the system receives a shock) ; and from the same cause,
the disease, instead of the extremities, occurs in the lungs or sto¬
mach, and the patient either sinks under the new malady, or es¬
capes to drag on a miserable existence, rendered irksome by habi¬
tual suffering.

“The same individual (to vary the case) on his return to a cold
climate, after some fits of bile, is attacked (from accidental ex¬
posure) with an acute inflammation of the liver, an organ already
irritable. The symptoms are modified by his state of health, and
require discrimination to detect them. Unprofitable and mistaken
measures of“ routine” are resorted to j the malady gains ground $
it is communicated to the lungs $ winter approaches $ consump¬
tion ensues j and the patient becomes a victim to the partiality of
his landlady for her apothecary, or to the general ignorance I have
spoken of respecting the medical profession, which first induced
him to put his life and health into such hands.

<f I have observed that the public is unable or unwilling to dis¬
criminate between the merits of persons practising the medical
profession — the latter is sometimes the case, but the former much
more frequently ; and that ignorance appears to me referrible to
two circumstances, one of which applies to the public, the other
to members of the medical profession.

The first is the general ignorance which prevails of the prin¬
ciples of a science which would nevertheless appear to be that of
which mankind is more interested in acquiring information than
of any other whatsoever — I mean that which treats of the struc¬
ture and functions of our bodies, and of the nature and principles
of diseased actions in general.

c< How is it that every man that lives in society, and who has
received the education of a gentleman, thinks it requisite to know
something of the laws of his country 1 Because the preservation
of his property and his rights are concerned with and protected
by them. Of agriculture and architecture ? Because his interest
and his comforts are connected with such knowledge. Why is it
that such a man seeks to acquire some knowledge even of far¬
riery and the diseases of the horse ? Because his enjoyments are
connected with the perfection of that animal. He takes a pride in
such knowledge, and would not by any means be thought to be
ignorant in those matters ; and yet, of that science which treats
peculiarly of himself, and with which his health, his life, and all

302

Critical Review.

his comforts are so often connected, he is entirely uninformed,
and does not hesitate to avow his ignorance

There is much truth in these observations, but the defects
in the practice of the medical profession, so justly described
by Dr. Morrison, are to be solely ascribed to the antiquated
and selfish Institutions, to the management of which, the re¬
gulation of the profession is most unfortunately entrusted in
this country. In England, Ireland, and Scotland, we have
twenty medical Corporations, including Colleges of Physi¬
cians, Colleges of Surgeons, Apothecaries’ Societies, and
Faculties of Physic and Surgery, and no two of these bo¬
dies enjoy the same rights or privileges. The physicians are
the doctissimi , the surgeons, the alieni homines , and; the
apothecaries despised by both, and despising both. The
physician contemns the mechanical pursuits of the surgeon,
the surgeon smiles at the assumed superiority of the physi¬
cian, and the apothecary forcibly demonstrates the folly of
these puerile disputes, and proves himself the Magnus Apollo
of the sanative art, for he is the General Practitioner — he is
e( the grand remover of all human ills.” He considers
<£ medicine one and indivisible,” and daily convinces his re¬
puted rivals of the utter absurdity of their unnatural and
unscientific distinctions.

The medical corporations of this empire were established
for the express purpose of supporting the dignity of the sci¬
ence of medicine and the welfare of the public, by regulating
the education and testimonials of their respective members,
for the glory of science, and the better preservation of public
health ; but in both of these objects have they utterly failed.
The inefficiency and delinquency of these bodies have been
already sufficiently exposed and discussed, and need no fur¬
ther consideration. Each and all have been proved guilty of
various acts of corruption, selfishness and oppression : and
hence the apathy shown them by the Government. Eternally
at war with each other, unmindful of the rights of the mem¬
bers at large, harrassing and annoying those who have
duly qualified in rival Institutions, they have lost all sight
of the public health, ai}d allowed this country to be overrun
with empiricism and its villany, to a degree unequalled in
extent in any other nation on the face of the globe. The
medical charters and statutes of England differ from those of
Scotland, and those of Ireland from both, and thus we are
blessed with the most contradictory and anomalous enact¬
ments in the same dominions. The members of one corpo¬
ration cannot enjoy the privileges of its rival, and, of late,
the Medical Boards of the Army, Navy, and East India

Dr. Morrison on the Principles of Medical Science. 303

Company, set all corporate qualifications at nought, and re¬
quire further probation. In such a distracted state of the
profession, we are not to be surprised “ that the uneducated
and illiterate retailer of drugs and nostrums,” should flourish,
and more especially in this country, where the Apothecaries’
Society authorise their members “ to practise Medicine,” a
privilege also enjoyed by the Royal College of Physicans. In
former times, the word apothecary was defined “ a man
whose employment is to keep medicines for sale,” but at
present there is no such person amongst us ; the apotheca¬
ries having been metamorphosed into general practitioners.
A question here presents itself to those acquainted with the
history of medicine, whether the general practitioners are as
well qualified as the physicians and surgeons ? If the inter¬
rogatory be answered in the affirmative, then there is no
need of Colleges of physicians and surgeons, and the sooner
they are abolished the better ; but if a negative answer be
returned, then the Colleges are entitled to respect, and their
members ought to be protected in their rights and privileges.
The general practitioners in England and Wales are well
initiated in the principles of materia medica and pharmacy,
their examination in anatomy and practice of medicine is su¬
perficial, and with their testimonial too many of them rest
contented. To this, however, they invariably add the signi¬
ficant words “ Surgeon and Accoucheur,” without the small¬
est title thereto, and then commence practice. Are these
practitioners to supersede physicians and surgeons ? We
leave the Corporations of physicians and surgeons to reply.
But it may be said, many of the members of the Apotheca¬
ries’ Society become members of the College of Surgeons.
Very true, but does an examination in anatomy and surgery*
qualify them to displace the physician ? Most certainly not.
Are practitioners who are examined in anatomy and surgery
only, to supersede the physician and English apotheary ?
We think not, but the public are of a different opinion. Let
us contrast the examination of a physician with those now
described. In all the respectable Universities, and in all our
Colleges of Physicians, the several examinations are carried
on in the Latin language, and comprise Anatomy, Physio¬
logy, Chemistry, Materia Medica, Botany, Pharmacy and the
Practice of Medicine. There are six examinations for the Doc¬
tor’s degree, and other three for admission into the respec¬
tive Colleges of Physicians, and surely these afford proofs
of the superior information of the physician, which the best
informed members of society have ever acknowledged. The

* In Scotland and Ireland the Surgical Examiners require a knowledge of the
respective Pharmacopoeias from candidates for their testimonials.

304

Critical Review.

public in general do not take the trouble to bestow a thought
on the qualifications of medical practitioners, and are ever
ready to avail themselves of medical aid on the easiest terms.
Hence it is, that the apothecaries, or general practitioners,
are physicians to nine-tenths of the public, in despite of all
corporate regulations. Matters would be well even under
these circumstances, if the public were preserved from the
rapacity and temerity of empirics ; but the public shall be
exposed so long as the revenue of this country annually re¬
ceives a million of money by stamp duty on nostrums and
quack advertisements. It is obvious that the professional
character must be extensively injured and debased by this
system, and that the regularly-educated practitioners, of all
classes, must be greatly impeded in the acquisition of fame
or fortune. But is it not marvellous that our medical cor¬
porations should not unanimously petition the Legislature
and the Government for the removal of such abuses ? For
thirty years have those abuses been repeatedly exposed in
our periodical journals, but without the slightest benefit.
Nor is it of the smallest use that the author before us should
again remind us of the subject. If his book, which is well
calculated for the purpose of general perusal, come to be
read, it might illumine 66 some of the collective wisdom of
the nation/' and lead to medical reform. We observe the
Legislature ever ready to advance the interests of the Church
and Bar, and, indeed, all other sciences and arts, except
Medicine. Why this apathy towards the noblest and most
important of the human sciences ? It is solely from the ad¬
ministration of the existing medical Corporations. We need
scarcely remind our readers of the opposition of Lord Thur-
low and Mr. Feel to the renewal of a certain charter ; but
it is useless to pursue the subject further. We fully agree
with Dr. Morrison, in his exposition of the present state of
the medical profession in the United Kingdom, which is in
substance what we have stated ; and think with him, that
the mystery affected by medical men in their proceedings,
and the unwillingness to communicate the information
sought of them by their patients, or their friends, is not only
in itself disgusting and ridiculous, but calculated to do in¬
jury to themselves and to the cause of science. As the
following extract may surprise, if not astonish, many of our
English and Foreign readers, we are induced to place it be¬
fore them : —

“ To those causes of ignoranee respecting our profession, as
applies to the public, are to be added the strange, anomalous, mul¬
tiplied, and even contradictory arrangements observed at the Col¬
leges and Schools where medical men receive their diplomas and

Dr. Morrison on the Principles of Medical Science . 305

qualifications for practice ; they are such that there are multitudes
of even professional men who are ignorant of them — scarcely any
one in possession of the whole of them. How, then, can it be
supposed that the public can be able to ascertain, by any inquiry
as to the diploma possessed by a medical man (even though there
existed a disposition to communicate such information) what his
presumed sufficiency might be ? The whole system appears to be
constructed with a view to baffle inquiry, and to envelope this
matter of qualification in the same mystery and confusion that co¬
ver every other circumstance regarding the medical profession.
There are Colleges and Universities of royal foundation that confer
degrees of Doctor of Medicine, which empower the possessors of
them to practise medicine “ all over the world,’' to use the words
of’ those diplomas ; there are Corporations established by royal
charter, called “ Colleges of Physicians," which refuse to admit
those M.D.’s as legitimate professors of their art, unless they are
again examined and approved by them, for which testimonial a
large sum is paid. Again, after undergoing all these ordeals in
one quarter of the empire (Ireland, for instance) a physician finds
himself as unqualified as ever in another.

“The Schools of surgery are equally irreconcileable with each
other ; and the diplomatists of the College of Surgeons of Lon¬
don, in which a Pott, a Cheselden, a Hunter, a Cooper, and a
Lawrence, have qualified (the men from whose works the profes¬
sion of surgery is learned), are considered as spurious and unqua¬
lified persons by the- surgeons of Dublin. Amidst all this mass of
mystery and contradiction, it is not to be wondered at that the
public should refuse to receive the decisions of the professors of
the medical art on the subject of the legitimacy or capacity of its
practitioners 5 but it is to be regretted that it has not in itself a
test to refer to ; and such a one would be found in the general
knowledge of the principles of the profession which I have recom¬
mended in these pages.”

The members of the Dublin College of Surgeons refuse to
meet their contemporaries of the London College in consulta¬
tion, nor can a member of the London College be appointed
surgeon to a county hospital in Ireland. On the other hand,
the members of the Dublin and Edinburgh Colleges of Phy¬
sicians and Surgeons, and Societies of Apothecaries, are not
recognized in England and Wales. Our author concludes
his introductory remarks by alluding to the conduct of those
medical men who enshroud all their observations in mystery
and ambiguity; and quotes Dr. Clutterbuck’s opinions in
corroboration of his assertion, and on the impropriety of
writing prescriptions in a foreign language, which prevents
the public from deciding between real and pretended merit.

“It must be admitted,” says Dr. Morrison, “ that physicians
have eontributed to foster the ignorance of the public on medical
subjects, by the air of mystery which they have affected to throw

VOL. III. NO. 16*. 2 R

306

Critical Review,

over their proceedings 5 by their abrupt and dogmatic manner in
many instances 5 by their haughty and absurd refusal to make
those communications so eagerly sought by their patients and their
friends relative to the nature of their maladies ; and by their dis¬
graceful bickerings with each other on the subject of precedence,
founded on the ridiculous, artificial, self-created distinction of a
diploma or degree from this college or that. This source of ig¬
norance to the public, and of injury to themselves and to the dig¬
nity of the profession, 1 fear would be found more difficult to
remove than that which I have treated of as connected with the
public itself. I have little hope that any remarks of mine will
have the effect of removing habits which have stood firm against
the attacks of ridicule, wielded against them by every comic wri¬
ter, from Moliere downwards ; but to shield myself from the im¬
putation of having taken an invidious view of the subject, or of
having hazarded sentiments on it peculiar to myself, I beg to
quote the words of Dr. Clutterbuck, in his lectures, on the subject.”

The work consists of two divisions. 1st. Of the Animal
System in a State of Health, including a condensed Ac¬
count of the Physiology of the different Systems. 2d. Of
the Animal System in a State of Disease, or the Pathology
of the different Systems. We cannot analyze a production
of this description ; but may observe, that Dr. Morrison has
condensed a vast deal of information in a small compass, and
presented it in an intelligible form to the general reader.
He has given the best opinions on every subject, and many
interesting personal observations There is something en¬
ticing in the title, “ Medicine no Mystery/’ which is calcu¬
lated to anest the attention of the lover of science j and cer¬
tainly, the information in the work must prove both interest¬
ing and instructive to the ordinary reader. If this work
were prefixed to some of the popular systems of medicine, it
would be more beneficial to science, and to the good of the
community. We have observed a few errors in the compo¬
sition, which ought to be corrected in a future edition.

ORIGINAL COMMUNICATIONS.

I. — Mr. Costello on Lithotrity *.

TO THE EDITOR OF THE LONDON MEDICAL AND SURGICAL JOURNAL.

Sir — In the Medical Gazette , of September 12th, a Bill of
Indictment is preferred against me. With a great variety of
other charges, which I shall notice as briefly as possible,
as ^proceed. I am reproached with having failed in two
cases, in which the lithotntic operation was attempted. I

We have assented to the insertion of this article, more amplified in its de¬
tails than it has appeared in the Medical Gazette, as we consider its author to
he the object of very indiscreet and unmeasured attack.— Ed

Mr. Costello on Lithotrity. 30/

was not aware, that any individuaFs private practice would
be held up to the public, in this country, without such indi¬
viduaFs consent, much less that it would be so unfairly misre¬
presented. Such courtesy accorded with the dignity of the
medical profession, and was, as 1 erroneously supposed,
until now, its distinguishing characteristic.

The cases in question are set down ( totidem verbis ,) as
failures, and are placed in disadvantageous contrast with
M. Heurteloup’s successful one. Happily, however, for
lithotrity, this question must be dealt with by facts — not
with mere assertions.

I should abstain from commenting on M. Heurteloup’s
case, had it not been rendered necessary to the full develop¬
ment of my defence. In the observations I am about to
make I shall, however, studiously forbear from any depre¬
ciation of its results.

My intention of introducing the method of Dr. Civiale
into England was known by my friends in Paris for a long
time previous to my coming to London. This intention
was warmly encouraged by a professional gentleman, the
most distinguished ornament of English Surgery • and,
amongst the very numerous recommendations offered to me,
none was to have been more zealous or effective than that,
of which, as I had been over and over again assured, I should
be the bearer to Mr. White. A correspondence was esta¬
blished between my friend and Mr. White, and a patient,
with stone, was at length procured. Matters were in this
posture, when I learned, to my great surprise, that my friend,
supposing my connexion with M. Civiale was never to cease,
had transferred all his promises of support from me to M.
Heurteloup. While these promises were held to the ear,
I learned some of the particulars of this patient’s case,
which led me to believe that it was by no means an unfavour¬
able one. The statement contained in the Gazette, though
it aims at establishing an opposite conclusion, confirms me
in this opinion.

Our foreign confrere having seen the gentleman, observed,
that his case was not likely to do credit to his or any other
operation. He, however, proceeds to examine the bladder;
the water injected through the catheter into this organ is
forcibly ejected, and, notwithstanding the superiority of this
instrument to ascertain the size, number, &c. of the calculi,
only one small calculus is discovered in a bladder containing
many. At the second meeting (24th July), M. Heurteloup
has not yet made up his mind as to this gentleman’s fitness
for the operation. Why so ? Does the sojourn of a few
small stones in the bladder for three, or even six months.

308 Original Communications.

determine so much local mischief, so much constitutional
irritation, as to make the decision of his fitness for opera¬
tion a matter of doubt ? If so, it must be an extraordinary
case indeed ! A three-branched instrument is, however, in¬
troduced, rather for the purpose of shewing the mode of do¬
ing it, than “ with the intent of performing an operation.”
One of the small stones is seized, the instrument is fixed in
a vice, and this small stone is drilled and crushed. The great
irritability and diminished capacity of the bladder, the result
of six months’ disease, are dwelt upon at some length, to
shew the unfavourable state of this case ; and, nevertheless,
at this first sitting, two injections of tepid water were thrown
into the bladder, one of about ten ounces. Ten ounces of
water injected into an irritable and contracted bladder !

This patient underwent three sittings or operations, two
explorations, besides repeated introductions of sounds, and
a month’s treatment. Mr. White shewed me the fragments
resulting from this operation. The instrument employed
was Dr. Civiale’s. I need not say how he would have dis¬
posed of such a case.

Let us now proceed to the review of the cases, in which it
is asserted I have failed. On visiting Bartholomew’s Hospital,
on the 1 st of August, after being introduced to Mr. Lloyd,
he spoke to me of a case, then in the hospital, which he
considered unfavourable for lithotomy, and, at the same mo¬
ment, proposed to me to see it. I had with me an instru¬
ment, which I had been shewing to Mr. Earle. The pa¬
tient, Hannah Stewardson, aged nineteen, lay in bed, to
which she had been confined since her entrance into the
hospital. Her calculous affection, dated from her infancy,
and since her tenderest years she Nhad laboured under an
incontinency of urine. She was pale, emaciated, and stunt¬
ed, not appearing to be more developed than a girl of four¬
teen or fifteen ; a mere skeleton, in fact, her sufferings hav¬
ing been, for a long time before, quite excruciating. To in¬
ject the bladder was out of the question. The instrument
was therefore introduced, without previously injecting the
bladder ; a large stone was immediately laid hold of, and,
not having the bow to drill it, it was crushed. The instru¬
ment was then withdrawn, the operation having lasted one
minute . Mr. Lloyd, now supposing that the stone was en¬
tirely crushed, introduced Mr. Earle’s dilator, with a view
to remove the fragments by the forceps. After he had suc¬
ceeded in passing his finger into the bladder, he found a con¬
siderable number of fragments beneath the neck, together
with a large stone, lying a little to the left. During the six
succeeding days she continued to pass those fragments, and

Mr, Costello on Lithotrity. 309

the tone of the bladder had been so much improved by the
operation, that she now, to her astonishment and satisfac¬
tion, began to be able to retain her water. This operation
was performed on the patient’s bed, in the presence of Mr.
Lloyd, and a vast concourse of pupils attending the hospital.
The patient, not knowing what sort of operation was about
to be performed on her, and imagining that I was going to
cut her, gave all the resistance in her power to the introduc¬
tion of the instrument.

On the 7th of August the second operation upon Hannah
Stewardson took place. Upon this occasion she objected to
having it performed in the presence of so many pupils, and,
accordingly, she was removed to the sister’s room ; and
again, only with the quantity of urine, which the bladder was
now able to retain, and without injecting the bladder, the
instrument was introduced. A stone was seized, measuring
eleven lines, or an English inch in diameter ; the drill was
turned twice or thrice round with the fingers, and the stone
being soft, it was crushed into fragments, almost imme¬
diately, by the pressure of the branches and perforator ;
some of the fragments were also seized and crushed. The
instrument was now withdrawn, loaded with moist detritus ;
and the patient was ordered a hip-bath. From this day for¬
ward she retained her water perfectly, and passed such a
quantity of fragments, in the course of eight or ten days, as
filled two small pill boxes. This operation was performed
in presence of Mr. Lawrence, Dr. Grayson, of New York,
Dr. Rawes, the Dresser, &c. On the 13th she was en¬
tirely free from pain ; her appetite and freshness of colour
returned, her nights were good, and she no longer wetted
the bed. On Monday, theljth, she refused to submit to a
third sitting, although she had had some pain on Saturday.
A fragment, she said, was coming forward ; and her refusal
arose from her expectation that it would be soon expelled.
Her expectation was realized ; for, on the same evening, she
passed a very large-sized fragment. She continued after¬
wards to improve rapidly, and left the hospital without con¬
senting to submit to an exploration of the bladder. Both
the sittings lasted about two minutes. The operation excit¬
ed great interest, a feeling which will always attach to this
case, from its having been the first successful case of litho¬
trity, performed in a public hospital in Great Britain. Hannah
Stewardson returned to the work-house. I visited her yes¬
terday, and found her, to use her own words, 44 in the best
health she has ever had.” The subjoined certificate com¬
pletes the evidence of Hannah Stewardson’s case : —

44 1, the undersigned, churchwarden of the parish of St.

310

Original Communications .

Anne, Blackfriars, city of London, certify, that Hannah
Stewardson, inmate of the workhouse of the said parish, and
lately under treatment for the cure of stone in her bladder,
at Bartholomew’s Hospital, by the new method for grind¬
ing and crushing it, has left that hospital ; and affirms, po¬
sitively and gratefully, that she owes her cure, which, she
assures, is quite perfect, to Mr. Costello j and that being
fully satisfied thereof, she refuses to undergo examination by
the sound. (Signed) “ John Howe,

Sept. 19, 1829. Churchwarden of the above Parish.”

My second case is that of Mr. Stone, of Folkstone. This
gentleman is now at the end of his treatment, and, although
I do not give him as completely cured, I may be able to do
so on Tuesday next, when a sitting, which 1 expect will
be a final one, will take place. This patient’s bladder con¬
tained two small stones, of the size of peach-stones. Two
sittings, the first of two minutes, the second of three mi¬
nutes, have sufficed for the destruction of these calculi. This
patient lodges at No. 72, Piccadilly, where such persons as
are curious to see the results of these two operations, may
satisfy themselves. This is the second case. Mr. R. AU
cock may ascertain whether it is, or is not, a failure #. Now,
let me suppose a case. If, after M. Heurteloup’s first or
second sitting on Mr. Wattie, I came forward, and stated,
that his operation was a failure, by what name would my
meddling impertinence deserve to be qualified ? Mr. Al-
cock, it would appear, is not partial to the success of litho-
trity, unless obtained by M. Heurteloup. He represents my
cases as failures. I decline the advantage of retortion. I
would rather ask, as the friend to lithotrity, why there should
be any failure by this method ? There ought to be none, in
proper hands, except where, from great and long-continued
constitutional and local irritation, or concomitant disease,
lithotomy holds out no chance, and there even lithotrity it¬
self will have its perils.

The profession and the public may now pass judgment
on my efforts. The next question is of higher interest to
both, I mean the results of M. Civiale’s practice. Mr. Al-
cock states, on the authority of a prejudiced commentator,
that out of eighty patients only forty-two were cured bv M.
Civiale.

M. Civiale, in his note read before the Academy of Sci¬
ences, in the month of March last, on the treatment and
cure of catarrh of the bladder in aged people, remarks, that
in the first year of his practice, two thirds of the patients

* Mr. Stone has returned home perfectly cured. Sir Astley Cooper, Dr.
Gairdtier, Mr. Andrews, of Stanmore, and Mr. Balderson, of Poland Street,
were present at the operation. — Ed.

Mr. Costello on Lithotrity. 31]

who sought relief by his method were refused from the unfit¬
ness of their condition to undergo lithotrity, a third only of
the applicants having been admitted. In the second year,
one half of the applicants and one over, obtained their cure
by his method. In the third and succeeding years, two
thirds and more of the applicants were received and cured.
Thus, when I left him in July, the number of patients who
owed their cure to this method, amounted to near one hun¬
dred and forty , and M. Civiale had then under operation
seventeen patients.

Of the patients refused by M. Civiale, two died before
they had been even so much as sounded. Twenty-one were
simply sounded before they were refused by him ; ten under¬
went exploration with the lithotrite ; four died from the
progress of the disease, or other causes, after their calculi
had been seized and attacked once ; and of three others, one
died of gastritis, one of a neglected retention of urine, with
which he had been seized in the country, where his affairs
obliged him to be for a short time ; and the third, a child,
nine years old, died several months after the operation, of a
suppuration of both the kidneys. Thus of eighty- two pa¬
tients, upon which M. Civiale is represented to have ope¬
rated, only forty-three were operated upon in point of fact.
Of those forty-three, only one died of gastritis. Will Mr.
Alcock explain how lithotrity could have supplanted the
cutting operation if its results had been so disastrous as he
states them to to have been ? He must learn to appreciate
his authority a little better. It is dangerous to allow one’s
self to be led by the conciluum ah irato>

If my friend Dr. Civiale’s successes had not been impru¬
dently placed in invidious contrast with those of M. Heurte¬
loup, I should have blushed to make them the subject of un¬
kind comment. The indiscretion of his friends, allows me to
lay aside this reserve. M. Heurteloup has never favoured sci¬
ence with the details of his forty-three cases. In 1827, he
meiely affirmed that he had (( introduced his instruments ,y
into the bladder of eleven patients. About the month of
March, of the present year, (I may inistate the precise date)
he informed the Academy, still without any details, that he
had operated in twenty-three cases. On the eve of his de¬
parture from Paris to come to London, this number he as¬
serted to different persons, had increased from twenty-three
to twenty-nine or thirty, and one which he has had in this
country, makes forty- three ! ! ! To convince the world of
his having operated in forty-three cases , I say let us have
the details. M. Civiale has published his without reserve.
But admitting that M. Heurteloup has operated in forty-

312

Original Communications .

three cases, and lost but one, it will still be for him to an¬
swer how MM. Desaugiers and Riviere came by their death.
Of course it is superfluous to sajr, that I expect that the
names of MM. Courtois, Neurohr, Delamontagne, and Ro¬
chet are not to figure in his table.

Your correspondents will have it that this question is de¬
cided in Paris, by the Academy of Sciences, in favour of M.
Heurteloup, and not in favour of M. Civiale. If this be so,
why is M. Heurteloup here ? He further supposes that I
am ignorant of the document which proves this decision,
namely, the programme of prizes. I am so little ignorant
of this document, that I was the first to publish it in En¬
gland, a month since. I prefaced this document by a state¬
ment of the fact, that the Academy in 1824, heard, read, and
adopted the report of its commissaries, the Barons Chaussier
and Percy, in which the claims to the discovery of litho-
trity, are decided in favour of M. Civiale, and in which his
instruments and method of operating are described. With
this preface, Mr. Alcock, if he take the trouble of re-pe¬
rusing the programme, will readily perceive that the Aca¬
demy in 1826, are no longer occupied in considering the
claims to the invention, but in awarding prizes for its suc¬
cessful application, and that amongst the candidates, M. Ci¬
viale figures for 6000 francs, while the others figure but for
2000 each. How comes it to pass, if Mr. Alcock is ac¬
quainted with those programmes of prizes, that he overlooks
the prize of 10,000 francs awarded to M. Civiale in 182/ ?

I shall close this discussion between MM. Civiale and
Heurteloup, by a few observations. M. Civiale’s claims to
the invention, are admitted by the Academy, who bestow on
him at different times, large sums of money, the government
honours him with the title of Knight of the Legion of Honour ;
one of the most eminent surgeons in France, the Baron Du¬
bois, affected with stone, overlooks his feelings of private
friendship for M. Leroy, and receives his cure from M. Ci¬
viale. The Administration of Hospitals, gives him a ward
for his poor calculous patients in the hospital of Necker.
In the space of four years and a half, nearly one hundred and
forty patients are cured by him, while those who arrive in
Paris, to undergo this operation, put themselves, almost
without exception, under his care ; and, finally, he is ho¬
noured by foreign potentates with medals and other titles
of merit, as well as by the friendship and correspondence of
such men as Soemmering, Scarpa, &c. &c. &c. Now sup¬
pose these facts to have no other support than my assertion,
the following questions will serve as a test of their correct¬
ness : Is the French nation so besotted ? is medical sci-

Mr. Costello on Lithotrity . 313

ence fallen so low ? Is Professor Dubois so reckless of bis
personal safety ? Are crowned heads such dupes ? Are
learned men so weak ? Is the Government, which dispenses
honours, so undiscerning ? Is the administration of Hospi¬
tals so indifferent to the lives of the poor, as to suffer a man
who we are told, succeeds in forty cases out of forty- three,
to deprive his country of his boasted services, and not only
retain, but prefer M. Civiale, who is represented to have
failed in forty out of eighty- two ? This would be repugnant
to common sense.

M. Leroy, according to your correspondent, is the inven¬
tor of lithotrity ; I have written an historical article on this
subject, in the Medical and Physical Journal for next month,
in which the proof is produced that such is not the fact.

Having fully discussed M. Leroy’s claims in my historical
article on lithotrity, I shall for the present confine myself
merely to the statement of a few facts connected with this
subject.

Mr. Alcock asserts, that the only instrument M. Civiale
had proposed in 1818, was a pouch, in which the calculus
was to be received, there to be acted upon, or dissolved by
re-agents ; and that M. Marjolin, to whom this instrument
was shown by M, Civiale, assured M. Leroy, that he had
seen this pouch instrument in M. Civiale’s hands. It is very
unfortunate for Mr. Alcock’ s statement, that M. Civiale had
never had such an instrument executed. It is unnecessary
to add, that he could not have shown it to M. Marjolin. It
is true, the project of such an instrument is contained in his
memoir of 1818 ; but in his memoir there is also the draw¬
ing and description of another instrument, which was des¬
tined for seizing the stone in the bladder by means of elastic
branches ; together with a perforator to drill or crush it.
This instrument is one of the three instruments proposed to
the Commission in this memoir, and was even then called a
u lithontripteur,” by its author. If Mr. Alcock has any
doubt of the truth of this statement, I request he will con¬
sult the report of the Barons Chaussier and Percy, read be¬
fore the Academy in the month of March, 1824, page 22.
Now, if such an instrument is contained in Civiale’s memoir
of 1818, and that it is, I have given full proof, let me ask
how M. Civiale can have borrowed it from M. Leroy, who
did not publish his w^atch-spring instrument until 1822, or
his elastic branch instrument until 1823 or 1824.

M. Leroy admits, and publishes, that he had read M. Ci¬
viale’s memoir in Baron Percy’s house, and that he found
the instrument in question therein described. A strange

314

Original Communications.

admission for one who endeavours to pass for the inventor
of it !

Not satisfied with his first instrument, M. Leroy lays it
aside, and in a new one substitutes for the watch-springs
the forceps of Franco’s relation. Now, in good truth, does
M. Leroy copy from Franco, or from Civiale, whose me¬
moir he acknowledges he had read ? Yet nevertheless, M.
Leroy will have it that he is the inventor !

When M. Civiale had obtained from the Academy the ad¬
mission of his claims, M. Leroy endeavoured to remove the
suspicion of plagiarism, that hung over him ; and for a time
he contents himself with maintaining that his inventions
were independent of those of any other person. Let us ad¬
mit that they are so. But does he not put even this merit
in danger, when he wishes his claims to be considered supe¬
rior to those of M. Civiale, who takes the lead of him in this
enquiry by four or five years, and who is the first to reduce
it to practice ?

M. Leroy, after much agitation of this topic, at last fails
in establishing his claims to the invention. He then throws
out the most odious insinuations against the Commissaries
of the Academy, Chaussier and Percy ; and hints that they
had connived at a substitution of 'pieces . Baron Percy, or
any honourable man, could not condescend to answer this
outrage ; but he writes him the following paternal reproof,
and M. Leroy, imagining that it justifies him, publishes it.

“I entertain no feeling of resentment against you, my dear
sir ; the only injury you have done, has been to yourself, and
had you even injured me, I should have already forgotten it.
But how is this contest, which you have provoked, to termi¬
nate, and whither will it lead you ? Your adversary, while
you spend your time in reclaiming, proceeds prosperously,
enjoying his successes, and appears not to be conscious of
the outcry you are endeavouring to raise.

He has just now forwarded several signed papers, which
he affirms to be authentic, and which I believe to be such :
you will be judged on peremptory proofs, and not on words,
which are susceptible of interpretation. I regret vividly,
that you have engaged yourself in such an affair. Read our
report, and you will see that the merit of anteriority belongs
to Dr. Gruitheusen, and that M. Civiale only made his ap¬
pearance ten years after him. He may have had the same
idea as Dr. Gruitheusen, in the same manner as I believe it
very possible that you conceived the project litigated, with¬
out any communication with either the one or the other. I
still have one of the little watch-springs, for which you have

315

Mr. Costello on Lithotrity.

since substituted the forceps of Franco’s relation ; you let it
drop in my room, when you came to shew me your instru¬
ments, with which, most assuredly, you could not have per¬
formed One of those brilliant operations of which M. Civiale
made us witnesses.

<c How much I regret that I cannot reconcile you to each
other ! You are both honourable men, well informed, and
zealous physicians ; my happiness would be to bring you
together amicably ; but your article, of I know not what
Journal, and your printed reclamation deprive me of all
means to do it. I shall, perhaps, be reduced to the neces¬
sity of submitting explanations to the Academy on Monday
next, which will not be to your advantage. Behold ! to what
one rash step leads, j But the written proofs which I have
to f urnish against your pretensions , will not alter the esteem
I feel for you, nor abate the attachment for you, of one of
your oldest predecessors.”

9th April, 1824. (Signed) Percy.

Mr. Alcock gratuitously asserts, that neither M. Civiale
nor myself have ever seen M. Heurteloup’s instruments.
Mr. Alcock could have no proof cf this. M. Civiale and
myself have had these instruments several times in our pos¬
session. Indeed M. Civiale could not have had the ridicu¬
lous presumption to demonstrate their defects to the Aca¬
demy, without satisfying himself, by actual inspection and
careful examination, that such defects existed. If Mr. Al¬
cock is anxious to have M. Heurteloup’s instrument, I shall
give him the address of an instrument maker, who shall ex¬
ecute it for him.

When Mr. Alcock will have perused the preceding facts,
he will be better able to judge, whether his statements were
calculated to injure me, and that unjustly. I leave it to his
own good sense to determine whether he to whom this ope¬
ration is yet novel, and who has judged me without granting
me the benefit of the axiom, audi alteram partem , will not
have to recall opinions, which, deprived of the support of
facts, must become suspicious to Mr. Alcock himself. Mr.
Alcock taxes me with feelings of petty jealousy. It must be
remembered, that I was dragged into this painful conti o-
versy. My friend and master was intemperately attacked.
Had I been indifferent to his defence, it would have argued a
bad cause on his side, or inability and ingratitude on mine.

I am, Sir, Yours,

W. B. Costello.

108, Jermyn Street,

September 2bth, 1829. ...

316

/ Original Communications .

II. — On the Nature and Treatment of Delirium Tremens.

By Michael Ryan, M.D.

As the systems of practical medicine in this country do not
contain an account of the disease at the head of this paper,
and as many persons lose their lives in consequence of this
omission, I am induced to attempt its description. Should
this paper be the cause of saving the life of a single indivi¬
dual, I shall have no reason to regret its obtrusion on the
junior members of the profession. I am not acquainted
with any disorder so often mistaken, and mismanaged as de¬
lirium tremens, and the reason is very obvious, because the
greatest portion of the profession, especially in this metro¬
polis, have not leisure to refer to any works, except the po¬
pular systems, and I am satisfied a vast majority of them
have never perused the original essays on the subject ; there¬
fore there is a sufficient reason for the present allusion to
the disease.

This disease was called brain fever, by Drs. Pearson and
Armstrong delirium tremens, by Dr. Sutton, and delirium
ebriositatis, by Mr. Blake y to each of which appellations
there are many objections. The term brain fever, is applied
to very different diseases — to typhus, phrenitis, and mania,
and various other complaints. are also aware that the

disease under notice may exist unaccompanied with tre¬
mors, and it may arise from the abuse of various stimuli, as
opium, and belladonna, &c., as well as from the abuse of ar¬
dent and fermented liquors. A much more correct term for
the disorder, in my opinion, is delirium nervosum, and for
the reasons assigned in the last Number of this Journal. I
believe it to be a pure nervous affection, and totally inde¬
pendent of lesion in the cerebral structure, and in no in¬
stance have the necrotomic examinations, hitherto pub¬
lished, disproved this opinion. There are three distinct
stages in this disorder — a stage of debility, a stage of ex¬
citement, and a stage of collapse. It generally terminates
on the fourth day * in recovery, or death ; and, occasionally,
in apoplexy, or mania. It may be idiopathic or symptoma¬
tic. It is mostly idiopathic, and most commonly attacks
persons of either sex, who are of intemperate habits. When
such persons have undergone capital surgical operations, it
may superyene, or when they labour under typhus, scarla-

* Dr. Begbie has said it may continue for several weeks. — Dissertatio Med.
lnuug. Ab Delirio Trementi. Edin. 1821.

Dr. Ryan on Delirium Tremens. 3 YJ

Una, erysipelas of the scalp, pneumonia, acute rheumatism,
cholera morbus, and many other diseases.

Symptoms. — The disorder usually occurs after a debauch,
especially in persons of dissipated habits ; and is sometimes
preceded by languor, lassitude, oppression at the praecordia,
or nausea and vomiting. There is much anxiety or inquiet¬
ude ; uneasiness, or pain in the head, tinnitus aurium ; in¬
somnolence, or disturbed sleep ; tongue white and moist ;
appetite prostrate ; great aversion to animal food ; heat of
skin natural, though the surface is covered with a cold,
clammy perspiration; pulse small and frequent. Some¬
times these symptoms continue for a day or two, when the
disorder becomes clearly developed. The restlessness in¬
creases, there is a deficiency of thought and memory, the
irritation of the mind increases, the countenance becomes
furious, the eye vivid and glistening, tremors of the hands,
arms, and lower extremities appear, the mental faculties be¬
come more confused ; the answers to questions are ex¬
tremely quick ; the vision is depraved, the pupil contracted,
but no intolerance of light; imaginary objects of the most
hideous nature, are presented to the view, insects, vermin,
racks, gibbets, robbers, murderers, fire, thunder, demons and
infernal spirits, in wild and terrific confusion, crowd upon
the disordered brain. In nearly all the cases I have ob¬
served, the patient thought the apartment filled with u de¬
mons and black angels.'’

The sufferer communes with himself, or addresses his de¬
ceased friends, or absent acquaintances. He supposes he
has suffered some great calamity, has been plundered,
wounded, failed in business, &c. ; and suddenly jumps out
of bed in pursuit of some phantom or enemy. He calls for
his clothes, and insists on returning to his own residence,
from which he invariably supposes himself absent, although
he recognizes his relatives for a moment ; he then relapses
into his former state ; and if remonstrated with, he shews
the greatest contempt for those about him. He is con¬
stantly examining the bed clothes, for insects, &c. and he
looks suddenly .under every article of furniture, in search of
some phantom or object that haunts his imagination. He
has a total loss of sleep, pulse more frequent, skin dry, or
covered with a cold perspiration; tremors increase, there are
spasms of the legs, and the extremities are generally colder
than the body ; he refuses food, drink, and medicine, or takes
them with avidity. He now makes the strongest efforts to
avoid his spectral illusions ; he answers questions correctly,
but not in succession ; his memory declines, or totally fails ;
lie is unable to protrude his tongue, and if asked how he

318 Original Communications .

feels, he replies, in perfect health. These symptoms may
continue for three days, when his tremors become greatly
increased. He becomes at length exhausted, and if the dis¬
order be to terminate favourably, sleep supervenes on the
fourth day, from which he awakes perfectly rational. If, on
the other hand, his symptoms continue, they become more
unfavourable ; the pulse is small and rapid, face pale, sub-
sultus tendinum, perspiration copious and foetid, alvine
evacuations discoloured, and he sinks without a struggle.
When sleep occurs,' it continues for twelve, eighteen, or
twenty-four hours. These are the principal symptoms of
delirium nervosum, but there are many others of minor im¬
portance.

Morbid Appearances. — As yet we have no account of the
morbid appearances in the idiopathic forms of this complaint.
In the preceding paper I have endeavoured to account for
the real nature or cause of this form of delirium, and arrived
at the conclusion, that it is purely a nervous affection.

Diagnosis. — -The symptoms and suddenness of the attack
of this malady clearly distinguish it from continued fever,
besides, the delirium in fever is continued, and there is no
possibility of questions being answered correctly. It cannot
be confounded with phrenitis, which is seldom seen in this
climate. It is more like mania, but in this affection there is
no rational answer ever given, nor are the other symptoms
of the disease under consideration present.

Prognosis. — From what has been already said, it is easy
to predicate the termination of the complaint. If the pulse
do not exceed 100, the issue, according to Mr. Blake, is fa¬
vourable, but the pulse may exceed this number, and the
case terminate successfully. If there be visceral disease, a
broken constitution, then the prognosis is unfavourable.

Treatment. — I have described the various modes of treat¬
ment in the last Number of this Journal, to which I refer
the .reader. In my opinion, the exhibition of the habitual
stimulus of the patient in idiopathic and symptomatic deli¬
rium tremens, or, rather, delirium nervosum, is the most
natural mode of stimulation, and, according to my experi¬
ence, the only certain cure for the disorder.

Hatton Garden, September, 1829.

III. — On Puerperal Hysteritis. By W. Hughes, Esq.

Dear Sir — If you think the following case of inflammation,
of the uterus in the puerperal state worthy of publication, it
is at your service. It is one of no uncommon occurrence,

Mr. Hughes on Puerperal Hysteritis. 319

but shows, in a marked manner, the advantages of active de¬
pletion.

Mrs. R — , aged 22, of spare and delicate habit, was in la¬
bour with her first child on Monday, August 17- She had
been suffering from spurious pains since Saturday, and had
not more than two hours’ sleep during the preceding night.
I was called to her about ten o’clock in the morning ; the
nurse told me she had been ill all night ; but, during the last
hour, the pains had become much stronger and more fre¬
quent, occurring about every five minutes. The liquor am-
nii had been discharged a few minutes before my arrival.
On examination, I found the os uteri fully dilated, and the
head of the child descending in the natural position. The
pains now gradually increased in duration and frequency,
and, for three hours, the patient’s sufferings were very
severe. At half past one, the child was born, and in a few
minutes afterwards the placenta was expelled, but ac¬
companied with less discharge than I ever remembered to
have witnessed, not more than sufficient to soil a single nap¬
kin. She experienced several severe pains afterwards, before
I left her. I therefore gave her a draught, with thirty drops
of tincture of opium. — Eight o’clock, p. m. Had passed
her urine freely, and without pain ; the after-pains had been
so severe as to prevent sleep ; lochial discharge very scanty,
and scarcely coloured; pulse 80; skin cool. Ordered
warm fomentations, to be freely applied to the region of
the uterus. Rept. haust. c. t. opii. m. xxv. — August 18.
Pains much relieved by the fomentations, but occurring at
intervals ; had dosed during the night, but no sound sleep.
Ordered an aperient mixture, with sulphate of magnesia
and mint water ; to be repeated every four hours, until
the bowels are relieved. — August 19th. Medicine operated
twice yesterday, and, in the early part of the evening
she was much better ; but the pains had come on dur¬
ing the night. She was now suffering from distressing
headache, much aggravated by admitting the light, with
some pain in the uterine region, but without tenderness on
pressure. Ordered, magnes. sulph. c. inf. senna, tertiis horis
donee alvus solnt. fuerit. — Eight o’clock, p. m. Medicine
had operated twice copiously ; symptoms considerably re¬
lieved. — 20th. Two o’clock, p. m. Had about two hours
sleep during the night, but early in the morning was at¬
tacked with cold shivering, accompanied with severe pain in
the lower part of the abdomen, shooting to the back ; coun¬
tenance flushed and anxious; acute pain in the head; the
skin, although moist with perspiration, was intensely hot ;
pulse 120, and full. I immediately opened a vein in the

320 Original Communications.

arm, and very quickly abstracted Jxvj. of blood; continued
fomentation ; haust. c. sulph. magnes. c. inf. senna statim. —
Eight o’clock, p. m. Bowels relieved once, freely. Head
much easier after the bleeding, but the pain had returned
within the last half hour. She now complained of chilli¬
ness, although the skin was still very hot, and perspiring
freely ; pulse 120. The blood was very firm and cupped,
but slightly bulled. Rept. v. sectio ad^xvj. Hydr. submur.
gr.v. statim. Haust. cathartic, 4tis horis. Hirudines xij. re-
gioni uteri ; a warm bread and water poultice to be ap-^
plied to the leech-bites. — 20th. Blood last drawn exhibited
a firm, buffy surface, and fully proved the existence of
acute inflammation. The leeches had bled very freely ; the
bowels had acted several times ; she still had some pain and
tenderness on pressure, but not severe ; pulse 100. Ordered
the fomentation to be continued. 22d. She now only com¬
plains of occasional pains, which are relieved by the appli¬
cation of hot flannels. From this time she gradually im¬
proved. The lochial discharge from the first was extremely
slight ; the secretion of milk was not suppressed. That ac¬
tive uterine inflammation existed in this case, is clear, both
from the continued severity of the pain, and the appearance
of the blood. The second bleeding seemed to make a de¬
cided impression on the disease. Had less active treat¬
ment been adopted, I have no doubt more serious symptoms
would have ensued, and, perhaps, puerperal delirium ; for,
the nurse said, she had been a (( little wandering,” during
the night. It will be seen that I took thirty-two ounces of
blood from the arm in less than eight hours, besides what
flowed from the leech-bites ; and she had been allowed no¬
thing since her accouchment but thin gruel and tea. She
continued to suckle her infant, and has now a plentiful sup¬
ply of milk.

1 remain, dear Sir, truly yours,

William Hughes.

90, High Holborn, Sept. 15th, 1829.

This case must prove highly instructive to the young prac¬
titioner ; it shews the insiduous manner in which hysteritis
may supervene. The treatment was active and judicious,
and, of course, successful. Fully one half of the ordinary
obstetric practitioners of the day would have set down the
disease, as they do every pain in the abdomen of a puerpe¬
ral woman, puerperal fever, and used depletion to a much
greater and unnecessary extent. — Ed.

BIBLIOGRAPHY.

GENERAL REVIEW OF FOREIGN AND BRITISH MEDICAL JOURNALS.

MEDICINE.

1. Traumatic Tetanus , cured by Acetate of Morphine, employed
lifter the Endermic method. By Dr. Gaspard Cerioli, of Cremona. —
The subject of this case was a female, aged twenty-nine, the
mother of five children, a nurse, whose constitution was robust,
and general health good. About the middle of October, 182S,
she wounded herself over the right eye-brow with a piece of
wood, and applied cold water to the part, and likewise emollient
poultices. Two days afterwards she was seized with a strong
contraction of the muscles of the neck and abdomen, accompa¬
nied with an incipient trismus. The tetanus became insensibly
general, the spasms excessively painful, manifesting themselves
occasionally in the limbs. . On the 22d October she was admitted
into the hospital at Cremona, and on the 23d presented the fol¬
lowing symptoms : — Face red, eyes brilliant, ■ sardonic laugh,
nostrils dilated, noise in the ears, sense of weight and pain in the
head, the latter insupportable in the wound, trismus well develop¬
ed, great hunger, which could not be appeased by the permanent
closure of the mouth 3 thirst ardent, respiration continually pain¬
ful, spasmodic contraction of the abdominal muscles 3 urine spar¬
ing, reddish, and highly irritating when voided 3 constipation 3
pulse frequent and hard 3 intellectual faculties perfect 3 insomno¬
lence constant. Venesection, warm baths, from one to two hours 3
frictions of camphor and opium on the neck and articulations of
the jaws ; internally a third of a grain of acetate of morphine every
second hour, and purgative enemata. All these means were con¬
tinued till the 27th, without producing any amelioration 3 the dis¬
ease, on the contrary, had increased 3 the tetanic contractions had
acquired the greatest intensity 3 the clonic spasms of the inferior
limbs were more frequent and painful. This exasperation of the
symptoms caused the suspension of the morphine and the re-itera¬
tion of the blood-letting.— 28th. Had a grain of ipecacuan every
two hours, to produce perspiration, but the second dose caused
vomiting and an aggravation of the symptoms j the medicine was
therefore discontinued. Such was the state of the patient, which
induced the belief that she must succumb very rapidly, when it
was deemed right to resume the morphine, but to employ it exter¬
nally. — November 1st. A blister was applied to the neck, and
when vesication was effected, the epidermis having been removed,
lint smeared with marshmallows ointment, to which was added
one-fourth of a grain of morphine, in fine powder, was applied to
the part. The same quantity was applied in the afternoon. The
effect produced was extremely remarkable 3 in a few hours the
clonic spasms were weaker, the motion of the jaws more free, the
contractions of the lineaments of the face became relaxed, the
pains of the neck and back had diminished sensibly, the sufferer
VOL. III. NO. 16. 2 T

322

Bibliography.

enjoyed a tranquil sleep, with slight occasional interruption. The
following day the amelioration was augmented. A third of a grain
of the morphine was continued twice a day ; the other medicines
were suspended. The ointment was continued to the 10th, and
on the 16th the patient left the hospital perfectly cured. She re¬
turned on the 20th of December, and reported that she had had
no return of the disease. — Annali Univ . de Med. Mai , 1829.

This is a highly instructive case, and corroborates the opinion
of those who maintain that all poisons applied to wounds act
through the medium of the nerves. The practice would be worthy
of a trial in cases of mania, and all other diseases in which opium
cannot be exhibited or retained in the stomach. In chronic affec¬
tions of the joints, the application made to a blistered surface
might be beneficial. The application of opium and other narcotics
to old irritable ulcers is often productive of very great relief. The
following case is a further exemplification of the great utility of
the practice. — Ed.

2. Neuralagia of the Face cured by the Acetate of Morphine , em¬
ployed externally. By the same physician. — Mrs. R. C., of a ro¬
bust constitution, but subject to hepatic colic, the menstruation
healthy to the fifty-sixth year ; laboured under scirrhus of the
neck of the uterus, and also a small tumour, probably of the same
kind, in her right breast. In the autumn of 1828 she had expe¬
rienced pulsative and lancinating pains in the left side of the face,
following the course of the inferior maxillary nerve. These pains
were preceded by a sense of trembling in the gum of the same
side. The pains irradiated with violence towards the roots of the
teeth of the right side, extended to the whole head, and continued
for four or six hours, and returning whenever the patient attempt¬
ed certain motions of mastication, or when any thing struck her
ears. As she was plethoric, blood-lettings, general and local,
anodyne, emollient and anti-spasmodic embrocations, such a3
hyosciamus, lactusa virosa, valerian, and assafoetida were employ¬
ed ; as also blisters behind the ears and to the nape of the neck.
No advantage was derived from all these means. The sulphate of
quinine produced sensible effect of a temporary kind, however, on
the periodicity of the disease. The external use of the acetate of
morphine afforded great relief, but the disease was excited, in a
slight degree, by exposure to cold air. — Op. Cit .

It is not stated whether the morphine had been applied to the
surface when vesicated, but, from the title of the report it is to be
inferred that the cuticle must have been removed. Mr. Kirby, of
Dublin, has applied the extract of stramonium in facial neuralgia,
in many cases, with success. — Ed.

3. New Operation for arresting Hemorrhage from Leech Bites.

v Dr. hoB enhald. Incases where infants are in danger of death

from hemorrhage, arising from leech-bites, our author passes a
stra ght ( r curved needle, extremely fine, and armed with a thread,
through the sides of the little wounds, and ties the thread with a
single knot. He has never seen ecchymosis, or any other unfa.

Disease of the Maxillary Sinus . 323

vourable accident follow the operation. — Grcefe, Journal fitr Chi-
rurgie, %c.

This operation has been already performed in this country. — Ep.

4. A New Alkali in Cinchona. Discovered by Dr. Sertuerner. _

Our author, as well as many other physicians, have observed, that
intermittent fevers, cured by the sulphate of quinine, returned
more frequently than those treated by cinchona in substance j he
was, therefore, induced to analyze the bark, but the results of his
experiments are not fully detailed. He alleges that he has found
a new alkali in the precipitate, occasioned by alkalies in an acid
solution of the extracts of cinchona, and this he has named chi-
nioidine (chinioidin) , which is intimately united to a resinous acid
substance, from which it is separated with difficulty ; and he has
found it in the yellow and red barks, united with quinine and
cinchonine. The chinioidine is distinguished by its great affinity
for acids, by its re-action on vegetable colours, its intimate com¬
bination with an extractive acid substance. Its salts are gluti¬
nous and fusible, at a slightly increased temperature. The chi¬
nioidine, united with quinine, forms a preparation which far sur¬
passes the cinchona bark in efficiency. Dr. Sertuerner has ex¬
hibited the new alkali, in an epidemic intermittent fever, in doses
of two grains, after which some vinegar is to be drank to neu¬
tralize the alkali of the gastric fluid, which sometimes predomi¬
nates in these fevers. From twelve to twenty-four grains of the
chinioidine will suffice to cure intermittents which resist the qui¬
nine, and prevent the relapses of these diseases. — Hufeland's Jour.
Jan. 1829.

GLASGOW ROYAL INFIRMARY.

5. Disease of the Maxillary Sinus. — Case. D. JVTQueen, set.
seventy, admitted November 13th, 1828, with the right nostril
occupied by a fungus tumour completely filling its cavity, and
pushing the septum narium towards the left side. The fungus re¬
sembled in appearance the common soft polypus of the nose, and
bled when touched ; right cheek tender and somewhat fuller than
the left ; right side of the roof of the mouth softer and more pro¬
minent than the left ; gums spongy, and most of the teeth (he was
seventy) loose, with slight purulent discharge oozing out ftom their
sockets ; right lachrymal sac much distended with constant flow
of tears ; right eye protruding about half an inch, with eversion
of the lower lid, and chemosis of the conjunctiva, large and slug¬
gish pupil, and somewhat impaired vision ; hearing of right ear
affected; occasional severe pain, commencing round the orbit,
and extending over the whole right side of the scalp, most fre¬
quent at night, and accompanied with throbbing of the temples.
These latter attacks were generally followed by bleeding at the
nose, which afforded relief ; the general health was good.

Twelve months previously he had received a blow above the
right ear with a stick, which stunned him, and occasioned slight
epistaxis. After this he became subject to headache, and in the
course of three months he noticed slight obstruction in the right

324 " Bibliography.

nostril, succeeded by occasional hemorrhages. Six weeks before
admission the vision of the right eye began to fail, but the eye¬
ball did not sensibly protrude till three months afterwards,^ since
which period the symptoms, to use an American phrase, pro-

^Thethjrd and fourth molares on the diseased side being extract¬
ed, a perforation was made through their sockets into the antrum j
only a little blood issued. On introducing a probe no firm tu¬
mour was perceptible in the antrum, but the cavity was found to
be filled with a soft pulpy substance, through which the probe
could be passed freely in all directions, coming into contact with
a small extent of bare bone in the direction of the orbit. On in¬
jecting tepid water through the perforation, it issued freely by the
nostril, bringing away, besides blood, a quantity of a white sub¬
stance, of the consistence of butter. The polypus being remov¬
ed from the nostril with the forceps, tepid water was repeatedly
injected through the perforation, until it issued unmixed from the
nostril, and the quantity of inspissated mucous thus extracted, was
greater than would have completely filled the antrum in its na¬
tural state. The injection with tepid water was afterwards con¬
tinued daily, and occasional anodynes were given to alleviate the
pain in the head. At the end of two weeks the swelling of the
cheek and palate, the protrusion of the eye-ball, the epiphora and
ectropion, had disappeared ; the vision of the right eye was com¬
pletely restored, but he still heard imperfectly with the right ear,
and suffered occasional attacks of pain in the right side of the
head. At the end of two months he left the hospital in perfect
health, excepting occasional slight headache. There was then no
discharge from the antrum, although the perforation had been
carefully kept open, and no bare bone could be perceived with the
probe. — Med. Chir. Rev.

6. Case of Gonorrhoeal Ophthalmia. — J. Watts, set. twenty-six,
admitted December 12th, 1828, with the lids of both eyes greatly
swollen and of purple colour ; the conjunctive of dark red colour,
much distended, and discharging a large quantity of thick, yellow
matter * state of cornese not to be ascertained on account of the
intolerance of light ; pulse 108, of good strength} skin hot,
tongue white. Four weeks previously he contracted gonorrhoea,
for which he used f some internal remedies, that at the end of a
fortnight greatlv diminished the discharge. Twelve days before
admission felt slight itching in both eyes, accompanied with heat
and acrid discharge, and after two days the eye-lids became swol¬
len and the discharge purulent. No change in the gonorrhoea
took place when the eyes became affected, but even on admission
he had some discharge from the urethra, unaccompanied with heat

or pain.

Although the first stage of the disease was past, it was thought
requisite to apply leeches several times around both eyes, during
the first two days after this patient's admission, and the applica¬
tion was followed by much relief of the pain. The eyes werefre- ^
quently washed out with a syringe and tepid water, emollient and

Lithotomy after the Operation for Fistula Ani, 325

anodyne cataplasms were applied, vinum opii was dropped in the
eyes, and blisters were placed on the temples and the nape of the
neck, and kept open during the course of the disease. No stimu¬
lants were applied to the urethra, as the discharge from it con¬
tinued unchanged. As the violence of the disease abated, which
it did very slowly, the injections of tepid water were exchanged
for a weak solution of corrosive sublimate in rose water, with the
addition of a little vinum opii, and afterwards for a solution of
lapis divinus ; wine, tonics, and nourishing diet were also given,
but it was not till two months from the time of admission that he
was able to leave the hospital. He had then been about three
Weeks free from pain and discharge from the eyes. The left eye¬
ball was much shrunk in size, and its vision was entirely lost from
exfoliation of the cornea. The right cornea had also suffered much
from the same cause, but a small portion of it still remaining
lucid, he could see with this eye so as to number large objects
held up before him, or guide himself through the ward. The dis¬
charge from the urethra continued through the whole course of
the disease 3 and at the time of his dismissal was still so con¬
siderable that he required the use of an astringent injection for its
removal.

It may be fairly presumed that the ophthalmia, in this case, did
not arise from the direct application of gonorrhoeal matter to the
eyes, because the disease appeared exactly at the same time in
both eyes, and the chances of simultaneous inoculation are not
very considerable. It is also plain that the occurrence of the af¬
fection of the eyes was not an example of metastasis, because the
gonorrhoea suffered no change on the appearance of the new dis¬
ease, but ran its usual course, continuing even when the ophthal¬
mia had ceased. It must be concluded, then, that this severe af¬
fection arose from a sympathy existing betwixt the eyes and the
urethra, a sympathy which fortunately operates only on rare
occasions.— -Ibid.

7. Lithotomy after the Operation for Fistula Ani — Consequences of
the Operation. — James Hardie, set. thirty-seven, admitted March
11th, 1829, with frequent desire to make water, which was passed
with much pain along the course of the urethra and neck of the
bladder, especially when the last drops were voided 3 urine some¬
times bloody, especially after exercise or the introduction of in¬
struments into the bladder, but without any mucous or sandy de¬
posit. A full-sized sound passed readily into the bladder, where
it struck on a hard smooth substance, which was always found ly¬
ing towards the right side* and could not be felt by the finger
passed into the rectum 3 the prostate gland was natural. JEx-
tending from the anus forwards, and towards the left side, occu-
pying part of the incision made in the lateral operation of litho¬
tomy, was the cicatrix of an operation for fistula in ano, perform¬
ed some years previously. The symptoms of stone commenced
about sixteen years before his admission, but had never been ur¬
gent, till within the preceding fortnight, when they followed, as
he imagined, the use of carbonate of soda internally.

326

Bibliography .

A few days after admission, the lateral operation was perform¬
ed by running a straight, probe-pointed bistoury along a curved
staff, grooved on its convex side. A little more than the usual
time was spent in cutting into the urethra, in consequence of the
hardness of the cicatrix just mentioned, but, the stone being ex¬
tracted on the first introduction of the forceps, the whole opera¬
tion was finished within six minutes. The calculus weighed about
an ounce and a half, and was composed of the phosphates of am¬
monia and magnesia. During the first few days no bad symptoms
occurred. About the fifth day the wound began to look foul, and
on the eighth day some flatus and a little feculent matter was ob¬
served to escape from it. On examination with the finger it was
found that the old cicatrix had ulcerated, producing a small aper¬
ture betwixt the wound and the rectum, immediately above the
sphincter. A bistoury was passed through the opening, and car¬
ried downward, so as to divide the sphincter. An elastic catheter
was kept constantly in the urethra, and stimulant dressings were
applied to the wound. Healthy granulations soon made their ap¬
pearance, and at the end of seven weeks the cicatrization was com¬
plete, but a small opening into the urethra still remained, through
which the greater part of the urine was discharged. On his re¬
turn to the hospital, as directed, at the end of three months after
the operation, the opening into the urethra had contracted so
much, that no urine escaped by it, if he kept his thighs together
during micturition, and even when he did not observe this precau¬
tion, the escape was trifling. It was proposed to apply the actual
cautery for the purpose of closing the fistulous opening, but
the inconvenience he suffered was so trifling that he declined to
submit.— Ibid.

MEATH HOSPITAL, DUBLIN.

8. Ligature of the Carotid Artery. — August 22d, 1829. — The
common carotid artery was tied to-day at this hospital, by Mr.
Porter, under the following circumstances : —

The patient, a woman aged about 40, and in every other respect
apparently healthy, was admitted on the 19th inst. with a pulsat¬
ing tumour, occupying almost the entire of the right side of the
neck. It extended from the root of the ear downwards to within
an inch of the clavicle ; in front it leaned against the trachea, and
posteriorly it had pushed the sterno-mastoid muscle considerably
out of its place. Its length might have been about five inches and
a half ; its breadth about four. It had continued for some years -
small, and making but slow progress ; but about three weeks
ago she received an injury, and then it increased with great rapi¬
dity, became painful, and deprived her of sleep. Its growth was
so rapid as to render it absolutely necessary to perform the opera¬
tion with as little delay as possible.

She was placed lying on a table, her head supported by pil¬
lows, and the light falling on the right side of the neck ; an inci¬
sion was then made from the lower edge of the tumour to the
sterno-clavicular articulation ; another about three inches long,
at right angles with the former along the clavicle, and the flap

Case of a Still-Born Child. 32J

dissected up. 1 he mastoid muscle was thus exposed, under which
a director was passed, and the sternal and two-thirds of its clavi¬
cular attachments were divided. A strong fascia then came into
view, which was pinched up in a forceps and divided, after which
the knife was almost entirely laid aside. The edges of the sterno¬
thyroid and sterno-hyoid muscles were pushed by the fingers of
the operator towards the trachea, and the sheath of the vessels
exposed ; this was torn by a director, and the artery thus com¬
pletely laid bare. Mr. Porter on this occasion used the same
needle which he had before employed for the ligature of the sub¬
clavian, the point of which containing the ligature screws off, and
is drawn up at the other side by means of a hook with the great¬
est facility. The needle was passed from without inwards, and
whilst the artery lay upon it, the vessel was compressed with the
finger, in order to see what effect it might have on the tumour j
the pulsation immediately ceased, and, the ligature was then tied
firmly and closely. The size of the tumour evidently became di¬
minished, even before the patient was carried from the table.
The Wound was closed with two stitches, and the entire operation
concluded in seventeen minutes. She lost not more than three or
four ounces of blood.

After the operation, she had a composing draught, the wound
being dressed with pledgets of lint, dipped in spirits and water j
and in about an hour afterwards, when the reporter left her, she
was perfectly tranquil and composed. The future progress of the
case shall be taken notice of. — Med. Gazette.

9. Ligature of the Subclavian Artery. — Perhaps it may be as well
to mention that the patient whose subclavian artery had been tied
left the hospital July 29th, thirty days after the operation ; how¬
ever, fiom making too free in his diet, the sac of the aneurism in¬
flamed and suppurated. On the 14th of August, the abscess was
opened, and nearly a pint of purulent matter, mixed with clots of
blood, evacuated. Pressure was applied over the sac, and the pa¬
tient never had an untoward symptom. At this moment the
wound is discharging a very small quantity of a serous fluid, and
the patient (from the absence of any unpleasant affection) may he
considered as completely recovered.-— Ibid.

10. Case of a Still-born Child that had been retained in the Uterus
Thirteen Calendar Months. By Peter Cullen, Esq. Surgeon, Sheer¬
ness. — The subject of this extraordinary case is a small active wo-
■man, aged 38, in good health, and the mother of seven children
exclusive of this. About the beginning of July, 1828, she missed
the catamenia, which should have appeared at that time, and soon
after found herself pregnant. In October following, she quick¬
ened, and felt the motions of the child till January, when they
ceased, and never returned. She had continued to increase in size
till that time, but afterwards decreased, and felt only a sensation
of a lump in the lower part of the belly, towards the left side,
which sensation continued till her delivery. Her health was good"
and she continued as active as ever.

At this time (January) she consulted me; when I gave it as my

32B

Bibliography .

opinion that her child was dead, and that she would be delivered
of it on or before the completion of the nine months. She engaged
me to attend her.

I heard nothing more of her till the 19th of August, 1829, when
passing by her house, I was called in, and found her in great pain,
like labour. An examination discovered it to be so 3 and, about
half an hour afterwards she was delivered of a male still-born
child, followed soon after by the placenta. The child seemed
to have died about the fifth or sixth month, which corresponds
with her account. It measured, in length, between nine and ten
inches ; weighed six ounces 3 was much reduced, shrivelled, and
emaciated 3 of the colour of tanned leather, without fetor or any
disagreeable smell. 1 have it by me now, immersed in spirits.
She is at this time (the 28th of August) doing well.

There is no reason to doubt the accuracy of this woman’s state¬
ment, she being of good character, and all the circumstances of
her condition well known to her neighbours. She fancied, after
the month of January, that her pregnancy had gone off, and that
all the symptoms which she had had were such as are customary
to women at what they term the turn of life, or final cessation of the
menses, of which she had seen none since her conception in July,
1828 ; and was, therefore, rather surprised when I told her she
was in labour. But her age being only 38, and the circumstance
above detailed, preclude the idea of the ‘f turn of life” with her.

I have submitted these facts without note or comment, as they
occurred, but will be very glad to read your observations or those
of your correspondents upon them. In the course of a long prac¬
tice, I have neither seen nor heard of any such occurrence, nor do
I remember reading it. It is a singular phenomenon, and very
curious both in a physiological and pathological point of view. — Lb.

1 1 . Medical Jurisprudence. Inquest on the Body of Mrs. Charlotte
Phillips. — This inquiry excited the utmost interest. On the arri¬
val of the coroner the jury were sworn, after which the following
evidence was taken.

Mr. Henry Phillips, the husband of the deceased, was first
sworn. I am a surveyor, and reside at Finchley 3 I have been
married to the deceased only five months. On Sunday last she
complained of slight indisposition, and proposed sending for Mr.
Snow, a surgeon, at Highgate 3 at the time I considered that her
illness was more imaginary than real, and endeavoured to per¬
suade her that she did not want a surgeon, but could prescribe for
herself 3 however, in my absence from home in the course of the
day, she sent a young female, who was in the house making
dresses for her, for Mr. Snow to attend j that gentleman being in
Hertfordshire, Dr. Tweedie attended for him, and called to see
my wife 3 the result of his visit was, that two pills, a draught, and
a box of ointment, were sent to her (the latter was subsequently
ascertained to have been left in mistake, although used by Mrs.
Phillips) 3 the direction was “ The pills to be taken at bed-time,
and the draught in the morning.’’ The orders were strictly ad¬
hered to by my wife 3 on Wednesday a mixture was sent, direct-

329

Medical Jurisprudence.

mg that three table spoonfuls were to be taken three times a day.
On Thursday, Dr. Tweedie called again, and on questioning Mrs.
Phillips, said he would alter the medicine 3 in the evening another
mixture, came, with the same direction, viz. three table spoon¬
fuls to be taken three times a day. On Friday morning fl left
home early, having business to transact at Barnet 3 at this time,
my lamented wife appeared quite well, and rose between seven
and eight o’clock. On my return, about eleven o’clock at night,
I was informed by my brother and sister-in-law, who were conti¬
nuing in the house, that Mrs. Phillips had been very unwell, and
had retired to her chamber some time, being so very much op¬
pressed with drowsiness. I understood at this time, that Mr.
Hammond, a surgeon, residing at Whetstone, had been sent for;
but, being from home, his assistant came, who, on seeing Mrs.
Phillips, said that the drowsiness was produced by the mixture
she had taken, and that she would be better in the morning, if she
was not disturbed. In consequence of this, I felt more composed
and went to bed, at which time my wife appeared in a sound
sleep 3 I did not disturb her. On awakening in the morning, I
laid hold of her hand and said “Charlotte, how do you feel your¬
self ?” No reply was made. On looking in her face, I was
amazed and shocked at discovering her apparently a corpse : I in¬
stantly got up, and dispatched messengers to Dr. Tweedie and
Mr. Hammond. This was about eight o’clock. Mr. Hammond
arrived before nine o’clock. Mr. Bisset, another surgeon, also
came promptly. Mr. Hammond examined the last mixture that
came, and said that it was chiefly composed of laudanum, and
that no doubt Mrs. Phillips’s death was caused by her taking
an over-dose of the mixture. Although I repeatedly sent for
Dr. Tweedie*, he did not arrive until near five o’clock in the
afternoon. Mr. Hammond’s assistant attributed her death to the
mixture which she had taken, nearly two-thirds being laudanum.
Dr. Tweedie asked to look at the mixture last sent 3 on tasting it,
he said that it was not composed according to his prescription
for Mrs. Phillips. Dr. Tweedie expressed a wish to take the mix¬
ture away, for the purpose of ascertaining its composition 3 but I
objected to his taking all. The prescription was made up by Mr.
Snow’s assistant.

By the Jury : I am convinced my wife had no intention of laying
violent hands upon herself 3 she was particularly tenacious of her
health 3 she was not in the habit of taking laudanum medicinally.

Alexander Tweedie, M.D., of No. 40, Ely-place, Holborn : On
Tuesday last, I was at Mr. Snow’s house, at Highgate, when a
very pressing message came for Mr. Snow to attend Mrs. Phil¬
lips 3 he being from home, Mrs. Snow begged me to go, which I
did 3 I found Mrs. Phillips labouring under the effects of disorder¬
ed bowels 3 there were also a deal of nervous irritability and flighti¬
ness ; on my return to Mr. Snow’s, I wrote a prescription for her,
which, I believe, was made up by Mr. Hill, the assistant 3 I saw

* We understand that Dr. Tweedie received no message whatever from Mr.
Phillips. — Ed.

mo. 16. VOL. in. 2 u

330

Bibliography .

Mrs. Phillips on the Thursday, and was induced to make out a
second prescription *. [The mixture which was alleged to have
been sent j;on the Thursday, was here produced and examined
by Dr. Tweedie, who said that it contained a large proportion
of laudanum and decidedly was not prepared from his last pre¬
scription 5 there was no portion of laudanum in the composi¬
tion of either of the prescriptions.] The doctor continued his
evidence as follows : — 1 cannot speak as to the making up of
the prescriptions, or the- mode of conveyance ; I have opened the
body of the deceased ; tbe brain was more vascular than usual j
the blood-vessels of the membranes were turgid with blood,
and there was a slight milky effusion 5 in the chest j nothing morbid
was found ; the external or peritoneal coat of the stomach was in¬
flamed in patches -} the intestines were sound. From the circum¬
stances of the case, and the symptoms detailed to me by Mr. Ham¬
mond’s assistant, when he visited her, I am of opinion that the
death of the deceased was occasioned by her having taken laudanum.

By the Coroner : 1 am of opinion that three table spoonfuls of
the mixture now produced, purporting to have come from Mr.
Snow’s, and said to have been prepared from my prescription,
taken three times a day, would account for the deceased’s dissolu¬
tion. I did not detect, on opening the body, any vestige of lauda¬
num in the bowels 3 it may be taken in the largest quantities, and
yet not detected in the system, after the digestion of the aliment.

Mr. Phillips put a vast number of questions to Dr. Tweedie,
which he answered to the apparent satisfaction of the jury.

Mr. Swan Hill, assistant to Mr. Snow, surgeon, of Highgate,
examined : I prepared Dr. Tweedie’s two prescriptions for Mrs!
Phillips j there was no laudanum in either of them ; I entered them
in the day-book 3 I enclosed a label with the bottles, which were
wrapped in paper ; proper directions were conveyed with the me-
dicine ; the first medicines I sent by the postman ; the last bottle
of mixture was fetched by Mr. Phillips’s servant boy.

By the Coroner : I am twenty-five years of age, and served five
years’ apprenticeship to a surgeon-apothecarv ; I have been in the
habit of compounding medicines since my apprenticeship, which is
now upwards of eight years.

By Mr. Phillips : The ingredients composing the medicines
made from Dr. Tweedie’s prescriptions for Mrs. Phillips, consisted
of bark and leaves ; there are no bottles of laudanum on the table
in the shop. I made up other prescriptions on the Thursday be¬
sides Dr. Tweedie’s.

* I lie following is a translated copy of Dr. Tweedie’s prescription, produced
at the Coroner’s Inquest.

Calomel, two grains ; compound extract of colocynth, or bitter apple, eight
grams ; oil of carraway seeds, two drops. Form into two pills to be taken at
bed-time.

Infusion of cascarilla bark, two ounces ; infusion of senna, three ounces ;
manna, half an ounce ; compound tincture of gentian, one ounce. Three table
spoonfuls of this mixture to be taken three times a day. — A. T.

For Mrs. Phillips, 3d Sept. 1829.

331

Aneurism of the Innomindta .

The Coroner observed, that it was a most mysterious affair —
how such a deadly mixture, as was contained in the last bottle
sent to Mrs. Phillips, could have left the shop of Mr. Snow, he
was at a loss to imagine ; the young man Hill seemed initiated
in the situation he filled, consequently it was not to be inferred
that he had made so gross a mistake in compounding it ; on the
other hand, the bottle had never gone out of the possession of the
boy who fetched it from the shop, until it reached the hands of Mrs.
Phillips ; it certainly was a most extraordinary affair — there was
one thing beyond all doubt, that was, that the unfortunate lady
had been deprived of existence by taking the contents of the bottle
which was sent from the shop of Mr. Snow, on the Thursday j he
(the Coroner), however, would leave the case in the hands of the
jury.

By the wish of Mr. Phillips, several of the friends of Mrs. Phil¬
lips were examined, to prove, beyond a doubt, her sanity also
that she lived on the happiest terms with her husband, and was
most careful of her health.

The jury having heard the whole of the evidence, consulted a
short time, and then returned a verdict — “ That the deceased’s
death was occasioned by an over dose of laudanum, taken medici¬
nally.”

The inquest terminated at two o’clock yesterday morning, hav¬
ing lasted ten hours. — Lancet.

Facts have lately been discovered which exculpate the medical
attendants, and place the horrid crime of murder to the account
of others. Ed.

12. Aneurism of the Innominata, treated hy tying the Subclavian
Artery. By James Wardrop, Surgeon to the King. — Having fully
explained in my work on Aneurism, and, previous to that publi¬
cation, in the pages of this Journal, the pathological principles
which led me to operate in aneurism, by placing the ligature on
the distal side of the tumour, and the soundness of these prin¬
ciples having not only been recognized, in a manner highly gra¬
tifying to me, by the distinguished surgeons of this country, but
by those of the Continent also, and the new operation having been
successfully practised by others, I am eager to embrace every op¬
portunity of submitting to the profession any circumstance which
may^serve still further to elucidate this important subject.

And although the principle, that it is not necessary for the cure
of an aneurism that the circulation of the blood in the tumour be
completely stopped, has been established, and the fact, that aneu¬
rism may be cured by tying the vessel on the distal, as well as on
the cardiac side has been proved, yet, at the time my work was
published, in only two instances had the new operation been
adopted, and the artery tied on the distal side of an aneurism,
when large branches intervened between the ligature and the sac ;
and an opportunity had not occurred of ascertaining the effects of
such an operation by examination after death.

No apology, therefore, appears to me necessary, for taking this

332

Bibliography.

early opportunity of publishing the mode of termination, and the
appearances observed after death, in the case of Mrs. Denmark ; a
case which, whether we consider the importance of the patholo¬
gical principles which it has been the medium of developing, or
the operation performed for her relief, has created a more intense
interest than perhaps any operation of modern times.

In the Lancet of September 9th, 1828, more than twelve months
ago, I published a report, being the fourth after the operation, and
then stated : —

(f The following is the present state of the patient (August 8tb,
1828.) : — She is more reduced in point of flesh than at the period
of the last report, but this has evidently been owing to the attack
of bronchitis, and the severe measures to which she has been sub¬
ject, for, within the last six weeks, she has regained her former
appetite in a wonderful manner j the difficulty of respiration has
greatly diminished, so much so, that she can now sleep in the
natural position, and she is entirely free from the dreadful sensa¬
tion of threatening suffocation. No tumour is perceptible in the
situation of the aneurism, but an unnatural feeling of hardness can
be perceived at the root of the neck, immediately above the ster¬
num, arising no doubt, from a condensation of the aneurismal tu¬
mour. The right carotid artery still pulsates, although not so
strongly as the left ; its pulsation corresponds with that of the
heart, but its branch, the temporal artery, affords no indication of
the circulation of blood ; the right radial artery beats with about
half the strength of the left. She suffers none of those pains in
the regions of the neck, shoulder, and back ; nor has she, for a
long time, experienced any of those severe headaches which for¬
merly gave her so much uneasiness. The oedema of the feet
has entirely disappeared, and she takes exercise in the open air
daily.’'

For some time after the date of this report, no change took
place in Mrs. Denmark’s state. She occasionally suffered from se¬
vere attacks of dyspnoea, which were generally speedily relieved
by blood-letting. In about three months, however, a swelling
was perceived in the space immediately above the sternum, and a
tumour arose, which, as it advanced, occupied the centre of the
neck, and covered the inferior portion of the trachea.

In the course of some months afterwards, a second tumour made
its appearance, occupying the site of the root of the right carotid
artery, and extending up the right side of the neck. These two
newly-formed swellings were so intermingled at their base with
the firm and consolidated remains of the original aneurism, that
the whole formed one formidable mass, the limits of which could
not be ascertained by the touch, and could only be a matter of
conjecture.

Many opinions were hazarded as to the origin and site of this
tumour ; my own opinion, however, of the seat of the disease re¬
mained unaltered ; and I now deliberated on the propriety of
tying the right carotid artery. It must be recollected that when
I first contemplated tying the subclavian in this case, I did so from

338

Aneurism of the Innominala.

the firm conviction that nature had already obliterated the right
carotid, that vessel having long ceased to pulsate ; and as suffi¬
cient time had elapsed, from the application of the ligature to the
subclavian artery, to allow coagulation in the tumour to take
place, to a certain extent, before the channel through the right
carotid was re-opened, when the circulation through that vessel
was observed on the ninth day after the operation to be imperfect¬
ly restored, it was a most unexpected and unpromising occur¬
rence ; nevertheless the tumour continued to decrease, the dis¬
tressing symptoms to disappear, and the patient’s health to im¬
prove, up to the publication of my last report.

However firmly I adhered to the original opinion I had formed
of the seat of this aneurism, there were some surgeons in whose
discrimination and judgment I had the greatest confidence, who
were dubious of the precise seat of the tumour. Such doubts, in
a case of so difficult diagnosis, together with a consideration of
the severity and danger of tying the carotid artery, even under
the most favourable circumstances, were to me sufficient reasons
for not performing that operation. I therefore endeavoured to
prolong the patient’s life, and, if possible, to mitigate the severity
of the symptoms, by a rigid system of depletion.

The aneurism now continued to enlarge, and increased in bulk
till the beginning of January last, when it attained its greatest
magnitude.

Since that time very little alteration in the state of the tumour
had taken place ; the sternal portion enlarged a little, the respira¬
tion and deglutition were both somewhat affected, and the former
considerably so at times, from a copious secretion of watery mucus
into the bronchise. The patient’s general health varied ; she was
sometimes comfortable and cheerful, at others languid and feeble;
the appetite always continued good. About two months ago, ge¬
neral anasarca came on ; but when it had increased so as to con¬
siderably distend the integuments, the fluid drained off from an
opening in the inferior extremities. The disease recurred, but to
no great extent. During this time she became weaker, and at
last was affected with a violent diarrhoea ; which, although check¬
ed soon after its accession, reduced her so much, that she gra¬
dually became more and more exhausted, and expired on Friday
last, the 13th instant.

Dissection. — The bulk of the aneurismal swelling had not di¬
minished after death. On removing the integuments of the neck,
the tumour occupied the central space between the two sterno-
mastoid muscles, the sternal portions of each of these muscles
passing over the side of the tumour. The mass may be said to
have been composed of three divisions : one sternal, arising im¬
mediately above the sternum ; another passed upwards along the
trachea ; and the third was the original portion of the aneurism,
which had consolidated by the operation. These three masses
formed, in conjunction, a lobulated tumour, larger than a turkey’9
egg. It had adhered firmly to the sternum, and had caused the
absorption of a portion of that bone.

334

Bibliography.

The aneurismal tumour, as might have been expected, from no
diminution having taken place in its bulk after death, felt like a
firm, fleshy mass. On laying it open longitudinally, it appeared
nearly solid. The coats of the tumour presented the usual ap¬
pearance observed in true aneurism 3 the clavicular and tracheal
portions of the sac were filled with firm coagulum, the cavity of
the aneurism being chiefly limited to the division between the
sternal and tracheal portions, and was about the size of a walnut.
The layers of the coagulum were remarkably firm, and of a pale
colour 3 being of a softer consistence and darker colour, as they
approached the boundaries of the aneurismal cavity.

Heart. — The parietes of this organ were thinner and softer than
natural, but no other change of structure could be perceived.

The only change to be perceived in the aorta was that the coats
had a deeper tinge of yellow than natural, rather thicker, and had a
few small points of ossification. The size of the artery, natural.

On cutting into the innominata from the aorta, the aneurism
was found to have originally extended from its origin to its
bifurcation.

The subclavian artery is divided at the place where the ligature
had been applied, and both the cardiac and distal orifices are con¬
tracted, and the sides of the vessel coalesce, and adhere firmly to¬
gether, so that a probe cannot be passed further along the canal
than to within about a quarter of an inch of the distal end of the
divided vessel.

The Right Carotid. — Pervious, and quite healthy.

The Lungs.— Healthy 3 the lining of the bronchia rather redder
than natural, and contained a preternatural quantity of muctis.

The result of this dissection leads to some important conclu¬
sions. In the first place, it establishes the correctness of the
diagnosis, and, further, it proves, that, if, in those cases wherein the
physiological and pathological principles I have advocated, can
lead to a practical application, success, according to the new mode
of treatment, may be confidently anticipated. It also proves, that
to whatsoever degree the progress of aneurismal swelling of the
innominata may be arrested in its growth, by the closure of the
subclavian, yet the current of the circulation through the carotid,
will be sufficiently strong to extend the walls of the vessel in the
direction of that current.

I have, in another place, demonstrated by dissection, that the
closure of the carotid is not in itself sufficient to prevent the in¬
crease of an aneurism of the innominata, a fact which was illus¬
trated in the case of Gordon *, wherein the carotid was obstructed
by a spontaneous process of cure, yet the aneurism continued
slowly to enlarge, and that portion of the tumour contiguous to
the carotid, as in Mrs. Deumark’s case, contiguous to the subcla¬
vian, became consolidated.

In my work on aneurism, I have taken some pains to point out
a rational means of forming correct diagnoses , founded on ana¬
tomy and well known principles of pathology, by which surgeons

* Vide Work on Aneurism.

335

Case of Noli me Tang ere.

may, in future, be enabled to distinguish the site of aneurismal
swellings at the root of the neck. To a want of this knowledge,
and in consequence of no author having even attempted to supply
so important a deficiency, may be attributed the distressing and
fatal blunders of many eminent surgeons. The details of this
case afford satisfactory evidence of the soundness of these diagnos¬
tic precepts. — Larvoet.

WESTMINSTER HOSPITAL.

13. Case of Noli me Tangere. — Jane Jenkyns, forty years old, a
milk-woman, of gross habit, who has resided many years in the
low neighbourhood of Petty-France, came under the care of Mr.
Lynn, having suffered several months from lupus. She states that
she has, in the course of her occupation, been exposed to great
variance of temperature, to heat, damp, and cold, in almost endless
succession. To counteract the wretched sensations arising from
this routine of life, she was accustomed to indulge freely in a
warm potation composed of milk and gin, and to eat highly-sea¬
soned viands.

About a year ago she perceived her appetite fall off ; the sto¬
mach became flatulent, bowels constipated, and the alee and co-
lumna vasi grew very irritable. The sebaceous follicles situated
on that prominent feature became inflamed, red, and indurated.
The circular tubercles rose to view, which, with the diseased fol¬
licles, ulcerated, and became covered with a yellow tenacious ex¬
udation. The disease extended laterally to the cheeks, and down¬
wards to the commissures of the lips, and the adjacent skin as¬
sumed a fiery red aspect.

Such was her appearance when admitted on the 1st July ult.
Ordered to take nightly this powder : Calomel, three grains ;
powdered rhubarb root, ten grains. Mix. And this lotion to be
frequently applied ; honey, an ounce ; alcohol, a fluid ounce ; dis¬
tilled water, eight fluid ounces. Mix. Low diet.

July 3d.— -The crimson hue of the parts, mitigated ; the bases
of the ulcers circular, elevated, and indurated. The chin is quite
exempt. Bowels well moved.

9th.— The hue of skin less vivid. Bowels sluggish •, consider¬
able pain of head. Cupped to eight ounces.

13th. — An attack of erysipelas has supervened ; this commenced
last night in the incisions of the scarificator, and has spread over
all the right side of the head ; right eye closed. Pulse rapid, and
moderately full. Tongue furred, of a drab colour.

A dose of calomel and jalap to be given immediately, and an
ounce of the following mixture every two hours until it operates :
Supertartrate of potass, two scruples ; subcarbonate of soda, one
drachm j powdered jalap-root, one drachm and a half. Infusion
of senna, six onnces. Mix. The surface to be liberally dusted
with wheat flour or oatmeal.

14th. — The bowels have been freely purged. The tongue is
clean. Pulse soft, about 78. The erythematous inflammation of
the same extent, though less intense. Mr. W. B. Lynn prescribed

336

Bibliography .

this medicine and regimen : Compound tinct. of eardomoms, one
ounce ; aromatic confection, four drachms; cinnamon water, eight
ounces. Mix. An ounce to be taken every three hours. A gill
of brandy to be drunk every day. The flour to be assiduously
employed.

20th. — The erysipelas has entirely disappeared. The cuticle is
scaling off, and the cutis is returning to its natural tint. The tu¬
mefaction of integument, around the bases of the lupus, has sub¬
sided, and a healthy disposition is evinced in the ulcerets, of which
the diameter is gradually contracting. The use of the honey and
alcohol lotion is resumed, and the bowels are regulated with
castor oil.

22d. — A constant itching in the affected parts; colour natu¬
ralizing. No sensation of heat ; mouth dry ; tongue slightly fur¬
red in the centre ; an effervescent draught occasionally. Brandy
continued, and cordial medicines omitted.

24th. — Progressively amending, the whole becoming covered
with new cuticle ; but the blush still remains, though less deep.

August 1st. —The general health is restored ; the face com¬
pletely healed, and the vascularity coalescing by degrees. Dis¬
charged this day. — Ibid.

ST. BARTHOLOMEW’S HOSPITAL.

14. Operation on the Lower Lip. — Mr. Lloyd, Saturday, August
22d, removed a cancerous portion of the under lip, by a semi-cir¬
cular incision. The patient, John Ford, aetat. sixty, underwent
the operation with great fortitude, and is, notwithstanding the
utter impossibility of closing the wound by approximation of the
opposite surfaces, doing extremely well, and promises to have a
very good lip ultimately. Mr. Lloyd used his own knife, which
afforded the spectators an opportunity of witnessing how much
pain is spared, and how much more readily the removal of a por¬
tion of lip is effected by the use of a proper instrument. — Ibid.

15. Puncture of the Bladder above the Pubes. -*■ Charles Windsor,
admitted September 1st, under the care of Mr. Earle ; has been
suffering from a stricture of the urethra for the last twelve months ;
can only void his urine guttatim.

2d, Great tenderness of the abdomen. Countenance anxious.
Retention of urine complete. Apply twenty leeches to the ab¬
domen ; the bladder had become so enormously distended that
Mr. Earle was sent for, who, after making an unsuccessful at¬
tempt to introduce the catheter, resorted to the operation ; about
three pints of thick unhealthy urine escaped ; towards the even¬
ing he became much easier ; is much better to-day (3d) ; tender¬
ness of the abdomen considerably less; urine passing freely through
the catheter. — Ibid.

ROYAL WESTERN HOSPITAL.

16. Case of Strangulated Inguinal Hernia and Operation. — Wm.
Smith, of a robust constitution, twenty-seven years of age, was
admitted into this hospital on the 30th July, at noon, with a tu-

Case of Strangulated Inguinal Hernia . 33 7

mour in the course of the right spermatic chord, and labouring
under symptoms of strangulated hernia.

He stated that he had a hernia two years, for which he wore a
truss, but having left it off to get it repaired, the intestine de¬
scended, whilst cleaning a horse on the preceding morning, and
he had not been able to return it ; that he had vomited twice dur¬
ing the morning. His pulse was full, about 105, and there was
no tenderness in the abdomen, but a slight pain in the tumour
when it was touched.

Mr. Truman being in the hospital at the time of his admission,
ordered him to be placed in a warm bath immediately, and while
he was in the bath applied the taxis, but without effect • he was
then bled to faintness, and the application of the taxis repeated,
but still the intestine could not be returned. He was then taken
out of the bath, and consented to undergo the operation which Mr.
Truman told him would be necessary for his relief. He vomited
once in the afternoon, and at six o’clock was removed into the ope¬
rating theatre. After the tumour had been shaved there appeared
a slight excoriation of the skin, which the patient said was caused
by the truss.

Operation. Mr. .Truman having pinched up the integuments,
made an incision through them about three inches long, in the
course of the tumour, and next divided a layer of the cellular sub¬
stance, having first passed a director under it; this part of the
operation was repeated till the sac was exposed, which was then
opened by cutting through a small portion of the lower part of it,
raised between the nails of the thumb and fore finger of the left
hand, to avoid wounding the intestine. A small quantity of straw-
coloured fluid escaped as soon as this incision was made. A di¬
rector was then introduced into the sac, which was laid open its
whole length, in the direction of the first incision, with a probe-
pointed bistoury, when a knuckle of intestine was seen, of a dark
mulberry colour, which was attached to the sac by weak adhe¬
sions of slight coagulated lymph. The operator, after having freed
the intestine from the adhesions, introduced the fore finger of the
left hand into the inguinal canal, in the first place, to ascertain the
seat of the stricture, which he found to be at the internal opening,
and next to serve as a director for Sir A. Cooper’s hernia bistoury,
with which the stricture was divided in a line parallel to the linea
alba. The intestine was then gently returned into the abdomen,
the lips of the wound brought together, and covered with strips
of adhesive plaster and simple dressing, over which a pad of lint,
kept in its place by a T bandage, was applied. The patient was
then carried to bed.

No medicine that night.

31st., Seven o’clock, a.m. — Has passed a good night, slept se¬
veral hours 5 countenance good, skin rather hot. Pulse full, 108.

No tenderness in the abdomen, bowels have not been opened. _

Ordered, ol. ricini Jss. stat. sumend.

Eleven o’clock, a. rru— -Bowels not yet opened, slight tenderness
on the right side of the abdomen immediately above the incision.

vol. in. no 1G. 2 x

338 Bibliography .

Pulse 108. Ordered, Hirudines xxx. loco dolenti stat., et repetat.
Ol. ricini, ^ss. pos t applicationem, hirudinum. — -The lepch-bites
to be fomented with warm water, and a large cataplasm applied to
the abdomen.

Four o’clock, p. m.-~ Pain removed ; bowels copiously opened.
Complains of thirst, feels much easier.

August 1st. — Noon , passed a good night, no pain. Pulse full,
95. Bowels not opened to-day. Repet. ol. ricini.

2d. — Passed a better night ; no pain ; skin hot ; bowels freely
opened. Pulse rather quick. Ordered saline mixture.

3d In every respect better j bowels open ; passed a good night.
To-day the wound was dressed, and looks very healthy.

From this time no unfavourable symptom occurred, and, with
the exception of a few doses of aperient medicine, he required no
further medical treatment.

23d. Discharged cured.

17- Cases of Hysteritis Puerperalis , By James Paxton, Member
of the Royal College of Surgeons in London, Oxford. — Mrs. B.,
set. twenty-eight years, of a florid complexion and sanguineous
temperament, had been married ten years, but had never been
pregnant till the present year. The usual time of utero-gestation
was passed without any of that troublesome sickness, or derange¬
ment of health, so often attendant on it. On the 21st of Novem¬
ber, 1828, labour commenced : the process went on favourably
and naturally, and at the end of four or five hours, Mrs. B. gave
birth to a well formed female child. The placenta was expelled,
with very little assistance, in a quarter of an hour afterwards.
Quietness and composure were enjoined 5 but the injunction was
not complied with : for the gratification of having become a mo¬
ther after the lapse of an almost hopeless term of years appeared
to give rise to an excitation too powerful for the due exercise of
the vital functions. In half an hour, distressing symptoms of hys¬
teria came on, as screaming, sense of suffocation, pale cadaverous
countenance, clammy sweats, and coldness of the extremities.
On examination, there was found considerable uterine discharge,
and a great sense of exhaustion followed. Wine and water was
given, and ammonia cum tr. opio gutt. xl.

22d. The patient had a quiet night 5 but this morning she com¬
plains of pain in the loins, and tenderness about the hypogastric
region. Passes water frequently, but in small quantities, and there
is a very considerable lochial discharge. Pulse L25 ; tongue dry j
thirst ; surface hot and dry, and looks pallid. Calomel gr.viij.
statim, et haust. salin, quartis horis.

23d. Had copious alvine evacuations ; less pain ; some sleep $
pulse 120. Pergat in usu medicamen. prescript. sine calomelane.

24th. Complains of headache : has had chills, alternating with
flushings of heat j acute and permanent pain in the same situation
as above described. When pressure is made, there is extreme
tenderness of the abdomen, but no tension ; there are also wander¬
ing pains over the whole body. Uterine hemorrhage continues.

Cases of HysterUis Puerperalis. 389

25th. Haust. inf. rosae cum magn. sulpb. 3 k quartis horis.
There is some abatement of the former symptoms. Large coagula
Were expelled from the vagina during the night. Haust. infus.
rosae cum acid, sulph. dil. quartis horis. Ol. ricini 3vi* statim.

28th. Up to this period no material change has occurred. The
pulse is small and frequent j tongue covered with light brown fur
on the back of it ; temperature of the skin beyond the natural
standard ; perpetual desire to void the urine, which is scanty,
deep coloured, and turbid. Lochial discharge continues in consi¬
derable quantity. No milk has been secreted. Complexion sal¬
low. On some occasion the patient was removed from her bed,
when syncope and clammy perspiration alarmed her attendants.
She has no appetite, but is thirsty. There is some degree of ful¬
ness and uneasiness in the abdomen, but not amounting to pain,
unless pressure is made with the hand, which discovers the uterus
to be thrice its unimpregnated size. Emp. canth. supra regionem
hypogast. applicandum. Pergat in usu medicamen.

December 3d. Some relief was procured : the pains were very
much diminished 3 and, on the whole, it may be said that the
train of unpleasant symptoms and constitutional disturbance is
subsiding. Pulse 105. Sometimes small doses of ammon. sub-
carb. was exhibited 3 at others, effervescing medicine and occasi¬
onal doses of ol. ricini.

This state of things continued, with little variation, till the 8th,
when marked rigors, sweats, and diarrhoea, suddenly, and, cer¬
tainly, unexpectedly, supervened. Wine and opiate confection
were administered ; but the following morning (the 9th), respira¬
tion became laborious \ the sight dim 3 mind wandering 3 pulse
scarcely perceptible j profuse colliquative perspirations bedewed
the body j and in the night the patient expired.

Sectio Cadave.ris.— The body was examined about twelve hours
afterwards, in the presence of Dr. Kidd. The liver, stomach, and
intestines, exhibited no morbid affection of any kind. There was
no effusion or unhealthy appearance of the peritoneum. The dis¬
ease was found to be limited to the uterus ; this organ was five
inches in diameter 3 its peritoneal covering had some slight pen¬
cilling of vascularity 3 but its internal structure had undergone
very extensive change. The whole inner surface was of a dark
crimson and livid hue 3 the cervix was completely gangrenous,
and gave forth a highly offensive vapour.

The second case occurred on the 24th of May, 1S29, on which
day Mrs. H. fell in labour with her second child. A midwife at¬
tended her for fourteen hours ; the membranes were ruptured, and
very considerable hemorrhage took place, producing great faint¬
ness. A medical gentleman (Mr. Tomes) was therefore called in,
who, very properly, immediately adopted an opposite plan to that
which . had been hitherto pursued. Instead of warm stimulants,
with which she had been plentifully supplied, he ordered cold
liquids, and sulphuric acid with infusion of roses. This suc¬
ceeded in suppressing the hemorrhage. The pains were trifling.
On examination the hand of the child was found to have fallen

340

Bibliography .

into the vagina. Mr. Tomes then requested my attendance. I
advised the extremity to be replaced, and the child to be turned ;
but, from the rigidity of the uterus, its powerful contraction, and
from the large size of the child, there was a delay of several hours
before this object could be accomplished. The feet were at length
brought down, and the body and head were then delivered without
difficulty. The placenta was not long detained. A sense of ex¬
cessive fatigue and faintness immediately succeeded, and a recur¬
rence of hemorrhage. Took tr. opii gutt. xl.

■25th. The patient was very restless, sighing,, and experienced
great pain in the back and hypogastric region. Pulse 140. Calo¬
mel gr.x. ; opiigr.ij. statim. Haust. effervescens quartis horis.

26th. More comfortable ; pulse 1 10. But in the evening, chills
and cold perspirations were frequent, and the pain increased. Ca¬
lomel gr.viij. ; opii gr.ij. statim. Pergat in usu haust.

27th. The patient feels less pain, and has had some sleep. Per¬
gat.

28th. Passed a restless night, and the pain has returned with
greater violence. There is a sense of exhaustion, fainting, anxiety,
and general uneasiness : in particular, pain over the uterus, which
has increased on the most moderate pressure •, but there is no ab¬
dominal tension. Lochial discharge in considerable quantity.
Applicentur hirudines xx.

Somewhat relieved j but the circumscribed swelling and ten¬
derness at the lower part of the abdomen continue, and in the
evening complained of great pain and tenderness about the os
uteri ; rigors or heats, depression of spirits, and general uneasi¬
ness. V.S. ad 5 xxiv . Haust. efferves. cum ant. tart. gr. I tertiis
horis.

The blood drawn exhibited marks of inflammation. The pain
and sensibility, however, was much diminished, and from this
time there may be stated to have been a rapid amendment, until
the 6th of June, when a slight attack of phlegmasia dolens super¬
vened, and protracted the cure for three weeks longer ; since
which the patient has been free from complaints, and, indeed,
about her domestic occupations.

The reflections I make on a comparison of these cases are,

1st. That copious depletion is the most powerful means of sub¬
duing inflammatory action of the uterus,

2d. That uterine discharges have no effect in relieving that or¬
gan, when suffering under inflammation.

3d. That neither the faintness experienced by the patient, nor
even uterine hemorrhage, or weakness of the pulse, should have
any weight on the mind of the practitioner, so as to prevent his
carrying local or general blood-letting to its requisite extent \ for
if there is fever, with constant uterine and general pain, this is
the true criterion for forming a judgment of the propriety of the
measure, and not any other consideration whatever. — Medical and
Physical Journal.

Inflammatory Diseases of the Eye.

341

MONTHLY SYNOPSIS OF PRACTICAL MEDICINE

HOSPITAL REPORTS.

WESTMINISTER HOSPITAL.

1. Inflammatory Diseases of the Eye , treated by Stimulating Ap¬
plications. — I. Edward Champion, setat. five weeks, was admitted
January 8th, 1829. The left eye was observed to be weak the
day after he was born, but no discharge was observed until the
next day, when it was in great quantity 3 three days after, the
right was found to be in the same state 3 the discharge is now
thought to be less. Has had advice, and used lotions externally *
has taken opening medicines likewise 3 his mother is subject to
fluor albus. The ung. arg. nitrat. was applied, after syringing
out the eyes with lotio aluminis 3 which was ordered to be used
several times a-day, on alternate days

IOth. The discharge is considerably less 3 the eyes are much
better. Rep. ung. et lotio.

13th. Nearly well. No discharge, except a very slight one in
the evening. Opens its eyes with ease. Rep. ung. et lotio.

15th. Cured.

H. — Edwin Carter, astat. eight weeks, admitted February, 19,
1829. The right eye was first affected, about three days after
birth 3 the left, a daj' or two later 3 it commenced with a great
discharge of matter 3 the lids were much swollen 3 conjunctive
of both eyes much injected ; lids still swollen 3 discharge great 3
child restless 3 cornea of the left eye clear, of the right ulcerated
and muddy. Has had a leech applied at three different times 3
blisters to the temples 3 has taken alteratives and used lotions,
without effect. Mother subject to fluor albus. Appl. hirudines
ij. temp, dextr. ung. argent, nitr. ad sing. ocul. The eyes to be
syringed out every hour with the lotion aluminis. Ol. riciiii 3b se-
cundis horis donee solvetur alvus.

24th. Freely purged by the ol. ricini. Can open his eyes him¬
self. Discharge has ceased. Lotio aluminis.

27th. Cured- In attendance on account of a leucoma remain¬
ing in the place of the ulcer, which has healed.

III. — Edward Shaughslay, admitted March 26th, 1829, aetat.
three weeks. The disease began about four days after birth, and
has continued nearly three weeks. Great discharge 3 lids much
swollen 3 child restless. Has had leeches applied twice 5 lids
have been scarified. Mother has fluor albus.

The discharge is rather less 3 cannot open his eyes himself.
On examining the left eye, the cornea appeared muddy, and had a
speck on the centre 3 the conjunctiva much injected. The right
eye could not be examined at that time, owing to the patient’s re ¬
sistance. In a few days afterwards it was examined, and ap¬
peared very like the left. Applic. ung. argent, nitr. sing. ocul.
Ung. zinci nocte utend. ad palp. Lotio aluminis sextis vices utend.
in die alternti. Pulv. alter nocte sumend. Infus. sennse mane.

342

Synopsis of Practical Medicine.

Discharge as much as ever ; lids less swollen ; eyelids more
easily opened. Continue treatment.

31st. Better 3 discharge less.

April 4th. Opens his eyes easily j discharge less.

9th. Very little discharge.

11th. Left nearly well > right much better. Continue treat¬
ment.

13th. Left cured y right discharges still a little.

18th. No discharge. Lotion continued.

21st. Cured.

IV.— Mary Kennard, aetat. twelve weeks, admitted March 2S,
1829. Lotio aluminis alone employed.

When five days old,|the left eye became inflamed, and dis¬
charged yellow matter the next day ; the right was not affected
until yesterday. Two leeches were applied near the inner can-
thus on Wednesday j they bled profusely. Infant is restless at
night. Has had castor oil frequently. Lotio aluminis ssepe utend.

30th. Much better $ opens her eyes. Cont. lotio.

31st. Continues better. Rep. lotio. Habeat. pulv. alter.

April 4th, Improving. Rep. lotio et pulv.

7th. The discharge more abundant ; most from the right eye.
Applic. ung. arg. nitr. ad oculis dextro. Lotio ad ocul. sinist.

10th. The right eye is the best.

21st. Better. Discharge thicker, much the same in quantity.
Rep. ung. dextro, et lotio ad sinist. Pulv. alt. rep.

22d. Discharge much less> can open her eyes much better.
Repeat.

24th. Nearly well j discharge very slight. Rep.

30th. Discharged cured.

WINCHESTER COUNTY HOSPITAL.

2. Extirpation of a Steat.omatous Tumour from underneath the
Angle of the Inferior Maxilla. — Haemorrhage — Ligature on the Ca¬
rotid Artery. — William Gibbs, a delicate youth, aet. sixteen, ad¬
mitted with a tumour, in dimension about the size of a large Wal¬
nut, situated under the arch of the inferior maxilla, on the right
side, and contiguous to its angle. It was apparently quite de¬
tached from the surrounding parts, being perfectly moveable in all
directions. To the feel it was extremely firm ; had been two
years attaining its present magnitude, and had made its appear¬
ance first on the masseter muscle, but, with its increase in size,
which had been considerable within the last six months, it had
descended into its present situation, proving no less annoying than
painful. The patient was anxious for its removal, and the opera¬
tion was performed accordingly, in the following manner. The
patient being seated in a chair, the tumour was brought from its
situation under the jaw, and firmly retained on the masseter
muscle. A perpendicular incision, to the extent of two inches and
a half through the integuments and cellular substance, exposed the
tumour j this was readily dissected away j it was, however, most
liberally supplied with blood-vessels, no less than five arterial

Extirpation of a Steatomatous Tumour . 343

branches of no inconsiderable calibre having been divided. The
hemorrhage was extremely profuse, and the vessels were not se-
cured wuhout much difficulty. The wound being dressed with
the adhesive plaster and bandage, the patient was removed to bed
in a very exhausted state. Two hours having elapsed after the
operation, blood was observed to issue somewhat freely from un¬
derneath the bandage. The whole of the dressings were removed
by the house-surgeon, with the view of securing the bleeding
vessel j but this could not be effected, and nothing short of very
considerable pressure on the carotid artery was of the least avail
in suppressing the hemorrhage. On Mr. Lyford’s arrival, the boy
had become so reduced that it was judged more prudent to apply
a ligature around the carotid artery than to lose any time by
searching for the bleeding vessel at the wound.

Operation. — The patient was placed on the table in the recumbent
posture, and the parts put moderately on the stretch, by flexing the
head towards the opposite shoulder. An incision on the inner
edge of the sterno-mastoideus muscle, to the extent of two inches
and a quarter, laid bare the omo and sterno-hyoideus muscles ;

these were drawn towards the trachea, and the jugular vein ex¬
posed. °

At this stage of the operation the difficulty described by Sir A.
Cooper was realized, arising from the swelling of the jugular vein,
and the protrusion of it before the artery ; the blood ebbing and
flowing through it in correspondence with the respiratory efforts j
and some difficulty was experienced in avoiding it, and withdraw-
ing, by means of the aneurismal needle, the artery from beneath
it. This being accomplished, one ligature only was applied, with¬
out the occurrence of any untoward circumstance. The external
wound was approximated by the adhesive plaster, and the patient
removed to bed.

10, p.m. Has been attacked with a severe rigor, which lasted
twenty minutes, but subsided on the application of warm bottles
to the feet, and the exhibition of some warm tea, with a dose of
the aromatic spirit of ammonia and camphor mixed. Has had no
sleep since the operation. Pulse 100, and feeble. Ordered an
anodyne draught.

2d day. Has had some disturbed sleep during the night. Pulse
110, and less weak. Has passed no urine since the operation;
complains of extreme pain and difficulty of deglutition ; skin hot
and dry ; is unable to protrude the tongue from the mouth. Or¬
dered the catheter to be introduced, and a small dose of castor oil
to be given immediately.

3d day. Has experienced a great disposition to sleep, which has
been counteracted by a constant tickling or irritation at the upper
part of the throat. Bowels have been relieved ; is enabled to
pass his urine without inconvenience ; the difficulty of deglutition
somewhat abated. Ordered to take a tea-spoonful of the follow¬
ing mixture occasionally. Syrup, papav. 3j- oxymel scillae, ^ss.
mucilag. g. acaciae, ^j. fiat mistura.

5th day. The wounds have been dressed for the first time, The

344 Synopsis of Practical Medicine.

upper one, from which the tumour was removed, had not ad¬
hered ; it contained some firm coagula, which were removed, and
the edges brought in contact as before by the adhesive plaster.
The lower wound, at which the artery had been secured, united
throughout its entire length, except at the place where the liga¬
ture issued. The irritation about the throat, and difficulty in pro¬
truding the tongue have both nearly disappeared. Pulse ninety-
six ; skin moist.

12th day. Patient has improved much in his general appearance
as well as in his spirits, which had been much depressed. The
wounds have been dressed every second day since the last report $
and to-day the ligature from the carotid artery, together with two
ligatures from the upper wound, have come away without any
force having been applied. All the unpleasant symptoms having
subsided, he expresses himself as being in every respect quite
comfortable. He has not been allowed to eat any solid food what¬
ever. Pulse eighty-six j skin moist 5 tongue clean.

15th day. Wounds dressed ; the lower quite cicatrized 5 the re¬
maining ligatures from the upper wound came away with the
dressings 5 the incised part itself much contracted. Ordered solid
food for the first time ; dinner to day to consist of fish.

24th day. The wounds healed. Patient discharged convales¬
cent.

The difficulty experienced in securing the vessels, and the sub¬
sequent haemorrhage, are to be attributed to the circumstance of
the tumour having been withdrawn from its situation under the
jaw, to the more commanding position on the surface of the mas-
seter muscle ; the extension of the vessels, supplying the diseased
part being thus effected, their incision was susceeded by such an
immediate and powerful retraction deep within the wound, in the
direction of the original seat of the tumour, as to prevent the pos¬
sibility of detecting with certainty all the arterial branches which
had been divided during the operation.— -Med. Provin. Gazette.

3. Cholera Morbus at Clapham. — The following alarming article
is extracted from a periodical, which we need not name, and its
proverbial want of accuracy and veracity has induced us, on nearly
all former occasions, to pass over the contents of its pages with,
what they alone have been entitled to, contempt. But the facts
in this paper, w’ere of so astounding a character, that we deemed
it right to request a gentleman to visit the scene of the catas¬
trophe, and it is but justice to state, that the mendacious editor
had, for once, a veracious correspondent, in the party who sup¬
plied the report.

The parents of the children have expressed their perfect satis¬
faction with the conduct of Mr. Day, whose kindness and care of
his scholars have given universal satisfaction.

On Friday, the 14th, (Thursday, 13th,) a son of Mr. Day,
schoolmaster, at Clapham, aged about three (two) years, having
been previously in perfect health, was attacked with violent vo¬
miting, purging, and convulsions. He became comatose, and
died in three (twelve) hours after the commencement of the attack.

345

Cholera Morbus at Clapham .

rc The rest of Mr. Day’s children, as well as his scholars,
amounting in number to thirty boys, between four and fourteen
years of age, remained all well the next day. This being Satur¬
day, several of the scholars went home to spend Sunday with their
friends, leaving in the school twenty-two boys 3 of these, twenty
were attacked between three and nine o’clock on Sunday morning,
with vomiting and purging of the most alarming character, at¬
tended with a degree of prostration which threatened many of
them with immediate death. The appearance of the matters vo¬
mited was somewhat various in different individuals, depending
probably upon the liquids previously taken. In some instances it
was tinged with green bile, and was of a subacid smell, but in the
greater majority of cases it was colourless and inodorous. The
stools also varied in appearance, but they were, for the most part,
pale, consisting of mucus and muco-purulent matter, slightly
streaked with scarlet blood.

The pulse varied also very much in different individuals : in the
early stages of collapse it was very frequent, but so feeble as to
be scarcely perceptible. When reaction took place, it had, of
course, more force, but less frequency. The skin was, in most
instances, cold and clammy, throughout 3 in a few cases, it was
for a short time hot, and the face was, in these, occasionally
flushed. There was a low delirium in some advanced cases, with
dilated pupils 3 but the sensorium was not affected in the greater
number of them. None of the little patients complained of pain
in the stomach or bowels, beyond the griping which preceded the
stools. There was, however, in a few of them, slight tenderness
and some tension of the abdomen 3 and, as far as the exact course of
the symptoms could be ascertained in such a scene of confusion, it
may be said, generally, that the disease seemed to come on very
much like the tropical cholera, with a short obscure stage of ex¬
citement, which was immediately followed by a state of extreme
collapse 3 and that this, under the use of stimulants, was succeed¬
ed, in those cases which were of the best aspect, by a stage of
warmth, gentle moisture, and general reaction. We have men¬
tioned that the disease was accompanied pretty generally with
convulsive action of the muscles 3 but it may be of importance to
remark that this, which amounted rather to a kind of twitch, or
subsultus, than to cramp, was confined to the upper extremities.

Such was the afflicting state of circumstances in this unfortu-
nate family up to the afternoon of Sunday. Messrs. Angas and San¬
ders, and Dr. Spurgin, of Clapham, who had been employed from
the first in rendering every possible assistance, now requested the
co-operation of Dr. F. M. Latham and Dr. Chambers. At this time
anpther of Mr. Day’s sons was evidently sinking, and a third, as
well as several of the pupils, were in a state of dangerous col¬
lapse 3 others, again, although not out of peril, were rallying from
the attack. The first question that suggested itself to the minds
of the medical men in consultation was, whether the symptoms
were referrible to any poison received into the stomach. The
scrutiny, however, which was instituted with reference to this

VOL. 111. MO. 16. 2 Y

346 Synopsis of Practical Medicine.

point, led to nothing satisfactory at the moment. It was then
determined to examine the body of the little boy who was the
first victim of the disease, and who, it should be recollected,
died in twelve hours after be was attacked by it. On laying open
the abdomen, the viscera presented themselves in a remarkably
healthy state, as far as external appearances went. The liver was
of a perfectly healthy size and colour ; the gall-bladder was
somewhat distended with healthy bile j the peritoneum through¬
out, pale, transparent, and perfectly free from any appearance of
thickening. On laying open the small intestines, however, it was
observed that the peyerian plexuses of mucous glands were en¬
larged in patches throughout the intestinum ileum, raising inter¬
nally, without destroying the mucous membrane covering them,
into condylomatous elevations : lower down in the small intes¬
tine a few of the glandulee solitaries were similarly affected, and in
the ascending colon and transverse arch these latter glands seemed
almost universally diseased, giving an appearance of pustulation,
or, rather, tuberculation to the whole interior of the bowel • the
interstices of the tubercles here, as well as in the small intestine,
being entirely free from vascularity. The mesenteric and meso-
colic absorbent glands in the neighbourhood of the parts most dis¬
eased, were congested and enlarged. rlhe stomach wras quite
healthy. The viscera of the thorax were likewise quite healthv.
The contents of the cranium also, which were carefully examined
were entirely free from effusion, or other trace of disease.

“The treatment which had been adopted, and which it was de¬
termined still to pursue, was, in the first place, to obey the great
indication of preserving life, by administering stimulants with
opiates to those who were sinking from exhaustion and spasm.
In the few instances in which the head seemed in the course of the
reaction to be affected, it had been deemed right to relieve this
symptom by the application of a few leeches to the temples. Be¬
sides these means, it was found necessary to apply mustard poul¬
tices to the abdomen, and to wash out the bowels with enemata,
administering afterwards full doses of calomel and opium.

“ Early on Monday, another of Mr. Day’s sons, a boy of four
(five) years of age, sunk under the attack, twenty-three hours
after its commencement. His body was carefully examined a few
hours after his death, and exhibited the following appearances : _

“ 4 he abdominal viscera, when first exposed, appeared (as in
the former case) perfectly free from the traces of inflammation or
other disease.

1 he examination of the bowels was commenced with that of
the intestinum ilium, in which the mucous glands, both aggregate
and solitary, were found generally enlarged, and the mucous mem¬
brane covering them in many places ulcerated. The interior of
the coecum, colon, and rectum, however, exhibited no appearance
of diseased mucous glands, although the membrane itself was
throughout uniformly congested, pulpy, and very easily separable
lrom the subjacent tissue.

: “ The examination was now pursued upwards from the ilium }

34/

Vest co - Vaginal Fistula.

ihe jejunum at the lower part was less diseased than the ilium,
and, as it approached the duodenum, was more and more healthy ;
the duodenum, however, on being laid open, exhibited a pustu¬
lated appearance, depending on enlarged follicles, very similar to
that of the colon in the former case. The mesenteric and meso-
colic glands belonging to the diseased portions of bowel, were
enlarged and more vascular than natural. The liver was also
quite healthy ; the gall-bladder contained more than an ounce of
perfectly healthy bile. It was remarkable, that the contents of
the bowels were nearly colourless, and had no fseculent, or indeed
any other peculiar odour. The stomach was perfectly healthy
The viscera of the thorax were likewise quite free from disease.
In the head, the ventricles of the brain were distended with about
three ounces of serosity, and the sinuses were somewhat more
charged than usual with dark-coloured blood. The brain and its
appendages were not otherwise diseased.

“ Most of the boys were removed by their friends in the course
of Monday, many of them in a very alarming condition.

‘f It is with much satisfaction we add to this melancholy state¬
ment, that the whole of the remaining sufferers have recovered.
There is every reason to believe, that the attacks were purely those
of cholera morbus. The food and other matters were placed in the
hands of Dr. Burton, the chemical lecturer at St. Thomas’s Hos¬
pital, by whom they were carefully tested., without producing any
results opposed to this opinion. The following is the analysis.

“ The fluid part of the contents of the stomach contained, inde¬
pendent of animal matter, a considerable portion of lime, together
with a little magnesia, the two earths being held in solution, ap¬
parently by the muriatic and sulphuric acids respectively 5 there
appeared also to be a small quantity of acetic acid present. The
acids were in slight excess.

«■ The insoluble portion of the contents were found to consist
exclusive of animal matter, viz. fibrin and albumen, of an insoluble
salt of lime, probably the sulphate of lime.

“ These ingredients, together with a little potassa, might have
been derived from the water, which also contained them largely,
among a few other harmless ingredients j and partly from the
rice, but neither the water, nor the contents of the stomach sent
to Dr Burton, nor indeed either of the articles of food, contain
any metallic oxide in appreciable quantity, nor could any delete¬
rious salt be detected in them.”— Lancet.

HOPITAL DE LA CHARITE.

4, Vesico -Vaginal Fistula ; application of the Twisted Suture fol¬
lowed by Death. — Genevibve Maury, setat. 36, of a good constitu¬
tion, and mother of several children, was on the 9th of July, 1829,
admitted intothe hospital. Her two last accouchments but one
had been very difficult, the one having required turning, the
other the application of the forceps. On the 7th of June last,
she was taken with labour pains, and delivered by means of
the forceps. During the application of the latter instrument,
one of its blades was pressed with some violence against the an¬
terior paries of the vagina, which at that moment happened to

348 Synopsis of Practical Medicine ,

be forcibly distended the patient felt a very acute pain, which,,
however, after the termination of labour, gradually subsided.
From that moment, she never had any desire to pass her urine,
which entirely escaped through the vagina. At the time of her
admission, the fistula had existed for thirty-two days, during
Which time, not a drop of urine had been passed volunta¬
rily, or by the urethra, which was, however, perfectly pervious.
The preternatural opening was found to exist at the neck of the
bladder, and to be thirteen lines in length ; its lower end was a
little above the urethral opening, the upper a few lines above the
neck of the bladder. When the patient lay on the back, the edges
of the aperture were perfectly closed, but gaped when she stood
upright, or walked. Her general health was not in the least af¬
fected. M. Roux having closely watched the case for about a fort-
hight, determined upon closing the edges of the aperture by means
of the twisted suture, and the operation was performed on the
21st July. The patient was placed on the abdomen, the pelvis
being higher than the head, and the legs kept asunder by two as¬
sistants, a speculum was introduced into the vagina, but being
found useless, was withdrawn. The edges of the fistulous aper¬
ture were seized with a pincette, one of the blades of which was
much broader than the other, and having been pared off, two
curved needles. were inserted, by means of the “ porte-aiguille/’
Fhe operation lasted two hours, owing to the difficulty which the
operator experienced in taking hold of, and paring off, the cal¬
lous edges, and in introducing the needles. The patient was re¬
moved to her bed, and an elastic catheter kept in the bladder.
An hour after the operation, she was taken with shivering ; the
urine passed through the catheter, and was tinged with blood.
In the night she had a few hours rest, but on the morning of the
22d, the urine still contained blood ; the pressure of the catheter
did not appear to molest the patient, but the least movement of it
caused most violent pain ; the abdomen was not tender on pres¬
sure, and in the evening a large quantity of clear urine was passed.
On the 23d, the external genitals were swelled, but not painful,
and the general state of the patient was satisfactory. On the 24th,
no alteration had taken place, except that the urethra was more
irritable than before. In the evening, the patient was all on a
sudden, seized with shivering, universal trembling, and sickness,
which were followed by great heat and copious perspiration ; about
ten o clock, all these symptoms had disappeared, but during the fol¬
lowing night she was rather agitated. On the 25th, she com¬
plained of great debility •, the needles were removed, and the elas¬
tic catheter was withdrawn ; on applying a silver catheter, the
water was passed in a full stream. In the course of the day she
had another attack of shivering, which was followed by heat and
copious perspiration. In the evening, the attack returned, and
during the night the patient was very restless. On the 26’th, she
had three attacks of shivering, the last of which took place to¬
wards the evening, and was accompanied by bilious vomiting ;
she was ordered the sulphate of quinine in syrup, papav. The ab¬
domen was not tender 5 respiration was rather quick, though the

Painters' Colic.

349

eliest was free from pain ; the secretion of urine was much dimi¬
nished, and the small quantity of it which was drawn off by the
catheter, was tinged with blood. The entrance of the vagina was
several times found filled with coagulated blood. On the 27th, the
patient had passed a very restless night ; in the morning, she had
another violent attack of shivering ; the urine was rather scanty ;
the vagina was again filled with coagulated blood. In the evening
at five, another attack of shivering occurred ; she took twenty-
four grains of the sulphate of quinine in three doses, and as the
last was followed by vomiting’, twenty-four grains were injected
into the anus. The catheter was repeatedly applied, but without
evacuating any urine. On the morning of the 28th, she was again
seized with shivering, but not so violently as before; she com¬
plained of pain in the epigastric region ; respiration was rather
quick. Thirty-four grains of the sulphate of quinine were again
given, in six pills; not more than about two ounces of urine were
removed by the catheter. In the course of the day, the patient
began to complain of pain in the right side of the chest ; there
was a slight cough ; respiration was sixty in a minute, the pulse
quick, and on percussion, the right side of the chest gave a dull
sound, and on auscultation, “ rale crepitant.” No attack of shi¬
vering took place in the evening; the patient was delirious, and,
at lucid intervals, complained of great dyspnoea and violent pain
in the chest. The stools were passed involuntarily ; the urine
was completely suppressed, and the pulse was 150. The applica¬
tion of sinapisms and blisters to the feet had no effect. The dysp¬
noea increased, and she died in the morning of the 31st.

On examining the body, the intestines were found adherent to
each other, and to the peritoneum, by means of false membranes 3
and the cavity of the larger pelvis contained a considerable quan¬
tity of purulent matter. The edges of the fistulous communica¬
tion between the vagina and bladder were thickened, softened, and
covered with a fetid sanies. The mucous membrane of the blad¬
der was of a greyish black colour ; it contained a considerable
quantity of dark-coloured mucus, and coagulated blood, but no
pus. The uterus had not yet returned to its usual size ; the fal¬
lopian tubes were greatly injected, and covered with pus. The
left pleura contained a great quantity of purulent matter, and the
tissue of the left lung distinctly exhibited the traces of the last
stage of pneumonia. The pericardium was much injected. The
right lung was on its surface filled with small abscesses, and ad¬
hered to the pleura ; interiorly, its tissue appeared healthy. The
rest of the examination afforded nothing of interest. — Journ Heb¬
domad.

5. Painters' Colic — Blindness — Delirium — Tetanic Symptoms —
Administration of Croton Oil mid Opium. — A painter, twenty-six
years of age, had suffered from attacks of colic during the last nine
years. For a fortnight be had severe pains of the abdomen,
which sufficiently marked the return of his professional malady.
An emetic and purgative were administered by his parents, after
which a doctor was sent for, who, suspecting inflammation of the
stomach, had forty- five leeches applied at three different times ;
on the last occasion a large quantity of blood was obtained, as
the leech-bites were allowed to bleed while the patient was in

350 Synopsis of Practical Medicine.

the bath. The pain was rendered less intense by these means, but
it became more diffused ; the diaphragm and limbs were painful,
and the patient bent forward to relieve his suffering. The head
became affected ; there were partial convulsions, his ideas wan¬
dered, and his vision was impaired. M. Cauzol was called to him
on the 21st of July, when he prescribed powerful purgatives, not
withstanding the copious stools he had previously had On the
22d, he was admitted into La Charite, with furious delirium, con¬
vulsions, tetanic rigidity of the jaws, blindness, dilatation and im¬
mobility of the pupils. He uttered cries, in the midst of which
the words my head, my head !” were distinguished ; while he
kept putting his hands to his head, and exclaiming ‘'cold, cold I”
His pulse was very much disturbed. He was ordered “ the pur¬
gative potion for painters/’ which was taken only in small quan¬
tity, on account of the rigidity of the jaws ; they were then sepa¬
rated a little, and three drops of croton oil given in a little tisane,
the whole of which, however, was not swallowed. In the course
of the day frictions were made on the abdomen with twenty drops
of the same oil, and in the evening three grains of opium were
given internally.

23d. All the symptoms abated *, the pupils were still dilated but
not immobile ; the patient appeared to regain his consciousness ;
there were no convulsions nor spasms. Four grains of opium
were administered in the same potion as before, and the same
dose repeated in the evening.

24th. The patient awoke, such is the expression which conveys
the best idea of the great change which had occurred. His vision
was perfectly restored •, he spoke, understood, moved his jaws,
and the whole appeared to him only to have been a dream. The
opium was repeated. — La Clinique.

6. Caesarean Section. — A female, 33 years of age, of a good
constitution, but whose bony system was extensively deformed by
rachitis, was examined by Dr. Muller, of Loewenberg. After two
days of ineffectual labour, the upper aperture of the pelvis mea¬
sured, in its antero-posterior diameter, not more than two inches
and a half ; and the cavity of the pelvis was, in some parts, only
eighteen or twenty lines ; the waters had escaped, and the child
exhibited distinct signs of life : the mother was greatly exhausted.
Under these circumstances, the Caesarean section was decided
upon, and performed in the linea alba ; the child was extracted
along with the placenta ; the hemorrhage was not very great \ the
wound was immediately closed, and had perfectly healed on the
forty-second day after the operation. — Rust's Magazin.

7. Discharge of a Foetus, 'piecemeal, through a spontaneous open¬
ing in the Abdomen. — A middle-aged female, who was pregnant
for the first time, had, very near her delivery, a fall from a consi¬
derable height, which brought on an attack of syncope, violent
flooding, and pain in the abdomen 3 these symptoms yielded to a
vigorous antiphlogistic treatment, but returned about a month
after the accident, without being accompanied by real labour
pains : the movements of the child had ceased since the fall.
After a few days, an inflammatory tumour formed in the umbilical
region, which caused a very painful burning sensation. The ge-

The Parisian Hospitals. 35 L

nitais were tumid and slightly swelled 5 the os uteri had not di¬
lated. The tumour gradually increased in size, and, after four
days, spontaneously burst, and discharged a large quantity of very
fetid serous pus 3 the aperture gradually became larger, and, on
examination of it, the foetus was felt, and extracted in pieces, ^and
completely putrid. During this operation, the uterus repeatedly
contracted, and the infusion of camomile flowers, which was in¬
jected into the wound, escaped through the vagina ; the lochia
were discharged partly through the vagina, and partly through
the wound. Under the use of tonic medicines, the patient re¬
gained her strength, and the wound was completely healed seven
weeks after the extraction of the foetus. — Ibid.

8. Description of an Uterus , Eight Years after the Caesarean Sec -
tion.— In Graefe and Walther’s Journal, M. Mayer, of Bonn, gives
the following description of the uterus of a female, on whom M. von
Walther had performed the Csesarean operation eight years previ¬
ously. The preparation is placed in the museum of the University.
The uterus is of its natural form, size, and consistence 3 its longi¬
tudinal diameter being two inches and seven lines, and the dis¬
tances between the insertion of the fallopian tubes, one inch and
ten lines. At the external surface of the anterior paries, a furrow
three lines in length, indicates the place where the incision was
made 3 the peritoneum isvery firmly adherent to it. The edges of
the wound were found to have considerably contracted 3 and ap¬
peared to be, as it were, turned in towards the substance of the
uterus 3 at the inner surface the cicatrix was a little more inferior
and larger by half an inch than exteriorly 3 it extended as low as
the neck of the uterus, where it was one line and a half in breadth.
The anterior paries of the uterus, in the neighbourhood of the cica¬
trix, was three lines thick ; the corresponding portion of the pos¬
terior paries was four lines. The cavity of the uterus was per¬
fectly natural, except that there was a very thin fleshy polypus at
the neck 3 the left tube and ovary were perfectly natural 3 those on
the right were adherent to each other by plastic lymph. The ova¬
ries exhibited numerous cicatrices. — Lancet,

9. The Parisian Hospitals. — The Hotel Dieu of Paris, gene¬
rally contains betwen 1000 and 1200beds3 the Hopital de la Pitie,
600 ; St. Louis, above 800 3 La Charit£ 300 3 the Hopital des
Veneriens, about 650 3 des Enfans, 550 3 St. Antoine, 250 3 Beau-
jon, 140 ; Cochin 100 5 and the military hospital of Val de Grace,
above 1300 beds. During the last winter the hospitals were rather
crowded 3 la Pitie often contained 700 patients j and the Hotel
Dieu, 1124, of whom 823 were physicians’, and 301 surgeons’ pa¬
tients. Of the physicians’, M. Petit has 143 patients under his
care 3 M. Borie, 923 M. Recauiier, 893 M. Husson, 144 3 M.
Gueneau de Massy, 131 3 M. Martin Solon, 90 3 and M. Caillard,
123. Of the surgical patients, 133 are Dupuytren’s, 77 Breschet’s^
and 92 Sanson’s. — Ibid.

352 Books Received , Literary Intelligence , S^c.

BOOKS RECEIVED DURING THE MONTH.

1. Pathological and Practical Researches on the Diseases of the Brain and
Spinal Cord. By John Abercrombie, M.D., Fellow of the Royal College of
Physicians of Edinburgh, &c. &c., First Physician to his Majesty in Scotland.
Second Edition, Enlarged. 8vo. pp. 476. Edinburgh, 1829. Waugh and
Innes.

2. Elements of Midwifery ; or, Companion to the Lying-in Room. By Chas.
Waller, Consulting Accoucheur to the London and Southwark Midwifery Insti¬
tution, and Lecturer on Midwifery and the Diseases of Women and Children,
at the Medical School, Aldersgate- street. 18mQ- pp. 132. London, 1829. S.
Highley.

3. The Mother’s Monitor ; or, Nursery Errors. By James Quilter Rumball,
Fellow of the Royal College of Surgeons. 12mo. pp. 131. London. J. Wilson,
Princes-street.

4. Sir Astley Cooper’s Lectures on the Principles and Practice of Surgery, as
delivered by him at the Theatre of St. Thomas’s Hospital. Taken in Short
Hand. 8vo. f.-cap. pp. 637. London, 1829. Westley, Strand.

f We have attentively perused this edition of Sir Astley Cooper’s Lectures
on Surgery, and have found it correct. The publication of these invaluable Lec¬
tures in a cheap form, which renders them accessible to that meritorious class
of Students on whom fortune has not deigned to smile, promotes the welfare
of science and humanity.

LITERARY INTELLIGENCE.

In the Press— An Exposition of the System of the Nerves. By Charles Bell,
Esq. Second Edition, with an Appendix of Cases. 1 vol. 4to., with Engravings.

In the Press A Manual of Midwifery ; or, a Summary of the Science and
Practice of Obstetric Medicine. By Michael Ryan, M.D., M.R.C.S., &c. Se¬
cond Edition.

An Estimate of the Real Therapeutic value of all the New Chemical and
other Remedies introduced into Medicine within the last twenty years, derived
from actual Practice, with Directions lor Preparing and Employing those which
are worthy the attention of the Medical Profession. By Richard Reece, M.D.

Me understand that there is a Work preparing for immediate publication,
intended for general readers, entitled, “ A Manual of the Economy of the Hu¬
man Body, in Health and Disease.” Comprehending a concise View of the
Structure of the Human Frame, its most prevalent Diseases, and ample Direc¬
tions for the regulation of Diet, Regimen and Treatment of Children and the
Aged ; with selections of the opiuions of the most approved Medical authorities
on the different subjects.

We observe the publication of the First Number of the “ Edinburgh Journal
of Natural and Geographical Science,” is postponed till the 1st of October.
Amongst the contents advertised, are many objects of interest to the Naturalist;
and we are glad to perceive, by the communications and papers on Geographi¬
cal Science and Discovery— a principal object with this publication -that an
impoitant hiatus in our periodical literature will now be filled up • and we
shah thus pax ticipate in an advantage which our Continental neighbours haye
long enjoyed in the Ephemera of the Baron de Zach, the Bullethrde la Societd
de Geographic, and the numerous Geographical Periodicals which are brought
out in France.

No. 1. of the Medical and Philosophical Gazette; or, Mreekly Journal of
Medical Literature and Popular Sciences.

All Communications and Works for Review to be addressed to the care- of
Messrs. Underwood, 32, Fleet street; or to to the Editor, at his residence, 61,
Hatton-Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 17. NOVEMBER 1, 1829. Vol. III.

CRITICAL REVIEW.

I. — Pathological Observations , Part II, on Continued Fe¬
ver, Ague, Tic Doloureux, Measles, Small Pox, and
Dropsy ; illustrated by Cases, tyc. fyc. By Wm. Stoker,
M.D., &c. &c. &c.

(Concluded from p. 299.)

We now commence our remarks on the second part of Dr.
Stoker’s work — the Medical Report of the Cork Street Hos¬
pital — and in it we find a vast deal of practical information.
Our author has constructed a Table, which contains, 1st,
the years since the Cork Street Hospital was founded ; 2d,
the number of patients admitted in each year ; 3d, the num¬
ber of those who died ; 4th, the average mortality, and last,
a series of chronological observations. By this document it
appears that the admissions were as follows : in 1804, 415 ;
1805, 1024; 1806, 1264; 1807, 1100; 1808, 1071 ; 1809.
1051; 1810, 1774; 1811, 1472; 1812, 2265; 1813, 2627;
1814,2329; 1815, 3789; 1816, 2703 ; 1817, 3682; 1818,
7608; 1819, 3873; 1820, 2974; 1821,2973; 1822,2307;
1823, 2668; 1824, 4599; 1825, 3878; 1826, 1082; 1827,
6544 ; 1 828, 2964 ; in all, during 25 years, 77,866. Such is
the Report of one of the Dublin Fever Hospitals only, which
affords a melancholy detail of the ravages of fever in a cer¬
tain district of the city. On perusing this valuable document,
we find fever has increased from 1804 to 1827, and subsided
very suddenly, in 1828. Dr. Stoker attributes the increase
of the disease to the following satisfactory causes.

<* The sources of employment have been either entirely stopped
up, or most pitiably narrowed ; and the miserable artificer has
been obliged too generally to support a precarious existence upon
occasional charity, or some occupation with which all his habits
and inclinations are, perhaps, at variance. That poverty has in..

354

Critical Review.

creased no less rapidly than disease, is, indeed, a truth so palpable,
as to need no proof.” — p. 4.

All the physicians of Dublin have invariably admitted the
legitimacy of this conclusion, and all have considered the un¬
equalled wretchedness of the lower orders as the chief pre¬
disposing cause of fever. There is no country in Europe so
extensively and constantly ravaged by fever as Ireland, as the
various Reports, published by the physicians of that part of
the empire, very fully prove ; and yet we are told by a writer
(for we acquit the editor of such absurdity) that the physi¬
cians of Ireland know nothing of fever. After all the reports,
all the works, and all the reviews of the Irish epidemic, of
1818, we are gravely told Cf that it was a very different dis¬
ease from common continued fever, as well in its symptoms
and course, as treatment and terminations*/’ Whether or
not the writer had observed the disease remains to be stated,
but we are incapable of understanding the reason this sweep¬
ing and gratuitous censure has been pronounced against the
physicians of a whole country. If this unceremonious and
unprofessional assertion were correct, then the opinions of
men of high talents and unlimited observation on the dis¬
ease, such as Drs. Percival, Stoker, Cheyne, Mills, Barker,
Crampton, Harty, Grattan, Graves, Marsh, in a word, of
all the profession of Ireland, are unworthy of confidence.1
Such a conclusion, on the mere ipse dixit of a reviewer, is,
in our humble opinion, somewhat questionable, and more
especially if that critic had not seen a single instance of the
disease. A sense of duty, as impartial journalists, compels
us to make these remarks, and we wish it to be clearly un¬
derstood that we shall never be the special pleaders for any
particular portion of the profession in this or any other part
of the empire ; our firm determination is simply this, that
we shall treat all alike, give merit where it is due, and faith¬
fully record the progress of medicine, unbiassed by any con¬
sideration but the welfare of science and humanity. And in
the discharge of our duty, we neither court the favour, nor
fear the disfavour of any man, or any number of men in our
profession. We are reluctantly led into this explanation from
the above unjustifiable censure, a censure that has been vir¬
tually reiterated in almost every page of the review of Dr.
Stoker’s work. Such nationality might have been palatable
at a time now no more, but will not suit the taste of any en¬
lightened man in the profession at the present period. It
may be said that we feel too warmly on the subject ; but we
have felt as -warmly in a late Number, when defending the

* Med. Chir. Review. Oct.

355

Dr. Stoker on the Pathology of Fever.

London and Edinburgh physicians from a similar attack,
made by a French Journalist. Can any thing, we ask, be
more unjustifiable than to set down the physicians of a whole
nation as ignorant of a disease with which they have had the
most extensive opportunities of being acquainted ? Let any
candid man peruse the works and reports published by the
Dublin physicians on the disease alluded to, and reviewed in
the periodicals of the day, and point out in what the progress,
treatment and terminations of that fever differed from con¬
tinued fever ? Let him refer to that scientific and impartial
work, the Edinburgh Medical and Surgical Journal, for the
last ten years, and then declare whether the disease was
fever or not. We can tell our contemporaries that many of
the physicians who have written on the fever of Ireland, are
men whose opportunities of witnessing disease in public and
private practice, are infinitely more extensive than those of
all the medical reviewers in the empire, and that they are
as little liable to mistake disease as any portion of the pro¬
fession in this or any other country ; nor will their profes¬
sional reputation be extinguished by the dictum of any man.
It is really too bad that the professional men of a whole na¬
tion should be put down a set of blockheads by a dash of a
reviewer’s pen — as if they had not had the same sources of
acquiring knowledge as the rest of their contemporaries.

We shall not prosecute this unpleasant subject farther,
we only exceedingly regret that we have had occasion to no¬
tice it. To return to the reviewer’s opinions of the epidemic
fever of . 1818, we find him asserting that “ as the disease
was induced by hunger, it was cured by diet, and propagated
by filth, it was alleviated by cleanliness.” The disease was
certainly produced by these causes, among the poor, but not
among those in better circumstances * ; and so far from it
having been cured so very easily, it attacked, during 1816,
17> and 18, 800,000 persons, of whom 40,000 perished.
We refer the reviewer to Dr. Marty’s work on fever, and to
the Edin. Med. and Surg. Journ. for the high opinion enter¬
tained for his ability and authority. We shall not follow
him in his reiterations, that the “ low typhus and epidemic
fever of Dublin merits no such appellations.” This may be
his opinion, but we must whisper in his ear, that many of
the physicians, whose opinions he deems valueless, are men
of the first practice, and who have seen more fever in a sin¬
gle year than all the medical journalists in the whole king¬
dom, during their lives. Nor is he more fortunate in accus¬
ing them of Brunonian views. “ To bleed in such a disease

* It first attacked the rich, in Ulster.— Harty, on Fever.

356

Critical Review.

would, undoubtedly, be death, to purge even would be dan¬
gerous. if not fatal.” Can the reviewer be really serious in
making this unfounded assertion ? Does he seriously suppose
that the physicians of Ireland do not treat fever by purging
and the usual remedies ?

In all our perusals of the sober and scientific Journals in
this country, during the last twenty years, we never recol¬
lect to have seen such an unblishing piece of misrepresenta¬
tion as this. Let us refer to their works for a refutation of
this — what shall we term it — this gross professional libel.
We can tell the reviewer that there has not been a work or
report published on the epidemic fever of Ireland, from the
time of Boate (who by the bye was the exact prototype of our
veracious opponent, if an Irishman) to the work before us,
that does not contain recommendations of bleeding and
purging when the symptoms indicated such treatment.
How many thousand times have we seen these methods of
treatment employed in the fever, “ which was not continued
fever” — and the former often with disadvantage, if not some¬
thing worse. As the faculty in Ireland have received such a
sound flagellation, of course, Dr. Stoker could not have ex¬
pected to escape. But his knowledge of the world, and of the
medical press, which is infected of late with the licentious¬
ness of “the best possible public instructors” will, we think,
prevent him from becoming so much debilitated by the at¬
tacks of his impartial reviewer, that he may recover the
shock, and once more oppose, if not refute, the ridiculous
theories of the day *. Dr. Stoker maintains that debility is
characteristic of the fever in Dublin, which the reviewer as¬
serts is not the case in London, and that

“ The Irish are the strongest birds of passage which we have, and
are that class of patients who require and withstand the most ac¬
tive measures. Robust in body and spirited in mind, unrelaxed by
luxury and hardened by exercise, disease of whatever kind readily
assumes in them an active character, and in fever, during the stage
of excitement, their organs are obnoxious to an unusual proportion
of inflammatory attacks. Why there should exist such a difference
between the Irish constitution in London and Dublin, as that, dur¬
ing the self-same disease, it must be supported by wine in the one
metropolis, and reduced by bleeding in the other. Dr. Stoker may,
probably, but we cannot, explain.” — p. 342.

Before we offer a comment on this paragraph, we shall
quote the reviewer’s description of the same people in 1818,

* We are far from thinking Dr. Stoker’s theory the best, yet it is just as good
as any other, for we know nothing of the proximate cause of fever.

Dr. Stoker. on the Pathology of Fever. 35/

of those robust and high-spirited individuals, who bear the
lancet so admirably in London. He says

Destitute of the necessaries of life, they become weak and
enervated 5 dispirited by the miseries which surrounded them, every
habit of cleanliness and order was neglected ; filth and famine thus
conspired to the propagation of disease, and constitutions enfeebled
by misery and want became easy victims to a malady whose fa¬
vourite haunt is the hovels of the destitute. — p. 338.

What a contrast between the Irish in Ireland, and the Irish
in London, butpei haps in their migration hither, the change
can be accounted for by some of the magic effects of the steam
engine, or by the comforts and luxuries on the road to St.
Giles s or to Saffron Hill. If we trace these birds of passage
in their flight from their native shores to their arrival in this
country, we can find nothing to explain the marvellous
change of constitution so ably described. Nor can we disco¬
ver it in their progress through the interior, deprived of
food, of the means of procuring nocturnal repose, unless
under the canopy which the firmament affords them, resum¬
ing their weary way to the land of promise, and at length
arriving at the end of their tedious journey, they find no¬
thing but disappointment ; for immediate occupation there
is none. And if they be so fortunate as to procure employ¬
ment soon after their arrival, do we not observe them la¬
bouring beyond their strength, “working over time,” and
their abodes fully as unhealthy and filthy as those they have
forsaken ? Their habits are unchangeable, their exertions
infinitely more laborious and severe, their aliment is cer¬
tainly better, but their propensities to the “ mountain dew”
as violent as ever. In a few short years we find them broken
down, bewailing the hard fortune that seduced them from
their homes, and applying to the proper authorities for
transmission to their native country. If this be a true pic¬
ture of the Irish in London, we beg leave to ask, how is it
they become “ so robust in body and high spirited in mind.”
and differ so amazingly in Dublin and London, and that dur¬
ing fever they require wine in the former, and the lancet in
the latter city ? So far from this being the case, we can
assure our readers that very extensive personal experience
in dispensary practice enables us to contradict the asser¬
tion. We have daily opportunities of observing fever among
the Irish, and can solemnly aver, that the lancet is rarely
indicated. The only difference we perceive between the
disease here and in Ireland, is, that it is seldom accompa¬
nied with petechiae, and we would risk our character on the
decision of the medical officers of our hospitals and dispen¬
saries as to the correctness of our assertion. In our opi-

358

Critical Review.

nion, persons so debilitated and enervated as the lower
orders of the Irish generally are, need more of the Bruno-
nian than the Sangrado practice. Time, nor space, nor
inclination, will not permit us to expose the impartiality and
taste of the reviewer any further, but we cannot avoid ad¬
verting to his extraordinary praise of the w'orks of Bateman,
Armstrong, and Clutterbuck, which are declared cc sine com-
jjaratione though “ the doctrine of localism has perhaps
been adopted too exclusively by one, and the treatment by
depletion, has, perhaps, been recommended too indiscrimi¬
nately by another*; but these are peccata virtuti propinqua
— not so much faults as failings (! !)— and without giving any
sanction in these philo- catholic times to Popish theology",
they cannot be far misplaced by being included in the class
of venial sins.” We fear, however, they are too often mortal
in their effects. Had Dr. Stoker resided in London, his trans¬
gressions, perhaps, might be included among the venial sins,
for “ had he circumscribed the applicability of his con¬
clusions to Dublin, or to the Cork Street Hospitalt? the
special theatre of his observations, however violently tend¬
ing we might have been to scepticism, the character of
the author would have procured respect for his prin¬
ciples, and, probably, some reverence also for his practice.
But, when uninvited and unprepared, he steps beyond the
sphere of his own movements, and leaving his own work¬
shop, begins to cut and carve after his own taste and his
own models, a foreign and unknown material, (the London
fever, unknown after so many descriptions sine compara-
tione), “ which, moreover, is the property of others (!), it
cannot be deemed bold for the owner to look after the inte¬
rests of his property, although, by doing so, he may peradven-
ture expose the principles or hurt the feelings of the intruder.
We shall not expose the absurdity of this doctrine, and only-
regret that any periodical in the kingdom should maintain
principles so preposterous and so repugnant to the interests
of science. The time has for ever gone by when national
jealousy was palatable to the minds of an enlightened public,
or a liberal profession ; nor shall the revival of such feelings
reflect great lustre on the fame or good taste of the experi¬
menter, more especially should he happen to be a man who
unnecessarily and unjustiliably abuses his fellow countrymen.
In these remarks, we again disclaim all favour or affection to
any country ; we have not the honour of Dr. Stoker s ac¬
quaintance,* and had he resided in any other part of the
united kingdom, he should as readily have had the benefit of

* Which is termed the blood-thirsty youug monster, by the Germans. — Ger.
Mag. of Literature, 1824.

f The largest Fever Hospital iu Europe.— Ed

I3r. Stoker on the Pathology of Fever. 359

our advocacy. But when we see a gentleman of his emi¬
nence, research, and experience in the observation of a dis-
ease, as appears by the tables already quoted, and coolly
told he knows nothing about it ; and when we see the whole
r acuity of hjs native city included in this critical anathema,
justice, honesty, and science demand and compel us to repel
the unwarrantable censure. We again repeat our conviction
that the editor of the Medico- Chirurgical Review is not the
author of the article on which we have animadverted ; and
this obviously appears by the appended notes. He has too
much good sense and knowledge of the world to broach such
heterodox opinions. It is not consonant to our notions of
the duties of a journalist, to hurt the feelings of an author ;
we conceive it is with his production, and not with himself’
we have to do ; nor do we wish to stand on any other terms
than those of respect with our editorial contemporaries.
Without intending the slightest disrespect towards any one
of them, we must observe, and we do so with regret, that
the medical periodicals are of late evincing too much of the
worst propensities of the public press, and forgetting that
sober and honourable course which has ever characterized
their venerable predecessors, and we hope will still dis¬
tinguish the writings of men devoted to science. We
shall now submit Dr. Stoker’s account of fever to our
readers, and leave them to form their own opinions, whether
he has merited such unqualified censure as has been so freely
bestowed on him. Immediately after the table of the pro¬
gress and mortality of fever in the hospital to which he is
physician, he informs us that the actual increase of the dis¬
ease was far greater than he has been able to shew.

The synoptical retrospect of the rise and progress of fever, as it
appeared at this hospital, is a document of much melancholy in¬
terest. The head and foot of the column of admissions, form so
fearful a contrast, and show so rapid an increase in the number of
sufferers, that it must excite in us a distressing surprise: this feel¬
ing will be heightened, perhaps, when it is known, that at those
times, when the numbers relieved by hospital assistance were
greatest, it also happened that the numbers to whom the hos¬
pital, from its limited accommodation, could afford no assistance,
were also greatest. It may further be observed, that there has
been a continued increase of fever for the twenty-four years
ending in 1S27 — comparatively slow, indeed, for the first seven,
but alarmingly rapid and irregular during the subsequent seventeen.

“ However great the increase which is thus exhibited may ap¬
pear, it is far from being so great as that which actually took
place. During the early years, to which the table refers, the
fever hospital in Cork-street was the only one existing in Dublin ;
and, consequently, the applications to it were all that were made

360

Critical Review.

for hospital relief ; but, subsequently, a number of other fever hos¬
pitals were erected in various parts of the city 5 so that when the
numbers on the above column of admissions were greatest, they
represented only that portion of the increase which was provided
for by one, out of the many existing fever hospitals.

£f As the reader may now form a tolerably accurate estimate of
the actual increase of disease, and has been reminded of the moral
and physical condition of the lower orders, while that increase
was going on, he will be desirous, perhaps, to be informed how it
is to be accounted for.

Upon reference to the table, it will be observed, that from the
year 1804 to 1817, there was, comparatively speaking, a gra¬
dual, though, during the latter part of that time, a rapid increase
of disease ; but it was not till 1S1? and 1818, that it appears, as by
some extraordinary effort, to have made a sudden and terrible
inroad upon the health and happiness of the people. In the year
after, however, it seems, in some degree, to have subsided, and
taken the more regular order of increase down to the close of
189.5, when apparently it again resumed extraordinary violence,
and inundated with misery all the habitations of the poor.

“ With respect to the increase of disease, down to the year
181S, it is, I believe, generally acknowledged, that it was the ex¬
tension of the same form of fever, to which the increased poverty
and helplessness of the people rendered them more liable. But to
account for the extraordinary increase in 1818, and likewise in 1826
and 27, different opinions have been entertained, and different
causes assigned. These differences shall now be detailed : — it being
first premised, that as the extraordinary increase of disease in the
years 1818 and 1826 were, by their manner of appearance and
departure identified, or, at least, as the differences respecting them
were the same, it will not be here necessary to treat them distinctly.

When disease had advanced to so dangerous a degree as to
excite very general alarm, and Government found it necessary to
institute inquiries, a letter was addressed by the Secretary of the
General Board of Health, to the physicians of the hospital. It
requested their opinions as to the cause , the manner in which it
acted, and the most probable method of removing or counteract¬
ing it. As the answers returned to these questions were likely
to direct, in a considerable degree, the measures about to be
adopted by the Board, it appeared that the duty thus required
was one of no ordinary responsibility. It was, therefore, with
exceeding regret that I found myself differing from my colleagues,,
while it was. impossible to compromise my belief. They were
of opinion, that contagion had £ acquired, within a short period
more than ordinary force and that it was owing to this circum¬
stance chiefly that so many were afflicted ; while I believed that
disease had been extended almost entirely by the miserable con¬
dition of the people. The power of contagion was not indeed to
be denied but that the increase of sickness was in consequence of
the increased force which contagion had gained within a short pe¬
riod, or that it owed its origin to contagion at all, was what my

361

Dr. Stoker on the Pathology of Fever.

experience seemed to contradict. As the settlement of this differ¬
ence is of paramount importance to subsequent inquiries, there
shall be here laid before the reader those considerations, upon
which I hope to justify the singularity of my opinions.” — p. 9.

Though many hospitals were erected in various quarters of
the city, the disease advanced, which event proved that it
arose from other causes besides contagion, and Dr. Stoker
was of this opinion, and in ascribing it to the distress of the
poor, boldly told the Government the real cause of the ma¬
lady. We regret that his colleagues had hot arrived at a less
temporizing conclusion, but they were at the right side, for
in the opinion of the Irish Government, the people of Ireland
are not in that state of wretchedness, which is generally sup¬
posed. When the fever of 1818 — 26 was so unusually pre¬
valent, it was ascribed by some to the suddenly increased
force of contagion; or to some new epidemic^” but the
misery of the people was not taken into account at all.
However our author has not forgotten this important point .

“ But if any thing were wanting to entire conviction on this
matter, a brief survey of the condition of the poor, during the par¬
ticular years, and those immediately preceding them, will pain¬
fully satisfy the want. The incidents which characterized those
years, will long remain in mournful recollection. All the evils
which had been growing for many years before, in a terrible ag¬
gregate of strength and number, then appeared in this country.
The proprietors of the soil had long been deserting it, and spending
in other countries the income from their estates. Hence, immense
tracts of reclaimable land lay neglected wastes, which otherwise
might have brought large returns of wealth for the expence of their
improvements, and become rich sources of employment, health, and
contentment to those who are so unjustly treated as intolerable in¬
cumbrances on the small proportion of the country which is duly
cultivated. Those lands, therefore, were divided and subdivided,
with little care for the interests of agriculture, and still less for the
happiness of the people ; and while the land was racked, and the
various denominations of unfortunate tenants pressed to make up
the rents for the absentee, the poor artizans, whose existence de¬
pended upon the liberal encouragement of the resident nobility and
gentry, sunk into poverty and vice. Truly has it been said, f It is
the state, the luxury, and fashions of the wealthy that give life to
the artificers of elegance and taste ; it is their numerous train that
sends the rapid shuttle through the loom ; and when they leave
their country, they not only beggar their dependants, but the tribes
that live by clothing them.’ The importance of this high autho¬
rity is wrell illustrated by the fact. The habitation of the miserable
weaver became a spectacle of filth and confusion — his hearth cheer¬
less — his only visitor the cold and wet which made its way through
the ill- saved roof — his helpless infants famishing around him. And
thus learning to regard all the energies of his manhood as useless
VOL. m. no. 17. 3 A.

Critical Revietv

and his loom but lumber, he often sunk down in mental agony,
and bodily exhaustion. In such a plight, it may easily be ima¬
gined, recourse was had to any and every means : every vice was
resorted to which could either intoxicate affliction, or destroy sen¬
sibility. Thus it was that disease procured another agent, no less
terrible than that from which it sprung. It was no unfrequent
spectacle to see his whole family, a wretched group, coming down
to the hospital gate, or carried thither in the vehicle for that pur¬
pose, severely sick indeed, but bearing the symptoms of no other
malady but that of cold and hunger *, nor was their condition less
necessary to be attended to than if they had laboured under a more
regular form of disease.” — p. 20.

Dr. Stoker next shews the identity of continued fever at the
present and remote periods, from the works of Boate, Rogers,
OConnell and Percival. In the year 1804 the fevers were
more of the intermittent and remittent types, which probably
induced Dr. Cullen to make paroxysmis quovis die binis a part
of the definition of continued fevers. The author describes the
constitutio epidemica after the manner of Sydenham, but this
description throws little light on the cause of fever. He
quotes Dr. Burne’s excellent work on adynamic or typhus
fever to prove, that the pathology and treatment of this dis¬
ease in London approaches much nearer the Dublin opinions
than in the time of Dr. Bateman. For this quotation he has
excited the ire of one of his reviewers, but we see no cause
for any animadversion on the occasion. Dr. Stoker thinks
the probable cause of the decrease of fever in 1828, was to
be ascribed to the removal of the misery and inaction of the
working classes, and to the considerable relief afforded them.
The fevers of Dublin are generally typhoid in their symp¬
toms, but sometimes inflammatory ; distinctions to be ob¬
served in the intermittents and exanthemata. With respect
to the use of bleeding in typhus fever, Dr. Stoker makes the
following judicious remarks : —

The effects of bleeding further evince, that our epidemic
fevers are not of the inflammatory kind. In the early stages of
mild and mixed cases, while the natural tendency to recovery is
still strong, the injury or uselessness of bleeding may not, per¬
haps, be so apparent ; yet, if the pulse be frequently examined
during the operation, as it ought in every instance, it will be found,
that debility, proportioned to the urgency of the case, speedily suc¬
ceeds. After the abstraction of two or three ounces of blood, the
pulse will sometimes sink — sometimes become unequal and re¬
bounding — an effect in any case very dfferent from what it would
be in mere inflammation. But the result of an extensive inquiry
in our hospital, into the comparative merits of bleeding, and other
remedies in fever, should, in my opinion, have long since settled
his dispute .

Dr. Stoker on the Pathologij of Fever. 363

It has often occurred to me, that not only the effects which
blood-letting evidently had upon the strength and condition of the
patient, but also the appearances of the blood drawn were, in a
great measure, indicative of the necessary treatment. And long
since, when my attention was directed to these appearances with a
different design, they seemed to me, both in the stages and sequels
of the varieties of our epidemics, to indicate, with considerable ac¬
curacy, the relative urgency and degree in which the inflamma¬
tory or typhoid characters prevail in each case. In the highest
degree of febrile excitation, at the commencement of these fevers,
unless where they are combined with inflammation, the blood
drnwn is seldom buffed. Where this combination of inflammatory
and typhoid fever exists, the buffy coat does, indeed, in most cases
appear, especially in those of sthenic habits, and in the vernal sea¬
son, but never so dense and colourless as in pure inflammation.
Moreover, the buffy coat appears almost exclusively upon the first
cup. — p. 43.

Our author informs us of the difference apparent in the
blood, abstracted before and after the crisis.

fe During the excitation which, at all stages, precede crises in
fevers, either of the continuous or intermittent kind, the almost
total absence of sizy surface, indicates how little inflammation
existed at the same time. On the other hand, when blood is
drawn after the crises, or in the sequel of such fevers, its sizy ap¬
pearance is generally proportioned to the degree of febrile excita¬
tion, aud indicates derangement, either in the chyliferous or san ¬
guiferous system, sometimes in both.” — p. 46*.

This difference has been noticed by Dr. Clanny in his va¬
luable observations on typhus *. Dr. Stoker describes the
difference of the buffy coat in pneumonic and hepatic dis¬
ease, which appeared in our last Number. Blood drawn in
the sequel of exanthematic fever, is at times sizy, independ¬
ently of iuflammation. He draws the following practical
conclusion from the foregoing facts, which the advocates of
the lancet would do well to consider very seriously.

“ I think that every practical physician will admit, that the pri¬
mary symptoms — the effects of bleeding — the appearance of the
blood drawn in different stages of the disease — and the indifferent
success that blood-letting met with when its relative merits were
tried — all favour the opinion that our epidemics are in their nature
typhoid. It now only remains to inquire whether post obit exa¬
mination denies or corroborates the reality of those appearances.
Now, morbid anatomy declares, that the phenomena presented by
inflammatory and typhoid diseases are quite different j and that
either the duration or effect of general fever and visceral inflam¬
mation are not necessarily the same ; thus corroborating, as far
as its evidence can go, the truth of my original opinion. — p. 50,

* Lecture on Typhus . — Lancet,

364

Critical Review.

Our author next relates cases, of the different forms of
which are highly instructive to the young practitioner ; and
then contends that vitiation of the blood is the primary
cause of fever. On this point we differ toto ceelo from Dr.
Stoker, and say, with great respect, that his proofs are quite
unsatisfactory. He ascribes the disorder of the brain and
all the functions to the state of the blood ; but we are firmly
convinced that the reverse is the real truth— -that the brain
and nervous system are first affected in fever. The morbid
state of the blood during fever is the effect and not the cause
of the disease ; for if venesection be employed in the com¬
mencement of fever, there will be no such appearances of
blood observed, and certainly none which could account for
the disease. The experiments of Dr. Clanny on this point
confirm this opinion, and set the question at rest. How far
the vitiation of the blood may cause disease, is merely con¬
jectural and undecided. The writings of Mr. Arnott, MM.
Dance, Velpeau and Blandin on the absorption of pus as a
cause of phlebitis and constitutional irritation or fever, leave
the subject as obscure as ever.

Dr. Stoker contrasts the opinions of Dr. Bateman in fa¬
vour of bleeding in the London fever, in 1818, and those of
Dr. Burne which are against it in the same disease in 1828;
for which exposure he has received due castigation, as we
have already stated, though we think very undeservedly.
Surely this great discrepancy could not have escaped the
notice of any systematic writer on fever. This discrepancy
cannot be accounted for further than that it might have
arisen from the changes which have occurred in the epide¬
mics themselves ; or from the influence of the climate of
London, which is so different from that of Dublin on the
constitutions of the lower order of the Irish, who suffer as
much from depressing causes here, as they have done in
their own country. The writer on whose opinions we have
offered some comments, denies the contrast, and does not
acknowledge the opinions of Dr. Burne as authentic. In a
few days we shall have the testimony of Dr. Southwood
Smith, who is one of the physicians to the London Fever
Hospital. But should he differ from Dr. Burne, the ques¬
tion will be by no means decided, because the latter talented
physician has fully as extensive opportunities of observing
the disease, as Dr. Smith, he being one of the medical offi¬
cers to one of the most extensive dispensaries in this metro¬
polis.

Dr. Stoker next details the remedies which he has found
most efficacious in fever, and they are the following : — ■

365

Dr. Stoker on the Pathology of Fever.

IN MIXED FEVER.

Cleanliness.

Ventilation.

Cool Regimen.
Plentiful Dilution.
Purgatives.

Topical Bleeding.
Antimonial, or James’s
Powder.

IN TYPHOID FEVER.

Yeast or Barm.

Wine.

Aperients.

Emetics.

Blisters.

Tepid, or Cold Affusion.
Peruvian Bark.

He employs many other remedies with advantage for the
r^iet particular symptoms, or such as are produced by
extraordinary idiosyncrasies. He recommends purgatives
before the use of any other remedies, and has always found
them injurious if used too freely. He has seen decided ad¬
vantages arise from the use of enemata composed of turpen¬
tine and castor oil, in cases of retention or suppression of
urine, or of obstinate vomiting. Symptoms which they seem
to relieve by removing impacted faeces from the large intes¬
tines ; and by vomiting the parts in the neighbourhood of
the kidneys, bladder, and their appendages.” p. 115. This
plan prevents the necessity of catheterism. Yet this* is one
of the physicians who is said to fear the use of purgatives in
lever . Our author has observed that topical bleeding is not
so frequently beneficial as it had been before the epidemics
assumed a pestilential character. Of late he has found de-
bility very much increased by opening the temporal artery,
and the wound was often surrounded with a dark erysipela¬
tous inflammation or an aneurism formed on it.

“The symptoms of general debility that appear to me to be most
remarkably connected with loss of arterial blood in typhoid fevers
are involuntary stools, and the urine passed unconsciously ; and
in other cases, retention or suppression of these discharges, both
arising from the same paralysis of the parts engaged. To the
omission of arteriotomy, therefore, I, in a great measure, attri¬
bute the circumstance of the. catheter being so rarely necessary in
my treatment of typhoid fevers •, a fact, which I now deem it the
more necessary to dwell on, from having formerly stated that in
the fevers I had previously met with, I had witnessed frequent
benefit from opening the temporal artery for the relief of symp¬
toms of unequal distribution of blood, and which I illustrated with
cases detailed, with that view.” — p. 117.

He strongly recommends leeches in cases of local conges¬
tion, and they in general afforded relief. They are also useful
when applied to the verge of the anus in certain cases. The
antimonial medicines, ant. tart. pulv. ant. and James’s
powder, are of superior efficacy, when there is determination
of blood to the head, and other parts after the employ me 11

366 Critical Review.

of eyacuants. He offers the following explanation of its
mode of operation.

“ The first sensible effect of this powder on the human system,
is nausea, proportioned to the dose, producing, during its conti¬
nuance, a diminution of the frequency of the pulse, and of the de¬
termination of blood to the head, (marked by the comparative
paleness of the face -,) to which general relaxation of the surface
succeeds, affectiug the extreme vessels, exhalent and absorbent, and
tending to that equable action by the excretory and secretory ves¬
sels, which is generally followed by a return of the natural evacua¬
tion. By such effects, the disposition to partial accumulation of
blood, on which local inflammation, in the course of fever, pro¬
bably depends, must be considerably counteracted ; and by the in¬
creased action of the absorbents, which succeeds their relaxation,
the return of the morbid accumulation is further prevented. The
direct influence which all impressions, made upon the stomach, has
upon thr nervous, sanguiferous, and absorbent systems, affords a
rational explanation of their agency in the modus operandi, which
is thus attempted with respect to antimonial medicines. The dose
which 1 have latterly administered is the same which I recom¬
mended from the beginning of my observations on its use in fevers,
viz. three grains three times a day } but in cases of violent deli
rium, or tendency to mania, the stomach being generally very
torpid, it will bear eight or ten times the ordinary quantity. In
such states, however, solutions of tartar emetic may often be ad¬
vantageously substituted.’ — p. 119.

He has also observed it promote the crisis if administered
timely, and thinks it a most valuable remedy in fevers. He
gives the most unqualified recommendation of yeast, and has
not seen a single case during the last fifteen years, which
caused him to regret its exhibition. He says —

“I have administered it in case where purple extremities or
gangrenous sloughing took place, accompanied by symptoms of
inflammation, when Peruvian bark could not be given with advan¬
tage 5 and also, when these pestilential characteristics occurred,
without inflammation of any important part ; and under such cir¬
cumstances, it appeared to me to assist efficacy of the bark in
arresting these putrid symptoms.” — p. 122.

He has employed it in 10,000 cases, and where the irritabi¬
lity of the stomach, by dark or green vomiting, precluded its
employment in the ordinary manner, it was administered in
the form of enema. It is seldom rejected by the patient,
and on the contrary is often relished. The dose and mode
of exhibition are thus described.

“ Barm or yeast is moderately laxative ; often superseding re¬
peated doses of purgatives 3 if not sufficiently so, I sometimes com¬
bine tincture of jalap with it ; but, in other cases, if the bowels are
too free, a few drops of tincture of opium are added to the dose.
Thus administered, it appears to me to correct the morbid con-

Dr. Stoker on the Pathology of Fever. 367

tents of the alimentary canal, and, consequently, the symptoms of
putrescence ; petechiae, and black loaded tongue, will be found, I
think, more effectually remedied by it than any other drug : ac¬
cordingly, as already intimated, I have often substituted it for bark
and wine, when these remedies could not be employed, on account
of the complication of inflammatory symptoms, and I have con¬
joined it with these remedies, when there was no such counter-
indication.

“ The dose, which I still continue to administer, is two table¬
spoonfuls, repeated every third hour ; and I generally direct it
with equal quantities of camphor mixture. If administered by
enema, three times the quantity, given by the stomach, may be
injected. And here, I should not omit to meet an objection to the
employment of barm in fevers, which has been made by persons
whose opinions I respect, * that it would be likely, by promoting
fermentation, to increase the tendency to tympanitic distention,
that is sometimes so obstinate a symptom in typhoid fevers.’ The
result of my trials, however, has been the very contrary to what
has been thus apprehended 3 for, in some of the most obstinate
cases of tymphany, that I have met with in typhoid fevers, ene-
mata of barm, and assafaetida have proved the most efficacious re¬
medies.’’ — p. 123.

With regard to the use of wine, our author, though op¬
posed to those who consider fever inflammatory, speaks with
reserve. He thinks it injurious if given indiscriminately in
the early stages of fever, and in complicated cases it may
be substituted for the antimonial solution. It is seldom or¬
dered in cases terminating before the tenth day, but it is
highly necessary in cases decidedly typhoid, especially when
they have been produced by contagion. But it need not pre¬
clude or interfere with the necessary evacuations. It some¬
times relieves determination of blood to the head in the more
advanced stages of fever — an excellent illustration of which
is given. We fully concur in this practice, for we have often
witnessed its miraculous effects. We are only surprized
that men who allow the worst symptoms of fever to super¬
vene, and would fear to exhibit the least stimulus, pour pure
brandy down the throats of their patients, when they are
evidently moribund. We have repeatedly witnessed this
practice, and were only surprized that any rational man
could have expected benefit from it. How often will all the
symptoms of congestion in the brain appear in the last stage
of fever, even evidence of effusion, and yet the patient recover
when all hope was lost. The writings of Professors Alison,,
Andralj and others, leave no doubt of the truth of this fact.
Wine, says our author, should not be omitted in protrac¬
ted cases of debility, even where local evacuants are in¬
dicated. Dr. Stoker is a strong advocate for emetics in

368

Critical Review.

continued fever, especially if caused by contagion or an epi¬
demic constitution of the air. He prefers blisters in the
commencement of fever to local bleedings, but if there be
great determination of blood to the head, then leeches ap¬
plied to the temples or inside of the nostrils, arq highly use¬
ful. He says, “the utility of blisters at every stage of fever
when coma threatens or supervenes, or when it is not re¬
lieved by evacuants, can be no longer doubtful. Cold affu¬
sion was not employed, as organic disease was prevalent in
most of the patients in the hospital. General bleeding has
not been recommended by our author in typhus or continued
fever ; and we must repeat that there are few physicians in
this empire who have enjoyed such extensive opportunities of
forming a proper estimate of its value. He, as well as most
of the physicians attached to fever hospitals, are opposed to
the indiscriminate use of the lancet as an infallible remedy
in low fever ; and they are supported by the weight of au¬
thority as already mentioned in our review of Good’s Study
of Medicine.

Such are the opinions of Dr. Stoker on the nature and
treatment of continued fever, and they accord with those
of the eminent physicians of this and preceding ages, with
the exception of the cause of the disease. There are vari¬
ous instructive cases, illustrative of the author’s practice,
detailed, which will be read with interest by those who
have had any opportunity of witnessing the disease. They
prove the author to be a man of science, of sound sense, of
accurate discrimination and of faithful observation; a judi¬
cious and successful practitioner. Dr. Stoker has appended
cases of intermittent fever, tic doloureux, measles, small¬
pox and dropsy, which appeared as the sequelae of fever, but
they present nothing unusual, and therefore need no exposi¬
tion in this place.

In conclusion we repeat the favourable opinion advanced
in our last Number, by confidently maintaining that the
practice recommended by Dr. Stoker is accordant with that
of the brightest ornaments of our profession. We have dif¬
fered with him on his theory of fever, which we think unte¬
nable, but still as good as any other that has been offered.
The truth is we know nothing of the proximate cause of fe¬
ver, nor does one of the proposed theories explain its pheno¬
mena. We part with our author with every sentiment of
respect for his well-meant endeavours to explain the real
nature of fever, and more especially for the successful and
judicious practice which he has inculcated.

Dr. Abercrombie on the Brain and Spinal Cord. 369

II. — Pathological and Practical Researches on the Diseases
of the Brain and Spinal Cord. By John Abercrom¬
bie., M.D., &c. &c. Second Edition, enlarged, 1829.

In volume xxix, 1828, of the former series of this Journal,
a very extensive review was given of the first edition of the
work before us ; and we shall therefore confine our remarks
to the new matter of the present edition, which consists of
thirteen additional cases, and some additional facts and ob¬
servations on diseases of the nerves.

Dr. Abercrombie is long known to the profession as one
of the first pathologists and morbid anatomists in this coun¬
try, and therefore his opinions are entitled to the greatest
respect. His observations on diseases of the head, chest,
and abdomen, are well known to the profession, and were
among the first attempts made in this empire to encourage
the cultivation of necroscopic examinations — the only true
mode of investigating the nature of disease. We think it right
to make these remarks, as many of our readers might be re¬
luctant in assenting to some of the opinions contained in the
work under notice. Having premised these few observations,
we proceed to notice our author's opinions.

The first case added to the former edition, is inserted in
page 67, under the term meningitis, by which the author
expresses “ inflammation of the arachnoid, or pia mater, or
both, as distinct from inflammation of the dura mater.”
It is as follows : — ...

44 Case XVIII.— A lady aged about thirty-eight was recovering from
her eleventh accouchement, when, at the end of a fortnight, she became
affected with a deep-3eated hard swelling in the right side of the pelvis,
which was tender to the touch, and was accompanied by a considerable
degree of fever. After repeated topical bleeding and other reme¬
dies, the febrile state subsided, the swelling lost its tenderness, and
seemed to be gradually diminishing in size, but its progress was very
slow, and after three or four weeks, she was still confined to bed, and
suffering a good deal of uneasiness; her pulse was now calm, but she
was considerably reduced in strength. At this time, she became, one
day, alarmed and agitated by some family occurrence, and immediately
began to talk wildly and incoherently, and after a restless night wa?
found next day in a state of the greatest excitement, talking incessantly
screaming and struggling, with a wild expression ot countenance, an<
a small rapid pulse. She was treated by topical bleeding, laxatives
cold applications to the head, &c., but with little or no benefit; am
on visiting her on the following day, I found her sitting up in bed ,
with a look of extreme wildness, both her hands in constant motior ,
talking incessantly and wildly; and I learnt that she had not cease 1
talking for one instant for the last twelve hours. Her pulse was no\ *
VOL. in. no. 17. 3 B

3/ 0

Critical Review .

rapid and feeble, and her countenance expressive of exhaustion. Ij?
consultation with a highly intelligent friend who had charge of the
case, I mentioned my experience of the fatal nature of the affection,
and proposed to make trial of treatment by stimulants. A glass of
wine was accordingly given, with evident abatement of the symptoms j
and it was ordered to be repeated every hour. At the end of the
fourth hour, she was perfectly composed and rational, her pulse about
90, and of good strength j and from this time there was no return of
the symptoms. The tumour in the right side increased in size, suppu¬
rated, was opened and healed favourably. From this time she continued
in perfect health, and has since passed through another accouchement
in the most favourable manner.

“ This case I have given as another example of this interesting
affection. I have employed the same mode of treatment, with similar
benefit in several other cases, both of males and females. The chief
difficulty is in deciding upon the particular cases to which the stimu¬
lating treatment is applicable. They appear to be those in which the
excitement is accompanied by a small and rapid pulse, and au expres¬
sion of paleness and exhaustion. When these characters are present,
however violent the excitement may be, l have not been deterred from
the practice, and in a considerable number of instances have found
much reason to be satisfied with it. I have tried it, but without the
same benefit, in some of the common cases of insanity, accompanied by
paleness and bodily weakness, but with a natural pulse. When there
is frequent and strong pulse, with flushing and other marks of increased
vascular action, it would of course be injurious.”— p. 61.

This case is detailed extremely loosely, and if taken alone
would not be deemed meningitis by one practitioner out of
fifty. We are not told how long the delirium continued,
and the symptoms were more like mania than meningitis.
The treatment by stimulation under the circumstance nar¬
rated, would have been pursued by every scientific practi¬
tioner — depletion was entirely out of the question. The two
following cases of u ramollissement of the brain, with re¬
markable symptoms,” are well worthy of serious attention.

Case XXX. — A gentleman, aged twenty-six, of a plethoric habit,
had suffered occasionally for two or three years from headach and
vertigo, which were always relieved by depletion. On 12th April
1827, while walking out, he was seized with confusion and giddiness,
embarrassed speech, and a considerable degree of paralysis of the right
leg. He was rather pale ; his pulse was 70 and soft j and he did not
complain of any headach. The usual treatment was adopted with
activity by Dr. Combe of Leith, without much relief. On the con¬
trary, after several days he began to complain of acute headach,
accompanied by vomiting and hiccup j and the other symptoms con¬
tinued nearly as before — his speech being laboured and (slow, and his
memory very defective. After some weeks those symptoms subsided^
so that he was able to walk out 5 but the headach continued with fre-

Dr. Abercrombie on the Brain and Spinal Cord. 3/ 1

quent vomiting. The pain was chiefly referred to the left side of the
head, sometimes to the occiput, and there was occasional numbness of
the right arm. When I saw him, along with Dr. Combe and Dr.
Kelly in July, his chief complaint was of frequent and irregular attacks
of vomiting, occurring daily, or repeatedly through the day. It came
on very suddenly, without previous nausea, and he was often awakened
in the night by the sudden attack of vomiting. He had now a pale
sickly look; there was no paralytic affection, and little complaint of
lieadach ; though he still had occasional uneasiness in the head, some¬
times referred to one part of it and sometimes to another. When he
did refer it to a particular part as the principal seat of the pain, it was
either the left temple or the occiput. But the headach at this time
was slight and transient, and the symptoms in the stomach were so
much the more prominent, that it was a matter of much doubt whether
there was now any fixed disease in the head. The vomiting was much
relieved by the oxyd of bismuth, so that he was free from it for several
days. But it soon returned and went on as before, with increasing
debility, great listlessness, and bad appetite ; pulse little affected. He
had now a peculiar unsteadiness of his limbs, so that on first getting
up into a standing posture, he staggered very much and required some
time and attention to steady himself. When he had accomplished
this he walked with tolerable firmness. The symptoms went on in
this manner till the 27th of October, when he was suddenly seized
with violent and continued convulsion, and died in nine hours.

ei Inspection. — In the substance of the middle lobe of the left
hemisphere of the brain, about the level of the lateral ventricle,
there was a portion in a state of complete ramoliissement, about an
inch and a half in length, and an inch in its other dimensions, and the
neighbouring parts appeared unusually vascular. The tuber annulare
and Pons Varolii were softer than usual, but otherwise healthy. No
other morbid appearance could be discovered in the head, and all the
other viscera were healthy.

“ It is unnecessary to point out the very remarkable features in this
case. The sudden attack so closely resembling the ordinary paralytic
attack, must have been connected with the commencement of the in¬
flammatory stage. The remarkable symptoms in the stomach in the
farther progress of the disease, and the mode of its termination, make
it altogether a case of great value in the pathology of this remarkable
affection. The following case shows the same morbid appearance,
with a train of symptoms considerably different, but with a remaikable
similarity in the mode of its termination.

“ Case XXXI. — A gentleman aged thirty-eight, during two years
before his death had suffered several epileptic attacks, from which,
however, he had always speedily recovered. On the morning of 27th
December 1827, he was found in bed speechless and paralytic on the
right side. He recovered his speech in the course of the day ; the
palsy continued in the usual manner, and after some time he began to
recover a degree of motion of the parts. When he came to Edinburgh
about a month after the attack, he had recovered the use of his leg so
far as to be able to walk once or twice across his room with much

372

Critical Review.

exertion; his arm was improved in a much less degree; his speech
was distinct, but his mouth was considerably distorted, and his mind
was somewhat impaired. He now consulted Hr. Thompson, and under
the usual treatment he was progressively improving, so that at the end
oi another month he could walk along the streets to a considerable
distance, though with a dragging motion of his leg, and could nearly
raise his arm to his head. In the evening of 22d February he went
to a supper party, and seemed remarkably well ; but departed consi¬
derably Irom the abstemious regimen to which he had been previously
restricted. About eight o’clock on the morning of the 23d he was
found in bed in a state of insensibility, accompanied by severe and
general convulsion, which was strongest in the limbs on the right side.
I he face was much convulsed, the eyes rolling and insensible, the
respiration laborious and convulsive. Blood-letting and the other
usual means were actively employed without any relief. The con¬
vulsion continued unabated in the state now described, when I saw
him at eleven, and he died at two.

“ Inspection. — The brain externally was healthy, except some old
adhesion of the membranes near the posterior part of the falx, and
very trifling effusion under the arachnoid. The ventricles contained
the usual very small quantity of fluid. On the outer side of the left
ventricle, and separated from it by a thin partition of healthy cerebral
substance, there was a defined portion in a state of complete and
diffluent ramollissement. The portion thus affected was about an inch
in depth ; about half or three-fourths of an inch in diameter at the
upper part, and became gradually narrower as it descended by the side
of the ventricle, until it terminated almost in a point. There was
considerable softening of part of the medulla oblongta, and the upper
part of the spinal cord. No other vestige of disease could be disco¬
vered on the most careful examination.

u I do not attempt to offer any explanation of the symptoms in these
two most remarkable cases, or to reconcile them with the old notions
in regard to diseases of the brain. I give them as facts carefully
ascertained, and faithfully related, to be illustrated by farther obser¬
vations on this very remarkable disease.’’ — p. 89.

Dr. Abercrombie next describes two interesting cases of
tubercular disease of the brain, in which the symptoms were
widely different.

“ Case LXXXII—A man, aged thirty-six, about a year before
his death, bad a tumour extirpated from behind the angle of the jaw,
on the left side, and immediately after the operation, paralysis took
place in the left side of the face, in consequence of which his mouth
was distorted to the opposite side in a most extraordinary degiee.
About six months after this, he began to complain of headach, and
giddiness, which often gave him the appearance of intoxication, and
after some time these symptoms were followed by impaired vision,
occasional strabismus, and a considerable degree of deafness ; and at
last by drowsiness, coma, convulsions, and death. As these symptoms
advanced, he became affected with numbness, and loss of power of the

Dr. Abercrombie on the Brain and Spinal Cord. 3 J3

right side of the face, which increased very gradually. During the
increase of this, the distortion of his mouth gradually diminished, and
lor some time before his death, his countenance had become entirely
symmetrical Both sides of his face were now entirely paralytic, but
with this difference that on the right side, the feeling was also lost,
while on the left the feeling was entire.

Inspection.— -In the centre of the middle lobe of the rio-ht hemi¬
sphere of the brain, there whs a tubercle about an inch long and three-
fourths of an inch in breadth. At its lower part it was attached to
the cerebral substance, but the rest of it was detached, being surrounded
with dark coloured pus. In the vicinity, there was increased vascu¬
larity with softening of the cerebral substance.

I shall only add on this subject one remarkable case of a tubercular
mass of very great size attached to the falx, which must have existed
for a long time without producing any symptoms.” — p. 179.

Hie following very instructive case claims especial at¬
tention.

‘•Case XCI. — A servant girl aged about twenty, fell backwards
with a child m her arms, and received the full force of the fall upon
the most prominent part of the occipital bone. She soon recovered
from the immediate effects of the injury, but continued to have pain
in the part 3 and after several months, was seized with paraplegia and
retention of urine. She was now confined to bed for three or four
months, after which she recovered the use of her limbs in a tolerable
degree, but the retention of urine continued, and she came to Edin¬
burgh in the beginning of 1828, which was more than a year after the
accident. The paraplegia was now nearly removed, but she had still
retention of urine, requiring the constant use of the catheter. On the
seat of the injury on the occipital bone, a round portion, the size of a
ciown piece was acutely tender, and very moderate pressure upon it
produced complete insensibility, which continued a minute or two, and
returned as often as the pressure was repeated. It had the appear¬
ance of syncope, but the pulse was not affected. In this state I saw
her, along with Mr. Lizars, and it was agreed to make a free crucial
incision through the part, and to keep the wound open by dressings so
as to promote suppuration. In doing so the pericranium was found
tender and somewhat thickened, but the bone was sound. On the
following day she passed her urine freely, and she continued free from
complaint as long as the wound continued to discharge. It healed at
the end of a fortnight, and the retention of urine returned immediately.
The incision was now repeated with the same result as before, her urine
being freely passed almost immediately. Various means were then
efhployed to promote a more complete suppuration from the wound,
but it healed after two or three weeks, and the retention returned as
before, with considerable tenderness in the affected spot. A third
incision was then made with the same effect as before, and various
applications were made with the view of promoting exfoliation of bone
as in Sir Edward Home’s cases, but without success, and the wound
again healed after three or four weeks. The fits of insensibility on

374

Critical Review.

pressure now returned, which had not returned after the former inci¬
sions, and along with them the retention of urine.

“ Since that time repeated incisions have been made with similar
results. The principal change in her situation now is, that she has
got free of the fits of insensibility upon the spot being pressed ) and
the effect of the incisions has continued longer, as on several occasions
she has remained free from the retention of urine for several weeks
after the incisions were healed, and at one time enjoyed perfect health
for three months. — p. 20 6.

Observant physicians have long remarked that in certain
cases of retention of urine, there is some latent or mysteri¬
ous affection at the base of the brain or cerebellum, and this
case is a further proof of the validity of that opinion. About
a year ago we had witnessed a case in many points similar
to that just narrated, and which also went to confirm the
opinion of the connexion between the brain and kidneys ;
we shall therefore briefly detail it.

E. G. aged eighteen, of a leucophlegmatic habit, of ex¬
cellent general health, the digestive aud uterine functions
natural ; complained of intense pain in the right temple,
which arose without any evident cause. She was ordered
purgatives, arteriotomy, and cold lotions to the head. These
remedies had the best effects, but the next day the pain was
violent in the other temple, and she earnestly requested the
performance of arteriotomy ; which again afforded immedi¬
ate relief. In a few days she experienced a recurrence of
pain in the occiput, for which cupping was successfully em¬
ployed, and the bowels duly evacuated. All pain in the head
was removed, but she could not evacuate the bladder. She
remained in this condition for three months, and required
the use of the catheter twice and thrice daily. Her appetite
was natural, the uterine secretion healthy. The urine was
clear, limpid, and considerably increased in quantity. She
never experienced the slightest symptom of hysteria, prior
or subsequent to the disease. She had no perspiration dur¬
ing her illness. When the vicissitudes of the weather were
considerable, she often required the catheter earlier than
the ordinary visit ; and if not employed she experienced
much pain from the distention of the bladder, which she suc¬
cessfully relieved by copious libations of common gin. On
one occasion she had taken half a pint of that liquor, though
the bladder was distended to an immense size, for it extended
nearly to the epigastrium. The catheter was employed, and a
large wash-hand basin full of urine drawn off. She frequently
relieved her pain by the spirituous potation. Several medi¬
cines were exhibited, especially those recommended by Sir
Astley Cooper, in paralysis of the bladder, but all in vain.

Dr, Abercrombie on the Brain and Spinal Cord. 375

Blisters were applied to the sacrum, an open catheter left in
the bladder for hours daily, and all in vain. At length the
pain in the temple returned, and the retention of urine
ceased. The pain, however, continued so violently as to
induce wandering and slight delirium, when the arteriotomy
was again resorted to, and with perfect success, but the
retention of urine returned. She became weary of confine¬
ment to her apartment, and in open defiance to advice, went
out in a cold day to visit an acquaintance. Next day the
abdomen was tumid, and evident sense of fluctuation was
appaient, even after the use of the catheter. General anasarca
now supei vened, and the catheter was no longer necessary.

y the usual diuretic and purgative treatment her dropsical
symptoms disappeared, and she was restored to perfect
health. Several practitioners witnessed the progress and
treatment 01 this case. About six months after her recovery,
t le light arm became paralytic, which was ultimately re¬
stored by vesication on the neck, as near the origin of the
brachial nerves as possible.

This case affords many curious reflections, but we must

eave our readers to form their own opinions on its pheno¬
mena.

Another inexplicable form of cerebral disorder is what Dr.
Abercrombie has designated 6( Apoplexy without any morbid
appeal ance, or Simple Apoplexy A As this description must
be new to many practitioners, we are induced to insert it;
Our author proceeds thus : —

“ When a person, previously in perfect health, falls clown suddenly
depnved of sense and motion, and dies after lying for a certain time
in a state of apoplexy, and when on the inspection of such a case, we
cannot discover in the brain any satisfactory deviation from the
healthy structure, this is the affection which I propose to call simple
apoplexy. I abstain at present from any speculations in regard to the
natuie of this remarkable affection, and shall confine myself to a
statement of facts calculated to establish its existence as a disease of
the brain, which may in this state be fatal.

“ Case XCI1. — A woman, aged about thirty, of a full habit, some
years before her death, had been affected with symptoms in the head,
accompanied by impaired speech, and partial loss of recollection.
Some effects of this attack had continued for a considerable time,
especially in her speech, but by degrees she had perfectly recovered,
and enjoyed excellent health for a long period preceding the attack
now to be described. She was stooping over a washing tub, when
she was seized with a violent fit of sneezing ; she almost immedi¬
ately became insensible, and would have fallen down had she not
been observed and supported by some persons standing by her, who
carried her to bed in a state of perfect apoplexy. All the usual reme¬
dies were employed in the most active maimer without the least effect

376

Critical Review.

in alleviating any of the symptoms — she lay with all the symptoms of
the most perfect apoplexy, and died on the following day. On inspec¬
tion no vestige of disease could be discovered in the brain, or in any
other organ.

“ Case XCIII. — A gentleman aged-twenty four, had been observed
for some days to be dull and drowsy, and he frequently complained of
his head. Not having appeared at his usual time one morning, his
friends went into his room, and found him lying across his bed, half
dressed, in a state of perfect apoplexy. The attack was evidently
recent j and it was supposed that he had been seized while he had
stooped over his basin in washing. His face was rather livid, his
breathing stertorous, his pulse slow, and of good strength. All the
usual remedies were employed with assiduity, but through the day
there was no change in the symptoms. In the course of the night he
recovered considerably, so as to know those about him \ but in a short
time after he relapsed into coma, and died early on the following day,
little more than twenty-four hours after the attack.

“ Inspection. — There was a slight turgescence of the vessels on the
surface of the brain •, no other appearance of disease could be detected'
after the most careful examination. All the viscera were in a healthy
.state.

“ For the following very important case, I am indebted to my friend
Dr. Duncan } it occurred under his care in the Clinical Ward, in
May, 1829. '

“ Case XCIV.-^A man aged fifty-four, of a plethoric habit and
short necked, was admitted into the clinical ward on 30th of May.
He was in a state of nearly perfect coma, speechless, and with palsy
of the right side to such an extent, that even the intercostal muscles
of that side did not act. The leg and arm of the left side were
occasionally affected with convulsive motions. Breathing stertorous
— deglutition much impaired. Pulse 74. The affection was ot three
days standing, and had come on with vertigo — loss of vision-violent
headach and vomiting.

“ All the usual remedies were employed in the most judicious and
active manner without benefit. On the 1st of June, there seemed to
be a slight return of intelligence, but he soon relapsed into coma, and
died on the 3d, without any change in the other symptoms.

“ Inspection. — A most minute and careful examination was made
of the brain, without discovering any appearance of disease, except
that the choroid plexus seemed rather darker than usual, and the
basilar artery was diseased at one spot. By the side of the artery,
there was a spot of the cerebral substance, no larger than a barley
corn, which appeared somewhat softened, but even this Dr. Duncan
considered as extremely doubtful.

“ These I think, may be considered as fair examples of simple
apoplexy in its idiopathic form -7 I add the following examples of the
affection supervening upon other diseases.

“ Case XCV. — A lady, aged, 50, had been liable for many years
to attacks of cough and dyspnoea, which were generally relieved by
opiates and blistering. On the 20th of December, 1 816, she was

Dr. Abercrombie on the Brain and Spinal Cord. 377

seized with one of those attacks in the ordinary form. On the 22d
she was better, though her breathing was still considerably oppressed.
On the morning of the 23d, she complained of headach, and wished
not to be disturbed. Soon after this she appeared to her family to fall
into, a sound sleep 5 but some time after, it was found to be perfect
apoplexy, from which nothing could rouse her, and she died about five
o’clock in the afternoon. I saw her only an hour before her death 5
she was then in perfect coma j her lips livid, her breathing quick and
oppressed, and her pulse frequent and feeble.

“ Inspection. — On the surface of the brain the veins were turgid,
and the substance, when cut into, exhibited a remarkable degree of
vascularity 5 there was no other appearance of disease. The lungs
were distended, and much loaded with thin mucus, but their structure
was tolerably healthy. The other viscera were sound.

“ Case XCVT. — A lady, aged forty-five, had for three months
before her death, been affected with the following symptoms, nausea,
and a peculiar uneasy feeling about the stomach, particularly after
meals \ a feeling of distention of the abdomen, costiveness of the
bowels, anasarca of the feet and legs. The appetite was tolerable, and
the pulse natural, but from being remarkably strong and active, she
became feeble, sallow, inactive, and listless. A variety of practice
was employed for three months with little benefit 5 the anasarca gra¬
dually extended ; effusion took place in the abdomen, and there was
much reason to suspect that it had also taken place in the thorax 5
the pulse, however, continued of natural frequency and good strength.
On the evening of the 18th of May, 1816, she was observed to talk
hurriedly and incoherently. On the morning of the 19th, she was in
a state of stupor, from which at first she could be partially roused 5
but soon after mid-day it increased to perfect coma. She then lay in
a state of perfect apoplexy, with stertorous breathing and much moan¬
ing, the face rather pale, the pulse 72 and of good strength, and she
died on the morning of the 20th. The catamenia had been regular,
except at the last period, which should have happened about the 12th
of May.

“ Inspection. — No disease could be detected in the head after
the most careful examination. There was considerable effusion both
in the thorax and the abdomen. In the heart there was considerable
hardness about the root of the tricuspid valves. No morbid appearance
could be discovered in the other viscera.

(f I have already referred to various cases mentioned by the older
writers, in which apoplexy was fatal, without leaving any morbid
appearance j and others are related by later authors of undoubted
authority. A man mentioned by Dr. Stark, after complaining of
headach and giddiness, fell down in a state of insensibility, with
some convulsion. He then lay in a state of profound apoplexy for
forty-five hours, when he died. No morbid appearance could be
discovered in the brain on the most careful examination. A young-
lady, mentioned by Dr. Powel, after appearing for one day very heavy
and disposed to sleep, fell into a state of perfect coma, which was
interrupted only by occasional attacks of general convulsion. With-

VOL. ui. no, 17. 3 c

378

Critical Review .

out any change in the symptoms, she died on the third day. After the
most minute examination, no morbid appearance could he discovered
in the brain. Similar cases are related by other writers, and, upon
the whole, I think we have sufficient ground for stating it as a fact,
that there is a modification of apoplexy which is fatal, without leaving
any morbid appearance that can be discovered in the brain.” — p. 216.

These extraordinary cases fully corroborate the opinions
which we have of late advanced on the head symptoms in
the last stage of continued fever, and clearly demonstrate that
such symptoms are not always dependent on cerebral con¬
gestion or inflammation. These six cases annihilate the
theory which refers fever to congestion or inflammation of
the brain. Here we have all the symptoms of congestion or
effusion in the brain, and no morbid appearances of any such
Conditions could be discovered on dissection. We leave our
opponents to their own reflections on these cases. The
next case is one of great interest, as it shews the impropriety
of persons predisposed to apoplexy, frequenting crowded
assemblies. It is the most rapidly fatal case of cerebral dis¬
ease that has occurred to our author.

“ Case CXI. — A woman, aged fifty-four, who had been for several
years liable to headach, attended a crowded meeting on the evening of
25th June, 1829, and seemed in perfect health. Towards the conclu¬
sion ot the meeting she uttered a loud and convulsive scream, and
instantly fell down in a state of insensibility. She was immediately
carried out and was seen by Dr. Macauley, who happened to be pie-
sent : he found her pale and totally insensible, and the pulse feeble :
and within five minutes fiom the first seizure she was dead.

“ Inspection. — The integuments of the head were much loaded with
blood. On removing the dura mater, there was a thin but very exten¬
sive appearance of extravasated blood, or rather ecchvmosis, which
covered nearly the whole surface of the brain. In the substance of
the anterior lobe of of the right hemisphere there was a coagulum of
blood the size of a large bean. All the other viscera were examined
in the most accurate manner, but nothing was discovered, except a
tubercle on the liver, and a small spot of ossification on the abdominal
aorta.” — p 245.

The next case is one of ramollissement of the cord, which
was under the care of Dr. Alison and our author.

“ Case CXI.- — A gentleman, aged forty-two, in October ]S27
began to be affected with pain in the lower part of the back, stretching
round the abdomen, and frequently shooting into the groins. After a
short time this was succeeded by coldness and numbness of his feet,
which gradually, extended upwards with diminished power of motion,
until, after several weeks, it terminated in perfect loss of motion of
both lower extremities, with retention of urine. There was pain in
some parts of the affected limbs, and in others a painful sensation of

Dr. Abercrombie on the Brain and Spinal Cord. 879

cold. This perfect loss of power continued five or six weeks, when,
after a great deal of treatment by cupping, blistering, &c. he reco¬
vered a slight degree of motion, but no power of the bladder. He
then began to be affected with spasms of the muscles of the back and
abdomen, with a very uneasy sensation of tightness across the abdomen,
and at times across the lower part of the thorax. The spasms occa¬
sionally assumed the characters of opisthotonos, and at one time he
had almost incessant hiccup, which continued in a most violent degree
for several days. After the employment of various antispasmodics,
this subsided under the use of musk. During the course of these
symptoms, he frequently complained of pain in various parts of the
spine, at first in the lower part, and afterwards higher up*, and the
feeling of numbness extended gradually upwards, till it reached nearly
the upper part of the dorsal region, and was felt in a very considerable
degree along the sides of the thorax.

“ After this he became liable to feverish attacks at night, termi¬
nating in the morning by very profuse perspiration, but this was
strictly confined to the parts which were not palsied, and there never
was the smallest moisture on the lower extremities. He had, also in
the upper extremities, a frequent feeling of intense heat, while the
lower continued cold and benumbed. During this time a considerable,
hut very imperfect degree of motion continued in the lower extremities,
but the bladder continued entirely paralytic.

“ In April, 1828, he went to the country, and at this time he had
such a degree of motion as to walk a little on a smooth garden walk,
leaning on two persons, or supported by crutches. But soon after this
he began to complain of pain in the head. It occurred in irregular
paroxysms, and was often referred to a small defined spot, on various
parts, especially behind the ear, and sometimes to the tip of the ear.
This pain seemed to abate under the use of arsenic ; but soon returned,
and became more fixed and permanent, and the palsy of the limbs again
increased. After an absence of about two months, he returned to town
in the beginning of July. At this time the headach was severe, and
the power of the limbs so much impaired, that he was entirely confined
to bed. In a few days after bis return, the right arm became parayltic,
and his speech considerably impaired. After a day or two, these symp¬
toms rather subsided, but in the follwing night he became comatose and
died in the afternoon. There never was complete loss of sensation of
the affected limbs ; he had only complained of it occasionally at parti¬
cular spots, and ol a general feeling ot numbness and coldness.

“ Inspection. — There were some scales of bone attached loosely
to the inner surface of the dura mater of the spinal cord. The whole
cord was of a pale rose colour, and in a state of complete ramollisse-
ment through its whole extent, being in every part entirely diffluent.
The medulla oblongata was tolerably healthy, except a slight degree of
softening on its anterior part *, and there was also a degree of softening
on the tuber annulare, which seemed to involve the origin of the fifth
nerve. Beyond this, the ramollissement became again more decided,
extending along the crura cerebri and cerebelli, and considerably into
the substance of the brain, at the part adjoining the crura. The

380 Critical Review.

brain, in other respects, was healthy, and there was no effusion in the
ventricles.

“ It is difficult to trace the precise nature and progress of the
affection of the cord, when the disease advances in so gradual a manner
as in this case, and terminates in disorganization so complete and
extensive. In tracing the history of the analogous disease of the
brain, we found reason to believe, that it is originally an inflammatory
affection of a low chronic character, seated in a small part of the
cerebral substance } that it may continue for a considerable time in the
state of simple inflammation, and then subside } or that it may termi¬
nate by a permanent change in the structure of the part, generally
with some degree of induration. In this state we find it when the
patient dies of another disease, as in Case cxxviii. When it is
itself the fatal disease, it seems to be so by passing either into ramollis-
sement, or intopartial and unhealthy suppuration. It is probable that
the same character of disease takes place in the spinal cord } and it is
found, in the same manner, sometimes in a state of ramollissement,
sometimes in the state of induration, and sometimes one part is found
indurated and another softened. In a remarkable case communicated
to Dr. Ollivier by Andral, the affection began with numbness of the
forefinger of the left hand, which gradually extended over the hand
and arm. After some time the other hand and arm became affected
in the same manner, and, after a year, the lower extremities. All
the limbs then became paralytic, with permanent contraction, but
without loss of feeling. The legs were bent upon the thighs, and the
thighs upon the abdomen, and the arms rigidly fixed across the thorax,
with the points of the fingers pressed against the palms of the hands.
If attempts were made to move the limbs from these positions, they
were thrown into spasmodic contractions with much pain. The patient
died in this state at the end of eight days from the commencement of
the disease. Along nearly the whole length of the cord, there was a
central cavity full of a soft grey mucus. It was considered as arising
from ramollissement of the grey central matter of the cord, and the
parietes of the cavity were formed by the white matter in a healthy
state. In a case by Ollivier, in which palsy took place in the same
gradual manner, but affected only the lower extremities, the patient
was confined to bed for seven years. His legs were drawn up upon
his body, and were entirely motionless, but preserved their feeling.
There was extensive ramollissement of the anterior pillars of the cord :
and a very remarkable circumstance was, that the softening was
greatest in the upper parts of the cord, the corpora pyramidalia, and
several parts of the brain, and became less towards the lumbar portion.
The intellectual faculties had been almost entirely obliterated, but the
motion ofhis arms continued entire to the last. Such are the difficul¬
ties and obsc rities of this interesting subject.” — p. 364.

The next case is one of disease of the processus dentatus,
and is deeply interesting.

“ Case CXLVI. — A gentleman, aged twenty-two, of a scrofulous
habit , in the early part of his life had suffered amputation on account

Dr. Abercrombie on the Brain and Spinal Cord. 381

of a disease of the knee, and afterwards was liable to pectoral com¬
plaints with haemoptysis. In the beginning of the year 1828, he began
to complain of pain and stiffness of the neck, referred chiefly to the
left side of it, and much increased by the motion of the head. The
pain sometimes extended into the larynx, and backwards towards the
scapula. After considerable relief from repeated blistering, &c. the
symptoms returned, accompanied by loss of appetite, frequent pulse
and night perspirations ; and soon after this he became affected with
difficult deglutition, some dyspnoea and hoarseness. There was now
also severe fixed pain referred to the back of the head, and much
increased by the motion of the parts ; so that he was obliged to support
his head with both his hands when he had occasion to make any change
of his posture. He was next affected with paralysis of the tongue and
the upper eyelid of the left side. On 16th January, 1 829, he was seized
with paralysis of the left arm, and two days after the right was affected
in the same manner. He had then great pain and difficulty in passing
urine, with obstinacy of the bowels, which nothing could overcome.
On the 29th, the lower extremities became paralytic, and he died on
the 31st, having suffered greatly on the day on which he died, from
difficult breathing.

“ Inspection. — All the external parts of the neck, the pharynx, &c.
were healthy, and no disease was discovered in any of the vertebrse in
their external aspect. The brain and cerebellum were healthy, except
some increase of vascularity. Within the foramen magnum, and
attached to the inner surface of the dura mater at its interior and lateral
parts, there was a spongy tumour of a greyish-yellow colour, which,
when cut into, presented a variegated structure, resembling fungus
hsematodes. The processus dentatus was rough and carious on its
surface, and it was so much elongated as to project half an inch into
the cavity of the cranium. Its ligaments also were partially destroved
so as evidently to allow it to encroach upon the area of the spinal canal,
and to compress the cord. The spinal cord at the upper part was
flattened, but not materially altered in its texture.” — p. 408.

The remaining additional matter occupies forty pages, and
is entitled ct Outlines of Diseases of the Nerves.” Our
author thinks there is reason to believe that nerves are liable
to diseases analogous to the disease of the brain, and of the
spinal cord, which may affect their substance or membranes.
He gives the following as the principal idiopathic diseases
of nerves.

(i I. A uniform dark red colour of the nervous substance, occupying
a defined space, perhaps an inch or two in extent.

“ II. Serous or bloody effusion within the sheath of the nerve,
penetrating the substance of the nerve, and separating its fibres from
each other.

“ III. Pus effused in the same manner among the fibrils of the
nerve.

“ IV. Kamollissement of the nervous substance.

382 Critical Review.

“ V. Ulceration of the substance of the nerve was observed by Mr.
Swan in connexion with a fungous ulcer on the leg.

“ VI. Small tumours attached to nerves, and productive of violent
symptoms, have been described by various writers.

“ VII. Nerves have been found both very much enlarged and very
much diminished in size j and they have been in a few instances found
with the nervous substance destroyed, the membrane at the part iorming
an empty canal. But these points have not yet been sufficiently in¬
vestigated.” — p. 437.

Dr. Abercrombie gives a summary of Professor Bell’s dis¬
coveries, and adds many important practical remarks.

“ The important practical application of the discoveries of Mr. Bell
is, that there may be paralysis of the muscles of one side of the face,
producing distortion of the mouth with inability to shut the eye-lids,
without disease of the brain, and consequently without danger. This
affection depends upon a disease limited to the portio dura of the seventh
nerve, and may be produced by inflammation of the ear or the parotid
gland, or tumours compressing the nerve on any part of its course.
The most common example of it seems to originate in a kind of
rheumatic inflammation produced by cold, especially by exposure to a
current of cold air, as when a person has sat long, or has slept opposite
to an open window, or has sat in a carriage with a cold wind blowing
on one side of his head. It is to be treated chiefly by local remedies,
as topical bleeding, blistering, and the application of warm water or
steam. In this manner it is often speedily removed, but in some cases
proves tedious, and does not go off entirely for several months. The
affection is of course still more untractable, or even permanent, when
it depends upon a permanent cause, such as tumours compressing the
nerve, or destruction of a portion of the nerve by wounds or extensive
suppurations. There is also a very formidable modification of it which
depends upon disease of the temporal bone.

“ The character by which these cases are distinguished from paraly¬
sis depending upon disease of the brain, consists chiefly in the sensi¬
bility of the parts remaining unimpaired. The loss of motion also is
confined to the muscles of the face and eyelids, and does not affect
those of the jaw. These peculiarities arise from the remarkable facts
discovered by Mr. Bell, Mr. Shaw, Mr. Mayo, and others, that the
portio dura of the seventh is a nerve of motion only, supplying the
muscles of the face and the orbicularis of the eye, but not the muscles
of the jaw *, and that the sensibility of all these parts, and the motion
of the muscles of the jaw are derived from the fifth, which, having a
double origin, is a nerve both of sensation and motion. An important
distinction, however, is to be kept in mind in regard to the paralysis
of the eye-lids which occurs in these cases, namely, that it is the ina¬
bility to shut the eye that arises from the affection of the portio dura
of the seventh. The dropping of the upper eye-lids and inability to
raise it, is a disease entirely of a different nature ; it depends upon an
affection of the third nerve, and consequently gives more reason to
suspect disease within the head,

Dr. Abercrombie oh the Brain and Spinal Cord. 388

“ When therefore we find paralysis and distortion of the face, with
oss of sensation of the parts, we have reason to suspect disease within
the head, the portio dura of the seventh and the fifth being both
affected. But when we have the paralysis without diminution of sen¬
sation the disease depends upon an affection of the portio dura alone,
and may be entirely without danger. Such cases however are not to
be treated lightly, but the cause of them ought to be carefully investi¬
gated ; for if there be any reason to suspect that the affection depends
upon disease of the temporal bone, it may come to be attended with
danger by inflammatory action spreading inwards to the dura mater or
brain. I here is another modification also which requires to be watched
with anxiety, namely, when the affection is accompanied with deafness *
as this gives reason to believe that both portions of the seventh nerve
are affected, and consequently to suspect an internal cause.”— p. 441.

. °ur author quotes the writings of the principal practi¬
tioners of this and other countries in illustrating the diseases
of the nen es, and evinces an intimate acquaintance with the
rapid progress of medical literature. This work is one of
the best monographs that has yet appeared in this country
and it will have a place in every medical library. It is far
superior to the treatise of M. Ollivier on the same subject, and
will be consulted with advantage by every class of medical
practitioners, in the intricate and dangerous diseases which
it treats of so ably and judiciously. It is a highly creditable
addition to the medical literature of this country.

Sin Essay on the Connexion between the Action of the
Heart and Arteries , and the Functions of the Nervous Sys¬
tem ; and particularly its influence in exciting the invo¬
luntary act of Respiration. By Joseph Swan. London
Longman and Co., 1829 5

Mr. Swan is well known to our readers as a successful cul¬
tivator of physiology ; and his various works on the nervous
system have received the commendations of the most emi¬
nent members of the profession. In the present work he
has undertaken to illustrate the important functions of re¬
spiration, the cause of which is, perhaps, unknown. He
observes —

“ In the following pages I have stated my own opinions with very
considerable hesitation, but as the great secrets of nature are seldom
to be revealed but by the succeeding labours of different individuals
so I have contributed, what appeared to me sufficiently important for
extending our knowledge, not only on this interesting subject, but on
various points connected with it.” — p. iii.

A/r^rV^Wan com\nences subject with a quotation from
Mr. Hunter on Life, which that immortal man “ believed to
exist in every part of the aniraal body and then mentions

384

Critical Review.

the dependence of muscular contraction or irritability, which
is called into action by connexions of muscles with the
nerves and brain, and spinal marrow, but the motions of
some muscles are, in a considerable degree, independent of
their attachments. In proof of this assertion, he urges the
following facts : —

“ The fetus in utero moves before the brain and spinal marrow have
acquired any sort of perfection of structure \ monsters move also,
where there is a deficiency of the brain ; and some vegetables have a
similar power of contraction, which, however, seems to be directed by
external agents, and is, in some degree, like that in the muscles of
animals after their nerves have been divided.

“ It has been observed, that the heart is a beating point in the ru¬
diments of the chick on the fourth day of incubation, and at this time
no other parts are particularly developed. The cause of it begins
with the application of heat to an egg, which has been impregnated
and is endowed with the living principle. This beating point is a
phenomenon to be ascribed to one of the laws imparted by the Creator,
and for which it is impossible to account by any reasoning.” — p. 2.

Our author describes the irritability of the heart, and the
intricate and elaborate arrangement of its nerves in man ; ex¬
plains its connexion with the organs supplied by the par va-
gum and great sympathetic, and endeavours to show that
artificial respiration proves the action of the heart, in a great
degree, independent of the nervous system ; for “ if an animal
be decapitated, and artificial respiration be produced, its
action (the heart’s) is restored and continued so long as
respiration is performed ,” p. 5. — We very much doubt the
truth of that part of the sentence marked in italics ; nor are
we aware of any instances in which the heart s action was
thus continued longer than a very short time. But Mr.
Swan has exceeded former physiologists by the following
marvellous discovery : —

“ After tying the principal arteries of a puppy, I removed the heart
and lungs, and placed them on a table exposed to the air, and the
heart continued to pulsate for several days. The resemblance of its
internal structure to that of the amphibia, which has, at this period,
hardly ceased to exist, may, in some measure, account for this same
spontaneous motion. I do not wish to inculcate that nerves are requir¬
ed for the functions of the heart.” — p. 8.

It is to be regretted that lie did not deem it necessary to
mention the exact number of days during which the heart,
thus isolated, had continued to pulsate. Mr. Swan is of
opinion, that there is inherent in every muscle the living
power, termed its irritability ; and also the superadded one
termed nervous, which he believes are distinct, and exist in
different degrees according to the structure and uses of the

385

Mr. Swan on Respiration .

muscles. He thinks the heart possesses some independent
power, partly for this reason : —

44 And if the different organs which compose the body had not been
separately formed during the fetal state, they must have made an
equal progress during their growth, and the heart could not then have
possessed that prominent action, and almost perfection, before the for¬
mation of many other parts, which are of equal importance for the
well-being of the body after birth.” — p« 10.

Our author next describes the manner in which the arte¬
ries are supplied with nerves, and concludes, that when
secretion goes on in the bladder where the spinal marrow is
compressed, it is to be ascribed to the nerves of the arteries
which are almost entirely supplied by the grand sympathetic.
He observes —

44 Some physiologists have thought that secretion can go on with¬
out the influence of the nerves, but I think it may be doubted whether
those minute filaments which adhere to the arteries may not have
escaped their observation, and have promoted the secretion> although
less powerfully than before.” — p. 15.

He next proceeds to describe the structure of the brain
spinal marrow, and grand sympathetic, but in this descrip¬
tion there is nothing unusual. In speaking of the motion of
the brain, oifr author makes the following remarks, among
many others : —

44 Adhesions between the membranes, by preventing the free mo¬
tion of the brain, may impair the intellectual powers ; and an inflam¬
matory state of the arachnoid membrane, or its consequences, may
make the pulsations borne with much inconvenience. In the follow¬
ing case, the diseased appearances of the arachnoid membrane, lining
the dura mater, corresponded exactly with those on the surface which
covered the convolutions, and there were also many adhesions be¬
tween them ; and these, I conceive, prevented the free motion of the
brain, and produced the cloudiness of the mental faculties ; and, on
any exertion of the mind, when the circulation was quickened, caused
such irritation as disturbed the ordinary action of the brain.”—
p. 37.

A case is related in proof of this opinion, but Mr. Swan
ought to have recollected, that in the worst forms of mania
we find no traces of diseased appearances in the brain, or its
tunics. His case is therefore merely an exception to the
ordinary appearances. The succeeding 60 pages are occu¬
pied with an account of the structure and functions of the
grand sympathetic nerve ; in fact, more than half the volume
is disposed of before the author commences his description
of the involuntary act of respiration. After having describ¬
ed all the nerves concerned in effecting the functions of re¬
spiration, our author arrives at this conclusion : —

386

Critical Review .

“ It thus appears that the motion of the heart and blood-vessels sets
in action, and produces the regularity of respiration, and that it is ef¬
fected not only by the association of the nerves, hut principally by
the mechanical excitement of the nerves which pass over those parts
in motion. By the communications of the grand sympathetic with the
phrenic, and also with the dorsal nerves, an associatiou is produced
between them ; and the motions of the heart and the subclavian and
intercostal arteries stimulate mechanically the phrenic nerves, and the
branches of the grand sympathetic connected with them and the inter¬
costal nerves, at the same instant. The communications of the grand
sympathetic with the par vagum may produce an association between
these nerves and the lungs ; and some degree of the same impulse
may be also given to them by the lungs themselves.” — p. 109.

“ Presuming the nerves to be associated and excited for the pro¬
duction of respiration in the manner I have described, it becomes a
question how it is managed that they excite the antagonist motions
of inspiration and expiration. If the muscles of respiration perform
either one act or the other, according to the disposition of their fibres,
it is, nevertheless, difficult to understand how they are both executed
with so much alternate regularity.” — p. 113.

Mr. Swan is unable to explain this question, unless in the
following manner : —

t( It is a law of nature that the heart should contract a certain
number of times, in a given space, in ifian and animals ; and, no
doubt, the same law imparts similar commands on the diaphragm, by
making it contract a proportionate number of times also.” — p, 116.

He next gives a very full account of the nerves, subser¬
vient to respiration in the different classes of animals, which
proves him an excellent comparative anatomist; and con¬
cludes his work by citing the opinions of the principal phy¬
siologists on respiration. The works of Fleurens, Le Gal-
lois, Mr. Lawrence*, Mr. C. Bell, Drs. Philip and White,
and Mr. Hunter, are all laid under weighty contribution.

After a careful perusal of Mr. Swan’s work, we have been
unable to discover any new facts illustrative of the function
of respiration, if we, perhaps, except the author’s position,
that the action of the heart and arteries stimulate the respi¬
ratory nerves. He has certainly evinced a great knowledge
of human and comparative anatomy and physiology, and has
given a very luminous exposition of the functions of the
cerebral, circulatory and respiratory systems, so far as they
depend on nervous influence. Thus far, the work is ex¬
tremely interesting and instructive, and reflects much credit
on its talented author.

* Medico -Chir. Trans., rol. v. p. 107.

Mr. Stafford on the Treatment of Excavated Ulcer. 38 7

— An Essay upon the Treatment of the deep and excavated
Ulcer , with Cases. By Richard Anthony Stafford,
Member of the Royal College of Surgeons, and lately
House-Surgeon to St. Bartholomew’s Hospital. London,
1829.

Among the innumerable diseases incidental to humanity,
there are few more obstinate and painful than chronic ul¬
cers ; nor are there any which so often defy the resources of
the healing art. Mr. Stafford proposes a new, and appa¬
rently a very successful mode of curing them. He first de¬
scribes the usual process of granulation, and adverts to the
manner in which nature throws off foreign bodies from the
different parts of the system — *wThich is by granulations.
He illustrates this point by numerous examples. He states
“ that the received opinion of the mode by which a foreign
body is expelled, from the mass of the flesh is, that the part
situated above it, and nearest the surface, is progressively
absorbed ; but this is only half the process, for granulations
are formed beneath, which push it on until it arrives at the
surface/’ p. 8. This he exemplifies by the passage of pins
when swallowed, from different parts of the body ; and also
by the line of demarcation formed between healthy and gan¬
grenous parts. When a slough is removed the sore is co¬
vered by healthy granulations. This is further illustrated by
exfoliation of the external table of the skull, which, when re¬
moved, it is found that healthy granulations existed under it
and pushed it forward. Taking this for granted, our author
considered that the application of four parts of white wax
and one of Venice turpentine, melted and nearly cool, and
thus applied to deep-seated ulcers would act as a foreign body
and be thrown off by granulation, and his conjecture has
succeeded far beyond his expectations. The mode of appli-
tion is thus described.

“ It consists in pouring into the excavation melted wax, of an ex¬
tremely adhesive quality, and just at that temperature when it is on
the point of cooling, and will immediately become solid in the wound.
In this manner the under surface of the wax, when cold, comes into
close contact with the general surface of the ulcer, and the whole ex¬
cavation is filled by it. Before employing it, however, it is necessary
that one or two precautions should be taken : first, in order to clean
the sore, as much of the pus as possible which rests upon it should be
absorbed by dry lint ; and secondly, in order to avoid burning the pa¬
tient, the wax should be at that point of heat which is called by the
chandlers setting ; that is, a portion of it should cling to the sides of the
vessel in which it was melted, and the rest should begin to thicken, and
have somewhat of an opaque appearance. In this state it will not he

388

Critical Review.

at much more than blood heat, and it can be used with perfect safety.
It is advisable, however, even when so far cooled, that a brush be
dipped into it, and that the wax be allowed to drop Irom that into the
sore. After the wax becomes perfectly solid in the ulcer, a strip or
two of adhesive plaster may be applied over it, to keep it in its si¬
tuation , when it may be left until it requires to be dressed again,
which will be on the third day after its application. By pursuing this
method of treatment, it will be foand that healthy granulations will
be produced, and appear upon the whole surface of the sore \ that it
will contract j and that the healing process will proceed very rapidly,’

— P 4-

After many judicious remarks, the progress of the healing
process by this method is described.

“On the removal of the first dressing, the sore generally presents a
cleaner surface, being more reddened y and sometimes even in the
early stages granulations are distinguishable. After the second dress¬
ing they are commonly spread over the whole surface of the sore \ on
the third they partly fill up the cavity, which is much contracted \ on
the fourth it appears still less ) and so on until it is completely closed,
and then the skinning process commences. During the course of
healing, likewise, it may be observed, that the granulations are small¬
er, more compact, and more florid. The cicatrix also presents a more
even surface ; it is of a firmer texture, less tender, and does not ap¬
pear so likely to break out again as the scars of those ulcers which
have not been treated according to this plan.” — p. 14.

The advantages of the proposed plan are next detailed.

“ The superiority of this plan of treatment is, that the sore is
healed much more quickly, being, in fact, so rapid, that it is accom¬
plished in one-third of the time usually occupied, and with much
greater certainty than where the common methods are employed. It
succeeds also where no other remedy will, as may be seen by the
cases. It excludes the air from the wound, shielding it at the ^ame
time from external objects 5 it makes equal pressure upon its surface,
and thus supports its tender vessels , and it imitates the process which
nature herself pursues, the healing of a sore by scabbing. All these
♦are of great use ; for, in the first place, by the exclusion of the air,
much irritation and pain is avoided \ in the second, by the support it
gives to the tender vessels of the ulcer, the cicatrix is of a more firm
and solid texture ; and in the third, by the scabbing process, it is
healed in a more regular manner. In addition to these advantages,
the pain, when the wax is upon the sore, is so little, that many of the
patients have informed me that they have been almost unconscious, not
only of its presence, but even of the existence of the sore itself.

The treatment has proved successful in the following

cases : —

“In the open and excavated bubo ; ulcers ol the legs , indolent
scrofulous- sores j excavations in the flesh, inconsequence ot slough¬
ing phagedena ; ulcers situated over large arteries j sinuses, and fis-

Mr. Stafford on the Treatment of Excavated Ulcer. 389

tulous passages, that have been laid open ; the sores left by exten¬
sive burns, broken chilblains, and, in short, those of any depth, from
whatever cause they may arise. In most of the cases I have just
enumerated, the wax has been employed ; but more particularly
in ulcerated legs, open buboes, and scrofulous sores. In these, of
whatever character or description they may have been, the treat¬
ment has succeeded, and the healing process has been forwarded with
greater rapidity than where the ordinary applications have been used.
Its utility does not appear to be confined to any one particular state of
the ulcer. When it is extremely foul, and even covered by a sloughy
matter, as in Butler’s case, on the removal of the wax it has presented
a clean surface. Where the ulceration has been extending, its pro¬
gress has been immediately arrested, and it has shewn a disposition
to heal. When the sore has been connected with varicose veins on
the leg, it has been attended with equal advantage ; and when its
character has been of so languid and indolent a nature, that no re¬
medy could excite a healthy action, the stimulus and support of the
foreign body, that is, the wax, has, as it were, like a charm, produced
strong and florid granulations.”

Mr. Stafford next relates a number of cases to illustrate his
treatment; these include thirteen of old ulcerated legs, which
were all cured, and he adds, from 150 to 200 cases have
now been treated with success according to this method
eight of excavated bubo in the groin, in some of which the
femoral vessels were exposed, and yet cures effected. Two
cases of sloughing phagedena “ on the left thigh immediately
adjoining the vagina,’' and “on the left nates between the
verge of the anus and vagina,” both successfully treated.
He also relates a case of cancer scroti, in a chimney-sweeper,
which extended to the groin, exposed the femoral vessels, so
tjiat the finger could be passed into the cavity of the pelvis,
and the inguinal artery be felt pulsating beneath it. The
plan of treatment pursued was as follows : —

“ First, a piece of lint, as broad as the sore, was introduced be¬
neath Poupart’s ligament, to prevent the melted wax running into
the cavity of the pelvis, and one end of it was left out, and turned
back on the abdomen. The wax was then poured into the cavity of
the sore, when at a proper heat, and allowed to cool. On the second
day from its application the solid mass was removed, and it was
found that the artery and vein were covered by granulations, and the
cavity was less. These granulations, however, were of a cancerous
nature. The discharge, also, was less, and there was no venous
blood. The wound was again dressed in the same manner, with the
same result — granulations had considerably lessened the cavity. On
taking away the third dressing the cavity was half filled up, and the
discharge much diminished ; on the fourth it was still lessened ; and
on the fifth the granulations were nearly equal with the surface. It
was now necessary to leave off the wax, on account of a great deal of
inflammation being present around the sore. The inguinal glands of

Critical Review.

390

the right thigh also began to ulcerate; the ulceration again receded
in the left: at length the artery was exposed, and the man died from
hemorrhage.”

Four cases of scrofulous ulcers were treated successfully
in the same manner. This essay reflects much credit on the
author, and should the practice he proposes prove success¬
ful with the profession, he will have conferred a substantial
benefit on the numerous sufferers from a very painful and
hitherto intractable class of diseases.

V .- — Elements of Practical Midwifery , or Companion to the
Lying-in Room. By Charles Waller, Consulting Ac¬
coucheur to the London and Southwark Midwifery Insti¬
tution ; and Lecturer on Midwifery, and Diseases of
Women and Children, at the Medical School, Alderso-ate
Street, 18mo, pp. 132. London, 1829.

We cannot better explain the author’s object in publishing
the work before us, than in his own words, which are as fol¬
lows : —

“ It Is the author’s Intention, in the succeeding pages, to present to
the Student of Midwifery, in a condensed form, those rules which are
particularly applicable to the practical department of the science.

“ The frequent inquiries amongst his own pupils for a book of this
kind, will, lie trusts, be a sufficient apology for the present undertak¬
ing \ which is intended as a remembrancer in the lying-in room, and
consequently will by no means supersede the necessity of consulting
the more voluminous treatises on this inteiesting and important de¬
partment of medical science.

“ To the gentlemeu attending the author’s lectures it cannot fail to
be acceptable, as it will form a Syllabus of that part of the Course1 in
which the varieties of parturition are described ; and, should the sphere
of its usefulness extend no further, he will be amply rewarded for the
time he has devoted in thus condensing and revising, for their instruc¬
tion, the practical rules of the art and science of Midwifery. _ Pre¬

face, p. iv.

Mr. Waller has certainly succeeded in condensing the
leading practical rules in obstetric medicine, but we doubt
much whether humanity would be benefited by the obstetric
practitioner losing all sight of the numerous diseases inci¬
dental to women in the unimpregnated, pregnant, and pu¬
erperal states, which are now properly included in the term
obstetrics. The utter neglect paid to* those diseases by the
great majority of students, is too notorious, and hence the
mistakes which we daily observe in the management of female
diseases. If students would comply with the author’s advice

391

Mr. Waller on Practical Midwifery .

and consult “the more voluminous treatises on this interesting
and important department of medical science/’ then our ob¬
jection could not obtain, but that is scarcely to be expected,
for young men will generally take the shortest road to know¬
ledge. However the future general practitioners must de¬
vote more attention to the study of the nature and treatment,
of the diseases of women, on which they will be examined
by the Society of Apothecaries agreeably to the recent judi¬
cious regulations. 1 his is as it should be, for every man must
admit, that the obstetric practitioner will be more frequently
consulted in the numerous diseases of females than in cases
of parturition, which are much less fatal, according to the
opinions of the best writers on the subject. On this account
we think the work before us liable to objection. Even in
the execution of the work, we think the author by far too
concise in many of his descriptions. Thus, in his descrip¬
tion of the pelvis, he omits the joints, the contents of the
cavity, the internal and external genitals — in fact he de¬
scribes the osteology, and then proceeds to the considera¬
tion of “ labour.” His “ division of labours,” is also objec¬
tionable, and far inferior to many others which have been
proposed. He divides them into,' 1. Natural; 2. Preterna¬
tural; 3. Instrumental ; 4. Complicated. According to this
division it would strike the unitiated that there was no such
thing as manual operation. Again what are the complicated
labours but preternatural ? This classification though
adopted by many others as well as our author, is decidedly
unscientific ; but this is accounted for by recollecting the
utter neglect in which obstetricy had been placed in this
country until a very recent period. We think the division
of labours into natural, preternatural, manual, and instru¬
mental, or into natural and operative, much better than that
proposed by our author. In describing the process of natu¬
ral parturition, allusion is necessarily made to the parts
omitted in the anatomical description, which must puzzle the
student, or those who have not attended lectures on obste¬
trics ; e.g. “sacro-iliac synchondrosis, decidual vessels, pla¬
centa and membranes, &c. &c.” These are some points
which we think it our duty to notice, though, in general, the
rules laid down are those usually adopted. Thus our author
recommends the application of a long towel as a bandage
round the abdomen during the descent of the head, which
must be progressively tightened so as to keep up a constant
and uniform degree of pressure upon the uterine region.
This practice may be useful in tedious cases or in debili¬
tated habits, but is quite unnecessary in natural labour. In
fact few persons ever think of employing it. In tying the

392

Critical Review.

umbilical cord we are told to apply two ligatures “ of about
ten threads each.” The threads must be fine indeed, if
more than three be necessary. We have lately been called
to a case, where the practitioner secured the cord with a
skein of strong thread, and left the whole as an appendage.
Mr. Waller has given a good description of the mode of resus¬
citating still-born, or rather asphyxiated iniants, but he has
not advised the application of ardent spirit to the respiratory
nerves of the face — a plan long since recommended by our
justly celebrated preceptor. Dr. Hamilton, of Edinburgh.
Dr. Hamilton employed the practice for many years before
the splendid discovery of Professor Bell, for he had observed
on one occasion, respiration did not commence while a por¬
tion of the membranes covered the face of the infant. Mr.
Waller omits the use of the tracheal pipe so much recom¬
mended by Dr. Blundell. Our author describes the manage¬
ment of retained placenta very judiciously ; and for torpidity
or inaction of the womb he recommends half a drachm of pow¬
dered ergot in warm tea — on a former occasion he preferred
the infusion of this medicine, but the decoction is decidedly
the best mode of exhibition, mixed with milk and sugar.
The powder is often vomited, and is oftener adulterated, and
thus cannot be depended upon. Had we not been assured
that our author did not lately visit the Irish metropolis, we
were disposed to pass the following sentence unnoticed.
“ Unusual toughness of the membranes containing the li¬
quor amnii, occasionally though not very Jrequently, pro¬
duces increased resistance.” This sentence reminds us of an¬
other which emanated from a professor at modern Athens,
who observed, in describing certain diseases of the bladder,
that u frequent erections were not unfrequent.” We are in¬
duced to notice this phraseology, because we know our au¬
thor’s good sense and candour will readily enable him to
perceive the justness of our remarks, for the profession are
very sensitive and expect that every reviewer will do his
duty impartially. Did we not think the work before us cre¬
ditable to the author, and useful to those for whom it is in¬
tended, and certain of a future edition, we should not trouble
our readers with our remarks, nor point out those blemishes
which detract from its value. The term round pulse (p. 32)
also is liable to objection. Mr. Waller considers a plurality
of infants to come under the division of preternatural labour,
but if the vertex present in such cases the labour is de¬
cidedly natural. It must be admitted, however, in such in¬
stances that the vertex of one infant, and the feet oi another
are most commonly the presentations, and in the latter case
our objection of course cannot obtain. In speaking of pedal

393

Mr. Waller on Practical Midwifery .

presentations our author makes the following remarks as to
the treatment ; —

“ The most favorable position of the child in these cases is with its
toes directed to the mother’s back, as the head will, under such cir¬
cumstances, pass through the pelvis with much greater facility than
when they are placed in the opposite direction : if, therefore, upon ex¬
amination they are found to be thus situated, no interference is re¬
quired till the scapulae are about to pass through the outlet j it (hen
becomes of great importance to prevent the arms from being pressed
between the occiput and symphysis pubis ; for, if they become thus
wedged in, the delivery of the head will be rendered extremely diffi¬
cult. In order to prevent this occurrence, the fingers are to be in¬
troduced into the vagina, and the arms gradually and cautiously (for
fear of fracture) thrown backwards into the hollow of the sacrum,
from whence they may be easily extricated, by sweeping them, as it
were, over the perineum.”

If the toes of the infant be to the mother’s back, and the
body expelled to the scapulae, we are at a loss to compre¬
hend how it is possible that the arms, which are in the trans¬
verse diameter of the brim, can be wedged between the
occiput and symphisis pubis. The arms in such case will be
on the sides of the head, but certainly not in the position laid
down by our author. In such cases Dr. Hamilton recom¬
mends two fingers to be passed on the shoulder and arm to
the elbow joint and the fore arm depressed so as to bring
the palm of the infant’s hand over its face by a sweeping
manoeuvre, the perineum to be supported with the other
hand. This is obviously the best practice, and is that re¬
commended by most obstetric writers. We are totally
unable to account for the inadvertency of our author in the
above recommendation : his rules are, in general, excellent,
but there are some few exceptions. The description of the
operation of turning is accurate and judicious, if we except
the recommendation of expecting the expulsion of the infant
in a doubled state in arm presentations, p. 46, an event that
scarcely happens in one of ten thousand cases, but in p. 47,
he says, this process or spontaneous evolution is rarely to be
expected. This contradiction is calculated to mislead young
practitioners. The spontaneous evolution scarcely ever hap¬
pens at the completion of the term of utero gestation, but ge¬
nerally before this period. We are highly pleased with our
author’s remarks on the use of instruments, they are extremely
judicious, if we except his strong recommendation in favour
of the long forceps, an instrument exceedingly dangerous in
the hands of young men. Mr. Waller says, u the perfectly
straight ones are best, the curve, recommended by some,
answering no useful purpose;” here he differs from other
VOL. ill. NO. 17. 3 E

394

Critical Review.

writers. We have used both the straight and curved forceps,
and much prefer the latter. Some obstetric lecturers in this
city have recommended a straight, short forceps, a very
clumsy instrument, which, when applied, has its handles
resting on the perineum, and not in the axis of the outlet,
so that if traction be made in the line of the handle, the pe¬
rineum must be injured. Besides, if the handle be brought
into the axis of the outlet, the extremities of the blades must
injure the rectum, which cannot happen with the curved
instruments. Mr. Waller states that the lever is not so safe
as the forceps, and hence the latter is preferred 3 but here he
differs from most of the eminent practitioners. In using the
lever there is no danger of contusing the soft parts of the
mother, and hence it is a much safer instrument. Dr. Low-
der used no other instrument for many years of his great
practice. We have often been surprised at the slight degree
of pressure effected by the lever on tlie child s head, which
will change the position, and have found the lever a safe and
valuable instrument. In describing placental presentations,
Mr. Waller advocates the old practice of boring the pla¬
centa, here again he is at issue with many eminent writers,
Baudelocque, Rigby, Dewees, and many others. Our author
gives a clear and comprehensive account of the operation of
transfusion. In describing the treatment of convulsions
during labour, he advises the free abstraction of blood and
cold to the head ; in the majority of instances treated in
this way, he says no manual interference is necessary for
the purpose of expediting the delivery. In such cases we
believe the best practice is that usually recommended,
namely, to deliver the woman as soon as possible. We
cannot assent to the exhibition of from forty to sixty
minims of tincture of opium in all cases after natural labour
to restore the circulation to its equilibrium. This is not the
usual practice, nor is it necessary except in rare cases. An
anodyne draught, composed of half the quantity of opium is
the usual and best practice. How many thousands of puer¬
peral women do well without any opium ? In describing the
treatment of laceration of the perineum, our author recom¬
mends warm fomentations, poultices, &c. in place of endea¬
vouring to effect union by the first intention. If the louei
extremities be approximated, and simple dressings applied, so
as to prevent the irritation of the lochia and urine, union will
be readily effected by the adhesive process, which we need
scarcely observe is preferable to the suppurative. lhe
directions for replacing inverted uterus, when the organ has
escaped the os externum are also objectionable. Our author
advises the fundus uteri to be grasped by the hand so as to

Dr. W aller on Practical Midwifery. 395

double it upon itself, v and pressure to be made on it, passing
it through the encircling os uteri, and carrying the hand far
enough to return it completely to its natural situation.
This practice would be dangerous if a fold of intestines filled
the uterus, and, besides, that part next the pubis should be
first returned in the same manner as a strangulated hernia.
Who would think of pushing up the most depending part of
a hernia ? In speaking of retention of urine, our author gives
no directions for the passage of the catheter, though there
is not one student in a hundred will be able to perform the
operation without exposing the patient, a practice unjustifi¬
able and unnecessary in the present state of science. Such
are the objections which obtain against the rules laid down
in the work before us, and there are others equally valid.
Thus Mr. Waller has omitted the principal puerperal dis¬
eases, which destroy more women than the various forms
of parturition. He has said nothing of intestinal irritation,
peritonitis, enteritis, hysteritis, the malignant puerperal fever,
phlegmasia dolens, mania, excessive reaction after hemor¬
rhage, ephemera, &c. &c. So far as the work extends, it is
useful to students, or those who have not perused any other,
but it is little more than an exposition of a few of the many
subjects comprehended in obstetric practice. There is some¬
thing more than operations in the management of the phe¬
nomena and sequelae of human parturition, and any man who
thinks otherwise, will very soon be convinced of his error.
The great fault with the work is, its conciseness, and, neces¬
sarily, its omission of many important subjects that fall to the
management of obstetricians. These defects may be obviated
in a future edition. Upon the whole the work contains a good
deal of practical information, and proves the author to be
well acquainted with the practice of obstetric medicine.

ORIGINAL COMMUNICATIONS.

I. — Meeting of the Irish Apothecaries.

To the Editor of the London Medical and Surgical Journal.

Dear Sir, — You will have perceived before this can reach
you, the proceedings of the Apothecaries of this country,
which took place a few days since at the Hall ; but I am
induced to give you a full account, as I am led to imagine
the English press will not deem the affair of sufficient im¬
portance for their intellectual readers. I need scarcely inform
you of the history of Apothecaries’ Hall, of its acts, or its
abuses and delinquencies ; suffice it to say, that it was im-

396

Original Communicaiio n s .

bued with that purulent ichor which so remarkably charac¬
terizes every medical corporation in his majesty’s dominions.
Before I proceed further, let me offer you my best wighes for
your able exposition of our medical corporations in your
review of Dr. Morrison’s work. It afforded me sincere
pleasure to see one independent editor on the medical press,
one man who fearlessly exposed all the sancta sanctorum of
our profession, and did not pander or crouch to any one of
the venerable bodies — an accusation which I must say, can
be fairly made against all, even the most intrepid of your
contemporaries. Is there any one among these immaculate
worthies that needs not reformation ? I answer in the nega¬
tive, and yet why have some of them been passed over in
silence. But I am digressing, and must take leave to observe
that had the members of the profession at your side of the
channel a small portion of our feeling, the cause of reform
would not have retrograded as it has done. In a single
month, there has been more achieved for that cause, by the
proceedings which I am about to describe, than by all the
vapouring and intemperance which distinguish your reform¬
ers. Impelled by the invincible spirit of the immortal Brien
Boromhe^ the Munster delegates not only fought and van¬
quished the valiant knights of the pestle and mortar in Mary
Street, but then appealed to the Secretary of State, and ex¬
plained their grievances, which were listened to with respect¬
ful attention. Lord Leveson Gower heard the story of their
misfortunes, and promised to redress their grievances the
next session of parliament, while your reformers have been
writing for years and have effected nothing. You, who are
at the portals of power, you, who have bored us usque ad
nauseam , with your expositions, have done nothing. By
our proceedings the lamentable state of medical men in these
countries, ‘cannot fail to be exposed to public view in a few
months ; and reform will be the inevitable consequence.
Our apothecaries are not in a worse plight than yours, and
yet with ten thousand times more disadvantages have they
won the prize ; have they made an irreparable breach in the
citadel of corporate corruption. The old women of our Hall
were thrown into a catalepsy by the delegates, they even,
in open violation of their act of parliament, refused their Go¬
vernor admittance ; one would have thought they had quaffed
a spirituous potation of that powerful herb the nightshade ;
they are defunct, their elegy has been sung by that public
spirited and talented son of Esculapius, Mr. Kenney, of Wa¬
terford. I cannot better describe the accusations against the
Apothecaries’ Company here, than in the words of Mr. Ken¬
ny, which, in substance, were as follows : —

397

Meeting of the Irish Apothecaries .

“ Mr. Kenny then said, he would take leave to address the meet¬
ing for some time, and he felt that he had derived considerable advan¬
tage from the circumstance of these propositions being read. The
chairman had said, that the proceedings should not be secret or occult
and that in future, every qualified member of the profession should
have a voice in regulating the affairs of the body. There was, how¬
ever, one subject left untouched, to which he should direct his own
attention. He did not see in any of the propositions which Mr.
Madden had just read, any allusion to the mode of future election of
Examiners. Now, the only way in which a just notion could be formed
of future legislation, was, by taking a retrospect of the past, and in
looking to the past conduct of the board, every one must see that the
rock on which the board split, was self-interest (hear, and no). Self
interest was the Sylla and Charybdis where the directors lost them¬
selves. He (Mr. Kenny) did not throw out his own crude and undi¬
gested thoughts. He would produce documents to prove his asser¬
tions to be facts, and relying on the force of these facts, he would
say that the Hall had been originally got up on the principle of a
trading Corporation. Any man who could lay out 100/. in the con¬
cern, could become eligible to be chosen a director } and possessing
the talismanic paper of the Bank of Ireland, a man was at once ino¬
culated with the knowledge of pharmacy. So that self was the all-
observing principle which regulated the board. And no blame to
them to look to their own interests — every man situated like them
would do the same. The balance of power was taken from the body
of the profession, and deposited in the Hall — and as is the case in all
Corporations, which have within themselves the seeds of their own de¬
struction, corruption crept in and the consequences were now obvious
to every man in his senses. Self-interest supersaturated all their pro¬
ceedings (cheers). He and Mr. O’Reilly, notwithstanding the con¬
vention act, came there, as the delegates of the Waterford apotheca¬
ries, and they were determined to discharge firmly, but respectfully,
the duty they owed to themselves and to their numerous constituents.
They only looked to the best means of elevating the character and
rank of their profession, by exerting themselves to remove out of the
body corporate that intermixture of self, which had vitiated all their
proceedings (hear, hear). They only wanted to raise the profession
above a mere trade, and to free it from an incorporation with the
venders of parchment and sealing wax. There were two questions to
be asked : — First, was impartial justice done by the Court of Direc¬
tors j and secondly, was the Court so constituted as to secure the legi¬
timate exercise of its power ? Looking to the past, they would see an
easv solution to these questions. The answer must be negative.
Could any confidence be placed in a body, which, since 1791, had con¬
ducted itself and elected itself like the directors of this Hall ? Would
not every man recognize in this principle of election the rottennesss of
its essence, and see that it carried within itself the seeds of self-
destruction ? (hear, hear) He would bring forward documents and a
mass of evidence which must carry conviction into any mind. These
had been shewn in Limerick to Mr. Spring Rice, and he gave an ad-

398 Original Communications.

vice to the committee there, which they would follow. By these it
would appear manifest that the board had not acted either, fairly, ho¬
nestly, or honourably (cries of order and cheering).

The Chairman said he was sure a moment’s reflection would tell the
gentleman he ought not to persevere in this course (cheers).

Mr. Kenny continued. He did not mean to offer any insult, but
he was determined to take away the veil which at present fell between
the public and the true state of the case. The provincial apotheca¬
ries were shewn little courtesy by the Hall, and they would shew
little in turn. The first charge then, which he would bring against
the Hall, was the sale of diplomas. In 1826 there was formed in
Waterford, an association of regular apothecaries, to coalesce with
the Hall, in bringing to justice uneducated tradesmen, who had pre¬
sumed to vend medicine. Mr. O’Reilly was their secretary j and,
accordingly, he wrote to the Hall, complaining of one Harrington, a
stocking- maker, who had opened an apothecary’s shop in the town.
Mr. Lloyd, on behalf of the Hall, stated in reply, that the board would
feel pleasure in supporting the society, and would give every facility
in bringing the offender to justice. After this Mr. Lloyd wrote again
calling on the society to remit to the Hall 20/. for expenses that might
be incurred, and proofs besides. Harrington was fined 20/., which
the board kept, but they returned the 20/. they got from the society.
However, Harrington afterwards came to Dublin, and for 20/. got
his diploma from the Hall — although they at the same time refused to
examine one of his (Mr. Kenny’s) apprentices, who had served seven
years, and was in every respect qualified to discharge the duties of an
apothecary. The cause of the refusal was, that the young man had
not attended, according to a bye-law of the Hall, lectures on phar¬
macy, &c. for six months. The only reason assigned for granting
the diploma to Harrington was, that he had been fined. So that a
violation of the law constituted a ground for receiving a favour. Mr.
Kenny, in a most eloquent speech of great length, adduced several
other charges of a similar nature against the board — and concluded
amid tremendous applause, by moving the appointment by ballot, of -a
committee of twenty-one, to draw up a report of the plan of a bill
which they might think fit to submit to Parliament, upon the state of
the profession as at present conducted, and to regulate the future ma¬
nagement of it.’’

Mr. Donovan, one of the most able chemists in the empire,
and Governor of the Hall, was in the chair, which liberal
conduct well accords with his love of science, and his ee sin¬
cere desire of advancing the dignity and honour of the
profession in general.” The following outline of a bill was
proposed by the Hall, and agreed to by the Meeting.

1. That the times of apprenticeship be reduced from seven to five
years.

“ 2. That no person shall be henceforth entitled to his examination
for the degree of a licentiate, until he shall have served five years with
an apothecary regularly qualified.

399

Meeting of the Irish Apothecaries .

<c 3. That no person shall be admitted to his examination for ap¬
prenticeship, betore the age of fifteen years.

“4, The testimonial of a medical examiner to be indispensable for
the examination of a licentiate.

“ 5. That due notice be given by the person to be examined.

“ 6. Licentiates to pay ten guineas, assistants and apprentices two
guineas before examination. This money to be returned in case of
rejection.

“ 7. An annual list of the names of licentiates to be published.

“ 8. Persons employing unqualified assistants, to be liable to a
penalty.

u 9. Compounding medicine to be a sufficient test to convict offen¬
ders.

u 10. Persons getting a medical diploma to be eligible as licenti¬
ates on producing a certificate of three years’ apprenticeship to a re¬
gularly qualified apothecary.

“11. That the governor, in order to prevent fraud, shall be em¬
powered to administer an oath to the person under examination,

“ 12. (We did not hear the twelfth proposition.)

“ 13. No Apothecary to grind or sell arsenic where medicine is
sold or compounded.

“ 14. No person to sell Prussic acid, sulphuric acid, or any other
acid, without writing the name of such upon the label and markino-
the word “ poison” under it. [Narcotics ought to be included.]

“15. No person, unless a qualified apothecary or druggist, to sell
medicines.

“ 16. Druggists to register their names and residences at the
Hall.

“ 17- Druggists and apothecaries to inform the Hall of any change
they may make in their residence.”

On a subsequent day, the Governor was refused admittance,
when a scene arose which baffles all description. The dele¬
gates repaired to the office of the Secretary of State, and ex¬
plained their grievances and were promised redress. I should
apprehend that discussion will effect much improvement, for
all we want is to apprize the public of the degraded state in
which Well educated men are placed, and the delusion which
blinds the same public with regard to quackery will speedily
vanish. What has become of surgical reform in London ?
Has it shared the fate of general reform ? Gone, gone to the
tomb of the Capulets. Your reformers are too phlegmatic,
they want that ardour of feeling and unanimity which we
have lately witnessed here. What has become of the Law¬
rences, the Tyrrells, and hoc genus omne ? Have they de¬
serted their friends, and joined their enemies ? The ancient
fabrics, based on the sandy foundation of monopoly, totter to
the ground, and require renovation to save them from utter
ruin. They are not suited to the taste and wants of an en-

403

Original Communications.

lightened generation. It is the interest of their conservators
to support them, however defective, as long as possible ; and
those timid and pusillanimous men who expect improvement
from them, are worthy of the insulting treatment they
receive. To reform these deiapidatcd fortresses we must
make a general effort, “ a long pull,, a strong pull, and a
pull altogether/’ No half measures will be effectual ; a ge¬
neral attack is indispensable, and I can see no reason why
the great bodies of physicians, surgeons, and apothecaries
should not rise cn masse , and unanimously demand the resti¬
tution of their rights and privileges. Let them meet and
detail their grievances and the evil doings of those to whom
the power of protecting them has been entrusted ; and
above all let their proceedings come before the public, and
then and not till then, shall reform be effected.

I fear I have trespassed too much on your patience, and
must conclude, by assuring you of my best thanks for your
advocacy of reform. eblanensis.

Dublin, Oct. 10th, 1829.

II. — Extract from a Lecture on the Practice of Medicine .

By Michael Ryan, M.X).

Medicine is the most ancient and noble of all the arts and
sciences. The first and most authentic history of the uni¬
verse confirms the truth of this fact ; for it informs us, that
the first of the human species was rendered liable to corpo¬
real infirmity immediately after his creation ; and, hence the
natural inference, that he was impelled by the innate prin¬
ciple of self-preservation, to employ means for the relief of
his sufferings. Thus, the healing art was nearly coeval with
man, and must have occupied his attention in the first days
of his existence. The vicissitudes of season, the varie¬
ties of climate, the influence of the circumambient atmos¬
phere, the action of surrounding bodies, and the construc¬
tion of the human frame, must have rendered disease nearly
coetaneous with mankind. The presence of bodily infirmity
produces pain, and impels man to seek immediate allevia¬
tion, and to employ means for that purpose, either by in¬
stinct, experiment, or spontaneous exertion. The many in¬
juries and accidents to which he was exposed in the early
and rude ages, must have frequently obliged him to suppress
hemorrhage, to remove the deformity of dislocation, and
to adjust the painful fracture. Thus necessity conceived the
art of medicine, reason nourished it, long use promoted it,
and experience at length completed it, and made it absolute.
The foundations of this art among mankind were laid by

401

Djl\ Ryan on the Practice of Medicine .

chance, instinct, and unforeseen events ; and these were im¬
proved by the success and recollection of former experi¬
ments. In the primitive ages, medicine was promiscuously
practised, every man having been his own physician ; but,
after a great lapse of time, from reasoning on a number of
observations, experiments and remedies ; and from a com¬
parison of events already observed with those of daily occur¬
rence ; it became a liberal art, and was practised by certain
individuals only; some of whom were appointed for the
treatment of particular diseases, and others for diseases in
general. Such was the manner of cultivating medicine even
after the deluge, by the Egyptians, Babylonians, Grecians,
Irish, Portuguese, Germans, Indians, Assyrians, and Chal¬
deans ; and hence it passed into the islands of Cnidos,
Rhodes, Cos, and Epidaurus. The names of the diseases,
their remedies, and events, were at first handed down from
father to son, and at length were inscribed on the walls and
paintings of the public temples. A system of medical in¬
struction was formed from these sacred records, which all
were obliged to follow in the cure of diseases ; which law
alone was the cause of the extermination of thousands, and
continued to prevail until certain individuals were allowed to
devote themselves entirely to the profession. Ancient me¬
dicine, like all the early transactions of mankind, is a mix¬
ture of monsters, giants, demigods, and fables ; and hence
there is a sufficient excuse for passing over the medical skill
of Hermes, Bacchus, Apollo, Hercules, and Chiron the Cen¬
taur. Without troubling you with the legends and dark
archives of antiquity, relative to this sera of the history of
medicine, he may be reminded of Ovid’s allusion to Apollo,
as the inventor of physic, in the following lines, which grace
the armorial bearings of one of our medical corporations at
present : —

“ Inventum medicina meutn est, opiferque per orbem

Dicor, et herbarum subjecta potentia nobis.’’

Met . i. 512.

But the first authentic account of physicians, is that of
Moses, in the c. 50 of Genesis, in the year of the world 2315,
and before the Christian sera 1689 ; and it appears that he
became acquainted with the practice of embalming the dead,
and with the management of many diseases. — Lev. c. 12-16.

Much fable, however, exists concerning iEsculapius, the
reputed father of medicine, and his life and period of birth
are involved in obscurity. He is said to have derived his
medical skill from the tablets in the Grecian temples ; and,
according to Clemens of Alexandria, to have delivered it to
his sons Machaon and Podalirius, who, though kings, were

VOL. Ill, NO. 17. ^ F

402

Original Communications .

surgeons to Agamemnon during the Trojan war, but declined
to undertake the cure of the pestilence which prevailed at
that period. They are justly considered the earliest sur¬
geons, and are not forgotten in the armorial bearings of the
British Colleges of Surgeons. They flourished about 1000
years before the present sera. About this period, Solomon,
and many of the prophets, cultivated the healing art ; but it
did not exist as a distinct profession until the time of Hip¬
pocrates, which was 460 years anterior to the nativity of the
Saviour. This was the author who first separated the heal¬
ing art from the study of religion and philosophy, and re¬
duced the chaos of his predecessors to a noble and dignified
profession he it was who first gave it the air of a science ;
he found it a skeleton, and clothed it with flesh, colour, and
complexion ; he embraced the cold statue, which, by his
touch, became life, sense, and beauty ; and his immense
works survive the vagaries which have passed through the
crude minds of thousands of giddy innovators. Hence he
is justly esteemed the father and the founder of physic. He
is thus spoken of by all his distinguished successors, and
especially by Galen : — u Verax, probus, magnus, omnium
philosophorum et medicorum princeps ; magister diligentissi-
mus nobilissimus, dux et auctor omnium disciplinarian, max-
ime admirandus, divinus senex, venerandus, vir qui nihil frus-
tra unquam dixit, aut scripsit. Vir etiam in minimis diligen-
tissimus ; et nunquam satis pro dignitate commendatus.,>
Many of the medicines now in use were recommended by him;
and he acted as physician, surgeon, obstetrician or accoucheur,
apothecary, and even nurse. The duties and qualifications
of medical men were never more fully exemplified than by
his conduct, or more eloquently described than by his pen.
But of these more fully hereafter. He admitted no one to
his instructions without the solemnity of an oath> the chief
obligations of which were, 66 the most religious attention to
the advantages of the sick, the strictest chastity, and most
inviolable secresy concerning matters which ought not to be
divulged.” His successors to thepresent aera were Aristotle,1
Theophrastus,2 Diodes, Praxagorus Cous, Herodicus, De¬
mocritus, Herophilus, Erasistratus,3 Ascleipiades,4 Dioseo-
rides,5 Musa,6 Serapion, Themison, Antonius, Euphorbius,
and Cassius Faelix. Such are the eminent medical writers
to the commencement of the first century ; from which pe¬
riod, to the dark ages, flourished Celsus,7 Largus,8 Rufus,9
Araeteus,10 Galen,11 Soranus,12 Oribasius,18 Paulus iEgine-

1 A. C. 384. a A. C. 381. 3A.C.324. 4A.C. 105. *A.C.68. 6Musaand

others in the first century. 7 A. D. 37. 8A, D.41. 974. lb99. “131. i*250.

•3 820. v

403

Dr. Ryan on the Practice of Medicine.

tus,14 iEtius. Alexander Trallianus,15 Aaron,16 Mesne,17 Rha-
s,es,ls Avicenna,19 Avenzoar, Constantine,20 of Carthage, Al-
bucasis21, and Abi Osbia. From this period to the com¬
mencement of the 16th century, the arts and sciences were
neglected ; a long and dark night of oblivion overshadowed
mankind; the human mind was enervated, depressed, and
sunk into the most profound ignorance ; and the lamp of
science seemed nearly extinguished in almost every part of
the western empire. A few eminent physicians flourished
even during this time, Giibertus Anglicus, Geddesden, the
first English court physicisn, Coelius Aurelianus, Linacre,
the founder of the Royal College of Physicians of this metro¬
polis (1518), Cornaro, Sylvius, Fracastorius, Paracelsus* *
Berengarius, Lommius, Pard, Servetus, Caius, Vesalius, Coe-
salpinus, Forestus, Fallopius, and many others, lived about
this period. Having arrived at the date of the foundation
of the London College of Physicians, a pause may be made,
and a brief account of the esteem and veneration which all
the ancient nations entertained for the healing art, may be
detailed.

11. — Esteem and Veneration for Ancient Physicians.

Hippocrates observed in his book on ancient medicine,
that the inventors of the art ascribed its origin to the Deity,
in which he concurred. Galen was of the same opinion.
The knowledge of the medicinal properties of plants and
animals, wras propagated by the first of the human species,
and afterwards increased by the industry of succeeding gene¬
rations, who gradually progressed in the acquisition of me¬
dical science, in the manner already mentioned *. In ancient
times, medicine was of such venerable esteem, that the in¬
ventors and improvers of it were accounted gods, and fre¬
quently styled the sons of gods. The heathens believed it
came by inspiration ; and even the Christians held the same.
St. Austin, de Civ. Dei, says— u Medicinal non invenitur un¬
de ad homines manare potuerit, nisi a Deo.” “ In nulla re,”
says Cicero, u homines propitis ad Deos appropinquant,

14 350. ,5550. ,6620. >7801. l8850. »9980. 9O1085. 1100.

* The ancient philosophers and medical writers have contended, that the
Omnipotent Author of the universe instructed the parent of mankind in the
nature and uses of all created things ; and hence they have inferred that lie was
apprized of their sanative and noxious properties. They also quoted, the Book
of Ecclesiasticus, wherein it is said, “ The Lord created medicines out of the
earth, and a wise man will not abhor them. Honour the physician for the need
thou hast of him, for the Lord hath created him. His art is an honourable one,
and shall exalt him before the mighty ones.”— C. xxxviii. It may be remarked
that this, as many other books of the inspired volume, are denied to be authentic
by the Established Church of this country; and have been excluded in her ver¬
sion of the sacred writings, though admitted by other sects of Christians. Other
references are made to the healing art in Exod. c. 21. Eccles. c. 47. Isias^e. 3.

404 Original Communications.

quam salutem hominibus dando.” Seneca observed, de
Beneficiis L. 6. “ quaedam pluris esse, quam emuntur : emis
a medico rem inestimabilem, vitam ac valetudinem bonam.'7
How expressive the sublime and beautiful language of Sterne
in his description of health, when he says, “ O blessed
health ! thou art above all gold and treasure ; Tis thou who
enlargest the soul, and openest all its powers to receive in¬
struction and relish virtue. He that has thee, has little
more to wish for ! and he that is so wretched as to want
thee, wants every thing with thee.” It is a certain matter
of fact, that medicine was encouraged, cultivated, and prac¬
tised, by kings, princes, philosophers, and pontiffs ; the
highest, wisest, and best of men. Thus Solomon, Saphoris,
and Gyges, kings of Persia ; Habidus, king of Arabia ;
Mithridate, king of Pontus ; Mesue, nephew to the king of
Damascus ; Avicenna, prince of Cordova ; Isaac, the adopted
son of the king of Persia; Nicholis V., and John XXII,
Roman Pontiffs, have illustrated medicine with their writ¬
ings. Homer records the high esteem entertained for Ma-
chaon and Podalirius, in the Grecian army ; Virgil that for
lapis, the physician of /Eneas ; and Silius Italicus, that of
Synalus the physician of Hannibal. The physician Philip
was the favourite of Alexander ; Timocleas and Nicias of
Pyrrhus ; Dioscorides, of Antony and Cleopatra ; Musa, of
Augustus ; Galen, of the Antonines ; and Oribasius, of
Julian. All civilized nations conferred the highest privi¬
leges and honours on the practitioners of medicine. A few
examples may be cited : —

III. — Rank , Privileges , and Honours of Ancient Physicians .

It is almost unnecessary to allude to the numerous tem¬
ples dedicated to fEsculapius, an account of which will be
found in the ancient history of Greece, and of other eastern
nations. Those erected at Epidaurus, Cos, Pergamus, and
Cnidos, were the most celebrated. The Athenians honoured
Hippocrates with an initiation into the grand mysteries, a
boon which was not conferred since the time of Hercules.
They presented him with a crown worth a thousand pieces
of gold, the freedom of Athens, and a splendid maintenance
at the public expense. The history of all ages and nations
evinces evidence of the high distinctions conferred upon the
cultivators of the healing art. The ancient Romans con¬
ferred great honours on the faculty. Julius Caesar made
them all denizens ; and Augustus banished all other Greeks
from the city except physicians. Constantine commanded,
(i that physicians, their wives and their children, with their
property, should be free from every duty, and from all im-

' 405

Dr. Ryan on the Practice of Medicine.

posts whatever. — Inst. B. 6. Argacathus was the first alien
who had the honour of having been made free of Rome.
The most wise and prudent emperors and kings have always
considered the importance of the healing art, and have been
ever solicitous of having learned and experienced physicians
to preserve their own and their subjects' health ; and hence
ancient and modern rulers conferred the highest privileges,
immunities, and honours on the cultivators of medicine.
Great were the rewards bestowed upon them in every nation.
It was deemed right to have them supported by the state in
many countries. In the book of Ecclesiasticus, already
quoted, it is said, “ the physician shall receive his reward
from the king." In further illustration, the letter of Arta-
xerxes, the great king of Persia, to Hippocrates, might be
quoted, in which he offered that unequalled physician “ as
much gold as he pleased, and all other necessaries, if he
would cure the Persians of a pestilence"; to which the noble
and magnanimous physician replied : — “ We sumptuously
enjoy food, raiment, and all the necessaries of life. It is not
lawful for us to accept the wealth of the Persians, nor free
barbarians from disease, when they are the enemies of our
country. The king of the Persians is ignorant that with
me a knowledge of science is preferred to gold." With that
fraternal conduct which ought ever to distinguish the pro¬
fession, he sailed to Abdera, to visit his distressed friend and
contemporary Democritus. Such was a splendid instance
of patriotism and medical ethics. Erasistratus, son of Aris¬
totle’s daughter, having cured King Antiochus, received a
hundred talents from Ptolomy, father of that prince, which
was equal to 15,000/. of our currency. Pliny has given this
account, and also has informed us, that Cassio, Calpitano
Aruntio, Albutio, and Rubio, who were successively state
physicians at Rome, received two hundred and fifty sesterses
annually, a sum equal to 1562/. British. Thaddaeus, a Flo¬
rentine, would not leave the city for less than fifty crowns a
day ; having been sent for to Rome to cure Pope Honorius,
he returned home with 10,000 crowns, fora short attendance.
Phalaris gave Polycletus four phials of pure gold, two cra¬
ters of silver of ancient workmanship, ten pair of Thericlian
cups, and 50,000 attic crowns. He also presented him with
the salaries of Admiral and Captain of the army, and com¬
plimented him farther, by observing, “ he was not able to
pay what the obligation of curing him merited." When
Melampus had cured the daughters of Prsstus, king of the
Argives, he received a third of that Monarch’s kingdom, a
third was also bestowed on his brother, and each was pre¬
sented with one of the princesses in marriage. The Great

406

Original Communicai ions .

Mogul, who reigned in India about the 17th century, allowed
his physician 100,000 crowns a year. Nysa Mollucus, king
of India, gave Garcias, a Portuguese physician, 12,000 par-
does, which were then estimated equivalent to as many
ounces of silver. Philip 11. of Spain gave 6000 crowns for
a short attendance, to his physician, Vallesius. Louis XI.
of France, gave his physician, Coctiere, 10,000 crowns a
month, the bishoprick of Amiens, which contained 498
parishes, to his nephew, and many other offices of profit to
himself and his friends. Numerous other examples of the
immense rewards bestowed on physicians might be men¬
tioned ; but allusion shall be made only to those common in
this country. During the early part of the last reign, the
state physicians, serjeant-surgeons, and surgeons, received
2000/. a year each ; and there is the strongest presumption
that the present state medical officers are as amply, if not
even more bounteously rewarded, by the most magnificent
and magnanimous Monarch who has swayed the British
sceptre since the days of Alfred. It is impossible to esti¬
mate the immense emoluments conferred by the private
generosity of the Sovereign, and the patronage necessarily
attached to the distinguished station of court physician and
surgeon. On a recent occasion, his Majesty has presented
Mr. O’Reilly, surgeon at Windsor, with 1,000 guineas for a
few days’ attendance, and was graciously pleased to appoint
him his domestic surgeon, at a salary of 2,000/. a year.
Having premised this much on the rewards of the medical
practitioners, a few remarks may be introduced on the edu¬
cation and qualifications of the profession in former times.

(To be Continued.)

III. — Case of Puerperal Convulsions , Mania , Sloughing of
the Genitals — Death. By Michael Ryan, M.D.

The subject of this case was aged 27, of a full habit, san-
guineo- bilious temperament, irascible disposition, and much
distressed by severe cough and obstinate constipation. She
was also labouring under great mental dejection, as this was
her first pregnancy, and she having been deserted by her
husband, and her means of support extremely limited. She
had applied to one of the dispensaries for her chest com¬
plaint, and was under the care of one of those gentlemen
whose code of professional faith would not permit him to
take the derangements consequent to utero-gestation into his
consideration. The consequence was that this woman’s .
bowels were totally unattended to, and were confined for
the period of a whole month previous to her confinement.
On the 4th of September last she was seized with the ordi-

Dr. Ryan on Puerperal Convulsions, $c. 407

naiy symptoms of parturition, and on the 5th with convul¬
sions. Hei attendant called in an eminent obstetrician from
the west end of the town, who found the uterus undilated,
and ordered her to lose Oij. of blood, and to have the follow¬
ing medicine.

ft. Submur. Hydrarg. gr. vi. statim, et Inf. Sennae c.
Magn. Sulph. m. s. ad alvi solutionem.

Sept. 6. Seven, a.?n. I was requested to see her, and on
entering the apartment was informed the infant was just ex¬
pelled— that she had had several fits during the last hour.
Respiration stertorous, face pale, tongue bleeding freely
from injury, inflicted by the teeth ; pulse extremely small
and soft, easily compressible— 120 ; pulsation of the tem¬
poral and carotid arteries very rapid 5 total insensibility ; ute¬
rus contracted; no hemorrhage. Having waited some time in
hopes of her reviving, as the cause of her sufferings was
removed, vinegar was applied to her lips, face, forehead and
temples, but as no sign of improvement appeared, the pla¬
centa was extracted, and Jxij. of blood were abstracted from
the temporal artery. Her attendant now arrived, and con¬
curred in the propriety of the practice employed. Sinapisms
were applied to the feet and ankles, and a purgative enema
recommended. Cold to the head.

Eleven, a.m. No return of the convulsions; appears
to be in a natural sleep ; countenance more natural ; pulse
still small and rapid ; no effect from the enema. She is
quite insensible. Reptr. enema.

Seven, p.m. Symptoms as at last, except that the bowels
have been freely opened ; dejections copious, black, fetid,
and scybalous ; pulse still small and weak ; great prostration
of the vital powers ; scarcely any lochial discharge ; was or¬
dered the following remedies.

ft. Camphorse 3ij. ; Magnesise Carb. ^ss. ; Sacch. puri Jj • y
Aqua? Bullients

M. Sit Mistura dequa sumatur semuncia 2da vel 3tia qua-
que hora.

6th. Slept well, 110 return of convulsions ; pulse frequent
and small ; no appearance of milk or lochia ; complains much
of the effects of the sinapisms ; mind still confused ; head-
ach. Cont. Mistura Camphorae. Renovetur lotio frigida
capiti.

7th. Symptoms as at last report.

8th. Pulse rapid and still small, though fuller ; counte¬
nance wild ; great volubility of speech, repeats questions and
all conversation ; is talking incessantly and incoherently ; is
constantly inquiring about her infant, and gets out of bed if
the attendants relax their vigilance for a moment. Her re¬
lations wish to have her confined in a straight waistcoat.

408

Original Communications.

Repetatur Mistura Camphor* cui adcle Liquoris Opii Se-
dativ 3j.

9th. No change in the symptoms.

10th. Pulse still small and frequent $ complains of pain in
the external genitals, which are oedematous, and inflamed on
the inner surface; there is a slough on the right labium
about the size of a shilling.

Foveantur partes affect* decocto Papaveris s*pe indies.
Habeat submur. Hydrarg. gr.ij. ; Opii Pulveris gr.ss. Fiat
pulvis 3tiis horis sumendus.

R. Infusi Ros* 3j. ; Sulphatis Quinin* gr.ij.

M. Sit haustus 2da g. q. h. sumendus.

To have generous diet.

11th. Tumefaction of the genitals much diminished ; feels
much better ; mind collected ; pulse very small, soft, and
easily compressible ; appetite craving. Her friends wish to
have her removed to a public Institution, to which I objected
from the great debility present. Cont. haustus et fotus

12th. She was removed last evening, at the recommenda¬
tion of a practitioner, and she died during the night.

This case is calculated to render us extremely cautious in
pronouncing favourable opinions in cases of convulsions in
the parturient or puerperal state. Hr. Hamilton has laid it
down as an infallible rule, that if the pulse be over 100 there
is always mischief to be dreaded, -and this axiom led me to
differ in opinion with the physician who had the care of the
case, and who considered recovery certain after delivery.
The arteriotomy was performed, as too much time would
have been lost in applying leeches, though I confess the
operation was never performed by me under greater anxiety,
for the patient appeared moribund, and the pulse more than
once appeared to confirm the opinion. However, the abstrac¬
tion of blood from the head was the only chance which re¬
mained. The after treatment differed in. some degree from
the ordinary plan by the application of sinapisms, but why
not relieve the brain by these means in puerperal as well as
in ordinary cases of increased vascular action in that organ ?
The camphor mixture was given in the form so strongly re¬
commended by Dr. Hamilton, but with an increased quan¬
tity of c. magnesia, according to the formula of the Dublin
Pharmacopoeia. The Liq. Opii Sed. was added when the
maniacal symptoms were fully developed — a plan proposed
by many obstetric practitioners of eminence. Besides, we
have strong evidence afforded that convulsions may depend
on increased irritability in nervous habits as well as an in¬
creased vascular action, and in such cases opium is of sin¬
gular service.

BIBLIOGRAPHY.

general review of foreign and British

medical journals.

MEDICINE.

1. State of the Medical Profession in Turkey — There are about

L I .'m factitrei‘S m Constan^°ple, principally Franks, from
I aly and Malta and a few Ionian Greeks, Armenians, and Copts:

o this number, there are, perhaps, five regularly educated physicians,
and two of these are English gentlemen, highly respected both by the
inks and Franks. Every medico has his allotted quarter : he beats
this ground daily in pursuit of patients, and visits all the coffee-
ouses in the district with a Greek drogueman, , as interpreter, at his
heels, whose occupation is to scent out sickness, and to extol the doc¬
tor. 1 hey are ever to be found on the most public bench of the coffee-
shop, smoking with profound gravity, and prying into the features of
those around them for a symptom of disease. I confess I had to de¬
scend to this degradation to get practice, in order to become acquaint¬
ed with the domestic customs of the people. The first day my drogue-
man, who had just left the service of a Roman doctor, and "bad been
practising on Ins own account since his discharge (for all droguemen
become doctors), took upon him to teach me my professional duty,
which he made to consist in never giving advice before I got my
fee ; in never asking questions of the sick; and in never givin« intel¬
ligible answers to the friends. I was to look for symptoms only in the
pulse ; 1 was to limit my prognosis to three words. In Shallah , or
t lease the Lord .’ for doubtful cases ; and Allackharim ! or “ God
is great !” for desperate ones.

I took my post in the coffee-shop, bad my pipe and coffee, while my
drogueman entered into conversation with the Tuiks about us. I soon
heard him narrating the history of a miraculous cure, which he had seen
me perform some days before, on the body of a dying Effendi ; how I
had taken out his liver, and put it in again, after scraping off the dis¬
ease ; and how the patient got well the next day, and gave me five
purses. I was exceedingly annoyed; but the fellow seemed to mind

my anger little, and even reproved “ my want of prudence” with a
frown.

Now, the only tiling that could have given origin to “ the scrapino-
of the man s liver,” &c. was my having opened a boil on his own back
the day before. The Turks swallowed the story; had it been more
marvellous, it would have been still easier digested. One turned up
his eyes, and said, “ There was but one God ;” another praised my
skill, and cried, “ Mahomet is the friend of God !” The latter gen¬
tleman held out his wrist to have his pulse felt, and said, in a very
civil tone of voice, Guehl, giaour, “ Come, you dog.” This endear¬
ing epithet Turks consider ought not to give an infidel offence, be¬
cause it is more a man’s misfortune than his fault to be born a “ Chris¬
tian,” and, consequently, “ a dog.”

My Greek, whose familiarity was very offensive (and it is a na¬
tional fault), now whispered in my ear, “ No bite, that fellow never
VQh. III. NO. 17 3 G

410

Bibliography .

” I gave the man, however, my advice, and got a cup of coffee
in return.

A well-dressed man, who had been sitting by my side in silence for
half an hour, at last recollected he had a wife or two unwell, and very
gravely asked me, “ What I would cure a sick woman for ?” It was
a question to delight the soul of Abernethy. I inquired her malady ?
a She was sick.” In what manner was she affected ? “ Why, she

could not eat.” On these premises I was to undertake to cure a pa¬
tient, who, for aught I knew, might be at that moment in articulo
mortis. I could not bring myself to drive the bargain j so I left my
enraged drogueman to go [through that pleasing process. 1 heard him
ask a hundred piastres, and heard him swear by his father’s head and
his mother’s soul that I never took less. However, after nearly an
hour’s haggling, I saw fifty put into his hand ; and the promise of a
hundred more, when the patient got well, 1 saw treated with the con¬
tempt which, in point of fact, it deserved. No man makes larger pro¬
mises than a Turk in sickness, and no man is so regardless of them
in convalescence. I visited my patient, whom I afterwards found both
old and ugly ; but I was doomed, on the first occasion, to see no part
of her form. She insisted on my ascertaining her disease with a door
between us, she being in one room and I in another ; the door was
ajar, and her head enveloped in a sheet, as it was occasionally project¬
ed to answer me, was the only part of her I had a glimpse of. This
was the only woman I ever attended here, or in the islands, who would
not suffer the profanation of my fingers on her wrist. I, however,
could just collect enough from the attendants as to cause me to sus¬
pect she had a cancer ; and I did all, under such circumstances, that
I could well do, I gave her an opiate. This lady was no sooner pre¬
scribed for than my attention was directed to the youngest wife, who
was pleased to need advice, though her sparkling eyes and smiling
lips denoted little of disease. She was extremely pretty, and removed
her veil with little difficulty ; but she would have her pulse felt through
a piece of gauze, which was sufficiently thin to transmit, not only the
pulsations of the artery, but also the pressure of the fingers, which
mode of communicating symptoms 1 found a very common one in prac¬
tice. I ordered her some medicine, which 1 am quite sure she did
not take, and which, in all probability, she did not require. After
smoking a pipe and drinking sherbet, I took my leave.

In a few days after this my first visit in Constantinople, 1 was sent
for to the house of a grandee, where a consultation was to be held on
a pacha’s case, and one of great importance. 1 found the patient ly¬
ing in the middle of a large room, on a mattress spread on the carpet;
for “ the four-posted beds” of Don Juan and Dudu have no existence
in Turkey, and both gentlemen and ladies repose on their mattresses
thrown on the carpet of the divan, in their daily habiliments, none of
which they doff at night.

A host of doctors, Jews, Greeks, Italians, and even Moslems,
thronged round the sick man ; and amongst them were jumbled the
friends, slaves, and followers of the patient ; the latter gave their opin¬
ion as well as the doctors, and, in short, took an acti/e share in the

State of the Medical Profession in Turley. 411

consultation. But he who took upon himself to broach the case to the
acu ty was a Turkish priest, who administered to the diseases both of
sou and body. He prefaced his discourse with the usual origin of
a tnngs.^ He said, “ In the beginning God made the world, and
ga\e the light of Islam to all the nations of the earth. Mahomet (to
w lose name be eternal honour,) was ordained to receive the perspi¬
cuous volume of the Koran from the hands of the angel Gabriel ;
w nch book was written by the finger of God, before the foundation
of the world; and in its glorious page was to be found all the wisdom
of every science, whether of theology or physic ; therefore , all learning-,
except that or the Koran, was vain and impious ; therefore he had
consulted it in the present case, and the repetition of the word honey,
he discovered tallied with the number of days his highness suffered
(to whom G|od give health) ; thei'efore honey was a sovereign remedy
and one of its component parts was wax, a true specific for the dis¬
ease before them. Hid not the bee suck the juice of every herb ?
was there not wax in honey ? did not wax contain oil ? therefore , why
not try the oil of wax ? Oh ! illustrious doctors !’’ he continued,

let us put our trust in God, and administer the dose. Our patient
has been thirty six days sick, therefore let him have six-and-thirty
drops every six-and-thirty hours. And, as there is but one God, and
Mahomet is therefore his prophet, let the oil of wax be given.”

The moment this rigmarole ended, all the servants, and even many
of the doctors, applauded the discourse.

lucre was no time allowed for discussion; the same arch priest
tooK. care to see the doctors feed forthwith ; each of us got four Spa¬
nish dollars, and left the unfortunate sick man to his fate. But,
going out, when I expressed my astonishment to one of the faculty
(an old Armenian), about the exhibition of this new remedy, he
looked around him cautiously, and whispered in my ear the word
“ poison !” On further inquiry, I found the bulk of the patient’s pro¬
perty was invested in a mosque. In spite of the remonstrance of my
drogueman, I returned to the door I had just quitted, and gave an
attendant to understand his master would die if he took the medicine.
1 he poor man died, however : I heard of the event about a month
afterwards.

I was shortly after called to a man who was said to have a fever.
When I visited him, I asked what was the matter with him, and
where he felt pain ? but his friend made the customary reply “ That
is what we want to know from you ; feel his pulse, and tell us !” I
accordingly did so, found it rapid, his breathing laborious, and his
skin hot ; but not one of the symptoms could 3 get from the patifent
or attendants. The Turks have the ridiculous idea, that a doctor
ought to know every disease by applying the fingers to the wrist. I
thbugbt from what I observed I was warranted in taking blood in
th is case. I did so ; but, no sooner had I bound up the arm, than X
was requested, for the first time, to examine the other hand, which I
did, and, to my utter astonishment, found two of the fingers carried
away, the bones protruding ; and then only was I informed that the

412 Bibliography .

patient was in the artillery, and had lost his fingers a week before by
the explosion of a gun.

I suspected at once the occurrence of locked jaw \ I felt his neck ;
it was like a bar of iron \ the man had been labouring under tetanus
for three days, and died the following morning. You may well con¬
ceive my indignation at such incredible stupidity as the attendants
exhibited here, and my choler at being told that the result “ had been
written in the great book of life,” and could not he avoided or deferred.
Be that as it may, I certainly would not have bled him, had I any
reason to suspect the affection of which he died. You may imagine
how difficult it is for a medical man to treat such people ; and, con¬
sequently, how rarely they are benefited by him.

There are few Mahometans who do not put faith in amulets : I
have found them on broken bones, on aching heads, and sometimes
over lovesick hearts. The latter are worn by young ladies, and consist
of a leaf or two of the hyacinthus, which the Turks call mus-charumi ,*
this is sent by the lover, and is intended to suggest the most obvious
rhyme, which is ydskerumi, and implies the attainment of their solt
denies.

Sometimes these amulets are composed of unmeaning words, like
the abracadabra of the ancient Greeks for curing fevers, and the abra-
calans of the Jews for other disorders. At other times they consist
simply of a scroll with the words Bismillah , “ In the name of the
most merciful God,” with some c.abalistical signs of the Turkish astro¬
loger Geffer ; but most commonly they contain a verse of the Koran.

I think the most esteemed in dangerous diseases are shreds of the
clothing of the pilgrim camel which conveys the Sultan’s annual pre¬
sent to the sacred city. These are often more sought after than the
physician, and frequently do more good, because greater faith is put
in them.

The most common of all these charms is the amber head, with a
triangular scroll, worn over the forehead, which the Marabouts and
the Arab sheiks manufacture, and is probably an imitation of the phy¬
lacteries which the Jews were commanded “ to bind them, for a sign,
upon their hands, and to be as frontlets between their eyes.’’ It would
he well if no more preposterous and disgusting remedies were em¬
ployed j but I have taken off from a gunshot wound a roasted mouse,
which, I was gravely informed, was intended to extract the ball.

A less offensive and more common application to wounds, is a roated
fig. I believe old women prescribe it for gumboils in England ; and
the practice is as old as Isaiah, who ordered ic a mass of figs” to He-
zekiah’s boil.

Of all Turkish remedies, the vapour bath is the first and most effi¬
cacious in rheumatic and cuticular diseases. I have seen them re¬
moved in one-fourth part of the time in which they are commonly
cured with us. In such cases I cannot sufficiently extol the advan¬
tages cf the Turkish bath. The friction employed is half the cure,
and the articulations of every bone in the body are so twisted and
kneaded that the most rigid joints are rendered pliant.

I have trembled to see them dislocate the wrist and shoulder joints

Report of the Edinburgh Surgical Hospita l. 413

and reduce them in a moment : their dexterity is astonishing, and
Mohammed’s shampooing, at Brighton, is mere child’s play in compa¬
rison. Query : would not gout be benefited by this remedy, provided
it could be really introduced into England as it is used in Turkey ?

As a luxury, I cannot better describe it than in the words of Sir
John Sinclair . It life be nothing but a brief succession of our
ideas, the rapidity with which they now pass over the mind would
induce one to believe that, in the few short minutes he has spent in
the bath, he has lived a number of years.”

I cannot conclude without telling you how all Frank medical men
are teazed by the Turks for aphrodisiacs, which they denominate mad -
joun : I am solicited for it at every corner j and it is lamentable to
observe, that hardly a man arrives at the age of five-and-thirty, whom
debauchery has not rendered debilitated, and dependent for adven¬
titious excitement for his pleasures. 1 he ladies, on the other hand, are
desirous of gaining honour by a progeny like Priam’s ; but they have
fevv children in general, for polygamy is, probably, injurious to popu¬
lation. They cease not, however, to annoy me for medicines to make
them fruitful j and are as solicitous for specifics as Rachel was to ob¬
tain from her sister some of the prolific mandrakes.

I had always occasion to observe that the sick man was all civility
and courtesy when his life was in jeopardy, but the moment he be¬
came convalescent he treated me with arrogance, as if he had been
ashamed of letting an infidel see that a Moslem was subject to the in¬
firmities of humanity. My services were forgotten whenever they
ceased to be required. AH 'the other medical men complained of the
same ingratitude-, indeed, no physician opened his mouth till the pa¬
tient opened his purse. The Greeks, certainly, behave better in this
respect \ but yet there is certainly that strange obliquity of principle
in them, that I never doubted, while a Greek fed me generously with
one hand, that he would not have picked my pocket with the other at
the same moment.

Such is the low state of medical science in this country ; and such*
probably, it was in Europe so late as the tenth century. It has been
rvell remarked, that the state of medicine may be considered as the
criterion or barometer of the state of science in a nation. Wherever
science and refinement have extended their influence, there medicine
will be most cherished, as conducive to the interests and happiness of
mankind. — Madden's Travels in Turkey , fyc.

2. Report of the Edinburgh Surgical Hospital. — The Edinburgh
Surgical Hospital was opened for the reception of patients on the 8th of
May. During the three months which have since then elapsed, 380
patients, labouring under surgical disorders, have applied to the insti¬
tution for relief. Of these seventy have been admitted into the house.

There have been performed thirty operations, viz Amputations of
the thigh, 3 * of the arm, 1 ; through the tarsus, 1 * of the great toe,

X 5 of the finger, 2 * Excisions of the mamma, 2 ; of tumours, 5 *
of the upper jaw, 1 j of the elbow joint, 2 j of cancerous sores, 3 *
of warty excrescences 3 * Fistula in ano, 1 * Hemorhoids, 1 * Poly¬
pus nasi, 2 * Hypospadias, 1 * total thirty.

414

Bibliography .

There have been two deaths, under the following circumstances :
An old woman, Isabella Macdonald, was brought to the hospital on
the 22d May, very severely injured by the wheel of a loaded cart
passing over her. There was a comminuted fracture of the left tibia
and fibula about their middle, where an extensive cicatrix indicated
the situation ot a wound which she had received in her youth from the
bursting of a blunderbuss. The left elbow was fractured through the
external condyle ot the humerus, and on the fore-arm of the same
side there was a large lacerated wound exposing the fascia. She was
a weak emaciated woman, between 50 and (iO years of age, equally
infirm in mind and body, and was regarded from all the circumstances
that have been mentioned, as little likely to recover. Nevertheless,
she did extremely well for about a week, the wound healed, and the
fractures seemed to be in a fair way of uniting ; but on the seventh
day it was observed that mortification had commenced at the injured
part of the leg, and, as the system became affected at the same time,
it was considered proper to afford the chance of amputation — a slender
one indeed, but still desirable in a case otherwise desperate.

Amputation above the knee by two lateral flaps was accordingly
performed, and again the patient seemed about to rally. Her pulse,
tongue and appetite became natural, and the stump showed no tendency
to mortification, but it did not heal by the first intention, and the
irritation attending the more tedious process by granulation proved
too great for the feeble remains of her exhausted strength. She be¬
came hectic, rapidly sunk under an uncontrollable colliquative diarr¬
hoea, and died on the 13th of June. On dissection there was found
extensive ulceration of the large intestines, apparently of old standing.

The second death was that of Nancy Kerr, aged two years, who
died in an hour or two after admission, and therefore ought not, accord¬
ing to the usual custom of hospital records, to be ranked among the
patients treated in the establishment. This child was brought in on
the morning of the 12th July, on account of a severe burn received
the preceding evening by falling into a pot of hot water. The ex¬
tremities at the time of admission were cold, there was no pulsation of
the limbs, convulsions speedily ensued, and death took place early in
the day.

Fractures. — Of these there are two of the thigh, one of the tibia
and fibula, one of the tibia, two of the radius, two of the olecranon,
two of the humerus, one of the clavicle., one of rib, one of metacarpus,
•i— in all thirteen.

The fracture of the clavicle was cured without any deformity
whatever, in a fortnight, by means of the simple bandage, which is
founded on the principle of keeping back the shoulders, and elevating
the elbow of the injured side with a sling, without placing any foreign
substance on the axilla.

Both the cases of fractured olecranon were worthy of notice, on
account of the absence of what is generally considered a characteristic
symptom of this injury, I mean a separation or drawing up of the bro¬
ken process to some distance from the shaft, by the action of the triceps.
Sir A. Cooper has well observed, that this does not always happen, being

Excision of the Elbow-joint. 415

occasionally prevented by the strong fibrous covering of the bone at the
injured part remaining entire.

1 Ins observation is important, since a surgeon not acquainted with
it might readily overlook the true nature of the accident, of which
mistake I have met with more than one instance, though the diagnosis

is still very easy, owing to the mobility of the fragment in a transverse
direction.

Excision of the Elbow-joint. — This operation was performed twice,
viz. on Janet .Burns, aged twenty-five, from Carnwath, and on John
Wells, aged nine. The mode of procedure was the same as that
detailed in the account lately published in this Journal of three cases
where the operation was performed.

There was nothing in the previous history of these cases worthy of
mention. They both laboured under well marked caries of the elbow-
j'oint, and would both a short time ago, have been condemned to ampu¬
tation without any ceremony. Janet Burns was harrassed by a slight
degree of chronic fbronchitis, which delayed her recovery, and ren¬
dered the complete and permanent establishment of her health some¬
what doubtful. She left the hospital considerably better in this re¬
spect than when she entered it, and with the prospect of retaining a

The boy was a most favourable subject for the operation. His
disease resulted from external injury, a fall on the elbow, his consti¬
tution was good, and he possessed a most excellent disposition, which
induced him to perform accurately whatever he was desired in regard
to the position and exercise of the limb. Five weeks have now elapsed
since the. operation, and he is beginning to regain command of the
joint, which is nearly as moveable as ever. I expect a most complete
recovery in this case, which will be the more remarkable, as a very
large portion of the ulna was removed. After. sawing off the extremity
of the humerus, and cutting away with the pliers the olecranon and
head of the radius, I thought from the sound appearance of the different
surfaces that enough had been done, and dressed the wound. But it
fortunately happened that when the excised portions were afterwards
more carefully examined, one of the gentlemen present, Hr. Vallange,
observed, that the cut surface of the olecranon presented a small cari¬
ous cavity, a portion of which must consequently have been allowed to
remain. I immediately undid the dressings, and by replacing the ole¬
cranon discovered the carious part, which was a sort of cylindrical
excavation no wider than a common quill, but running deeply into the
bone. Having ascertained its extent by introducing a probe, I insu¬
lated the ulna as far as was necessary, and cut it across through the
shaft, so as to detach tne whole spongy portion of the bone, which was
then removed, though not without some difficulty, owing to the con¬
nexion of the bracliiaeus internus.

In. this case the only muscle left undisturbed was the biceps ; and
the difficulty of moving the joint ought to have been, if possible, still
greater than some people allege it to be, when merely the triceps is
detached from its insertion. It has surprised me considerably to find
that my pupils felt it difficult to conceive how the efficiency of the

416

B i hllography .

muscles could be restored in these circumstances, since there are so
many parallel cases ol every day’s occurrence — for instance the use of a
stump, which is so soon regained, owing to the muscles fixing them¬
selves round the bone.

The difficulty of conceiving this very easy matter, was, however so

great, that I requested Mr. Y . , whose case is detaiLed in iny

former paper on this subject, to allow the gentlemen attending my cli¬
nical lectures to satisfy themselves by ocular and manual examination
of the very perfect command which he was able to exercise over his
arm. This gentleman is preparing to finish his education as a clergy¬
man, and finds himself able not only to write sermons, but to execute
all the ordinary motions of the arm.

Amputation through th& Tarsus. — Ann Stewart, aged ten, entered
the hospital on the 4th of June on account of caries of the foot, which
had existed two years, in consequence of inflammation induced by the
fall of a heavy stone on the instep. There was an opening over the
middle cuneiform bone, through which a probe could be passed perpen¬
dicularly and transversely in a curved direction to the head of the me¬
tatarsal bone of the little toe, indicating throughout its course the
existence of caries. There was considerable thickening of the foot at
the part mentioned, but higher up it was quite natural. Amputation
of the foot had been proposed, but this I was unwilling to perform, pts
it seemed that the operation of Chopart could be practised with evtfry
prospect ol success. Having obtained full permission from the parents
to do whatever was thought proper, I proceeded as follows : — Having
ascertained the situation of the joint between the astragalus and os
naviculare oy feeling the projection of the latter bone, and that between
the os calcis and cuboides by observing the middle distance between
the line of the fibula and head of the metatarsal bone of the little toe,
I made a semilunar cut from the one to the other, and then, instead of
dividing the articulations, which I think renders the subsequent forma¬
tion of a good flap very difficult, transfixed the sole of the foot from
one extremity of the cross cut to the other, and then carried the knife
close along the metatarsal bones, so as to detach an ample but well-
formed covering for the face of the stump. The disarticulation was
next effected with the utmost ease, so as to finish the operation in a
very short time, and the plantar arteries being secured, the flap was
retained in its proper place bj' five or six sutures.

4ne wound healed by the first intention, and the patient was able
to put her foot to the ground in less than a fortnight. It was then
observed, too, that she had regained the power of counteracting the
extensors of the ankle, owing to the flexors having obtained new at¬
tachments. This is an interesting fact, as many people have objected
to the operation on the ground of its leaving no antagonizing power to
the gastrocnemius and other extending muscles of the joint, whence
the heel would be drawn up so as to point the cicatrix to the ground.
Being in Gottingen some years ago, and seeing a patient on whom
Langenbeck had recently performed the operation, I particularly in¬
quired if, in his former cases, of which lie had had two or three, any
inconvenience on this account had been experienced, and was assured

Exfoliation of the whole Upper Jaw . 41/

that there had not. The fact just mentioned will help to explain this.
About six weeks after the operation, Ann Stewart came to the Hos¬
pital and walked into the presence of myself and pupils, when we
were examining the out-patients, so that I really could not from her
gait fix upon the defective foot.

Excision of the upper Jaw.— As this case was fully detailed in the
last Number of this Journal, I have only to state with regard to it
that the unfavourable prognosis then given has not been verified, in¬
asmuch as though nearly three months have elapsed since the opera¬
tion was performed, there is no appearance of a recurrence of the dis¬
ease. I am at a loss to account for this, unless the separation of a
very large slough about a week after the operation be considered a
sufficient explanation. At all events, the man continues quite well,
with the exception of a small gap in his cheek, and feels particularly
comfortable in being freed from the distracting and incessant pain
which formerly tormented him.

Exfoliation of the whole upper Jaw. — The extraordinary case of an

out-patient may here be mentioned. Mrs. C - , about nine years

ago, when twenty years of age, became afflicted with a sore on the
nose, for which, by the advice of a surgeon in town, she took very
large quantities of mercury. The sore extended, the bones became
affected, and a rapid exfoliation commenced, which soon deprived her
of all the face, except the lower jaw and part of the ossa malarum. I
first saw this wretched woman about four years ago, when she pre¬
sented an appearance inconceivably shocking. The eyes were di¬
vested of their coverings, the pharynx was completely exposed to
view, and the tongue lay exposed from root to apex, surrounded by the
foul and vacillating teeth of the lower jaw, while the whole surface
exhibited a most unhealthy description of ulceration. 1 saw her about
six weeks ago, having not done so for a long time previous, and was
surprised at the change which had taken place. A cure, so far as a
cure was possible, had been completed the whole ulcerated surface
was healed, and the eyes were covered with a firm skin. She was
miserably weak, and for a long period had subsisted on little else than
laudanum, of which she took daily at least half an ounce. She died
soon after this time, when I fortunately obtained the whole head, and
ascertained that the remaining bone was every where perfectly sound.

I do not know how this cure can be explained, except on the principle
of the hunger cure ; and think it may perhaps lead to a trial of this
severe but powerful remedy in other desperate cases.

Actual Cautery . — For some time past I have made much use of
another remedy very fashionable in Germany, I mean the actual cau¬
tery, as a counter-irritant. In the morbus coxarius , and similar dis¬
ease of the shoulder joint, (the Omalgia of Fust,) I have derived the
most striking benefit from its employment. The only case affording
fair opportunity for its application was that of William Aitkinson,
set. thirty-six, a plasterer, who was admitted on the 9th of June, la¬
bouring under extreme weakness and loss of command of the inferior
extremities, with pain and weakness of the back, which was tender to
pressure in the region of the loins. His complaints had existed for
VOL. hi. no. 17. 3 u

418

Bibliography .

six months, and were increasing. I burned him very freely with the
prismatic cautery of Rust on both sides of the spinous processes of the
lumbar vertebrae, and had the satisfaction of seeing him improve daily,
so soon as the slough separated. His improvement was regular and
progressive, so that when dismissed on the 22d July, he laboured un¬
der awkwardness more than weakness of the limbs \ he was able to
walk quickly, and even to leap with both feet — in short, had the pro¬
spect of a perfect recovery.

Amputation of the Thigh. — One of the most interesting cases was
that of John Parkinson, set. 10 years, who entered the house on the 17th
June on account of what seemed at first phlegmonous erysipelas of the
left leg* The whole limb from the ankle to the middle of the thigh was
much swelled, red, and excessively painful. Having learned that these
complaints had existed for nearly a week, notwithstanding the re¬
peated application of leeches, and observiug that the pain, which was
chiefly referred to the inner or tibial side of the knee, appeared to be
more agonizing than that usually occasioned by inflammation of the
skin and subcutaneous tissue, I suspected that the mischief was
deeply seated. On the following day, perceiving an obscure sense ol
fluctuation, I made several free incisions into the limb, and evacuated
a great quantity of bloody pus. The limb became much less tense and
painful, and I hoped that my diagnosis had been incorrect, but this
prospect of amendment was soon blighted. The pain, though dimi¬
nished, still continued, the discharge was profuse and unhealthy, symp¬
toms of hectic made their appearance \ and when the different open¬
ings over the tibia were examined by a probe, the bone was found to
be completely insulated from the soft parts. The bone having thus
died without providing a substitute, it seemed to me impossible to save
the limb \ but as many people would have thought me rash had I
acted immediately on this conviction, I resolved to wait until the af¬
fair was more clearlv decided. He became weaker and weaker; he
passed frequent stools tinged with blood \ and on the 30th he was so
very low, that I blamed myself for having waited so long, and feared
that amputation would hardly save him. Another unpleasant symp¬
tom also now appeared, viz. a swelling of the lower third of the thigh,
evidently connected with the bone, and extreme tenderness on pres¬
sure, which led us to apprehend that the femur was about to die like
the tibia. Discouraging as these circumstances were, we resolved on
the operation, as affording the only chance, especially as it would be
the most likely means of checking inflammation of the femur, if it ex¬
isted, and of facilitating the removal of any exfoliation that might en¬
sue from it.

“ The operation was performed as usual by two lateral flaps. On
examining the limb, we found, that, with the exception of a small part
near the ankle, the tibia was dead throughout its whole extent \ even
the epiphysis of the knee had perished, and lay bathed in the contents
of a great abscess, which distended the joint, and reached up the thigh
so far, that the incisions of the operation had almost opened it, though
they were made purposely very high, to avoid the suspected part of tire
bone.

419

Mr. Syme on Amputation of the Thigh.

qffpr l\ diairhoea and other unpleasant symptoms disappeared soon

B fh °PeraJI0nVUnder careful medical and dieteticai treatment.

seemed f °u \ (oi\tniSht the wound was healed, and the patient
seemed safe, but he then began to droop, his diarrhoea and other hec-

ane^rPt°-mS 7^^’. and matter profusely from two small

ape. ures in the cicatrix of the stump, which became somewhat swollen

fn, nefr e the.trCb* He Continued in V'etty much the same state

(1 Pi W nf^tniSht’ ,Wl he5 We JudSed k exPedient to send him home,

ardent t0 ?7 the effeCt °f a change of ail > and gratify his own

a.dent mngmg. About a week after his return, which was on the

°; Jl,1y, he began to improve, his hectic symptoms left him and
dnep^'l1^ C<?ntracted t0 lts proper size. A probe being then intro-
_ f i* “eng1 one erf the openings above-mentioned, encountered an
exiohation partially detached, but not loosened from the femur.

v nen it separates, an opening must of course be made for its extrac¬
tion; but unless some adverse change takes place, there can now be
little rear as to his ultimate recovery.

This case is interesting in several respects. Though the pha*
langes of the fingers too frequently perish through their whole extent,
in consequence of the acute inflammation, which occurring in this si-
u at ion is designated paronychia, it is rare to meet with a similarly
spee y and complete destruction of the large bones. It is true that
some people who still believe in the possibility of dead bone being ab-
Sy! r 6 ^ . e. lv*ng vossels, or dissolved by the pus, may entertain a

f itterent opinion. This is not a proper occasion for entering on dis¬
cussions respecting necrosis, otherwise it might easily be proved that
the whole shaft of a bone very rarely dies entire, and that, when it
does so, there is either no reproduction, or the substitute has been
formed more or less completely previous to the demise of its parent.

In this case the destruction was not confined to the shaft, but ex¬
tended into the knee-joint, contrary to the tenet of some writers, that
t le epiphyses are exempt from necrosis. There are several prepara-
tiono in my museum which show the same thing, particularly one of a
tibia, which was lately given me by my friend and former pupil, Dr.
Arrot. It was amputated by his brother in Arbroath, on account of
extensive abscesses of the knee-joint.

The exfoliation also which is now going on, notwithstanding the
speedy and apparently perfect union of the flaps, is interesting as an
indication of the tendency to die, which is occasionally observed in the
whole osseous system. Every practical surgeon must have noticed
cases where the shafts of almost all the bones of the body were affected
with necrosis, just as their heads are at other times occupied by scro¬
fulous caries.

Amputation of the Thigh. — William Macintyre, aged fifty-four, en¬
tered the Hospital on the 29th of July, on account of a diseased state
of the inferior extremity, which made him desirous to part with it.
Ihe foot presented an extraordinary appearance, being greatly en¬
larged, and strangely altered in form, so as to constitute a shapeless
unwieldy mass, equally useless and unseemly. He stated, that for the
last five or six years, he had suffered from repeated and almost unin-

420

Bibliography .

terrupted attacks of inflammation and suppuration of the limb, in the
course of which time most of the toes dropped off. There was still a
large sore in the fore part of the foot, but most part of its surface, to-
gether with that of the leg, was covered with thick cicatrices. The
patient suffered little, except from unwieldiness of the limb, owing to
the weight of the foot, and stiffness of the ankle-joint, which, by pre¬
venting him from placing the heel on the ground, rendered progressive
motion quite impossible, except by means of crutches, but he was ren¬
dered so unhappy by this state of helplessness, as to desire the only
relief which it was in our power to afford — removal of the limb. rLhe
thickened and indurated condition of the soft parts rendered it impos¬
sible to obtain a covering for the bones any lower than the highest
practicable point for amputating below the knee, viz. at the tuberosity
of the tibia, and here only by forming two equal flaps according to the
plan described in a former Number of this Journal. 1 his operation
having been performed, we were sorry to find that the bones presented
such an unhealthy appearance, as precluded any reasonable prospect
of a cure, and therefore, however unwillingly, determined on repeating
the amputation above the knee. This was immediately done, the pop¬
liteal artery, which alone required a ligature, was secured, and the
edges of the w7ound being stitched together, and suitably dressed, the
patient was conveyed to bed wonderfully little exhausted by his suffer-
ngs. He did extremely well afterwards, with the exception of some
nausea and vomiting on the third day, and has now every prospect of a
speedy and perfect recovery.

Amputation of the Bore-arm — J. Baxter, a w hite-faced unhealthy-
looking boy, had, for six or eight months, laboured under a scrofulous
enlargement of the wrist, with caries of radius. I did not think this,
in any respect, a proper case for excision of the diseased bone, and
therefore amputated the hand by two flaps. Dissection proved the
necessity of the operation, by showing the whole synovial apparatus of
the carpus greatly thickened, and completely degenerated into the true
gelatinous condition which indicates the scrofulous action. The radius
was even more widely diseased than had been supposed.

Amputation of Fingers and Toes — It was necessary to remove se¬
veral fingers and toes, on account of the destructive effects of paro¬
nychia and caries of the articulations. The amputations were all per¬
formed at the metacarpal and metatarsal joints by two lateral flaps,
which were not made, however, quite according to the plan of Lisfranc,
who forms one wdiile cutting into the joint, and the other when cut¬
ting out from it. This method answers very well where the parts con¬
cerned are in their natural state, as to softness and laxity, but can
hardly be accomplished without injury to one or other of the flaps
where they are thickened and indurated in consequence of the preced¬
ing inflammation. In such cases, I think it is much better to form
the two flaps previous to opening the joint, and even make a little
dissection if it is required, to separate their preternaturally firm con¬
nexion to the subjacent parts.

Though the bad consequences .of leaving an articular surface in
amputation are certainly by no means so great as they were formerly

421

Mr. Syme on Excision of the Mamma .

supposed to .be, it cannot be denied that the wound, after apparently
being nearly or entirely healed, is subject to repeated attacks of pain
and redness, with more or less discharge of thin serous matter. This
disturbance, which is doubtless to be ascribed to irritation, attending
the removal of the cartilage, by absorption, occurs more frequently, and
to greater extent when the disease, requiring amputation, is acute,
than when it is chronic, of which there was a good illustration when
the cases in question were contrasted with that of amputation through
the tarsus, since in three ol the former there was considerable trouble
from the source referred to, while in the latter the much more exten¬
sive articular surface offered no obstacle to the cure.

It would, 1 am convinced, be a prudent precaution in removing
fingers, where the integuments concerned in the operation are altered
by the disease, to take away the articulating extremity of the remain¬
ing bone. This can be readily done with cutting pliers, and will pre¬
vent any risk of the bad consequences above-mentioned. Thus, in
operating on .Robert Loughead, a stout overfed porter, whose great
toe was carious, in consequence of a bruise received some weeks pre¬
vious to admission by the fall of a heavy box, and where the integu¬
ments were much thickened, & c. 1 cut off the round articular head
of the metatarsal bone.

- Excision of the Mamma. — Mary Messer, set. thirty-eight, from Tor-
woodlee, had been afflicted for nearly three years, with all the symp¬
toms so well described by Sir A. Cooper, under the title of irritable
tubercle of the breast. About two years ago she consulted me on ac¬
count of these complaints, when 1 recommended the use of means
proper for restoring the uterine secretions, which had long been very
irregular, and, for three months previous to that time, altogether sup¬
pressed. She complied with these directions, and, in the course of a
week, had a return of the interrupted discharges. Her complaints
were then much alleviated, and continued to be so for several months,
when, though the uterine actions continued regular, the symptoms of
her complaint became considerably aggravated, and, at length, the al¬
most incessant, occasionally most unsufferable, pain of her breast,
shooting into the arm, shoulder, and side, tormented her so grievously,
both night and day, that she resolved on having the disease removed
by the knife. With this view she was sent to the Surgical Hospital
by my friend, Dr. Anderson, of Selkirk.

Conceiving it right to comply with the patient’s urgent desire to
have the breast excised, since all other means of relief had failed, and
success bad attended extirpation of the testicle when similarly affect¬
ed, I performed the operation on the 13th of May. The wound
healed by the first intention, and she left the hospital on the 23d, quite
free from her former sufferings, and in a state of mind very different
from the extreme dejection and anxiety which characterized it pre¬
vious to the operation. According to the latest accounts from Dr.
Anderson she continues perfectly well. The breast, on dissection,
exhibited the appearances described by Sir A. Cooper, being merely
more dense and uniform in structure than usual.

Excision of the Mamma.-' Janet Anderson, set. forty, entered the hos-

4 22

Bibliography.

pital on the 8 tli of May* on account of a scirrhous mamma, which
had recently suppurated to a small extent on the surface ; it was re¬
moved a few days afterwards, the wound healed by the first intention,
and she would have been dismissed as quickly as the last mentioned
patient, but an abscess formed in the axilla, which excited our worst
suspicions, and induced us to detain her for some time longer. For¬
tunately this abscess did not turn out to be malignant, but healed most
satisfactorily, and the patient was dismissed quite well on the 18th of
J une. She returned a few days ago to show that she continued free
from complaint, and offer thanks for the care which had been bestowed
upon her, previously to departure for the north.

Margaret Mathieson, aged twenty-three, was recommended to the
hospital on the 10th ot June, by Dr. Johnston of Kirkaldy, on ac¬
count of a very large and exceedingly hard tumour in the axilla. It
filled the axillary cavity so completely as to prevent the arm from be-
ing approximated to the side, and was occasionally the seat of severe
lancinating pain. It had existed more than half a year, and was con¬
tinuing to increase progressively. Notwithstanding the youth of the
patient, the symptoms just mentioned would probably have induced me
to remove the tumour, had other circumstances been favourable to this
proceeding, but it was rendered quite impracticable by the firm con¬
nexions of the tumour j and even could this objection have been over¬
come, the existence of many hard tumours of a smaller size in the neck
and throat would have rendered an operation quite unjustifiable.

It occurred to me, that, as the uterine discharges were suspended,
advantage might result from the internal administration of cantha-
rides, especially^as this medicine has a very remarkable effect in pro¬
moting the action of the absorbent vessels in general. In no long
time alter commencing the course prescribed to her, she noticed a re¬
markable diminution not only ol the pain, but also of the swelling, and
regularly improved until the 10th of July, when, being comparatively
speaking, well, she returned home in great joy at her recovery.

IF arty Excrescences. — 01 these, the most remarkable was that of
J. M., aged thirty-two, who was admitted on the 8th of June, to be
relieved of a most painful and unseemly growth from the glans and
prepuce. Some months previously he had had the prepuce slit open
on account ol warts which continued to increase after they were ex¬
posed to view, so as at length to occasion the frightful mass for which
he sought relief. A very small part of the anterior part of the glans
was visible j behind this there w^as a hard irregularly tuberculated
tumour, about the size of a small orange, from which proceeded a most
fetid discharge, and frequent severe burning, lancinating pains shooting
into the groins. It is not improbable, that when pathological distinc¬
tions were less attended to than they are at present, this tumour would
have been at once regarded as cancerous, and considered a sufficient
warrant for amputation of the penis.

Concluding, from all the circumstances of the case, that the disease
was not malignant, I cut away the excrescence by means of a straight
sharp-pointed bistoury, introduced between it and the glans, so that
the morbid part was detached in the form of a ring. Some small por-

Mr. Syme on Fistula in Ano. 423

tions which remained were afterwards easily taken away by scissors.
The wound was dressed with dry caddis ; it healed most kindlv, and
permitted the patient to depart in a fortnight.

Hcemorr holds. — Of this disease a very severe case occurred in a
young man, John Begrie, set. twenty-two, from Greenock, ivho had,
for many months, been harassed by frequent and painful stools, with
purulent and bloody discharge. He had suffered several operations,
as he said, for fistula, and believed that his complaints depended on
stricture of the rectum. On examination I could not find any con¬
traction of the gut within reach of my finger j and before subjecting
him to the exploration of bougies, I determined to remove several
large vascular and painful haemorrhoids, which existed round the
verge of the anus. Jhere were several more excrescences of the same
sort within the sphincter, but it did not seem to me prudent to inter¬
fere with them, at all events, in the first instance, since the removal
of external piles so frequently cures those which are internal. I ac*
cordingly excised the first-mentioned tumours by means of double
hooked forceps and scissors, and had the satisfaction of finding my
prognosis amply verified, as the patient left the establishment in a few
days restored to health.

Fistula in Ano. — There was only one operation performed for this
complaint, and it was interesting merely as an instance of the extreme
facility with which this formerly so much dreaded disease may be cured
by the improved practice of modern surgery. It appears that the cir¬
cumstances of most importance to be recollected are, 1st, That the in¬
ternal opening must be included in the incision of the sphincter ; 2d,
That when the internal opening exists, which it most invariably does,
it is situated very close to, or, rather at, the sphincter ", 3d, That it is
not necessary to divide the gut higher than the internal opening ; and
lastly, that no dressing ought to be interposed between the cut edges,
at all events not after the second day. It is truly astonishing that
so many practitioners should still remain unacquainted with these
important facts which lead to a practice as simple and successful, as
the one, or rather the many, which preceded it, were operose, distress¬
ing, and inefficient.

It is particularly to be regretted, that the observation of M. Ribes,
in respect to the situation of the internal opening, should have mot
with so little attention in this country.

John Finlay, set. forty-five, had suffered for many months from fis¬
tula in ano. The operation was performed on the 17th June, and he
left the hospital eight days afterwards in such a state of convalescence,
as enabled him to resume his employment as night patrol in the police
establishment 5 and to use his own words in a letter of thanks ad¬
dressed to me the other day, <c has been on duty ever since both wet
and dry, has not experienced the least symptom of his complaint, and
is now as sound and stout as he ever Avas in his life.”

At the same time with this patient, I operated upon a gentleman
who had long been harrassed in the discharge of his military duties,
by a similar complaint. On the second day after the operation, lie
dined abroad at some distance in the country, and in a few days more

424

Bibliography .

departed for London, where what remained of the wound healed with¬
out any trouble, so that he returned in perfect health. Fistula in ano
is too frequently connected with morbid conditions of the lungs and
intestines, equally fatal and incurable •, hut where it exists without
such complication, ought to be regarded as one of the most simple and
satisfactory subjects of surgical practice.

Hypospadias. — The case of John Sparks, set. two and a-half, la¬
bouring under congenital hypospadias, was remarkable, in so far as,
besides the preternatural aperture at the neck of the glans constituting
the disease, there was an appearance of the proper opening, separated
from the former by a bridge of skin. On introducing a probe into
the superior or proper opening, I found that it did not lead to the
urethra, but terminated in a narrow cul de sac , about half an inch deep.
The preternatural opening was extremely small, indeed hardly visible,
and it was on account of the difficulty of voiding his urine through it
that the patient’s friends brought him to me in quest of relief. It
would have been easy to afford temporary relief by dilating the unna¬
tural opening ; but it seemed to me better to perform the operation
so as to attain this object, and also prevent the future inconvenience
of being unable to effect impregnation owing to the dependent position
of the orifice of the urethra. I therefore divided the septum be¬
tween the two canals, and propose, so soon as the wound is healed,
to close up what is necessary at the lower part of the opening, so as
to give it the proper direction.

Cancer of the Lip. — The general or rather invariable plan of re¬
moving cancerous sores of the lip followed in this country is to include
them in two oblique incisions, which unite at an angle, more or less
acute towards the chin. When the disease affects the lip to much
depth, this proceeding is probably the most advantageous that can be
adopted, but when it is superficial, and especially when the surface is
extensively affected, it is equally injurious and unnecessary. In such
cases the surface alone requires to be removed, and if this be done
properly, instead of the hideous deformity which results from removal
of the lip, there is hardly any alteration to be perceived. It is in such
cases that the plan recommended by Richerand, in the Annuaire Me-
dico-Chirurgicale is decidedly preferable to the common one, which
ought to be restricted to those occasions where the lip is deeply affected.
I find on a comparative trial with other means that the curved scis¬
sors are by far the most convenient for effecting the removal in
question ; but instead of healing the wound by granulation, according
to the advice of Richerand, it is much better to unite the skin and
mucous lining of the lip by means of sutures, either twisted, or, what
answers better, interrupted.

George Angus, eet. fifty, from Limekilns, applied to the hospital on
account of a sore on the lower lip, which had existed for two years,
and resisted all the ordinary measures for its cure. There were two
horny excrescences proceeding from it, and the patient complained of
occasional pain. As there was no induration of the lip under the base
©f the sore, 1 removed it with curved scissors at one cut, and sewed the

Hydrocele. 425,

edge together. The patient suffered no inconvenience, and returned
home in three days without the slightest deformity .

Tumour of the Orbit. — -Edward Ramage, aged three, from Selkirk,
was sent to town by my friend, Dr. Anderson, on account of a tumour of
the orbit which had existed or rather been noticed for six months.
There can be little doubt that it was of older standing, since the first
thing that attracted attention was the one eye being smaller than the
other, in other words, the distention of the lower eyelid so much that
it prevented the eye from being seen. The patient latterly complained
of pain in the swelling, but continued to enjoy the most robust health.
I made an incision on the tumour in the direction of the fibres of the
orbicularis palpebrarum, and exposed its surface so far as was possible
by dissection. Having ascertained, what we had previously every
reason to expect, that it went back into the orbit, I attempted to dis¬
engage it from the surrounding parts, but finding that it rested closely
on the orbitary plate of the maxillary bone, I removed the bulk of
the mass, and then, by careful manipulation with my fore-finger dis¬
lodged what remained. The pieces when put together seemed to be
perfect and nothing more of it could be felt in the orbit. The tumour
possessed a very dark colour, and so far might be called melanotic, but,
instead of having the friable, granular, or almost semifluid consistence
of the morbid formation usually designated by this title, it had a fibrous
structure more like that of the worst species of osteo-sarcoma. Our
prognosis, therefore, as it might be supposed, was not very favourable.
The patient, however, did well, and in the course of a fortnight re¬
turned to the country, where, the last time I heard of him he was run¬
ning about as usual.

Hydrocele. — There were only two cases of hydrocele, but both rather
interesting. The first was that of William Macintosh, set. twenty-
eight, a north country cattle drover, who entered the hospital on the
17th of May, labouring under the following complication of diseases :
— sores on the penis, bubo, ague caught on passing through some of
the fenny districts in England, and a hydrocele of nine years standing.
Having subdued his other disorders, I punctured the hydrocele, and
evacuated a large quantity of chocolate-coloured fluid, holding in sus¬
pension many of those shining scales which my friend Dr. Christison
has found to be Cholesterine. As there was much enlargement of the
testicle, and great thickening of the sac, we did not think it right to
inject, and proposed to the patient to perform either the old operation
of excising the sac, that is to say, a portion of it, or the more simple
process of castration. He preferred the latter, but before sub¬
mitting to it found it necessary to return to the north to execute some
business of importance. It is this sort of hydrocele which has been
named hematocele, and probably with some reason. In the case
just related it Tvas observed that when the dark brown fluid was
allowed to stand quietly in the glass, a quantity of pure blood collected
in the bottom, and in another case, formerly under my care, the he¬
morrhagic nature of the disease was still more manifest. I punctured
a large hydrocele, and drew off a quantity of the same sort of fluid as
above described •, but finding that by far the greater part of the
VOL. III. NO, 17 ^ 1

420

Bibliography.

swelling still remained, and that the patient, who for several years has
been frequently prevented by fits of pain from following his avoeation
for weeks together, was now suffering more than ever, I proposed re¬
moval of the testicle, and performed the operation with perfect success.
On examining the tumour, I was not a little surprised to find the tes¬
ticle, quite sound, and that what had led me to think it enlarged
was a great mass of dense fibrinous matter, which adhered no less
firmly to the tunica vaginalis than the coagulum of an old aneurism
does to its inner surface.

The other case of hydrocele treated in the hospital was that of
Alexander Wood, aged twenty- four, a well marked case of hydrocele
of the cord. I drew oft’ the contents, which were perfectly pale and
limpid, but did not infect, since it seems that dropsy in this situation
is not so apt to return after evacuation as when it is seated in the tu¬
nica vaginalis.

The patient accordingly had a very slight return of the swelling,
which soon subsided, and he has been dismissed cured.

Compound fracture of the Wrist . — Kenneth Mackenzie, aged thir¬
ty-eight, a sailor on board a merchant vessel, while at Marseilles,
about five months previous to his admission, Tell from the top of the
main-mast^ and, besides sustaining other injuries, fractured the left
wrist. He was long in the hospital at Marseilles, and since his dis¬
charge had assisted in the escape of several small pieces of hone.
Judging from the smooth surfaces and angular edges of these pieces,
which he had preserved, that they had been detached by violence
and not by ulcerative absorption, I concluded that the sinuses, pain,
and swelling of the extremity which still continued, were owing to
some other loose fragments still remaining, and, having detected one
with the probe, lost no time in removing it. He immediately began
to improve, and though the joint remained stiff, the laxity the inte¬
guments, the freedom from pain, and the drying up of the discharge,
proclaimed a most beneficial alteration.

It was my intention to have detailed some other remarkable cases,
particularly one of a wonderfully extensible state of the skin, similar
to the wrell known one of the Spaniard recorded by Job a Meekren,
or that of Eleanor Fitzgerald by Mr. John Bell, and also to have
made some general observations on other surgical subjects, particularly
the treatment of burns, glandular swellings, and ulcers, of which there
were a great many of all descriptions, especially among the out-pati¬
ents. The results of blistering old indolent sores in imitation of the
natural cure, which is occasionally observed to happen after an erysi¬
pelatous affection of the ulcerated limb, appeared among these deserv¬
ing of notice. But this report has already attained such a length that
it would be improper to prolong it any further.

Many people thought it rash in me to undertake a clinical course
before having a single patient in the hospital ) but I trust that what
has been said here will be sufficient evidence that materials for the
purpose were not wanting. And there can be no doubt, that now,
when the hospital is fully established, and every day becoming better
known to the suffering poor, it will be in my power to increase the

On the Means oj affording Respiration to Children 9 $c. 42 7

interest not only of my Clinical Lectures, but also of the Reports,
which it is my intention to publish regularly thiough the medium of this
Journal.

It would have been tiresome to mention all the occasions on which
I derived advantage from the sound judgment of my excellent col¬
league } but I cannot conclude the -present report without expressing
my grateful sense of the acknowledgments due from all connected with
the establishment to Dr. Ballingall, for the manner in which he dis¬
charged his duties as consulting surgeon. — Edinburgh Medical Jour¬
nal.

3. On the Means of affording Respiration to Children in reversed
Presentation. By Jacob Bigelow, M.D. Professor of Materia Me¬
dina in Harvard University. — It is familiar to obstetric practitioners,
and is noticed by most writers on midwifery, that in those cases of la¬
bour in which the body of the child, is delivered before the head, a
considerable degree of danger exists in regard to the life of the child.
Buies for the conduct of such cases are laid down by writers, yet it
cannot be denied that, in the hands even of skilful practitioners, many
child ren which are alive when the body is expelled, are irrecoverably
lost before the head can be extracted. In these cases death takes
place because the connexion with the mother is interrupted, by com¬
pression of the cord, or detachment of the placenta, before a communi¬
cation with the atmosphere is effected.

It is the object ol the present paper to show, that in many such
cases the life of the child may be saved, by forming a communication
between the mouth and the atmosphere, previous to the delivery of
the head.

Alter the body is expelled, if the head can he seasonably delivered,
either by the recurrence of pains, or by the successful efforts of the
practitioner, no difficulty ordinarily occurs. But this desirable state
of things cannot always be realized. Too frequently the size of the
head, and the resistance of the pelvis or soft parts, renders the deli¬
very difficult and hazardous, and the practitioner in the midst of his
eftorts, is apprised by a convulsive jerk or spring of the body, that a
state of extreme danger exists, and that the time has come at which
the child must breathe or will speedily die. If at this period the fin¬
gers be introduced, so as to reach the mouth of the child, it will he
perceived that each jerk of the body is attended with a gasp, and
convulsive effort at inspiration, performed by the mouth and chest of
the child. In this state of things, if air be conveyed to the mouth of
the child, it wili immediately breathe, and the efforts of nature, as
will hereafter be shewn, may in most cases he safely waited for to as¬
sist in expelling the head.

The method to be pursued in conveying air to the mouth, depends
upon the situation of the head. If the chin has descended low in the
pelvis, so that the mouth rests upon the perinseum, or lower part of the
sacrum, and can be readily reached by the fingers, the hand of the
operator alone is sufficient to give the assistance required. But if the
mouth is situated so high in the pelvis as to he reached with difficulty,

428

Bibliography.

or if, from the large relative size of the head, there is much compres¬
sion, the assistance of a tube may be of use. The mode of proceeding
which I have found successful in various instances is as follow's : as
soon as the body and arms are extracted, supposing the face towards
the sacrum, an assistant supports the body, carrying it towards
the pubis \ or the reverse, should the position of the face be to the
pubis. The accoucheur should then introduce the hand to which the
face looks, till the middle fingers rest upon the mouth of the child.
The hand is then to be raised from the tin oat of the child, making the
ends of the fingers a fulcrum, and pushing the perinseum backwards.
The air will thus pass upwards as far as the chin of the child. The
middle fingers are now to be separated about half an inch from each
other, and thus a complete passage will be formed between them, by
which the air will reach the mouth of the child. If the child be in a
healthy state up to this period, it will immediately breathe and cry,
and the delivery of the head may be safely postponed until the natural
pains recur. If, from any degree of asphyxia, the child does not im¬
mediately bereathe, it may often be made to do so by dashing cold
water upon the body, or by other stimulating processes. It has even
appeared to me to be practicable to inflate the lungs, in some cases,
through an elastic catheter. When the mouth is so high in the pel¬
vis as to be reached with difficulty, or when the compression is so great
as to obliterate the cavity between the fingers, a flat tube will be
found useful, made of metal, of spiral wire covered with leather, or of
elastic gum, and having its largest diameter about half an inch. If
the tube be of metal, or of any incompressible material, it should be
withdrawn during a pain, to prevent contusion of the soft parts, and
immediately replaced, if the pain subsides without expelling the head.
Such a tube may be considered as a prolongation of the trachea, and
is fully sufficient to sustain life by respiration for a considerable time.
The tube must be guarded and directed by keeping it between the fin¬
gers of the inserted hand.

The foregoing practice is not new, though it appears to have been
lost sight of by most writers on midwifery. I am not aware that it is
mentioned by Smellie, Denman, Hamilton, Burns, or Dewees. Mer-
riman alludes to it as a thing which is possibile but does not speak ex¬
perimentally on the subject. In one of the older writers, however,
(Pugh’s Treatise of Midwifery, published in 1754), a practice nearly
similar i3 described, and warmly recommended from the author’s ex¬
perience. — American Journal of the Medical Sciences , August.

Dr. Bigelow relates three cases in which he saved the infant’s life
by this method. The practice is wTell worthy of serious consideration.
— Ed.

4. Perforation of the Stomach , without Ulceration or Softening oj
its Coats. By Leonard Peirce, M.D. of Sutton, Massachusetts.
Fletcher Bottomly, a native of Cheshire, England, came to the United
States in June, 1827, then aged nineteen years \ he followed weaving
in a woollen manufactory.

January 30th, 1829. — I was called about six o’clock this evening
to visit him, but being from home, did not see him till nearly eight

Perforation of the Stomach. 429

1 found him suffering from severe pain in the region of his stomach —
feet and hands cold— pulse small and fluttering— countenance con¬
tracted and anxious. On inquiring of himself and his comrades, I
learned that he had been as well as usual till about five this evening,
when he was suddenly seized with a violent pain at the epigastrium*
which soon extended downwards, but the seat of the pain remained at
the stomach. When first seized, the pain was so violent that he
cried out, “I am dying,” and threw himself- upon the floor, holding
his bowels with his hands, and pressing his body and thighs together
He was soon helped to his lodgings, which were a few rods distant, but
was unable to walk upright, remaining bent, supporting himself with his
hands upon his knees. The pain still continued violent, but was not now
confined to his stomach, being occasionally as low down as the pubic
region. Before I had arrived he had taken an emetic of ipecacuanha,
containing eight grains of calomel, which had vomited him twice with
some relief; but the pain being now in his stomach, I gave him tepid
water, which vomited him twice more, and he expressed himself consi¬
derably relieved. X now applied flannels wet with warm water to his
extremities, and gave him two grains of solid opium. His extremities
soon became warm ; pulse fuller and stronger ; the pain abated consi¬
derably, and he fell asleep. X now directed one ounce of castor oil to
he given every three hours until liis bowels were moved, and left him
tor the eight.

31st. — At Seven, a.m-. I found him considerably prostrated, and in
pretty severe pain. Pulse fluttering, and extremities cold. The
bowels were rather fuller than natural, but were not tender on pres¬
sure; had passed a restless night, and taken the oil without producing
any sensation of motion in his bowels; quite thirsty. X now divided
two drops of croton oil into six parts, and directed one part to be
given every half hour until the whole was taken, unless a motion was
produced. Stimulants were given, and water gruel for drink. 4 p.m.
Had taken all the croton oil without producing the slightest cathartic
effect. XJulse much as in the morning ; complained of considerable
soreness in his bowels, which were rather fuller than in the morning.
I should have given enemata, but for want of the proper apparatus
was obliged to postpone them, and directed one ounce of castor oil to
be given every hour, and put a blister upon the epigastrium. Eight
p.m. Directed an enema of decoction of senna, which passed off in
about twenty minutes without bringing any faeces with it. In a few
minutes I repeated the injection, which soon passed off unmixed with
any alvine matter, [directed an enema of milk and molasses, of each
four ounces, to be given every hour until his bowels were moved • con¬
tinued the drink of water gruel ; left him for the night.

February Is#.— Four a.m. vomited a small quantity of a dark, fe»
tid liquor, and in about fifteen minuses expired.

X very readily obtained leave of the friends to examine the body,
which X did at Two, p.m. ten hours after his death.

The blister had produced very slight vesication, and the bowels were
considerably tumid. On cutting through the parieles of the abdomen
there was a sudden gush of liquor consisting of those articles he had

430 Bibliography.

taken into his stomach, castor oil, water gruel, &c. I observed to
the bystanders that there was a rupture ol the stomach or intestines,
and then I supposed it to be from ulceration. After removing the
fluids from the abdominal cavity with an injecting syringe, I laid open
the abdomen, and proceeded to search lor disease, I he* vessels of the
omentum, and of the peritoneal coat ol the intestines ’tfere consider¬
ably gorged with blood, but there were no unnatural adhesions between
any of the parts. The mucous coat ol the intestines was of a healthy
appearance, except in some places in the small intestines there were
minute scarlet dots thickly set together. The urinary bladder was
entirely empty, and of a healthy appearance. Kidnies healthy. I he
liver was of a pale ash colour externaliy, and internally much paler
than natural. On arriving at the stomach, I found about half an inch
above the pylorus, on the anterior part, an opening about two and a
half lines in diameter. This had the appearance of having been
punched out with a cutting instrument, and was not much unlike the
holes made in harness for the buckle tongues, but the edges were not
quite so well defined as though cut with an edged tool. There was
no appearance of disease about the perforation, either externally or
internally, except that the mucous lining of the stomach was filled
with black and brown dots of about the same appearance, except in
colour, as the grains of Indian meal taken in the gruel.

Bottomly w7as of a melancholic temperament, tall, spare, and tempe¬
rate in the use of spirituous liquors. He was a voracious eater, de¬
vouring as much at his regular meals as two common eaters, and fre¬
quently eating between meals, and always taking some cold food just
before going to bed. He had for several years previous to lus death
been afflicted with purulent ophthalmia. Since the time of his arrival
in this country he had been very costive, generally not ha\ing a stool
oftener than once a week. He had within three or four months of his
death, three small, hard, red, or rather purplish tumours directly in
the pit of his stomach, which were very sore and painful, slow m
forming, and difficult to cure. He usually applied a plaster of shoe¬
maker’s wax to them, which caused them to ulcerate and discharge a
sanious, bloody matter, and then they would heal. The last one
was a little previous to his death, but had at the time got entirely
well.

5. Doses of Camphor. — M. Scudery, and other Italian physicians in¬
stituted a number of experiments to prove the effects of camphor on a
healthy individual. They conclude as follows : 1. That a dose of eight
or ten grains, has scarcely any perceptible effect, and 9j-ij. in divided
doses may be given. 2. That the effects of camphor on the economy
are to excite the circulation and elevate the animal heat. 3. That
it does not excite irritation in gastro-intestinal membrane, nor pain
nor borborygmi, but constipation. 4. That it acts specially on the
genito-urinary organs in augmenting the energy of their lunctions.
Voluptuous reveries, erection 6f the penis, sensation of heat in the
urethra during the passage of urine prove its stimulant action. 5.
That vertigo, vivid impression on the eye, cephalalgia, acceleration oi
t he circulation, and excitation of the genito urinary organs announce

431

Great Dilatation of the Heart.

the action of camphor to he directly on the brain, cerebellum, and great
sympathetic. 6. That its action is increased by union with alcohol,
and diminished combined with nitre. — Annali Universali di Med;
Juin,

SAINT GEORGE’S HOSPITAL.

6. Great Dilatation of the Heart — Dilatation with Hypertrophy of
the Left Ventricle — Disorganisation of the Liver. — Richard Collard,
aged thirty-six, a coach maker, admitted Aug. 19th, under the care
of Dr. Chambers. Face puffy, phlegmatic, and bilious— anasarca of
lower extremities — some ascites — dyspnoea — incapability of lying on
left side— strong and extended action of the heart — pulsation and
undulation at the root of the neck — pulse 120, small and rather
hard — skin cool and clammy — tongue clean, bowels open — stools clay-
coloured — urine dark and very scanty.

Ailing two years with loss of appetite and occasional palpitations at
the heart — six months ago legs swelled, became excoriated, and dis¬
charge even at the present time — abdomen swelled about the same
period — skin has been tinged yellowish for the last five or six weeks
— urine has been scanty for a month. He attributes his complaints
to distress of mind.

Png. Hyd Fort . 3I. reg. hepat. 0. n. infricand. Haust. Nitri. c.
Spir. dEth. Nit. 3b ter die. Potass. Supert. Pvlv. *ss. 0. ni. Di.
ordinar.

On the 21st a scruple of jalap was added to the supertartrate every
morning, and spirit lotion was ordered for the legs

24th. 41 as had three paroxysms of a mixed epileptico-apoplectic
character. They occurred towards night, the longest was of two
hours duration, and they were followed by deep sleep. At present be
looks better and the swellings are diminished — bowels open thrice in
tWfenty-four hours. On the 26th he was not so well, had cough and
troubled sleep, and the bowels were not open.

H. Serin, c. Tinct. Jal. giss. Potass, supert. pulv. gi. 0. m. loco,
pulv. Potass, supert. See. Emp. Canth. lat. sinist. Rep. alia.

On the 31st the blister was repeated and three minims of laudanum
added to the diuretic draught. On the 4th Sept, the face was yellow ;
orthopneea*, sharp and rather full pulse. On examining the heart by
the cylinder, the sound of the ventricles was rather rough, prolonged,
and approximating to slight bruit de sovffiei — impulsion considerable,
especially of the left ventricle — dulness of sound on percussion over a
large cardiac region. Dilatation of the heart , hypertrophy and dila¬
tation of left ventricle — very little , if any induration of semi-lunar
valves. There being some bruit over the clavicles apparently in the
aorta, slight dilatation and commencing depositions were suspected.

On the 3d the bowels being much purged and the stools bloody, he
was ordered to omit the former medicines, and to take a draught of
chalk mixture with five minims of laudanum after every loose eva¬
cuation. On the 4th the diarrhoea, or rather dysentery, was checked,
the patient having had one motion. The lips were completely exco¬
riated and excessively sore, the anasarca and ascites were less. The
nitre draught to be resumed , with the r mercurial inunction — chalk

432

Bibliography.

mixture if the diarrho&a returned. He now became rapidly worse,
and was evidently sinking am the Gth. Brandy was administered, but
he died on the 7th.

Sectio Cadaveris. Legs cedematous — face puffed and bilious — body
much loaded with fat.

Thorax. About a pint, or more, of clear yellow fluid in the right
side 3 two thirds of that quantity in the left. Bight lung goYged with
serum, but not much blood •, some parts more or less solid, without
hepatization. Left lung oedematous, and in much the same state as
the right, but not to so great a degree ; no tubercles in either lung.
Mucous membrane of bronchi, large and small, deeply congested, and
the tubes themselves choaked with Irothy serum.

About a couple of ozs. of clear yellow serum in the pericardium.
Heart externally a very large one, and loaded with fat, particularly
on the right side. Great dilatation of the cavities of the right auricle
and ventricle, their parietes being little increased in thickness — still
more dilatation of the left chambers and hypertrophy of the walls of
the left ventricle, though not to an extreme degree. Valves and aorta
sound.

Abdomen. Very little fluid in this cavity. Liver large, hard,
granulated, and of the colour and appearance of yellow wax-kidneys
large, pale and somewhat soapy in appearance — no ulceration of the
intestines.

Cranium. Much transparent fluid between the arachnoid and pia
mater — universally blanched, soft and macerated condition of the brain,
but no organic alteration — some clear limpid serum in the ventricles. —
Med . C/iir. Rev.

ROYAL WESTERN HOSPITAL.

7 . Extraction of the Breech-pin of a Musket from a Boifs Orbit. —
George Agate, eighteen years of age, presented himself at the Boyal
Western Hospital, on the 20th of June last, with a scar about an inch
and a half in length over the right eye, and a piece of iron protruding'
through the integuments of the upper lid $ the eye-lids were closed.
He stated, that on the 27th of last February he was shooting with a
musket loaded with a double charge, which burst when he fired it,
and he believed that the piece of iron now protruding through the eye¬
lid was the breech-pin of the gun, as it had never been found. He
became insensible immediately after the accident, and continued so
for several days •, and some brain and several pieces of bone had
escaped from the wound, which afterwards gradually healed, leaving
no part of the iron visible. It had, however, lately descended, and
appeared through the integuments of the upper eye-lid. It caused
him no pain, but he felt as if some heavy body were in his eye $ his
health he stated to be good.

Fie was examined by Mr. Truman, who found, with the aid of a
probe, that a massive body occupied the orbit, a very small portion of
the surface of that body being exposed, as was before said, through
the upper lid of the right eye. Little pain, and no nervous irritation
were excited when it was moved with the forceps. On raising the
lid, no part of the eye was visible, but a mass of irregular granula-

Extraction of a Breech-pin from a Boy’s Orbit . 433

tions appeared to have taken the place of the cornea, and anterior sur¬
face ot the sclerotica. Mucus was constantly discharged from be¬
tween the eve-lids. It was determined to extract the foreign body ;
and Mr. Truman performed the operation on the 22d of June, in the
following manner : — He introduced a director at the opening through
which the surface of the foreign substance appeared, intending that
its point should come out between the eye-lids at their inner junction.
This, however, he was not able to effect without cutting down upon
the point of the director, through the granulations which had grown
over and confined the foreign body ; and now, as they were also at¬
tached to the under surface of the upper eye-lid, impeded the passage
of the director. Having done this he divided the portion of the eye¬
lid which laid over the director. An assistant then raised the outer
flap with a pair of forceps, and with another pair of forceps Mr. Tru¬
man took hold of the foreign substance, and freed it, by dissecting
through the granulations, and, after moving it about a little, succeed¬
ed :n extracting what appeared to be the breech-pin of the gun, weigh¬
ing two ounces and five grains. There was slight hemorrhage from
a vessel in the orbit, which, however, was arrested by pressure with
the finger. The edges of the wound formed by the division ot the
upper lid were now brought together, and kept so by strips of adhe¬
sive plaster ; over them simple dressing, and a pledget of lint were ap¬
plied, to be kept moistened with the following lotion : — Spirits of
wine, two ounces ; water, one pound.

23d. — Slept well during the night ; no pain ; pulse 86.

25th. — Skin rather hot; bowels confined ; ordered a dose of house
medicine ; the wound dressed, which looked healthy.

26th. — Bowels opened ; wound occasionally dressed till the 8th of
July, when he was discharged cured, at which time a part of the cor¬
nea lucida could be seen ; and though he could not then distinguish
light from darkness with this eye, a gentleman who saw him last week
states that he can now do so.

As it was doubted that some portion of the brain had escaped, Mr.
Truman applied to Mr. Peter Evershed, of Billingburst, in Sussex
(under whose care the lad was first placed), for information, who gave
the following particulars

“ February 27th. — I was this morning called to attend on George
Agate, who was suffering from a lacerated wound and fracture in the
lower part of the os frontis, occasioned by the bursting of a gun.

“ There was a considerable discharge of blood from the wound,
mixed with brain, and the right eye wras forced from its socket ; on
closer examination of the finger, I discovered and removed two loose
portions of bone, one on each side of the wound, replaced the eye,
which was lying out of the socket; dressed the wound with dry lint,
and a bread poultice over it.

“ The wound is supposed to have been caused by the breech-pin,
but it has penetrated too far to be discovered without using more force
than I think proper.

“ Immediately after removing him he was seized with general con¬
vulsions, at which time light-coloured blood was discharged freely

vol, in. pro. 17. 3 K

434

Bibliography.

from the wound, with portions of brain, in all, I think, about a tea¬
spoonful (independently of what came away before).

“ Prior to this the mental faculties were but little affected, except
that there was a dulness*, the convulsions continued an hour so strong,
that two men were required to hold him ; he then fell into a state of
stupor, with occasional convulsions, until midnight, when his mother
arrived, whom he immediately recognized.

“ 28th.—' To my surprise, 1 fouud him this morning tolerably sen¬
sible, exhibiting only a little dulness, which, however, did not amount
to stupor. He was slightly convulsed , the palpebree of both eyes
quite closed j he complained of scarcely any pain 5 pulse even at 90 j
little thirst \ head rather hot } any noise, or jarring of the room gave
pain j about a tea-spoonful more brain came away in the dressing ;
the wound looks dark, from the gunpowder 5 no appearance of more
loose portions of bone, nor of the breech-pin.

“29th. — Convulsions gone \ more sensible j wound suppurating^
from this time he has gone on without an untoward symptom j at the
end of ten days the breech-pin descended so as to be visible, and easily
moved up and down.”— Lancet

8. Extract from Observations on Strictures of the Rectum. By
Henry Earle, F.R.S. — Having lately to examine the body of a child,
aged fifteen months, who died of hydrocephalus acutus, I was struck,
on opening the abdomen, with a very remarkable deviation from the
usual course and length of the large intestine. The descending colon,
on gaining the brim of the pelvis, instead of proceeding downwards, to
form the sigmoid flexure, suddenly took an upward direction under
the arch of the stomach, crossed obliquely to the right iliac region,
and then descended to form the rectum. The portion of intestine,
above described, was more than twelve inches in length, and was free
in the cavity of the abdomen, being quite enveloped in peritoneum,
like a small intestine, and having a reduplication of peritoneum simi¬
lar to the mesentery, of three inches in length. It was not sacculated
like the rest of the colon, having no visible longitudinal bands, and in
every respect, except its volume, it bore a close resemblance to a por¬
tion of small intestine. It was so loosely connected, and so pendulous,
that it might very easily have been included in a hernial sac on the
right side. I have considered this fact deserving of being recorded
in your valuable journal, not only from its being peculiar, but from the
important practical inferences which may be drawn fiom it. I have
many times met with similar deviations to a less extent, more espe¬
cially in female subjects, where the colon will often be found to cross
over to the right side, before descending to form the rectum. I had
occasion to mention this circumstance last spring, in some clinical
observations on a case of diseased rectum 5 and, in the course of the
same week, two instances occurred in examinations which were made
in the dead-house, illustrating the truth of the position. I mention this
to prove that it is by no means a rare occurrence, though, in no work
on anatomy which I have perused, is any mention made of such a de¬
viation.

Mr. Earle on Strictures of the Rectum . 435

The importance of every surgeon being aware of the possibility of
such an occurrence will at once strike your readers, when it is consi¬
dered what serious and even fatal injury might ensue from a surgeon
attempting to pass a rectum bougie according to the prescribed rules,
in such a case. He would infallibly meet with resistance, which he
would probably mistake for stricture, and if he employed any degree
of force, he would lacerate the bowel, and destroy his patient j for, be
it remembered, that this accident is far more likely to occur when the
coats of the intestine are healthy than when they are thickened by
disease. This was the case in an instance which lately formedth e
subject of a judicial inquiry ; the intestine was quite free from the
semblance of stricture or disease, and, consequently, was more easily
lacerated by the degree of force employed to overcome the imaginary
stricture j and here, sir, I will take the liberty of offering my testi¬
mony on the subject of strictures of the rectum — a testimony founded
on upwards of twenty-four years’ practice in the largest hospital in
London, and on examination of most of the collections of morbid pre¬
parations.

It is my firm conviction that strictures at the sigmoid flexure, or
higher up, are very rare occurrences indeed. The most common seat
of disease of the rectum is from two to five inches up j a part which can
always be satisfactorily examined with the finger of the practitioner,
or with the assistance of a speculum ani. When stricture is said to
occur beyond this, I should always be inclined to be sceptical, as many
circumstances render it very difficult, if not impossible, to ascertain
the fact during life. In some instances I have no doubt the gut takes
the direction which it was the object of this paper to explain j in
others, the promontory of the sacrum projects so as to mislead the
practitioner j in others, again, there may be enlargement of the ovary,
or other tumours in the pelvis, which may afford an obstacle to the in¬
troduction of instruments. These circumstances may, and I have no
doubt have often, misled surgeons.. But L fear this excuse cannot be
offered for those who would represent stricture of the sigmoid flexure of
the rectum as one of the most frequent maladies which flesh is heir to.
Such men, I fear, are more inclined to deceive others than to be the
dupes of their own imperfect knowledge. If this were not the case,
why should they be so over-anxious to keep their patients in ignorance
of the real state of their bowels, by the daily exhibition of purgatives,
when the appearance of one natural evacuation would undeceive them
and their patients, and would afford more satisfactory evidence of the
actual state of things than all the bougies that were ever invented ?
I trust that I shall not be considered improperly severe in thus ex¬
posing a growing evil, and v/arning the rising generation irom listen¬
ing to the plausible assertions of men who betray the sacred trust con¬
ferred upon them, and who prefer the acquisition of lucre to the ho¬
nourable discharge of the duties of their profession.— Med. Gazette .

MONTHLY SYNOPSIS OF PRACTICAL MEDICINE.

LONDON MEDICAL SOCIETY.

1. Delirium Tremens — Puerperal Mania. — The proceedings of
this Society commenced September 28, Mr. Callaway, President, in
the chair. The president congratulated the members on the very full
attendance of the evening, and felt satisfied that the zeal and talent
which characterized their proceedings during the last session, would
be fully equalled during the present. He begged leave to suggest
what appeared to him an improvement in their discussions, which
was, that every member who intended to relate cases would submit
the leading features of them to writing, and thus much time would
be saved in making inquiries, which were indispensably necessary
when cases were stated viva voce , as it often happened some of the
chief features were omitted. The minutes of the last meeting were
read, and related to a case which presented the usual symptoms of de¬
lirium tremens accompanied with cynanche tonsillaris. The necrop-
*it appearances in the brain indicated a slight degree of congestion.

Mr. Ashwell read the history of a very well marked case of puerpe¬
ral Mania in which he had employed all the remedies hitherto recom¬
mended and unsuccesfully. Leeches were applied to the head, on two
occasions, when the paroxysms became much increased in violence.
Another peculiarity in the case was the periodicity of its attacks.
Frtmi all he had seen of the disease, or read upon the subjeet, he
agreed with those who considered it a nervous disorder, and seldom
dependent on increased vascular action in the brain. He introduced
the subject in the hope of eliciting some suggestion from the society,
which might alleviate the melancholy state of his patient. He wished
also to hear the experience of the members as to the prognosis, dura¬
tion, and treatment of the disease. His patient was five months
afflicted, and it Was her first parturition.

Mr. Holmes had known a similar case which was finally cured by
placing the patient in a lunatic asylum.

Mr. Kingdon was of opinion that the process of lactation which
was intimately connected with parturition and the puerperal state,
should, if possible, be suppressed j in fact, that the system should he
restored to rts natural condition, as if in the unimpregnated state, and
that the child ought to be weaned to effect this object.

Dr. Williams concurred in this opinion. ' ‘ 1

Mr. Ashwell replied, that such was the affection of his patient fat¬
her infant, that ablactation could not be effected without greatly ag¬
gravating the symptoms.

Dr. Welshman related several cases in which the patients were
allowed to suckle, and where recovery took place. According to his
experience, patients generally recovered. He had known a lady who
was maniacal after four successive parturitions. He considered the
exhibition of large opiates highly dangerous, and related a case in
which two eminent practitioners urged that medicine so far, as, in his
opinion, to have caused death.

Dr. Uwins would be inclined to use depletion in certain cases, and
then exhibit opium.

Delirium Tremens — Puerperal Mania. 43 J

Dr. Burne remarked, that in a conversation which he had had lately
with Dr. Monro, at Bet lilem Hospital, that gentleman stated, that
this form of mania was seldom fatal.

Mr. Lloyd related several important fcases, in one of which the
disease continued for three, and in another for eleven years, before
recovery occurred. In one of these cases, the lady had a lucid interval
every other day, and often entertained her friends, and on the next day
was perfectly maniacal.

Dr. Ryan begged to ask, whether camphor had been tried freely,
as recommended by continental writers? . '

Mr. Ashwell replied in the affirmative.

Mr. Shearly observed that he had witnessed its good effects combined
with the tine, valer. am.

Dr. Shearman stated that a physician of eminence had recom¬
mended the tart potassse in such cases, and found it highly useful,
although he was unable to explain its mode of operation.

Mr. Procter related a case of the disease under notice in which the
uterus was found inflamed on dissection. It was denied, however,
that this was a genuine example of the puerperal mania. Adjourned .

Meeting of October 5th.

2. Puerperal Peritonitis. — Several observations were made on the
minutes of the preceeding meeting, and the subject of puerperal peri*
tonitis came under discussion.

Dr. Whiting observed, that during the prevalence of this form of
peritonitis in hospitals, erysipelas also prevailed, and he proceeded to
argue that this last form of inflammation was sometimes the real na¬
ture of peritonitis.

Dr. Walshman was of the same opinion.

A member enquired the diagnosis between the ordinary and ery¬
sipelatous forms of peritonitis ? . ,

Dr. Walshman replied that the pulse was small, soft, and easily com¬
pressible in the latter form, and that the disease was mostly fatal.
As to the treatment, early and copious depletion was alone to be de¬
pended on.

Mr. Waller was anxious to enquire, whether puerperal peritonitis
might exist without pain or tenderness on pressing the abdomen, as a
case had lately fallen under his care, in which a physician pronounced
it peritonitis from the state of the pulse, according to Dr. Hamilton’s
opinion.* The patient died, and the appearances of peritonitis were

perfect. # *

Dr. Ryan remarked that the question put was decided long since
on the continent, in the negative, which was now admitted in this coun¬
try. Dr. Ayre had mentioned to him a case in point, where even
ulceration of the ileum had taken place, and the foeces had escaped
into the cavity of the abdomen, yet there was no pain or tenderness of
the abdominal parietes on pressure.

* Dr Hamilton has been misrepresented or misunderstood on that point ;

for his opinion was, that if the pulse exceeded" 100 in the puerperal stage there
was danger of some mischief ^ hut he did not paiticulaiize peiifonitds. , li.D.

438

Synopsis of Practical Medicine .

A Visitor mentioned several similar cases.

Dr. Williams was very much inclined to doubt the possibility oi
peritonitis occurring without pain, and he founded his opinion on the
authority of Dr, A bercrombie of Edinburgh, who had written so ably
on the subject.

Meeting of October 12.

3. Peritonitis unaccompanied with pain in the Abdomen. The dis¬
cussion of the last evening was resumed.

Mr. Costello stated that peritonitis very often occurred without the
presence of pain, or tenderness of the abdomen on pressure, and re¬
ferred to the excellent paper published by Mr. Iving.

Mr. Macilwain cited several cases in support of the opinion.

Dr. Walshman alluded to four cases of the disease which had proved
fatal very speedily, and which fell under his observation within a re¬
cent period.

The discussion again turned on the pathology of puerperal peritoni¬
tis, and whether the disease was infectious. The time ol the Society
having expired, the subject was adjourned to the next meeting.

Meeting of October 19.

4. — Pathology and Necropsy of Puerperal Fever. — The minutes
of the preceding Meeting having been read, Mr. Pereira observed,
that he did not comprehend how the peritoneum, a serous membrane,
could be the seat of either erysipelatous or phlegmonous inflammation,
Tike every other particular tissue in the body, it was liable to inflam¬
mation, but, in his opinion, of a specific nature.

Dr. Whiting rose to reply, and argued to support the opinions he
had advanced on a former evening. He considered the skin, for ex¬
ample, presented different appearances when inflamed, as in measles,
variola, and scarlatina. He considered inflammation modified more
by external causes than by structure. He referred to the works ol
Dr. Gordon, of Aberdeen, Dr. Armstrong, and Mr. Hey, in support
of the opinion, that peritonitis was the cause of what was called puer¬
peral fever.

Dr. Byan remarked, that all the eminent physicians who had seen
the fatal or malignant puerperal fever of hospitals, unanimously agreed,
that the disease was different from peritonitis. In this phalanx, were
Drs. W. Hunter, Hulme, Leake, John and Joseph Clarke, Young,
Arthur and James Hamilton, Denman, Labatt, Douglass, Haighton,
Lowder, Dewees, Gooch, and a host of others. They found the dis¬
ease was not to be arrested or cured by depletion. This was the gene¬
ral opinion, until the writers named by Dr. Whiting had advanced a
different pathology in l8l4*, but Dr. Hamilton denied that they had
described the real disease as seen in hospitals. It appeared too, from
necropsic appearances observed during the ravages ol the disease in
Vienna, in 1819, that the os and cervix uteri were first affected and
found gangrenous \ and there the depleting plan was also unsuccess¬
ful. This is so well known to those who have really seen the disease,
that in a late clinical report of the Dublin Lying-in Hospital, which
was published in one of the periodicals, general bleeding was not re¬
sorted to, because it was always found useless. The internal and ex-

7 J

439

Synopsis of Practical Medicine.

iernal use of mercury, and the like use of the oil of turpentine after
^tlv® leecIling were the means employed, and these unsuccessfully.
-Or. Gooch has also stated, that the lancet is not the remedy. Those
who describe the disease as peritonitis, have only seen patients in pri¬
vate practice ; and it is well known that the disease under notice is
seldom to be observed out of hospitals

Mr. Waller and Mr. Doubleday considered the malignant puerpe¬
ral disease totally different f rom peritonitis.

. jP*! Walshman never observed the disease to be communicated by
infection, though he is aware that very eminent men have asserted the
contrary.

Mr. Brown had bled freely in peritonitis, and generally with suc¬
cess. His cases occurred in private practice, and he did not state
whether he considered them similar or dissimilar to puerperal fever.

Meeting of October 26.

5. Lithotrity— Incontinence of Urine— SpinaBifida.— ThisMeeting
was the largest which we had ever witnessed. Mr. Costello commenced
by stating, that he deemed it unnecessary to occupy the time of a sci¬
entific society similar to that which he had the honour of addressing,
with a history of lithotrity, more especially, as he had published such
history in the last and present Numbers of the London Medical and
Physical Journal. He would, therefore, proceed at once to demon¬
strate the structure and uses of the instruments of his friend and mas¬
ter, Dr. Civiale. Mr. Costello then explained in a clear, easy, con¬
cise, and familiar manner the very ingenious and perfect instruments
employed in the various 1 itliotri tic operations. He performed the se¬
ries of these operations, and repeatedly received the applause of the
meeting. He replied to all the questions put to him by the President,
Mr. Kingdon, Mr. Cooke, Mr. Taunton, Mr. Jones, Mr. Dendy, and
various others, whose names are unknown to us. He detailed the
cases operated on by M. Civiale, which amounted to 137, and some of
those in which he had successfully performed the operation in this
country. It was highly pleasing to observe the frankness and can¬
dour of the narrator, and the honourable and dignified silence he ob¬
served when requested to state the failures which he had known attend
the opeiation in the hands of others. His conduct throughout was
honourable, candid, and characteristic of the genuine cultivator of
science, and gained him an unanimous vote of thanks from one of the
most respectable and numerous meetings which has assembled within our
recollection.

Dr. Blicke related a case of incontinence of urine in a young lady,
aged I 5 years, which withstood the ordinary treatment. He injected
the bladder with warm water, which relieved the disease for a-day, but
symptoms of irritation and inflammation having supervened, he was
obliged to employ the antiphlogsitic treatment.

Mr. Kingdon described a similar case which was induced by partu¬
rition \ the woman had laboured under the disease for seven years, and
was subjected to a variety of treatment unsuccessfully. To remedy
this complaint, Mr. K. introduced a common dressing forceps into the

* For a full account of Puerperal, see a former Number of this Journal.
(July.)

440

Books Received , Literary Intelligence , SfC.

urethra, separated the blades, and turned them round in every direc¬
tion. This simple operation was followed by complete success.

Mr. Shearly presented to the Society a foetus with spina bifida. He
had not seen the parent during parturition, and, therefore, was unable
to state whether the tumours had been ruptured during delivery.

Dr. Blicke observed, that he had lately seen a similar ease, but the
tumour presented a cicatrix at birth.

New Regulations of the Royal College of Surgeons, confirmed
Oct. 29. We perceive the following changes —

1. Six months attendance on any of the recognized Hospitals, and
twelve months on a Provincial Hospital, recognized by the Council.

2. Members or Licentiates of the British Colleges of Surgeons, or
of any University, will be admitted to examination on presenting their
Diploma, License, or Degree.

The Royal Western is virtually recognized by these Regulations.

BOOKS RECEIVED FOR REVIEW.

1. Transactions of the Medico Botanical Society of London. Vol. 2, part I.
—London, 1829. 8vo. pp. 78,' with Plates. John Wilson.

2. A Manual of General Anatomy, or a Concise Description of the Primitive
Tissues and Systems which Compose the Organs in Man. By A. L. J. Bayle,
D.M.P. &c. &c., and H. Hollard, D.M.P. &c. &c. Translated from the French
by Henry Stoker. London, 1829. 12ino, pp. 318. John Wilson.

*** The compressed, yet comprehensive, form in the Manual before us
must find a place in every medical library. It is an accurate translation, and
entitles Mr. Stoker to the commendations of every scientific member of the Pro¬
fession.

3. A New Method of Treating Burns and Scalds, and certain Cutaneous
Eruptions. By Michael Ward, M.D. S.R.C.S.L., late Surgeon to the Manchester
Infirmary, Dispensary, Lunatic Asylum, and House of Recovery, and Senior
Physician to the Buxton Bath Charity. London, 1829. 8yo. pp. 86. Longman
& Co.

The whole of the new treatment consists in dredging the scalded or
burned parts, whether vesication be produced or not, with flour, and repeating
the application when the pain returns. Dr. Ward has cited several cases relieved
by this treatment, and extracts from other practitioners, corroborative of its
efficacy. We have tided this plan with and without success, but in no case so
constantly recommended by our author. Should this simple practice prove suc¬
cessful, Dr. Ward will have the gratification of having his name recorded among
those of the best friends of humanity.

4. A Practical Treatise on Acute Abdominal and Pelvic Inflammation, con¬
taining a comprehensive Clinical View of Inflammation of the Stomach, Bowels,
Peritoneum Uterus, &c. ; with a Certain and Expeditious Method of Cure. By
David Nicholas Bates, Medical Practitioner. London, 1829. 8vo. pp. 136.
Baldwin and Craddock.

5. A Letter to Lord Robert Seymour, with a Report of the Number of Luna¬
tics and Idiots in England and Wales. By Sir Andrew Halliday, K.H. and M.D.
London, 1829. 8vo. pp. 88. T. & G. Underwood.

This important Report we shall notice in our next. It affords a melan¬
choly proof of the increase of mental disease in this country, and reflects great
credit on its author for the zeal and research which he has displayed in obtaining
this information, while i.^ shows the narrow-mindedness of those official per¬
sons who fruitlessly endeavoured to impede his laudable inquiries.

In our Report of the Cholera Morbus at Clapham, extracted from the Lancet,
the inverted commas should have terminated before the commencement of the
third concluding paragraph.

All Communications and Works for Review to be addressed to the care of
Messrs. Underwood, 32, Fleet* street j or to the Editor, at Ins residence* 61,
Hatton Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

DECEMBER 1, 1829. Vol. III.

CRITICAL REVIEW.

i.—A Practical Treatise on Diseases of the Genitals of the
Male ; with a 'preliminary Essay on the History, Nature ,
and general Treatment of Eues Venerea. By John Mad¬
dox Titley, M.D. London : George Herbert., pp. 403.
1820.

A work on the diseases of the male genitals, has long been
desiderated by the profession in this country \ and on perus¬
ing the title of that before us, we supposed such a produc¬
tion had at length appeared. On glancing over the con¬
tents, we were soon undeceived, as we discovered only the
few diseases described in the popular treatises on surgery.
There is, consequently, still room for a complete and com¬
prehensive treatise on these diseases, which should embrace
all the malformations, all the disorganizations, and all the
causes of impotence and sterility in the male. Mr. Hunter
has briefly alluded to the subject of impotence — a subject
which deserves much attention, as it too often leads to
grievous misunderstandings in families. Sir Astley Cooper
has glanced at it in his invaluable lectures ; but we still
want a comprehensive work on the diseases which induce
it ; and on the numerous other maladies incidental to the
male genitals, and unnoticed by our author. Independently
of the many physical causes of impotence, are the moral
causes, so well described by the French writers. — Diet, des
Sciences ivied. Nouv. Tableau de V Amour conjugal par Bous-
quet , Sfc. tyc.

We expected to have found in the treatise before us some
account of hypospasdias, epispasdias, tumours of the cor¬
pora cavernosa, elongation of the frsenum preputii and fun -
gus haematodes of the penis, diseases of the verumontanum,
prostate gland, and vesiculse seminales. Dr. Titley has

VOL. III. NO. 18. T

442

Critical Review.

prefixed to bis work a preliminary essay on the history, na¬
ture, and general treatment of lues venerea. From all his
research and personal observation he is disposed to believe
that lues venerea is neither new, nor, according to any defi¬
nition hitherto proposed, a specific disease/" p. 1 *. In
this conclusion he is borne out by the writings of our most
distinguished medical officers of the army, whose observa¬
tions are opposed to the opinions of Astruc, Hunter, Adams,
and all others, who have thought the disease imported by Co¬
lumbus— a specific disease, different from all the ulcerations
of the genitals described by the writers anterior to 1494.
He restricts the term lues venerea to that form of the dis¬
ease which is followed by primary and secondary symp¬
toms ; and the term tc syphilis to the limited form of the affec¬
tion which, according to more recent doctrine, admits a pecu¬
liar kind of sore only called Hunterian chancre as the primary
symptom of a specific disease. This assignment of terms
is confessedly arbitrary, but, by thus explaining, I hope to
escape the censure of equivocal dealing with nomenclature,
even in a case where it had been previously less vague and
equivocal.” We are at a loss to perceive the necessity for
this distinction in the application of these terms, nor do we
think it by any means warranted. Our author denies that
sufficient proof has been afforded to establish the breaking
out of a new plague in Europe, after the return of Colum¬
bus. He offers the following satisfactory reasons for his
dissent.

“ Mankind have the same structure as they had of old j the
same susceptibilities, the same appetites and lusts ; and are, so far
as regards our present subject, in the same condition of external
circumstances $ at least we neither know nor can reasonably pre¬
sume to the contrary. Since, therefore, lues venerea does now
exist continually, by inartificial propagation, in all the varieties of
European climate, I conclude that it has existed there from the
earliest periods, to a greater or less extent.” — p. 3.

He also quotes a passage from Celsus : —

" Next are the matters relating to the privy members. Among
the Greeks the vocabulary of this subject is more endurable, and
has been generally received into use, seeing that it is employed in
almost all the writings and oral communications of their physi¬
cians. With us terms are more gross, and none of them are sanc¬
tioned by custom, of those who observe delicacy in language ; so
that at once to fulfil the requisitions both of our science and of
decency, is a difficult task. However, I am not therefore to be
deterred from writing • because, in the first place, I ought to in-

* Mr. Carmichael has arrived at the same conclusion Work on Syphilis.
j). 40. . ... .

Dr. Titley on Diseases of the Male Genitals. 443

elude every point which I have understood to be conducive to the
preservation of health, and, farther, because a method of treatment
should be in every individual’s hands, in a case where the parts
affected are not exposed to inspection of another without extreme
reluctance.” — p. 4.

We have the following passage from the third book of
Hippocrates, on epidemics : —

“ Many have aphthae and ulcers of the mouth ; considerable
runnings from the pudenda ; ulcerations ; tumours, external and
internal, about the groin 5 humid ophthalmia, of long continu¬
ance, with pains ; flesh-like excrescences, called fisci, of the pal-
pebrae, both internal and external, which destroyed the vision of
many. And, moreover, there arose many ulcers of other kinds,
even uport the genitals. And there were many carbuncles during
the warm season, and other sores, which are called putridities.
Large pustules. Many had herpes, (or ulcers that creep from
part to part).” — p. 7-

In further proof of his argument, he gives extracts from
the works of Lanfranc, of Milan, 1290 ; Gordon, of Mont¬
pellier, 1300 ; Guido de Cauliaco 1 ; Velascus cle Taranta2;
Peter de Argleta, of Bologna3; our countryman, Arden,
1380 ; and Chancellor Gascoign, of Oxford, in 1420, who
knew many men to die of a disease gotten by connexion with
women, which caused putrefaction of the genital organs, and
of the entire body, and that John of Gaunt died uex tali
putrefactione membrorum genitalium et corporis sui causat.A,
per frequentationem mulierum.” Although our author has
evinced much research in tracing the history of genital ul¬
cers in the male, as described by writers previously to 1494,
he has left many important records unnoticed. A few of
these may be quoted. De Blegny endeavours to prove the
existence of venereal ulcerations in the male organs so early
as the Mosaic age * *, and, indeed there is circumstantial evi¬
dence afforded by the medical precepts inculcated in the
book of Leviticus. Lefevre de Villebrune maintains that the
disease was known eight centuries before the return of Co¬
lumbus f. Hippocrates also described erysipelas and gan¬
grene of the penis in his Lpidemics ; and ulcers oi the
uterus and suppurating glands in the groin,” in his Morb.
Mulierum. Astruc denied that venereal ulcerations described
by the ancient writers were syphilitic, as they7 were cured
without mercury. Celsus describes gonorrhoea when he

1 1360. 2 1400. 3 1470

* L’Art de guerir les Malad. Veneriennes. See also the works of Luisinus,

Girtaner, Plocquet, and Reuss. , ,. . , . .

t Retz Annales. Mr. Carmichael has quoted the testimonies of Astruc,

Becket, Hunter, Adams, Abernethy, and Bateman, to prove the existence of
syphiloid diseases before the introduction of syphilis.

444

Critical Review.

says, nimia profusio seminis sine venere, sine nocturnibus
imaginibus.” — L. 4. c. 1. He speaks of buboes, L. 5. c. 28 ;
of ulcers of the penis, L. 5. c. 9. Dioscorides *, Galen2, and
Scribonius 3 * have described the primary symptoms of syphi¬
lis. The younger Pliny, L. 5. Epis. 24, describes the case
of a woman who died of ulcerated genitals, contracted from,
her husband 3 and Palladius records a similar instance in the
5th century. Hist. Lusiaca. It does not appear that mer¬
cury was named by any of these writers, nor by the Ara¬
bians, Isaac, Mesne, Rhazes, and Avicenna, though they used
it in cutaneous diseases. It is not clear whether or not the
Greeks, Latins, or Arabians, ascribed the disease to impure
coition, though there can be no doubt that such was the
fact. This was admitted earlier than the introduction of the
new disease. Thus, Michael Scott, in his work, u De Pro-
creatione Hominis/5 published 1214, says, ee si vero mulier
fluxum patiatur, et vir earn cognoscat, facile sibi virga vi-
tiatur, ut patet in adoles centulis qui hoc ignorantes vitian-
tur quail do que virga quandoque lepra.” Rhazes, who died
1010, observes, u accidit Machumet filio Alchasem, pruritus
in corpore et bothor (pustulae). Et bothor etiam in virga
non cum ejus capite, et prognosticatus fui quod evenerint in
cap it e ejus virgse quia viderim ipsum emittentem saniem
cum urina.” The writers named by Dr. Titley in the extract
given above, as well as Gaddesden, 1320, all describe ulcers
of the penis, which arose from impure connexion. It is also
worthy of mention, that many of the writers who flourished
at the period of the importation of the supposed American
disease, opposed the use of mercury. Thus, Grundbeck
affirms, 1496, that not only ulcerations of the penis, but all
venereal diseases, could be cured by venesection from the
foot, laxatives, dietetic drinks, and that the sick man be¬
came “ validior, sanior et robustior quam unquam ante hac
fuit.” Torella, in 1497, condemns the use of styptics,
which would drive the disease to the internal parts. To re¬
cent ulcers he applied aloes, to chronic tutty, with success.
He also describes five cases of secondary symptoms which
were cured without mercury *. Massa also cured the dis¬
ease in the same manner f. Vigo also cured some forms of
the disease without mercury, but in obstinate cases resorted
to that remedy. Ulrichus de Hutten, Antonius Gallus, and
Alphonso Ferri, cured the disease w7ith sarsaparilla, guaia-

1 Apud Guerer. p. 7. 2 Finib. Med. pp. 189 and seq. et Medico.

3 De Compositis Med.

* De ulceribus in Pndendagra. Ed. Boerhaave, pp. 538, 546.

+ Nicolani Massse de Morbo Gallico, c. 7, 1532.

Dr. Titley on Diseases of the Male Genitals. 445

cum, China. Boerhaaye treated it in a similar manner. Dr.

Sr™ one of first who revived this mode of
treatment in the present century. Med. Chir. Trans. Who-

theri6thacemaS t0 lewn ,thf hist01'y 0f the ^ease during

before us 11 &i ° ™ °PPortui% by the author

beiore us. We shall leave this part of the work, and pro-

treatment ofth^6 COntrf ,ictoiT accounts of the natureand
treatment of the venereal disease, which prevails at the pre-

sent period Dr Titley, after much ingenious reasoning

concludes that all forms of venereal ulcers arise from one

genus, and do not exist as distinct species.

“No form of primary sore, yet described, is anything more
than a pattern arbitrarily selected from an endless number a^id gra¬
dation of forms, so blended and confounded together that no two
appearances can be delineated, between which Experience does not
present sores with more or fewer of the characteristics of either -

Hun ,erian sore ; and yet none ought to pronounce that they
were not chancres, because many intervening forms had been seen
which connected the standard sore with the variety. It could

an! flr'thcn!t,'ned Mr: Hnnter’s description differed from them
any farther than in maturity or full development. I have found

some with even, and some with ragged edges— some with a very

e erminate, and some with a very obscure exterior margin!

Some with much callus on the superficial circuit and little or none

!of! ^Se-some bwder in the base, with a rim almost or quite
soft. Moreover, ulcers of one kind, often as they proceed, vary
then aspect so as to become distinctly referable to another kind,
and it riot unfrequently happens that primary sores, of different
species (according to our arbitrary distinctions), have existed at
the same time in the same patient/ A knowledge of such facts
necessanly leads to the inference that varieties of constitution
(fluctuating, as it does, even in the course of a few hours under
treatment, or under the influence of in-artificial agents), do in
tru h shape the sore, and transform it. These facts are, to me,
qu, e irreconcilable w.th the idea of specific ulcers and specific
poisons , and, at all events, though the specific distinction of pri¬
mary ulcers, and even the need of a specific remedy were ever so
well demonstrated, such affections are only one portion or link in
a chain of many consecutive symptoms.” — p. 27.

Our author is disposed to question Mr. Carmichael’s con-
c usions that there are four distinct species of venereal
ulcers, each followed by peculiar symptoms ; and he quotes
the works of Dr. Hennen, Mr. Hill, Mr. Guthrie, Mr. Rose,
and Mi. Hvans, against such conclusions. Mr. Carmichael
observes^ that from the difference that exists in the appear¬
ance and progress of certain groups of concomitant symp-

446

Critical Review.

toms, he presumes the existence of a plurality of venereal
poisons. In support of this conclusion, he adduces the ob¬
vious variety of character in primary ulcers and venereal
eruptions, the latter so numerous as to afford specimens of
nearly all the cutaneous diseases. If one venereal poison
only exist, then we must conclude that the regularity of the
progress and uniformity of the symptoms which are observed
in all morbid poisons are not observed in this, which is
making an unreasonable and unwarrantable exception to a
universal law of nature. From an attentive consideration of
a vast number of cases, Mr. Carmichael concludes that there
are four different kinds of primary ulcers, every one of which
is distinguished by peculiar symptoms and forms of erup¬
tion. Work on the Venereal Disease , 2 d Edit. 1825, p. 53.

Dr. Titley thinks, however, that Mr. Evans has afforded in¬
controvertible evidence, u which completely proves the truth
of the doctrine that one cause produces every type of lues,
and that the differences of form arise from the differences of
constitution.”

f< Mr. Evans says, that, while at the military hospital of Va¬
lenciennes, the usual number of venereal ulcerations continued,
he was frequently present at the stated examinations of the public
women, and was always surprised at the small portion of disease
existing among them. At one examination, no less than two
hundred women, of the lowest description (the most frequented
by soldiers), were inspected, and notone case of disease was
found. At the departmental hospital of Lille, to which place
the public women were sent when diseased, Mr. Evans was
equally struck with the few cases of ulceration presented, for,
of upwards of one hundred female patients at the time he visited
it, not more than three were found to have the elevated ulcer, and
there was not one case of the indurated kind. Gonorrhoea, ex¬
coriations, from want of cleanliness, warts, oondylomata, and
eruptive diseases, composed the rest.” — p. 34.

Our author might have gone further in elucidating his
position from the writings of Mr. Evans and Dr. Hennen,
which tend to prove that the matter of true chancre will not
affect another person with the same kind of ulcer ; that the
natural secretions of the genitals in uncleanly females will
produce anomalous and infectious sores on those who have
sexual commerce with them and that a female who has go¬
norrhoea and no ulcer will communicate true chancre to one,
superficial ulcer with elevated edges to another ; gonorrhoea
to a third without any ulcer ; and to a fourth neither ulcera¬
tion, discharge, nor any complaint whatever. Mr. Cooper,
in his edition of Good’s Study of Medicine, agrees with these
conclusions. Dr. Titley is of opinion that Mr. Hunter has

!>i\ Titley on Diseases oj the Male Genitals. 447

not added much lustre to his great name by his work on the
venereal disease. He says —

-**• l\C cd.vays remarked, that they who adopted the views of
xlr. Hunter on venereal disease, have been much entangled and
embarrassed, when endeavouring to explain or to defend them.
As far as my judgment goes, the detail of experience, in his own
booK, justified him in no more than affirming that his lues venerea
was curable, in most cases, by mercury ; by no means that it

• °Ivd on from ,3ad t0 worse without mercury, or that, without
it the disease was incurable. Nor can any thing be more miser¬
able than the fallacy of shifting his specific test at one time to the
description of ulcer, and at another to the cure by mercury. His
facts and consequences stand simply thus The lues venerea of
my pattern yields only to mercury 5 yet I have seen some cases
which 1 could not discriminate from my pattern, which were cured
without mercury ; therefore, these last cases were not lues ve¬
nerea. It is to be regretted that Mr. Hunter did not urge his
doubts, for he manifestly had doubts, instead of which they are so
suppressed by zeal to make a system, that they are scarcely no¬
ticed among his decisions. Perhaps these objections to his doc-
trines might have been overborne, as heretofore, by the clamour
of his followers, but that we have a stubborn fact to produce, suf¬
ficient to show that he should have tried without mercury, and that
then he would have taught more wisely ; for we know, beyond
controversy, that every form of venereal disease now can, and we

may reasonably presume, always could, be cured without mer¬
cury. — p. 38.

Mr- Hunter been deeply versed in the records of
Medicine, he never could have arrived at the above con¬
clusions, especially as to the use of mercury. But his opi¬
nions were original in general, and his acquaintance with
the writings of his predecessors extremely superficial. Had
he been aware of the opinions of the writers of the early
part of the 14th and 15th centuries above quoted, it is most
piobable he would not have offered opinions which are ob¬
viously untenable. Our author observes, that he cannot find
any one of more recent times who has so just a claim “ to
the first opposing of the unqualified exibition of mercury as
Hr. Clutter buck/’ In a pamphlet published by him in 1799
he says, <c 1 have seen cases which induce ine to believe
that the venereal disease, in some of its stages, may get well
without mercury or any other remedy.” What did this de-
claiation amount to after all, but what many writers in the
dark ages had asserted ? It remained, however, for the army
surgeons fully to prove the truth of this opinion.

Dr* Titley lefers to the writings of Dr. Fergusson, Mr.
Hose, Dr. Banks, Mr. Guthrie, Dr. Thomson of Edinburgh
Dr. Hennen, and the Reports of other Medical Officers&of
the Army, collected by Sir James M‘ Gregor, containing

448

Critical Review .

nearly 2/M)Q cases of primary and secondary ^philis which
were cured without mercury. Our author introduces an¬
other valuable proof, which is as follows : —

“ It appears that, during five years, no less than 16,985 vene¬
real patients were treated in the hospitals of Sweden. Of this
number thirty-nine and a half per cent, were trusted solely to
strict dietetic rules, and six weeks were generally found sufficient
for the cures, if the symptoms were not very severe. Secondary
symptoms happened in the proportion of seven and a half per cent.
Local and other modes of treatment were ordered for five and a
half per cent., and of these seven per cent, had after-symptoms.

“ The mercurial treatment was adopted in forty-nine and one-
eighth per cent. Of cases of secondary symptoms there wrere
fourteen per cent. The fumigatory treatment by cinnabar was
employed in six and a fourth per cent. ; the relapses were as
twenty-two to the hundred.

“ A line of practice very similar to that employed in the Bri¬
tish military hospitals is adopted by M. Fricke, in the venereal
cases admitted into the hospital at Hamburgh. Every patient is
bled to the amount of from six to twelve ounces, and the opera¬
tion is repeated if necessary. About half a dram of sulphate of
magnesia is then given every three hours, and continued until re¬
peated evacuations are produced. If the bowels afterwards be¬
come constipated, or the ulcers heal slowly, the use of the same
remedy is renewed. As an external application to the chancres,
Goulard’s water, or two ounces of sulphate of zinc in six ounces of
distilled water is employed. When the size of the sore is much
diminished, and it is no longer painful, limewater is used. If
either of these lotions cause pain or inflammation, it is to be still
farther diluted.

“ Buboes are first treated by compression, and, if resolution
cannot be promoted, they are opened with a bistoury, and after¬
wards dressed with dry lint. Condylomatous tumours are remov¬
ed by the knife, or cauterized, and the wound dressed with the
same lotion as for the chancres. The patients are kept upon very
low diet, consisting of vegetables, bread, and * soupe a l’eau,’
twice a-day. If at the end of a few days the symptoms are not
alleviated, a few doses of mercury, in small quantities, are given,
and are found sufficient to effect a cure.

“ The results obtained by this mode of practice are highly sa¬
tisfactory. Chancres and buboes are speedily cured, and the ci¬
catrices are by no means so evident as when mercury has been
employed. Chancres, from three to four lines in diameter, are
generally cured, in female patients, in from one to three weeks.
Rather a longer time is required in male patients, M. Fricke,
who has the advantage of retaining patients thus treated under
his observation, has not yet observed any secondary symptoms.

“ Taking the British and Swedish reports, there are, in round
numbers, 8,500 cases numerically vouched for, in which other me¬
dicines than mercury, or mere regimen, effected a restoration of

449

Dr. Titley on Diseases of the Male Genitals.

health j and these were not selected individually, as less severe or
more promising specimens of disease, but occurred for a given
length of time, in given places and establishments including every
example of venereal sore or symptom that could possibly happen.
— p. 58.

Dr. Titley combats the objections of Professor Bell to the
non -mercurial plan., and alleges that all his patients had used
mercury, and been vitiated by it before they came into his
hands. Such persons, when reinfected, were not proper
subjects for the non-mercurial treatment. This is certainly
a satisfactory reply, and it is mollified by the following de¬
claration : —

To any thing from Mr. Bell I should attend with the most fa¬
vourable disposition which it is possible to entertain toward a man
most justly distinguished 3 but because I know that such feeling
towards him prevails every where most deservedly, I have con¬
scientiously and fairly combated the tendency of his paper as freely
as he impugns the tendency of the tracts published bv the military
surgeons.” — p. 62.

Our author sums up his whole arguments, and concludes
that lues has always existed ; that syphilis was not a new
disease in 1/94 • and that every form of venereal ulceration
can be cured without mercury. In speaking of the use of
mercury, our author makes the following judicious observa¬
tions, which are well worthy of attention, at a period when
mercurial medicines are so extensively and indiscriminately
employed : — /

“ It is scarcely necessary for me to remark that I object to
courses of mercury • I do object to them strongly, and, as I shall
show, not without reason. My own experience, to which I re¬
quire no consent, has long convinced me that, in almost every in¬
stance, where a course of mercury has been administered, various
distressing effects of the remedy have remained. It is usual with
many practitioners to enjoin pure air, warmth, temperance, exer¬
cise, attention to the bowels, and regularity of life, after a mercu¬
rial course 3 and I sincerely join with them in esteeming such ad¬
vice to be a momentous part of our duty. But the recommendation
is rarely attended to 3 yet I never knew an instance, where it was
not followed, in which some derangement of the general health,
and often confirmed constitutional disorder, did not ensue. I
would not be understood as wishing to disparage the use of this
medicine as an occasional alterative 3 or in some cases of fever,
especially in a tropical climate, where I have seen large doses of
calomel act like a charm 3 or in instances of acute inflammation,
which demand an instant and powerful counter-agent. But I
anxiously desire to dispense with the exhibition of mercury in
courses, and, when carried to the length of any considerable in¬
fluence upon the system, in diseases of slow progress. We have
lately been told that mercury is productive of no evil consequence
vol. 111. no. 18. 3 m

450

Critical Review .

when administered, even to profusion, in the East, for complaints
of those climates not venereal ; and hence we are to infer, that the
production of disease of the bones, in venereal patients, is not to
be ascribed to mercury, but to the virus of lues. But we have
melancholy and substantial proofs, in this country, that such tid¬
ings from the East are not to be implicitly trusted. I am informed
that there are in the museum of Fort Pitt, attached to the military
hospital at Chatham, many preparations of the bones of men dis¬
organized, if abundant testimony can be believed, by mercury
alone ; the subjects from whose bodies they were taken never hav¬
ing had any venereal complaint, but were all treated by mercury
for other affections. These preparations were sent from our own
oriental colonies. At home, if we see such a terrific spectacle,
we are often assured, even where no evidence of the fact can be
adduced, that it is the consequence of venereal infection. But
there are, nevertheless, many such preparations in our various
museums, which have been referred, upon strong grounds, to the
operation of the specific alone, though, of course, those grounds
have been disdained by many. Nothing is more common, at the
public hospitals of this country, than for patients to return after a
mercurial course for venereal disease, complaining that they are
tortured with nocturnal agonies. The surgeons, in general, know
these sufferings to be produced from mercury, and not from vene¬
real disease, and the general direction is to clothe warmly, and
avoid cold air, &c. The surgeons are, I believe, correct in their
opinion as to the cause ; but do such pains exist, can they exist,
without some process going on which ought to be suspected of
evil tendency ? I know of no continued pains of similar character
which do not indicate mischief in the constitution. I have known
cases, too, in which bones have been fractured by apparently in¬
adequate exertion of patients under, or soon after, courses of mer¬
cury, and have been satisfactorily informed of others. And fur¬
ther, if the extracts from the writings of the army surgeons, which
I have given, be perused, we surely cannot refrain from allowing
considerable weight to their affirmation, that affections of the
bones have been extremely rare, when the non-mercurial plan was
pursued; and, I am fully justified in adding, might possibly, in
the few examples which did occur, have been owing to a previous
disorder of the habit from courses of mercury. I think it should
always be inquired whether such treatment has been undergone ;
anticipating, from what my own practice has shown, a result con¬
firmatory of my opinion of the ill effect of that medicine. We
are not without high authority for specifying actual, and, in a pa¬
thological point of view, terrible injuries, plainly owing to the
cause which I have inculpated. Dr. Armstrong, speaking of chro¬
nic diseases of the heart, enumerates, among the causes, long con¬
tinued courses of mercury. He says again, and truly, that, by
mercury carried to ptyalism, the action of the heart is frequently
preternaturally excited or depressed, and sometimes rendered irre¬
gular. Again, in phthisis, almost all have united to admit that the
same medicine aggravates the disease. But the most remarkable

Dr. Titley on Diseases oj ike Male Genitals. 451

manifestation of such evil that I know, is noticed by Mr. Joseph
Swan ^ late of Lincoln, who states, that in the spinal chord, and its
nerves, he has seldom seen inflammation, except in the semilunar
ganglia of the great sympathetic nerve, which, when the system
has been impregnated by mercury, are inflamed, both superficially
and in the section, so as to contrast with ganglia in a healthy state ;
as a bloodshot eye differs from an eye which is uninflamed.” —
p. 66.

The best apology we can make for this long quotation, is
its very great importance. The author concludes his pre¬
liminary essay by offering some conjectures on the modus
operand! of mercury, which we omit, as they lead to no prac¬
tical advantage. In this essay Dr. Titley has evinced a good
deal of research, and much observation, and we think it
does him no small degree of credit. If it diminish tne very
indiscriminate use of mercury which is now unfortunately
the general practice of the day, he will have much rea¬
son to be pleased with the effect of his production. In
speaking of the able and revered author of the Military Sur¬
gery, Dr. Titley has always styled him Mr. Hennen. It can
scarcely be possible that Dr. T itley could be ignorant that
Dr. Hennen was a graduate in medicine when he published
the last edition of his work. We think our author must
have perused an early edition of the Military Surgery, and
we are inclined to hazard this conjecture, as we have found
him quoting the former editions of other works. Bui this
is a venial transgression, and we hope he will make atone¬
ment in a new edition. We now proceed to notice the oody
of the work. It is divided into four parts 1. contains
diseases of the penis which originate from sexual intei-
course, viz. the elevated, superficial, indurated, callous,
phagedaeno-gangrenous, and sloughing ulcers -Buboes
secondary venereal affections — the papular, pustulai, tuhei-
cular, and scaly eruptions — Iritis — Periostitis. Diseases

which may or may not originate from sexual inteicouise
phimosis, paraphimosis, excoriation. Diseases which do
not originate from sexual intercourse — herpes and psoriasis
of the prepuce, warts, phlegmon, anthrax, tubercles, the
erratic ulcer, ossification of the septum between the coipora
cavernosa, cancer of the penis. 2. Contains diseases of the
urethra ; simple and venereal gonorrhoea, choidee, gonoi-
rhoeal rheumatism, gonorrhoeal ophthalmia, chronic gonor¬
rhoea or gleet. Strictures of the urethra, temporary and
permanent strictures, bleedings from the uietma, false pas¬
sages in the urethra, retention of urine from stricture, rup¬
ture of the urethra and extravasation of urine, fistulae in
perineo. 3. Contains diseases of the scrotum— in flamma-

452

Critical Review .

tion, suppuration, gangrene, itching of the scrotum, varico¬
cele, chimney-sweeper’s cancer, anasarcous hydrocele of the
scrotum, anomalous affection of the scrotum, elephantiasis
of the scrotum. 4. Contains diseases of the testicles, &c.
Diseases of the tunics, chronic hydrocele of the tunica va¬
ginalis, acute and congenital hydrocele, hydrocele of the
herniary sac, hsematocele, cartilaginous bodies in the tunica
vaginalis. Diseases of the spermatic cord ; circocele, diffused
hydrocele of the spermatic cord, encysted hydrocele of the
spermatic cord. Diseases of the testicles, acute inflamma¬
tion of the testicle, fungus of the testicle, hydatids of the
testicle, irritable testicle, neuralgia of the testicle, atrophy
of the testicle, simple chronic enlargement of the testicle,
sclerocele, scrofulous enlargement of the testicle, hydro- sar-
cocele, fungus haematodes of the testicle, scirrhus of the
testicle, operation of castration.

We have attentively perused the whole of the work before
us, and found it replete with much valuable information on
the different subjects of which it treats. It is the most com¬
prehensive monograph on the diseases of the male genitals
which we possess, and ought to have a place in every medi¬
cal library. Every page of it is full of information, but so
many diseases are described as to render it impossible to
attempt their analysis. We shall therefore content our¬
selves with strongly recommending the wTork to every class
of our readers.

II. — A Practical Treatise on Acute Abdominal and Pelvic
Inflammation , containing a Comprehensive Clinical View
of Inflammation of the Stomach , Bowels , Peritoneum , Ute¬
rus, Sfc. with a certain and expeditious Method of Cure .
By David Nicholas Bates, Medical Practitioner.

The title before us led us to peruse the body of the work,
and having ascertained the new and extraordinary mode of
treatment proposed, a question at once presented itself, what
is the qualification of the proposer ? The term “ Medical
Practitioner” does not add much weight to the qualification
of a medical man, more especially should such a man pro¬
pose a practice subversive of that universally received by the
most eminent physicians and surgeons in every country. In
making these observations, we do not wish or mean the
slightest offence, and though opposed to the sectarianism of
our profession, we must admit that the qualification or title
derived from some one of our medical corporations would
stamp much more importance on a work than that before

Mr. Bates on Acute Abdominal Inflammation . 453

us. We are disposed to think that the term Medical Prac¬
titioner places the owner without the pale of the profession,
and therefore we must be cautious in giving our assent to
the opinions of one thus situated, however ingenious they
may appear. With regard to the treatment of inflammation
of the abdominal and pelvic viscera, our author recommends
the exhibition of opium by enema and by the mouth, pre¬
ceded by the abstraction of a pint of blood, Ci provided the
strength will admit it, but if there be great exhaustion from
the long continuance of the affection, from previous deple¬
tion, excessive vomiting or purging, however the latter may
be occasioned, the practitioner had then better refrain from
blood-letting, and have immediate recourse to the opiate
enema.” — p. 35. The opiate enema should be used with or
without depletion, if the evacuation be judged either unne¬
cessary or improper. The following is the form and quantity
found most convenient and efficacious. R Tine, opii, gij ;
Decoct. Amyli calefact, $x.ij j M. fiat enema quam primum
injeciendum.

“ The general effect of this in quelling pain, sickness, and
diarrhoea, if the latter be present, is almost instantaneous ;
the patient who, previous to its exhibition, had been writh¬
ing under the agonies of acute inflammation in the stomach
and intestines, or peritoneum generally, with continual retch¬
ing and vomiting, and perhaps diarrhoea, at once becomes calm
and composed, and complains only of great tenderness in the
abdomen, more particularly in that part which was the seat of the
disorder. If there be no return of pain in twelve hours, another
enema, containing not less than a drachm of tine, opii should be
exhibited to prevent a return ; but if there be a renewal of the
primary symptoms, at whatever period, the quantity first used
may be again repeated. The tenderness of the body will be found
to continue for a day or two after the subsidence of the pain, but
will gradually diminish until it finally ceases. It will be necessary
to confine the patient to the horizontal position for no less than
two days after all the symptoms have disappeared.” — p. 37.

This practice has not been tried in acute hysteritis, but
the author has no doubt of its efficacy. W arm fomentations
and leeches to the abdomen, followed by opiate frictions and
bottles filled with warm water to the feet, are also to be
tried. The second plan, which is said to be infallible, is as
follows : — R Pulv. opii ; pulv. antimonialis ; pulv. acaciae aa.
gr. j ; confect, rosse caninae, q. s. Fiat bolus quam primum
sumendus, in hora repetendus, et binis horis continuandus
(?) donee dolor cessat. Sometimes the third or fourth bolus
will produce the desired effect ; but if the tenth or twelfth
do not afford relief * then the opiate enema is to be tried.

454

Critical Review.

The pulv. antim. is preferred to the submurias hydrarg.
<f more particularly as the latter is apt to disagree with a
scrofulous constitution, and to produce unpleasant symptoms
in all ; it is not so efficacious in relieving pain and sickness,
and in encouraging a diaphoresis/’ p. 43. This is a very
erroneous piece of medical reasoning, to speak as leniently
as possible ; but the following clearly proves the author to
be either self-instructed or entirely unacquainted with the
received opinions.

In speaking of the diarrhoea which depends on colitis, or
inflammation of the colon, and is accompanied with alvine
evacuations mostly dark green or black, our author says —

The practitioner is apt to consider the dark coloured excretion
as the *' irritamentum malorum’ (mali potius) and evinces his
hostility to it by the continued employment of purgatives, not¬
withstanding which the evacuations obstinately remain unaltered
to the last, and the patient is reduced by these unavailing means to
a state of fatal exhaustion. Instead of giving purgatives in such
a case, the opiate enema described in the other plan should be em¬
ployed, to allay the preternatural action (of what by which this
change in the secretions of the intestinal canal has been effected,
apd to check the debilitating evacuations ; this part being thus
restored to the performance of its healthy functions, the feces will
gradually, reassume their usual colour and consistence. ’> — p. 46.

Here is pathology with a vengeance. The literal inter¬
pretation of this paragraph means, that inflammation of the
intestines induces a preternatural action, which causes the
appearances of the feces. Mr. Abernethy and Hr. Armstrong
may hide their diminished heads after this ; and their infal¬
lible panacea, the submurias hydrarg. or blue pill, with or
without opium, can no longer be employed. We would
strongly recommend the perusal of Mr. Abernethy s work
on the constitutional origin of local diseases to our author.
He shall there learn that large doses of opium are not the
remedy for dark green or black alvine dejections. Mr. Bates,
however, informs us, that

“ Hydrargyri submurias, either alone or combined with any pur¬
gative, must be totally excluded (\vhen the enteritis has nearly
abated, and slight tenderness only remaining,) from its well known
irritating qualities : in every case in which the employment of it
has come under my observation, it has never failed to increase the
pre-existing irritation, or excite it anew.” — p. 47.

Has Mr. Bates perused Dr. Armstrong’s paper on the use
of calomel and opium in enteritis ? We think not, or he
could never have made these statements. He also maintains
that constipation is not so injurious as is generally supposed,
and relates cases in which he allowed it to exist with im-

Mr. Bates on Acute Abdominal Inflammation. 4 55

punity. He inveighs against the employment of strong pur¬
gatives in such cases, and certainly with reason ; for if ex¬
hibited at all, it should be after general and local depletion,
warm baths, and fomentations. Dr. Armstrong thinks de¬
pletion the best mode of opening the bowels in enteritis.
The remaining part of the volume consists of the relation of
cases in which the plan proposed by the author was suc¬
cessful. Many of these cases were not examples of inflam¬
mation, and they are sq loosely detailed that it is often diffi¬
cult to discover what were the causes of them. In no in¬
stance has the author mentioned the cause to which the dis¬
ease was ascribed, or the previous state of the bowels. We
shall relate a case in proof of our assertion.

Mr. Daniels, aged 40 years, of a robust constitution, and of a
plethoric habit, was suffering (^Sept. 14th, 18L24) most excruciat¬
ing pain in the abdomen, which was swelled and extremely tender,
more particularly above the umbilicus. He had been taken ill two
days previously, during which the frequent vomitings and almost
continual diarrhoea of a greenish black watery matter, and which
still continued, had, with the pain, reduced him to a desperate state
of debility. The pulse was small, quick, and feeble ; he had great
thirst and restlessness, with frequent tossing ; the countenance
was particularly anxious, and almost cadaverous.” — p. 57..

Was this enteritis, peritonitis, or cholera morbus ? What
was the cause of the disease ? was it cold, constipation, in¬
temperance, improper use of fruits, or what ? Our author
enters on the explanation of the phenomena of inflammation,
and says it is always preceded by pain. If he refer to An-
dral’s work on inflammation of the abdominal viscera, or to
our report of the proceedings of the Medical Society of Lon¬
don in our last Number, he will find that peritonitis may
occur and prove fatal without any pain or tenderness of the
abdomen. He overlooks the disorder named intestinal irri¬
tation by Drs. Granville, Marshall Hall, and others, in
which the opiate plan is generally found efficacious ; and we
have no hesitation in ascribing many of the cases denomi¬
nated by Mr. Bates to this state, and not to acute inflamma¬
tion. Further observation is necessary before the practice
he recommends can be preferred to blood-letting, and the
ordinary treatment ; but we cannot agree with those who
have scouted the proposal of our author. Fie has certainly
not exceeded the opinion of Dr. Armstrong, which was that
large doses of opium were as much to be depended on in
enteritis as the antiphlogistic plan. C£ I have witnessed,”
says that talented writer, “ some cases of inflammation of
the bowels where full doses of opium finally effected the
cure, after bleeding and purging had completely disappointed

456

Critical Review.

my expectations. So great, indeed, is my confidence in full
doses of opium in peritoneal enteritis, that if compelled to
say, supposing myself the subject of the disorder, whether
I would exclusively rely upon them solely, or upon blood¬
letting solely, I should certainly fix upon the former ; at the
same time, I should like to have the simultaneous influence
of both remedies, being convinced that they are far more
serviceable combinedly than separately employed*/5 Dr.
Armstrong, however, recommends bleeding to syncope, then
three grains of opium, strict quietude, so that if possible
sleep may be procured. The object in giving the opium is
to prevent a subsequent increase in the force and frequency
of the heart’s action, and a return of the abdominal pain,
while it induces a tendency to quiet sleep, and a copious
perspiration over the whole surface. u In many cases this
simple procedure will remove the inflammation at once, no¬
thing being afterwards necessary when the patient awakes,
but spare diet, absolute rest and quietness, with an occa¬
sional mild laxative.” If the pain return in any part of the
abdomen in three or four hours, the patient is again bled as
before. Now, taking the first quotation for granted, we find
Mr. Bates’s proposal fairly admitted. It remains, however,
to be proved and sanctioned by further observation of the
profession. The practice must appear objectionable to many
as subversive of that usually adopted ; however, we think
our author entitled to a hearing before he is condemned.
Many of his cases presented the symptoms of acute inflam¬
mation, and were relieved, according to his testimony, by
large doses of opium. The work, upon the whole, is well
worthy of attentive perusal.

III. — Clements of General Anatomy , containing an Outline
of the Organization of the Human Body. By R. D.
Grainger, Lecturer on Anatomy. London, Highley,
1829. 8vo. pp. 525.

A Manual of General Anatomy , or a Concise Description of
the primitive Tissues and Systems which compose the Or -
gans in Man . By A. L. J. Bayle, D.M.P. &c. &c. and
H. Hollarjo, D.M.P. &c. &c. Translated from the French
by Henry Stoker. London, J. Wilson, 1829. 12mo.

pp. 318.

Anatomy, or the science of organization, can be looked on
in many distinct points of view. It comprehends the series

* Trans, of the Associated Apothecaries, &c. 1825, vol. 1, p. 315.

Mi. Grainger s Elements of General Anatomy. 45/

of organized beings, it generalizes the results of structure,
and the laws by which they are regulated. This is General
Anatomy, or what the French style V anatomie transcndante
ou philosophique an immense study, which displays an ad-
mil able uniformity in the midst of a prodigious diversity of
beings. Anatomy, when studied comparatively, embraces
the same organs of the different species of animals, from that
which enjoys the largest to that which possesses the most
limited developments : this is named Comparative Anatomy.
If anatomy be confined to one species of animals, it is styled
special, and when applied to man, is called human anatomy,
and when applied to the domestic animals, is called vete¬
rinary anatomy. Human anatomy presents two grand divi¬
sions. that applied to the healthy organs denominated
Physiological Anatomy ; that devoted to the organs when
diseased, named Pathological Anatomy, which is also termed
Necrotomy, Necropsy, and Autopsy. Physiological Ana¬
tomy is again divided into two great branches ; the first, the
description of all the organs in their natural situations, with¬
out division ; this is descriptive anatomy : the other, the
description of the texture or elements of organs, which was
called general anatomy by Bichat. Lastly, there is the ana¬
tomy ot the foetus. Again, anatomy is divided into surgical

Though general anatomy was the real bases of the de
scriptive anatomy, yet in this country it has been entirely
neglected until within a recent period, when the translation
of Bichat’s immortal work had appeared. During the last
year, two British works on the subject have been published,
the first by Dr. Craigie, the other by Mr. Grainger, and now
we have the very comprehensive and copious manual before
us. . It is really astonishing that the examiners of our uni¬
versities and colleges should have been so long content with
the knowledge of descriptive anatomy from candidates seek¬
ing medical honours. Yet such is the fact, and we are sorry
to assert that not one candidate in every hundred for medi¬
cal honours is acquainted with general anatomy, or the or¬
ganic elements that compose the different tissues in the
human body ; and yet how indispensably necessary is this
knowledge to the proper comprehension of the science of
the nature and treatment of disease. Here we must admit
that our continental brethren far exceed us, and are decid¬
edly before us in this important branch of science. In a
late number of this Journal, Dr. Craigie’s work was noticed*,
and was the first British treatise on general anatomy. Of

* No. 2. vol. 2, pp. 387, 484, May 1829.

3 N

vol. iii. no. 18.

Critical Review .

458

that ably executed production the editors of this Journal
have spoken favourably. Previously to the appearance oi
that work, Mr. Grainger was engaged in compiling a treatise
nearly on the same subject, but he has confined himself to
general anatomy and physiology, omitting pathology, and
thus the works of these writers materially differ. The
Manual of General Anatomy , by MM. Bayle and Hollard,
possess the advantages of both the former works, far it
comprehends the general, physiological and pathological
anatomy, in a concise and comprehensive form. It is a work
that must find a place in every medical library ; it is valu¬
able to the established practitioner and to the student. It
contains all the real and solid information on the subjects on
which it treats. It fills up a chasm in our medical litera¬
ture, and entitles its translator, Mr. Storer, to have his
name recorded among those of the improvers of British me¬
dicine. If the manual were prefixed to a concise text book
on descriptive anatomy, the interests of humanity and
science would be greatly promoted. There is a glaring de¬
fect in our numerous class books on practical anatomy, they
are all silent on the organic elements, or real structure of
the various textures of the body. We still want a manual
which would combine general, descriptive, physiological,
and pathological anatomy. Bichat has immortalized himself
by such a work, and we hope the time is not remote when
we shall have a compendium of such information for our
students. We have at length made some advances towards
the complete cultivation of anatomy in its fullest extent.
The works before us will contribute very considerably to
promote that object. We hope the manual will be in the
possession of every student, because it contains more diver¬
sified information than either the works of Dr. Craigie or
Mr. Grainger. u Fiat justitia, ruat coelum”

Mr. Grainger is well known to the profession as one of
the most distinguished anatomical teachers of the day, and
therefore eminently qualified as a writer on that branch of
science to which he has devoted himself. At the request of
his numerous pupils, he promised to compile an elementary
work, collected his materials, “ and by careful and repeated
examinations ascertained, as far as the imperfection of our
knowledge will allow, the structure of each part that is de¬
scribed.” — Preface . Our author had arranged and completed
his manuscript when Dr. Craigie’ s work appeared, and hav¬
ing proceeded so far in his design, and being under a pledge
to complete it, he thought he should not have been justified
in foregoing his original intention. He informs us of the
object he had in view, in the following words : —

Mr. Grainger’s Elements of General Anatomy . 459

ifMy object,” says our author, ffhas been to convey a concise,
and, at the same time, a comprehensive account of the several
substances which form the human body. To the description of
the different tissues, some observations on their uses are added,
for the purpose of showing how admirably each structure is
adapted to the functions it is destined to fulfil.”

We highly approve of the union of anatomy and physio¬
logy in the work before us, but regret the omission of pa¬
thology. Our author makes no claim to much novelty,
and acknowledges that he has availed himself of the great
number of facts which have been collected by Bichat, Be¬
dard and Meckel, and all those that are contained in the
many valuable works and detached papers that have been
published in this country. Though his chief object has been
to facilitate the studies of his pupils, yet he entertains some
hope that the work may prove not altogether useless to
those who are engaged in the practice of our profession.
For “in the present day when morbid anatomy is so zea¬
lously cultivated, the kind of information included under the
term general anatomy, is essentially necessary ; because it
is impossible to appreciate the changes produced by disease,
in the various parts of the body without being previously
acquainted with their natural and healthy structure.” — Pre¬
face , p. viii. We are happy to perceive the coincidence of
opinion on this point between Mr. Grainger and ourselves ;
indeed daily observation must convince the most sceptical
of our brethren of the necessity of cultivating general ana¬
tomy, in order to appreciate the changes induced by disease.
Our author observes that he has adopted the term general
anatomy, employed by three of the most eminent authorities
of modern times — Bichat, Beclard and Meckel, to designate
that branch of anatomy which has for its object the investi¬
gation of the tissues of the body. But he correctly re¬
marks : — “This expression is, in some respects objection¬
able, for in its strict acceptation, it comprehends every thing
that relates to the science of organization ; but custom has
sanctioned the use of it in this more limited meaning.”

Mr. Grainger’s work is divided into two parts : 1. The
introduction. 2. The body of the work. The introduction
is divided into nine sections, which are as follows. I. Of
organic and inorganic bodies, composition of both, proper¬
ties, origin, causes of dissolution and table of the differences
between inorganic and organic bodies. II. Of vegetables
and animals, differences between them, table of their differ¬
ences. III. Of animal organization ; fluids of animals ;
classes of fluids; solids; organs of animals ; forms of ani¬
mals ; modification of forms ; functions ; nutrition, sensa-

460

Critical Review.

tion ; volition and generation. IV. Of tlie human body ;
external form ; symmetry ; divided into head, trunk, and
extremities ; composition of the body, table of alimentary
substances ; table of proximate principles ; table of acids ;
intimate structure ; description of Meckel ; observations of
Dr. Edwards, Dr. Hodgkin. V. Of the fluids. VI. Of the
solids. VII. Of the functions. VIII. Of the development
and organization, including the different periods of life from
conception to decay. IX. Of death, and its consequences.
The body of the work is divided into eleven chapters. I. Of
the cellular and adipose tissue. II. On the serous mem¬
branes, synovial, and splanchnic serous membranes. III.
Of the cutaneous system and mucous membranes. IV. Of
the vascular system, lymphatic system. V. Of the glandu¬
lar system. VI. Of the cartilaginous system. VII. Of the
fibrous system. VIII. Of the fibro-cartilaginous system.
IX. Of the osseous system. X. Of the muscular system.
XI. Of the nervous system.

The author gives the most minute and recent information
on the multiplicity of subjects described in his work, and
has evinced much talent, research, and judgment. His
classification differs very slightly from that of Bichat ; it is,
however, less minute. The introduction embraces many to¬
pics of considerable interest and manifestly connected with
general anatomy. In this part the work exceeds that of Dr.
Craigie, and also the manual before us. On the other hand.
Dr. Craigie’s production excels in the important subject of
pathology. But Mr. Grainger has produced the most com¬
plete British system of physiology. His style is good, his
language clear and concise, and his information the most
extensive hitherto published in this country. His work
must be fairly considered a standard one, and is indispen¬
sable to every class of practitioners as w^ell as to anatomical
students. He has fairly represented the received opinions,
however unsatisfactory many of them may appear from the
present state of science. We find him differing in opinion
with Dr. Craigie, and the foreign writers on general ana¬
tomy on many points, but this was to be expected from the
instability w7hich characterizes the science of medicine.
We would suggest to our author somewhat more attention
in the arrangement of the respective subjects in a future
edition. The plan adopted by the authors of the manual
before us is worthy of imitation. They first name the tis¬
sue, next its synonymes, definition, division, structure, vari¬
ations from age, physical and chemical properties, vital pro¬
perties, functions, and morbid anatomy ; and each of these
divisions commence a new paragraph. At the conclusion of

Transactions oj the Medico-Botanical Society. 461

each description, the works referred to on the subject are
enumerated.

It is perfectly impossible to analyse a work which em¬
braces such an immense variety of subjects as Mr. Grainger’s
Elements on General Anatomy. But we have much plea¬
sure in stating that our opinion of every part of the produc¬
tion is most favourable. We strongly recommend it to
every class of the cultivators and practitioners of medical
science as a work of authority and reference — it is generally
correct, though on many points opposed to the opinions of
other writers of eminence. This is a matter of no great
importance, because every ardent and zealous cultivator of
medicine will avail himself of the advantages derivable from
works on the same subject, both domestic and foreign. The
Manual of Bayle and Hollard, translated by Mr. Storer, is a
valuable addition to the medical library • it contains a vast
deal of information in a concise and concentrated form, and
is published at a price which renders it accessible to the
most humble class of students. It ought to be a constant
companion to those engaged in the prosecution of practical
anatomy, and equally so to those engaged in the practice of
the healing art.

Transactions of the Medico- Botanical Society of Lon¬
don.^ Vol. I. Part 1. London, 1829. J. Wilson, 8vo.
pp. 78, plates.

An Introduction to Medical Botany , illustrated with Coloured
Figures. By Thomas Castle, F.L.S., Member of the
Royal College of Surgeons, &c. London, 1829. E. Cox.
12mo, pp. 172.

In No. XV. of this Journal (September), we have given an
account of the constitution of the Medico-Botanical So¬
ciety, and should have noticed the interesting volume be¬
fore us much earlier, had not a press of other matter pre¬
vented us. On perusing this part of the Society’s Trans¬
actions, we find it contain six papers, which are as follow :
I. General Proceedings of the Society, from October 12,
1828, to January 16, 1829. II. Observations on the Hai-
marada of Guiana, by Dr. Hancock. III. Observations on
the Orayuri, or Angustura Bark Tree, by Dr. Hancock.
IV. Considerations on the Utility of Botany in Medicine,
by Dr. Grateloup, of Bordeaux. V. Catalogue of the Me¬
dicinal Plants of Tuscany, by Professor Octavian Targioni.
VI. Observations on Sarsaparilla, and its preparation, by
Dr. Hancock. There is also an Appendix, containing a List

462

Critical Review.

of Honorary Fellows, Foreign Members, and Fellows, elect¬
ed from October, 1827, to January, 1829; and other Lists
of Donations, Books, MSS., and Drawings, Plants, and Mis¬
cellanea. The three essays, by Dr. Hancock, are most de¬
serving of notice, as they contain much novelty, and are sub¬
versive of the received opinions of the profession. The first
and second of these papers present us with facts, which can
scarcely be doubted, but that on sarsaparilla, which reverses
the pharmacopoeial directions, as to the preparations of this
medicine, will not be so readily received by those who have
witnessed their best effects, when administered as recom¬
mended in the pharmacopoeias. Of this more particularly
hereafter. The essay on the Haimarada of Guiana was read
in May, 1828, and, among other observations, contains the
following : —

The Haimarada , is called so by the ArowaKs, and by
the Dutch Creoles Bitter Blairr.

“ It is greatly esteemed by the natives as an antibilious
emetic and febrifuge, and is, indeed, a most efficacious re¬
medy in malignant fevers and dysentery, especially in cases
depending on a disordered state of the liver.

“ It may not be improper to notice, the high terms in
which the native Indians and Creoles of Essequebo express
their commendations of this plant ; if questioned on the
subject, they exclaim, ‘ it is our physic when we are sick
with the fever, and have pain in our stomach and bowels ;
it throws off all the bile, and soon subdues the fever,’ &c.

“ We may thus observe, amongst these rude children of
nature, some gleams of the gastro-hepatic theory of fevers,
so prevalent, at present, amongst our European brethren.
This plant is, indeed, their main resort, both in continued
and intermittent fevers.

“ Their method, in the former disease, is to boil a small
handful of the fresh leaves in water, of which they take a
sufficient quantity to produce full vomiting, repeating the
dose for two or three following mornings, and even four or
five, if the fever prove obstinate.

“ In intermittents they employ it as an emetic, agreeably
to the practice of Celsus : — ‘ Cum primum aliquis inhorruit,
et ex horrore incaluit, dare ei oportet potui tepidam aquam
subsalsam, et vomere eum cogere ; nam fere talis horror
ab iis oritur, quss.biliosa in stromacho resederunt.’ (Lib. iii.
cap. 12.)

“ It must be observed withal, that they make great use of
baths, fomentations, and frictions, in continued and inflam¬
matory fevers in general ; and little or nothing is wanting,
except the use of the lancet, to render their practice in fevers

Transactions of the Medico- Botanical Society . 463

tolerably complete. As it is, however, it appears to be not
less successful than ours.”- — p. 9.

Dr. Hancock next gives the botanical characters, for
which we refer the reader to the work before us, as also
for its chemical properties. Its medical uses are thus de¬
scribed : —

“ Infusions of this plant have a faint herbaceous odour,
and a flavour somewhat similar to that of the quassia amara,
but more bitter. It leaves a peculiar impression on the pa¬
late, as it were of a metallic taste. Both water and alcohol
extract its virtues 5 proof spirit is, perhaps, the most perfect
menstruum.

“ In respect to the chemical analysis of this vegetable, I
have made no adequate or conclusive experiments, to enable
me to decide upon the nature of its active constituents. It
resists, in a remarkable manner, the action of the other ve¬
getable infusions, and of most ot the metallic re-agents
usually employed.

“ As an emetic, about 25 grains of the dried herb, in
powder, may be taken, or the infusion of 30 grains, made in
the manner of tea with boiling water, and in this dose it
acts easily and efficaciously. A dose of this kind, for seve¬
ral mornings successively, is a most effectual method of sub¬
duing a dysentery, especially when accompanied by a re¬
dundant secretion of bile ; and 2 or 3 grains may withal be
repeated twice a day.

“ The same method proves most successful in bilious re¬
mittent and intermittent fevers.

cc When haimarada is administered in small doses, with
common salt (muriate of soda), its action is directed upon
the intestines and the kidneys.

cc Its activity is also manifested both as a diuretic and a
sudorific, by combination with nitre and opium.

“ As a tonic, diuretic, and resolvent, it is best, as with
most other potent remedies, to begin with small doses (as a
grain or two twice or thrice a day) , gradually to augment the
dose till a decided effect be produced upon the system, and
to continue its use for a sufficient time, varying the dose ac¬
cording to its effects, and as the judgment of the practitioner
may suggest.

“ It has some powers as a vermifuge, and is reputed to be
an antidote to the bite of venomous serpents.

t£ Externally, it is praised as a vulnerary ; and I can bear
witness to its utility as a detergent and corrector of foul
and spreading ulcers.

u Its ultimate operation on the stomach is tonic and
bracing, improving the appetite and digestive functions.

464

Critical Review.

From these effects, [its^aptitude for expelling bile, together
with its bitterness and certain other analogies, I was in¬
duced to employ it in chronic disorders of the liver. The
results have appeared to me so favourable, that I have thence
chiefly been induced to solicit the attention of the faculty to
this humble plant ; hoping that, in abler hands, its virtues
may be more fully developed, and turned to yet greater avail
in certain untoward disorders. From what can be gathered
of its nature, I am inclined to believe, that it may be found
peculiarly applicable as a remedy in jaundice. I have never
tried it, however, in this complaint.

u I would by no means be understood to say, that I de¬
pend on this remedy alone in chronic disorders of the vis¬
cera, as indurations and enlargement of the liver, spleen.
See. I would only assert, that my experience has, to my
own satisfaction, most decidedly proved its value as an im¬
portant aid in such cases.

“ I usually employ, at the same time, a light mercurial
course, frequent fomentations, and repeated applications of
blisters/’ — p. 13.

The following observations, on the indiscriminate use of
mercury, in affections of the liver, deserve attentive con¬
sideration : —

“ I think I shall not be contradicted by the candid prac¬
titioner, when I assert, that we have, in general, been in the
habit of placing too much reliance on the use of mercury in
those complaints, without reflecting on the results. This
must certainly be owing to the influence of fashion, or to
some mistaken views ; for I would submit the question to
any man of experience and candour, whether its success has
been in any degree satisfactory, and what striking advan¬
tages he may have observed, from the use of mercury alone
in hepatites. Surely the experience of the fourth part of
a century within the tropics, which some few of us have
passed, should enable us to form an opinion of our own on
these points, unbiassed by the shackles of routine, or the
prevailing fashion of the day.

“ We know that mercury forms one of the most valuable
remedies we possess, capable of effecting important purposes
in the treatment of disease ; but we also know that it is so
egregiously abused, empirically and indiscriminately em¬
ployed, and so frequently to the exclusion of more appro¬
priate remedies, as to render it doubtful whether, upon the
whole, it has not been productive of more harm than good to

society. . . 5

“ Why should we repose such an overweening confidence
in a single metal, where benignant nature uas bestowed her

Transactions of the Medico-Botanical Society.- 465

choicest gifts. The vegetable tribes not only furnish the
most potent poisons, but also their antidotes, and are the
most salutary and appropriate remedies for the various dis¬
tempers to which our frail nature is daily exposed.

“ It behoves the members of our profession duly to con¬
sider these things. Let us hope that the subject may en¬
gage the attentive reflection of those whose opportunities
and active minds shall qualify them for breaking down the
trammels of authority, and the barriers to improvement, in
our most obscure and problematical art of physic.” — p. 14.

We wish the advocates of blue pill would reflect a little on
this paragraph. Dr. Hancock concludes his paper with a
description, in English, of the plant, and of the plate of it,
which is now first published. Our author endeavours to
prove, in his paper on the Angustura bark, that Baron
de Humboldt and M. Bonpland had not seen the real tree
that produces it, and that they did not visit the Missions of
Carony in which the Angustura tree is only to be found :
of this our author was informed by others, who may, or may
not have spoken truly, and we have therefore some hesitation
in receiving this evidence as invalidating the description
of the illustrious tlumboldt. But our author’s personal ex¬
perience and observation afford much more conclusive evi¬
dence. The Cuspa is a tree ofCumana, but the Orayuri or
Angustura tree is a native of Carony. The author has given
the botanical characters most minutely, but they need not be
inserted here. He asserts thatWildenow erroneously form*
ed a new genus, which he called Bonplandia, or the plant
sent him by Baron Humboldt, as the one in question, not¬
withstanding there already existed a genus of that name ;
and although the Angustura obviously belonged to the genus
Galipea of Aublet. Dr. Hancock quotes various writers in
support of his position. He proposes the name Galipea
officinalis , instead of Caspar ia. The medical properties of
this remedy, according to the accounts of Dr. Hancock, are
highly valuable. In 1817;, a most fatal bilious intermittent
fever prevailed at St. Thomas de Angustura, which assumed
all the characters of yellow fever. The cinchona having
been expended, Dr. Hancock had no other resort but the
quina de Carony, or Angustura, which was prepared and ex¬
hibited as follows : —

“ Into a large jug, containing about six gallons, we put
one pound of coarsely-powdered bark, with an equal quan-
titity of brown sugar, filled it nearly with boiling water,
and added about four ounces of wheaten bread to hasten
fermentation. It was then stopped close, placed in the sun,
and shaken frequently. As soon as fermentation was well

466

Critical Review.

begun, it was considered fit for use, and administered in the
quantity of from four to six ounces to the dose, three or four
times a- day.

“ The success of this seemingly odd preparation was very
remarkable. The irregular paroxysms of fever were sus¬
pended on the second or third day after commencing its use.
The number of deaths of patients, from fever, was soon di¬
minished to one-fourth of that which before fell victims to
this dreadful scourge ; though prior to this time it was gra¬
dually on the increase. In the month preceding the adop¬
tion of the Cortex Angustura, fifty-three persons died of
fever 5 the month following there were but fourteen, and se¬
veral of these were in a dying state when they began to use
the bark.

6C I, at first, conceived that fermentation might injure the
remedy, but had subsequently every reason to suppose that
the evolution of the carbonic acid rendered the remedy more
energetic, and more grateful to the palate and the stomach.
Besides this, the acetic acid and small portion of alcohol ge¬
nerated in the fermentation would contribute to extricate
more completely the active element of the bark, thus im¬
proving the remedy by augmenting the solvent powers of the
menstruum.

ct It was not long before I perceived the efficacy of the
fermented infusion in dropsy, for many of the fever patients
were hydropic, and it was found that their swellings rapidly
diminished on the use of the infusion. This naturally in¬
duced me to give the same remedy, as a tonic, to those pa¬
tients who were simply dropsical, or without fever. Its
power in those proved more striking and decided than any
thing I ever witnessed before in medicine. No regular ac¬
count of these, however, was kept, as it was administered to
a great number of patients in and out of the hospital.

“ In the more severe cases of dysentery, the Dover’s pow¬
der was given with each draught of the infusion, in doses of
from five to ten grains, three or four times a day.

f* We had thus no reason to regret the exchange we had
from necessity made, for the Angustura bark was found to
be greatly superior to the Peruvian bark. Though some pa¬
tients were averse to it at first, they soon requested to have
it, when they saw their companions in sickness recovering
so fast under its use.

I am fully convinced, from ample experience, of the vir¬
tues of this bark, that it is one of the most valuable febri¬
fuges we possess, being adapted to the worst and most ma¬
lignant bilious fevers, while the fevers in which cinchona is

Transactions of the Medico- Botanical Society. 467

chiefly administered are simple intermittents, for the most
part unattended with danger/’ — p. 26, 28.

A beautiful plate of the Galipea officinalis is appended to
this important essay. We now proceed to notice Dr. Han¬
cock’s observations on sarsaparilla, and they are worthy of
great attention. This is the sixth essay in the volume under
notice, and is entitled, (£ Observations on Sarsaparilla and
its preparation, with incidental Remarks on certain other
remedial agents in the cure of obstinate Chronical Disorders.
By John Hancock, M.D.,” &c. &c. This paper was read in
May last, and is, in our opinion, of such importance as to be
worthy of insertion in our pages : —

(e The admirable effects, and consequent high price, of the
article in question, has induced the inhabitants of those
countries from whence it is imported, to gather it from all
the different species of Smilax, the roots of which have any
resemblance to the genuine sort, and even from some other
plants of different families. Till a very recent period, the
people of Essequebo mistook for Sarsa, even the pendent
fibres ( not roots) of a species of climbing Arum, with large
heart-shaped leaves ; and, however gross the error, I found
certain medical practitioners there, indulging in the belief of
its being the genuine drug, and employing it as such ! W e
cannot .be surprised, therefore, to find the European market
deluged with false kinds of sarsa, which sufficiently accounts
for the little credit given it by many of the faculty, both at
home and abroad.

tc Of the six cr eight species of smilax which I have ob¬
served growing in the woods of Guiana, I never found but
one to manifest to the taste any thing of the sensible quali¬
ties of the genuine medicinal sarsa ; the rest being, for the
most part, perfectly insipid in the mouth and fauces, and, as
far as my experience goes, nearly inert as remedies. In re¬
ference, indeed, to medicinal powers, there are evidently two
distinct divisions of this genus of plants, although we know
of no botanical characteristics for thus distinguishing them
into two sections. Botanical analogy seems entirely to fail
us in this instance. It appears fully evident, however, that,
of this numerous genus, but a very small proportion indeed
are to be considered as possessiug any very marked medi¬
cinal properties.

cf The species just alluded to, as possessing some active
properties, grows on the declivities of the hills and moun¬
tains up the Essequebo, and, doubtless, in various other parts
of the interior. The stem is round, armed with short curved
spines ; the leaves are oblong, pointed, distant, smooth, and
glossy ; the root is a tuber, with numerous divergent fibres,

468 Critical Review.

of two or three lines in thickness* and several feet in
length.

“ Unfortunately, the traveller’s attention is absorbed by
a vast variety of interesting scenes, while traversing the
Guiana forest, and he is prone to neglect special objects. I
have no doubt, however, that the Rio Negro sarsa will one
day be found growing abundantly within the limits of British
Guiana ; and whoever makes this discovery will confer an
inestimable benefit on the public. Not only this, but the
discovery of the true ipecacuhana plant, and the cinchona
tree, are amongst the important discoveries which may be
anticipated in Guiana, either upon the plains, or on the range
of its interior mountains. Such discoveries are to be ex¬
pected from the real botanist, who combines a knowledge of
the external forms of plants, with the more important
science of their intrinsic properties, their application to me¬
dicine, to the arts, and domestic economy. I must here ob¬
serve, that, from my examination of samples of the genuine
drug from the Rio Negro, as it arrived atAngustura,with parts
of the stem adhering, it appeared that the species described
by Wildenow, as the smilax syphylitica , caide aculeato te-
reti aculeis axillarihus. is not that which is regarded as the
true and more active species, which has no axillary spines,
and may therefore still be considered as a nondescript spe¬
cies. The natives (the Mandavaces of Cassiquari,) of whom
I made inquiry, denied that the true kind was to be found
on the banks either of the Cassiquari or the Guiana, as they
call the Rio Negro. I placed the more reliance on this in¬
formation, as these were Peones who had been employed in
digging the sarsa, which, as they asserted, was chiefly ob¬
tained on the elevated lands of the Rio Imiquen, at Untu-
rana, and Caraburi. They acknowledged too, that, when
the right sort was not found in plenty, they sometimes dug
one or two others, which they esteemed to be nearly equal
in quality.

“ The sarsa of the Rio Negro, which comes by way of
Angustura, or of Para, is the best. Respecting this species,
indeed, I can speak with confidence, having had very ample
experience of its medicinal properties, especially in Angus¬
tura, where I lived nearly four years. It is the only remedy
used for the cure of venereal affections, and many others
falsely considered as such in the Orinoko ; not to mention
its great power in rheumatism of long standing, and in a
multiplicity of chronic complaints.

<c The sarsaparilla which is usually met with in the shops,
however, is, for the most part, nearly inert, either from age,
or being procured from various non-medicinal species. It

Transactions of the Medico-Botanical Society. 469

should be taken from recent importations, in the roll, and
not that which is kept slit up, in the shops, which is very
often quite useless. Good sarsaparilla has a peculiar nause¬
ous acrimony when chewed ; and this is almost the only cri¬
terion we have for judging of its medicinal activity.

ee It is quite amusing to observe the diverse opinions re¬
specting the nature and properties of this medicinal root.
In Mr. Rennie’s Supplement, p. 384, it is stated, that c ge¬
nuine sarsaparilla is covered by a brown or reddish bark,
with a central woody portion, soft, white, and sometimes
like starch. This part is useless, the virtues residing in the
bitter principle of the bark ; and the more it inclines to a
red colour, it is the richer and more powerful. The gray
and dirty-brown sorts are not good. The best sorts comes
from Jamaica and the Brazils, called Lisbon sarsa ; the worst
from Honduras and Vera Cruz. — {Pope.’) Here, it would
appear, that it is only the thin pellicle of bark, a sort of
epidermis, which is allowed to possess any useful property ;
and the colour of this pellicle is the only character called in
for discriminating the different kinds, or for judging of their
medicinal powers !

Cf The fact is, the real and only criterion for knowing good
sarsa, is almost universally neglected, viz. its sensible qua¬
lities in the mouth ; and which affords the best and most
effectual guide for enabling us to judge of the intensity and
value of vegetable remedies in general. It is by the taste
and odour, chiefly, that we judge of good Peruvian bark,
rhubarb, jalap, &c. ; and even the speculators about Cincho¬
nine would be guided more by such tests, in choosing good
bark, than by their hypothetical ones of glue and tan.

“ The medicinal properties of sarsaparilla, moreover, are
not confined to the bark so called, but are found to reside
almost equally in all parts of the root, as the cuticle, woody,
and farinaceous portions. This has been fully proved in
Demerara, by the results of their separate administration in
actual disease. The same will easily be believed by a trial
of their sensible effects on the mouth and fauces.

(e The medicinal powers of sarsaparilla, I am inclined to
believe, depend on a certain acrid or nauseous matter, or on
a principle similar to that of ipecacuhana, judging from its
sensible qualities and clinical effects ; and this acrimonious
or nauseous matter, which I find to exist in the more active
medicinal sarsa, is, in some measure, covered or concealed
by its demulcent or mucilaginous particles, which may also
contribute something to its curative powers, added to the
diluting effects of the water employed. As sudorific s, their
action seems to be similar. So also, in emetic properties,

470

Critical Review.

when the sarsa is taken in large doses, and not spoiled by
long boiling. However this may be, I suspect that ipecacu¬
anha might, in many cases, be employed with equal advan¬
tage where sarsa is indicated. This, however, I know, from
sufficient experience, that the powers of sarsaparilla are, like
those of ipecacuhana, quite destroyed by long boiling. It is
true, indeed, that the condensed vapour arising from both is
perfectly insipid ; but it is, with regard to ipecacuanha, well
known that, 4 though the water distilled from it has scarcely
any emetic effect/ it becomes nearly inert by long coction 5
and precisely the same is true with regard to the sarsa.

4 4 After long boiling, indeed, the peculiar odour which
rises abundantly on the coction of good sarsa, is almost ex¬
tinguished. From the sarsa prepared in this way, I found
no sensible results upon any patient, nor were its peculiar
nauseating, drowsy, and racking effects, produced by a large
quantity, although the decoction of six or eight ounces were
tried at a dose.

44 These experiments having been carried to a sufficient
length, most of the same patients recovered under the use
of the sarsa, taken from the same parcels as before, but now
prepared by simple maceration in hot water, i. e. affused in
a boiling state, and kept near the boiling point for some
hours. In all cases, the sarsa was directed to be well bruised
in large mortars, and in the mean time all other remedies
were abstained from, which might, in any way, affect the
result.

44 Knowing, then, the destructive effects of long boiling
on this drug, we cannot wonder at the doubtful and discor¬
dant reports given of it by our medical and pharmaceutical
writers, after they have directed it to be boiled down to one
half, &c. which must truly render it very nearly useless and
inert.

44 Another preparation, still more preposterous, appears
to be exceedingly in vogue at the present time, that is, to
boil down the decoction of sarsa into an extract. By this
absurd practice, its virtues are still more completely de¬
stroyed. It is much to be lamented that such vast quanti¬
ties of this valuable root are thus thrown away in vapour, a
boiled, if not a burnt offering, to the goddess of Folly. On
entering some of the shops in London, where this process is
carried on upon a large scale, we find the rooms teeming
with the effluvium, which may be regarded as the active
principle, or, at least, as an element necessarily connected
with it ; since we find that, in proportion as we drive off
this odorous principle by heat, we despoil this remedy of its
active properties.

Transactions of the Medico-Botanical Society . 4/ 1

cc Mr. Brande remarks, at page 404 of his very useful
Manual of Pharmacy, that, u there is much difference of
opinion respecting the activity of this extract, (as directed
by the College), among those who admit the efficacy of
other forms of sarsaparilla. It is certainly the worst prepa¬
ration of that remedy, as it is usually met with, for it is
easily decomposed by heat , and always suffers more or less
during the protracted evaporation that is required.” These
remarks are exceedingly just, and similar ones have been
made by Murray and Thompson, yet they seem to be en¬
tirely disregarded by the practical pharmaceutists, perhaps
because they consider them not to be derived from actual
experiment.

tc As prepared by the College directions, the extract must
certainly be quite inert ; and it would seem, that some pre¬
sentiment was entertained of its inefficacy, for, by way of
compensation, as it were, it is directed to be given in the
decoction of the root ! But certain sages of our profession
have assigned to this useless extract, and to that not less
useless syrup of sarsaparilla, which is prepared from the
extract, their best offices, when, in prescribing the decoction,
they say f thicken it with extract, and sweeten it with sy¬
rup !’ We have seen those boasted extracts and syrups
used in great quantity, and at great cost, but in vain ; when
afterwards a quart of the strong infusion has removed all
the violence of the symptoms.

“ In speaking of the deterioration of sarsaparilla by long
boiling, I have only insisted on that which depends on the
loss of its active principles by evaporation ; but that which
arises from the action of the air and heat, during a tedious
process of boiling, must, in a great measure, subvert its affi¬
nities, form insoluble compounds, and precipitate such of
the active materials as may not be dissipated in vapour. It
is, doubtless, the latter, however, or the evolution and loss
of its volatile parts, which proves the most injurious.

The boiling in vacuo , as it is rather improperly termed
(for we can scarcely consider it a vacuum, where the space
is continually occupied by the production of aqueous va¬
pour,) is said to be a vast improvement in the preparation
of decoctions, extracts, &c. It doubtless will be an advan¬
tage where much boiling is really necessary , principally by
avoiding the access of air, smoke, and sooty matter, by
which the extracts will at least appear more clear and pleas¬
ing to the eye ; but it will by no means obviate the main
objection just stated to the process of boiling, while it is
far too operose and expensive for general use ; and if, as
asserted, the atmospheric pressure be taken off, it will not

4/2 Critical Review.

only facilitate the evaporation of the water, but that of the
volatile elements of the drug likewise. There is, however,
no occasion whatever for boiling : if the drug be duly bruised
or reduced to a gross powder, the affusion of boiling water
and digestion therein, just below the boiling point, will ex¬
tract the active properties of this or other vegetable reme¬
dies, as completely as could be done by the longest coction,
and without the loss or dissipation of their volatile parts ;
and when required, it may be effected with a very small
quantity of fluid, if a powerful press be employed after &ue
maceration in hot water. The medicinal properties of dried
vegetables, may thus be extracted as perfectly as could be
done by expressing their juices in a fresh or green state.
Those containing resinous principles, require, of course, a
similar operation with alcoholic menstrua or proof spirit.
This method would be the most expedient for procuring un¬
altered the native properties of all those remedies depending
on volatile or fugaceous principles, as in the narcotic drugs,
or those containing essential oils, for example, hemlock,
henbane, savine, &c.

66 Over such preparation as I have just deprecated, that
employed by the Spaniards of the Orinoko, is indisputably
superior. There, it is prepared constantly without boiling,
either by digestion in wine, or a spirituous menstruum, 01
by an infusion with water, allowing it to stand for eight or
nine days exposed to the sun’s rays, or by a fire-side in the
rainy season, and forming thus a strong vinous or fermented
liquor. After my return from the Orinoko to Demerara, in
January, 1818, 1 had opportunities of trying its action on
numerous patients in every way I thought proper ; and I
found, by a long series of experiments, that the fermented
infusion was equally as efficacious here as in the Orinoko.
It appears to me very probable, that the acetous and alcoho¬
lic principles gradually evolved in the course of txie fermen¬
tation, serve more effectually to extract the active properties
of sarsaparilla than can be done by any other method we are
acquainted with. There seems to be a certain fixed prin¬
ciple in the sarsa from Para and the Rio Negro (and pro¬
bably in other kinds also), which is not so completely taken
up or dissolved by boiling water, for after exhausting half a
pound of this sort by two digestions, boiling, and pressure,
I added to the dregs half a pint of proof spirit, and digested
this with a gentle heat for a few hours in a close vessel, then
affusing hot water to the amount of that taken off fiorn the
first boiling, and pressing again, I procured, by this last,
operation, about four pints of an infusion, which possessed
the acrid properties of the sarsa, in a much higher degree

Transactions of the Medico-Botanical Society. 4/3

even than that obtained by the first decoction with simple
water.

“The activity of sarsa as a medicine, seems to depend on
a kind of narcotic quality, affecting the tongue and fauces
with more or less of a nauseous acrimony — the degree or in¬
tensity of which, affords the best indication of the strength
and value of the drug. Its effects on one patient, an Afri¬
can, were certainly those of a narcotic, agreeably to the
best definition of this term. It was given him in a large
dose, the infusion from 4oz. of Rio Negro sarsa. It caused
nausea and great prostration of strength, a degree of tor¬
por which induced him to lie upon the ground, with unwil¬
lingness to move or to get up. He said that it made him
‘ sick as death, and broke all his bones.’ There was scarce¬
ly any alteration in the pulse, unless it were a little re¬
tarded.

“ Whatever restorative and aphrodisiac virtues may have
been by the ancients attributed to the Ophrys Satyrion , or
the different Orchideae, it appears to me, that the sarsa is
the only medicinal agent justly entitled to the character of
a direct restorative. This property, at the same time, seems
to be totally unconnected with, or independent of, its farina
or amylaceous principle, since it is found to produce the
same restorative effects, not only when prepared by an aque¬
ous menstruum, but also in a saturated alcoholic tincture,
which we know could not take up those amylaceous or simply
nutritive particles.

“ This is one of the most remarkable effects of the genu¬
ine sarsa, and tends clearly to exemplify its eminently salu¬
tary properties, namely, the augmentation of flesh, and me¬
lioration of the habit, so frequently observable in patients
who have taken it for some time. It was noticed by many
of the planters of Demerara, as well as by eminent medical
practitioners, that not only did sores heal up, and swellings
of the joints subside, on the use of the sarsa, but that the
patients acquired a plumpness, smoothness of the skin, and a
degree of activity unknown before.

“Whatever be its mode of action, its advantages will
doubtless be found very great in the treatment of phthisis
and scrofula, and especially in correcting a constitutional
diathesis tending to those disorders.

“ It is esteemed by the colonial Spaniards, as a remedy
for every stage of syphilis. When they go under a course
of this remedy, they drink barley water, vegetable acids, and
cooling articles, to counteract the heating effects of the sar¬
sa, for they consider it very heating. Perhaps they should

VOL. III. NO. 18. 3 I'

4J4 Critical Review.

ascribe this effect more to the vinous menstruum which they
employ.

“ Much has been said by different writers regarding the
specific powers, so termed, of sarsaparilla, as a remedy in
lues venerea. Although well convinced of the great efficacy
of the genuine sarsa, under proper regimen, in the various
stages of lues, I consider it no specific ; and it is not parti¬
cularly as an antivenereal remedy that I would insist on its
value, but as a general corrective and sanative agent in scro¬
fulous swellings, ulceration, and lesions of various kinds,
and especially in general marasmus, cachexia, debilitated
and emaciated habits, and in disorders arising from the
abuse of mercury.

“ Those narrow views and vain discussions about the spe¬
cific action of sarsa in syphilis, have had the effect of keep¬
ing down its character, as a great and extensively useful re¬
medy— a character which it certainly deserves. It is to the
want of a proper regimen under its use, to the introduction
of spurious kinds, and to faulty modes of preparing it (by
long boiling especially), that we are to attribute the fre¬
quent failures which many complain of, and for which it is
even totally neglected by some practitioners.

“The disease, however, which in the Orinoko and Vene¬
zuela, most frequently demands the employment of this in¬
valuable alterative, is a species of rheumatism, which com¬
monly follows gonorrhoea, making its attack soon after the
discharge has been suddenly stopped, and the patient has
been exposed to cold and moisture.

“ This species of rheumatism, from suppressed gonor¬
rhoea, is so common an occurrence in Venezuela, that it usu¬
ally takes the name of galico (i.e. venereal) ; and as most
rheumatic affections are there referred to this cause, we
rarely hear it spoken of under any other title.

“ The true gonorrhoeal rheumatism, however, makes its
attack upon the muscles, the ligaments, and even the peri¬
osteum of the bones, soon after the discharge disappears.
The joints are rendered immoveable; all the limbs, the
spine, hips, and shoulders, suffer excruciating pain ; after a
time, these, symptoms are followed by tophi upon the tibia,
os frontis, and bones of the fore-arm, and the patient, if not
timely relieved, becomes quite crippled and emaciated.

“ Whatever obloquy may arise from an avowal of our own
misfortunes, the paramount objects of truth and candour
compel me to say, that such as just described was my own
case during several months of the year 1B14[* and that, after
a full, but ineffectual trial of mercury, and the usual Euro-

Transactions of the Medico-Botanical Society. 475

pean remedies, I was entirely restored to health, by taking
a single, or small jug of the Jarave del Bey.

“ Having been long a convert to some of the exploded or
unfashionable doctrines of the humoral pathology, it may
readily be believed, that my faith was not diminished by
considering the striking translations of disease, from one
part to another, so apparent in the foregoing, and in nume¬
rous other cases equally convincing.

“ They also satisfy me, that, in certain cases at least, and
these more frequent than is commonly imagined, secondary
symptoms follow gonorrhoea as well as syphilis ; and, when
added to the observations of the army surgeons, (as to go¬
norrhoea producing chancre, and chancre, gonorrhoea), they
tend to establish the identity of these diseases. ”

The remaining part of the paper consists of clinical re¬
marks on different chronic diseases, which we regret our
limits preclude us from inserting. Our author alludes to a
scrofulous form of ulcer which infects the negroes in differ¬
ent parts of the body, and in its rise, progress, and structure
has close analogy to tubercles in the lungs. Mercury and
sarsa are the chief remedies in such cases, and hence our
author states that it naturally occurred to me that the
same method ought to have its influence in some cases of
pulmonary lesions with severe cough and purulent expectora¬
tion, as also in ulcerations of the bladder and other viscera.”

It is true,” he observes, “ I had but few opportunities of
repeating experiments proper for illustrating this important
point, having left the colony not long after I had formed the
plan here alluded to. My experience in this, however, was
such as to afford me the most confident hope of its ultimate
success in phthisis and internal ulceration.”

We should cheerfully attend to these suggestions, if satis¬
factorily authenticated, but we are inclined to refuse our as¬
sent to this reasoning, when the thought crosses our mind
that we know nothing of the pathology of pulmonic tu¬
bercles. It may be that the philanthropic feelings of our
author have reminded him of the maxim of Galen, u et me¬
lius eegros juvare cum periculo quam nullo prosus remedio
sinere mori.” In speaking of iodine. Dr. Hancock states that
he had seen chronic hepatitis cured by it, and a case of ap¬
parently tuberculous cough was also cured in six weeks.
He also found sarsa a valuable anti-hydropic. Such are the
leading points in this gentleman’s paper on sarsaparilla, and
if found correct by future observers, as we are strongly dis¬
posed to believe, they will reverse the opinions generally
entertained as to the preparations of this remedy. On speak¬
ing to some of our friends, especially the medical officers of

Critical Review .

4/6

the army, they favoured us with very suspicious looks when
we mentioned the tenor of the essay before us. They stated
the many cures they had performed with the ordinary for¬
mulae of the pharmacopoeias ; and in fact, they seemed ex¬
tremely sceptical. For our own parts we are convinced by
the reasoning and details of Dr. Hancock, for we have re¬
peatedly observed the inefficacy of sarsa, even after the full¬
est trials, and used according to the collegiate formulae.
We have had a case of secondary syphilis very recently un¬
der our care, and were astonished at the declaration of the
patient, which was, that he had taken ten pounds of sarsa
root, as directed, without the smallest benefit. In several
cases we have observed the decoction taken for months
without the slightest benefit. We can readily account for
the cause of failure, by referring to the statements we have
quoted. If there were no other paper in the production be¬
fore us but this one, it entitles the volume to the grateful
remembrance of those engaged in the arduous and respon¬
sible duties of the practice of medicine. We hope the forth¬
coming part of the work, which we believe is now in the
press, will prove equally interesting and valuable. From
the unlimited extent of the Medico-Botanical Society, for
its members are to be found in every civilized country, and
from the numerous important communications transmitted
to that highly useful and scientific body, we have strong
expectations that its future transactions will be among the
most valuable in this country. The addition of remedies
to the materia medica, the more accurate description of those
in use is of solid benefit to humanity and science. Celsus
was right when he said, “ morbi non eloquentia sed remediis
curantur.”

We now proceed to make a few observations on the se¬
cond work, whose title is given at the head of these re¬
marks. In accordance with the universal progression of
medical science, the functionaries to whom the regulation
of medical education is intrusted, have of late required the
study of medical botany of their respective candidates. Our
junior friends were destitute of any compendious work on
the subject, but we are happy to say their wants are sup¬
plied by the very valuable little production before us. Mr.
Castle is the author of many useful works which have all
been favourably received by the profession. This introduc¬
tion to Medical Botany, is a useful elementary work, exceed¬
ingly well arranged, and very ably executed. We warmly
recommend it to every student in medicine, as an elementary
guide. A better introduction to the study of the delightful
and interesting science of Medical Botany cannot be con¬
sulted.

Sir A. Halliday on Lunacy in England and Wales. 477

V . — A Letter to Lord Robert Seymour ; with a Report of the

Number of Lunatics and Idiots in England and Wales.

By Sir Andrew Halliday, K.H. and M.D. London :

T. and G. Underwood, 1829. pp. 88.

Sir Andrew Halliday is well known to our readers as a
zealous and indefatigable investigator of the condition of
those unfortunate members of society who are deprived of
the light of reason, or who labour under mental imbecility,
or a total aberration of the intellectual faculties. In com¬
mon with the majority of our profession, he was struck with
horror at the cruelties and barbarities practised in the gol-
gothas allotted to the wretched beings, the subjects of men¬
tal decay ; and was among the first who, by his representa¬
tions and communications to the public, though anonymously,
led to the appointment of the Select Committee of the House
of Commons of 1806 and 7* So unsatisfactory and incorrect
was the return of the number of insane poor in England,
made to that committee, that the whole number was said to
be 2,248, while our author proved that 230 existed in Suf¬
folk and Norfolk, from which not a single idiot or lunatic
had been previously returned. In the session of 1815 and
1816, Mr. Rose’s committee was appointed, when the clear¬
est evidence was afforded of the abuses and horrors of the
private inad-houses of this metropolis. And at that time
such houses were subject to the inspection, we blush to de¬
clare it, of members of our profession — the elect of theCollege
of Physicians. Such was the activity and fostering care of
the medical commissioners, that the legislature, in its wis¬
dom, has disburdened them of such labour in future *. The
philanthropic Mr. Rose, with great pains, prepared a bill,
which was well calculated to remedy every existing or anti¬
cipated evil. It passed the House of Commons unanimously,
but was rejected by the Lords, in consequence of the late
Lord Chancellor having promised to frame a measure better
suited to the wants of the sufferers. The affair having got
into chancery, it there remained dormant for nine years,
notwithstanding the horrible details of the manner in which
the inmates of lunatic asylums were treated in this boasted
land of liberty. But the procrastinating Chancellor took
the whole matter on his own shoulders, and promised to pre¬
pare a bill much more perfect than any that the Commons
in Parliament could prepare or devise. In the year 1828,
the law relative to county and private mad-houses was

* Act July, 1828, 9 Geo. IV. c. XU.

Critical Review.

478

changed by the admirable acts introduced by Lord Lans-
down, and all the abuses and horrors completely prevented.
Vide 9 Geo. IV. c. xl. “ An Act to amend the Laws for the
erection and regulation of County Lunatic Asylums, and more
effectually to provide for the care and maintenance of pauper
and criminal Lunatics in England 9 Geo. IV. c.xli. “An Act
to regulate the care and treatment of Insane Persons in Eng¬
land.” This applies to private mad-houses, and authorises
the Secretary of State to appoint medical and civil commis¬
sioners annually. These acts ought to be in the hands of
every medical practitioner, as they inflict penalties for any
unjust or partial proceeding of physicians, surgeons, and
apothecaries. Every man who has a spark of humanity or
benevolence in his composition must feel rejoiced at the pro¬
tection afforded the liberty of the subject, and the interests
of unfortunate maniacs by these important enactments. Sir
Andrew has much reason to be proud of the successful
changes which he has mainly contributed to effect in the
treatment of lunatics. These acts are so explicit, that we
have been surprised to perceive his complaints against cer¬
tain official men, who endeavoured to impede him in his
useful, though melancholy inquiries. He observes in his
dedication to that revered and respected nobleman, Lord
Robert Seymour, whose name once more appears before the
public, connected with the welfare of the demented —

“ I have had to struggle against (worse than the cold indiffer¬
ence) the opposition of some official men, and all the common
difficulties that assail a private individual ! My energies have
been cramped, and my sphere of usefulness restricted, yet my ^zeal
has, in no measure, been lessened ; and, in as far as it goes, your
Lordship will find that this report presents a very fair view of the
statistics of insanity in Great Britain. It is calculated to set at
rest a question that involves much of our character and conduct as
a Christian nation, and that affects, more or less, in all their rela¬
tions, the happiness and comfort of every member of the com¬
munity.

“ The prevalence of insanity in England is no new doctrine.
Foreigners, of all countries, have universally asserted it, and many
amongst ourselves have implicitly believed the assertion j but,
up to the present moment, the soundness of that doctrine has been
firmly disputed and combated, though, as one of its ablest op¬
ponents candidly confesses, ‘ little else than conjecture has ever
been brought forward on the subject.’ Now, however, I am en¬
abled to lay .before your Lordship and the public a series of re¬
turns, authentic and tolerably accurate, which not only shew that
insanity, in all its forms, prevails to a most alarming extent in
England, but that the numbers of the afflicteu ha^e become more
than tripled during the last twenty years.’’ — p. iv.

Sir A. Halliday on Lunacy in England and Wales. 4J9

By the first act, quoted above, sect. 35, overseers of pa¬
rishes are obliged to make returns of all lunatics, under a
penalty of 10/. But we can easily conceive that many of
such persons are such lazy drones as to be reluctant in
making a return to a private individual, however laudable
his object.

Our author, after great personal labour, gives the statistics
of every county in England and Wales, and an account of
the number of lunatics and idiots in each. His account of
Middlesex is so manly, we cannot but quote it : —

ts This great metropolitan county of England — the centre of
her power and the seat of her government — the place where laws
are made, and where they are, perhaps, less attended to than in
any other portion of the empire — is said to be twenty-four miles
in length, and scarce eighteen in breadth, but comprehends the
two vast cities of London and Westminster. The air is mild ; and,
having a fine dry gravelly soil, the county may be said to be re¬
markably healthy and very productive but the wealth and the po¬
verty of its crowded cities are a never-failing nursery of wretched¬
ness and disease. Here all classes of society are gathered, as it
were, into a focus ; and the baneful effects of over-indulgence in
one part, and starvation in another, are most fully evinced in the
character and conduct of the people $ yet the ravages of disease
are not so apparent now as in former times 5 and many of the
worst scourges of human nature are no longer to be found even in
the most wretched corners of London.

“ The keeping of mad-houses has long been a gainful trade in
this county, and many have realized very large fortunes by the
confinement of their fellow-creatures. The oldest public esta¬
blishment in England is the Royal Hospital, called Bedlam ; and
it was long little better than a miserable dungeon for lunatics.
There they were confined, but more as prisoners than patients];
and it was like the Bastile of Paris — a prison from which few were
ever liberated. About the middle of last century St. Luke’s was
formed by private charity ; it is now a noble building, with large
and permanent funds, which, while properly administered, cannot
fail to be of incalculable advantage to the community 5 yet the si¬
tuation and restricted space which it occupies prevent its ever be¬
coming an eligible asylum for the treatment of lunatics upon the
principles of moral management which have now been proved to
be so beneficial.

“ The whole of file licensed houses in and about London are
under the superintendence of a board of commissioners, consisting
of sixteen noblemen and gentlemen, and five physicians. It would
have been more for the interests of humanity had the number been
reversed, and that the board had consisted of sixteen physicians
and five lords or gentlemen, as the subject ought to be viewed
niori^ as a question of medical treatment than as one of criminal
police. What is called the metropolitan district extends over the
whole of Middlesex and a part of Surrey and Essex ; and, accord-

Critical Review.

480

iner to the return printed by order of the commissioners, it con¬
tains thirty-five licensed houses, with a total of two thousand and
thirty-one patients, of whom eleven hundred and fifty-four are
paupers, and eight hundred and seventy-seven private patients.
There are two hundred and twenty-eight patients in Bedlam, and
two hundred and eighty-five in St. Luke’s, making the total num¬
ber confined in this district two thousand five hundred and forty-
four persons, exclusive of those that are known to be at large, or
are confined in work-houses, which, by a return made out some
years ago by Mr. Browne, the present clerk of the commissioners,
amounted then to a large number, and they have not decreased.

“ It is to be regretted that the late Act of Parliament has been
so little attended to in this great county. Either the magistrates
have failed in issuing their warrants, as that act requires they
should do, or the overseers of the poor have incurred the penalties
which it inflicts • for, up to the present moment, the clerk of the
peace is unable to make out any correct return of the number of
lunatics and idiots in Middlesex ; and it is the only county in Eng¬
land or Wales that is deficient in this respect.”— p. 24.

Having given a similar account of the respective counties,
Sir Andrew concludes his important letter with a summary
of the lunatics and idiots in England and Wales : —

“The number as actually ascertained by authentic returns, the
total amount for England and Wales will stand thus
By the returns of the clerks of the peace of
the several counties of England, it is ascer¬
tained that there exist . ; • 12,547

By the returns of the clerks of the peace in

Wales . 896

By a return from the Victualling Board, it is
found that there are in the naval asylum at

Haslar . 1^

By a return from the Army Medical Depart¬
ment, there are in the military asylum at

Chatham . 1^2

Total . 13,720

(e Having thus ascertained that very nearly fourteen thousand
insane persons do actually exist in this part of the United King¬
dom, I am certain it is no exaggerated statement to estimate the
numbers not returned at two thousand five hundred.’

Our author supposes that the proportion of insane persons
is one in every thousand of our population ; in Wales, one
in 800; in Scotland, in 1821, one to 5J4. This exposition
must appear new to many of our readers. In England
scarcely one-third of the inhabitants are employed in agri¬
culture^ in Wales more than one half are so employed, while
in Scotland there is not quite one-third. On this point our
author makes some interesting remarks, and also attempts
to explain the reason of the increase of lunatics in agncul-

Sir A. Halliday an Lunacy in England and Wales. 481

tural districts. He thinks the hard labour and bad fare of
pregnant females leads to violent exertion and distortions of
the body, by which the growth of the brain may be affected,
its development impeded, and even the form of the cranium
altered.

“ We know/’ says our author, “ that females will continue to
labour throughout the whole of their pregnancy*, and no one who
has ever lived in the country will hesitate to pronounce the labour
of a farm servant most prejudicial to the growth of the foetus in
utero. The position of the body, as in reaping 3 the constant and .
often violent exertions of the muscles 3 and, even in walking in a
hilly country, the changes in the position of the body, and in the
compression or relaxation of the abdominal muscles, are sufficient
of themselves to affect the contents of the pelvis, and particularly
in the latter stages of utero-gestation. In mountainous districts,
also, the food is more scanty and with more difficulty procured,
the atmosphere is more changeable and more humid than in level
plains, and both affect more or less our physical powers ; and in
whatever way a monstrosity or irregularity of structure may be
engendered, we know that it is easily propagated 3 the child will
more or less resemble the parent in his hereditary as well as ac¬
quired defects 3 and one great cause of the increase of this spe¬
cies of insanity has arisen from our careless inattention in suffer¬
ing female, as also male, idiots to procreate their species. The
Cretins of the Alps, and the idiots in Scotland and Wales, have be¬
come numerous from this cause alone 5 and should the people of
England continue to view the subject with that apathy they have
hitherto shewn, the increase of the malady in another half century
will be such as to endanger most seriously the comfort and well¬
being of the whole community. Whence arises the present pre¬
valence of crime and general depravity, but from our negligence
in attending to the physical properties upon which the moral qua-
lities of the mind so essentially depend. “ Train up a child,’’ said
the inspired writer, <f in the way that he should go, and when he
is old he will not depart from it.” This applies as much to his
bodily powers as to his mental endowments 3 and if we are zea¬
lous in procuring for the mind fit instruments, there is every
chance that its work will be properly performed. The reforma¬
tion of the man must commence with the child 3 and it would be
more true philanthropy to prevent the increase of diseased human
beings than to provide for the comfort of depraved criminals.”—,
p. 73.

We cannot give our assent to this physiology ; it wants
much evidence to establish it. But we turn to a more satis¬
factory part of the letter, where our author contends that
insanity will be diminished if those whose duty it is to su¬
perintend asylums will perform their duties fearlessly and
faithfully.

<e In conclusion, I would further observe, that, overwhelming
VOL. Ill, NO. 18. 3 Q

482

Critical Review.

as the number of our insane population is now proved to be, and
rapidly as their numbers are found to have increased, I have no
hesitation in asserting (for I do so advisedly), that if those to
whom Parliament has delegated the trust will understand the du¬
ties they have to perform, and will faithfully and fearlessly per¬
form those duties, the numbers of both lunatics and idiots will be
greatly lessened ; and, with regard to the first class, the disease
may be so changed in its character as no longer { to be depre¬
cated as the heaviest of all divine visitations.’ It has been owing
almost entirely to that indifference, which has so long existed
♦ among all classes of the community ; to those prejudices which
have been so insidiously and so indefatigably propagated ; and to
the cruelties and seclusions that have been so wantonly practised
in all cases where the disease was either suspected or confirmed,
that a common and casual ailment has so often been converted
into a frightful and incurable malady. Hence the great number
of incurable idiots that are to be found in every hamlet and in
every rank of life ; and hence, too, the present extraordinary
amount of what I have called our insane population. That such
indifference and cruel treatment did not always arise from improper
or selfish motives, I have had more than sufficient evidence. I
have known men of enlarged minds and of the greatest humanity
— men whose understandings I have considered as the most en¬
lightened — whose ideas I know to be the most liberal — -fly from
every investigation of this subject as from a pest-house ; and some,
by their actual opposition or careless inattention, have rendered
the exertions of others not only less efficient, but have prevented
altogether their being followed up to any good purpose. The
windows in the New Bedlam were, in the first instance, left un-
glazed, so that the patients were either to be kept in utter dark¬
ness or exposed to the inclemency of the weather at all seasons ;
and I remember well the difficulty Lord Robert Seymour had in
persuading the governors to consent to the windows in the front
of the building being brought down so low as to enable the in¬
mates, while walking in the gallery, to enjoy an occasional glimpse
of the animated scene around them. But, after what we have seen
and heard for the last thirty years, it is, indeed, most gratifying to
have to record, that now not only more rational views, as to the
disease itself, but as to our duty towards those afflicted with it, are
generally entertained and universally practised ■, and that, not¬
withstanding the indifference of some I could name, and of whom
I had hoped for better things, no one will venture to deny the pos¬
sibility, nay, even the very great probability, of effecting a perfect
cure in almost every recent case of insanity. Neither will it be
insisted upon that chains and darkness are any longer a necessary
remedy in the treatment of this complaint, or that cruelly lace¬
rating the body is the surest method of soothing the irritated
mind.” — p. 75.

Sir Andrew expresses his thanks to the clerks of the
peace for the courtesy with which they had received his fre-

Sir A. Halliday on Lunacy in England and Wales . 483

quent applications, and endeavours to shew that an inspec¬
tor of lunatic asylums ought to be appointed, otherwise the
act will become a dead letter. The Secretary of State has
the power to make such appointments. Sir Andrew com¬
plains of the trouble and expense he has encountered in ob¬
taining his information.

“ I have had,” he says, “ to travel five hundred miles to see the
returns in the Home Office, when (as was formerly the case under
Lords Sidmouth and Lansdowne) they could have been sent down
to me without either trouble or expense ; perused too with much
more satisfaction to myself, and more benefit to the public, and
just as safe as in the pigeon-holes, where I found them (generally
unopened) on my visits to Whitehall.’’ — p. 79.

We have been somewhat surprized at the statements of
our author relative to the comparative frequency of mental
imbecility or decay in England, Scotland, and Wales. One
would have supposed such disorders were of more frequent
occurrence in large cities and manufacturing towns, where
artificial habits, intemperance, speculation, and the various
other enervating causes prevail, than in agricultural districts.
We believe this is the general opinion, and cannot be shaken
by the statements before us. Sir Andrew admits that his
report is not perfect, though the most correct hitherto pub¬
lished. But many of our author’s inferences are drawn from
conjecture ; thus, for example, the increase of the popula¬
tion since the census of 1821 was taken ; and, again, he of
course could not ascertain the exact and immense number,
of lunatics and idiots unimmured in asylums. So far as he
has gone, he clearly proves the rapid increase of mental de¬
rangement in this country, and this melancholy fact entitles
the production before us to serious attention from every rank
in society. His strictures on the regulations of many of the
lunatic asylums are just, and in unison with the opinion of
every man who has a spark of humanity in his composition.
Every honest and upright man must condemn the horrors
and atrocities which have been practised in lunatic asylums,
and applaud the wisdom and humanity of the legislature in
protecting one of the dearest rights of our glorious constitu¬
tion, “ the liberty of the subject,” and preventing the out¬
rageous cases of wrongful confinement, arising out of feel¬
ings of avarice, family disputes, and interested motives.

We think Sir A. Halliday has done himself much honour
by the great personal trouble and expense he has incurred
in procuring the information he has now published on the
increase and management of the umortunate insane of this
country.

This letter is well worthy of attentive perusal by every
class of society.

484

Original Commun ications.

ORIGINAL COMMUNICATIONS.

I .—An Account of the total Failure of Mr. Chenevix s Mes¬
meric Operations in Dublin. By T. C. Choker, M.D.
South Frederick Street.

In the “ experiments and observations on mesmerism/’ by
Mr. Chenevix, published in the London Medical and Physi¬
cal Journal, I was surprised to find any allusion made to his
Dublin experiments to establish that doctrine, as we had
both agreed in March last, that they had been a total fail¬

ure.

Mr. Chenevix’s words to me then were, “most extraordi¬
nary, no results “ Dublin’ has been a total failure “ I
confess Dr. Croker your invincibles are bomb proof.” After
the third day’s failure at the hospital for incurables, Mr.
Chenevix declined revisiting it, as he said, “it was useless.”
The notes on cases there (which Mr. Chenevix sent me his
acknowledgments for) have not been published ; though it
appears to me to be “ the duty of a conscientious narrator,
to relate, with equal frankness, every portion of his story
that the public may come to a fair conclusion. In Glynne’s
case was a cure effected ? Though so much stress is put
on her walking without a crutch; I believe her lameness was
imaginary, or feigned to entitle her to more attentions, &c.
Her character will not bear scrutiny, she has been drunken,
ill conducted, and reported to the governors of other impro¬
prieties.

On the 28th of March, any “ forcible impression previ¬
ously excited,” was removed, when Glynne’s left hand still
continued intractable, and Mr. Chenevix then expressed
himself disappointed and mortified.

Glynne had been admitted several years ago into the hos¬
pital for vomitings, which were then “deemed incurable
“ the plain and undeniable fact is, they still continue every
day after meals, to her great annoyance ! ! The nurse said
she had two fits, but I did not see her in either of them, so
cannot say. The patient strongly affected (Hutchinson),
derived not the slightest benefit, but declared magnetism
made her worse, and strongly objected to his repetition.
Her symptoms, chiefly hysterical, were produced by excited
mental impressions. She still remains with Glynne — in¬
curable. A private patient, after Mr. Chenevix had be¬
stowed much time to no purpose on her case, called me
aside, and begged of me “to take the poor gentleman away,
as it was a mere humbug ; that she “ felt no relief whatever.

485

Dr. Ryan on the Ancient Study of Medicine.

that the gentleman's motives were good, but that he afforded
her no relief.” Her complaints were asthma and diseased
liver.

I have seen Mr. Chenevix try his experiments on the dis¬
torted spine * (excurvation) forwards, on cripples, on cases of
ossified joints ; on cases of palsy, in which the brain had been
many years affected with functional disease ; on consump¬
tive patients, on a case f of arthritic nodosities ; and con¬
tracted joints, with arthritic depositions and dropsy of the
extremities, and many others ! ! Could mesmerism relieve*
any such, I too, would become its advocate. Mr. Chenevix
accompanied Dr. Marsh and me to Stephen’s hospital, of
which he has made no mention in the pamphlet sent me,
but there likewise a total failure ensued. On the whole I
must still retain the opinion I held in common with Mr.
Chenevix in March last, that “ Dublin had been a total fail¬
ure,” that there were (C no results!” That the incurables
(or as Mr. Chenevix then designated them, the invincibles)
were bomb-proof!!!

II. — Extract from a Lecture on the Education and Qualifi¬
cations of Medical Men in former times. By Michael
Ryan, M.D.

{Continued from page 406.)

A physician was described in the early ages, (£ a good man,
skilled in medicine,” and that he might be really good, the
father of the art required an oath, the principal obligations
of which were the strongest incentives to the practice of
virtue. His interesting study of the structure, functions,
derangements and restoration of the most complicated but
complete fabric, the microcosm of man ; his ardent cul¬
tivation, to an illimitable extent, of the noblest branches of
human literature, and the immense history of animal, vege¬
table and mineral productions, and of all things created for
the use and benefit of his species, irresistibly impel him to
form the most sublime conceptions of the wisdom, omnipo¬
tence and beneficence of the Almighty Author of all things ;
and stimulate him to pursue with delight the marvellous and
fascinating paths of nature and of science ; while his reason
and judgment enable him “to investigate truth and useful
knowledge, by constant research, sober reflection, and re¬
peated observation ; and thus he acquires the information
necessary for the primary object of his profession, which is
the restoration of health. Thus it was that the science of

* Connor's Case.

t Harris— since dead.

485

Original Communications.

medicine was formerly considered a part of philosophy,
when the cure of disease and contemplation of moral and
natural history were cultivated under the same teachers ;
and in this manner was it taught by Diodes, Chrysippus,
Praxagoras, Empedocles, and Democritus; and was first
separated from the study of religion and philosophy by
Hippocrates. The dignity of medicine arose from the no¬
bleness of its subject and is its real object or end; its sub¬
ject is the human body, which excels that of all other cre¬
ated bodies, and its end or object is health which is the
oreatest temporal concern of man. For these reasons,
Aristotle, and all the ancient philosophers, allowed the first
rank to the best benefactors to man, namely, to those who
preserved his life and health. The professors of medi¬
cine, have had always precedence of those of the law, be¬
cause the preservation of life, is preferable to the preserv¬
ation of property, liberty, or honour. Cicero has left us
affirmative evidence of this position. The healing ait was
never sullied by ignobleness nor ignominy, it is the compa¬
nion of nature, and the restorer of her works, and displays
nothing but ingenuity and beneficence in its proper minis¬
try. It is ever ready to undertake the most painful labours
for others, and affords the greatest of all human blessings ; it
opposes itself readily to the miseries and calamities of man¬
kind, and alleviates the fallen and oppressed state of mor¬
tality, while it governs not only the ministry of the body,
but the functions of the mind. Such has ever been the ex¬
cellence of medicine, and such are the noble objects of its
real and well-instructed professors. If abuses exist in the
profession, if ignorant and illiterate men assume the rights
of the faculty, and degrade the profession, the fault lies with
legislators, and not with a profession who have no power to

prevent it. . .

Democritus said medicine was the sister 01 wisdom, be¬
cause wisdom liberated the mind from disorder, and medi¬
cine removes diseases from the body. Wisdom was defined
£C the science of divine and human things,” and a knowledge
of which is necessary to a good physician. Hence it was
that cosmography and astrology formed a part of the medical
education in former times ; that information might be de¬
rived from situation, and the vicissitudes of the atmosphere.
Even at this time these sciences are not omitted, though not
specifically denominated in the course of medical education.
They are displayed in our knowledge of endemic and epi¬
demic diseases, and in the natural history of the animal, ve¬
getable, mineral and gaseous productions subservient to the
practice of medicine ; and in materia medica, chemistry and
botany. Arithmetic was also required, likewise geometry,

487

Dr. Ryan on the Ancient Study of Medicine.

the various learned languages, especially Greek, Latin and
Arabic. The Greek, Latin, French, German and Italian
languages are still indispensable to the student of medicine.
Rhetoric was deemed necessary by the ancients, for the
power of persuasion was considered of signal use, to solace
the sad, to cheer the timid, to pacify the irritable, and to
coerce the furious. Every practical man acknowledges the
utility of treating his patients agreeably to such maxims.
The fears, the wishes, the dislikes, the eccentricities and
apprehensions of the sick and their friends, and the duties
and responsibilities of the ordinary attendants, require no
small share of the rhetorical powers of the practitioner, so
as to insure a proper mode of treatment. Anatomy, physio¬
logy, and pathology, were little known to the ancients, and
therefore the scientific progress of the art was greatly im¬
peded. When we consider this fact, it is really marvellous
how accurately our predecessors arrived at the diagnoses,
prognoses, and therepeia of diseases. It is to be remem¬
bered that comparative anatomy led to some notion of the
structure of the human body. The materia medica of the
ancients was highly cultivated, and contains most of the ac¬
tive remedies in modern use. Natural history, physics, and
moral philosophy, were included in the ancient study of me¬
dicine, and are now required by many foreign universities.
Ethics were necessary to assuage the perturbations of the
mind, which are such powerful causes of disturbing the body,
of debilitating the system, and of retarding convalescence ;
and the rather, as the affections of the mind and diseases of
the corporeal structure, often mutually affect each other.
Thus Galen has written a work entitled, “ Quod animi mores
corporis temperaturam sequantur,” and another “ De cog-
noscendis curandisque animi affectibus.” Thus it was
deemed necessary to have a sound mind in a sound body.
This precept is indispensably necessary in the practice of
medicine, for whoever wishes to enjoy bodily health, must
first compose the mind; then exercise the mind and body
together — a maxim to be adopted by all, but most especially
by the cultivators of literature, and the more abstruse and
difficult sciences. The cure of the body can seldom be ac¬
complished without the tranquillization of the mind — with¬
out the inspiration of confidence and hope ; and such com¬
posure of the powers of the mind is better in many instances
than any medicine whatever. Such is the influence of the
moral over the physical principles in man. Hence it follows,
that ethics, or moral philosophy, has a great influence over
disease, and must be alternated with practice of the healing
art. It is a matter of surprise, that the present teachers of
the nature and treatment of disease never direct the atten-

488 Original Communications.

tion of the student to the disordered conditions of the mind,
which are the most prolific sources of corporeal suffering.
The over-exertion of the mind is the constant cause of hy-
pochondriacism, of diseases of the stomach, liver, the brain,
of mental disorders, or those which affect the manifestation
of the mind, as insanity, &c. &c. Fear is the greatest cause
of fevers, and I believe to this alone the ideal phantom of
contagion owes its dominion in a great degree. Anger is
the most common cause of disorders and diseases of the
heart. Grief, ambition, envy, jealousy, and indeed all the
other mental emotions, have the most decided influence in the
cause of diseases. The medical student of our times is un¬
initiated in the knowledge of the power possessed by the
mental faculties on the body, and receives his academic
honours without having bestowed a thought upon the sub¬
ject. What a contrast there is between the profound edu¬
cation of the ancient cultivators of ijiedicine, and the super¬
ficial system of instruction in these times. It is now the
fashion to boast of the march of mind, of the universal pro¬
gression of intelligence, of the great discoveries in medicine,
and vet there is no modern writer whose works can be com-

pared to those of Hippocrates, Galen, and many other an¬
cient writers, in point of learning, research, and extent of
knowledge. The present systematic works cannot bear any
comparison with the ancient ones. Even in point of no¬
velty, they scarcely have any claim, especially as to remedial
agents, for, in truth, most of our new discoveries, as they are
exultingly designated, have been described under other
names by our predecessors ; and this fact should remind us
of the axiom of Solomon, u there is nothing new under the
sun.” Great improvements have been made in anatomy,
physiology, pathology, and chemistry, but the materia me-
dica and practice of medicine are virtually unchanged. Me¬
dicinal substances have been analysed and rendered more
simple and active, but few have been added to the ancient
stock.

A question was discussed by the ancients, whether the
study of astrology was useful, and whether it was necessary
to the medical practitioner ? The affirmative of both posi¬
tions, is confirmed by many arguments. In Genesis, it was
said, u let there be lights in the firmament of the heaven, to
divide day from night ; and let them be for signs, and for
seasons, and for days and years.” The four seasons are de¬
fined by the access or recess of the sun ; day is a solar cir¬
cuity, and year is an entire motion of the sun around the zo¬
diac ; and month is circumscribed by the motion of the
moon. All herbs and plants revive in the spring and de-

489

Dr. Ryan on the Ancient Study of Medicine.

cline in autumn ; many fishes, as well as the tides, are in¬
fluenced by lunar progression. The periodicity of diseases
can be ascribed to no other causes than planetary influence.
Hence the science of astrology is necessary to the physician.
The father of physic has left us a treatise on the influence of
air, water, and situation ; and the illustrious Sydenham, and
many others, imitated his example, by detailing the progress
of epidemic diseases. The classic writers have not omitted
the influence of the planetary system on the various produc¬
tions of the terrestrial globe. Even the season is said to in¬
fluence procreation, an opinion which cannot be doubted* ;
and hence Aristotle said, Sol et homo, generant hominem.”
Astrology was divided into two parts ; astronomy, which
teaches the longitude, latitude, and declension of the planets
and stars, the solar eclipses, the conjunction and opposition
of the moon ; in fact, all that refers to the planetary system ;
and cosmography, geography, navigation, the composition
of horology, horometers, and mathematical instruments.
The other part was named judicial astrology, which was said
to predict futurity ; but this was never cultivated to any ex¬
tent by physicians. Natural philosophy, logic, rhetoric, and
anatomy, were considered as necessary for the principles,
materia medica, botany, chemistry, pharmacy, moral philo¬
sophy, and surgery, for the practice of the healing art. With
all these a medical practitioner ought to be conversant ; but
in our time many of these are neglected, especially natural
and moral philosophy, astrology, and cosmography. Hence,
from the neglect of ethics, the conduct of the faculty has
been denominated avaricious, envious, selfish, and inglorious.
Medical knowledge was communicated orally in the schools.
It was held that one could not read in an hour as much as
could be spoken by a teacher of research and observation :
but the student was to consult the best works at the same
time, and compare their doctrines with those of his precep¬
tor. He should also acquire information from conversations
with his teachers and other learned individuals. He should
be familiar with all the remedies in medical use, and should
acquire such knowledge by attending to practical pharmacy ;
in fact, he should commence his studies by inspecting the
pharmaceutical laboratory, and learn the mode of preserving,
compounding, and dispensing those remedies which are sub¬
servient to the practice of his profession. The period of
study was not defined, because some persons, from natural
imbecility, were unable to employ sufficient labour; and
others, who, if they should spend their whole life in reading,

* Traits Elem. ; del’art des Accouchemens par M. Velpean, 1829.
vol. in. no. 18. 3 n

490 Original Communications.

could derive no advantage. Constant study was deemed too
laborious for all, and remission was prescribed, to allow the
mind and intellect to become more vivid. It was not only
considered necessary to study during youth, but to extreme
old age, as the whole life was thought inadequate for the
complete acquisition of medical science. Hippocrates
affirmed to Democritus, that cf he had not arrived at the end
of medicine, although he had lived to old age.” The stu¬
dent of medicine should have a strong and vigorous under-
standing, no ordinary genius, an excellent education, un¬
ceasing assiduity and inclination to study, learned teachers,
great diligence and discrimination. No profession requires
the possession of higher mental faculties, so accurate an ob¬
servation, retention, and valuation of so great a variety of
single facts ; a more diligent exercise of the senses, a well-
directed attention, a faithful memory, a cautious comparison,
and discrimination susceptible of doubt, and careful in ar¬
riving at just and natural conclusions. His whole life must
be one continued course of study, of reflection, of observa¬
tion, and of judgment. He must exert the greatest mental
and corporeal labour in analyzing, adopting, accumulating,
and simplifying that information which is most important,
and then direct its application and combination to the ma¬
nagement of human diseases. His profession is the most
extensive, abstruse, and difficult of all human pursuits, it
extends from matter to space ; and hence it is, that the best
judges of literature have universally admitted the properly
educated physician to be the best informed member of so¬
ciety. Drs. Johnson and Parr, and Rousseau, were of this
opinion. Though the difficulties of obtaining a complete
knowledge of medical science are great, patient labour will
conquer them : omnia vincet labor. In further confirmation
of the correctness of cultivating the healing art, as already
stated, l must refer to the remarks of an eminent and highly
talented professor, in his introductory lecture

Fortunately for the modem student, the original medical
works to the revival of literature in the middle ages, do not
exceed 100 in number, and scarcely one half of these is woi-
thy of perusal. To the short interval of the last three cen¬
turies, the immense fecundity of the medical press is to be
ascribed. Few works contain any material discoveries, or
useful improvements. The life of man, unless it were Pro"
tracted to the age of the antedeluvians, would be too shoit
to explore, and his memory unable to retain, one half of t e
opinions maintained in the different epochs of the history o

* Dr. Connolly, of the London University.

Dr. Ryan on the Ancient Medical Ethics. 491

medicine. The essence of many medical works might be
easily condensed into a few pages. Many of them are mere
recapitulations of their predecessors ; others are filled with
absurd hypotheses and ridiculous theories. The man who
has fortitude to encounter the perusal of the greater portion
of the ancient medical writings, may be compared to the in¬
dustrious bee, that patiently extracts a little honey amid
crops of weeds and thistles. The modern student is spared
this herculean labour, which is only to be encountered by
his teachers ; and even partially by them, as the universal
opinion of the profession obtains, that a prodigious crowd of
former writers merit no place in our remembrance. They
are like the innumerable herd of men who have passed in
review upon the theatre of the earth, now decayed and for¬
gotten, and no longer the objects of attention. To peruse
the works of most of them would only encumber the head
with a jumble of words, and burthen the memory to no
useful purpose. The works of Hippocrates, Aristotle, Theo¬
phrastus, Dioscorides, Galen, Celsus, Araetus,Oribasius,TraP
lian, Paulus iEginatus, iEtius, Avicenna, Averroes, Rhazes,
Avenzoar, Mesue, Serapion, Pliny, Coelius Aurelianus, Rufus,
Fallopius, and Pare, may be perused, even in our day, with
interest and advantage. Most of these, and many others,
are included in the systems of Isaac of Arabia, of Avicenna,
and Averroes.

Ethics , or Precepts of Professional Conduct , inculcated hy

the Ancients .

Medical ethics are the institutes and precepts which re¬
gulate the professional conduct of the practitioners of the
healing art towards each other, and every class of society.
“ They are principles of urbanity and rectitude, which can¬
not fail to enlarge and invigorate the understanding ; and
the observance of the duties they enjoin would soften the
manners and expand the affections, and form the individual
to that propriety and dignity of conduct which are essential
to the character of a gentleman.” Thus, Dr. Percival.
There never was a period, in the history of medicine, in which
ethics have been so neglected and violated as at the present
time ; nor where the honour and dignity of the profession are
so degraded and disregarded. It is therefore necessary to re¬
mind the junior members of the medical profession of those
principles which have regulated the conduct of their prede¬
cessors, and which, to a very small extent, still regulate that
of well-informed practitioners. The subject may be divided
into three parts, 1st. Of the Ethics of the Ancients ; 2d.

492 Original Communications.

Of the Ethics of their Successors ; 3d. Of the Ethics of the
Moderns.

Ethics of Hippocrates. — The father of medicine was of
opinion that a medical man should have a healthy appear¬
ance, or the vulgar would consider him incapable of curing
diseases of others. His appearance should be respectable,
his dress decorous; and he should use the purest perfumes.
He ought also to cultivate moderation or temperance of
mind, not only taciturnity, but every other moderation of
life. These are requisite for the acquisition of the glory of
his science. His morals ought to be excellent and unex¬
ceptionable, conjoined with gravity and humanity. A rash
disposition and promptitude, however useful to others, are
to be contemned. As to gesture, his countenance should be
composed to prudence ; not rough, however, lest it appear
proud and inhuman. Whoever is disposed to risibility and
extraordinary hilarity is deemed troublesome — both are to
be carefully avoided. He ought to be correct in every cus¬
tom of life. In all affairs there is much in the justice of
station, and a physician has great intercourse with his pa¬
tients; he is scarcely ever to converse with women or vir¬
gins, for there, he meddles with a jewel of great value.
Hence, to them and all, he should demean himself honour¬
ably and politely, and excel in all the virtues of mind and
body. In medicine are inherent all these things — a con¬
tempt for lucre ; bashfulness, demureness, and modesty in
apparel ; reputation, eloquence, judgment, lenity, ambition
for honour, cleanliness ; a cognition of all remedies, useful
and necessary for the preservation of health, life, and a free
use of them ; an aversion to the superstition to the gods,
though a due pre-eminence to them. In his attendance
to the sick he should be correct in his approach, speech,
gesture, apparel, and appearance. He should learn all
things in the labaratory, which are employed for the cure of
diseases ; he should possess all the instruments requisite for
his practice. In all cases that require manual operations,
such as excision or ustion, celerity and tardiness must be
adopted as occasion shall require. The situation of the dis¬
ease must be considered, as some parts are more vascular
than others. Care is required in performing the operations
of venesection and cupping. The management of ulcers,
tumours, and wounds, should be judicious. Ample direc¬
tions are given for the performance of all manual opera¬
tions*. Calumny and illiberality are disgraceful to prac¬
titioners. The publication of the errors of another is highly

* Hippocratis de Medico.

493

Lr. Ryan on the Ancient Medical Ethics.

culpable. A medical man should be moderate towards all,
silent on sudden emotions, ever ready to answer ; frugal in
food, content with a little affluence, powerful in speech, and
should display all his information for the promotion of the
glory and the discovery of truth. To all these precepts nature
is the best guide. Whatever is artificial is evidently unna¬
tural. We should collect all these precepts, and reduce
wisdom to medicine, and medicine to philosophy. A phy¬
sician is a philosopher, and is estimated as a god. He ought
to cherish the virtues already enumerated; and avoid making
the profession incontinent, mercenary, and sordid, with its
practitioners insatiable, and remarkable for cupidity, detrac¬
tion, and impudence. The physician should pay due ho¬
mage to the Deity, from whom medicine flows, as well as
all blessings and eternal happiness. Let him be pious, and
not vainly arrogate to himself any merit in the cure of dis¬
eases, for all his skill is conferred upon him by the Deity,
and the favourable or fatal issue of any disease depends upon
the wTill of Providence. Hence the prognosis ought to be
cautious, as a disease, slight in the commencement, may
afterwards assume a formidable aspect, and prove fatal.
He should pronounce his prognosis with urbanity ; for auste¬
rity affords a difficult access to the healthy as well the sick.
Let him be cautious in conversation with the vulgar, and
give only the necessary directions. This is the true mode
of behaving himself. Let him also be able to prepare the me¬
dicines for the sick, and even to afford them any assistance
in the absence of ordinary attendants. He is to retain in
memory all remedies, their mode of preparation and appli-
cstion, and the use of all mechanical means which are
employed in the cure of diseases. This is the beginning,
middle, and end of medicine. Events, sanctioned by expe¬
rience, are to be predicted. It is proper to remember, in
visiting the sick, that his aspect be distinguished by humility
and modesty, with suitable appearance, taciturnity, and
calmness, and then take his seat by his patient, and exhibit
all things with diligence, and answer all objections, and esta¬
blish constancy in all perturbations of mind, and shall allay
tumult by reason, and be ever ready to afford relief in every
emergency.

The errors of patients often frustrate the best intentions
of the practitioner ; care is, therefore, necessary that ad¬
vice shall be implicitly followed, because they seldom con¬
fess their infractions, but unjustly bear blame towards the
physician. All remedies are to be employed quietly and
succinctly, so that the patient may readily comply with hila¬
rity and a cheerful countenance. He is to be deterred from

494

Orig inal Communications.

his desires, when improper, and persuaded to use remedies,
however unpleasant, when beneficial to his condition. No
improper or dangerous remedy is ever to be exhibited, even
to a common malefactor. Every remedy is to be tried which
has been recommended by the majority of the profession.
The physician should embrace all those precepts, observe,
keep, and exert them. They are observed by all, on ac¬
count of their splendour, and those who travel in this path
shall accomplish for themselves glory with their seniors and
with their successors *. Remedies must be used, even when
proposed by the vulgar, if they tend to the cure ; for medi¬
cine is a universal art, perfected by the observation of man¬
kind. The patient should be cautioned, but also left to his
own discretion. If attendance be commenced, without re¬
ward or fee having been offered, the patient is not to be
abandoned. Any discussion about it is injurious to the
mind of the sufferer, especially in acute diseases. When the
celerity of disease is rapid, there is no time to arrange about
reward ; and it has no effect with a good physician, who is
only anxious to preserve life, and enjoy the higher quality of
the universal esteem entertained for him. It is much better
to reproach those cured of diseases, than to take their
money while they labour under them. Some, on account of
friendship or acquaintance, suppose they ought to be attended
gratuitously ; but these are worthy of neglect. A genuine
physician will be more confiding in the justice of his patient
than churlish. Wherefore, in all cases, the best treatment
is to be employed ; and the cupidity of reward should be
consonant to the custom of our contemporaries, and to the
wealth, affluence, and means of the sick ; and sometimes
attend gratuitously, that you may have more thanks for such
attendance, than for that which has been rewarded. If an
opportunity offer, in the case of a stranger or a necessitous
person, these are to be succoured immediately ; for whoever
will exhibit himself humanely towards mankind, he will
be said to have a real love of his profession. Some men
are so greedy of fortune that they extract riches from the
most indigent, but these men seldom prosper, and only de¬
grade the profession ; while the humane and good man flou¬
rishes, and is considered an honour to his art. Consulta¬
tions cannot be refused, even to the necessitous. This I
affirm by an oath, that one medical man should never invi¬
diously calumniate another. No practitioner should rob an¬
other of his merit, or diminish the confidence of his patient f .
Such was the code of ethics of the father of physic, the due

* Id. De Decenti habitu; aut decoro.

+ Id. Praenotiones-

Dr. Futhill’s Report of the Westminster Eye Infirmary . 495

observance he confirmed by the following oath, to which all
his disciples were obliged to subscribe : —

The Oath of Hippocrates . — “ I swear by Apollo the phy¬
sician, by iEsculapius, by Hygeia, and Panacea, and by all
the gods and goddesses, that, to the best of my power and
judgment, I will faithfully observe this oath and obligation.
The master who has instructed me in the art I will esteem
as my parents, and supply, as occasion may require, with the
comforts and necessaries of life. His children I will regard
as my own brothers, and, if they desire to learn, I will in¬
struct them in the same art, without any reward or obliga¬
tion. The precepts and explanations, and whatever belongs
to this art, I will communicate to my own children, to those
of my master, and to such other pupils as shall have sub¬
scribed the physicians’ oath, but to no other persons. My
patients shall be treated by me, to the best of my power
and judgment, in the most salutary manner, without any in¬
jury or violence. Neither shall I be prevailed upon by an¬
other to administer dangerous medicines, nor be the author
of such advice myself ; nor shall I recommend to women a
pessary to procure abortion, but will live and practise chaste¬
ly and religiously. Lithotomy I shall not meddle with, but
will leave it to operators in that way. Whatever house
I am sent for to 1 will always make the patient’s good my
principal aim ; avoiding, as much as possible, all voluntary
injury and corruption, especially all venereal matters, whe¬
ther among women or men, bond or free. And whatever I
see or hear, in the course of a cure or otherwise, relating to
the affairs of life, nobody shall ever know it, if it ought to
remain a secret. May I be prosperous in life and business,
and for ever honoured and esteemed by all men, as I observe,
and not confound this solemn oath. And may the reverse of
all this be my portion if I violate it, and forswear myself.”

The chief obligations of this oath are required by the Uni¬
versity of Edinburgh, on conferring the degree of Doctor in
Medicine ; but by no other university, or school of medi¬
cine or surgery, or college of physicians or surgeons in the
united empire.

(To be Continued.)

III. Cases treated at the Westminster Eye Infirmary, Warwick
Street , under the Superintendance of G. S. Guthrie, Esq.
— By Richard Tuthill, M.D. Assistant- Surgeon, 52d
Light Infantry.

Case of Amaurosis cured by 01. Terebinth. — Wm. Spread-
berg, set. forty, admitted 13th October, 1829, a man gi a

496 Original Communications.

sanguine temperament and tolerably stout habit of body, a
native of Hampton, Middlesex, a blacking manufacturer by
trade, served as a soldier between five and six years in the
East Indies, in the foot artillery ; during that period he had
a slight bowel complaint ; he also received a slight contusion
in the lumbar region, from part of a building having fallen
upon him. He had resided in England the last seven years,
and says he has been in the enjoyment of good health ex¬
cepting the last year or fourteen months. About a year and
nine months ago a small lump was felt as if on the anterior
part of the right eye, accompanied with dimness of sight, a
pain extending through the cerebrum parallel to a line drawn
from the superior part of the frontal bone, towards the occi¬
pital, and of a sense of heaviness across the eye -brows. A
year ago the left eye became affected in the same manner as
the right. As soon as the left eye became engaged in the
malady, all objects when looked at appeared double, and this
optical defect has increased to a considerable degree ; sees
things more distinctly in a feeble light, or towards the dusk
of evening ; the stronger the light is the more complete the
double vision. Small black spots appear constantly before
his eyes. When the pupils are dilated by the belladonna, a
slight milky or turbid looking substance is seen. Had lived
freely ; tongue foul ; appetite bad. Detract, sang, ex tempor.
Jxvj. cum c. Habeat pulv. jalapee c. 3ss*j omni mane 2 die.

20th. Says he can distinguish objects more distinctly and
at a greater distance. No pain of head; feels a sense of
numbness occasionally in the cerebellum. Tongue foul; ap¬
petite improved. Bowels open ; double vision continues; the
milkiness of eye has disappeared. Repetatur detract, sanguin.
ex temp. Habeat pil gambog. c. pil hydr. gij. h. s. sulph.
magnes. 5ij. in aquae Jij* mane sequente.

22d. No pain or uneasiness of head ; dimness of sight
and double vision continue. Tongue foul, appetite improved,
bowels open, pulse regular ; distinguishes objects at a greater
distance to-day, but last night he experienced a greater
degree of dimness, in consequence of the formation of a
viscous secretion from the eyes. No morbid appearance
can be seen in the external part of either organ. Says he
has been subject to occasional attacks of rheumatism, but
feels none at present. Was not cupped the last day. Re¬
petatur detract, sang. Jxvij. ex temp, omit pil. Habeat spt.
terebinth. 5j. h. s. sulph. magnes 3iij. mane.

27th. Improved in every respect ; can see better ; double
vision greatly diminished ; feels more active and comfort¬
able. Haber>f spt. terebinth. 3j. mistur. mucilag. ter die.
Pone in oculo spt. rorismar.

Or. Futli ill’s Reports of the Westminster Rye Infirmary. 49/

Oct. 3. Vision improved. Says the drops made his eyes
feel comfortable. No uneasiness in the urinary organ from
medicine. Repetatur medicamentum.

10th. Says he is much better, only one spot appears now
before' the right eye, and none before the left. Sees better ;
appetite improved, bowels regular. Medicine has produced
no unpleasant effect. The spirit of rosemary caused a consi¬
derable discharge from the eyes, which was followed by a
very agreeable sensation. Cont. medicamentum.

17th. The dimness varies ; says he thinks it less at one
time than another. The black spot exists before the right
eye when viewing any object. Cont. medicamentum.

Inflammation and Opacity oj the Cornea , treated with
the Spirit of Turpentine. — Peggy O’Donnell, set. twenty- six,
admitted 20th October, 1829, a native of Ireland, a ser¬
vant, of sanguine temperament, appears in good health, with
the exception of her eye ; reports that about a month ago she
received a slight blow upon the eye, which was immediately
followed by an unpleasant and painful sensation. The pain
increased, and redness of the anterior part of the eye ensued.
She applied of her own accord four leeches one day, and two
another day, and cold bread and water poultice : the leeches
produced some relief, but the poultice none at all. At pre¬
sent the eye appears irritable, and considerably inflamed.
The vessels of the conjunctiva, covering the selerotic, are so
much gorged with blood as to give it the appearance of a
dark pink patch, about the size of the white of the thumb
nail, having in its centre a few pustules. Vision is very
obscure, can merely distinguish the shade of bodies. Has
some pain in the eye during the day, but feels it very acute
when she becomes warm in bed. Habeat spt. terebinth. 3j.
ter in die.

22d. Inflammation less, feels the eye improved, and more
comfortable. Cont. medicam.

24th. Improving. Cont. medicam.

25th. Cont. spt. terebinth.

27th. Can see a little better ; cornea more transparent ;
vessels less distended with blood 5 eye irritable. Cont. me¬
dicam. Applicetur vesicat, pone aurem sinistram, pone in
oculo vini opii guttas. ij.

31st. Repetatur spt. terebinth.

Nov. 3d. Considerably improved ; inflammation and irri¬
tation very much decreased. Cont. medicament.

12th. Cornea clearer, no pain of eye, sees and feels better.
Medicine has produced a desire to make water more fre¬
quently. Habeat spt. terebinth. 3j. bis de die et decoct,
hordei; c. pulv. g. Arab, et sacch. ad libitum.

vol; iii. mo. 18. 3 s

498 Original Communications,

13th. Cont. l/th. Cont.

19th. Cornea almost clear, sight very much improved ; no
pain or uneasiness, feels no irritation in the urinary organs.
Bowels regular ; conjunctiva natural. Cont. spt. terebinth.

Inflammation of right Eye , with a 'purulent discharge . —
Daniel Garrett, get. two years, admitted 3d Nov. 1829 ; lym¬
phatic temperament, unhealthy appearance, bloated coun¬
tenance. The mother reports, that an eruption appeared
on the face and lips ten days ago, and that two days after
the right eye became inflamed. At present the conjunc¬
tiva, lining the palpebrge, is very much thickened and
studded with large granulations of a deep florid hue. There
is also a discharge of purulent matter. Cornea is clear ;
the eye is very irritable, and cannot be opened, in conse¬
quence of considerable tumefaction of palpebrae. The face
is covered with scabs. Pone in oc. ung. argent, nit. ; ap-
plicetur ung. nit. hydr. diiuti faciei ; habeat pulv. rhei gr.vj.
hydr. c. cret. gr.ij. h. s. ct. liquor, potassge gutt. cum lactis
Jijj.. ter die.

5th. Inflammation less, eye and countenance improved.
Cont. medicamenta.

10th. Has not attended since the 5th. He opens his eye
to-day of his own accord. Inflammation considerably di¬
minished ; bowels open. Cont. medicament.

19th. Has not attended since the 10th. Inflammation and
discharge of purulent matter ; much lachrymation and irri¬
tation. Inflammation and thickening of conjunctiva not so
great as at first. Rep. medicam.

A Case of Intermittent Fever , in which blood was drawn
during the cold stage , treated by Dr. Tuthill . — Private W.
Asbourne, 52d regiment, get. twenty- six, sanguine, bilious
temperament, admitted into the military hospital, Portsea,
Hants, at 10 a.m . 23d May, 1829. He reported that he had
a paroxysm of ague at mid-day, during the two days previ¬
ous to his admission, which he described as consisting of
the cold, hot, and sweating stages. An hour and half after
he came into the hospital, the cold stage of ague came on.
He complained of a creeping sensation, numbness and cold¬
ness of the extremities, particularly in the superior. Coun¬
tenance was expressive of anxiety, pallid, and sickly. Eyes
were dull and heavy, tongue white ; appetite impaired ; pulse
105, small and feeble ; bowels open. The cold stage was ac¬
companied with pain, a hardness, fulness, and sense of weight
in the region of the spleen, oppression at the precordia, and
laboured respiration. As soon as the cold fit was completely
established, I made him sit in a chair. I then opened a vein

Dr. Tuthill on Blood-letting in Intermittents, Sfc. 499

in the arm, from which I allowed 48 ounces of blood to flow,
and not until this quantity wras drawn did syncope take
place. All the unpleasant feelings accompanying the cold
stage (as before described) gradually subsided as the blood
escaped from the arm. He recovered from the syncope in
a few minutes, and after that a purgative was administered ;
the body was sponged with luke warm water, and rubbed all
over with a towel. Vespere. The blood cupped, and a large
quantity of serum appeared ; the crassamentum was pretty
firm, but not so much so as I have seen it when drawn from
patients suffering from acute inflammation ; no sign of the
huffy coat. Countenance improved, bowels open from the ac¬
tion of the medicine, stools dark coloured, pulse 78, full and
soft ; felt considerably better, and said he experienced little
or no inconvenience from the fever during the day. The length
and force of each stage of the paroxysm were greatly dimi¬
nished in comparison to what he experienced during other
intermittent attacks which he had. Three grains of quinine,
in the form of pill, were ordered to be taken every half hour,
for three hours previous to the time the ague was expected
to occur on the next day.

24th. No ague ; slept well ; had a gentle laxative.

25th. Slept well ; had no ague ; made no complaint; pulse
72, regular ; countenance more natural, tongue clean, bowels
open, appetite improved. No medicine.

26th. No ague; slept well; says he never felt better; pulse
72, regular ; countenance more expressive of health than
ever I saw it before.

28. Felt quite well, and sufficiently strong to go to his
duty. Discharged to duty.

I had the opportunity of seeing this man almost every day
up to the latter part of September, in consequence of living
in the same barraeks, and I never witnessed any individual
to have improved so much as he did after this attack of
fever. He had three attacks of ague a few months before
May, which were well marked intermittents, and of a longer
and more tedious duration. A small quantity of blood was
drawn twice in the cold stage of one, and purgatives and the
quinine were employed in it, and the other febrile attacks.

In another Number of this Journal I shall give some ob¬
servations on the remittent and intermittent fevers, as they
occur in Africa and the West Indies.

A Case of Poisoning by Oxalic Acid . — About a quarter or
twenty minutes to twelve, Saturday night, 14th Nov. I was
requested to see a woman who was said to have taken poi¬
son. The individual, aetat. twenty- three, was in a state
of great prostration when I reached her lodging, which was

500 Original Communications.

a very few minutes after being called. Her pulse was feeble
and easily compressed ; countenance pallid^ dejected, and
sunken ; eyes turned a little upwards and inwards, pupils di¬
lated, arms thrown upon the head, as if there was no power
of motion in them ; vomited a quart of a light coffee-coloured
fluid, which emitted no peculiar smell. The respiratory
muscles were feeble in the performance of their functions.
The diaphragm appeared to be chiefly in requisition in car¬
rying on respiration. The extensor muscles lost their tone;
when raised in the bed her head fell forwards, or to either
side. The power of voice was gone ; I asked her several
questions, but received no answer. I gave her 3SS. of the
sulphate of zinc in solution, and tepid water. The fauces
were irritated to excite the vomiting. She was in the sitting
position ; friction of the chest, abdomen, and extremities
was employed. The emetic acted very feebly ; the stomach
pump was introduced, and a littl^ brandy was administered.
Such was the plan of treatment pursued, as no clue could
be detected, until too late, which led to a knowledge of the
poison she had taken. She had a copious dark-coloured
feculent evacuation from the bowels about ten or twelve
minutes after I had seen her, and almost immediately after¬
wards death supervened. Her sister informed me she had had
a convulsive fit two hours before I visited her, and that she
believed she had taken the poison not earlier than ten mi¬
nutes before I saw her. Of this I have no doubt, from a
variety of circumstances ; and I am convinced she had had
it 20 minutes before I reached her house. Shortly after she
had died, her sister shewed me a lady’s chemise, upon which
were strewed a number of small needle-form lamellar crys¬
tals, one of which I tasted, and not without being convinced
that it was oxalic acid, from its peculiar taste. A few crys¬
tals were dissolved in distilled water ; to this was added a
little lime water, which produced a copious white precipi¬
tate ; similar results took place when lime water was added
to the dark fluid ejected from the stomach.

The following day, at three p. m., I opened the body, in
the presence of Messrs. Holmes and Robarts, when the fol¬
lowing appearances presented themselves. The dura mater
was redder than usual, the superficial veins were gorged,
the pia mater was very vascular. The ventricles of the brain,
excepting the fifth, were filled with blood. The substance of
the brain was studded with unusually large spots ; it was firm
in its consistence, and otherwise healthy. From six to
eight ounces of blood were obtained from the centre of the
brain and its sinuses. The nervous membrane of the pha¬
rynx oesophagus, and for some distance beyond the cardiac

Mr. Ore on the Cure of Chancre by Cautery, 501

end of the stomach, was so corroded and disorganized as to
admit of being rubbed off by the slightest touch of the fin¬
ger. The remaining portion of the inner coat of the stomach
was very much corrugated, a supernaturally red colour was
perceptible all over it, and a black viscid substance lay be¬
tween the folds". The duodenum and jejunum presented
the appearance of inflammatory action. The uterus was al¬
tered in its shape from what we usually perceive in the un¬
impregnated state ; it was of a bell shape ; its cavity was
somewhat enlarged, and its inner surface was covered with
a thick reddish matter, not unlike the membrane desidua
about to be formed. The os uterus was blocked up with a
gelatinous substance. The fallopian tubes were a little red¬
der than natural. This woman did not menstruate for six
weeks previously, and from this and the other circumstances
already stated, it is more than probable that impregnation
had taken place, and induced her to commit that rash act
which put an end to her existence. The ovaries were en¬
larged ; in the internal part of each were two vesicles, about
the size of a small pea ; one of the ovaries was larger than
the other, and in it a corpus luteum was discovered. Supe¬
rior to the fimbriated edge of each ovary was a hydatid,
about the size of a small hazel nut.

IV. — On the Cure of Venereal Chancre by the use of the ac¬
tual and potential Cautery , with Cases. By J. A. Ore,
Esq., Assistant Surgeon 8th Hussars *.

In submitting the following cases, with remarks, to the me¬
dical public, it is rather my aim to obtain a more extended
trial of the actual cautery in the cure of chancre, than any
individual novelty which this mode of cure may excite.
Having some time ago transmitted, in another shape, notes
of a similar nature to Sir James M£Gregor, Director General
of the Army Medical Department, the active and zealous
promoter of medical inquiry, and to the Royal Medical So¬
ciety of Edinburgh, both the distinguished individual alluded
tOj and the Medical Society were desirous of ascertaining
whether secondary symptoms supervened on the cure by the
actual cautery 5 but although two years and upwards have
now elapsed, I am still equally unable to state with any de¬
gree of certainty the ultimate protection from secondary
symptoms afforded by this remedy ; certain, however, I am,
that up to this period not the slightest appearance of se-

* Formerly of the 95th Regiment, &c. &c.

502

Original Communications.

condary syphilis has presented in any of the individuals
whose cases follow.

The appearances after the application of, and during the
cure by, the actual cautery, I have observed to be as follows :
the sore, or ulcer, as the case may be, after the application,
emits a slight ichorous discharge, generally for the first
three or four hours, but marked with less local inflammation
or irritability than that produced by the lunar caustic ; but
on the second dressing, which I have invariably done with
merely a little dry lint, the edges of the sore seem more
healthy, and the whole surface is frequently covered with a
thin light scab, which, if the dressing be judiciously applied,
remains often until the sore underneath is healed up.

In cases of chancre accompanied with irritative bubo, oc¬
casioned by the individual not reporting himself ill until dis¬
covered at the usual health inspections, or by his continuing
the performance of his duties until absorption had taken
place, I have invariably deferred using either the actual or
potential caustic until the local or constitutional disturbance
has been, in a great measure, allayed by bleedings, lotions,
antiphlogistic regimen, &c. &c., and always hitherto with
success.

In none of the following cases has mercury in any shape
been used, and with little exception they have all been
treated by a rigid adherence to the antiphlogistic regimen,
and in the form of medicines merely an occasional aperient
of sulphate of magnesia, with a few grains of tartar emetic
dissolved in each dose, effecting by this intention slight
change of action in the habit of the patient, and rendering
the purgative more powerful in its evacuant qualities.

By the most minute inquiries these men state themselves
never to have had venereal disease in any shape previous to
the present period, but their statements cannot always be
relied on as unequivocal.

Case 1st. — Private J. Dinan, aetat. twenty, 95th regiment.
The report on admission stated him to have an ulcer on the
prepuce, with bubo of a week’s standing ; for the cure of
which lunar caustic has been applied. Twenty-six days in
hospital, and discharged cured. This man was chiefly con¬
fined to low and milk diet, and had an occasional saline
purge. 1826.

Case 2d. — Private D. Downy, aetat. nineteen, same regi¬
ment, admitted January 10th, with syphilitic ulcers on the
glans and preputium penis, with pain, redness, and tume¬
faction of the glands of the left groin ; for which an emol¬
lient cataplasm was applied, and on the 13th the inflamma¬
tion in the groin having subsided, the lunar caustic was ap-

Mr. Ore on the Cure oj Chancre by Cautery . 503

plied to the sores on the penis, and he remained under cure
until the 8th March, when he was returned fit for duty. This
man had no medicine, with the exception of slight saline
purges, was kent on low and milk diet, and confined to an
horizontal position.

Case 3d. — E. Leigh, aetat. eighteen, same regiment, ad¬
mitted 12th Jan. 1826, stating himself to have been ill for
some days past with sores on the glans, fraenum, and pre-
putium penis, possessing a dirty yellow tinge, and inclined
to become indolent ; belly freely moved previous to admis¬
sion by the exhibition of a solution of glauber salts, having
two grains of tartar emetic dissolved in it. This man had
poultices and the caustic in solution applied, and was kept
on restricted diet until the 7th February, when he was dis¬
charged cured.

Case 4th. — Alex. Valentine, aet. nineteen, same regiment,
admitted January 13, 1826, with ulcers on the glans, frae¬
num, and preputium penis, and buboes in both groins.
Poultices were applied to the groins, and frequent brisk ca¬
thartics administered. On the fifth day after admission the
buboes were opened with the lancet to their whole extent,
and a large quantity of dark purulent matter came away. On
the 20th January the report stated him to be in a state of
approaching convalescence, and the sores clean, healthy, and
suppurative. This man had a good deal of symptomatic
fever, which gradually subsided on his being restricted to an
horizontal position, and enjoined remaining quiet. He had
cathartic and antimonial medicines, and on the 31st was dis¬
charged cured. Diet, milk and light chicken soup, occa¬
sionally alternated with the usual spoon diet of the hospital.

Case 5th. — Rich. Cours, set. twenty, same regiment, ad¬
mitted Jan. 14th, 1826, had swelling in the groins, with se¬
vere lancinating pain, and partial inflammation of subjacent
parts. A profusion of small pimples, filled with a whitish
fluid, were here and there dispersed over the glans penis.
Bowels slow ; tongue coated ; very slight constitutional irri¬
tation. Had a brisk purgative, consisting of sulph. sodse,
5iss. with tartar emetic gr.ij. ; emollient applications to the
groins, with caustic wash for the eruption on the glans
penis, which on the 17th broke out into small sores, with
dirty and irregular edges ; the purgatives, as also the emol¬
lient and caustic medicines, were respectively continued,
and on the 28th he was discharged to duty, cured.

These cases, which were invariably treated with the caus¬
tic, either in its solid or diluted state, did well, and no se¬
condary symptoms have presented.

I will now proceed to detail a few cases, in which the

504

Original Communications.

actual cautery had been used, by which it will appear that
this latter mode of cure has the advantage of being more
rapid, and, I may add, equally efficient as the former ; which
mode may be more safe, convenient, and ultimately prove most
efficacious, I am unable to judge, and would fain forego any
controversial points, in the hope of my proposal being more
generally tried ; trusting that wise experience alone will
eventually decide its utility, and shew the propriety of choice.

Case 1st. — George Birney, private 95th regiment, setat.
twenty, Sept. 12th, 1826, was admitted into the hospital
with gonorrhoea and chancre on the inside of the prepuce, at
its junction with the glans penis, as also with pain and in¬
flammation, accompanied with tumefaction of the glands of
both groins, and very little or no fever ; emollients, for the
first two or three days, were applied to the groins, and on
the 14th September the actual cautery was applied to the
sore on the glans and prepuce. He had frequent doses of
aperient medicines, and on the 26th October was discharged
cured.

Case 2d. — Private John Greenwood, 95th regiment, set at.
twenty-two, admitted Oct. 6, 1826, with sores of a dirty yellow
colour and of irregular form on the glans and lining of the
prepuce, states having observed them some days previous
to admission. Belly slow and irregular ; no constitutional
disturbance. The actual cautery was applied, and in a day
or two the sores became, on the separation of a thin white
pellicle which followed the application of the cautery, clean,
and assumed a healthy appearance. From this period they
gradually grew more healthy, and on the 26th of the same
month he was discharged cured. Diet, principally consist¬
ing of spoon meat, and latterly more full allowance of light
animal food.

Case 3d. — Private Pat. Shaughnessy, 95th regiment, set.
twenty. This man was on duty detached from his regi¬
ment, and had been in another military hospital with go¬
norrhoea and chancres ; and by his own account, which is
very indistinct and unsatisfactory, he was partially cured
previous to joining his depot; he has now chancres on the
glans, with ulceration of the prepuce, and considerable
fever and irritability. The antiphlogistic regimen, so far as
low diet and the exhibition of aperient and antimonial medi¬
cines, was had recourse to, and on the twentieth day he was
discharged to duty. He had the actual cautery applied, and
simple dressings to his sores.

Case 4th. — Private J. Clarke, 95th regiment, set. twenty,
admitted Oct. 1st, 1826, with chancres and sores between
the glans and preputium penis, which had existed for three

Employment of Cotton as a Dressing for Blisters. 505

or four days ; the glands of the left groin swollen and pain¬
ful; bowels irregular. He had emollients in the first stage,
and latterly the application of the actual cautery to the sores,
and was confined to his couch, and had repeated doses of the
emetic-cathartic mixture, and on the 30th October he was
discharged cured.

In closing these notes, I beg leave to state, that the ge¬
nerality of those latter cases were sores on the inside of the
prepuce, and between that and the glans penis, and were,
as is well known, far more tedious and difficult of cure than
chancres, or sores presenting on the external surface of the
prepuce.

Portobello Barracks, Dublin, Oct. 13. 1829.

Mr. Ore appends a table, shewing the comparative suc¬
cess of cases cured by caustic and the cautery. The patients
cured by the first plan were in hospital 26, 59, 27, 19, and
16 days ; those treated by the cautery 45, 21, 20, and 31 days.

This paper is very creditable to the writer ; it proves him
to be a man of observation and reflection, and also shews
the accuracy which distinguishes the reports of all our mili¬
tary surgeons.

BIBLIOGRAPHY.

GENERAL. REVIEW OF FOREIGN AND BRITISH MEDICAL JOURNALS.

MEDICINE.

1. On the Employment of Cotton as a Dressing for Blisters. — By
A. P. Merrill, M.D. of Natchez, Mississippi. — I have long had it
in contemplation to communicate for the North American Medical
and Surgical Journal a new mode of dressing blisters, which, so
far as I know, has its origin with me.

Blisters, that are not required to be kept discharging for any
length of time, are readily healed by the application of finely
carded cotton, as in cases of vesication from burns. The cotton
should be applied as soon as the vesicating plaster is removed,
half an inch or more in thickness, and sufficiently large to ensure
the complete absorption of the discharge. In two days, under
ordinary circumstances, a new cuticle will be formed, and the
blister cured. This dressing gives no pain, and may be adopted
with particular advantage' in dressing blisters upon the nucha,
when the patient is confined in bed, and also for persons who are
not confined by indisposition ; as blistered surfaces, when dressed
in this manner, give so little inconvenience as not to interfere with
the motions of the body in common exercise. — North American
Med. and Surg. Journal.

506

Bibliography .

2. Eruption of Measles confined to one half of the Body. — A child*
three years of age, had, for some time after its birth, been affected
with a constant sweating of one half the body, which strange af¬
fection, however, had, after the use of general baths, disappeared
for nearly two years ; when, during an epidemic occurrence of the
measles, the child was attacked with them, but only on that side
of the body which had been the seat of the previous perspiration.
The patient passed safely through the attack. — Rust's Mag.f. d.
gesammte Eleilk.

3. Nitro Muriatic Pediluvia. —In Meeker s Annalen for May,
182S, there is an account of the employment, by Professor Ith, of
Berne, of a pediluvium, consisting of a high vessel of water, in
which are poured a table-spoonful of hydrochloric (muriatic) acid,
and one of nitric acid. The patient immerses his lower limbs up
to his knees in this bath, and repeats it every evening for six or
eight evenings. The results, as detailed by Dr. Ith, are the fol¬
lowing : — 1. The cure of a great number of intense cephalalgias,
arising from causes the most various, such as a fall on the occi¬
put, obstinate constipation, and other affections of the digestive
canal. In all such patients, with the exception of one of a very
plethoric habit, the headaches, which had been in vain combated
by other remedies, promptly yielded to the application of the
pediluvia. 2. In one case, after every pediluvium, there were
borborygmi colics, and abundant fecal discharges in other in¬
stances, there only supervened softer, and rather more copious
stools than common. 3. A complete and radical cure was pro¬
duced by eight of these pediluvia, in a case of hypochondriasis, car¬
ried to monomania, and even in one of cephalalgia, threatening to
terminate in phrenitis, and under the influence of which there was
developed, in a short time, on the forehead, a kind of tophus.
Frequent and copious alvine evacuations, procured by medicine,
had failed to give relief. 4. The last patient not only experienced the
above mentioned effects in the abdominal viscera, but he expe¬
rienced also, during the use of the pediluvia, an acidulous taste in
the mouth. 5. In a case of want of appetite of long standing,
accompanied by headache and constipation, the appetite was
promptly re-established, even before the pains of the head had dis¬
appeared. 6. The local effects of these pediluvia only consisted
in a slight redness and tumefaction. In one case the swelling
lasted for several months, but at last disappeared spontaneously.
(Our countryman. Dr. Scott, has anticipated this practice.)

4. Causes of Puerperal Peritonitis. — M. Duges, Professor at
Montpellier, has made some observations on the causes of peri¬
tonitis, among puerperal females. We shall extract some facts
from a short analysis of the memoir, in the Jour. General, for Oc¬
tober, 1828.

Cases of puerperal peritonitis appear at different seasons of the
year, and are sufficiently numerous to constitute true epidemics.
They are rarely sporadic. They are manifested most frequently
in cold and moist weather, and, hence, generally occur in January
and February, in October and Aovember. The disease does not

50 /

Ossification in the Placenta .

appear m those months where there is dry heat or dry cold. A
cold, moist atmosphere is, however, not alone sufficient for the
occurrence of puerperal peritonitis ; for this, as well as for other
epidemics, we must admit an occult cause, connected, no doubt,
with atmospheric influences 5 because these influences may exist
without any epidemic being the consequence.

Errors in diet operate merely as exciting causes of puerperal
peritonitis. This disease is more frequent and severe among fe¬
males who have suffered from disease during gestation, or who
have been exhausted by misery and want.

What connexion is there between this inflammation and the
suppression of the milk, or of the lochiae, and how far should it be
considered as the result of a metastasis from the mammae '? It
results from the facts examined, that ordinarily the suppression of
the snilk, or the lochiae, occurs after the invasion of the disease,
and consequently is the effect, and not the cause, of the disease.
In many cases, also, even of great intensity, there is no suppres¬
sion of either of these discharges. Of 89 cases the lochiae were
suppressed at the beginning of the inflammation in 25 5 at the 10th
to the 18th day in 27 3 and in 37 cases the lochiae were not sup¬
pressed, and have sometimes been augmented. Of 89 cases,
there was a suppression of milk before the occurrence of the dis¬
ease in 20 5 in 62 the secretion was only during the continuance
of the disease and, finally, in 7 females, the mammary secre¬
tion continued in spite of the peritonitis.

In answer to the question, whether primiparous females are
more liable to peritonitis than those who have previously borne
children, M. Duges appeals to facts. Of a given number of wo¬
men with puerperal peritonitis, three-fifths were primaparous.

Of 456 accouchmens, followed by puerperal peritonitis, 6 were
cases of twins, and of these three of the patients were ill before
their confinement.

As to the duration of the labour, it lasted more than eight hours
among the greater number of those attacked by peritonitis 5 and of
456 cases, 9 occurred where the child was born dead, and in a pu¬
trescent state, and 32 after the labour was artificially terminated.
In the greater number of cases hemorrhage had supervened after
parturition. We must regard, therefore, as predisponent causes
of peritonitis puerperalis, all the manipulations which become ne¬
cessary in cases of hemorrhage, and especially the introduction of
the hand, injections into the uterus, the use of the tampon, &c.
(For a fuller account of this disease, vide pp. 11, 31, 438.)

5. Ossification in the Placenta. — In the Vierteljabrigen Sanitats-
berichten (Hufeland and Osann’s Journal, June, 182S), Dr. Katerau
states, that in the month of February, 1828, a woman was deliver¬
ed of a healthy female child she had complained many weeks
previous to her confinement of a pain in the womb, and a feeling
as if something within it pricked and cut her ; for these sensa¬
tions many remedies were administered without effect. After the
tolerably speedy birth of the child, the placenta did not come
away, and the midwife supposing it to adhere, proceeded to loosen

508

Bibliography .

it, which was easily done. During the operation the patient com¬
plained of violent pricking within the uterus.

Upon inspecting the placenta (remarks the Doctor), I founcl
that throughout its substance were interspersed numerous spicula
of bone, the whole of which resembled the points of ossification
in a fetal skull } they were firmly united to the integuments of the
placenta, and in some parts, especially over the insertion of the
cord, were arranged together so as to present somewhat of an
arborescent appearance.

6. Inoculation for Hydrophobia. — MM. Vatel and Girard, at the
Veterinary School of Alfort, inoculated a horse, two dogs, and
three sheep, with the saliva of a sheep which gave symptoms of
madness after having been bitten by a rabid dog. Not the least
indisposition resulted from the inoculation, although the animal
from which the saliva was taken died soon afterwards. — Journ. des
Progres.

7- Combination of Belladonna, Ipecacuanha, and Sulphur in Per¬
tussis. — In Horn’s Archives for 1827, Dr. Kahleiss first directed
the attention of physicians to this combination, the efficacy of
which he had established, by its employment in nearly 100 cases
of the disease. In Hufeland’s Journal for February of the present
year, he states that, since the appearance of the communication
alluded to, he has had further opportunities of testing the value of
the remedy, in consequence of hooping cough having several times
prevailed epidemically. He directs for a child two years mid,
pulv. rad. belladon. gr.iv. pulv. Doveri, gr. x. flor. sulph. 9iv.
sacchari 51}. M. f. pulv. xx. One of these powders is to be taken
every three hours, and between each, a tea-spoonful of the follow¬
ing mixture : syrup, liqu. aq. ehamsemeli Jk > acid, hydrocy-
anici Vauquelini gtt.xii. M.

With many children of the above age, and even some months
younger, the dose of the belladona here directed will not be suffi¬
cient to reduce the frequency or violence of the cough. In these
cases, it must be increased to five or six tenths of a grain in each
dose, and an additional drop or two of the acid may be added to
the mixture. For children of from nine to fifteen months, each
powder should contain from an eighth to a sixth of a grain of the
belladonna} one-fourth to three-eighths of a grain of the Dover’s
powder, and three-fourths of a grain of sulphur. For a child three
years old, one-fifth of a grain of belladonna } four to five years
old, one-fourth of a grain } six to eight years old, three-eighths of
a grain } ten years old, half a grain.

In some cases, the effects of the remedy are not perceptible un¬
til it has been continued for five or six days. The paroxysms of
the disease will now become less frequent, and soon after diminish
in severity. By eight, ten, or, at the farthest, twelve days longer
continuance of the remedy, the disease will be completely removed.

In a few instances, after two to four days employment of the
above prescription, in the doses indicated, a dilatation of the pu¬
pils, and a scarlet efflorescence over the whole body, will be pro¬
duced. The remedy, in such cases, must be omitted for 24 or 36

Intermittent levers treated by the Sulphate of Quinia . 509

houis, and then resumed with a less proportion of the belladonna.
The mixture containing the acid need not, however, be discon¬
tinued. — North Amer. Med. . Journ.

8. Specific for the Hooping Cough. — In Rust's Mag. f. die ge-
sammt. hei lk. (No. 2, 1828), it is stated that Dr. Meyer, of Min-
den, has, in a few days, been enabled to remove all the symptoms
of pertussis by the external application of morphia. He directs a
small blister to be applied over the praecordia the detached cuticle
being removed, the exposed surface is to be sprinkled over with
half a grain of morphia, rubbed up with starch. The morphia to
be repeated every evening. The only internal remedy he employed
was an emetic. If necessary, the blister may be re-applied every
third day. In five cases, the disease was so far diminished in
eight days, that no further treatment was considered necessary.

9. Intermittent Fevers treated by the Sulphate of Quinia, applied
according to the Endermic Method. — In the Annali Universal! di Me -
dicina, for November and December, 1828, Dr. Speranza gives an
account of his successful treatment of fifteen cases of tertian fever,
by the endermic method of applying the sulphate of quinia. In
all of these the fever had appeared some days before he prescribed
for them. In none except two was there any very manifest local
irritation j and in these latter, the symptoms were gastric. With¬
out giving to any of them purgative medicines, he had immediately
a blister applied, and in most instances on the day of the febrile
paroxysm : the sulphate of quinia was put on at the end of the fit,
or the beginning of the apyrexia. The arm was the place chosen
for the application of the blister, as the most convenient for dress-
ing. Ihe skin was first strongly rubbed with concentrated vine¬
gar, in order to hasten the formation of the serous sac by the blis¬
ter. Immediately after raising the epidermis, eight to ten grains
of the salt, mixed with a small quantity of oiniment, were placed
on the denuded surface. The sore was dressed on the second day,
by removing whatever remained on its surface, either of ointment
or membranous concretions. From the appearance of the residue,
there seemed to be about one-half of the sulphate of quinia ab¬
sorbed.

The adoption of this method was followed in most cases by the
disappearance of the fever even after the first application of the
medicine, and without the necessity of recourse to a second.

Not only were fevers primitively of a tertian type treated in this
way, but also others, which had been at first continued, before
being intermittent. In no cases was there a relapse, which is quite
common after the use of sulphate of quinia internally. In some
subjects, in whom different organic affections required the use of
evacuants or tonics, after the disappearance of the fever, this latter
was not found to return after this secondary treatment.

No irritation of the neck of the bladder or urinary organs oc¬
curred after the application of the blister in the febrile paroxysm.
In some cases the inflammation of the arm, consequent on vesica-
tion, ran so high as to require topical remedies.

510

Bibliography.

10. Account of an Apparatus for ascertaining the value of different
Alkalies. — The apparatus consists of a glass jar about one inch in
diameter, containing about five cubic inches, and graduated into
inches and tenths ; a dropping tube about seven or eight inches
long, divided into thirty equal parts ; a porcelain mortar and
pestle ; a weight of 100 grains, and a bottle of sulphuric acid, so
diluted that the quantity contained in twenty- two divisions of the
dropping tube willjust saturate fifty grains of crystallized sub¬
carbonate of soda. To determine the point of saturation, litmus
paper may be used, or, what is much more convenient, infusion of
cabbage.

Method of Use. — The sample to be examined, having been
pounded sufficiently to pass through a coarse sieve, rub up some
of it in the porcelain mortar until it be reduced to a very fine pow¬
der ; from this weigh 100 grains, and return it into the mortar ;
add thereto boiling water, a small quantity at a time, and con¬
tinue to rub it as long as any grittiness appears under the pestle ;
suffer it to stand a short time, and pour off the liquid into a pint
or half-pint vessel with a lip ; add more boiling water to what
remains, and again use the pestle, repeating this to ensure the per¬
fect solution of all the soluble part of the sample, until about half
a pint of boiling water has been employed ; transfer the whole into
the same vessel, stir it well together, and allow it to stand for the
insoluble part to subside ; when this is effected, measure off the
clear liquor by pouring it into the graduated jar, and set it by for
use ; measure also the remainder, first shaking it up, and hav¬
ing noted the total quantity, this remainder may be thrown away.
Take of the clear solution just one half of the whole amount of
the two quantities, and add thereto about a table-spoonful of the
infusion of cabbage; then, having filled the dropping tube to the
upper division with the test acid, drop so much into the sample,
constantly stirring the mixture, as will just change its green
colour to crimson ; the quantity of acid used, as indicated by the
divisions on the tube, will show the per-centage of alkali in the
sample, if it be barilla, kelp, or manufactured soda ; but, if the
sample be pot or pearl ashes, augment the proportion of test acid
used, by adding to the number of divisions indicated by the drop¬
ping tube, one half such number, and the total will be the per¬
centage of alkali in such sample.

Should it he desired to ascertain the quantity of carbonic acid
contained in the sample, we need only note the point at which the
solution becomes blue in the foregoing process, and deduct the
divisions then indicated by the test tube from the subsequent total
amount ; every ten of the remainder will then indicate seven per¬
cent. of carbonic acid, whether of barilla or of pot-ash.

The apparatus is made and sold by Mr. Bate, Philosophical-in¬
strument maker, 21, Poultry. — Quarterly Journal .

11. Extirpation of the Uterus. — Since we reported, in a recent
Number, the case- in which M. Recamier extirpated the uterus at
the Hotel Dieu in Paris, this formidable operation has been per¬
formed twice by M. Roux — viz. on the 20th and 25th of Septem-

Extirpation of the Uterus. 511

l?er. The first of these cases occurred in private practice, and the
latter in the hospital.

L — — , aged 38, entered La Charite the 25th of August, labour¬
ing under an organic disease of the uterus. She had married at
twenty-two, and had had five infants, the youngest being six years
old. Four years ago she began to experience wandering pains
about the uterus. These had become more acute during the last
six months, and the patient had a very abundant bloody dis¬
charge ; six weeks before her admission into the hospital the flow
had been very considerable. The menses, for the first time, were
absent at their proper period, the middle of September. Exami ¬
nation, per vaginam, had discovered a disorganization of the neck
of the uterus, which was very hard, unequal, and with deep fis¬
sures ; in addition to which the exploration detected a very consi¬
derable tumefaction of the body of the uterus — circumstances
which were verified by several practitioners.

September 25. — M. Roux performed the operation in the pre¬
sence of MM. Boyer, Lerminier, Fouquier, and Recamier, be¬
sides a great concourse of pupils and practitioners assembled in
the theatre, a circumstance strongly censured by the reporter,
who otherwise is favourable to M. Roux. The patient being
placed as for the operation of lithotomy — first, the uterus was
easily brought down as low as the vulva, by means of a pair of
forceps ; secondly, the vagina was divided, and the anterior sur¬
face of the uterus separated from the posterior surface of the
bladder ; thirdly, the perineum was opened j fourthly, the open¬
ing was enlarged at the sides with a probe-pointed bistoury $
fifthly, either on account of the volume of the uterus, which was
augmented, or from the shortness of the operator’s finger, M.
Roux had some difficulty, and occupied some time, in reaching
the fundus, so as to divide the superior part of the ligaments ;
sixthly, the operator for a moment thought of increasing the de¬
pression of the uterus with Blundell’s crotchet, but he afterwards
abandoned this idea. Seventhly, the upper part of the broad liga¬
ments was divided. Eighthly, two ligatures were placed upon
the lower part of the broad ligaments. Ninthly, the size of the
body of the uterus prevented it from passing the entrance of the
vagina, great delay took place in producing anteversion of the or¬
gan : M. Roux made many efforts, and M. Recamier then assist¬
ing him, the uterus burst forth, covering the operators with blood.
Tenthly, after the exit of the body of the uterus, the lower part of
the broad ligaments was divided, as were the round ligaments, and
the neck of the uterus was separated from the rectum. Eleventh¬
ly, on tightening the ligatures, that on the right side broke, and
was not replaced. The operation lasted twenty-nine minutes.

The difficulty of effecting the anteversion of the uterus led some
to think that the retroversion, after the manner of Blundell, would
perhaps have been preferable.

The lips of the os uteri were tumefied, modulated, and sepa¬
rated by fissures, at the bottom of which the mucous membrane
was already excoriated. The body of the uterus was about two

512

Bibliography .

inches and a quarter at its greatest breadth, and the length from
the os uteri to the fundus exceeded four inches. The uterus was
uniformly hypertrophied, and its substance altered in colour and
texture. • .

The patient, when she was removed to bed, was extremely pale
and her pulse concentrated but little blood escaped by the
wound. Compresses, clipped in cold water, were placed on the
abdomen and vulva, and were frequently renewed. Soon after
there was some bleeding, but which (says the reporter) was much
more calculated to prevent inflammation than to cause death j ne¬
vertheless, the unfortunate patient did die. About ten o clock at
night, extreme prostration came on, which lasted all night, and
she sunk next morning, twenty-four hours after the operation.

The examination after death discovered a little blood in the pel¬
vis, and some redness of the peritoneum at the same place, as if
from imbibition. There was no distinct trace of actual inflamma¬
tion : the bladder and rectum were perfectly entire. No other
phenomena worthy of remark, and nothing explanatory of the fa¬
tal result was detected. — La Clinique.

There is a very different account of the symptoms, operation,
necropsy of the uterus, and of the body given by that truly inde¬
pendent and really impartial Journal, the Lancette Franc. The
bad symptoms of the case under notice, were developed about
three months, the menstruation was perfectly regular, which did
not indicate formidable degenerence. M. Roux used Dr. Blun¬
dell’s crotchet with both hands for a long time to depress or bring
the uterus, but ineffectually. The efforts of traction were the most
violent and long continued, the manoeuvres were the most pain¬
ful and useless, the cries of the sufferer the most piercing, im¬
pressing the spectators most vividly, before prolapsion of the ute¬
rus was effected. The fingers were repeatedly employed in place
of the instruments, and vice versa. M. Recamier, who assisted, at
length succeeded in bringing down the uterus to the great satis¬
faction of the spectators, the posterior incision was practised, and
there was little hemorrhage j on examination of the uterus, it
presented no remarkable change neither m its tissue nor colour ;
it was hypertrophied, or augmented in size. The cervix was scir¬
rhous, which does not affect the body of the organ for several
years. There was hemorrhage after the woman was put to bed,
which was a little considerable, she never rallied, and died next
morning.

Autopsy twenty-three hours after Death. — The whole peritoneum
was intensely red, there was a considerable quantity of blood in
the right iliac fossa, and the tissues were generally imbibed. The
ovaries were enlarged and diseased. rlhe intestines were natural.
The Lancet observes that M. Roux formed a very inaccurate idea
of the chances of success. Recamier s patient was in a more fa¬
vourable condition. Dr. Blundell operated on a subject favour¬
ably disposed, but M. Roux did not possess the same discrimination
of Blundell, for the details of extirpation were totally unknown to
* him, and he did not meditate of the proceeding of the English

513

On the different Species of Myrrh .

operator, for J. Blundell did not decide to operate until he had
known the great mobility of the uterus. Mr. Blundell after hav¬
ing cleared the rectum, did not attempt to produce anteversion as
did M. Recamier, but retroversion of that kind that the organ
most readily was brought to in the palm of the left hand. This
unfortunate woman died of hemorrhage from the uterine vessels.
The other patient, operated on September 21st, died of acute peri¬
tonitis after an escape of urine into the abdomen. It is much
more rational to account for death in this way, and by excess of
pain * as stated by M. Roux.’’ These cases afford further evidence
against the propriety of extirpation of the uterus, and the reflections
add great credit to the candour and honesty of our esteemed and
valued contemporary. It gives us sincere pleasure to perceive
the just opinion entertained of Dr. Blundell in the French metro¬
polis, which reflects much credit on the impartiality and discrimi¬
nation of our Gallic brethren. We sincerely wish our British
hospital reports would present such fairness and impartiality, and
in this observation we include all those published in this country.
As to reports furnished by operators themselves or partially
given, they are of little value in the estimation of the thinking
portion of the profession. These observations have escaped us
currente calamo , and though they lead us from their general appli¬
cation, too near the iron maces of our brethren of the grey goose-
quill, we are quite secure, being armed with the impregnable
shield composed of the most durable materials — the sincere desire
of promoting the interests of science and humanity. Ours is not
the cause of faction or of party, but of every man in the empire.
We only wish that British reports of disease, should appear in the
same style as those of the continent j and evince more of the ge¬
neral, and less of the personal interest. — Ed.

12. Myrrh. — The following communication, respecting myrrh*
has been made to MM. Saigy and Raspail, editors of the Annales
des Sciences d' Observation, by M. Bonastre.

I have succeeded in discovering that, in commerce, even at Pa¬
ris, there are two very distinct species of myrrh : the true or an¬
cient, and the false or modern 5 this last is said to be brought
from India ; it is that mentioned by Pliny, but the second of his
species, which, according to this author, came by the Red Sea,
and by caravans to Alexandria. I think that the second of my
species, or the false, is that which MM. Ehrenberg and Hemprich
discovered in Nubia, and which they refer to the Balsamodendron
myrrha .

By the following characters they may be distinguished from
each other. Equal parts of nitric acid will cause the development
of a colour rose, red, of the lees.of wine, or sometimes violet, in the
tincture of true myrrh ; and a light yellowish colour in the new
myrrh, which is the false myrrh. Of eighteen specimens which
were presented to me for real myrrh, sixteen only evolved a red

* Menorrhagia;.

VOL. III. no. 18. , 3 u

514

Medical Jurisprudence and Police .

colour by nitric acid. The two others were not coloured $ one
belonged to bdellium, and the other was a sort of resin.

13. On the different Genera and Species confounded with Cinchona *
M. De Candolle has published a short notice on the different ge¬
nera and species of bark, which have been confounded under the
name of cinchona ; the following are his conclusions : —

i. It results from the enumeration made, that the forty-six spe¬
cies of trees or shrubs, until now more or less confounded in
books, compose eight distinct genera, namely — cinchona, buena,
remigia, exostemma, pinkneya, hymenodyctron, luculia, dana'is.

ii. What is known of the bark of these eight groups appears to
indicate a decided connexion between the external forms and the
medical virtues, and in particular, that although all these barks
may be usefully administered in intermitting fevers as bitter or as¬
tringent, it appears that the barks of cinchona only contain quinia,
and that they probably are those which only are endowed with
anti-intermitting properties.

iii. The yellow bark of medical of is produced from the
cinchona puhescens , and probably also in part from C. Purpurea
and C. Humboldtiana. The orange bark from the C. Lancifolia ;
the red bark from the C. Scrobiculata and the C. Magn folia ; and
the pale bark of best quality from the C. Condaminia, whilst that
of inferior quality comes from a mixture of many species.

iv. The eight genera obtained by the dismemberment of the old
genus Cinchona are sensibly in the relation of the geographical dis¬
tribution of these vegetables over the globe, Luculia and Hymeno-
dyctron in the East Indies ; Dana'is in the southern isles of Africa
(Bourbon and France,) Pinkneya in Carolina and Georgia ; Remi¬
gia in Brazil ; Buena and Cinchona in Peru and the Andes of Bo¬
gota. The genus Exostemma is an exception to this regularity j
but it may be observed that true Exostemma lives in the Antilles,
Pseudostemma in Brazil ; and the Brachyanthes are divided be¬
tween America and the Philippine islands, with this circum¬
stance, that the species of the Philippines form perhaps a distinct
genus. — Bib . XJniv. xli. 144.

MEDICAL JURISPRUDENCE AND POLICE.

. i)di ..... ■ . :

1. New Regulations of the College of Surgeons. ( Confirmed Oc¬
tober 29 J Regulations respecting the Professional Education of
Candidates for the Diploma.

I. Candidates will be required to bring proof —

1. Of being twenty-two years of age.

2. Of having been engaged six years in the acquisition of pro¬
fessional knowledge.

3. Of having studied anatomy, by attendance on Lectures and
Demonstrations, and by Dissections, during two anatomical sea¬
sons.

New Regulations of the Royal College of Surgeons. 515

(An anatomical season is understood to extend from October to
April inclusive.)

4. Of having- attended two courses of Lectures on Surgery, each
course comprising not less than sixty Lectures.

5. Of having attended Lectures on the Practice of Physic, on
Chemistry and on Midwifery, during six months j and on Botany
and Materia Medica during three months.

4. Of having attended, during twelve months, the surgical prac¬
tice of a recognized hospital in London, Dublin, Edinburgh, Glas¬
gow, or Aberdeen ; or for six months in such an hospital, and
twelve months in any properly constituted provincial hospital,
acknowledged by the Council as competent for the purposes of in¬
struction.

(It is earnestly recommended that Candidates shall have studied
Anatomy by Lectures, Demonstrations, and Dissections, for one
anatomical season prior to their attendance on the surgical prac¬
tice of an hospital.)

II. Members and Licentiates in Surgery of any legally consti¬
tuted College of Surgeons in the United Kingdom ; and Graduates
in Surgery of any University requiring residence to obtain De¬
grees will be admitted for examination, on producing their di¬
ploma, license, or degree.

N. B. All certificates recognized by the Royal College of Dub¬
lin and Edinburgh, or by the Universities of Glasgow and Aber¬
deen, as to attendance on hospitals or lectures in these places re¬
spectively, will be received.

These regulations are, decidedly, the most liberal that have as
yet emanated from the College. They are still very imperfect j
but we are only surprised that they are so liberal, from the great
opposition of certain members of the Court of Examiners and
Council, whom we could name, and whose personal interests will
be greatly injured by the changes introduced. On this point we
shall speak more fully by and by.

The first change introduced is in the 3d and 4th regulations,
which requires two courses of six months’ duration, of Anatomy,
Demonstrations, Dissections, and Surgery ; in other words, the
candidate must attend four courses of anatomy and surgery, ac¬
cording to the former regulations.

We highly approve of this regulation, for the former period of
study, on this foundation of professional knowledge, was mani¬
festly too short.

The nextehange is in the 6th regulation, which consists in the re¬
cognition"' of twelve months’ hospital attendance in any properly
constituted provincial hospital, acknowledged by the Council, as
competent for the purposes of instruction j” and six months’ attend¬
ance on some of the metropolitan hospitals, already required. This
regulation, though liberal, is not so much so as it might be, as sur¬
gery is as well practised in the provincial as in the metropolitan
hospitals. But we are to remember how much the emoluments
of the London hospital surgeons, who, form a large part of the

516 Medical Jurisprudence and Police.

Court of Examiners, will be diminished even by the present re¬
gulations 5 and loud and strong were their remonstrances against
the change. The adoption, therefore, of this regulation, reflects
great credit on the justice and liberality of the Council, who pre¬
ferred the interest of the profession, generally, to the monopoly of
the few. Still some allowance is to be made for the wounded feel¬
ings of those among the Examiners, whose chief source of income
is derived from hospital fees. They are not the only individuals
to be found who are sensitive to their interests. They might ex¬
claim, in their justification —

“ Quid non mortalia pectora cogis

Auri sacra fames.”

The time has now arrived when the exorbitance of hospital fees,
both medical aud surgical, must be curtailed, and this is effected
by a subsequent clause in the regulations before us, which recog¬
nizes certificates of attendance on any of the hospitals or lectures
received by the Royal Colleges of Dublin, Edinburgh, or by the
Universities of Glasgow or Aberdeen. This is the worst thrust
of all — this is a brain-blow to the metropolitan monopoly in at¬
tendance on lectures or hospitals. Well may the distracted mo¬
nopolist, in the bitter anguish of his disappointment, exclaim—

“ Farewell, a long farewell to all my greatness.”

Men of Dublin, men of Stephens's, of the Richmond, and of the
Meath, what say . you to this regulation ? — Another feature in this
regulation, of dire import, is the recognition of lectures delivered
in all the private schools in the United Kingdom, and of those
lecturers in London and the provinces, who have no connexion
with the College of Physicians. Heretofore every lecturer on the
practice of medicine in this metropolis, no matter how high his
professional attainments and testimonials from the universities of
this or foreign countries, was obliged to become a member of the
College of Physicians, or his certificates would not be received.
It appears, however, that the Council of the Royal College of Sur¬
geons have arrived at the extraordinary conclusion, that the re¬
gular graduates in medicine of any university may acquire as com¬
petent a knowledge of the healing art as if they were re-examined
by the Royal College in London. But, in the name of common
sense, why should the certificates of Edinburgh or Dublin gra¬
duates in medicine, be held good, if the lectures be delivered in
either city, and refused, if such lecturers should settle in London ?
Yet such is the sagacious law of the Apothecaries’ Company, who,
from a community of fraternal feeling with the College of Phy¬
sicians, compel all such lecturers, on settling here, to be re-ex¬
amined, and pay a large sum for admission into an institution that
ever after treats them with the utmost contempt ; and precludes
them from all participation in the affairs of the body, and stamps
upon their brows the degrading words, Minus Docti.” The
Council of the Royal College of Surgeons, on the other hand, ac¬
tuated by more enlightened views, and fully sensible of the uni¬
versal diffusion of the same principles of medical science in all the

New Regulations of the Royal College of Surgeons. 517

universities, colleges, and private schools of medicine and surgery
in this empire, have wisely and properly recognized the certificates
of regularly qualified teachers in every part of the United King¬
dom. Here again they have justly preferred the interests of the
many to the monopoly of the few. When we consider the con¬
stitution of the Examiners and Council of the College of Surgeons,
and self-interest which most of them have sacrificed in adopting
the regulations before us, we think they have evinced as much libe¬
rality as could be expected from any other men under the existing
circumstances. In recognizing the attendance on hospitals and
lectures, in every part of the United Kingdom, they have destroy¬
ed that strong hold of monopoly, which disgraced their body,
during the last quarter of a century. There is still much room for
further improvement — there is still much to be done for the pro¬
motion of the rights and privileges of British surgeons.

NEW REGULATIONS OF THE EDINBURGH COLLEGE OF SURGEONS.

2. Regulations to be observed by Candidates, previously to their
being taken upon trial for obtaining Diplomas from the Royal College
of Surgeons of Edinburgh. — The Royal College of Surgeons in
Edinburgh, anxious to promote the dignity of the healing art and
welfare of humanity, have issued the following judicious regula¬
tions for the information of those who intend to apply for their
diploma. The course of study which they prescribe is more ex¬
tensive than those required by the London or Dublin Colleges.
Convinced as we are, that the dignity and utility of every branch
of medicine, will be promoted in proportion to the diffusion of
science among its cultivators, we highly approve of the regula¬
tions before us. We cannot help thinking, however, that the Col¬
lege have proceeded rather too far, in requiring the study of me¬
chanical philosophy, as a branch of surgical education. We would
much rather have observed the study of medical jurisprudence en¬
forced than merely recommended ; and we cannot comprehend
the reason of its exclusion from the course of medical education
in this country. On it depend some of the greatest privileges of
the Britisli constitution, the lives, liberty, honour and property of
every class in society j and also professional reputation in a con¬
siderable degree. While we approve of the well-meant endea¬
vours of our public bodies to promote the proper education of our
brethren, we only regret that there can be no protection afforded
those who comply with our collegiate regulations. The public
bodies should shake off that lethargy which has so long paralysed
them, should call on the government and legislature to protect the
duly qualified practitioner, from the ruinous invasion of the hordes
of empirics which infest this country, and destroy the unthinking
in vast numbers. We have reformations in the criminal and civil
law effected on the largest scale — w7e have property protected, but
not health, which is above all such considerations. The salus populi
suprema lex , the first maxim in the fundamental principles of our
glorious constitution seems to be entirely forgotten by modern
legislators — the public health and welfare are totally unworthy of

518 Medical Jurisprudence and Police.

consideration. As the corporate heads of the profession have
drank so deeply of the waters of Lethe, we ardently hope the pro¬
fession at large will soon arise from their slumbers, and expose
the degraded state of a science the most useful and important to
mankind. But to the regulations.

“The Royal College are also fully aware, how much the success
of the student, in the prosecution of the various branches of me¬
dical science, must depend upon the direction of his early studies ;
and, under this conviction, they wish earnestly to impress on the
minds of parents and others, how important it is to the interest of
the public, and to the future comfort and respectability of the
practitioner, that all who apply to the study of surgery, should
have the benefit of a liberal enucation. In addition, therefore, to
the positive regulations on that head now adopted by the College,
they are inclined to hope, that medical practitioners in every part
of the country will be disposed to second their endeavours, to en¬
courage the young men who are placed under their care, or who
may apply to them for advice, in the study of the Latin , Greek , and
Modern Languages ; and of the elements of Mathematics and Natu~
ral Philosophy , as the best preparation for their entering upon a
course of* medical and surgical education. And they strongly re¬
commend to their own Fellows, and to other practitioners, not to
take any young man as an apprentice, until he shall have gone
through his preliminary course.”

(The College strongly recommend apprenticeship as the best
mode of obtaining the necessary information. — Ed.)

“ Schools of Medicine, Courses of Lectures, Qualificationof Teachers ,
<Sfc. — Every Candidate for a Surgical Diploma must have followed
his Studies in a University ; or Established School of Medicine
or in a Provincial School specially recognised by the College, and
which shall conform to such laws and regulations as have been,
or may hereafter be enacted.

Under the title Established School of Medicine, are compre¬
hended all places in this country where diplomas in surgery are
granted, and such foreign schools as are acknowledged by the
constituted authorities of the countries where they exist.

No Provincial School shall be recognised where there is not a
General Hospital, containing at least eighty beds, at which regu¬
lar medical and surgical attendance is given, and where there are
not established courses of lectures on anatomy and chemistry.

No Course of Lectures given at a Provincial School shall be re¬
cognised, unless it be of the same extent and duration as the course
required on the same subject in Edinburgh.

The extent and period of study allowed to be gone through at
a Provincial School, will be regulated by the means and facility of
study which the College receive evidence of its affording $ but, in
all cases, at least two winter, or one winter and two summer ses¬
sions of the course of study required for a diploma, must be passed
at a university, or at one of the established schools of medicine.

In Edinburgh, the lectures to be attended as part of the surgi¬
cal curriculum, shall be delivered by Professors in the university.

New Regulations of the Royal College of Surgeons 519

or Fellows of the Royal Colleges of Physicians or Surgeons there :
and elsewhere, by professors of universities, or by Fellows of the
Royal College of Physicians of Edinburgh, and Fellows or Licen¬
tiates of the Royal Colleges of Physicians of London and Dublin,
and of the Faculty of Physicians and Surgeons of Glasgow j and
by persons holding a medical degree or surgical diploma, whose
courses of lectures have been recognised by the college on special
application.

No tickets of a professor or lecturer shall be recognised, who
teaches more than two of the branches required by the college ;
but anatomy with practical anatomy ; and chemistry, with practi¬
cal chemistry, shall each, in reference to this regulation, be con¬
sidered as one branch.

Course of Study. — Every candidate for the diploma of the Royal
College, either previously to, or during his medical education,
must have received regular instructions in the Elements of Mathe¬
matics; and must have attended a course of Mechanical Philosophy ,
of at least three months’ duration, delivered by a professor of that
branch in a university, a lecturer in a public institution, or a
teacher specially recognised by the college.

The candidate must have attended the following separate and
distinct courses of lectures during a period of at least four winter
sessions, or three winter and three summer sessions, provided that
in each summer session he shall have attended one or more of the
courses prescribed or recommended by the college, exclusive of
hospital attendance, and also provided that the summer courses of
lectures shall not commence till after the conclusion of the winter
courses.

Practical Anatomy, One Course, duration at least six months ;
or Two ditto, three months each. Anatomy, Two ditto, six
months each. Chemistry, One ditto, six months. Practical Che¬
mistry, One ditto, three months. The number of Pupils in each
class being limited todwenty-five. Materia Medica and Pharma¬
cy, One ditto, six months. Institutions of Medicine, or Physiolo¬
gy, One ditto, six months. Practice of Medicine, One ditto, six
months. Clinical Medicine, One ditto, six months j or Two
Courses, three months each, during the period of attendance at
the hospital where they are delivered. Principles and Practice of
Surgery, Two Courses, six months ; or Principles and Practice
of Surgery, and Military Surgery *, one ditto, six months. Clini¬
cal Surgery, one ditto, six months, or two ditto, three months
each, during the period of attendance at the hospital where they
are delivered. Midwifery, and Diseases of Women and Children,
one ditto, three months.

With the exception of the courses of clinical medicine, clinical
surgery, and military surgery, in which lectures are not delivered

* The Course of Military Surgery must be delivered by a professor of that
branch in a University ; or by a Lecturer, who, in addition to the other re¬
quired qualifications, has served in the Medical Department of the Army or Na¬
vy; and the Course of Lectures must be of at least six months duration, Lec¬
tures being delivered at least thrice per week.

b20 Medical Jurisprudence and Police .

daily, the six months’ courses delivered in Edinburgh, by Fellows
of the College, or others, are understood to consist of five lec¬
tures per week for a period of not less than five months.

Two London courses of three months each, on any of the above
subjects, shall be taken as equivalent to one six months’ course.

The candidate must also have attended for eighteen months, a
public general hospital, containing at least eighty beds ; or for
twelve months such a Public General Hospital , and six months a
Medical or Surgical Hospital or Dispensary , recognised by the Col¬
lege on special application.

The candidate shall be required, in addition to the tickets or
proof of entry to the different classes, to produce certificates of his
having attended these classes, from the respective professors or
lecturers ; and in the case of practical anatomy, the certificate
must express that the candidate has been actually engaged in the
dissection of the human body, under the personal superintendance
of the professor or teacher, during the course of his attendance.

The candidate, at the commencement of his examination, will
be required to translate into English some portion of a Latin au¬
thor.

The following order of study is recommended as a guide to the
student, though not absolutely enjoined.

First Year, Anatomy, Chemistry, Mechanical Philosophy, if not
previously attended. Second Year, Anatomy, Practical Anatomy,
Institutions of Medicine or Physiology, Surgery, Materia Medica,
and Pharmacy, either in this or the third year. Third Year, Prac¬
tice of Physic, Clinical Surgery, Practical Chemistry, Hospital.
Fourth Year, Surgery, or Military Surgery, Midwifery and Dis¬
eases of Women and Children, Clinical Medicine, Hospital.

Besides the courses of lectures on the different branches of medi¬
cine required by the College, they strongly recommend to students
to avail themselves of the opportunities they may possess of attend¬
ing lectures on Medical Jurisprudence, Botany, Natural History,
Comparative Anatomy, and Pathological Anatomy.

The fee for a diploma is six pounds.

The regulations as to lecturers, teachers, &c. &c. are to take
effect immediately.

Examination . — The days of Examination are the first and third
Tuesdays of every month.

No candidate will be admitted to examination before the termi¬
nation of his last year’s course of study.

Applications for examination must be made to the President of
the Royal College, two days previously to the day of examination.

Every candidate for a diploma, on applying to the President for
examination, is required to present his tickets and certificates, and
also a written statement, containing his name, age, and country,
and a list of all the classes, hospitals, and dispensaries, attended
during each session of his study.

If the candidate be an apprentice for three years, he must also
produce his discharged indenture. If for five years, he may apply
at the enu of four, without losing any privilege, provided he has

New Regulations of the Royal College of Surgeons. 521

written permission from his master, and that the date of his in¬
denture, and whether it be for the freedom or not, is certified at
the bottom of the written permission by the secretary. All ap¬
prentices must also state the names of their masters, the dates of
their indentures, and length of time for which they were bound.

Printed forms will be furnished by the officer of the College, to
each applicant, which he will fill up and sign, before applying to
the President, who will give him a letter authorising the Examina-
tors to take him on trial.

The fees payable to the funds of the College must be lodged be¬
fore examination in the hands of the Treasurer, who will certify
this upon the President’s letter, after inspecting and being satisfied
with the certificates.

The fees will be returned to unsuccessful candidates, whose
names will be concealed.

Unsuccessful candidates will be remitted to their studies for a
period, not less than three months, to be determined by the judg¬
ment of the Examinators.

The President, if he judge it proper, can order a meeting on
any day, at the request of a candidate 3 but in that case, the can¬
didate must pay two guineas in addition to the cnstomary fees 3
and this money is not returned to him, in the event of his being
rejected.

Fees payable to the Funds of the Royal College. — For a diploma
the sum of six pounds sterling.

Apprentices or Fellows of the Royal College bound for the free¬
dom, pay no fees to its funds, for diplomas or certificates 3 their
other apprentices pay one pound eleven shillings and sixpence.

Candidates for the certificate of qualification to act as assistant
surgeon in the navy, who, have not paid for any previous qualifi¬
cation, the sum of four guineas.

Assistant surgeons, who have already obtained certificates from
the College, applying for certificates for the qualification of full
surgeon, three guineas.

Assistant surgeons in the navy, having previously obtained the
diploma of the College, when candidates for the situation of full
surgeon, the sum of two guineas.

A surgeon in the navy, having obtained certificates from the
College, may receive a diploma, on paying the usual fees to the
secretary and officer.

An assistant surgeon in the navy, having obtained his certificate
frdm the College, may receive a diploma, on paying the difference
of expense betwixt that of the certificate and of the diploma, and
the usual fees to the secretary and officer.

Fees payable to the Secretary. — For a diploma to a student or ap¬
prentice, ten shillings and sixpence sterling ; besides nine shil¬
lings and sixpence as the expense of vellum, &c. for the diploma,
and box wherein it is contained.

For a certificate to surgeon or assistant surgeon in the royal
navy, ten shillings and sixpence.

Fees payable to the Officer. — For a diploma or certificate, three

VOL. III. NO. 18. 3 X

522 Proceedings of the London Medical Society .

shillings ; or, if he takes charge of getting the diploma or certifi¬
cate signed by all the cxaminators, five shillings sterling.

By authority of the Royal College,

(Signed) William Wood, President.

Surgeon s Hall, Edinburgh, July 18129.

LONDON MEDICAL SOCIETY.

Proceedings since our last.

Meeting Nov. 10. — T. Callaway, Esq., President, in the chair. ,

The minutes of the last meeting, which wholly referred to Mr.
Costello’s account of lithotrity, having been read, the President
observed, that he should be happy to hear any remarks on the
applicability of the new operation, and in what cases it ought to
be preferred to lithotomy, and vice versa. If any gentleman pre¬
sent had seen the operation performed on the living subject, his
remarks would be deemed a favour by the Society.

A pause having ensued, the subject of hernia came under dis¬
cussion. Mr. Callaway related some interesting cases, among
which was that of a milkman, of seventy-six years of age. He
had long been afflicted with a large scrotal hernia of the left side,
which became strangulated in consequence of. his having raised a
vessel towards his head. He refused submitting to the operation
for eight days, during which the bowels were constipated. He
was placed in a warm bath, and the taxis tried unsuccessfully. Ge¬
neral bleeding and tobacco enemata were not employed, on ac¬
count of the great age of the patient. On the eighth day the ope¬
ration was performed, when a large portion of intestine was re¬
turned, but a considerable portion remained irreducible. The case
was considered hopeless, from the inflamed state of obtruded por¬
tion of bowel. The bowels acted spontaneously soon after the
operation ; the man recovered, and has enjoyed good health for
five years. This case shews the necessity of caution in forming a
prognosis, and also that recovery in extremely unfavourable cases
may happen. ,

Mr. Kingdon remarked, that cases of strangulated hernia were
among the most common which fell to the lot of dispensary sur¬
geons. He wished to observe that, according to his experience,
those cases in which the incarcerated intestine presented a granu¬
lated and inflamed appearance had generally done well ; and, on the
other hand, the cases which presented little, if any, discoloration,
terminated fatally. Mr. Kingdon related cases illustrative of th^se
conclusions. In one instance a female was the patient, and there
was only slight vomiting, hiccough, no tenderness of the abdomen.
On dividing the hernial sac, the intestine presented the usual ap¬
pearance after death, and was returned after the division of the
stricture. The woman never rallied, and expired in a few hours
after the operation. On dissection, there was a line of demarcation
observed on the mucous surface of the incarcerated bowel, above
and below the strangulated part, which was the only morbid ap„
pearance to account for death.

523

Proceedings of the London Medical Society.

Dr. Whiting said that he did not think such appearance sufti-
cient to account for death, and proceeded to prove that in strangu¬
lated hernia, the affected portion of the intestine and that above it
were paralyzed, which he believed was the case in colica pictonum.
He quoted the authority of Dr. Abercrombie in corroboration of
his opinions, and was desirous to hear further pathological remarks
on this point.

Mr. Kingdon did not consider the want of action in an inflamed
bowel in strangulated hernia arose from paralysis, but rather from
a disinclination, if he might use the term, or an indisposition in
inflamed muscular fibres to act. He also stated, that the late Mr.
Taunton scarcely ever bled before or after the operation for stran¬
gulated hernia, and he was always successful. He could not help
stating, that he had met the present Mr. Taunton in a case of this
kind, when the operation was performed on a female. He (Mr.
K.) considered bleeding necessary, but Mr. T. requested him to
wait two hours, and in the mean time try the liq. am. acet. c. tinct.
hyosciam. Actuated by the great success of Mr. T.’s father, he
complied, but certainly in opposition to his own opinion 5 how¬
ever, when he returned in two hours, there was no necessity what¬
ever for the lancet : the patient recovered.

The President requested Mr. Taunton to favour the Society with
a detail of his father’s opinions and practice in the cases under
consideration.

Mr. Taunton replied, that the statements made by Mr. Kingdon
were perfectly correct. His father was of opinion that the lower
classes, in manufacturing towns, were bad subjects for depletion in
any disease, and that the early performance of the operation in the
cases under notice obviated the necessity of venesection. His
success was certainly as stated ; and, influenced by it, he (the
speaker) had requested Mr. Kingdon to defer depletion in the case
alluded to.

Mr. D. Edwards observed, that he had heard the lectures of the
late Mr. Taunton with great pleasure. He was happy to bear
testimony to the truth of the assertions just made. Mr. Taunton
even withheld the lancet in pleuritis and other inflammations j
and as a substitute employed the following mixture : — Liq. am.
acet. §iv. ; vini antirn. 3jj. > t. opii ^ij. ; dose, an ounce every six
hours. He also applied a blister in pleuritis.

Dr. Whiting considered this practice highly judicious, and had
no doubt that nauseating medicines were successful in many cases
of acute inflammation. He was once called to an old lady, who
laboured under pleuritis, and was under the effects of squill, which
was given as an expectorant. The medicine caused great pros¬
tration, and, on its omission, the sufferer was relieved *.

Mr. Kingdon highly approved of the practice, as prostration of
strength, and a state something similar to that caused by blood¬
letting was produced, which arrested inflammation. There was

* The exhibition of large doses of tartarized antimony, in pneumonia, acute
rheumatism, and other inflammations, was not alluded to.

524 Proceedings of the London Medical Society.

still a great difference, which was, that one could remove the ef¬
fects of the medicine by discontinuing it. but could not supply the
loss of blood so easily.

Mr. Ash well was much gratified with the discussion, and thought
it involved many interesting points of practice. He had seen many
cases of strangulated hernia in the hospital to which he was an ap¬
prentice, and often thought depletion was carried too far.

The President could not avoid expressing the gratification he
felt at the very interesting and important discussion of the even¬
ing ; but he still thought that many valuable facts, connected with
hernia, were left untouched, and ought to be considered at the
next meeting. Thus, it wras generally said, that femoral hernia
in the male was very unfrequent, though, according to his ex¬
perience, the fact was otherwise. He had lately seen nine cases
of it. The fatality of operations for umbilical hernia deserved re¬
flection and discussion 5 in his own practice he had lost four cases,
and those who had heard Sir Astley Cooper’s Lectures must recol¬
lect a similar occurrence in the practice of so high and distin¬
guished an operator. If he recollected rightly, the late Mr. Taun¬
ton was of opinion that venesection, after hernia, impeded the ex¬
ertion of nature, in obliterating the sac, and this was the reason
which precluded the use of the lancet. It should be recollected
how nature, in any case, when uninterrupted, obliterated the sac ;
but was impeded by venesection. In wounds of the abdomen we
generally bring the parts in apposition, and afterwards interfere as
little as possible. In such cases it is not uncommon to have the
wound filled by omentum, the part sealed, and a cure effected.
This was beautifully displayed in the morbid specimen presented
by Mr. Grainger, during the last session, when the liver had been
transfixed. He merely threw out these hints, and had to apolo¬
gize for having taken such a part in the discussion, and hoped that
every point connected with it would be properly discussed at the
next meeting.— -Adjourned.

Meeting, Monday, Nov. 17 '.

Mr. Kingdon, Mr. Callaway, and Dr. Whiting rose to correct
some inaccuracies in the minutes of the last meeting, and com¬
plained of the misrepresentations of their remarks, in the reports
of the hebdomidal publications.

The subject of hernia came again under discussion.

Mr. Taunton read an account of the comparative frequency of
hernia in both sexes, from the records of the Truss Society, to
which he is one of the surgeons.

Mr. Stephens wished to attract the attention of the meeting to
that species of hernia to which he had given the name of obstructed
hernia, in his work. He related the histories of two cases with
great minuteness and prolixity, from which it appeared that ob¬
structed hernia consisted in an adhesion of the intestine to the
sac, and the inflammation of such adherent portion of the bowel.
He did not mean to say that every such adhesion was to be con-
sidered obstructed hernia ; and stated that the symptoms, in such

Proceedings of the London Medieal Society. 525

cases, were milder than when the intestine was strangulated. How¬
ever, the patient gradually sinks, and an operation is the only re¬
medy. This was the substance of his remarks *.

Mr. Proctor inquired the diagnosis between obstructed and
strangulated hernia ?

Mr. Lloyd could not concur in the statements made by Mr.
Stephens, as he and every surgeon were well aware that adhesion
of the hernia to the sac was of frequent occurrence, and was not
attended with danger in general, nor was an operation necessary
m such cases. He thought the term obstructed hernia was rather
infelicitous.

jMr. Kingdon considered that no well informed surgeon would
allow his patient to sink in cases of hernia, without performing an

operation j and he requested the President to state his opinion on
that point.

Mr. Callaway fully concurred with Mr. Kingdon.

Mr. W ray remarked, that strangulated hernia was exceedingly
frequent in manufacturing districts ; in Lancashire, for instance,

and seldom required an operation. It was generally reduced bv
the taxis.

Dr, Walshman related several cases, in which the tobacco enema
was successful in facilitating the operation of the taxis.

Meeting , Nov. 23.

The subject of hernia was again very fully discussed, but no¬
thing novel was introduced.

Dr. Nagaiy submitted a detail of two cases of exompholos
which were operated on successfully by Mr. Lawrence. One of
the patients was in the eighth month of pregnancy. It was neces¬
sary to secure twelve arteries in the omentum in the other instance.

Mr. Kingdon related another case of umbilical hernia in a fe¬
male, aged seventy. He remarked, that the integuments were as
thin as parchment, and slightly discoloured. On dividing the sac,
he found the omentum adherent, which he separated at the inferior
part, when he discovered a small portion of bowel, which was
easily returned into the abdomen. He next pushed the omentum
against the abdominal aperture, and closed the wound by the usual
means. In such cases he considered it the best practice to inter¬
fere with the omentum as little as possible.

Mr. Stephens made several observations on the different kinds
of hernia, and said that in what he had named obstructed hernia,
the bowel became obstructed in consequence of the peristaltic mo¬
tion being impeded at the adherent part ; in fact, that an angle was
formed at this point. He reiterated the remarks as reported at
the last meeting.

Mr. Gosset could not agree with the last speaker, as every sur¬
geon was well aware that in old herniae adhesions existed for a long
time, and were unattended with bad consequences. Neither

* We think the term obstructed hernia, as applied by Mr. Stephens, extremely
objectionable ; and, we believe, most of the reviewers of his work were of our
opinion.; — Ed.

526 Proceedings of the Medico-Botanical Society.

could he consent to the classification proposed. The colour of
the hernia in cases named obstructed, as well as in strangulated,
might depend on venous congestion. He had seen only one case
in which the strangulated portion was truly inflamed, and then the
colour was a bright scarlet. The case occurred in Guy s Hospital.

Mr. Callaway also expressed his dissent to the opinions main¬
tained by Mr. Stephens': He considered it injudicious to wait for
the appearance of the ordinary symptoms of strangulation. He
fully concurred in the opinions expressed by Mr. Kingdon.

Mr. Gosset also agreed with Mr. Kingdon, and begged to ask
what formed the strangulation in the cases of Mr. Lawrence ?

Mr. Jones referred to the account, but could not inform him on
the subject. He only saw the word strangulated in the history of
the cases. Mr. Jones also quoted the work of Scarpa, to show that
bands might extend from a hernia to the sac, the bowel be passed
into the abdomen, and afterwards inflamed in consequence of these
bands.

Dr. Blicke was surprized to hear of ligatures applied to vessels
in the omentum, as he had operated in many cases, and never found
them necessary.

Mr. Gosset begged to inquire of Dr. B. if he had always returned
the divided omentum, and never had seen hemorrhage ?

Dr. Blicke replied in the affirmative.

Mr. Gosset observed, that fatal hemorrhage was known to occur
in such eases. The fact was recorded by Mr. Key in his edition
of Sir A. Cooper’s work on hernia.

Mr. Callaway bore testimony to a similar case, in which the pa¬
tient was lost from hemorrhage into the abdomen, and the ope¬
rator was one of the first men in the kingdom, to whom, if he
named him, every one would bow with respect.

Mr. Burton Brown begged to trouble the Society with a short
case before the meeting adjourned. It was one of hemorrhage at
the third month, in which he exhibited 5iiss. of secale cornutum in
divided doses, without effect. It seemed to improve the pulse but
very temporarily, as syncope again recurred. Ihe vagina was
plugged with a silk handkerchief torn into strips, which stayed
the flooding. This case shewed the ergot of rye was not always
successful.

MEDICO-BOTANICAL SOCIETY, Nov. 10.

We were highly pleased at the first meeting of the ensuing ses¬
sion of this society, which took place a few days ago, when a
numerous assemblage of professional and literary gentlemen at¬
tended. The oration was delivered by the director, Mr. Frost,
and contained a review of the progression of the society during the
last session. The addition of several men of high rank, of great
eminence, from different parts of the old and new world, was an¬
nounced, and corroborated the high' opinion we expressed of the
society in a former Number. Truly may the words of the immor¬
tal poet be applied by the society, “ Quae regio in terris nostri non
plena laboris.’’ Great augmentation has been made to the library
and museum since the last oration, which shews the activity and

Failure of Lithotrity. 52 J

zeal with which the affairs of the institution are managed, and re¬
flect great credit on the distinguished President, Earl Stanhope,
who, to the more renowned and splendid talents of a statesman, as a
peer of the realm, unites an ardent love of all the sciences condu¬
cive to human happiness. The indefatigable zeal and exertions of
ie director, Mr. Frost, in promoting the interests of the society,
deserves honourable reminiscence. A collection of valuable plants’
were presented by Mr. Aiton from his Majesty’s garden at Kew, to
the society ; and it is worthy of record that a portion of the royal
garden at that place is with great liberality alloted to the purposes
o the society, and to which the members may have access on ap¬
plication. Among the plants sent to the society was one of the
orchidse, of unusual size, introduced some years ago from South
Ameiica. At the request of Mr. Frost, it has been named Stan-
hopea insignis. The business of the evening consisted of the in¬
troduction of new members, the announcement of donations, and
the delivery of the oration. It was announced that the gold and
silver medals of the society will be awarded “ to the two best
essays on the materia mediea of any country.” The meeting then
adjourned to Tuesday, December 8.

HOTEL DIEU.

Three vesical Calculi — Failure of Lithotrity — Bilateral or Trans-
vei sal Operation Extraction of two Calculi — No trace of the lithotritic
instruments on their surface -Death- -Autopsy --Encysted Calculus un¬
discovered during life. — i he subject of this case laboured under stone
for many years, and having submitted to catheterism, it was de¬
cided to perform lithotrity. rIhis operation was had recourse to
four different times in the month of September 1828. The operator
(whose name is not mentioned J was satisfied that he had seized
the calculus, and endeavoured to crush it at each sitting. The
slowness of the treatment, the pain and fatigue which it" caused
the patient, determined him to^ abandon it. M!. Leroy having been
consulted, on sounding the sufferer, decided that lithotrity was im¬
practicable. The patient then ardently solicited M. Dupuytren to
perform the operation of lithotomy according to his own method.
Professor Dupuytren considered the case an unfavourable one for
the operation, as the patient laboured under paraplegia, and consi¬
derable oedema of the inferior extremities, and advised him to be
content with palliative means. The patient, however, persisted in
his resolution, and M. Dupuytren performed the bilateral opera¬
tion, the first days of August, 1829. Two calculi were extracted,
one the size of the large phalanx of the thumb, the other more
considerable. The bladder was sounded by the operator and se¬
veral others who were present, among whom was M. Leroy d’Eti-
olles, and no other calculus was discovered. The patient was put
to bed, and treated in the usual manner j nevertheless, he died
seven days after the operation.

Autopsy. — The bladder was examined in the theatre of the Hotel
Dieu, in the presence of the students, and presented six or seven
large cells, on one of which a calculus the size of a walnut was dis¬
covered. Dr. Paillard, who narrates the cure, was astonished that

528 Books Received , Literary Intelligence , $c.

there were no traces of the lithotritic instruments on the calculi,
and doubts whether they had been seized at all. — Journ. Hebdom.

The pompous titles at the head of this case led us to suppose
that it was calculated to invalidate the utility and importance of
lithotrity, but this impression was dissipated on the perusal of the
whole case. It must be borne in recollection, that many of the sur¬
geons of Paris are unfriendly to the splendid operation of lithotrity,
and are by no means disconsolate at its reputed failures. In this
case it was as proper to apply the words v wines tentatives de lithotri-
tie et lithotomie , as confine them to lithotrity alone ; and as to the
astonishment of M. Paillard, we are only surprized that he should
have expected traces of the lithotritic instruments on the calculi
eleven months after their application. We are well aware of the
feelings of certain surgeons of the Hotel Dieu towards an opera¬
tion which has considerably diminished their fame as lithotomists.
By the way M- Civiale is declared the best lithotrist, by the Rev.
Med. Oct. — Ed.

BOOKS RECEIVED DURING THE MONTH.

1. An Intr6duction to Medical Botany, illustrated with coloured figures. By
Thomas Castle, Member of the Royal College of Surgeons. London, 1829,
12mo. pp. 172. E. Cox. For a review of this work, see p. 476.

2. Letters addressed to the Royal College of Physicians, on their Constitution
and Charter, with Prefatory Observations to his Grace the Duke of Wellington.
By Sir Arthur Brooke Faulkner, Fellow of the Royal College of Physicians. Lon¬
don, 1829, 8vo. pp. 48. Longman and Co.

It is a new feature in the history of the College of Physicians, that one of their
Fellows should expose their imbecility, defects, and impolicy, and advocate the
rights of the profession at large. These letters were first addressed to the Col¬
lege, and having been unnoticed, are now published. They are not the result of
spleen, or self-interest, but of an honourable feeling towards the welfare of the
profession in general. They prove the impolicy and injustice of persecuting
British graduates in medicine, while legions of empirics are unmolested. The
author alludes to the reformation effected in the ancient civil and criminal law,
and asks, is the College to stand still, while, the rest of the world is in motion ?
He clearly shews that the narrow policy of the College has diminished the class of
physicians and supplied their place by surgeons and apothecaries. We cannot
devote further space to the subject at present, but shall advert to it very fully in
our next N umber.

3. A Series of Tracts on the baneful effects of Intemperance, printed by the

Temperance Society of Dublin. These essays are written by divines and physi¬
cians, and were suggested by the happy effects of Temperance Societies in the
United States of America. The animadversions of the writers are most exten¬
sive, and comprehend every class of soeiety, and on these grounds we presume
the editors of the medical and public press have been favoured with these pro¬
ductions. ^

LITERARY INTELLIGENCE.

In the Press, to be published in January, in One Vol. 4to.

]. The Nervous System. By Charles Bell, F.R.S. containing his Papers read
before the Royal Society, with Engravings and an Appendix of Cases and Con¬
sultations, illustrating the doctrines advanced in the Text.

2. Dr. Seymour has in the Press a Work on the Diseases of the Ovaria; in¬
cluding Encysted Dropsy and Malignant Diseases of those Organs. To which
are prefixed. Physiological Observations on the Structure and Functions of these
Parts, in the Human Being and in Animals. In One Vol. 8vo. with Engravings.

All Communications and Works for Review are to be addressed to the Editor,
to the care of Messrs. Underwood, or to his residence, 61, Hatton Garden.

INDEX

VOLUME THE THIRD.

Abdomen, Delivery of a Foetus
through the - - 74, 350

Abercrombie , Dr. on Diseases of
the Brain and Spinal Cord
(Reviewed) - - 369, 380

Abernethy, Mr. on Indigestion - 100
Absorption of Placenta, case of - 146
Academy of Medicine, Report of 57
Acetate of Morphine, Poisoning
by - - 57

■ - - - ■ - , Use of in

Traumatic Tetanus - - 321

Acid, Oxalic, poisoning by -499
Address of Earl Stanhope to the
Medico -Botanical Society,
(Reviewed) - - 220

Amaurosis, Professor Langen-
beck, on - 68

- , Cure of by Ol. Tere¬
binth. - - 495

American Journal of Sciences,
Extracts from - - 165

- North, Medical and

Surgical Journal - 505

Amussat M. new Mode of arrest¬
ing Hemorrhage • - 243

Amputation, Dr. Ballingall on 153

. - of the Thigh by Mr.

Syme - - 418

- — Shoulder, by Dr.

Ballingall - - 152

- - - - Fore Arm, by Mr.

Syme - - - 420

- Fingers - 416

- - of the Tarsus - 420

- Penis - - 171

Analysis of all opinions on the
malignant Puerperal Fever 18

Anatomy Bill, Remarks on - 40

- , Imperfections of 42

Andral M. on Indigestion - 100

Aneurism, tied at Distal Side, by
Wardrop and Dupuytren 168, 331

- by Anastomosis - 216

Angustura, real Nature of - 465

Animals, Lower, Pulse of - 86

Antidotes to Prussic Acid 58, 173

Antimony Tart. Large Doses of 147

- - -Effects of Externally - 244

Antrum, Cancer of the - 284

Aorta, Retroversion of Valves of 65
Apoplexy without Effusion 375

- - — , Remarks on - ib.

Apothecaries’ Company, Actions
by - 175

- - Irish, Reform of 396

Apparatus, &c. for Alkalies - 510
Arm, Laceration of, in a Mill 157

- Presentations, Remarks on 393

Arnott , Mr. on Phlebitis - 204
Arteries Carotid, Ligature on 342

- — -, Subclavian - 168

— - , Innominata - 331

- , Divided, Pressure on 80

- - , Torsion of - 243

- — , Metallic ligatures on 165

Ashwell , Mr. on Puerperal Mania 247

Asphyxia, New Mode of Reco¬
very from - - 58, 60

Ballingall , Dr,, Clinical Reports
by - - 148, 151, 153

Barr as M. on Dyspepsia - 102

Bateman's, Dr., Synopsis on Cuta¬
neous Diseases by Dr.Thomson
(Reviewed.) - - 303

Bath Hospital, Reports of 76, 77,
336

Bates, Mr., on Abdominal Inflam¬
mation (Reviewed) - - 452

Biography of Sir H. Davy - 88

Black Cancer, Case of - 168

Bladder, Case of Puncture of - 355
Bleeding in Continued Fever,
weight of authority against, 274, 296

- from Leech Bites,

mode of arresting - - 243

Blandin, M. on Fracture ofThigh 69
Bladder, Fistula of, Application
Actual Cautery to - - 70

Blicke , Dr., on Ischuria and Spina
Bifida - - 440

Blood, State of in Typhus - 363

- , as a Criterion in Disease 293

- of Liver, Remarks on - ib.

- , Lungs - - - ib.

- , Experiments on - 291

- , Seat of disease - 294

530

INDEX

Blundell , Dr. on Extirpation of the
Uterus - - 249

Body, Foreign, in the Ear for years 174
Books Received, Lists of, 175, 264,

352, 440, 528

Botany, Mr. Castle’s Elements ( Re-

- , Transactions of Medico-

Botanical Society ( Reviewed ) 461

viewed) • - - 479

Bostock’s, Dr. Analysis of Fluid
of Hydrocele by - - 212

Brain, Diseases of 369

- , Rainollissement of - 370

- - , Tubercular disease of - 372

- . Injuries of - - 76

- - , Physiology of - - 3S3

— - - , connexion of with the Mind 44

- , State of in Delirium 226-436

— - — - — - Puerperal Ma¬
nia - - 106-435

- - — — Apoplexy - 375

- Typhus - 353

- - , Disease of, attended with

Ischuria - - - 373

— - - , Effusion not the effect of

Inflammation - 143

Breechpin Extracted from Orbit - 432
Brodie , Mr. on Aneurism, by An¬
astomosis - t - - 216

Broussais, M. on Elephantiasis
Testis - - - 157

- - *s Practice in Typhus - 235

Brucine, Poisoning by - - 57

Buffy Blood, Theories of - 294

Bulimia, Case of - - - 83

Burne, Dr. on Otorrhoea - 137

Burns, New Cure of - - 440

Caesarean Operation, Mother and
Infant saved - 72-350

Calculi in Frontal Sinus - 145

- , Bilateral Operation for - 527

- , Instruments for Triturating

239-439

Calomel, Utility of, in Puerperal
Fever - - 33, 36, 38

Camphor, Large Doses of pro¬
posed - - - 430

- 1 — ? Use of in Mania - 171

Canal, Intestinal Follicularlnflam-
mation of, in Typhus - -271

Cancer, Essay on, by Mr. Travers 2 75

- , Pathology of, by various

Writers - - - 276

- of the Lip - - 2Si-334

i - - - Nares and Antrum - 280

- - Eyelids and Orbit - 287

- Alveolar Membrane

of the Lower Jaw - - 282

■ - — Tongue - - 283

- * - Fauces and External

* 2S4

Cancer in the Breast - 233-241

- Melanotic of the

Hand - 168

■ - Zygomatic Fossa - 175

- Uterus - - 248

— - - Pelvis - - 176

- Medullary, of Face and

Lower Jaw - 280

— - - Eyelids and

Orbit - - - ib.

- - - Eyeball and

Orbit - 281

- Lower Lip ib.

— - Lower Jaw 282

- - — - - - - Tongue - 283

— - of Antrum, Fauces, and

Pharynx - 284

Carotid Artery, Ligature on - 342
Castle's , Mr., Elements of Botany
(Reviewed.) - — 476

Catamenia, Precocious, Case of - 246
Cautery, actual, in Vesico-vaginal
Fistula - - - - 70

- — - in Morbus Coxarius - 417

Cephalalgia, Intermittent, cured
by Quinine - - 146

Cerebri Hernia, Case of - - 76

Cerebro-spinal System in Man - 176
Chancre, Cure by Cautery - 504
Charity, Hospital, Reports, 71, 347,
349, and 351

Chenevix, Mr., Failure of Mesme¬
rism by - - - 477

Child retained in Uterus Thi.teen
months - ■ - 327

Children, Five at one Birth, Case
of - - - 75

Chirurgus on the Anatomy Bill - 40
Chlorine Antidote to Hydrocyanic
Acid - - - - 58

Cinchona, different Species of - 514
Cinchona, New Alkali in, more
powerful than Quinine - - 327

Clanny, Dr., on Typhus - 270-363
Clark, Dr., on Climate (Reviewed.) 1 16
Clapham, Cholera at - 344

Climate, Dr. Clarke on - - 116

Colica Pictonum, Case of - 349

College of Surgeons, Regulations
of 440

College of Physicians, Royal,
Proceedings at - - 71

Colleges of Physicians and Sur¬
geons, Remarks on - 300, 514
Conception, Influence of Season
and Physical Causes, on - 173
Constitution, Effects of Phlebitis
on - - - - 204

Consumption, Signs of Recovery - 260
Contagion, Remarks on - 265

Convulsions, Puerperal, Case of - 206
Coombe, Mr., on Phrenology - 107
Cooper, Mr. S., Study of Medi¬
cine by - 1, 89, 177, 265

Ear

Cord, Spinal, Diseases of - 378

Cornea, Opacity of cured by 01.

Terebinth. - - 497

Coroner’s Inquest - - 328

Corporations, Medical, Remarks
on -

- 1 — , Functions of - 383

Costello, Mr., successful Opera¬
tions of Lithotrity by - 307-310

- , History of Lithotrity by,

at London Medical Society - 439
Cotton, Use of, to Blisters - 505
Croker, Dr.-, 'Exposure of Mesme¬
rism by - 477

Cutaneous Diseases, Synopsis of 203

Dance, M., on the Use of large
Doses of Tart. Ant. in Inflam¬
matory Diseases - - 147

Davy, Sir H., Biography of - 88
Death by Submersion, Cause of - 57

- , New Mode of Treatment 158

Deformities, Physical Causes of 67
Delirium Tremens, Pathology and
New Treatment of - 316 436

Delivery through the Abdomen - 74

— - - of Five Children at a Birth 75

Denmark, Mrs., Report of her
Case, by Mr. Wardrop - 331

Dentition, Physiology of - 5

De-wees , Dr., on Practice of Phy¬
sic - - - 145

Diploma, qualifications for - 302
Disease, State of Blood in - 270-363

- , Malignant, Account of -275

Drowned, New Treatment of the 58-60
Drunkenness, Effects of, on Brain 230
Dublin Fever Hospital, Reports of

233-253

- Lying-in Hospital - 31

- Meath - - - 326

Duncan, Dr., Case of Laryngitis
by - - - ^ - 252

Dupuytren, M. actual Cautery by,
in Vesieo-vaginal Fistula * "- 70

- , Case of Explosion of

a Pistol in the Mouth, Lacera¬
tion of Soft Parts, Fracture of
inferior Maxillary Bone - - 70

- , Case of Extososis of

Toe ^ - - - 16S

- , Ligature at the Dis¬
tal side of Subclavian Artery -

- , Treatment of Foreign

Body in the Ear - - 174

- on Extirpation of the

Uterus - 24S

Duty on Patent Medicines - 88
Dysentery, use of Nitrate of Soda
in 146

Dyspepsia, Limosis, various Theo¬
ries on - - - - 89

Ear, Foreign Body in, for years 174
1 undent Discharge of - 137
Hurl, Mr., on Strictures of the
Rectum ... 434

Edinburgh Medical Journal, Ex¬
tracts from ^ 141, 143, 155, and 157
Infirmary, Reports of

148, 245, 251, and 252
Surgical Hospital Re-
ports - _ 413-427

Education, Medical, in Early Ages 478
Effluvium, offensive Effects on the
Body -

Elbow Joint, Excision of - 415

Elliotson's, Dr., Cure of Tetanus
by large Doses of Iron - - 212

5 Case of Genital Irri¬
tation by - _ _ 172

Elements of General Anatomy, by
Mr. Grainger (Reviewed) ’ -456

- -

Bayle and Hollard

- of Midwifery, by Mr.

Waller - . 390

— - of Medical Botany, bv

Mr. Castle - . 47^

England, Climate of - . jjg

- ~, comparative Salubrity of

different Counties in - . 83

Enteralgia, Case of . _ 145

Enteritis, Peritonitis, New Cure for 452
Epidemic Fever, Chronological
Account of, in this Empire - 184

- - , Puerperal . . is

^ Pathology and Necroto-
my°f • - - 34-438

- * - , various Modes of Treat¬
ment of- . .. - 3S

Ergot of Rye, Remarks on - 65
Erysipelas concomitant with ma¬
lignant Puerperal Fever - 438
Excision of the Mammae - 243,421
°1 the Hemorrhoidal ex¬
crescences - _ 429.

- of tile Warty ditto - 421

- for Hypospasdias - 424

- for Tumours of the Or-

bit 425

- for Removal of a piece of

Iron - _ _

- - - - of a Tumour at the Angle

of the Jaw - _ 340

- of an Exostosis of the

Great Toe - _ - ICS

Experiments with Metallic Liga-

tures - - - -165

- - - , on the Blood 291, 294

363 ’

Extra Uterine Fcetation - 64-74

Eye, Inflammation of, treated bv
Ol. Terebinth. . - 341

- -> Tumours of _ 2Sl-42£>

532

INDEX.

Eye Infirmary, Westminster, Re¬
port of - - 495

Eyeball, Medullary Tumour of - 281
Eyelids and Orbit, Cancer of - 280

Face, Cancer of - 2S0, 281, 284

- , Medullary Tumours of - ib.

Facial Nerve, Paralysis of- - 166
Facial Neuralgia cured by Acetate
of Morphine - - 322

Fauces, Cancer of 284

Femur, Fracture of, 69, 78, 219, and
148

Fever, continued. Nature and Cure
of, 80, 265, 285, and 353
- , Malignant Puerperal, a Chro¬
nological Account of - - 11

- - , Opinions for and against

its being Peritonitis - - 31

- , called Peritoneal by Dr.

Gooch - - - 21

- , Autopsy of - 34-438

- , various Modes of Treating 38

Fistula in ano. Operation for - 423

- , Vesico-vaginal, treated by

actual Cautery - - 70

- , treated by twisted Suture 347

Fluids of Hydrocele, Analysis of 212
Foetal Monstrosity, cause of - 67
Foetation, extra Uterine - 64-74

Foetus, Birth of, through the Ab¬
domen - - - - 74

Follicular Inflammation of the In¬
testinal Canal - - - 271

Fractures, Dr. Ballingal on - 148

- , Mr. Syme on 414

- of the Skull ' - 76-77

- - Compound oftheWrist 50-426

- - of the Femur 69,78, and 219

France, Climate of - - 193

Frost , Mr., Oration by (Reviewed) 220

Galipea Officinalis, or Angustura
Bark, Use of - - 462

Gastroenteritis Cause of Fever - 98

Gastromania, Epidemic Nature of 98
General Practitioners, Rights of 52,

55, 303

Genital Organs of Male, Dr. Titley
on ( Reviewed ) - - 441

- Irritation and Impotence of 172

- Female, sloughing of - 406

Glasgow Infirmary, Reports of - 323
Gonnorrheeal Ophthalmia, Case of 324
Gooch , Dr., on some of the most Im¬
portant Diseases of Womea ( Re¬
viewed) - - 8-100

- on Irritable Uterus - 113

- - — on Diseases of the Mind in

Lying-in Women - - 106

Good, Dr., Study of Medicine by'
(Reviewed) - 1, 89, 177, and 265

Guthrie, Mr., Treatment of Dis¬
eases of the Eye by - 341

Grainger , Mr., General Anatomy
by ( Reviewed ) - - 456

Guy’s Hospital, Reports of 174-431

Haemorrhage, New Method of Ar¬
resting - - 243-322

- , Uterine - - 394

Hsemorrhoidal Excrescence, Re¬
moval of 423

Haimarada of Guiana, Use of - 462
Hancock, Dr., Remarks by, on the
Haimarada of Guiana - ib.

- , on Angustura Bark 465

- , on Sarsaparilla - 467

Halford, Sir H., Test of Insanity
by - - - - 63

Hall , Dr. Marshall, on the Perfo¬
ration of the Stomach - - 141

Halliday, Sir A., on Insanity - 477
Hand, Melanotic Tumour of - 168
Haslam, Dr., on Puerperal Mania 107
Hastings , Dr., on Ischuiia - 140
- ~, on the Use of the

Stethoscope - - - 257

- , Reports of Diseases

of the Lungs - - 259

Head, Injuries of the - 76-77

Health, Doses of Camphor on - 430
Heart, Action of, after Removal
of the Head - 484

- , Action of after Isolation - 384

- , Influence of the Sensorium

on action of the - - 385

- , Hypertrophy of - - ib.

- , Wound of, not fatal - 87

Hemicrania, Periodical, curious
Case of - 145

Hernia, Crural, fatal Case of - 7 1

- -, Inguinal, Strangulated - 336

- - - , New Species of 175

- , Scrotal, immense Case of 169

Hodgkin, Dr., on Retroversion of
the Valves of the Aorta - 65

Holl , Dr., on Redundancy of Or¬
gans in a whole Family - 67

Hollard's General Anatomy (Re¬
viewed) - * - 455

Hospitals, Dublin - - 326

- — , Paris, Account of - 351

- , Italian, Reports of - 321

- , German 248, 350, and 351

- - , London 171, 172, and 249

- , Scottish, 148, 245, 251, 252,

331, 413, 427

- , American - - 161

- , English Provincial 171, 336

H6tel-Dieu, Reports of, 70, 106, 168,
24S, 351, 527

INDEX.

533

House of Commons, Debates of, on
the Anatomy Bill - - 40

Houston, Dr., on Ergot of Rye - 65
Hughes, Mr., on Hysteritis Puer¬
peralis - - - 318

Humoral Pathology, Revival of

289, 393

Hunterian Society, Proceedings of 64
Hydrocele, Fluid of, Analysis of 212
Hydrocephalus not caused by In¬
flammation - - - 143

Hypertrophy of the Heart - 338
Hypospasdias, Case of - - 424

Hysteralgia Puerperalis, Case of 133
Hysteritis Puerperalis - 318, 338

Impotence, Case of - - 172

Incontinence of Urine, Cases of - 439
Indigestion, various Theories on 98
Inflammation of Veins consequent
to blood-letting, Cases of - 204

- , Follicular, of Intestines

in Typhus - - - 271

- - - of Peritoneum, Intes¬
tines, New Cure of - - 452

Inflammatory Pseudo, Diseases - 254
Inflation of the Lungs improper in
cases of Drowning - - 57

* - — . how properly performed 60

- — applicable to Asphyxi¬
ated, or Still-born Infants

Influence of Climate in Chronic
Diseases ... 194

Informations against Venders of
Patent Medicines - - 88

Injuries of the Head - 76, 77

- of the Fauces from Cun-

Shot - - - - 70

Inoculation for Hydrophobia - 508
Ischuria Cases of - - 140

Insanity, State of Brain in - 107

- , Puerperal, curious Cases

of - 43, 436

• - , Dr. Gooch on - - 106

- , Camphor in - 71

Inquest on Mrs. Phillips - - 328

Intellect uninjured in Diseases of

the Brain - - ~ 44

Intermittent Fever, Cure, of by
Blood-letting - - 499

- , Cure of, by

External Use of Quinine - 509
Intestinal Canal, Irritation of, and
Hysteralgia - - - 133

Intestines; sudden Protrusion of
into the Scrotum - - 169

Irish Apothecaries, Proceedings
of 395

- Company, Mo¬
nopoly of - - 396

Iron Subcarb. in Tetanus - 212

Irritable Uterus, Dr. Gooch on - 113

Italian Hospitals, Reports of - 322
Italy, Climate of - - 193

Intra Uterine Respiration* Cases of248

Jaw, Tumour of - - - 342

— - - , Lower, Case of Alveolar

Process of 282

Johnson, Dr. James, on Indiges¬
tion - - - 99

Jurisprudence, Medical, Remarks
on - - 52, 88, 175

- , Case of Mrs. Phil¬
lips - - - 328

Kingdon, Mr. on Incontinence of
Urine .... 439
- on Hernia, &c. - 525

Labia Pudendi, Sloughing of, after
Parturition - - 406

Labours, Classification of - - 361

Labour with Convulsions, and sub¬
sequently Mania, Case of - 406

- with 5 Children at a Birth 75

- impracticable, Csesarean

Operation - 72, 350, and 351

, Management of all Kinds of 393
, Description of - 439

Laennec, Remarks on his Opinions 257
Langenbeck, Dr., on Amaurosis - 68
Laryngitis, Tracheotomy unsuc¬
cessful Case of - - 252

Law, Mr., on Spina Bifida 157, 440
Laudanum, Mysterious Case of
Poisoning by - - - 32S

Lee, Dr., on Phlegmasia Dolens 208
Leeches, Mortality of - -175

Leechbites, Suppression of Hae¬
morrhage from - - 322

Lerminier, M., on Dyspepsia - 100
Leroy, M., on Submersion - 57, 60
Ligature on the Carotid Artery - 342
— — — — on the Axillary Artery

168, 326

- , Subclavian - 327, 331

- , Temporal - - 216

- Metallic, advantages of - 165

Limosis Dyspepsia, Dr. Good on 99
Lip, Operation for a New - 244

- , Removal of - 281, 424

- , Cancer of - - - - 336

Lisfranc's, M., Operation for
Cancer of the Zygomatic Fossa 175
Liston , Mr., Tracheotomy by - 252
Lithotomy, Cases of 65, 171, 173, and
325

Lithotrity, Remarks on - - 239, 439

- , successful Cases by Mr,

534

INDEX.

Costello, first Operator in Lou- '
don - 308, 310

Lloyd , Mr., on Puerperal Mania
a 336,436

- Removal of Lower

Lip by - 336

Locke , John , a Physician— Case
of Neuralgia by - - 61

London Medical Society, Reports
of - - 436, 440, 522, 6

- , Fever, Account of - 335

Lunatics in England, Account of 477
Lungs, Diseases of— fallacy of
Stethoscope in - - 257

Lyford, Mr., on United Fracture 78
Lying-in Institution, Ladies’, Re¬
marks on 224

- Women, Disorders of

Mind in ... ib.

Lynn , Mr., Noli me Tangere cured
by - - 335

Medullary Tumours of Mouth and
Fauces - - 282

Melanotic Tumours of the Hand 168
Menstruation, Precocious, Case of 246
Mercury, Abuse of, in most Dis¬
eases - - - - 452

Mesmerism, Failure of . 484

Mestevier, M., on Congestion of
Lungs from Opium - - 57

Mind, Immateriality of, Dr. Ryan
on - - - - 43

- , Dr. Gooch on Disorders of,

in Puerperal Women - - 106

Morbid Appearances absent in
Apoplexy, Dr. Abercrombie on 375
Morphine, Acetate of, Poisoning by
an immense Dose— Recovery - 57

Mouth and Fauces, Medullary Tu¬
mour of - 282

- - - , Cancer of - 284

- - - - — , Diseases of, by

Dr. Good - - 5

Myrrh, different Species of . 513

Madden , Mr., on the State of Me¬
dicine in Turkey - - 499

Maxillary Sinus, Disease of - 323

Malignant Diseases, Mr. Travers
on 275

Mania, Remarks on - 71, 107, 111
Materiality and Immateriality of
the Mind, Remarks on - - 43

Macryurdo, Mr., on Lithotomy - 65

Malformation from defective Plas¬
tic force - - - 67

Mamma, Venereal Ulcer on, from
Infant - - - - 249

Marryat, Dr., on large Doses of
Tart. Ant. ... 14S
Mascagni , Professor, Anatomical
Plates, Adult Size, by - 246

Measles on half the Body . 506

Medicine, Academy of, Meeting
of - - - - 57

Medicines, Patent, Duties on - 88

Medicine no Mystery ( Reviewed ) 300
- — , Study of, by Dr. Good

( Reviewed ) 1, 89, 177, and 265

- , Practice of, Dr. Ryan on 48

Medical Botany, Introduction to
(Reviewed) - - - 461

Medical Society of London, Re¬
ports of - 436, 440, 522

Medico-Botanical Society, Trans¬
actions of ( Reviewed ) - 500

- - - Account of Proceedings .

of- - .- - 220,526

- ChirurgicalTransactions

( Reviewed ) - - 206

Medullary Tumours of Face and
Jaw - - - 280

- - * - — Eyeball and

Orbit - • - - - 281

Necgele, Professor, on Absorption
of the Developed Placenta - 246

Nsevus cured by Vaccination - 246

Nares and Antrum, Cancer of - 284

Nerves, Functions of, by Mr.

Swan - 3S3

- , Diseases of, by Dr. Aber¬
crombie - 381

- , Facial Paralysis of - 166

Nervous System, Physiology of - 384
Neuralgia treated by John Locke 61

- - cured by Morphine - 322

Nice, Climate of 193

Nicol, Dr., on Recto-vaginal Fis¬
tula - - - 155

Nitromuriatic Pediluvia, Effects of
on. Disease . . 506

Noli me Tangere, cure of - 335

Norman, Mr., on Fracture of Skull 76
Nose, New Operation for - 244

Nosology, Dr. Good on - 3

Odontia, Dentition, Dr. Good on - 5

01. Terebinth, in Puerperal Fe¬
ver ------ 33, 38

Ophthalmia, Acute, Treated by 01. v
Terebinth, Cases of - 341

- : - , Purulent, Cure of . 496

- — , Gonorrhoeal - - 824

O’ Reardon, Dr., on Fever - 232
Opiates in Puerperal Intestinal
Irritation - - 27, 133

- , large Do^es, Cure for In¬
flammation of AbdorainalViscera 452
- employed Externally, En-

INDEX.

535

dermically in Tetanus, with suc¬
cess - 321

Otorrhcea, Treatment of - 137

Ore, Mr., on Cure of Chancre, hy
Caustic and Cautery . . 501

Organs, Redundancy of in a whole
Family - - - 65

Orjilci , M., Case of Poisoning by 57

Painter’s Colic, curious Case

of -

349

Paralysis of Face

166

Parisian Hospitals

351

Paris and Philip, Drs., on

Indi-

gestion

100

Patent Medicines, Duty on

Pathology, Humoral, Revival of

363

Pau, Climate of

193

Penis Amputation of

171

Perforation of the Stomach,

Case

141,

428

Periodical Hemicrania, Case of - 145
Peritoneal Fever, Dr. Gooch on 12-30
Peritonitis, cure of, by Opium -

- , not always attended by

Pain - 438

- , Puerperal - 51, 436, 438

- , Cause of . 506

Pertussis, Specifics for . . 509

Pharynx, Cancer of 284

Phlebitis, Constitutional Effects of 204
Phlegmasia Dolens, Pathology of 208

- , Remarks on - ib.

Phillips, Mrs. Inquest on - 328

Phrenology, Objections to - 48, 113
Physicians’ College, Proceedings of 61

- College, Remarks on 302

- - 9 Honours, Re¬
ward, and Privileges of - 403

Placenta, Absorption of - 246

- — , Adhesion by Cellular-

Membrane - - - 133

- , Ossification of . 507

Pleuritis, large Doses of T. Ant.

in 244

Pneumonia from Immersion in Cold
Water - - - 127

Poisons act through medium of
Nerves - 269

Poisoning by Morphine - - 57

- *, from Laudanum, Myste¬
rious Case of - - - 328

Polypus Uteri, Dr. Gooch on - 9

Porter, Dr., on Bulimia - - 83

Primary and Secondary Amputa¬
tions, Cases of - - 153

Profession, State of - 55, 302

Pruritus Vulvse, Case of - 58

Puerperal Convulsions, Mania and
Sloughing of the Genitals - 406

— - - Malignant Fever - 11,39

■— - , Etiology, Pathology,

Necrotomy, and various Modes
of Treatment of - - 51,438

Puerperal Mania - - 107

- , Etiology and Danger of 111

Pulmonary Diseases, Stethoscope
in - - 257

- , Congestion

after poisoning by Opium - 57

Quarrier , Dr., on Feigned Diseases
of the Heart - - 38

Ramsbotham, Dr., on Extra Ute¬
rine Foetation - - 61

Recto-Vaginal Fistula, Operations
on 1&7

Rectum, Strictures of, Mr. Earl
on 434

Regulations of the College of Sur¬
geons - - 440

Respiration, Mr. Swan on - 380

- , Means of affording to

Infants in Reversed Presenta¬
tion - - - 427

Review of Abercrombie on the
Brain and Spinal Cord - 369

— - Bateman’s Synopsis by

Dr. Thomson - - 203

- Bates on Abdominal In¬
flammation . . 452

neral Anatomy - _ 456

- Castle on Medical Botany 461

- Clarke on Climate 1 16, 193

- Gooch on Female Diseases

8, 106

- Good’s Study of Medi¬
cine - 189, 177, 265

- - Grainger on General An¬
atomy .... 456

- Stafford on Excavated

Ulcers .... 387

- Swan on Respiration, &c. 383

- Titley on Diseases of Male

Genitals . , .441

- Transactions of the Me¬
dico- Chirurgical Society . 461
- - Transactions of the Me¬
dico-Botanical Society 204, 275
Recamier, M., on Extirpation of
the Uterus . . . 248

Rheumatism, Acute, large Doses
of Tart. Ant. in . . 147

Roux, M. Operation by .71

- on Extirpation of the

Uterus . . . 512

Ryan, Dr., on Immateriality of
the Mind . . .44

- - Arguments against Phre¬
nology by . .46

536

INDEX.

Ryati, Dr ., on Adhesion of the Pla¬
centa, Hys'teralgia, and Intesti¬
nal Irritation . . . 133

- - on the Pathology and

New Mode of treating Delirium
Tremens . . . 227

■ - on the Honors, Privi¬

leges, Veneration, and Rewards
of Medical Practitioners . 403

- on Convulsions, Mania,

and Sloughing of the Genitals . 406

- on Medical Ethics . 491

Rye, Ergot of, Remarks on 65, 116

Salter , Mr ., Cases of Fractured
Thigh by, in Cancerous Diathesis 419
Scalds, Treatment of by Flour 440
Science, Medical, Dr. Ryan on 435
Scirrhus of Genitals . . 441

- , Structure of . . 276

Sciatica, Cure of, by Ol. Terebinth. 146
Scrotum, immense Size of . . 160

Sedatives in Intestinal Irritation . 133

- in Puerperal Mania 71, 109

Sensorium, Influence of, on the
Heart . . . 385

Secale Cornutum, Remarks on 65, 116
Seton, Cure of Ununited Fracture by 78
Shear ly, Mr., on Spina Bifida . 440
Shearman , Dr., on Hydrocephalus 143
Silk Ligatures, Experiments to
prove the Disadvantages of . 165
Skull, Fracture of . 76, 77

Smith, Mr. on the Success of Pres¬
sure on Divided Arteries . 80
Softening of the Stomach, Case of

141, 428

South of Europe, Climate of . 193
Spina Bifida, Cases of . 157, 440
Spinal Cord, Functions of . 380-387
St. Bartholomew’s Hospital, Re¬
ports of . . 171, 336

St. George’s Ditto . . 431

St. Thomas’s Ditto . 172, 249

Stafford, Mr., on Excavated Ul¬
cers (Reviewed) . . 387

Stanhope, Earl, Address of to the
Medico-Botanical Society (Re¬
viewed J . . . 220

Stethoscope, Fallacy of . 257

Stoker, Dr., on Pathology 285

- on Fever . . 353

- on Blood in . 363

Storer, Mr., Translation by, of
Manual of General Anatomy
(Reviewed) . . . 458

Stomach, Perforation of, Cases of

141, 428

Strangulated Hernia, Cases of . 336
Study of Medicine, new edition,
by Mr. Samuel Cooper . 1, 89, 177

Subclavian Artery, Ligature on at
the distal side of Aneurism . 327
Submersion in Water, Death by . 57

- - - best Mode of Recovery

from . . . .68

Surgeons, Royal College of Lon¬
don, Regulations . .514

- - ? Edin¬
burgh, Regulations . .515

Surgical Reform, need of .516

Suture Twisted in Vesico-Vaginal
Fistula . j . 347

Swan, Mr., on the Brain, Heart,
and Respiration (Reviewed) . 380
Syphilis, Treatise on, by Dr.Titley 441

Tartar Emetic in large Doses . 147

- - - externally applied,

great Use of . . . 244

Temporal Region, Aneurism in . 216
Testis, Enormous Size of . 160

Test of Insanity . . 63

Tetanus, large Doses of Subcarb.

Iron in ... 212

- "cured by external Use of

Morphine . . . 321

Thigh, Amputation of . .418

- Fractures of . .78

Thomson, Dr., Edition of Bate¬
man’s Synopsis by . . 203

Tic Doloreux, Case of . . 61

- treated by Ol. Terebinth. 146

Titley, Dr., Treatise by, on Male
Genitals, (Reviewed). . . 441

Tongue, Cancer of . . 2S3

Torsion of Arteries to arrest He¬
morrhage . . . 243

Tracheotomy, Case of . . 252

Travels in Turkey by Mr. Madden 409
Travers, Mr , on Malignant Dis¬
eases . 275

Truman, Mr., Successful Opera¬
tion by, for Strangulated Hernia 335

- Extraction of a Breech-

pin from the Orbit . . 432

Turkey, State of Medicine in . 409
Tuthill, Dr., Various Reports by 495
Tweedie, Dr., Evidence of in Mrs.

Phillips’s Case . . 32S

Twisting of Arteries to arrest He¬
morrhage . . . 243

Typhus, Nature of . 80, 265, 285, 28/

- , whether Contagious . 267

- , State of the Blood in . 270

- , Ulceration of Intestines in 271

- , Theories on Proximate

Cause of . . 287

- , Objections to all pro¬
posed Theories . . . 294

- , Best Treatment of . 273, 365

INDEX.

537

Ulcers, Excavated, New Mode of
Cure for .... 387

- - - — of the Genitals, simple 442-444

- , Syphilitic 445

Umbilical Cord, great Length of 24S
Urine, Incontinence of 373, 374, 439
Uterus, Extirpation of . . 24S, 512

- - Remarks on . . .512

- , Irritable, Dr. Gooch on 113

- , Examination of, Eight

Years after Caesarean Operation 351

Vaccination, Naevus Maternus
cured by ... 246

Vatel, M., on the Pulse of Ani¬
mals . . . . 86

Vena Saphena Major, Inflammation
of its Cellular Coat . . 250

Veins, Inflamed, Constitutional Ir¬
ritation by 204

Venereal Disease, History of . 442

- Sore on Mammae from a

Child . . . 249

Vesico-Vaginal Fistula . . 70

Villermd , M., on Conception . 173
Violence, Fracture of the Thigh
without . . . . 219

Vitiation of the Blood, Revival of
Humoral Pathology . . 285

Vulvae Pruritus, Case of . . 5S

- , Sloughing of . . 406

Wallace , Mr., on Pneumonic In¬
flammation . . .126

Waller , Mr., Elements of Mid¬
wifery by (Reviewed) . .390

Ward, Dr ., on a New Mode of
treating Burns and Scalds . 440
Warburton, Mr., Anatomy Bill by 40
War drop , Mr., Report of Mrs.

Denmark’s Case by . .331

Western Hospital, (Royal) Reports
of 336, 432

Westminster Hospital, Reports of

335, 341

Whiting, Dr., on Puerperal Fever 438
Winchester Hospital, Report of . 342
Wound, Extensive, of the Heart,
not suddenly fatal . . 87

END OF THE THIRD VOLUME.

C. SMITH, PRINTER, 18, WY CH- STREET.

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Full text of "The London medical and surgical journal : exhibiting a view of the improvements and discoveries in the various branches of medical science. Volume 3, July - December 1829."

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