The London medical and surgical journal : exhibiting a view of the improvements and discoveries in the various branches of medical science. Volume 5, July - December 1830.

a

■ —

■

THE

LONDON

MEDICAL AND SURGICAL

■' JOURNAL;

INCLUDING

THE LONDON MEDICAL REPOSITORY.

EXHIBITING

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

EDITED BY

MICHAEL R Y A Na M. D.

Qurerere Verum. Horace.

VOL. V.

FROM JULY TO DECEMBER, 1830.

LONDON:

PUBLISHED BY THOMAS AND GEORGE UNDERWOOD,
32, FLEET STREET.

] 830.

I X

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 25.

JULY 1, 1830.

Vol. V.

CRITICAL REVIEW.

I. —' Observations on Puerperal Inflammation , commonly

called Puerperal Fever, being the subject of an Oration
delivered before the Hunterian Society of London, in
February, 1830. By J. T. Conquest, M." D., Physician
to the City of London Lying-in Hospital.

II. -— Dev Fief res Puerperales , observees a la Maternite de
. Paris, pendent V- annee 1829,- des diverses Methodes
► therapeutiques employees pour les combattre et speciale-

ment des Mercurieux, des Vomitifs, et des Evacuations
Sanguines. Par M. Tonnelle, Aneien Interne des,*
taux. Arch. Gen. de Med. Mars et April, 1830.

Observations on the Puerperal Fevers, observed in
the Maternite of Paris' during the year 1829, with the
different Modes of Treatment,' especially Mercurials ,
Emetics, and Sanguineous Depletions. By M. Tonnelle^
• TaLen from the Records of the Hospital, with the consent
of M. Desormeaux, Chief Physician to the Institution.

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

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

vol. v. no. 25,

n

2

Critical Review.

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

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

“ Those complaints to which I more particularly refer are,

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

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

Dr. Conquest on Puerperal Inflammation.

3

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

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

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

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

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

I

4 Critical Review .

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

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

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

“The disease is most frequently epidemic during the winter and
spring, and has always been most fatal during and immediately after
severe and long-continued frosty weather ; and yet, strange and in¬
explicable as is the fact, during the prevalence of cold it runs its
course most rapidly, and often assumes the low type, as during this
season, (1830.)

“ I am particularly solicitous to establish,

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

Dr. Conquest on Puerperal Inflammation. 5

ing the long and tedious months of seclusion which precede their con¬
finement.

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

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

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

6

Critical Review .

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

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

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

Dr. Conquest on Puerperal Inflammation. 7

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

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

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

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

Critical Review.

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

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

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

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

M. Tonnelle on Puerperal Fever.

9

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

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

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

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

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

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

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

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

VOL. V. - NO. 25,

c

10

Critical lievieiv.

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

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

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

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

11

M. Tonnelle on Puerperal Fever .

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

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

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

12

Critical Review.

i

and is nearly as constant as peritonitis. It may exist aloim,
or be combined with, the preceding' alterations. It in general
does pass beyond the uterus, but sometimes extends to the
ovarian, hypogastric, and abdominal veins. In some eases
it is confined to certain veins, in others no part of the uterus
can be incised without pus being effused in drops from the
divided vessels. It is on the sides of the uterus and near
the broad ligaments that the vessels are usually inflamed.
It exists more rarely near the insertion of the placenta,
though M. Dance has asserted the contrary. The lymphatics
are easily distinguished from the veins by their superficial
position on the sides of the uterus, by the tenacity of their
parietes, by their whitish and milky aspect, their communi¬
cation with the peritoneum, their contiguity to the large
veins, their flectuosities, and swelling at different points.
These swellings often contain pus, and may admit a cherry
stone or bean. We must not confound these with abscess of
the substance of the uterus. The internal membrane of
these vessels is seldom changed, it maybe thick and yellowish.
It should be remembered that the lymphatics may take up
puriform, acrid, or foetid fluids after delivery, and become
inflamed. The presence of pus in the vessels, and its neces¬
sary transmission through the circulation, causes rapidly an
evident palpable infection in the mass of blood, and a certain
number of phenomena which impress on puerperal fever an
especial character — a characteristic physiognomy. The fol¬
lowing cases, taken from a hundred, furnish the proof : —
Case I. Puerperal Fever, with Uterine Phlebitis. — Vic-
toire Arno, set. 22, in excellent health, was delivered after
an easy labour. The fourth day she complained of rigors,
and pains in the hypogastric region, which were combatted
by an application of fifty leeches. 5th.- — Abdomen tumid,
with extreme sensibility ; face red, animated, pulse hard and
frequent ; lochia and milk suppressed ; leeches repeated,
oleaginous draught and hip-bath. 7th. — Inflammatory symp¬
toms succeeded by profound prostration, face pale, eyes dim,
tongue dry, pulse small, frequent, and irregular ; articula¬
tion difficult, rigors and involuntary evacuations. In the
evening there was delirium. '8th.^-The body covered with
a viscid sweat, extremities cold, and death approaching ra¬
pidly. Mercurial frictions, in the quantity of three ounces,
were used daily, calomel and hyociamus freely employed
with great attention during this last period. Autopsy, twenty-
four hours after death. — The internal surface of the uterus
was covered with a putrilaginous foetid matter, but was un¬
changed j the section of the organ presented the veins and
lymphatics filled with pus towards the base of the broad

M, Tonnelle on Puerperal Fever .

13

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

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

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

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

14

Critical Review.

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

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

M. Tonneiie on Puerperal Fever.

15

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

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

Case VI. Puerperal Fever , with Uterine Phlebitis , Per¬
foration of the Stomach, and Ramolissement of all the
Organs. — A patient, set. 28, of a good constitution and ex¬
cellent health, was delivered, after a favorable labour in
July, 1829. The third day she complained of rigors and
abdominal pains, for which forty leeches were applied.
4th. — She had much vomiting and fever, the abdomen was
tumid and sensible, respiration anxious, pulse contracted and
very frequent, prostration and stupor ; leeches re-applied.
5th. — Delirium, vomiting, and she refused her drinks. Mer¬
curial frictions, two ounces daily. 6th. — Delirium continual,
face sunk, pulse small and frequent, coma, refusal of drinks,
death. Autopsy .—The peritoneal cavity contained a small
quantity of sero-purulent fluid. The uterus occupied the
whole pelvis, its veins were filled with thick yellow pus,
which was poured forth from all points of the organ, but
especially its lateral parts ; towards the superior angles nu¬
merous large lymphatics were filled with pus, which were
prolonged into the broad ligaments, and ascended with the
ovarian veins to the abdomen. The great curvature of the
stomach was pierced by three apertures, each as large as a
three franc piece, the edges irregular and ragged, remark¬
ably soft, and of a brown colour, which gradually disap¬
peared ; some soft adhesions of recent formation united
these openings to the spleen and left lobe of the dia¬
phragm. The lungs were strewed with circumscribed nodo¬
sities, analogous to hemoptoic engorgements. The brain,
the heart, the liver, and in general all the organs offered a
softness and extreme flaccidity, which contrasted singularly
with the fine developement and rich coloration of the mus¬
cular system. The influence of pus in the whole circulation
was imprinted in strong characters on all the organs. The
disorganization wTith perforation of the stomach appears a
cadaveric phenomenon, but the symptoms observed during
life, the blackish colour of the vicinal parts, the ramollisse-
ment of all the other organs, and finally the adhesions which

16

Critical Review.

commenced round the perforations, exclude the idea to which
we refer. The ramollissements of dissimilar organs arose-
from a deleterious cause exercising1 its baneful influence on
the whole economy, as in the pestilential diseases, in typhus,
in the poisoning- of the blood by miasm, or in animals by
the injection of putrid matter in the veins.

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

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

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

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

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

M, Tonne! 1 e on Puerperal Fever.

17

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

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

Case XIII. — Typhus after haemorrhage, death.

Case XIV. — Typhus after delivery, gangrenous diathesis,
disorganization of the stomach.

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

“ Such are the numerous alterations we have observed in puerperal
fever, a disease extremely complex in its anatomical lesions, and
not less so in its symptoms.”

The following table will give a general idea of the dif¬
ferent alterations: — In 222 cases, the peritoneum was af¬
fected in 193; the uterus and its appendages in 197 ; the
alterations of the uterus and peritoneum, were differently
combined in 165; those of the former were isolated in 29,
of the latter in 28. The alterations of the uterus were,
simple metritis, 79 ; superficial ramollissement, 29 ; pro¬
found ramollissement, 20 ; inflammation of the ovaries, 58;
with ulcers, 4 ; — total, 190.

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

Suppuration of the veins writh those of the uterus, 32 ; with
ramollissement or putrescence, 11 ; with metritis and mmol-

n

VOL. V. - NO. 15.

i

18

Critical Review.

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

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

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

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

The inflammatory fever depends on phlegmasia of dif¬
ferent organs, as the peritoneum, uterus, and its appendages.

The typhoid form, on alteration of the blood consecutive
to suppuration of the vessels ; or concomitant with pu¬
trescence or ramollissement.

The ataxic form, on lesion of innervation.

These we shall describe in a future number, and observe
that we have condensed these clinical reports very consider¬
ably. All must agree that this is a most graphic and scien¬
tific description of the causes of the fatal diseases denomi¬
nated puerperal fever ; and that science is deeply indebted to
the author. The solidists will learn here a lesson which
must convince the most sceptical amongst them of the
absurdity of ascribing fatal child-bed fever to peritonitis.
They will also learn the impropriety of sneering at the
opinions of those who have seen most of the disease, a list
of whom will be found in our review of Dr. Gooch’s work,
and who maintained that the disease was not peritonitis. The
disciples of Armstrong, Hey, and Gordon, and they were
numerous, must now bite the dust; these men who cured the

19

M. Tonnelle on Puerperal Fever.

iiospital puerperal fever by antiphlogistic measures, and who
denied its typhoid or putrid origin.

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

III. — Observations on the Pathology of Venereal Affec¬
tions. By Benjamin Travers, F. R. S., Senior Surgeon

to St. Thomas’s Hospital. 8vo. pp. 75. London, 1830.

Longman and Co.

This little volume consists of an annual discourse, comme¬
morative of the Hunterian Society, delivered by Mr. Travers
at the close of his presidency of that body. The object of
our author is an unsuccessful attempt to prove the identity
of gonorrhoea, or we would say venereal uretritis, and sy¬
philis — an opinion maintained by Mr. Hunter, and denied by
almost all his successors. Mr. Travers has set little value
on modern works on the venereal disease, indeed he has not
condescended to notice one of them ; and probably as there
was not one that takes his view7 of the subject. He is also
forgetful of the arguments of those who are diametrically
opposed to his conclusions. In a word, there is scarcely an
assertion he makes which cannot be easily refuted ; and it is
quite astonishing that a surgeon of his eminence could hold
such heterodox opinions. His fame and eminence as a sur¬
geon stamp an authority on his work which will insure it a
general perusal ; and as his conclusions are calculated to lead
to the administration of mercury in common gonorrhoea — a
practice unnecessary and injurious according to the universal
voice of the profession, we cannot but examine his positions
with great attention.

Mr. Travers argues, that as certain forms of leucorrhoea
affect the husband, and cause purulent ophthalmia, there¬
fore gonorrhoea is not referrible to any specific quality of
matter. We admit the premises, but deny the conclusion.

20

Critical Re vine.

The symptoms and progress of urethral discharge in the
male, and of purulent ophthalmia, when caused by leueor-
rhcea, are much milder than if caused bv gonorrhoea. In the
former there is scarcely any ardor urinee, and never any of
the sequela? of gonorrhoea; indeed the urethral discharge is
slig ht and seldom purulent, never inconvenient, and scarcely
ever requiring medical treatment, Jn the latter the oph¬
thalmia is not so violent or obstinate as when caused by
gonorrhoea ; neither does it follow that because leucorrhoea
may cause the diseases alluded to, gonorrhoea is not a spe¬
cific disease. But what appears a more fatal objection to
the assertion, is afforded by our author in a subsequent page,
when he holds gonorrhoea and syphilis to be one and the
same." Surely syphilis is at all events a specific disease,
and totally different from leucorrhoea, or rather, as our con¬
tinental brethren would say, vaginitis.

The next position is that gonorrhoea is of a simple inflam¬
matory nature, its ordinary origin is from the irritation of
purulent matter, and may arise independent of intercourse,
or after connexion with a sound female.

This position is admissible in simple, but not in virulent
gonorrhoea. There is no fact better attested than this, that
purulent discharge from the genital organs of both sexes,
from the period of infancy upwards, may arise from causes
purely physical, chemical, or specific. Venereal excess be¬
tween two persons whose organs are healthy, may cause a
discharge more or less intense in one or both ; but still the
symptoms are not so violent as in gonorrhoea. Even children
of both sexes are subject to genital discharge before and
during dentition, from worms, or from local injury of the
sexual organs, as in cases of defloration of female children.
The last fact is one of great importance to those who are
called on to give evidence before magistrates, or in courts
of justice, in charges of rape. The accused may be free
from gonorrhoea, and declare that if the child is infected it

is not bv him. The medical man should ascertain the
t •/ » » » .

lesions, and discriminate between pmulent discharge the
consequence of violence and inflammation, and that arising
from infection. The history of the case will enable him to
form a correct opinion in the majority of instances, and he
ought to ascertain whether the child has not been subject to
discharge previously to the supposed offence. In a case in
which we were consulted, and which is recorded in our
January number, p. 48, the girl had laboured under purulent
discharge five years before, and was then ten years old, and
exceedingly delicate. On that occasion we afforded abun¬
dant evidence of the liability of female infants, and of girls

Mr. Travers on the Venereal Disease .

21

to the age of puberty, to purulent discharge from the vagina.
But to return to the point in question. We know that equi¬
tation, injury on the perineum, calculus in the bladder, stric¬
ture of the urethra, haemorrhoids, gout, rheumatism, certain
cutaneous diseases, as herpes, impetigo, serpigo, lepra, &c*.,
the terebintbinate medicines, lytta, spices, diuretics, sexual
intercourse during the catamenial or lochial evacuations,
the introduction and long retention of a bougie in the ure¬
thra, irritation in different parts of the alimentary canal, con¬
stipation, certain aliments and medicines, as new beer, aspa¬
ragus; &e. — in a word, diseases of organs which strongly
sympathize with the genito-urinary system may cause simple
gonorrhoea. Cases are recorded in which gastro-enteritis,
diseases of the respiratory system, coryza, cynanche, pneu¬
monia, and asthma, had terminated by a copious discharge
from the urethra. It is admitted that there is a reciprocity
of action between the mucous, serous, fibrous tissues, the
digestive, respiratory systems, the urinary apparatus, and
the urethra, and uterine system, and that none of these sys¬
tems can be irritated or inflamed without affecting the ure¬
thra or uterine apparatus. So also the latter organs cannot
be affected without implicating the former tissues in various
degrees. Dr. Titley relates a case in which he supposed
venereal g*onorrhcea existed for a period of three days, and
for which he prescribed the usual remedies, but before the
patient had taken the medicine, he was seized with a smart
attack of £*out, and in a few hours the urethral discharge had
vanished. \\ e have no evidence, however, to shew that
simple gonorrhoea can infect a healthy person, or be fol¬
lowed by phimosis, paraphimosis, excoriations, orchitis
(hernia hum.) irritable bladder, or the usual sequel© of the
virulent form of the disease.

The next opinion offered by our author is, that in go-
norrhceal matter from an unbroken surface, there is no poison,
and no secondary symptoms follow, f< for the inflammatory
secretions of the sound surface are not absorbed into the
system ; but if there be excoriation or gonorrhoeal ulcer,
then the matter is poisonous, is absorbed, and causes se¬
condary symptoms.' " — p. 11. Few surgeons will agree with
Mr. Travers on these points. It would have been interest¬
ing to examine the proofs in favour of the transition of
simple purulent discharge into infectious matter. None,
however, are adduced, and it is rather too much to suppose
we- shall take the statement for granted on mere assertion.

Pa ssing over the pathological inaccuracy of calling a sur¬
face sound, that is, healthy, when inflamed, and examining
the assertion that absorption does not take place except the

22

Critical Review.

surface is broken, we should like to know by what argu¬
ments Mr. Travers could have refuted the general opinion,
that syphilitic matter is absorbed on the unbroken surface of
the glans penis, or prepuce, or that mercury, fixed and es¬
sential oils, turpentine, and ether medicines, are absorbed
under similar circumstances. The received opinion is, that
absorption goes on in every tissue in the body. Drs. Dill
and Murray have established this point, in their interesting
works, which we noticed on a recent occasion, more espe¬
cially as to cutaneous imbibition. How often have we
allayed excessive vomiting', after the failure of the usual
remedies, by opiate frictions and plasters applied to the
epigastrium. Have we not daily examples of absorption
taking place in the serous, mucous, and synovial tissues'?
If the modern theory of the pathology of dropsical effusion be
correct, which is that it is caused by increased vascular action,
either congestion or inflammation of the serous or cellular tis¬
sues, have we not conclusive evidence that absorption goes
on in these tissues when thus affected by the sudden removal
of the effused fluid ? Again, have we not shewn the morbid
effects consequent to phlebitis of the uterine and other veins,
when absorbed into the system, and without any breach of
inflamed surface ?

But Mr. Benjamin Bell has proved that inoculation of
the glans penis with gonorrhoeal virus will not produce
chancre or secondary symptoms, and that the insertion of
chancrous matter in the urethra will not produce gonorrhoea
but chancre — facts which are totally disregarded by our
author. If there is excoriation or ulcer from g’onorrhoea,
he holds absorption of the virus, which he first maintained,
was no virus at all, takes place, and secondary symptoms
will follow. How is it, we ask, that no one else beside
Mr. Travers has arrived at this conclusion'? How is it that
gonorrhoea generally, almost invariably, passes through its
different stages without causing excoriation or secondary
symptoms, and yet it is one and the same as syphilis? But
this point will come again under consideration. The follow¬
ing is our author’s account of secondary symptoms arising
from gonorrhoeal ulcer : —

“ The secondary symptoms of the gonorrhoeal sore are as strongly
marked, and present as distinct a character as those of lues. The
glands in the groin are oftener enlarged and indurated, than other¬
wise, in protracted cases ; but, as in proper gonorrhoea, the affection
is sympathetic. The appearance of secondary symptoms is certainly
not peculiar to these cases. The inflammation of the velum palati
and uvula is diffuse and superficial ; the surface is roughened with
innumerable small tufts of white lymph, or pitted with small and

Mr. Travers on the Venereal Disease. 23

shallow indentations, where ulceration has taken place. These are
so slight as often to escape ordinary observation. They are seen
chiefly upon the tonsils, uvula, apex, and edges of the tongue. The
sharp, deep, and clean fissures of the tonsil, like the roughened and
pitted tonsil, are consequent upon gonorrhoeal ulcers of the genitals ;
but this appearance is later, and I am disposed to think, induced by
the partial and alterative action of mercury upon the system ; in
other words, a progressive stage towards the cure. The gonorrhoeal
sore throat is accompanied by considerable irritability, to stimulant
fluids especially. The excavated ulcer of lues, with its abrupt high
coloured margin, is not more strongly characterized, or more readily
distinguished. The cutaneous affections are slight, and in character
presenting less variety than those of lu£s, so far as my observation
enables me to speak. The papular and squamous are the most com¬
mon, the puscular and tubercular, occasional. The lichen and pso¬
riasis upon the trunk and limbs, and the achor and acne indurata,
thickly distributed upon the face and verge of the hairy scalp, are the
forms which I have chiefly recognized. The attempt to discriminate
and class the minute varieties of primary sores, and to establish cor¬
responding determinate forms of cutaneous eruption, appears to me
to suppose an uniformity at variance with observation, if not with
nature, and to render what is sufficiently clear for all practical pur¬
poses, studiously obscure. General character is a sure and sufficient
guide. This will pretty infallibly distinguish the gonorrhoeal sore
from the chancre, the gonorrhoeal sore throat from that of chancre,
and in most instances, the eruptions consequent upon either, from
the eruptions produced by mercury. I have not, however, attained
such nicety of discrimination, as to pretend to determine the cha¬
racter of the primary sore from that of the eruption, with any feeling
of confidence. The scrotum is frequently the seat of scabbing exco¬
riations and eruptions of a peculiar character, connected with a
morbid thickening and elongation of its extensile cutis. These, I
believe, are generally depending upon direct irritation. The verge
of the anus likewise presents peculiarly characterized eruptions,
which 1 have been sometimes disposed to regard as resulting from a
similar cause.

“ The conjunctival palpebra sometimes inflames, producing psoro-
phthalmia, and the membrane of the septum and interior nares exul-
cerates. Tenderness and soreness affect the flat bones occasionally ;
but I do not think the periosteum inflames to deposition, unless after
exposure to cold under the excitement of mercury. This symptom,
however, is from these circumstances uncommon except among the
working classes, whose sufferings in all ways are subject to great
aggravation from this cause.

“ One or more joints are sometimes painful when the eruption or
sore throat are present.

“ Ligamentous inflammation, especially in the large joints, as in
the knee or elbow, and inflammation of the sclerotic tunic of the
eye, are frequent accompaniments of the gonorrhoeal inflammation in
scrofulous subjects, and are sometimes vicarious with it. These,
the inflammation of the neck of the bladder, the hernia humoralis

24

Ori g in a l Com mu meat ions.

and bubo are sympathetic affections, independent of absorption, and
by some regarded as translations of the inflammation, the gonorrhoea
usually declining when they appear. But the circumstance is too
variable to admit of this explanation in general. The neck of the
bladder, testicle, and groin are affected by sympathetic continuity
and contiguity ; the ligamentous capsules and sclerotic by remote
sympathy. These textures resemble each other, both being fibrous,
but they have no analogy to the urethra ; and unless we suppose
the ligamentous sheath of the penis, or the close coat of the testicle
intermediately affected, the link which connects them is not ob¬
vious.” — p. 18.

The purulent ophthalmia caused by the disease under
notice, is also described, and we are informed that a portion
of the matter spirting- into the eye of a medical man in the
act of syringing- that of a patient, has too often proved de¬
structive to sight, and lastly the gonorrhoeal poison, like
small pox, is communicated to the foetus in utero by an in¬
fected mother, also to an infant at the breast; p. 19. The
last is another notable discovery. Before we offer a com¬
ment on these extracts, we shall add our author’s plan of
treatment. He employs the ordinary remedies in simple
gonorrhoea, but he administers alterative doses of mercury,
such as Plummer’s pill, with sarsaparilla, when secondary
symptoms appear. Such is the mode of curing gonorrhoea
by the senior surgeon of St. Thomas’s Hospital. We need
scarcely remark, that nearly all the hospital surgeons of this
city, who have written or lectured on the disease, hold an
opposite opinion to Mr. Travers, both as to its nature and
treatment ; and no one more remarkably than Sir A. Cooper,
whose just condemnation of the administration of mercury
in the treatment of gonorrhoea is well known to the profes¬
sion. The majority of the surgeons of the same hospital are
of the eminent baronet’s opinion, as well as the whole pro¬
fession. This diversity of opinion is extremely remarkable
after all that has been written on the venereal disease.
Mr. Travers, however, attempts to prove the identity of
gonorrhoea and syphilis; he says, “ they are one and the
same, and differ only in degree of intensity and extent of
their operation.” — p. 22. His arguments appear to us un¬
satisfactory and inconclusive ; they are as follow : —

“ I have said, that whilst on both sides the surfaces remain sound,
no constitutional disease is discoverable. But before we decide that
the matter secreted in gonorrhoea and in syphilis have no relation to
each other, we must shew that the gonorrhoeal secretion being ab¬
sorbed into the circulation, as in the case of superficial sores, is inca¬
pable of producing constitutional, or as they are called secondary
symptoms. Now I aver that such a connecting link between these
diseases exists, and is palpable to observation. I have already

Mr. Travers on the Venereal Disease. 25

described the symptoms arising from the gonorrhoeal matter, and it
cannot I think be denied, that the resemblance is such to those of
syphilis, as to establish their very intimate relation if not their iden¬
tity. If a constitutional disease be traceable through the medium of
gonorrhoeal sores in a subject hitherto immaculate, the next step in
the inquiry is to determine the operation of a constitution already
tainted with the poison of gonorrhoea upon sores of this description.
Are not the natural secretions of the bowels, the skin, and the kid¬
ney, influenced by the deranged state of the constitution ? Are not
the morbid discharges from simple wrounds and ulcers, having their
origin in casualties, also subject to vitiation from a similar influence ?
We know that the unhealthiness of the matter of ulcers and suppu¬
rating surfaces, of whatever description, is constantly and truly re¬
ferred to a prevailing morbid state of the system. Thus, if a poisoned
habit contracts a sore, though the sore may have been caused by an
accidental laesion of the skin, it becomes at once contaminated, and
secretes a virus possessing properties not observed to belong to the
secretion of a fresh and healthy system : the property, for example,
of exciting upon a new surface an inflamed vesicle or pustule, which
is followed by an excavated ulcer, instead of a superficial, raised or
level, sore, and which runs into phagedenic ulceration, whether on
the glans penis, or the tonsil ; of affecting parts of the system not
within the ordinary range of the milder poison, as the iris and the
periosteal membrane;* of exhibiting cutaneous eruptions peculiar in
colour, figure, &c., and differing somewhat in other respects, though
that remains for future research to determine, from the class to
which they respectively approximate.

“ From this observation it would seem that the gonorrhoeal and
syphilitic poisons are the same in kind, and that the only difference
between them consists in the degree of their intensity and extent of
their operation. The purely local production of the gonorrhoeal
matter, prior to the participation of the constitution, would lead us
to expect a wide difference between the secondary symptoms of
gonorrhoeal sore and those of lues ; in which last the sore is as much
constitutional as local, and the matter secreted is in effect a poison.
For I consider that the primary sore of lues is in its nature a consti¬
tutional or secondary sore, having originally been the production of
a system already impregnated with the venereal poison. The matter
of poison being once engendered, its communication to another re¬
quires no such conditions as a breach of surface or an impure con¬
stitution in the recipient. In its most intense and concentrated form
it may at once be communicated by its proper irritation and inflam¬
mation to a novice, and the recurrence of the circumstances stated
as explanatory of its origin and derivation from the gonorrhoeal stock,
must be sufficiently frequent to perpetuate and renovate the matter
of infection without limit.” — p. 26.

From tfrese premises are drawn the following* conclu¬
sions : —

“ It appears then that a simple or primary gonorrhoeal sore may,
VOL. v. — no. 25. E

2b

Critical Review.

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

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

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

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

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

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

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

Mr. Travers, on the Venereal Disease. 2 7

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

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

28

Critical Review .

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

Mr. Travers on the Venereal Disease.

29

that so eminent a physiologist could have arrived at such a
conclusion. Dr. Hamilton has long taught that ill cured sy¬
philis in either parent was a cause of premature labour after
the seventh month, and Dr. Beatty of Dublin, has published a
valuable paper in confirmation of the opinion, which we have
noticed elsewhere in describing this kind of labour.

“ The infant, if born alive, is weak and delicate, and seldom lives
—it generally dies in the womb ; and its death is marked by a shiver¬
ing fit, cessation of motion in it, and flaccid breasts. This sort of
pregnancy frequently occurs to the same woman. A course of mer¬
cury before conception is the only remedy, when a venereal taint is
suspected ; and it must be used by both parents. Trans. Dub. Col.
of Phys. 1824, v. 4. Also Drs. Joseph Clarke and Hamilton. I
have lately met with two cases of this disease : one woman miscar¬
ried at the seventh month, with a copious discharge of amniotic fluid,
and a putrid infant ; she had lost six children in this way, and three
at the eighth month — According to Dr. Beatty of Dublin, both parents
must use a full course of mercury ; and unless a large quantity be
taken, a cure will not be effected. His papers, in the transactions of
the Dublin College of Physicians, vol. 4, p. 24, are worthy of se¬
rious perusal. He informs us, that the Dublin physicians have held
this opinion since 1792. Dr. Hamilton inculcated it in 1819 and
1820. After taking a proper quantity of mercury, healthy infants
will in future be produced.” — Manual of Midwifery, p. 183.

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

30

Critical Review.

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

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

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

“ If ulceration is making rapid strides, the better plan is to in¬
troduce the remedy by the skin in frictions, night and morning1 ; and
if the system resists its entrance, to aid the process by the pill. In
cases of great debility, I begin with the oxymuriate or the mercury
and chalk, as a test of the capability of the system to bear it. The
anodyne, if need be, and the tonic of course should be continued.
In most cases mercury and bark or sarsaparilla are exhibited with
excellent effect at the same time. In ulcers of the throat fumiga¬
tions are of the greatest efficacy. I often depend upon them alone
in weakly persons, while other medicines are directed to the sup¬
port of the system. They effect an improvement more rapid in

Mr. Travers cm v 'er, treat

31

He adverts te the recent plan of treating syphilis without
mercury, and concludes that the mercumlhts ani their op¬
ponents discourse c-t verr iiTe rent to. mgs. He men returns

to the treatment.

He enumerates the secondary eruptions and observes that
the profuse and wasting action of mercury is nevcr called for
that we knew little of its mode of action, except a? a stimu¬
lant at the same time to the arterial ani absorbent actions,
and easeetenbT a purgative to the while secretory system.
Our noth: r next considers the imuricn s effects of a cc mb na¬
tion of the venereal poison, ani the actio n of mercury upon
the system, subject to a iiitiinal aggravation from scrofula
ami the operation of cold mi Intemperance The each-xis
thus derived are a most thrmiiable class of diseases. The ef¬
fects of mercury are the predisposiig, ani col is and dram
drinking the exciting causes of these inseas.es.

The only mercurial eruptio ns, * according to Mr. Travers,
are enema ani impetigo miens, ani the immense number as-
eribedto this cause bv manv. are almost invariablv subjected

•mm"* m «

t: the use of the medicine whim is supposed to induce them.
The emaciation . pallor, fetor, the deep, eroding, foul ulcers,
the worm eaten bones of the while cranium, the sloughing
of the posterior fauces, of the soft ani hard palate, the fall¬
ing in of the nose, the loss of the genitals the agonizing
night rams, the severe hectic, ani c Tensive sweats. See.
are best relies ed by infusion decoction, of sarssrarnha in
line water. Its n aver says Mr. Travers. * ; is the most ex¬
traordinary nitre so than of anv other drug with which I am
acquainted. To regard it as inert, as a mere .diluent, or an
m : Tensive nutrient . is either a proof of very limited experience

32

Critical Review.

or a very prejudiced observation.” We fully agree with our
author on the last point, and are convinced were the me¬
dicine properly prepared, we should have heard much less of
its failure. Mr. Travers next describes a peculiar and for¬
midable form of venereal, which we shall place before the
reader in his own words.

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

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

Mr. Travers on the Venereal Disease.

33

pelvis deprived of its soft parts. The girl dies typhoid with a dry
black tongue, and is first delirious, then comatose.

“ When the pain is severe, and the disc of inflammation strongly
marked, blood-letting is beneficial to both. I usually apply lint
soddened in a saturated solution of the extr. opii. over this a poultice
of linseed meal, and cover the whole with a fomentation flannel.
This seldom fails to relieve, if not to remove the pain. The exposure
of the sores and the change of dressings much augment it ; the con¬
tinued application of warmth and moisture as much abate it. After
clearing the bowels with castor oil, I give a draught of camphor
julep with a drachm of ether, and ten minims of the tinct. opii.
every four hours ; and half a grain of opium additionally, if the pain
is very urgent, ff the slough is fast, and the ulcer extends, the
surface is washed freely with the strong nitric acid, and it is remark¬
able that very shortly afterwards the girl expresses great relief. The
London treacle poultice I likewise find an excellent application,
covered by the fomentation flannel. The object to be looked to for
directing the application, is the colour of the surrounding skin; when
this pales, the dilute nitric acid lotion, ten drops to an ounce of
water, is the best application. Fresh eggs and milk, and as the sto¬
mach acquires tone, a mutton chop, and from ten to twelve ounces
of port wine daily, are an appropriate support. The occasional re¬
petition of the oil or the common enema ghould not be neglected
under the habitual employment of opium.

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

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

— no. 25.

von. v.

r

34

Critical Revievj.

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

IV. — A Treatise on Deformities ; exhibiting a Concise
View of the Nature and Treatment of the principal Dis¬
tortions and Contractions of the Limbs , Joints , and
Spine ; illustrated with Plates and Wood-cuts. By Lionel
J. Beale, Surgeon. 8vo. pp. 248. Five Plates. London,
1 830. J ohn W ilson.

(Continued from Vol. IV. p. 483.)

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

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

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

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

Mr. Beale on Deformities of the Limbs , fyc.

35

degree of the deviation of the parieties of the thorax. The large ves¬
sels, the thoracic duct, and great sympathetic nerves, follow the
course of the spine, and make the same curves. The viscera of the
abdomen are also displaced and often compressed, but they suffer less
in general, than in curvature forwards.” — p. 151.

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

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

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

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

m

Critical R eview .

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

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

Mr. Beale on Deformities of the Limbs, fyc. 3 7

■ >

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

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

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

38

Critical Review.

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

Mr. Beale on Deformities of the Limbs, fyc.

39

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

f\

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

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

ORIGINAL COMMUNICATIONS.

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

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

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

40

Original Communications .

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

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

Dr. Ryan on Ethics of the Present P eriod. 41

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

Dr. Gregory defended the necessity of medical men being
versed in all the branches of the healing art, and concludes
by observing, “ Every department of the profession is re¬
spectable, when exercised with capacity and integrity. I only
contend for an evident truth, either that the different branches
should be separately professed, or, if one person will pro¬
fess all, that he should be regularly educated to, and tho¬
roughly master of all. I am not here adjusting points of
precedence, or insinuating the deference due to degrees in
medicine. As a doctor’s degree can never confer sense, the
title alone <5an never command regard ; neither should the
want of it deprive any man of the esteem and deference due
to real merit. If a surgeon or apothecary has had the
education, and acquired the knowledge of a physician, he
is a physician to all intents and purposes, whether he has a
degree or not, and ought to be respected and treated accord¬
ingly. In Great Britain, surgery is a liberal profession. In
many parts of it, surgeons or apothecaries are the physicians
in ordinary to most families, for which trust they are often
well qualified by their education and knowledge ; and a
physician is only called where a case is difficult, or attended
with danger. There are certain limits, however, between
the two professions, which ought to be attended to : as they
are established by the customs of the country, and by the
rules of their several societies. But a physician, of a candid
and liberal spirit, will nfiver take advantage of what a nominal
distinction, and certain privileges, give him over other men
who, in point of real merit, are his equals; and will feel no
superiority, but what arises from superior learning, superior
abilities, and more liberal manners. He will despise those
distinctions, founded in vanity, self-interest, or caprice ; and
will be careful that the interests of science and of mankind
shall never be hurt, on his part, by a punctilious adherence
to formalities.

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

vol. v. — no. 25. e

42

Original Comm it n ic alio n s .

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

The attendance should be in proportion to the urgency
and danger of the disease. A patient or his friends have a
curiosity to know the nature of the medicine prescribed,
which it is often very improper to gratify ; but other cases
occur in which it may be proper to acquaint the patient with
the nature of remedies, as the peculiarities of constitution
require great attention, both as to the quantitj7 and quality of
certain medicines. Such are the chief of the duties of medical
men, according to the amiable and revered Dr. Gregory ;
the observance of which cannot fail to promote the honor
and dignity of the profession. He included many minor
topics, which need not be recorded at the present period.

There are certain duties belonging to the learned profes¬
sions which are supreme, and which no individual and no set
of men can either, for themselves or their successors, vio¬
late, renounce, or neglect, without substantial injustice.
These duties, so far as they relate to physicians, are com¬
prised irf the oaths required by the Universities, Colleges of
Physicians, and in one of the Colleges of Surgeons, in this
empire. The substance of these oaths is that proposed by
Hippocrates nearly 2000 years ago, and the oath was for¬
merly administered in all Universities in which medicine was
taught, to those who were created doctors, and to those who
were licensed to practise by the Colleges of Physicians. The
oath required by the Edinburgh University is in the follow¬
ing words. After an invocation of the Deity, the graduate
pronounces these words : “ Turn porro artem medicam caute,
caste, probeque excercitaturum, et quoad potero omnia ad
segrotorum corporum salutem conducentia cum fide procu-
raturum quae denique inter medendum visa vel audita silere
convenit non sine gravi causa vulgaturum. Ita presens spon-
denti adsit numen.” fC To practise physic cautiously , chastely
and honorably ; and faithfully to procure all things conducive
to the health of the bodies of the sick ; and lastly, never,
without great cause, to divulge any thing that ought to be
concealed, which may be heard or seen during professional
attendance. To this oath let the Deity be witness.” I be¬
lieve no similar oath is required by the Universities of Ox¬
ford, Cambridge, Dublin, Glasgow, Aberdeen, or Saint
Andrew’s, or by any of the Colleges of Physicians or Sur¬
geons, except those of London. The Royal College of
Physicians requires the following promise from its members,
fellows, and licentiates, and prescribes a code of moral sta¬
tutes: — Dabis fidem te observaturum statuta Collegii, aut
mulctas tibi contra facienti irrogandas prompte persolu-

Dr. Ryan on Ethics of the Present Period.

43

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

De Conversatione Morali et Statutis P cenalibus .

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

2. Nullus Socius, Candidatus, vel Permissus salutatione
officiosa, vel animi benevoli obtentu, opem medicam ultro
offerat, nedum subministret segro cuilibet, quern Medici
cujusvis, sive Socii, sive Candidati, sive Permissi, curse
commissum esse cognoverit, et ad quern non accersitus
fuerit.

3. Si quis autem malitise hujusmodi convictus fuerit,
praeter ignominise notam quam isti (quantum in nobis est)
inuri volumus, quadraginta solidos mulctetur a Presidente
et Censoribus.

4. Si quis paciscatur cum Pharmacopolis de aliqua pretii
parte ex medicamentis praescribendis percipienda, si sit
Socius aut Candidatus, et hujusce delicti a Prsesidente et
majore parte Sociorum in Comitiis majoribus sive ordinariis
sive extraordinarus prsesentium convictus fuerit, e Societate
nostra, vel e Candidatorum ordine, expellatur.

5. Sin Permissus delicti hujusce a Prsesidente et Censo¬
ribus, aut eorum majore parte, convictus fuerit, decern libras
quotiescunque id admiserit, mulctetur.

6. Medicus quisque, sive Socius, sive Candidatus, sive
Permissius fuerit, sing’ulis suis schedulis, in quibus mgri eu-
ratio prroseribitur, diem praescriptionis, aegri nomen, et su

44 Original Communications .

O

denique nominis literas initiales adscribat j nisi causa intersit
a Praesidente et Censoribus approbanda.

7. $i plures Medici curationis gratia convenerient, consul-
tandum est surama modestia, et non nisi semotis arbitris a re
alienis. Nec quisquam prsescribat, imo ne innuat quidem,
quid agendum sit, coram aegro, aut adstantibus, priusquam
junctis consiliis inter ipsos Medicos curandi methodus fuerit
constituta. Sin autem Medici in diversas iverint sententias,
ita ut in eandem medendi methodum consentire nequeant,
surama tamen prudentia et moderatione se gerant ; eorumque
dissentionem ita, ut tarn eegro quam amicis ejus quam mini¬
mum molestiae pariat, ordinarius medicus aegro aut adstanti¬
bus significet.

8. Qui leges has eonsultandi non ohservaverit, et a Prse-
sidente et Censoribus aut eorum majore parte convictus fuerit,
quinque libras mulctetur.

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

10. Omnes mulctae quae per statuta nostra irrogatae fue-
rint illico solvantur.

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

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

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

4. — If any one shall bargain with apothecaries for any
per centage on prescriptions, if a fellow or candidate, and
if convicted in the manner before mentioned, he shall be

Dr. Ryan on Ethics of the Present Period. 45

expelled from the fellowship, or from the order of candi¬
dates. ;

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

6. — Every physician, whether fellow, candidate, or licen¬

tiate, shall inscribe his initials, the date of the prescription,
and name of the patient, on every prescription, unless some
cause intervenes which shall be approved by the president
and censors. - , ; . ;

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

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

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

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

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

46

Original Communications .

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

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

[ 47 ]

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

II. — Case of chronic disease of the Liver.

By G. G. Warden, Esq. Surgeon, Limehouse Fields.

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

48

Original Communications .

nausea. Medical assistance was immediately sent for and
refrigerating medicine administered, pulse 120 intermittent,
great debility, 10th. — About 10 or 12 ounces of blood were
again ejected, not so congealed and of arterial colour, pulse
varying from 120 to 130. lith. — V.S. t0 3xij.l2th. — No return
of haematemesis, 13th. — Pulse 100, regular, debility not so
great, difficulty of keeping the bowels relaxed. 14th. — Left his
room and came down stairs; when sitting on his sofa, he com¬
plained of a sensation of something having suddenly burst
in the abdomen, which immediately produced syncope ; Mr.
Fitzpatrick was immediately sent for, and on examination
the tumour could be distinctly traced, and the abdomen had
assumed a regularity of form. An* operation was proposed,
and a trochar was introduced midway between the superior
spinous process of the ilium and the last inferior costa, and
two pints of serous fluid were extracted. A second opera¬
tion was proposed to be performed in the lined alba, a little
above the symphysis pubis, but on account of the diversityof
opinion of the medical attendants respecting its propriety, it
was deferred. From the drawing off of the fluid, he gradually
improved so much so as to be able to take exercise (the sys¬
tem being kept up by stimuli) until the 28th of March last,
6 p.m. when walking with Mrs. W. he requested her toleadhim
home, as he was losing his recollection, and expired the fol¬
lowing day, at the hour and day he prognosticated he should
die.

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

Mr. Fischer on the Cure of HydrojAiobia . 49

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

Query. — What was the tumour that contained the fluid,
extracted in the operation, and what could have become of
the coats of the tumour, as no traces of the same were to
be found in the post mortem examination 1

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

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

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

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

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

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

As to cure the bite of serpents in South America, where I
was a missionary amongst the Indians for a series of ten
years, viz. at Surinam, Berbice, and Demerara, between the
4th and 7th degree of latitude, I never heard there of the Mi¬
kania Guaco, but 1 actually and effectually cured all kind of
very painful and dangerous serpents’ bites, after they had been

vol, v. — no. 25.

n

50

Original Communications.

O

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

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

If then any antidote for serpents’ bites will cure hydro¬
phobia, my specific salt, viz. common kitchen or cooking
salt, w7hich is in every poor man’s house, will undoubtedly
cure hydrophobia.

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

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

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

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

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

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

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

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

51

Mr. Fischer on the Cure of Hydrophobia.

i

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

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

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

Having quoted the above journals, I shall now inform the
reader of what caused me toftry and apply salt to serpents’
bites. It is a page of the late Bishop Loskiel’s, (with whom
I was personally acquainted,) in his History of the Missions
of the Moravian Church in North America, which says, as
far as I recollect, that at least among some tribes , they were
not at all alarmed about the bites of serpents, having always in

use such a sure remedy as salt, for the cure of them so much

•/

so, that they would suffer a bite for the sake of a glass of
rum.

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

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

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

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

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

A most extraordinary instance, an English Journalist said.

52

<1 • n v , C om -m& xic&ii 0*4 .

some veers ago o: the ratal fcnseqacace of hydrophobia,
has occurred a: Bombay.

**" A £en:2einaii was barren by a dog and in Lis pari oiar debit
a friend. — he cams to see him . both lingered sine rime and
died."

-*' Can ns one rmirtame himself by discovering a
rernedv ; Government indeed shoal a crier a rrineelv sum

• i •

for a care of it.”

I — The A mu Matermms (or Mark of the Mother), cared

bv d aecimtiori.

m

ra m nr era a zi m no vtxms kuuc&l a ~ ~e>~ - ~ .

Sra — rr_ ; a : this re.anra :: a use e-a: aa:e tae fe¬
ller benign extension of the property of -raceme lymph, be
fa Toured by yen: approbation aan m sen: an in a work so
pre-eminently conducted and widely circulated as tae Lin¬
den Mem cal anm Surgical Journal. it will be highly gratify¬
ing and sensibiv felt bv veer obedient ana oimred mm:n
• • « —

J GHN M \a>H All

53. Jem vn Streef fane. 1130.

Tex Listen of ‘he fallowing case relating to surgical prac¬
tice. and connected with vincinati: n. may. it is hoped. he
•aeemea wonhv cf emnnncaaor I: proves an important
fact that amf ^rferra j mav he efeeraallv removed bv

• — V

the lenient means, ye: powerful agency c: vaccine lymph.
This method cf care in sni-h cases, being of compara¬
tively reoent date. :: mav nm as yet n -rheas he generally
known ; and therefore the primary object ts to aaat in far¬
ther emending the Ln_w ledge cf the advaitage derivable
from the practice.

Tnet the sufferings of naiLm: from small pox are gieath.
dim ini' bed by ate sebsthotiaa of vaccine*., on Is most ree-
dilv admitted bv all the members of the ben tv. as well as
the public. Bat h is team a to manifest its nrhenee by cb-
fitentug the uni muxtermmjs without danger or pain. This
disease Is cbTiocsiy named after, and also attributed to tae
imagananaa cf the mother, d.rlrg the period c: gestation,
whose tender besom is wounded by imririnnf of the deepest
regret, while sae sen eras tae fasimtt : g. bat nsaxmad fea¬
tures of her offspring. Tae i vressmg appreh ns.oa of
da: arcr and sure man striting’ arnm ‘he dice a an nee ted

Mr Manlali A^r .1 3/ i.

Z3

with n* reaztrraL by the r^mfil «l£Mgq with me n~’~ o€
the sammm is coined e tv c_spiisd t t die miSd oc*!niix

ef raoczao.

The .ztsfdl a&: T5.=c*fer scare cf the sc ::-^r: •=• -j*
die samcijcit blcol Tessels !-?a*:kz to the 'art wtea
din-dec ct the knife hmmnv c:c-rnoe in - = ~ — e: t i i ire

T T T ‘ _ _

z me s>_-t-Ci -i ’ - k sec

m:i m

hsmirrbijre . whi.L is also hjeieasec mrcogt b~ m
dire :: me irJaalcIe drealati

j
_

knecaie cause :-: cei:_rr cmm.niny nf«q>vs e reccces
CGeralesteaee. inn a pratrac-fed recc mry :: hesltn Bn
exermc icier ail me scnermm h oec*hc«e even when
aHfally cerfimed c* sr neme* Lhtle bet er ;h» me
disease, and merer me m nee:i;e ie^ree c: recrisl 5
bet m.j cb-ane: . in cccmc recce or me ex r^mccn ef¬
fected K the scribe! kavi^ * -1— « ri.ft ■■• ■ . <■ (• 1 k

me frmmmrl *nc ramfrl cf me men err

- - - ■ ■ j

m MsntLv scan : *

*■ “j *

mesmes at me nee

3 t i..x r‘.c\l -XT e^SSO C

T' : r~ ' ;

' c -roc mm n ee mere erne

1 ^ ■

re *cn:. m rename ::

the Leermc cf
otmoFt rriev cf me snrec Tee nm h-rwemn cf
me fjUrmnn ease may eceimelfy seme m frmre :r i»srr:
in dLspelimsr the icnrecensr-r-n :: ±1! sorh cesm.nes I:

ei also be exe*
seat- mx be. ce~-

mr trial nr mm: exrersrm m

nr £

- :

. e s. enm nnme see* e*e_

m chose ccnsrcmorns whith ire

5 _ s_ec«rzh*-_ e . r

rressrrc bears nr ccnrccsrr mm tbit whim is formed by

- ~ v-r rfa
— — —

Tn:s emrnn- :r :s been ickno»Ie*Je«»i

* micmcee

those me mm a.m~ it e bmc_v sne-

mim* c€

mm.

T

. _ rr

ceeoeo. trader :he immemire end skhfni
those ex rebec : sure errs Mr La mem e inn Mr

Game lime: Min Is30. i heilcin n si 1: fee mre cf
cce year ire e mb: mem? ms m :-o cr: eo. On me exter¬
nal :::c ie cf me rime: e.row 1 m m nzz-:-i > i ^rts fes-
nnm. bon need cm xcj irregnlsr Margin m ecmh mne-e
qaam-s of an inch, in t-rmnb fall mi: in mrh. me m me
arm a: cm j tc ::•: c s me w hole resets b c 1 pari Le . :mie ,
aon cc 1 deep no c: cla ret ernm Arhe? cm kirn nTe romnns
came let: arts. 1 cmccsmea mice *c rhe ere*: rec. who,
wen 1 fee ice c: irtel imenee rearL*. comchec by iE-:*:zr
the enme serfire. is well is me ?:rc-nc:pt:z:r cc me
’irt/. to be rrwlv toce-mmn w::h 1 li cee : . moeiceco-

_ ^ ^ m ^ r ^ * •

1 men with f m l mrome l :ccch I: my be cc<:cc m 1
pcameal view here m reemne. isuc afrec -ce«: :icn each cf

: me hc-viO

w ccoa-

tne cctse mres. vherher oa the len ana. i|
l essen b v the t^nriwaeii and insemicc cf the : erd : n c: me

54

Original Communications .

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

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

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

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

Mr. Marshall on Ncevus Maternus.

55

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

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

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

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

The success of the operation appears to be wholly de¬
pendant upon a large number of vesicles, sufficient to excite
the action of the absorbent system, but above all by form¬
ing a crust large enough to cover the whole surface of the
ncevus', which holds mechanically hi its substance the colour¬
ing vessels of the part, which during its prog'ress, is at
length cast off by a re-production of skin.

We understand that the operation has sometimes proved

56

Original Communications .

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

The ncevus mat emus is variously defined by anatomists ;
the etymology of this word, however, is well under¬
stood to comprehend a natural mark, freckle, spot, blemish,
or excrescence in the body.' T-he ‘foregoing case, although
deep in colour, and of an average size, did not project be¬
yond the natural surface of the skin, while others extend
a little above, and are found, perhaps, of a more direct*
aneurismal affection of the cutaneous arteries. But never¬
theless, they equally require removal, and the mode of
operating and curing by the vaccine lymph is just the same,
and applicable to all. .• i :

The ncevus maternus has- been lately extirpated by an
eminent surgeon, who has most, kindly communicated- the
principal phenomena that accompanied the case 5 which,
however, fell short of the termination we had at one time
reason to anticipate, as the treatment was not followed up
while: opportunity offered. As many of the incidents con¬
nected with the case were somewhat peculiar, they became
so ;particularlydnteresting’,: that theywere deemed worthy
of promulgation ; (inasmuch as they may assist in illustrat¬
ing the superior advantage of obliterating - the- disease
through the innocent medium and gentle means already
exeiuplifiedj and notwithstanding the total; failure of the
case,; we may be , permitted • to -say, 0“ fas est ab koste
doaerj” 1.0 97 - . . ; ■. i

A male infant w:as afflicted - with a ncevus maternn-s , ex-
eeeding an inch; in length, and forming a narrow parallelo¬
gram, .situate, upon the upper part «*f;the chest, neaT the
right .collar bone. . Since itwas evidently increasing in size*
its removal was deemed expedient by means of excision.

Mr. Marshall Nafvits Matermts . 57

The operation was accompanied by a profuse haemorrhage,
and several enlarged cutaneous vessels were secured by
ligature ; the wound, however, quickly healed, but unfor¬
tunately, a part of the mark escaped the knife, which, by
enlarging-, hastily acquired the size and form of the flat
surface of a split pea. The young gentleman, however,
not having been vaccinated, the remaining part of the mark
was freely punctured and innoculated with recent vaccine
lymph ; all of the punctures bled so much as to frustrate
the operation. The patient having been also vaccinated in
one of the arms, a solitary vesicle resulted, which, however,
from the general failure of the rest caused a state of vex¬
atious disappointment, and after all the circumstances of the
ease, this vesicle turned out to be an unwelcome intruder.
The following plan was projected, but through the hurry
of other avocations it fell to the ground, but nevertheless,
the value of the intended practice remains unshaken. To
prevent as much as possible the threatened diminution of the
power of the vaccine lymph, both constitutionally and lo¬
cally, arising from this maturing vesicle ; the ncevus was to
have been re-vaccinated on the fifth day, subsequent to the
original puncturing, with recent lymph from sixth day vesi¬
cles, with the confident hope of thus ensuring a higher
chance of success. The adoption of this measure was
strongly recommended, because we have frequently had
occasion to remark, in the course of practice, that the
earlier the lymph is employed, the greater is the certainty
of successful vaccination. In private practice, it is readily
allowed that parents and guardians are generally better
satisfied with the appearance of the vesicle on the eighth
day, although it partakes of ancient prejudice, yet in a case
of so much importance, where the aim is humanely intended
to supersede the casualties of a cruel operation, a little ar¬
gumentative reasoning, with a faithful explanation, would
speedily remove the opjections of the most fastidious.
Hence we are justified, of the charge of inconsistency in
all such pressing cases, to deviate even from the golden
rule of vaccination, which we have laboured to inculcate
never to be acceded ; or should the operation have been
already, or primarily done from eighth day lymph, that in
the possible event of either a total, or more especially a
partial failure of the punctures, as soon as this important
point can possibly be accurately ascertained, the adoptipn
of even the fifth or sixth day’s lymph had better be sub¬
stituted for the eighth.

VOL. v.-— no. 25.

i

58

Origin aL Communications .

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

V .—Cases of Rheumatism affecting the Ovaria, with Prac-
■ i tical Remarks. By J ames Copland, M.D. Consulting
Physician to Queen Charlotte’s Lying-in Hospital, Senior
Physician to the Royal Infirmary for Diseases of Children,
&c.

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

* CEuvres posth. t. ili, p. 5P. v

M. VilleneuveDiction.de Sciences Medicates, t. xlviii . p. f*60.

p Des Malades propres aux Femmes, p. 562.

§ Art. Ovaire Diction, des Scion, Med. t. xxxix. p. 15.

Dr. Copland on Rheumatism affecting the Ovana, 59

♦

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

Case 1. July 3, 1820. —I was called at ten o’clock, p.m. to
Mrs. P. residing’ at Walworth, aged about 30, of a full habit
of body, and sanguinous temperament, married, but without
children. She had been ill about three days, and she attri¬
buted her attack to having- slept in a damp bed.

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

fib Hydrarg. submur :

Pulv. ipecueuanhse aa. gr. vij ;

Opii puri qr. ij ;

Syrup, simp, q. s. m. faint pilulse iij. sfatim sumendae.

Vx Mist. Camphorae, Bjss.

Magnes. Sulphatis, 353. ; ,

Tine. Colchiei, 5j>

Spirit Lavaod. Comp. 5ss. m. a fiat haustus quamprinium mane
capiendus.

4th. A oon. — The pills procured her a good night, with
copious perspiration; 'and she had two bulky, bilious, and
offensive motions this morning from the draught. , She com¬
plains now of the pains more towards the lumbar region,
where they arc still as severe as ever ; and they shoot across

60

Original Communications.

the iliac regions to the inferior part of the hypogastrium, on
each side, in the situation of the ovaria, where the pain is
permanent and severe. It is increased on pressure. Urine
in small quantity, high coloured, with a frequent desire to
pass it. .Darting pains in the mammae, with nausea. Pulse
90, and oppressed, much thirst, no appetite, tongue still
loaded. The perspiration continues copious, but without re¬
lief of the pain. 1 now directed a full blood-letting from the
arm, which was performed by my friend Mr. Bryant, to the
extent of eighteen ounces, and prescribed the following :

XC Massse Pilul. Hydrarg. 9j.

Hydrarg. Submur. gr. v.

Extract! Colocynth. co. 3j. m. liant pilulee viij.

Capiat binas statim, iterumque eras, primo mane.

1,V Mist. Camphorae, 3vjss. ;

Tinct. Colchici, 3ss. ;

Spirit /Etheris Nitrici, 5bj- ;

Syrup Aurantii, 5jss. •; m. tiat Mist, cujus Cochlcaria ij< larga
capiat tertiis lioris.

R Hydrarg. Submur. qr. vj ;

Pulv. Ipecacuanha, qr. vjj ;

Opii puri, gr. i j ;

Syrup, simp. q. s. in. tiant pilule iij. bora somni sumendae.

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

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

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

Upon examining the lower region of the abdomen, a small

Dr. Copland on Rheumatism affecting the Ovaria. 6i

tumour may be felt in each iliac region, rising above the pu¬
bes in the situation of the ovaria, they are painful on pressure.
Complains also of the darting pains and soreness of the
mammae. The mercurial taste is now evident in the mouth.
Mercurial preparations were therefore omitted.

Admoveantur harudines xviij. imo abdomini, posteaque foveatur
abdomen.

fy. Aquse Menth. Virid. Bviss ; •

Magnesise Sulphatis, Bj ;

Tinct. Colchici, 5vj ; * " , • • 1

Spirit Lavandul. Comp. 3j^ ;

Olei. Caryoph. m. vj.

Capiat Cochlearia ij. larga tertiis horis.

fy. Pulv. Ipecucuanhse, gr. vj.

Opii puri. gr. ijss. ■ >

Syrup. Simp. q. s. m.

Fiant Pilulse ij. hora somni sumandec.

6th. — The bowels have been freely opened, but the mo¬
tions are still bilious and offensive. Tongue also loaded in
the middle, but cleaner towards the edges. The pain in
the situation of the ovaria is much diminished since the ap¬
plication of the leeches, which bled freely. Sickness fflso
is much less troublesome. Pulse 88, and softer. Urine
paler,and accompanied with less pain and difficulty to pass it.
There was some appearance of the catamenia early this
morning', although a fortnight before the time ; but they
have now disappeared.

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

IU Tinct. Aloes. Comp.

- Castorei aa, 3yj.

- Colchici, oSS. ' ,

Aquse Menth. piper, yvj.

Olei. Juniperi Sabinse, m vj. misce: Fiat Mist, cujus cochlea-

ria duo larga tertia quaque hora sumat.

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

The pain still continues to shoot occasionally to the iliac
regions, but is not now so readily increased by pressure in
these situations; and there is still a darting pain in the
mammae sometimes felt, but the sorenesss has disappeared.

Continue the mixture prescribed yesterday. As she had
some return of appetite, she Was permitted to have some
light iish for dinner,

62 Original Communication s .

8th. — The catamenia are now abundant; and she com¬
plains only of slight sickness in the morning, and of occa¬
sional shooting pains in the region of the ovaria, and
in the mammae. Tongue not quite clean ; appetite return¬
ing. The bowels have been freely open ; evacuations more
natural.

Infus. Calumbse, Bvjss. ;

Tinct. Calumbse.

Spirit ./Ether. Sulph. Comp. aa. *ss., M. -

Fiat mist, cujus sumat coehlearia duo ampla tertiis vel quartis horisS

]y Pulv. Rhei, gr. xv ;

Magnes. Carbonatis, gr. xxv ;

Pulv. Ipecacuanha, gr. j ;

- Zingeberis, gr. vijj ;

Aquse Menth. pip. 31SS. ; m. bat baustus hora somni sumendus,
prius agitata pbiala.

9th. — Feels quite recovered this morning, and is now able to
leave her bed. "l ongue clean, and pulse but little above the
usual standard. The sickness and shooting pains disap¬
peared soon after taking the mixture. The catamenia
abundant. The draught procured a copious and healthy
evacuation this morning. Appetite has returned, and she
complains only of weakness.

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

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

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

Dr. Copland on Rheumatism affecting the Ovaria* 63

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

Case If. — 1 7th March, 1826. — I was called to Mrs. C. re¬
siding in Portland-street, aged 34, married and the mother of
th r.ee children. She had experienced two abortions, and had
had several attacks of rheumatism. The menstrua! secre¬
tion had been regular and abundant, and somewhat more
frequent than usual. She had been, during the preceding
fortnight, labouring under a severe attack of rheumatism of
the let t thigh and hip, and referrible. chiefly to the situation
of the sciatic nerve. For this she had had recourse to some

liniment or embrocation which she had used assiduously,

*

but had taken no other medicine; soon after the use of this,
she was seized witlr severe pain in the left side of the hypo-
gastrium and loans, with darting pain in the left mammae : but
the pain had quite left the original seat. Upon examination
by the hand a tumour of about the size of an egg couid be
felt deeply seated in the region of the left ovarium. She
had much fever, occasional sickness: the pulse was 96 and
somewhat full and hard, and the tongue loaded and furred.

04 Original Communications.

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

I directed twenty leeches to be applied on the hypogastric
region, and these to be followed by warm fomentations. Pills
of calomel, ipecacuanha and opium, similar in respect of the
quantity of each of these substances, to those prescribed in the
first case, were directed to be taken at night, and a purgative
draught early in the morning ; a mixture, consisting of mist,
camphorae, magnes. sulphas., tinct. colchici and spirit ether,
nitrici. was ordered to be taken through the dav : and an

QJ %) '

emollient saline enema was administered, in order to remove
any fecal accumulation and cause of irritation which might
exist in the colon. These medicines acted copiously, and
brought away bulky, feculent, dark and offensive motions.
Considerable relief w'as procured from these means, which
were continued without change during- the 18th and 19th.
The pain and tumefaction of the ovarium still, however,
continued : blit the symptomatic fever was diminished ; the
tongue was cleaner and the evacuations were of a better
colour and less offensive.

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

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

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

Dr. Copland on Rheumatism affecting the Ovaria. 65

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

1, Bulstrode Street, Cavendish Square,

2 6th June, 1830.

BIBLIOGRAPAHY.

• • ■ ' ' * • '• • " " ■■ ' -US-V-sr ! ; ’ ' \

ANATOMY.

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

observes : —

■

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

* Dublin, 1830. 8vo. ppi 39. Seven Plates. Leckie. London
1830, 8vo. pp. 50. ■

- t J* F. Meckel, Manuel d’Anat, t. ii. p- 318.

VOL. v. no. 25.

K

66

Bibliography .

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

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

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

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

Anatomy.

67

dev elopement of the human structure. The muscles are detached by
springs, in successive layers, until the skeleton is exposed. The in¬
ventor next removes the calvarium, when the brain is presented in
sections, and the origin of the nerves, plan of the eye, nasal fossae,
back of the mouth, &c. are almost naturally displayed. He removed
the intestines, and demonstrated the portal and circulatory systems,
the diaphragm, lungs, pericardium, and cavities of the heart, con¬
taining red and black blood. The labour of twelve years was
bestowed on this grand piece of mechanism, and similar models are
executed at the price of 300f., or 120/. This invention is valuable
if it even convey general notions of descriptive anatomy ; but the
splendid plates of Mascagni, in which every organ and tissue of the
human body are most accurately represented of the adult size, and
which may be inspected at our publishers, are, we hesitate not to
pronounce the most accurate delineations ever made by human in ¬
genuity. These magnificent engravings excel those of this or former
ages. They present the most complete resemblance — a perfect imita¬
tion of the human structure. They are published under the sanction
of Berlinghieri, Barzelloti, and Rosini, professors in the University of
Pisa.

MORBID ANATOMY.

' 3. A work entitled, “ A ,V ademecum of Morbid Anatomy, medical and
Chirurgical, with pathological observations and symptoms, illustrated
by 250 drawings,” has been recently published*, and contains “ Ob ¬
servations on, and illustrations of, the changes of structure found in
the brain, thoracic, abdominal, and pelvic viscera, and of the organs
of generation in both- sexes. It likewise gives the pathological symp¬
toms, by which we judge of disease during life, and a true description
of the changes are exhibited after death.” This is a useful work,
and will be referred to with advantage by young practitioners. The
plates are well executed, and illustrate many varieties of diseased
structure. The symptoms of each disease are given in general with
accuracy, and are placed opposite to the plate illustrative of the
malady. The engravings are executed with great clearness, the
morbid appearances are well represented ; and we can safely recom¬
mend the work both for the accuracy of its design, and the elegance
of its execution. It fills up a void which has long existed in an im¬
portant department of medical science. To the profession generally,
it will be found a most valuable acquisition. It is evidently compiled
by a man of sound sense, practical experience, and very extensive
knowledge of the subject. It is the only work of the kind in a con¬
venient form ; its materials are carefully collected and judiciously
illustrated; and its price is very moderate.

OBSTETRICY.

4 Extraordinary Obsteric Figure. — Dr. Azenne has constructed a
figure for facilitating the acquirement of obstetricy. He has suc-

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

68

Bibliography .

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

MEDICINE.

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

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

f On Canine Madness, comprizing the symptoms, post mortem ap¬
pearances, nature and cure of rabies in the dog and other domestic
animals, 1830, 8vo. pp. 52, Longman and Co.

Medicine.

ffl

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

“ The human being, however, has a dread of water, which the
quadruped has not. It is true that the dog is unable to swallow,
but he flies eagerly to the water ; and all other quadrupeds, with per¬
haps an occasional exception in the horse, drink with ease and with
increased avidity.”

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

70

Bibliography,

his colleagues have operated on 400,000 persons bitten by dogs (he
could not say that all of them were rabid) and he was not aware that
one of them had been lost. *e This at least, is most consolatory,
whatever may become of my theory of the caustic/’ He also states,
that excision after the appearance of the disease, may save the pa¬
tient ; and if the symptoms recur, they may be again subdued by re¬
excision. Med. Chir. Annals of Altenburg, 1821. Troillet. He pre¬
fers the caustic, but candidly admits, that it and the knife may fail,
and that re-inoculation has been produced by the latter. Lastly, he
describes the effects of various preventives, ‘‘the box — alisma plan-
tago — belladonna — Scutellaria — combinations of drugs — experiments
on the Scutellaria and belladonna combined, bleeding, cauterization of
the poll, mercury, opium, ammonia, cantharides, guaco, veratrum
sevadilla, the ticunas.” All of which are inefficacious. We strongly
recommend Mr. Youatt’s very scientific pamphlet to our readers.

6. Piperine in Intermittent Fever. — Drs. Elliotson and Roupell
have recently spoken of the value of piperine in the cure of inter¬
mittent ; but the article is so very expensive in this country, that it
cannot come into general use for some time.

, 7. London Medical Society. — The last meeting of this society,
for the season, took place a few evenings ago, when a paper was
read by Mr. Stephens, on suppuration of the joints, after smallpox,
unpreceded by inflammation. Dr. Copland alluded to cases of
uterine phlebitis, in which purulent deposits took place, and he was
iuclined to think from the suddenness of the formation of the absceses
without inflammation. He alluded to the opinion prevalent on the
continent, that pus might be eleminated from the minute vessels
unaccompanied by inflammation.

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

Mr. Lloyd, Mr. Proctor, and Mr. Dendy agreed with the last
speaker.

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

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

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

Medicine.

71

tive exercise for half an hour or an hour after the bath. The symp¬
toms become diminished in a short time, and after fifteen days or a
month, a chorea that had existed for many years will be entirely dis¬
sipated. Simple affusion of cold water on the head and body, re¬
peated seven or eight times in succession, produces the same good
effects. This method is preferred when women are affected. Three
cases recently cured by this plan, in the Hotel Dieu, are related.
The first case was that of a boy, set. 16, who had been affected
with chorea for many years. He was admitted the first week of
April last ; and was ordered decoction of valerian and cold baths, as
already mentioned. The fourth day there was decided amendment,
and in five weeks. May 15, he left the hospital, perfectly cured.
The second case was one of a girl, set. 17, who had been one month
affected with chorea. Cold affusions only were applied, and in
three weeks she was cured. The third case was one of a girl, set.
13, sister to the first patient. She had never menstruated, and was
three years affected with chorea. The whole body and both sides
were attacked with the disease. She was subjected to twelve cold
affusions on the 1 6th of May : they were continued till the 28th,
when she had no sign of the disease. She used no other remedy. —
Journ. Hebdom. Juin.

9. We have lately been consulted in a violent case of Chorea of the
right side, and finally of the left, combined with hysteria, by Mr.
Bradford, of Fleet Street. The lady was aged 16, had menstruated
twice, but at an interval of some months between the periods. The
right inferior extremity was constantly affected with painful spasm,
and often flexed on the pelvis. The right arm was also in constant
motion. There was the globus hystericus. The bowels were
habitually constipated. The complaint was ascribed to excessive
mental exertion at school. Sir Astley Cooper had seen the case,
and recommended small doses of oxym. hyd. This remedy pro¬
duced no effect ; the symptoms became aggravated, the limbs were
constantly affected with spasm, and the patient continually scream¬
ing from pain ; such was the state of the sufferer at our visit. The
bowels having been properly regulated, she was ordered carb. ferri,
in doses of 15 grains, three times a day — the dose to be gradually in¬
creased — and a mixture composed of tine. Valerian am., tinct. foetid,
tinct. castor., sulph. aether., and tinct. opii. — and the cervical and
dorsal vertebrae were rubbed with ung. tart. ant. three times daily,
as recommended by Mr. Tate. This plan of treatment was continued
for three days, with an increase of the iron to 25 grains, with some
relief; when the hysteric paroxysm increased to the highest degree,
and the patient appeared as if affected with opisthotonos for two
hours. It appeared to us that this paroxysm was probably a critical
change, and this opinion we communicated to the ordinary attendant
on our way to see the patient. On our arrival she was much more
tranquil than during our attendance ; the motion of the limbs was
much less ; the pulse, however, 130. The relatives were so much
alarmed at the late paroxysm, that they seemed desirous of having
further advice, though they expressed the fullest confidence in the

n

Bibliography.

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

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

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

SURGERY.

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

In the museum of the Royal College of Surgeons. The preparation
had been sent to London several years since, and was placed in a
cellar, where it might still have remained, had not the attention of
Dr. Stevens been directed to it, by the doubt thrown on the opera¬
tion by Mr. Lawrence, in his last course of leetures at St. Bartholo¬
mew’s Hospital. The preparation was examined by that gentleman*
and several other eminent surgeons, who admitted that the vessel had
been tied. The patient lived ten years after the operation. The in¬
ternal iliac has also been tied in this eountry by Atkinson, but con¬
secutive hemorrhage destroyed the patient : it was tied in America
by Dr. Pommeroy White, in the West Indies, (the preparation sent
to Sir A. Cooper, and placed in the museum of Guy’s Hospital) and
also in St. Petersburg'. It was said that Mr. John Bell performed
this operation.

12. Siaphyloraphiy — -Reunion of the soft palate, M. Roux per¬
formed this operation on the 4th of May, the forty eighth time with
success. The opening in the palate was slight, three sutures were ap -
plied and adhesion was perfectly effected, op. cit.

13. Academy of Medicine, Paris, May, 4. — Hydrophobia, M.
Ferns reported on a memoir by M. Cbaume, of the department of
Loiret, which contained an account of six persons who were bitten
by a she wolf in September, four of whom died, and two were now in
health. They were most severely bitten, and were saved by excision
of the injured parts ; the mode of performing this operation was pecu ¬
liar, but not described until a future sitting, when it will be fully
detailed. The thanks of the academy as also their medal were
awarded to the author. The wolf was killed, but no trace of inflam¬
mation discovered, op. cit.

14. Aneurism of the heart and aorta. — M. Larrey, presented a man
aged from 36 to 40, affected with hypertrophy of the heart, whose
state was singularly improved under the influence of rxioxas and sca¬
rifications.

Physiology.

15. Royal Academy of Medicine, Paris , May *22d.— ~M. Piorry
reported to the Academy, the result of his experiments on the insuf¬
flation of the lungs of living rabbits, of the lungs of sheep, and man
after death. He concluded, 1st, that insufflation seldom causes rup¬
ture of the lungs unless too long and too violently continued, that
death is caused by a mixture of air and blood in the heart, or by a
double hydrothorax, or by the distension of the abdomen, that this insuf¬
flation may cause subpleural, but not interlobular emphysema, and
that insufflation of the digestive tube is almost as promptly mortal as
that of the lungs, by preventing the descent of the diaphragm and im¬
peding respiration. *2ndly. That crepitation always indicates disease,
and depends on froth in the bronchi, or on the mixture of air
with an effused fluid, giving rise to rale and causing asphyxia or death.
3rdiv. That the effusion of blood into the trachea from a wound is
dangerous, as it is expectorated or absorbed with difficulty, and is dis¬
posed to be converted into froth. 4th. If water pass into the lungs
during submersion, it is easily poured off bv giving a declining posi-

Vol v — xo. 25. L

74

Bibliography'.

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

MM. Leroy, Magendie, and Dumeril are opposed to M. Piorry ’«
opinion.

CHEMISTRY.

16. Institute of France, Meeting, May 10. — Salieine substitute for
quinine. M. Magendie read in his own name and in that of M. Gay
Lussac, a report on a memoir by M. Leroux, apothecary of Vitry-le-
Francais, relative to a chemical analysis of willow bark, and on the
discovery of its immediate principle as a substitute for sulphate of
quinine. M, Leroux had considered this substance a new alkali, but
he renounced this opinion after having experimented before the above
commissioners as the extract of willow did not combine with acids as-
alkaline substances do, it was decomposed by them, and by commixture
lost all its properties. He therefore was mistaken in thinkinghe had
discovered a sulphate of salieine. His report was nothing more than
the discovery of a substance called salieine, which in a pure state
presented itself in the form of very fine white pearly crystals, very solu¬
ble in water or alkahol, but not in ether, its taste very bitter- and
aromatic. It is obtained by boiling lbiij of the bark, salix helix,
(Defontaines), for an hour, then drying and pow7dering it, in Oxv of
water impregnated with carb-potas yiv. when cold, liquid acetate of
lead Oij, are to be added, when a deposit takes place ; it is filtered
and treated with sulph. acid, and the lead precipitated by a current
of liydro-sulphuric acid. The excess of acid is saturated by the c.
ealcis, filtered, the liquor concentrated and saturated to neutraliza¬
tion by diluted sulph. acid (etendue,) it is black and filtered while
hot, it is crystalised and dried without exposure to light. This ope¬
ration affords an ounce of salieine, but on a large scale double th e
quantity is obtained. Mr. Magendie has employed the remedy on se¬
veral occasions in June 1829, and has found it an excellent febrifuge.
He has cured many cases of intermittents in a day, by three doses of
salieine of six grains each. M M. Miguel, Husson, and Bally of
the Hotel Dieu and Le Charit6 and many other practitioners have
tried it with similar success, and all declare that from 20 to 30 grains
will arrest the febrile access of whatever type. M. M. Brugnatelli,
Buckner and Fontaine had experimented on this substance, but were
unable to isolate it pure and crystalised, which M. Leroux only has
accomplished. — Journ. Hebdom. Mai. 15.

Hygiene.

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

Hygiene.

ih

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

MISCELLANIES,

18, Royal College of Physicians, May 31. — Dr. Turner in the chair.
Dr. Hawkins read a paper detailing experiments, relative to the pre¬
vention or cure of Hydrophobia, and the bites of Serpents by Caesar
Hawkins, Esq. surgeon to St. George’s Hospital. The author of this
paper has arrived at the conclusion, that there are two forms of
hydrophobia both in man and animals ; or that the disease may be
mild or severe. He remarks, that little attention has been paid to
the incipient symptoms which are too often overlooked. He had em¬
ployed the guaco, but with no better effect than when he had achni-
■nistered prussic acid, and his experiments led him to conclude that
the effects of this antidote are extremely doubtful.

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

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

Ik S. Quinse, gr. xxiv. Pil. Cambog. c. gr. xxxvi. fiat pill xij.

Th Pulv. Ipecac, gr. Jliyd. c. creta, gij. S. Quinae, gr. ss., rnagnes.
vel. pulv. rhei q.s, m. ter indie sumundae.

76

Miscellanies.

ROYAL SOCIETY OF LONDON.

19. Lithotrity. — This interesting and important improvement in Sur¬
gery, is now beginning to attract universal attention. At a meeting
of the Royal Society on Thursday 19th ulto., the most crowded of any
which took place this season, a paper was read from the pen of Mr.
W. B. Costello, entitled “ Lithotrity ; its applicability , as on operation
for the cure of Stone> illustrated by a series of cases” Mr. Costello
is an Englishman, and has, till lately, been the colleague of the dis¬
coverer of this method, Dr. Civiale, of Paris, conjointly with whom
lie has relieved a great number of persons suffering from this malady.
In France, Lithotrity has already taken its rank amongst surgical ope¬
rations, and it is this gentleman’s object, Us he expresses it in his
paper, “ to endeavour to render this method of operation popular in
England.” Since his arrival in London, last July, several very re¬
markable cures have been effected by him.

Mr. Costello’s paper begins by stating the importance of enquiring,
whether the benefits Lithotrity pretends to offer, be not more specious
than real ; and for the purpose of guiding this enquiry, he submits to
the Royal Society a series of cases illustrating its advantages. His
paper embraces other objects. The importance of the new method
of curing stone, having excited the attention of the public, a clear
statement of facts is rendered necessary — “ 1st, in order to set bounds
to the enthusiasm of those, who expect more from it than this method
can accomplish ; 2nd, to enable practitioners in general to discrimi¬
nate those cases, which are within the scope of this operation ; and
lastly, to impress on the minds of the sufferers themselves, the neces¬
sity of applying in time, the cure of this cruel disease ; — the new
method being always certain, and attended with very little pain in its
early stages.

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

Miscellanies.

W 3T-

fortunate ; and the fourth, who required two applications of the in¬
strument for his cure, thought so lightly of the matter, that at the
second sitting, he told the operator, ‘ ‘ I have suffered severely for the
last year, and I dreaded the cutting operation of all things ; but I
shall now take no more trouble about regimen, for if my disease re¬
turn, it is only the business of five minutes to be rid of it.”

Mr. Costello closes the narration of the simple cases by the follow¬
ing reflections These cases exhibit the operation of Lithotrity in
the most favourable point of view, and are well calculated to shew
the safety and efficacy of this method. It is obvious, the earlier this
operation is resorted to, the more certain and easy will be the Cure.
When time is not given to bring on the general sympathy of the con¬
stitution, with the local irritation, — and local irritation has not gone
the length of producing organic alterations in the urinary apparatus,
then is the application of Lithotrity certain in its effects, and attended
with little or no pain, or to speak more strictly, with none beyond that
produced by ordinary catheterism. The importance of an early ap¬
plication of this method, is well established by the results of our
practice in France. In 1824, only one-third of the sufferers,
who sought for relief by the new method, were considered in a fit state
for its application. Progressively, their number augmented to one-
half and two-thirds. During the last year M. Civiale had occasion
to perform the cutting operation in only two instances out of upwards
of thirty cases, and he lately observes in his correspondence with me,
that he has not had any of those formidable cases so frequent in the
commencement of his practice. Lithotrity in France has thinned the
number of calculous patients ; and those who in their turn have the
misfortune to be afflicted with stone, now begin to apply in time.
The establishment of a Lithotritic ward in the Hopital-Necker, under
the care of my friend, M. Civiale, will contribute mainly to the ad¬
vancement of an sera in Surgery, when cutting for stone will be a
rare event indeed. Though unsupported by the great dexterity and
surgical tact of the inventor of this operation, yet, I venture to hope,
that its progress in this country will be equally prosperous ; indeed,
such must be the desire of every friend to suffering humanity.”

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

Mr. Costello ushers in the narration of the cases contained inthesecond
class, by appropriate reflections. He candidly admits that their treat¬
ment is more tedious, painful, and difficult, than that of the cases in
the preceding series ; but he adds, even in these cases the success of
the new method is equally certain, and free from danger. In one of
these cases, the forceps of Sir A. Cooper had been employed but
without success, the calculi being too large for extraction by this in¬
strument. The patient was cured in three sittings, (the last of which
took place in Sir A. Cooper’s drawing-room ;) and after the opera¬
tion walked down stairs, in company with the medical men who had

78

Mi seel lanies .

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

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

Miscellanies,

79

true, it might have been considerably abridged ; but the patient lived
near me, in town, and for his sake as well as of that of lithotrity in
England, I felt bound not to be precipitate, lest I should have ex¬
posed myself, or the method, to a chance of failure.’5 There is
another case to which we deem it proper to advert, though in as few
words as possible ; it is that of Mr. J. V. Batley, a young painter of
great promise. This gentleman had laboured under this complaint
for the space of ten years, the calculus had attained the size of a hen’s
egg (the largest which Mr. Costello’s instrument can grasp,) and he
was wasted to a skeleton ; notwithstanding these unfavourable cir-^
cumstances, Mr. Costello effected his cure.

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

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

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

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

Dr. Whiting, Professor of Materia Medica, explained the medical
uses of the most important of those described by the lectruer on
Botany. .

BOTANY.

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

so

Miscellanies r

mus should be in flower when collected for medical use, without refer¬
ence to age. A paper was read from Dr. Hancock on a South American
plant, which he has found as valuable as cinchona, and he doubted
very much the febrifuge properties of the latter.

Dr. Whiting also very much doubted the tonic power ascribed to
this and other medicines.

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

Dr. W. did not consider himself at liberty to enter into a debate,
as the constitution of the society was against discussion. The mat¬
ter here dropped. It would perhaps be as well if the professors of this
society confined themselves to an exposition of the received opinions ;
for if they indulge in theorising or opposing the received doctrines,
they cannot expect that many talented physicians who hear them
will listen to such declarations without replying to them.

Mr. Everet was unanimously elected professor of chemistry to the
Society.

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

Various branches of the medical profession have colleges, charters,
and corporations, from which the General Practitioner is either altor
gether excluded, or attached as an appendage only ; he is not ad¬
mitted to a participation in their councils, or to share in their honours ;
as a General Practitioner, he belongs exclusively to no one branch,
and is, therefore, virtually excluded from all. -

A Society has, therefore, been formed, entitled “ The Metropo¬
litan Society of General Practitioners in Medicine and Sur¬
gery,” which is intended as an union of the Pactitioners of this class
throughout England and Wales, for the protection of their mutual,
and individual interests ; having the following objects ; —

1st. — Such alteration of existing laws and customs as shall pro¬
mote the prosperity, and respectability of the general body of practi¬
tioners.

2nd. — The adoption of such measures as may be conducive to the
advancement of medical science, and of professional information.

3rd. — The periodical assembling of the members for literary and
scientific discussion — for the cultivation of social intercourse, and for
the consideration of general measures relative to the Society.

4th. — The creation of a fund to be appropriated to the protection
of the Members and for the general exigencies of the Society.

5th— The establishment of a benevolent fund, by contributions from
Members of the Profession at large and other charitable persons, for
the relief of distressed medical men and their families.

Miscellanies.

81

\

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

Notwithstanding that there are numerous charitable funds for re¬
lieving distressed members of particular branches of the Medical pro¬
fession, it is found that there are many Members of that Profession
who are not objects of relief from any of those funds ; and it is! there¬
fore, to supply this desideratum, that the Plan of a General Benevo¬
lent Fund has been adopted, the applicatoin of which, it is intended,
should not he confined to this Society exclusively , but should be extended,
at the discretion of the .Committee, to every Member of the Profes¬
sion.

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

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

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

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

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

William Gaitskell, President.

23. Ophthalmic Hospital, St. Petersburg. — From May 1828 to May
1829, 5751 individuals presented themselves at the hospital; of these
3797 were men, and 1954 women, the number of their visits w~as
17,687. The number of the operations was 520 — 4 for artificial pu-
pa. 78 for cataract, 205 for contraction of the eyelids, 34 extirpa¬
tions of tumours, 131 extractions of foreign bodies, 5 operations for
staphyloma, 10 punctures of the cornea, 1 for fistula lachrymalis, and
43 for different operations.

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

vol, v, — no, 25. M

s

Miscellanies .

©=>

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

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

Miscellanies. , So

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

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

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

Miscellanies .

$4

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

Miscellanies.

85

large towns, and who may neither have opportunity nor pecuniary
means of becoming acquainted with the multifarious medical produc¬
tions, domestic and foreign, which daily issue from the press. This
Journal can be procured through the Clerks of the Roads, General
Post Office, at a trifling additional expense. It is published the 1st
of every month, the price 2 s. 6d.

Appeal to the Profession on behalf of a distressed Member.

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

The London University . — We are sorry to perceive that a serious
misunderstanding has occurred between the Council of the London
University and its Professors, The cause of the existing differences
has not transpired, and fame with her thousand tongues has of course

been active on the occasion. Mr. Bell has resigned, as he considered

( # ...

the promises made to medical students in his introductory lecture
could not be fulfilled. We cannot understand the force of this reason,
as every candid man must admit that the medical professors in
their respective departments are men of the first rate talents, and
as a body stand unequalled in the medical schools of this metropolis.
Every one of them has his name inscribed in the annals of science- —
a fact that deserves consideration from those who attempt to depre¬
ciate the character of the medical department of the University. The
establishment of a royal rival institution may have some effect on
those who are so very prominent in the ranks of the opposition ; but
we very much doubt whether the embryo college vrill equal its pre¬
decessor. Tcmpora mutantur , #c.

86

Miscellanies.

BOOKS RECEIVED DURING THE MONTH,

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

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

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

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

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

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

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

7. An Inquiry concerning the Indications of Insanity, with Suggestious for the
better Protection of the Insane. By John Connolly, M.D. Professor of Medicine
in the University of London. London, 1830, 8vo. pp. 496. John Taylor.

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

8. Flora Medica, No 31. London, 1830. John Wilson.

O. A Practice of Physic, comprising most of the Diseases not treated of in “ Dis¬
eases of Women,” and tc Diseases of Children. By Wm P. Dewees, M. D. Ad¬
junct Professorof Midwifery in the University of Pennsylvania, See. Sec. Sec. Phi¬
ladelphia, 1830. 2 vols. Svo. pp. 833.

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

Miscellanies.

10. On the Diseases and Injuries of Arteries, with the Operations required for
their Cure — being the Substance of the Lectures delivered in the Royal College of
Surgeons in the Spring of 1829. Ry G. J. Guthrie,|F. R. S. Professor of Anatomy
and Surgery to the Royal College of Surgeons, Surgeon to the Westminster Hos¬
pital, to the Royal Westminster Ophthalmic Hospital, &c. &c. London, 1830, Svo.
pp. 416. Burgess a d Hill.

*** A work of great practical utility.

The following Journals are received regularly —

11. Medico-Chirurgical Review and Journal of Practical Medicine. Edited by
James Johnson, M. D. &e.

12. The Edinburgh Medical and Surgical Journal. July.

13. The London Medical Gazette, June.

14. The Midland Medical and Surgical Reporter. May.

■ * .......

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

t •

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

17. Gazette Medicale de Paris, Journal de Medecine et des Sciences accessories
paraissant tous les samedis. No- 1 to 14.

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

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

20. Journal des Progres des Sciences et Institutiones Medicales en Europe et
Amerique. Tome i, 1830. Paris.

21. Annales de la Medecine Pbysiologique. Mai.

22. Journal Universel des Sciences Medicales.

23. Journal Generale de Medecine Juin.

24. Nouvelle Bibliotheque Medicale. Juin.

25. Archives Generales de Medecine. Juin, 1830.

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

27. La Lancette Francaise. Juin.

*

28. La Clinique, Annales de Medecine Universelle. Juin.

29. Journal Hebdomadaire, Juin,

30. Journal der Chirurgie und Augen Heilkunde. Herausgegeben von C. F. V.
Graefe und Ph. V. Walther.

88

Miscellanies.

31. Archiv fur Aipat'omie-ufid Physiologie. J. F. Meckel’s.

*< -) y r ’ • • * i ’ , 1 ‘ 1 •*»> - -*

32, Journal der Pratischen heilkunde. Hnfiand & Osan’s.

. 33. Magazin fur die gesammte heilkunde. Rust’s.

•*. _ • .4 4 "f , ' :

34. Annali Universal] di Medicina del.Dottore Omodei. Milan.

35. Remarks on Hydrophobia prophylactic and curative. By John Murray,
F. S. A. F.L.S. &c. &c. London, 1330. Svo. pp. 82. See Bibliography.

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

37. Account of the Varieties in the Arterial System in the Human Body..: By
P. H.\ Green, A.B.M. D. Trin. Coll. Dublin. Seven Plates. Dublin, 1830. Svo.
pp. 39. J. M. Leckie. Reviewed in the present Number.

• " '. f

38. Neurology of the Human Body. By Barremans, revised and adapted to the
English Nomenclature. By Thomas King, late House Surgeon to the Hotel Dieu,
Docteur en Medecine de la Faculte de Paris, Member of the Royal College of Sur¬
geons in London, and Lecturer on Anatomy at ’the Alde:sgate Street Medical School.
Ten splendid Plates, with description. London, 1830. 8vo. pp. 16. Feuillet, Du-
mus, and Co. Leicester Square.

*** These splendid plates can be so arranged as to represent the body of the adult
size. They not only illustrate the minutest ramifications of the nervous system,
but various other tissues and organs. They are beautifully and accurately exe¬
cuted, both plain and coloured ;. and the adaptation of the. description to our
nomenclature is highly creditable to the attainments and industry of Mr. King.
They are rendered at a price so moderate as to be attainable to students, and are
well worthy of a place in every medical library, lecture room and private surgery.

Communications have been received from Dr. Sutton of Greenwich, Mr. Marshall,
Dr. Stoker of Dublin, Mr. Boyle of Dublin, Dr Dewees of Philadelphia, Mr.
Foote, Mr Warden, &c. - . . / .

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

I

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 26. AUGUST 1, 1830. VOL. V.

CRITICAL REVIEW.

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

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

Jackson.

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

VOL. V.— NO. 26. ' * 1

90

Critical Review.

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

91

Dr. Devvees on the Practice of Physic .

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

The second work at the head of this article is M. Mar¬
tinet’s Practice of Medicine, which is a proper companion
for his well known and justly esteemed Manual Pathology.
This is an excellent compendium of the French practice,
while it is adapted to our own by the emendations of Dr.
Norton. We have not met a work for a Son<r time which

o

contains in the same space so much useful matter; and we
strongly recommend it for its accuracy, perspicuity, and the,
valuable practical precepts with which it abounds. The
grounds upon which it founds its claims to approbation are,
brevity, accuracy, and natural arrangement. We are satis¬
fied that no medical man, young or old, can peruse this work
without gaining much information and knowledge.

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

92

Critical Review.

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

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

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

*

In elleclual and Moral Relations, 1830 See our Jan. No. vol. iv, p. 23.

Dr. Conolly on indications of Insanity.

93

thought, and by induction and careful analysis, lie has hap¬
pily contrasted sanity with insanity. The style is pure and
unadulterated English, no slight merit in these times, while
the tone of the work is manly, unprejudiced, and impartial,
and impresses the reader with a very favourable opinion of
the head and heart of the author, who has thrown the shield
of reason and philanthropy over that unfortunate class of
beings who are deprived of the chiefest faculty of our species,
which makes man the lord of the creation, and elevates him
far above its transient and useless concerns. We have no
hesitation in declaring1 this to be one of the most able and
satisfactory works on the philosophy or rather physiology of
the human understanding which has been hitherto produced.
Dr. Conolly has done for this branch of science what Dr.
Arnott has done for physics ; he has produced a work which
will have an honourable place in the annals of medicine,
while it reflects great lustre on the splendid institution to
which he belongs. We must however observe that it is not
a finished performance, for it is silent on the pathology of
insanity, a defect which we did not expect in a production
by the learned and experienced author. All our metaphy¬
sical writers have included as much pathology as he, but he
has exceeded all in the simplicity, beauty, accuracy, and
fidelity of his description of the constitution of the human
mind. Instructive and interesting as his description is, we
must decline to attempt its analysis, as the majority of
modern readers are much more partial to practical than to
theoretical details, and will be satisfied with being informed
of our author's conclusions. In justice -however to him and
to the favourable opinion we give of his w ork, we must make
a few extracts, most strongly recommending the original to
every class of medical men.

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

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

04

Critical Review .

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

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

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

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

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

Dr. Conolly on Indications of Insanity*. 95

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

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

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

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

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

96

Critical Review.

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

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

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

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

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

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

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

Dr. Conolly on the Indications of Insanity. 97

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

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

Further citations are unnecessary to prove with what perspi¬
cuity and force Dr. Conolly treats his subject. It must be
admitted by the most fastidious and cynical critic that his
descriptions are faithful, his deductions natural, his reasoning-
conclusive, his arg-uments decisive, his proofs convincing,
and his conclusions legitimate. He has avoided the wild and
extravagant reveries in which former writers on the human
mind so invariably indulged — he has appealed to the obser¬
vation and experience of every man. In his account of the
modifications and inequalities of mind in different individuals
he has cited the works of ancients and moderns illustrative
of the eccentricities and oddities of mankind in every age ;
and has afforded us an amusing and instructive narrative, in
a style not surpassed by our best novelists. He has adduced
numerous cases of this kind from personal experience, and
concludes, that in many instances persons are insane on a
certain point, though sensible in the ordinary affairs of life.
He arrives at the following* conclusions on the nature of
insanity: — “ The judgment is but the result of comparison ;
comparison is alternate attention ; attention is a faculty
dependent on the brain — the judgment is perverted in insa¬
nity, though in different degrees. The impairment of any
one or more of the faculties of the mind, accompanied with,
or inducing a defect in the comparing faculty is insanity

He illustrates these conclusions by a most minute analysis
of an immense number of cases of insanity detailed by
others, and arrives at the conclusion that men were insane
on a certain point, though rational on all others. But he is
of opinion that no man ought to be confined, unless he is
disposed to injure himself or others. He proves by the best
reasoning, that many of those who were consigned to mad¬
houses on account of some harmless eccentricity, should
have been left at liberty, and were perfectly competent to
manage their affairs. This part of the work will be perused
with great interest and advantage. We cannot conclude our
remarks on this section of the work without observing, that our
author has shewn an intimate acquaintance with general as
well as medical literature, of both the past and present ages.

VOL. V. NO. 26.

o

98

Critical Review.

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

[ yy ]

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

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

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

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

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

That a work of this description is much wanted, as Mr.
Hodgson’s excellent production is long out of print, must
be admitted ; and we are happy that a man of Mr. Guthrie’s
talents and experience has undertaken the task of supplying
the want. If his first paragraph be correct, and we have no
reason to doubt it, what must the profession think of the
College of Surgeons, who have voluntarily withheld for a
period of 30 years, the promulgation of the claims of Mr.
Hunter to the correct pathology of aneurism. What ought
the profession think of men who suppressed such important
information, and allowed foreigners to claim a priority of
discovery, to which it appears they have had no just title ?
Who can view such conduct without indignation. Our

100

' Critical Review.

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

* Diction, de Med. etde Chir. Pratiques. Art. Anevrysm ?.

Mr. Guthrie on Diseases of Arteries .

101

and they maintain that facts the most numerous and authentic
have proved this to be the cause of aneurism, as well as
rupture of the internal coat of the vessel. This is the
opinion of our author, who also asserts that no coagula occur
in preternatural dilatation, but are seen after the abrasion or
rupture of the inner coat, f<r a distinction,” says he, esta¬
blished particularly in England, for the sake of clearness of
expression, without being- of any practical utility, and the
same may be said of all internal aneurisms.” p. 49. This
distinction is not confined to this country, it is also held in
France,* and is said to be of great practical utility, simply
because, if concentric layers or coagula occurred in the
former, they would prove fatal. Our author calls partial
dilatation of the vessel true aneurism, and here he is again
at issue with our Gallic contemporaries. He is very properly
opposed to Scarpa’s opinion that rupture of the inner and
middle coats of an artery is the sole cause of aneurism. We
shall not follow^ him in his description of the various kinds
of aneurism, but observe that he considers chronic irrita¬
tion or inflammation the most probable cause of all. He has
not explained the modus operandi of such causes ; but we
may remind the reader that chronic inflammation diminishes
the force of cohesion of the parietes, deprives them in a great
degree of their contractibility, which in the natural state
enables them to resist the impulse of the ventricle. This
property being weakened in any part of an artery, dilatation
is inevitable, and may be complete or partial, according to
the degree of arteritis. The intensity of the circulation on
the arches of arteries may cause aneurism ; and our author,
as well as Scarpa, has shewn that the most powerful causes
of the disease are calcareous, terreous, atheromatous, and
ulcerous conditions — all the results of arteritis. Mr. Guthrie
next considers <c the termination and spontaneous cure of
aneurism,” which may be, 1, by coagulation of its contents ;
2, by sloughing ; 3, by accidental pressure of the sac upon
the artery. These methods are well illustrated by our
author. He proves the certainty of their occurrence, but is
unable to explain it satisfactorily. He next considers the
“ symptoms of internal aneurisms,” and clearly shews that
the diagnosis in such cases is extremely difficult. The suc¬
ceeding section is on the symptoms and diagnosis of
external aneurisms ; and in such cases the disease is of course
more readily discovered ; and numerous cases cited which
must be familiar to every surgeon of ordinary observation.
The “ medical treatment of aneurism” is next described,
which consists of rigid abstinence, approaching to starva-

* Op. Cit. — Art. Anevrysme.

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Critical Review.

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

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

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

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

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

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

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

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

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

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

Mr. Guthrie on Diseases of Arteries.

103

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

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

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

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

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

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

104

Critical Review.

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

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

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

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

Mr. Guthrie on Diseases of Arteries.

105

Explanation be correct or not, the fact is certain. A prae*
tical hint of greaJ importance is the following

“ When an artery is merely cut or torn, but not completely-
divided, it is in the same state with regard to hemorrhage, as if it
had given way by ulceration. It can neither retract nor contract,
and will continue to bleed, unless pressure be accurately applied and
maintained, until it destroys the patient. The practice to be pursued
is to divide the vessel if it be a small one, such as the temporal
artery, when it will be enabled to retract and contract, and the
bleeding will soon cease. If an artery of larger dimensions be
wounded, a ligature should be applied above and below the wound,
and the vessel may or may not be divided between them, at the
pleasure of the surgeon.” p, 253.

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

The opinions of Mr. John and Charles Bell are next as
severely animadverted on, and pronounced to be contrary
to the true principles of surgery,” 268. M. Dupuytren’s
opinions on the application of ligatures are keenly contested,
and his proverbial want of candour well illustrated in his
ascribing to Anel what was due to Hunter. Mr. Guthrie
convicts the worthy Baron on his own admission, and places
him in a most pitiable condition. The Baron, like many of

the race who write,” has published opinions already on
record, and by his contemptuous silence on the just claims
of British surgeons, exposes either ignorance or envy, and
richly deserves the lash of criticism, which has been freely
applied on the present occasion. Mr. Guthrie illustrates his
operations on wounded arteries by numerous cases, and
arrives at the following conclusions, which are so important
that we place them before our readers : —

1. When a large artery is divided and bleeds, the wound should
be enlarged if necessary, and a ligature placed on both the divided
ends ; but if the artery be only injured and not quite divided, the
ligatures should be applied one above, the other below the injured
part. The artery may or may not be then cut across, at the pleasure

Vol v — no. 26.

p

IOG

Critical Review.

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

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

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

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

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

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

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

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

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

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

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

Mr. Outline on Diseases of Arteries.

107

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

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

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

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

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

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

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

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

“ 18. The place of operation should be in almost all cases at the
seat of the original injury, but there may be an exception ; viz.

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

Critical Review.

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

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

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

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

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

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

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

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

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

[ 109 ]

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

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

[ 110 ]

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

Among our original communications will be found a letter
from Dr. Stoker, explaining the cause of the imperfections
of this volume, which arose from it having been printed in
Scotland, and consequently his inability to revise and correct
typographical errors. The object of this production is a
reply to the Strictures of the Medico Chirurgical Review,
and Hamburg Magazine of Literature, on the author’s late
work, with further proofs deduced from morbid anatomy in
support of his principles, and some interesting clinical
reports on the efficacy of millefoil, yarrow, (A civil lis milli-
folium, Lin.) in dropsy, pompholyx diutinus, pemphigus,
gangrenosus, or burnt holes and other eruptive diseases. Our
author apologises for the marks of haste in this and his former
works, and states in excuse that in one of the institutions with
which he is connected, during the period of a quarter of a
century, considerably more than 80,000 patients have been
received into its wards, and the number of applicants has been
120,000. Yet this is the physician who has been gravely
told by a writer in our esteemed contemporary, that he
knows nothing1 of fever. He cites the last works of Mason
Good, Armstrong, Burne, Clanny, Lawrence’s Lectures, and
this Journal in support of his opinions. He says,

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

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

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

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

Dr. Stoker on Animal Fluids and Solids.

ni

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

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

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

H2

Critical Review .

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

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

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

Dr. Stoker on Animal Fluids- and Solids.

113

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

“ At one time on this evening I found him sitting near the fire,
the heat of which he said he found very comfortable. He looked at
it steadily, and wTas not at all disturbed by its blaze, and yet he could
not endure the approach of a lighted candle, from which he withdrew
suddenly, making a succession of short sobbing inspirations. When
I inquired how he did, he replied, 4 Egad I am middling, Sir, I would
be very well only for breath, and if 1 could drink, but I can do that
some better than I did. To show me how much he was improved in
this particular, he called for some water. ‘ Give me some water,
that I may shew Mr. Kirby the capers I’ll cut in swallowing it/
The effect, however, was followed by consequences as frightfully
violent as those which had taken place at any preceding period. At
twelve o’clock at night his pulse was stronger than in the morning ;
less easily compressible, and fuller. At palf-past twelve, blisters
were applied to the back of the neck, throat, and interior part of the
thorax. In an hour afterwards he was very delirious ; he refused to
take his pill, and endeavoured to sing a favourite air. He grew calm
before two o’clock, expressed his gratitude for all the attention
that was paid to him,. attributed his tranquillity to his blisters, which
he tbought^the * best job yet that happened to him/ but still refused
his medicine. At two he swallowed his bolus, compound of Stra¬
monium, and Pil Hydrarg. ; and had a motion, at which circumstance
he was much pleased. He drank some water from a sponge, and he
thought his breath much stronger.

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

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

Q

114

Critical Review.

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

“ When he next called for his sponge soaked in whey, I gave him
one which contained half an ounce of tincture of opium, which he
continued to suck from it, but with the usual difficulties. After he
returned the sponge I pressed from it about one drachm of laudanum.
He now complained of slight giddiness, refused to take any more of
that medicine, desired some drinks, and suggested ‘ that perhaps he
could take it out of a pipe.’ I fixed a tin to a gum elastic bottle
filled with water. When 1 moved towards his mouth he turned
away from it, and in an irresistable manner begged ‘ I would not
hurry him but let him take his time.’ The attempts to drink by
this contrivance were as painful and as fruitless as the former. His
violence now began to increase and for the first time he showed his
aversion to some of his attendants. He was pleased to see his
brothers, shook them continually by the hands, and then desired them
’to go away. On hearing his mother’s voice he was distressed a good
deal, and wished to have her with him.

“ What had been done hitherto having availed nothing, it wa3
proposed to take a large bleeding from the arm ; upwards of thirty
ounces were drawn accordingly, in a full and rapid stream* The
blood was so unusually florid and issued with such force, that it
might be imagined it issued from an artery. It likewise coagulated
more slowly than usual, formed but a very small proportion of serum,
and did not exhibit the least appearance of buff. Though his pulse
grew much weaker, his strength was not reduced, nor did he feel
debilitated by the evacuation.

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

Dr. Stoker on Animat Fluids and Solids. 115

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

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

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

“ At nine o’clock in the evening. Dr. Leahy and I visited him,
with a view to get him to take some wine. He was then sitting on
his bed without his coat and vest. His relations were at tea, of
which we were told he had partaken. On our entering the room he
lost his calmness, and rushed towards the window, in a dreadful
burst of passion. I was alarmed by the apprehension that he would
throw himself out of it, but we soon learned that it was done with
the view to retain himself from the feeling of suffocation. It did not
appear that the coldness of the night ever was perceived by him.
Returning to his bed he sat with his back towards us. He would
sometimes turn round sharply and angrily. He seemed as if he
suspected some sudden surprise from behind him ; his inspirations
were very short ; he was very talkative ; looked wildly — was quite
pale — the glossiness of his eye increased — he was greatly agitated
when he heard a whisper among his friends, though not in the least
disturbed at the noise of the tea things, or at their presence. Some
wine, butter-milk, and tea, being placed before him on his form,
while we all observed a dead silence, he looked at them with atten¬
tion, turned round and took a suspicious view of us, and then he gave
the following delirious sollioquy : — 1 There is wine, nay, there are
three happy couples, that now happy people, but I’ll not touch it —
and there is butter- milk that another happy couple, its very good.

116

Critical Review.

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

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

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

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

p. 82.

Dr. Spillan ’s Supplement to the Pharmacopoeias. 117

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

Ip foliorum recent Millefolii ^ij.; infunde per horam in Aquae
bullientis quantitati sufficiente ut coletur. unciae duodecim, etcolaturse
adde.

Syrupi aurantii 3j.

Dosis uncia quaterin die.

ip folior. recent millefolii.

Adipis preparatse aa 3j •

Adipis ovili 3j.

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

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

VII. — Supplement to the London, Edinburgh, and Dublin
Pharmcopoeias. — By D. Spillan, A. M. M. D. Dublin,
1830. Hodg’es and Smith, pp. 218.

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

118

Critical Review .

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

*

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

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

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

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

1.19

Dr. SpillaiVs Supplement to the Pharmacopoeias.

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

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

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

“ With regard to the other surfaces, to which medicinal substances
may be applied, they neither possess the same interest, and more¬
over, the effects to be produced by application to them are merely

local.

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

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

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

* This gastro-intestinal irritation often exists, in the course of phthisis, in
organic diseases of the heart, intermittent and continued fevers ; a circumstance
which should modify the treatment to be adopted.

120

) Critical Review.

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

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

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

Dr. Spillan’s Supplement to the Pharmacopoeias. 121

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

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

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

“ On the Action of Medicines by Revulsion, — When a medicinal
substance, applied to any part of the body, irritates that part, it causes
an afflux of blood to it, and thereby a proportional diminution in the
quantity of that fluid contained in the vessels of the contiguous parts.

yol. v.— no. 26.

&

Critical Review.

Vtl

-This principle is oftejp taken advantage of in the removal of irritations
and inflammations. In this way, sinapsisms, blisters, rubefacients,
&c.* prove efficacious in removing inflammations of the thoracic or
abdominal viscera On the same principle, also, purgatives, by excit¬
ing a temporary irritation in the intestines, are found useful in some
affections of the head and chest. Diaphoretics, diuretics, and em-
"menagogues may also be considered as acting on this principle. By
exciting the action of the cutaneous vessels, of the urinary and
uterine organs, they exercise on the other organs a revulsive influence.

“ On the Power of Habit over the Action of Medicines. — If the
same medicinal substance be applied every day without interruption
to the same part of the body, it is observed to lose its power by little
and little, and to fail in affecting parts in which it had previously
excited the most striking effects. As the medicinal substance itself
has obviously undergone no change, and as it still retains all its pro¬
perties, both physical and chymical, it must be the vital state of the
living tissues, and the susceptibility of the parts to which the medicine
is applied, that has undergone this alteration. This phenomenon,
curious as it is in a physiological point of view, is still more im¬
portant, when considered in reference to therapeutics. We may
learn from it, that we should progressively augment the dose of these
medicines, whose use we intend to continue for any length of time,
if wre wish them to retain the same uniformity and extent of action,
and also that we should suspend their exhibition from time to time,
lest the different organs may, from the power of habit, become insen¬
sible to their impression. It may not be amiss here to observe, that
narcotic medicines are much more under the influence of habit, than
those of a stimulant or irritating property. Whilst the power of
habit may thus render one surface insensible to the action of a
medicine, it will not necessarily exempt the other parts of the system
from its influence, provided its molecules have been taken up by
absorption. This independence of the general on the local action
does not however hold good with respect to the effects arising from
sympathy, which take their origin in the organ immediately receiving
the substance. The sentient extremities of the nerves of this
organ being no longer affected by the medicine, the nervous commu¬
nications which transmitted its virtue to distant parts are broken off,
and then the sympathetic effects are no longer produced.

“ On the effects of Medicines. — Tire effects of medicines are .of two
kinds. 1st. The immediate or physiological . 2. The secondary or

therapeutical. By the former are meant those changes produced in
the movements and functions of the different organs, the direct and
immediate consequence of the impression made on the system, whe¬
ther through the medium of the absorbents, or through the commu¬
nicating powers of the nerves.

* It may be observed here, that blisters should never be applied at the com¬
mencement of an inflammation, as, from the irritation they necessarily excite, they
would rather augment than diminish the evil. The constitutional symptoms should
.be first subdued by the proper measures.

Dr. Sp ilia n s Supplement to the Pharmacopoeias. 123

“ By the secondary or therapeutical effects are meant those modi¬
fications and changes produced in the movements and functions of the
several organs, whereby, in a body actually diseased, some important
result may be produced, which shall counteract and arrest the efforts
of the disease, and excite those of an opposite character, which may
prove salutary

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

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

Our author further adverts to the immediate effects, pro¬
duced on the tissue of organs by medicines.

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

* The principal advantage which the practice of medicine has derived from a
knowledge of the action of jnediciut*5 on the fluids, is in the case, of preventing and
obviating the Hi hie acid diathesis, viz. by saturating with an alkali the free acid,
which precipitates the lithic acid from its combinations, :

124

Critical Review.

tissues of the digestive and respiratory organs, those of the heart,
arteries, and capillaries, that of the brain, and its appendages, those
of mucous and serous membranes and of the secretory organs,
whilst on the other hand, the cellular tissue, the lymphatic ganglions,
aponeurotic and cartilaginous structures are nearly insensible to all
such impressions. It is of great importance, in a therapeutical point
of view to remark, that disease modifies very much the susceptibility
of all the organic tissues. Thus, in fever and inflammation, the
brain and circulatory apparatus, the lungs, stomach and intestines,
&c. are much more sensible to the action of medicines, than in the
state of health. Nay more, so great is the difference which disease
induces in the operation of medicines, that when any organ is in¬
flamed, it is to it almost exclusively that the entire power of the
medicine seems to be directed. Thus, if a tonic be administered in
any inflammatory affection, the part so affected feels an increase of
heat, pain, and tension, whilst the ordinary tonic effects of the sub¬
stance so given are not at all perceptible in other parts of the system.
Thus a person having an ulcer in any part, experiences in that part
lanc'nating pains, after taking more stimulating food or drink than
ususl.” — p. 123.

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

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

Dr. Spillan's Supplement to the Pharmacopeias. 125

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

will.

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

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

“ With respect to the secondary effects of medicinal agents, they
are, as has been observed, consequences of the primary ; they are
dependent on them, and both these effects1 stand to each other in the
relation of cause and effect. We have seen these agents, by the
properties they possess, submit the animal economy to an operation
more or less marked, more or less extensive, the several organs have
experienced a temporary change in their state -and in their functions ;
these changes must be attended with some results. In a stale of
health, this disturbance passes off after a time, and is no longer
perceptible after the medicine has ceased to act. But in disease,
where the functions of life are disturbed, and the movements of the
several organs are deranged, these effects become much more im¬
portant. It is in the midst of this pathological disturbance that the
medicine produces that state of the system which corresponds to its
properties. It is impossible that this its action should not influence
the development and progress of the disease; it will alleviate some
affections, and exasperate others ; this change so effected constitutes
the secondary effects. The necessity of carefully distinguishing
between the primary and secondary effects of medicinal agents, will
appear, if we consider the confusion and seeming contradictions

126

Critical Review.

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

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

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

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

“ The ancients considered that medicines acted on the causes of
disease ; whilst they are now more properly considered to act on the

Dr. Spillan’s Supplement to the P harmacopveias . I 27

organs . They attended exclusively to their curative effects ; we shall
attend first to the changes which they effect in the movements of the
several, organs in the exercise of their functions, and from these we
shall make their curative effects to flow. These curative effects
depend on the immediate effects which they cause, whether their
action be local, or general, or at once both local and- general. Some
medicines are no doubt useful by reason of their possessing a specific
influence on the causes of disease. These, however, are few in
number, and confined to a very small number of diseases. Vermifuge
medicines seem to belong to this class. Sulphur, found so useful in
soome skin diseases, seems to produce its good effects by acting
directly on the cause ; perhaps mercury also may derive its beneficial
effects in syphilitic affections by acting directly on their cause. We
shall confine our attention here, however, to those medicinal agents
which derive their therapeutic properties from the impression they
make on our organs, and the changes thereby brought about in the
exercise of their functions/’ — p. V27,

Dr. Paris, and many other pharmacological writers, have
long’ since shewn the absurdity of attending to strict chemi¬
cal principles in prescribing medicines. Indeed every man
who is at all conversant with the treatment of disease, is
well aware of the fact, that many unehemical prescriptions
produce the best effects in the alleviation or cure of disease.
Those who object to such medicines are generally theorists
or chemists, and seem to forget their absolute ignorance of the
changes, which the most chemical formulas must undergo,
before mixing with the circulating fluids. We are not sur¬
prized at this ; for mankind high and low, have in all ages
been led astray by theorists. The chemical physician ex¬
claims against the combination of acetate of lead and opium;
the clinical physician finds it a most efficacious remedy. We
might illsutrate this diversity of opinion, by innumerable
examples ; but it must be unnecessary to adduce proof of
a position universally admitted. Here we close our extracts
for the present ; but shall resume in our next, with the fol¬
lowing very interesting corollory, “ medical substances pos¬
sess not any specific property, distinct from their physiologi¬
cal action, and to which the curative effects, following their
use can be attributed.” The opinions maintained in this lit¬
tle work are so conclusive and valuable, that we thought it
but justice to allow the author to introduce himseif to our
readers ; and we are happy in being able to congratulate him
on the ability he has shewn in the execution of his task. He
has revived the consideration of a neglected region of science,
and decidedly the most important that can occupy the atten-
. tion of the practitioner. We strongly recommend this work
to students and junior members of the profession, *

128

ORIGINAL COMMUNICATIONS.

\ * . 4 V . . . ‘ '

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

a preparation of Opium.

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

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

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

Mr. F oote on Mental Disturbance.

i 20

a dozen times, and each time the patient by a sudden jerk
drove it out again, notwithstanding he was held in his chair
by several powerful men — even when the piston was in action
he grasped the pipe in such a manner that it prevented the
fluid from flowing several times : the pump was used several
times for the space of two hours, until the fluid ejected was
no longer coloured by the poison. He drank plentifully of
warm water in the intervals. [And let me now pay a just
tribute to Mr. Weiss, for a more excellent instrument, when
in action, I never beheld.]

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

Ik- Acet. Destill. 5j.

Aquse Destill. §v.

Mft. Mist.

11, p. m. Reaction has taken place ; the pulse has risen,
is freer from drowsiness, and complains of severe head=
ache, bowels confined.

Fiat Vensesectio.

R Acid. Citric, gr. Xxx.

Pulv. acacise. 5ij-

Aq. Purse. 3v.

Syr. Croci. 5hj-

M. ft. Mist, de qua sumantur cochlear; ampl . tria, omni tertii
bora.

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

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

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

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

s

1 30

Ori gin at Commv n teat ion s .

face flushed, eyes bright and glistening*, skin, especially of
the scalp, hot, very loquacious, and calling for his ac¬
quaintance, “ that they might take warning by him.” He
was apprehensive of losing his speech, and continually
changing the subject of his discourse; but frequently re¬
verting to his previous ideas ; in addition to which, he was
fretful and impatient, flinging his arms about, and striking
his thighs : tongue rather furred, pulse did not deviate much
from the natural standard ; did not complain of pain in the
head or giddiness. He w7as bled from the arm to sixteen
ounces ; his hair wras cut short, and cold water was applied to
the head — when this was done he was very anxious to see
himself in the glass, but was pacified on being told he was
not much changed in appearance.

lb Hydrarg. submur. gr. v.

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

1>. Magnes. sulph. 5i}-

Infusi Sennae 51].

Magnes. carb. 9j.

M. ft. haust. \ horae post pil. sumend.

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

1>. Pulv. Ipecac 9j.

Antim. Tart. gr. ij.

Aquae, Destill, 3ij- M.

Fiat haustus emeticus statim sumendus.

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

1, p. M., The vomiting' continued frequently, bringing up
large quantities of bile — he was now calm and sensible, and
could recollect a great part of what had passed. The
flinging of his arms had ceased, he was free from pain in the

Mr. F o o 1 c on Mental Disturbance . 131

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

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

Pv. Potass. Carbon. 5ss.

Aq. Destill. 5ix.

Syrupi, 5j. M.

Acid. Citric, gr. xvj.

Aq, Destill ^ss. M. his additis moxque in ipso actu effervescentise
hauriat, et post horam repetend.

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

7, p. M. Is aoinof on well — is allowed toast and water, and
soda-water.

IF Hyd, Subm, gr.-iij.

Extr. Colo. Comp. gr. viij. M. ft.pilulne ij. h. s. s.

II . Magn. Carb. 3j.

Syr. Simp/3j.

Potass. Subcarb. 3j.

Succi. Limon. ^ss.

Aq. menth. vir. 5j. M. ft. haust. hora nonet vespertina, et primo
mane sumendus.

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

IF Liq. Potass. Citrat. 5ss.

Magn. Carbon, gr. xv.

Aq. M. Vir. 5yj.

Potass, nitrat. gr. iv.

Syr; Simp. 3j. M. ft. haust. ter die sumend.

!>'. Hyd. Submur. gr. ij.

Extr. Colo. C. gr. vij.

Pulv. Antim. gr. ij.

01. Carui. gtt. j. M, ft. pil. ij. h. s. s.

i.3'2 Original Communications.

He is perfectly sensible, and is about to leave town.

24th. Slept the first part of the night, after which his
sleep was disturbed, dozing only ; felt a little nausea this
morning, which, since the operation of the pills, has gone
ofi — pulse 76, and soft, tongue cleaner, no head-ache, appe¬
tite pretty good, is quite collected.

ROYAL WESTMINSTER OPTHALMIC HOSPITAL.

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

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

With this view the following’ cases may perhaps prove
interesting.

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

Habeat, 01. Terebinthince 5i- ter die.

Oleum Terebinthinat-in the Diseases of the Eye. 133

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

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

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

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

Case II. Jane Spittle, set. 36, was admitted May ISth,
having syphilitic iritis of the right eye, accompanied with
sore throat, and eruptions on the skin. She was ordered a
pill composed of three grains of calomel, and a quarter of
a grain of opium, three times a day. Had not applied here
again until now, June 29th, and says that she had only
taken four pills when her face became very much swollen,
and she was confined to her bed for three weeks, suffering
under a dreadful salivation, from which she has not yet
quite recovered. Her eye and throat, however, gradually
got well, during that period. She has now returned with a
similar attack of inflammation of the left eve, which has
been gradually getting' worse for the last week. She com¬
plains of the most acute pain over the brow, and extending
down that side of the face, so intolerable at night that she
cannot sleep. The conjunctiva and sclerotica are very much
inflamed, leaving, however, a very distinct white line round
the margin of the cornea; iris much darker than natural;
pupil of the same size as the other, but rather irregular and
fixed. Cornea remains clear. The lids are rather swollen
and inflamed. Three days back to relieve the pain she was
cupped, and took a drachm of the Vinum Colchici at night,
but without benefit. She complains also of great weakness
with sickness and loss of appetite; pulse quick and small;
bowels confined.

/

134

Orig i tied C omm u n icatio n s .

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

Capiat. 01. Terebinth. 3j- ter die, et.

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

July 1st. Inflammation continues much the same. Pain
however has been much less severe at night. To continue
the medicines.

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

Sumat. Pulv. jalap. Comp, 3iss. statin.

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

Rep. med.

8th. Nearly well, very little redness remaining , pupil
rather small, but regular. Says that she is quite free from
pain, and her sight very much improved.

Rep. med.

Applicetur Ernpl. Bellad. tempori. sinistro.

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

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

To the Editor of the London Medical ty Surgical Journal.

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

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

Dr. Stoker on the Pathology of Dropsy. 135

tals, with those of London, as stated by Dr. Hawkins ; I of¬
fered arguments deduced from morbid anatomy, for the prin¬
ciples I have adopted, in preference to those lauded by the
London criticism ; but a leading object of the publication was
to prove by cases that the ratio symptomatum was available,
in suggesting the ratio medendi. The cases which I selected,
were from private and hospital practice and were chiefly
those of dynamic dropsy and appeared to me well calcu¬
lated to shew that morbid condition of the blood, returned
to the greater circulation, by the vena cava from the want of
few changes in its passage through the liver becomes the
source of morbid actions or embarrassment in the functions
of the viscera of the chest, and of consequent dropsy there
and elsewhere, and the successful employment of medicines
by these principles tended further to establish them. The
application of leeches to the verge of the rectum, to diminish
the accumulation of dense veinous blood in the mesentery,
of blisters to the region of the liver, and the use of warm
mercurial purgatives, to relieve the biliary system in general,
and remedies to restore the healthy functions, have frequently
removed symptoms which have been generally attributed to
diseases of the heart. 1 also stated my experience in the
use of millfoil, yarrow, (Achillea Millefolium) in dropsy
and gangrene, as a rtjbifacient and hydragogue, .and as a
restorative of the function of sanguification and the aqueous
secretions. I request you will have the goodness to forward
a copy imperfect as it is to the editor of the Medico Chirur-
gical Review mentioning' to him the circumstances under
which it is presented and I hope that gentleman will per¬
ceive there is no object in view besides the promotion of
medical knowledge ; and therefore will receive my explana¬
tion in the proper feeling in which it is offered. I cannot
conclude without offering you my best thanks for the kind
observations with which you have favoured me, which are
the more valuable as I have not the honor of your acquaint¬
ance, both in your reviews of Dr. Good’s work, of Dr. South-
wood Smith’s, and more recently of Dr. Steven’s essay on
the blood.

I have the honor to be Sir,

with great respect and esteem,

your obedient servant.

W. Stoker.

21, York Street, Dublin,

June 25th 1830.

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

136

Original Communication s.

o

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

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

I will never set politicks against elhicks, for true etfrlcks are but a handmaid

to divinity and religion.” — Bacon.

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

Dr. Ryan on Ethics of the present Period. 137

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

T

ror.. v.— no. 26.

138

Original ( Communications.

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

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

o

* Analysis of Medical Evidence.

[ 139 ]

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

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

140

Original Communications .

his mind agitated by the knowledge of the sufferings of ano¬
ther. The surgeon should change his apron when besmeared;
and the tables or ins1 ruments should be freed from all marks
of blood, and every thing that may excite terror.” Morals
and religion must be attended to in hospitals, but all indis¬
creet zeal is not only injurious in dangerous cases, but even
fatal. Intrusion on the religious opinions of the sick is highly
improper, and is too often allowed or encouraged in many
hospitals. The sick should choose their own clergyman. In
many cases it is necessary to advise the patient to make a
will, as the inmates of hospitals are often possessed of pro¬
perty, or in expectation of it, and their heirs might lose it.

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

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

Dr. Ryan on Ethics of the present Period.

141

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

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

Consultations, says Dr. Percival, should be promoted, in
difficult or protracted cases, as they give rise to confidence,
energy, and more enlarged views in practice. On such
occasions no rivalship or jealousy should be indulged. Can¬
dour, probity, and ail due respect should be exercised towards
the physician or surgeon first engaged; and as he may be
presumed to be best acquainted with the patient and with
his family, he should deliver all the medical directions
agreed upon, though he may not have precedency in senio¬
rity or rank. It should be the province, however, of the
senior physician, first, to propose the necessary questions to
the sick, but w ithout excluding his associate from the privi¬
lege of making farther enquiries, to satisfy himself, or to
elucidate the case.

142

Origin al C.ommun {cations .

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

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

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

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

Dr. Ryan on Ethics of the present Period . 143

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

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

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

144

(J r i gin a l Comm u n i cat ions.

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

Men of such talents, characters, and habits, whether phy¬
sicians or surgeons, can neither improve by experience them¬
selves, nor contribute to the instruction of others, and the im¬
provement of their art. They are peculiarly unlit to practise
m an hospital, where, on account of the great number and
urgency of the cases to be treated, the greatest extent and
accuracy of knowledge, the greatest quickness, precision,
and discrimination in applying it, and, in one word, the
greatest effort of attention and thought is required. Any
deficiencies in them, which in private practice might well
have escaped observation and censure, must soon become
conspicuous on so public a stag'e; just like those oi a lawyer
at the bar; and will not only bring on themselves reproach
and contempt, but will in some measure aflect the character
of the hospital itself. Whatever lessens the confidence oi
the public in the administration of it, and of the patients who
resort to it, in the skill of those to whose care their health and
lives are entrusted, tends strongly to frustrate the benevolent
purpose of the institution, and is, in truth, a very great injury
to the public. Some men, naturally oi good sense and
quick discernment, and active, vigorous minds, who attend
accurately to what passes around them, are distinguished
even at an early period of life for sagacity, prudence, deci¬
sion, and quickness in conduct, and a thorough knowledge of
the characters of men, and the management of business.
They are accordingly respected in the world, and often con¬
sulted on nice and difficult occasions by those who are
acquainted with them, and who very wisely rely more on the
judgment of such men than they would do on their own.

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

A man of such a character never can deserve respect, or
confidence, or employment, even in his own profession i and

Dr. Ryan on Ethics of the present Period.

145

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

It must be unnecessary to enter into serious proofs of the
importance of consultations. The mere want of medical
assistance, says the distinguished physician whom I have
just quoted, is in many cases so bad, as to imply almost
certainly very pernicious, if not fatal consequences. In such
cases to withhold it voluntarily, would be almost as criminal
as to suffer a wretch to perish by withholding food from
him. This point being proved, a few words may be said
on the utility of numerous consultations. The opinion of
Dr. G. is so excellent upon this topic, that it must be
quoted. With respect to physicians and surgeons both,
and their patients, it is plain that all the good that can be
expected from a consultation maybe obtained from one of two,
or three, or four, at the utmost, at least as well as from one
ten times as numerous ; and I should think it almost as plain,
that much of that good may be prevented, and much positive
evil done, by a very numerous consultation.

On this point, I presume, without vanity, to know as much
as most men. For full half of my life, I have been a pro¬
fessor of physic in the University of Edinburgh, during which
time consultations have been a great part of my business, to the

number certainly of some thousands. Nineteen times out of

%/

twenty at least I have been the youngest physician of the con¬
sultation ; and of course, when any written directions were
to be given to the patient, have had the honour to put them
in writing, to the number, I presume, of two or three hundred
at least. I can say with confidence in point of fact, that I
never knew any good come of a very numerous consulta¬
tion ; and I doubt much whether any physician or surgeon
of competent experience will give a different account of the
result of what he has observed. The conduct of physicians
and surgeons, when themselves or any of their families are
sick, affords a still better proof and illustration of the same
truth, and is indeed supreme and decisive authority with re¬
spect to what is useful, or what is useless, or worse than
useless, in medical consultations. With us all considera¬
tions of economy are out of the question. Bad as we may
be thought, we are not such Cannibals as to prey on one
another. We may all have, for nothing, to ourselves and
our families, as much assistance in point of physic and
surgery as we choose. We feel strongly, that we have not
sufficient calmness and firmness to judge and act properly,
when the lives of those are at stake in whom we are most
tenderly interested : and as to ourselves, when sick, we all

VOL. v. no. 26.

u

Original Com m uni cat io u s ,

O '

146

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

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

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

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

Dr. Ryan on Ethics of the present Period.

147

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

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

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

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

148

Original Communications .

wished to protract its duration,, by not ordering such me
dicines as some other physician had prescribed, with the
greatest success, in a case exactly similar : that it was a
proof of the greatest avarice and illiberality to take his fee
for doing nothing ; — in short, that he ought to be immedi¬
ately dismissed, and that Doctor - - should be sent

for.

BIBLIOGRAPHY.

ANATOMY AND PHYSIOLOGY.

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

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

MORBID ANATOMY.

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

Morbid Anatomy ,

149

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

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

ABDOMEN.

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

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

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

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

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

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

THOBAX.

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

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

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

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

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

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

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

150

Bibliography.

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

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

Henry Halford.

Matthew J. Tierney.

Astley Cooper.

> Benjamin Brodie.

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

He had a fever whilst he was in Spain !

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

Morbid Anatomy.

151

time to his death, which took place in May, 1574, he never enjoyed a
tranquil hour, and various reports were bruited about respecting the
mode of his decease. Many regarded the event as a punishment for
his enormous crime, and asserted that he fell the victim to a sweating
of blood ; others on the contrary attributed it to the machinations and
ambition of the Duke d’Alen^on. In order to set at rest all rumours
and dispel these suspicions, Catherine decided that the body of her
dear son should be examined, and Charles was thus the first king of
France, the first descendant of Charlemagne, whose body was pro¬
faned by the scalpels of his subjects. From that time to this, the exa¬
minations of their monarchs after death has become a matter of court-
etiquette in the French dominions. Before we proceed to the ac¬
count of the dissection of Charles, it will be interesting to recite a few
particulars respecting his mortal illness.

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

“ Rapport du corps mort du feu roi Charles IX.

“ ‘ Anno domini miles, quinquent. septuag., quarto pridii kal. junii,
hora a meride quarta, facta est dissectio corporis Caroli IX. regis Gal-
liarum christ., assidentibus medicis hie subsignatis et chirurgis qui
earn administrarunt, in qua accurate hsec observata et deprehensa
sunt.

“ ‘ 1. Hepatis totum parenchyma arefactum, exangue, et extre¬
mis lobis ad simas partes vergentibus nigricans.

“ ‘2. Folliculus fellis a bile vacuus, in sese considens, subater.

“ ‘3. Lien nullo modo male affectus.

152 Bibliography .

“ * 4. In ventriculo nulla noxa, et stomachi cum pyloro integri-
tas. .

“ ‘ 5. Intestinum colon flavum colorem contraxerat, cseteris ben&
habentibus.

“ ‘6. Epiploum male coloratura supramodum extenuatum ; parte
aliqua ruptum, et omnis pinguidinis expers.

" ‘7. Ren uterque nullo vitio obscessus, nullo similiter vesica,
nullo ureteres.

“ *8. Cor flaccidum et velluti contabescens ; omnis aquoso hu-
more, qui pericardio contineri solet, absumpto.

“ ‘ 9. Pulmo qui in partem sinistram thoracis incubebat, a costis
illegitimis ad claviculas usque totus lateri adliaerebat, ita firmiter et
obstinate, ut avelli potuerit sine dilaceratione, et discerptione cum
putridine substantise, in qua sese prodidit vomica rupta, e qua collu-
vies purulenta, putrida et graveolens effluxit, cujus tanta fuit copia,
ut in asperam arteriam redundant, et praeclusa respiratione praecipitis
et repentini interitus causam attulerit.

“ ‘ 10. Alter pulmo sine adhsesu fuit, magnitudine tamen natura-
lem constitutionem, turgidus et distentus superans (ut et sinister su-
perabat in substantia, insignem corruptelam prae se ferens) parte su-
periore putris, refertus et conspurcatus humore pituitoso, mucoso,
spumoso, purifinitimo.

. 4 11. Cerebrum omni vitio carens.”

■ . “ Medici qui praefuerunt,

c< Regii Mazille. Vaterre. Alexis Gaudin. Vigor, Lefevre, Saint
Pons.

“ Parisienses. Pietre, Brigard, Lafile et Duret.

“ Chirurgi regii qui administraverunt, Pare, d’Ambroise, Portail,
Eustache, Dioneau Dubois, Lambert et Cointenel.^

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

Henri III.

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

Henri IV.

. The Alfred of France, Henry the Great, was stabbed in his carriage
on the 4th of May, 161j0 ; he died almost immediately, after uttering
a few words and discharging blood by the mouth.

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

Morbid Anatomy.

1 53

trunk of the pulmonary artery, a little below the left auricle. There
was much blood extravasated in that side of the chest, and both lung*
were filled with it.

Louis XIII.

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

A circumstance is related of this Louis on his death bed, which is
worth transcribing. “ When,” says the historian, £t his physician, at
his earnest desire, numbered the fleeting minutes that remained, and
pronounced that his life could not exceed two or three hours, he re¬
ceived the intelligence with resignation and even satisfaction ; and
looking fervently up to heaven, added, “ Well ! I consent with all
my heart.” Here is the account of the dissection.

“ Postero autem die (id est 15 mensis maii 1643), hora sexta mai*
tutina defuncti regis cadaver apertum prsesentibus serenissimo principe
ac domino de Nemours, marescalco sive castrorum prsefecto primario ;
domino de Vitry, domino de Souvre , primo cubiculario nobili sive
inter nobiles, regi a cubiculis primario, medicis regis ac reginse pri-
mariis aliis quoque medicis et chirurgis, ex utraque familia chirurgo-
rum Paris .... Atque in hoc regis cadavere ulcera plurima pure sania
ac tabo manantia reperta sunt, variis partibus inusta, mesocolo in-
testinis omnibus crassioribus, sed unum colo extreme insederat, quod
intestinum ipsum exederat et perforaverat, unde purulenta multa ex
putrefactis prsedicti mesocoli glandulis et vasis emanans et alvo in-
feriore, coercita et cumulata trium librarum semisestariorum parisien-
sium mensuram implere poterat. Deprehensus quoque in rene dextro
abscessus sed exiguus, et ferine nihil faciendus. In fundo ventriculi
lientre abraso vicinis grandior et alii perexigui plures, et humoris
fusci, fuliginosi atque ex viridi nigritantis copia insignis, quo, aut
simili omnia ad unum intestina, usque ad extremum recte referta
erant.

“ Vesicula fellea hepati subjecta et imis ejusdem partibus, affixa
ab humore bilioso crassiore prope vacua. Hepar exsuccum plank ac
retorridum .... simile quod et duriusculi contra ventrem lanabat et
solvebatur in grumos. Pulmonis sinistri lobus, pleurae firmiori adhe¬
rens et affixus ulcere maximo et profundissimo, pure plurimo confer-
tus, et putrefactus apparuit.”

Louis XIII. would thus appear to have died of phthisis pulmonalis
with ulcerations of the bowels.

Louis XIV.

Sectio Cadaveris. — The whole of the left side of the body ap¬
peared gangrenous, from the extremity of the foot to the top of the
head. The epidermis was generally detached from the cutis, the right
side was gangrenous in several places, but less so than the left, and
the belly was excessively blown up.

On opening the abdomen, the intestines, especially those on the
left side, were found “ altered,” with some marks of inflammation;
the large intestines were enormously dilated. In the left kidney wa»

Vop. v. no. 26. x

154 bibliography.

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

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

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

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

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

Louis XV.

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

The superstitious fears entertained regarding small pox completely
drove the attendants in the palace from the body of the dead monarch.
The first gentleman of the bed chamber, more faithful or more bold
than the rest, demanded of Lamartiniere, then chief surgeon, why he
did not proceed to examine the corpse, and added, that he must do so.

“ My Lord Duke,” answered Lamartiniere, with his usual brusquerie ,
“your office renders it imperative upon you to hold the head of the
deceased during the process. I declare to you, that if it is opened,
neither you, nor I, nor any one of those assisting, will be alive eight
days afterwards.” Need we add, that Monsieur le Due said no more
about the matter !

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

Louis XVII.

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

\ 55

Morbid Anatomy.

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

On opening the abdomen, about a pint of yellowish and very fetid
seropurulent fluid flowed out. The intestines were blown up, pale,
adherent to one another, and to the wails of the abdomen, and studded
with a great number of tubercles of different sizes, which contained
the same description of matter as that in the internal tumours. The
omentum and mesentery -were filled with “ lymphatic tubercles” like
the former, and others were dispersed over the peritoneum. 1 he in¬
terior of the stomach and intestines, the liver, the spleen, the pan¬
creas, and the kidneys were sound.

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

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

Louis XVIII.

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

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

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

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

Medicine.

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

I5S

Biclograj/hy.

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

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

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

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

In November of the same year, and in February 1827, I was again
consulted by this gentleman, on account of some dyspeptic symptoms,
Which were soon relieved by medicine, his body being as usual, na¬
turally and freely open every day. From this time, I saw nothing
more of him for twelve months, when in February, 1828, he again
applied to me, on account of his usual dyspeptic complaints, but with
this difference, that his bowels, which had been exceedingly regular
all his life, were novr sluggish, and required the frequent use of ape¬
rient medicine. On this occasion, I prescribed the comp, rhubarb
pill of the Ed. ph. which proved effectual, and together with other
treatment, gave him so much relief, that again 1 heard nothing of
him for five months, when in July, 1828, he called upon me, and
complained much of flatulence, acidity, and irregularity of the bowels.
He was this time also very much relieved by aperients, but the ac¬
tion of these medicines was not so certain as formerly ; and when
the bowels were not freely moved, he suffered much from ful¬
ness. ", ;

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

Medicine .

157

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

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

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

Saline aperients diluted in imitation of Cheltenham water, were
now prescribed, and succeeded very well in evacuating the bowels.

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

158

Bibliography .

Injections and saline aperients were had recourse to unremittingly
with partial success ; the violent spasms returned frequently, and the
most severe were followed by inflammation. The violent contractions
of the intestine constituting the spasms, were always more or less
relieved by laudanum ; but opium, in this form, made the mouth and
tongue dry, and was followed by head-ache and languor. From
these ill effects, the liquor opii sedativus was free, but the most effi¬
cacious preparation was the acetate of morphium in the form of a pill,
and in the dose of from ^ to the ^ of a grain, repeated as circum¬
stances required. The last preparation was found a most valuable
medicine, and never failed to mitigate the excruciating pain and
other sufferings of the patient’s last days.

In this way the patient lived on, passing scarcely any feculent mat¬
ter, and suffering pain and inflammation by turns till the 20tli of
February, 1829, on which day the spasms returned violently about
six o’clock in the morning, and soon after seven the patient felt a
sudden and dreadful pain dart from the left side across the belly above
the navel, which he compared to the discharge of a pistol. Quickly
afterwards the belly became tense, the respiration difficult, and the
poweis of life depressed. It at once occurred to me that the colon
had given way above the stricture, which I stated to the friends, and
prepared them to expect the rapid dissolution which took place in
the course of eleven hours.

Sectio cadaveris. — The abdomen being opened, a large quantity of
feculent matter, of soft consistence, was seen lying among the intes¬
tines and upon the mesentery, and was found to proceed from a trans¬
verse rupture of the colon, about an inch long, at the spot from
whence the violent pain darted. The whole of the colon was filled
with feculent matter of the same kind ; the sigmoid flexure was seen
stretching across the brim of the pelvis to .the right side, when it
turned quickly upon itself and terminated in the diseased portion,
which was situated directly under the promontory of the sacrum.
The diseased part was about the size of an egg, and consisted of a
scirrhous degeneration of those structures of the intestines situated
between the mucous and peritoneal coats. The aperture of commu¬
nication between the colon and the rectum through the diseased part
scarcely equalled the size of a swan quill, and had a curved direction,
which proved the correctness of the opinion, that force used in at¬
tempts to pass a bougie would be likely to rupture the bowel. The
lower opening looked backwards and downwards to the hollow of the
sacrum, and its margin was knotted and irregular as has been de¬
scribed. There were adhesions of the sigmoid flexure to the small
intestines, and the scirrhous mass was adherent to the sacrum.

Case II. — Annular Contraction of the large Intestine. — Of the se¬
cond case, which was an annular stricture, I regret that I am only
able to present a few particulars, not having the means of obtaining
the early history. It occurred in a female pauper in Covent Garden
workhouse, who had been admitted three weeks before her death, in
a state of extreme emaciation, and witha remarkably distended flatu¬
lent abdomen ; she passed scarcely any feculent matter during the

159

Medicine.

three weeks, and was constantly vomiting, so that nothing except
brandy and water and similar beverage, could in any way be retained
on the stomach.

Secfio cadaveris. — Before the abdomen was opened, traces of the
convolu' icins of the intestines were evident, by corresponding eleva¬
tions of the integuments : these convolutions were found to be dis¬
tended with Gas, and the colon was full throughout of soft feculent
matter ; and at the termination of the sigmoid flexure in the rectum,
was a circular contraction of the bowl forming the annual stricture.
There was no thickening or disease about the part, and the contrac¬
tion had the appearance of the bowel tied with a ligature, except that
there were neither folds nor puckering.

Observations . — The ulcerations, the heat of the mouth and trouble
in deglutition, detailed in the history of the first case, shewed a con¬
dition of constitution prone to morbid action, which having first fixed
on a part of the digestive canal, determined that canal to be the even¬
tual seat of disease.

A very prominent circumstance in the dissection of both these
cases, was the soft consistence of the feculent matter, particularly
when it is rememembered that, from the slow acccumulation, the fe¬
culent matter had been lying in the colon for several weeks in the
first case, and in all probability for several months in the second.
This is the more curious; because in ordinary constipation of the
bowels, the feculent matter becomes hard and knotty in eight and
forty hours, sometimes in twenty-four, and continues so till eva¬
cuated ; hence it occurred to me that the soft consistence above al¬
luded to, was probably one of those remarkable provisions which na¬
ture is often observed to make'against disease, 'and if this is the case,
the same soft condition of the retained faeces may be expected in all
cases of stricture. Experience, however, dees not afford me a suffi¬
cient authority of facts to come safely to a conclusion on this point,
but the probability which I have expressed is much strengthened by
two cases, one of which occurred in private practice, and w7as men¬
tioned to me by Mr. - , a pupil of Guy’s Hospital, who wit¬

nessed the dissection ; and the other in a patient in the same hospital,
in the both of which the accumulated faeces were in the same soft
state. I do not know that this circumstance has been hitherto
noticed, nor can I find in the works upon stricture of the rectum, any
evidence that bears satisfactorily on the question.

Did the faeces undergo the same change as in ordinary cases of
constipation, there would be no possibilty of evacuating them through
a stricture, and the irritations and accumulations wmuld be quickly
and uniformly fatal ; whereas the reverse is a matter of daily obser¬
vation. The sympathies by which this usual change in the faeces re¬
tained in the colon is prevented, are the more remarkable, because
they influence only the part of the large intestines above the stric¬
ture, for the soft feculent matter which gradually oozes through the
contractions into the gut below, very soon becomes solid and figured,
as I had an opportunity of witnessing in the first case, in which it
was not uncommon for solid figured peices to come away, al-

160

Bibliography.

though all above the stricture was quite soft, as seen by dissection.
This last fact is also mentioned by Mr. White.*

The soft feculent matter was also of a most healthy character,
being homogeneous, and containing an abundance of good bile ; from
which it may be concluded that digestion was perfect, notwithstanding
many of the symptoms said to be indicative of indigestion were ur¬
gent, as flatulence, fullness, acidity, and eructations ; whence it is
apparent that the sufferings usually referred to the stomach, may
arise from another cause than disorder of that organ.

In both instances the patients died from the mechanical obstruc¬
tion ; in the one the disease was not malignant, in the other the ma¬
lignancy had not come into operation, the patient having died before
the destructive effects of cancer had taken place, as ulcerations
sloughing, discharge, and sympathetic irritations and fever; the sub¬
ject for consideration, therefore, was the treatment of the obstruction;
the observations on which refer only to the first case.

The eminent surgeons consulted were unanimous as to the inex¬
pediency of attempts to force a passage by the bougie, owing to the
situation as well as to the malignancy of the disease ; in which opi¬
nion all must concur, who have witnessed the torture that attends
the use of a bougie in scirrhous disease of the rectum, and which is
not recompensed by any benefit ; this stricture not admitting of dila¬
tation, the effect of the bougie is to bruise and hasten ulceration, or
increase it if present. Although the most desirable means by way
of operation, was the introduction of a hollow tube through the
stricture to facilitate the passage of injections, yet this was found im¬
practicable, the distance of the strictured part from the anus being
too great to admit of the finger as a guide, and without this, the ca¬
pacious and yielding rectum left no chance of effecting the passage
of such an instrument. In this dilemma, and in my frequent consul¬
tations with Mr. Wadd, I suggested for discussion the prop riety of
making an artificial anus, which although he discouraged, I cannot
but think might be attempted under favourable circumstances as re¬
gards the operation, and urgent circumstances as regards the prolon¬
gation of the patient’s life.

It may be said, that between the two evils of a stricture and an
artificial anus, it is difficult to choose, to wffiich I assent generally ;
but w7hen the patient’s life must fall a sacrifice to the mechanical ob¬
struction, and when the prolonging his life for a few months only is
of great consequence to his family, the suggestion is wrorthy the con¬
sideration of surgeons ; for in the first case, the malignancy of the
disease would not have destroyed life for months in all probability ;
and in the second case, there being simply an annular contraction,
life would have been preserved by an artificial anus, which would
have permitted the regular evacuation of the bowTels. To render the
operation justifiable, the colon should be empty, and the means of
attaining this end are the object of the medical treatment of stric¬
ture generally.

All are agreed that the aperients wffiich must be necessarily
given, should be of a mild character, and the recommendations of

* Observations on Stricture of the Rectum, 3d edition, page 37.

Medi cine.

161

authors who have treated on the subjects are limited to castor oil,
senna, and sulphur ; thus leaving unnoticed saline aperients, which
as will presently be seen, are the most efficacious. These medicines,
castor oil, senna and sulphur, although desirable from their mild qua¬
lities, are very uncertain and ineffectual in cases of stricture ; it is
true they promote a moderate, and so far, a proper peristalic action
of the intestines, but as they do not render the feces watery, this
action is not followed by sufficient evacuation, and therefore not
of sufficient relief. Sulphur is objectionable on other grounds; it
has been known to form into balls when taken in large doses,
and in this way may add to the mischief. The same objection ap¬
plies also to magnesia, which has been found accumulated in a large
quantity above the stricture.

While the subject of the first case was at Cheltenham and taking
the waters, the evacuations were so thin that the colon emptied it¬
self effectually every day, and under these favourable circumstances
the patient lost all complaint and improved surprisingly. This first
suggested to me the use of saline aperients, which were given in the
form of Seidlitz powders and of sulphate of magnesia, in a very di¬
luted solution ; and they were found to operate much more pleasantly
and efficiently than other aperients. These, however, and the Chel¬
tenham water itself drunk in town, were by no means so certain in
their operation as the waters drunk at Cheltenham, owing, no doubt,
to, the want of auxiliary circumstances which are known to favour
the operation of mineral waters, as change of scene, absence from
the fatigue and anxiety of business, early rising, and exercise. On
one occasion, when castor oil was substituted for salts, its effect was
exceedingly injurious ; it duly excited the action of the intestines,
but as it did not render the fseces watery, they could not pass the
stricture freely, and the consequence was violent spasmosdic pain
and vomiting.

Drastic and heating purgatives are very properly objected to in
all cases of stricture ; nevertheless, the distress of the patient on one
occasion was so great for the want of evacuations, that a person of
very great practical attainments was induced to propose the adminis¬
trations of croton oil, the propriety of which was much discussed, on
account of its irritating properties and violent action ; but its employ¬
ment being much urged by the proposer on the score of its unrivalled
purgative power in other cases, it was exhibited in the dose of one
drop, which was repeated in the space of half an hour. The effect,
as was anticipated, was nearly fatal ; it produced most violent con¬
tractions of the intestines, and spasmodic pains, with a distressing-
heat along the whole alimentary canal, and constant and urgent, but
ineffectual efforts, to go to stool, the scanty evacuation consisting of
nothing more than a bloody secretion from the rectum, the product of
excessive irritation.* The violent action of the intestines led one to

* As from the vast accumulation of feculent matter found on dissection, it was im¬
possible that any particle of the croton oil could have reached the rectum , the ex
cessive irritation must have heen the result of sympathy, which may go far to ex¬
plain the phenomenon of the inflammation of the rectum which occurs tn case*
of poisoning from arsenic.

Vol. V. NO. 26. *

Bibliography.

fear a rupture of the colon, of which the sequel of the case proved
there was great danger.

In the medical treatment of stricture of the large intestines, then,
saline aperients are the best and most efficacious ; and where the
disease does not admit of relief by surgical interference, the physician
would best consult the interest of his patient, by urging him to reside
at Cheltenham or Leamington, and by the aid of warm bathing and
of drinking the wafers regularly, to avail himself of the means which
will most certainly mitigate his sufferings and prolong his life. —
Midland Medical Reporter.

7. Observations on the Treatment of Delirium Tremens, and on
the use of the Warm Bath in that disease. — The means commonly
employed in the treatment of temulence and delirium from intem¬
perance, were uniformly successful in the Baltimore Alms-house
Infirmary, in a multitude of cases, for two years antecedent to the
spring of the present year, 1829. Those means were emetics—
afterwards mild cathartics, (Epsom salts and magnesia,) in cases
complicated with gastric and biliary derangements, or much febrile
disorder ; the evacuants followed promptly by anodynes, graduated
in force or repetition, by the amount or persistance of nervous dis¬
turbance. In cases of the disorder already arrived at the stage of
per vigilant delirium, miscalled ‘ mania a potu,’ (as is correctly re¬
marked by Dr. Coates,) if higher vascular tumult attended, wre here
also employed an emetic, afterwards a nauseant, tartar solution— as
a sedative, and concurrently with the effects of the latter, opiates,
in doses designed to enforce sleep, made full, and renewed so fre¬
quently as to have the effect of each successive dose to come in aid
of the impression of those preceding.

“ The opiate employed was Dover’s powder, zij. grs. — or pure
opium, one or two grains — or laudanum, forty drops — or black
drop, x. gtt. ; the interval of exhibition usually two hours, but re¬
gulated by the symptoms. Where sensorial and nervous irritation
were greatly exalted, attended by deficient reaction, and signs of
general atony, small, quick pulse — cold surface — livid complexion,
&c. all evacuants and direct sedatives were omitted, and the patient
entered at once upon the use of opiates. But here the doses wrere
made smaller than in those cases where the sum of vital power was
less obviously deficient or expended, and the force of opiate was
graduated as nearly as possible to the torpor or exhaustion of the
function of general life. Here too cordials of the vinous or spiritous
class were allowed, concurrently with the employment of the
opiates ; and it was to this stage of temulence that spirits and sti¬
mulant drinks of all kinds was restricted. It was only in cases where
the tumultuous excitation of the cerebral and nervous functions was
found associated with cold congestive torpor of the distributive
system, or with a low, irritative grade of excitement, tending to
rapid collapse, that we deemed it either medically or morally right,
to renew even the temperate use of the primary agents of the
disorder.

Medicine ,

163

“ In emetics, then, nauseants, anodynes, and cordials, regulated
or combined in their exhibition by the character of cases falling
under treatment, we had for a long time found efficient and unfailing
means of controlling the various forms of temulence and delirium a
potu. In no case of temulence advanced to the stage of delirious
excitation, did we find emetics alone induce sufficient restraint of
the cerebral and nervous derangements, to allow perfect tranquillity
of mind, or sound sleep. Vomiting often took off too much of the
hallucination of the patient, and substituted some intelligence for
previous total folly ; but there was a constant tendency to relapse
into mental error, and we found it better to confirm the advantage
gained from the emetic, by calling in the aid of opiates afterwards,
rather than await the return of the delirious paroxysms, and trust to
subdue them by repeated emetics. The possible consequences of
vomiting as a debilitating mean, suggests a caution in the repetition
of emetics in temulent cases : and confidence in their permanent or
final efficacy in those cases, is abated by the fact, that it is not
uncommon to find some of the worst forms of delirium tremens,
complicated with, and aggravating under, almost constant sponta¬
neous vomiting.

“ In cases of temulence with strong vascular action, which
vomiting did not sufficiently calm, or where in such cases emesis
was deemed improper, nauseants were employed in the form of
drinks, charged with medicines of that class, sometimes tartar, or
ipecacuan, or zinc. This given for some hours, seemed often to
prepare the nervous impression by opiates, and we had frequent
reason to infer, that after this mode of previous treatment, we suc¬
ceeded in inducing quiet and sleep, with smaller and fewer doses of
opiates, than in cases where such preparation was omitted or deemed
unsuitable.

'* The opiate course of treatment did not always succeed without
difficulty, and sometimes not without an auxiliary of the sedative
class. Cases of vigilant delirium which had resisted opiates singly,
in full doses, repeated two, three, or four times, at intervals of one
to two hours, were sometimes quieted by a liberal portion, either to
ten grains, of camphor, added to the next opiate dose. In a few
instances, where opium alone, or in combination with camphor, had
been used freely and diligently, without producing either quiet or
sleep, the addition of musk to the opiate has seemed suddenly to
suspend the general temulent irritation, and sound sleep has soon
followed. We have tried various modes of exhibiting the opiate in
temulence, hoping to find some rule for its use, combining the
greatest efficiency with the smallest quantity of the agent. We
have administered it in half-grain doses, repeating every thirty
minutes, and in doses of one grain every hour — again beginning
with half a grain, we have doubled the dose at every exhibition, in
the ratio of compound increase, as far as we dare carry it on this
rule. Each of those plans has succeeded ; but my experience leads
me decidedly to prefer half-grain doses of opium, or an equivalent
in laudanum, repeated every half hour. The plan of doubling the

164

Bibliography .

dose at every exhibition, with the view of multiplying equally or
more, the sum of quieting influence, often disappointed my expecta¬
tions, and it was frequently necessary to arrest die experiment, and
retrograde in the dose toward the first quantum

“ The form of opiate employed in temulence seems sometimes to
influence the result, as well as the amount. The pulv. Doveri an¬
swered well in habits giving an inflammatory character to the grade
of excitement associated with temulence, but from its tendency to
depress the tone of stomach, impair the appetite, and occasionally to
vomit, as often as repeated, it sometimes became necessary to with¬
draw it before sufficient opiate impression had been made. Even
where its depressing or disturbing effect upon the stomach did not
interfere with its continuance, it seemed to conduce to sleep less
than equal quantum of good opium or laudanum. Pure, dry opium,
(the older the better, if well kept,) wras long esteemed bjr us our
surest antidote. In this disorder, however, experience taught us,
that in obstinate cases, varying the form of the agent was sometimes
productive of benefit. In one case, where opium of the best quality
had been exhibited to the amount of sixteen grains in twelve hours,
without the smallest indication of submission to its influence, fifteen
drops of black drop, at one dose, was followed by sleep in thirty
minutes, which lasted, with a single interruption of a few moments,
fourteen hours.

The web of the black spider has received commendation from many
respectable sources, as a sedative angent, capable of calming with
peculiar ease and certainty, morbid excitability of the cerebral and
nervous systems. On the credit of those qualities it has been em¬
ployed in the various forms of temulence, and not without a share of
reputed success, sufficient to entitle it to consideration in that state
of constitutional irritation.' ” — American Journal of Sciences.

8. j Endermic medication. Cure of Inter mitt eats, by the application
of quinia to a blistered surface. — Dr. Gerhard, relates the result of
his observation in 200 cases, in which he tried endermic medication.
He does not state the nature of these cases, but relates five of inter-
mittents in which a blister four inches square was applied to the epi¬
gastrium, and dressed with four grains quroua and strach sprinkled
on the surface four times a day. Some of these cases were obstinate
and were cured in a few days by this methed. He has written an
interesting paper on the value of this method in the Not'th American
Med. and Sur. Journ, April.

SURGERY.

9. Fractured Neck of the Scapula. — John Harrison, set. 85, an
active old man, was admitted on the 13th September, 1828, into the
Norwich Hospital, under the care of Mr. Cross. On examining the seat
of injury there was much the appearance of a dislocation of the left
shoulder ; viz. loss of its roundness from sinking of the deltoid
muscle, and the head of the humerus felt in the axilla. He stated
that he met with the accident from a fall in the street a fortnight
before. As far as could be ascertained, the blowr was received upon

Surgery ,

165

the shoulder, and the arm was not extended at the time, as it usually
is when a dislocation has taken place. He bad gone about without
much pain, and had sought no advice respecting his case till a day or
two ago, which he was induced to do at that time, because the arm
and hand had become much swollen and cedematous. By raising the
shoulder, the bone was moved into its place, but it sunk again as
soon as the support was removed. This explained the nature of the
case, and in corroboration of its being a fracture, a crepitus was felt
by placing the hand on the shoulder and raising the arm. The cora¬
coid process also fell, and became imperceptible to the finger, when
the shoulder was allowed to sink. A roller having been applied to
the forearm and arm, the fractured bone was reduced by raising the
humerus, whilst parallel to the chest, and drawing its head outwards.
It was maintained in this position by a conical pad, the base of which
was placed in the axilla, and fixed in that situation by tapes crossing
on the shoulder, and tied on the opposite side. A roller round the
body and arm kept the elbow applied to the chest, so as to throw the
head of the humerus outwards.

Oct. 30th. — The bandages have been renewed every week or ten
days, and the patient has been walking about well during the whole
time.

Nov. 6th. — The limb has been supported with the sub-axillary pad
and bandages up to this time, and on removing them to-day, the
shoulder is found to have a good rounded shape, and is firm, as if
union had taken place, but the apparatus is to be applied for another
week.

14th. — The pad and bandages were removed to-day, and the
shoulder is perfectly rounded and well shaped. The limb bears to be
moved freely ; and as there is no doubt of firm union having taken
place, the man is discharged. Two months afterwards, Mr. Cross
stated that he saw him enjoying full and free motion of the injured
shoulder.

Two days previously to admission, the patient applied to a surgeon
for relief, who, after a slight examination, sent him to the hospital
under an idea that he had met writh a dislocation of the humerus into
the axilla. The similarity, in appearance, which the two accidents
usually present, readily leads to the occurrence of such a mistake,
which, however, may easily be obviated by a strict and minute ex¬
amination, and by attending to the circumstances pointed out in the
relation of this case, viz. the ease with which the parts are brought
to their proper position ; the returning of the deformity as soon as
the limb is left unsupported : and the falling of the coracoid process
along with the limb, so as not to be felt in its usual situation. — Med.
Gazette.

10. Elephantiasis of the Scrotum. — “ When the scrotum is the part
affected, I apprehend that, after a certain time, the lymphatic vessels
become so much enlarged and relaxed, that they continue constantly
to pour out their contents, so that the tumour increases independently
of the febrile attacks. Where the penis is affected as wTell as the
scrotum, those parts enlarge together in an equal ratio ; but if the

166

Bibliography.

scrotum only be affected, then the penis, as the scrotum enlarges,
becomes drawn in, so as ultimately to disappear and become com¬
pletely imbedded in the tumour ; the prepuce being distended elon¬
gates, and opens by a naval-like aperture on some part of the anterior
surface, or even at the very end of the tumour. There is no limit to
the magnitude which tumours of this kind may acquire. The tes¬
ticles at first may be plainly felt in their natural situation in the
centre of the swelling, but in a more advanced stage they cannot be
discovered in consequence of the great thickness of the intervening
integuments. For the most part they are healthy ; though they may
be simultaneously affected with any other disease to which they are
subject, without reference to this. Hydrocele of one or both tunicae
vaginales is a very frequent occurrence, and the disease may be com¬
plicated with hernia.

“ There are many remarkable cases of this disease to be found
in various authors. Dionis relates a case, the history of which,
together with a drawing, were transmitted to him from Pondicherry
in 1710, and this was, for a long period, I believe, the only case on
record, but since that time almost innumerable examples of the same
affection have been published. The tumour, of which Dionis makes
mention, occurred in a negro, and is represented as being uneven,
and hard as a stone ; it was one foot three inches in length, the same
in breadth at the lower part, and its circumference was three feet six
inches ; the weight, as well as could be judged, was sixty -three
pounds. The scrotum of the negro, of whom Cheselden has given
a plate in the fourth edition of his anatomy, was of the same dimen¬
sions as the above. The tumour, which Walther dissected after the
death of the patient, descended to the knees ; the skin of the scrotum
was was three times thicker than natural, and the cellular membrane,
which surrounds and lies between the testicles, was distended by a
viscous fluid, on which the weight of the tumour, which was nearly
forty pounds, principally depended. Morgagni mentions two cases
of tumours, which he calls sarcoceles, but which were evidently of this
nature ; one of them was very similar to the case of Walther, a
print of which was sent to him from Syracuse, and its authenticity was
confirmed by the public authorities of that city. The other was seen
by Morgagni himself at Padua, in the year 1730, in a man who
passed through that town on his return to Este, the place of his
residence ; this tumour was the size of two men’s heads united
together, it was unattended with pain, and had been many years in
attaining that magnitude.

“ The person who had the tumour of which Meheede la Touche
has given a description was seventy years of age ; it was one foot
six inches in length, and three feet one inch in circumference ; the
penis was imbedded in the tumour. There is a case, however,, of
which Chopart speaks, more remarkable than any of the foregoing,
both with regard to its size and weight. The individual wras pre¬
sented to the academy of surgery in the year 1768 ; he was a negro
from the coast of Guinea, aged 50 years, robust, and five feet five
inches in height ; he had lately arrived from Martinique, where he

Surgery.

167

had lived for twenty-two years. The scrotum reached to the ancles,,
and was two feet two inches in circumference at the upper part, and
three feet two inches at the lower ; its length was two feet and a
half, and its weight forty pounds. The man was placed in the
JBicetre amongst the invalid pensioners, and died soon after of a
fever. Chopart was of opinion that the extirpation or amputation of
this monstrous sarcocele would only have tended to hasten the negro’s
death, and informs us that an operation of this kind was performed
unsuccessfully by M. Raymondon, on a man forty-two years of age,
who had a similar kind of tumour of the scrotum, but much less,
being twenty-three inches in length, and thirty-two in circumference
in the largest part ; it had attained this size in thirteen years, and
caused neither pain nor inconvenience except from its weight.
M. Raymondon, imagining that the tumour contained an effused fluid,
made a deep puncture with a trocar, but without letting out any
fluid. A second puncture was made with the same result ; the next
day, with the advice and in the presence of several surgeons, he
amputated this tumour near its summit, preserving the penis and
right testicle which was sound, but the left being diseased was
removed. The patient died six hours after the operation. The
tumour weighed twenty -nine pounds.

“ Imbert de Lonnes removed a tumour of this kind, weighing
thirty pounds, from the celebrated Charles de la Croix, formerly
minister for foreign affairs in France ; it had existed fourteen years,
and the operation, which lasted two hours and a half, was successful,
but is not otherwise described.

“ Baron Larrey describes this disease under the name of Sarcocele
and says that all the persons he saw with it were, at the same time,
more or less affected with elephantiasis. He relates the case of an
agricultural labourer, who came from Upper Egypt, whose scrotum
was estimated to weigh fifty pounds ; and states, that' in different
countries in Egypt he saw ten or twelve others nearly as large. An
old man of sixty, an inhabitant of Cairo, sent for the Baron, to
consult him respecting an enormous sarcocele, reaching to the lower
part of the leg, which he had had for twenty years, and which from
its size compelled him to keep in bed. His anxiety to be relieved
from so frightful an infirmity had induced him to take the advice of
the medical men of the country, who had tried without effect various
measures, as caustics, incisions, powerful discutients. He next con¬
sulted an English physician who was travelling in Egypt, and in the
hope of obtaining a perfect cure he consented to allow him to apply
the actual cautery ; but the repeated application of this agent pro¬
duced no effect, and the tumour continued in the same state. Some
years afterwards he applied to a Spanish physician, who was also on
his travels ; he passed a sharp instrument deep in the tumour, under
the supposition of its being a hydro -sarcocele, but nothing was dis¬
charged but a small quantity of blood. The sarcocele, far from
yielding to these measures, increased.

“ The propriety of removing the diseased parts having been deter¬
mined upon at a consultation, the following day was appointed for

168

Bibliography,

performing the operation; but the Baron received a sudden order to
follow the army, which had commenced its march towards Alexan¬
dria, and was thus prevented from carrying his design into execution.
He, however, did remove from a cook, in a convent of Capuchins at
Grand Cairo, a sarcocele of an oblong form, weighing about three
pounds.

“ The following case is related by Dr. Hendy, of Barbadoes ; — A
black man, cetat. 50, formerly healthy, about four years ago was first
seized with the glandular disease, attended with a very considerable
inflammation and enlargement of the scrotum. From his own
account, as well as from the symptoms, the local affection seemed to
have been entirely confined to the scrotum and cellular substance,
for he never had any symptoms that argued a diseased state of the
testicles. On each attack, the lymphatic glands, both in the thigh
and groin, were enlarged and painful for several hours' before the
commencement of fever, which was ushered in with the usual symp¬
toms of coldness, shivering, &c. In about thirty hours the fever
went off with profuse sweating, but the inflammation of the scrotum,
which came on with the hot fit, continued for several days, and
always left behind it a proportional enlargement. For the first two
years the attacks were frequent, and the increase of the scrotum
consequently was very rapid ; afterwards they were less frequent,
but the enlargement from each was more considerable ; and, from its
enormous weight, he was sensible of <a gradual increase even during
the intervals. The surface of the immense mass was very rough and
uneven, and felt to the touch as if it contained a half coagulated
fluid. No part of the penis could be discovered, and the urine was
voided at an opening towards the inferior and anterior part of the
tumour. From an accurate admeasurement its dimensions were
found to be, from the pubes to the opening above mentioned twenty
inches; its whole length twenty-four inches, and its circumference
six feet. The left leg was also enlarged by the disease, but in no
uncommon degree. A mortification of the part terminated the mi¬
serable existence of this poor creature ; and Dr. Hendy states that
five other cases had come within his knowledge, where the scrotum
being much enlarged, had sloughed, leaving the testicles entirely
denuded.

“ In the case of Paunchoo, related by Mr. Corse, in the second
volume of the Transactions of a Society for the Improvement of
Medical and Chirurgical Knowledge, it would appear that the tumour
had formed without being preceded by febrile attacks. He states,
that the patient first perceived a slight pain at the raph6, in the lower
part of the scrotum, which gradually increased, and, in four days a
swelling came on, which was confined to the skin of the scrotum.
The pain abated, but the swelling continued to increase, and in the
course of five years the penis and scrotum were blended in one mass.
The length of the tumour was twenty-five inches ; the circumfer¬
ence, at the middle thirty-eight inches, at the root fourteen, and at
the protuberance near the end twenty inches.

“ Never having seen nor heard of any case similar to this, Mr.

Corse was at a loss to know what name was applicable to the dis¬
order, and, doubtful of the propriety of attempting any operation for
his relief, he carried him to Calcutta in January, 1791, and got him
admitted into the general hospital. It being agreed, on a consulta¬
tion. that nothing could be done for him, he soon returned to his
place of residence, and Mr. Corse tried various medicines, but
without effect.

“ In the Philosophical Transactions mention is made of a case on
the coast of Africa, in which the scrotum was so large as to prevent
the individual leaving his bed.

“ Mr. Wadd relates a case of this disease (of which he gives a
drawing) affecting the integuments of the penis The man was a
native of Africa, twenty-five years of age, and being useless to his
master, was sent from the West Indies to England for the purpose of
being disencumbered of his burthen. Amputation of the diseased
prepuce was proposed, but the operation was delayed from the novelty
and curiosity of the case, and the vessel leaving the port of London
sooner than was expected, the patient returned wTith his disease.
The length of the penis was fourteen inches, and the circumference
twelve inches and a half.

“ Soon after my return to the island of St Christopher, having-
finished my medical education, amongst many other estates 1 was
appointed to the medical care of one belonging to Mr. Bourryau, and
there I found a negro named Montserrat, who, though young and
otherwise healthy, was rendered useless to his owner and burthen-
some to himself, from an enormous enlargement of the scrotum,
The disease prevented him from walking further than a few yards,
and this was accomplished with great difficulty ; he was thus almost
entirely confined to his hut. The tumour was somewhat of an oval
form ; its neck extended from the symphysis pubis to the anus, and
the body of the tumour projecting a considerable distance both before
and behind, descended to within an inch of the ground, dragging
down the abdominal integuments : it measured in length twenty -nine
inches, and in circumference forty-three ; the spermatic cords could
be distinctly felt, somewhat enlarged, but without hardness or in¬
equality. The testicles could not be discerned. The penis was
deeply imbedded in the tumour, and the urine was discharged at a
navel-like orifice, situated (when the patient was standing) nine
inches below the symphysis pubis. On stretching this passage
laterally, the extremity of the penis could be seen at the distance of
three or four inches up this canal, which was formed by an elonga¬
tion of the prepuce. The surface of the tumour was equal and
smooth ; the superficial veins were much enlarged ; the superior part
was thinly interspersed with hair, and the inferior was at times scaly.
The integuments felt extremely thickened, but were not of equal
firmness all over, and they retained for a time the impression of the
finger. The man’s appetite and general health were good. He
stated that when in bed, and under the influence of lascivious ideas,
he was subject to erections of the penis, at which times this member
would project at the orifice above mentioned (which from his hori-

Vol. v. no. 26.

Y

I TO

Bibliography .

zontal position approached, of course, much nearer to the pubes),
but said that they were never attended with seminal emissions.

“ After a careful examination, I informed him that I considered
the extirpation of the tumour practicable, though the operation would
necessarily be attended with extreme hazard. He replied that life
was quite burthensome to him, that he would rather die than remain
longer in his present condition, and that he would readily submit to
any operation, how great soever the risk. My friends, Drs. William
and Thomas Swanston, having done me the favour to visit the man,
and concurring with me as to the practicability of its removal, we
decided on the operation ; but it being then the hurricane season of
the year, a period always unfavourable for the performance of surgical
operations, he was recommended to wait until the weather became
more settled, Finding there was a possibility of being relieved of
his incumbrance, he became so importunate with me to have the
operation done immediately, that, with a view to quiet him, a large
blister was applied on each side of the scrotum, and kept open for
some time by means of the unguentum sabinse. A very deep seton
was afterwards made on each side ; but, notwithstanding these dis¬
charged freely for nearly six weeks, no diminution of bulk was
observable.

“ On the 5th of December, 1813, I performed the operation,
assisted by my friends, Drs. Swanston and Dr. James T. Caines, in
the following manner ; — -the patient being placed upon a table on his
back, with his breech towards the edge, and being properly secured
and supported, an incision was made, commencing at the symphysis
pubis and extending in a line towards the opening of the prepuce ;
the dorsum of the penis was thus exposed, and its point being held
between the finger and thumb of an assistant, the prepuce was cut
across and the penis dissected out. A flexible catheter was then
introduced into the bladder ; all our previous attempts to accomplish
this object having failed, in consequence of the retrocession of the
penis ; the spermatic cords, which were at a great depth, were next
cut down upon, a temporary ligature passed around each by means of
an aneurism needle, and they were then divided. The incision being
carried backwards on each side to the verge of the anus, the opera¬
tion was finished by detaching the tumour from its connexions with
the perineal fascia and adjacent parts. The temporary ligatures
placed on the cords were then removed, and the arteries secured
separately. The integuments were brought together and retained by
a few sutures and slips of adhesive plaster, and were sufficient to
cover the perineum and to surround the root of the penis, so that this
member was the only part which remained uncovered by integu¬
ments. The haemorrhage during the operation was less than we
could have expected, considering the magnitude of the tumour.

“ The man recovered without experiencing an unpleasant symp¬
tom. The wounds in the groins and in the perineum were united at
the end of three weeks, but the penis was not completely cicatrized
before the beginning of April.

“ On examination of the tumour after its removal, the testicles
were found to occupy their natural position. The left was about the

Surgery.

171

size of a hen’s egg ; the tunica vaginalis of the right contained three
pints of fluid, and the testicle was considerably diminished. The
layers. of membrane investing the spermatic cords were filled with
fluid and gelatinous matter. The substance of the scrotum at the
upper part was about two inches, but nearer the base it increased to
four and a half inches in thickness, and much fluid oozed from its
substance ; its cavity was filled with a gelatinous matter and fluid,
which formed a jelly on cooling. The tumour weighed seventy
pounds avoirdupois.

“ I transmitted the history of this case to my much-respected
friend and preceptor, Mr. Thomas Blizard, by whom it was read to
the Medico-Chirurgical Society on the 20th December, 1814; and
it is published in the sixth volume of their Transactions.

“ A few months after the foregoing operation, my friend Dr.
Caines performed one of a similar kind on an elderly negro, named
Castello, at which I was present. In this case, there was a hernia on
the right side, the sac of which adhered almost universally to the
adjoining parts, and to separate this required a tedious dissection.
This being accomplished, and the hernia with its sac returned into
the abdominal cavity, the operation was conducted as in the former
case. The tumour weighed fifty pouuds. On the 10th July, 1816,
I assisted the same gentleman in a similar operation, and again in
1820. In the former case the scrotum was nearly as large as Gas¬
tello’s, and there was a hydrocele on each side. All the patients
recovered.

“ On the 26th June, 1816, I operated on three men with ele¬
phantiasis of the scrotum. On the 9th August, 1817, I removed the
scrotum of a negro ; the right testicle was enlarged to the size of a
man’s fist and indurated, and, on dividing it, I found a portion of
the centre ossified. On the 21st June, 1819, I performed a similar
operation. All the patients recovered.

“ But the most remarkable tumour of this description, which I
have either seen or heard of, was attached to a man belonging to the
estate of the Rev. Mr. Verchild ; and from this the late Mr, Wilkes
endeavoured to separate the unfortunate possessor on the 6th Feb¬
ruary, 1815. I was accidently prevented from being present at this
operation, but the following particulars were communicated to me by
Mr. Wilkes. The length of the tumour was two feet five inches ;
its circumference five feet ten inches ; and its weight one hundred
and sixty-five pounds avoirdupois. The operation occupied nearly
eight hours, and the man died apparently from exhaustion towards
its conclusion ; a copious venous haemorrhage followed each stroke,
of the knife ; the lymphatic vessels were very much enlarged and
were apparent, traversing the tumour. My friend Mr. Jordan, of
Weymouth-street, at that time stationed in St. Christopher, as
surgeon to the forces, was present, as were also Messrs. Richards
and Waterson of the 15th regiment, and Dr. Clifton, a practitioner
of the island. The operation was likewise viewed by several gentle¬
men not of the profession, and the tumour was seen by the Rev. Mr.
Verchild and Mr. Goldfrap.

m

Bibliography.

“ I once assisted at an operation of this hind which terminated
unfavourably. The tumour in this case measured in length twenty
inches, and in circumference forty-four. The patient was' a young
man, and, although anxious for the removal of the tumour, yet he
was under a state of great alarm, as was evident both from his coun¬
tenance and manner. Notwithstanding the operation was performed
with great dexterity and celerity, not having occupied half an hour,
and the haemorrhage was very trifling, yet the poor fellow most un¬
expectedly died on the table,

" Whilst these swellings are yet of moderate size the operation is
comparatively easy ; but when they have attained a magnitude ap¬
proaching to that of my first case, then it becomes, probably, the
most laborious piece of dissection that occurs in the practice of
surgery.” — Tilley on Diseases of the Male Genitals.

Midwifery.

11. Case of Gaslro-hysterotomy (Ccesarean SectionJ in case of seven
months1 pregnancy , in which labour commenced, ceased, purulent dis¬
charge from vagina , passage of arm, forearm, and carpal bones — opera¬
tion performed nearly nine months after the cessation of parturient
action. — Dr. Toy, of Virginia, relates the very interesting case,
whose title is now given, the facts of which are, as follow. The
lady, who was the subject of this case was seized with apparent la¬
bour, Nov. 1, 1828, the os tincse dilated membranes burst and two or
three gallons of water, escaped. The next, she complained of pain
in the abdomen which was tumid, tense and hot, pulse, small and
quick, great restlessness and anxiety, os tincse soft and dilated and
the external parts swollen and inflamed. Fomentations, secale cor-
nutum, febrifuge medicines. No part of the foetus was felt. The
patient did not expect to be confined until Dec. 10th. Face, feet
and legs were swollen, and considerable fever present. 12th. An
offensive discharge from vagina “resembling matter from an ulcer.”
18th. All unpleasant symptoms abated except swelling and discharge.
The latter continued till January, and the bones had passed three
weeks previously. Tonics were employed. The first week in April
a small discoloured spot appeared above the umbilicus on the right
side, which was painful. May 7th, There was an aperture through
the spot, through which a small probe could be introduced. The dis¬
charge from the vagina had ceased about the end of Jan., but it was
now slight from the abdomen. An operation was proposed, but re¬
fused ; tonics and palliatives employed. On the 12th August, the
operation was performed, and we shall let the narrator describe it in
his own words.

“We proceeded to remove the bones on the 12 th of August, her
husband, an old woman, Dr. Banks, and myself being the only per¬
sons present. The aperture had increased in size considerably, being
about two lines in diameter at the surface. I made the first incision
about four inches long, in the direction of the linea alba, commencing
two inches above the umbilicus, and one inch to the right of it. This
was continued through the parietes of the abdomen and uterus into

Midwifery .

173

the cavity of the latter, the incision I crossed in its centre, by another
at right angles with it of equal length and depth. The top of the
cranium was found presenting, the bones appearing to be firmly
united.

“ I attempted to introduce a pair of small obstetrical forceps, with
the view of removing the head at once This, however, was
found to be impracticable without using more force than I judged
prudent, as the uterus was firmly and rigidly contracted around it. I
used therefore, a pair of strong forceps from a pocket case, and with
these succeeded in detaching and removing the bones of the cranium
separately and successively ; all the other bones of the foetus remain¬
ing. We found that adhesive inflammation had united the uterus to
the parietes of the abdomen for some distance around the opening,
the diameter of the circle of adhesion was more than an inch. The
operation occupied about fifteen minutes. After repeatedly washing
the part, the edges of the wound were brought together, and dressed
with adhesive plaster. Stitches were found unnecessary. Over this,
pledgets of lint and a compress of old linen were applied, and a roller
passed round the abdomen. Before the wound was dressed the lady
expressed herself entirely relieved from the uneasiness which the pre¬
sence of the bones had so long occasioned. She complained of some
pain about the uterus.

‘‘ On our visit the next day, she was in all respects doing well. The
pain which she complained of the preceding day had continued for
some hours, but she was now entirely easy, and expressed in strong
terms the relief which she had felt since the removal of the bones.

“ In six weeks she was entirely well, and had visited several of her
neighbours. The opening which had existed previous to the opera¬
tion was not entirely filled up, but the incisions united by the first in¬
tention.

“ I saw this lady in December last — she was then in fine health and
very fleshy. The catamenial discharge had returned and was now-
regular. ' . i

'• This case could not have been one of extra-uterine conception, for
the early history of the case together with the discharge of the soft
parts and bones per vaginam, prove incontestibly that it was uterine,
even if the operation had not demonstrated the fact. Neither can it
be believed that there had been rupture of the uterus at any period
during the progress of this case, for when the bones were removed
they were firmly enclosed in the uterus, and there was no other open¬
ing but the passage externally, for which we think there is little diffi¬
culty in accounting. The pressure of the bones against the walls
of the uterus, produced inflammation and suppuration, which, passing
by continuity of surface to the parietes of the abdomen occasioned the
aperture. The inflammation thus excited also produced adhesion be¬
tween the uterus and abdominal parietes, which union must still
exist-— indeed, when I last examined her, the parietes of the abdomen
were considerably drawn in by this attachment.

Believing this case to be of considerable interest to the medical

174

Bibliography.

world, and besides, one of rare occurrence, I have been induced to
subm it it for publication/’ — Amer. Journ . of Med. Sciences.

The history of this case is defective, and does not afford any clue to
the exact nature of the phenomena detailed. The author has not given
any account of the former history of the patient, nor thrown any
light on the cause of retention of the foetus after natural labour had
commenced. The case however is of great value, and entitles Dr.
Toy to great credit for the bold and judicious manner in which he
treated it. The result of the operation clearly demonstrates the fea¬
sibility of gastro -hysterotomy, when the vital powers are not too
much reduced. — Editor.

MISCELLANIES.

12. Pathology of Purpura Hemorrhagica. — Dr. Harty, of Dublin,
has published an interesting paper, on purpura hemorrhagica, in the Edin.
Med. Journ. July, in which he maintains that the disease depends on
a disordered state of the alimentary canal, or abdominal viscera, and
that this state is obviated by continued purging for several days.
Mercurial purgatives are to be preferred, and depletion employed
sparingly to diminish febrile action. He details some cases illustra¬
tive of the efficacy of mercurial medicine.

13. Stethoscope. — Dr. Forbes has published two lectures on the
value of auscultation and percussion in diseases of the chest, which
we strongly recommend to those about to commence the "study of the
only sure mode of ascertaining the diagnosis of this important class of
diseases. No man can read this exposition without the conviction of
the great value of auscultation and percussion in thoracic diseases,
and the able author has demonstrated the facility with which this im¬
portant knowledge can be acquired. We are happy to state that Dr.
Forbes has been appointed physician to His Royal Highness the Duke
of Sussex, which affords another example of the beneficence of our
gracious Sovereign, in rewarding talent and merit. His motto, seems
to be “ palmam qui meruit, ferat.”

14. Popular Lecture on the component parts of the Animal body: —
Mr. Dewhurst has published a lecture on the component parts of
the animal body, in which he displays much ability, and gives a good
outline of the structure of the human body. The student or general
reader may acquire a good deal of info-mation, by the perusal of this
dissertation.

15. Report of the Cork-street Fever Hospital, Dublin. — We have
been favoured with a copy of the report of the Fever Hospital,
Cork-street, Dublin, from 1829, to January, 1830, with the medical
report annexed, which we believe to be the production of Dr.
O’Brien. We have only space to observe that the report is ably
drawn up, and affords ample proof of the judgment and ability of
the author as a practical physician. We shall analyse it in our next.

16. The London University . — We are sorry to observe the dis¬
putes which agitate this valuable institution. The professors and
council are the contending parties, and all seem unmindful of the
axiom, that i( a house divided against itself cannot stand/’ There is

Miscellanies.

175

one point of dispute on which we must animadvert, and that is, the
discovery of the council, which commands one of the professors to
appear before them, to have his competency examined by one of his
own pupils. Such an absurd and ridiculous mandate has never dis¬
graced the history of any similar establishment, and it clearly proves
the incompetence and arrogance of those individuals, the majority of
whom are ignorant of the science on which they pretend to adju¬
dicate.

We understand that Dr. Paris, has lately made a very curious dis¬
covery, relative to the solvent powers of water upon lead, which will
have the effect of modifying the theory of Sir H. Davy, relative to
the protecting influence of metals upon each other, and of offering a
new field of investigation. The experiments have not yet been pub¬
lished.

After the foundation of the College of Physicians, it is true, em¬
pirics were occasionally treated in the most summary manner, and
their dealings with the credulous must have been wicked and gross, to
have deserved such a punishment as the following, recorded by Stow,
in his chronicles :

“ A counterfeit doctor,” says he, “was set on horseback, his face
to the horse’s tail, the same tail in his hand as a bridle, a collar of
Jordans about his neck, a whetstone on his breast, and so led through
the City of London, with ringing of basins, and banished. Such de¬
ceivers, continue the chronicles “no doubt, are many, who, being
never trained up in reading or practice of physic and chirurgery, do
boast to make great cures, especially on women, as to make them
straight that before were crooked, corbed, or crump in any part of
their bodies, &c. But the contrary is, true ; for some have received
gold, when they have better deserved the whetstone.” — Family Li¬
brary, No. XIV.

17. Sight restored by Lightning. — A singular circumstance oc¬
curred in the house of Ed. Parker, Walker Street, Toxteth Park,
on the night of the 25th ult. An old. man, aged 101, named
Charles Rigby, who has been blind for the last seven years, was
lying in bed about seven o’clock on that night, when a flash of
lightning entering the room had such an effect upon him, that
almost immediately he partially recovered his sight, and he informs
us that it has been getting stronger every day since that time.

18. Coffee. — The roots of succory, and those of the dandelion,
form one of the best substitutes for coffee. Dr. Hewison, of Edin¬
burgh, prefers dandelion coffee to that of Mecca ; and many per¬
sons, all over the Continent, prefer a mixture of succory and coffee
to coffee alone. Dig up the roots of dandelion, wash them well,
but do not scrape them ; dry them ; cut them in bits the size of
peas, and then roast them in an earthen pot, or coffee roaster of
any kind, and grind them in a coffee mill, or bruise them in any
way. The great secret of good coffee is to have it fresh burnt and
fresh ground. — Loudon's Manual of Cottage Gardening, fyc.

176

Miscellanies .

19. On the action of Medicines, effected by Contiguity. — Expe¬
rience has proved, that when a medicinal substance comes in con¬
tact with any part of the body, its action is not confined to the
mere part, but often propagates itself through the subjacent tissues
to deep-seated organs. On this principle, when the liver and
bladder, or other internal organs are affected, emollient applications
are made to the surface over them. On the same principle, catap¬
lasms, ointments, &c. covering tumours, swelled glands, &c. are
found useful. Physiology proves to us, that by irritating the excre¬
tory ducts of a gland, the secretion of that gland are excited and
accelerated. Thus purgatives, when they enter the duodenum,
irritate the ductus choledochus, and thereby cause the liver and
pancreas to secrete more abundantly. — •Spillan.

BOOKS RECEIVED DURING THE MONTH *

1. Report of the Managing Committee of the House of Recovery and Fever
Hospital in Cork Street, Dublin, for one year, ending 4th January. 1830. with
the medical report annexed. Dublin, 1830. 8vo. pp 11*2. Richard and Webb .

2. An Introduction to Systematical and Phisiological Botany, illustrated with
explanatory engravings. By Thomas Castle, F.L. S, Member of the Royal
Collegeof Surgeons, &c. London, 1829. 12mo pp. 285, coloured plates. Sold
by E. Cox. Southwark; Baldwin and Cradock, Paternoster Row, and T. and G.
Underwood, Fleet Street.

3. A Concise Treatise on Dislocations and Fractures, being a selection from the
most approved Foreign and English surgical authorities, from the days of Celsus
to the present time, illustrated by fourteen plates. London, 1830. l2mo. pp. 114,
published by James Bulcock, Chelsea.

4. A Treatise on the Mineral Waters of Harrogate and its vicinity. By Adam

Hunter, M. D., &c. &c. &c. London, 1830. 12mo. pp. 138. Longman and

Co. Black, Edinburgh.

5. An Inquiry as to the Expediency of a County Asylum for Pauper Lunatics,
second edition, with considerable additions. By W. Palmer, D. D. a magistrate
of the counties of Devon and Somerset. Exeter, 1830. 8vo. pp. 36. Trew-
man and Co. Exeter; Rivingtons, and T. and G. Underwood, London.

7. Two Lectures on some of the Physical Signs of Diseases of the Chest. By
John Forbes, M. D. F. R. S. Portsmouth, 1830. 8vo, pp.26.

8. A Dissertation on the Component Parts of an Animal Body. By Henry
Wm. Dewhurst;, Surgeon. London, 1830. 12mo. pp. 64. Published for die
author by Callow and Wilson, Princes Street, Soho, and Sherwood, Pater¬
noster Row.

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

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 27. SEPTEMBER 1, 1830. Vol. V.

CRITICAL REVIEW.

I. — Cholera , its Nature, Cause, and Treatment ; with
original views, Physiological, Pathological, and The¬
rapeutical, in relation to Fever ; the action of Poisons
on the System, fyc. fyc. ; to which is added, an Essay
on vital temperature and nervous energy ; explanatory
more particularly of the nature, source, and distribu¬
tion of the latter ; and of the connection between the
mind and the body , fyc. fyc. By Charles Searie, Sur¬
geon of the Hon. East India Company’s Madras Esta¬
blishment. 8vo. pp. 255. London/1830. John Wilson.

It is a maxim in medical literature that style and composi¬
tion are not so necessary as in other kinds of writing ; but
we could never comprehend a particle of reason in support
of this assertion. Of late years the worst species of writing
is medical, and rarely do we find a work written correctly.
The work before is an excellent illustration of our state¬
ment, it is contrary to every rule of composition, and of
course must be ambiguous, if not unintelligible. The first
sentence of the preface extends to twenty-eight lines of
small print, in which there are almost as many transitions
from subject to subject as there are lines, and which ought
to have been divided into several sentences. The same
defect appears in every page, and renders the meaning of
the author doubtful, and often incomprehensible. In fact,
the work sets criticism at defiance, for no man could under-
take the task of exposing its inaccuracies. It is right to
illustrate the justness of our censure by a quotation.

“ The object of this work, is the improvement of our practice,
in the attempt to define principles of treatment of a disease, the
pathology and nature of which from being but imperfectly under¬
stood, many — very many, annually fall a sacrifice — at least such

vol. v. no. 27.

z

178

Critical Review.

is my belief ; not that 1 charge my professional brethren with any
culpability in which I am not equally implicated ; no, it was the
experience of want of success in my own practice, with the loss of
a relative, on the same occasion that the public sustained so heavy
a one, in the death of the late revered Governor of Madras, Sir
Thomas Munro, who also fell a victim to this disease ; leading me
to the conclusion that there was something radically wrong in our
views and treatment, induced me to investigate the numerous public
records on the subject ; from which I had deduced certain inferences,
and was embodying my thoughts in a shape suitable with the inten¬
tion I meditated, of submitting my views to the Medical Society
of Madras, then existing, when becoming myself the subject of
its attack, it not only afforded me an opportunity of verifying the
conclusions I had arrived at, with regard to the line of practice
which should be pursued in the treatment ; but under this personal
experience, having strictly attended to the progression of the symp¬
toms, and my feelings,, it gave me a clue, which enabled me to
solve the difficulties I before laboured under, with regard to the
explanation of the symptoms and nature of the disease ; in short,
the explanation I arrived at, operating upon my mind with all the
force of the most perfect conviction, induced me to extend my
original design, and to submit my views to the press at Madras, in
an Essay, under the title of ‘ Cholera Pathologically and Practically
considered.’ ” — p. vi.

Without troubling’ the reader with further extracts, we
shall endeavour to detail faithfully the author’s views on
the nature and treatment of cholera. More than half his
work consists of extracts from the Madras medical reports,
various periodicals and monographs, and contains a
good, though very confused description of the disease. It
appears by the concurrent testimony of the majority of the
numerous writers whom he quotes, that in severe cases of
cholera, there is palliditv and coldness of the skin, some¬
times lividity, imperfect oxygenation of the blood in the
lungs, as the blood is dark and thick both in the veins and
arteries. Such is said to be the condition of the blood
when drawn from the temporal artery. The necroscopic
appearances are congestion in the brain, lungs, and alimen¬
tary canal. In some cases there were effusion, and extrava¬
sation in the brain ; the lungs were so congested (i as to
resemble a mass of bruised flesh,” the liVfer and spleen were
not invariably affected, but were often filled with dark
blood. The gall-bladder was almost invariably filled with
bile, though its duct was pervious. The mucous surface
of the stomach and .intestines was dark with patches of red,
the urinary bladder was empty and contracted. The general
opinion on the etiology of the disease is, that it arises from
malaria, the product of swamps, stagnant water, or putri-

Mr. Searle on the Cholera of India. 179

fying animal and vegetable substances ; and this opinion is
attested by the singular fact that cattle and poultry were
destroyed in the contaminated districts, and presented the
same appearances of congestion as the human subject.
Mr. Searle cites a host of authorities in proof of cholera
being caused by malaria, and he is silent on the question
of the contagiousness of the disease. He next describes
the effects of malaria on the different functions, and arrives
at the very un physiological conclusion, that the primary
operation” of the febrile cause is not on the brain and
spinal marrow, but on the skin and lungs, the poison is
absorbed from these parts, is mixed with the blood, which
it contaminates and renders unfit for the purposes of life.
The brain is secondarily affected by its receiving contami¬
nated blood. To this deranged state of the circulation
he refers all the phenomena of the disease. This theory
is manifestly untenable, it is contrary to the received opi¬
nion in every country, as to the primary effects of malaria
or contag'ion on the body, and is most completely annihilated
by the incontrovertible conclusions of Morgan and Addison
on the effects of poisons. The spasms he ascribes to con¬
gestion at the roots of the spinal nerves, a condition first
pointed out by Dr. Sanders, of Edinburgh, and which
Mr. Searle hes found to exist in every case which he has
examined. He endeavours to explain the semeiology of the
disease agreeably to his theory, but as his premises are
untenable, it is unimportant to hear his conclusions. He
divides the disease into three species, which he has infeli-
citously designated cholera asphyxia, cholera congestiva,
and cholera morbus. The classical scholar will be shocked
at these terms, and the clinical practitioner will question
their accuracy. Every one of these terms are objectionable.
The word cholera was employed alone by the ancient
Greek and Roman physicians, and the addition of the word
morbus, is an excrescence of modern growth. It would be
just as correct to say typhus morbus, or podagra morbus,
terms that would strike the veriest medical tyro as barba¬
rous and superfluous. The first species, cholera asphyxia,
(asphyxiata ?) is ushered in by great prostration of the vital
powers, mortal coldness, cessation of the circulation, and,
sudden death, which is sometimes preceded by convulsions.
Such formidable symptoms often characterise typhus fever,
yellow fever, and plague, but as yet no writer has appended
the word asphyxia to these diseases.

The second species, cholera congestiva, is thus defined : —
The patient is suddenly seized with vertigo, borborygmi,
and diarrhoea, dejections of a conjee or barley water ap-

ISO

Critical Rexiew .

pearance, succeeded by great prostration of strength, tremor
or twitching of the extremities, alias clonic spasms,’ ’
countenance sunk and ghastly, cold damp skin, feeble pulse
and prsscordial oppression. A sense of burning heat soon
arises in the stomach, attended with great thirst and an
insatiable desire for cold water, and violent spasms affecting
every part of the body, especially the lower extremities,
supervene, which are speedily followed by collapse, lividity
of the skin, cold clammy perspiration, coma and death.

The third species, cholera morbus, is ushered in by the
usual symptoms of fever, which are soon accompanied by
vomiting and purging of a slimy bilious matter, attended
with griping, violent head ache, and painful spasms, and
soon terminate like the second species.

Mr. Searle proceeds to describe the treatment which he
adapts to his theory of the disease, and which appears in
many points objectionable. Thus he considers mercury
almost a specific in the cure of the disease, “ aided, of
course, by such remedies as circumstances require to fur¬
ther its action.” Very few practitioners depend on mercury
at the present day, and we must observe, that its power as
a stimulus, in the first species of cholera, in which the vital
powers are prostrate, and congestion of all the viscera pre¬
sent, appears to us inactive and doubtful practice, which
we should not think of employing in the fever of this coun¬
try when characterised by such symptoms. The author
virtually agrees with us, if we understand him rightly, for
he adds, in the same sentence in which he recommends mer¬
cury, that general and local stimuli are indicated, such as
external heat and friction, the recumbent posture, ammonia,
warm spirits and water, &e.— -and stimulating saline clysters

with a view of increasing serous exudation, and by con¬
sequence, removal of congestion from the mesenteric and
gastric vessels as well as from the brain, thus aiding ab¬
sorption of our remedies from the stomach and bowels.”
He endeavours to explain this mode of treatment by the
experiments of Magendie, which shewed that absorption
does not take place on congested surfaces ; and here, as in
all other details of treatment, our author theorizes too
much, and leaves an impression on the reader’s mind, that
his recommendations of cure are more speculative than prac¬
tical or real. His observations on blood letting are curious ;
he holds that blood should be drawn from a small orifice,
the patient being in the recumbent posture, as venesection
is resorted to for the purpose of exciting the heart’s action
only. He says, the greatest caution is required during the
operation, and that the rising or flagging of the pulse is the

Mr. Searle on the Cholera of fridia.

181

only certain indication as to the propriety and safety of
continuing the depletion. But in a succeeding part of the
work,' we are informed copious depletion is the sheet anchor,
and the most efficacious of all the modes of treatment.

Dr. James Johnson was, we believe, the first who recom¬
mended depletion in cholera, and superseded the empirical
practice of large doses of mercury. Subsequent experience
has corroborated the excellence of his judicious advice.
When excitement has commenced, our author recommends
bleeding, purging, calomel, leeches over the affected organ,
clysters, sinapisms or blisters to the extremities. He ad¬
verts to the state of collapse, so common after excitement,
and states positively that he has rescued many persons from
the jaws of death by quinine, a practice which he thinks
highly important in the intermittent, remittent, and typhoid
fevers, and which he suggests to the notice of Drs. Smith and
Tweedie — a practice which has been successfully employed
by the most eminent physicians which this empire has pro¬
duced, and which we have found most beneficial in some
thousands of cases. But it does not accord with the solidism
of the day, and hence it has been most preposterously
decried. A section is introduced on the effects of opium
on the system in health and disease, and our author con¬
cludes that this remedy is useful in the stage of collapse
only. The next chapter is a popular description of the
treatment of cholera. First, the patient is to be put to
bed in an airy chamber, and an emetic of black mustard
seed, two table spoonsful in half a pint of warm water
exhibited, which acts better than any other emetic, and
causes a glow of warmth throughout the system. After
this the following enema should be administered every half
hour, or oftener: — A dessert spoonful of table salt, a pint
of warm water, and a spoonful of common or castor oil.
This remedy tranquillizes the stomach, and enables it to
retain a scruple of calomel, which is to be washed down
with a table spoonful of brandy, and two of warm water.
The remainder of the treatment is described in the following
words : —

“ If the case is urgent, the same dose of calomel may be re¬
peated every hour ; otherwise, in two hours ; or if the patient is
much improved, in half the quantity ; and thus prolonging the
interval, or reducing the quantity — it must be continued, according
to the state of the patient, till bilious stools and urine are produced ;
the spirit and water, or mulled wine either ; or where the system
is very low, thirty drops of (sal volatile) aromatic spirits of ammo¬
nia, or of hartshorn in half a wine-glassful of water, may be singly,
or alternately administered, every quarter or half hour ; with the

182

Critical Review.

precaution before given, to avoid oppressing the stomach by undue
quantity.

“ In addition to these means, if the skin is cold, warm flannels
should be constantly applied ; or if the skin is damp and the patient
suffers by cramps in his legs and arms, the parts may be well com¬
pressed, and rubbed with the flannels besprinkled with hot salt.
We have yet omitted to mention a very important remedy, one
capable of producing much good, or no less harm — this is blood¬
letting — which if the patient is an European, or native of pretty
robust habit, should be early resorted to — if the pulse admits of it,
that is, if compared with another person’s- — it is of pretty moderate
strength ; the object to be borne in mind by bleeding in this case,
is to excite, by removing oppression from the brain and circulation,
and not to subdue the action of the heart, that it should be taken
from the patient whilst continuing in the recumbent posture, — and
here I must insist once for all, that on no account and for no pur¬
pose is the patient to be permitted to sit up, or leave the recumbent
state, or sickness almost immediately takes place ; the evacuations
should therefore be received in a bed-pan, or cloth ; and the blood
be taken from a rather small orifice, that, the stream being in con¬
sequence small, the system may have time to accommodate itself to
the deprivation, — the effect of which, however, should be carefully
watched — the operator keeping his finger during the time on the
pulse, at the same time encouraging the patient by suitable con¬
versation ; when, at the instant it is found to flag, without reference
to the quantity withdrawn, whether much or little the finger should
be placed over the orifice ; but it must be borne in mind, that fear,
nausea, or sickness may occasion this result, that should the quan¬
tity taken have been small after a few minutes — if the pulse reco¬
vers its wonted strength, as it is an object to carry it to as great an
extent as the circumstances of the patient admit — the finger may be
removed from the orifice in the vein, and the blood allowed again
to flow, with the precautions before specified ; but should, after a
further small loss, the same result ensue, it is clear that any addi¬
tional attempt at this time would be injurious ; though it may be
afterwards practised, as excitement becomes developed, either in
relief of spasms, sense of burning heat in the stomach, or pain in
the head, or oppression of breathing ; and with the precautions I
have given, may be frequently put into practice, and without the
possibility of harm — but on the contrary with the happiest effect ;
for in this disease small bleedings in relief of the engorgement of
the brain, stomach, and heart, are clearly and most forcibly indi¬
cated. (See case A. in the Appendix.) The same intention is
partially fulfilled by the clysters, but as warmth and excitement
become developed, evinced too by the desire the patient has for cold
water — these may be aided, or superceded by a weak and cold solu¬
tion of Cheltenham or Epsom salts, or of cream of tartar, with
which the patient may be now indulged — in the quantity of a wine-
glassful at a time, instead of the cordials, which would now prove
injurious ; these will not, however, supercede the calomel, the ne-

Mr, Searle on the Cholera of India. 183

cessity for which still continues, not only till bilious stools are pro¬
cured, but even then, though in smaller doses, till healthy evacua¬
tions follow. It may however now, on febrile symptoms taking
place, be well to combine it, with an equal weight of James’s
fever, or antimonial powder, and give it, if it is preferred in the
form of pill ; but mind if the calomel is thus combined, acids, such
as cream of tartar, are not admissible, as an emetic compound would
be the result. The calomel and antimonial powder we would now
advise, in the proportion of two grains of each, every two hours,
with a tea- spoonful of Epsom or Cheltenham salts, in a claret-
glassful of water with every second dose ; and if there is much
thirst, the patient may at the same time be allowed a wine-glassful
of barley or cold water every half hour ; and the same be continued
till the secretions of bile and urine are restored ; when, and not
before, may the patient be allowed some sustenance, the best of
which will be light beef tea, or chicken broth, for it must be re¬
membered, and borne in mind, during the convalescence, that in
proportion to the feeble state of the patient, so is the stomach weak,
and powers of digestion.

“ Many have an objection to salts, where this is the case two
table spoonsful of castor oil may be substituted, or a dose of rhu¬
barb and magnesia when this is preferred. Should the operation
of the purgative be attended with much exhaustion, it may be ne¬
cessary to support the patient with some spiced broth, wine and
water, or mulled wine ; or it may even be necessary to moderate it
if there is much sinking, by a dose, of from twenty to forty drops
of laudanum ; but this is providing against contingencies, which
with moderate care and attention will seldom be found necessary.

“ The secretions from the bowels are now sometimes so exceed¬
ingly acrimonious, that in passing along the line of bowels and
from the anus, they produce, from extreme irritation, very con¬
siderable exhaustion ; when this is the case it will be advisable to
inject an occasional emollient clyster, of starch or conjee water,
with oil ; to the first of which, may be added a tea-spoonful of
laudanum, and this repeated if necessary ; at the same time hot
flannels maybe applied to the belly.” — p. 119.

When the disease comes on insidiously, with symptoms
of indigestion and diarrhoea, a grain of opium is to be
added to the calomel, and the remainder of the treatment
is the same as already described, except that rhubarb and
magnesia, or castor oil is preferable to salts. Should
there be burning heat of the stomach, calomel is to be
given every hour, small quantities of cold water to be
allowed, and a dozen leeches applied to the epigastrium.
If spasms supervene, bleeding may be employed with the
precautions already mentioned. Great relief is afforded by
the fan or hand punkah, which aids the respiratory function,
and is extremely agreeable to the patient.

184

Critical Review.

In the asphyxiated form of cholera, the treatment con¬
sists of the exhibition of brandy and water, aromatic spirit
of ammonia, calomel saline clysters, frictions over the
heart, stomach, and extremities, and when excitement com¬
mences, stimulation is to be diminished, and depletion cau¬
tiously employed.

The third species differs little from common cholera, and
is to be heated by an emetic in the cold stage, and after
its operation by calomel, warm wine and water, or ginger
tea, and when excitement commences, cautious depletion,
warm bath, and clysters are to be employed. In the stage
of collapse, calomel and opium are highly serviceable as
stimulants, blisters are to be applied to the head and sto¬
mach, and the skin previously rubbed with a composition
of ten grains of oxymuriate of mercury, a drachm of can-
tharides and a little oil of turpentine ; and further, that
camphorated mercurial ointment be well rubbed in the
axillae and on the inside of the thighs. Mercurial inha¬
lation is also strongly recommended, and advised to be
procured by sprinkling some red sulphuret of mercury or
calomel, on-an iron heated to redness, and placing it near
the patient. Mr. S. thinks this kind of inhalation would
be useful in poisoning by narcotics. He proposes a simple
and expeditious means of procuring and employing vapour
in fever, rheumatism, and other diseases. He proposes to
place the patient on a cane chair, under which some ardent
spirit is ignited, the patient and chair being covered with
a blanket. This is somewhat similar to the plan proposed
by Dr. Murray, in his work on Heat and Humidity, which
we noticed in a late number.

The next chapter is on the prevention of cholera. We
find nothing novel in this, for the only advice given, is to
avoid the predisposing and exciting causes ; in a word, to
avoid all causes of debility, and regulate the bowels and
attend to the general health. The appendix consists of re¬
ports of cases, and occupies half the volume.

If the pathology proposed by Mr. Searle be correct,
there is a striking analogy between cholera and yellow fe¬
ver, as well as typhus ; and the successful plan of cure
recommended by Dr. Stevens is well worthy of a trial.
Had our author been less digressive, and solely confined
himself to his subject, his work could not fail to be encou¬
raged. In its present form, it is too speculative, and con¬
sequently will be looked on with caution or suspicion as a
practical guide. The author should have given much more
of his own experience, and much less of that of others.
The work will be useful to those who are destined for
India, and the general reader of "hat country will find it
instructive and important.

[ 185 ]

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

We resume with infinite pleasure our analysis of the valu¬
able and unassuming work before us, and commence with
the able author’s proofs of the following proposition : —
<e Medicinal substances possess not any specific property
distinct from their physiological action, and to which the
curative effects following their use can be attributed.”

“ No medical substance ever produces an amendment in a
disease, without primarily producing an organic operation in the
body affected. The primary or immediate, and the secondary or
curative effects, are so closely connected that the former must al¬
ways precede the latter. Again, when from any cause a medicinal
substance has lost its power of acting on the organs, or when, from
the force of habit or of idiosyncrasy, the organs are insensible to
its action, so that its exhibition causes no change in the system, it
becomes useless as a therapeutic agent. We may observe also, that
those substances which produce the most extensive changes, and
give the greatest shock to the system, are those whose therapeutic
powers are best demonstrated and least disputed ; we may adduce
as instances, tartar emetic, opium, the several preparations of
bark, &c. Moreover, medicines sometimes, instead of proving useful,
and of putting a stop to the morbid phenomena to which they wTere
opposed, produce a fatal exasperation in the symptoms, which no
one hesitates to refer to the unseasonable impression made by them
on the seat of disease. Why should we not make their more favour¬
able effects flow from the same source ?

All acknowledge that medicinal substances, in order to be useful,
must be exhibited at the proper time, inasmuch as a substance w7hich
would prove useful at the commencement of a febrile attack, would
be of no avail in the middle of it, and even injurious at the termi¬
nation, which could not be, if those agents possessed positive and
absolute virtues, wThereby they must cure such or such a disease
independent of the address of the physician who prescribes them,
and who selects a proper time for their exhibition. As a further
proof of the truth of our position, we often find that external cir¬
cumstances, which are capable of producing a shock or revolution
in the system, oftentimes serve as most effectual remedies in disease.
Thus, a sudden fright has oftentimes cured an intermittent, by excit¬
ing a violent shock in the system, at the moment when the fit wras
about to commence ; we often see a new disease put a stop to one
of long standing, which had resisted all the medicinal substances
employed for its cure. No one certainly will say that these circum-
* stances possess curative virtues independent of the primary impres¬
sion they make on the system. From all this we may fairly con¬
clude that medicinal substances derive their property of curing or

Vol. v. no. 27.

A A

186

Critical Review.

alleviating disease from their active powers, and that the advantages
arising from their nse proceed not from any specific virtue intended
to produce them. Thus the words, “febrifuge,” “ antispasmodic,”
“'antiscorbutic,” &c. should be looked on as conventional terms
admitted into medical language, not so much to designate any real
existence, as to announce a probable or likely result from the use
of substances to which these attributes are attached.” — p. 129.

Every man of experience will freely acknowledge the
correctness of these opinions. The student ought to give
them his most serious consideration. The author has ren¬
dered science his debtor by his very graphic description of
the action of medicines on the living system, and by his
exposure of the incorrectness of many of our medical
terms, which all must admit to be purely conventional.
He proceeds as follows : —

“ The advantage arising from the administration of medicinal
agents being dependent on the primary impression made by them
on the several organs, when the physician prescribes them, he knows
merely whether he shall stimulate the organs ; whether he shall
retard the rapidity of their movements ; whether he shall augment
or diminish the tension of the several tissues ; whether he shall
irritate a surface, or augment a secretion, &c. but beyond this he
knows not ; the benefits to be derived from this organic operation
are the work of nature. To be sure the experience of the physician,
aided by the light of physiology, may enable him to calculate on
the probable effects of the medicine, whether it will bring about the
desired amendment or not ; but farther he cannot go. All his
hopes of putting a stop to, or alleviating the morbid affection, must
ultimately depend on the workings of that conservative principle*
implanted in animal nature, whereby life is sustained from the be¬
ginning to the end of its existence, in opposition to those noxious
and destructive causes, which are constantly assailing it. If medi¬
cinal substances were endowed with the virtue of curing certain
determinate diseases, it would follow, that the same medicinal sub¬
stances should be employed for the cure of the same disease :
whereas, on the contrary, we know that different practitioners ad¬
minister different medicinal substances, and pursue different modes

* The existence of the restorative principle here alluded to, called by some
the vis medicatrix naturce, is too obvious to be denied ; we see wounds heal,
and various diseases removed without any interference of art whatever. On this
subjecthear Sir Gilbert Blane : “ Such is the virtue of the self-preserving and pre¬
siding energy, that whatever deserves the name of cure, is referable to it as
the wo.' k of nature; for the operations of art consist merely in regulating it,
either by exciting it when languid, restraining it when vehement, in changing
morbid action, or in obviating pain, or irritation, when they oppose its salutary
course. This, I apprehend, is so well understood among well educated phy¬
sicians, that the woid cure,' as applied to their own merits, is proscribed as
presumptuous.” — Med. Leg. sect. vi. p. 259.

Dr. Spillan’s Supplement to the Pharmacopoeias. 187

of treatment in the same diseases, and all with the same ultimate
success ; the only mode of accounting for this apparent anomaly,
is by admitting that it is nature, and not medicine, which restores
the diseased organs to their natural state. Medicines are no doubt
the occasional cause of this happy result, by exciting salutary mo¬
difications in the state of the effected parts, by exciting evacuations
from the different emunctories, and by aiding the favourable efforts
of nature ; but in all this they act but as indirect causes, and the
cessation of the pathological affection cannot be set down as the
necessary consequence of their inherent principles acting on the
several organs. It is from the circumstance that medicinal sub¬
stances possess not any specific power to cure disease, that their
dose and mode of administration always decide their success. It
is not sufficient merely that the patient should take the medicine
called for by the disease ; it is necessary that the physiological
change produced by it in the system should be proportioned to the
pathological changes caused by the disease. The mode of admi¬
nistering medicinal substance will also claim attention ; the prac¬
titioner who believes that it is these substances that by their inhe¬
rent virtues cure disease, feels quite indifferent as to the immediate
effects caused by them ; it is enough for him that the medicine has
been administered ; he is totally regardless whether the physiolo¬
gical effects produced are proportioned to the intensity of the
disease, whilst he who considers that the advantages to be derived
from these substances are consequences of their primary effects on
the organs, and of the modifications which they excite in their
functions, is careful to watch these effects, and to proportion them
to the pathological disturbance.

“ From what has been said, it appears, that in order to be able
fully to appreciate the advantages which may be derived from medi¬
cinal substances in the practice of medicine, it is absolutely neces¬
sary to attend to their primary effects. In every age, however,
from the very infancy of the healing art, the contrary course has
been pursued, and the curative effects alone have been the object of
research with medical men ; from whence it comes to pass, that the
Materia Medica is a collection of false conclusions and misrepresen-
tions, rather than a true science. Thus, the practitioner who be¬
lieves in the curative virtues of medicinal substances, confines his
undivided attention to these, and when he studies the action of any
such substance, it is merely to find out what disease it can cure.
When he administers a medicine in any disease, he merely attends
to the change which will come on in the symptoms, always con¬
cluding that the exhibition of the medicine, and the amelioration
which may succeed, are closely connected, and stand to each other
in the relation of cause and effect ; post hoc , ergo propter hoc. On
such a fragile basis has the science of medicinal substances been
founded ; hence it is that it has too often consisted of observations
engendered by false experience, and propagated by easy credulity.
Did we but reflect on the many cases in which unassisted nature
triumphs over disease, and on the spontaneous tendency which the

188

Critical Review.

several organs of the body have to resume their healthy functions,
and also on those temporary as well as permanent amendments,
which must be attributed to the influence of the vital principle,
we certainly would not feel so sanguine in our hopes to be able to
distinguish, after the exhibition of a medicine, the change which
may result from its operation, from that which may be the result of the
vis medicatrix naturae : nor is the conservative principle of nature
the only source of error which the physician should avoid in inves¬
tigating the properties of medicinal substances. Whilst diseases
are running through their several periods, how often do we not see
amendments take place, which must be attributed to the influence
of external causes ? The practitioner who refers every amendment
to the action of the medicine which may have been used, takes not
into account the share which these causes may have had in inter¬
rupting the progress of the disease, in alleviating symptoms the
most alarming, and even in re-establishing health.

“ In order, then, to be secure from falling into these errors, and
to be able to distinguish the results of the action of a medicine
from those which appear during its use, but independently of it,
our only method is carefully to note the primary or immediate effects
produced, since it is from these the therapeutic advantages which
follow must proceed. Not to be led astray in deciding on the
merits of any medicinal substance, we must first attend to its pri¬
mary action on the several organs, note the changes caused by it in
the performance of their functions ; then consider the pathological
lesions, the cure of which we attribute to it, their character and
their extent. Then, on comparing the operation of the remedy,
and the disease, we shall see whether there exists a connexion
between them. The physiological effects produced by such sub¬
stances should always explain the cures attributed to them, and
these should exist between them the relation of cause and effect.
It is this relation that should be established and proved. Such is
the ground-work, such the proper object of pharmacologv.” —
p. 134.

Our author next details the therapeutic effects of medi¬
cines, and affords much instruction upon this important
point.

“ With regard to the period when the therapeutic effects of
medicinal substances develope themselves, it is to be observed that
some produce their effects immediately after exhibition, others not
until they have been continued for a considerable length of time ;
thus, when we give a tonic in weakness of the stomach, the benefit
caused by its impression on that organ immediately appears. In the
same way, after administering an emetic or a purgative, we can judge
whether their operation has been favorable or not. But the evidence
of the therapeutic effects of medicines is not always so prompt or so
striking. It often happens that these effects are not observable until
after their use has been continued for weeks or even months. Such
effects are seldom however the simple product of the medicine em-

Dr. Spillan’s Supplement to the Pharmacopoeias. 189

ployed ; other causes may have contributed to their production, such
as diet, exercise, change of climate, change of season, &c. The ad¬
ditional efficacy imparted to medicinal substances by hygienic means,
could not but strike physicians, and inspire them with a desire
to avail themselves of such aid in therapeutics. This combination of
medicinal and hygienic means, directed to the cure of disease, and
regulated so as to produce one common effect, is what forms the
curative method. This may be distinguished in two parts, one posi¬
tive, and the other negative ; the first including the medicines em¬
ployed, the hygienic circumstances made to act on the patient, &c.
whilst the second includes those habits of living, diet, &c. to which
the individual had been previously accustomed, and from which it is
necessary that he should now abstain, as being likely to prove in¬
jurious.5 ’ — p. 135.

There is no practitioner who will not subscribe to the
valuable opinions laid down in this paragraph. How often
do we observe the force of this statement illustrated in
practice. How important did our predecessors consider the
influence of what they quaintly designated the non-naturals,
which were but the causes adverted to by our talented
author ? The following observations are also deeply inter¬
esting, and of great practical utility : —

“ The therapeutist should study the nature, and know the extent
of the lesion which constitutes the disease. These become manifest
either by direct signs, such as are seen on the parts affected, as red¬
ness, increase or diminution of volume, induration or softening, in¬
crease or diminution of temperature, variation in the sensibility, &c.
or by indirect signs, as in the change which the functions of the se¬
veral organs undergo, the increase or diminution of their secretions,
&c. These latter signs are in general our only guides in the affec¬
tions of the organs contained in the different cavities of the body.
The symptoms, signs, and morbid phenomena should engage attention,
however, only so far as to enable us to arrive at a knowledge of the
lesions which exist in the body, wherein they manifest themselves.
The physician who collects them for the purpose of constituting a
disease of them, and of finding a place for it in a nosological arrange¬
ment, loses sight of the cause of the disease and of that which keeps
it up. He, on the contrary, who uses the symptoms as guides to
conduct him to the state of the lesion, and to discover to him the
character and extent of the disease, at once sees what he has to
dread, and to what his attention should be directed. The former
asks, what the disease is ? whilst the latter inquires, where it is ?

“ In investigating the seat and nature of a disease, the following
order has been recommended. The head should be commenced with
including the cerebrum, cerebellum and their membranes ; then pro¬
ceed to the spinal cord ; attentively consider the alterations which the
cerebral apparatus may undergo, and which may be inferred from the
pain, heat, tension, weight, &c. felt by the patient in different parts

190

Critical Review .

of the apparatus ; any change also, which the mental faculties may
exhibit, as also the organs of sense, and the action of the muscles,
will assist in directing our inquiry. From the head we pass on to
the chest, and examine the state of pulmonary and circulatory organs ;
from thence we proceed to the abdomen, and from the appearance of
the tongue and lips, and by the application of the hand, by pressure,
and by the number and nature of the alvine evacuations, we infer the
state of the viscera therein contained ; nor should we be inattentive
to the state of the urinary apparatus, manner in which the functions
of the skin are performed, &c. By means of this inquiry we may
easily arrive at the seat of the disease, be enabled to judge of the
character and nature of the pathological lesions which may exist ; and
consequently be directed in our choice of the medicinal means, which
these lesions call for, and in the degree of strength required in the
operation of our remedies, as also in the manner of employing them.
Whilst this method will clearly point out to us the indications which
the physician should fulfil, it will, at the same time, point out the
contra-indications which should be kept in view. An organ, for in¬
stance, is the seat of a pathological lesion ; this lesion calls for a
medicine endowed with a certain virtue ; but some other organ,
equally the seat of disease, will be injured by this same medicinal
agent ; consequently its employment is contra-indicated.

“ From investigating disease by the several organs in the manner
now laid down, this advantage will result, that we shall no longer
see physicians, when examining the same patient, differ as to the
nature of the disease with which he may be affected, inasmuch as
they will not set out with preconceived notions, and neglecting
symptoms, which they may deem of little importance, direct their
exclusive attention to others which may conform more closely to
their particular doctrines. By passing in review all the several
organic apparatuses, no lesion can escape, facts cannot be disfigured,
nor an arbitrary association of symptoms be any longer admitted.” —
p. 138-

The succeeding remarks are a valuable lesson to those
pathologists who invariably expect to find the causes of
death on dissection. Exclusive solidism, that short road
to the end of physic, seems to be blocked in many parts by
recent writers ; and we cannot help thinking, it will be de¬
serted as impassible in a few years. We leave its few ad¬
mirers to digest the following comments, and to refute
them if they can : —

“ It would at first view appear, that post mortem examinations,
by discovering to us the lesions which caused the disease, should
point out the mode of treatment. But the weakness of such a con¬
clusion will at once appear, on considering that the parts, which
were the seat of disease, are no longer what they were during life.
Those circumstances, which formed precise therapeutic indications
have now disappeared ; those causes which kept up threatening and

Dr. Spillan’s Supplement to the Pharmacopoeias. 191

alarming symptoms, are now effaced by death. A general and
uniform coldness has now taken the place of those elevations of
temperature once so sensible. In fact, it is not the lesions, such as
they are seen in the dead body, that the physician is called on to
combat, but such as existed before death, such as the symptoms
revealed them. Nor should we forget that post mortem examina¬
tions present to our view the product of the disease, rather than
the disease itself. The frightful appearances which then present
themselves, justify the diagnosis of the physician ; they discover
what the pathological affection was ; they allow us to conjecture
the order which it followed, and to represent to our minds the pro¬
gressive changes which the diseased parts underwent, in order to
arrive at the state in which they now are. But the therapeutist
should consider that these alterations take place only after a con¬
siderable lapse of time, that they have had a beginning and an
increase, and that in the time during which they existed, several
periods may be distinguished. These reflections are of consider¬
able importance ; for, on observing the modifications which the
tissues experience, the lesions which the viscera undergo, the dis¬
organization of which all the parts of the body are susceptible, one
cannot help being surprised at their number and extent, as well
as discouraged on comparing with them the power of medicinal
agents.

“ The researches of pathological anatomy seem then to have
a tendency to diminish the physician’s confidence in medicine, and
to inspire him even with a determined prejudice against it. But,
as has been already said, it is not the lesions, such as they now are
seen, that our therapeutic resources are intended to combat. These
lesions have then attained their termination ; they have passed the
point, where their course might have been suspended. These lesions
have had a beginning, a developement : when they were recent,
slight, and before they had penetrated too far, they were by no
means above the therapeutics ; there was then some proportion
between these lesions and the power of medicinal agents. It is no
longer difficult then to conceive, that such agents may bring about
the cure of affections similar to those, whose anatomical products
have been just now stated, by their being attacked at the commence¬
ment, and before they could effect all the mischief which post mor¬
tem examinations present to our view. The utility of therapeutic
means depends on the period of their employment. Means, which
if used to day, would certainly cut short a disease, will be inappli¬
cable or insufficient some days later. In conclusion, we shall add,
that it is a living lesion which the therapeutist has to treat ; that,
in order to ascertain the nature of the remedy called for, he should
represent it to himself, such as it is during life, with its colour,
temperature, the changes in its sensibility, and that it is necessary
to attack it a proper time, before it has destroyed the natural
texture of the parts where it has its seat, if he wishes that the
operation of medicinal agents should be of any avail.

“ These principles give to the practice of medicine a solid basis ;

192

Critical Review.

nor can the art of healing be still considered as all conjecture, first,
when it determines the lesions which constitute disease, assigns
their seat, measures their extent, and announces the modifications
which they cause the several organs to undergo ; secondly, when
it declares beforehand the physiological effects which medicines
produce, and foresees the primary operations of the means to which
it has resourse. No doubt, the therapeutic effect of the operation
is always uncertain ; too often it corresponds not with the expecta¬
tion of the physician : but can medicine hope to cure all the lesions
of which organs are susceptible ? Have not limits been put to its
power by the Creator himself ?” — p. 140.

How often have we been wearied with the exhibition of
morbid specimens at our debating societies, while those who
presented them could give no account of the symptoms
that existed during the illness of those from whose bodies
they were taken ; and yet meeting after meeting have such
exhibitions taken place, to use a technical phrase, usque ad
nauseam. We hope this useless practice will be discoun¬
tenanced in future, and that the time of our societies will
not be wasted by the display of disorganizations, with
which every man of ordinary information must be familiar,
and which only remind us of the imperfect state of medical
science and practice — a piece of information which every
hour’s experience impresses upon our memory. It affords
us much gratification, to perceive the sentiments of a writer
of Dr. Spillan’s talents accordant with our own. But to

A.

resume our analysis.

Having concluded the consideration of the operations of
medicines, our author proceeds to detail the effects of the
different classes of remedies. He adopts the classification
of Mr. Barbier, which has for its basis the physiological
operation of medical agents, and is more permanent than
the arrangements founded on their therapeutical effects.
The classification is as follows: —

“ 1. Tonics, or medicines which strengthened the tissue of the
organs.

“ 2. Excitants. Medicines which stimulate the tissue of the

“ 3. DifFusibles. J organs.

“ 4. Emollients. Such as relax their tissues.

*• 5. Temperants. Such as moderate the too great activity of
the organs,

“ 6. Narcotics. Such as diminish cerebral life.

“ 7. Purgatives. Such as irritate the internal surfaces of the in¬
testines.

“ 8. Emetics. Such as irritate the gastro-duodenal surface.

“ 9. Laxatives. Such as disturb the natural movements of the
intestines.

Dr. Spillan’s Supplement to the P harmacopoeias . 193

“ 10. Medicines, whose mode of action is not well determined,
or which cannot be referred to any of the preceding classes” — p. 149.

The . observations on the effects of tonics on the \itaJ
functions are so exceedingly important, that we quote them
at length, as they have been almost forgotten by practi¬
tioners. We promise our readers that they shall be amply
repaid for the trouble of perusing them. There is no part
of medical science so much neglected as that under notice ;
and therefore we need not apologize for devoting so much
space to its consideration. The only person to whom we
owe an apology, is the author whose work we place under
such ample contribution. The following are Dr. Spillan’s
views on the effects of tonics : —

“ The medicinal substances ranked under the class of tonics, in¬
clude the several species which have received the name of coroborrants
or strengtheners, styptics, astringents , &c. The active property of
these substances determines in the several organs a change or modi¬
fication of their tissue, which shall now be pointed out. In order
fully to appreciate the impression which medicines of this class make
on the several tissues, it is necessary to see them successively in con¬
tact with these tissues ; 1. In their natural state,. 2. In a state of

morbid debility. 3. In a state of irritation or inflammation. If the
organ on which we desire to study the action of a tonic is in its na¬
tural and healthy state, the influence of this tonic is difficult to be
discovered during its action on the body ; the organs will not change
their mode of action ; the several functions will be performed with
their usual regularity. Should the organs on which the force of the
tonic is exerted, be in a weakened condition, then the impression
made by the medicinal substance will have the effect of producing
manifest changes in it. Their movements, before enfeebled and lan~
guid, will become stronger, and it may be observed, the greater the
debility and languor, the more striking will the effects of the tonic be.
When the vital properties of the several organs are more developed
than natural, the effects of tonic medicines will still be discoverable.
By increasing the already too great activity of the several parts of
the system, they excite disturbance, and the pathological state which
follows their use, still further proves the nature of their powers, that
state being generally of an inflammatory character.

“ From what has been said on the subject, it will appear, that
they may be used with advantage in morbid affections arising from
general debility. It is also manifest, why their effects on the animal
economy are so little perceptible, their action being directed entirely
to the insensible contractility of the organs, the tissues of which be¬
come in consequence more firm and more condensed.

“ A tonic medicine given in a small dose, has merely a local ac¬
tion ; whilst if the dose be augmented, and the active principles be
absorbed in sufficient quantity, the entire system is subjected to its
influence. It may not be uninteresting to run through each- of the

Vol. v. no. 27.

B B

1 94

Critical Review .

systems of the body, and to note the changes made in their action by
the exhibition of a tonic. We shall thus be enabled to form a just
idea of the importance and extent of the properties of this class of
medicinal substances, and to see what advantage therapeutics may
derive from their employment. We shall commence with the diges¬
tive apparatus, and first consider how it may be affected in its
healthy or physiological state.

“ Observation demonstrates, that after the exhibition of a tonic
medicine, the coats of the stomach experience a fibrillary contraction,
whereby they become more firm and more compact, and the stomach
in a manner contracts on itself. We are equally warranted in sup¬
posing, that according as the substance advances into the interior of
the intestinal canal, a similar effect is produced on its coats. The
exhalations, and several secretions' which ordinarily moisten the mu¬
cous membrane of these parts are suspended. The impression made
on this membrane is communicated to the muscular tunic, the fibres
of which become contracted ; in consequence of this change the body
of the intestine becomes harder, firmer, and more resisting, whilst its
cavity is at the same time diminished. The changes observed in the
function of digestion, after the exhibition of a tonic, points out that
its influence on the organs subservient to this function is to strengthen
their tissue and augment their vigour. We see tonics given in a
small dose increase the appetite and bring it on sooner than usual ;
several individuals find their digestion facilitated and expedited by
their employment ; a digestion, habitually languid and difficult, by
reason of debility of the digestive organs, is rendered stronger and
less distressing after the use of a tonic. It may be observed, that
the alvine evacuations acquire an unusual degree of consistence from
the employment of tonic medicines, and sometimes appear diminished
in quantity. This may be accounted for by the encreased degree of
absorption along the intestinal surface, whereby the residue of diges¬
tion is deprived of its liquid parts.

When tonic substances are taken in very large quantities into
the stomach, they produce considerable disturbance in the functions
of the digestive organs. They excite a sensation of heat in the epi¬
gastrium, which is diffused over the abdomen, is propogated to the
chest and to the head, and is even felt in the limbs. When the sub¬
stance has entered into the intestines, these become distended and
swollen by the exhalation of gas, whilst the muscular fibres are affec¬
ted with spasmodic contractions, giving rise to collicky pains.

“ Sometimes however we may perceive tonic medicines produce
liquid and even abundant dejections. From having observed this re¬
sult, Cullen considered himself warranted in placing bitters under the
head of purgatives.

“ Pathological state. When the stomach or any portion of it is in
a state of irritation, the exhibition of a tonic substance disturbs the
action of this organ, and prevents the regularity of its functions.
Irritation of the stomach manifests itself by redness and dryness of
the lips and tongue, by the smallness and diminished appearance of
the latter organ, by thirst, sensibility of the epigastrium, &c. ; these

t

Dr. SpillaiTs Supplement to the Pharmacopoeias. 195

symptoms are all aggravated by the use of tonic* medicines. If the
stomach, instead of mere irritation, is actually inflamed, the exhibi¬
tion of. tonics will give rise to phenomena still more striking ; their
use is followed by a painful sensation of heat in the epigastrium,
which the patient compares to a consuming fire, by swelling of this
part with great pain on pressure, great thirst, anxiety, oppression,
and different other phenomena presented by the organs of circulation,
respiration, by the brain, &c.

“ The coats of the stomach sometimes undergo a morbid change,
which gives them a softened appearance, whiph change causes great
debility in the powers of this organ ; there is anorexia, a dislike of
mucilaginous or fatty aliments : in such cases the use of tonics has
the most happy effects; they re-establish the natural functions of this
viscus, by inducing a more free and easy digestion.

“ If the tissues of the stomach are hardened, if scirrhus or cancer
occupies any portion of it, the effects of tonic medicines cannot be
determined before hand. They vary according as these lesions are
situated towards the cardiac or pyloric extremity, near the great or
small curvature of the stomach. In such cases tonics have occasion¬
ally afforded temporary relief, by retarding the vomiting, and dimi¬
nishing the frequency of the sour eructations which so often accom¬
pany such affections, and by inducing a desire for food, which pre¬
viously had not existed.

“ The action of tonics on the intestines in disease merits particular
attention. When the mucous membrane is in a state of irritation,
the exhibition of tonics will have the effect of exasperating the dis¬
ease. Should inflammation exist in these parts, the effects of tonics
will be still more intense. When blood is exhaled from the mucous
surface of the intestines, a tonic may have the effect of arresting the
hemorrhage. If this happens to be at the same time the seat of ul¬
cerations, as is seen in dysentery, the effects of tonics will no longer
be certain : they will vary with the pathological condition of the in¬
testinal surface.

“ In wasting of the intestines, which is observed in the examina ¬
tion of dead bodies, and which is, in general, the result of long pro¬
tracted disease, in addition to the diminution in substance, there is
usually greatirritability, and consequently frequent alvine evacuations,
whereby the aliment is carried off by stool previous to its complete
elaboration. In such cases tonics may be of advantage, by assisting
the function of digestion, and rendering the stools more regular.

“ If ulcerations exist on the surface of the intestines, the effects
of tonics will be found to vary according as these are observed to be
of an old or recent date, superficial or deep-seated, and according to
the state of the ulcerations. If these be recent, tonics may by de¬
veloping the vitality of the parts bring on cicatrization ; should in¬
flammation accompany them, tonics may have the effect of exasperat¬
ing the case. It is necessary to observe, that ulcerations seated on
the large intestines cannot be much influenced by tonics taken by the
mouth, inasmuch as their active principles are almost all absorbed in

196

Critical Review.

the small intestines, before they can reach the large. The best mode
of applying tonics in such cases is by injection.

“ It often happens that the stomach and intestines are affected
only in their vitality, without their tissues experiencing any structural
or organic lesion. This arises from the increased, diminished, or ir¬
regular distribution of nervous influence to these parts. The origin
of such affections may be referred either to the brain, whose influence
on these tissues of the stomach and intestines is changed, or to the
nervous cords received by these parts. If the nervous influence be
increased, the digestive organs become more than ordinarily sensible ;
digestion itself causes the sensation of weight and of painful tension.
If it be irregular, there appears a crowd of phenomena, such as
spasm, colic, sudden swelling of the intestines, pains communicating
with the vertebral column, vomiting, &c. If the nervous influence be
diminished, we observe want of appetite, languid or imperfect diges¬
tion, diarrhoea, &c. In the two first cases tonics will but exasperate
the affection ; whilst in the latter they will, if taken in moderate
doses, regulate the digestive function ; a result, no doubt, depending
on the influence of the tonic on the nerves of the stomach and intes¬
tines.

“ Tonic substances, though not coming in immediate or direct
contact with the other parts of the digestive apparatus, as the liver,
pancreas, and spleen, may however, act on those organs ; 1. by that
sympathy which the nervous plexuses establish between all these
parts; 2. by the entrance of their molecules into the circulation; 3.
by the contiguity of the intestinal tissues to the organs. The liver is
more than any other organ, subjected to the action of medicinal sub¬
stances. In its healthy state the action of tonics has no appreciable
effect on it ; but when in a state of irritation or inflammation, the
exhibition of a tonic never fails to exasperate all the symptoms.
Bilious vomiting may be the consequence ; the inflammation will often
spread to the other parts of the abdominal cavity, particularly to the
stomach and intestines. If there be a diminution in the volume of
the liver, tonics will excite the action of nutrition, and they will con¬
cur in restoring to it its natural or physiological dimensions. This
morbid state of the liver is very common ; it arises directly from
langour in the assimilating functions of this viscus, or may proceed
from an inordinate absorption, which carries away the materials be¬
longing to its substance ; this change may take place at the end of
acute disease, in which the liver has been somewhat inflamed. We
sometimes meet with the liver very much enlarged ; in such cases the
vitality of the organ being inordinately developed, an excess of bile
is secreted ; a reflux of which into the stomach brings on bilious
vomiting. The skin assumes usually a yellowish tint. When such
an affection exists tonics augment it, by increasing the already too
great assimilating powers of this organ, and exciting still more the
secretions of bile/’— p. 149.

We have here ample matter for reflection, and. that which
is of immense importance in practice. It would be an act

Dr Spillan’s Supplement to the Pharmacopoeias. 197

of injustice on our part to mutilate the remaining observa¬
tions on the action of tonics on the circulatory, respiratory,
and nervous system, and at the risk of being accused of
drawing too freely on our author’s pages, we must make ano¬
ther long quotation, which shall conclude our analysis for the
present ; but such is the importance of the work, that we
must resume in our next number.

“ Physiological state. Tonics influence the organs of circulation in
two ways ; when taken intQ the stomach, the impression made by
them on the nerves of that viscus is continued to those of the heart,
and this sympathy may change the action of this organ. But it is by
the molecules of these substances being taken into the circulation,
and thus coming in immediate contact with the substance of the
heart and arteries, that the organs subservient to this function are
principally influenced. When a dose of tonic medicine has been
taken sufficient for its influence to become general, it is easy to per¬
ceive that the contractions of the heart are performed with greater
energy, and that this organ propels the blood with greater force into
the blood-vessels ; the coats of the arteries also become more resist¬
ing and more rigid ; the pulse becomes more firm and harder, the
vessels appear under the finger diminished in size, and at the same
time more tense. It is at the same time worthy of remark, that the
course of the blood is not quickened, it being one of the characters of
a tonic to strengthen the organs without accelerating their action.

“ It is necessary to distinguish the effects of a tonic medicine aris¬
ing from the impression of its molecules on the tissues of the heart
and arteries from those which do not appear until after a long con¬
tinued use of this substance. Thus, one dose of a tonic will render
the pulse either more full or more frequent, but after the continued
exhibition of this substance for some time, it will assume all these
characters ; these changes will be referrible to the change made in it
by the function of nutrition.

“ Pathological state. When in febrile diseases the pulsations of
the heart are become more quick than ordinary, and its contractions
stronger and more rapid, and the pulse at the same time is accele¬
rated, it is natural to suppose that these organs are in a state of irri¬
tation, whether this irritation arises from the sympathy between the
heart and any other part of the system which may be diseased, or from
a direct affection of the heart itself. This state of irritation in the
organs of circulation presents itself in a great number of diseases.
The effects of tonics under such circumstances are sufficiently obvi¬
ous ; when to a patient with a quick, frequent, and hard pulse, burn¬
ing heat and dryness of the skin, a tonic is given, we uniformly find
all the symptoms exasperated after each dose, the pulse is redoubled
in force and frequency, the heat becomes more oppressive ; presently
there comes on anxiety, restlessness, &c. If any organ be in a state
of inflammation, observation shews us that the exhibition of a tonic
never tails to heighten and extend the disease, the capillaries of the
inflamed organ being irritated by its particles. From what has been

198

Critical Review.

stated, it is unnecessary to detail the mischief which would result
from the administration of tonics, when the organs of circulation are
in a state of actual inflammation.

“ In hypertrophy of the ventricles, particularly of the left, tonics
render the pulse stronger and quicker, and the beating of the heart
more violent, and never fail to augment the cerebral disturbance, as
well as the other symptoms usually accompanying this affection.

“ In atrophy of this organ tonics render the pulse stronger for a
time, and the pulsations of the heart itself more sensible. This state
of the organ is frequently observed in convalescence from fever,
during which the tissue of the heart may undergo considerable modi¬
fications, its function of nutrition being interfered with during the
process of the disease.

“ The functions of the heart may be perverted independently of
any structural lesion. This may be attributable either to the exces¬
sive or deficient supply of nervous influence. In the former case
there will be violent palpitation of this organ, and great irregularity
in the pulse ; in the latter the action of this viscus will be slow and
weak, as will also the pulse. In the one case tonics will generally
exasperate the symptoms, whilst in the other they may prove ser¬
viceable.

“ With respect to the action of tonics on the Organs of Respi¬
ration in their healthy state, little can be said either interesting or
important. But when any part of these organs happen to be the
seat of inflammation, whether the mucous membrane, as in bron¬
chitis, or their parenchyma, as in pneumonia, or the pleura, the
exhibition of tonics will be found invariably to exasperate all the
symptoms. In hemoptysis tonics may serve to constringe the capil¬
laries of the bronchial membrane, and thereby put a stop to the
evacuation ; but in such cases the injudicious use of this class of me¬
dicines may do much harm.

“ The action of tonic medicine on the Brain and its appendages
in their physiological state is by no means striking. But when this
organ or its membranes are in a state of irritation or inflammation,
we invariably find medicines of this class considerably to augment
all the symptoms. When the arachnoid is inflamed, the exhibition
of a tonic exasperates the acute headache accompanying such a
state, as also the restlessness, delirium, intolerance of light and
sound, &c. In the course of febrile diseases, the spinal arachnoid
is often the seat of irritation, giving rise to symptoms which are
developed in the chest, abdomen, and in the limbs. There is pain
in the neck, between the shoulders, along the back, in the loins,
according as the irritation occupies one or other of these regions.
In such cases the use of tonics will do considerable mischief. The
cerebral mass itself may be affected either by congestion, effusion,
or actual inflammation. The former state is oftentimes induced by
the use of tonics in febrile diseases. It is unnecessary to state,
that in all such affections medicines of this class are entirely contra¬
indicated.

t

Dr. Spillan’s Supplement to the Pharmacopoeias. 199

“ The substance of the spinal cord may also experience several
sorts of lesions : from its intimate connexion with the system of
the ganglionic nerves, or with the trisplanchnique nerve, it becomes
impossible to distinguish the affections peculiar to each of these two
important parts of the cerebral apparatus. From the circumstance of
the spinal cord and ganglionic system of nerves, holding all the vis¬
cera under their control, it comes to pass, that lesions of these parts
manifest themselves in different parts of the system, by disturbing
organs which are perfectly sound. Thus, spasms of the oesophagus,
difficulty of deglutition, palpitation of the heart, cramps of the sto¬
mach, colics, &c. oftentimes arise by no means from any lesion of the
parts where these symptoms are developed, but from a lesion of the
spinal cord or ganglionic plexuses. Convulsions, shaking of the
limbs. Saint Vitus’ dance, oftentimes depend on irritation of the spinal
cord or its membranes. Hysteria and epilepsey have their original
frequently in the cord.

“ The substance of the spinal cord may likewise be the seat of
disease ; there is then manifested great disturbance in the functions
of respiration, circulation, and digestion, so that one might refer the
disease to the thorax and abdomen, and not to the cord itself. Or¬
ganic disease of the heart has been frequently suspected, from the
disturbed and irregular action of this organ, where the spinal cord was
really the seat of disease. It is to be observed, as before, that in all
cases of irritation of the cord tonics are contra-indicated.

“ Besides these structural affections of the cord, it is also subject
to what may be considered vital lesions. Thus weakness in the
heart’s action, in the functions of the stomach, of the intestines, and
of the lungs, may exist without the tissues of these viscera presenting
the least alteration, and are to be referred to a diminution in the
quantity of the nervous influence distributed to those parts. In such
cases tonics will prove serviceable, as well as by exciting the vitality
of these viscera, as by stimulating the spinal cord to resume its
natural influence over the viscera. It is in this way, no doubt, that
tonics act when given to remove weakness- of the stomach, loss of
appetite, slow digestion weakness of pulse, &c.

“ As the effects of tonic medicines on the other parts of the system
do not possess any considerable interest, we shall now consider the
therapeutical employment of this class.

The nature of the impression made by tonics on the several
tissues, as well as the physiological changes caused by them, should
direct physicians in their employment. The immediate effects which
they produce, compared with the pathological lesion which they are
intended to combat, will point out whether advantage or injury will
result from their exhibition. As in the treatment of disease it is to
the morbid lesion to which the attention of the therapeutist should be
directed, so it is in the several organs that he must seek them. We
shall commence with affections of the digestive apparatus.

“ Tonics have been strenuously recommended in cases of loss of
appetite, of indigestion, &c. and their efficacy in these cases appeared
so well established as to have procured them the name of stomachics.

200

Critical Review.

r * 'if •

However, the practitioner will do well to investigate the cause of
these affections, and to observe with care the nature of the lesion
which disturbs the natural functions of the stomach.

“ Should this disturbance depend on irritation of the mucous
membrane of the stomach, it is obvious that tonics would but increase
the mischief, whereas if it depended on debility, or a diminution in
the quantity of nervous influence transmitted to this viscus, their use
will be productive of much benefit. The same observation may be
made regarding the intestinal canal.

** In nervous affections of the heart, tonics have been found ad¬
vantageous ; but where there is organic disease of this organ, as hy¬
pertrophy of one or both ventricles, their use is contra-indicated.

“ In pneumonia and pulmonary catarrh, after all inflammatory
symptoms have been combated, tonics are frequetly found serviceable
in assisting expectoration.

“ In diseases of the lymphatic system, as in scrofula, tonics from
the basis of the different methods of cure. By their use the diges¬
tion is improved, and the function of nutrition is carried on with more
regularity.” — p. 156.

The only remark we shall make on this important extract
is, that Dr. Elliotson recommends large doses of quinine,
when abdominal or thoracic inflammation is present — a re¬
commendation contrary to the universal opinion of the pro¬
fession. Med. Chir. Trans, v. xiij. p. 464. However highly
we esteem Dr. Elliotson s talents, we cannot help agreeing
with the multitude, but leave the reader to form his own
opinion.

III. — Clinical Illustrations of Fever , comprising a Report
of Cases treated at the London Fever Hospital in
1B28-9. By Alexander Tweedie, M. D. Member of the
Royal College of Physicians, London, Physician to the
London Fever Hospital. London, 1830. 8vo. pp. 204.
Whittaker and Co.

IV. — Report of the Managing Committee of the House of
Recovery and Fever Hospital, Cork Street, Dublin, for
the year ending 4th January , 1830, with the Medici
Report annexed. By John O’Brien, M.D. Physician to
the Cork Street Fever Hospital, Dublin. Dublin, 1830.
8vo. pp. 113. R. D. Webb.

The greater part of Dr. Tweedie’s work consists of reports
of cases treated in the London Fever Hospital in 1828-9;
and the treatment differs in no respect from the ordinary
plan pursued; his original views on the nature of the disease

Dr. Tweedie on Fever.

201

can be detailed in a few words. Tn common with the largest
portion of the profession, he maintains that fever is prima¬
rily a general disease, and that local inflammation is a
secondary affection of very frequent, but not of invariable
occurrence. He holds that the brain and nervous system
are primarily engaged in the febrile action ; the disturbance
in the brain, is in the beginning simply functional, though
it may sooner or later, according to particular circum¬
stances, assume an inflammatory character. The circula¬
tion and secretions are next disordered, and “ in simple
fever there is no preponderance of action in any organ,
all parts of the system partake equally in the general dis¬
turbance.” When excitement occurs, the transition to
inflammation is very rapid, and will affect the brain in one
patient, the organs of respiration in another, the abdominal
viscera in a third, the mucous coat of the intestines, or
many organs may be simultaneously affected.

“ Fever is not inflammation — it is therefore not cured by reme¬
dies, that effectually remove the latter, though its violence may be
mitigated, and its duration shortened by the judicious modified
application of the same measures.” — p. 8.

Our author further states, that he daily sees examples of
simple fever without any evidence of local inflammation ;
but remarks, that the latter may come on imperceptibly, or
with scarcely any premonitory indications. The brain and
nervous system are very generally, if not universally in¬
volved in the febrile action — but these are secondary effects
of fever. In such cases the most vigilant measures should
be at once adopted to prevent those changes of structure
which so speedily take place, and render the case almost
hopeless. Dr. T. has seen but one case of paralysis conse¬
quent to celebral affection. He next adverts to the fre¬
quency of affections of the respiratory organs in fever.
In one hundred and three cases the lungs were more or less
affected in one third. In pneumonia and bronchitis after
bleeding, the best effects were produced by the exhibition
of one or two grains of tartarized antimony, every second,
third or fourth hour — a plan highly praised by our author’s
colleague, Dr. S. Smith. In numerous cases the inflam¬
mation of the chest was overlooked by the attendants pre¬
viously to the admission of the patients into the hospital,
and in such case the utility of the stethoscope was unques¬
tionable.

Dr. T. considers the morbid condition of the intestinal
mucous membrane one of the specific effects of typhus ;
but unfortunately for his opinion such condition is far from

Vol. v. no. 27. c c

202

Critical Review.

being invariably present. Another point dwelt on is the
change of the blood, and its non-coagulation when ab¬
stracted in the last stage of typhus, an occurrence noticed
at least five thousand times before. Indeed, we do not
know a single work on fever in which this morbid stage of
the blood is not attested, from Sydenham to Clanny,
Stoker, Stevens, &c.

Simple typhus, or the adynamic fever of Pinel, is said
to be a disorder of function only, and of rare occurrence
in this country, and this opinion is supported by Dr. South-
wood Smith, while Dr. Burne maintains that this species is
characteristic of the continued fever of London.

The next subject discussed is the complication of typhus,
with inflammation of the contents of the head, chest, and
abdomen, which is said to be of frequent occurrence.
Every man conversant with fever is aware of the fact.
Dr. Tweedie cautions his contemporaries against the decep¬
tion which arises from absence of pain in muco- enteritis,
while inflammation proceeds slowly but steadily. We have
shown in our last volume how peritonitis may prove fatal,
though undiscovered during life ; and how much more likely
may inflammation of the intestinal mucous tunic be over¬
looked.

The vermilion colour of the tongue, so much dwelt on
by the French and others, is not a certain diagnostic of
disease in the bowels ; we have a patient at this period
whose tongue always presents this appearance when he is in
good health.

Dr. Tweedie proceeds to describe the causes of fever,
and here we find nothing novel ; — cold, intemperance, fa¬
tigue, and malaria, are said to be the most common causes
of the disease. Famine is a powerful predisposing cause,
and in illustration of this position, our author states that
he did not recollect a single instance of a butcher being
sent into the hospital. The exemption of this class of peo¬
ple from plague, when it last visited London, is mentioned
by those who described the disease at that period.

Our author follows the multitude as a eontagionist, and,
like his associates, arrives at the very unphilosophical con¬
clusion, " that fever will spread by contagion, but that the
probability of its extension depends very much on cleanli¬
ness, the proper ventilation of the sick chamber, and the
purity of the surrounding atmosphere.” Suppose we were
to substitute the word syphilis, a really contagious disease,
for the word fever, in this sentence, how untenable and
ridiculous would the position appear. And yet the sentence
before us, when strictly examined, is equally objectionable.

Dr. Tweedie on Fever.

203

At one period contagion was the only cause of fever ; but
now debilitating causes, however numerous, are allowed to
share the power of that ideal phantom. But all debilitating
causes, moral and physical, cannot produce any of those
diseases which are really contagious. Dr. Tweedie adduces
the following facts as a positive proof of contagion: —

“ The London Fever Hospital is placed in an open space, situate
in the vicinity of the metropolis, close to the Small-Pox Hospital.
Both these establishments stand in the centre of a large field, where
the production of malaria is extremely improbable. I can state,
from the most authentic sources, that every physician, with one
exception, (the late Dr. Bateman) who has been connected with
the Fever Hospital, has been attacked with fever during his atten¬
dance, and that three out of eight physicians have died.

“ The resident medical officers, matrons, porters, laundresses,
and domestic servants not connected with the wards, and every
female who has ever performed the duties of a nurse, have one and
all invariably been the subjects of fever ; and to show that the
disease may be engendered by fomities of clothing, the laundresses,
whose duty it is to wash the patients’ clothes, are so invariably and
frequently attacked with fever, that few women will undertake this
loathsome, and frequently disgusting duty. p. 88.”

Now this evidence, though considered conclusive, is by
no means so to us. It must be recollected that the present
physicians to the London Fever Hospital are staunch conta-
gionists ; and consequently their precautions while visiting
their patients, are calculated to intimidate all persons con¬
nected with the sick. Fear, that powerful debilitant, rankles
in the heart of every one of these attendants ; the air of
the wards, however well ventilated, must be more or less
contaminated, the progress of fever is accompanied with
consequences frightful and disgusting to ordinary attendants,
all eminently calculated to depress both mind and body,
and produce the disease. That these causes produce fever,
independently of malaria or contagion, cannot be doubted
by any man who is acquainted with the history of the epi¬
demic fevers of this empire. Again, we do hot discover
the medical and civil attendance of all fever hospitals
affected with the disease, to any thing like the extent in the
instance before us. The records of medicine bear ample
evidence, that those who fear fever, whether medical or
civil, seldom escape the disease, and are generally destroyed
by it, while those who entertain no such apprehension al¬
most invariably escape. This fact was abundantly exem¬
plified in the epidemic fever of 1818-19. Again, the ab¬
sence of fever in the Small Pox Hospital, though conti¬
guous to the Fever Hospital, proves nothing. In the for-

£04

Critical Review.

mer, there are few patients, and none labouring- under fever ;
while in the latter there are the worst forms of fever, con¬
gregated from the most unhealthy parts of the metropolis.
Under such circumstances, and for the reasons already
mentioned, the contamination of the air in the fever wards
may be such as to cause fever independently of contagion.
But whence the perpetual immunity of medical men in ge¬
neral from contagion ? This simple problem has never
been answered, nor it never can be solved by exclusive
contagionists. The idea of men being daily exposed to
contagion, and conveying it in their apparel from family to
family, and escaping themselves from its effects, is one of
the greatest absurdities that ever disgraced the theory of
medicine. The late celebrated Dr. Gregory was wont to
observe in his lectures, that he must have been exposed
some thirty thousand times to fever, and yet he escaped
the disease, so accommodating was contagion to the illus¬
trious professor. Yet he was a staunch contagionist. If
we look to the history of fever in Ireland, we find it attes-
tated by the writers of several centuries, that famine and
fever bear to each other the relation of cause and effect,
and that the cause being removed the effect ceases, while
the disease has spread over the whole face of the country.
How can this fact be reconciled with the doctrine of con¬
tagion ; how can the exclusive contagionist explain the
sudden cessation of disease at a time it is so extensive, that
it is impossible to separate the healthy from the sick. Such
is the dilemma of those who advocate the doctrine of con¬
tagion, who maintain that it is the sole cause of fever. But
it is useless to argue with the admirers of antiquity, who
despise legitimate induction, who refuse to acknowledge
the result of faithful observation and multiplied experience,
and who put reason and common sense entirely out of the
question.

Our author has given a tabular view of the mortality of
fever in different hospitals ; and this varied so much in the
same hospital at different times, and must always vary from
situation and diversity of epidemics, that nothing conclu¬
sive can be learned in respect to treatment.

We have now to notice Dr. Tweedie’s method of treat¬
ment. He is of opinion that there are few cases which are
not benefitted by blood letting, “ but it is not a remedy
which should be indiscriminately adopted, as if fever wrere
identical with inflammation,’ and that “ an epidemic may
appear which will not bear the same bold treatment which
has been recommended.’'

Dr. Tweedie Qn Fever.

20$

He states that 280 lost blood— 146 from the arm, 70
locally, and 64 both generally and locally ; the average
quantity of blood drawn was about 19 ounces.

“ Of the whole number bled (280) there were

Cases.

Of Simple fever . 26---

Affection of the brain - - -110 - - -

- chest 81

- abdomen 22 - - -

- head and chest 20 -

- head and ab¬
domen -------12---

- - head, chest and

domen . 9 - - -

280”

Blood letting was generally employed in the early stages,
but in some cases, when the disease was advanced, and
visceral inflammation supervened, which could be arrested
by the lancet only. Our author is not an advocate for in¬
discriminate depletion, and on the use of this as on all
remedial agents, he lays down admirable and judicious
rules. In bronchitis of fever he prefers cupping to leeches ;
he rejects emetics and diaphoretics, which he deems inert
and productive of injurious effects, by excluding more pow¬
erful measures. We doubt much the concurrence of the
profession with the notion of rejecting diaphoretics, espe¬
cially antimonials ; and daily observation must convince us
of their utility, from the praises bestowed on them by the
largest proportion of practitioners. Cold affusion never
extinguished fever, but the cold dash is lauded to extra¬
vagance, both by our author and Dr. Smith. This consists
of pouring cold water on the naked scalp, the stream being
gradually raised as the patient can bear it.

Wine was given with the best effects, in fourteen cases
out of 521. Purgatives were freely employed, but never
produced intestinal , inflammation, so much dreaded by the
French.

Such are the opinions of Dr. Tweedie, which are credit¬
able to him as a practitioner ; but are by do means entitled
to that extravagant commendation bestowed upon them by
some of his reviewers. His work is a safe guide so far as
it extends, but that it is superior to all other productions on
fever, because the author happened to witness the treatment
of this disease in the Edinburgh Infirmary, is an assertion

Average
quantity
of blood.

8 ounces.

- 20

- 17

- 15

- 21

- 16

.5 : i * ; \ r

- 24

206

Critical Review.

too preposterous to require serious notice. We believe
there is scarcely a writer on fever in this country who has
not enjoyed the same advantage, if there is any advantage in
the matter ; but with all due veneration for our alma mater,
we cannot help thinking that the reputed superiority of
modern Athens alluded to on this and other occasions, is
estimated by a very considerable portion of the faculty of
many parts of this empire, as a very vain and gratuitous
assumption. Such are the prevailing sentiments of the
largest portion of the profession in this section of the nation ;
and we remind our contemporaries of the fact, when they
forget themselves so far as to laud an imperfect essay on
such shallow ground, and condemn a systematic work,
which in point of style, composition, and information, is
infinitely its superior.

The universal advancement of the age in medical science,
and above all, its diffusion by the press, have destroyed all
individual claims to superiority ; and the less attempts at
pre-eminence the more accordance with the spirit of the
age. Such empty pretensions do not suit the taste or
feelings of the profession at present, and cannot be tole¬
rated. We have been led into these remarks by the ful¬
some adulation, gross flattery, and ill-deserved compliments
bestowed on one work on fever ; while another, which the
best and most impartial judges in our profession have de¬
clared to be one of the best, w as censured with an acrimony
of feeling, an asperity of reproof and a harshness of ex¬
pression perfectly uncalled for, and unwarrantable. We
hold it to be the duty of an impartial critic, to impute
praise or blame to authors with candour and equity, and
the reviewer who acts otherwise will not enjoy the confi¬
dence of the profession.

Dr. O’Brien commences his interesting report by observing,
that a revolution, not unusual in epidemic maladies, and
similar to those wdiich mark the vicissitudes of other great
natural phenomena, has occurred with respect to fever in
Dublin. Not only has this disease fallen below its ordinary
numerical standard, but appeared evanescent and altogether
extinct. At one period there was not a case of typhoid
fever in the Dublin Hospital. This occurred when public
distress had obtained its greatest height in that city : and
is an exception to the universal observation, that famine
and fever have almost invariably borne the relation of cause
and effect. The author admits the power of distress in

Dr. O’Brien- on Fever in Dublin . 207

conjunction with certain moral habits as the chief cause
of fever ; but he bolds that these evils alone are incapable
of causing- continued fever in any individual instance, much
less in its epidemic form ; and that to produce this effect,
another set of causes, called exciting, is indispensably
necessary. These causes will operate tenfold on an impo¬
verished multitude, but when they are absent, he says, we
are instructed by the events of the past year of the immu¬
nity from fever Our author is at issue with an overwhelm¬
ing majority of his contemporaries upon this point, as will
be seen by referring to the works of Harty, Barker, Cheyne,
Stoker, and many others. It would have been interesting had
he accounted for the frequency of fever in Dublin and every
other part of Ireland ; and its infrequency in England and
Scotland. The difference of climate will not explain the
difference— there must be something in the physical and
moral condition of the Irish people.

An important table is given of the admission, discharges,
and mortality in the Cork Street Hospital, from 1st of
January 1829, to 1st of January 1830 ; by which it appears,
the admissions were 3153 — males 1114 — females 2039;
cured 2836 — died, of males 97 — females 135 — total 232 ;
mortality for males 1 in 11 — for females 1 in 14 — total mor¬
tality 1 in 13.22.

“ The records of this hospital furnish evidence that the mortality
has never increased regularly in proportion to the admissions ; but
on the contrary, when the admissions have been most numerous,
the relative mortality has, generally speaking, been least. Thus,
in the three great epidemic fevers which occurred in Dublin, in the
course of the last 20 years, the mortality in 1815, was 1 in 20 ;
in 1818, 1 in 30 ; and in 1826, 1 in 28 ; while in the three years
1823, 1824, 1825, which presents a considerable reduction in the
admissions, the total mortality was 1 in 11, and in the two
past years 1828 and 1829, in which the admissions were also much
diminished, the total mortality was 1 in 14.

“ The inference from this fact is, that the majority of cases which
constitute our epidemic fevers, are of a mild character, a dispensa¬
tion by which Providence interposes to mitigate the severity of its
own inflictions. ” — p. 9.

Our author appends a table shewing the mortality in the
London and Dublin Hospitals, for a series of years, by which
it appears the mortality was much greater in the former than
in the latter. We leave those who think the London practice
sine comparatione to reflect on this fact.

208

Critical Review.

The following table, and the comments of our author
are highly instructive and deeply interesting : —

Year,

1816

one in

London.

Mortality.

11.8

Manchester.

Mortality

Dublin.

Mortality.

15.30

1817

— —

12.25

15-94

1818

—

5.75

— 11.75 —

30.5

1819

—

6.72

— 9.5 —

17.6

1820

—

9.97

— 8.25 —

14.64

1821

—

5.04

— 8.0 —

12.7

1822

—

6.18

— 7. —

16.92

1823

—

6.11

— 6.33 —

11.71

1824

—

6.0

— 6.83 —

12.13

1825

—

5.1

— 6.4 —

10.17

1826

—

5.34

— 6.66 —

28.5

1827

- — ■

7.25

— 9.86 —

19.13

1828

—

7.22

— 10.25 —

15.35

“ In the last epidemic fever which prevailed in Edinburgh, from
November 1826, to June 1827, the mortality in the Infirmary and
Fever Hospital of that city was 1 in 10.33. — Ed. Med. Jour:

“ The reason assigned by the authors above-mentioned for the
high rate of mortality in the London Fever Hospital, is the advanced
period of the disease at which patients apply for, and obtain admis¬
sion. The neglect of an early application, however, is a subject of
constant complaint in the Dublin as well as the London Fever Hos¬
pital : and we think this circumstance alone insufficient to explain
the great difference of mortality in both hospitals. We believe the
fact to be, that the proportion of very severe or bad cases to the
aggregate of admissions, is greater in the London than the Dublin
Hospital ; but whether this is to be attributed to the comparatively
limited scale of accommodation in the London Hospital, and the
consequent exclusion of all but the more violent cases — or whether
the peculiar habits and modes of life of the lower classes in the
British metropolis, palpably so different from those of the same
class amongst us, do actually communicate a more dangerous and
malignant character to the disease under consideration, we have not
been able to dicide.

“ We do not exactly agree with the opinion of Dr. Hawkins,
that the difference in medical treatment, either in the same Or dif¬
ferent hospitals, exercises no material influence on the mortality ; as
the admission of such a principle is calculated to induce carelessness
and apathy into the practice of physicians, and it is also objection¬
able as tending to equalize and confound the information, judgment
and experience of men. We are far, however, from the meaning
to apply this remark to the London and Dublin Fever Hospitals, in
the former of which the practice, though a little differing from ours,
particularly in the article of blood-letting, is notwithstanding able
and judicious-” — p. 11.

The mortality in the London Fever Hospital was double
that of Cork Street Hospital some years back, a difference

Dr. O’Brien on Fever in Dublin.

209

very considerable indeed, which our author is inclined to
attribute to local circumstances with which he is unac¬
quainted ; and which operate more powerfully than any
difference of type which may exist between the fevers of
both cities. He illustrates this point by further valuable
observations : —

“ In St. Thomas’s Hospital, London, the mortality for a period
of ten years, among the physician’s cases, according to Sir G.
Blane, has been 1 in 7 for males, and 1 in 10 for females. In
St. George’s Hospital, the reports for 1825 add 1827 afford a mor¬
tality of about 1 in 9. In the Royal Infirmary, Glasgow, the mor¬
tality from typhus fever, in the year 1827, was 1 in 9 ; the mortality
from dysentery was 1 in 8 for males, and 1 in 10 for females.

“ In the great hospitals of Paris, Vienna, Berlin, &c. the mor¬
tality has been still higher than in London, and the general inference
we are warranted in drawing from the information communicated by
Dr. Hawkins is, that the mortality of Cork Street Hospital has
been less than that of any similar institution in Europe, This fact
must prove highly gratifying to the physicians of this institution.”
— p. 13.

The following remarks coincide with those of Drs. Smith
andTweedie, and establish an important fact, the frequency
of local inflammation as a consequence of fever: —

“ It would be a mistake to suppose that the mortality of this
hospital arises solely, or even principally, from continued fever ;
for, in fact, this disease constitutes but a small proportion of the
mortality, except in the epidemic visitations of the disease. The
majority of fatal cases in the past year arose from the usual local
phlagmasise of the thoracic and abdominal viscera, among which
acute and chronic bronchitis (the peripneumonia notha of former
times) and dysentery occupied, and generally occupy, the highest
place ; and a considerable number also died of the chronic diseases
of those organs which passed from the acute to the chronic stage,
either in the hospital or previous to admission.

“ The mortality of this class of diseases, is always considerably
greater than that of idiopathic or simple fever ; hence, when this class
of diseases predominates over fever, as it did in the year 1829, our mor¬
tality is considerably higher than when simple fever forms the ascen¬
dant disease. The best proof of this is, that during the prevalence
of the two great epidemic fevers of 1818 and 1826, when all our
cases were exclusively composed of pure fever, the mortality was
not half so great as in the two past years, the mortality in 1818
being only 1 in 30 — in 1826, 1 in 28.” — p. 13.

Dr. O’Brien next adverts to the various theories of fever.
It is superfluous to trouble the reader with a detail of the
discrepant theories of fever, which we have so often placed

VOL. V. NO. 27.

D D

210

Critical Review.

before him ; and shall content ourselves with stating- the
peculiar views of our author. He commences by defending
Dr. Cullen’s definiton of fever.

“ Dr. Cullen defines simple or idiopathic fever, to be “ Pyrexia,
sine morbo locali primario.” This definition, if taken in a strict
and literal sense, is not only at variance with Dr. Cullen’s own
notion as to the proximate cause of fever, for he believed it to
arise from irritation of the brain ; but we submit, is contrary to
common sense ; for it appears impossible to conceive how any
morbific cause, operating on the human body, could act, except
by affecting parts in succession ; and to say, that a general disease
exists without a local primary disease, is to say, that a disease
exists without a beginning or origin ; — the same observations will
apply to the essential fever of M. Pinel. Against this point in the
doctrine and definitions of his predecessors, M. Broussais has le¬
velled all his artillery, both of argument and irony ; and has intro¬
duced the term “ ontologie,” or essentialism, to ridicule the ab¬
surd abstraction, as he conceives, contained in the term essential
fever ; i. e. a fever without a local origin. To complete and render
intelligible Dr. Cullen’s definition, it would be necessary to add the
word “ evidente i. e. “ Pyrexia sine morbo locali primario evi-
dente;” and we have no doubt, from what Dr. Cullen says in his
“ First Lines,” that this was the sense, in which he intended the
definition should be understood. According to this construction of
it, we shall find the definition describing fever as a disease, which
may haye a local origin ; but that origin not perceptible to our
senses, and unknown. Whether this be true or false, as a matter
of fact, it will, at least, render the definition intelligible, and free
from the charge of “ essentialism.” — p. 18.

Every acute observer will agree with Broussais and our
author, that a morbific cause must act upon some organ
or organs, and these organs are manifestly the cerebro¬
spinal system.

Dr. Burne, in his interesting work on fever, objects to
the term typhus, and recommends its rejection from pyrec-
tic nosology, on the ground of its various and different
applications by medical writers. The suggestion is worthy
of adoption, but we fear no term can be proposed which is
less objectionable. Thus Pinel makes adynamic fever a
species of the essential fevers of the French, and Dr. Burne
employs it as a generic or ordinal term to express the es¬
sential fevers of the French, and epidemic fevers of the Irish
writers.” Dr. O’Brien, however, states that of late years,
the fevers of Ireland have been more of the synochoid
than adynamic type. He doubts the propriety of consi¬
dering typhus and synochus distinct genera, he agrees with

Dr. O’Brien on Fever' in Dublin.

211

those who include both in the genus typhus, and sub¬
divide it into inflammatory and simple typhus.

“ The author confesses that he agrees in sentiment with those
authors ; he believes that the distinction between those divisions of
fever arise from circumstances purely accidental, and not from any
precise generic, or specific difference existing in nature ; and that
they are modifications of the same disease, growing out of those
circumstances. The modifying circumstances may appear to be,
1st, the strength or debility of the constitution, or powers of life
in the individual who receives the infection ; and, 2dly, the quan¬
tity or dose of the morbific material, whatever its nature be, which
produces it. In a constitution naturally feeble, or in one exhausted
and debilitated by external causes, or by age, the reaction is feeble,
and the synochoid period is accordingly short lived, indistinct, or
evanescent ; and thus, the exquisite typhus may be formed ; again,
when the constitution is vigorous, the frame athletic and youthful,
the reaction will be energetic, and the synochoid period will be of
long duration, and strongly marked. — Similar modifications will
arise out of the different doses of the infecting material by which
the disease is generated. Between those extremes a multitude of
intermediate shades of type will exist, as there are various degrees
of the modifying causes, which it will be difficult to reduce to either
of the original genera.

“ Of this difficulty sufficient evidence will be found in the writ¬
ings of authors who have treated of this disease, in the works of
no two of whom a perfect accordance will be found, as to the no¬
menclature and arrangement of fevers. Further, in the synochus
(i. e. synocho -typhus), of Dr. Cullen, numerous varieties of type
arise out of the different relative lengths of the synochoid and ty¬
phoid stages. In the short fevers of this country, as the five and
seven-day fevers, and the ephemerae, the typhoid stage is short, or
altogether absent, while, in protracted fevers, the synochoid stage is
of various lengths, but always much shorter than the typhoid.
These endless varieties of type cannot, it is clear, be expressed by
any two definite terms, but may, with less confusion, be comprised
under a more general or ordinal term — the author shall accordingly
adopt the term typhoid fever, to express every form of fever, of
of which typhus or typhoid symptoms form a part or the whole —
which again he shall subdivide into two species, the synochus of
synocho-typhus and the perfect typhus. This division is not essen¬
tially different from Dr. Cullen’s, but merely an expansion of it.” —

p. 21.

Our author next details sixteen cases which exhibit the
different types of fever which prevail in Dublin, from which
he deduces the following general conclusions : — First,
that there exists a primary gastro-enterite, attended by a
fever of a peculiar kind, approximating in some respects to
typhus, like all phlegmasiae of the gastro-intestinal canal,

/

212

Critic al Re view . *

yet differing' from it by some striking* peculiarities. The

following train of symptoms is peculiar to this disease : —

1

“ Pain, uneasiness, and generally fulness of the epigastrium,
or abdomen, or both aggravated by pressure, and accompanied by
head-ache, nausea, or retching, and, in many instances, by fre¬
quent vomiting, particularly after the introduction, even of the
smallest quantity of fluid or solid aliment, into the stomach. The
appearance of the tongue is peculiar and characteristic ; it is either
of a vivid or dark red colour, over its entire surface, or it is red at
the edges and point, but covered with a dark -white fur in the centre,
through which specks of red are occasionally visible ; the centre,
however, is also frequently brown, or even of a yellowish hue,
whilst the edges are dark red, as above described, and the papillae
all over the surface unusually prominent ; and this organ, on the
whole, presents a most striking appearance of irritation and sub-
inflammation in this disease than in any other type of fever. The
pulse is usually deficient in fulness ; it is small, frequent, and com¬
pressible, and approximates more to the typhoid than the synochoid
character. It is also accompanied by a lower temperature of the
skin ; and, in a word, displays none of the signs of that strong
re-action, which marks the early stage of synochus. It is distin¬
guished, however, from typhus by the comparative mildness of the
cerebral affection ; the author has, indeed, been frequently sur¬
prised at the clearness and integrity of the intellectual faculties, in
the midst of that extreme depression of the muscular powers which
characterises this type of fever. This disease is slow and gradual
in its access as well as its progress ; the patient feels himself ill for
some time, affected with loss of appetite, costive bowels, uneasi¬
ness, and occasionally twitches of pain at the epigastrium and in
the abdomen, which continue until the febrile movement is deve¬
loped, when the train of symptoms before described, sets in with
all its violence. The progress is also remarkably slow, the disease
being frequently protracted to the sixth or seventh wreek before
convalescence takes place. It is further distinguished from typhus
by the absence of petecliiee, a black crust on the tongue, or black
sordes of the teeth and gums, which the author has never observed
in any of the clearly marked cases of this disease he has witnessed.
The bowels are either constipated, or too relaxed, and occasionally
these two states alternately succeed each other. The abdomen is
tumid, resisting and tender to the touch, when pressure is employed
externally ; — the sleep is uneasy, interrupted, and delirious ; but
when awake, the patient seems to suffer little diminution of his
intellectual powers.

“ As a further proof of the real nature of this affection, it may
be stated, that the author has invariably observed, that in propor¬
tion as the abdominal symptoms were mitigated or subdued, the
affection of the head and the febrile symptoms suffered a simulta¬
neous mitigation or removal. The colour of the skin in this dis'ease
is commonly one of the shades of yellow ; — occasionally the tint is

Dr. O’Brien on Fever in Dublin.

213

deep and dark, as in the case of Kitts (No. 1,) where it approached
to one of the lighter shades of mahogany. The intense bright yel¬
low colour of the skin, peculiar to jaundice, and, we presume, to
yellow fever, has not occurred in this hospital since the epidemic
fever of 1826; but, from the author’s recollection of the cases
which then occurred, he is inclined to consider them as modifica¬
tions of the disease we have been considering.

“ Secondly. — The disease now described may be secondary, that
a, , may supervene on typhoid fever, a predisposition being probably
wormed by previous disorder of the stomach and alimentary canal,
functional or organic, or by the prevalence of that epidemic con¬
stitution or malaria which disposes to diseases of the stomach and
bowels, as cholera, dysentery. &c. This adjunct to typhoid fever
may occur at an early period of the disease, but it is more fre¬
quently observed to accompany the advanced stages.

In those cases, we are taught by numerous dissections made
by modern pathologists, that the principal, in many instances, the
sole seat of disease, is the lower part of the ileum, near its junc¬
tion with the ccecum, which is probably to be attributed to the
densely glandular structure of this part of the intestine, and partly,
as we believe, also to its inferior situation, which favours the accu¬
mulation of acrid secretions in thik part. In a disease like typhus,
where the sensibility is greatly impaired, or even destroyed alto¬
gether, this affection may exist, without being felt or complained
of by the patient ; but it will very seldom, indeed, fail to be de¬
tected by careful examination externally, or by diarrhea, or a tym¬
panitic state of the abdomen — which latter are its appropriate
signs, when the patient is in a state of coma or insensibility.
Another of its symptoms, more rare than those above-mentioned,
is hsemorrhage from the bowels, which, if superadded to a tympa¬
nitic state, presents the most intense and hopeless form of this
affection. With respect to the colour of the alvine discharges of
this affection, it is stated by Dr. Bright, that they are generally
ochre coloured ; but the author has more frequently seen them of a
dark or mud colour, yet he has also frequently observed them as
described by Dr. Bright.” — p. 54.

Dr. O’Brien is of opinion that there are good grounds in
nature for dividing idiopathic continued fever into two great
classes, which lead to important indication of treatment;
synochse, or inflammatory fevers ; synochus and typhus, or
typhoid fevers ; but between classes are various interme¬
diate shades of type, which it is difficult to allocate to either
class. In the first class, the heart and arterial system are
chiefly affected, the sensoriurn and nervous system being
comparatively exempt from its influence. In typhus, the
brain, nervous system, and spinal chord are first affected,
and through them the heart, arteries, and their capillary
extremities. The modifications of the various species will

214

Critical Review.

depend on the modifications of the morbific cause, or on
the original conformation or constitution of the sick ; but
here the relation between cause and effect is as yet beyond
our comprehension. In typhus, the prominent features of
the disease from first to last are nervous, modified by the
various degrees of arterial and vascular action by which
they are accompanied. The author proceeds to illustrate
the pathology of fever, and offers the following reflections
on the subject, which shall conclude our remarks for the
present : —

“ If we examine the first of the two species of typhoid fever,
(synochus) we shall observe the phenomena to succeed each other
in the following order : — first, a stage of nervous and vascular de¬
pression ; secondly, a stage of vascular excitement or reaction ;
and thirdly, a stage of universal exhaustion and debility, announc¬
ing a more complete depression of the nervous, vascular, and mus¬
cular powers than in the first stage. In the perfect typhus again,
the whole series of phenomena exhibit only increasing degrees of
nervous, vascular and muscular depression ; the power of arterial
reaction is annihilated, and the state of the system approaches to
that of general paralysis.* The outline of this description has
been already published by the author in the Annual Report of this
hospital, for the year 1814,f and the principles of practice wThich
flow from it inculcated in all his subsequent ones. Whether the
power applied to the sensorium, in this case, be sedative, as
Dr. Cullen thought, or excitive, is a question evidently beyond our
power to determine ; we merely know its visible and palpable
effects. This leads us to the consideration of the physiological
condition of the brain itself in this disease. It appears that in
every case of typhoid fever, at least the exceptions are so rare that
they only serve to establish the rule, there is a determination of
blood to the head, sufficiently manifested by the red and injected
eye, the burning forehead, the throbbing temples, and the acute
head-ache, which accompany this disease at variable intervals of
time after its developement. This state of the organ is by some
called inflammation, whilst others, although they admit a determi-

* To this state the term adynamia has been applied ; but the author is un¬
willing to render a subject, sufficiently obscure in itself, still more so, by involv¬
ing it in scholastic and ill-defined terms.

Every physician, we believe, who has treated this disease, will at once admit
that exhaustion and debility form one of the most striking and characteristic
symptoms of perfect typhus. We are far, however, from supposing that this
debility is the cause or essence of the disease, and we doubt if any modern
physician thinks so ; — we believe it to be a consequence — a symptom only, but
one of the utmost importance, and of which the practitioner should never loose
sight.

f The first train of symptoms are nervous, the second vascular, the third
vascular and nervous.” — Annual Report for 1814.

Dr. O’Brien on Fever in Dublin.

215

nation of blood, yet deny that the state induced possesses the cha¬
racters of inflammation ; and the term congestion has been intro¬
duced to express the condition of the cerebral vessels under those
circumstances. Thus it appears, that the dispute on this subject is
primarily one about words ; but it is also a dispute about the pre¬
cise nature of inflammation itself, with which, in truth, we are but
imperfectly acquainted. We know, however, with certainty, and
to this fact, perhaps, our knowledge in every case of inflammation
is limited, that the ordinary condition of the brain in typhoid fever
is that of vascular fulness and distension ; but beyond the expression
of this simple fact, strict philosophy will not permit us to proceed.
Dissection may, indeed, occasionally discover the vestiges of acute
inflammation in the brain ; but we believe, in the majority of cases,
it has failed to detect it. This condition of the brain, the author
holds to be consecutive, not primary, in the morbid series, which
constitutes the disease, but when once fullv established, it becomes
itself a new source of morbid actions, re -acting on the sensorial
disorder which produced it ; and thus, by its direct and reflex
influence, producing the characteristic phenomena of the disease.
But this condition, which may be called typhoid inflammation, may
also be propagated to other organs essential to life, as the lungs,
stomach, &c. ; and we are instructed by dissection, that nearly the
whole of the mucous surface, or internal lining of the body, is in
a state of vascular distension in typhoid fever.

“ 4thly. — We are not as }^et sufficiently advanced in the science
of the animal fluids to determine what part the blood plays in the
generation of fever, but so far as experiments have been made, it
has been found, when drawn in the first or second day of perfect
typhus, but little altered from its natural state ; we know, how¬
ever, with certainty, that in a short, but indefinite period after the
disease, the blood and other animal fluids suffer a manifest altera¬
tion in their physical properties ; and thus, in their turn, become a
part of the morbid circle, which constitutes the disease.

“ From all that has been above stated, it follows, as a necessary
inference, that M. Broussais’s doctrine is chiefly erroneous in its
indefinite application and its universality, in extending the significa¬
tion of terms, proper only to the species, to a whole class, and in
laying down as the etiology of the class what is only true of the
species.

“ The author is far, however, from wishing to deprive M. Brous-
sais of his just meed of praise. Although the gastroenterite had
been previously accurately described by other writers, yet to him
belongs the merit of directing the attention of physicians in a more
particular manner to this disease, and more clearly and completely
developing its pathology ; and hence, we do not hesitate to say,
that we number him among the improvers of practical medicine,
and the benefactors of mankind.

“ The original describers of this species of fever, and not inferior,
perhaps, to any of their successors, were the German physicians
llcederer and Wagler, who describe this disease as having prevailed

216

Critical Review.

at Gottingen, in an epidemic form, in the year 1760, (“ de Morbo
Mucoso”) and whose work exhibits an admirable history of its
symptoms, and morbid anatomy.

“ The disease was subsequently described by M. Pinel, partly
under the titles of “ Fievre Gastrique,” and “ Embarras Gas-
trique,” and partly under that of “ Fievre Muqueux;” and in
England, it has usually been known under the general appellations
of bilious disorder, and bilious fever, titles inappropriate, and
wrhich by no means express its real character. In France, it again
became the subject of investigation by M. Petit and Serres, and
by M. Breatonneau, and more recently, in an elaborate work by
M. Louis ; but all these authors appear to me to have confounded
the primary with the secondary form of the disease ; and M. Louis,
in particular, has adopted the theory of Broussais in its fullest
extent. In England the subject has received further illustration,
from the cases published by Dr. Bright, of London, and the trea¬
tise of Dr. Bume/> — p.58.

IV. — A System of Medical Nosology. By I. Macbraire,
M.D. L.E. Member of the JR oyal College of Surgeons,
Edinburgh, Assistant Physician to the London Hos¬
pital, Physician to the London Dispensary, Vice Presi¬
dent of the Hunterian Society, & c. : sm. 8vo. pp. 107.
Latin and English. Longman and Co. 1830.

greatest

The importance of nosology, the doctrine or science of
diseases, to the healing art, leads us to notice the volume
before us we should hail an unquestionable improve¬
ment in this branch of medical literature as the
boon the press could afford us.

Nothing shows this importance more clearly than the fol¬
lowing consideration : — every individual, on commencing
the study of physic, must adopt some methodical arrange¬
ment of the subject ; he must have a text book or a guide
to his inquiries ; the subject is one which will not admit of
an artificial and arbitrary disposition, principles must form
its basis, and, in the present state of our knowledge,
theories will enter into its composition, by which means,
opinions are formed and prejudices are engendered ; these
become the prevailing doctrine of the day, and rooted first
impressions from this source alone, have operated and con¬
tinue to operate, powerfully and wofully in retarding the
progress of inquiry and improvement.

That the system of Dr. Cullen effected much good, at
the period which gave birth to it, and that its author was

Dr. Macbraire on Nosology .

2\7

deserving- of the high encomiums with which he met ; that
his genius* simplicity* ingenuity* intrepidity* and perse¬
verance* will claim the admiration and thanks of physicians
for ages* and that an acquaintance with it is necessary to
a medical education* : — even now* that its errors and inade¬
quacy have become a trite and universally accorded theme*
we, in common with his greatest admirers* are willing to
allow; but that*

<e The recent improvements” (our author means since the
time of Cullen*) made in the medical science* have been
so numerous and of so important a character, that some
change appears indispensably necessary in the system of
nosology* which has been so long the student’s text book*”
is equally evident* and has been acknowledged by the pro¬
fession at large for years past. The prevalence ’ of this
opinion has given origin to various new systems ; those of
Macbride* Crichton, Darwin, Parr* Young* and last in series*
but first in importance to the physiological system of the
late Dr. Mason Good.

The Culienian system* so ably propounded by its master*
and so enthusiastically supported by its admirers in every
school of importance in Europe* was for years the text
book of physic ; in process of time it became inadequate
for its purpose* and has long been gradually falling into
disuse and disrepute ; moreover* with the system the science
itself has sunk in the scale of importance, and instead of
being looked upon as one of elementary consequence* it is
totally neglected by the medical student of every class* and
by the practitioner is referred to more as an object of
curiosity than one of necessity* or as having any direct
beneficial tendency.*

One principal cause for this neglect* has been the total
exclusion by the different examining bodies of a knowledge
of nosology, as a necessary qualification for those about
to enter the profession ; and this again may probably be
accounted for by the consideration* that the system of phy¬
sic of Dr. Cullen came into the world with a species of
authority which none other since has had the advantage of ;
it held its domain supported by the highest talent and the
greatest enthusiasm* until The March of Intellect ” out¬
stripped its popularity* and that it has not been superceded
by any other, is admitted universally to be preferable.

Our author’s intention is to improve upon Cullen s Trea¬
tise * and to render it more in conformity with the pre-

* Dr. Cullen’s Nosology is still a Text Book in Edinburgh. — Ed.
Vol, V. NO. 27. X X

218

Critical Review.

sent advanced state of mediccd knowledge f principally
for the use of students as a e< text book we shall
give our readers a brief statement of this performance,
closing with one or two observations.

We must premise, however, that the production of our
author is a complete failure, it is objectionable in classic
beauty, in arrangement, both natural and scientific ; is
even inferior to Cullen’s nosology, and cannot be compared
to Good’s. The author should have made himself master
of all the nosologies extant, and improved upon them ; but
on the contrary, he seems to be unacquainted with many
of them.

In the first place, we have three classes corresponding to
those of Dr. Cullen, the names only being altered from
pyrexia , neuroses, and cachexies, to angloses , neuriccs,
and cachexii, to which is added a fourth class — cutanea,
and the class locales of the prototype, is rejected alto-

of five orders in the first class, we have here only
two — febres and phlegmases ; the exanthemata are al¬
lowed to a genus of continued fevers; the hemorrhagics
are denied a place in the system as being only the sequel
of diseases; and of the 'profluvia, catarrhus is a species
of phlegmases , viz. bronchitis and dysenteria, a variety
of another species of the same order — clonitis chronica.
The febres are divided into continues and inter mitt entes ,
with a definition, the first comprising four, and the latter
three generae ; in the phlegmases we find a similar division
into p. membranctrum and p. viscerum ; we have four genera
of p. membranum, according as the cellular, mucous, se¬
rous or fibrous textures may be affected ; but the nine
species of which the p. viscerum is composed, have no
generic distinctions whatever.

The second class, or neuricae, has two orders, encepha-
licae and nervosae, each containing two genera. The ence-
phalicce relationes , comprise the comata and several of the
spasmi of Cullen. Encephaliccs mentales, answers to the
order vesaniae ; nervosce vites animalis has only the one
species neuralgia, and nervosce vitae organiccs is made up of
the principal remaining genera of the order spasmi reduced
to species.

Class. 3. — Cachexii has no ordinal division, it comprises
four genera only; viz. scrophulus, scorbutus, syphylus, and
phthisus. The marcores and intumesentiae, including all
dropsies, are like the hamorrhagiae, denied a place in the
arrangement, as being sequelae morborum .”

gether
Inst i

Dr. Macbraire on Nosology .

219

In class 4, cutanea, the arrangement of Willan, is adopted,
with the exception that the order exenthematae, pemphigus
of the order bullae variola of the order pustulse, and vari¬
cella, miliariae and aphtha of the order vesiculse, are trans¬
ferred to class the first.

As specimens of the ability of the doctor to form genuine
and specific essential character, we select the following : —

“ Cl. 1. Or. 1. Div. 1. Gen. 4. Exanthematicae Sp. 3. Scarla-
tinis febris ardens contagiosa. Quarto morbi die facies aliquantum
tumens : simul in cute passim rubor floridus, papulis exigius tandem
coalescentibus, post tres dies in squamulas furfuraceas abientibus
inflammatione tonsillane ssepe comitante, dein saepe supervenien-
tibus pulmonam cedemate et anas arcae.

“ Cl. 4. Or. 1, Gen. 1. Strophulus.

“ Papulae, infantum cutem occupantes.

“ Cl. 4. Or. 1. Gen. 2. Lichen.

“ Papulae, adultorum, et infantum cutem occupantes.

This brief statement will be sufficient for our readers to
form an opinion of the merits of the plan. In regard to
the nomenclature, the examples given serve to show that by
its adoption we should incur all the inconveniences resulting
from a change of names, without any of the advantages ex¬
pected to be derived from one corrected and simplified
throughout ; — we are surprised the learned author, occu¬
pied in such an undertaking, should retain such terms as
scarlatinis, scorbutus, &c. The higher division of the sys¬
tem are unprecedently irregular and imperfect ; the clauses
are insufficient in number to comprise the whole catalogue
of human maladies ; and we may remark in passing, that
the locales of Cullen, or the anomalse of Sauvage, are far
preferable to no place whatever, for a great variety of dis¬
eases in a system of nosology ; the principle which ex¬
cludes hemorrhages and dropsies might be applied to many
affections admitted; again, the generic and specific defini¬
tions are either diffuse or obscure : of the former there are
only about forty-six in number. We could point out many
irregularities, and a deviation from scientific principles in
their construction, but this article is sufficiently extended,
and enough has been said to answer every useful purpose.

In conclusion, we cannot help expressing our surprise
that the learned gentleman should have taken no notice
of the systems which have intervened between his own and
that of Dr. Cullen, and that in his preface he treats the
subject as if such authors had not existed. As we find
Dr. Good’s name frequently quoted in the notes, we pre¬
sume he was well acquainted with that physician’s works, and

220

Original Communications .

with his physiological system of nosology ; a production
far superior to any other which has appeared upon the
subject , the general adoption of which by teachers and
examiners, and the consequent revival of nosology as a
necessary branch of education would, we believe, contri¬
bute greatly to the best interests of the profession ; and
we do not hesitate to recommend it strenuously to those of
Dr. Macbraire’s pupils, who have advanced as far as the
study of medicine.

ORIGINAL COMMUNICATIONS.

I. — Observations on Judicious Necrotomy .

I shall be glad, through the medium of your excellent
Journal, to lay before the members of the profession two
points for consideration, hoping that in some way cr other
they may be attended with advantageous results, though
they* may be neither very speedy, nor at first of a very deci¬
sive nature. One of the matters in question is of incessant
recurrence ; the other is comparatively rare, but connected
with considerations of no small importance.

The slovenly manner in which the coroners of this country
generally discharge their office has long been proverbial ;
but there is no doubt that they are frequently encouraged
in carelessness, if not led into error, by medical practi¬
tioners. I hold it to be an axiom, that very rarely will any
of us be able to assign the indubitable cause of a person’s
death, without a post mortem inspection of the body. We
may, it is true, form a tolerable accurate opinion where we
have had access, to observe a train of symptoms during
prior disease — at least for private satisfaction ; but when it
becomes a matter of positive statement upon oath, and the
death has been sudden, he must be very presumptuous who
would venture before the public with a confident assertion,
that may bring an innocent person to the bar of a tribunal
on a charge affecting his life — or (what is not at all impos¬
sible) so speak, and speak in ignorance, as to let a guilty
assassin escape.

But there is connected with proceedings of this nature, a
question of economy, of a more sordid description cer¬
tainly, to which I hope that the attention of the profession
may with propriety be drawn.

Observations on Judicious Necrotomy. 221

Any medical man is liable to be summoned before an
inquisition ; and if it so happens either that his knowledge
of the case is limited, tr that he is called upon for an
opinion as to its nature, he will seldom indeed be in a con¬
dition to speak to the cause of the person’s death. We
may suppose such a course of examination to be entered
upon as the following: — fC To what do you attribute the
death of this person V “ I cannot tell without having the
body opened.” (e But by means of that operation you
could V* “ In all probability a very accurate opinion would
then be formed.” ee Have the goodness to proceed to make
the necessary examination.” ie I am willing to perform any
professional act, but I require reasonable remuneration for
my loss of time in doing it, for the trouble, risk, and re¬
sponsibility which I must incur ; and my demand is -

There is no fund out of which the medical man can be paid
this just and equitable demand ; and it has sometimes
happened, that the jury has been obliged to separate with¬
out coming to any other decision than that they had found,
or been shewn a dead body. This is a mockery of the mat¬
ter altogether. But in some instances the parish surgeon
performs the operation, and receives an inadequate fee for
so doing ; or it may be that this cast of his office is included
in the general contract ; and it is not likely that a sufficient
and intelligent examination will be instituted where the ob¬
ject with ail parties is to get through the business as rapidly
as possible, and give as little trouble as may be.

1 consider this to be one of the causes of the failures so
remarkable on the part of medical witnesses on capital
trials arising out of inquisitions. The preliminary steps are
taken so inefficiently, that the proceedings before the coro¬
ner, and the opinion solemnly pronounced by his jury as to
the perpetration of a wilful murder, are frequently, very
frequently, perhaps it would not be too much to say most
frequently, overturned upon more accurate investigation,
and the medical witness finds the opinion given by him for¬
merly, and for which instances might be quoted, of votes
of thanks, most completely refuted, often by himself ! Let
the medical man be paid for assisting to promote the ends
of public justice, as well as the coroner, or any other func¬
tionary, and then deal smartly with him if he do not per¬
form his duty. It is gross nonsense to talk about throwing
impediments in the way of justice. Public justice is not
a pauper, and her proceedings ought not to depend on
gratuitous contributions of labour and skill any more than
of money. I exhort the profession to insist upon an equit-

22*2 Original Communications .

able stipulation for such important services ; and where it
is refused, decline to assist. The coroner can compel
attendance for the purpose of telling- what we know ; but
I question much his power to order us to seek knowledge.

The other point for consideration 1 shall state very briefly,
and I have no desire to interfere with abstract questions,
either of a legislative character, or matters of personal
feeling on the part of our brethren ; believing myself, at
the same time, to be exempt from all unusual squeamish¬
ness and affected delicacy. But I must declare that 1 look
upon the part which surgeons (for it professedly devolves
upon them) perform in the punishment of convicted mur¬
derers, to be rather at issue with their true respectability.
This question has been repeatedly discussed, and I am
quite willing to leave every one to the enjoyment of his
own opinion, without wishing to think the worse of him
for not considering himself in a situation analogous to that
of a public officer, whose respectability is not rated very
high. I admit readily that to teachers of anatomy, the pre¬
sent of a healthy subject is a boon, and such of course do
right in accepting of it. But there are many practitioners
throughout the country to whom the consignment must be
quite the reverse, and my object, on the present occasion,
is to inquire by what law any surgeon whatever is compelled
to dissect and anatomize the body of a murderer? At pre¬
sent 1 know of none; and with all my desire for the spread
of anatomical knowledge, I question whether it would not
do good, if difficulties were made about carrying this part
of the sentence into effect. The law would, in some way
or other, have to be altered, and I think the interests of
anatomy would gain. For my own part, were I living in a
country town, and the authorities call on me to assist in
punishing a felon, any way connected with professional acts,
whether by trying a dangerous remedy upon him while
living, putting him to death by means of poisons or sur¬
gical operations, or dissecting and anatomizing him after
the executioner had done his part of the process, I say,
I might possibly seek to know by what act of parliament I
am compelled to join in this sort of business, if I do not
choose it: and whether, if I choose to undertake the car -
nijicious office, I should not be entitled to remuneration
from the county fund ?

These views of the subject are not, as far as I know,
entertained in any other quarter; but as 1 do not pique
myself unduly upon their importance, 1 consign them to
the pages of the London Medical and Surgical Journal ,

Dr. Ryan on state of the Medical Profession. 223

without the publication of my name. The editor knows
whence they came, and will be satisfied as to the nature
of my motives in forwarding* them.

II. — Dr. Ryan on state of the Medical Profession.

The dubious state of the English law on the right of
apothecaries to demand compensation for their attendance,
has given rise to a system injurious to the profession and
public, that of prescribing an unnecessary quantity of medi¬
cine, and by this means acting contrary to their own feelings
as men of education, and virtually imposing* upon the public.
They must have some remuneration for loss of time, or how
are they to support their families and establishments'? Can
it be expected that an apothecary or surgeon apothecary in ex¬
tensive practice in London, will spend his time in driving from
one part of this immense city to the other, without some com¬
pensation for his services ; and this he is compelled to acquire
in the disreputable manner already mentioned. It will be said
by physicians and surgeons, that the general practitioners,
as they are unclassically denominated, are intruders, and
have no legal right to practise medicine and surgery. No
doubt they have no legal right to practise physic or surgery,*
but it is equally clear that they are patronized and generally
employed by the public. The want of such a class of prac¬
titioners arose from the exorbitant fee for medical attendance,
physicians and surgeons demanding a guinea for every visit
or prescription, a sum much more than the majority of society
can afford. The junior members of these professions are
compelled to make the same demand, and in this way the
public to a great extent are precluded from procuring the ad¬
vice or attendance of physicians and surgeons. The apothe¬
cary becomes the general practitioner, because people will
prefer his opinion to their own, and especially as he is con¬
sidered entitled to no fees. This line of practice has become
so general, that some few* doctors and a large proportion of
surgeons have adopted it. The character of this body of
practitioners, however, is naturally less esteemed by the pub¬
lic, as they are compelled to sacrifice reputation to interest,
and to subject themselves to the humiliating mortification of
being compounded with druggists and chemists, while the

* The laws relating to the Medical Profession. By J W. Willcock, Esq.
Barrister at Law. London, 1830.

Original Communications.

legitimate physicians and surgeons regard them as intruders,
and treat them with jealousy or, contempt. As the law was
said to allow no compensation for advice, they were ac¬
counted unreasonable when they made a specific charge for
attendance ; and they were obliged to order an unnecessary
quantity of medicine, and charge a high price, to remunerate
them for attendance, to thegreatannoyance of the public, and
to the degradation of the profession. From this mode of re¬
munerating general practitioners, which is distressing to the
majority of that body, and which is happily at an end, by a
recent decision of the King’s Bench, the sick wrere obliged
to take more medicine than was required for the cure of their
disease ; and this is still too often the case, when a physic;an
is called in by the attending apothecary. The esteem and
veneration entertained for the profession at large are di¬
minished, the medical character is lowered and degraded by
this state of things, and the public confidence in the healing
art is so much injured of late, that many deprive themselves
of its aid altogether. The profession, though brought to a
degree of perfection hitherto unequalled, has its dignity and
degrees so despicably fallen, that the most illiterate assume
and usurp its titles, and the university graduate is almost
ashamed to be styled Doctor, since he must share his title in
common with the surgeon, the apothecary, the chemist, the
druggist, and the nefarious quack. Every man may stile
himsell Doctor, and impose on the public with impunity.
Such is thestate of physic in London, in 1830. The English
apothecary however is as much “ sinned against as sinning.”
He is obliged to receive a medical and surgical education,
expend five years in acquiring pharmaceutical knowledge,
and undergo examination, before he is legally qualified. He
then commences his profession, and has the mortification to
discover that any man may usurp his rights, by placing the
words chemist and druggistover his door. He also learns that
his illiterate rival, who has received no medical education,
robs him of his real vocation, the composition of medicine,
vends drugs at half the price he charges, compounds nearly
all physicians’ prescriptions, prescribes for the sick ; in a wmrd
is physician, surgeon, apothecary, and obstetrician. The
Apothecaries’ company have the power to prevent all this
abuse, if they would only do their duty. In Scotland, the
surgeon apothecary must be a licentiate of the Royal College
of Surgeons of Edinburgh, and must have received an ex¬
cellent medical and surgical education.

Jn Ireland, the apothecary is not obliged to receive a me¬
dical or surgical education, though he practises every branch
of the healing art, and has his peculiar rights infringed on.

225

Dr. Ryan on the state of the Medical Profession.

especia uy in the remote parts of the country, by his old
colleague the grocer.

Under all these circumstances, can it be expected that the
regular physician or surgeon ought to meet the general prac¬
titioners of this empire, and those who assume the title of
such in consultation ? The Colleges of Physicians and Sur¬
geons have invariably decided in the negative. If the mem¬
bers of each branch of medicine received the same educa¬
tion, of course there could be no objection to their meeting
in consultation ; but this has never been the case, and
therefore the law and the public have wisely decreed a dis¬
tinction of medical practitioners, which no class of the faculty
can destroy. That it is quite preposterous to attempt it, the
recent history of medicine in this country amply testifies. It
may be said, that the science and art of medicine are “ one
and indivisible,” and therefore ought to be studied and prac¬
tised by every member of the profession. Granted, if every
man could either comprehend or understand the science and
the practice of the healing art, but as yet no man has had
the temerity to boast of a perfect knowledge of the subject.
Hippocrates, who afforded the best evidence of the most ex¬
tensive knowledge of the various branches of medicine of
any of his successors, candidly acknowledged that he had
not arrived at the end of physic. But now a days, it is se¬
riously asserted, that every young gentleman of one and
twenty, who qualifies at the Apothecaries’ Hall, or Royal
College of Surgeons, is perfectly acquainted with medicine,
and competent to treat all diseases incidental to humanity.
Such is the march of intellect of the age. Unfortunately
for this assertion, the most eminent members of the profession
are of a different opinion. They unanimously maintain that
no man, however talented, can be a complete master of the
science and practice of medicine in its full acceptation, that
every man ought to acquire as much information as possible
in all its branches ; but that the practice of any one branch
is as much as he can undertake with satisfaction to himself,
or benefit to mankind. Such is the received opinion, with
respect to practice in the large cities, in which a division of
the practice of medicine is universally observed. After all
that has been stated on the contrary, there is no instance in
the history of the profession, of one individual having pro¬
duced a good system of physic, surgery, midwifery and
pharmacy, much less a complete system. The reason is
obvious, any one of these branches is sufficiently extensive
to occupy the mind ; but a complete knowledge of all is far
beyond the limits of the human understanding. If this

Vol. v. no. 27.

F F

226

Ori ginal C omm uni cations .

position be admitted, and where is the welL educated phy¬
sician or surgeon who can deny it, it follows that the division
of the medical profession is consonant with reason, common
sense, and expediency.

This division however is most valuable to the affluent ;
and is manifestly injurious to the great mass of society, the
middle and lower classes, who are precluded from enjoying
the advantages it affords. To supply the wants of these
classes, the general practitioners are supposed to be neces¬
sary, indeed indispensible, though this is very- doubtful when
we consider how easily the aid of young physicians and sur¬
geons may be procured, as well as the aid of their seniors
at the numerous charitable institutions. But the lowest class
of society ought to be enabled to purchase the services of
well educated practitioners, and this could be easily accom¬
plished, by regulating fees according to seniority, the fee of
the junior being such that all might afford to give it. This
plan has been adopted in France and other countries, with
the best effects to the profession and the public. The young
physicians and surgeons of France;, men of the first rate
education and talents, some of them the best writers of the
day> take fees of one, two, three, five, ten francs, and so on to
one or two louis, according to their standing ; and this plan
does not degrade their characters any more than the subal¬
tern officer or midshipman is degraded by his situation, or
the admiral or general by having passed through the lower
stations, or the clergy who receive their tithes in proportion
to the wealth of individuals. Were the medical profession
in this country to follow this example, there would be no
inducement to prescribe unnecessary medicines, a great many
useless if not dangerous practitioners might be spared, young
physicians aud surgeons would be employed, who under
the present circumstances have no chance of practice in
consequence of requiring fees similar to their seniors, and
who must commence their career, after an expensive educa¬
tion, by affording gratuitous advice. The change would ele¬
vate the medical character, by removing the temptation to
many degrading practices, now too common among all
classes of practitioners. Though this regulation of remu¬
neration is not formally adopted by the legal heads of the
profession, still it is sanctioned by the majority of physicians
and surgeons in this metropolis to a certain extent, as the
most eminent accept a fee of half a soveriegn for advice at
their own houses. This is not generally known, but it is a fact;
and many talented young barristers accept a similar fee for
chamber advice. The Apothecaries’ company of Ireland
have regulated the fees of the respective grades of their body.

Dr. Ryan on the state of the Medical Profession. 227

apprentices, assistants and licentiates. The apprentice is
entitled to half a crown, the assistant to a crown, and the
master to ten shillings for each visit, or to a guinea if called
up at night. These fees are regularly charged and paid.
The price of medicines, draughts, mixtures, pills, boluses, &c.
are regulated, and the bills of apothecaries may be taxed at
the Hall in Dublin There is no power given by the Irish Act
34 Geo. 3. to regulate fees, or the price of medicine, but the
courts of law have repeatedly decided upon the legality of
the proceeding. This is a good hint to the company in this
country, whose powers are much more extensive, by the 55th
Geo. 3. Besides the decision in the case of Hendy v Han¬
son has established the right of English apothecaries to fees,
provided they charge a fair and moderate price forjuedicines.*
The good effects of this decision will be speedily felt by the
profession, and in due time by the public. According to the
present system the British and Irish apothecary, by whom the
medicines prescribed by physicians are presumed to be pre¬
pared, is scarcely ever in his shop. The moment he receives
his licence he ceases to be an apothecary. From that mo¬
ment he considers himself a general practitioner, and regards
his business as a secondary pursuit. He procures a school
boy as an apprentice, and to him is intrusted the serious and
important office of compounding medicines. The most ac¬
tive poisons are placed within his reach, and are at his dis¬
posal. That serious accidents, and even the destruction of
life occur from this cause, the public prints daily inform us.
The fact is, there is no such person as the law styles apothe¬
cary in the British dominions. The apothecary prescribes in
all cases, he seldom permits a physician to be employed un¬
less he considers the patient past recovery ; and the physician
called in by the apothecary conceals his mistakes, and often
consults him precisely as if he was a regularly educated prac¬
titioner. In extreme cases the presence of the physician only
serves to hide the blunders, and protect from blame the in¬
competency of the former attendant, but the physician who
is a party to the delusion, can be actuated only by corrupt and
mercenary motives. He must also act against his conscience
in prescribing or sanctioning much more medicine than is
necessary, though it is an axiom, that the best physician is
he who orders the least medicine.” The practice of consult¬
ing with apothecaries leads to this monstrous state of things,
and the majority of apothecaries themselves feel the bad
effects of the system, as well as every one else, and would

* Willcock, op. cit.

228

O r i s; i n a l C o mmu ni cations.

y

never lend themselves to it; unless actuated by necessity.
But the surgeons infringe upon the physicians as well as the
apothecaries, and this has been so much felt that the Royal
College of Physicians in London,, cautioned certain eminent
surgeons against the practice ; a caution which was despised
in the teeth of the law. The fact is, we have the various
classes of the medical profession, educated and illiterate, en¬
croaching on the rights and privileges of each other, in¬
trenching beyond the lawful boundaries, violating treaties
and engagements, and openly transgressing against the
laws. This will appear very obvious, by a reference to the
valuable treatise of Mr. Willcock, already quoted. Under
such circumstances it is impossible for harmony and good
feeling to be cherished by the profession. The want of an
esprit de corps, so remarkable in other professions, exposes
ours to disrespect and contempt in the eyes of the public.

It would far exceed the limits by which I am circumscribed,
were I to attempt to enumerate the defects of the medical
profession in this country ; I shall, however, attempt to
depict the most prominent of them when detailing the laws
relating to the practice of medicine. Notwithstanding all the
abuses detailed, the finest feelings of our nature actuate us
in the dischargee of our professional duties. The institutes
of our conduct are not exceeded in excellence by those of
any other profession. The preceding sketch of ethics attests
the fact. To return to the pleasing subject of ethics, we
have to enumerate a few other rules which guide the higher
orders of the profession, and which were proposed by
Dr. Percival.

Whenever a physician or surgeon officiates for another,
wdio is sick or absent during any considerable length of time,
he should receive the fees accruing from such additional
practice : but if this fraternal act be of short duration, it
should be gratuitously performed ; with an observance
always of the utmost delicacy towards the interest and cha¬
racter of the professional gentleman, previously connected
with the family.

Some general rule should be adopted by the faculty, in
every town, relative to the pecuniary acknowled gments of
their patients ; and it should be deemed a point of honour
to adhere to this rule, with as much steadiness , as varying
circumstances will admit. F or it is obvious, that an average
fee, as suited to the general rank of patients, must be an
inadequate gratuity from the rich , wdio often require atten¬
dance not absolutely necessary ; and yet too large to be ex¬
pected from that class of citizens, w'ho would feel a reluc-

Dr. Ryan on the state of the Medical Profession. 229

lance in calling for assistance,, without making some decent
and satisfactory retribution.

But in the consideration of fees, let it ever be remembered,
that though mean ones from the affluent are both unjust and
degrading, yet the characteristical beneficence of the pro¬
fession is inconsistent with sordid views, and avaricious ra¬
pacity. To a young physician, it is of great importance to
have clear and definite ideas of the ends of his profession ;
of the means for their attainment ; and of the comparative
value and dignity of each. Wealth, rank, and independence,
with all the benefits resulting from them, are the primary
ends which he holds in view ; and they are interesting, wise,
and laudable. But knowledge, benevolence, and active vir¬
tue, the means to be adopted in their acquisition, are of still
higher estimation. And he has the privilege and felicity of
practising an art, even more intrinsically excellent in its me¬
diate than its ultimate objects. The former, therefore, have
a claim to uniform pre-eminence.

Dr. Percival adds in a note ; at a period when empirics and
empiricism seem to have prevailed much in Rome, the ex¬
orbitant demands of medical practitioners, particularly for
certain secret compositions which they dispensed, induced
the Emperor Valentinian to ordain, that no individual of the
faculty should make an express charge for his attendance on
a patient • nor even avail himself of any promise of remu¬
neration, during the period of sickness ; but that he should
rest satisfied with the donative voluntarily offered at the close
of his ministration A By the same law, however, the Emperor
provided that one practitioner, at least, should be appointed
for each of the fourteen sections into which the Roman
metropolis was divided with special privileges, and a com¬
petent salary for his services; thus, indirectly, yet explicitly
acknowledging, that a physician has a full claim in equity, to
his professional emoluments. Is it not reasonable, therefore,
to conclude, that what subsisted as a "moral right, ought to
have been demandable, under proper regulations, as a legal
right l For it seems to be the office of law to recognize
and enforce that which natural justice recognizes and sanc¬
tions.

The Roman advocates were subject to the like restrictions,
and from a similar cause. For their rapacity occasioned the
revival of the Cincian ordinance — f<r qua cavetur antiquitas ,
ne quis oh causam orandam pecuniam donumve accipiat .”
But Tacitus relates, that when the subject was brought into

* Vide Cod. Theodos. Lib. XIII. Tit. III.

230 Original Communications.

discussion before Claudius Caesar, amongst other arguments
in favor of receiving fees, it was forcibly urged sublatis stu -
diorum pretiis, etiam studia peritura ; and that in conse¬
quence, the prince S( capiendis pecuniis posuit modum usque
ad dena sestertia quce egressi repetundarum tenerentur

A precise and invariable modus , however, would be inju¬
rious both to the barrister and the physician, because the fees
of each ought to be measured by the value of his time, the
eminence of his character, and by his general rule of
practice. This rule, with its antecedents, being well known,
a tacit compact is established, restrictive on the claims of the
practitioner, and binding on the probity of the patient. Law
cannot properly, by its ordinances, establish the custom,
which will and ought to vary in different situations, and
under different circumstances. But a court of judicature,
when formally appealed to, seems to be competent to autho¬
rise it if just, and to correct it if unjust. Such decisions
could not wholly change the honorary nature of fees ; because
they would continue to be increased, at the discretion of the
affluent, according to their liberality and grateful sense of kind
attentions ; and diminished, at the option of the physician, to
those who may from particular circumstances, require his
beneficence.

From the Roman code, the established usage, in different
countries of Europe, relative to medical fees, has probably
originated. This usage, which constitutes common law,
seems to require considerable modification to adapt it to
the present state of the profession. For the general body
of the faculty, especially in the United Kingdoms of Great
Britain and Ireland, are held in very high estimation, on
account of their liberality, learning, and integrity. And
it would be difficult to assign a satisfactory reason why they
should be excluded from judicial protection, when the just
remuneration of their services is wrongfully withheld. In¬
deed, a medical practitioner, one especially who is settled
in a provincial town, or in the country, may have accumu¬
lated claims from long protracted and even expensive atten¬
dance ; and his pecuniary acknowledgments may be refused
from prejudice, from captiousness, from parsimony, or from
dishonesty. Under such circumstances, considerations of
benevolence, humanity, and gratitude, are wholly set aside :
for when disputes arise, they must be suspended, or ex¬
tinguished ; and the question at issue can only be decided
on the principles of commutative justice.

* Annal Lib. XI. Tag, 168. Edit. Lipsii.

Dr. Ryan on the state of the Medical Profession. 231

All members of the profession, including- apothecaries
as well as physicians and surgeons, together with their wives
and children, should be attended gratuitously by any one or
more of the faculty, residing near them, whose assistance
may be required. For as solitude obscures the judgment,
and is accompanied with timidity and irresolution, me¬
dical men, under the pressure of sickness, either as affect¬
ing themselves or their families, are peculiarly dependent
upon each other. But visits should not be obtruded offici¬
ously, as such unasked civility may give rise to embarrass¬
ment, or interfere with that choice, on which confidence de¬
pends. Distant members of the faculty, when they request
attendance, should be expected to defray the charges of
travelling. And if their circumstances be affluent, a pecu¬
niary acknowledgment should not be declined ; for no ob
ligation ought to be imposed, which the party would rather
compensate than contract.

When a physician attends the wife or child of a member
of the faculty, or any person very nearly connected with
him, he should manifest peculiar attention to his opinions,
and tenderness even to his prejudices. For the dear and
important interests which the one has at stake, supersede
every consideration of rank or seniority in the other ; since
the mind of a husband, a father, or a friend, may receive
a deep and lasting wound, if the disease terminate fatally,
from the adoption of means he could not approve, or the
rejection of those he wished to be tried. Under such deli¬
cate circumstances, however, a conscientious physician will
not lightly sacrifice his judgment ; but will urge, with pro¬
per confidence, the measures he deems to be expedient, be¬
fore he leaves the final decision concerning them to his more
responsible coadjutor.

Clergymen, who experience the res augustse domi, should
be visited gratuitously by the faculty. And this exemption
should be an acknowledged rule, that the feeling of indivi¬
dual obligation may be rendered less oppressive. But such
of the clergy as are qualified, either from their stipends or
fortunes, to make a reasonable remuneration for medical
attendance, are not more privileged than any other order of
patients. Military or naval subaltern officers, in narrow
circumstances, are also proper objects of professional libe¬
rality.

As the first consultation by letter imposes much more
trouble and attention than a personal visit, it is reasonable,
on such an occasion, to expect a gratuity of double the
usual amount. And this has long been the established
practice of many respectable physicians. But a subsequent

232

Original C ommunications .

epistolary correspondence,, on the further treatment of the
same disorder, may justly be regarded in the light of ordi¬
nary attendance, and may be compensated as such, accord¬
ing to the circumstances of the case, or of the patient.

Physicians and surgeons are occasionally requested to fur¬
nish certificates, justifying the absence of persons who hold
situations of honour and trust in the army/ the navy, or
the civil departments of government. These testimonials,
unless under particular circumstances, should be considered
as acts due to the public, and therefore not to be compen¬
sated by any gratuity. But they should never be given
without an accurate and faithful scrutiny into the case ; that
truth and probity may not be violated, nor the good of the
community injured, by the unjust pretences of its servants.
The same conduct is to be observed by medical practi¬
tioners, when they are solicited to furnish apologies for
non-attendance on juries ; or to state the valetudinary in¬
capacity of persons appointed to eyecute the business of
constables, churchwardens, or overseers of the poor. No
fear of giving umbrage, no view to present or future emo¬
lument, nor any motives of friendship, should excite to a
false, or even dubious declaration. For the general weal
requires that every individual, who is properly qualified,
should deem himself obliged to execute, when legally
called upon, the juridical and municipal employments of
the body politic. And to be accessory, by untruth or pre¬
varication, to the evasion of this duty, is at once a high
misdemeanour against social order, and a breach of moral
and professional honor.

The use of quack medicines should be discouraged by the
faculty, as disgraceful to the profession, injurious to health,
and often destructive even of life. Patients, however, under
lingering disorders, are sometimes obstinately bent on hav¬
ing recourse to such as they see advertised, or hear recom¬
mended, with a boldness and confidence which no intelligent
physician dares to adopt, with respect to the means that he
prescribes. In these cases, some indulgence seems to be
required, to a credulity that is insurmountable And the
patient should neither incur the displeasure of the physician,
nor be entirely deserted by him. He may be apprized of
the fallacy of his expectations, whilst assured, at the same
time, that diligent attention should be paid to the process
of the experiment he is so unadvisedly making on himself,
and the consequent mischiefs, if any, obviated as timely as
possible. Certain active preparations, the nature, compo¬
sition, and effects of which are known, ought not to be
prescribed as quack medicines.

Dr. Ryan on the state of the Medical Profession. 233

Among- the various kinds of imposture practised in po¬
lished society, quackery has been the most successful, in
consequence of the inestimable value justly set on health.
It is unnecessary to expatiate on this theme, as it is gene¬
rally acknowledged. The whole of our medical laws were
enacted for the suppression of empiricism, but at no period
of our history was it so general as at present. In every
other nation in Europe it is suppressed, quack nostrums are
prohibited, and it is only in this enlig-htened country they are
tolerated, and blazoned forth as cures for incurable dis¬
eases. The Colleges of Physicians possess power to abate
this evil, but on this and every other occasion they have
neglected the interests of medical science and the public.
They have calmly and heedlessly witnessed the degradation
of the profession. The grand secret of the encouragement
of quackery is this, that the government derives an im¬
mense revenue, at least £.100,000 annually, from stamp
duty on patent medicines and quack advertisements. During
the last session of Parliament, it was admitted that the
revenue on patent medicines, in England alone, and ex¬
clusive of advertisement duty, which was treble the sum at
least, was £30,000 a year. The duty derived from this pol¬
luted source in Scotland and Ireland was not stated. The
income estimated above, is obviously less than the real
amount. How disgraceful to the British pharmacopoeias is
this state of things, and yet the framers of the pharmaceu¬
tical codes are perfectly indifferent about the matter. It
would be an insult to the reader, to offer serious proofs of
the injury inflicted by unrestrained empiricism, both on the
profession and public. We shall dismiss the subject by
observing, that quacks are subject to two years imprison¬
ment in France, or to be sent to the galleys for five years.
Again, no man is allowed to practise obstetrics unless duly
educated, even midwives must be instructed, and apothe¬
caries must confine themselves to their proper business,
compounding medicine.

At the close of every interesting and important case,
especially when it has terminated fatally, a physician
should trace back, in calm reflection, all the steps which
he had taken in the treatment of it. This review of the
origin, progress, and conclusion of the malady ; of the
whole curative plan pursued, and of the particular opera¬
tion of the several remedies employed, as well as of the
doses and periods of time in which they were administered,
will furnish the most authentic documents, on which indi¬
vidual experience can be formed. But it is in a moral view

4

Vol. V. NO. 27.

G G

234 Original Communications.

O

that the practice is here recommended, and it should be
performed with the most scrupulous impartiality. Let no
self-deception be permitted in the retrospect ; and if errors,
either of omission or commission, are discovered, it be¬
hoves that they should be brought fairly and fully to the
mental view. Regrets may follow, but criminality will thus
be obviated. For good intentions, and the imperfection of
human skill, which cannot anticipate the knowledge that
events alone disclose, will sufficiently justify what is past,
provided the failure be made conscientiously subservient to
future wisdom and rectitude in professional conduct.

The opportunities which a physician not unfrequently en¬
joys, of promoting and strengthening the good resolutions
of his patients, suffering under the consequences of vicious
conduct, ought never to be neglected. And his councils,
or even remonstrances, will give satisfaction, not disgust,
if they be conducted with politeness ; and evince a genuine
love of virtue, accompanied by a sincere interest in the
welfare of the person to whom they are addressed.

The observance of the Sabbath is a duty to which medical
men are bound, so far as is compatible with the urgency of
the cases under their charge. Visits may often be made with
sufficient convenience and benefit, either before the hours
of going to church, or during the intervals of public wor¬
ship. And in many chronic ailments, the sick, together
with their attendants, are qualified to participate in the
social offices of religion ; and should not be induced to
forego this important privilege, by the expectation of a
call from their physician or surgeon.

A physician who is advancing in years, yet unconscious
of any decay in his faculties, may occasionally experience
some change in the wonted confidence of his friends.
Patients who before trusted solely to his care and skill, may
now request that he will join in consultation, perhaps with
a younger coadjutor. It behoves him to admit this change
without dissatisfaction or fastidiousness, regarding it as no
mark of disrespect ; but as the exercise of a just and rea¬
sonable privilege in those by whom he is employed. The
junior practitioner may well be supposed to have more
ardour than he possesses, in the treatment of diseases ; to
be bolder in the exhibition of new medicines ; and disposed
to administer old ones, in doses of greater efficacy. And
this union of enterprize with caution, and of fervour with
coolness, may promote the successful management of a
difficult and protracted case. Let the medical parties,
therefore, be studious to conduct themselves towards each

Dr. Ryan on the state of the Medical Profession. 235

other with candour and impartiality ; co-operating-, by mu¬
tual concessions, in the benevolent discharge of profes¬
sional duty.

The commencement of that period of senescence, when
it becomes incumbent on a physician to decline the offices
of his profession, it is not easy to ascertain; and the deci¬
sion on so nice a point must be left to the moral discretion
of the individual. For, one grown old in the useful and
honourable exercise of the healing art, may continue to
‘ enjoy, and justly to enjoy, the unabated confidence of the
public. And whilst exempt, in a considerable degree, from
the privations and infirmities of age, he is under indispen¬
sable obligations to apply his knowledge and experience in
the most efficient way, to the benefit of mankind. For the
possession of powers is a clear indication of the will of our
Creator, concerning their practical direction. But in the
ordinary course of nature, the bodily and mental vigour
must be expected to decay progressively, though perhaps
slowly, after the meridian of life is past. As age advances,
therefore, a physician should, from time to time, scrutinize
impartially the state of his faculties ; that he may determine,
bona fide, the precise degree in which he is qualified to exe¬
cute the active and multifarious offices of his profession.
And whenever he becomes conscious that his memory pre¬
sents to him, with faintness, those analogies, on which me¬
dical reasoning, and the treatment of diseases are founded ;
that diffidence of the measures to be pursued, perplexes his
judgment, that from a deficiency in the acuteness of his
senses, he finds himself less able to distinguish signs, or to
prognosticate events ; he should at once resolve, though
others perceive not the changes which have taken place,
to sacrifice every consideration of fame or fortune, and to
retire from the engagements of business To the surgeon
under similar circumstances, this rule of conduct is still
more necessary. For the energy of the understanding often
subsists much longer than the quickness of eye-sight, deli¬
cacy of touch, and steadiness of hand, which are essential
to the skilful performance of operations. Let both the
physician and surgeon never forget, that their professions
are public trusts, properly rendered lucrative whilst they
fulfil them ; but which they are bound by honour and pro¬
bity to relinquish, as soon as they find themselves unequal
to the adequate and faithful execution.

The following admirable rule of conduct of physicians
towards apothecaries, was laid down by Dr. Percival, and
cannot fail to be approved of by every honourable practi¬
tioner : —

236

Original Communications .

In the present state of physic,, in this country, where the
profession is properly divided into three distinct branches, a
connexion peculiarly intimate subsists between the physi¬
cian and apothecary, and various obligations result from
it. On the knowledge, skill, and fidelity of the apothecary
depend, in a very considerable degree, the reputation, the
success, and usefulness of the physician. As these quali¬
ties, therefore, justly claim his attention and encouragement,
the possessor of them merits his respect and patronage.

The apothecary is, in almost every instance, the precur¬
sor of the physician ; and being acquainted with the rise
and progress of the disease, with the hereditary constitu¬
tion, habits, and disposition of the patient, he may furnish
very important information. Tt is in general therefore,
expedient, and when health or life are at stake, expediency
becomes a moral duty, to confer with the apothecary be¬
fore any decisive plan of treatment is adopted ; to hear his
account of the malady, of the remedies which have been
administered, of the effects produced by them, and of his
whole experience concerning the juvantia and lacdentia in
the case. Nor should the future attendance of the apothe¬
cary be superseded by the physician ; for if he be a man
of honour, judgment, and propriety of behaviour, he will
be a most valuable auxiliary through the whole course of
the disorder, by his attention to varying symptoms ; by the
enforcement of medical directions; by obviating misappre-
hensions in the patient, or his family ; by strengthening the
authority of the physician ; and by being at all times an
easy and friendly medium of communication. To subserve
these important purposes, the physician should occasionally
make his visits in conjunction with the apothecary, and re¬
gulate by circumstances the frequency of such interviews ;
for if they be often repeated, little substantial aid can be
expected from the apothecary, because he . will have no
intelligence to offer which does not fall under the observa¬
tion of the physician himself ; nor any opportunity of exe¬
cuting his peculiar trust, without becoming burthensome to
the patient by multiplied calls, and unseasonable assiduity.

This amicable intercourse and co-operation of the phy¬
sician and apothecary, if conducted with the decorum and
attention to etiquette, which should always be steadily ob¬
served by professional men, will add to the authority of
the one, to the respectability of the other, and to the use¬
fulness of both. The patient will find himself the object
of watchful and unremitting care, and will experience that
he is connected with his physician, not only personally, but
a sedulous representative and coadjutor. The apothe-

Dr. Ryan on the sttxte of the Medical Profession. 23 7

cary will regard the free communication of the physician as
a privilege and mean of improvement ; he will have a
deeper interest in the success of the curative plans pur¬
sued, and his reputation will be directly involved in the purity
and excellence of the medicines dispensed, and in the skill
and care with which they are compounded.

The duty and responsibility of the physician, however, are
so intimately connected with these points, that no depen¬
dence on the probity of the apothecary should prevent the
occasional inspection of the drugs which he prescribes. In
London, the law not only authorizes, but enjoins a stated
examination of the simple and compound medicine kept in
the shops. And the policy that is just and reasonable in
the metropolis, must be proportionally so in every provin¬
cial town throughout the kingdom. Nor will any respect¬
able apothecary object to this necessary office, when per¬
formed with delicacy, and at seasonable times ; since his
reputation and emolument will be increased by it, probably
in the exact ratio, thus ascertained, of professional merit
and integrity. ' , : .

A physician called to visit a patient in the country,
should not only be minute in his directions, but should com¬
municate to the apothecary the particular view which he
takes of the case ; that the indications of cure may be
afterwards pursued with precision and steadiness ; and that
the apothecary may use the discretionary power committed
to him, with as little deviation as possible from the general
plan prescribed. To so valuable a cla,ss of men as the coun¬
try apothecaries, great attention and respect is due. And
as they are the guardians of health through large districts,
no opportunities should be neglected of promoting their
improvement, or contributing to their stock of knowledge,
either by the loan of books, the direction of their studies,
or by unreserved information on medical fsubjects. When
such occasions present themselves, the maxim of our judi¬
cious poet, is strictly true, the worst avarice is that of
sense.” For practical improvements usually originate in
towns, and often remain unknown or disregarded in situa¬
tions, where gentlemen of the faculty have little intercourse,
and where sufficient authority is wanting' to sanction inno¬
vation.

It has been observed, by a political and moral writer, of
great authority, that “ apothecaries' profit is become a bye
word, denoting something uncommonly extravagant. This
great apparent profit, however, is frequently no more than
the reasonable wages of labour. The skill of an apothe¬
cary is a much nicer and more delicate matter than that

238

Original C ommu ni cations .

of any artificer whatever ; and the trust which is reposed in"
him is of much greater importance. He is the physician of
the poor in all cases, and of the rich when the distress or
danger is not very great. His reward, therefore, ought to
be suitable to his skill and his trust, and it arises generally
from the price at which he sells his drugs. But the whole
drugs which the best employed apothecary, in a large mar¬
ket town, will sell in a year, may not perhaps cost him
above thirty or forty pounds. Though he should sell them,
therefore, for three or four hundred pounds, or a thousand
per cent, profit,1 this may frequently be no more than the
reasonable wages of his labour charged, in the only way
in which he can charge them, upon the price of his drugs.”

The statement here given, exceeds the emoluments of the
generality of apothecaries in country districts. And a phy¬
sician, who knows the education, skill, and persevering
attention, as well as the sacrifice of ease, health, and some¬
times even of life, which this profession requires, should
regard it as a duty not to withdraw, from those w'ho exer¬
cise it, any sources of reasonable profit, or the honourable
means of advancement in fortune.

Practices prevail in some places injurious to the interest
of this branch of the faculty, which ought to be discouraged.
One consists in receiving an annual stipend, usually degrad¬
ing in its amount, and in the services it imposes, for being
consulted on the slighter indispositions to which all families
are incident, and which properly fall within the province
of the apothecary. We could name a physician in Bath,
who, though a saint, acknowledged that he farmed whole
families in this way ; and in Cheltenham, we are told, that
a physician farms a respectable individual, in a public situa¬
tion, at £.25 per annum • and a veterinary surgeon farms his
horses at £.200.

Physicians are sometimes requested to visit the patients of
the apothecary, in his absence. Compliance, in such cases,
should always be refused, when likely to interfere with the
consultation of the medical man usually employed by the
sick person, or his family. It would be for the interest and
honour of the faculty to have this practice altogether inter¬
dicted. Physicians are the only proper substitutes for phy¬
sicians, surgeons for surgeons, and apothecaries for apothe¬
caries.

When the aid of a physician is required, the apothecary
to the family is frequently called upon to recommend one.
It will then behove him to learn fully whether the patient
or his friends have any preference or partiality ; and this he
ought to consult, if it lead not to an improper choice. For

Dr. Ryan on the state of the Medical Profession. 239
« %

the maxim of Celsus is strictly applicable,, on such an oc¬
casion ; ubi par scientia, melior est amicus medicus quam
extraneus. But if the parties concerned be entirely indif¬
ferent, the apothecary is bound to decide according1 to his
best judgment, with a conscientious and exclusive regard to
the good of the person for whom he is commissioned to
act. It is not even sufficient that he selects the person on
whom, in sickness, he reposes his own trust; for in this
case, friendship justly gives preponderancy, because it may
be supposed to excite a degree of zeal and attention, which
might overbalance superior science or abilities. Without
any regard to any personal, family, or professional con¬
nexions, he should recommend the physician, whom he
conscientiously believes, all circumstances considered, to
be best qualified to accomplish the recovery of the patient.

In the county of Norfolk, and in the city of London,
benevolent institutions have been lately formed, for pro¬
viding funds to relieve the widows and children of apothe¬
caries, and occasionally also members of the profession,
who become indigent. Such schemes merit the sanction
and encouragement of every liberal physician and surgeon.
And were they thus extended, their usefulness would be greatly
increased, and their permanency almost with certainty secured.
Medical subscribers,, from every part of Great Britain, should
be admitted, if they offer satisfactory testimonials of their
qualifications. One comprehensive establishment seems to
be more eligible than many on a smaller scale. For it
would be conducted with superior dignity, regularity, and
efficiency ; with fewer obstacles from interest, prejudice,
or rivalship ; with considerable saving in the aggregate of
time, trouble, and expense ; with more accuracy in the cal¬
culations, relative to its funds, and consequently with the
utmost practicable extensions of its dividends.

Scch are the admirable institutes proposed by Dr. Per-
cival, for the regulation of professional conduct, and I
have quoted them at length, as I was unable to offer any
so excellent. They have entitled him to a niche in the re¬
public of medical literature, and will pass his name down
to our latest successors. The preceding rules of ancient
and modern ethics, afford ample materials to our colleges
of physicians for arranging a complete code, such as is
much wanted by the profession at the present period, while
it may inspire youqg practitioners and students with those
noble sentiments which have invariably distinguished the
profession. In order to afford further means for the for¬
mation of a code of ethics, I shall give a concise account

240

Original Communications .

of the laws relative to the practice of medicine in the
United Kingdom of Great Britain and Ireland.

Laws relating to the Medical Profession in Great
Britain and Ireland .

After a great deal of research and labour* I had compiled
and arranged the materials for this essay* when my labour
was lost, by the publication of Mr. Willcock’s, which has
just issued from the press. It affords me much gratifica¬
tion* that most of the information I had gained is now
placed before me, authenticated by the authority of a ta¬
lented lawyer* of a gentleman quite free from partiality
towards any of the colleges, and who instructs the legal
as well as the medical profession. His work is one of deep
interest to medical men, as it shews that the London Colleges
of Physicians and Surgeons, and the Apothecaries’ company,
have full power to correct all the abuses which now de¬
grade our profession. In fact* Mr. Willcock’s treatise con¬
tains much more information than the conjoint production
of Dr. Paris and Mr. Fonbianque, and illustrates many im¬
portant points of medical police* unnoticed by the latter
writers. As this excellent and instructive work contains the
fullest account of the laws relating to the practice of me¬
dicine in England* it would be superfluous in me to execute
my original design, and I shall therefore content myself
with condensing the chief points of value, without destroying
the spirit of their meaning, while I shall enumerate the laws
relating to the duties of medical men injudicial investigations*
which are omitted by this author.

It must be superfluous to enumerate the ancient orders of
the medical profession* including regular and irregular prac¬
titioners* neither is it necessary to enumerate the present or¬
ders of the faculty* which are generally known in every
civilized country. Mr. Willcock devotes his first and second
chapters to these topics, and next details the whole of the
statutes and patents relative to physicians* surgeons* and
apothecaries, as also those of a general nature which
affect the profession. After a luminous commentary on every
act and charter, and on every decision relative to medical
men, he maintains that the law is at present as follows : —

Physicians. — Any person who is not a member* fellow* or
licentiate of the Royal College of Physiciaiis in London, and
who practises physic in or within seven miles thereof, is lia-

Dr. Ryan on the stale of the Medical Profession 241

ble to a penalty of £5. a month, or if in the country, unless
he is a graduate of Oxford or Cambridge. Every person so
practising in any part of the Kingdom, even though his
practice was not attended with serious consequences, is also
guilty of a misdemeanour at common law. These rules do
not apply to a person who may happen to administer medi¬
cine to the best of his ability, to such as may be unable to
obtain the assistance of a regular practitioner.

“ The penalty of £5. is recoverable from such only as
have continued their practice for one month at least, and to
prove this, it is necessary to shew that the defendant has
continued to hold himself forth to the public as a physician,
for one entire month within the precinct of London, if the
proceeding be instituted by the college, or in the country if
it be instituted by the common informer ; and to shew some
instances, or at least one instance of his actual practice within
that period, from which it may appear that such practice
was in the character of a physician. The word physician by
no means implies the necessity of shewing that the defendant
was or assumed to be a graduate in physic, the statutes aim
against such as were not graduates in physic.”

Our author respectfully questions the decision in Dr.
Harrison’s case, and denies its legality. The verdict was
given on the ground that the case was surgical, but the
judge considered the evidence sufficient to shew that the
Doctor had professed and acted as a physician. f,r But with
the utmost deference to so high and impartial an authority,
I venture to submit that the earlier cases, and cases decided
upon argument in full court, but which seem not to have
been noticed in arguing Dr. Harrison’s case, are directly and
clearly contrary.” Two decisions of the King’s Bench and
one of the Common Pleas were made upon the point, besides
which the Statute 32 Hen. 8. has expressly declared that
surgery is a special member of physic, and within the legiti¬
mate range of the physician’s vocation. “ My assumption is
that an action will lie at the suit of the college, although the
practice proved be surgical, unless the defendant by his
plea, show that he is legally entitled to practise as a surgeon,
by specially setting forth his licence by the College of Sur¬
geons.”

By the original charter and by the Statute 32 Hen. 8. it is
evident that every person of the same faculty, of or in Lon¬
don, was entitiled to be admitted into the association of
commons and fellows. But as to the persons who should
afterwards enjoy that distinction, the original charter and all
subsequent statutes are silent, pp. 34,44.

vol. v. xo. 27.

H H

242 Original Communications.

ic It is directly in the teeth of the statute, that no persons
can become candidates, who are not graduates of Oxford,
or Cambridge.”

Surgeons. — <<r There is no doubt that the surgeon can
make and compound all medicines and medicaments ap¬
plicable to the diseases, submitted to the superintendance
of his branch of the faculty. And he may either administer
them himself, or prescribe what he thinks proper to be ad¬
ministered to others.” By the 3rd Hen. 8. persons can be
punished for practising surgery in any part of the Kingdom,
except in London, or within seven miles thereof. None can
practise in or within seven miles of London, until examined
and admitted by the College of Surgeons ; but there maybe
two classes of surgeons throughout the rest of the Kingdom.
First, the members of the college who may practise in every
part of his Majesty’s dominions, and secondly, the surgeons,
licensed under the 3rd Hen. 8, who may practise within any
particular diocese in which they are licensed, except in
London and Westminster, and within seven miles around
these cities.

Every person, except a physician, is liable to be fined £.5
a month, unless a member of the college, who practises in
London or Westminster, by action in any court held in the
city of London. The same penalty may be enforced for
practice in the country, unless the person be a member of
the college, or licensed by the ordinary of the diocese, or
in his absence by the vicar general, (3 Hen.'#.) and the
proceedings are the same as against unqualified physicians. ”

BIBLIOGRAPHY.

PHYSIOLOGY.

1. Structure and functions of Spleen. — Mr. Dobson has published
“ An Experimental Inquiry into the Structure and Functions of the
Spleen.'’ He first gives a succinct account of the various conjec¬
tures on the use of this organ, and proves them all unworthy of adop¬
tion. He made the following experiments to ascertain the precise
period at which any alteration takes place in the spleen by the
digestive process : —

Exp. 1. — I gave to a middle sized dog a hearty meal of beef and
mutton ; the animal ate heartily. In four hours after, I opened the
abdomen, and exposed the spleen immediately; it was large and
firm ; its veins appeared completely gorged with blood ; on cutting
fhe organ, a large quantity of dark-coloured blood flowed out : the
exact amount could not be estimated ; but I should suppose there

Physiology .

243

was about four ounces : it concreted in a very short time. The
coagulated mass, however, was soft, easily broken down, and pre¬
sented more the appearance termed grumous blood, than the proper
sanguineous fluid.

Exp. 2. — A dog was procured as near in size as the one in the last
experiment as could be met with ; the animal took a full meal of
beef and mutton ; in five hours after, the abdomen was opened ;
the spleen was very large and turgid, with blood. The appearance
of the blood was very similar to that in the last experiment ; the
quantity, however, was much greater.

Exp. 3. — The spleen of a dog (of an equal size to the preced¬
ing) was examined twelve hours after any food had been taken ; a
very remarkable difference was observable ; it was very small and
flabby, and contained only a very small quantity of blood. The ap¬
pearance of the blood differed little from that in the preceding ex¬
periments ; I thought it not quite so dark.

To ascertain the comparative bulk of the spleen in dogs, I pro¬
cured two of equal size, and examined their spleens at the same
period after a meal ; the difference in size was so trifling, as not to
invalidate in the least the couclusions I intend to draw from the pre¬
ceding statements.

Not wishing, however, to rely implicitly on these experiments,
for fear that some accidental circumstance might have influenced
the appearances, I repeated them, but found the results to be pre¬
cisely similar. Other experiments also were performed at various
periods during the digestive process and after its completion ; the
size of the .spleen was invariably found to be in a ratio to the quan¬
tity of nutriment taken into the system, and to the period at which
it was examined after the animal had eaten, that is to three hours
after a meal, little alteration in this organ was perceptible ; but in
four hours after, it was large ; and in about five hours appeared to
arrive at its maximum, and then gradually to decrease in bulk for
twelve hours, which was as far as I observed its condition.

My next experiments were to remove the spleen from dogs, and
to observe any effect which might be produced in the system.

Exp. 1. — The spleen of a dog was removed; the animal appa¬
rently suffered little from the operation. On the following day I
gave it a quantity of food ; it ate voraciously ; for three hours after
no perceptible alteration was produced ; but in four hours after,
indications of uneasiness were shown ; the animal became restless,
and lastly sunk into a nearly torpid state ; it was often moaning,
the pupils were dilated, — the heart labouring ; there was frequent
micturition ; the respiration was exceedingly laborious, and, in
short, there was every mark of plethora, or over-fulness of the
vascular system. In the course of two hours from this period, the
animal began to recover ; and in about three hours these symptoms
had subsided, considerable languor remained. The animal took a
large meal twice or thrice in twenty-four hours, and after each,
precisely similar effects were presented. The animal became more
feeble daily — in a month after the operation, it died.

244

Bibliography .

Exp. 2. — I next removed the spleen from another dog, hut in¬
stead of giving full meals, as in the last experiment, I gave a small
quantity of food every hour, or every two hours. The animal ate
voraciously ; no unpleasant symptoms occurred ; this plan was pur¬
sued for three weeks, when the animal to all appearance was quite
wrell ; in fact, it became fat ; the ligature from the splenic artery
had come away, and the wound in the abdomen healed. I then
commenced giving full meals twice in twenty-four hours, the same
train of symptoms followed each meal, and at the same period, as
in the last experiment, though perhaps not so urgent ; the animal
died in a month from the commencement of this plan of feeding.

In both dogs I observed that the intestinal evacuations were of a
lighter colour than natural. On examining the body of each after
death, a small quantity of limpid serum was contained in the bag
of the tunica arachnoides, and more than a natural quantity in the
lateral ventricles ; the veins of the brain were in a highly con¬
gested state ; the abdominal viscera presented no unnatural ap¬
pearances, but the portal system of veins was much gorged with
blood. The deductions to be derived from these experiments, and
from the former ones seem sufficiently obvious ; but previous to
making them, it may be requisite to refer in a succinct manner to a
few circumstances connected with the digestive and circulatory sys¬
tems, so far as they may bear on this question.

From these experiments our author draws the following con¬
clusions : — -

“ That the spleen acts as a reservoir for containing the additional
quantity of blood which the vascular system has received, by means
of the nutritive process. It is evident from the remarks on chylifi-
cation there is a greater quantity of blood in the system at five
hours after a meal than at any other period ; and as we have pre¬
mised, that the blood-vessels are not capable of containing this
increase with impunity, I infer, that the spleen serves as a reser¬
voir to hold this surplus ; because at the time the chylifactive pro¬
cess is at an end the spleen is found distended with blood. Then,
as detailed in the third experiment, at twelve hours after a meal,
the spleen wras small, and contained very little blood ; the reason of
this phenomenon is obvious ; at five hours after a meal, the nutri¬
tive process is nearly completed ; at five hours after a meal, the
spleen arrives at its maximum size : now, as secretion goes on in
the various emunctories, there must consequently be a reduction of
the circulating mass ; and to compensate for this, blood is simul¬
taneously expelled from the spleen, so that in twelve hours the
whole is removed ; no more circulating through that organ than is
necessary for its support.

“ We have now to examine the second series of experiments.
When the spleen was removed from a dog, and full meals given to
the animal, the effects indicated clearly that a greater quantity of
blood had been formed than the vessels were capable of containing,
compatible with the free action of the vital organs ; but as the fluid
became diminished in quantity by the secretory functions, healthy

Physiology .

245

action in these parts was again established. But it was observed,
that if a small quantity of food was given at a time, though often
repeated, no deleterious influence was exerted ; that is, if the increase
in the volume of blood was not more than equivalent to what had
been previously expended by the secretions, no injurious effects were
produced.

Mr. Dobson endeavours to establish this principle, “ that the
circulatory vessels are capable of containing only a certain quantity
of blood with impunity, and that when an increase in the volume is
produced, as after digestion, the spleen performs the office of a re¬
servoir to receive the surplus ; they show also, that when the fluid
contained in the vessels becomes reduced in quantity, as from bleed¬
ing, the spleen affords a supply, so as to enable the various organs
to perform their necessary offices ; and further, they afford colla¬
teral evidence of the spleen being more elastic than the blood¬
vessels.

When we find such a change produced in the spleen after a meal
of solid food, we naturally inquire the effect of a quantity of fluid.
When a man sits down and drinks ten or twelve pints of ale, or
two or three bottles of wine, a considerable quantity of fluid must
be absorbed into the system ; and were there not a reservoir at¬
tached to the circulation, injurious consequences would undoubtedly
ensue. Though relief in these cases might be obtained in some
measure from the secretory organs .taking on an increased action,
still that would not be sufficient to relieve effectually the vascular
system. But so wise is that mechanician, our Creator, that he con¬
structs his machines not only to suit, ordinary states, but to sustain
them under casual exigencies. I have twice had an opportunity of
examining the spleen in men who had been accustomed to take
large quantities of ale, &c. and in both, the spleen was much larger
than natural. In one of these cases the spleen was enormously
enlarged, and gave the idea, on pressing it, of a bladder half
filled with oil.

Our author offers some interesting observations on the pathology
of the spleen, which deserve attention.

" The most common change which the spleen undergoes is an
augmentation in its size, termed “ ague cake this state being
observed after long and inveterate cases of intermittent fever, more
especially if the system has been previously debilitated by intem¬
perance, or the individual be of a scrophulous diathesis. After pro¬
tracted intermittents, the spleen is often found to weigh from three
to five pounds. There are cases on record of this organ weighing
from thirty to forty pounds. It has occasionally been found like a
mere bag ; and during life so much enlarged as to be felt through
the abdominal parietes. Opportunities for examining the spleen after
intermittents are much more rare at the present day, than formerly,
when this malady prevailed to a much greater extent. The expla¬
nation of those morbid conditions of this organ is obvious ; the
spleen receives a surplus of blood every twenty-four hours during
the cold stage of the paroxysm, or according to the type of the

240

Bibliography.

fever ; its vessels and its elastic envelope are extended beyond their
ordinary state of dilatation, and before they can resume their na¬
tural condition another rush of blood comes into them, and so on
successively, until their power of contractility is entirely abolished ;
enlargement of the organ is the natural consequence, disease is set
up, inflammation and its effects ensue, thickening of the covering
or a tuberculated state of that membrane ; tubercles also are oc¬
casionally found disseminated throughout the substance of the
organ.

There is an old observation, and one which has been confirmed
by modern experience, that hemorrhage from the nose is often con¬
comitant with obstruction of the spleen.

It requires to be investigated what influence the spleen exerts in
the production of dropsical effusions ; observations on this point may
probably induce us to direct some attention to the agency of this
viscus, more particularly in reference to anasarca and ascites.

Hemorrhage from the intestines, though of comparatively rare
occurrence, does take place ; this may arise from some fault in the
intestinal vessels, but I feel disposed, in most cases, to suspect the
spleen to be implicated ; and the function of this organ being de¬
ranged, nature relieves herself by these vessels.

Are amenorrhcea and menorrhagia dependent on,' or connected
with, disordered functions of the spleen ?

Pain in the left hypochondrium is a very common complaint
amongst females about the commencement of the catamenial epoch ;
the pain is referred to the precise seat of the spleen, and is often
very difficult and tedious to remove.

Splenitis is an affection described by medical authors as rarely
occurring. It is stated that relief has been obtained in some cases
by vomiting of a dark coloured fluid, very much resembling coffee
grounds, and also, by hemorrhage from the hemorrhoidal vessels.

The author deduces the following practical conclusions : —

Every reflecting individual, will, I feel persuaded, accede to the
opinion, that the circulatory apparatus is adapted to contain a cer¬
tain volume of blood ; and on the purity, or on a certain state of
the blood, combined with quantity corresponding to the capacity of
the vessels, does this apparatus preserve its integrity and true action;
and whenever the blood-vessels receive blood of an impure quality,
or in an undue quantity, disordered action results. From whatever
cause the blood acquires this unhealthy quality, the circulation of
it through the vasa vasorum will affect the vessels, and thus, their
equilibrium of action being disturbed, it will readily be conceded,
that an additional quantity of fluid will not only act in maintaining
that excited state, but augment it.

Ex. gr. If in a case of inflammatory fever, a state of the sys¬
tem already excited, and exciteable, I increase the quantity of
blood by ordering fluids to be drunk. What will be the effect ?
they will be absorbed into the vessels, the vessels must be further
excited from distension, and the impetus of the whole vascular sys¬
tem necessarily augmented to convey it ; and this principle is espe-

Physiology .

247

cially applicable to the spleen. If this organ, as I have endea¬
voured to prove, be a reservoir for the superabundance of blood in
the system, when the spleen is affected with disease of any kind,
any addition to the mass of blood must increase inordinate excite¬
ment already existing in this organ ; and even a healthy organ is
likely to suffer when the volume of blood is greatly augmented ;
that harmony which naturally exists between the contained and
containing parts being subverted. This principle will, I am per¬
suaded, be a powerful means, not only in the removal of disease,
but in preventing its accession.

The practical inferences I have to offer, as deduced from these
statements, are the following ; —

1st. That the quantity of fluid usually taken into the system at
one time, is greater than the apparatus is capable of containing
with impunity ; and in consequence of this, excited vascular action,
with all its train of morbid consequences, is a common effect.

2nd. That in disorders affecting the spleen, as in intermittent
fever, and as well of the whole vascular system, the practice of
giving large quantities of fluid, is not only unphilosophical, but
decidedly injurious.” — We strongly recommend this essay to the
attention of our readers.

2. Absence of the Pulse — The pulse is in some instances entirely
absent, without interfering with health. This circumstance occurred
in the mother of Dr. S. of this city. The pulse disappeared during
an attack of acute rheumatism, which did not appear to retard her
recovery, and it never returned during her subsequent life. She
was active in mind and body, and possessed unusual health. In no
part of the body could a pulse be detected. I attended her during
a part of the time of her last illness, which was an acute inflam¬
mation of the intestines, but no pulse existed. She died while I
was absent from the city, and an examination was not made to
elucidate the cause of this remarkable phenomenon. — Dr. Jackson,
in Amer. Journ. of Med. Sciences.

3. Theory of the Sources of Animal Heat. — The bodies of animals
are endowed with the faculty of preserving the same heat in every
variety of climate. Though this subject has been an object of
curiosity in all ages, it is still involved in obscurity. In almost all
the theories which have been constructed, and particularly in the
view which I am about to submit, the lungs, in the mammalia at
least, are supposed to be the organs by which the heat is evolved,
and regulated, and transmitted through the body. The elasticity 9
of their structure is of such a nature, that when extended into a
larger volume, as in the act of inspiration, a multitude of internal
cavities, similar to those which are found in sponge, &c. must be
formed, the dimensions of which will together be equal to the dif¬
ference between the dimensions of the lungs in their collapsed and
expanded states. These cavities, which are all of equal calibre, and
consist chiefly of the bronchi, and the pulmonary arteries and veins,
with their ramifications, must necessarily be occupied by some ex¬
traneous substance. The ramifications of the bronchi, or air ves-

248

Bibliography.

sels, seem to compose the chief part of the pulmonary structure, and
freely communicate with each other/ The blood-vessels are the
pulmonary arteries and veins, the capillary terminations of which
have two communications which require to be noticed. The arte¬
rial capillaries have a communication with the venous, through
which the blood circulates from the arteries to the veins. Besides
these, the pulmonary arteries, as well as those belonging to the
larger circulation, have terminations through which red blood is not
transmitted. These open into the internal surface of the bronchi,
and, from their office are called exhalants. It is now well esta¬
blished, that the veins are also well furnished at their extremities with
openings which do not admit, in ordinary circumstances, the red
part of the blood. That the pulmonary veins are furnished with
such openings, sufficient proof will be supplied in the sequal. These
openings perform an office the reverse of that of the arterial exha¬
lants. They take up substances from the surface of the bronchi, and
on that account they have been termed imbibers. To enable these
vessels to accommodate themselves to the various sizes required by
their office, there must, then, be passages of supply and discharge
for the materials which fill them on inspiration. The air vessels are
supplied through the windpipe, but it is not so evident from what
sources the materials are drawn to allow the blood-vessels to expand,
or through what channel their contents are discharged , The mate -
rials cannot consist of blood, for no blood can enter the pulmonary
arteries, or pass out of the pulmonary veins, except through the
portals of the heart, and these portals do not open and close in
correspondence with the required periods of supply and discharge.
The movements of the heart are not timed by the movements of the
lungs. Four pulsations of the heart may generally be counted dur¬
ing each complete respiration. It may indeed accidentally happen,
that a discharge of blood may be made into the pulmonary arteries,
at the moment in which inspiration commences, but, at the same
moment, an equal quantity is abstracted from the pulmonary veins
to fill the enlarging auricles of the left side of the heart. When¬
ever, then, a quantity of blood is thrown into the chest, an equal
quantity is, in the same period, discharged out of it, and also every
discharge of blood from the thorax is accompanied by the entrance
of an equal quantity through another channel. The quantity of
blood therefore at any time contained in the lungs does not appear
to be at all modified by respiration.

Our search, therefore, for other channels of supply, has led us
to the following view of the origin of animal heat.

As the blood-vessels of the lungs must be filled, the air received
into the windpipe will not terminate its progress with the bronchi,
but will pass through the openings (now greatly enlarged) between
the bronchi and pulmonary veins, will -enable the latter to assume
their proper dilatation, and will intimately mingle with the blood
in a thousand minute passages. Partly by mechanical, and partly
by chemical agency, a portion of this air, while the blood with
which it is commixed is still in the lungs, is converted from the

Physiology.

249

aerial into the fluid state. The consequence of this conversion is
well known to be, an evolution of heat. But all the inspired air
is not converted into liquid in the pulmonary veins. After the pas¬
sage of the blood out of the lungs, a portion still retains the gaseous
condition ; it is mingled with the blood in the form of small globules,
and while it circulates through the system, is gradually converted
into liquid, and evolves heat, and preserves throughout the tempera¬
ture of the body. The impurities of the. body are at the same
time absorbed into the blood, and occasion the colour of the venous
fluid.

During inspiration, the blood of the pulmonary arteries is sub¬
jected to a diminished pressure. A part of it is consequently con¬
verted into air, and reduced in temperature. At the same instant
air in the veins is converted into fluid. Thus the heat of the blood
in the arteries is kept up at the temperature at which the ebullition
is continued. The impurities of the venous system most readily, in
these circumstances, assume the gaseous form. By the formation of
an elastic fluid, the pulmonary arteries are enabled to assume the
augmented calibre, to which they are urged in consequence of the
expansion of the lungs. In the succeeding expiration, the lungs
press these vessels into their former calibre, and expel some of their
contents, the aerial matter finds a ready exit through the capillary
vessels of arteries which open into the bronchi, and which, in
ordinary circumstances, do not carry red blood, and then makes its
exit through the windpipe, the blood shows its liberation from adul¬
teration by resuming the vermilion hue, and is again fitted to be the
vehicle of heat and nutriment to the whole system.

According to the preceding view, then, the greater part of the air
which we inspire, is received into the blood-vessels of the lungs, is
mingled with their contents, and gradually changes into liquid as
it circulates. The part of the air which has been inspired is dis¬
charged from the windpipe in an undecomposed state. On the con¬
trary, the greater part of the air expired has proceeded from the
venous blood returned to the lungs, and consists of the usual gaseous
products of the vegetable and animal fermentation, — nitrogen, hy¬
drogen, carbonic acid gases, and a little vapour. Accordingly, an
examination of the chemical relations between the atmosphere
breathed and the lungs, tends to prove that nitrogen and carbonic
acid gases can find access into the bronchi without entering by the
windpipe, and that there is no source whence these gases could have
sprung but the blood in the pulmonary vessels, and that the air
inspired may find its way from the bronchi, without being trans¬
mitted back through the windpipe or without being decomposed.
What further proofs are there, then, by which the existence of the
supposed passages for the air from the bronchi into the pulmonary
veins is believed to be established ? First, it is rendered probable
by the analogy of structure. That openings exist between the ve¬
nous capillaries belonging to the larger circulation, and that the
principal part of the office of absorption is performed by these
capillary ramifications, is rendered probable by the explanation of

Vol. v. no.* 27. ir

Bibliography .

the causes by which venous blood is moved, and has been esta¬
blished beyond all doubt by Majendie. There is every reason to
suppose, that the veins of the lungs are constructed in the same
way with the veins in other parts of the system, and that such
ramifications are to be found between those veins and surfaces of
the bronchi. Analogies are also supplied by comparative anatomy.
The air vessels in many insects, as in the locust and silk-w^orm, are
observed to communicate freely with the blood-vessels, from which
the return of air or any liquid is prevented by well adapted valves.
Substances, also, capable of being inspired, and of indicating their
presence by sensible qualities when mixed with blood, as fine pow¬
der of stone and of metal, were found after death, by Bertier of
Bordeaux, to have obtained a passage from the lungs into the pul¬
monary veins, and the left chambers of the heart. The next ques¬
tion is, What becomes of the air which is admitted into the pulmo¬
nary veins during inspiration ? The air taken into the blood-ves¬
sels in the way now alleged must be received in infinitely divided
portions, and intimately mingled with the blood. It may be ab¬
sorbed by the blood, it may be chemically combined with some
parts of it, or it may be mixed with it, still retaining its gaseous
form. There is every reason to suppose that each of these processes
takes place in part. By the operation of the two first, a portion
of the air will be changed from the gaseous to the liquid form while
it is still in the lungs, and heat will necessarily be evolved, but the
temperature of the blood in the lungs is prevented from rising be¬
yond a certain degree by a process which has already been alluded
to. The remaining portion of air drawn into the pulmonary veins,
is transmitted, with the blood in which it floats, and heat is dis¬
engaged. This change may not be supposed to be completed be¬
fore the blood has finished its journey in the arteries, and then its
colour is converted from vermilion into purple. Loaded in the man-
mer supposed by Dr. Crawford, and in which I am disposed to
acquiesce, with these products of decay from the body, the blood
returns to the lungs, where the products are discharged from it into
the bronchi, and thence out of the system through the windpipe,
in the form of impure air. Thus purified, it is transmitted into the
pulmonary veins and resumes its vermilion hue. — Condensed from
the Paper of Dr. Carson, of Liverpool. North of England Journ.

4. Dysentery. — Dr. Gilby, a physician to the Lunatic Asylum,
West Riding of York, has found acetate of lead and opium highly
efficacious, after the inflammatory symptoms had been removed by
leeches and mercury, and when a bloody diarrhoea continued. —
When the purging was the effect of relaxed and irritable membrane,
the sulphate of copper and opium, as recommended by Dr. Elliot-
son, were given with the happiest effects. Op. cit.

Acetate of lead and opium may be given in every stage of dysen¬
tery with the best effects, and will generally cure the disease with¬
out general or local bleeding. Repeated experience has convinced
us of the success of this combination, and has led us to think that
the Cullenian pathology of the disease is the best. — Ed.

Medicine.

251

PRACTICE OF MEDICINE.

5. Endermic method. — Dr. Carbutt, of Manchester, has published
a case of quotidian intermittent, which was cured by sprinkling a
few grains of sulphate of quinine on a blistered surface. He has
also cured haemoptysis by large doses of quinine after venesection,
acetate of lead, sulphate of zinc, and sulphuric acid had failed. —
Condensed from the North of Eng. Med. and Sura. Journ. Aug.

6. Syphilis cured in an infant by mercurial frictions applied to
a goat that suckled it. — Dr. Vere Delisle communicated a case to the
Academie Royale de Medecine, in which a woman, three months
after delivery, contracted a syphilitic disease, caracterised by ulcera¬
tions on the inside of the labia and a gonorrhoeal discharge. The
child whom she suckled was soon affected with venereal pustules
and ulcerations round the anus. It was now made to suckle a goat,
and the inside of the thighs of the animal having been shaved, two
drachms of mercurial ointment were rubbed in every other day.
The child was cured in a month. — Archives Generates.

surgery.

7 . A concise Treatise on Dislocations and Fractures, being a selection
from the most approved Foreign and English Surgical authorites, from
the days of Celsus to the present time, illustrated by fourteen plates.
London, 1830. 12mo. pp.110. — This little volume exhibits a concise
and correct account of the nature and treatment of dislocations, and
fractures, illustrated by plates representing the various forms of these
diseases, and the most approved methods of operation, with the ap¬
plication of splints and bandages. The student and young practi¬
tioner will find this work one of the most valuable of modern times.
It is compiled from the writings of the best surgeons ; it embraces an
account of the symptoms, and treatment of every dislocation and
fracture, illustrates them uncommonly well by wrood cuts. The price
of the volume is remarkably moderate, and this useful elementary
work may be procured — a disideratum which was long felt in conse¬
quence of the extravagant price set on former publications on the
subject, which placed them totally beyond the research of the great
bulk of practitioners. In place of expending two guineas in the
purchase of a work on this branch of surgery, the student has now to
expend the sum of four shillings and sixpence. The medical pro¬
fession in common with the public patronizes cheap literature ; and
we are confident that ponderous quartos, and bulky octavos, must
ere long give way to more modest, and no less useful productions, in
the unassuming form of duodecimos. This is only as it should be,
knowledge will be more extensively diffused, and the interests of
science and humanity better promoted.

8. Cure of Subcutaneous ncevus by the seton. — Mr. Fawdington, of
Manchester, has published three cases of nsevus cured by seton.
He advises the remedy in cases where the size of the tumour
precludes the use of the knife, caustic or ligature. He states that
it will lie used with more success than tying the artery which sup •

252

Bibliography.

plies the tumour; and that.it is followed by scarcely any disfigure -
ment. 'idle skain of thread should be large enough to fill up the
apertures made by the needle, and thus to arrest haemorrhage, .and
by using this precaution, a sufficient degree of irritation will be
produced to excite inflammation and suppuration throughout the
diseased mass. The first case was that of a fine male infant, about
three years and a half olti, who had a nsevus between the angle of
the jaw, and mastoid process extending upwards to the zygomatic
arch. The whole formed an oval tumour, which measured five inches
and a quarter in its long axis, and four inches transversely. It had
no pulsation, was purplish, soft and compressible,, and had large
veins on its surface. A skain of common sewing thread was passed
through it with a sadler’s needle, and no dressings were applied.
On the third day the tumour was inflamed, and on the sixth in a
state of suppuration, on the tenth resembled the site of an abscess
or common boil, and at one part but a portion of the tumour re¬
mained, through which a seton was passed with similar results.
In four months there was not a vestige of the original disease.

The second case was one of an infant of ten months old, who
had a nsevus on the forehead. A seton partiahy removed it, a
solution of sulphate of copper was applied, which produced inflam¬
mation and suppuration, but a second seton was required to com¬
plete the cure. — Condensed from the North of Eng . Med. &; Sur.
Journ. Avgust.

MATERIA MEDICA.

9. Practical Remarks on the nature and effects of the expressed Oil
of the Croton Tiglium, with cases illustrative of its efficacy in the cure
of diseases. By Michael John' Short, M.D. London, 1830. Longman
and Co. — This interesting essay is embellished with a fine engraving
of the croton tiglium. Dr. fehort comments on the progress of me¬
dicine, on the mutation of opinion, and on the additions which have
been recently made to the materia medica, which bring him to the
immediate subject of his work. He commences with a botanical
description of croton tiglium. He gives the Linnaean description of
the plant, but states the first account of it was given by Jacob Bobart,
in “ Plantarum Historia, Oxoniensis universalis, in 1649, tom, ii. p.
349, which our author cites at length. It was also described by
Ramphius in his Herbarium Ambynense, tom. iv. p. 98 ; by Rheed in
hisMelabaricus, tom. ij. p. 62 ; by Buraian in his Flora Seylonica, by
Gaertner in his work, de Seminibus, by Laureiro in his Flora, Conchin
China; by Lunan in his Hortus Jamaciensis ; by Murray, Bergius and
Dr. Hemming in his Asiatic Researches. Our author next informs us
of his object in publishing the present treatise.

“ My object in the publication of the present treatise is, to extend
the now limited use of the 01. Croton Tiglium to diseases in which
it has not as yet been generally administered ; and by the commu¬
nication of cases which have occurred to me in the course of a long
experience of its nature and properties, in India as well as Europe, to
give it that place in the opinion of the profession to which its many
valuable properties entitle it.

Materia Medica.

253

The unmerited disrepute into which this medicine has fallen, from
the adulterations to which it is usually subjected before it comes into
the hands of the medical practitioner, has rendered it a medicine
rarely to be found in the prescriptions of the physician, even in cases
where the exhibition of the genuine oil would be attended with con¬
siderable advantage : and nothing short of a practical illustration of
its benefits will restore it to that celebrity, which it possessed shortly
after its re-introduction into European practice by Dr. W. E. E.*
Conwell, of the Madras service/’

A number of cases is detailed in which the oil of the Croton Tig-
lium, was given with success though obviously contra-indicated.
From its acrid properties it has been deprecated in inflammation of
the stomach and bowels, but the following cases are detailed by
Professor Monchini of Rome, to prove its efficacy and safety in such
diseases.

He relates two cases of inflammation of the bowels (gastro ente¬
ritis), in which he employed the oil. He mixed one drop of the oil
with an ounce of simple syrup, which was taken at two doses, at half
an hour’s interval. The first patient, who was a female, felt no
warmth in the throat. She had, in two hours after taking the medi¬
cine, one evacuation from the bowels, and twelve others during the
night. It affected her very much, but the pain was much less con¬
siderable. The other patient, aged 25, previous to the visit of the
Professor, had fever, rigors, pain and tension of the belly, hard pulse,
flushed face, anxiety, nausea, and the bowels had not been opened
for seven days, although many glysters of oil and common salt had
been administered. At three o’clock he took away twelve ounces of
blood, applied fomentations and frictions with oil to the belly, besides
several enemata of a decoction of oil and marshmallows. At eight
o’clock in the evening, finding that the bowels had not been opened,
he ordered a drop of the Croton Oil to be given in an ounce of the
syrup of marshmallows, in two doses, with an interval of two hours,
provided the first had no effect. The first dose, however, in a short
time, produced seven stools. The patient then fell asleep : and
although there remained a little fever in the morning, it was not
necessary to use any other remedies but fomentations and a diluting
beverage to complete the cure.

Dr. Short relates the following case ; —

David Cleveland, a mariner, aged 38, had visited tropical climates,
where he had suffered from inflammation of the liver, which left that
viscus enlarged, and, as he describes it, as hard as a stone. This
state of disease had existed about five years ; during this time he had
visited various countries, living freely whenever opportunity offered.
He came under my care in November, 1828. He had lately returned
from sea, and attributed his illness to sudden exposure to cold after
great exertion. He complained of great pain in the region of the
liver, could not bear the sligtest pressure, and was nearly bent dou¬
ble. Great difficulty of breathing. Pulse 120, hard and full.
Tongue coated. Fully satisfied, from much experience, of the efficacy
of the Croton Tigiium as a febrifuge purgative, I ordered two drops

254

Bibliography.

to be taken immediately in a little mucilage, and to be repeated every
four hours ; the patient to drink freely of warm gruel. I visited him
after he had taken the third dose, when his pulse was soft, and redu¬
ced to 80. Dyspnoea much relieved, and the pain considerably less.
He had had innumerable watery stools, and the operation of the me¬
dicine had even produced deliquium animi. The acute form of the
disease was thus cut short ; and I had only to contend with the
chronic complaint, which was treated as follows : — Pil. hydrarg. gr.
v, made active with tiffs of the 01. Croton Tiglii, taken every night.
Cold infusion of sarsaparilla, acidulated with acid, nitric. Ibi. per
diem ; keeping up a pustular eruption over the right hypochondrium
with a liniment composed of 01. Tiglii & Lin. Saponis, one part of
the former to three of the latter. He was discharged cured on the
20th of February following, all hardness and enlargement of the liver
having disappeared.

Much has been urged against the administration of a medicine so
active in its operations, in the ordinary forms of disease ; I can,
however, fully testify to its perfect safety, and its utility in every case
where a purgative was indicated, in infancy and adult age, either as
a simple purgative, an hydrogogue, or where I desired to produce a
sensible effect on the system, and objected to venesection on account
of the permanency oh its effects. In corroboration of this, I insert
extracts of letters, written by M. Majendie to the Academie des
Sciences de Plnstitut de France ; by Dr. Le Fort, Physician to the
King of France, and Chief Medical Officer at Martinique ; by In¬
spector Tegart, of Barbadoes, to the principal Medical Officers of
Stations in the Windward and Leeward Islands, dated Barbadoes , 21 st
June , 1821 ; by the same to Sir James M'Grigor, Director General
to the Army Medical Department, dated Barbadoes, 30 th Nov. 1821 ;
by the same, addressed to the Army Medical Board, and dated Feb.
28 th, 1824.

Efficacy of Croton Oil in constipation, and as a hydrogogue exem¬
plified by cases in the London Hospital.

John Hickman, setatis 21, was admitted an in-patient of the hos¬
pital on the 24th of August, 1827. He represented his illness to
have commenced ten days before, with a violent twisting pain in the
bowels, attended by constipation. During that time his medical
attendant had given him 1 60 grains of calomel, a pound and a half
of salts, and a pound of castor oil, besides venesection, twice, to the
amount of sixteen ounces each time, with enemata innumerable. The
removal of this patient from his bed to the hospital caused a general
depression. On his arrival, his pulse was scarcely perceptible ; pain
on pressure of the abdomen. Two pills, each containing one minim
of Croton Oil, were given immediately, and, as re- action did not take
place for some time, he was put into a warm bath. When put to
bed a second time, the bowels began to act, and continued all night
and part of the following day, when an immense quantity of feculent
matter was dislodged ; by this all pain and uneasiness was removed,
and in a fortnight he was discharged, cured.

Mary Ann Robertson, setatis 16, reported on her admission, that,

Materia Medic a.

‘255

for four months before, her belly had gradually increased in size ; that
she had been under medical treatment out of doors, but without hav¬
ing derived any benefit.

After her admission, three days were allowed to pass without en¬
tering on any particular plan of treatment, as the fluctuation was
very obscure. After the lapse of that time, two minims of Croton
Oil were administered in the evening, which began to operate about
twelve o’clock, p. m. The number of stools were not counted by this
patient, as she was greatly distressed by the involuntary discharge of
urine. So great was the quantity discharged, that it ran through the
bed, and literally overflowed the ward ; the tumefaction entirely sub¬
sided ; and in ten days she was discharged cured.

Our author cites the history of a case of tetanus, successfully treated
by Mr. Lawrence by the Oil, which has been published in his lectures,
and therefore need not be introduced in this place ; the following
cases of phrenitis and hydrocephalus, are worthy of perusal.

A. S. aged 38, had been troubled some days with severe pain of
the head and throbbing at the temples. He had been cupped twice
within the last thirty-six hours. When I saw him, it required three
men to keep him in his bed. His face was flushed, eyes glassy and
starting, conjunctiva much injected, scalp hot and constricted, pulse
small and hard, tongue covered with a dark coating. Took twenty-
four ounces of blood from the arm ; ordered cold lotion to the head,
and one drop of Croton Tiglium oil, to be repeated in an hour if the
bowels be not freely opened. I saw the patient again in six hours.
The second dose of the oil had produced several loose stools. He is
more quiet ; but the pain in the head is very distressing. Ordered
twelve leeches to the temples, to continue the application of the cold
lotion, and one drop of the Croton oil to be given every six hours.
The following morning he was much relieved ; has been for nearly
the last hour constantly on the water-closet. Pulse softer, face and
eyes of a more natural appearance. He vomited, during the night, a
dark bilious fluid. The stools black and very offensive ; complains
of inclination to vomit on taking any fluid into the stomach. Ordered
effervescing draughts of aerated kali, with recent lemon juice, every
four hours. In the evening the symptoms of cerebral affection returned
with nearly as much severity as ever. I ordered him to take ten
grains of calomel immediately, and one drop of Croton Tiglium oil
every two hours during the night, and the cold application to be con¬
tinued to the scalp. Morning ; has had innumerable stools of a dark
watery character, and mixed with scybalee ; pulse soft and natural ;
complains only of weakness. Ordered one drop 01. Tiglii. three
times a-day, with the following draught, —

Ik Potass. Subcarbon. 3i.

Confect. Aromat. 5ss.

Aquae Menth. Sat. jiss.

Succ. Limon. recent. 3i-

Next day. Has improved since yesterday; stools more natural;
tongue becoming clean ; pains in the head quite gone. This treat-

256

Bibliograghy.

ment was continued two days longer, when a little tonic only was re¬
quired to re-establish his health.

The following cases of hydrocephalus I submit without a com¬
ment : —

Ellen Chalmers, aged 5 years, was brought to me by her mother
who bore the marks of the scrophula. She said the child had been
weakly from birth. Her present illness had been of eight or ten
days’ duration. The circumstance which first excited her alarm was
the great enlargement of the head. The pupils were dilated, sleep
disturbed,, bowels constantly constipated. I ordered half a drop of
Croton oil to be given in a little powdered sugar three times a- day,
and the whole of the spinal column to be rubbed with an ointment
formed of one part of Croton Tiglium oil and four parts of Ung.
Hydrarg. fort, night and morning. The third application produced
extensive pustular eruption. The oil acted well on the bowels.
The character of the alvine evacuations was altered, from a green
curdy matter to almost natural faeces, in the space of three days ;
and every distressing symptom was removed in twelve days fromth e
commencement of the treatment. The head was much decreased in
size ; and I recommended the country air, and to continue to give a
drop of the oil in sugar occasionally.

- Beachey, aged 4 years, had been ill about a week. The

mother obsevring an irregularity of the bowels, had given a purge of
infusion of senna. The symptoms becoming alarming, I was sent
for. I found the child in bed, rolling the head. Any attempt to move
him appeared to distress him much, and was attended with screaming.
The pulse was quick and small ; the skin hot : the tongue much fur¬
red ; pupils dilated ; and his sleep disturbed ; with those peculiar
screams which are so characteristic of hydrocephalus ; refuses all
kinds of food ; desires only cold water. I ordered five grains of
calomel with ten of jalap to be given immediately ; half a drop of
Croton oil three times a- day ; a blister to the back of the neck. The
following day, the blister had drawn well, and the bowels had dis¬
charged frequently ; motions dark-coloured and watery. The skin
was not so hot ; the pulse slower ; the other symptoms as yesterday.
Ordered the blister to be dressed with Cerat. Sabinte, and the Croton
oil to be continued.

Third day.— Slight amendment. Treatment continued.

Fourth day. — Stomach very irritable, rejects every thing — medicine
producing several stools of a dirty brown colour, and very offensive
smell. Ordered a blister over the stomach. The blister at the back
of the neck inflamed, and discharging freely. The savine dressing to
be discontinued, and bread poultice to be applied. The Croton oil
to be continued.

Fifth day. — Stomach quiet ; has slept .undisturbedly nearly four
hours ; evident amendment.

Sixth, Seventh and Eighth days. — The treatment was continued.
Very little affection of the head remaining. The bowels seem to
have become habituated to the medicine, which now produces only
two or three motions in the twenty-four hours. The tongue still

Materia Medicci ,

257

coated. Ordered hydrarg. cum creta gr. v. every night. Half a drop
of the Croton oil twice a-day. This treatment was continued twelve
days, when the child was quite restored to health. Twenty months
have now elapsed, and it still continues wrell.

We insert the following account of Cholera in India, which
corroborates that of Mr. Searle, and will be found in a preceding
page.

There are two species of cholera prevalent in the East Indies —
the species peculiar, perhaps, to that country, and the bilious
cholera, similar to that of England, but, as is to be expected from
the nature of the climate, exhibiting in India much greater severity
in its symptoms, and inflicting more permanent injury on the consti¬
tution it attacks. The one seems to arise from some peculiar state
of the atmosphere, and, like other diseases produced by miasmata,
appears to exert its agency primarily and principally on the nervous
system. The other is undoubtedly caused, in some cases, by an in¬
flammatory state of the alimentary canal, from the application of cold,
& c. ; but in nine cases out of ten, by the presence of acrid bile,
which at this time is poured out by the liver, much increased in quan¬
tity, and, I have no doubt, considerably altered in quality. The for¬
mer, like all other diseases where the nervous system is primarily
affected, is rapid in its progress ; so rapid, indeed, that it affords little
time for the interference of the medical practitioner. The latter is
slower in its effects, and allows sufficient time for the application and
operation of medical treatment. The usual mode of treatment
followed in India is the exhibition of calomel, opium in its various
forms and afterwards saline purgatives with senna. I was induced,
however, from the opinion I had formed of the cause of the complaint,
to begin with the purgative plan ; and the success which has attended
my practice warrants me to recommend it with confidence to the
consideration of the profession;

Of all other purgatives, I consider the Croton Tiglium Oil by far
the best in all cases of this kind. If there be any inflammatory ac¬
tion going on in the intestinal canal, either from external causes, or
from the presence of irritating matter within, the Oil will be found
the most effectual application, as it will remove the cause of irritation
sooner than any other purgative with which I am acquainted ; and at
the same time, diminish inflammatory action more speedily, and, in
my opinion, more effectually, than even the abstraction of blood. As
a proof of these assertions, I have selected the following case, from
many similar ones which occurred to me in my practice in Madras,
during a period of four years ; not because the effects of the exhi¬
bition of the Oil were more obvious or more satisfactory, but because
as the ordinary mode of treatment had been frequently applied before
in the same patient, and under the same circumstances, we are thus
enabled to institute a comparison, and this case is consequently more
conclusive.

A lady, of a nervous temperament and bilious habit, aged about
35, came under my care, labouring under a severe attack of bilious
cholera, a complaint of which she had had frequent serious attacks.

Vol. v. no. 27.

K K

258

Bibliography.

I found the vomiting of black bilious matter and the purging exces¬
sive. Wishing to evacuate the contents of the bowels as soon as
possible, I ordered one drop of the 01. Tiglii. in 5ij- of syrup to be
given every four hours, and told the lady to drink freely of warm
barley-water. Three doses of the medicine completely cleared out
the bowels, removed the spasmodic action, and appeared to have re¬
stored the healthy action of the liver ; for, on the next day, no ail¬
ment existed ; the appetite had returned, and in the evening she said
she felt quite well. In all her former attacks, she had been treated
with large doses of opium, which produced great stupor, without
relieving spasm. Calomel and the other usual remedies had also been
applied ; and it was generally upwards of a month before she had
perfectly recovered. x

Dr. Short has also exhibited the remedy in hysteria epilepsy, gout,
spasmodic colic, toenea, and rheumatism with great success. He
thinks it superior to other purgatives. He has used it externally as
an irritating liniment, and is convinced it is preferable to tartarized
antimony or lytta, it stimulates the skin much sooner than either of
them, diffuses more warmth, and can be better regulated as to its
effects. He has employed it in this way in acute and chronic rheu¬
matism, in neuralgia, in glandular, and other indolent swellings, and
in pulmonary complaints. In combination with Ung. Hyd. the mer¬
curial action is speedily produced.

Such are the valuable effects of the Croton oil, and we think the
profession deeply indebted to Dr. Short for the information he has
given. His treatise is well worthy of attentive perusal, and every
practical man will freely acknowledge the value of its contents.

9. Sedative effects of the spider's web. — The web of the black
spider has received commendation from many respectable sources,
as a sedative agent, capable of calming, with peculiar ease and cer¬
tainty, morbid excitability of the cerebral and nervous systems. On
the credit of those qualities it has been, employed in the various
forms of temulence, and not without a share of reputed success,
sufficient to entitle it to consideration in that state of constitutional
irritation. In the summer of 1827, we tried this article in many
cases, and in full doses. To test its qualities, it was given, where
the state of the patient admitted, uncombined with opiates. When
thus used, its effects were generally partial or doubtful, and its powers
inadequate to the production of tranquillity or sleep. In one case
only have I found this substance to exert great or decided sedative
attributes. This was the case of an intelligent young man (in
private practice) who, after consuming, by his own report, three
quarts of brandy, in thirty-six hours, fell into a state of temulent
excitation so excessive, that he was incapable of keeping a recum¬
bent or even a sitting posture, for more than a minute, but paced
his chamber with a ceaseless step for two days and nights. He
was not delirious : on the contrary his conversation wras rational,
though hurried and vehement. But he was so far under the in¬
fluence of spectral hallucination, that if he closed his 6yes for a
moment, day or night, he wras instantly visited by a host of phan-

Chemistry .

259

toms of frightful aspect ; hence his aversion to lie down, or make any
voluntary effort to sleep. This patient took opium, opium with
camphor, and black drop, at short intervals, and in full doses,
until the quantum of opiate approached the utmost limit of probable
safe administration, without even partial relief of constitutional
irritation, or any apparent proneness to sleep. The temulent ex¬
citement kept unabated for twenty-four hours, the second night
passed in constant vigilance, locomotion, and mental excitement,
and it seemed probable that excitation so intense, protracted, and
unremitting, must soon lapse into delirium or convulsions. At this
time, the morning of the third day (the second of my attendance)
he began the use of the fresh web in pills of five grains every hour.
Its effect was prompt and unequivocal. He calmed, even sensibly
to himself, with every dose, and watched with desire for the time of
repeating the pills. The first effect of the web was to abate his
restless movements about the room, he became disposed to sit down,
and kept his chair, with short intervals of walking, for some hours.
In the evening he consented to go to bed, got up once or twice, but
returned to bed without difficulty ; took an opiate at night, the first
for eighteen hours, and slept continuously for eight hours. The cure
was completed without difficulty, by repeating the web less fre¬
quently next day, quiet, suitable nourishment, and another opiate
at night. The patient spoke emphatically, both the first and second
day, of the soothing influence produced by the pills. He was not
at the time informed of their composition. — American Journal of
Medical Sciences.

Chemistry.

10. Preservation of Blood . — Sugar refiners and others are often
inconvenienced by the difficulty of obtaining blood at the time when
it is required for use. M. Toursel has endeavoured, in part, to re¬
move this difficulty, by proposing a method of preserving this agent
for some time without injury. It consists in putting the blood into
bottles, or other vessels, with very narrow mouths, and being careful
to fill them up to the neck ; a layer of oil, to the depth of at least
half an inch, is then put upon it to cut off communication with the
atmosphere, and the whole is left to itself. M. Toursel states that
he has, in this manner, preserved blood, with all its physical and
chemical qualities, from the 1st of December, 1827, to January,
1829. — Journ. de Commerce.

MEDICAL JURISPRUDENCE.

11. Shocking effect of Quackery in London. — We have often re¬
minded the College of Physicians of their power to suppress
quackery, and never was there an instance better calculated to rouse
them from their lethargic slumbers, than the melancholy one which
we are about to relate. Can it be credited, that the lives of the
community may be sacrificed in a country that boasts of superior
civilization, in the following manner ?

A lady in perfect health, and in the * prime of life, twenty-four

260

Medical J urisprudence.

years of age, accompanies her sister to the house of an audacious
quack, who not only pretends to cure consumption, but to prevent
all diseases, and whose votaries are the Peerage and Commoners ot
England. The wily empiric tells another patient, that the lady
whose tragic fate we are about to detail, must die of consumption
in less than two months, unless she submits to his mode of treat¬
ment. The unfortunate female consents, and the treatment is com¬
menced, which consists of the application of a powerful escharotic to
the back, which produces such inflammation and sloughing, that the
deluded victim is destroyed by constitutional irritation, and when in
the act of dying, is assured by the ignorant pretender to physic,
she is doing exactly as he wishes, and that he would give one hun ¬
dred guineas could he effect similar sores on more of his patients.

A coroner’s inquest is held, when the following evidence is pro¬
duced, which we copy and condense from the public papers.

Inquest on the body of Miss Cashin, lately under the care of Mr. St.
John Long, curer of all diseases, who is patronized and encouraged,
by the Peerage and Commoners of the United Kingdom of Great Bri¬
tain and Ireland, and tolerated by the Royal College of Physicians
in London, contrary to the law of the country which constitutes that
body, and originally incorporated it for the suppression of quackery,
and protection of the lives and health of his Majesty's liege sub¬
jects.

On Saturday, the 21st ultimo, a coroner’s inquest was held at the
Board Room, Hampstead Road, to inquire into the cause of the
death of Miss Cashin, a young lady of the highest respectability,
a native of Ireland, who died in consequence of the treatment em¬
ployed by a person named John St. John Long, residing in Harley
Street, Cavendish Square, a man who professes to prevent and cure
all diseases, but particularly consumption.

Mrs. Roddis deposed, that she accompanied the deceased to
Mr. Long’s, in Harley Street, on Friday week, to ascertain his
opinion of her back, when he declared “ it was precisely what he
wished it to be.” On the following day, witness was called to the
young lady’s apartment, and found her in the greatest agony, and
on looking at her back, saw it in a state which it was impossible
for her to describe. In the evening Mr. Long came, and pronounced
the back to be in a very good state, and that he “ would give a
hundred guineas if he could produce a similar wound upon the per¬
sons of some of his patients.” Witness pointed to a certain spot,
and inquired the cause of its appearance, which he said arose from
inhaling, which was a part of his system, and without such appear¬
ance no good could be expected. Witness wished he would order
a composing draught, but he replied, a tumbler of mulled port wine,
was better than all the doctors in the world could prescribe. He
denied the patient was in danger. Mr. Brodie was called, ordered
some medicine, which relieved the sickness of the stomach, and re¬
commended a poultice to the back. On the following day the
patient expired. The lady was in perfect health when she applied to
Mr. Long, and did so, as she was told he could prevent any com¬
plaint with which a person teas likely to be affected.

Medical Jurisprudence.

261

Mr. Brodie deposed, that on inspecting the back of the deceased,
he observed a slough as large as the palm of his hand, the sur¬
rounding skin was inflamed, she had incessant vomiting, for which
he prescribed what remedies he thought best. On the following
day he found the patient dead, and the slough considerably extended.
He considered the wound in the back the cause of death.

Mr. Sweetman, friend to deceased, stated, that the sister of de¬
ceased had died that day, and was also under the care of Mr. Long—
a declaration which produced an extraordinary sensation among the

jUIT;

Sir Francis Burdett, M. P. came forward to speak of Mr. Long’s
competency. He, Sir F. had called on him, as he had heard of two
persons cured of tic doloureux by him, with a view to learn whe¬
ther any relief could be afforded the Marquis of Anglesey, and from
what he saw, was convinced there was no danger in his mode of
treatment ; for having the gout in his hand, he suffered the remedy
to be applied, though with the conviction that it could do him no
good, and in order that he could report to the Marquis of Anglesey
the effect. His lordship got better at the time ; but so satisfied
was deponent of the effects of the practice, that he recommended
Mr. Long two patients.

Mr. Wakley, who attended as a friend to the relatives, cross-
examined Sir Francis, when the following evidence was given : —

That witness did not know any person relieved by Mr. Long : that
he derived no benefit whatever from the application ; that Lord
Sligo told him he was cured of the gout by Mr. Long, and that he,
Sir F. had not made medicine his study; knew nothing of Mr. Long’s
preparation, and could not distinguish prussic acid from water.

Dr. Alexander Thomson gave a most minute detail of the morbid
appearances, and so enshrouded it with technicalities, as to bewilder
both coroner and jury. He proved “ there was no sloughing on
the back,” and could not take upon himself to say what was the
cause of death, until he had examined the head and spine. The
inquest was adjourned for the purpose, and after the dissection, he
deposed, that the brain was healthy, the sheath of the spinal cord
reddish, the pleura and stomach highly inflamed, and that there was
no difference of opinion between Mr. Brodie and himself.

Mr. King was present at the dissection, the brain was healthy —
the body appeared that of a healthy , person who died after a short
illness, observed a large scar on the back, nearly as large as the
crown of a hat, as if a red hot iron had been applied ; the sur¬
rounding parts gorged with serum, did not examine the pleura or
stomach ; was of opinion that the state of the back was produced by
a very strong ecsharotic, and should say very few persons could re¬
cover after such an injury ; the injury on the back was the sole
cause of death ; believed the patient was not consumptive.

Mr. Wildgoose, surgeon, appeared for Mr. Long. The gist of
his evidence was, that <£ he should not have supposed the state of
the back would have caused death.”

Mr. Wakley cross-emamined this witness in a manner which
excited much laughter.

Dr. John Hogg was present at the examination of the spine ;

262

Medical Jurisprudence.

observed the cord discoloured opposite the injury on the back, it
was of a crimson appearance and thickened, the cord was healthy, as
also the brain ; “ the violence done to the nervous system was quite
sufficient to cause death, particularly in the case of a nervous and
delicate young lady. He should not think of making such a wound
in any case.”

Dr. Goodeve corroborated the preceding evidence.

Dr. James Johnson deposed, that the sheath of the spine was
slightly discoloured, but the whole was not thickened ; did not
think the redness was the cause of inflammation ; was of opinion
that the patient died from several effects, the primary cause being
from the local inflammation which produced incipient gangrene,
fever resulted from that inflammation, and the inflammation of the
stomach, and pleura resulted from the fever. Death was produced
by these combined circumstances, all depending on inflammation
of the back.-

Mr. Mackelcan and Mr. Evans coincided with the other medical
witnesses.

Mr. Sweetman corroborated the evidence of Mrs. Roddis, and
stated further, that Mr. Long informed him how deceased became
his patient. “ He told me that a young lady, one of his patients,
asked him what he thought of Miss Catharine Cashin, who was in
the habit of going to his house with her sister Ellen, and Mr. L.
told the young lady, that Miss Cashin would be seized with con¬
sumption in less than two months, unless she allowed herself to
be rubbed by him with his mixture. She told her mother, who
consented to her undergoing this treatment, lest she might have to
accuse herself of any neglect in the cure of her children.”

The following classes of persons came forward to prove the safety
and infallibility of Mr. Long’s practice, either on themselves or
their families. A marchioness, a lady of title, a general, a surgeon,
a solicitor, and a number of ladies and gentlemen ; — one gentleman
proved that he was under the care of Sir Astley Cooper, who con¬
sidered his case a dangerous one, and afforded him no relief, and
that he was cured by Mr. Long. Another was sent home to die of
consumption by Sir Anthony Carlisle,* and cured as if miraculously.
In fine, all the witnesses, who amounted to sixty-three, were under
the care of regular practitioners, and derived no benefit, but were
either cured or relieved by Mr. Long’s friction and inhalation, which
were employed in every case. The escharotic lotion was applied to
the chest, back, temples, hands and legs, and always produced
violent inflammation and sloughing. In one case it was applied to
a leg affected with erysipelas, it produced a great pain, but cured
the patient in a few days. The marchioness swore that she applied
Mr. Long’s lotion to her hands without injury.

This melancholy case affords us another excellent opportunity of
commenting: on the medical evidence. It is clear from the evi-

O 4

dence of Dr. Thomson, that he is a tryo in medicine, and presents
a good example of the necessity of enforcing the study of medical
jurisprudence. He first affirms there is no slough on the back, '

* Sir A. has contradicted this. — Times. Aug. 31st. Ed.

Medical Jurisprudence.

263

though proved by one of the most scientific and eminent surgeons
in London ; and next, he cannot say what is the cause of death,
until he examines the brain and spine. Could any practitioner of
common observation, have the slightest hesitation in ascribing the
cause of death to the extensive eschar on the back, or hesitate half
a moment to ascribe the other morbid appearances to this cause ? Is
there a fact better attested than this, that the constitutional irrita-
consequent to such a cause, would destroy life, unless arrested by
proper treatment. And whoever heard of examining the brain and
spine in such a case, to discover the cause of constitutional irritation
tion, or, in other words, of death. As well might one examine the
brain to discover the cause of death from a severe burn, tetanus,
hydrophobia, &c. Again, of what utility was it, to puzzle the court
by a technical description of every organ in the body, and cause the
body to be disinterred without the slightest necessity ; for there was
not a well informed man in the profession, who perused the evi¬
dence, but would declare such sloughing on the back produced by a
strong escharotic, and moreover on a person in perfect health, was
the cause of death ? Could any man acquainted with the effects of
local and constitutional irritation, hesitate a moment in forming an
opinion on the cause of death in this unfortunate case ? But there
are exceptions in the persons of Dr. Alexander Thomson and
Mr. Wildgoose. Of all the medical evidence in this case. Dr. John¬
son’s was the best, the most scientific, concise, and conclusive ; it
was such as men of scientific acquirements and actual experience
would have given. We may remark, that it is a principle in judi¬
cial medicine, that medical men should be as intelligible and as
conclusive as possible, avoiding all unnecessary displays of techni¬
cality and rigmarole. This was well exemplified by the evidence of
Mr. Brodie. Dr. Hogg, Mr. King, and Mr. Wildgoose, allowed
themselves to wander too much from the real question, and the
latter appeared more in the character of an advocate than a medical
witness.

We should strongly advise some of the medical men who figured
in this inquiry, to look into some work on medical jurisprudence,
before their next appearance in a court of justice, and also to
peruse some standard work on the question on which they intend to
give evidence . One would think science had fled from the profes¬
sion, when its members come before their contemporaries and the
public, and broach the most heterodox and absurd opinions.

For the information of our continental and transatlantic contem¬
poraries, we state, that Mr. Long has been hither^ the most suc¬
cessful pretender to physic in London, his income was estimated at
£.10,000 a year, his patients were every class of society, from the
peer to the peasant. It appeared in evidence, at the above inquiry,
that four short years ago, he was a painter or limner, and having
received, by inspiration, the gift of preventing and curing all dis¬
eases, in the manner so powerfully illustrated in this article, he
commenced to practice, “ the science and art of healing on new
principles.” Of his gross ignorance, we afforded ample evidence in
our notice of his work in a former number ; than which a more

264

Miscellanies.

ignorant production never emanated from the press. There was not
a correct remark from one cover to the other, but a tissue of vile
trash, from beginning to end ; and it only surprizes us that any
person of common sense, much more that our nobility and
gentry, could be duped by such a production. We should have
passed Mr. Long unnoticed' had not his baneful practice afforded
us a sad example of, we fear, frequent occurrence, nor should we
even notice him at present, had the result of the coroner’s inquiry
the slightest effect upon his life or liberty, for such is the defective
state of the law in this country, that the said inquiry is simply
“ much ado about nothing.” Our humane law, as exemplified in
Van Butchell’s case, will bear him harmless. Much higher motives
have induced us to publish this inquiry, namely, the better con¬
servation of the public health. In .another part of this number,
will be found an account of the amplest power intrusted to the
College of Physicians for this purpose. We shall conclude, by
allowing one of the fellows of the college to speak upon this point.
Dr. Brooke Faulkner observes, in speaking of the college prose
cutions of regular Doctors : —

“ Yet such is your eagerness in your prosecution of men like
these, when they refuse to take out your licence, that the country
may overflow with the rankest vermin of empiricism, from Pall
Mall East to the Land’s End, and you take no concern about the
matter. The informer appears before you, narrates, with every
minutia of circumstance, the depredations of divers charlatans in
his neighbourhood, slaying on the right hand and on the left, and
every day gaining name and fame, just in proportion as they give
employment to the undertaker. There is no lack of evidence here
to enable you to prosecute. All the facts and particulars are ready
in full, tangible proof ; every moving circumstance is touched upon
by your informant that can add pathos to his appeal ; you are
besought by the responsibility of your trust ; and every claim of
humanity is eloquently urged in the imploring petition. The answer
is, you are busy prosecuting Dr. Harrison.”*

MEDICAL CORONERS.

It affords us much pleasure to observe the support which Mr Wakfey has received
in his canvass for the coronership of the county of Middlesex. Though we differ
from him on many subjects, we are ready to adrr . * his coming forward on this

occasion, at the solicitation of a large body of fi lolders, whether the result
be successful or otherwise, must be productive of much good, as the question of
the fitness of medical men for the office of coroner has been fairly brought before
the public. Should he be elected, and we sincerely wish him success, a great
improvement will be’ effected in an ancient and valuable department of our judi¬
cial proceedings; for the example of Middlesex, or more properly of London,
should he be elected, will be generally followed throughout the empire, and the
interests of the medical profession and of the public, considerably promoted.

* Letters addressed to the Royal College of Physicians, on their Constitution and
Charter, with prefaratorv observations, to his Grace the Duke of Wellington.
By Sir Arthur Brooke Faulkner, Fellow of the Royal College of Physicians.
London, 1829.

All Communications and Works for Review are to be addressed to the care of
Messrs. Underwood, 35, Fleet Street; or to the Editor, at his Residence, 61,
Hatton Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 28. OCTOBER 1, 1830. Vol . V.

. . . -- • ■■■■■ . — — — : — ■ —

CRITICAL REVIEW.

I. — A short Tract on the Formation of Tumours , and the
peculiarities that are met with in those that have become
Cancerous , with their mode of Treatment. By Sir Everard
Home, Bart. V.P.R.S. F.S.A* F.L.S. Serjeant Surgeon
to the King, & c. & c. &c. 8vo. pp. 98. 4 plates. London,
1830. Longman and Co.

The venerable author of the work before us, concludes his
distinguished literary career with the present production.
The high reputation of this distinguished man will never
cease to be remembered while medical science has its vota¬
ries. It is quite superfluous for us to detail his valuable
contributions to science ; they are universally known and
appreciated. We may briefly remark, however, that his
f,r Lectures on Comparative Anatomy, in 6 vols. 4to., with
numerous engravings ; his Practical Observations on the
Treatment of Strictures in the Urethra and (Esophagus,
3 vols. 8vo. ; his Observations on the Treatment of Diseases
of the Prostrate Gland, 2 vols. 8vo. ; and his numerous Essays
in the Philosophical Transactions, &c.” evince extensive re¬
search, indefatigable industry, accurate discrimination, sober
reflection, repeated observation, and much originality. —
Posthumous eulogy wTill do the talented author ample
justice.

It affords us sincere pleasure to observe such an eminent
member of our profession, commence a work with the fol¬
lowing declaration, which is alike honourable to him as a
philosopher and a man, and offers strong proof that en¬
lightened medical men are not so indifferent to religion as the
world imagines. The public, who are generally fools, are
of a different opinion ; but those acquainted with medical
history may triumphantly refer to its pages, where the fact
Vol. V. NO. 28.

L L

266

Critical Review .

is attested beyond dispute, that the most eminent members
of the faculty have been distinguished for their piety ;
among whom we find the illustrious names of Harvey,
Locke, Sydenham, Boerhaave, Haller, Arbuthnot, Hoff¬
man, Sthal, Baglivi, Steno, Riverius, Brown, DeHean, and
in our own day, Gregory, Baillie, Bateman, Davy, and a
host of others wTho are still the ornaments of the profession.
But the really learned of the faculty have never been in¬
fected by the poison of infidelity. Sir Everard commen¬
ces his preface as follows : —

“ As this short tract is the last of my professional labours that
will be submitted to the public, I cannot, at the age of seventy-four,
make a better preface to it, than by an humble prayer of grateful
acknowledgment to the Allwise Creator, who has permitted me to
continue the investigation of his most wonderful works for so long a
period, and thus enabled me, in many instances, to alleviate the
miseries of suffering humanity, and to glorify the name of the Author
of our existence.”

It will be recollected, that our author published an ac¬
count of tumours in the thecae of nerves in 1800, in the
Trans, of a Society for the Improvement of Medical and
Chirurgical Knowledge, and in 1805 a Tract on Cancer,
and his object in the present work is to make known the
facts he has since observed respecting tumours in general, and
cancerous ones in particular. He makes the following re¬
marks upon the pathology of these classes of diseases : —

“ As the blood is the fluid in which these materials are circulated,
and the arteries are the vessels which, under the agency of the nerves,
deposit the supplies required, while the lymphatics carry off the parts
rendered useless, we must first acquire a knowledge of these vessels,
and of their actions when the body is in health ; since it is only when
such actions are perverted, or otherwise interfered with, that the
produce of disease is met with.

These subjects I have treated of in another work ; and here we
have only to consider those cases where either the blood or some part
of its ingredients, in consequence of external violence, are deposited
in greater proportions than is required to repair the injury, as it is
from this accumulation that tumours are produced ; and in general
they resemble in structure, more or less, the substance of the natural
parts by which they are immediately surrounded. Fatty tumours are,
nothing more than a deposit of fat in parts that have been slightly
injured, and have never recovered their healthy actions, but go on
depositing that substance where it was not required.

Where the injury has been more severe, the materials of which the
consequent tumours are composed differ according to the quantities
and new combinations of the extravasated materials ; but although

Sir E. Home on the Formation of Tumours. 26 7

unlike one another, still, however, in general, in their texture, they
bear a resemblance to the healthy parts by which they are sur¬
rounded.” — p. 4.

He describes a particular kind of tumour situated in the
substance of nerves, which deserves attention.

“ A lady, twenty years of age, had a tumour on the outer side of
the biceps muscle of the right arm, the size and shape of a pullet’s
egg ; it was moveable in the surrounding parts ; it had been several
years in acquiring its present size, and was very painful when pressed
upon. Its rapid increase induced her to have it removed by the
knife. When the parts were fully exposed, the surface was smooth
and shining. At both ends the tumour terminated in a white cord.
Upon cutting through the outer covering, the real tumour wras found
to be enclosed in a nerve. When this discovery was made, it was
thought prudent to divide the nerve at both ends, and remove the
whole. The skin did not unite by the first intention, but the parts
healed very kindly. The patient had no use afterwards of her thumb
and fore-finger, and had a numbness in these parts ; the skin which
covered them was unusually rough and dry, and the cuticle came off
in scales. On examining the tumour, three inches of the nerve itself
had been removed ; it was separated into two portions, each much
flattened, and passing over the sides of the tumour. There was also
a thin nervous expansion, not thicker than a membrane, completely
investing the whole. This was readily separated, although more
firmly attached at the extremities.

“ The tumour, when its substance was examined, had the appear¬
ance of being made up of serpentine fibres running in the course of
the nerve ; these were separate from each other, and the interstices
filled up by the substance of the tumour ; but near its surface the
tumour had a radiated structure.” — p. 7.

A singular tumour is described and illustrated by plates,
which arises from the diploe of the skull in consequence of
injury, makes its way through the external table without
injuring the internal one, and is certainly not generally
known. An extraordinary case is given, in which the tumour
arose underneath the external table of the right parietal bone,
and rested on the shoulder ; its cranical attachment was
osseous, and was divided by a saw. There was no local
or constitutional irritation after its removal, and the woman
has continued quite well, now a period of fourteen years.
She is a nurse in St. George’s Hospital. A similar case was
successfully treated, by Mr. Robert Keate, of the same
hospital. The appearance of our author’s patient, before
and after the operation, is admirably represented. These
cases disprove the doctrine of phrenology in a remarkable
manner.

268

Critical Review.

“ Cases of this kind completely expose the fallacies of the doc¬
trine of craniology, than which nothing can be more absurd ; since
the external surface of the internal table of the skull, and that of
the external table, can never be under like circumstances, nor have
similar changes in them produced from the same causes or corres¬
ponding circumstances ; and yet the sole foundation of this doctrine
is a supposition that the effect of the developement of the brain
upon the internal table is produced in an equal degree at the same
time in the external table, which, from the nature and texture of
the diploe, can never happen. ” — p. 17.

The remainder of the volume is devoted to the subject
of cancer, and affords no new information. A number of
cases are detailed in which operations were performed ;
but the pathology of cancer is left as obscure as ever. Our
author is of opinion, that the same parts in different indivi¬
duals, under similar circumstances of violence, do not
always form cancerous tumours, so that these tumours must
depend on peculiarity of constitution ; and therefore in
their origin cannot be cancerous. There seems to be a
contradiction of terms in this statement, at least there is
much ambiguity, for in the succeeding paragraphs, we are
told there are no hereditary diseases. Again, it is implied
that defect of constitution is the cause of cancer. Every
one is aware that tumours of the breast may or may not
become cancerous ; and in proof of this fact, our author ad¬
duces a case in which a policy of assurance was disputed, in
consequence of a discrepancy of opinion between himself
and Mr. Cline, which is worthy of attentive consideration.

“ A gentleman who had a similar accident, followed by a tumour
in the breast, which he did not believe of any consequence, insured
his life, and declared himself labouring under no disease. He after¬
wards died from a cancer formed in that tumour. Mr. Cline was
consulted, and said that the tumour in the pectoral muscle was a
cancer, and had been so from its first formation. In this opinion he
was supported by another surgeon ; and therefore the office refused
paying the insurance, as the gentleman died in consequence of the
fungous excrescence which this tumour afterwards produced. The
case came before Sir William Grant, then Master of the Rolls, who
was staggered by Mr. Cline’s affidavit, but not convinced, and called
upon me to know my opinion. I stated, that if Mr. Cline was cor¬
rect, all such accidents would be immediately followed by cancer,
which I knew was not the case, and gave him several instances in
confirmation of my assertion, in particular, that of Mr. Hunter ;
and the gentleman’s executors gained their cause ; since Mr. Cline
could bring no proof when the cancerous disposition first took
place ; and as the gentleman, at the time he took the oath, could
have no knowledge that the swelling brought on by the accident
could be the forerunner of any disease.” — p. 21.

Sir E. Home on the Formation of Tumours. 269

There are few cases of forensic medicine which are so
often disputed as policies of life insurance, or such as
require more judgment from the practitioner. It would be
well if we had a good treatise on this subject for the
guidance of young practitioners, as extensive frauds are
daily committed by the respective parties in these transac¬
tions. To return to the subject more immediately before
us, we have to observe, that our author considers the serum
and lymph globules are the parts vitiated, and capable of
propagating the poison. This of course is pure conjec¬
ture, and is even doubted by the author himself in a future
page.

He adduces cases of hydatids of the breast, which were
mistaken for cancer, as evidence against this hypothesis.

Sir E. next describes the progress of cancer, and in proof
of his competency to undertake this task, he states that he
lived with Mr. Hunter till his death, and had the superin¬
tendence of all his numerous cases, and that his whole
observation has been derived from a practice of fifty-seven
years. He details several cases in illustration of the pro¬
gress and treatment of cancer, but they are generally de¬
void of interest, as they throw no new light on the sub¬
ject. (< I am sorry to add,” says he, “ that very little
progress has been made, either towards a cure or a preven¬
tion of the disease taking place.” He has found the inter¬
nal and external use of hemlock of most value, and claims
the discovery, that the powder is the most restorative pre¬
paration of sarsaparilla, an opinion he has maintained for
the last fifteen years. Ample experience has convinced
him that the power of sarsaparilla is greatly weakened by
heat.

Such are the opinions contained in the work before us.
The production is worthy of attentive perusal, as it con¬
tains numerous clinical reports, which will be perused with
advantage by operating surgeons.

II. — A Treatise on the Venereal Diseases of the Eye. By-
William Lawrence, F.R.S. late Professor of Anatomy
and Surgery to the Royal College of Surgeons in Lon¬
don, Surgeon to St. Bartholomew’s Hospital, and Lec¬
turer on Surgery in that Hospital, &c. &c. &c. 8vo. pp.
337. London, 1830. John Wilson.

Our author informs us, that the work before us is drawn up
entirely from his experience, and its contents are as follow : —

270

Critical Review. *

Ch. I. — An introductory and historical view of the subject-
division of the diseases of the eye into gonorrhoeal and syphi¬
litic. Ch. II. — The symptoms, diagnosis, prognosis, causes
and treatment of gonorrhoeal inflammation of the conjunctiva.
Ch. III. — Mild gonorrhoeal inflammation of the conjunctiva.
Ch. IV. — Gonorrhoeal ophthalmia of the external tunics and
iris, including details of xxiv eases, which occupy sixty-
six pages. Ch. V. — Syphilitic diseases of the eye, with
symptoms, diagnosis, prognosis, and treatment, exemplified
by xxix cases, the account of which extends to nearly a
hundred pages. Ch. VI. — Syphilitic ulceration and erup¬
tions of the eyelids, illustrated by five cases. The different
diseases are first described, and references so constantly
made to the cases, that it is totally impossible to attempt
an analysis of the work, without occupying an extent of
space which far exceeds that by which we are circumscribed,
and which could be converted to better use than to the dry
details of cases. The whole opinions of the author might
have been given in a dozen pages ; indeed, we are confident
that we could condense them into even half this space.

We expected a much more comprehensive work from

Mr. Lawrence, one that would comprise the whole diseases
of the eye, and still not more expensive than the present
publication. The work before us is by far too expensive
for the quantity of matter which it contains, and we pro¬
phesy that the respectable publisher will speedily discover
the truth of our prediction. There is as much original and
important matter in Mr. Travers’ little essay, at a fourth of
the price ; and we must further observe, that the author

and publisher ought to have been aware of the profes¬

sional taste for cheap literature, and that some of the
most distinguished surgeons of this capital have ruined the
sale of their works by the exorbitance of price, and stimu¬
lated others to publish pirated impressions at a cheaper
rate.

We shall now proceed to place before our readers,
Mr. Lawrence’s opinions on the nature and treatment of
venereal diseases of the eye.

He commences by alluding to the delicate and compli¬
cated structure of the eye, its liability to common disease,
with the various results, the modification of morbid affec¬
tion in scrophulous, gouty and rheumatic constitutions ; its
liability to cancer, fungus, hcematodes, melanosis, and ve¬
nereal disease. The last named disease, he observes, has
been unnoticed by some recent writers in this country,
though St. Yves, Astruc, Camerer, Swediaur, Benjamin
Bell, and Richter, have described gonorrhoeal ophthalmia.

Mr. Lawrence on the Venereal Diseases of the Dye. 271

Iritis was first noticed by Professor Schmidt, of Vienna,
in 1801. Mr. Hunter was not aware of gonorrhoeal ophthal¬
mia, though he speaks of supposed venereal inflammation
of the eyes. Mr. Pearson knew nothing of gonorrhoeal
or syphilitic affections of the eye, as appears from his letter
to Mr. Briggs, the learned translator of Scarpa’s treatise on
diseases of the eye, which letter is quoted by our author.
He also expresses his surprise that two such writers as the
illustrious Hunter and the erudite Pearson, who were al¬
lowed to be intimately acquainted with venereal disease,
should be silent on the affections under notice ; and he
endeavours to explain this ignorance, by observing, that the
study of ophthalmic surgery had been entirely neglected in
this country until within a few years, and that eminent sur¬
geons were accustomed to send their ophthalmic patients to
ignorant oculists. Recent writers have proved themselves
acquainted with this subject, but none of them have con¬
sidered venereal affections of the eye professedly or gene¬
rally ; and hence our author has undertaken the task, and
has drawn his views of the symptoms, progress, effects,
and various forms of treatment from his own experience,
which we need scarcely observe is extremely extensive.

Mr. Lawrence divides the venereal diseases of the eye into
the gonorrhoeal and syphilitic ; the first consists of three
distinct forms of ophthalmia ; 1st, acute inflammation of the
conjunctiva ; 2d, mild inflammation of that membrane ; 3d,
inflammation in the sclerotic coat, sometimes extending to
the iris.

Our author gives the synonyms of the first form, which
are as follow : — Acute gonorrhoeal inflammation of the con¬
junctiva, gonorrhoeal ophthalmia, blepharophthalmia, and
ophthalmia gonorrhoica vera of Beer. This bears a close
resemblance to the purulent ophthalmia of British writers,
and has been so graphically described as to render a copy
of the author’s account of it wholly unnecessary, more
especially as it is accurately given in his lectures on sur¬
gery. We may briefly remark, however, that he tells us,
<e it is the most violent and rapidly destructive inflamma¬
tion to which the eye is subject, and fortunately it is one of
rare occurrence.” The changes which it commonly pro¬
duces in the cornea are sloughing, ulceration, and inter¬
stitial deposition, ending in opacity, or escape of the hu¬
mours and collapse of the globe, obliteration of the ante¬
rior chamber, and flattening of the front of the eye, sta¬
phyloma, prolapsus iridis, obliteration of the pupil, and
anterior adhesion of the iris. The progress of every one
of these diseases is minutely described, and numerous

272

Critical Review.

references made to cases illustrative of them. The prog¬
nosis is as follows : —

“ The violence of the inflammation, its rapid course, and the
disorganization or changes of structure, which it so speedily pro¬
duces in the cornea, are attended, under all circumstances, with the
greatest danger to sight, which, in a large proportion of these cases,
is either lost or seriously injured. Thus of the fourteen cases which
I have related, loss of vision took place in nine from sloughing,
suppuration, or opacity of the cornea. In two of these one eye
was lost, and the other recovered. Sight was restored in the other
five, with partial opacity of the cornea, and anterior adhesion of the
iris in three of the number. So short a period intervenes between
the commencement and the full developement of the complaint, that
in many instances irreparable mischief is done to the eye before our
assistance is required. If we see the complaint in the first or second
stage we may expect to arrest its progress by active treatment ; but
success does not invariably attend our efforts even under such favour¬
able circumstance, as Case V. proves. Our prognosis will princi¬
pally turn on the state of the cornea ; if that should possess its
natural clearness, the eye may be saved. If it should become hazy
and dull, and more particularly if it should have assumed a white
nebulous appearance, consequences more or less serious will inevi¬
tably ensue.” — p. 26.

Our author cites the opinions of Pearson,, Beer, Scarpa,
and Vetch against the idea, that gonorrhoeal matter pro¬
duces the disease under notice*, but he adduces cases from
his own practice, which leave no doubt of the converse of
these opinions. He admits, however, that in a great pro¬
portion of gonorrhoeal ophthalmia©, we cannot trace the dis¬
ease of the eye to the application of infectious matter,
either from the same or another individual. The eyes are
said to suffer by metastasis, and according to Richter,
Scarpa, and Beer, the urethral discharge is suppressed, but
this did not happen in our author’s cases, nor in those
detailed by Delpech — the discharge was lessened but
not suppressed. Again, the suppression of the discharge
by surgical treatment, is not followed by ophthalmia. Since
the disease of the eye may occur while the urethral dis¬
charge continues, and since it does not take place when
the discharge is stopped, we cannot admit, says our author,

that the affection of the eye owes its origin to the cessa¬
tion of the diseases in the urethra.”

“ I am inclined to refer its occurrence to the state of the con¬
stitution, without being able to point out in what that state consists,
and to regard it as a pathological phenomenon analogous to those
successive attacks of. different parts which are observed in gout and
rheumatism. The two other forms of ophthalmic inflammation,
which take place in conjunction with gonorrhoea, show themselves
only in rheumatic subjects, and generally in connection writh other

Mr. Lawrence on the Venereal Diseases of the Eye. 273

arthritic sufferings ; and the difference between one of these and
the affection now under consideration is only in degree. This view
of the subject may throw some light on the circumstance that,
though direct infection operates equally on both sexes, the gonorr¬
hoeal ophthalmia, said to originate in metastasis, seems to be confined
to the male. I have never seen it in the female ; and Beer, in the
passage last quoted, says, that he has observed it only in the young,
robust, and plethoric men.” — p. 35.

We now arrive at the treatment of this disease, which
will appear to many physiologists and pathologists fully
as dangerous as the disease itself. No doubt the disease
requires the most active treatment, but we cannot help
thinking, that many practitioners would hesitate to employ
depletion to the extent recommended in the following ex¬
tract, for the injury done to the constitution must un¬
questionably produce most fatal diseases, if not death itself.
In making this remark, we do so on mature, deliberation,
and we refer those who choose to doubt its accuracy, to the
best works on physiology, and especially to Dr. Marshall
Hall’s work on the curative and morbid effects of blood
letting,” and to M. Andral’s Pathology. Indeed, it must
be obvious to every man of practical experience, that de¬
pletion, carried to the extent recommended, and employed
indiscriminately, in all ages and constitutions, for no excep¬
tion is made, could not fail to produce more fatal effects
than the disease before us. We shall adduce the most
respectable evidence in favour of our opinion, after the
insertion of Mr. Lawrence’s plan of treatment.

“ The only chance of arresting this violent disorder, and pre¬
serving the eye from its destructive effects, is afforded by the
boldest antiphlogistic treatment ; particularly by the freest abstrac¬
tion of blood generally and locally. We must bleed largely from
the arm, and take blood by cupping on the temples, or by nume¬
rous leeches applied round the part ; and these measures must be
repeated at short intervals, until the vascular congestion is relieved,
and the attendant pain removed. The other parts of the antiphlo¬
gistic treatment must be combined with this free abstraction of
blood ; but our great reliance must be placed on the latter. In Case
V. blood was taken very largely, both locally and generally, and
other powerful antiphlogistic means were resorted to ; these mea¬
sures were employed in a very early period of the complaint ; yet
the eye was lost. From the unfortunate termination of this case,
and from the unfavourable issue of others recorded in this paper, I
infer, not that antiphlogistic treatment is incapable of arresting this
inflammation, but that it has not been employed to a sufficient
extent ; and if I had to treat some of these cases again, I certainly

VOL. IV. no. 28.

M M

m

Critical Review.

should bleed more freely. I think that as much blood should be taken
from the arm as will flow from the vein, and that the evacuation should
be repeated, as soon as the state of the circulation will allow us to get
more. This plan of depletion should be pursued until the local ex¬
citement is subdued. ‘ These,’ says Mr. Bacot, f are cases,
which defy all the usual etiquette of regular and ceremonious visits.
If we wish to save our patient from the destruction of his vision, we
must scarcely depart from his bed-side until the inflammatory
symptoms are controlled. The lancet must be hardly ever out of
our reach, for if ever there was a disease in which blood may be
taken away without limitation, it is this.’ Mr. Wardrop informed
me, that the only case of gonorrhoeal ophthalmia he had seen in
which the eye was saved, was that of a young woman, in whom
venesection was repeated as often as blood could be got from the
arm. She lost 170 ounces in a few days, and looked as if every
drop of blood had been drained from her body ; the skin having
nearly the hue of a wax candle. In the cases which terminated
most favourably, among those recorded in this paper, blood was
taken very largely. In Case VIII. forty ounces of blood were taken
from the. arm on the 6th November, being the 6th day of the disease,
and twenty-four leeches were applied. The same number of leeches
was repeated on the 7th, 8th, 9th, and 10th ; on account of a relapse
eighteen leeches were applied on the 13th, twenty ounces of blood
taken by cupping on the 14th, and twenty-four ounces by vene¬
section on the 15th. In Case IX. twelve leeches were applied on
the 20th September (the fourth or fifth day of the disease) ; sixteen
ounces were taken from the temporal artery on the 2 1 st, and forty-
four ounces from the a~m on the 22nd, twelve leeches being applied
on the same day ; twenty leeches were applied on the 23rd, and on
the 24th ; twenty ounces by cupping on 26th ; thirty-six ounces by
venesection on the 27th, and the same quantity on the 28th. In
Case XII. although the loss of blood was not considerable, it
operated very powerfully on the circulation and strength of the
patient.

“ For the slighter symptoms, which may show themselves after
the inflammatory action has been subdued, local bleeding will
suffice. The more vigorous depletion is recommended where the
inflammation is fully developed, without the cornea being yet affected,
or where the condition of the cornea may be doubtful ; that is, where
we may entertain the expectation of saving the organ from all
injurious change.

“ If sloughing or suppuration should have already occurred, it
will be of no use to pursue this very active treatment, although
more moderate depletion may still be necessary. General sloughing,
or general suppuration of the cornea, is usually attended by diminu¬
tion of the inflammation, and cessation of pain, or at least com¬
parative ease ; the loss of blood therefore is no longer required for
the relief of suffering ; and it would be without an object, as vision
is irreparably destroyed.

“ But inflammation may continue with undiminished violence

Mr. Lawrence on the Venereal Diseases of the Eye. 275

after the occurrence of partial sloughing ; and active depletion may-
still be necessary, both to limit the extent of the mischief, and to
favour the processes of separation and restoration. In Cases VIII.
and IX. very free depletion, both general and local, was employed
after the cornea had suffered partially in this way ; and the treat¬
ment was completely successful in preserving sight. In Case III.
where one cornea had sloughed entirely, and the other eye was
actively inflamed, the venesection and local bleeding employed on
account of the latter had no prejudicial effect on the former.” —
p. 39.

He says,, experience does not warrant us in ascribing
much efficacy to blisters, but they may be resorted to after
antiphlogistic means. The ordinary local applications pos¬
sess little efficacy, whether hot or cold, and must be changed
according to the feelings of the patient. Astringents and
tonics are useful when the inflammatory symptoms are sub¬
dued. The best forms of astringent applications are from
two to ten grains of alum to an ounce of water, the solu¬
tion of the nitrate of silver, and the undiluted liquor plumbi
subacetatis. Such is the plan of treatment proposed by
the eminent author, and which appears to us objectionable,
for the reasons already stated, and also for those we shall
immediately offer. He has not said a word on active pur¬
gation, diaphoretics, or active counter irritation. He states
the testimony of others to which we alluded above, and
which shews that his depleting plan need not be employed
to any thing like the extent recommended by himself and
many other surgeons.

“ The use of a strong astringent has been recommended in the
very commencement of the affection, as a means of cutting it short,
and preventing the development of the inflammation. Mr. Melin
proposed this mode of proceeding in ordinary conjunctival inflam¬
mation, having considered that acute ophthalmia was in general
treated too actively, and that a mere local disorder could not require
such extensive depletion as was usually practised and recommended.
He was further induced to try the practice, from having witnessed
the good effects of a solution of lunar caustic, in some cases of
gonorrhoea, both in allaying the pain and suppressing the discharge.
The strength of the solution employed was four grains to the ounce
of distilled water, which was dropped into the eyes twice a day : it
excited pain and a sensation of roughness, with an increased flow of
tears for about twenty minutes, after which the eyes felt much
relieved, and in a few days the cure was effected. ‘ Since that
period/ says Mr. Melin, ‘ I have treated nearly three hundred
cases of acute ophthalmia,' without either local or general bleeding,
and I have had ample opportunities of proving its eflicacy. — p. 43.

Critical Review,

2 76

“ Very strong testimony in favour of the astringent plan of treat¬
ment in ordinary purulent ophthalmia, is given by Dr. O’Halloran,
who had enjoyed ample opportunities of observing the disease, as an
army-surgeon, for many years, and in various climates. He had
become dissatisfied with the antiphlogistic treatment, from having
found it frequently either insufficient or injurious, and was hence led
to use astringents, not only in the early stage of the disease, but
when the purulent discharge and chemosis were fully established.
He employed the sulphate of copper in substance, rubbing with it
the inner surface of the eye-lids after everting them, or he dropped
into the eye the ten grain solution of nitrate of silver ; and generally
used one or the other once a day. He gave purgatives and applied
fomentations. If the symptoms indicated that the internal parts of
the organ were affected, he directed the application of leeches.
After mentioning a case treated successfully with the sulphate of
copper and the caustic solution, he adds, ‘ the foregoing case with
some hundreds on record, of the different varieties, shew with what
efficacy and safety blue-stone may be applied to the eyes when under
disease ; its effects in removing the affection of the parts and allay¬
ing the irritation are remarkable. I can safely say, that abstraction
of blood will be rarely necessary in this disease, if the plan recom¬
mended be strictly attended to ; and I moreover am of opinion, that
if any inquiry be instituted amongst the army- surgeons, it will be
found that those, who used the greatest depletion, were the least
successful practitioners, and that sloughing, ulcers, &c. more fre¬
quently succeeded the evacuating plan, than when the patient was
partly left to nature.’'’ — p. 45.

Our author states in a note appended to this extract,
that since he has written it, he has employed the caustic
solution in a case of gonorrhoeal ophthalmia with the best
result, and he has also purged his patients freely. He refers
to cases treated with mercury by Mr. Macilwain and
Dr. H ennen, but adds, that it did not check simple puru¬
lent or gonorrhoeal ophthalmia in his own practice.

He adverts to the practice of Richter and Scarpa, who
consider suppression of the gonorrhoea as the cause of oph¬
thalmia, which consists of the antiphlogistic measures, emol¬
lient poultices, and injections and bougies ; the former re¬
commending the bougie to be smeared with gonorrhoeal
discharge or red precipitate ; the latter contenting himself
with the simple bougie and injections of warm oil. Beer
thinks inoculation is the most certain method. Mr. Law¬
rence is of opinion that these measures are recommended
rather on theoretical grounds than from experience, as none
of the writers mention the results of their own practice.
Again, when the violence and rapidity of the disease is
considered, and the slowness of this practice, we cannot but

c,

Mr. Lawrence on the Venereal Diseases of the Eye. 2 77

' \

think that irreparable mischief would be done to the organ
during the lost time in such attempts.

Dr. . Archer, of Virginia, after free antiphlogistic measures,
has found great advantage from a blister applied directly
over the eyes, and much injury from it when applied over
the temples.” In the second stage of the disease, the in¬
fusion of datura stramonium, applied by means of cloths
to the eye, and continued from one to three hours, accord¬
ing to the violence of the pain, never failed to relieve it.
To prevent irritation from the motion of the eye, he recom¬
mends one or two grains of oxym. hyd. in an ounce of
olive oil. His practice is detailed in our March No. v. 4,
p. 250. Mr. Travers recommends free depletion, active
purgation and nauseating doses of tartarized antimony, to
keep up perspiration, nausea, and faintness. When inflam¬
matory action is reduced, astringents and tonics are to be
employed. We might multiply authorities to a great ex¬
tent in favour of Mr. Travers’ plan of treatment, while we
must confess that we know of no writer who agrees with
our author in his recommendation of abstracting blood,
while any can be procured from a vein. In fact, we are
inclined to suppose there is a typographical error in the
passage which contains this advice, as we are sure that a
writer of the author’s great and well deserved experience,
would never have made a proposal, which, employed indis¬
criminately as he advises, is little short of ordering patients
to bleed to death, or at least ruining their constitutions, and
exposing them to many fatal diseases.

Taking the author’s account of gonorrhoeal ophthalmia
upon the whole, it is far inferior to that of Mr. S. Cooper, in
the Surgical Dictionary, and reflects no great credit upon
him. It would be superfluous to contrast Mr. Cooper’s
account of the disease with that before us, as his work is
in every body’s hands, but we fearlessly maintain it is much
better, and inculcates a much safer practice.

The next chapter, is on ** mild gonorrhoeal inflammation
of the conjunctiva.” Moderate depletion and the caustic
solution, are said to effect a cure.

The sclerotic tunic and iris may be affected wflth gonorr¬
hoeal inflammation. The former is of a pink or purplish
red ; the conjunctiva is slightly engaged in the disease, and
there is great intolerance of light. Though the pupil may
be contracted, and the sight dim, recovery may take place,
even when a lotion only had been applied. Copious deple¬
tion will be necessary for the cure of the disease if violent,
but cupping and leeches will suffice in milder instances.

278

Critical Review.

Warm fomentations are generally most agreeable to the
patient’s feelings. When the inflammation is diminished,
blisters may be tried, and the cure completed by Plummer’s
pill. If the disease supervenes on rheumatism, colchicum
will be used with advantage. The disease may be com¬
bined with conjunctivitis, or the urethra, eyes, and joints
may be inflamed at the same time, or successively. The
following graphic description deserves great attention : —

“ The affection of the eye last described is exactly the same as
rheumatic inflammation of the sclerotica and iris occurring indepen¬
dently of gonorrhoea- Both this and the mild purulent inflammation
of the conjunctiva are to be regarded as rheumatic affections of the
organ excited by gonorrhoea ; that is, they take place in individuals,
in whom this constitutional disposition is shewn by inflammation
affecting either the synovial membranes or the fibrous structures of
several joints. Although the organs seem at first view very dis¬
similar, there is an analogy of structure between the parts which
suffer in the two instances ; that is, between the synovial mem¬
branes and the conjunctiva, and between the ligaments and fibrous
sheaths, and the sclerotica. Hence we need not be surprised at
finding that the eyes suffer under the influence of that unsound state
of constitution, which leads to these affections of the joints. The
structure originally affected, the lining of the urethra, is also a
mucous membrane, which sometimes becomes inflamed, and pours
out a puriform discharge, in gouty and rheumatic subjects, from in¬
ternal causes. That the essential cause of this combination of mor¬
bid phenomena is peculiarity of constitution, may be inferred from
the repetition of attacks, and the length of time for which some
individuals are harassed by successive appearances of disease in
various parts. In Case XVI. rather severe purulent ophthalmia
occurred in August, 1822, and a similar one followed soon after;
from that time to the present, six attacks of rheumatic iritis have
taken place. In Case XIX. discharge from the urethra without in¬
fection occurred four times ; then inflammation of the foot ; three
years after, severe inflammation of the chambers of the aqueous
humour ; then gonorrhoea and mild purulent inflammation of the
conjunctiva, followed by rheumatic inflammation of various joints ;
and afterwards severe rheumatic inflammation of the sclerotica and
iris. In Case XXI. violent gonorrhoea was followed by acute in¬
flammation of the external tunics; a second gonorrhoea excited, first
purulent ophthalmia, the acute inflammation of the external tunics,
and subsequently rheumatic inflammation of various joints. Two
years after severe rheumatism was brought on by cold. 1 lately
saw a gentleman with gonorrhoea, mild purulent inflammation of
the eye, and rheumatic affection of the foot and back ; it was the
fourth attack he had experienced of the same combination of symp¬
toms. One patient seen by Mr. Brodie had undergone four attacks,
all of which began with gonorrhoea ; it was followed, first by puru-

Mr. Lawrence on the Venereal Diseases of the Eye . ‘279

lent ophthalmia, and then by inflammation of the synovial mem¬
branes of several joints. In another there had been eight attacks
at various intervals during a period of seventeen years.

As the train of diseases just described must be referred prin¬
cipally to peculiarity of constitution, gonorrhoeal infection is not
essential to their production ; it is only to be regarded as one of the
exciting causes, and perhaps the most frequent. There could be no
doubt that gonorrhoea had been contracted in the six cases from
XVI. to XXI. inclusive. On the other hand, in Case XVI. the patient
was convinced that he had not received infection ; according to this
description, the usual characteristic of gonorrhoea virulenta had been
wanting. Mr. Brodie seems to have considered that the discharge
from the urethra, in some of the instances which he had seen, was
not caused by infection. In the case of the gentleman, who had
had eight attacks, inflammation of the urethra with discharge was
the first symptom, and occurred before the age of twenty ; he
believed, however, that he had not been exposed to the risk of
infection. In three of the attacks, purulent ophthalmia was the first
symptom, being followed by discharge from the urethra and inflam¬
mation of the synovial membranes. In the other four attacks,
inflammation of those membranes occurred without any previous
disease of the eye or urethra. In another case discharge from the
urethra brought on by the use of the bougie was the first symp¬
tom.^ — p. 6.

The succeeding seventy pages are occupied with details
of cases of gonorrhoeal ophthalmia, corroborative of the
author’s views in the preceding narrative, and may be
perused with advantage. His next chapter is on syphilitic
iritis, and here we find nothing novel. The fact is, that the
author’s opinions are already before the public in his pub¬
lished lectures, and we are unable to divine what induced
him to reprint them in a separate form, unless to illustrate
them by notes and cases. He gives a luminous description
of iritis, and concludes that it is not caused by mercury.
He also states that it seldom attacks children, and out of
numerous cases, he has only seen it in two instances. The
prognosis is minutely described, and after due consideration
of all circumstances, is favourable, if proper treatment be
employed. The various modes of treatment are next ad¬
verted to, and may be reduced to the antiphlogistic and the
mercurial. Mr. Lawrence maintains that both methods are
indispensable, and clearly shews that exclusive dependence
on either will lead to unsuccessful results. In some cases
depletion and mercury are moderately employed, while in
others, salivation has been kept up for three months, and
wilh complete success. When pain is violent over the orbit
at night, great relief will be afforded by rubbing six grains

280

Critical Review .

of mercurial ointment, and two of powdered opium, before
the time at which the nocturnal pam is expected to recur.
This plan, however, does not arrest the inflammation, as the
internal use of the remedy does.

Artificial dilitation of the pupil is a point of great im¬
portance in the treatment, and this is to be effected by cer¬
tain narcotics, as belladonna, hyosciamus, laurocerasus, and
stramonium. Our author recommends the extract of bella¬
donna or hyosciamus, in the proportion of a scruple, to be
rubbed down with an ounce of distilled water ; the solution
to be strained through linen, and a few drops to be intro¬
duced between the lids; or the extract to be brought to
the consistence of honey with distilled water, and to be
rubbed over the brow, and after an hour may be washed
off. It may dilate the pupil for hours or days, sometimes
injure vision, but never permanently ; it has been used with
effect for fifteen years, and retained its power of dilating
the pupil during that period. Belladonna, or the other
narcotics, do not exert their power when the iris is highly
inflamed, though they may elongate or separate adhesions,
and liberate the pupillary margin. This effect will be greatly
promoted by the use of mercury ; and our author attests
such separation from his own practice. The writer next
endeavours to explain the mode of. action of mercury in
iritis, but confesses that as yet we knowT little of the ope¬
ration of that medicine. He adduces the evidence of Beer,
Saunders, and Farre in its favour. He observes,

• 4 , ' f i * * * • ~ . # >

“ If mercury be capable of stopping that increased and altered
action of the capillary vessels of the iris, in which inflammation of
the texture consists, we should expect to find it equally useful in
other inflammations, since the process is essentially the same through¬
out the body. I have found it no less efficacious in inflammation of
the retina, whether acute or chronic. We cannot indeed, offer
equally clear evidence of its power in this case, because the affected
texture is hidden from our view. But I have so repeatedly seen
diseases in which the symptoms left no room to doubt that the
retina was inflamed, give way to the use of mercury, after resisting
the simple antiphlogistic treatment, that I employ the remedy on such
occasions almost as confidently as in iritis. Strumous inflammation
of the cornea, proceeding to interstitial deposition and consequent
change of structure in the part, may generally be arrested by the
mercurial treatment. I have many times seen disturbance in the
circulation of the head yield to mercury after resisting for a long
time antiphlogistic treatment and other means. Common observa¬
tion has established the fact, that the free exhibition of calomel,
after direct depletion, is of great advantage in inflammations gene-

Mr. Lawrence on the Venereal Diseases of the Dye, 281

rally ; and recent experience lias shewn that this plan is particularly
beneficial in inflammations of the serous membranes, especially the
pericardium, pleura, and peritoneum. In these, as well as in croup,
where the power of the remedy has long been recognised, the effu¬
sions of lymph form a striking analogy to the case of iritis. I have
lately used mercury with most decided success in an extensive
phlegmonous inflammation of the thigh, where it prevented sup¬
puration ; and in a more chronic inflammatory affection of the
integument and cellular tissue at the back of the neck, very similar
to that of carbuncle. The inflammation, swelling, and induration
in the latter case, slowly increased, in spite of the free use of leeches
with other suitable antiphlogistic treatment, until mercury was used,
and they regularly gave way to the influence of that remedy. A
further evidence of its general antiphlogistic power, is afforded by
the common belief, founded on experience, of its utility when
administered for a long time as an alternative in various chronic
enlargements. Hence we may conclude that the utility of mercury
in inflammation of the iris does not depend on its possessing any
specific power over that texture ; and we shall be disposed to concur
with Dr. Hamilton, of Lynn, w ho first recommended its employ¬
ment in inflammations, as now practised, in ascribing to it a
general power of arresting inflammatory disturbance.” — p. 201.

Another remedy has been proposed for the cure of iritis, by
Mr. Hugh Carmichael, of Dublin, in cases which mercury
is inadmissible, in consequence of its occasional injurious in¬
fluence, or of the debility produced by protracted disease.
The following is the formula recommended : — IV. olei tere¬
binth. rectif. 5j. vitellum ovi. unius ; tere simul et adde
gradatim, emulsionis amygdalarum %iv. syrupi corticis au-
rantii 5ij. sp. lavend. comp. jiv. olei cinnamomi. m. iij. su-
mat cochlearia duo larga ter die.* Mr. L. has no expe¬
rience of this remedy, but it has been tried by Mr. Guthrie
in some cases with success, and in others without benefit.
The reader will find an account of the efficacy of the re¬
medy published in the last volume of this Journal, by
Dr. Tuthill, Mr. Foote, and also in our August nunjber,
all of which evidence was afforded by the practice of
Mr. Guthrie, at the Royal Westminster Ophthalmic Infir¬
mary. Such are the chief points in the chapter on iritis,
and these are supported by details of thirty-nine cases, which
occupy one hundred pages of the volume. The last chap¬
ter is on f<r syphilitic ulceration of the eyelids,” illustrated

* Observations on the Efficacy of Turpentine in the Venereal and other deep-
seated inflammations of the Eye, with some remarks on the influence of that
medicine on the system, accompanied by cases. 8vo. Dublin , 1829.

Vol. v. no. 28.

N N

2-S2 ( ri.fi teal Re cine.

by eases, the substance of which is, that the disease may
be easily mistaken for common ulceration.

We have now arrived at the end of our labour, and have
endeavoured to place the substance of this volume before
our readers. If they find nothing novel in it, we cannot
possibly help it. We must persist, in our former statement,
that the author’s lectures contain the principal part of this
work; in fact, the number of either of our hebdomadal
contemporaries, which contains his lectures on diseases of
the eye, contains infinitely more useful and varied matter
than the goodly 8vo. before us. We must further observe,
that the narration of sixty-eight cases, illustrative of three
diseases, gonorrhoeal ophthalmia syphilitic iritis, and sy¬
philitic ulceration of the eyelids, was an unnecessary
detail, and by no means complimentary to the under¬
standing of the profession. The author is undoubtedly one
from whom a great variety of information might be ex¬
pected, in 337 pages of octavo. His fame, however, will
insure the work some circulation ; and it will be lauded iu
the strongest terms by some of our contemporaries. It
would be a valuable production if its contents were not
already before the profession. It is painful to us to speak
in these terms of a work emanating from so eminent an
author, but truth, candour, and impartiality compel us to
do so.

III. — Practical Observations on Leucorrhcea, Fluor Albas
- or Weakness , with cases illustrative of a new mode of
treatment. By G. Jewel, Member of the Royal College of
Surgeons, one of the Accoucheurs to the St. George’s
and St. James’s Dispensary, Lecturer on Midwifery, &c.
8vo. pp. 108. London, 1830. John Wilson.

The object of this work is to direct the attention of the
profession to the pathology of leucorrhcea, which our au¬
thor believes has not been well understood. He says he
has taken a new view of the subject, and proposes a new
mode of treatment. He has avoided the description of ex¬
tensive structural charges or displacement of parts, and con¬
fined himself to the elucidation of functional disorder, though
he thinks the line of demarcation between disorder of
function and disorganization of structure, scarcely appre¬
ciable. But we must remark, on this part of the preface,
that the author has not confined himself to the description
of functional disorder only, but embraced inflammation,
excoriation, tumours> &e. He recommends the use of
nitrate of silver in strong terms for the cure of leucorrhcea,

Mr. Jewel on LeucorrJuxa, §’c.

283

and very properly observes, that time and experience must
determine its efficacy in the hands of others. The only
caution, we must premise, upon this point is, that the re¬
commendation of the remedy is too general, that the form
of disease in which it may be useful, is not sufficiently
defined, and that its indiscriminate use in the various stages
of inflammation and ulceration, which cause various forms
of leucorrhcea, would be, in our opinion, not only question¬
able but injurious practice.

Mr. Jewel commences with his views on the pathology
of leucorrhoea, which differ in no respect from those gene¬
rally received. He alludes to the sympathy of the uterine
apparatus with the various organs of the body, but does not
illustrate this point so well as he might have done. He
details the opinions of Drs. Clarke, Burns, Pinel, Dewees,
Gardien, and Cullen, which need not be stated, as they
are kuown to every one, aiid exist in most of the works on
obstetrics. He also refers to the opinions of Drs. Hamilton,
Gooch, Marshall Hall, and Addison, which are likewise
generally known. He details some cases illustrative of his
treatment, an example of which we shall insert. He informs
us, that in all cases of profuse leucorrhoea, there is ten¬
derness of the cervix uteri, and that many such cases are mis¬
taken for seirrhus. He dwells upon the irritable uterus, so
ably described by Gooch. We shall insert a few of his cases,
and offer some remarks upon them.

“ Case I. — S. J., setat 49, residing in Bridle Lane, a patient
under my care at the St. George’s and St. James’s Dispensary, on
the 10th of June. She is the mother of fourteen children, exclu¬
sive of two abortions, and has, during the last twelve months, been
subject to profuse catamenia, and excessive leucorrhoeal discharge of
a yellowish colour. She has pain in the loins, shooting in pa¬
roxysms through the region of the uterus, in which there is also a
sense of fulness, and throbbing. She complains of great languor,
.with loss of appetite, and uneasiness, at the pit of the stomach*
She is frequently attacked with the globus hystericus, and disturb¬
ance about the head, and says that a flow of tears affords her much
relief. Pulse 85. Bowels confined.

“ Ten ounces of blood to be abstracted from over the sacrum by
cupping.

IJr Magnes. Sulph. 5xi.

Infus Rosse. ^viiss.

Acid. Sulph. dil 5b— M. ft. Mist, cujus sumantur
Cochlearia duo vel tria ampla, mane, quotidie.

Ik Argent. Nitrat. gr. xii.

Aq. distill. 5vi. — M. ft. Injectio.

" 14th. During a period of twenty-four hours after the cupping,
she felt extremely faint and sick, and now complains of increased

. .viO

ub-’"’

284

Critical Review.

languor. Says she has used the injection regularly, notwithstanding
the presence of the catamenia, and that it occasioned no degree of
pain, except a little smarting, the parts having been for some time
in an irritable state.

“ To omit the aperient medicine.

“ The strength of the injection to be increased from grs. ij. to
grs. iv. to the ounce of water ; and to take a pill, containing five
grains of the extract of hyoscyamus and half a grain of opium, at
bed time.

“ 18th. The sanguineous discharge has ceased, having con¬
tinued only a week, its usual period being from ten days to a fort¬
night. The leucorrhoeal fluid has become “ white and thinner than
it has been for several months.” The local pains are greatly re¬
lieved, but she still complains of occasional heat and throbbing
about the womb.

“ To continue the injection.

22nd. The leucorrhcea has ceased, and the local heat and
pains have almost left her. There is still great languor, and loss
of appetite.

fy. Infus. Rosa?, 3viiss.

Sulph. Quinin. 9i.

Tinct. Card. Comp. 3ss. — M. ft. Mist, cujus

sumantur Cochlearia duo arnpla ter die.

“ To continue the injection.

“ 26th. The vaginal discharge has not re-appeared. Her spirits
are better, and the appetite improves.

“ Continuentur remedia.

“ 30th. There is no leucorrhoea. Her general health continues to
improve, and she intends to go into the country in the course of a
few days. Discharged cured.” — p. 21.

There was no vaginal examination made in this case, and
consequently no correct idea can be formed of the morbid
condition vvhich gave rise to the disease. Besides, injec¬
tions of the liquor aluminis compositus, would have effected
a cure as readily as the remedy employed. The fact is,
that alum injections, varied in strength, according to the
pathological condition of the vagina and cervix uteri, will
cure leucorrhcea in nine cases out of ten, and that in a few
days after the patient had been under the tonic and con¬
stitutional plan for months or years. We have described
this mode of treatment at length elsewhere,* and in a single
chapter, have embodied a much more extensive account of
the various forms of the disease, than there is in the pro¬
fessed treatise on the subject before us. That there are

* See Manual of Midwifery.

Mr. Jewel bn Leucorrhoea, §c. 285

cases of morbid sensibility of the vagina, accompanied by
leucorrhoea, which defy the usual injections, is a fact known
to every practitioner of ordinary observation, and in such
cases we agree with the author, that the nitrate of silver is
a valuable remedy ; but that it ought to be employed in
every case of leucorrhoea, whether dependent on slight in¬
flammation, congestion, or ulceration, is a practice to which
we cannot give our assent.

Our author makes the following judicious remarks on
the diagnosis, between tenderness of the cervix uteri and
scirrhus, which deserves attention : —

“ This inflammation of the cervix uteri, like scirrhus, or any
organic disease of the uterine system, attacks occasionally at the
period of life when the catamenia are about to cease, but I have
more frequently found it to exist in married females, from the age
of twenty-six or twenty-seven to that of forty, and I have recently
seen several cases occurring in young married females, within three
months after the birth of the first child. The local symptoms in
both diseases, are very nearly allied. There will be occasional lanci¬
nating pains through the region of the uterus, with a constant dull
kind of pain about the inferior portion of the sacrum, the hip or
groin, attended by an irritable bladder, or frequent desire to void the
urine, and in some severe instances, by tenesmus, and pain within
the vagina when in the sitting posture. The vaginal discharge is
commonly of a milky or cream-like colour, now and then having
a glutinous consistence ; and is often, in the more acute cases,
mixed with a dark coloured or grumous secretion. Menstruation,
if not interrupted by lactation, may be resumed with its usual
regularity, although, after a time, some deviation takes place : gene¬
rally, in the first instance, by its continuing several days beyond
the accustomed period. 1 have remarked that, although the local
pains are not unfrequently increased in severity at the commence¬
ment of menstruation, a great relief is afforded as soon as the
catamenial secretion becomes more abundant. Upon making an
examination per vaginam in this disease, the os uteri will not be
found open to the same extent as in scirrhus, (an exception may
be made in the case of a woman who has had a numerous family,)
nor will its margin present the same cartilaginous hardness to the
touch. The pain does not appear to be situated in the edges of
the os uteri, as described by some authors, but in the cervix, as
pressure upon this part alone occasions the patient to complain.
The uterus will be found projecting lower in the vagina than
natural, but this will depend upon the nature of the disease ; the
more acute, ' the further it will have descended. It should be
recollected, that prolapsus uteri is a very common effect of pro¬
tracted leucorrhoea, when, in addition to the symptoms already
enumerated, there will be fulness about the pudendum, or weight
on the perinaeum, and a dragging sensation about the loins, with

286

Critical Review.

difficulty in voiding tlie urine, and sometimes extreme pain in coitn,
w hilst the discharge will be frequently tinged with blood. These
symptoms become modified or severe, according to the degree of
descent which has taken place, or the excitability which exists in
other and distant organs ; hence, in a case of simple relaxation,
there will oftentimes be merely a sensation of weakness, and ful¬
ness about the pubes, with an increased, but mild, mucous dis¬
charge from the vagina „ I have seen several cases of prolapsus
uteri, in their incipient state, most effectually relieved by the ap¬
plication of the means hereafter named.

“ But even supposing that no diagnostic marks existed, to guide
the judgment of the young practitioner, in distinguishing between
chronic inflammation and incipient scirrhus of the cervix uteri,
two questions will arise, to which no very decisive answers can be
given. Is it not possible for inflammation, in its ordinary form, to
terminate in carcinoma, or, to say the least of it, in disorganization ?
If the disease is confirmed scirrhus, may it not be arrested in its
progress, if not entirely removed ? I would reply to the last ques¬
tion, by observing, that I have seen more than one case, where a
morbid affection of the cervix uteri had been pronounced by emi¬
nent practitioners to be carcinoma, but in which the disease had
been afterwards totally eradicated, the uterus again taking on its
healthy functions, and the woman bearing children as before.” —
p. 29.

*

The following’ case affords a fair illustration of our
author’s practice, and deserves attention : —

“ Case II. — Mrs. C., setat 33, called on me, on the 24th of
February, 1829, at the request of a medical friend, Mr. Reid, of
Charlotte Street, Bloomsbury. She had been delivered three years
before of a healthy child, after an easy labour. For the last two
years and a half she has been subject to constant and profuse
leucorrhceal discharge, with frequent and shooting pains through
the region of the uterus, and about the right groin, with occasional
dysuria and tenesmus. The general health is greatly disturbed ;
bowels irregular, with loss of appetite. Upon making an examina¬
tion per vaginam, pressure of the finger upon the cervix uteri
occasioned considerable pain, which, in subsequent examinations,
often continued several minutes after the finger had been withdrawn.
The os uteri was considerably more open than natural, but its
margin was not indurated. She had been under the care of several
respectable practitioners, and the impression on her mind was that
she was labouring under cancer of the womb.

c‘ In the first instance, the usual mode of treatment was adopted.;
blood was abstracted by means of cupping from over the inferior
portion of the sacrum, to the amount of eight ounces, and repeated
•three times, with an interval between each of about three weeks.
She had taken aperients frequently, and injections of various kinds
had been used with little or no benefit.

Mr. Jewel on Lencorrhoea, §c.

“ July 2d. The nitrate of silver was conveyed by means of a
tube, and applied to the cervix uteri for the space of a minute,
which occasioned no degree of pain, except what might have been
produced by the introduction of the finger.

6th. The nitrate of silver again applied as before.

“ 9th. The discharge has diminished, but the pains not having
abated, eight leeches were ordered to be applied to the right groin.

“ 12th. The nitrate of silver again applied.

" 18th. The discharge is lessened considerably ; and the patient
now expresses a belief that she shall soon be restored to health,
having previously imagined her case to be hopeless. The nitrate of
silver again applied.

“ 27 th. The pain is relieved; her general health is improved, and
she sleeps well at night. The nitrate of silver applied in the usual
manner. It is necessary to observe, that she has taken the hyos-
cyamus at night, (one drachm of the tincture,) and the bowels have
been regulated by aperients. The following tonic has been pre¬
scribed :~

Infus. Rosse, 3viiss.

Sulph. Quininse, 5SS*

Elix. Vitriol. 5i- — M. fiat. Mist, sumantur
Cochlearia duo ampla ter die.

“ August 8th. The discharge is scarcely perceivable. The nitrate
of silver applied as before.

“ 25th. The patient is perfectly well, having neither vaginal
discharge nor local pains.” — p. 32.

Our author next adverts to the opinions of Drs. Denman
and C. Clarke, on the treatment of cancer, which warrant
the conclusion that incipient seirrhus uteri may be arrested,
if not cured, by antiphlogistic measures. He thinks it a
dangerous and unscientific doctrine, to suppose that cancer
exists throughout the system, and that when eradicated
from one part, it may appear in another, as it puts a stop
to all pathological inquiry, and leads to palliative and in¬
efficient treatment. We cannot agree with him upon this
point, as the records of medicine afford ample evidence of
the negative, and of the recurrence of cancer after the best
performed operation.

The causes of leucorrhcea are next described, and very
accurately enumerated, and some good hints are given on
its pathology. Thus in twenty-four necrotomic inspections,
by Blattin, the secretion proceeded from the uterus in nine
cases; from the cervix uteri and vagina in thirteen cases,
and in two from the uterine tubes. From this statement,
it is manifest that the nitrate of silver, or any other remedy,
is not. applicable in all forms of the disease. In some in¬
stances a mucous discharge is said to arise from excoria-

288

Critical Review.

tions about the nymphae, and here our author recommends
his remedy as the most efficient. He next gives a good
account of leucorrhcea in children — in pregnant women, and
at the turn of life, and notices the colour and consistence
of vaginal discharges. He details the opinions of C. Clarke
and Dewees upon this subject, which are universally known ;
and describes the predisposing and exciting causes of leu-
corrhoea, among which he properly includes the influence of
seasons, of contaminated air, of epidemicis, hereditary pre¬
disposition, metastasis, irritation from ascarides and leu-
corrhoea of habit. Lastly, he describes the treatment, and
notices the opinions of many of the best modern writers.
It must be unnecessary to trouble the reader with an ac¬
count of treatment usually employed in this disease. But
we refer him with pleasure to the author’s testimony in
favour of iodine, in induration of the uterus and ovaries.
In almost all cases he has found its effects (( marked and
decisive.” He says,

“ I may here notice a case of diseased ovary, in which this little,
but important, organ had morbidly increased to the size of the
foetal head. The general and visceral disturbance occasioned by its
presence in the pelvic cavity, had become so distressing, that the
patient, notwithstanding the fatality of an operation had been re¬
presented to her, often expressed an earnest desire to have it
removed. After various means had been employed, without any
beneficial result, she was put upon a course of iodine, commencing
with ten drops of the tincture three times a day, gradually increasing
the dose to thirty-five. She has been under the influence of this
medicine about ten weeks, and at the present time, the tumour is
scarcely to be felt. She has suffered nothing from such large doses
of the medicine, but, on the contrary, her spirits are greatly im¬
proved, and she anticipates, with great confidence, a perfect resto¬
ration to health. Dr. Thomson, the able professor of materia
medica at the London University, has related a case of ovarian
dropsy, in which, after the woman had been tapped in the usual
manner, and seven quarts of albuminous serum, mixed with pus,
removed, iodine was administered, and carried to the extent of
thirty-six drops of the tincture three times a day. The result was,
that the tumour wholly disappeared, and the woman was perfectly
restored.

“ Dr. Coindet has said, that the iodine acts in a particular man¬
ner on the uterine system in deficient menstruation.

<f In the Transactions of the Licentiates of the King and Queen’s
College of Physicians in Ireland, there is a paper by Dr. Thetford,
in which he describes the complete success which attended the use
of iodine, in an indurated enlargement of the uterus. The os uteri
projected nearly to the labia, the uterus itself having become of
osseous hardness, and so large as nearly to fill the pelvic cavity.

Mr. Jewel on Leucorrhoea , Sfc. 289

Mercurial alteratives had been tried without success. The tincture
of iodine was then administered, beginning with' seven drops three
times . a day, in a wine glass of water, the dose being gradually
increased to ten. Progressive absorption of the diseased substance
of the uterus rapidly took place, and the catamenia were regularly
restored: The iodine had been continued six weeks. It can scarcely
be necessary for me to remark, as the subject has been so often
alluded to by others, that the effects of iodine upon the system
should be carefully watched, inasmuch as when the constitution of
the patient is delicate or irritable, or where an idiosyncrasy exists,
its exhibition, even in small doses, is occasionally followed by
symptoms of a peculiarly distressing kind, such as palpitation of
the heart, and other nervous feelings, vertigo, sickness, &c. when,
at least, a temporary cessation of the medicine will become neces¬
sary. ” — p. 81.

Mr. Jewel next describes the effects of nitrate of silver.
He considers its efficacy is to be ascribed to its producing
a new action or excitement in the part from which the secre¬
tion has its origin. There cannot be a question of the
validity of this reasoning, but it is equally clear that the
remedy cannot be applied to diseased surfaces in many
cases. The truth of this observation must be admitted by
every practical man, for the reasons already assigned, and
for those afforded by the author’s description of the manner
of applying the remedy, which is as follows : —

*

“ The mode I have adopted in the application of this agent,
has been either to conceal it in a silver tube, as it is employed in
cases of stricture, (except that the tube should be adapted to the size
of the argent, nitrat.) or in the form of solution, in the proportion
generally of three grains to the ounce of distilled water, the strength
being gradually increased. A piece of soft lint may be moistened
with the solution, and introduced, for a short period, into the vagina
several times in the day ; or a bit of sponge, firmly and neatly tied
to the end of a slip of whalebone, may be passed into the vagina,
up to the os and cervix uteri, well saturated with the solution. This
can easily be effected by the patient herself. It is necessary that
the application should be frequently repeated, or no permanent
benefit can be expected. Should it become requisite to employ a
strong solution, and to apply it to a certain part, or ulcerated sur¬
face, it can be accomplished with a degree of nicety, by means of a
camel’s hair brush, introduced through the speculum, or dilator.
This, however, can only be done in the absence of excoriations, or
tenderness, as the introduction even of a common syringe, some¬
times produces a considerable degree of pain and irritation ; inde¬
pendently of which, some females will not submit to the introduc¬
tion of any instrument. In married women, there is not the least
difficulty in using the dilator, neither does its introduction, under
common circumstances, occasion any degree of pain. By means of

Vol. v. no. 28.

o o

290

Critical Review.

this instrument, the condition of the cervix uteri and vagina can be
readily ascertained.

“ A few remarks upon the use and choice of the syringe, when
injections are employed, will not, I trust, be considered a digression.
It must be obvious, that if the act of throwing in the injection be
attended by any muscular effort, the injected fluid cannot reach its
destined point, namely, the neck of the womb, and upper part of
the vagina. In using the common straight syringe, a degree of
bodily exertion cannot be avoided, whatever may be the position of
the patient, and consequently the operation must prove very ineffi¬
cient, if not altogether useless. The pipe of the syringe ought to
be curved, so that when introduced, its point may come in imme¬
diate apposition to the os uteri, and the patient should place herself
in the recumbent posture, in which position she should remain at
least several minutes after the syringe has been withdrawn. The
principal advantage in injecting the fluid is, that if any superficial
ulcerations exist, they will be readily healed.

“ It is very satisfactory to observe, that the nitrate of silver,
when judiciously used in either of the forms above recommended,
gives no pain nor irritation, at least no more than is occasionally
produced by the injection of any common astringent.” — p. 85.

Our author details a few cases in which the remedy was
successful, and then endeavours to form a diagnosis between
leucorrhoea and gonorrhoea. He notices the latter disease,
as the remedy te is, in almost every instance, th^ most cer¬
tain in effecting a cure.” The severity of symptoms in
gonorrhoea, is the diagnostic mark of the disease. The
nitrate is to be used as in leucorrhoea.

Such are the peculiar opinions of Mr. Jewel on leu¬
corrhoea. His work, though by no means as perfect as it
might be, will be perused by young practitioners with ad¬
vantage. It contains much valuable information, and de¬
serves a place in the library of every man engaged in ob¬
stetric practice. Had the author described the different
species of leucorrhoea, as laid down in the works of Hamil¬
ton, Burns, C. Clark, Dewees, and many other writers, and
considered their pathology, he could not have arrived at
the conclusion, that nitrate of silver is a certain cure for
so many morbid conditions as induce the disease in question.
He should also have given a correct diagnosis, and ought
not to recommend a single remedy as a specific, for the
different degrees of diseased action, which produce the nu¬
merous discharges generally comprehended under the term
elucorrhcea, both by the profession and their patients. —
Should he adopt these suggestions in another edition, his
work will be considered one of reference and authority.

[ 291

IVr — Two Memoirs read before V Acad emie Roy ale des
Science, at Paris, on the successful Inhalation of Di¬
luted Chlorine, in the early stages of Pulmonary Con¬
sumption. Translated from the French of M. Gannal.
By William Horatio Potter, M.R.I. Operative Che¬
mist. 8vo. pp. 90. London, 1830. Callow and Wilson.

V. — A Treatise on Pulmonary Consumption : its Preven¬
tion and Remedy. By John Murray, F.S.A. F.L.S. &c.
pp. 156. London. Whittaker and Co.

The works before us are offered to the profession by two
operative chemists, as containing- an account of a certain
cure for consumption. The authors ought to have recol¬
lected the slender pretensions they must possess to instruct
medical men in the cure of disease. Their zeal in the cause
of humanity has induced them to overstep the boundaries
of discretion ; and common sense ought to have restrained
them from obtruding their opinions with too much confi¬
dence upon the faculty. The first work merits attention, as
it is a translation of the production of a French physi¬
cian ; the second has no claims to consideration, as its ten¬
dency and object are intended to inform medical men, not
only of a cure for consumption, but for divers other dis¬
eases, by one remedy ; in fact, it must be considered em¬
pirical, as will appear by the sequel. The original of the
first work was read before the Royal Academy of Medicine
in Paris, in 1827, and made a deep impression upon that
learned body. The doctrine it proposes is scientific, and
of course worthy of notice. It affords some evidence in
proof of the value of chlorine gas in pulmonary consump¬
tion. Its author delivers the result of his experience with
candour and modesty, and with the greatest deference to
the opinion of the profession. He is not an enthusiast,
but a faithful observer ; while Mr. Murray advances his
opinion with as much dogmatism as even Paracelsus him¬
self. The sect of chemical physicians has long since ceased
to exist, but we are occasionally favoured with the conjec¬
tures of operative chemists on the cure of diseases. We
are ready to grant that much good has resulted from
modern chemistry, by exposing the incompatibility of cer¬
tain medicines when combined in prescriptions ; but we
ought to recollect that we are perfectly ignorant of the
numerous changes which the most chemical formula must
undergo in the human body. It is therefore obvious, that

292

Critical Review.

chemists ought to be more reserved and cautious, in speak¬
ing too dogmatically upon the effects of remedies. We
need only refer to the records of medicine in proof of our

assertion.

It is now generally admitted that there is scarcely any
medicine, when taken into the stomach, which has a direct
action on the lungs, and hence the fatality of the diseases
of these organs. Even the direct application of medicinal
agents to the mucous membrane of the lungs, can have
little effect upon the various disorganizations of the organs
themselves. If proof were required of this opinion, it is
amply afforded by the failure of inhalation of the various
gases, factitious airs, fumigations from pitch, tar, oil, oak
bark, arsenic, sulphur, muriatic acid gas, &c. A late writer
accounts for this want of success, by maintaining that
the gases were inhaled in a dry state, for dry or anhydrous
air only irritates, and parches the minute ramified membra¬
neous tubes, of which the bulk of the lungs is composed,
and that the tissues are not pervious to the natural progress
of oxyg’enation, unless they are moist and the gases hu¬
mid.” Such is the opinion of Dr. Murray, of Belfast, in
his excellent work on the Influence of Heat and Humidity,
with observations on the inhalation of iodine, and various
vapours in the cure of pulmonic complaints. This opinion
is further confirmed by the testimony of M. Gannal, who
maintains that chlorine gas must be humid to ensure its
effects. Thus Mr. Potter observes in his preface —

“ Among the numerous publications of various pretensions to the
public favour, which are daily presented to the medical world, — few
or none contemplate the direct application of remedial agents to
ulcerated lungs. To fill up this chasm in medical literature is the
object of the present memoirs ; they prove in an incontestible man¬
ner that Chlorine gas, diluted with a large proportion of common air,
and softened further by its combination with aqueous vapor, is a
powerful therapeutic means of cicatrizing ulcers of the lungs, where
they exist, and of preventing their formation when a predisposition is
indicated. And even where the system has already succumbed to the
baneful influence of this disease, which causes so many thousands,
in this country especially, to become early tenants of the tomb, even
in these cases where, by the presence of all the fatal symptoms recog¬
nised by the practitioner, as indicating if not a speedj^, at least a cer¬
tain dissolution, the effect of this agent has been evidently to pro¬
long life and palliate suffering : and, in some few instances, has
effected an absolute and permanent cure. Such is the combined
testimony of several eminent and scientific Frenchmen, and it remains
for the sounder and more steady judgment of the English experi¬
mentalist, to ascertain the extent of its claim to public credence.” —
Preface.

Mr. Potter on Cure of Consumption .

293

The following reasons have induced M. Gannal to direct
his attention to the employment of inhalation of gases : —

“ Two modes of treatment have been adopted by physicians to
ward off the terrible incursions of pulmonary consumption ; the first
we may denominate indirect or revulsive, and it consists either in the
external application of topical stimulants upon the principle of coun¬
ter-irritation, and thus opposing the internal inflammation by onex
created artificially upon the surface, of sufficient energy to effect a
cure, or in administering by the mouth certain medicines capable of
reducing the too great intensity of vital action, and thus procuring
relief.

“ These modes are generally united in practice, but such is their
inefficiency, that they seldom do more than arrest the progress of a
disorder, which, when once fully developed, as manifested by the
hectic fever and diarrhoea, is considered incurable by the majority of
practitioners. Convinced of the insufficiency of either external or
internal remedies, physicians have at different times, demanded of
chemical science, some gaseous substance, which being blended with
the air and carried with it to the lungs, might by direct contact sooth
the irritation of the organ, modify the secreting power of its mucous
membrane, or cicatrise existing ulceration.

“ Great expectations were elicited by the employment of this
novel and direct mode of treating phthisis ; aqueous vapours pro¬
duced either from water alone, or certain mucilaginous decoctions,
the vapour of tar, of sea- weed, and various other substances were
employed, and were at first found useful in slight cases, but their
success in cases of longer standing, where inflammation had already
made considerable progress, was unsatisfactory and doubtful;

“ Towards the close of the last century, that brilliant epoch, when
modern chemistry preceded that revolution which raised it to the
foremost rank among the useful sciences ; at this epoch, I repeat,
the theory of Lavoisier respecting inspiration, and the important con¬
siderations which flow from it, relative to the influence of oxygen
gas upon the animal functions, caused many to imagine that this gas
might prove beneficial to consumptive patients. Various experiments
were made to this end between the years 1781 and 1790, the results
were at first encouraging ; the dyspnoea was relieved, pain was lulled,
the expectoration was gradually diminished, the cough was eased,
and every one now thought that a cure was at hand. But this happy
state of things was not of long duration, fifteen days after these first
effects of vital air, acute symptoms of excitement showed themselves
in the lungs, blood was brought up in the sputa, the fever increased,
the colour became more lively, the heat greater ; thus it was found
necessary again to recur to antiphlogistics, and the disease which
seemed checked, now resumed its course, and proceeded with greater
rapidity towards its fatal termination than before the gas was ex¬
hibited. Fourcroy, at once a witness and relator of these facts,
declared that oxygen gas was far from being a remedy applicable to
phthisis, as had been imagined. This check suspended further expe-

294

Critical Review.

rimental inquiry, and crushed that enthusiasm which had already
taken possession of the minds of many.” — p. 12.

The efficacy of chlorides on ulcerated surfaces, and in
arresting mucous discharges from the vagina, afforded
analogy, that it might produce the same happy effects in
ulcers and increased mucous secretions, which, for the most
part, constitute consumption. Accident proved this to be
the fact.

“ Being, in the year 1817, attached to a manufactory of St. Denis,
I observed that those workmen who happened to be affected with
phthisical symptoms experienced relief, and quickly recovered their
health, while exposed to the exhalations of the chlorine disengaged in
the various processes. I communicated this fact first to Dr. Bourgeois,
then to the celebrated Laennec himself, who, in the year 1823, after
my communication, made some trials with the chlorine fumigations,
at the Hopital de la Charite at Paris, which however were not fol¬
lowed up. M. Laennec made use of the solution of the chloride of
lime sprinkled about the room of the sick, and also upon some sea¬
weed with which the floor was previously covered. This mixture,
although it was not possible to say to which substance should be
ascribed the effect produced, gave favourable results, but not suffici-
ciently decisive to occasion them to be continued.

“ Since this period I have had occasion several times again to be
a witness to the good effects of chlorine, in pulmonary complaints.
In Sept, last, in consequence of a letter inserted in the journals, the
object of which was to claim the priority of applying this agent, I
was invited by several physicians to exhibit it to their patients.” —

p. 16.

Dr. Murray has attested this fact, in his observations on
the bleaching manufactories, near Belfast. Dr. Sanders, of
Edinburgh, had long since recommended the fumes of mu¬
riatic acid gas and of ether, in pulmonary ulcerations of
depraved condition. This plan could not succeed, as it
produced too much irritation ; and it is proved beyond all
doubt, by the author before us, that chlorine gas must
be pure and diluted to be useful.

“ Though I will not at this time venture to speak positively on
this point, I think that the chlorine disengaged from the chloruretted
oxides (potass, soda, and lime) is contaminated with some particles
of a foreign nature, which affect its purity when it is immediately
applied to the delicate organs of respiration. This statement is ren¬
dered more probable by considering what follows : — I caused some of
my patients to respire chlorine evolved from a chloruretted oxide, but
at the third fumigation they experienced a lively sensation of warmth
in the chest, constriction of the throat, thirst, and all the signs apper¬
taining to a powerful stimulus, which made me quickly desist.

“ Chlorine then, as produced from its combination with oxides, is

*295

Mr. Potter on the Cure of Consumption .

not of sufficient purity to warrant our applying it to the delicate and
already irritated organs of the phthisical patient.

“ To remedy this inconvenience, I make use of a solution of the
pure gas in distilled water. I take a three-necked bottle, the first
opening receives a straight tube, the extremity being plunged into
about four ounces of water ; the second opening has a tube, which
leaving the top of the bottle is bent at right angles, and terminates
in a flattened embouchure ; the third is furnished with a glass stop¬
per : it is by this last opening that the water is changed, and the gas
introduced. The water in the bottle at the time of fumigation
should be at the temperature of about 32° of the centigrade thermo¬
meter equal to 89° 6’ of Fahreinheit’s scale ; a certain quantity of
liquid chlorine is then added ; and by gently shaldng the bottle, a por¬
tion of the gas is disengaged, which may be breathed by applying
the mouth to the extremity of the bent tube. As the air is gradually
withdrawn from the bottle, a fresh quantity is supplied from the atmos¬
phere by the straight tube, bubbles up through the weak chlorine
solution charged with the gas. The fumigation may be continued
for the space of four or six minutes, after which the disengagement
of gas ceases.*

It is of the utmost importance, that we proceed with the greatest
caution, being guided by the consideration of the energetic nature of
the means employed, as also of the delicate fabric of the organ con¬
cerned. In my practice I commence with ten drops of the liquid
chlorine to two volumes ; if the patient can well bear this dose, and
according to the susceptibility of his lungs, I raise it gradually to
12, 15, 20, 30, 50, 60, 72 at a time. However, there are scarcely
two persons who can bear exactly the same doses ; We must there¬
fore, as it were, carefully explore the state of the organ to be acted
upon, and from thence deduce the proper quantity.

“ The same reasoning holds good as regards the number of fumi¬
gations, during the twenty-four hours. They must be regulated by
the effect produced, and the sensibility of the parts, generally the
number may be from six to eight. It appears evident according to
the above process, that the chlorine inhaled cannot enter the lungs
unless impregnated with a number of aqueous particles ; from which
circumstance it is much less irritating than in the dry state ; and
lastly, not being commixed with any foreign matter, its action con¬
fined to itself is not complicated with any superadded irritation.

“ We may also just observe that the apparatus required for its
exhibition, is simple, easily obtained, and moreover portable, and
being made entirely of glass, the chlorine cannot possibly become
comtaminated with metallic molecules, and thus interfere with its
purity ; it cannot for example act upon the copper, convert into
a chlorine, and in this state painfully affect the lungs, or as there
have been some instances, cause extensive inflammations.” — p. 23.

The author concludes his first memoir with these re¬
marks —

* The apparatus may be procured at 11, Old Compton Street,

296

Critical Review.

“ Inspiring the gas in its pure state is certainly better than in¬
haling it, as produced from the chloruretted oxides, or when con¬
ducted through metallic tubes to the organs of respiration.

“ Lastly, it is to be observed, that by the influence of chlorine,
all the patients breathed freer, dilated the chest more easily, that
they felt a pleasant sensation while inhaling the gas in a remarkable
manner, and that their appetite returned, and often so as to render
it necessary to increase the quantity of food allowed them. All
these facts indicate a diminution of pulmonary irritation, and an
increase of energy communicated to all the vital powers.

“ It follows, therefore, from what has been premised, —

“ 1st. That in no case has the inspiration of chlorine proved
hurtful or troublesome.

“ 2nd. That in cases where the disease had made considerable
way towards its consummation, and was therefore incurable, it
afforded relief and prolonged life.

“ 3dly. That in cases where other medicinal aids were of no
avail, it succeeded in effecting a cure after a shorter or longer in¬
terval and that from all these considerations, it is one of the most
efficient means that medical art can oppose to tubercular phthisis.” —
p. 34.

The second memoir consists of details of cases,, in which
the chlorine afforded great relief, and in some instances
produced a complete cure. The following cases are the
most remarkable : —

“ Madame Mitteau, 25 years of age, short, and of a delicate con¬
stitution, experienced, in consequence of a shock occasioned (April,
1827) by a sudden announcement of bad news, a violent degree of
oppression, attended by difficult respiration. Having consulted a
physician, she was bled in the right arm ; in the evening, 25 leeches
were applied, part to the anus, and part to the right side of the lower
belly ; refreshing drinks were prescribed with a low diet, or at least
very little aliment was allowed for several days. This treatment
produced great relief, and for a month the patient was tolerably well ;
however, every now and then she felt a pricking at the upper part of
the right shoulder.

“ At the end of a month, this pricking sensation became a sharp
and lasting pain, which was not referred to the posterior part of the
thorax alone. The whole of the right lung had become painful, and
the upper part seemed particularly to be the seat of disease. Ma¬
dame Mitteau had a cough, which from being at first dry and seldom,
was now frequent and accompanied with purulent expectorations ;
leeches were applied to the sternum, which produced some benefit.
Thus matters went on until November, at which time the expectora¬
tion became more abundant. Inflammation attacked the abdomen,
and the patient made water with difficulty, which was attended, for
the space of two months, with violent pains ; the menses were sup¬
pressed, and Madame Mitteau’s health was much on the decline till
the end of the winter. Dr. Honlet, who attended her for three

Mr. Murray on the Cure of Consumption . 297

months, invited me to see her ; she was at this time excessively thin
and weak ; her appetite was gone ; her sleep short and restless. A
febrile paroxysm was observed every evening, with frequent colic and
diarrhoea. The left side of the chest indicated a healthy state, but
the upper part of the right side had a dull sound, which was con¬
tinued to the upper third part. In the centre was heard a mucous
rattle with wheezing. The expectoration was surprisingly abundant,
very thick, and of a most repulsive odour. It was in this state that,
on the 28th of March, I commenced the fumigations.

“ During the first eight days no change was perceived, but to-
- wards the 18th of April she felt stronger ; her rest was also more
tranquil ; the skin became firmer ; the chest freer, and the appetite
returned. The relief appeared wonderful. The patient coughed
less from the early part of May, at which time she was so far re¬
covered as to be able to walk on the boulevards.

“ Early in June the expectorated matter had lost its bad smell, be¬
came mucous and less abundant. The strength was so far restored,
that the patient could walk, every day, from No. 129, Faubourg, St.
Denis, to No. 31, la Rue Bourbon — Villeneuve. Madame Mitteau
still feels, occasionally, slight pains in the upper part of the right
shoulder, but they are not of long duration ; the left lung seems per¬
fectly healthy. In the right may be observed marked pectoriloquism,
towards the upper part, but the rattle that was there remarked, is
now scarcely audible. She goes on as well as it can possibly be ex¬
pected, although she is not particular in her choice of food, nor in
the quantity she eats. We must surely consider the disease, if not
cured, at least singularly ameliorated.

“ The effect of the chlorine, in this case, has been evidently to
prolong life, relieve pain, and to restore to her usual pursuits, a pati¬
ent whom every one had given over.”

Another ease, of apparently confirmed phthisis, was
cured by chlorine ; there was no hope of recovery enter¬
tained by numerous physicians. The work deserves the
serious consideration of the profession.

Mr. Murray recommends the chlorate of potas, not only
as a cure for consumption, but as a specific for cynanche
tonsillaris, ulcerated trachea, and adduces a number of
cases, authenticated by practical medical men, in proof
of his assertion. These cases, however, are so loosely
detailed, that they afford no evidence of the existence of
the diseases which they purport to describe. Some of them
occurred to Mr. Murray himself, who is not a medical
practitioner, and therefore are of little value. But we shall
allow him to speak for himself.

“ Shortly after our return from France wTe had occasion in our own
person to put the efficacy of this medicine to the proof, in conse-

VOL. IV. no. 28.

p p

298

Critical Review .

quence of having received a serious fall, by which we voided a con-
siderable quantity of blood. We commenced with doses of eight
grains three times a day ; the immediate relief obtained was remark¬
able, and in a few days the cure was complete. Since that period
it has been used on our recommendation with great success, by a
clergyman of the Church of England, who had twice ruptured a blood
vessel, — and even in violent uterine haemorrhage, a medical gentle¬
man of Derby has employed it in his practice on our suggestion with
the most beneficial effects.

“ Though its more direct agency seems to be connected with the
circulation, it also exercises a very marked one in a torpid state of
the liver, and a physician wrote us he had employed it in a case of
this kind, at our special request, and that it had proved triumphant
where all other remedies had constantly failed. Nor is this a soli¬
tary case of the kind, since we possess many others, but this volume
was never intended to be a register or catalogue raisonnee of cases.
In our own person, and in that of many others, it has been found a
specific in cynanche tonsillaris, from which we have been in the habit
of suffering at regular periodic returns, in spring and autumn, and
the only anterior relief was the lancet applied to the abscess. By
the exhibition of 6 or 8 grains of the chlorate morning and evening,
it has been always immediately subdued ; by persisting in this for
several times on its first attack, it has been banished from the system,
and we have remained free these several years from its visitations.
Of its efficacy in morbid glandular affections, there can therefore be
no doubt. In chronic catarrh of many years standing, it has effected
a complete and permanent cure. Though personally susceptible, we
scarcely know, in propria persona, what a permanent cough is, since
we find it is soon dismissed by judicious doses of chlorate ofpotassa.
We are not particularly attentive to quantity, but generally com¬
mence with 6 or 8 grains, and have given it one of our children, a
few months old, in doses of two or three grains, with the most
salutary effects. At our suggestion it has been made up into lozenges,
and thus become a convenient mode of exhibition in catarrhal
complaints.

“ The agency of chlorate of potassa on the system is very mild
and gentle. It speedily reduces febrile excitement, and in a case
which was supposed to be ulcerated trachea, two doses of eight grains
each reduced the pulse from 120 to 97 ! The system, however, so
far from being lowered, is contrariwise strengthened — facts which we
have personally experienced as often as years have passed over us.
Its effects are somewhat diuretic, at least in morbid glandular affec¬
tions, and from that interesting circumstance we doubt not but its
judicious administration, in combination with other medicines, might
give relief in hydrothorax, and in an early stage of the disease perhaps
effect a cure. We are supported analogically in this belief, from
having witnessed its beneficial results in anasarca of the legs attend¬
ant on a case of phthisis.” — pp. 130 — 132.

Allowing full credit to the statements of this extract, we

299

Mr. Murray on the Cure of Consumption.

must remind the author, that ulcerated trachea and pulmo¬
nary consumption are very different diseases. Besides, ac¬
cording' to M. Gannal, chlorate of potas is not the best
mode of employing chlorine. There is only one point of
value in his recommendation, and that is, that the remedy
can do no injury, and therefore it deserves a trial ; but we
repeat our position, that medicines, taken into the stomach,
can have little, if any effect, in diseases of the lungs ; and
this objection also obtains in cases of ulcerated trachea.

If there be any probability of alleviating consumption, it
must be by inhalation, and a judicious use of counter irrita¬
tion, in the fullest sense of the word. A great deal of error
is committed by the majority of the profession, and, of
course, by non-professional persons, who consider all the
diseases of the chest consumption. Well informed medical
men will only smile at this prevailing error, and lament the
gross credulity of the public in such absurdity. But we
need not lose time in commenting on topics which are so
universally understood, and therefore shall conclude by
inserting two cases, detailed by two surgeons, Mr. Hughes,
of Stafford, ahd Mr. Hall, of Apeton, in favour of the pro¬
posed remedy. Mr. Hughes proceeds as follows *

“ A young married woman, not lately pregnant, and who had
miscarried two or three years ago, consulted me about two months
since. She had the usual symptoms of phthisis, with evident indi¬
cation of tubercular deposit, ascertained both by percussion and the
stethoscope. The gas, aided by counter-irritants, sedatives, and
aperients, has nearly, if not quite, restored her to health.

“ I have this evening, June 8, seen the married female wrhose
case I related in my last ; she has now no pain in her chest, nor any
other symptom of phthisis. Her chest sounds well, yet there is a
very slight dulness on her left side above the mammae, — the former
seat of pain.

“ Mr. John Hall, of Apeton, near this place, a member of a very
consumptive family, having lost a sister and a brother, the latter of
whom I saw during his illness, permits me to communicate to you
the following particulars, the result of our mutual reminiscence. —
He was attacked in the Christmas of 1828, after exposure to wet
and cold, with violent pain in his chest, cough, &c. ; a surgeon bled,
blistered, and physicked him, and he partially recovered. In May
following he came under my care, conceiving himself ill ; his breath¬
ing was so bad that he could not walk two hundred yards ; he was
greatly emaciated, though his appetite continued good, and had pain
in the right side of the chest. The indication of disease afforded
by percussion was most striking. I detected the seat of pain thereby
alone. There was no other disorder than phthisis ; no violent symp¬
toms, yet he was evidently sinking. I immediately began with the
potassse oxym. and the gas. He went home much better in a fort-

300

Critical Review .

night, and I saw him not again at that time. In six weeks he was
so well that he discontinued the use of remedies, too soon, he thinks.
Soon afterwards he frequently walked six miles and back in a day,
without any unusual effort or inconvenience. Toward the end of
November he had an attack of pleurisy, as before, and the early
treatment was the same. He had severe pain on the left side, slight
cough, but little expectoration, and inability to inspire deeply. When
he came to me, a fortnight afterwards, the symptoms were mitigated,
yet he had still some pain on coughing, or filling his chest, was much
emaciated, and very weak. He hnd no night sweats ; could not
count audibly more than six or seven at a breath ; chest sounded well
on the left side ; the right, as formerly gave a dull obtuse sound.
Staid in Stafford a fortnight. Treatment as before. Could walk
better, but began to loose breath after walking three-quarters of a
mile on his way home.

“ On the 10th of last February, when this account was taken, he
had recovered flesh and colour. His own words follow : “ Lusty as
ever I was : no cough, no pain — can walk two or three miles with
pleasure, — get stronger and better every day:” the chest sounds well
to seventh rib on left side — to third rib on right side. The dulness
on the right side is less in degree — in intensity. His pulse was near
a hundred when he first applied for relief, on both occasions ; and
was reduced in frequency to the natural number (seventy or eighty in
a minute) before he left. His age is about forty. It will be perhaps
not unimportant to introduce the case by stating that Mr. Hall ap¬
plied, not to me in the first instance, but to my father, an old and
able practitioner ; and that my father referred him to me, knowing I
wished — thanks to you — to have the treatment of cases of Consump¬
tion. Considering Mr. Hall’s disorder to be decidedly of that hitherto
hopeless kind, he smiled incredulously when I expressed my expecta¬
tion of curing it.

‘ “ I this morning made inquiry of a lady in this town respecting
the present state of health of her late servant, whom I had the satis¬
faction to treat successfully after your plan two years ago. Informa¬
tion that the young woman continues in perfect health had reached
the lady as late as a month from this time. When under my care her
age was about twenty-one years : she was pale, slender, particularly
flat-chested, and stooped. Her disorder, having advanced gradually
and insidiously, had almost quite disabled her before she felt the
necessity of seeking medical aid. Perhaps too she was deluded by
that false and fatal hope, which is almost diagnostic of tubercular con¬
sumption. At last her mistress insisted that she should have profes¬
sional advice, having previously provided her with a separate bed, lest
her breath should induce the same disease in her young fellow-ser¬
vant. (I state this last particular as affording indirect evidence.) —
The woman, when I first saw her, had a rapid pulse, cough, humid
respiration, and spoke only in a whisper. She had pain in the chest,
and a very obtuse sound on striking the sternum between the upper
part of the mammse. She was compelled to move about very slowly,
and could only count four or five at a breath. At the end of six

Mr. Murray on the Cure of Consumption. 301

weeks from this time all these alarming symptoms had subsided ; she
could move as quickly as she wished without distress or difficulty,
and readily inspire air enough to enable her to pronounce twelve or
fifteen syllables in a full voice — not a whisper as at first. In this
case the nitrous acid and oxymuriate of potassa, were (with occasional
aperients) the only medicines used.” ’ — pp. 143 — 146.

As other remedies were employed with chlorate of potas
in these cases, it is not easy to discover what share the
latter has had in the alleviation. There can be no objection,
however, to give it a trial, as it may possess some medi¬
cinal property when taken into the circulation of the blood.
Mr. Murray is entitled to our thanks for having published
his remedy. He has clearly shewn that it may be employed
with safety, and perhaps with some advantage.

VI. — An Important Address to Wives and Mothers, on
the Dangers and Immorality of Man- Midwifery . By A
Medical Practitioner. 8vq. 1830.

VII. — Eyes for the Blind. — Man-Midwifery exposed , fyc.
By M. Adams. 8vo. 1830.

Of all the' beastly, licentious, demoralizing, and menda¬
cious productions of this age, these before us stand unpa¬
ralleled. Miserable and half-starved booksellers have often
been indicted for publications much less indecent and ab¬
horrent. These are of course anonymous, but rumour has

ascribed one and both to a silly old man named C -

not the notorious wretch who has so often debased man,
below the lowest of the brute creation, by his horrible
publications, but an exact prototype. We shall not pollute
our pages with the filthy and disgusting trash contained in
these miserable pamphlets, but shall refute the groundless
assertions which are maintained in them. We must premise
that the reputed author has never practised midwifery, and
consequently is ignorant of its dangers and difficulties,
though he has the effrontery to declare that man-midwifery
“ is a disgrace to morality and feminine dignity,” that medi¬
cal aid is unnecessary ; and that medical men solicit the chas¬
tity of their patients, and seduce them generally. What a
doting, ignorant person, the man must be, who seriously
maintains such absurd opinions. How grossly ignorant
must he be of the innumerable difficulties attendant on par¬
turition. But no man acquainted with obstetric practice could
entertain such opinions ; and one unacquainted with the

302

Critical Review.

subject, must be extremely foolish to expose his ignorance.
Has this licentious and profligate pamphleteer ever perused
a treatise on obstetricy ? Has he ever considered that men,
a thousand times more talented than he, have published
large volumes upon the subject ? Does he presume to
think, that he is right, and nine-tenths of the profession are
wrong ? If he be of this opinion, some brace of mad
doctors ought, out of sheer compassion, and for the main¬
tenance of professional dignity, have him confined as a
lunatic ; for now a-days men are deprived of their liberty
on much more slender proof of mental aberration. We
are quite serious in our suggestion, for there is not a sha¬
dow of doubt, but the author of these infamous produc¬
tions is a monomaniac on the subject of what he vulgarly
denominates man-midwifery. It must be unnecessary to take
the trouble of offering a serious refutation of the absurd
opinions advanced by this pitiable writer. But as he pro¬
bably enjoys lucid intervals, a few observations may be
useful to him, and contribute to expel the singular delusion
under which he labours. We must inform this man
“ of enlarged intellect,” from personal experience, that
the confidence inspired by the presence of a medical man,
will greatly abridge the sufferings of a parturient female,
and that his aid in difficult and dangerous cases is invaluable,
as it frees the patient from the most painful sufferings,
which, without it, must continue for hours or days to the
final destruction of the lives of both parent and offspring.
Savage and unfeeling is the man, who would inculcate the
doctrine of depriving his fellow creatures of relief, under
such circumstances. He is a disgrace to his species, and a
malignant libeller of his profession and of humanity. He
has forgotten the primeval malediction, which has for ever
doomed the human female to the agonies of child-bed, and
he is ignorant, or pretends to be so, of the innumerable
difficulties which may aggravate her sufferings, and which
can only be removed by the aid of our profession. In
further illustration of this reasoning, we shall cite our own
remarks on another occasion.

“ Happily for humanity, the process of labor is safe and free of
danger, in a vast majority of cases, especially where females live
according to nature’s primitive laws ; but among the higher and
middle classes, where these laws are violated or forgotten, where
the constitution is impaired by the luxury and dissipation of modern
times, the process of child-bearing is attended with considerable
danger, both before and after it shall have been completed. These
observations are equally applicable to the lower classes in our cities,
whose customs, habits, pursuits, and constant inebriation, render

An Important Address to Wives and Mothers. 303

them liable to many accidents during parturition, and to a vast
number of inflammatory and febrile diseases after delivery. The
universal testimony of all unprejudiced medical men confirms the
truth of these assertions. It is well for suffering humanity, the
process of parturition may be greatly accelerated, and the greatest
of mortal suffering relieved by the skilful exertions of the obstetri¬
cian, and with the most perfect safety to the parent and offspring.
It is well known that the very presence of a medical man will often
afford relief, without the performance of any manual operation what¬
ever. The confident assurance to the patient of her safety will
inspire that balmy hope, which will hasten delivery much better than
any other means. On this account there are few intelligent females,
who do not prefer medical attendance during labour, to that of any
other description. This is the case in every civilized country, as
women are well aware of the superior knowledge which medical
men possess of their constitutions ; and hence in modern times, we
observe a wise and judicious preference given to male obstetricians,
and midwives are scarcely ever exclusively employed, unless among
the ignorant or lower classes.” — Manual of Midwifery by M. Ryan ,
M. D.

This is a sufficient reply to the position, that medical aid
is not required at the nativity of our species. If more evi¬
dence were wanted, we need only refer to the voluminous
works on obstetrics, from the time of Hippocrates to the
present period. These were unnecessary, according to our
sensible author, and their authors who appeared in different
countries, during a period of even two thousand years, had
employed themselves unprofitably and uselessly. Happily
the opinion of the profession is against this author, who,
Goth as he is, must yield to reason and to science, which he
cannot control. The voice of the profession, and the sanc¬
tion of an enlightened public, are against him. All are
fools, but this mighty Daniel. The most serious charge
made by this defamer is, that medical men solicit the chas¬
tity, or generally seduce the females under their care. The
obscene and beastly remarks on this point are so gross,
that it astonishes us how any man of an ordinary education
could be capable of inditing them. We cannot find lan¬
guage sufficiently strong to express our reprehension of such
sentiments, and more especially when the writer is a mem¬
ber, a most foolish one, to be sure, of our profession.

To assert that medical men solicit the chastity of females
in the agonies of childbed, when stretched upon the rack
on which nature has laid them, is an idea as absurd as it is
unnatural. The feelings of every man must convince him,
that sensual impulse is not excited by parturient screams and
tortures. Gallantry and brutality are as incompatible with

304

Critical Review .

one another, as this writer’s nonsensical reveries are with
common sense. His cerebellum must be peculiarly deve¬
loped, it would he interesting- to learn its phrenological
description. Here wre are reminded of our misfortune in
not being phrenologists, but having lately learned that emol¬
lient cataplasms are applied to the occiput for the cure of
gonorrhoea, by the disciples of Gall, perhaps such might
be useful in this case, though our own opinion is, that some¬
thing in the shape of Mr. St. John Long’s innocent lotions
would be more efficient in extracting “ the acrid matter”
from the diseased site of sensuality, than any thing else. If
medical men betrayed the moral duties they owe the public,
and acted as this wholesale defamer asserts, they would be
degraded by society, and severely punished by the law of
the land. Their immoralities could not escape detection,
and their punishment would be public execration, and the
utter ruin of their professional character. If the gratuitous
and ridiculous assertion against which we argue were cor-
rect, our courts of justice would be constantly occupied
with actions against medical men, and yet in the annals of
these venerable institutions, we find only two examples of
such actions recorded, and these of recent occurrence. We
need scarcely state that both delinquents were obliged to
relinquish the profession. We must apologize for impugn¬
ing such false assertion and malignant libel by sober argument,
which we should have treated with ridicule and contempt.
The charge of immorality is refuted by daily observation.
Censure need not be applied to such insufferable nonsense.
Conduct so absurd and ridiculous, as this pamphleteer has
been guilty of, must excite general contempt ; in fact, it
could have little effect upon the mind of a rational being.
This trash has been shouted through the streets, for the lauda¬
ble purpose of exciting the “ green-eyed monster” in the minds
of the ignorant, and to sow the seeds of discord in families,
while it tends to lower the characters and morals of British
females, w ho were hitherto considered patterns of chastity and
virtue. Englishmen; husbands, fathers, and brothers, what
say you to this? You all will reply, verily the intellect of
this defamer of the human race must be sadly perverted.

No treatment can be too bad for the depravity of the writer
in question. He is as insensible of shame as he is to the censure
of the profession to which he belongs, and to which he is the
greatest original afforded by its annals. He is much more
obscene and disgusting than the most infamous quack in this
city of empirics. He is the worst enemy of decency and
public morals, and ought to be prosecuted by the society
for the suppression of vice, or by his Majesty’s Attorney-

~dn Important Address to Wives and Mothers. 305

General. Fellows much less guilty have been prosecuted,
hut he moves in respectable society ; he is not a proper
object for prosecution, there being one law for the rich, and
another tor the poor in this country. Had he been a starv¬
ing bookseller, prosecution would speedily overtake him,
and arrest his iniquitous career.

ORIGINAL COMMUNICATIONS.

. ' i

*

J.- — Affection of the Heart, 8fc. By W. Dobson, Esq.

H. S. set. 21, a plethoric girl. Had uninterrupted good
health until five months ago. Has been accustomed to carry
great weights up fifty steps, many times in the day. Felt
severe pain in the back after carrying one of these loads.
Since, has had a feeling of fatigue in the spine, after exer¬
tion, or being in the erect posture for some time, but no
pain. Four months ago began to suffer from palpitation and
dyspnoea, on the slightest exertion, which have gradually
increased. Pain in the centre and left side of the chest.
For which she wras bled ; had blisters and other counter-
irritants applied to the chest, but only affording temporary
relief. Numerous medical men had seen her, who concurred
the heart was diseased, and were assured she must inevitably
die in a short time. July 9th. I was called to see her.
States she has every evening a severe paroxysm of palpita¬
tion of the heart, and most distressing difficulty of breath¬
ing, which continues for two or three hours— sometimes
longer. In the intervals is pretty comfortable : tongue
white: appetite deficient : flatulence, especially after eating:
bowels constipated : secretions unhealthy: fulness and ten¬
derness at the epigastrium, and in the whole course of the
colours. Catamenia regular. On pressing the spinal column,
complains of tenderness in its whole extent, but especially
over the 2d, 3d, and 4lh cervical, the 5th, 6th, 9th, 10th,
and 11th dorsal vertebrae ; at these parts the slightest pres¬
sure produces great suffering. Previous to my examina¬
tion, was not conscious of any pain there.

During one of the paroxyms I was called ; the heart was
throbbing violently : the pulse rapid (110) and bounding:
skin universally cold: face pale and swollen. The respira¬
tion exceedingly hurried and laborious. In short, it seemed
to be performed by the effort of the will ; and as if the

Vol. v. no. 28.

Q Q.

oOd Original Communications.

diaphragm was either in a state of active contraction, with¬
out corresponding1 relaxation, or totally paralysed. Sen¬
sibility of the skin increased : troublesome itching of the
skin about the neck and breast : muscular twitchings of the
left fore-arm : dull pain in the course of the large nerves
of the arm : heart very excitable : the most trifling circum¬
stance (as a rap at the door) excites it to very rapid action.

By the successive application of leeches, blisters, and
various counter-irritants to the spine, the disorder of the
heart and lungs was soon removed. In fact, the disturb¬
ance in these parts abated, just in proportion to the diminu¬
tion of the spinal tenderness. The common antiphlogistic
measures were enjoined. Attention being paid particularly
to the intestinal secretions. Nux vomica, I found a valu¬
able adjunct in relieving, manifestly, the dyspnoea, the mus¬
cular twitchings, and the pains of the arm.

In the course of a month all thtfse formidable symptoms
had disappeared ; only slight epigastric tenderness remained,
but which was soon removed by a blister, and restoring the
secretions from the bowels to a healthy state.

I have omitted the details, as it w7ould have occupied too
much of your valuable pages.

The dependants of the heart’s action on the nervous sys¬
tem, is by many practitioners entirely overlooked. The heart
is supposed to be excited to contraction, by the blood in its
cavities, acting either from some inherent stimulus, or by
distending the walls of that viscus, or by these conjointly.
To ground the heart’s action, on sensibility, is, at the least,
a paradox ; it being so well known that the heart will con¬
tinue to act for a considerable period after its removal from
the body. At the time of Harvey, when the physiology of
the nervous system was so imperfect, it would appear
plausible to account for the heart’s action on this principle.
But since the investigations into this intricate system have
developed the causes of many a phenomena, previously
inexplicable, we may now carefully make new inductions,
and attempt to illumine those deep recesses of physiology
and pathology, which hitherto have been in entire obscurity.
That the heart’s action is connected with the circulation of
blood through its cavities, no one will deny. But that it
is directly dependent on this operation, is quite erroneous ;
and one familiar illustration, out of many that might be ad¬
duced, will suffice to, confirm this idea, viz. syncope, a state
where consciousness is abolished, and every action suppressed
for a variable period. Now, the first mark of recovery, is pul¬
sation of the heart, and we enquire, what caused the heart
to move ? Was it the entrance of blood into its cavities ? No :

307

Mr. Dobson on Affection of the Heart, cfe.

the blood is passive in its motion. Did the vessels give the
blood motion ? this is denied. Then, the obvious inference
is, thp heart is excited to act by some other agent, and
such is the case. That the heart resumes its action from a
principle in its nervous and muscular structure, and from its
communication with the ganglia of the sympathetic, main¬
tains this property, seems perfectly evident, and is totally
independent of the blood in its cavities. And it were easy
to prove, both by fact and analogy, if we could change
the route of the blood, so that not an atom should pass
through the heart’s cavities, the movements of this organ
would be equally energetic; and so far from the blood’s
motion being the direct cause of the heart’s action, the
circulation is only the effect of these active contractions.

All must agree that the heart is active in its agency, and
not a passive organ, not excited to move by the blood in its
cavities.

The connexion which subsists between the sympathetic
and the cerebro-spinal system, accounts for derangement in
the heart’s function, when the spinal marrow is diseased.

From the history of the preceding case, it would appear
that from over exertion of the spinal column, the spinal
marrow became primarily diseased, and it is an allowable
conjecture, there was extension of this to the ganglia of
the sympathetic (by the communicating nerves), and pro¬
bably its branches also, participated in the same, from con¬
tinuity, and thus produces derangement in the organs sup¬
plied. For we can as readily conceive, disease in the
nerves, inducing disorder in their situations, as of disease in
the ganglia, manifested in The parts where their nerves are
distributed. Where we find analogy in anatomy, we must
look for the same in pathology.

It will be observed, there was no uniform irregularity of
the pulse. This circumstance, I consider a strong evidence
of the non-existence of organic disease in the heart.

The deranged action of the diaphragm (as evidenced by
the dyspnoea) the epigastric tenderness, and all those ano¬
malous symptoms detailed, seem equally referrible to dis¬
order of the nerves and their connexions. The urgent dysp¬
noea, was undoubtedly dependent on that exquisite tender¬
ness over the centre of the cervical vertebra, where the
phrenic nerves originate. The muscular twitchings of th(?
fore-arm, on the origin of the axillary plexus, and that of
the intercostals, on the corresponding portion of the spinal
marrow. The palpitations on the cervical ganglia and their
communicating nerves.

SOS

Original C ommu nica lions ,

What influence the e( nervus vagus” exert on the heart,
is not yet established. It is considered neither a ct sensi¬
tive/’ nor a motor” nerve.

Dr. W. Philip’s researches show, that when a narcotic
(as opium) is applied to the brain, or spinal marrow, the
heart’s action is either retarded or accelerated, but not
irregularly. Does the nervus vagus serve as a medium of
impression from the brain to the organs it supplies ? As
when mental emotions produce increased action of the
heart (so strikingly manifested in this case) and loss of
appetite, & c. its use may be analogous to the communi¬
cating nerves, between the spinal marrow and the sympa¬
thetic, viz. to convey the mandates of the will to the heart,
the lungs, and the stomach, &c.

The sympathetic, endowing the organs it supplies with
that special power of action.

The nervus vagus, to bring these actions under the in¬
fluence of the brain.

These few observations, though very concise, may assist
in calling the attention of practitioners to this formidable,
and not uncommon malady. The interesting and very valu¬
able treatise of Mr. Teale, on fr Neuralgic Diseases,” can¬
not be too attentively perused ; but it contains more in¬
trinsic value than any panygeric I could bestow.

14, Arabella Row, Pimlico.

II.— -State of the Medical Profession in Dublin. Ry

Unus Quorum.

As you have taken so much interest in fearlessly exposing’
the abuses and defects of our profession, and more than
once alluded to the state of matters in Ireland, I enclose
you a few remarks on the state of the profession in Dublin.
We had been led to think that our Royal College of Sur¬
geons would have acted liberally on receiving their new
charter ; but I need scarcely observe, that their new regu¬
lations are as narrow and as selfish as before. It was
rumoured that the College would have been thrown open to
to all who presented themselves for examination, and a woe¬
ful drawback would be made from the coffers of the junta
at Lincoln’s-Inn-Fields, by giving Irish students in general
an opportunity to qualify at home, but no such thing was
meditated. The college, ever true to narrow-minded prin¬
ciples, and extremely sensitive of personal aggrandizement.

State of the Medical Profession in Dublin. 309

have virtually closed their portals against all, save their
own apprentices. They effected this by requiring a much
longer,, and more expensive course of study, a double fee
for their licence, and more severe examination from those
who are deprived of the means of paying the exorbitant
fees required of apprentices. They forsooth offer an ex¬
amination on such conditions, and in the true Stock Ex¬
change method, require the sum of £.60, to be deposited
in the national bank, the sum from apprentices being £.30,
and the fee in London £.22. Thus it is that wealth is a
passport to medical science in Dublin ; and talent is neg¬
lected and degraded. But no candidate will apply for ex¬
amination, as he is certain of rejection, unless he has
apprenticed himself to some one of the examiners. The
only resourse he has to adopt is, to present himself at the
London College, where he is sure to be treated in a gentle¬
manly manner, and have a fair and impartial examination.
But on his return home, he is treated with contempt by the
scions of the Dublin corporation, he cannot be surgeon to
a county hospital, and he will not be met in consultation.
He is a regular surgeon, and according to your excellent
article in your last number, has an undoubted right to prac¬
tise in any part of his Majesty’s dominions. But as he has
not condescended to be one of the forty apprentices,”
which some of the college party possess, he is a fit and
proper object for contumely and scorn. In vain he exhibits
his diploma, and points to the illustrious names of Astley
Cooper and John Abernethy, they procure him no respect,
and his document is only ridiculed. He meets a fellow
student of the apprentice tribe, who heard the same lectures
with himself, and whom he often assisted in his studies ;
aud from him too, he experiences coldness and disrespect.
And this monstrous system is to continue, because half a
dozen Hospital surgeons and censors of the college glut on
apprentice fees. If there be not a fatality attending every
measure in which the college are concerned, by what excess
of folly has it happened, in an age like the present, that
these ungracious regulations which have ever distinguished
their administration, should carry with them a strong ap¬
pearance of personal interest, where no such interest ought
to exist, to the injury of the largest portion of the profes¬
sion, and to the highest dishonour of themselves. These
principles and proceedings, odious and contemptible as they
are, in effect are no less injudicious. An enlightened profes¬
sion are roused by every appearance of monopoly and
oppression ; and will one day or other make common cause
in opposing them.

310

Original Communications .

- As Ireland has been alwags doomed to play the Co¬
medy of Errors/’ in every thing, the reform promised by
Lord Gower, in pharmaceutical matters, will of course be
forgotten. His lordship is no longer connected with this
country, and peace be with him, say I, — and consequently
will forget his solomn promise to amend the apothecaries
act. The Dublin company of” drug venders, are much of the
same stamp as their fellow labourers at your side of the
water. They are not quite so impertinent as yet, and they
want Courage to interfere with the rights of the physicians
and surgeons. But no doubt they will imitate the glorious
example of their seniors in London, and by and by, pro¬
ceed to stultify the Colleges of Physicians and Surgeons,
as the London company have so ably accomplished. Our
t( old hags of Rhubarb Hall,” do not examine in physic or
surgery, and for a good reason, they dare not attempt it.
But they are more alive to their own proper calling than the
Londoners, for they threaten to fine all irregulars, and have
frightened these interlopers out of their senses. I have
often laughed heartily at the threats of the worshipful com¬
pany, being aware that it would cost them £.200, to enforce
a fine of £.20. They are cunning enough, however, to suc¬
ceed, by sending an inspector through the provinces, who,
informer like, takes cognizance of those unfortunate appren¬
tices and assistants, who open shops without a licence, or, in
modern phrase, a diploma, threaten them with the vengeance
of the Hall, but promise the required licence on the pay¬
ment of the mulct — the druggists and grocers are left un¬
molested, but the profession alone must suffer.

I was happy to peruse your extracts from Dr. Grattan’s
essays on the state of the profession here, and I should be
still happier if you noticed Mr. Donovan’s more recent pub¬
lication on the subject. This gentleman is governor of the
Hall, and has dealt destruction among the pharmacopolists.
He had the manliness and independence to preside at the
radical meeting ; and was literally turned out of the esta¬
blishment of which he is the legal head. This was truly
Hibe/nian, you will say. However, he has received the
commendations of every independent man in the profes¬
sion.

We are now preparing for the winter campaign of lec¬
tures* and our forces have mustered in great numbers. We
have many rival schools, and a wonderful change in the
demeanour of the monopolists. It would surprize you, to
observe the affability and communicativeness of our great
lecturers and hospital surgeons, their former pride and inso¬
lent muteness no longer exist. Such are the good effects of

Metropolitan Society of General Practitioners. 311

opposition. The last regulations of the English college,
which liberally recognized all our hospitals, have largely
contributed to the marvellous improvement in the manners
of our surgeons and teachers. I assure you, that a poor
green-horn of a student, is no longer sneered at for asking
a question, and that aphonia, which was wont to seize the
surgeons when visiting their patients, unless when appren¬
tices were present, is no longer prevalent ; loquacity, bor¬
dering on garrulity, is now the order of the day.

Another great improvement has been recently effected,
by the establishment of a few rival obstetric institutions.
Instruction is now afforded at half the expense, and the
monopoly of the once famous Lying-in Hospital, is nearly
destroyed. Thanks to Dr. Montgomery, Dr. Gregory, and
Dr. Cusack, for this improvement. As I have refrained
from censuring individuals in this letter, I shall not begin
towards its close, though the conduct of some of the per¬
sons connected with obstetric establishments, loudly calls
for exposure. But on another occasion I shall trouble you
with a brief sketch of some of the crying abuses of our
hospitals and schools. I have passed by our college phy¬
sicians, and have merely to observe that they proceed in the
old humdrum manner, and are as insensible to the interests
of science and the public as any of their fraternity. They
have lately done one laudable act, in appointing the talented
and experienced Dr. Lahy Professor of the Practice of
Medicine.

Dublin, Sept. 20th, 1830.

III. — Metropolitan Society of General Practitioners.

Sir,-— The journal which you so ably conduct, was once the
advocate of the general practitioners, and I trust you will
allow an old subscriber to offer a few wrords in defence of
the Metropolitan Society of General Practitioners. Some
objections have been raised to the principles of this society,
but I can discover nothing in them which any reasonable
practitioner can object to. The general practitioners are a
distinct body, and differ from any of the former classes of
the profession. They are surgeons and apothecaries, and
were called into existence by the wants and wishes of the
public. In your valuable papers on the present state of the
profession, which do you infinite honour, for their indepen¬
dence and impartiality, you have clearly shewn how the

312

Origin al C ommimieation s .

body to which I am proud to belong’ was established by the
public. How is it possible that the middle and lower classes
can procure proper advice on the usual terms of physicians
and surgeons? The thing is utterly impossible; and could
only be effected by diminishing the fees of the legitimate
practitioners. You have referred to the sanction of this
plan by the French ; but 1 am confident the high aristocra-
tical feelings of the colleges would be against the introduc¬
tion of such an innovation. The real cause which gave rise
to general practitioners, is the toleration of chemists, drug¬
gists, and infamous quacks, all of whom have ruined the
legitimate apothecaries, the physicians and surgeons ; and
hence the former, in self defence, were obliged to adopt
the present mode of gaining support. Though regular sur¬
geons for the most part, and regular apothecaries, yet they
found the whole practice of physic, surgery, pharmacy
and midwifery, in the hands of those I have mentioned, and
hence compelled to adopt some plan of pursuing their pro¬
fession. Have not even physicians been obliged to unite
with them ? They are, however, looked on with a jealous
eye by physicians and surgeons, though the colleges of these
bodies, and the company of Apothecaries, are solely to
blame for the present anomalous state of the profession in
this kingdom. Each and all of them have grossly neglected
the duty they owe the profession and the public. None of
them patronizes the general practitioners, and therefore the
latter must look to their own interests. I can see nothing
improper in their doing so ; every man, whatever may be
his station in society, endeavours to protect his own in¬
terests.

I am. Sir, yours, & c.

A General Practitioner.

London, Sept. 15, 1830.

IV. — Extraordinary instances of Reproduction.

By Michael Ryan, M.D.

I was requested by Mr. Sandell, of Gray’s Inn Road, to
visit Mrs. P. of Paradise Street, Battle Bridge, who laboured
under, aggravated hysteria and dyspepsia, which she ascribed
to repeated abortions. The history of her case is one of
interest, in a physiological point of view. She is aged 41,
of a sanguine temperament; she menstruated at 12, and
married between 18 and 19; had a seven rponths child in

Extraordinary instance of Reproduction.

313

the eighth month of her marriage. Has had twins about the
fourth month, three times during the year 1829, and again
in December 31st, when she was attended by Mr. Whitmore,
of Cold Bath Fields, and delivered of two infants ; and on
January' 28th, 1830, she was attended by Mr. Thomas, of
Bagnigge Weils Road, and delivered of an infant, which he
considered of the same age as the preceding. On the 7th
of June last she aborted, at the 3rd month ; on the 9th a
second foetus was expelled, she was attended by Mr. Sandeil ;
and as there was no discharge whatever, from that time to
this, considers herself still pregnant. The abdomen is about
the size of a woman in the fifth month of utero -gestation ;
she has had twenty-four children in twenty-one years. She
menstruated regularly previous to marriage. She is always
in good health when suckling, and ill when breeding ; she is
always pregnant about the fifth month of lactation ; men¬
struation has often taken place during pregnancy, and was
followed by abortion ; she has never suffered from leucorr-
hcea ; her diet consists of bread and porter, but no animal
food; she often rejects large quantities of bile, and can
foretell its approach by the smell of her breath.” Her
mother is seventy years of age, and in good health ; has had
eighteen children born alive.

The wife of her husband’s first cousin, resides at Mount
Pleasant, in this neighbourhood, is in her 45th year, and
has had thirty-two children, including miscarriages. Within
a few years “ she bred with dropsy ; her legs burst, and
the water spouted across the room,” but she went to the
full time ; she is now in good health, and has not ceased to
menstruate.

Two cases of dysmenorrhcea have lately fallen under my
care, both aggravated by marriage, and both followed by
pregnancy — facts which disprove the general opinion, that
impregnation scarcely ever takes place when the disease is
present. My friend, Mr. Bradford, of Fleet Street, had
attended one of these cases, her age was twenty-three; the
other was under my own care, is eighteen years of age, and
in the fifth month of pregnancy. Neither of them passed
the membraneous shreds, described by obstetric writers.

V. — Laws relating to the Medical Profession. ( continued . )

By Michael Ryan, M.D.

It has been asserted, at the late reform meetings, that the Col¬
lege of Surgeons had no power whatever* and ceased to have an
existence inlaw, but a little reflection would have convinced
those who entertained this opinion, that such an influential
VOL, V. NO. 28. R R

314 Original Communications.

body could not fail to procure the notice of the legislature,
if such were necessary.

Apothecaries. — The proper practice of an apothecary,1’
says Mr. Willcock, op. cit. “ consists in preparing with ex¬
actness, and dispensing such medicines as may be directed
for the sick, by any physician lawfully licensed to practise
physic, by the president and commonalty of the faculty of
physic in London, or by either of the two universities of
Oxford or Cambridge, and in applying or administering the
same. They are also at liberty to administer medicine of
their own authority, and without the advice of a physician.
It is not usual for them to prescribe medicine to be pre¬
pared and supplied by others, no person is bound to pre¬
pare such medicine, and I am not aware of any penalty
incurred by compounding it.”*

The Company of apothecaries consists of one master, two
wardens, and twenty-two assistants, and no man can be
elected to any of these offices, who has not previously
been a member of the society for ten years. The master,
wardens, or court of examiners, may appoint five apotheca¬
ries in any county of England and Wales, except in or
within thirty miles of London, to examine assistants to
apothecaries, but no person is eligible who has not been an
apothecary for ten years.

No person can practise as an apothecary in England or
Wales, until he has been examined by the court of ex¬
aminers appointed by the company of apothecaries, and
has received their certificate of his being duly qualified to
practise, unless he was in practice upon the 12th of July,
1815, and also upon the 1st of August, 1815, and no person
can claim to be examined until he is twenty- one years of
age, has served five years to an apothecary, and produced
testimonials to the satisfaction of the court, of a sufficient
medical education, and of good moral conduct. Any fal¬
sified certificate or statement renders the licence void in law,
and subjects the person who makes or offers it to fine and
imprisonment. The court can decide what is a sufficient
medical education, though they cannot in this respect make
rules wholly unreasonable. The applicant for examination
is required by the statute to give notice to the clerk of the
society, on the Monday previous to the day of examination,
and to deposit his testimonials at the same time with the
beadle. The day of examination is every Thursday, at
half past four o’clock. No person can act as assistant unless
approved of by the court of examiners, or by the country
examiners. The sum of ten guineas is paid for a licence to

* A Treatise on the Laws relating to the Medical Profession, 1830.

Dr Ryan on Laws relating to the Medical Profession. 315

practise as an apothecary in London, and six guineas for a
licence to practise in the country, or within ten miles of
London, and the difference of four guineas must be paid
if such person settle in London. The sum of two guineas
is charged on the certificate of any assistant to an apothe¬
cary.

Chemists and Druggists — The right of chemists and
druggists to prepare and dispense medicines, according* to
physicians’ prescriptions, has not as yet been brought into
question. And, as apothecaries have, in the course of
time, established as a right, what was at first considered an
encroachment on the department of the physician, the admi¬
nistering of medicine to the sick of their own authority ;
so the druggists seem to have acquired, by general acquies¬
cence, a right of compounding medicines according to the
prescription of a physician, which was certainly at first an
infringement on the privileges of apothecaries.” Willcock,
op. cit. The 55th Geo. Ill, has expressly secured the rights
of chemists and druggists.

Accoucheurs and Midwives . — There is no restriction
placed on affording assistance to parturient women ; but it
is illegal to treat diseases antecedent to or consequent upon
child-birth.

Administration of Medicine gratuitously , is not a viola¬
tion of any law relative to the medical profession.

Unqualified Apothecaries. — A penalty of £.20 is imposed
on any person practising as an apothecary in England and
Wales, without a certificate from the court of examiners,
unless such person had acted as an apothecary on or before
the 1st of August, 1815. This fine is recoverable in the
courts of record, and the company must prove one act of
practice. The penalty of £5. for acting as assistants, is re¬
coverable by an action of debt, brought by the common
informer and the company, but not by the latter in their
corporate capacity.

Mal-practice in Medicine. — There are four kinds of mal¬
practice, which relate to physicians, surgeons, or apothe¬
caries.

1. Wilful mal-practice, which has for its object the destruc¬
tion or injury of the patient, or of a child of which a woman
is pregnant If death or bodily injury ensue, the accused is
guilty of murder or felony. There is only one case in which
the premature expulsion of the foetus is warrantable, and
that is, when the woman is so deformed, that the infant can¬
not be born alive at the full period. Here the operation is
performed to save the life of the infant and mother, though

316

Original Communications .

the law does
1830.

not justify the operation. — Cabinet Lawyer ,

By 43 Geo. Ill c. 58, Lord Ellenborough’s Act, enacts,

Administering' drugs, or using any other contrivance to
destroy a living infant, unborn, is felony, not only in the
person who actually perpetrates the offence, but in those
who counsel and assist therein. And, though the mother is
not quick with child, to attempt to procure an abortion, is
punishable with fine, imprisonment, whipping, or transpor¬
tation, for any period less than fourteen years. Women'
concealing the birth of an illegitimate child are liable to
two years’ imprisonment.”

The provisions of this statute are extended by Lord
Lansdowne’s Act, 9 Geo. IV. c. 31, June, 1828,

(( Using any poison or noxious thing, or any instrument,
to procure the miscarriage of any woman quick with child,
or counselling or aiding therein, is felony, punishable with
death ; the same offence as to a woman not quick with child,
or proved to be such, is felony, punishable by transporta¬
tion for not exceeding fourteen nor less than seven years, or
imprisonment with or without hard labour not exceeding
three years, to which imprisonment (if the court think fit)
once, twice, or thrice public or private whipping may be
superadded.

“ Concealing the birth of a child by burial of the dead
body or otherwise, is a misdemeanor, punishable with im¬
prisonment for any term not exceeding two years ; and it
shall not be necessary to prove whether the child died be¬
fore, at, or after its birth ; provided, that if any woman
tried for the murder of her child shall be acquitted, the
jury may find, in case it shall so appear in evidence, that
she was delivered of a child, and attempted to conceal the
birth, upon which the court may pass such sentence as if she
had been convicted upon an indictment for the concealment
of the birth.” s. 14.

Every person convicted of the abominable crime of
buggery, committed either with mankind or with any animal,
shall suffer death as a felon.” s. 15.

Every person convicted of the crime of rape, shall
suffer death as a felon.” s. 16.

Unlawful and carnal knowledge of any girl under ten
years of age is punishable with death ; above ten and under
twelve, with imprisonment with or without hard labour for
such term as the court shall award.” s. 17.

“ It shall not be necessary, in any of the four preceding
cases, to prove the actual emission of seed in order to con-

Dr. Ryan on Laws relating to the Medical Profession. 317

stitute a carnal knowledge, but the carnal knowledge shall
be deemed complete upon proof of penetration only.”
s. 18.

2. Avaricious mal-practice has for its object the lucre of
the practitioner, who employs improper drugs or treatment
to the injury of the health of the sick. This prevails among
druggists and low apothecaries, who substitute one drug for
another; and constitutes a cheat at commonlaw, and is punish¬
able by fine and imprisonment. The discovery and correc¬
tion of this abuse is confided to the medical corporations.

3. Negligent mal-practice, is where there is no criminal or
dishonest object, but gross neglect of that attention which
the patient requires. This is a misdemeanor at common
law.

4. Ignorant mal-practice, is that which has for its object the
practice of medicine, surgery, or pharmacy, without due
information and legal authority. f( This is a great misde¬
meanor at common law, whether in a licensed or unlicensed
practitioner.” The party injured suffers a private wrong,
and may bring an action for damages adequate to the loss
he has sustained.

The censors of the College of Physicians have full power
to correct defaults in the exercise of the profession, which
includes physic, surgery, and pharmacy, in London, and
within seven miles thereof, and this power may be exerted
over all graduates in physic of any university, or whether
they do or do not assume the style of doctor or the cha¬
racter of a physician. Op. cit. It is necessary that the mal¬
practice should be in physic, but it is apprehended that this
would include surgery and pharmacy. The censors are to
determine what is, or what is not mal-practice, and the
unfitness or unsoundness of the medicine prescribed. They
may fine or imprison, or fine and imprison the party ; or if
they impose a fine alone, they may enforce payment of it
by imprisonment. The fine must not exceed £20. “ They

still retain,” says Mr. Willcock, et the authority, and in the
present state of the metropolis, they ought to resume the
exercise of it, and they may, in the discharge of their duties,
with impartiality and moderation, confidently rely upon the
succour of the courts of Westminster. A court of justice
cannot be obsolete by the neglect of its judges, the present
censors may exercise these powers as fully as if they had
been daily exercised by their predecessors, from the time
of Henry VIII. ; not only may they receive their jurisdiction,
but they are bound to revive it; in so much that should
they reject a charge of mal-practice preferred by any per-

318

Original Communications .

son, the court of King's Bench would, by mandamus, com¬
pel them to convene, and to hear and decide upon the accu¬
sation.”

It appears, from the same authority, that the president
and vice-presidents of the Royal College of Surgeons in
London, have full power to correct mal-practice in surgery,
by members, or irregulars, and the observations made on
the power and duty of the censors of the College of Phy¬
sicians, are equally applicable to them. The same authority,
so often quoted, declares that the Apothecaries’ company
have no power to appoint inspectors of shops, or to fine
persons for keeping bad drugs ; at least, doubts may be
entertained upon this point.

Civil responsibility of Medical Practitioners. — An action
will lie against a physician, surgeon, apothecary, and every
other person professing to cure wounds or diseases, for every
injury that may arise from his want of skill or want of
attention. An action will also lie against a physician, who
makes experiments for any injury produced by them, unless
the experimenter informs the patient of his intention, and
obtains his consent.

If a physician, surgeon, apothecary, or other medical
practitioner, undertake the cure of any wound or disease,
and, by neglect or ignorance, the party is not cured, or
suffers materially in his health, such medical attendant is
liable to damages in an action of trespass on the case ; but
the person must be a common surgeon, or one who makes
public profession of such business as surgeon, apothecary,
&c.; for otherwise it was the plaintiff’s own folly to trust to
an unskilful person, unless such person expressly undertook
the cure, and then the action may be maintained against
him also.

An action will lie against a surgeon for any deviation
from the established mode, as trying a new instrument, if it
injure the patient. Slater v. Baker and Stapleton, 2 Wils.
359. The defendants disunited a callous of a fractured
leg by a new instrument. Damages £500. Verdict con¬
firmed by the whole Court.

An action will lie against a surgeon for gross ignorance
of his profession, as well as for negligence and carelessness.
Seare v. Prentice. 8 East’s R. 348. Quere the authority of
this case? In the case of Neale v. Pettigrew, the plaintiff
dislocated his arm; it was badly set by the apprentice of
defendant, for which the master suffered damages £800.

Remuneration of Medical Practitioners — A physician
cannot maintain an action for his fees, for they are honorary

Dr. Ryan on Laws relating to the Medical Profession. 319

and not demandable of right., and it is much more for the
credit and rank of that body (the physicians), and perhaps
for their benefit also,, that they should be so considered ;
“ and I much doubt/’ says Lord Kenyon, f<r whether they
themselves would not altogether disclaim such a right as
would place them upon a much less respectable footing in
society than that which they at present hold.” Chorley v.
Bolcot, 4 T. R. 37. It was contended in this case, that
there was no authority in the books for placing physicians
and barristers’ fees on the same footing, the regulations
with regard to barristers being founded on the ground of
public policy, as appears in Tacitus.

But though a physician cannot recover his fees by a
process of law, yet pro concilio impenso and impendendo
these are a good and valuable consideration for an annuity.
9 W. Rep. 50, 7 Co. Rep. 10, 28.

If a bond, bill, or note were given for medical attendances,
the consideration would be good, though the original fees
could not be recovered.

If a medical practitioner who has no diploma, pass himself
off as a physician, he .cannot maintain an action for his fees.
Lipscombe v. Holmes. 2 Camp. 441. Though as a surgeon
he might have recovered compensation, and even if he were
no regular surgeon, he could recover in an action of as¬
sumpsit. Gremaire v. Le Clerc. Bois Valor, 2 Camp. 144.
But query the authority of this case.

If there be any promise, a physician may recover on a
quantum meruit. Shepherd v. Edwards. Hill 11, Jac. 2,
Croke 370. The plaintiff here declared he was a physician
and surgeon, had cured the defendant of a fistula, and had
judgment ; but query, did not he sue as a surgeon ? But
in Dale v. Copping. Bulst. p. 1, 39, the promise of an
infant to pay a certain sum to the physician to cure him of
epilepsy was a contract and held binding.*

But can a doctor of medicine who is not a member of
the London College of Physicians, or a graduate of either
of the English universities, recover as a physician unless on
a promise which amounts to a contract?

The Scotch and Irish schools of physic and surgery are
corporations not confirmed by law, and their graduates or
licentiates are not allowed to practise in England unless
they be re-examined by the London College of Physicians.
But the common law of England extends to Ireland. It

* Elements of Medical Jurisprudence by Paris and Fonblanque, vol. i. 1823.

320

Original Communications .

would be prudent then for all medical men to have a verbal
or written promise, a bond, bill, or note for attendance, in
order to entitle them to recover. Some recent decisions of
importance took place in Ireland on the recovery of medical
compensation, which shew the unsettled state of the law on
the subject.

A case was decided at the Kilkenny summer assizes, 1824,
before Mr. Justice Johnson ; it was that of Ryan v. Gorman.
The plaintiff was a doctor of medicine of Edinburgh, and a
surgeon of Edinburgh and London Colleges, who attended
defendant and his family for several weeks through fever,
at the request of defendant’s wife, who promised him the
ordinary remuneration, as also did defendant. He per¬
formed no manual operation, except the removal of a blister,
which was not within the province of a surgeon. It was
contended for defendant, that as plaintiff acted as physician,
and the disease being a medical one, he could not recover ;
but the court decided that the promise was binding, and on
being handed the report of the case of Sheppard v. Hill
above quoted, and also Dale v. Copping, the judge gave a
verdict to plaintiff on a quantum meruit.

A similar case, if correctly reported, was differently
decided at the Clonmell spring assizes, 1826, before Mr.
Justice Moore. It was that of Kelly v. Latham. The
plaintiff, a physician and surgeon, attended the defendant’s
mother, who sent for him and promised to pay him when he
was able. The disease was a medical one, consumption.
On the last admission, Mr. Doherty called for a nonsuit on
the ground, he could not recover for his attendance in a case
purely medical.” Mr. Serjeant Lloyd observed, that what¬
ever capacity he acted in, whether physician, surgeon, or
apothecary, he should be paid. c< The jury,” said his lord-
ship, have to try whether Mr. Latham employed Dr. Kelly
generally as a medical practitioner without any reference
to his being a physician or surgeon, and the evidence to
what Mr. Kelly was employed for. A verdict was found for
the defendant, with 6d. costs.

Surgeons. — A surgeon is entitled to recover reasonable
remuneration for his care, attendances, skill, labour, medi¬
cines, and applications in surgical cases, but not if he put
his attendances in the character of a physician, either by
prescribing as a physician, or assuming to hold the degree
of doctor in medicine, or by sending in his account with
blanks opposite to the statement of his services ; for, in the
former case, he has relinquished the character of a surgeon,
and assuming to be a physician, the court will not allow

Dr. Ryan on Laws relating to the Medical Profession. 321

him to put off that assumed character, merely to entitle him
to that remedy which he has relinquished by his illegal act
and affectation of dignity, and having left the amount in
the latter case to the discretion of the patient, he must be
content with what may be paid. Willcoek, op. cit. The
reasonableness of a surgeon’s charges will be decided by the
jury. He will be allowed for his medicines when such are
used as are within his proper province. But if he infringe
on the physician or apothecary, his conduct being illegal,
he has no remedy for the recovery of remuneration. Ib.

Apothecaries. — An apothecary may charge for his attend-
ances, provided he only charge the intrinsic value for his
medicines. Handy v. Henson, op. cit. This has been the
case in Ireland for a long time.

Protection of Medical Character . — If a man libel a phy¬
sician, by saying Dr. — is a bad one, or employed mala-
praxis, the slander admits the professional qualification, and
legal evidence of his qualification will not be required. — -
4 T. R. 366. Smith v. Taylor, 1 N. R. 196. Phil, on Evi.
v. 2, p. 154, But where the slander denies qualification, legal
proof must be given. Op. cit. 155. The degree of doctor
of physic may be proved by the original book of the uni¬
versity or corporation, which contains an entry of the degree
having been conferred ; or it may be proved by an examined
copy of this entry. Moises v. Thornton, 8 T. R. 303, 307.
Or if the medium of proof is a diploma of a university,
bearing its seal, the instrument must be proved by legal
evidence. If the written instrument be produced as the
original act of the university which conferred the degree, it
must be proved that the seal affixed is the seal of the uni¬
versity, which may be done by any one who knows it to be
such. S. C. 307- If the instrument produced is a copy of
the original act of the university, it must be proved in the
usual way, as a copy for the university cannot, under their
seal, give evidence that the plaintiff had taken such a de¬
gree. — Phillips on Evidence.

Physicians . — By the 14th and 15th Henry VIII. the
king’s charter for incorporating the College of Physicians
of London is confirmed ; they are to choose a president, and
have perpetual succession, a common seal, and ability to
purchase land and make by-laws. Eight of the chiefs of
the college are to be called elects, who, from among them¬
selves, are to choose a president yearly.

.Physicians in England shall be examined by the College,
and have testimonial letters from the president and three

Vol. v. no. 28.

s s

322

Original Commit nications.

elects, unless they be graduate physicians of Oxford or
Cambridge. Physicians practising in London, or within
seven miles, without being approved, forfeit £5. ; and, in
any other part, unless approved by the bishop of the dio¬
cese, they are subject to the like penalty.

By the 32 Hen. ^ III. c. 40, four physicians shall be
chosen by the College to search apothecaries’ wares, and,
in company with the warden of the mystery of apothecaries,
may destroy adulterated drugs. Apothecaries refusing to
be searched forfeit £5. ; and physicians to act, 40s,

Physicians may practise surg'ery in London.

The fees of a physician, like those of a lawyer, are
honorary, and not demandable of right; consequently, a
physician cannot maintain an action for them, 4 T. R. 317-

Surgeons. — By the 32 Henry VIII. the barbers and
surgeons were incorporated into one company, but, at the
same time, a distinct line of division was drawn between the
practice of the two branches of the profession. By this act,
no person practising the art of barbery is to intermeddle with
that of surgery, except as to drawing of teeth, which barbers
may continue to do as before ; and, on the other hand, no
person devoting himself to surgery, is to exercise what is
pithily called “the feat or craft" of shaving.

By the 18 Geo. II. the union of surgeons and barbers of
London is dissolved, and the surg’eons of London were made
a separate corporation, with power to enjoy the same privi¬
leges as by former acts or grants.

Candidates to serve as surgeons in the army or navy shall
be examined by the Surgeons’ company.

By the 25 Geo. II. the bodies of murderers, convicted and
executed in London or Middlesex, shall be delivered to
Surgeons’ Hall ; and, in any other county, to such place as
the judge shall direct.

By the 34th & 35th Henry VIII. any subject of the king,
having knowledge of the nature of herbs, may minister to
any outward sore, wound, or disease.

An action on the case lies against a surgeon for gross
ignorance and want of skill in his profession, as well as for
negligence and carelessness, to the injury of a patient.
Seare v. Prentice, 8 E. R. 348.

Apothecaries. — Apothecaries were originally associated
with the grocers, but obtained a separate charter of incor¬
poration from James I. in 1606.

By the 6 Will. III. c. 4, apothecaries free of the com¬
pany in London, practising there, or within seven miles, are
exempt from parochial offices, and from serving on juries.

Dr. Ryan on Laws relating to the Medical P rofession. 32

producing* a testimonial of their freedom. Apothecaries in
other parts, brought up in such art, or having served an
apprenticeship of seven years, are also exempted.

In the session of 1815, an important act, the 55 Geo. III.
c. 194, passed, for regulating the practice of apothecaries
through England and Wales. By this act, the masters and
wardens of the Apothecaries’ company, or persons ap¬
pointed by them, may enter the shop of apothecaries, and
examine drugs, and impose and levy fines for such as are
unwholesome or adulterated. Penalty for the first offence,
£5.; for the second, £10.; for the third, and every subse¬
quent offence, £20. Vide ante, p. 98.

Any apothecary refusing to compound, or unfaithfully
compounding the prescription of a regular physician, is
liable to be fined £5. ; and for a third offence of the same
kind, forfeit his certificate.

By the same act, amended by the 6 Geo. IV. c. 133, no
apothecary, after the 1st of August, 1815, (except persons
in actual practice on or before that period,) is to practise,
unless he has received a certificate of being duly qualified.
No person can be admitted to be examined unless he be
twenty- one years of age, and have served an apprenticeship
of, at least, five years, with an apothecary or a surgeon.
Penalty for acting without certificate, £10. ; or if only an
assistant, £5.

By the same acts, no apothecary shall be allowed to re¬
cover any charge claimed by him in any court of law unless
he was in actual practice on or before the 1st August, 1815,
or that he has obtained a certificate to practise as an
apothecary.

By the 6 Geo. IV. surgeons in the navy and army, and
apothecaries in the army might practise without a certificate
from the court of examiners, or without having been in actual
practice prior to 1st August, 1815. This act is repealed.

In the constructions by the courts under these acts, it is
held that an apothecary who claims an exemption, on ac¬
count of having practised prior to the 1st August, must have
actually exercised his proper vocation, — namely, the making
up of a physician’s prescription ; without this, unless he has
received a certificate, he cannot recover for medicines.
Apothecaries’ Company v. Waburton, 3 B. & A. 40.

In an action to recover the amount of an apothecary’s
bill, the plaintiff, who proves a certificate from the Society
of Apothecaries, need not also prove an apprenticeship
served. Sherwin v. Smith, 1 Bing, 204.

324

Origin al C ommunications .

The acts do not extend to chemists and druggists.

Privileges of Medical Men. — Physicians who are licensed
by the Royal College in London, are exempt from serving on
juries or all inquests whatever, but this exemption does not
extend to graduates of the universities. 14 Hen. 8. 6 Geo. 4.

The members of the Royal Colleges of Surgeons in Lon¬
don, Dublin, and Edinburgh, when in actual practice, are
exempt from serving on juries. 6 Geo. 4. Apothecaries are
also exempt by this statute. Fellows and licentiates of the
College of Physicians, regular surgeons and apothecaries,
are exempt from watch, ward, constablewdck, and the other
offices of the city of London, and from bearing arms.
32 Hen. 1. 1 Geo. 4.

Privileges in respect of Insane persons. — No person/
except a parish pauper, f can be admitted into any house kept
for the reception of insane persons in England, without a
certificate, bearing date not more than fourteen days before
such admission, and signed by two medical practitioners,
each of whom must be a physician, surgeon or apothe¬
cary,! unless any special circumstance have prevented the
patient being repeatedly visited by two such practitioners,
in which case he may be admitted, on the certificate of one
practitioner, but such certificate must be signed by some
other medical practitioner, within seven dayg after the pa¬
tient’s admission. || The certificate must state the patient is
a fit person to be confined, the day on which he has been
examined, the name and abode of the person who directed
the examination, the relationship or connexion of such per¬
son and the patient ; the name, age, residence, and former
occupation of the patient ; the asylum, if any, in which
he was previously confined — and whether he has been found
a lunatic or of unsound mind, under a commission issued
by the Lord Chancellor, Lord Keeper, or Commissioners
of the Great Seal ; or if any such particulars cannot be
inserted, the special circumstances preventing’ such insertion
must be stated, also if only one medical man has certified.
9 Geo. 4. c. 41. By the same act, any medical man cer¬
tifying without having examined the patient, is guilty of
a misdemeanor, as also the person receiving the patient ;
and no medical man who is proprietor or part proprietor, or
attendant of a house for reception of lunatics, can certify
in a case connected with such circumstances.

* 9 Geo. 4. c. 41
% Ibid. || Ibid-

t 9 Geo. t. c, 40,

Dr. Ryan on Laws relating to the Medical Profession. 325

Every establishment containing one hundred patients must
have a resident physician, surgeon, or apothecary, and if it
does not contain so many, it must be visited twice a week
by a physician, surgeon, or apothecary, unless it is kept by
a regular medical man ; and the medical attendant must
report to the keeper^ the condition of the house and the state
of the patients’ health, and must, once a month, enter the
same in a book in a form prescribed by the act.

The same certificate is required for committing an insane
person to a private asylum, public hospital, or other cha¬
ritable institution, except Bethlehem Hospital, the Military
and Naval Hospitals, and the Lunatic Asylums, established
under 48 Geo. 3, or 9 Geo. 4.

Commissioners are appointed in London and Middlesex
to grant licences, and examine into the state of lunatic
asylums. The act requires that some of the commissioners
should be medical men. In England no medical man can
be employed in any of the public services unless a member
of the colleges, universities, or apothecaries company. The
governors of some public institutions adopt the same pro¬
visions. The following acts relate to the appointment of
medical men to public offices 43 Geo. 3, c. 90, 53 Geo.

3, c. 65, and 11 Geo. 4, and 1 Will. 4, to militia men; 4 Geo.

4, c. 64, and 4 Geo. 4, c. 69, to prisons ; 6 Geo. 4, c. 80,
and 30 Geo. 3, c. 49, to workhouses ; 43 Geo. 3, c. 56, to
ships carrying fifty persons. The surgeon, in the last case,
may be a member of the London, Dublin, or Edinburgh
colleges, and must be provided with a medicine chest. He
must keep a journal, containing a true and correct account
of every thing relative to the food, health, disease, and
mortality of the ship’s crew, in a form prescribed by the act
under a penalty of lOOf. The bedding of each passenger
must be aired daily upon deck, if the weather permit, and
the vessel must be fumigated with vinegar at least twice a
week, under a penalty of 20Z. for each neglect.

The following statutes and patents relate to the medical
profession in England, according to Mr. Willcock : —

Statutes — Physicians. 9 Hen. 5, 22 Hen. 6, 19 Hen. 7 ,

3, 5, 14, 15 and 32 Hen. 8, 1 Mar., 3 Jac. 1, 10 Geo. 1,

6 & 10 Geo. 4.

Surgeons. 3, 5, 32, 33, 34, 35 Hen. 8, 18 Geo. 2,
6 Geo. 4.

Apothecaries . 32 Hen. 8, 1 Mar. 6, 7 Will., 10 Geo. 1,

55 Geo. 3, 6 Geo. 4.

General Statutes. 5 Hen. 4, 33 Hen. 8, 1 Ed. 6, 1 Mar.

5 Eliz. 2 Jac. I, 8, 9 Anne, 9, 16 Geo. 2, 42, 43 Geo. 3,

6, 9 Geo. 4.

326 Original Communications .

Patents . — Physicians. 32 Hen. 6, 7 Eliz., 15 Jac. 1,
15 Car. 2.

Surgeons. 3, 4 Hen. 5, 25 Hen. 6, 1 Edw. 4, 15, 19
Hen. 7, 2, 3 Hen. 8, 2 Jac. 1, 5 Car. 1, 40 Geo. 3, 3
Geo. 4.

Apothecaries. 19 Edw. 3; 20, 27, 30, 34, 35 Hen. 6.
13 Jac. 1.

I shall now add the statutes and charters relative to the
profession in Scotland and Ireland.

Scotland . The universities and college of physicians of
Scotland are incorporations, and as far as my research ena¬
bles me to state, are not confirmed by acts of parliament, with
the exception of the Royal College of Surgeons in Edin¬
burgh. The college of surgeons was incorporated in 1505,
and afterwards confirmed by numerous statutes. This body
is empowered to grant a licence to practise surgery and
pharmacy in Scotland only. The University of Edinburgh,
in conferring the degree in medicine, authorizes its owner
to practise uhique gentium3 but it is evident, from the expo¬
sition of Mr. Willcock, that such graduates cannot practise
legally in England ; and, as there are positive statutes, con¬
ferring rights and privileges on the Dublin College of Phy¬
sicians, it is clear that the degree in question can have no
force in Ireland. This was exemplified by a decision of the
Court of King’s Bench in Dublin, in 1818. An action was
brought by the Apothecaries’ Company, of Dublin, pur¬
suant to their act, 31 Geo. 3, against Mr. Butler, who had
been duly qualified in London, agreeably to the 55 Geo. 3.
But it was decided by the court, that he had no right to
practise in Ireland, until he had a licence from the Apothe¬
caries’ Company of Dublin. It is also obvious that a licen¬
tiate of the Dublin company could not practise in England,
nor in Scotland. It is doubtful, however, whether the Dub¬
lin College of Physicians are vested with sufficient power
to prevent graduates of the Scotch or other universities from
practising in Ireland ; but they refuse to meet such graduates
in consultation, until they have become licentiates of the
college, and this by-law almost amounts to a prohibition.
The best account I have found of the laws relative to the
physicians in Ireland, is in Mr. Scully’s Penal Laws, which
is as follows : —

Ireland. — “ A society of physicians in Dublin, was incor¬
porated in 1691, by royal charter, under the name of The
King’s and Queen’s College of Physicians.” This charter
purported to arm the society with powers of an extraordinary
and extensive nature, which (if confirmed by act of Par-

Dr. Ryan on Laws relating to the Medical Profession. 327

liament) would invest in them a monopoly of the practice
of physic, as well as of medical honours. One of its pro¬
visions directed, ee that no physician, or other persons,
should be permitted to practise physic in the city of Dub¬
lin or its liberties, without the licence of this society.”
The charter, however, has not acquired any legal validity
in this particular ; for, its confirmation has never been ob¬
tained from the Legislature, although frequently solicited.

The Legislature has, however, recognized the existence
of this society, without adopting its charter.

ee Thus, in 1761, an act was passed, authorizing the
King’s and Queen’s College of Physicians in Ireland, to
enlarge their number by admitting four learned and worthy
doctors of physic into the fellowship of their body-— to
appoint inspectors of apothecaries’ shops — to frame a phar¬
macopoeia or code of drugs, &c.

In 1767,, it was enacted, that no person should be ap¬
pointed physician to any county infirmary, unless examined
and certified by this college of physicians.

In 1785 and 1791, this college was empowered to elect
the members of a school of physic, to be established in
Dublin, to consist of three professors, (and, upon a certain
contingency, of four professors) called professors upon the
foundation of Sir Patrick Dunn, and to appoint clinical
lectures, to be given in Dublin.

This college has also been incidentally noticed by the
legislature upon other occasions of lesser importance, but
without any addition to its powers.”

The 5, 6, 7, 8, 13, 14, 15, and 16 Geo. 3, authorize the
erection and establishment of the different county hospitals ;
and by the 26 Geo. 3, no person can be appointed surgeon
to any of the said hospitals,” unless certified by the Royal
College of Surgeons in Dublin ! By 45 Geo. 3, grand
jurors are empowered to present for specified sums, for the
.support of such hospitals or infirmaries, and also for dis¬
pensaries, and this statute is further amended by 54 and
58 Geo. 3, which comprize fever hospitals, and order a sur¬
geon, and not a physician, to be the medical attendant of
these institutions. 11 Geo, 4, and 1 Will. 4. The salaries of
medical attendants on prisons, and expense, of medicines,
are regulated by the 7 Geo. 4. c. 74. The dispensary act,
45 Geo. 3. c. 91, is as follows:—

And whereas the distance of many parts of each county
from the infirmary therein established, does not allow to
the poor of those parts the advantages of immediate medi¬
cal aid and advice which such infirmary was proposed to

328::^ woV* > *f v OrigmM CdmMuftimwdTis: s" ' 1 A

affo^J: be itf, therefore ^enacted, that in all cases where the
said corporation shall certify to the grand jury of the comity
wherein such corporation ds established, that they have ac¬
tually received, from private subscription or donation, any
sum or sumsfpf tnoney since the preceding assizes, for the
purpose of establishing in any town or place therein a dis¬
pensary for furnishing medicine and giving* medical aid and
relief to the poor, it shall be lawful for such grand jury to
present to be raised on the; county at large, and paid to the
said corporation, a sum equal in amount to the sum or Sums
so received by such corporation, to be applied by the go¬
vernors and governesses thereof, or such committee of them,
not fewer in number than five, as they shall appoint for the
purpose at any general /quarterly meeting, together with the
monies so received by private/ subscription or donation, in
providing medicines and medical or surgical aid arid advice
for the poor of such town or place and its neighbourhood,
in such manner as they or the said committee shall in their
discretion deem most advisable; and that all monies so
raised for such local dispensaries, as well as all monies so
received from private subscription or donation for their vise,
shall he accounted for upon oath at each summer assizes
before the grand jury and the court. nanw tat<

“ And be it further enacted, that every person who shall
subscribe and pay towards the establishment or maintenance
of any such local dispensary, or towards the county hos¬
pital qr infirmary, any sum not less than one guinea, shall
be a member of the body corporate of the infirmary or
hospital of such county for one year, from the date of the
payment thereof to the said body corporate, so far as re¬
lates to the management and direction of such local dispen¬
saries; any, thing in the said act to the contrary notwith¬
standing.” This act is amended by 58 Geo. 3.

The grand juries require the medical attendants of dis¬
pensaries to have attended lectures on midwifery.

Surg eons. *—The Royal College of Surgeons was incor¬
porated by 24 Geo. 3, in the year 1784, and this charter
having expired, it was renewed by the 10 Geo. 4, during the
last year. The. members of this eollege refuse to meet
those of the London -and Edinburgh Colleges in consulta¬
tion, and look upon them as an inferior order of surgeons,
and exclude them from all situations of value, though, ac¬
cording to the authority of Mr. Willcock, a member of the
London College lias an undoubted right to practise, and
of course enjoy his rights and privileges in every part of his
Majesty’s dominioaslq hits Avirfi ylf^iiqKO

Dr. Ryan on Laws relating to the Medical Profession. 329

Apothecaries . — By the 31 Geo. 3, the company of apo¬
thecaries are empowered to prevent all persons who act as
apothecaries without their licence, the action to be brought
in the Courts of Record in Dublin, and the penalty of £20.
The statute requires an apprenticeship of seven years to
qualify for examination for the licence. The act also re¬
quires, that every apothecary shall keep a record of the
names of all persons to whom he sells arsenic ; and not to
supply it but to respectable persons.

<f Medical practitioners are allowed remuneration for at¬
tending coroner’s inquests, but the sum shall not exceed
five pounds, no matter how far they have to travel. —
10 Geo. 4.

The legislature of this empire has entrusted vast power
to the legitimate members of the medical profession, in
deeming their evidence conclusive, in an immense number
of civil and criminal proceedings ; and confided to them the
protection or destruction of the best privileges of our glo¬
rious constitution — the life, liberty, honour, and property
of every rank in society. Every man of sense in the pro¬
fession ought to reflect seriously on the great responsibility
he owes the public, the dignity of the faculty and his own
reputation, when he is called upon, as every man may be,
to discharge the duty of medical jurist. In order to re¬
mind him of this most important duty, I shall insert a list
of cases in which medical evidence is required, and shall
follow the arrangement of Sir W. Blackstone, in his Com¬
mentaries upon the Laws of England. Cases in which me¬
dical evidence is required. In the first place, such evidence
may be called for by all courts of judicature, in respect to
the absence of witnesses or jurors, wdio plead indisposition
as an excuse ; and no medical man can, consistently with his
duty to the laws of the realm and to the dignity of his pro¬
fession, certify otherwise than truly. In a word, the prac¬
titioner should feel himself bound, by every principle of
honour, not to impede the administration of public justice,
nor to grant a certificate for exemption from attendance
unless on proper grounds. This principle should guide us
in all cases, and especially in applications for absence from
military or naval duty. The medical jurist is morally and
legally bound, on all occasions, to speak the truth, the
whole truth, and nothing but the truth.”

But in criminal process they are often referred to, as in
certain cases of reprieve. The most common example of re¬
prieve, which is referred sometimes to medical men, is
where a woman is capitally convicted, and pleads pregnancy

VOL. V. NO. 28.

T T

330

Origin al C ommun ica tions .

in stay of execution. Upon this point the law is very
defective,, for it supposes the foetus inanimate unless it has
quickened, though the infant is alive the moment of its
formation. The law is as follows: — 1

fr In this case, the judge directs a jury of matrons to
inquire into the fact, and, if they bring in their verdict,
quick with child, (for unless the child be alive in the womb,
it is not sufficient) the execution is stayed, either till she is
delivered or proves, by the course of nature, not to have
been with child at all. But if she proves with child a
second time, she cannot have the benefit of this reprieve ;
for she may be executed before the child quickens, and the
law will not be evaded by her incontinence.

Another cause of reprieve is, if the offender become
insane between the judgment and execution ; for, though a
man be sane when he commits a crime, yet, if he become
insane after, he shall be indicted; if after indictment, he
shall not be convicted ; if after conviction, he shall not
receive judgment ; if after judgment, he shall not be or¬
dered for execution.”

Medical evidence is required when a prisoner affects in¬
sanity, or when an impannelled juror pleads illness.

Liability as Witnesses. — The next subject that claims
attention is medical evidence. There is no part of the duty
of medical men of such serious consequence to the public
and to their own reputation, nor one which is generally
more unpleasant to their own feelings. Like all other wit¬
nesses, “ they must appear when supoenaed, or forfeit one
hundred pounds to the king*, and ten pounds to the party
aggrieved, with damages equivalent to the loss sustained by
their want of evidence, but no witness is bound to attend,
except his expenses are first tendered to him, unless he
reside within the bills of mortality, and is summoned to
give evidence within the same.

By 7 Geo. 4. c. 40, all persons appearing upon recog¬
nizance or subpoena to give evidence in prosecutions for
felony, either before the examining magistrate, the grand
jury, or on the trial, are entitled to their expenses and a
compensation for loss of time, and this although no bill
of indictment be preferred. The same provision extends to
cases of misdemeanor, with the exception, that no allow¬
ance is made for attending the examining magistrate.”

It is right to state that medical men must divulge profes¬
sional secrets when giving evidence in courts of law. Phil,
on Evid. v. i. p. 135. Elem. of Med. Jurisprudence, by

Dr. Ryan on Laws relating to the Medical Profession. 33 1
Paris and Fonblanque. Yet this seems contradicted in a

■ v i » * ^ • 'v. . -■

recent work, but the witness will be directed by the court.

The next division relates to persons and classes in every
rank of society, as clergy and laity, civil and military,
masters and servants, and a variety of minor divisions. —
With respect to the clergy, there is one point worthy of the
attention of medical men, namely, that the Archbishop of
Canterbury exercises the right of conferring all the de¬
grees which are taken in the universities.” It need scarcely
be stated, that the Primate of all England has very recently
conferred the degree of medical doctor. The class in so¬
ciety is composed of the nobles and commons, and here the
rule of precedence only need be alluded to. In the table
of precedence, we find the order as follows : — Next to
knights’ younger sons, stand colonels, next doctors, then
esquires, and next gentlemen. *e- The title of esquire is
now commonly conferred on literary characters, the higher
classes of merchants, bankers, attorneys, solicitors, and
medical men.” ,

Divorce. — The law of this country is as follows : — A
total divorce is given, whenever it is proved that corporeal
imbecility existed before marriage. In this case the con¬
nexion is declared to have been null and void ab initio.
Imbecility may, however, arise after marriage, but it will
not vacate it, because there was no fraud in the original
contract, and one of the ends of marriage, the procreation
of children, may have been answered.” Blackstone’s Com¬
mentaries, by Christian, v. 1. p. 140. An excellent account
of the causes of impotence and sterility is given in Dr.
Beck’s Medical Jurisprudence, and by M. Bousquet, in a
work entitled De l1 Amour Conjugal ; the latter includes the
moral as well as the physisal causes. Dr. Blundell related
a case in his lectures, which proved impregnation may take
place, though the urethra open through the corpus spon¬
giosum. f<r The infant was the exact similitude of the
father.” I have known a case in which two inches of penis
sloughed, the patient recovered and had a child. The penis
may slough to the pubes, and on recovery the sufferer may
procreate.* These cases are exceptions to the received
opinions. The subject of doubtful sex or hermaphroditism,
is fully considered by the writers already referred to. Black-
stone asserts that monsters can inherit, and shall be con¬
sidered male or female, according to that kind of sex

* See- our last volume, p 322, Mr. Hurd’s case.

332

Original Communications .

which doth prevail, (B, 2. p. 247,) and it ought to be bap¬
tised. ‘f Coke Littleton, 8. a. The same rule guides in
cases of tenant by the curtesy.” The ancients have war¬
ranted cases of procreation between hermaphrodites, which
are entirely unworthy of credit, for every anatomist knows
the difference between the male and female pelvis, a dif¬
ference that renders the process of parturition through that
of the male physically impossible.

Parent and Child. — The law defines a legitimate child,
is one born in lawful wedlock, or within a competent time
after a lawful marriage.” Though pregnancy is commonly
terminated at the ninth calendar month, it may be pro¬
tracted to a longer period, to the tenth, eleventh, eleventh
month and a half, and no limit is placed by the law on the
subject.*

Rights of Authors. — In the case of Abernethy v. Hut¬
chinson, an injunction was applied for to restrain the publica¬
tion of the surgical lectures of the plaintiff ; the application
was refused, on the ground that the lecturer had no written
copy of his lectures, prior to their delivery. The principle
laid down was, that, though any one may have a property
in an oral discourse, or even his own thoughts, yet, to esta¬
blish a right to such property, there must be a visible and
tangible record, by writing, of its existence, otherwise it
cannot be identified, and the owner’s claim established.”

Libel. — A fair criticism on the works of a professional
artist, in the course of his professional employment, is not
actionable, however mistaken it may be ; if it is unfair and
intemperate, and written for the purpose of injuring the
party criticised, it is actionable. Soane v. Knight, Moo. &
Malk. 74. M.S. 1827.

Cotton Mills. — The 6 Geo. 4. c. 63, comprises important
provisions for the preservation of health, and regulating the
hours of work of children who are placed in such fac¬
tories

Insurance of Lives. — A medical man can insure his life
for the amount of property he derives from his profession.
It is right to mention what the law considers good health.

Where there is an express warranty that the person is
in good health , it is sufficient that he is free from any exist¬
ing ailment ; for it can never mean that he is free from the

* Ryan’s Manual of Midwifery, &c. 1829, art. Duration of Pregnancy. See
further observations bv the same author. Loud. Med. Gaz. Dec. 19^ J829.
p-37i. . : •

Dr. Ryan on Laws relating to the Medical Profession. 333

seeds of disease. Even if the insured labour under a par¬
ticular infirmity, if it can be proved, by medical men, that
it did not at all, in their judgment, contribute to his death,
the warranty of health has been fully complied with, and
the underwriter is liable.

With respect to the risk which the underwriter is to run,
it is usually inserted in the policy, and includes all suicide *
or death by the hand of justice. When the risk is once
began, there can be no apportionment or return of pre¬
mium, though the underwriter is discharged.”

Offences against the 'public peace — If a medical man
attend professionally at a duel, he is liable to be indicted
for murder, should the opposite party lose his life. Hence
medical men remain some distance from the scene of action*
but sufficiently adjacent to afford aid if necessary!.

Offences against the public health.— Any trade or busi¬
ness injurious to the public health, whether by the erection
of an establishment, which might contaminate the air by
noxious inhalations, is a misdemeanor at common law.

Exposing a child abroad, when labouring under small pox,
either inoculated or natural, is an indictable offence.

The 43 Geo. 3. c. 58, Lord Ellenboroughrs act, already
referred to, in speaking of abortion, included cases of shoot¬
ing, or attempting to shoot, stabbing, or cutting with sharp
instrument, as felonies ■; but this act is extended by 9 Geo. 4.
c. 31, Lord Lansdowne’s act, which comprises any attempt
to poison, drown, strangle, stab, cut, or wound, even with
a blunt instrument, as capital offences; and the conceals
ment of the birth of a child, whether by a married or single
woman, is made a misdemeanor.

Self destruction. — The usual practice of juries, in case$
of self-murder, is to bring a verdict of insanity ; judging,
probably, that the act of self-destruction is such a strange
anomaly in human conduct, such a wide aberration from the
principle of self-preservation, which universally actuates
sentient beings, as to form of itself unequivocal testimony
of deranged or maddened intellect.

The medical practitioner ought to be intimately acquainted
with general and morbid anatomy, of the elements which
compose the different tissues of every organ in the human
body, otherwise it is impossible for him to appreciate the
changes produced by disease. We have now works of
reference on this point, those of Dr. Craigie, Mr. Grainger,
Mr. Storer, Martinet, &c. &c. It is unnecessary to adduce
arguments to prove that the life, liberty, and reputation of

334 Original Communications .

aI J’Uzx tl . lOHiTOiiifi J t f w* | * (j i f y -f »• . . ... | v... J - v • ^ t

those accused of homicide, chiefly depend upon medical evi¬
dence.

Rape.— Rape 'is the offence of having* carnal knowledge
of a woman by force, against her will, which, by the 18
Eliz. c. 7 3 is felony, without benefit of clergy.

The carnally knowing and abusing any woman- child,
under the age of ten years, in which case the consent or
non-consent is immaterial, as by reason of her tender age
she is incapable of judgment or discretion, is felony. Car¬
nal knowledge of a child, between ten and twelve years
old, with or without consent, is a misdemeanor.

A boy, under fourteen years of age, is deemed in law in¬
capable of committing a rape, and, it seems, is not punish¬
able.

In an indictment for rape, the party ravished is an admis¬
sible witness ; but the value of her testimony must be left
to the jury. For instance, if the witness be of good fame,
if she presently discovered the offence, and made search
of the offender ; if the party accused fled for it ; these are
concurring circumstances, which give greater probability to
the injury, after she had opportunity to complain of its
perpetration ; if the place where the fact is alleged to have
been committed is where it was possible she might have
been heard, and made no outcry : these carry a strong, but
not conclusive, presumption that her testimony is false or
feigned.

Moreover, an assault to ravish, however shameless and
outrageous it may be, unless it amount to some degree of
consummation of the deed, is not a rape.

It is the essential character of this crime, that it must
be against the will of the female on whom it is committed.
And if a woman be beguiled into her consent, by any artful
means, it will not be a rape ; and therefore, having carnal
knowledge of a married woman, under circumstances which
induced her to suppose it was her husband, was held, by a
majority of the judges, not to be a rape. Russ. Ry. C. C.
487. However, the crime is not mitigated by showing that
the woman yielded, at length, to violence, if her consent
were obtained by duress, or threats of murder ; nor will
any subsequent acquiescence on her part do away with the
guilt of the ravisher. It is a rape to force a prostitute
against her will ; so it is for a man to have forcible know¬
ledge of his own concubine, because the law presumes the
possibility of a return to virtue. A man, however, cannot
be himseif guilty of a rape upon his own wife, for the ma¬
trimonial consent cannot be retracted. I Hale, 629 ; but he

Dr. Ryan on Laws relating to the Medical Profession. 335

^ 0 4 3v*vT\y^ O v jy {% t-3*4 \ &

may be criminal in aiding and abetting another in such a
design. ’

All who are present, of both sexes, aiding in the perpe¬
tration of rape, are principals in the second degree.

Unnatural Offence. — Buggery, from the Italian bugge-
rare, is a carnal copulation against nature ; as a man or
woman with a beast, or a man with a man, or a man unna¬
turally with a woman. It was anciently punished with burn¬
ing, some say burning alive ; but it is now a capital felony,
and punished, as other capital felonies, with hanging.

The law requires the same evidence of penetration and
completion in this case as in the preceding crime ; both
parties are equally guilty, as well as all present and assist¬
ing therein. If committed on a boy under fourteen, it is
felony in the agent only. 1 Hale, 47.

Blackstone properly observes on this truly unnatural
offence, that it is a crime which ought to be strictly and
impartially proved, and then as strictly and impartially
punished. But it is an offence of so dark a nature, so
easily charged, and the negative so difficult to be proved,
that the accusation should be clearly made out ; for, if
false, it deserves a punishment inferior only to the crime
itself.” This law is modified by the 9 Geo. 4. c. 3l, already
cited.

Anatomy. — The exhumation of dead bodies, even for the
purpose of anatomical science, is a misdemeanor, it being
contrary to common decency, and repugnant to the general
feelings of mankind. 2 Leach, 560.

Curtesy, by the law of England, is where the wife had an
estate in fee, and has issue born alive, but the mother dies,-
and the husband holds the lands during life. I have else¬
where cited cases of this kind, in which medical evidence
alone decided the question. — Manual of Midwifery .

BIBLIOGRAPHY.

PHYSIOLOGY.

1. Singular Phenomenon produced by Opium. — M. Cavalier states
that he had used an enema, consisting of two ounces of mucilage
and a grain and a half of opium. He was seized with nausea, but
no vomiting ; and having removed the cover of the night-lamp, the
appearance of the light produced vomiting, and this increased
whenever he submitted to the action of light. He endeavours to
explain this curious phenomenon, but leaves it as obscure as he
found it. — Rev. Med. Fran, and Etrangere.

336

Bibliography.

SUltGERY.

2. M. Dupuytren on wounds produced by fire-arms, especially those
received in the late revolutionary struggle.— His introductory remarks
related to tlie state of the hospital recently, at the period in question.
The first combats took place in the Palais-Royal and in the streets
St, Honore and Richelieu on the evening of the 27th, when six or
seven gun-shot cases were carried into the Hotel Dieu ; but it was
on the day of the 28th, and morning of the 29th that the greatest
number was received. The height at which the thermometer stood
during the two latter days was remarkable; and it may not be un¬
worthy of notice, that it was in summer, and at a like elevation of tem¬
perature, that the great insurrections of the Revolution occurred. —
The fact is left to the physiologists for explanation ; it will be more
important for us to consider the effects of this state of the atmosphere
on the wounded patients. The vulgar opinion is, that hot weather
is unfavourable for the treatment of wounds — the contrary is the
truth ; hot weather, in fact, is never the exciting cause of hospital
sore or gangrene. M. Larrey has long since made this remark ;
he observed that iq Egypt the cure of wounds went on far more
easily and rapidly at a very extraordinary elevation of temperature
than in cold countries — in Russia, for example. Several, however,
of the fatal cases which have occurred in the Hotel Dieu may be in¬
directly attributed to the temperature ; for many of the patients,
oppressed with the heat, threw off their garments and bed-clothes,
while exposed to currents of air injudiciously established in the
wards, and thus were attacked with severe abdominal inflammations.
Cases of arachnitis, pleurisy, pneumonia, and liver complaints, be¬
came frequent — many of them fatal; while the smell of the wounds
and the crowded wards had apparently no ill effect. It ought to be
made an invariable rule in hospitals never to open opposite casements
at one and the same time ;• but first those of one side, and then the
other alternately.

The Hotel Dieu was most centrally situated with regard to the
principal scenes of action, and hence received by far the greatest
number of the wounded— -about 400 ; those chiefly who were injured
in the combats of the Greve, the Chatelet, and the Louvre. The hos¬
pitals St. Antoine and St. Louis were also pretty well supplied. It
must be observed, that the combatants in these struggles were very
differently circumstanced ; on one side there was a numerous army
(not less than 9 or 10,000 men), well provided with arms, well dis¬
ciplined, and expert ; on the other, throngs of people in a state of
excitement, full of ardour and courage, but without order or com¬
mand, their only arms — pistols, old muskets, fowling-pieces, broad¬
swords, and some cannon (when they could be procured), but cannon
without proper ammunition, they being obliged to charge their pieces
of ordnance with paving stones, wedges of wood, lumps of lead,
billiard-balls, &c. It will hence be easily accounted for why the
wounds inflicted by the military were so much more serious than
those made by the citizens. Much less ravage, however, has been

Surgery .

337.

produced by cannon-balls than might have been expected, in conse¬
quence, no doubt, of the irregularity of the streets and the numerous
indentations and places of shelter ; for more mischief was done by
case-shot, which was very abundantly made use of. Nor has any
instance been observed in the Hotel Dieu of the total removal of a
limb by artillery; portions have been carried off by pieces of balls, & c.
one woman has had a great part of the deltoid taken away by a piece
of bullet — the head of the humerus is exposed, but she is going on
well, A young man, in the ward Sainte Marthe, has received a
severe wound in the chest ; the ball entered at the anterior superior
region, and has been extracted from the back ; he also is pretty well.
It was asserted that the soldiers used chewed halls, and the people
hammered ones, in order to render the wounds the more grievous.
This was not true. To chew a ball is by no means so simple a busi¬
ness, and all that the best teeth can do upon it is to make a number
of holes on the surface without prominences— not certainly tending
to render the projectile more murderous ; and as to the compressing
of the bullets, if a hammer was ah all employed for the purpose, it
was simply to beat them out, so as to make them fit the fusils whose
calibre would not otherwise admit them. It was asserted, too, that
some of the arms were poisoned ; but this was also a complete false¬
hood. — Journ. Hehdomadaire. .

MIDWIFERY,

3. Extra-uterine Pregnancy.- — Dr. Wilmans relates a case of
extra-uterine pregnancy in Huf eland’s J'urn, der Parkt. Heildkund
Marcht, 1829, in which the foetal bones escaped by the rectum
and bladder. During the period in which the bones were passing,
the woman had had four natural labours.

Mr. S. Cooper has requested ouradvice in a case'somewhat similar.
The woman has had a living child during the passage of the bones
per vaginam, a femur, a rib, and one parietal bone' of a foetus of
four months have only passed as yet.— Ed.

MATERIA MEDICA.

4. Mode of Solidifying Turpentine, Oil of Turpentine, and
Balsam Copaiva. — M. Faure, apothecary at Bordeaux, proposes the
following mode for effecting the object at the head of this article.
He triturates 14 drachms of pure clear turpentine, and 36 drachms of
calcined magnesia in a marble mortar, until they are accurately
mixed, and he next places the compound in a close vessel. In twelve
hours it will be of the proper consistence for pills. He employs
nearly the same process for the solidification of the essential oil.
He mixes 6 drachms of pure turpentine, 2 of oil, and 36 of calcined
magnesia. He places the compound in a close vessel, and agitates
it from time to time. In six or eight days it will be of the pillular
consistence. The balsam is also hardened by magnesia. — Jour . de
Med. Pratique de Bourdeaux.

5. Efficacy of Belladonna in Pertussis. - — M. Mequel has ad¬
ministered belladonna in the commencement of hooping cough, in

Vol. v. no 28.

u u

338

. I ,, s •

Bibliography.

ji.

ylbiini .g^iftsqoicf gli uim-niimu ,ao?i k> aiagorfaBgka * : . • * *

progressive doses, until signs of narcotism have appeared, such as

agitation and redness of the face, when the dose is to be dimi¬
nished, or -the medicine entirely discontinued ; the remedy loses its
effects, if kept for a year, when two-thirds of the grain of the root
will have little effect on a child two years old. The dose of the
fresh root is one- eighth of a grain three times a daV.— Arch fur
Mediz. Er.fah rung , 1&29.

6. Cure of Fascial Neuralgia by Belladonna. — M. Claret asserts,

ipiat he has cured six cases of fascial neuralgia by friction, over the
painful part with , ten grains of belladonna, reduced to the fedii-
sistence of honey by admixture with water. — Rev. Med. Fran, et
Etrangere. r ^ r . , AV ' „ ^

7. Efficacy of Secale Cornutum in Hcemo'nrhages . — Dr. Spazani
has related cases of menorrhagia, epistaxis, uterine congestion,
haemoptysis and heematuria, which he cured with secale corntittim.
He thinks the medicine contra-stimulant, and that it possesses a
peculiar action on the minute vascular ramifications. — Annali Univer .
viduMeUicme&i

8. Use of the Fumes of Belladonna in Phthisis. — -Dr. Palozzi has
derived great benefit in liis own and other cases from smoking the

i heaves of belladonna for a quarter of an hour, morning and evening.

? - — II Raccogliatore, No. 1. ■, t .akdsaocf an lenmsm «

■ 9. Use of Nitro-muriatic Pediluvia in Diseases of the Liver. r—

- Dr. Tannini has spoken in high terms of the value of the nitro-
muriatic bath in chronic affections of the liver. — Osservatore Medico

si diow aiH .awoffs Joskins gd$ m

10. Menstruation continued to the 94th year.— A case is recorded
in the Ann. Univ. di Med. of a female, aged 94, whose relatives
were remarkable for their longevity, and who continued to men¬
struate from the 53rd to the 94th year, and ,at present she is in
perfect health. .ogslaav

H9(j

vsn

no

rd .sjnoiujie

CHEMISTRY.

1 1 . New mode of preparing the carbonate of iron. — Take of sulphate
of iron and'sub- carbonate of soda, each % ounces. Pound each salt, and
dissolve them separately in warm water.5 It necessary, filter. Being
filtered and cool, mix the solutions in a deep vessel, capable of holding
one or two gallons of water, which fill up cold. Stir, let subside,
and then decant the clear liquid from the precipitate. Fill up again
with water, and likewise again decant ; and repeat this operation two
or three times, so as to separate the soluble salts. Next put the pre¬
cipitate on a filter of cotton or linen cloth, supported by a square
frame. When the, water has ceased to pass, gather into one hand
the edges of the filter, so as to make it a sort of bag, and with the
other twist- it round* from the holding hand downwards/ so as to
squeeze out the remaining water. The precipitate will now bdve the
appearance of clay, too soft for moulding. With soft sugar and aro¬
matic powder j in suitable proportions, make it into an electuary.

* •

Chemistry *,

Tiros w t? obtain a carbonate of iron, uniform in its properties, hardly
deteriorated by the process it undergoes, and little liable to change
by keeping.

The precipitated carbonate of iron, while yet moist, is soluble in
carbonic acid, .-Hence a teaspoonful of the above electuary is soon
dissolved in a glass of ginger beer, except the aromatic powder it
contains. It may be asked, therefore, whether an eligible medicine

pupce of sulphate of iron, and an ounce of sub-carbonate of soda ;
. then cork and set them aside, as usual, till they be ready. I pre¬
sume that the production of carbonic acid, by the fermenting process,
would go on as usual, and that when drawn in due time, we would
find the carbonate of iron entirely dissolved in the ginger beer.

' ' fovj J\ied. Jpurn.

J3 SSSfec

„ IUi

f dohlw .minimum

BOTANY,-.;-.

P, IP, Yl

eiSiA

JSGlf

Sill

S>fld

An Introduction

Illustrated with explanatory engravings. By Thomas Castles, H. L. S.
Member of the Royal College of Surgeons, &;t\ London, 1830. d 2°. pp.
s*2f8 SL E. Cox. — The design of the present work is to place before the
student a comprehensive outline of the Science of Botany in as plain
a manner as possible. The author who is favourably known to -the
profession by his numerous publications, evinces his usual zeal and
industry in the work before us. He has arranged a very useful in¬
troduction to the study of Botany, divested as free from technicalities
as the subject allows. His work is therefore calculated -for the gene¬
ral reader. Its contents are as follow ; — history of botany, elements
of botany, language of botany, Linmean artificial system, Linnseun
natural system, Jussieu’s- natural system, anatomy and physiology of
1 plants, and harmonies of vegetation. As an elementary work, , this
production may be perused with advantage. It is a popular work
not calculated for medical students, but they will find the author’s
introduction to medical botany worthy of attention.

-APOTHECARIES

' "DOS

COMPANY.

vp .tins n ■ medical police-

13. Regulations to be observed by Students, whose attendance on,
Lectures shall commence on or after the Is/ of Jan. 1831.* — -Every
candidate for a certificate to practise as an apothecary, will be required
to produce testimonials of haying served an apprenticeship f of not
less than five years to an apothecary.

:w

in

on

* Students who are at present pursuing their medical studies, andthosowho may
begin to attend lectures at the commencement of the next medical session (viz.
October), will be received as candidates for examination by complying with the
regulations heretofore. published. *iam*d .

f . The. apprenticeship.' mnst have been served with a person legally qualified to
practise as ari apothecary, either by having been in practice^ pifioP to or hhtthe 1st
of August., lftlo, or. by having received certificate of. his' qualification from the
Court of Examine's.

340

Bibliography.

\

Of having attained the full age* * * § of twenty-one years:

Of good moral conduct f : and,

Of having devoted at least two years to an attendance on lectures
and hospital practice. ,

The candidate must have attended the following courses of
lectures X —

Chemistry — Two courses, each course consisting of not less than
forty-five lectures.

Materia Medica and Therapeutics — Two courses, each course
consisting of not less than forty-five lectures.

Anatomy aud Physiology — Two courses. Anatomical Demonstra¬
tions — Two courses ; of the same extent as required by the Royal
College of Surgeons, of London.

Principles and Practice of Medicine — Two courses, each course
consisting of not less than forty-five lectures, to be attended sub¬
sequently to the termination of the first course of lectures on Che¬
mistry, Materia Medica, and Anatomy and Physiology.

Botany — One course.

Midwifery ; and the Diseases of Women and Children — Two
courses. To be attended during the second year.

Forensic Medicine — One course. To be attended during the
second year.

Students are moreover recommended diligently to avail them¬
selves of instruction in Morbid Anatomy.

The candidate must also have attended for twelve months , at least,
the physician’s practice at an hospital, containing not less than sixty
beds, and where a course of clinical lectures is given ; or for fifteen
months at an hospital wherein clinical lectures are not given ; or for
fifteen months at a dispensary § connected with some medical school
recognized by the court. The whole of such attendance to be sub¬
sequent to the first year of attendance on lectures.

The testimonials of attendance on lectures, and hospital practice,
must be given on a printed form, with which students may be sup¬
plied, on application, at the under-mentioned places.

In London, at the beadle’s office, at this Hall.

In Edinburgh, at Messrs. Mac Lachlan and Stewart’s, book¬
sellers.

In Dublin, at Messrs. Hodges and Smith’s, booksellers.

* As evidence of aye, a copy of the baptismal register will be required in every
case' where it can possibly be procured. ylaroos affct io ilialo • • •

f A testimonial of moral character from the gentleman to whom the candidate
has been an apprentice, will always be more satisfactory than from any other
pei sou.

% The lectures required in each course respectively, must be given on separate
days.

§ Certificates of attendance on the physician’s practice at dispensaries will con¬
tinue to be received until the 1st of Jan. 1833, from all such as have heretofore
been admitted, but after that time the present regulation will be strictly adhered to.

Medical Police,

341

In the provincial towns, where there are medical schools, at the.
hospital, or from the teacher who keeps the register of the school.

Students are enjoined to observe that no other forta of testimonial'
will be received ; and that no attendance on lectures will qualify a
candidate for examination, unless the teacher is recognized by the
court.

The teachers in Dublin, Edinburgh, Glasgow, and Aberdeen, re¬
cognized by the constituted medical authorities in those places respec¬
tively, are recognized by the court.

REGISTRATION. <

A book* is kept at the Hall of the Society for the registration, at
stated times, of the names of students, and the lectures, hospitals,
or dispensaries they attend.

All students, in London, are required to appear personally, and to
register the several classes for which they have taken tickets; and
those only will be considered to have complied with the regulations
of the court whose names and classes in the register correspond with
the testimonials of the teachers.

The book will be open for the registration during the first twenty-
one days of the months of February, June, and October, from nine
o’clock until two. :

The court also require students at the provincial medical schools
to register their names in their own hand- writing, and the classes
they attend, with one of the teachers + in each respective school,
within fourteen days from the commencement of each course of lec¬
tures, and those students only will be deemed to have complied with
the regulations whose names are so registered.

Each student, at his first registration, will receive the printed form
on which he is to obtain the certificates of his teachers.

The examination of the candidate will be as follows : —

1. In translating parts of Celsus deMedicina, or Gregory Con¬
spectus Medecinse Theoretics, Pharmacopoeia Londinensis,
and Physicians’ Prescriptions.

2. In Chemistry.

3. In Materia Medica and Therapeutics.

4. In Botany.

5. In Anatomy and Physiology.

6. In the Practice of Medicine.

NOTICE.

Every person offering himself for examination must give notice in
writing to the clerk of the society on or before the Monday previ¬
ously to the day of examination, and must also at the same time de-

* The book will be opened for die registration of those students whom these regu¬
lations affect, on the 1st of Feb. 1831.

f The students will be informed at each school, respectively, of the name of the
teacher to whose care the register will be confided.

342 ! Bibliography.

posit all the required testimonials at the office of the beadle, where
attendance is given every day, except Sunday, from nine until two
8-efoclt.’^- ^mirsqab ss ni Site - - ibl hm Jm>w sift',

Candidates will be- admitted to examination in the order in which
their names stand on the notice paper ; and those neglecting to at¬
tend agreeably to their notice, will, upon a subsequent application,
be placed at the bottom of the list. ; ^ - * '

X By the 22d section of the Act of Parliament no rejected candidate
can be re-admitted to be examined until the expiration of six months
from his former examination.

The court meet in the Hall every Thursday, where candidates are
required to attend at half-past four o’clock.

(By order of the court) John Watson, Secretary.1*

Apothecaries’ Hall, Sept. 9, 1830. jlo

t A * A.v’..1' •. !.*..> xl Xa.su * r * i X IJO 1 ifQ I0OTI * yji'lf (j

-.--The Act directs the following sums to be paid for certificates.

For London, and within ten miles thereof, ten guineas.

For all other parts of England and Wales, six guineas.

Persons having paid the latter sum become entitled to practise in
London, and within ten miles thereof, by paying four guineas in
addition.

For an assistant’s certificate, two guineas.

For information relative to these Regulations, medical students are
referred to Mr. Watson, who may be seen at his residence, 43, Ber-
ners-street, between the hours of nine and ten o’clock every morning
(Sunday excepted) ; and for information on all other subjects con¬
nected with the Act for better regulating the Practice of Apothe¬
caries,” application is to be made to Mr. Edmund Bacot, clerk of the
society, who attends at the Hall every Tuesday and Thursday, from
one to three o’clock.

< It is expressly ordered by the court of Examiners, that no gratuity
be received by any officer of the court.

MEDICAL JURISPRUDENCE. 03

14. Dr. Gordon Smith has taken the trouble to reply to our
comments on the medical evidence delivered at the late inquest on
the unfortunate Miss Cashin, and not only defends that given by
Pr* Alexander Thomson, but has been good-natured enough to
rmake a few sharp personal animadversions upon our competency to
form an opinion upon the subject. In order to place the justness of ,
, his remarks fairly before our readers, we must premise a few words
in explanation, and observe, that /4 a man always speaks with pain of
himself.” In common with many eminent men, Dr. Smith was
pleased to favour us with the highest eulogy for our articles on
Ethics and Medical Jurisprudence, and employed language such as
‘‘ these articles will immortalise you,” &c. &c. In a letter which
was to be read at the Medico-Botanical Society, when the noble
president,- Earl Stanhope, and council proposed the editor of this
journal, as Professor of Toxicology, he stated “ If the expression of
my opinion as to your eligibility can be of the slightest use to you,

Medical Ju risprudence.

m

it is: at your service in aiiy - shape ; and I. hope the day is<f§q|i£|fir
distant when we shall be fellow labourers in the strictest sense of
the word, and for the benefit of society, in a department of science
hitherto known almost (I grieve indeed to say it) only to our¬
selves.” In a communication dated August 9th, requesting our
opinion on a matter of vital importance to the interests of the study of
jurisprudence, he said, “ I shall give any alterations you may
propose the most candid and deferential attention.” Unfortunately
we forgot the story of Gil Bias and the archbishop of Toledo, and
in an evil hour, did suggest some alterations in the matter, and
hinc iliw lachrynue. In justice to ourselves and our critic, we must
observe, that our suggestions were generally adopted, and we
firmly believe chiefly contributed to the subsequent acquirement
of the object we both had in view. We received the warmest
acknowledgments from our correspondent, and again on the appear¬
ance of our last number ; but with an expression of regret for our
strictures on Dr. Thomsons evidence In ten short days afterwards.
Dr. Smith publishes his reply in the “ Lancet,” doubts all our pre¬
tension and competency to teach or even offer an opinion on me¬
dical jurisprudence ; and gravely advises us to study the best works
upon the subject. But to crown all, he has since favoured us with
a most friendly letter, in which he says, “ Allow me to congra¬
tulate you upon the formidable position of the medical jurist, and
also on the distinguished part you will now be called upon1: to
perform in that capacity. The Apothecaries’ Company have done
then duty, as you will perceive by their new regulations. You and
I must pull together if possible, notwithstanding the jobation I have
given the Medical and Surgical in the “ Lancet.” This is rather
strange language addressed to one who knows nothing of juris¬
prudence, and whose incompetency wras so lately pronounced by the
writer ex cathedra. We are extremely sorry that Dr. Smith, to
whose talents we have ever paid that tribute of respect which they
so well merit, should be placed in so awkward a position as the
eulogist and censurer of one who never gave him any cause of
offence. If his opinion of us in the reply which we hasten to insert
he the real one, what was that of the above correspondence ? or
vice versa. Could he not discuss a scientific question without descend¬
ing to personality, or must he convey sneers as little worthy of his
own character and station, as we shall shew they are useless to
his defence? But enough; we shall refute his reply by his Own
published opinions. He must have forgotten the recorded opinions
in his “ Principles of Forensic Medicine,” and in his “ Analysis of
Medical Evidence,” when he broached the most contradictory doc¬
trines in the “ Lancet.” We must leave him to explain which
he wishes to be of standard authority. Leaving him to arrive at ; a
conclusion, we fearlessly affirm that we could cite the whole of the
writers on ethics and state medicine in this and other countries
against this assertion, “ Dr. Thornson is a good example of whht a
medical jurist ought to be,”- as exemplified at the late inquest, but

344

Bibliography.

our opponent shall be our chief authority. In reviving this dis¬
cussion, Dr. Thomson has to thank his chivalrous friend ; and we
must assure him that we should not have done so voluntarily, and
also that we should be extremely sorry to give him pain, much less
offence. He will recollect that his evidence, and that of all the
other medical men, are fair subjects for impartial criticism ; and he
will bear in mind, that our talented contemporary, the Med.
Chir. Rev. and the Med. Gazette, have been much more caustic on
the occasion than ourselves .

We shall now insert Dr. Smith’s reply, and add our rejoinder.

To the Editor of the Lancet.

“ Sir, — In the last Number of one of the monthly medical
Journals, I was sorry to find some animadversions upon Dr. Alexan¬
der Thomson, and upon the report delivered by him to the jury,
which so carefully investigated the cause of Miss Cashin’s death. To
these I beg to offer a few words in reply.

“ I agree with the writer of the article that the Doctor presents
“a good example,” &c., but my assent to the truth of the observa¬
tion is dictated by a different view of the cause. He is, in my opi¬
nion, most decidedly a good example, and if such an example were
generally imitated, we should not be disgusted so often as we are
with the unintelligible slip-slop and unredeemed nonsense, uttered by
medical men, upon occasions of judiciary investigation.”

Dr. T. is really a good example of what a medical jurist ought
not to be, for the following reasons. He swore there was no- slough,
and that he could not state what was the cause of death without
examining the brain and spine, after Mr. Brodie had sworn there
was slough or mortification on the back, which was the cause of
death.

“ When there is a great difference in the testimony between
medical witnesses, there must be something wrong.” — Principles of
Forensic Med., by J. Gordon Smith, M.T), 2d. ed. p. 527.

Endeavours were made to reconcile this discrepancy, which were
neither satisfactory to the profession nor to the public. “ It will not
do under such circumstances to receive one statement first and after¬
wards substitute another. Such practice would strike at the foun¬
dation of evidence.” — Analysis of Med. Evid. by same, p. 43.
To retract what has been decidedly affirmed would be rebutting his
own evidence. — op. cit, p. 75. “A scientific witness would be
truant to his own character, if when publicly called upon to speak
of his knowledge, he gave an imperfect or erroneous statement,
which it might fall to the share of others to correct ; and it does
appear to me, that it would be little more in his favour if he cor¬
rected himself upon compulsion. — p. 88. “ The report goes out to

the world, and the testimony of the medical man runs the gauntlet
of all those who may be able or disposed to display its defects and
more serious vices.” — p. 89.

It is contrary to the principles of ethics and medical jurisprudence

Medical Jtt rispru den ce.

345

for a medical witness to act as counsel for the prosecution, to cross
examine witnesses, to appeal to the coroner and police magistrate for
the committal of the accused, to appear before a judge when holding
the accused to bail ; in a word, to become the prosecutor. We
defy Dr. Smith or any one else to cite one volume out of 10,000 on
forensic medicine, which maintains that such a witness is a good ex¬
ample of a medical jurist. W e shall allow the Doctor to speak upon this
point. He observes in cautioning the medical witness against bias
or partiality, “ without proceeding farther in the general denun¬
ciation of this impulse,” &c. * * * * I shall confine myself to a
simple warning of danger to the witness. “ I believe it is a general
rule of evidence, that no person interested in the question can be a
witness.” — op. cit. 70, 71. And we most firmly believe, that Dr.
Thomson’s evidence will go for nothing at the Old Bailey, for this
very reason.

“ I hardly apprehend that the Doctor is exactly “ a tyro in medi¬
cine,” for I remember being present, many years ago, when he elo¬
quently aud learnedly took a conspicuous part in a discussion at the
Medico- Chirurgical Society ; and I have ever since entertained a
high respect for his talents and acquirements. I believe he has, in
the interim, been sedulously and successfully engaged in applying the
first of these advantages to the improvement of the other. But I
take it for granted, that the writer does not know him personally, and
from certain facts which have recently transpired, you may possibly
conceive him to be novus, if not juvenis, in the profession.”

To this we answer, that Dr. Thomson was a student at the
London University last winter, and from his evidence as published
in our last, is both novus and juvenis in the profession. This is also
the opinion of the editors of the Med. Chir. Rev. and Med. Gazette,
so that if we err, we do so in good company.

“ Fault is found with his report, upon the following general
grounds; into particulars it is neither requisite nor possible for me
to enter : — 1. That he ought to have had no hesitation about the es¬
char being the cause of death; 2dly. That the examination of the
brain and spine was unheard of as the means of discovering the cause
of death — appending to this remark the surmise, that the cause of
death — from several circumstances specified, might be looked for in
the brain with utter hopelessness of success ; 3dly That the Court
was puzzled by his technical description of every organ in the body ;
4thly. That the body was disinterred without the slighest neces¬
sity ; 5thly. That there is not a well informed man in the profes¬
sion who would not declare the sloughing to be the cause of death ;
6thly. That no man acquainted with the effects of local and consti¬
tutional irritation, would hesitate a moment in forming an opinion on
the cause of death in this unfortunate case ; 7thly. That it is a prin¬
ciple in judicial medicine, that medical men should be as intelligible
and as conclusive as possible ; Sthly. That they should avoid all un¬
necessary displays of technicality and “rigmarole.”

Vol. v. no. 28.

X X

346

Medical Ju r imprudence.

f1 Such are the charges quoted in the order in which they appear,
und I proceed to consider them seriatim. : —

“1. It is observed that the existence of the eschar was proved by
one of the most scientific and eminent surgeons of London. No one
will question the claims of the gentleman alluded to ; but it is not
always the most eminent practitioner who forms the best medical
witness. I record this as a principle in judiciary or forensic medi¬
cine, and could very easily quote practical illustrations in support of
it; but of some of these the writer is or ought to be well enough
aware already. Thomson acted upon a knowledge of the importance
of the occasion, and of the rules which, in similar circumstances,
ought to direct our conduct. He was quite right in hesitating before
pronouncing a positive opinion in a matte? of such moment. It is
also to be observed, that the surgeon alluded to had finished all that
part of the investigation which devolved upon him ; whereas the gen¬
tleman who has received (without incurring') the censure of the critic,
was at the time yet engaged in pursuing Ms.”

The last paragraph scarcely requires refutation, for it refutes
itself. If Dr. T. was quite right, Mr. Brodie was quite wrong, and
this requires no farther comment. The profession will judge for
themselves. But if the reverse was the fact, as our contemporaries
and every man of science we met with during the inquiry admitted,
then the gentleman alluded to incurred the censure he received . We
are ready to admit, that he was actuated by the best motives in
defending the interests of science and humanity ; but that is not the
question at issue.

“ 2. I should have expected a teacher of medical jurisprudence to
have bestowed commendation, instead of disapprobation, concerning
the second article animadverted upon ; but I am compelled to take
him as I find him. So far is the course of examination instituted by
Dr. Thomson from being “ unheard off that no other is observed by
the best medical jurists. All the cavities must be examined before
any necrotomist can swear to the real cause of death. For, although
he may not find traces of a positive nature, the result of such a care¬
ful and minute inspection will enable him to deny the existence of a
variety of causes which might be alleged without foundation ; and
such denial he cannot possibly be in a condition to make, unless such
a course of examination shall have been attended.”

We should like to see Dr. Smith cite some medical authority for
examining the brain or spine, in such a case, or in cases of severe
burn, tetanus, and hydrophobia, for the actual discovery of the
cause of death. We would advise him to refer to (“ and study”) the
works of Sir A. Cooper, Mr. Travers, &c. for the received opinions
on the effects of severe local irritation when produced in a person in
perfect health ; and inform us what morbid appearance in the brain
or spine can explain the cause of death. We repeat that such an
examination is never made, is unheard of ; and even admitting that
congestion, inflammation or effusion was discovered in the head or

Medical Jurisprudence.

347

spine, and produced by an eschar on the back, the size of the crown
of a man’s hat, what would be the inference, but that the injury on
the back was the cause of death ? Is it not, we ask, a received
opinion, that intense pain of any kind, if allowed to continue, must
destroy life, independently of all structural lesion ? Will not
the slightest wound induce tetanus and death, and the brain be
found healthy ? We never said a word against examining the
cavities, and therefore this part of the reply was gratuitous and
requires no answer. We regret our opponent’s disappointment at
our fallacy of dogmas as a teacher of medical jurisprudence ; and
we hope he may speedily regain his usual spirits, and not distress
himself too much about our deficiency. With respect to the ne¬
cessity of technical expressions, we must insert another paragraph
before we oifer our reply.

“ 3. I am not aware that the Court complained of having been
puzzled by him ; he was at hand to explain any thing of an obscure
or unintelligible nature. It is the prudential and proper line of con¬
duct to be pursued, in drawing up official reports, to use professional
or technical expressions ; for these go before the public, and it is a
fertile source of error and confusion to adopt popular terms, in which
the foundations of science were not laid, and which are not, even
now, admitted into the nomenclature.”

<f 4. The disinterment of the body was rendered necessary, be¬
cause the family of the deceased opposed an inspection to the full and
requisite extent ; it therefore became essential to be armed with au-
thorit}^ for the purpose of judiciary satisfaction. In the mean time
the interment had taken place; and whatever further investigation
it was thought onerous to make, you will agree with me could not be
conveniently performed in the grave. Disinterment is a frequent
occurrence for such purposes.

“ Had it been my duty to have occupied the place of the
author of the report cavilled at, my report would have been at
least as technical, leaving it to the Court to ask for explanations
where such might have been wanted. Allow me, as things hap¬
pen to be, to ask into what domesticated terms Dr. Thomson’s
censurer would render the following, which occur in the report ? —
Reticulation; abdomen; tense ; tumid; acromion process ; spinous pro¬
cess of the occipital bone; cellular tissue ; fascia; mediastinum;
phrenic ; sartious ; diaphragmatic : congestion; bronchitis ; purulent ;
pleura; costal; pericardial; tubercle; abscess ; mucous membrane;
capsular; stellated; pulmonary artery ; valves of the heart ; efferves¬
cence ; petechia; peritoneum ; cardiac portion of the stomach; duo¬
denum; mesentery; ilium', colon; rectum; fceculent matter; flatus;
arachnoid; and some others which I have not quoted. Who can
render these into plain English ? Or are there not some of thepa
which, if by circumlocution they could be so rendered, the public
prints would not hesitate, if they were even able, to express ?”

To this we reply, that there was no morbid appearance in the body
which could account for death, except the eschar on the back ; and there-

348

Medical Jurispru den ce.

fore it was unnecessary to employ such irrelevant technical expressions
or render them into domesticated terms ; and we reiterate our opinion,
“ that the court was, and according to Dr. Smith, must have been
puzzled by a technical description of every organ in the body,” which
were all healthy except the stomach and pleura, and were unnoticed
by the most experienced of the witnesses. “ For any witness to
babble in a court of justice is highly indecorous ; for a man of science
to do so on matters of opinion would be ridiculous.” — Principles of
Forensic Med. supra, cit. The same author directs us in giving
evidence “ to advance our judgments in the most precise and simple
manner, and condemns the plan of overwhelming the court by a flow
of garrulity, and that a witness may gallop off in this way, and
perhaps proceed to some distance, seel cui bono .” — Analysis. “ His
opinion ought to be conveyed in a perspicuous manner.” — Haslam,
Hutchinson. “ He should avoid as much as possible all obscure and
technical terms, and the unnecessary display of medical erudition.” —
PercivaVs Ethics. “ He should study logic and not rhetoric,” —
J. Gordon Smith , <M.D.

“ 8. The last article of animadversion is completely answered by
this reply to No. 7. But I must request some explanation of the
term “ rigmarole.” Although my early manhood, and the prior por¬
tion of my professional life, were spent in the service of his Majesty,
wherein we may learn the meaning as well as the application of queer
terms, I should have stretched myself under many a bush before I
had found out £< rigmarole” to be applicable to such a report as the
one in question.”

Our capacity is too limited to enable us to comprehend the exact
meaning of this paragraph, we are totally at a loss to discover the
relevancy of the writer’s campaigns in his Majesty’s service,
“ wherein he learned queer terms, and his stretching himself under
a bush,” to discover the applicability of rigmarole “ to the report in
question.” As we have not enjoyed such great facilities of acquiring
our etymology, being engaged for the greater part of our lives in the
medical schools of Dublin, Edinburgh, London, and Paris, we admit
our opponent’s superiority, while we refer him for the solution of
the important point at issue to his old acquaintance Samuel Johnson,
who will inform him that the import of the object of his fruitless
research is nothing more nor less than “ a repetition of idle words,”
which was strictly applicable to the greater part of the report in
question. And the same authority informs us, that our opponent’s
term for such evidence happens to be synonymous with our own for
babble , means to “ talk idly,” so that here we may join issue. We
must in turn request some explanation of the term “ jobation ” So
much then for our opponent’s defence of Dr. Thomson’s evidence ;
we leave him to enjoy the fruits of the victory lie has achieved.
We shall not disturb him in his triumph in demolishing so feeble an
antagonist ; but ask him a simple question at parting. Dqcs he
seriously believe, that there is one eminent physician or surgeon in

Medical Jurisprudence.

349

this empire who agrees with him, that his friend is a good example
of a medical jurist ? His last paragraph refers entirely to ourselves,
and deserves consideration.

“ For the present I shall go no further ; but if the writer in ques¬
tion seriously intend to teach medical jurisprudence, I fear that I
must exhort him to study the most approved authors upon the prin¬
ciples of that singular science. I thought that medical jurists
entertained no difference of opinion upon such matters. It re¬
mains, therefore, to be cleared up, whether such a difference be¬
tween the writer and myself really exists, or whether this display on
his part does not entitle me to question the validity of his pretensions.

I am. Sir, your obedient servant,

J. Gordon Smith.

Professor in the University of London.

September, 1830.

We are deeply indebted to the writer for his very sincere and
friendly exhortation, but beg to inform him that we have long since
carefully studied the most approved authors on the subject, and
among them even his own productions. We fear, however, from the
facts stated in the first part of these remarks, and the tenour of his
“ reply,” it behoves us to call to mind the salutary admonition,
Timeo Danaos, &c. Without questioning his infallibility, we must
observe, that our published opinions on this singular science, are
not contradictory , and we suspect that we have proved to his satis¬
faction, that the difference of opinion which he has fancied to exist
between us, is simply the offspring of his own imagination. Be this
as it may, we doubt much whether this display on his part does not
entitle us to question the validity of his pretensions to an infallibility
and a superiority which he imagines ‘he enjoys over all his con¬
temporaries. He will please to bear in mind that the science of
forensic medicine flourished long before his time, and was encouraged
in Edinburgh many years before he was found amongst its culti¬
vators, and will continue, even though deprived of his patronage,
and therefore its friends and advocates ought not to excite either
peevishness or jealousy in his bosom.

We can also tell him in the most positive terms, that he will ere
long have more rival teachers than one to demolish, and when he
commences his next attack, we would strongly advise him not to
commit himself as he has done on this occasion, by giving his
opponent an opportunity of refuting his arguments by his own re¬
corded opinions. The lateness of the inquest which concluded on the
day of publication of our last, prevented us from commenting as we
wished on the medical evidence on the occasion in question ; and we
shall now offer a few remarks upon it. The discrepancy of the
medical witnesses is most remarkable, we find them confounding three
different diseases. Mr. Brodie swore there was sloughing, “a term,”
says he, “ synonymous, or nearly so, with mortification.” — Med.

350 Medical Jurisprudence .

Chir. Rev. — While every tyro is aware that these terms are
perfectly distinct from each other, and from gangrene. — Vide
Cooper’s Surgical Dictionary, 1830. Dr. Thomson affirmed, “ there
was no sloughing, for by sloughing we mean the coming away of
a dead part.” Dr. King, or Dr. Hogg, or Mr. Wildgoose did not
state the scientific term for the state of the back, whether gangrene,
mortification or sloughing. Dr. James Johnson designated the state
of the back incipient gangrene ; but all agreed that the state of the back
was the cause of death. The diversity of opinion among the medical
men as to the exact nature of the disease, is highly discreditable to
the majority of them, as men of science and as medical jurists.
We entertain no doubt but all will receive a formidable cross ex¬
amination at the trial; and we cannot help thinking, that an intel¬
ligent jury of plain strait forward Englishmen would be puzzled to
pronounce what was the exact disease of the back in this case. It is
even quite impossible for any scientific man who has perused the evi¬
dence, to say what was the exact morbid condition of the eschar ; but
every medical man of common sense and ordinary acquirement must
at once declare that the eschar was the cause of death from its effect
on the nervous system. We apprehend the judge will expatiate
upon the discrepancy of the evidence ; and as to Mr. Long, he will
come off with flying colours. His fame, however, will suffer ; his
patients will decline, his power of preventing and curing all diseases
will be questioned ; and gullible as John Bull naturally is, he will
display his ordinary good sense, and say, has not this man lost two
sisters in one week ? That the public should be imposed on by
quacks is what any sensible medical man must expect^ when he
looks at the state of the profession, when any illiterate scoundrel
may proclaim his infallibility, while the president and censors of
the College of Physicians, with ample power to prevent them, are
busy in intriguing about the court for their own personal aggrandize¬
ment, and forgetting to discharge the sacred trust reposed in them by
the legislature, for the protection of public health, and the interests
of the whole profession, of which they are but an insignificant part,
and when their conduct is fairly examined, they must be pronounced
by every thinking man, as dangerous and arrant humbugs in the true
sense of the word, as the villainous empirics whom they allow to
sacrifice his Majesty’s subjects. We have shewn from Mr. Will-
cock’s work, in a former article, that the Colleges of Physicians and
Surgeons have full power to punish quacks and irregulars ; and why
in the name of reason, science, and humanity, do they not do their
duty ?

15. Trial of Quacks. — At the Lancaster assizes, J. Ferguson, aged
30, was indicted for killing Betty Kay, at Great Bolton, on the
12th July. It appeared he was not regularly educated as a medical
man, but lived in his youth writh his brothers, who were surgeons in
Bolton, that he had relinquished the profession, and employed
himself as a weaver, but attended women in childbed. He agreed
for 5s, 6d. to deliver deceased ; was intoxicated, inflicted injury on

Me die al Juris p r u deuce *

35 I

her, and allowed her to die of haemorrhage from retained placenta.
He was found guilty, and sentenced to six months imprisonment
only !

At Bristol assizes, an action was brought against a Dr. Soligman,
who represented himself physician general to the army of the King
of Prussia. He advertised to cure “ watery^ gout, broken navels,
dry bumkins, windy cramps under the breath rib, ike.” The plaintiff,
a Mr. Greenhorn, brought an action for the recovery of 7s. 6d. a day,
for 90 days, which he paid the doctor for attending on his son, who
had dislocated his ancle. The treatment consisted of frictions to
the shoulder, which were to replace the bone with loud roaring,
but unluckily failed to produce this effect. The physician general
recovered the suit, as the plaintiff was satisfied with his terms.

Copy of Petition presented to the House of Commons, by Mr. Hume,

Tuesday, July 6, 1830.

To the Honourable the Commons of the United Kingdom, in Par¬
liament Assembled :

The Petition of the undersigned, Member of the
Honourable Society of the Inner Temple,

Humbly sheweth,

1. That your Petitioner considers the toleration of that
abominable nuisance. Medical Quackery, or Empiricism, as a dis¬
grace to a country professing Christianity and civilization, and has
long regretted that the vile and destructive trade of tampering with
the lives and health of the community should have received a
legal sanction and protection by virtue of the Stamp Duty on the
villanous trash.

2. That the mischievous trade of Quackery and imposition is
daily increasing, and that hordes of empirical jugglers are engaged
in its propagation in every quarter of the metropolis, and make their
periodical circuits throughout the country, scattering death and
destruction among the population of the empire, and fattening on
the murders which they are continually perpetrating with their
poisons : and, to add to the monstrous combination against the
lives and health of the community, that the aid of even the pulpit
has been invoked to further the propagation of the imposture.
Instances are on record where mercenary dissenting preachers have
been wicked enough to sermonize and expatiate on the pretended
and miraculous virtues and benefits of the poisonous nostrums of the
mountebank jugglers and impostors.

3. That the culpable toleration of the frauds of those vermin, and
of the secret and wide-spreading destruction of health and life which
is the consequence of their murderous nostrums, is a national oppro¬
brium, equally disgraceful to the legislature and the government,
and has been so stigmatized by many eminent foreign writers. Was
there ever a more monstrous absurdity exhibited in the most bar¬
barous country and the most uncivilized age, than that empirics and
impostors of the most detestable description should be legally and au¬
thoritatively enabled to rob mankind of their health, their property,
and their lives, and to announce that they practise their impostures

352

Miscellanies.

under the sanction of a government Stamp Duty, and vend their
nostrums as “ prepared and sanctioned by his Majesty’s august
authority /” and that all this mischief should be allowed to be in¬
flicted on society merely for the sake of the paltry and disgraceful
revenue, arising from the pest, to the Exchequer ?

Wherefore your Petitioner prays, that your Honourable
House will be pleased to devise some wholesome
regulations, calculated to suppress the frauds and
murderous designs of jugglers and impostors of all
descriptions, and at the same time to repeal that
most monstrously impolitic statute, the Patent
Medicine Act.

And your Petitioner, as in duty bound, will ever pray,
(Signed) John Dingwall Williams.
Inner Temple, June 21, 1830.

miscellanies.

Metropolitan Society of General Practitioners.

To the Editor of the London Medical and Surgical Journal.

16. Sir,-— -As your Journal was once the advocate of apothecaries,
I trust you will do an old subscriber the favour of inserting a few
remarks on the utility of the “ Metropolitan Society of General
Practitioners.” In the formation of this society every effort was
made to avoid giving offence to any portion of the profession, nor
can any of its friends perceive in its rules any thing which they have
cause to regret. That the great body of general practitioners, who
are excluded from all connection with the medical corporations,
should endeavour to protect their own interests is not very un¬
natural, and that they should endeavour to establish a fund for
the relief of distressed members of the profession, including all
classes, is not an objectionable proceeding. They are not apothe¬
caries nor surgeons, but a distinct class of practitioners which society
has sanctioned. They only seek to defend their interests; and
what class of the profession has not done the same ? A great deal
has been said against the society, because it has not been established
at a public meeting and so on ; but allow me to ask what good has
resulted to the cause of reform from public meetings ? What has
become of all the intended meetings — when are they to take place ?
The truth is, Sir, that sober-minded men are opposed to such
meetings, and will never come forward as public disputants. The
editor of the Lancet and yourself object to the term general prac¬
titioner, but neither of you have condescended to propose a sub¬
stitute * * for it. I repeat that those who adopt that title are not

*

* We readily insert the above, though it reached us too late for the department
of this journal allotted to original communications. We have never said a word
against the society in question, as it appeared to us to be unobjectionable and
worthy of support from the class of the profession it more immediately concerns.
True we have objected to the unclassical and unmeaning term. General Practitioner,
which we defy any man to translate into any of the learned languages ; under this
impression we acknowledge our inability to propose a substitute for it. — Ed.

Miscellanies

353

surgeons or apothecaries, that their education differs from that of
either, though it comprises that of both, and consequently entitles
them to practise surgery and pharmacy. If the public sanction
them, I am at a loss to discover of what import is a title.

I am, sir, your obedient servant,

A General Practitioner.

The interests of the public and of the profession will be thus greatly
promoted, and one important step gained towards the cause of
medical reform. The nefarious quacks, and the ignorant pretenders
to physic will receive that chastisement they so well deserve ; and
legitimate members of the profession will have some opportunity of
enjoying their rights, and obtain that recompence for which they
sacrificed their time, talents, and property. We need scarcely
observe, that the example of Middlesex would be followed by every
county in the united kingdom.

17. London University . — Mr. C. Bell has resigned the professor¬
ship of surgery, and Mr. Pattison has been appointed his successor.
Mr. Bell continues to teach physiology At the suggestion of Mr.
Pattison, Mr. Bennett has been associated with him in the chair of
anatomy. Mr. Bennet is assisted by Mr. R. Quain in the demon¬
strations and dissections.

18. Expense of Medical Education in the London University . — The
expense of the course of medical education in this institution is 66/.
which is from 20/. to 30/. more than in the majority of private
schools in this metropolis, and far exceeds that of the schools in
Dublin or Edinburgh. This is bad policy.

19. Metropolitan Society of General Practitioners* — We are happy
to inform our readers, that the Society of General Practitioners have
taken premises at 4, Regent- street, where they have a reading-room
supplied with the medical periodicals, magazines, and daily papers.
They invite all classes of the profession to become members of the
society. An institution of this description was much wanted, and
cannot fail to receive that encouragement which it so well merits.
We cordially wish it success.

20. Medical Coroners . — Though Mr. Wakley has lost his election
for the coronership of Middlesex, yet he has much reason to be proud
of the immense support he received from above 3,500 of the in¬
dependent freeholders of the county. The contest has effected one
grand object, and that is in informing the public of the necessity of
appointing medical coroners. Had the public press acted impartially,
Mr. Wakley would have been successful. There can be no doubt of
his success on the next occasion, which is near at hand, and then the
empirics and the thousands of unqualified practitioners in this me¬
tropolis will have cause to tremble. The public health will be more
carefully attended to, and every class of medical men, in every
relation of society, must discharge their duty with care, caution,
attention, and according to the received opinions of the profession.

Vol. v. no. 28.

X X

354

Miscellanies.

Medical Appointments at Court

21 . “ There is much whispering in the Profession relative to the re¬
cent medical appointments about His Majesty’s person, and to the
use made of a delegated authority, which we notice that if the ru¬
mours be incorrect they may be the sooner set right.

All the medical appointments of His Majesty as Duke of Cla¬
rence are said to have been superseded, and the name of one
party only to have re-appeared among those appointed to attend the
Ki g. Sir H. Halford, Sir Gilbert Blane, and Sir Matthew Tierney,
have been appointed Physicians in Ordinary to His Majesty, to which
a salary of 3001. per annum is annexed. Sir Henry Halford, as Pre¬
sident of the College of Physicians (a regulation procured by himself
from the late King, but for some reason or other never acted upon till
now) is ex officio one of the Physicians to the King, nay the first
Physician ; but, as he may not always continue President, he has
taken the precaution to be appointed Physician in Ordinary in the
usual course ; which double appointment of the same person to the
same office is said to give the fortunate holder a right to a double sa¬
lary, that is, six hundred instead of three hundred pounds per annum.
Sir Henry Halford stands doubly at the head of the list, though in
conjunction with Sir Gilbert Blanes a physician of greater age, of the
highest scientific character, the oldest and longest medical adviser of
his late Majesty, at the head of his list during his whole reign, as
well as that of his present gracious Sovereign before his Accession,
and the only one of the gentlemen whose names are above recorded
who had the honour of attending the Duke of Clarence in early life.
It is also said that a Dr. Hawkins, a young physician of singular good
fortune as a medical pluralist (there being fewer stipendary places in
the medical profession than any other) has been appointed Physician
to the Royal Household (Sir Gilbert Blane, being dismissed from this
place also) holding at the same time the appointment of Registrar to
the Royal College of Physicians, Physician to the Middlesex Hospital,
and Professor to the King’s College ; also, last if not least, about to
become nephew by marriage to the President. When the appoint¬
ment of Physician to the Household was first announced, there was a
general impression that it was Dr- Bisset Hawkins, a most promising
young physician, and already very favourably known to the philoso¬
phical and professional world by an ingenious and scientific work :
but this turns out to be an error.

We stated, lately, that owing to some influence of the back
stairs, the name of Sir Gilbert Blane, which was directed by His
Majesty to be placed first on the list of his Medical establishment,
had been, notwithstanding His Majesty’s injunction, placed after that
of the President of the College of Physicians, that is after that of Sir
Henry Halford’s. We were unwilling at that time to go farther, in
order to allow the authors of this intrigue an opportunity of rescind¬
ing an act equally derogatory to their own honour and to his Ma¬
jesty’s best interests.

As our hint has been disregarded, we shall now redeem our pledge
with the public, and state some circumstances from which it may be
seen how far we were authorized in the assertions wre have already

made.

Miscellanies .

355

We affirm, on authority which none of the parties concerned will
dare to contradict, that His Majesty wrote, with his own hand, to
Sir Henry Halford, requiring him to place Sir Gilbert Blane’s name
first on the list of his physicians. We affirm also, that Sir Henry
Halford, in answer to the inquiries of a certain official of the house¬
hold, did write, that in consequence of His JWajesty’s pleasure, ex¬
pressed in his own handwriting, he had placed Sir Gilbert's name fore¬
most on the list. We affirm, thirdly, that the list, as it now stands,
and by which the two first places are assumed to himself, is such as
it came from the hands of Sir Henry Halford himself. It is no part
of our duty to reconcile words with actions. We state the facts
plainly and simply, as we believe and as we know them to be. It is
evident, however, that here a great act of injustice has been done,
and that the King’s kind intentions have been intercepted by a ser¬
vant and a delegate.

These are not times to trifle with the faith of Princes. The world
is witness, in other countries, of the ruin induced by the falsehood
and selfishness of courtiers. We trust that our present gracious
Sovereign, whose benevolent intentions have been so unequivocally
manifested, will be preserved from the snares of such false friends.” —
Sun. — John Bull. Fiat justitia, ruat caelum.

. Nothing has occurred for a long time which has excited
more disgust and disapprobation throughout the profession than
the late appointments of the medical attendants to his most
gracious Majesty. Even the silly and ridiculous bulletins, which
were pure nothings, were consistent when compared with the
appointments in question. Every one inquired “ who is Dr. A. ?
who is Dr. B. ? and who is Dr. C. ? I have never heard of any of
them. They are unknown in the annals of science.” But most of
them are fellows of the College of Physicians, and the personal
friends or tools of the president ; and to him they owe their unmerited
elevation. There is nothing extraordinary in a man serving his
friends or dependents, provided he does not sacrifice the interests of
those who have stronger claims to notice. That our gracious and
truly magnanimous sovereign would supersede his former attendants,
men to whom he confided the care of his health for many years, is
an idea which no man in his dominions would entertain for a
moment. So far from this being the case, we know from authority
that cannot be doubted, that his Majesty actually inserted, with his
own hand, some of the names of his former physicians, and first on
the list that of the talented and erudite Sir Gilbert Blane, Bart.
By a degree of insolence on the part of some of his seivants, which
forcibly reminds us of Cardinal Wolsey, who, in corresponding with
the court of Rome, modestly commenced with , “ Ego et rex meus,"
Sir Gilbert was deprived of one of his appointments to make room
for a juvenile successor, and his name was placed second on the list.
Oh, shame, where is thy blush ! It is impossible to designate this
audacious and unjust conduct in appropriate language. Of the
parties concerned, we speak impartially ; we do not enjoy their
personal acquaintance, but when we see an individual of Sir Gilbert
Blane’s splendid talents and distinguished character, one who has

Miscellanies.

3 56

stood high in official situation, who has been associated in those
splendid naval events which have raised the glory of this empire,
who has made naval medicine what it is, by his wise and prudent re¬
gulations, which have mainly contributed in the prevention of the
horrid diseases of our fleets, armies, and hospitals, and which even
received the admiration of Lord Spencer as First Lord of the Ad¬
miralty, who appointed him one of the Commissioners of the Sick
and Hurt ; and so interested our most gracious Monarch, then Duke
of Clarence, through whose influence he was appointed Physician
Extraordinary to the Prince of Wales, and Physician to the Royal
Household ; and who had numerous other marks of respect from the
royal family and the government at different times, when we see
such a man as this slighted by base intrigue, we must in common with
the independent part of the profession use the strongest terms of
reprobation of such conduct. But to return to Sir Gilbert. In
addition to the many distinctions already enumerated, he has been
repeatedly applied to by his own and other governments for instruc¬
tion and advice on important matters of public health. He wras
called upon, in conjunction with the royal physicians and other
leading characters, to draw up the regulations on the subject of
quarantine, which formed the basis of the act of parliament on this
head. He was also called upon in 1 800 to offer his advice on the
best mode of managing the convicts in the Hulks at Woolwich, to
prevent infection, and visited Newgate for the same purpose by the
authority of the Secretary of State for the Home Department. He
was likewise consulted by the Secretary of the Colonies, as to the
best mode of transporting our army from Egypt, to avoid the
danger of importing plague. The Board of Controul applied for his
suggestions in ameliorating the regulations of the medical service
in India, and of the transports to Botany Bay. The committees of
the House of Commons have also requested his opinion on various
subjects. He was dispatched to Walcheren to give his opinion;
and it was novel that a naval physician should supersede the first
army medical authorities. His report, made conjointly with the
army physicians, caused the governmennt to abandon the expedition,
too late to repair past evils, but in time to save the lives of thousands.
On his return, the Prince Regent conferred upon him the title of
Baronet. As a literary and scientific writer * he stands one of the
first. His Medical Logical holds a first place in our medical litera¬
ture. He is the only physician in England who is a member of the
Royal Academy of Sciences of Paris, and was elected in preference
to Huf eland and six other candidates. We said he was consulted
on the subject of state medicine by other governments. He received
a gold medal from the late Emperor of Russia, and another from the
King of Prussia ; and a letter of thanks from the President of the
United States of America, written with his own hand. He was
personally known to George the Third for more than half his reign,
and received from him great attention ; and enjoj^ed the confidence
of his late Majesty, who appointed him his physician, and also to
the household, a situation in which, contrary to the will of the
sovereign, he has been unjustly deprived in the late appointments.

Miscellanies .

357

“ He is one of those,” says his biographer, “ who though officially
connected with the court, has neither sacrificed his own dignity nor
his scientific pursuits, at the shrine of favouritism and dependence ;
on the contrary, he has studied to owe his professional distinctions
to merit alone, and who would scorn to draw his pre-eminence from
college monoply to the exclusion of talent wherever it came from,
or to obstruct its progress. Sir Henry Halford should have been
aware that those professional characters in whom his Majesty has
as much confidence as in himself are licentiates, some of them even
with Scotch honorary degrees.” Sir Gilbert is a Fellow of the
Royal Societies of London, Edinburgh, and Gottingen, a proprietor
of the Royal Institution, and Member of the Imperial Academy of
Sciences of Petersburgh, and of the Royal Academy of Sciences
of Paris, as already mentioned. We are indebted to a work en¬
titled “ A Picture of the Royal College of Physicians of London in
1827,” for much of this narrative ; a work which also contains a
faithful memoir of Sir Henry Halford himself, and concludes that of
Sir Gilbert Blane in these words : —

“ Before closing the memoir of this distinguished physician, whom
we may not improperly term “ President of the Licentiates,” for he
has, it well known, declined being a Fellow; we cannot avoid
making some comparison between him and the present President.

The head of this learned body should certainly always stand high
as a literary character, and be distinguished no less for his learning,
than his mere professional knowledge. We do not mean to say that
Sir Henry Halford is deficient in medical acumen, but, compared with
Sir Gilbert Blane, he is not equal as a scholar or a writer. His only
work, already noticed, his Grand Climacteric, is a production of which
it has been sarcastically said, that it had neither subject nor object ;
the subject (the disease) being a nonentity, and the object (the cure)
being not even touched upon. Certainly, much might have been said
on the Laws of Longevity, and the Regimen adapted to old age. Sir
Henry’s failure in these respects, perhaps gave rise to Sir A. Carlisle’s
treatise on Old Age and its Diseases.

Sir Henry’s pamphlet on the Appearance of the Remains of King
Charles I., when exhumated at Windsor fifteen years ago, particu¬
larly the appearance of the vertebrae cut through by the axe, was
merely written for the moment, to mark him as the chosen attendant
of royalty on this melancholy occasion. For besides these, there ap¬
pears only one paper under his name, in the 6th volume of the Col¬
lege Transactions, on “the sudden and unexpected Fatality of certain
Diseases.” It would be invidious to criticise this, as the intention
is good ; but is clear, the writings of a professional man are the only
criterion of his real merit, and it will be decided more impartially by
posterity, when court favour and court intrigue are past, whether the
physician,, at the head of practice and of the College, was also at this
period at the head of Medical Literature.”

Sir Gilbert, has offered prize medals for the encouragement of me¬
dical officers of the Royal Navy, and the improvement of physic and
surgery, in that part of the public service, the terms on which these are
to be obtained, we insert hereafter. The medal is now in full opera-

358

Miscellanies.

tion, all but the engraving of the die, which will cost the benevolent
donor 1501. and the whole expense, will cost him more than 5001. It
is highly gratifying to observe this venerable character, as warmly
engaged as ever, in promoting the interests of mankind and his pro¬
fession : and every one of his enlightened and independent contempo¬
raries must feel highly indignant at his having been treated with
contempt or neglect. But he is only one of the numerous distin¬
guished physicians, who have been badly treated in the late appoint¬
ments. It would be invidious to name others ; but we ask, why have
the medical attendants of our gracious and truly beloved Monarch,
when Duke of Clarence, been deprived of that promotion to which
they were justly entitled? It is universally known through the profes¬
sion that the exclusion of these individuals, was contrary to the King’s
wishes and commands, and is solely to be ascribed to those, to whom
he delegated the power of appointing his medical attendants. It is
truly astonishing that this power should be partially exercised, and
still more so, that a sovereign distinguished for every virtue that
adorns the human character, should be represented as having forgot¬
ten the interest of his former medical attendants, in whom he had re¬
posed the utmost confidence for many years, and treated them with
cold indifference and neglect, and blasted all their long cherished
hopes, and just prospects of preferment. The conduct of those who
have placed their august master in such a light, deserves his greatest
displeasure ; and it has received the strongest reprobation of every in¬
dependent member of the medical profession. The silence of our
contemporaries upon this subject is highly inexcusable, but we agree
with Junius. “ that the liberty of the press, is the palladium of all
civil, political, and religious rights of Englishmen” ; and with Cur¬
ran, that it is, “ that great sentinel of the state, that grand detector of
public imposture * * * * when it sinks, there sinks with it, in one
common grave the liberty of the subject and the security of the
crown.” The press is the grand, and only corrector of abuses in our
profession, and as such we shall ever fearlessly employ it.

Plan and Regulations of the establishment and adjudication of two

Prize Medals for the encouragement of the medical officers of the
royal navy, and the improvement of physic and surgery in that
department of the public service. Founded by Sir Gilbert Blane,
Baronet, First Physician to the King, F.R. SS. Lond. Edin. Gott.
Member of the Imperial Academy of Sciences of Russia, of the
Institute of France, &c.

Sanctioned by the Board of Admiralty, 2d March, 1830.

1. The founder considering how much it will conduce to the
advancement of the public service, that emulation should be excited
among the medical officers of the royal navy by honorary distinctions
for professional merit, has vested the sum of three hundred pounds in
the three per cent, consolidated bank annuities, in the Royal College
of Surgeons of London in trust, with the dividends which shall be
from time to time receivable, for the purpose of conferring, once in
two years, two Gold Medals of equal value, on two medical officers,
surgeons of ships of war, in commission, or assistant surgeons of
king’s ships in commission, not bearing surgeons, who, in the time

Miscellanies. 359

required, shall have delivered, into the proper office, journals, evincing
the most distinguished proofs of skill, diligence, humanity, and
learning in the exercise of their professional duties ; these journals
to he delivered in the form in which they have been kept from day
to day, stating the symptoms, as they shall have occurred at the
time ; but without prejudice, or hindrance, to their making such
observations practical or theoretical as they may judge proper t
annex to them.

2. The first selection to be made by the medical commissioners c
the 12th August, 1831, from the journals delivered between t1
12th of July, 1827, and the 12th of July, 1831. All future sele
tions, to be made on the 12th of August, at the interval of t * >
years from each other, from the journals delivered in the two p « •
ceding years up to the 12th of July immediately preceding sif i
selection.

3. In the selection of these journals the founder proposes that £ e
medical commissioners of the navy shall, out of the whole jour ! Is
delivered to them in the course of the intervals above specif i,
make choice of such as in their judgment possess the highest de } ee
of merit, in number not more than ten, nor less than five, which e ill
be transmitted to the founder during his life-time, for his selec on
out of the number so sent, of two, or one, in case there should .ot
be another of sufficient merit, the author or authors of which, in his
judgment, may be most deserving of the prizes. And after his
decease, the said journals to be conveyed to the president o the
College of Physicians, who, after due examination, is to comimii ate
them to the president of the College of Surgeons, and after ] per
deliberation, the said presidents are to call to their assistan the
Senior Medical Commissioner of the royal navy, and jointly wi him
select from the said journals one, or two, the author or autl s of
which, in the opinion of the majority, possess the highest merc and
become thereby entitled to the medal or medals. The m< 1 or
medals, when adjudged, are to be put into the hands of the atl ding
medical commissioner to be by him presented to the sm issful
candidate or candidates. All the journals of the first selectio to be
returned into the custody of the medical commissioners.

4. In case of the impossibility of performing the before m< ioned
duties through the illness or unavoidable absence of the par s de¬
scribed, the duty is to devolve on the next in rank, that is a the
Senior Censor of the College of Physicians, the vice preside] of the
College of Surgeons, or the Junior Medical Commissioner.

5. In case it should happen at any of the periods of adjv nation,

that in the opinion of the founder, or of the two presidents, cer his

decease, there shall not be found a journal or journals of [equate

merit to entitle any candidate to the prize, the medal or me* s shall
be withheld until the next period of adjudication, and the adjudi¬
cated medals are to be conferred on such, as may possess efficient

merit over and above those subject to adjudication at th; period.
But this regulation is to be so construed and limited, tha 10 more
than four prizes shall be adjudicated at any period ; and the un¬
adjudged medals should exceed this number, their value in nonev is

Miscellanies .

*v4i r. -'v,! jU'v $•••'•*

to be given to the Supplemental Fund for the children of medical of¬
ficers.

6. In case at any time the founder, or the two presidents shall omit
to make the adjudication for a longer period than three months, they
shall be considered as having forfeited their right, and the ultimate
selection shall devolve on the medical commissioners, who in case of
difference of opinion may call in such a referee as they may judge ne¬
cessary or advisable.

7. The founder shall provide and deposit with the Royal College
of Surgeons, the die engraved for the medal, from which they will
cause the medals to be struck at the prescribed periods, and to be
delivered to the medical commissioners to be presented by them to
the successful candidates.

8. No successful candidate to be admitted as a competitor a second
time.

9* The presidents of the Royal Colleges of Physicians and Sur¬
geons, and the senior medical commissioner, to be considered as
guardians of the fund and its equitable administration.

10. In case any of those surgeons, whose journals have been ap¬
pointed to an hospital, or any other situation on shore, except that of
medical commissioner, such surgeons shall still be deemed eligible
candidates for the medals in case of adequate merit.

1 1 . After a lapse of not less than ten years from the decease of
the founder it shall be competent for the presidents of the two royal
colleges, and the medical commissioners of the navy, to hold an
interview for the purpose of consulting whether any and what ad¬
ditions and alterations would be advisable in the preceding plan and
regulations, and to adopt them, in case of their being unanimous for

‘ the adoption : subject themselves to the approbation of the Lord
High Admiral, or the commissioners for executing the office of
Lord High Admiral.

The founder, with all deference to the high professional authorities
who are to adjudge the medals, begs to suggest and recommend as
follow — -

X . That a book be kept in the custody of the medical commission¬
ers of the Royal Navy, wherein is to be transcribed the plan and re¬
gulations, and to serve also as a record of the periodical Adjudica¬
tions, and wherein not only the names of the successful candidates
may be inscribed, but also of all those of the first selection ; among
whom it cannot be doubted, that there will be found tokens of merit,
which may go without their due reward from the limited number of
medals, and all of whom will of course possess a considerable share of
merit above the unselected, and be deserving of consideration.

2. That there be transcribed into this book of record such remarks
as may have arisen out of the examinations, deliberations and discus¬
sions of those appointed to adjudge the medals, and wThich may prove
a source of much vuluable information, not only for the interests of
the Navy but of the community at large, while it will open a source
of liberal and useful intercourse between the members of the different
public professional institutions of the Empire, provided some degree
of publicity should be given to them.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 29. NOVEMBER I, 1830. Vol. V.

! CRITICAL REVIEW.

, l J V > -i - ' ■ • 1 * ‘ * •

I. — A Practical Treatise on the Diseases of the Eye . By-

William Mackenzie, Lecturer on the Eye in the Univer¬
sity of Glasgow, and one of the Surgeons to the Glasgow
Infirmary. London, 8vo. pp. 861. 1830. Longman & Co.

II. — Trade Pratique sur les Maladies des Yeux , on Le-
conk donnees V Infirmarie Ophthalmique de Londres en
1825 et 1826, sur V Anatomic, la Physiologic et .de la
Pathologic des yeux. Par le Docteur W. Lawrence,
traduit de V anglais avec des notes , et suivi d*un Precis
de V anatomic pathologic de V ceil. Par le Docteur C.
Billard (d’ Angers.) 8vo. pp. 499. London and Paris,
1830. J. B. Bailliere.

v ' v . h A

« - - 1 * i { • * * ♦ \

f i i V ... . . . r ‘

Mr. Mackenzie’s work is decidedly the best and most com¬
prehensive on the diseases of the eye ever published in this
country, and will be one of reference and standard autho¬
rity. He describes about two hundred and eighty diseases,
and many more, if we include the different species. Such
a work was much wanted, fgr there is nothing equal to it
in our language. It is a work of great practical utility,
and will find a place in every medical library. The author
has afforded ample proof of great observation, extensive
experience, considerable research, and high talent. No man
can say of this production, book is a book, although
there is nothing in it.” The contents alone occupy ten
pages of small close print. There is no book making* here,
the pages are large and solid, and every one of them re¬
plete with valuable and varied information. It is quite
impossible to review a work of this extent, we can only
notice a few articles. The following account of gonorrhoeal

VOL. v. no. 29.

y y

362

Critical Review.

ophthalmia forms a great contrast to Mr. Lawrence’s de¬
scription detailed in our last, but especially as to the treat¬
ment. We are extremely happy to observe our comments
on the dangerous plan recommended, of abstracting blood,
while any can be obtained from the vein, supported by
such high authority. A moment’s reflection must convince
any man who calls to mind the difference of age, sex, tem¬
perament, habit, state of general health, and idiosyncrasy,
that no rule can be safely laid down as to the quantity of
blood which ought to be taken ; for the effects of loss of
blood are so various as to set all rules at defiance. Hence
few practitioners of the present day will order a definite
quantity ; they use the caution, so well expressed by the
phrase, pro ut ferant vires ; and the man who orders the
removal of a certain quantity, forgets one of the most
important and valuable principles of science. The exces¬
sive and profuse depletion upon which we comment, is not
deemed necessary by the author before us.

Treatment. This ought to he exactly the same as in the Egyp¬
tian ophthalmia. Abstinence from all stimulants ; blood-letting, both
general and local ; and the exhibition of purgatives, or emeto-pur-
gatiyes, and diaphoretics, are to be had recourse to in the early
stage. The discharge is to be frequently and carefully removed
with the muriate of mercury collyrium, the conjunctiva is to be
touched once or twice a day with the nitras argenti solution, and the
lids are to be prevented from adhering by the use of the red preci¬
pitate salve. Counter-irritation ought to be employed from the very
first, by means of sinapisms and blisters to the neck, between the
shoulders, or behind the ears. If either the pain of the eye is pub-
sative, or the circumorbital region affected with nocturnal paroxysms
of pain, calomel and opium are to be given, till the mouth is sore.
Warm fomentations, the vapour of laudanum, opiate friction of the
head, and the like, will serve to moderate the pain ; but our chief
reliance must be placed on depletion, counter-irritation, scarification,
and smarting applications to the conjunctiva, for removing the
disease. Snipping out a portion of the chemosed membrane, so as
to procure a considerable flow of blood, is highly serviceable.

“ Bleeding alone must not be depended on. * flhe inflammation
produced/ says Mr. Bacot, * in the four instances that have come
under my observation, is of the most violent and intractable descrip¬
tion, and has produced the total destruction of the organ of vision,
in the space of two or three days, notwithstanding the most vigorous
employment of general and topical blood-letting, and other anti¬
phlogistic means.’

“ The acetate of lead and the sulphates of zinc and copper, at
least in the early sta*ge, will be found to aggravate the symptoms.
These are the local remedies recommended by Mr. Allan ; and the
case already quoted, the publication of which does great credit to

y

Mr. Mackenzie on Diseases of the Eye . 363

his candour, shows how little adapted these applications are to this

disease.” — p. 370.

Our author describes purulent ophthalmia of new-born
children, which is so important, that we insert the article

in full.

“ Infants, soon after birth, are subject to a puro-mucous in¬
flammation of the conjunctiva, commonly denominated ophthalmia
neonatorum , or the purulent ophthalmia of infants. We have reason
to believe that this disease is, in general, an inoculation of the con¬
junctiva by leucorrhoeal fluid, during parturition ; and that, there¬
fore, it may be prevented, in almost all cases, by carefully washing
the eyes of the infant with tepid water, as soon as it is removed
from the mother. This is too seldom attended to ; the child is
allowed to open its eyes, the nurse sitting down with it on a low
seat before the fire, or in a draught of cold air from the door, and
nothing is done to the child for perhaps half an hour or longer.
Exposure to the light, to the heat of the fire, or to the cold draught
from the door, are all likely enough injuriously to excite the eyes
of the new-born infant ; and, accordingly, some have been led to
attribute the purulent ophthalmia which so frequently shows itself
about the third day after birth, to these causes. It will, in general,
be found, however, that when the child becomes affected with this
ophthalmia, the mother has had leucorrhoea before and at parturi¬
tion, and that the eyes have not been cleaned for some time after
birth. To this the ophthalmia seems to be owing, for, like a
disease communicated by contagion, it is sudden in its attack, and
much more violent than we almost ever see catarrhal ophthalmia,
so that it resembles in this respect the Egyptian, or the gonorrhoeal
inflammation of the conjunctiva. That some of the cases of puru¬
lent ophthalmia, in infants, are catarrhal, is by no means unlikely ;
occasionally they may arise from the application even of gonorrhoeal
matter from the mother ; but by far the greater number, I believe
to be the consequences of leucorrhoeal inoculation.

“ Symptoms. It is commonly on the morning of the third clay
after birth, that the eyelids of the infant are observed to be glued
together by concrete purulent matter. On opening them, a drop of
thick white fluid is discharged, and on examining the inside of the
lids, they are found extremely vascular and considerably swollen.
If neglected, as this disease but too often is, or treated with some
such useless application as a little of the mother’s milk, the swel¬
ling of the conjunctiva goes on rapidly to increase, the purulent
discharge becomes very copious, and the skin of the lids assumes a
dark red colour. In this state the eyes may continue for eight days,
or a few days longer, without any affection of the transparent parts,
except perhaps slight haziness of the cornea. About the .twelfth
day, however, the cornea is apt to become infiltrated with pus, its
texture is speedily destroyed, it gives way by ulceration, first of all
exteriorily to the pus effused between it's lamella?, and then through

S64

Critical Review .

its whole thickness, and this either in a small spot only, or oyer
almost its whole extent, so that sometimes we find only a small
penetrating nicer, with the iris pressing through it, in other cases
the whole cornea gone, and the humours protruding.

“ It is melancholy to reflect on the frequency of destroyed vision
from this disease, especially as the complaint is completely within
control, if properly treated. The attendants unfortunately are not
alarmed sufficiently early, by what they consider as merely a little
matter running from the eye ; and but too often it happens that
medical practitioners, are also betrayed into the false supposition,
that there is nothing dangerous in the complaint, till the cornea?
hurst, and the eyes are for ever destroyed. Many children have
been brought to me in this state ; but the most deplorable instance
which I have witnessed of the effects of this disease, when neglected
or mistreated, was that of two twin infants, from Perthshire, for
whom I was consulted, some time ago. One of the children had
lost the sight of both eyes totally, while the other retained a very
partial vision with one eye.

“ That this disease is a puro-mucous or blenorrheeal conjunctivitis
is, sufficiently evident. It is scarcely necessary to spend time in
refuting Mr. Saunders’s notion of its being an erysipelatous in-
hammation. His opinion regarding the mode in which the cornea is
destroyed in this disease appears of more importance, and equally
incorrect. He maintains that it is by sloughing, not by suppuration
and ulceration, that the destruction of the cornea is effected. The
opportunities which I have had of watching the progress of the
affection of the cornea have convinced me of the contrary. Onyx
•or infiltration of pus between the lamella* of the cornea is the uni¬
form harbinger of destruction ; the lamellae exterior to the pus give
way by ulceration ; the ulcer spreads and deepens, till the cornea is
penetrated, and often almost altogether destroyed. Any thing like
mortification, or sloughing, I have never seen. The coming away
of the purulent infiltration, exposed by ulceration, must haye given
rise to Mr. Saunders’s notion of successive sloughs.

“ Infants labouring under this ophthalmia are fretful and
uneasy, and rest ill during the night. The tongue is -white, and
bowels deranged. If the disease is neglected, the fresh wastes away,
and the Integuments become loose and ill-coloured.

44 Prognosis. When a child Is brought to us with this disease,
our first business is carefully to clean and examine the eyes, ex¬
plaining to the nurse the manner in which she is to remove the
purulent discharge from time to time, and stating plainly what is
likely to be the result of the morbid changes already present in the
coraese. If these important parts are only free from ulceration,
and from purulent infiltration, however violent the inflammation may
be and profuse the discharge, our prognosis may be favourable — the
sight is safe. If there is superficial ulceration, without onyx, pro¬
bably a slight speck may remain. If the ulceration is deep, an
indelible opacity must be the consequence. If the iris is protruding
through a small penetrating ulcer, the pupil will be permanently dis-

Mr. Mackenzie on Diseases of the Eye. 365

figured, and vision more or less impeded. If the ulcer is directly
over the pupil, the probability is that the pupillary edge of the iris
will adhere to the cicatrice, and vision be lost until a lateral pupil be
formed in after-life by an operation. If there is a considerable
onyx, we can promise nothing, for although under proper treatment,
the matter may be absorbed, this is by no means a certain result ; the
purulent exudation may, on the contrary, increase, the cornea burst,
and the eye become partially or totally staphylomatous. Whenever
the person who brings the child to me announces that the disease
has continued for three weeks, I open the lids of the infant with the
fearful presentiment that vision is lost, and but too often I find one
or both of the cornea gone, and the iris and humours protruding.
In this case, it is our painful duty to say that there is no hope of
sight, - , >

“ Treatment. 1. As it is of the utmost importance to remove the
purulent discharge, from time to time, in the course of the day, I
may perhaps be excused for explaining minutely how the eyes are
to be cleaned. The surgeon lays a towel over his knees, on which
to receive the head of the child, whom the nurse, sitting before him,
lays across her lap. The fluid for washing the eyes is the tepid
solution of one grain of corrosive sublimate in eight ounces of
water. The lids are opened gently, and, with a small bit of sponge,
the purulent discharge is removed. The lower lid, and then the
upper, are next everted, and wiped clean with the sponge. The
upper lid has a tendency to remain everted, especially if the child
cries. This is overcome by pushing the swoln conjunctiva into its
place, and bringing down the edge of the lid. All this ought to be
repeated three or four times, or oftener, in the twenty-four hours,
by the nurse. 'v ' ■ " f

“ 2. The corrosive sublimate collyrium, used in cleaning the
eyes, tends gently to repress the discharge. Alone, however, it is
not sufficient for that purpose, and we have recourse, therefore, to
astringent applications of more power. The solutions of nitras
argenti and sulphas cupri are those I have found most useful. Once,
or at most twice a day, I apply, with a large camel-hair pencil, the
solution of four grains of the former, or six of the latter, in an
ounce of distilled water, to the whole surface of the inflamed con¬
junctiva, immediately after having cleaned it as above described.
Not only the local, but even the constitutional good effects of
removing and restraining the purulent discharge are very remark¬
able. The first night after the use of the collyrium and drops, we
generally find that the infant has been much quieter than it had been
when the disease was neglected.

“ 3. To prevent the eyelids from adhering during the night, the
red precipitate ointment is to be applied along their edges at bed¬
time.

“ 4. The above remedies are perfectly sufficient to remove this
disease, if had recourse to within two or three days after the first
symptoms have shown themselves. I have seen two applications
of the nitras argenti solution, viz. on the third and fourth days

366

Critical Review.

after birth, or first and second days of the disease’s showing itself, re¬
move the complaint completely, although thick matter had been se¬
creted by the conjunctiva. In cases attended by a discharge less dis¬
tinctly puriform, the use of the red precipitate salve at bed time has
sometimes been sufficient. In cases, again, which have been neglected
for perhaps eight or ten days, it is necessary to take away blood
from the conjunctiva by scarification, or from the external surface
of the eyelid by the application of a leech. The latter may be had
recourse to in the first instance, and unless followed by marked
abatement of the redness and swelling on the inside of the lids,
the conjunctiva may next day be divided with the lancet. The
taking away of blood in either of these ways is productive of much
benefit, and ought by no means to be omitted, if there be any ten¬
dency to chemosis or any threatening of haziness of the cornea.'
A more profuse loss of blood than can be obtained by the methods
here recommended, I do not consider necessary.

“ 5. A remedy of great service in this disease is the application
of blisters behind the ears, or to the back of the head. Cantharides
plaster spread on a bit of candle-wick, and laid between the head
and the external ear, is a convenient mode of breaking the skin ;
and by continuing this application either constantly, or several hours
daily, a continued discharge will be procured. As soon as there is
a discharge of matter from the blistered parts, we find an amend¬
ment in the affection of the eyes ; but if the ears are allowed to
get well, we often observe a renewal of the inflammation of the
conjunctiva, and a more copious flow of puriform matter, which
again subside if the blisters are reapplied.

“ 6. An occasional dose of castor oil will be found useful.

“ 7- Recovery from this disease is often tedious. For weeks,
we continue the treatment above recommended, and although there
is no change for the worse, nor any affection of the cornea, and
perhaps but little purulent discharge, still the conjunctiva continues
inflamed, and the symptoms on the whole stationary. Under these
circumstances, I have found small doses of calomel highly useful.
From a quarter to half a grain daily will be sufficient.

“ In threatened disorganization of the cornea, Mr. Saunders has
strongly recommended the extract of cinchona. The sulphate of
quina will probably answer better, and be more easily administered.
Half a grain may be given twice or thrice daily.

“ 9. The relaxed conjunctiva, after the purulent discharge has
entirely subsided, may be advantageously touched once a day with
vinum opii, in place of the metallic solutions. I have sometimes
treated cases with the vinum opii throughout, but I consider this
remedy as more applicable for the chronic stage of the complaint than
for the acute.” — p. 365.

We endeavoured to give a list of the diseases of the eye de¬
scribed by Mr. Mackenzie, but it was impossible to condense
one line of bis extensive contents, or to occupy ten pages of
our space in the mere enumeration of the diseases of which he

Mr. Mackenzie on Diseases of the Eye - 36 7

has so ably and lucidly treated. The following- comprehen¬
sive account of scrofulous ophthalmia merits attention : —

“ Scrofulous ophthalmia is distinguished from all the other inflam¬
mations of the eye by symptoms so very striking, that any one who
has seen the disease once or twice, cannot mistake it, even although
the general habit of the patient be concealed from him. Slight red¬
ness, great intolerance of light, pimples or small pustules on the con¬
junctiva, and specks on the cornea, resulting from these pimples, are
the symptoms which characterize this ophthalmia ; a disease to which
scrofulous children are so liable, that out of the 100, 90 cases of in¬
flammation of the eyes in young subjects are of this kind. It is very
often the first manifestation of a scrofulous constitution ; and, ne¬
glected or mistreated, becomes the frequent source of permanently
impaired vision, or even of entire loss of sight. This disease seldom
attacks infants at the breast ; from the time of weaning till about
eight years of age is the period of life during which it is most pre¬
valent. Sometimes only one eye is attacked ; at other times, both
are affected from the first. Not unfrequently, the disease passes from
the one eye to the other. When both are inflamed at once, the one
is generally much worse than the other.

“ Symptoms — 1. Redness. At the commencement of the disease
the redness of the conjunctiva is very slight. It often exists only on
the inside of the lids. Sometimes a few scattered vessels are seen
coursing through the conjunctiva towards the cornea ; In other cases,
no enlarged vessels are perceived, so that the disease in this incipient
stage, is distinguished more by intolerance of light than by any direct
signs of inflammation. In most cases three or four enlarged vessels
are discovered, running from either angle towards the cornea, or over
its edge towards its centre. They are evidently superficial, and even
project above the level of the conjunctiva. Not unfrequently they
form a considerable fasciculus ; and we know from abundant experi¬
ence of this disease, that at the end of such a cluster of vessels, a
pimple is very likely to appear, if already there does not exist some¬
thing of that sort too small as yet to attract notice. Although in by
far the greater number of cases, the redness is scattered, it sometimes
happens that it is pretty general over the conjunctiva, even from the
first. As the disease advances, the redness becomes increased, and
the sclerotica also appears somewhat Inflamed.

“ 2. Pustules — Ulcers — Protrusions — Specks. This ophthalmia is
an eruptive disease. It affects the conjunctiva, not as a mucous mem¬
brane, but as a continuation of skin over the eye. One of the most
remarkable symptoms of the disease is that at the apex of each of the
bundles of blood-vessels, there arises one or more phlyctenulae or
minute pustules. In many instances, a single minute elevated point,
of an opaque white colour, near the centre of the cornea, is all that is
to be seen of this kind ; in other cases, numerous pustules or phlyc¬
tenulae are scattered over different parts of the conjunctiva, some on
the cornea, and others over the sclerotica. The edge of the cornea
is a very common situation for them. They vary in size according to

368

Critical Review.

the part of the conjunctiva in which they appear, being commonly
smallest on the cornea.

“ Beer has particularly mentioned phlyctenulae as distinguished
from pustules in this eruptive ophthalmia. We unquestionably tneet
with pimples of different sizes in this disease Some patients have
them all small like what are termed phlyctenulae, and others have
them all large like pustules. The former contain a smaller quantity
of fluid, and that thin and colourless. The fluid contained in the
latter is greater in quantity and more like pus. I have not been able
to decide whether there is any specific difference between the phlyc¬
tenular and the pustular cases. I have frequently observed that the
pustular cases are not, in general, attended with so much intolerance
of light. The cases in which children lie for weeks and months with
their eyes shut, are phlyctenular. The pustular variety certainly
does not differ from the phlyctenular merely in the inflammatory
action being more severe in the former; for we meet with cases of
very large pustules, in which the inflammation and pain are mode¬
rate, compared to what attend some cases of phlyctenula. The
ulcer which succeeds to phlyctenula is sometimes superficial, but at
other times it grows deep, and penetrates into the substances, or
even through the cornea, so that no distinction can be grounded
on the kind of ulcer which follows the bursting of these pimples.

The phlyctenulae and pustules which occur in scrofulous ophthal¬
mia may be absorbed ; and then, if situated on the cornea, they
leave a little albugo, the effect of that effusion of coaguiable lymph
which surrounds every circumscribed abscess, but which will, in
general, be totally removed by absorption in the course of time.
Occasionally it happens, that after an albugo is removed by absorp¬
tion, a transparent dimple is left in the cornea, which is long of
filling up. In some cases, we see the albugo, begin to spread over
the cornea in an irregular manner ; pretty considerable red vessels
running into it, and additional lymph being supplied to it, so as to
form what I call vascular speck, which is a very tedious and trouble¬
some symptom.

“ Fully as often, these pimples burst, and become small ulcers,
sometimes superficial and considerable in extent, more frequently
deep and funnel-shaped. This forms one of the most distressing
and formidable symptoms of the disease. Over the sclerotica, indeed,
an ulcer, arising from the rupture of a phlyctenula, or pustule, is of
less consequence, but, on the cornea, the transparent inlet of light,
an ulcer of any description is an event exceedingly to be depre¬
cated. It is very apt to disfigure the eye: and by the opaque
cicatrice, which it leaves behind, permanently to obscure vision.

“ The formation of an ulcer, especially if it be situated on the
cornea, always produces an increase of pain and redness ; the pain
being greatly aggravated on any attempt to move the eye, and ac¬
companied by a gush of hot tears.

5 The ulcer produced by a pustule is apt to become surrounded by
a soft reddish edge, easily excited to bleed, especially if situated in the
loose conjunctiva over the sclerotica ; but on the cornea, the edge of

Mr. Mackenzie on Diseases of the Eye . 369

the ulcer is sharper and more abrupt, and the surface of a gray or
ash colour, is frequently covered with an adhesive flocculent matter.
It but too often happens that this kind of ulcer is permitted, by
neglect or mismanagement, to penetrate gradually through the whole
of' the laminae of the cornea, into the anterior chamber. Through
the little fistulous opening of the cornea thus formed, the aqueous
humour is discharged, and a small portion of the iris protruding,
looks not unlike the head of a fly. Hence this symptom is termed
myocephalon . This piece of iris unites, by adhesive inflammation,
to the opening through which it is prolapsed, the ulcer around it
gradually contracts and whitens at the edge, the protruded portion
of iris disappears, and a white indelible cicatrice of the cornea par¬
tially or entirely prevents vision. A cicatrice of the cornea is called
a leucoma, in contradistinction to albugo ; the latter opacity being
the result of effusion, not of ulceration. If the ulcer has extended
deep into the substance of the cornea, and much more if it has pene¬
trated through it completely, the leucoma which follows remains
for life, although in the progress of growth, and after a length of
time, it may contract considerably. The cicatrice resulting from a
superficial ulcer may entirely disappear. Indeed the cicatrice from
a superficial ulcer is sometimes transparent from the first.

“ If several pustules form on the cornea at the same time, it some¬
times happens that they unite with one another before they burst,
so that the purulent matter is infiltrated between the lamellae, and
thus a kind of onyx is formed. At other times, onyx appears at the
lower edge of the cornea, independently of the existence of pustules.

“ In some cases of ulcer of the cornea, the progress of the ulcer is
unimpeded till the whole thickness of the cornea is penetrated, except
the lining membrane ; which seems to arrest the ulcerative process,
but being unable to withstand the push made by the aqueous
humour, is projected through the ulcer in the form of a small vesicle.
This is what is called hernia corncce. At last this vesicular pro¬
trusion gives way, the aqueous humour escapes, prolapsus of the
iris follows, and a dense opaque cicatrice will be the result.

“ Where there has been an extensive prolapsus of the iris, through
an ulcer of the cornea, the pseudo-cornea which is formed over the
protruded portion of iris, is sometimes unable to withstand the pres¬
sure of the aqueous humour, but is pressed forwards so as to form a
partial stahpyloma ”

Our author next accounts for the pain, intolerance of
light, epiphora, occasionally iritis, ophthalmia tarsi, and
then makes some pertinent remarks upon the strumous
diathesis, food, air, exercise, clothing, climate, exciting
causes, as measles, scarlatina, small pox, dentition, and
injuries applied to the eyes. He then describes the treat¬
ment.

“We are obliged to speak of the treatment of strumous ophthalmia
in very different language from what we employ in advising remedies

Vol. v. no. 29.

z z

Critical Review,

370

for almost any other inflammatory disease of the eye. In other oph¬
thalmia;, we say, follow this plan of treatment which we recom¬
mend, and the disease will speedily be overcome. We speak thus
of the catarrhal ophthalmia, and of several others, but we cannot
speak in this way of the scrofulous. W e are forced to confess that
in many cases this ophthalmia proves rebellious. If it be asked
why it does not yield even to the best directed treatment, we answer
this question by proposing another ; namely, why does an inflamed
gland of the neck, in a scrofulous individual prove so troublesome,
going on to suppurate in spite of every means adopted to promote
resolution, and after it has suppurated and burst, continuing to dis¬
charge for years ? The strumous constitution is the cause of the
extreme tediousness of this ophthalmia, as well as of the frequently
intractable nature of other strumous diseases ; and till we discover
means for curing scrofula, this ophthalmia wfill continue occasionally
to mock, by its stubbornness, even the best and most carefully
pursued plan of cure.

“Is it curable then? Are we to do nothing for it ; - but shake
our heads, and leave the eyes to be destroyed ? Not at all. Much
may be done to relieve this disease. Although it is very difficult to
cure it thoroughly, especially when the patient continues exposed to
the influence of the same causes which originally produced it, yet it
is rare indeed that medical treatment does not moderate the symp¬
toms, and avert those changes in the transparent front of the eye,
which in neglected cases are so often the cause of loss of sight. But
when the practitioner does meet with cases, as sometimes he must
do, which receive no benefit for weeks and months, but perhaps rather
get worse, notwithstanding all that is done for them, he must not
blame himself too much, but reflect on the intractable diathesis with
which, in such cases, he is called to contend, and which he cannot
change, and but too often can scarcely in the smallest degree
ameliorate.

“ In the treatment of this disease, it is necessary constantly to
bear in mind that it depends on a constitutional cause. To relieve
the local affection, therefore, will not be sufficient. We must en¬
deavour to improve the general health.

“ 1. General Remedies. 1. Bleeding. General blood-letting is
hardly ever required ; nor need local bleeding be bad recourse to,
unless considerable febrile excitement, as well as local distress, be
present. When the inflammatory action runs higher than ordinary,
or where it is suddenly or violently augmented by the formation of
pimples or ulcers on the cornea, it is proper to moderate the impetus
of the blood by the application of leeches to the eyelids or the
temple. If the constitution is not as yet impaired by long con¬
tinuance of the disease, and the employment of many debilitating
remedies, repeated recourse must be had to the use of leeches, so
long as the redness of the conjunctiva is considerable, and the in¬
tolerance of light acute. It must be kept in mind, however, that
not unfrequently we may dispense with bleeding entirely, by
putting the patient under the influence of tartar emetic ; and that by

Mr. Mackenzie on Disease of the Eye.

37 1

depletion alone, no case of this disease can ever be cured. On the
contrary, repeated bleedings, without the use of other remedies,
reduce too much the general strength, and render the eye more sus¬
ceptible of destructive changes.

‘‘ 2. Emetics and nauseants. One of the most powerful and
successful methods of treating scrofulous ophthalmia is by means of
tartar emetic, either in such doses as to produce vomiting ; in
smaller quantities frequently repeated, so as to excite nausea ; or
combined with a purgative. There is perhaps no remedy in the
whole materia mediea which possesses equal powers of a sedative
kind in this disease.. It reduces very considerably the necessity of
general and local blood-letting.

“I generally commence the treatment of a case of scrofulous
ophthalmia with an emetic, either of ipecacuan or tartrate of an¬
timony, and with uniform good effects.

“ In cases where there is considerable quickness of pulse, I fre¬
quently put the patient on a course of nauseants, or of emeto-cathar-
tics. For instance, to an adult a mixture may be given of from one
to four grains of tartar emetic, with from one to two ounces of
sulphate of magnesia, dissolved in a pound of water. Of this solu¬
tion two or three tablespoonfuls may be taken every half hour till
vomiting is excited ; after which, the dose is to be repeated at
intervals of three, four, or six hours, as circumstances may require.
This is the method to be followed in acute cases. In chronic cases,
the nauseant may be exhibited at longer intervals. It may then be
more conveniently exhibited in pills ; each pill containing from a
quarter to half a grain or more of the tartar emetic.

“ In cases of children, the same solution of tartar emetic and salts
maybe employed, or a solution of tartar emetic by itself, or powders
of the same rubbed up with a little sugar. From the twelfth to the
sixth of a grain, may be given according to the age of the child,
thrice a day. When there is much quickness of pulse,., this plan
will often prove effectual, while purgatives or tonics would produce
little or no good.

■ “3. Purgatives. In children labouring under strumous ophthal¬
mia, there is commonly a full and hard abdomen, and a loaded state

•»

of the stomach and bowels. Even in feeble and emaciated children,
it will usually be found, that, by the exhibition of purgatives, a large
quantity of unnatural foeculent matter will be discharged. In such
cases the administration of purgatives is followed by marked benefit ;
without these, other remedies avail but little. In recent cases, a
purge of calomel, with jalap, rhubarb, scammony, will often be
sufficient to remove the attack of ophthalmia altogether. Such a
purgative is to be repeated at intervals of two, three, or more days,
according to the urgency of the symptoms. It not only empties the
bowels ; but reduces very powerfully the impetus of the blood in the
affected part, increases the action of the absorbents, and restores to
a healthy state the secretions of the digestive organs. It proves, in
short, alterative, as well as depletive ; and its use as such may be
persisted in, in many cases, for a length of time, with very decided

372

Critical Review.

benefit. I have found the purgative plan to be more useful than
any other, in those cases in which an impetiginous eruption over
the body accompanies the affection of the eyes. Care, however,
must be taken not to push its debilitating action too far.

“4. Tonics. There are several remedies of this class, which
prove strikingly beneficial in the treatment of scrofulous ophthalmia.

“ After a trial of numerous and various internal remedies in this
disease, I have found none so useful as the sulphate of quina. It
exercises a remarkable power over the constitutional disorder which,
attends this ophthalmia, and thereby over the local complaint. Th r
dose which I employ is generally a grain thrice a day, rubbed up
with a little sugar ; in very young children, half a grain ; and in
adolescents or adults, two grains. Cinchona is not a new remedy
in this ophthalmia. Dr. Fothergill recommended it many years ago
in very strong terms ; but its powers, in the form of powdered bark,
or in any other form in which I have tried it, are insignificant in
comparison to those of the sulphate of quina. In most instances, its
effects are very remarkable ; and, indeed, (although I have met
with a few cases which appeared to resist its beneficial influence),
in most of the little patients to whom I have administered it, it has
acted like a charm ; abating, commonly in a few days, the excessive
intolerance of light and profuse epiphora, promoting the absorption
of pustules, and hastening the cicatrization of ulcers of the cornea.
The use of this medicine may be begun as soon as the stomach has
been cleared by an emetic, and the bowels put to rights by repeated
doses of calomel with rhubarb, or some other such purgative, unless
the pulse is very quick, when small doses of tartar emetic will be
preferable, or when an impetiginous eruption is observed on the
surface of the body, in which case a course of purgatives ought to be
adopted.”

Chalybeates are used next to quinine; the precipitated car¬
bonate of iron and tartrate of potass and iron, are the forms
of iron said to be most useful. Rhubarb and super carbonate
of soda are also recommended, and the mineral acids, espe¬
cially the sulphuric, will also be found useful. Tepid baths
are soothing in the acute stage, while cold bathing and
change of air, are highly beneficial after the attack is sub¬
dued. A dry, warm, inland situation, is preferable to the
sea coast. The glow from the sea is very apt to aggravate
slight attacks, and give rise to relapses.

<f 5. Alteratives. Calomel is very often administered in strumous
ophthalmia; more frequently, however, as a purgative than as an
alterative. That this medicine is injurious to children, does not
admit of doubt. That their constitutions are often shattered by an
indiscriminate use of calomel, and that in this way they are rendered
more susceptible of suffering from the exciting causes of scrofula,
is a truth which, at the present day, is overlooked to a roost la¬
mentable degree. - <-

Mr. Mackenzie on Diseases of the Eye. 3 73

“ Given as an alterative in strumous ophthalmia, 1 have frequently-
known mercury prove injurious, because mistimed ; that is to say, it
was administered before the irritation depending the acute stage of
the disease was moderated by depletion, After local blood-letting,
and the use of evacuants, we sometimes find decided advantage from
the exhibition of calomel with opium. This combination may even
be pushed, in some cases, till the mouth is affected, with benefit.

“ 6. Diaphoretics. Keeping up a healthy action of the skin is of much
importance in this disease. This may be done by the tepid bath every
second or third day, followed in adults by the use of the flesh- brush.
Dover’s powder at bedtime sometimes proves useful, by promoting a
healthy action of the skin, as well as soothing irritation, and procur¬
ing sleep. In cases where the perspiration is immoderate, this medi¬
cine is not less remarkable for its good effects than where the surface
of the body is dry and husky. Tartar emetic operates also with
good effect on the skin, and sympathetically on the conjunctiva.

“ 7. Diet. During the continuance of an attack of active inflam¬
mation, abstinence from animal food, and from all kinds of fermented
and heating liquors, should be strictly enjoined ; but when the acute
symptoms have subsided, and the disease assumed a chronic charac -
ter, the patient ought to be put upon rather a generous diet. As there
can be no doubt that unwholesome food is one of the chief causes of
scrofulous ophthalmia among the poor, it is of much importance to pro¬
cure for the patients in these circumstances, a more invigorating diet.
It is necessary strictly to forbid the use of articles likely to derange
the stomach ; as pastry of every sort, comfits, vegetable jellies, and
preserves ; and indigestible substances, as unripe fruits, nuts, and
the like.

“8. Temper. This disease is extremely apt to render the child
fretful, and by mismanagement to lay the foundation of bad temper,
which, on the other hand, tends much to prolong and aggravate the
symptoms. We find in good-natured children, and in those who are
under proper management, that the disease disappears much more
readily ; while in spoiled children, who cry perhaps for hours after
the eyes are examined, or after the application of any remedy, it is
apt to become almost incurable.

“9. Position in bed. The head should be raised as much as possible
during the night. On no account, ought the child to be suffered to
lie burying its face in the pillow.

“ Local remedies. 1. Shading the eyes. The morbid irritability
which marks this disease so strikingly through all its stages is to be
relieved by wearing a broad <_>reen shade over the forehead; and by
avoiding all employment of the eyes upon minute objects, especially
in a strong light. It will not be necessary to confine the patient to
a dark room, nor to forbid him from going abroad in fine weather.
We often see children labouring under strumous ophthalmia with'
handkerchiefs bound over their eyes, especially when they are taken
out of doors. This practice is decidedly injurious, heating the eyes
too much, and adding to the intolerance of light.

“ 2. Evaporation. In recent and slight attacks, the inflammation,.

I

374

Critical Review.

- /’

pain, and instability, may be moderated by the use of evaporating
and slightly astringent lotions, applied tepid or cold according to the
feelings of the patient. In most instances, they agree better in the
tepid state. A decoction of poppy-heads, with a few drops of al¬
cohol ; a weak solution of acetate of ammonia ; a little rose water ;
or’ a solution of one grain of corrosive sublimate in eight ounces of
water, will answer the purpose. The application of cold water to
the eyelids, face, and head, generally gives relief in this ophthalmia ;
but in many cases, the reaction which follows is hurtful. The same
may be said of alum curd, and cold sugar of lead poultices, enclosed
in a thin linen bag, and laid over the lids at bedtime.

“ 3. Fomentations. When the symptoms are in any degree
severe or of long continuance, warm soothing applications will be
found more useful than cold ones. With a bit of sponge or flannel,
the eyes may be fomented once or oftener in the day with hot de¬
coction of chamomile flowers, or of poppy-heads, or with a hot
infusion of opium. Much relief is experienced from exposing the eyes
to the vapour of laudanum, or of camphor, raised by means of a cupful
of hot water. Warm poultices during the night are often useful.
They are to be made with crumb of bread, warm water, or sugar of
lead water, and a little fresh butter ; and never with milk.

“ 4. Scarification of the inside of the eyelids, especially in chronic
cases, where the palpebral conjunctiva is much loaded with red
vessels, will be found one of the most valuable means of cure. In
eases of vascular speck, division of the fasciculus of vessels running
over the sclerotica to the albugo, cannot be dispensed with ; no
other remedy having the same power of checking tills very annoying
and dangerous symptom.

r “ 5. Counter-irritation. We derive great benefit from blistering
in this disease. The intolerance of light is often suddenly and
almost completely removed by this remedy, the child being enabled,
in a few hours after the blister rises, to open its eyes, although it
had not done so for months before. The temples, behind the ears, the
crown and back of the head, and the nape of the neck, are situations
generally chosen for the application of blisters. The last is the
most painful, but not the least effectual. In general, the discharge
ought to be kept up, by the use of some stimulating dressing ; or if
this is not done, a quick succession of blisters ought to be employed.

“ Friction with tartar emetic ointment has sometimes been had
recourse to in this disease, for the purpose of bringing out a crop of
pustules. This is a practice much more painful than blistering, the
pustules if considerable in size leave indelible pits, and from mis¬
management of the remedy large portions of the skin are sometimes
made to slough; so that, on the whole, blistering is preferable.

“ Issues in the neck or on the arm are beneficial, both in relieving
the symptoms of strumous ophthalmia, and in preventing relapses

“6. Stimulants applied to the inflamed surface of the eye, in this
disease are decidedly useful. Indeed it is scarcely possible to effect
a cure without them. The impetiginous state of the conjunctiva, or
in other word's of the skin covering the eye, which constitutes stru-

Mr. Mackenzie on Diseases of the Eye, 3 75

ftious ophthalmia, not merely bears stimulants, but like most other
chronic cutaneous diseases, is uniformly benefited by their applica¬
tion, if they be well chosen, carefully used, and properly timed.
They often act as the best local sedatives, if applied after the acute
inflammatory excitement is subdued by the general remedies already
enumerated. Employed before this is effected, they will scarcely
fail to prove hurtful. In this respect, the treatment of scrofulous
ophthalmia is directly contrary to that of the puromucous inflamma¬
tions of the conjunctiva ; for in them we employ stimulants from the
very first, but in the scrofulous ophthalmia we must delay till the
symptoms of irritation are somewhat abated.

“ Various stimulants have been used in this ophthalmia; but the
nitras argenti solution and the red precipitate salve are the most
deserving of confidence. Next to them, I would place the vinum
opii. Whichever be selected, its application must be continued with
regularity once a day, or once every two days, the child being laid
in the horizontal position, the head fixed between the knees, and the
lid opened so as fully to expose the diseased membrane. The solu¬
tion of four grains of the nitras argenti in one ounce of distilled
water is the stimulant which I generally employ. It evidently pos¬
sesses very considerable power in abating the vascularity of the
conjunctiva, hastening the absorption of pustules, cicatrizing ulcers,
and clearing specks of the cornea. The relief which it affords to
the intolerance of light is not the least of its good effects. In this,
it probably operates by inducing the healing of minute ulcerations,
and the contraction of enlarged blood vessels, both of which give
rise to the sensation of sand in the eye, to spasm of the lids, and
epiphora. Whenever ulceration is present on the cornea, recourse
should be had to the solution of nitras argenti. A stronger solution
than that of four grains to the ounce of distilled water maybe employed,
and with a small camel-hair pencil applied directly to the surface of
the ulcer, without permitting the solution to spread over the rest of
the eyes.

“7. Solid Caustic. Where an ulcer threatens to penetrate deep
into' the substance of the cornea, or when it has already perforated
into the anterior chamber, with or without prolapsus of the iris, it is
proper to toucli the ulcer, or the myocephalon, every second or third
day, with a pencil or lunar caustic, filed to a sharp point. Scarpa
has given the best account of the effects of this remedy, to which I
shall again have occasion to refer, under the head of ulcers of the
cornea.

“ 8. Belladonna. The case of James Tassie, already detailed at
page 394, strikingly illustrates the utility of applying the extract of
belladonna in cases of central ulcer of the cornea. Even when the
edge of the pupil is involved in such an ulcer, the dilating power of
the belladonna may be sufficient to free it, and thus to preserve the
pupil entire. In cases of perforating ulcer near the edge of the
cornea, I am inclined to refrain from the use of belladonna ; for,
while the dilatation cannot in this case be carried so far as to remove
the iris from the vicinity of the ulcer, I believe the state of palsy.

370 Critical Review.

into which the iris is thrown, is apt to favour rather than prevent
prolapsus.

“ Relapses. No disease is so apt to recur as scrofulous oph¬
thalmia. It is therefore necessary for children who have once
suffered from it to be submitted, from time to time, to the inspection
of their medical attendant, who must endeavour promptly to subdue
every sympton of a re-attack, and to conduct his patients safely
through that period of life which is most exposed to the disease.
In this way, much mischief will easily be prevented, which, neg¬
lected, may require years to remove, or prove altogether beyond
remedy.” — pp. 400.

Variolous, morbillous, and scarlatinous ophthalmise, are
generally neglected by practitioners, though they are among
the most common diseases destructive to vision. We there¬
fore place them before our readers.

“ In former times small-pox proved but too often the cause of
serious injury to the eyes, or even of entire loss of sight. It was by
far the most frequent cause of partial and total staphyloma. But
since the introduction of inoculation, and still more of vaccination,
such injurious effects from variolous ophthalmia are much more rare.

“ Symptoms, In most cases of small -pox, pustules form on the
external surface, and on the margins of the eyelids. When they are
numerous, as in confluent small-pox, they cause such swelling of the
lids as completely to close the eyes. As the disease proceeds,
matter is discharged partly from the meibomian follicles, partly from
the variolous pustules, the eyelids are glued together so that the
eys cannot be opened for days, and merely from this state, without
any pustules being formed on the conjunctiva, the eyes are irritated
and painful. At last, as the disease subsides, the swelling of the
lids falls so that they are again opened, and the eyes may be found
uninjured. It is in this way that the vulgar talk of persons being blind
in small-pox for so many days, and then perfectly recovering their
sight. But although the cornea has not suffered in these cases, the
eyelids and the lachrymal apparatus are often left in an injured state;
and not unfrequently small -pox proves the exciting cause of strumous
affections of the eyes and eyelids, which may continue troublesome
for years. The small-pox pustules on the lids are apt to destroy the
eyelashes, to leave red marks and scars, render the edges irregular,
and liable to inflammation and excoriation from slight causes, and to
produce ophthalmia tarsi, and very frequently trichiasis and dis-
tichiasis. Chronic blenorrhcea of the lachrymal sac, and pustular
conjunctivitis, are also frequent sequelae of small-pox.

“ Schemes have been proposed for preventing the pustules of
small-pox from spreading to the face, or at least for moderating the
effects of the eruption. We find that this disease is apt to attack
with peculiar severity any part of the surface of the body labouring
at the time under accidental irritation, and hence it has been sup¬
posed that soothing applications may moderate the. eruption and its

Mr. Mackenzie on Diseases of the Eye. 3 77

effects. Covering the face with a cloth spread with cerate, and
fomenting it from time to time with chamomile decoction, have been
used for this purpose, and can do no harm. When the pustules on the
eyelids are fully matured, we may afford considerable relief by prick¬
ing them one by one with a needle, so as to evacuate their contents ;
and by carefully removing the crusts which form after the pustules
burst, having first softened them with some mild ointment. The lids
are frequently to be bathed with tepid milk, and bits of sugar rag
moistened with the same are to be laid over them.

‘f There is in every case of small-pox, some redness of the con¬
junctiva. But danger is chiefly to be apprehended when a variolous
pustule or pustules appear on the cornea, where, unfortunately, they
are much more apt to occur than on the conjunctiva covering the
sclerotica. A pustule on the cornea, forming at the time of the
general eruption, is extremely apt to prove destructive. When it
bursts, the ulcer thus formed but too often deepens and spreads, the
cornea is penetrated, the iris advances and adheres, the pupil may
thus be obliterated, or the cornea being much changed in structure,
and adherent, in a great part of its extent, or completely, to the iris,
partial or total staphyloma may be the result. In bad cases, almost
the whole of the cornea is destroyed, by infiltration of matter and
ulceration.

“ During the suppurative stage of small-pox it is difficult to say
what extent of mischief is going on in the eye, under the closed and
swoln eyelids. If the patient feels pain in the ball itself, with dry¬
ness, stiffness, and a sensation of sand in the eye ; if the uneasiness
be much increased on attempting to move the eye, or on exposing it
to light even through the swoln lids ; and if in addition to the matter
discharged from the pustules on the edges of the lids and from the
meibomian follicles, there is a frequent discharge of hot tears, then
it is probable that there is acute variolous conjunctivitis, and perhaps
pustules on the cornea. But if the eye is easy, only shut up from
the state of the lids, there is probably no danger. The eyes, however,
are not safe, even after the small-pox pustules over the body have
blackened and the scabs fallen off. I have seen both pustule of the
cornea and onyx produced after the general eruption was completely
gone. This has been called with sufficient propriety, secondary va¬
riolous ophthalmia. It sometimes occurs as late as five or six weeks
after the patient hp.s recovered from the primary disease. It is cer¬
tainly not so severe an affection as the primary, but is still dangerous
in regard to vision. A dull whitish point is observed in the cornea,
with surrounding haziness ; the whiteness becomes more extensive,
amounting perhaps to the 1 2th of an inch in diameter, and then the
part becomes yellow. If two or more points should form, the whole
cornea is rendered nebulous ; or this effect may be produced from
one large variolous pustule. An onyx at the same time may appear
at the lower edge of the cornea. The sclerotica is reddened. Pain
and epiphora are excited on exposure to light. >

The secondary variolous ophthalmia seldom leads to destruction
• of the cornea. By proper treatment, the matter of the pustules or

Vol. v. no 29. 3 A

378

Critical Review.

onyx is sometimes absorbed. In other cases, ulceration takes place,
leaving, after cicatrization, a permanent leucoma or white speck.
The surrounding haziness of the cornea is gradually dissipated ; vision
is injured according to the situation and size of the leucoma. By
the formation of an artificial pupil, vision may in many cases of
this sort be restored. Even when partial staphyloma has formed,
this operation is often applicable.

“ Treatment. The best general treatment of small-pox must be
followed ; a moderate temperature, tepid ablution, and a cool re¬
gimen. Emetics are occasionally useful ; even blood-letting may be
cautiously employed in some cases, and laxatives are always to be
administered. If the eyes are particularly affected, they must be
frequently bathed with tepid water or poppy decoction, and the
edges of the lids smeared with a little cold cream. In many cases,
the lids are so much swoln, and so completely sealed up, that it
would be in vain to attempt any application to the conjunctiva, till
the eruption begins to fade and the swelling to fall. Leeches may
,be applied, not only without impropriety, but with decided advan¬
tage, behind the ears or on the temples, and followed, if it appear
necessary, by blisters. About the eighth or ninth day of the erup¬
tion, free purging will be found useful, not merely in reducing the
suppurative fever, but in relieving the uneasy and inflamed state of
the eyes. The lids now begin to be opened, so that a little fluid can
be injected between them and the eyeball. A wTeak solution of
nitras argenti, or diluted vinum opii, may be used for this purpose.

“ As to the treatment of secondary variolous ophthalmia, I have
found tartar emetic, given so as to vomit and purge freely, to be
productive of the best effects, evidently abating the inflammation,
and promoting the absorption of the pustules and onyx. Leeches
and blisters are also useful. As soon as the acuteness of the inflam¬
mation is somewhat abated by these means, much advantage will be
gained by putting the patient on a course of sulphate of quina.
.Undiluted vinum opii appears to answer best as a local application.
The eye is to be touched with it once a day. Belladonna is to be
applied to the eyebrow, in order to keep the pupil dilated.

“ A certain degree of conjunctivitis always attends measles and
scarlet fever, but is in general much less severe than the variolous
inflammation of the eye. In measles and scarlet fever, the change
which the skin undergoes, amounts to little more than vascular con¬
gestion, and the conjunctiva, a prolongation of skin, betrays there¬
fore little more during the presence of these diseases, than some
degree of redness, with intolerance of light, slight pain, and epiphora.
Occasionally, however, we have phlyctenulae, onyx, and ulcers of the
cornea, brought on by the morbillous and scarlatinous ophthalmiae,
particularly when the subject is scrofulous. Indeed, it is difficult to
distinguish either of these ophthalmise from the scrofulous, till the
eruption on the skin makes its appearance. On the other hand, we
often hear of the dregs of the measles and of scarlet fever producing
affections of the eye and eyelids. By this, is generally meant that
the scrofulous diathesis has been called into action by these diseases,

Mr. Mackenzie on Diseases of the Eye. 379

and that ophthalmia tarsi or phlyctenular conjunctivitis has been the
result.

“ In measles there is a catarrhal affection of the Schneiderian
membrane, with sneezing and cough, and occasionally the attending
conjunctivitis is not so much eruptive as blenorrhoeal. I have seen
cases in which the eye had been destroyed by severe puro-mucous
ophthalmia excited by measles.

“ In some rare cases of scarlatinous ophthalmia, the iris and
capsule of the lens become affected. I operated some time ago on a
boy of about eight years of age, in whom specks of the anterior
hemisphere of the capsule wrnre brought on in this way.

“ Treatment. The affection of the eye in measles and scarlet
fever, does not in general require active treatment. The eyes should
be guarded from strong light, bathed occasionally with tepid water,
and the bowels kept freely open. If the symptoms are more than
commonly severe, leeches may be set on the temples, and blisters
applied behind the ears, or to the nape of the neck. The nitras
argenti solution will be found highly useful, whether the ophthalmia
be eruptive or puro-mucous. Sulphate of quina may be given
internally with good effects. — p. 406.

The remaining sections in this chapter are as follow: —
rheumatic, and catarrho-rheumatic ophthalmia, scrofulous
corneitis, rheumatic, syphilitic, pseudo syphilitic, scrofulous
and arthritic iritis, choroiditis, retinitis, aquo-capsulitis,
inflammation of the crystalline lens and capsule, inflamma¬
tion of the hyaloid membrane, traumatic, compound and
intermittent ophthalmia?. In conclusion, we have to state,
that every disease of the eye is described in this work. We
strongly recommend it for its accuracy, perspicuity, compre¬
hensiveness, and the very important practical details with
w7hich it abounds. It is an accurate, well digested, wrell
written work, evincing deliberation, research, judgment and
fidelity. It is one of the best monographs which modern
times have produced, and is a valuable addition to our
medical literature. It will add to the well-earned reputa¬
tion of the author, and it is highly creditable to the univer¬
sity to which he belongs.

Mr. Lawrence’s excellent lectures on the anatomy, phy¬
siology, and pathology of the diseases of the eye, formed
the best and most comprehensive work, until the appear¬
ance of that whose analysis we have concluded. We need
scarcely observe, that these excellent lectures were pub¬
lished in the Lancet, in 1825, and are now translated into
French, and further extended by Dr. Biliard, the accurate
translator, who was pupil to the author, and obtained his
permission to publish the edition before us.

380

Critical Review.

It would be a work of unnecessary labour, to trouble
the reader with Mr. Lawrence’s opinions, which must be
familiar to every one, and we may merely observe, that they
comprehend a faithful account of fifty-seven diseases of the
organ of vision and its appendages, to which are added, by
the translator, the following: — defects of primitive confor¬
mations, anopsie, monopsie, augmentation of the number
of the eyes, anormal situation of the eyes, defect of con¬
formation of the lids, anomalies of the lachrymal gland,
anomalies of the iris, optic nerve, and lens, congenital
alterations of the humours of the eye, general considera¬
tions on the lesions, and accidental tissues of the globe and
dependencies, congestions, inflammations, divers alterations
of the eye, accidental productions, divers modes of disor¬
ganization of the eye, hypertrophy, and atrophy. This is
a cheap and valuable work, which ought to be in the posses¬
sion of those who have not an English edition, as it contains a
good deal of highly valuable information. It is well translated,
and the additions of Dr. Billard are interesting and instruc¬
tive. We strongly recommend it to students as a substitute
for the former, which is treble the expense, and too volu¬
minous for this class of readers. Young practitioners, who
are setting out in their career, will find it a valuable addi¬
tion to their libraries, and even the most experienced must
be instructed by the additions, which are not to be found
in any work hitherto published on ophthalmology in this
country. On many occasions Mr. Lawrence differs from his
contemporaries, and the opinions of a man so eminent are
entitled to notice and respect.

III. — On the recent Improvements in the Art of distin¬
guishing the various Diseases of the Heart , being the
Lumleyan Lectures delivered before the Royal College
of Physicians in the year 18*29. By John Elliotson,
M.D. F.R.S., &c. &c. London, 1830. Folio, pp. 36.
Longman and Co.

Dr. Elliotson is a powerful advocate of auscultation, and
strongly defends Laennec, to whom he pays the just tribute
which his great discovery deserves. The avowal of our
author is candid and honorable to his own high character,
as will be seen by the following extract : —

“ The discoveries made by Laennec in the symptoms of these
disorders are great enough to entitle him to all the honours which

Dr. Elliotson on Diseases of the Heart.

381

have ever been acquired in pur profession. He has enabled us to
judge of diseases, often not otherwise with certainty distinguishable
or not at all, and this with an accuracy inconceivable to those who
are unacquainted with his investigations ; to distinguish diseases of
the heart, which were formerly, and are still too often all, either
expressed by the easy term disease of the heart, without a spe¬
cification of the parts affected in the complicated organ ; or as
often passed over entirely, while the case is mistaken for hydro¬
thorax, or some pulmonary affection, and to distinguish diseases of
the lungs, which, in many cases, could not be pronounced upon
with accuracy, of which, in others, the diagnosis was always uncer¬
tain, and moreover to point out the very part affected.

“ But the very accuracy of Laennec’s discoveries is objected to.
We are asked Cui hono? The answer is plain. It is universally
allowed that every disease should be described, and its nature
ascertained, as accurately as possible. Now with every advance in
accuracy of description, and in knowledge of the source of symp¬
toms, diagnosis imperceptibly and inevitably becomes more accurate.
To condemn accurate diagnosis is therefore to condemn accurate
knowledge — to rest satisfied with imperfect information when in¬
dustry would give us more — to admire ignorance when knowledge
is within our reach. Besides, diagnosis ought to be universally
cultivated without reference to its utility in particular instances. It
is a part of our science ; every part must be cultivated for the per¬
fection of the whole, and what may not be practically useful to-day,
may become so to-morrow, &c.

“ But there is immediate utility in the discoveries of Avenbrug-
ger and Laennec. No one will pretend that the. diagnosis in chronic
diseases of the, chest is, with the exception perhaps of phthisis,
generally satisfactory. Before I adopted auscultation, I know that
1 frequently discovered diseases of the heart after death where I had
not previously suspected it, and frequently found the organ sound
when I had suppossed it diseased. When I was correct in expect¬
ing to see organic affection of the heart, I was often wrong as to
the precise nature of the lesion. Too often has auscultation at once
revealed distress of the heart to me, when, by good practitioners,
no affection of the heart, or even of the chest, had been suspected,
or the case had been named nervous palpitation or asthma, when
the lungs had been regarded as the seat of the malady, or the case
been treated with the more violent remedies of hydrothorax. Re¬
peatedly have I seen chronic bronchitis, with extreme* conjestion
of the lungs, mistaken for hydrothorax, and unavoidably so, from
the omission of percussion and auscultation, because the symptoms
were precisely the same, with the exception of those which percus¬
sion and auscultation only could disclose. Inflammation of the
substance of the lungs takes place continually during other diseases,
without being obvious before death to any but the auscultator and
percussor. Without the aid of the ear, who can ever distinguish
emphysema of the lungs, or in every case pneumato-thorax ?
Both may be readily mistaken for hydrothorax,” &c.

382

Critical Review.

Dr. Stokes, of Dublin, and Dr. J. C. Gregory, of Edin¬
burgh, have adduced ample proofs in corroboration of our
author’s opinions ; indeed, every ardent cultivator of science
bears similar testimony, and it is only the lazy routinists,
who oppose the splendid and important modes of discrimi¬
nating pulmonic and cardiac diseases in the manner sug¬
gested by the proposers of auscultation and percussion. Dr.
Elliotson, how ever, is of opinion that semeiology must be
duly considered, and by both methods an accurate diagnosis
may be arrived at.

He details some interesting cases of diseases of the heart,
which are well worthy of attentive perusal, the narration of
which would far exceed the limits by which we are circum¬
scribed ; and after all there could be little practical advan¬
tage derived by placing them before our readers. Unfor¬
tunately cardiac diseases must be ranked among the opprobria
of our art, though it is a matter of great interest, to be able
to draw a correct diagnosis and prognosis.

There is one great fault in this production, and that is,
it is published in folio, and at a very high price for the
small quantity of matter w7hich it comprises ; the plates are
good, and well engraved from the accurate drawings of
Mr. Alcock, wdiich might be reduced to the quarto or octavo
form. It is a great and prevailing error to publish works
at extravagant prices, which render them inaccessible to the
largest portion of the profession, and stimulate the unprin¬
cipled to piracy. Sir Astley Cooper and Mr. Charles Bell
have fallen into this error, and may be fairly said to have
printed, but not published, many of their works, and thus
excluded nine-tenths of the profession from the advantages
their productions afford. Hence the cheap and spurious
editions of expensive works, which compel the publishers
to reduce their exorbitant charges. Had Dr. Elliotson’s
work appeared in an humbler form, it wTould be in the
hands of every practitioner, as no physician in the kingdom
stands higher, and more justly so, than he does in the
estimation of his contemporaries. He defends Laennec’s
opinions on the motions of the heart, in opposition to Dr.
Corrigan and others, and we shall now place the opinions
of all parties before our readers.

“ Laennec’s correctness, in ascribing the first of the two sounds
of the heart’s action in health to the ventricle, and the second to
the auricle, has been called in question, some asserting that the first
sound is the result of the auricular contraction, and the . second of
ventricular ; some that they occur at the moment of the dilatation,
not at the moment of the contraction of the cavities ; and some that

Dr. Elliotson on Diseases of the Heart ,

383

Laennec was right in regard to the ventricular sound, but that the
second sound cannot arise from the contraction of the auricle, as
Harvey, Haller, Senac, all declare that the auricle may be seen to
contract immediately before the. ventricular aclions ; and they con¬
sider, therefore, the sound which follows the ventricular, to be pro¬
duced by some unknown cause, and the auricular contraction to be
without sound, two very singular and very considerable supposi¬
tions. The alteration of the sound in narrowing of the respective
openings proves, I think, that Laennec is right ; for if the opening
from a ventricle is narrowed, the healthy sound ascribed by Laennec
to the ventricles is altered ; and if the opening from an auricle is
narrowed, the healthy sound ascribed by him to the auricle is
altered. An argument, in favour of the priority of the auricular
contraction, has been deduced from the veins of the neck, in some
cases, regularly swelling, immediately before the pulse is felt. But
the obstruction of the auricle causing this swelling, does not, I
apprehend, occur during their contraction, for at that moment there
is a free space in the ventricles to receive the auricle blood, and it
is only a part of the auricle that has the power of contraction.
The obstruction which produces the swelling must take place as the
ventricles becomes filled, and the auricular blood consequently
accumulates, and therefore the swelling of the veins must be ex¬
pected when the ventricles will receive no more, viz. immediately
before they contract, or while they are contracting. There is no
wonder, theiefore, that the arteries, according to this account, beat
first ; then a second sound of the heart is heard, 1 presume the
auricular action ; and then a short interval occurs before the veins
pulsate — before the blood accumulates in the auricles previously to
their contraction. The jugular veins are said, by some, always
to be dilated quite synchronously with the pulse of the arteries.

“ Since the delivery of these lectures, Laennec’s accuracy has
been called in question by others, and the stroke of the heart’s
apex, and the first sound of the heart, declared to happen before
the pulse, and to be produced by the dilatation and repletion of the
ventricles ; and the second sound to occur at the moment of the
contraction of the ventricles, and to arise from the flapping of the
parietes of the emptied ventricles together.

“ I would reply in the first place, as before, that when an obstruc¬
tion exists at the mouth of the aorta, or pulmonary artery, a morbid
sound occurs at the moment Laennec supposes the ventricles to
contract, and when at either auriculo-ventricular opening, at the
moment he supposes the auricles to contract. This could not happen
had he mistaken the periods of the ventricular and the auricular
contractions. Secondly, when the pulse at the wrist follows the
stroke of the heart, it does so after only a very minute interval — such
as may be explained by the distance of the radial artery from the
heart — and actually occurs decidedly before the auricular sound, that
which is now declared to be the ventricular. Moreovei, when the
pulse at the wrist is observed to follow the stroke of the heart, the
pulse at the innominata (so much nearer the heart) may be found

384

Critical Review.

to precede that at the wrist, and to occur all but simultaneously with
the heart’s stroke, so that the relative distance of the parts explains
the whole difference, and the pulsation of the arteries in all cases
clearly arises from the stroke of the heart. If an artery is observed
still nearer the heart than the innominata, no interval between its
pulse and the stroke of the heart is perceptible. In four rases i f
aneurism of the ascending aorta, producing a strongly-pul sating
tumour to the right of the sternum, this and the heart, when the
fore-fingers were placed upon both, were felt, and by all seen to
pulsate quite synchronously. When the obstruction is at the mouth
of the aorta or pulmonary artery, the preternatural sound I have
always noticed synchronously with the pulse ; when at an auriculo-
ventricular opening, in the intervals of the pulse, after or before it.
It sometimes, in the latter case, is so prolonged as to last till the
pulse is again felt, so that there is no interval, but merely an equal
alternation of the ventricular and the preternatural auricular sound ;
or even an interval occurs after the ventricular stroke, probably
from the auricle not being disposed for contraction at the usual time,
on account of its contraction having been so lengthened by the dif¬
ficult escape of its blood, that a longer rep >se is required than just
during the ventricular contraction ; here the auricular sound occurs
first, then the ventricular, and then the interval.

“ Thirdly, the sounds considered by Laeunec to be auricular
and ventricular are heard loudest both in health and when mor¬
bid, at the seat of auricles and ventricles respectively.”

Dr. Corrigan’s opinions are corroborated by Dr. Stokes
and Mr. Hart, in a short paper in the October number of
our northern contemporary ; and also by another from the
pen of our talented correspondent Mr. Dobson. It is a
curious fact, that these three gentlemen should have arrived
at the same conclusion with Dr. Corrigan, and without the
slightest knowledge of each other’s experiments. Dr.
Stokes and Mr. Hart have recorded the following opi¬
nions : —

“ 1st. That in a state of health the impulse of the heart precedes
that of the arteries.

“ 2d. That the interval between the impulse of the heart and the
pulse in the arteries is in the direct ratio of the distance of the ves¬
sels from the centre of the circulation. Thus the interval between
the impulse of the heart and that of the arteria innominata is often
so slight as to be scarcely perceptible : the pulse of the carotid pre¬
sents a longer interval, and so on with the rest.

“ 3d. The pulsations of arteries in different parts of the body,
but at equal distances from the heart, are synchronous. Thus be¬
tween the pulsations of the femoral and the radial artery, as felt at
the wrist, no difference could be observed.

“ 4th. The greater the distance the longer will be the interval ;
then the pulsations of the radial artery always precede those of the
tibial.

Dr. Elliotson on Diseases of the Heart.

385

5th. That, although the actual pulsation depend on the systole
of the left ventricle, yet the diastole of the vessels does not occur
synchronously in all parts of the body, but is progressive.

All .these observations are most easily made on the healthy
adult subject, whose heart is acting slowly, but at the same time
strongly.”

Mr. Dobson’s opinions will be found in our last, to which
he has added the following proof in the Lancet ; —

“ Having introduced my hand into the thorax of a dog, I grasped
the two venae cavae, so as to preclude the entrance of blood into the
heart. _ What was the effect ? Why the action of the heart was still
maintained ! Though somewhat enfeebled, it continued to dilate and
contract alternately and regularly. The circumstance* which seemed
remarkably peculiar, was, the diastole, both of the auricles and ven¬
tricles, was apparently more energetic than the systole. In this ex¬
periment I witnessed the following phenomena : —

“ 1. That, during the diastole of the ventricles, the heart was
visibly augmented in size ; and that, during the diastole, it was when
the stroke against the side of the thorax occurred, not only the apex,
but the anterior surface of the heart, impinged against the thora¬
cic wall. .

“ During the systole of the ventricles, the heart diminished in size ,
and receded into the thorax.

“ Remembering that, as taught in the schools, this stroke of the
heart against the chest resulted from the aorta endeavouring to
straighten itself, when blood was thrown in, tilting the apex against
the chest. To obviate this effect I grasped the vena? cavse, and thus
removed that attributed cause, but the phenomena occurred as before,

“ These experiments and observations were made at the least
twelve months . ago ; consequently, previous to the publication of
Dr. Corrigan’s interesting essay.”

W e shall closely watch the progress of this inquiry, and
place it as early as possible before our readers.

TV. — Transactions of the Association of Fellows and
Licentiates of the King and Queen s College of Physi¬
cians in Ireland. New Series, vol. i. Dublin, 1830. J.
M. Leckie.

Another volume of the valuable Transactions of the Dublin
physicians lias just issued from the press, which, like its
predecessors, is replete with sound practical information.
We feel much obliged for an early copy of the work,
and shall place a portion of its instructive contents
before our readers. There are two papers by Dr. Mont-

Vql. v. no. 29. 3 b

386

Critical Review.

gomery, Professor of Midwifery to the College, which are
deeply interesting, and prove the author to be a man of
acute observation and sound judgment. The first is entitled

Case of Ovarian Disease of a remarkable Character,’1
illustrated by two well executed plates ; — the second, De¬
scription of a very remarkable malformation in a foetus, in
which nearly all the abdominal viscera and the intestinal
canal were external to the body illustrated by an engrav¬
ing. We shall notice each of these curious and valuable
papers, and allow the author to introduce himself to our
readers.

“ Ovarian Disease. — Mary Clarke, aged 45, the mother of nine
children, the youngest of whom was nine years old, was admitted
into Sir P. Dun’s Hospital, and came under my care on the 15th of
August, 1S28. She complained of a tumour in the right iliac
region, which she had first perceived about seven years before ; in
addition to this she had slight ascites, which had commenced within
the last four months. She formerly had hernia at both sides, greater
at the right ; the intestines, however, did not now descend, but the
sac was distended by the descent into it of some of the dropsical
fluid. She said that she had been for some time annoyed by fre¬
quent discharges from the vagina of the fluid like water, which came
away in small quantities, and she had suffered occasionally from
uterine haemorrhage ; on examination per vaginam, I found that
there existed a small cauliflower excrescence of the os uteri ; the
urine was scanty, and the pulse weak, but not much accelerated.

“ The countenance had the peculiar expression of distress, which
we so frequently observe in patients reduced and harassed by ail¬
ments depending on considerable organic alteration in some internal
viscus or structure, and exhibited a very unpromising appearance ;
this expression of the countenance, to which, I confess I attach
much weight, taken in combination with the disease of the os uteri,
the tumour in the abdomen, and the ascites, which I looked on as
its effect, justified, I thought, the most unfavourable prognosis ;
and although I determined on, and adopted the administration of
diuretics and other remedies, I had but little hope of advantage from
their use.

“ After the bowels had been freely emptied, she took a combi¬
nation of calomel, digitalis, and squill in pills, and a solution of
■crystals of tartar, which was afterwards exchanged for decoction of
broom tops. This treatment was after ten days discontinued, as
the bowels appeared to be disordered by it.

On the 17th, a good deal of uneasiness and tension, with some
pain in the right side and across the abdomen, were complained of,
which symptoms were relieved by the application of leeches to the
abdomen, and the use of the warm hip bath. Pills of calomel and
squill to be taken, which in two days so disagreed, that they were
omitted on the 29th. At this period a great increase had taken place
in the quantity of urine ; but notwithstanding this increase of natural

Dublin Medical Transactions.

387

secretion, the effusion into the abdomen had greatly accumulated,
and occasioned a most distressing sensation of tension.

“ I wish here to remark particularly, that the distress complained
of was altogether out of proportion to the degree of distension, and
in consequence, the poor patient was excessively anxious to have
the fluid drawn off by tapping, before it was apparently necessary,
and when the tension was not sufficient to admit of the operation ;
in two days more, however, the fluid had considerably increased in
quantity, causing a great addition of suffering, which the patient
described as affecting her chiefly at the right side, and across the
lower part of the abdomen, the situation chiefly occupied by the
tumour.

“ August 31. — She was tapped by Dr. Jacob at the left side,
as far as possible from the tumour ; and about six quarts of a clear
yellow fluid were drawn off with great and instantaneous relief,
both of the pain in the side, and indeed, of all the uneasiness pre¬
viously complained of. I observed that as the fluid was passing
through the canula, several thin membraneous flakes passed with it,
and on examining these afterwards, I was impressed with the idea
that they were portions of ruptured hydatids.

“ The evacuation of the fluid, and the consequent flaccidity of
the abdominal parietes, allowed a more satisfactory examination of
the abdominal tumour, which could be traced down into the pelvis
at the right side, and extending beyond the median line of the
abdomen ; the liver did not appear to be at all enlarged.

“ September 3. — Uneasiness about the bladder and perineum ;
relieved by leeches and a warm bath.

“ September 4. — Four days after the operation of tapping, an
accumulation of the fluid in the abdominal cavity was evidently
taking place, and anasarca appeared in the left leg and thigh. I
directed pills of blue pill, squill and opium, with draughts contain¬
ing nitrous ether, and the abdomen to be well rubbed three times a
day with a liniment composed of three parts linimentum ammonia?,
and one part oil of turpentine.

“ September 8. — In consequence of heat of skin, full pulse and
some pain in the side, I had eight ounces of blood taken from the
arm, which produced no relief.

“ September 9. — Complained of diarrhoea, to which I directed
immediate attention.

“ The means hitherto used for the cure of the dropsy were
totally inefficient, and the fluid re-collected so rapidly, that the
operation of tapping was again performed on the 11th of September,
at the earnest desire of the patient. The same quantity of fluid as
before was drawn off, and a substance of a reddish colour, and
membrano- gelatinous consistence, escaped through the canula as on
the former occasion ; and, as before, the most complete relief fol¬
lowed the operation.

“ On examining the abdomen, the tumour was manifestly greatly
increased in size ; as well as I could judge, it was at least half as

388

Critical Review.

large again, as at the time of the first tapping, though the interval

was only twelve days.

“ The question may naturally occur, what was done for the dis¬
ease of the os uteri ? In truth, I paid it no separate attention, the
excrescence was very inconsiderable in size, and the quantity of
watery discharge so trifling as to be of no importance ; for which
reasons, I deemed it advisable to direct all my attention to other
circumstances.

“ The diarrhoea still continued unabated, notwithstanding the
means used to restrain it, so that at the end of five days she was
much weakened and exhausted ; but the dropsical effusion did not
now accumulate with so much rapidity as before.

“ September 17. — Ordered a grain and half of sulphate of qui¬
nine, with extract of gentian three times a day, port wine, and rice
boiled in milk.

“ September 19. — Evidently sinking ; complained of pain in the
stomach and bowels, which appeared to arise from flatulence, and
was completely relieved by a carminative draught containing acetum
opii.

“ September 20. — Still lower ; entreated for a repetition of the
draught, which she got ; was perfectly collected.

“ September 21.- — Was unable to swallow, but spoke plainly,
and was quite collected ; died at 5 p. m.

“ Examination, eighteen hours after death. — Great emaciation
of the body ; the left leg and thigh much enlarged by anasarca ;
on opening the abdomen the bowels were found much inflated, and
immersed in a considerable quantity of a deep yellow coloured
serum, similar to what had been previously evacuated by tapping ;
on turning over the body to get rid of this fluid, a quantity of pus,
certainly not less than two pints, escaped from the abdominal cavity ;
I remarked generally of the viscera, that very little blood remained
in their vessels.

“ On turning aside the integuments, a very singular ap¬
pearance presented itself ; a tumour chiefly composed of fine mem¬
branes, dividing it into innumerable cells, which, with their fluid
and transparent contents, resembled, at first sight, hydatids ; the
membraneous septa dividing the cells were supplied with blood
vessels of a considerable size running along their edges, so that the
whole tumour presented a clear red colour; At its upper and left
part there was a deep cleft or fissure, into which the open hand
might be passed without any force, and when carried downwards,
and towards the right side, it entered a round sac equal in size, and
much resembling a large flat turnip ; this was the right ovary which
lay just under, and was filled with the same structure as the part of
the tumour first brought into view.

‘ f In fact, it seemed as if the peculiar structure had at first grown
in the ovary, which thereby became greatly enlarged, until at
length the coat of the ovary had given way, and out of the fissure
so formed, the morbid growth continued to enlarge, turning over

Dublin Medical Traits actions.

389

the edges of the fissure, and covering the front and sides of the
ovary in which it had formerly been contained, so that the tumour
was in a great measure turned inside out:

This change in the state of the tumour might, I conceive, have
happened in one of two ways ; either by the coat of the ovary giving
way to the pressure of the morbid growth within it, which seems
probable, from the circumstance of that substance having evidently
continued to grow out of the fissure ; or the breach in the coat or
capsule of the ovary might have been produced by external violence
or accident, a cause but too probably true, as I afterwards ascer¬
tained that the poor creature had been exposed to a great deal of
ill-treatment from a brutal husband. The tumour was of such a
size, that while its inferior extremity was in the pelvis, its superior
border was as high as the ensiform cartilage, its length being twelve
inches, and its breadth nine.

Some slight, but firm membraneous bands connected the tu¬
mour to the neighbouring parts ; these I divided, and the uterus and
bladder were removed from the pelvis along with the tumour, their
natural connexion being carefully preserved. On examination, the
uterus itself was found enlarged to twice its ordinary size, and
scirrhous ; the os uteri exhibited the numerous flocculent processes,
which are all that remain of cauliflower excrescence after death ;
the left fallopian tube was healthy, but the ovary was somewhat
enlarged, tuberculated on its surface, and very hard ; the right fal¬
lopian tube was healthy, and the marginal process by which its
fimbriated end is ordinarily connected to the remote extremity of
the ovary, was attached over the surface of that body, in this case
so enormously enlarged. The liver was rather smaller than usual,
and perfectly healthy.

“ On this case and dissection I would now wish to make two or
three brief observations. With regard to the tumour itself, without
wishing to theorize or offer any opinion on its peculiar nature, I
believe, in the first place, that it is a form of disease not before
observed, as affecting the ovary, or at least not hitherto described,
as far as my research enables me to speak. I have dissected a great
number of cases of ovarian disease, and have preserved specimens
in my museum, of almost all the different species enumerated by
authors, but to none of these does the disease in this case bear the
slightest resemblance in character ; another peculiarity, which I
look upon as very remarkable, consists in the open state of the
tumour, and its internal surface being in consequence exposed in
the living body, and literally in a great degree turned inside out.

From the surface thus exposed, serum must have been abund¬
antly poured out, and hence perhaps a cause, or at least one source
of the effusion into the peritoneum, and whether the circumstance
can be fairly attributed to this, or to some other more general cause,
it is to be recollected, that during the period in which the effusion
took plane most rapidly, the tumour was found to have nearly
doubled its surface.

390

Critical Review.

“ The state of the tumour appears to me also to account for the
great disproportion between the uneasiness felt, and the degree of
distension existing.

<£ It seems not so easy to account for the oedema of the thigh
and leg occurring at the left side, while the tumour was at the right.
A very intelligent pupil, Mr. Dwyer, who gave me his valuable
assistance in the dissection, suggested that it might perhaps have
been caused by the weight of the tumour pushing the enlarged and
scirrhous uterus forcibly to the opposite side of the pelvis, and I
agree in the probable correctness of this ingenious suggestion.

“ The situation of the tumour explains at once the reason why
the intestine did not descend into the hernial sac.

“ A circumstance of much interest is the formation of such a
quantity of pus, as evidence of very considerable inflammatory action
having taken place, without its existence being indicated either by
the degree of pain or the character of the pulse. At no period
during her illness was the pain at all severe, but consisted rather in
a sense of general uneasiness ; and free pressure could all along be
borne with little or no inconvenience ; the pulse though frequently
rather quick, between 90 and 100, was as often not accelerated,
and always soft and feeble. Throughout the whole course of the
treatment, I considered general blood-letting not only uncalled for,
but absolutely inadmissible, except on the day mentioned, and then
it was productive of no benefit, but the removal of the fluid from
the cavity of the abdomen in both instances, produced at once com¬
plete relief, so that every part of the abdomen could be pressed and
handled with the greatest freedom, without inconvenience to the
patient.

“ This appears an interesting illustration of the fact long since
noticed by Morgagni and Van Swieten, and recently so ably insisted
on, and established by Dr. Abercrombie, that abdominal inflammation
may exist even in its destructive form, without its existence being
indicated either by pain, or the state of the pulse.

“ Perhaps I ought not to omit to mention that I was much struck,
as were those present at the examination, with many points of iden¬
tity in the appearances presented to us, with those usually witnessed,
as the pathological results of puerperal fever.

“ The appearance of the tumour, and its relation to other parts,
are represented in the engravings ; the parts themselves, exactly as
they were removed from the body, are preserved in my museum.” —

p. 11.

The author commences his description of a malformation
in a foetus, by referring to Geoffray St. Hilaire’s Philoso¬
phic Anatomique Monstruosities Humaines, for a case some¬
what similar, but which scarcely lessens the claim to
novelty in this instance. The lady was delivered at the
seventh month, and the foetus presented the following ap¬
pearances : —

Dublin Medical Transactions .

391

“ The size of the fetus is what might be expected in the seventh
month, its length being fourteen inches : the upper part of the
thorax, with the arms and hands, are well formed and justly propor¬
tioned, as are also the head and face, the features of which are
even more than usually handsome and expressive ; a rare circum¬
stance in cases of monstrosity of this particular description ; see
plate 3. The lower part of the thorax is compressed, both from the
sides, and backwards towards the spine, and this compression back¬
wards is still more remarkable in the integuments of the abdomen,
outside of which lies the whole of the alimentary canal (except the
oesophagus,) together with the liver, pancreas and spleen. Viewed
anteriorly, the liver is the object which most prominently arrests the
eye, and below it the convolutions of the intestines ; if the liver be
raised or turned aside, the stomach, pancreas, and spleen present
themselves immediately behind it.

“ The placenta remains attached by its funis, which is very short,
not more than four and a half inches long, and having its vessels
running parallel, instead of being twisted round each other, as they
should be ; attached to the circumference of the placenta are the
natural membranes, and an additional membranous pouch is firmly
attached to one part of its anterior surface, which will require a more
particular description.

“ There are neither genital organs, nor anus, in the usual situation
of these parts. In the monster described by St. Hilaire, these parts
were in their natural situation, which was also the case with those
described by Rudolphi : see pp. 188 and 199.

“ The left thigh and leg are well formed and naturally placed,
but the right limb is distorted, and from its connexion with the
pelvis, returns at an acute angle with the body, so that the foot
lies when undisturbed, towards the right ear.

“ Viewed posteriorly, the lobulated external surface of the pla¬
centa, one lobe of the liver, the stomach with its great arch directed
upwards, the spleen, and a tumour about as large as a goose-egg,
springing from the lower half of the spinal column, are the objects
which appear necessary to notice, in order to complete this general
description of the external appearances.

“ Dissection. — The contents of the thorax did not differ in any
respect that I could observe from the ordinary condition of the
viscera contained in that cavity.

“ The abdomen, of course, presented several peculiarities. In the
first place, the anterior integuments lay in contact with the spine
almost throughout, so that in fact there was but little cavity,' except
in one situation, which was immediately behind the umbilicus, and
there collected into one spot, lay the only abdominal viscera which
were internal.

“ They lay in a sort of sac of about an inch and half diameter,
and consisted of one kidney, with its renal capsule and ureter, the
uterus and vagina, ‘ 11 n ’etait reste, dans la cavite abdominale
chez notre monstre, d’autres visceres, que ceux des systcmes urinaire
«t sexuel,’ St. Hilaire, p. 191.

392

Critical Review.

“ The kidney lay towards the left side of the sac, with its renal
capsule in its proper situation, the ureter was about two inches and
a half long, somewhat convoluted, and alternately distended and
contracted throughout its length ; I could not, after the most careful
examination, ascertain where it terminated ; air blown into its renal
extremity first distended its cavity forcibly, and then gradually
escaped from the remote end ; but where I could not discover by
dissection. I traced it to the surface of the uterus, where its tube was
so diminished as to be incapable of transmitting a bristle : it passed
through the peritoneal covering of that organ, and was insensibly
lost ; neither could I discover any organ or cavity like the bladder,
nor could I, as I have just said, trace the single ureter to any ex¬
ternal opening by which fluid might escape, had it been secreted by
the kidney.

“ In St. Hilaire’s monster there were two kidnies, with ureters
following the usual course, and terminating in the bladder, p. 190.

‘c A little to the right side of the entrance of the cord into the
abdomen, is a small regularly formed circular aperture, with promi¬
nent edges ; marked G in plate 3 ; this is the external orifice of, or
entrance into the vagina, which lies immediately behind the integu¬
ments, and is in form of a circular pouch of about half an inch, or a
little more in diameter ; into the remote end projects the os uteri of a
natural form and appearance, but the uterus itself is malformed, being
of this shape, and having only one fallopian tube running off from its
apex, as if it were a continuation of the part, and having a continu¬
ous cavity as in the bicorned uterus of a quadruped. I could not
discover any ovary at either side of the uterus.

“ Immediately over and at each side of the small external aper¬
ture of the vagina, are two corrugated and prominent bodies of a
spongy texture, and about as large as peas ; from their situation and
structure, I presume they are imperfectly and malformed labia.
Between these bodies and a little to the right of the orifice of the
vagina, is a very small circular aperture, marked H in plate 3, which,
from its situation, I concluded was the orifice of the urethra ; but no
such duct exists, and this small aperture is impervious, and merely a
very short cul de sac.

“ St. Hilaire’s monster was a male, and the genitals presented but
little irregularity, p. 199.

“ The anterior integuments of the thorax and abdomen were quite
closed both above and below the umbilicus, nor was there any de¬
ficiency of integument in that part ; a circumstance in which this
specimen differs from the examples of external viscera, which I have
been able to find recorded. In that described by St. Hilaire, the
trunk was open anteriorly, ‘ superieurement jusqu’ a la naissance
des clavicules, et inferieurement jusqu’a la symphyse des os ante-
rieurs du bassin.’ — Philosophic Anatomique, p, 184.

“ The oesophagus occupied its natural situation from the fauces to
near the cardiac orifice of the stomach, where it issued from the ab¬
dominal cavity to join the stomach which lay outside ; its passage
through the integuments beingprotected bya close union with the parts

Mr. Montgomery on Malformation in a Foetus. 393

through which it passed : the stomach, spleen, pancreas, and liver,
were placed as nearly as possible in their natural relations with
regard to each other, and were perfectly well formed, as was also the
intestinal canal, which consisted almost exclusively of small intestines
only ; by tracing it from the stomach downwards, I found that its
termination was at the opening of the ileum into the coecum, where
it forms the ileo-coecal valve, which however, in this instance, opened
externally, and the contents of the intestines passed out freely when
pressed the valvular orifice at M ; the appendix vermiformis is at¬
tached to this opening, but there is no further portion of the coecum,
colon, or rectum to be found ; in fact the whole of the large intestine
is deficient.

“ These abdominal viscera were evidently, during the uterine
existence of the child, contained in the pouch of membrane already
mentioned as adhering at one of its extremities to the serous surface
of the placenta ; and at the other end attached all round the umbilicus
to the edges of the circular space, within which are the orifices of the
vagina and intestine, labia, &c. and then enlarging, it formed a flask¬
shaped bag or sac, within which lay the external viscera, to which
it had in this way the relation of the abdominal peritoneum, and for
which, indeed, we may look upon it as having been a sort of
substitute.

“ On more minute examination of the relations of this membranous
pouch, I find that it is formed by the amnion disposed in a curious
way ; the pouch lies between the cavity of the amnion and the in¬
vesting chorion, but yet having amnion both inside and outside of it ;
it seems that while the child lay as usual in the general cavity of the
amnion, the abdominal or umbilical region remained in contact with
the amnion, as it always is in the first period of foetal life, and then
the external viscera, as they grew, pushing forward, carried before
them the amnion with which they were in contact, and reflected it
upon itself, forming a pouch, just as the abdominal peritoneum is
related to the liver or stomach.

“ I find this arrangement corresponds remarkably with the account
given by St. Hilaire of the disposition of the membranous septa ob¬
served in his case, which he describes as ‘ disposes pour la plupart
comme les lames du peritoine, ils etaient une continuation des mem¬
branes de l'amnios.’ see p. 210.

‘ ‘ This preternatural union between the foetus and its placenta is
made by St. Hilaire, the essential character and cause of a class of
monsters in which the brain is partially outside the cranium, and en¬
veloped in the attached membranes ; to this class he has given the
name hyper encephalic

“ Very lately also a book has been published by Itudolphi on this
subject, entitled ‘ Monstrorum trium, prseter naturam cum secundinis
coalitorum disquisitio.’ These were all hyperencephali, and except
in the formation of the head, exhibited nothing remarkable ; the
work contains nothing to illustrate the specimen I am describing.

* * The umbilical cord ran along the reflected portion of the amnion
of nearly five inches in length, and instead of being free as usual,

vol, v. no. 29. 3 c

394

Critical Review.

with the membranes surrounding it, it was bound down by the
amnion, and lay quite fiat on the surface of the placenta, and along
the duplicature of the amnion ; it contains only one vein and one
artery ; the exact origin or course of the single artery, I regret I am
unable to describe ; the parts having been so dissected before I dis¬
covered the peculiarity, that I could not trace the artery to its
source.

“ The tumour on the back is spina bifida, arising from the lumbar
vertebrse, and presenting nothing but the ordinary construction of
such tumours ; its size was (before opening it) such as to contain
about six ounces of fluid, and having cut out the back of the ver¬
tebral column all along from the connexion with the skull, the dura
mater is displayed from its exit from the cavity of the cranium along
the spinal canal, from which it issues, where the lumbar spinous
processes are deficient, and dilating, forms the lining membrane of
the tumour.

“ The bones of the pelvis, posteriorly, are very loosely connected
to the sacrum, and anteriorly have no connexion at the symphysis,
the bones of the pubis being separated from each other to a distance
of nearly three quarters of an inch, so that in fact there is no pelvic
cavity.

“ The spine is very much distorted, having both an anterior and
lateral curvature.

“ A very accurate cast of this monster was taken before the parts
were disturbed, and is preserved, together with the body of the
monster, in my museum ; for a correct representation of the general
appearance and form, see plate 3.”

V. — The Dublin Hospital Reports and Communications in
Medicine and Surgery. Vol. V. 8vo. pp. 631. Eight
Plates. Dublin, 1830. Hodges and Smith.

It affords us much gratification to notice another volume
of the Dublin Hospital Reports, and also to inform our
readers that it far excels its predecessors in importance and
varied practical information. It is admitted by every well
informed medical man, that the Dublin Reports and Transac¬
tions are among the best*! if not the very best, of our
clinical productions ; and we are happy to state that
<( arrangements have been made to ensure the co-operation
of the physicians and surgeons of the Dublin Hospitals,
and it is hoped that the Reports will in future contain a
much more extensive series of hospital communications,
and consequently it is in contemplation to publish them at
shorter intervals. The first part of the sixth volume will
appear on the 1st of March, 1832.’'* — Preface.

Dublin Hospital Reports.

395

The contents of the volume before us are as follow : —
1. Clinical Report of Cases in the Medical Wards of the
Meath Hospital during the Session of 1828 and 1829, by
Robert J. Graves, M. D., & c. and William Stokes, M.D.,
&c. 2. Practical Observations on certain Diseases of the

Anus and Rectum , by A. Coiles, M. D., &c. 3. Observa¬

tions on the Mucous Membrane of the Rectum , by J.
Houston, M. D., See. 4. A case of Aneurism of the
Abdominal Aorta, with Dissection and Observations , by
T. E. Beatty, M. D., &c. 5. History of two cases of

Aneurism successfully treated by Ligature, by W. H.
Porter, M. R. C. S„ &c. 6. Physiological and Practical

Observations on the Utero Placental Circulation and the
Phenomenon of the Placental Soujflet, with its utility in
detecting the existence of Pregnancy , and the death of
the Foetus in Utero, by Evory Kennedy, M. D., &c. 7.

Observations on some of the Affections of the Fingers and
Toes, attended with Fungous Groivths, by F. Rynd, A. B.
&e. 8. A case of Ruptured Intestine, with remarks on

some effects of Contusion of the Abdomen, by J. Hart,
M.R.I.A., &c. 9. Pathological Observations, by John

Houston, M.R.I.A. 10. A case of Obstinate and Exten¬
sive Psoriasis successfully treated, by W. West, M. D.,
M.R.I.A. 11. Cases of Diseased Brain, by Robert Law,
A.M., M. D. 12. Small and frequently repeated Bleed¬
ings in Haemoptysis and Incipient Phthisis, recommended
in a Letter to R. J. Graves, M.D., from John Cheyne,
M. I)., &c. 13. Contributions to Ophthalmic Surgery , by

Arthur Jacob, M. D., &c. 14. A case of Inflammation of

the Vena Cava, Iliac and Femoral Veins, by John Cramp-
ton, M.D., &c. 15. Cases of Cancer Uteri, with Observa¬

tions chiefly intended to illustrate the pathological
changes caused by that Disease, by W. F. Montgomery,
A. M., &c. 16. An account of two newly discovered

Muscles for compressing the Dorsal Vein of the Penis,
in Man and other Animals, and also of a similar pro¬
vision for compressing the Veins of the Chameleon s
Tongue, by John Houston, M. R.I. Ac, &c. 17. Report

of the Wellesley Female Institution, by Samuel Cusack,
M.D., &c. 18, A case of Encysted Abscess in the centre

of the Spinal Cord, by John Hart, M. R. I. A., &c. 19.

Experiments relative to the Carbonic Acid of Expired Air
in Health and in Disease, by James Apjohn, M. D., &c.

20. A case of Chronic Cynanche Laryngea , in which the
operation of Tracheotomy was performed , by W. H. Porter.

21. On the Effects produced by Posture, on the frequency

396

Critical Review .

and character of the Pulse , by R. J. Graves, M. D., &c.
22. Report of the Coombe Lying-in Hospital , by Richard
Reed Gregory, Member of the Royal College of Surgeons,
and Master of the Hospital. 23. Case of Foreign Bodies
in the Trachea, by Rawdon M’Namara, M. R. I. A., &c.
34. Observations on a peculiar convulsive Disease affecting
young Children, which may be termed Sjjasm of the Glottis,
by H. Marsh, M. D., &c. •

The authors of these papers are generally professors or
lecturers on medicine and surgery, and, with two or three
exceptions, are hospital physicians or surgeons. Every
article is ably treated, and abounds with valuable practical
information. We are sorry to state that the volume reached
us too late for analysis in this number, except Dr. Mont¬
gomery’s articles, which arrived earlier, but we shall notice
it very fully in our next and succeeding ones. The report
by Drs. Graves and Stokes occupies 128 pages, and com¬
prises an account of a great variety of interesting cases.
The succeeding papers are equally valuable ; the whole
deserve unqualified approbation. We strongly recommend
the work to every class of practitioners. We only wish
that the medical officers of all large hospitals in Great
Britain would imitate the example of their Dublin contem¬
poraries— a wish entertained by the whole profession. There
is no reasonable excuse to be offered for the neglect 'of the
hospital physicians of England and Scotland, and that
usually given, ef want of leisure,” might be as justly offered
by the writers before us, many of whom are in the most
extensive practice.

It would be much better for the medical officers of the
metropolitan hospitals to report their own cases, and
authenticate them, than have them garbled and mutilated
as they generally appear at present. Authenticated reports
would be much more satisfactory to the profession than the
anonymous and imperfect ones now given. If the medical
officers treat their patients scientifically, they can have
nothing to fear by publishing their cases. Let any unpre¬
judiced man compare the London, Dublin, Edinburgh, and
continental hospital reports, and he must be surprised at
the vast contrast between them. This is a fact which can¬
not be doubted by those acquainted with the present state
of clinical literature. Of late years, we seldom see the
age, constitution, temperament, habit, or former diseases of
the patient recorded, so that the majority of cases published
are of no value, as the treatment must be modified by
the above circumstances. In all the foreign reports, these
circumstances are invariably attended to, and thus are the
cases valuable.

[ 397 ]

VI. — Medico-Chirur gical Transactions , Vol. XV. Part II.
8vo. pp. 451. London, 1830. Longman and Co.

This volume contains only three papers, and is one of the
most insignificant hitherto published by the society. The
first paper is tf on the anatomical characters of some ad¬
ventitious structures,” by Dr. Hodgkin. The author com¬
mences with a description of cysts formed by serous mem¬
branes, which, he says, differ from hydatids. He divides
them into two species ; — 1st, simple cysts, which have not
the power of reproduction -2nd, compound cysts, which
reproduce. The first kind is exemplified by cysts in the
choroid plexus, and the second, by those in the ovaries
and folds of the broad ligaments of the uterus. Simple
serous cysts are found in the base of the brain, choroid
plexus, eyelids, and along the edges of the tarsi, or deep
in the eye, lungs, female mammae, folds of the broad liga¬
ment and ovary. When present in the ovary, they form
ovarian dropsy.

The second class of adventitious serous membranes, are
found in the broad ligaments, uterus and ovaries. The
internal surface of these cysts present elevations more or
less rounded, and of various sizes, covered by the lining
membrane of the sac. These tumours are cysts of a secon¬
dary order, containing a serous or mucous secretion. On
the internal surface of these secondary cysts, are clusters
of tertiary cysts covered by the lining membrane of the
cyst in which they are contained. The membranes of these
cysts are liable to inflammation, both adhesive and suppu¬
rative. When adhesion occurs, it becomes difficult to dis¬
cover the structure of the cyst, and when suppuration is
present, it is confined in one or more sacs, as we see exem¬
plified in paracentesis of ovarian dropsy.

The secondary cysts are of three kinds ; the first has
neither slender necks nor broad bases ; the second has
slender peduncles ; the third has a broad attachment and
flattened form.

Adventitious cysts, assuming the form of reflected mem¬
branes are also found in the testicle, female mamma and
eye.

Dr. Hodgkin proceeds to consider the heterologue de¬
posits confounded by anatomists, under the names of can¬
cer, scirrhus, and carcinoma. He thinks they may be
grouped in one family. He gives the following account
of their structure : — -

' - . ‘ , • ' - ' » } ;

“ If we carefully dissect down to the surface of these tumours,”

says Dr. H. “ we shall usually find that it has a capsule or covering.

398

Critical Review.

which has, I believe, generally been supposed to consist of the altered
and condensed cellular membrane of the parts which have given way
before the growth of the tumour. This idea is probably correct with
respect to the unequally thick external part of the capsule ; but if we
dissect carefully, and examine those tumours in which the process of
decay has either not commenced, or has made very little progress,
we shall find that surface which is next to the mass of the tumour
more or less smooth and even, and on raising it we find that it is
reflected over one or more somewhat periform bodies, attached by a
base, which is generally narrow and peduncular, to some part of the
circumference of the enclosing capsule. Unless the tumour is very
small, it is much more common to find several rather than a single
body of this kind, and as there is often little, if any fluid intervening
between them and the enclosing capsule, their form is somewhat
modified by their mutual pressure. Sometimes, though more or less
closely applied to each other, these pedunculated bodies are perfectly
detached at their sides, and may, consequently, be readily traced to the
point which forms the common origin of their peduncles. At other
times these bodies are so adherent amongst themselves, and the mem¬
brane covering them is so tender and delicate, that without very
great care the arrangement of their structure may be overlooked, in
consequence of the pedunculated bodies being broken or torn through
in a different direction from that to which their mode or formation
would naturally dispose them. * * *

“ If we continue dissecting and raising the outer cyst, forming
the reflected membrane which covers the radiating pedunculating
bodies, we shall generally find, that on one or more sides it dips
down deeply into the mass of the tumour, and forms a part of the
septum which separates the one packet of pedunculated bodies from
the others which generally concur to form the mass of the tumour ;
for it comparatively rarely happens that the tumour is composed of a
single cyst filled with pedunculated bodies. On examining the
different ency sted packets of pedunculated bodies which compose the
tumour, we shall often find some indication of their having taken
their origin from nearly the same spot, which is generally the most
indurated part of the tumour. We may likewise observe, that the
different secondary tumours, or encysted bundles of pedunculated
bodies, are in very different stages of progress.”

Dr. Hodgkin gives the following account of scirrhous
tumours : —

“ True scirrhous tumours appear sometimes to depend on a single
primary tumour, at other times, several may be satisfactorily made
out. That part of the tumour which appears to have been the com¬
mon origin of the primary cysts, where there are more than one, or
from which the contained pedunculated bodies radiate when there is
only a single primary tumour, is in general the most indurated
portion, and is, at the same time, the most indistinct in its structure.
When examined externally, after the surrounding natural structures

Medico-Chirur gical Transactions .

399

have been carefully dissected off, this part of the tumour is found to be
the most irregular, has a somewhat corrugated appearance, and sug¬
gests the idea of its having been the sort of root by which the adventi¬
tious growth was implanted on the natural structures. The radiated
appearance so strongly insisted on by most authors who have described
scirrhous tumours, and the rationale of which I trust I have shown,
is particularly conspicuous when the section passes through this
point. The fluid part of a true scirrhous tumour bears in general a
very small portion to the rest of the structure, it has a viscid or
mucous character, more especially where softening has not taken
place ; but where this process is going on, it assumes the character
of an offensive ichorous discharge, and acrid and highly deleterious
qualities have by some been ascribed to it.

“ The process of softening sometimes commences internally at
one point, at other times in several small isolated points ; in others,
again, the ulceration through the integuments is the first part of the
process of decay.

“ True scirrhous tumours, notwithstanding the length of time
during which they continue to grow, very rarely acquire a con¬
siderable size. Indeed, it not unfrequently happens, that the wast¬
ing of the neighbouring structures, and more especially of the female
mamma, which is by far the most frequent seat of true scirrhus,
more than compensates for any increase of volume dependent on the
new formation.

“ The tumours now under consideration, in many instances re¬
main for a length of time in an indolent state, without passing into a
state of softening, or producing an external ulceration. Before this
ulceration takes place, the tumour becomes adherent to the skin, and
though there is generally but little redness observable in these
tumours, a spot, most frequently of small extent, becomes of a bright
and cherry-red or of a purple livid colour before the continuity of the
integuments is destroyed. It is needless that I should again describe
the characters of a malignant ulcer, which are in general very com¬
pletely seen in the ulcerative stage of true scirrhus. It may, how¬
ever, be said, that the ulceration of true scirrhus is attended with a
more decided loss of substance than that of the next form of tumour
of which I shall speak — viz. cerebriform cancer, and which is often
attended with large, rapid, and irregular growth from the ulcerated
surface, whence the names of fungoid disease, fungus medullaris, &c.
have in all probability been derived. The ulceration of true scirrhus
is indeed bounded by its elevated wall of circumvallation ; but the
central parts, gradually hollowed away by the softening of the very
imperfectly organized structure, present a foul and deep chasm.”

Our author inclines to believe that scirrhous tumours may
be thrown off by sloughing, granulations occur, cicatriza¬
tion follow, and a cure be effected. He states that scirrhus
uteri does not present cells or cavities, though the tumour
acquires a greater size than in other parts. He next de¬
scribes the growth of encephaloid tumours, cerebriform

400

Critical Review.

cancer, medullary sarcoma, spongoid inflammation, fungus
hoematodes, and fungoid disease. The diagnosis offered,
differs in no respect from that which is generally found in
works upon the subject.

The Second paper is entitled ff Observations on the state¬
ment made by Dr. Douglas, of Cheselden’s improved lateral
operation of Lithotomy,” by John Yellowly, M.D. The
object of this essay, is to prove the error committed by
Douglas, John Bell, and others, which is as follows : —

“ His knife first enters the groove of the prostrated or straight
part of his catheter, through the sides of the bladder immediately
above the prostate, and afterwards the point of it continuing to run
in the same groove in a direction downwards and forwards, or to¬
wards himself, he divides that part of the sphincter of the bladder
that lies upon that gland, and then he cuts the outside of one half
of it obliquely, according to the direction and whole length of the
urethra that runs within it, and finishes his internal incision, by
dividing the muscular portion of the urethra on the convex part of
his staff.” — p. 346.

* •'*.*• t ■ - ■ . * — - - ■* • -

This mode of operating is not mentioned by Cheselden
in any of the editions of his works, and is one, according
to Dr Y. “ which makes it difficult to believe that it was
actually performed.”

The third paper is entitled ee Pathological Researches on
inflammation of the veins of the uterus, with additional
observations on phlegmasia dolens,” by Robert Lee, M.D.
We have noticed this in our last vol. pp. 330, 331, in an ori¬
ginal essay on phlegmasia dolens, and shewed how Dr. Lee,
in a preceding vol. of the Trans, before us, maintained phle¬
bitis of the crural veins was the cause of the disease. In
further disproof of the opinion, we refer the reader to our
notice of M. Tonnelle’s autopsies of puerperal fevers, which
shew extensive uterine phlebitis without any swelling of the
inferior extremities — a fact also attested at p. 331, already
referred to. The cases narrated by M. Dance, of the Hotel
Dieu, and referred to in the essay on phlegmasia dolens,
are also exceptions to the pathology proposed by Dr. Lee.
We are ready to admit, however, that swelling of an infe¬
rior extremity, may possibly arise from uterine phlebitis,
but contend that it is by no means so frequent an occurrence
as one is disposed to imagine.

[ 401 ]

ORIGINAL COMMUNICATIONS.

I. — Mr. Mitchell’s case of Calculi in the Vesiculce

Seminal es.

To the Editor of the London Medical and Surgical Journal.

Sir, — The following1 ease will probably merit a place in
your valuable Journal ; if so, you will oblige your most
obedient servant,

Charles Mitchell, Surgeon.

A tall man, of good complexion, aged 45, was attacked
with rigors after exposure to cold in the month of January,
accompanied w ith cough and pain in the chest ; the rigors
were most severe during the night, continuing sometimes
upwards of an hour, upon the decline of which warmth
ensued, followed by profuse perspiration.

He applied to Dr. Pinkard, under whose care he con¬
tinued for six weeks, during which time he took nauseating
powders, but objected to bleeding, which was proposed ;
and finding that no advantage accrued from the powders,
he left them off. A week after, w hile walking in the street,
conversing writh a friend, his intellect became impaired; he
talked irrationally and was confused ; the man asked him

m •/ J

if he knew wffiat he was talking of, when he felt entirely
lost. The man saw him home, when his speech left him,
and continued so for two days, only returning upon the
application of a blister to the nape of the neck, and the
administration of a purgative. J saw him in the beginning
of March, when he complained greatly of the pain in his
chest, attended with tightness, and accompanied by difficult
respiration, cough, and sweating ; considerable elevation of
shoulders during inspiration, and attended with pretty high
action of the circulatory system. Upon placing the ear
over any part of the right side of the chest, a hissing noise
was distinctly heard (caused, I presume, by the air rushing
into a hollow cavity.) He was bled to six ounces, blood
was cupped and buffy ; had a blister applied to his chest,
and took 5iss. of liq. potassse in the course of the day,
with a view to mollify any tubercular formation, with half
a grain of squill and digitalis four times a day. In the
course of six days the sweating became very troublesome,
although the other symptoms had considerably lessened in
their severity.

VOL. v. no. 29. 3 D

402

Original Communications .

H e now took two drachms of diluted sulphuric acid, with
twenty drops of laudanum, in the course of the day. — -
Another patient, who was hectic from consumption, and
under the use of the acid and laudanum, had a severe attack
of colliquative diarrhoea, notwithstanding which she con¬
tinued one drachm of the acid. On the fourth morning
after, the diarrhoea ensued, she was seized with griping' in
her bowels, unusually violent, with an inclination to go to
stool, when she emitted nearly one pound of blood, which
coagulated ; after which she recovered rapidly, the diarr¬
hoea entirely ceased, the sweating subsided, the cough and
spitting gradually abated. (However, this must be attributed
entirely to a natural effort of the system.) From this di¬
gression, I must advert to the other patient, who continued
the acid and laudanum for three wrneks ; wrhen the cough
and pain had become so severe, attended with puriform
expectoration, that it, was necessary, in consequence of the
existing irritation, to extract blood, which was done to ^iv.
Two days, however, only elapsed, when he lost his speech
a second time, whde walking in the street ; he returned
home ; appeared pale and cold, with his mouth drawn to
the left side. In the course of a wreek he lost the use of
the right side, but retained the feeling. Three weeks after¬
wards he had a fit. of suffusion of the face and eyes, drow¬
siness, accompanied by sickness ; after which the phthisical
symptoms subsided, the cough being only occasionally
troublesome. A blister was applied to the nape of the
neck, and renewed a second time without advantage ; he
was confined to his bed till the latter end of August, during
w^hich time the bowels remained regular and appetite good.
In fact, little characterised these months, excepting pain in
moving the right arm, which was apparently exquisite.
Towards the latter end of August he became severely
affected with cholera, wdiich continued for twenty-four
hours ; it at length however yielded to opiates, but the
accompanying diarrhoea continued, attended with tenderness
all over the abdomen; moreover the right iliac region, where
five leeches were applied, succeeded by a blister. Chalk
and opium were administered without effect ; I proposed a
small bleeding, but the friends objected. An opiate injec¬
tion produced a little quietude, not only in the bowels, but
of the whole system ; the relief being temporary, the diarr¬
hoea continued, the cough became considerably aggravated,
the appetite failed, sleeplessness ensued, until the skin was
literally constricted upon his very bones ; when finally,
nature drew a veil over his existence.

Mr. Mitchell’s case of Calculi in the Vesiculce , Sfc. 403.

T

Autopsy. — Upon removing the skull cap and dura mater,,
a thin coating of lymph was effused underneath the
arachnoid—-the pia mater was injected with blood— the
ventricles and base ’contained not less than eight ounces of
serous fluid, although the man remained sensible to the last.
The left ventricle had acquired a greyish appearance— the
anterior lobe of the left hemisphere was softened, so much
so, indeed, as entirely to obliterate the anterior cornu of
the left ventricles, the medullary matter of uhich swam in
flakes upon the serous fluid. Upon removing’ the sternum
and true ribs at their cartilages, the right lung was found
firmly adhering to the ribs, through the medium of the
pleurae ; each stroke of the knife, upon which, and the
adhering portion of the lungs, exposed fresh collections of
matter. One very large abscess had burst, and the matter
insinuated itself at the lateral origin of the diaphragm ; the
left lung contained numerous tubercles, from the size of a
pin’s head, forming a regular series to that of a walnut,
without any regular formation of matter.

The lower part of the jejunum, and the whole of the
ilium had a dark appearance, so likewise the lower portion
of the ascending part of the colon, the villous coats of
which were unusually vascular, a degree of deposition ele¬
vating its villous coat preceding its absorption, forming
ulceration, was continuous throughout the whole course of
the ilium ; the mesentery was extremely vascular, and its
glands considerably enlarged. The caecum, caput coli, had,
besides deposits, four large, ulcerated places, thickened at
their edges; two large ones, as in the lower part of the
colon, within two inches of the caecum, one as large as a
shilling. The transverse arch and descending portion, was
perfectly free from vascularity, deposit, or ulceration. The
right yasicuia seminalis, contained more than two hundred
stones, which, I presume, depended upon the inactive state
of the genital system, by which the secreted semen became
viscid, gorging up the passage, or so much so, to find an
entrance into the passage ; and the animalcules, which Lee-
wnhock discovered, by the aid of a microscope, no doubt
formed a nucleus for the earthy deposit, showing the vast
number contained in a small quantity of semen, when its
thinner part becomes absorbed. Six of these animalculee I
once observed without the assistance of a microscope, being
the third sensible emission of a young man, unacquainted
with the nature of a discharge; the second of which pro¬
duced nausea and vomiting ; I saw the third upon the cover
of a book which he brought me. I had no doubt as to its

404

Original Communications .

nature, and upon strictly questioning' him, I soon found that
he had procured his semen by artificial means, for which
he received a severe censure. The small gelatinous emi¬
nences, which I conceived to be the animalcules, swam in,
and were surrounded by a pale, thin, milky fluid. Upon
the peritoneum, as it lies over the upper part of the sacrum,
and is reflected from the anterior surface of the rectum upon
the posterior of the bladder, there were numerous glandular
eminences, and from the fact of them being repeatedly met
with, as well as elsewhere, it falls favourable to those phy¬
siologists who have deemed glands as essential to secretion
under every circumstance.

Lamb’s Conduit-street, Oct. 16, 1830.

II. — Mr. Foote, Jun. on Intermittent Head-ache.

J. B. aet. 24, married, tall and pale, of the sanguineo-
lymphatic temperament, of general good health and regular
habits. Exposed himself to cold by sitting without fire,
with wet feet and damp clothes the whole day, after a
thorough drenching in <f the pitiless storm.”

On the 26th August, 1830, he complained of severe head¬
ache, increased by stooping, and accompanied by an in¬
tolerance of light, exposure to which considerably aggra¬
vated the pain. It is situated at the top of the head, over
the brow, and in the eyes, with a sensation of heaviness in
the head and eyes ; the scalp hot, the eyes glistening, in¬
flamed and sutfused with tears: pupils highly dilated and
did not contract on the approach of light: his vision was
also in some degree affected : tongue white and furred ;
complained of pain on pressure on the region of the stomach,
and on the lower margin of the liver : pulse quick and hard
(100) : bowels open.

A bleeding ah ractiio was directed, but he would not allow
it to be performed. In consequence the following' medicines
(fould only be given : —

IU Ext. colo. c. gr. x. Hyd. submur. gr. ii.

P. antim. gr. ii.

Mft. Pil. ii. nocte sumend.

Magn. sulph 3j. mane summend.

27th a. m. — The medicine has not yet operated, and the
pain is much increased, as also the heat about the scalp :
pain in the stomach, the photophobia, &c.

Mr. Foote, Jun. on Intermittent Head-ache.

405

He now consented to be bled, and twenty ounces were
abstracted from the arm, when he fainted. On recovering-,
he said that the pain, though much relieved, was not en¬
tirely gone ; in consequence a few more ounces were allowed
to flow, and that not succeeding in removing the pain, eight
leeches were applied directly to the temple*, four to each,
which, after bleeding some time, removed it completely.
Soon after the leeches fell off, the aperients began to act,
and he considered himself as cured ; but that not being relied
on, small doses of the tartarized antimony were admi¬
nistered occasionally throughout the day, keeping up a slight
degree of nausea.

28th. — A fresh attack of pain, heat of the scalp, &c.
has again occurred. At eight in the morning, the same
hour as yesterday, the coincidence of the hour of the attack
induced some questions ; by his answers to which it was
discovered, that the head ache, aversion to light &c. had
occurred for four mornings previously at the same hour.
It was now considered as a genuine intermittent, and to be
treated as such ; but the pain being excessively severe, and
as he earnestly wished to be relieved from it, six leeches
were applied : they bled freely, and speedily removed the
pain. Afterwards

fjf. Liquoris arsen. gtt. xii.
Aquae, distill. 3iv.

Sp. lavend. c. 3ss.

Mft. Mist. sum. 3 tiam a partem, 7 hor.

29th. — The pain recurred this morning as severe as ever-,
but at seven instead of eight : bowels not open since the
preceding evening. *

Habeat pil. purg. statim sumend.

He had likewise a lotion, composed of the strong acetic
acid and rectified aether, to sponge the forehead with.

When the pills had operated, which they speedily did,
the pain was much relieved ; and had entirely disappeared
by ten, in so much that he again considered himself cured,
and craved for something more substantial than his anti¬
phlogistic regimen allowed him.

fff. Lig arsen. gtt. xviij.

Dec. cinchon. 3iv.

Sp. lavend. c. 5ss.

Mft. Mist. 3 tiam partem, 12 ma, 1 na mer.
et 7 mis horis sumend.

30th. — The pain has again recurred this day one hour pre¬
vious to the former attack, namely, at six in the morning ;
but it is not quite so severe, The pills, as yesterday.

406

Original Communications.

aoain removed it, and near the same hour, when the follow-

mg' mixture was administered: —

©

14- Sulpli. quinse. gr. ix.

Aq. m. vir. $iv.

Acid, sulph. dil. gtt. xv.

Tinct, aurant. 5j-
Mft. Mist. sum. 3 tiam partem,

1 ma mer. et 5 tis horis.

3i st. — The pain did not occur until half past seven, and
was very' trifling in comparison with the other attacks. It
went off at nine, thus lasting only an hour and a half. The
mint water was changed for the inf. aurant. c. as it did not
sit easy in the stomach.

Sept. 1. — Nearly well.

III. — Inquest on the Body of Miss Gaskin.

To the Editor of the London Medical and Surgical Journal.

Sir, — I trust that you will deem the best answer to the notion of
my inability to have conducted such an examination as that of the
body of Miss Catherine Cashin will be found in the opinions of a few
celebrated anatomists and pathologists, under whom I have had the
honour of studying, or with whom I have the pleasure of having
studied. The opinions, of which the following are extracts, were
obtained when I was a candidate for the situation of curator to the
museum of a public body. Dr. Alexander Monro, of Edinburgh,
observes, “ It affords me much gratification to bear testimony to
your zeal and progress in the study of anatomy, so that I think you
■well qualified for discharging the duties of the office to which you
aspire Dr. Knox, of Edinburgh, with whom I studied for some
time in his private dissecting-room, says, “ I with much pleasure,
and independent and wholly uninfluenced by personal motives,
declare you to be exceedingly well qualified to hold such an office,
and that there are very few persons to be found possessing either
your abilities or industry.” Mr. Charles Bell, in writing to Mr.
Brodie, states, “His education has been very complete, his attainments
are of the first order, and such as must make him very useful to a
new institution. You may see his preparations and his drawings, by
which you will perceive that he is excellently well calculated to form
or add to a collection, as well as to make it useful to the students.”
Mr. Bennett, the professor of anatomy in the University of London,
writes the following opinion : “I have had the pleasure of intimately
knowing Dr. Alexander Thomson since the opening of the university,
where he has been a most zealous student, and can, therefore, with
confidence bear testimony to his undoubted capability to fill the
office he aspires to in King’s College. I have met, both at home and
abroad, in my capacity of teacher, many young men, who probably

Letter from Dr. A. Thomson.

may excel Dr. Thomson, each in some particular department, but
never have I known one whose information and acquirements were
so comprehensive and extended. With such attainments I deem
Dr. Thomson peculiarly well adapted to perform the duties of a
curator, an office, which of all others in a medical school, requires
in the individual holding it an education of the highest order. I can
testify particularly to Dr. Thomson’s knowledge of anatomy, and
from the specimens of preparations made by him, I believe him to
possess a very superior taste and tact in that very difficult depart¬
ment.” Dr. Granville, who has watched me more or less through
life, observes, “ I have found him anxious for knowledge, assiduous
in his enquiries, original in many of his researches, and dexterous as
well as skilful in dissecting, making preparations and taking draw¬
ings of the various parts of those animals, which engaged most of his
time and attention. His scientific qualifications are in perfect
accordance with his desire to advance natural history and the
science, which teaches the structure of man ; all which circum¬
stances added to his great zeal and natural bias for philosophical
investigations, render him well qualified for the situation of a curator
of an anatomical museum of natural history in general.” Mr.
King, well known for his anatomical powers, late of Aldersgate-
street, writes to me. This I can affirm, that I never saw a post
mortem examination better conducted than what I saw you engaged
in, I mean that of the body of Miss Cashin. I saw enough to con¬
vince me you stand, or ought to stand, among the first men in our
profession.” Dr. Clark, of Cambridge, no mean anatomist, certifies,
“ that Mr. Alexander Thomson, of St. John’s College in this Uni¬
versity, has lately passed the medical examination with great credit
to himself ; and that in the anatomical department thereof, which
came under my own more immediate observation, he distinguished
himself in such a way, as to allow- me to state without reservation,
that I consider him well qualified to discharge the office of Physician
to the London University Dispensary, wTith honour to himself and
benefit to the establishment.” Mr. James Syme, the celebrated
surgeon of Edinburgh , and my old teacher of anatomy, writes me
thus; “ You possess the advantages of excellent talents, extreme
fondness for your profession, and opportunities of studying it, in all
its branches, that fall to the lot of few of its members. It will
afford me great pleasure to hear, that you have succeeded in obtain¬
ing the situation which is at present the object of your wishes, and
so far as my recommendation can go, I most freely give it.” I will
trouble you with only two more opinions out of the hundred which I
laid before the Council of King’s College, but which I have since
withdrawn, because I will never belong to any institution which has
not liberality inherent in its constitution. I shall now give you the
. opinion of a gentleman, who is known never to say more than he
thinks of any man, and never to restrain himself from expressing a
bad opinion he may entertain of any man. Few men, therefore,
escape the lash of his tongue, still fewer the shrug of his significant
shoulder - . I mean Dr. D. D. Davies. “ In my own department

408 Original Communications.

of instruction at the university, I can safely say that no student, who
attended my lectures at the same time with yourself, gave more
pertinent answers to my questions in the class-room examinations,
nor furnished at other times more various and substantial evidence of
a full and perfect comprehension of my principles and precepts. I
am moreover aware, that your general character in the university
has been that of an ardent and successful student. Your devotedness
to the study of pathological anatomy seems to me to give you a
peculiar claim to notice, as a candidate for the office of curator of a
museum of anatomy. I shall be most happy to hear of the success
of your application/’ Lastly, Sir, let me lay before you the opinion
of the accomplished and scientific Dr. Hope, of St. George’s Hospital,
one of my old fellow students : “1 have been acquainted with Dr.
Alexander Thomson since the year 1822, and can bear testimony to
the extraordinary zeal with which he prosecuted his professional
siudies while in Edinburgh. He distinguished himself particularly
for his profound and exact researches in physiological and morbid
structure, for the beauty and fidelity of his delineations of disease,
and for the prominent part wffiich he took in the debates of the
Royal Medical Society on . practical as well as scientific subjects.
Since his return to London I have seen him prosecuting clinical
studies with his wonted ardour, and I have great pleasure in ex¬
pressing it as my opinion, that he is calculated to become a dis¬
tinguished member of his profession, and an ornament to any public
institution to which he may be attached.” Such, Sir, are some of
the golden opinions, that from twelve to fourteen hours honest
labour daily for thirteen continuous years, in three universities, has
procured for me. They must disarm my enemies of the force of
their sarcasm, as they remove the foundation for a belief in my ig¬
norance and incompetence. With regard to my youth, it is my
proudest ornament and greatest consolation, because with God’s
blessing my years shall only add improvements to my mind, and
confirm in me the strong love of truth for the sake of humanity, which
my virtuous mother early taught me to consider, as the grace and
ornament of brilliant talents, the best apology and safeguard for
those that are inferior. I must acknowledge your urbanity and
gentlemanly demeanour to me, and thank you sincerely for this op¬
portunity of vindicating my honour.

Alexander Thomson.

70, George-street, Euston Square.

We publish with pleasure an authentic account of Dr. Alexander
Thomson’s detail of the necrotomic appearances of the body of Miss
Cashin ; and also subjoin a very complimentary testimonial from the
jury in that gentleman’s favour. To this we add a few extracts from
the testimonials of some of the most eminent professors of anatomy
and surgery in this empire, in proof of the zeal, industry, and ability

j Examination of the Body of Miss Cashin.

409

■\vith which lie has pursued his studies. We cheerfully insert these
documents to shew the profession, that we have had no sinister motive
in commenting upon his evidence ; and we shall as readily admit
communications from any of the other medical \\ itnesses on whose
evidence we animadverted, if requested to do. so. Before the words
we now indite will appear, the trial of the accused will have taken
place, of which we shall give a special report, and it will then be seen
whether our remarks and predictions were right or wrong. At all
events we are conscious of having acted fairly and impartially, and
of having had no object in view, but the promotion of the dignity
of our profession and the interests of humanity.

Dr. Alexander Thomson’s account of the autopsy of the late Miss
Cashin ; —

On examination we found the body well proportioned, plump,
and in good condition ; the hair of a dark brown. Anteriorly over
the whole of the abdomen and thighs, the skin peeling apparently
from the effects of decomposition. The skin of the neck, shoulders,
and face covered with green reticulations in the course of the blood
vessels. The neck above the clavicles swollen and puffy, feeling
when pressed as if containing air. The lower part of the face and
upper lip covered with semi fluid-blood, which was discharged from
the nose in the act of removing the body from the coffin. The
features were well formed, and the nose prominent and straight, lips
thin and mouth distorted to the right side ; the nails grown to a
considerable length but straight. Breasts full and plump ; abdomen
tense and tumid, and face of true proportion; body equally well
proportioned at the back. The back and shoulders of a greenish hue,
excepting a patch of about nine inches long and six and a half broad,
and diagonally of about seven and a half inches irregular at the
margin, denuded of cuticle and of a black colour, intensing towards
the centre, and reddening towards the margin, and a little beyond
the margin towards each shoulder. The spot was equi-distant from the
acromion process of each shoulder, and spinous process of the occi¬
pital bone. The surface of the sore was hard and dry ; the true skin,
for the scarf skin or cuticle had been removed double the thickness
of that beyond the patch, indurated and semi-cartilaginous, offering
great resistance to the knife. The cellular substance, fasciae., and
muscles blended into one hard mass, from which they could with
■difficulty be separated by dissection. The cellular substance, fascia
and muscles of the remainder of the back and posterior half of the
lateral parts of the thorax and abdomen, minutely traversed with
vessels carrying red blood, and the fat of these regions of a reddish
colour. The cellular tissue of the back and loins infiltrated with
serum. The anterior mediastinum healthy in appearance, but dis¬
tended considerably with air. The cellular membrane in the course
of the phrenic nerve also distended with air; the left cavity of the
thorax contained about an ounce and a half of sanious serum, but
neither in its costal, diaphragmatic or pulmonary portion was traversed
by; vessels containing red blood. The lungs of this side readily

Vol. v. no. 29. * 3 E

410

Original Communications ,

collapsed, and expelled the whole of the air, and appeared of a dull
greenish blue hue exteriorly, and interiorly of a purple dark port
wine hue, apparently from, venous congestion. This lung had at its
superior part a small adhesion connected with a cicatrix of the lung,
arising from an old attack of bronchitis; this cicatrix contained,
however, two small cavities, filled with purulent fluid. The lungs of
the right side white, internally they were of the same hue and
appearance as those of the left ; were everywhere in close adhesion
with the mediastinum diaphragm and thoracic parietes through the
medium of their pleura, which was connected by recent but organised
adhesive , bands, traversed minutely by longitudinal and parallel
vessels, carrying red blood to the costal, diaphragmatic, pericardial
and mediastinal pleura. The lobes of this lung were adherent to
one another by more ancient adhesions ; and at its upper part it
contained a cicatrix similar in form, appearance, structure, and
magnitude, which was about that of a walnut, to the cicatrix of the
left lung, but containing no recent purulent matter- Neither lung
contained any tubercles, nor do I believe from their appearance ever
had, for the bronchial glands were in a perfectly healthy state, and
the cicatrices noticed were evidently the result of abcesses of some
earlier period of life, wdiich had been long entirely obliterated. The
bronchial tubes of both lungs, and the whole of the trachea was
minutely injected with red blood, but in no case did there appear
ulcerations of their mucuous membrane, while the hue of the blood
was so dark, and the blood itself so recently decomposed, that it
would be impossible for me to say more than that I do not believe it
to have been arterial blood, because there- was no matter effused
into the bronchial tubes or trachea, the surface of which was nearly
dry. The pericardium, though opaque, was entirely free from any
appearances of recent inflammation, although it contained about
three teaspoonsful of sanious serum. I must, however, observe, that
the foregoing observation applies chiefly to the capsular parts of the
pericardium, for there were some small stellulae of red vessels on
that part investing the heart itself, and some unusual injections of
that portion of it which surrounds the heads of the great vessels,
viz. of the aorta and of the pulmonary artery. The valves of the
heart were perfectly natural in every respect, but the whole of the
lining membranes of the heart were much and deeply stained wTith
the blood, which in all the cavities of the heart, was in a state of effer¬
vescence and decomposition. The substance of the heart was un¬
usually pale and yellowish buff in hue, and the whole more flaccid than
usual. This substance contained no injected vessels, but a few bloody
petechiae. 4 he abdominal cavity contained two or three teaspoons-
full of sanious serum. The peritoneum was not, however, tra¬
versed by red vessels in any part except in the region of the
mesentery, where it was considerably inflamed. The stomach was
externally of a red hue as if stained with blood, contained internally
about half a wine glassfull of dark greenish brown foetid viscid
mucus, and had its mucous membrane most minutely and densely
studded with stellular of red vessels, particularly in the cardiac por-

Examination of the Body of Miss Cashin. 411

lion of its greater curvature. The same appearance was observed
in the first three inches of the duodenum. No other trace of inflam¬
mation was found in any part of the intestinal tube, which was
opened and very carefully and minutely examined, from one end to
the other. Indeed the branches of the mesaraic arteries, after reach¬
ing the intestinal tube, were remarkably destitute of blood. The
whole of the surface of the ilium was covered with thick, pappy, reddish,
translucent, and somewhat viscid mucus ; the latter part of the ilium
and the colon and rectum contained a considerable quantity of soft,
natural, healthy looking fseculent matter. It is worthy of remark,
that the whole of the intestinal canal was distended with flatus, and
had its coats more attenuated and translucent than I ever remember
to have seen in any case that I have examined.

s 9 i « » 7 ' * '*• ** * • <■_ —

Account of the Examination of the Brain, Muscles of the Bach,

and of Spinal Marrow.

The deep seated muscles of the back were in a soft and pappy
state. The external coat of the spinal marrow was universally of a
reddish brown hue, which was partly removed by washing in water.
No minute vessels carrying red blood were traceable in it, so that
this colour might arise either from a stain or from inflammation.
About four inches of that part of this Coat, which covers the hinder
half of the spinal marrow, lying immediately under the centre of the
sore of the back, was very much thickened. Between the thinnest
layer of this coat, and the free serous or arachnoid coat, were found
several small bands of recent adhesive matter. The remaining mem¬
branes, particularly of the posterior half of the spinal marrow,
were also highly coloured, perhaps from a stain. No trace whatever
of disease was found within the cavity of the head.

Letter from the Jury to Dr. Alexander Thomson.

London, 2d September, 1830.

Sir, — Allow me, in the name of myself and my fellow jurymen,
to requst your acceptance of our testimony. In opposition to the
malicious, false, and despicable attack made upon you in the
“ London Medical Gazette” of last week. We beg you to receive
our thanks for your minute and careful examination of the body of
the unfortunate Miss Catherine Cashin, for the patient and clear
manner in which you explained to the jury the meaning of every
technical term which you employed, and for the unhesitating and
open manner in which you answered all questions, from whatever
person they came, for the deep interest you have taken in this case,
and for your whole conduct during the inquest, which we shall not
soon forget.

We have the honour to be. Sir,

Yours respectfully,

(Signed by the Jury).

412

Original Communications .

IV. — Observations on F or ensic Medicine . By M. Rayn, M.D.

There are many bodily imperfections which are not suffi¬
cient to deprive married persons of mutual succour. The
principal end of conjugal union is the establishment of a
contract, by which the parties promise the exchange of mu¬
tual succour, and many of the ordinary infirmities are not
a sufficient motive to prevent consolation being given by
those affected. Marriage is defined a civil and religious
contract between male and female, by which they engage
to live together in mutual love and friendship for the purpose
of procreation. Some diseases are aggravated by marriage,
as inveterate scrofula, epilepsy, confirmed phthisis ; and as
these and other diseases may be communicated to the off¬
spring, they are considered by many as impediments to
matrimonial union. Again, rachitis is often transmitted to
infants ; and this rachitic predisposition in the female, pre¬
disposes her to spinal and pelvic deformity, and it too often
happens in such cases, that the female, the day she hopes
to be a mother, is consigned to the tomb. Mania and
other forms of mental imbecility, are impediments to the
marriage contract. It is necessary for this compact that
there should be capacity to contract, and the consent of
both parties. The various requisites for conjugal union,
are seldom duly considered by society ; in fact, few persons
trouble themselves about them. The age, constitution, or
health of the parties, are scarcely ever considered, though
highly important. Ail physiologists agree that early or
premature procreation is objectionable on many accounts,
from the imperfect developement of the parties, the small¬
ness of the pelvis, which exposes the woman to protracted
suffering during parturition, and too often to loss of life.
It is universally known to all practical obstetricians, that
females, who become mothers at an early age, purchase
ihe honor of maternity at a very dear rate. Such persons
are liable to numerous disorders during gestation, the pelvis
is unable to support the gravid uterus, it is too small for
the passage of the infant, consequently parturition will be
laborious and protracted, and finally must be completed by
artificial means ; while the degree of pressure on the im¬
portant organs of the pelvis, produced by parturition,
causes great suffering and . danger to the woman, and may
he followed by deplorable disease, or death itself. It is
also generally admitted by the most eminent writers, that
the present mode of female education is highly injurious to

Dr. Ryan on Forensic Medicine.

413

health, predisposes to spinal curvature, and consequently
to pelvic deformity, thereby rendering- the object of pro¬
creation highly dangerous to the other sex. Writers on
spinal diseases have very fully illustrated this position.
Again, great injury is inflicted on the natural develope-
ment of females, by the custom of tight lacing, the func¬
tions of the thoracic and abdominal viscera are impeded,
the developement of the mammae and nipples is prevented,
these parts are removed by absorption from pressure, the
lactiferous ducts are almost obliterated; the nipple is un¬
developed, and therefore lactation is impeded, and the
natural food of the offspring greatly diminished. Duges,
and other foreign writers, allude to unnatural excitement
of the generative organs, and contend that masturbation is
the cause of rickets and of various chronic and incurable
diseases. In the male sex, it is productive of the worst
consequences, and often causes impotence and sterility.
The female is unfit for the purpose of procreation until
after the twelfth or fourteenth year, or until menstruation is
established ; for at an earlier age the sexual organs are
undeveloped, there is no venereal desire, and sexual inter¬
course is painful. Hence the cruelty and barbarity of
violating female children of tender age, which shall be
farther explained in the description of rape.

The male is also incapable of performing his part in the
mysterious process of procreation until after puberty, and
according to the law of this country before the fourteenth
year. He is not qualified to enter into matrimonial engage¬
ments until the completion of the twenty-first year.

There is no subject which distresses married persons so
much as want of family, or leads to so much domestic
feuds and unhappiness, and finally to the nullification of
marriage. It is necessary for the medical jurist to be fully
informed of all the causes which disqualify both sexes for
the object of procreation. All disqualifications for matri¬
monial union may be divided into two classes ; 1, those
caused by defect of mental power ; 2, those caused by de¬
fect of sexual organization. The disqualifications are there¬
fore moral and physical, and are expressed by the terms
impotence and sterility. These terms are often used synony¬
mously, though widely different. Impotence consists in the
incapacity for copulation, or in the impossibility of exercis¬
ing the venereal act ; sterility consists in the aptitude of the
organs for procreation, without the power of reproduction.
Thus a person may be impotent, but not sterile and vice
versa. Some writers apply the term impotence to the male,
and sterility to. the female, but such a distinction is arbi-

414

Original Communications .

trary and unscientific, the female may be impotent from
malformation, and the male sterile, from excessive ^enery.
We may observe here, that sterility does not afford a just
plea for the nullity of marriage. We have now to consider
the manifest causes of impotence in both sexes, physical
and moral.

Physical manifest , natural or accidental impotence ,
of the male. — The causes of manifest impotence of the
male, are absence of the penis or testicles. There must be
total loss of the penis, as the slightest penetration into the
vagina is sufficient for procreation. (Blundell, Richerand,
Hurd, in Lond. Med. & Surg. Journ.vol.iv.) The absence of
the testicles from the scrotum, is no proof of their non-exist¬
ence in the abdomen ; unless the penis be small, the voice
puerile, the beard absent, the form delicate, and the whole
physical and moral constitution feminine. It is well known
that the testicles may not descend into the scrotum, and be
fully developed in the abdomen, and perform their functions
perfectly, and according to some writers, much better than
in the natural situation. The removal of one testicle by
castration or disease, is no impediment to procreation.
(Astley Cooper, Marc. Diet, des Sc. Med.) When both
testicles are diseased, their secretion is injured or destroyed,
and impotence is the consequence. Both testicles may be
removed by castration, yet procreation be effected, as the
vesiculae seminales may contain a sufficient quantity of semen
for one or two prolific emissions, after which the person will
be impotent. But such persons, and also eunuchs, have
erection and emission, which consists of the prostatic fluid,
the mucus of the seminal vesicles and urethra.

The urethra may open above the pubes in monsters,
(Duncan and others), and in such cases the individual is
impotent. Mahon and nmny other jurists, contended that
individuals were impotent who where affected with hypospas-
dias ; that is, when the urethra opens through any part of
that canal from its orifice to the scrotum. If the opening
be so placed that it may enter the vagina, impregnation will
follow. Frank relates a case in point. He knew a father
so affected, transmit it to his son, and even to three gene¬
rations. Another individual had three sons. Bull, de la
Faculte de Medicine, 1810. Morgagni, Petit-Radel, Saba¬
tier, who was hypospasdiac, Gauthier and Richerand have
observed analagous facts. Diet, de Sc. Med. art. Hypos-
pasdias.

Sometimes the urethra opens along the dorsum penis;
this constitutes epispasdias. It is evident that the reasoning
employed in the preceding case is applicable to this.

Dr. Ryan on Forensic Medicine.

415

Dimensions of the penis, extraordinary thickness and
length; are considered by some writers as causes of impo¬
tence. Fodere is of opinion that the respective organs may
be so disproportionate, as never to be adapted to each
other ; and the physical inconveniences are such as to ex¬
pose the female to great injury and danger to her health.
It must be admitted, however, that thickness of the penis,
which excites great pain in some women, procures volup¬
tuous sensations in others, and that the vagina is capable of
great dilatation, which may be effected by gentle and gradual
efforts, and reduced to a state capable of receiving the virile
member. Though extreme length of the penis may pro¬
duce contusion of the os and cervix uteri, it cannot be
deemed a just cause of impotence, because, by certain
precautions, this danger may be avoided, unless there is
great difference between the age of parties. Diminutiveness
or shortness of the penis is no proof of impotence, for the
reasons already stated. Obliquity, tortuosity or bifurcation
of the penis, stricture of the urethra, phymosis, paraphy-
mosis, or excessive length of the framum,. cannot be con¬
sidered absolute causes of impotence, as they can be reme¬
died by surgical operations. Large scrotal hernia; cause
recession of the penis, and render coition impracticable ; but
in some cases relief may be afforded. The same observa¬
tions apply to large hydrocele. Sarcocele or scirrhus of
testicle does not cause absolute impotence, as it may be
removed by operation ; and one testicle remaining is suf¬
ficient for procreation. The testicles may disappear by
disease, (Hamilton, Larrey, Fodere,) or by the use of
iodine. Three conditions are necessary on the part of the
male for copulation — erectio et intromissio jpenis, cum
seminis emissione. Impotence in men depends on defect
of some one or more of these conditions ; erection, intror
mission and ejaculation of the spermatic fluid. The causes
of impotence are more commonly observed in man than in
the other sex ; and this is easily accounted for, by the
greater part the male has to perform in nuptial congress.
This is evident from the phenomena which give the virile
member the form and disposition proper for erection, the
introduction of the organ, and the ejaculation of the
semen, effected by a violent and complicated action, which
requires a concurrence of many indispensable conditions,
as the organs not only contract spasmodically to effect the
expulsion of the male fluid, but all the body participates in
this convulsion at the moment of emission, as if nature at
this instant forgot every other function. The causes of im¬
potence in man arise from two sources, from malformation

416

Origin al C Omm m nications .

of the genitals, or from want of action in them; but in
females, impotence can only depend on malformation,
natural or acquired, as the organs have little to do in the
act of copulation, they being merely auxiliary to it.

The causes of want of erection may be divided into phy¬
sical and moral. The physical causes depend on defects of
the body, as paralysis of the penis, curvature of the spine,
frigid and apathetic temperament. The moral causes are
such as act powerfully on the imagination, and suddenly
produce an atony of the genitals, or induce an inactivity in
organs properly developed. The genital organs, says M.
Vdrey, offer two states during life, in the young and old,
which are the frozen zones of existence, the intermediate
state is the torrid zone of life. The infant has nothing to
give, the old has lost all. This doctrine, though generally
correct, admits of exceptions, as children have been pre¬
cociously developed even before the fourth year, examples of
which I have cited in my work on Midwifery ; and our
author described a boy, aged seven years, a native of the
department of Lot, who was as fully developed as an adult,
and who made the most furious comic attacks on his female
acquaintance, and absolutely deprived one of them of that
which she could never regain. On the other hand, a French-
man, aged ninety-nine, married a tenth wife, and was a father
at 102 (Bosquet), and Thomas Parr, married at 120, and
performed his nuptial duties so well at 140, as to make him
forget his old age. He was even compelled to appear in a
white sheet at one of our churches, for an amour, in his
150th year. He outlived nine kings of England. (Elliotson.)
But in general, the power of procreation continues from
puberty to the 65th year. Immaturity of age, or senescence,
may be put down as the first causes of want of power of
erection. Among such causes, we must reckon a frigid or
apathetic constitution, a total insensibility to sexual desire,
and this is said to be an aggravated or profound lymphatic
temperament. Descourtliz describes persons of this tem¬
perament in these words : — The hair is white, fair and
thin, no beard, countenance pale, flesh soft and without
hair, voice clear, sharp and piercing, the eyes sorrowful
and dull, the form round, shoulders strait, perspiration
acid, testicles small, withered, pendulous and soft, the sper¬
matic cords small, the scrotum flaccid, the gland of the
testicles insensible, no capillary growth on the pubes,
a moral apathy, pusillanimity and fear on the least occasion,
are symptoms of anaphrodisia, or impotence, or sterility ;
and any one having the majority of these signs, is incapable
of copulation or generation.” PropositionssurFAnaphrosidie.

Dr. Ryan on Forensic Medicine .—Impotence. 41 7

. A habitude of chastity is another opponent to erec¬
tion, such as in the ancient fathers of the desert, and in
those, who by fasting and other forms of church discipline,
extinguish those feelings implanted by nature, but in their
opinion contrary to that purity which should .distinguish
those who have made vows of chastity. The organs of
such persons decay like all corporeal organs, whose functions
are not exerted. Long continued debauchery will cause
impotence, whether with women or by musturbation. Every
practitioner has met with cases of both these kinds. The
impotence, says Pinel, caused by the latter excess, reduces
youth to the nullity of premature old age, and is too often
incurable. Drs. Gregory and Parry have forcibly commented
upon this baneful habit, as also many other distinguished
writers. Long watching, great fatigue, mental or corporeal,
want of nutriment, excessive evacuations, sanguineous or
otherwise of blood, bile, faeces, saliva, menses, scorbutic
cachexia, marasmus, peripneumony, hydrothorax, anasarca,
malignant fevers, diseases of the brain and spinal marrow,
whether from external injuries or poisons, and numerous
other diseases, are temporary causes of impotence. Sexual
desire is suppressed by acute diseases, and returns after
convalescence. Zacchias and Beck relate numerous cases in
proof of this position. We see this further illustrated
during the convalescence after fevers, when erection often
occurs. Some diseases stimulate the generative organs, as
calculus in the kidneys or bladder, gout, rheumatism,
haemorrhoids, leprosy, and other cutaneous affections. Ex¬
cessive venery is a frequent cause of want of erection and
impotence. I have been consulted in numerous cases of
this description, especially after marriage. And this is a
frequent cause of want of family in young married per¬
sons.

The abuse of narcotics, saline refrigerants, acids, acid
fruits, iodine, camphor and nitre, are causes of impotence.
Of all causes cold is the most powerful. Thus in the Polar
regions, there is neither love nor jealousy.

Moral Causes. — There are no facts which so evidently
prove the influence of the moral over the physical state of
man, as the phenomena of erection. A lascivious idea will
arise in the midst of our gravest meditations, the virile
organ will answer its appeal, and will become erected, and
fit for the functions which nature has confided to it. But
another thought arising, will instantaneously extinguish with
the most frigid indifference, all our amorous transports.

This statement is well exemplified by the effects of the

VoL. V, NO 29. -3 F

418 Original Commmnications.

passions. Chagrin, inquietude, and debilitating passions,
prostrate the whole economy, jealousy, and profound medi¬
tations, impede the faculty of procreation. Thus at the very
moment when enjoyment is about to be commenced, too
eager desire, the trouble which seizes on too ardent an
imagination, the excess of love, the fear of not being loved,
timidity, respect, doubt of capability, the fear of being
surprised, the shame of excessive modesty, on being in the
presence of witnesses, antipathy, the sudden knowledge of
some physical defect in the female, aversion from filth,
odour and pre-occupations of the mind, are sufficient to
oppose erection, and to abate it most suddenly. But who
can enumerate all the moral causes capable of impeding
or destroying erection ? A sigh, doubtfully interpreted, a
recollection, an equivocal word, are sufficient to destroy
the illusion, and congeal the most violent passion. A newly
married man has become suddenly impotent, on discovering
his bride was without a hymen ; and a debauchee has as
suddenly become anaphrodisiatic, on finding the membrane
perfect. (Diet. Des. Sc. Medicales.) And thus with a literary
man, a philosopher, or those who have a ruling idea, which
excites the brain more than the sexual organs. The fear
of being impotent is the most frequent and powerful cause
of this condition. Thus the cases related by the immortal
Hunter, and the absurd impressions of former times as to the
influence of his Satanic majesty, and his worthy colleagues
the witches. Men supposed there was no physical power
when the moral state had consumed their desires, and they
were impotent, as long as they supposed themselves so.
Such is the power of the moral over the physical state of
man. How many impotent persons of this class were cured
with bread pills by Hunter ; and how many are annually
cured by mere placebos ? In remote ages, men allowed the
illusions of the imagination to have a most extraordinary
power over their minds and bodies. This was most remark¬
able in the subject before us.

Thus we cannot easily comprehend how the power of
rue, or St. John’s wort, could prevent a man properly de¬
veloped, from performing his nuptial duties, on his bridal
day ; nor how the pronunciation of a few obscure and un¬
intelligible words could have a similar effect. These words
were to be written on paper with the blood of a bat, sewn
up with a needle, which was used in making the shrouds
of the dead, and then the charm was to be tied round the
neck of the new married man. (Venette — also les Secrets
du Petit Albert.) To cure these enchantments, the church
prescribed prayers, and the doctors physic, Mr. Hunter’s

Dr. Ryan on Forensic Medicine. — Impotence. 419

plan was best. He ordered timid bridegrooms to refrain
from any venereal combats for a week, no matter what might
be their desires, and then to try their prowess. This cure was
effectual, and many of his patients succeeded sufficiently as
to remove all unfavorable impressions of impotence ever
afterwards. They casually took some mild form of medi¬
cine, and a few drops of tincture of opium each night,
during the period of preparation.

Impotence natural , manifest or accidental in woman . —
It has been long held, I think erroneously, that the genera¬
tive organs of the female are more complicated than those
of the male ; and therefore, that the causes of impotence
are more numerous and less apparent in the other sex. If
we examine the genital organs of both sexes anatomically,
we will find them equally complicated, and possessing an
equal adaption or arrangement of parts, as well as an
identity of structure. Thus we find the structure of the
penis, very similar to that of the genital fissure and vagina,
the double fold of prepuce the cavernous structure, its per¬
formance of a part of the genito-urinary functions, the
openings of the vesiculse seminales and uterine tubes, the
vesiculee seminales and uterus, the testes and ovaries, the
spermatic cords and the uterine tubes. We also find the
diseases of one sex as numerous as those of the other, and
those who doubt the assertion, need only refer to the works
of Chopart, Titley, and others, on diseases of the genito¬
urinary organs of the male, for ample proof of the position.
I need scarcely observe, that diseases of the vasa deferentia,
vesiculse seminales, the pressure of tumours, hydatids, & c.
on these parts, diseases of the prostate gland, urinary
calculi, diseases of the urethra, fistulse in perineo, diseases
of the bladder, penis and scrotum will be found as numerous
as those of the generative system of the other sex. Besides,
it would be inconsistent with the wisdom and beneficence of
Providence, that one sex should have more to do in the
perpetuation of the species than the other.

The causes of impotence in woman, are malformations or
diseases of the organs subservient to procreation. Some of
these causes are apparent, others obscure. The apparent
causes are obliteration of the external sexual organs, both
soft and hard, absence of the vagina and uterus, and great
deformity of the pelvis, with numerous diseases of the
external and internal genitals. The vagina and uterus have
been found to consist of a dense fleshy substance, (Mor¬
gagni, Mott, Fodere) and the vagina has been partially
closed by such substance, (Pare, Kuysch, Fabricius, Phy-
sick, Fodere.) In my work on Midwifery, I have said,

420 Original Communications. ■ . -

“ the vagina may be absent, (Haller, Vieq. d’Azyr. Jourm
des Scavans, Boyer, Caillot, and Willaume,) unusually
small, impervious from adhesion, tumours, or a frsenum
passing above the hymen, or it may be filled with a fleshy
growth. If too narrow, it may be dilated with a bougie or
a tent sponge ; and when unattended to, must be divided
by incision, to admit the passage of the infant. It has
closed up after conception. There is sometimes a great
congenital confusion of parts, so much so, that it would be
tedious, if not impossible, to describe them. In cases of
extreme narrowness, impregnation may take place, and the
canal be gradually dilated during parturition. I have seen
four cases of cohesion of the labia externa, at the age of
puberty, so complete, that only a small probe could be in¬
troduced at the superior commissure. The vaginal canal
may be totally or partially obliterated, and in such cases
an operation is impracticable, and impotence absolute.”
The vagina has opened into the bladder, (Sue) rectum,,
anterior parietes of the abdomen, and pregnancy has oc¬
curred in the two latter cases. Morgagni attests that of the
abdomen, lib. v. epist. 6 7 ; and the last is given in the
Annales de Med. de Montpellier, which led the celebrated
Louis to propose the following question to the casuists : —
i( an uxore sic disposita uti fas vel lion, judicent theologi
morales ?” Barbant cites two examples of pregnancy of this
kind. Die. des Sc. Med. art. Impuissance. Orfila contends
such malformation is a cause of impotence, for though
coition is not physically impossible, it is contrary to the
laws of morals and of nature. The Royal Court of Treves
annulled a marriage in such a case. In cases of vesico¬
vaginal, recto-vaginal fistulse, and amplification of the va¬
gina from laceration of the perineum, inflammation and
ulceration may occur and impede sexual intercourse, but
such cases could not warrant a divorce, as they occurred
after marriage. Excessive straitness, or partial occlusion of
the vagina, are not impediments to procreation, as fecunda¬
tion may occur, if the spermatic fluid be applied inside the
labia, as already mentioned. Besides, fecundation has
happened, and the hymen perfect. Ruysch, Pare, Smellie,
Hildanus, Mauriceau, Boudelocque, Nsegele, Nysten. Jour,
de Med. de Corvisart, and Leroux. Prolapsion, and some
forms of ulceration of the vagina, are only temporary causes
of impotence. Cauliflower tumours of the clitoris or nymphee
may be temporary causes of impotence, as also tumours in
the vagina. Manual of Midwifery, p. 55. Burns. Trans.
Dublin College of Phys, 1824, v. 4. Ed. Med. and Sur,

Dr. Ryan on Forensic Medicine. — Impotence. 421

Jourii, 1805. Leucorrhcea is one of the most common
causes of sterility.

The uterus may be absent, (Columbus, Sehlegel, Mor¬
gagni, Meyer, Renauldin, Hamilton, Bousquet, Theden,
Engel, Lieutaud, Caillot, Ford, and- Breschet.) I might
quote numerous writers who describe the cavity of the uterus
divided by a septum, but it is not stated whether or not
procreation was impeded. Many authors have also described
partial or total obliteration of the uterine cavity, among
whom are Bichat, Lallement, Segard, Gardien, &c. The
uterus may be double, that is, there may be two uteri.
Haller, Purcell, Med. Facts, vol. 3. Mem. Med. Sci. v. 4.
Lond. Med. Journ. 1782, v. 3. Diet. des. Sc. Med. T. 6.
Duges, Journ. de Progres, v. xxii. A vicious direction of
the os and cervix uteri, or complete occlusion of the former,
are irremedial causes of sterility. The whole of the causes
of impotence and sterility in females, may be arranged
under three classes ; 1, those depending on the organs which
receive the male fluid, namely, the genital fissure, the
vagina and uterus ; 2, malformation or diseases of the organs
that transmit it to the ovaries, and reconvey the embryo to
the uterus, and these are the fallopian or uterine tubes ;
3, the malformation or diseases of the ovaries or organs,
which supply the germ for fecundation. Inflammation,
ulceration, scirrhus, cancer, ossification, calcareous deposit
or tumours in any of these organs, may be the cause of
sterility. In fact, any disease of the female genitals,
attended with much constitutional disturbance, may be held
a temporary cause of sterility. Tumours of various kinds,
callosities, cicatrices, adhesions, from disease or mecha¬
nical violence, displacement of the uterus, prolapsus, pro¬
cidentia, retroversion, antiversion, lateral obliquity, and
the various disorganizations incident to muscular, serous
and mucous tissues, when present in the female organs, are
causes of sterility. In the last volume of this Journal, is
an account of two singular cases of procidentia uteri; in
both impregnation was effected through the natural orifice,
though permanently fixed without the genital fissure for
years. I have also published cases of dysmennorrhcea, in
which pregnancy occurred. In the disease called irritable
uterus, so well described by Gooch and others, a cure may
be effected. In absence of the ovaries and uterine tubes,
there can be no conception, or in dropsy, or enlargement
of the former, or in occlusion or adhesion of the latter to
the uterus, or adjoining parts. There are some cases of
constitutional sterility, which are inexplicable ; for example.

422

Original Communications .

those in which a woman has had no family for years, and
at length becomes a mother.

The principal moral causes of impotence are hatred, dis¬
gust, fear, timidity, an excessive ardour of desire, divers
ramblings of the imagination ; in a word, every passion
strongly excited, that is to say, all cerebral action so strong
as to diminish that of the genital organs, which require for
cohition great exaltation. Impregnation may happen under
such circumstances. Fodere is of opinion that complais¬
ance, tranquillity, silence, and secrecy are necessary for pro¬
lific coition ; it is arrested as if by enchantment, by noise,
dread, fear, publicity, jealousy, contempt, repugnance,
slovenliness, by love too much respected, and by every
thing that can illumine the imagination.

Many of the causes of impotence in both sexes may be
removed, but many are beyond the reach of art. It has
been long maintained, that the powers of the mind have
great influence in promoting and impeding the process of
procreation. Much may be said for and against this posi¬
tion. In discussing this question in the work so often re¬
ferred to, I have said — fC In order to have coition effectual,
there is a mutual relation necessary — a union in mind and
pleasurable enjoyment as well as in body, and unless this
union of love be mutual, conception will seldom, if ever
happen ; for it has been long observed, that frigidity and
reserve in either party, will defeat procreation — a want of
love being a certain cause of barrenness. Hence, in unequal
marriages, where one of the party is old and the other young,
there is scarcely ever offspring. Again, it has been observed,
that in cases of rape, impregnation seldom occurs.

In order to effect procreation, there must be an ability
and fitness of disposition in the sexual organs of both par¬
ties. The disproportion of the organs impede or prevent
conception. This is observed very often, when persons of
extreme difference of stature cohabit. The most frequent
cause of want of family, is too frequent intercourse ; the
male semen will be too weak, and the female will become
relaxed, have increased mucous vaginal discharge, which will
extinguish the vivifying principle of the male altogether.
Hence we see strong, young, vigorous, and amorous per¬
sons remain married five, six, and seven years without
children. I know three respectable families in this predica¬
ment. I am inclined to think that the male semen is not
sufficiently strong when only allowed to accumulate for a
day ; in fact, all healthy persons who desire children, should
cohabit but once or twice a week, and they will be seldom

Dr. Ryan on Forensic Medicine. — Impotence.

423

disappointed in their expectations. The sexual act is not
performed well when repeated too often. Hence when boys
or extreme young* persons get married, they seldom propa¬
gate. It is an opinion, that the greater the quantity of
semen, the more perfect the formation, and even future
disposition of the offspring, and the greater the pleasure
experienced by both sexes. The first opinion is attested in
the inspired writings, Gen xlix. v. 3. The more the semen
is preserved, it is more powerful and ought to be retained
for a few days, in order to render the sexual congress
effectual.

“ Care, thought of business, sorrow, sadness, and depres¬
sing passions should be avoided, as they have a bad effect
on the conception. This has been long the prevailing
opinion among mankind, especially among physicians, natu¬
ralists, and I might add, sentimentalists too.”

On the other side, I have said, in disproving the vulgar
notions, that the power of the mother’s imagination can de¬
form the infant.

Conception is independent of the mother’s will and
pleasure. How many women are desirous of children, and
yet have none ; while others, not only conceive, contrary to
their wishes, but go to their full time in despite of the
various means they wickedly and designedly employ to de¬
stroy the foetus. Again, the nutrition and growth of the
infant go on according to the laws of nature, whether the
woman wishes or not. It is also out of the mother’s power
to choose a boy or girl — to have one or more children at a
birth — to cause the infant to be fair, dark, large or small,
weak or strong, or to give it her own or the father’s features.
If then, women cannot, by imagination or will, promote or
impede conception, how can any one believe, without dero¬
gating from the power and wisdom of God, that they can
disfigure the infants, and injure the works of nature ? Is it
not absurd to suppose that the mother has more influence
over her child, than over her own body ? The idea is pre¬
posterous. If she cannot, by the strength of her imagina¬
tion, make any mark on her own body, or change the
figure, situation, quantity, and number of her own limbs,
why should we believe she can do so to the body of the
infant ? Is it not silly and ridiculous to think, that if the
affrighted mother apply her hand to any part of her body,
which may be done accidentally and undesignedly, this can
affect the same part of the infant ? Does she mark that
part of her own body, by such application of the hand?”

From the preceding statements, we may, I think, deduce
the following general principles : —

424

Original Communications .

1. To declare either sex impotent, it is necessary that
certain physical causes be permanent, malformations or
accidental lesions, and be evident to our senses, which art
cannot remedy, and which prevent the faculty of exercising
a fecundating coition.

2. These causes, when rigorously examined, are few in
number.

3. The moral causes of impotence ought not to be taken
into consideration, as they would serve as an excuse for an
individual accused of impotence.

In this country the medical jurist is seldom required to
decide questions of impotence or sterility in our, courts of
justice, but every medical practitioner may be consulted
in private, either before or after matrimonial engagements.
He^may be the cause of great domestic trouble, and em¬
bitter the life of male or female. He should be exceedingly
cautious in fixing the stigma of impotence or sterility on
either party. The legitimacy of children may be contested
on a plea of impotence, and such a plea may be offered
by a man accused of rape. It is therefore evident, that a
proper knowledge of the subject is necessary to the medical
practitioner.

BIBLIOGRAPHY.

. Jt s • . > •» . • / * ' t . ' ■ .* . > » 4 . / f

1. Of the Pulse and its Modifications. By S. Jackson, M. D.
Assistant to the Professor of the Institutes and practice of Medicine
and Clinical Practice in the University of Pennsylvania. — It has
been a subject of dispute whether the arteries experienced a dilata¬
tion in consequence of the impulse communicated to the blood by
the contraction of the ventricles. A very slight dilatation certainly
does occur, though much less than formerly supposed, or might be
believed, from observing superficially the pulse. This point appears
to be very accurately settled by the experiments of Spallanzani,
Parry, and Poiseuille.

Three circumstances govern the pulse, of which it furnishes the
indications ; 1st, the frequency or slowness, force and rythm, or
order of the ventricular contractions ; 2d, the quantum of blood
actually contained in the vessels or proper vascular system, which is
governed by the state of the capillary and areolar circulation ; and
3d, the state of the arteries.

1st. The pulse depending so much on the action of the heart,
partakes of all its aberrations from the natural state, and these de-

Physiology.

viaticus are the consequence of idiopathic affections of the heart, or
of its sympathetic disorders. The last are the most common, for
the diseases of acute, and most of those of chronic irritations, ex¬
tend their influence to the heart, and involve it in the morbid con¬
dition.

The modifications of the pulse arising from the contraction of the
heart, are those affecting its frequency, slowness, force, and rythm
or mode of pulsation.

Frequency of the pulse is the most constant and certain symptom
of an existing irritation in the organs. Whenever the heart ex¬
periences irritation, either sympathetically or primitively, its con¬
tractions are quickened, and so long as a frequent pulse continues,
whatever may be the improvement of other symptoms, we should
always suspect a lurking inflammation, and endeavour to extermi¬
nate it. The diminution of the frequency of the pulse, in acute
diseases, is uniformly a favourable sign, while its persistance is as
positive an evidence nearly of the continuance of the disease. In
convalescence from gastro-enteritic fevers, after the perfect reinstate¬
ment of the alimentary organs in their healthy state, I have fre¬
quently found the frequency and irritation of the pulse continue,
and every attempt to increase the diet or invigorate the patient by
tonics, to be attended with febrile |excitement. The irritation of
the heart in these cases, at first merely sympathetic, had become
established permanently, and did not terminate with the cessation of
the primary irritation. It is to be overcome by local depletion from
the cardiac region, blisters to the same part, small bleedings, and
restricted regimen. If neglected, organic disease of the heart will
sometimes succeed, or the patient be cut off by dropsical effusions.

Frequency of the pulse may be combined with its force and ful¬
ness, but they do not necessarily accompany each other.

The contractions of the heart, in the majority of persons, average
from sixty-five to seventy in the minute ; above that number, the
pulse is said to be frequent. It often mounts as high as one hun¬
dred, one hundred and twenty, and seldom beyond one hundred and
fifty in the minute.

When the contractions of the heart are very feeble, from the emp¬
tiness of the vascular system, they increase in frequency, as though
the deficiency in the quantity of the blood circulating, was to be com¬
pensated by the increased velocity oi the circulation. It is scarcely
possible to mistake the frequency of the pulse from this cause, for
the frequency produced by irritation. It is always attended with
extreme weakness of the pulse.

Quickness of pulse differs from frequency ; it has reference to the
time of each pulsation, and depends on the systole of the heart
being performed with a rapid contraction. Most commonly it ac¬
companies frequency of the pulse, and is an evidence of existing
irritations. The frequent pulse of exhaustion is generally a quick
pulse.

Slowness of pulse is usually employed as opposed to its frequency
and expresses the fewrer number of pulsations than is usual in a given

v

von. v. no. 29. 3 o

426

Bibliography.

time. Rareness or paucity of pulse would be a more correct desig¬
nation, to distinguish it from slowness, as contrasted with quickness.
The diminution in the pulsations of the heart, manifests the absence
of irritation in that organ, or its declension, if they had been previ¬
ously frequent. Rareness or paucity of pulse accompanies at times
a full and strong pulse, particularly in the congestions of the cerebral
organs, and is also an attendant on a small and feeble pulse, espe¬
cially in chronic diseases, attended with serous effusions. It is pro¬
duced by digitalis, and appears to be a specific action of that remedy,
diminishing the irritability of the heart, and consequently the number
of its contractions.

Slowness of pulse, as opposed to its quickness, has relation to each
pulsation. It arises from the same causes as rareness of the pulse, a
state of ab-irritation or asthenia of the heart or mobile onran of the
circulation, and sometimes of the softening of its parietes.

A strong or forcible pulse proceeds from the energy of the ventri¬
cular contractions. Most commonly it belongs to a fulness of the
vascular system, or plethora, and manifests excitement and vigour in
the heart. It attends on hypertrophy of the left ventricle.

A feeble pulse marks, in most instances, a low state of excitement
in the heart, and indicates exhaustion of the vascular system. It may
be accompanied with slowness or frequency . In carditis and pericar¬
ditis the pulse is said to be feeble, which then proceeds from the dis¬
ability of the ventricles to contract, like other muscles, when they or
their sheathes are in a state of acute inflammation.

The last modification of the pulse emanating from the heart, relates
to its rythm, or mode of action. In this respect, the pulse may be
equal or regular, unequal or irregular, and intermittent. In a regular
or equal pulse, all the pulsations are similar ; a pulse is unequal or
irregular, when the pulsations do not correspond to each other in fre¬
quency, quickness, and force ; a pulse is intermittent, wrhen, after
several pulsations, there occurs a momentary repose. These con¬
ditions of the pulse proceed from different modes of contraction of
the ventricles. The irregular and intermittent pulses belong to
organic diseases of the heart, and occur also in acute diseases, from
sympathetic disturbances in that organ, which, I am disposed to
believe, are only excited by irritations of the digestive organs. At
least, I do not recal pulses of that character in the diseases of other
organs, except of the heart itself. The irregular is a more un¬
favourable than the intermittent pulse. I have known instances
in which an intermittent pulse was natural to the individual ; it con¬
tinued for years, and during the enjoyment of good health.

2d. The capillary system modifies the pulse, as to fulness or
emptiness, by determining the quantity of blood contained in the vas¬
cular system, and regulates, in these respects, the state of the direct
circulation. This last supplies the capillary system, which attracts
from the arterial and withholds from the venous vessels the propor¬
tion of blood it requires, determined always by the state of its
excitation — the vascular or direct circulation is governed, as to
repletion or vacuity, by the state of the capillary circulation in the

Physiology.

42 7

different organs. Fullness or emptiness of pulse are, then, indica¬
tions of the condition of the capillary circulation. These states of
the pulse are produced, however, under particular circumstances, and
in a manner requiring to be noticed.

When a limited extent of the capillary system is engorged with
blood, as occurs in irritation and inflammation, the circulation of the
congested part, is sluggish or suspended, and the portion thus
affected, ceases to admit further supplies for the time, from the artery
conveying the sanguine humour to it. The amount of blood which
previously passed into the capillaries, is now accumulated in the
artery, and passes into the veins exclusively by the direct communi¬
cation, existing between those vessels. They are consequently replete
with blood — the artery, completely distended, is full and hard, and
it more perceptibly manifests the momentum of the heart’s con¬
tractions. This I regard as the correct explanation of the full,
strong pulse, felt in the arteries supplying an inflamed part, as in
the radial artery, in very acute inflammation of the hand.

Inflammation of the brain or meninges with light congestion, pro¬
duces the same effect in the carotid arteries ; and to a greater extent,
the same circumstance is observed in the extreme congestions of the
brain, as in apoplexy. In these last cases, the pulse of the whole
vascular system, is full, strong, and often slow. The degree and
extent of the congestion, which occupies the external as well as in¬
ternal capillaries of the head, arrests the capillary movements, and of
course the demand of these organs receiving in a natural state, as is
estimated, an eighth of the whole circulating fluid, while the general
torpor of the capillary system throughout the economy, which attends
on this disease, diminishes, in some degree, the call made on the cir¬
culating fluid. The vascular system, in consequence, acquires a
repletion of blood, the vessels are distended, the pulse full and strong,
and as no irritation exists in the heart, its contractions are slow.

Precisely the reverse is the effect on the general or vascular cir¬
culation and pulse, of irritation in the extensive membranous tissues
rich in capillaries, and in capacious organs of highly vascular struc¬
ture, producing in them profound congestions. The quantity of
blood these organs and tissues are capable of containing, and which,
under the influence of irritation they abstract and withhold from the
vascular system, is so great as to reduce the general circulation to a
state of extreme exhaustion. A small deficient current flows through
the arteries and returns immediately by the veins. The heart in a
state of asthenia, contracts with feebleness on its half-distended
cavities, and the pulse is scarcely to be perceived, and sometimes is
entirely absent, when the volume of blood is not adequate to bring
the elasticity of the arterial coats into action.

In the commencement of irritations of the internal viscera, espe¬
cially of the digestive or alimentary organs, before reaction, or the
irradiation of the irritation into other organs has ensued, the capillary
and areolar circulation of the external surfaces is diminished, the
capillary circulation concentres towards the seat of irritation, where
the blood accumulates, and is detained until it is dispersed by the

428

Bibliography :

establishment of reaction. This concentration of the circulating’ or
nutritive humour in a portion of the capillary system, forms the cold
stage of fevers, and is the essential condition of visceral congestions,
which have formed so prominent a feature of late in some systems,
though their mode of production was not understood. Its direct
effect is to abstract blood from the vascular system, equivalent to a
depletion, and the quantity of blood of which the vessels are deprived,
is proportioned to the intensity and extent of the concentric move¬
ments of the capillary circulation, and degree of congestion induced ;
it is often equal to the abstraction of many pounds of blood. Hence
arises, in this state, the weak, feeble pulse, a sign of debility in the
contractions of the heart, and emptiness of vessels.

The same result, as to the vascular circulation and pulse, is pro¬
duced by extensive irritations of the cutaneous surface, determining
sanguine congestion of its capillaries. This state exists in the erup¬
tive fevers, or exanthemata?, when of a high grade, and which are
then attended with a weak, empty pulse. Scarlatina, when of in¬
tense character, as in its malignant form, is a remarkable illustration
of the fact. The disease, in this state, exhibits the skin from the
head to the feet of a deep red, demonstrating the actual presence
of red blood in the skin, in a quantity entirely unnatural. The in¬
ternal mucous tissues, in this malignant form of the disease, is shown
by dissection to be in the same condition. Here then is presented
the ocular demonstration of the permanent congestion of the cu¬
taneous capillaries, the detention of a large quantity of the circulating
fluid in them, and its consequent deprivation from the vascular
system. Now in this form or stage of scarlatina, the pulse is always
deficient in fulness and force, and in the highest grades of the disease,
the pulse is reduced to such extreme exility, it is scarcely distin¬
guishable.

This feeble, empty pulse of scarlatina maligna, has been supposed
to be the consequence of extreme debility of the vital powers, and
to require the sustaining energy of stimulants and tonics. I have
never witnessed from their employment, more, even when lavishly
administered, than a transient effect on the circulation, and by aug¬
menting the morbid irritation of the cutaneous and mucous surfaces,
and thereby confirming their congested state, they have increased
the vascular exhaustion, and have enfeebled to a greater degree, the
action of the heart and pulse. Cold or tepid evaporating ablutions,
used according to circumstances, by diminishing the cutaneous irri¬
tation, relax the capillary congestion, the blood resumes its natural
course into the vascular system, which fills up and expands, and the
pulse acquires fulness and firmness. I have seen, in scarlatina, the
pulse, as ablutions were employed or discontinued, become alternately
full and firm, or empty and feeble. In rubeola or measles, when
malignant, and in confluent small-pox, the exhaustion of the vascular
system, and extremely small and feeble pulse, are produced in this
same manner.

This principle, which I consider as of the highest importance in a prac¬
tical view, when fully appreciated, has a very extensive application ;

Physiology .

429

and it places in a very clear light, the important fact, that a patient,
in irritations of great activity, is threatened at the same instant With
impending dissolution, from opposite conditions of the organs — that
is, from extreme feebleness and exhaustion of the vascular circula¬
tion, and violent congestive irritation in the capillaries of the ce¬
rebral, pulmonary, or abdominal viscera, suspending their functions.
It exhibits also the necessity, under those circumstances, of resorting,
at the same instant, to a compound and opposing treatment, explains
the objects to be attained by it, and the manner in which it is to be
directed.

3d. The arteries modify the pulse, when they are themselves in a
pathological state, to which they are subject, as well as the other
organs of the economy. Acute inflammation, as in arteritis, causes
firmness in their coats, and the pulse is then hard. The inception
of ossification renders the pulse obscure, and when it is complete,
the artery losing its elasticity no longer responds to the shock com¬
municated by the heart, and the pulse is lost. The coats of the
arteries, in some instances, are softened from a species of infiltration
of fluid into their interstices, which lessens their elasticity and im¬
pairs their power of reaction.

The calibre of the artery has an influence over the pulse. I have
seen, in a case of dilatation of the heart, all the arteries preterna-
turally small, and which produced a remarkably small pulse. Undue
enlargement of the arteries is not uncommon. The pulse, in a nor¬
mal state of the circulation, is then large and full, and under excite¬
ment, is exceedingly deceptive. It appears to indicate profuse and
repeated bleedings, but fails with rapidity under sanguine depletion,
assuming a peculiar yielding and flaccid sensation, as though the
vessel contained a gaseous or exceedingly tenuous fluid.

The pulse in many individuals is very feeble ; it is scarcely dis¬
cernible. They enjoy, notwithstanding, excellent health. The
energy of life does not depend on the force and velocity of the vas¬
cular or direct circulation, but on the activity of the capillary cir¬
culation. Persons who are prone to obesity, have usually a small
and feeble pulse. It is a common explanation of the fact, to attri¬
bute it to compression on the arteries from the accumulation of
adipose matter. This is not correct ; the arteries and whole vascular
system in such persons, is not developed to the same extent as in
others, and the vascular circulation is more inactive.

The pulse is in some instances entirely absent, without interfering
with health. This circumstance occurred in the mother of Dr. S. of
this city. The pulse disappeared during an attack of acute rheuma¬
tism, which did not appear to retard her recovery, and it never
returned during her subsequent life. She was active in mind and
body, and possessed unusual health. In no part of the body could a
pulse be detected. I attended her during a part of the time of
her last illness, which was an acute inflammation of the intestines,
but no pulse existed. She died while I was absent from the city,
and an examination was not made to elucidate the cause of this
remarkable phenomenon.

430

Bibliography.

A great variety of pulses have been described by writers, who
have drawn between them fine lines of discrimination, and attempted
to establish a particular pulse for every disease, and for every critical
symptom, the occurrence of which, it was believed, could be pre¬
dicted with certainty, or whose existence could be announced merely
by the pulse. By the late Professor Rush, the pulse was regarded
as a perfect nosometer, measuring with nearly absolute precision the
state of the whole economy, and the grade and character of every
morbid condition.

These exaggerated views of the importance of the pulse, originated
before the circulation was discovered, and the production and nature
of the pulse was known. They were subsequently maintained by
erroneous opinions of the character of the circulation, its active forces,
and the structure and office of the vessels. The direct circulation
alone was understood, the capillary, and interstitial or parenchyma¬
tous were not comprehended, and the heart and large arteries were
believed to be the sole causes of the circulatory phenomena. But if
the doctrine of the circulation we have advocated, founded on the
analysis of the organs and mechanism of this function, be adopted as
correct, it must be clear, that the pretensions claimed for the pulse;
as a universal diagnostic standard, must be considerably reduced.
As a positive indicator, it characterises only the action of the heart,
and the degree of repletion of the vessels. The state of the capillary
circulation, and consequently of the organs of the economy generally,
is not manifested directly by the pulse, which in the determination
of this point, is of secondary importance. For this purpose it is to
be taken in connexion with the symptoms exhibited in the dis¬
turbances of other functions, and compared with them. The heart
sympathising in most cases in the morbid affections of all the im¬
portant organs, and the circulating fluid being influenced in its
distribution by diseases of intensity, the pulse serves to give the value
of the other symptoms, and to render their nature manifest ; and it
thus furnishes secondarily and by comparison, signs indicative of the
condition of the capillary circulation, and the character of the patho¬
logical state of other organs than of the heart.

From this examination, it then results, that the pulse is not a
general nosometer, but, as a standard of disease, is principally con¬
fined to the affections, either primitive or sympathetic, of the heart,
and of the direct circulation. When, as frequently occurs, the heart
and the direct circulation, from a paralysed or quiescent state of the
sympathies, do not participate in the morbid disturbances of the or¬
gans, the pulse fails entirely in presenting any positive indications of
the state of those organs or the nature of the affection.

The forces regulating the direct and the capillary circulation being
distinct, and the offices of the two being totally different, they are
often placed in a state of antagonism, and exhibit phenomena of
opposing characters. The pulse in these circumstances, while it
faithfully marks the precise condition of the heart’s action, and the
state of the circulation, would betray us into fatal errors, if it were
consulted in order to determine the condition of other organs- In

Miscellanies.

431

the congestions of the abdominal and thoracic viscera, the functions
of those organs are oppressed with a load of blood, while the heart
is barely kept in action from the extreme deficiency of that humour
in the vascular system. In the close also of diseases of acute in¬
flammations, widely diffused throughout the economy, important
organs are pressing on to disorganisation, demanding local depletion,
and other sedative measnres, with revulsive operations, while the
action of the heart is fainting from debility, and requiring to be sus¬
tained by diffusible stimulation. These opposite dedications cannot
be revealed by the pulse. They are to be determined by other signs,
and a reliance on the pulse, in the manner that has been taught by
high authorities, as a guide in estimating the condition of the eco¬
nomy, and in directing remedial measures, will lead to wrong con¬
clusions, and a practice often fraught with mischief.

MISCELLANIES.

MEDICAL JURISPRUDENCE.

Extraordinary Inquest at Hampton, from Observer, Oet. 3.

2. Yesterday (Oct. 2) an inquest, under extraordinary circum¬
stances, Was held at Hampton, before Mr. Stirling, to inquire into
the cause of death of Frances Clarke and her unborn child. The
death took place about two months ago, and a considerable degree
of excitation has existed for some time in the neighbourhood, owing
to a rumour that her death was caused by the unskilful treatment of
Mr. Bowen, a medical gentleman who attended her in her confine¬
ment. A great number of medical gentlemen attended to give their
opinion on the subject. Mr. Wakley was also present.

The body was removed from the grave, and placed on a tomb¬
stone, round which a canvas tent was erected. It was inspected by
the jury, and was not in such a state of decay as had been ex¬
pected.

Ann Ellam deposed, that near three months ago, she was sent
for by deceased, between five and six of a Sunday evening. She
went, and at the desire of deceased, went for Mrs. Chilman, the
midwife. Mrs. Clarke had been taken in labour about four o’clock
that morning : was very bad indeed, and all that night her cries and
screams were dreadful ; towards morning she was very bad, and said
she must die. Witness went to Hampton for Mr. Davis, 'who was
from home, but his assistant, Mr. Bowen, came about half-past ten,
and remained about half an hour ; he returned about nine at night
with instruments, which he used ; about seven o’clock on Tuesday
morning, at Mr. Bowen’s desire, they sent out for a boot hook,
which he used with Mrs. Clarke, and at a quarter past ten Mrs.
Clarke died ; when witness asked Mr. Bowen if he thought there
was any hope of the labour being over, he said, yes, very soon.
Mr. Taylor was sent for, to which Mr. B. did not object, but he
refused to write a note for him ; Mr. Bowen was using the instru¬
ments at the time-— he used them with very great force, so that the
perspiration poured off him ; he placed his feet against the bed and

432

Medical J urisprudence.

pulled with great force ; when asked how he was going on, said that
when he wanted skill, he would send for it, and if they could find
out any one that could do more than he could, they might send for
him ; he afterwards insisted on assistance being sent for, when the
hook Mr. Bowen was using gave way ; there was a sound as if a
stick had broken, and the child’s arm came off. Mr. Taylor sent
an answer that he would come, if Mr. Bowen would only write a
note for him ; Mr. Bowen was very cross ; I never received such
rough treatment* before.

Sarah Chilman, a midwife, sent for a doctor in proper time, and
was glad to get her owrn neck out of the halter ; she proposed to
Mr. Bowen to send for Mr. Taylor, but he said, if Mr. Taylor came,
he would leave ; the deceased wished to have Mr. Taylor, and said
he had been with her before, and brought her through it.

Mr. George Jewel, surgeon, and teacher of midwifery, stated,
that he wras present at the examination of the body that morning ;
he considered the removal of the arms, under the circumstances,
perfectly justifiable ; the instrument ‘called a blunt hook might have
been proper to apply, and a boot hook was a good substitute, (both
hooks were here produced, and very nearly resembled each other.)
Assuming the facts to be as stated in evidence, he conceived that
the use of instruments was fully justified. Judging from the ap¬
pearances and evidence, he should say that the practice of Mr.
Bowen was correct.

Mr. George Taylor, surgeon, of Kingston, stated, that he never
saw Mr. Bowen before that day ; there was no sufficient evidence to
warrant the assertion that the practice of Mr. Bowen in the case
was erroneous ; unless under very extraordinary circumstances, wit¬
ness should not have taken off the arms.

Sir Andrew Halliday, of Hampton Court, Physician to their Ma¬
jesties,* stated that he had had a conversation with Mr. Bowen on
the subject, in consequence of the reports he had heard, and Mr.
Bowen had fully satisfied him he was not to blame.

The Jury expressed themselves satisfied with this evidence.

The Coroner called the attention of the jury to the evidence given
by a professor of the obstetric art, to the difficulties frequently
attending labour cases — for example, the Princess Charlotte of
Wales, who could command the first advice in the kingdom, fell a
victim in such a case. The jury, after consulting for about half an
hour, returned the folio wung verdict : — “ Died by the visitation of
God, and we are of opinion, that the medical attendant is not in
any respect to blame.”

During the examination of the witnesses, several persons in the garb
of gentlemen, some of them medical men, interrupted the proceed¬
ings by impertinent observations. It is astonishing that they were
not silenced by the coroner, or if incorrigible, as the report states,
that they were not turned out of the room. Medical, men who display

* This is erroneous. Sir Andrew is not physician to their Majesties. — Bn.

Medical Jurisprudence .

433

party spirit, act in open violation of the received principles of
ethics, degrade their profession, and impede the administration of
justice.

t c » . , f

Assuming the above report to be correct, this inquest is one of
interest to all those engaged in the practice of obstetricy. It gives
rise to many serious reflections, and affords a salutary lesson to
practical obstetricians. For the medical jurist it is one of import¬
ance. We shall therefore offer a few comments upon it.

The disinterment of the body after a period of three months,
for the purpose of judicial investigation, though required by law,
could be of little, indeed of no use, in such a case as this. If the
pelvic viscera were injured by pressure of any kind, the effects of
such could not be discovered after such a lapse of time. No man
living could testify with positiveness upon the subject. The evi¬
dence before us is inconclusive and imperfect, and of course un¬
satisfactory. It does not appear what was the habit of body, the
temperament or constitution, or age of the deceased — how many
children she had had, or what was the presentation, whether
shoulder, side, arm, arms, &c. It is clear, however, that the arms
were removed, and must have presented one or both, or must have
been brought down for that purpose. It does not appear whe¬
ther opium was given, or any attempt made to turn, though it is
clearly manifest to any man of judgment or experience, that turn¬
ing ought to have been attempted and performed, before the ope¬
rator was justified in dismembering the infant. Had opium failed
to tranquillize the parturient action which wTas violent, the lancet
should have been employed, and the patient bled nearly to syncope,
or if strong and plethoric, to complete fainting, when turning could
be easily performed. The immense force employed in extraction
was not warrantable, according to the opinions laid down by the
best obstetric writers, of this and foreign countries. .Making every
allowance for the purturbation of mind of the operator, he ought
to have recollected the after consequences, and that though he might
succeed in effecting delivery, the recovery of his patient was not to
be forgotten. Too many young practitioners lose all sight of after
consequences, and consider the employment of instruments the
grand point, quite forgetting that if any injury be inflicted by them,
the woman will most probably die in a few days afterwards ; and,
instead of gaining reputation by the operation, their characters
suffer very considerably. Whether Mr. Bowen followed the usual
course of practice in this case, cannot be learned from the evidence.
But one thing can be learned, that his peevishness and refusal to
write to the practitioner in whom his patient had confidence, and
desired, was highly culpable. It was contrary to the maxims
inculcated in every standard work on midwifery, and on the ethics
of our profession. It is well known to obstetricians of experience,
that the presence of a stranger, and of one in whom the patient has
no confidence, for if she had in this case, she would not have de¬
sired other assistance, is highly prejudicial to the progress of natural

Vql. v. no. 29. 3 h

434

Medical Jurispruden ce.

labour, and placed the practitioner in an unenviable situation in such a
case as that before us. We have known and recorded two cases in
which the females lost their lives, in consequence of the behaviour of
medical men, and soley from fear, but it is unnecessary to dwell
upon a point that no man can dispute.

The next part of the evidence which deserves attention, is that
of medical witnesses. Mr. Jewel considered “ the removal of the
arms under the circumstances perfectly justifiable.” It is unfortu¬
nate that he did not state the circumstances, as we are totally at a
loss to surmise what they could be, unless in embryotomy. Indeed,
we know of no circumstances, unless embryotomy, which could
justify such a proceeding ; they have never been mentioned during
our long perpetual pupilage under Dr. Hamilton, nor have we ever
stumbled upon them in the course of our obstetric researches, which
we have given some proof, are not the most limited. No man could
condemn, in more forcible terms, the removal of the arm, than
Dr. Hamilton, and for the sound reason that its removal could not
change the position of the infant ; and this is the opinion of the
best obstetric writers. In such cases the operation of turning ought
to be performed ; and if impracticable, which may happen, though
rarely, if the proper measures be employed ; then the thorax ought
to be eviscerated in the manner described in our work on midwifery,
and delivery effected, which may be done successfully, as we have
accomplished and already recorded. But the arm or arms need not
be removed for the reasons already assigned. The French and
American writers are also of this opinion. But it does not appear
from the testimony of the case before us, whether or not the infant
was extracted — we should think not from the facts stated ; and if
this be the case, we are not much surprized that the good people of
Hampton should have displayed “ a considerable degree of excita¬
tion” on the occasion. It is very extraordinary that this inquest
should have been delayed for two months ; if it was necessary at
all, it should have been held at a time that the morbid appearances
of the body, if any, could be accurately described. But if Mr.
Davis be one of the court attendants, and there is a gentleman of
that name one of them, then the Gordian knot is cut. We do not
by any means insinuate any thing against Mr. Davis, whether court,
or no court attendant, for from all wTe have heard of the gentleman,
who is, we believe, surgeon to his Majesty, he is a most honorable
man, and an ornament to his profession. What we mean to say is
simply this, that in case Mr. Davis, the employer of Mr. Bowen,
is attached to the court, the people in the neighbourhood, however
excited they might have been, might have considered their remon¬
strances useless. This was a false view, for if his most gracious
Majesty, or his amiable and beloved consort heard of the affair,
there was no doubt from their philanthropy and benevolence, but
an inquiry would be instituted. We shall offer no remark upon the
cause of death in this case, nor upon the verdict of the jury. We
are glad that a member of our profession was honorably acquitted ;
and we trust, should he see our remarks, that he will remember

f-.'y;

Medical Jurisprudence. 435

that the case is one for fair and impartial criticism ; and moreover
that our observations are conjectural, so far as the inquest is con¬
cerned. The case is one which shews that the absolute necessity
of employing medical men of sound erudition and extensive ex¬
perience, as witnesses and coroners ; men who would sift the affair
to the bottom, and not present to the profession such an imperfect
statement as that before us. For strong reasons we shall not dwell
upon this topic any longer. The only other point worthy of re¬
mark is, the allusion to the Princess Charlotte’s melancholy fate. It
is to be regretted that some one present did not inquire of the worthy
coroner, how it happened, that the heiress to the British sceptre,
the expected successor to Elizabeth and Ann — she who possessed
the wit and energy of the one, and the wisdom and gentleness of
the other — the young, the fair, the cheerful, the sy metrical, the
healthy, the enobled, the exalted, the wealthy, the admirable and
beloved Princess Charlotte, had not the benefit of farther advice, or
the best advice in the kingdom. She, “ who was all the heart
wishes, or eye looks for in woman,” adorned with all that earth or
heaven could bestow to make amiable, the pride and hope of Bri¬
tain, in the spring of life, “ fell a victim,” says the worthy coroner,
“ in such a case.” It needed no ghost from the tomb to communicate
this information ; but much more important information is wanted ,
which, happily for the wicked, cannot be revealed by the dead. A
time, however, will yet arrive, when the secret will bejrevealed to the
whole human family. Perhaps it may be in the bosom of the coroner,
and the medical men present neglected the interests of the profes¬
sion, in not inquiring what was the cause of death in her Royal
Highness’s case, and also the death of her of her innocent
helpless infant. They could all have assured the coroner, that women
of fine form, in the prime of life, in good health, and especially
whose families were remarkable for their longevity, seldom, if ever,
fall victims “ in such a case.” We should not have touched this
topic had our remarks applied to the living, and those to whom they
do apply, are no longer sensible to praise or censure.

Whatever is, is right. This world ’tis true.

Was made for Caesar — but for Titus too.

DISSENSIONS IN THE LONDON UNIVERSITY.

From the foundation of the London University to the moment we
write, we have been, and still are its zealous though feeble advocates.
We cherish the noble principles upon which it is founded ; and we
deeply regret that dissensions of no ordinary character should have
arisen in its halls. The medical profession has been anxiously waiting
for a detail of these dissensions, which has not as yet been afforded.
Such a detail is not more interesting to medical men than to the
public at large. In giving an authenticated account of the disputes
and turmoils of this institution, we have no motive, no object to
serve by such a narrative. We cannot be accused of partiality

436

Miscellanies „

towards the writer, whose public conduct on a late occasion, called
forth our severest animadversion. Though we regret in common
with the profession that medical men should interfere in politics, yet
we must freely admit the high professional attainments of Dr. Thom¬
son, and the harsh and unwarrantable manner in which he has been
treated by the Council and some of the Professors, and the imperious
and indignant manner with which the most distinguished students have
been assailed by a. junta of the Council. It is manifest that the
complaints of the students ought to have been attended to, and if
just, ought to be redressed, for surely the Council must be aware* that
when students discover any incapacity in their teachers, they can
never derive instruction nor shew that respect and attention due to
their Professors. The appointment of Professor Bennet is the
clearest proof of the justness of the students’ memorial ; and the
Council acted unwisely and indecorously in branding the students
with such opprobrious epithets, as “ impudent, factious, ignorant,”
and at the same time being compelled to comply with their wishes. It
will be seen by the following narrative, that our observations are
warranted, and it is to be regretted that an institution, whose motto
is “ Patens omnibus scientia,” and which we hoped to see the first
in the world, should be the theatre of discord. We by no means
admit, that students should intermeddle in the management of the
University ; but from the facts before us, they acted with strict
propriety in respectfully remonstrating with the Council, and their
remonstrance should have been met without delay, indecision, or
shuffling. The Council ought to be fully aware, that many who
entered the University had completed their anatomical studies else¬
where, and also that some of the best anatomists in Europe were
among their own professors, and therefore that the students were
enabled to discover any imperfection in teaching this branch of
medical education. We have further to observe, that we cannot
approve of the strong language of many parts of the subjoined docu¬
ment, for the suaviter in modo is as important on the present occa¬
sion as the fortiter in re. We have also to mention, that sve
disapprove of the publication of some letters which were never
intended for the public eye, and can be only justified by the ter¬
giversation of the writer towards the individual to whom they were
addressed. In republishing the memorial to the Council, we have to
inform our readers, that it has been printed, published, and circu¬
lated throughout the country, and even under such circumstances it
should not appear in oilr pages, were it not indespensibly necessary
to complete the chain of facts set forth in this communication. The
public and the profession are anxious to learn the cause of the dis¬
sensions in the University, and have an undoubted right to be fully
and fairly informed upon the subject. We sincerely regret the
situation in which the Council and some of the Professors appear,
and reiterate our declaration, that a sense of public duty alone
induces us to insert this communication, however well authenticated
its details have been by the gentlemen who have entrusted it to our
care. It is necessary for the Council, the students, and the public.

Miscellanies.

437

that a correct statement of the causes of the discussions should be
published.

To the Editor of the Medical Gazette.

A SOP FOR CERBERUS !

Sir, — It is indeed a melancholy truth, that the London University
has been divided by dissensions among the Professors, by discontent
among the pupils, and by the determination of four members of
Council, who have been taking upon themselves to elect professors
obnoxious to the students, to oppose all the wishes of those pupils,
from whom alone they derive their credit and support. At the con¬
clusion of last session, during which the murmurs of discontent
against the ignorance and Indifference to science of Professor Pat¬
tison, had been gradually swelling upon theear,Eisdell, who gained the
gold medal in Dr. Grant’s class, and who had peculiarly distinguished
himself above the other anatomists of the school by his accurate and
extensive knowledge of develop emental anatomy, sent a protest to
the Council, complaining of Professor Pattison’s total neglect of this
very important branch of anatomical science, and also of the general
deficiency of his lectures in regard to the new facts in anatomy and
doctrines in physiology. Dr. Davis observed, “ that that fellow
Eisdell, ought to be expelled immediately,” an observation of which
Professor Parrazzi has naively remarked, “ that it was far more
Austrian than English.” Mr. Pattison told Eisdell that “ he was
disappointed in his character.” The medical professors, however,
in a body were delighted ; for, they had long been acquainted with
and deplored the total inadequacy of Professor Pattison to fulfil with
credit either to himself or to the institution, the arduous duties of
the anatomical chair. The Council, however, though they were by
no means unacquainted with the serious objections urged by the
pupils against Professor Pattison, although these objections recalled to
their minds the discussions, which had occurred at the commence¬
ment of the institution in regard to the propriety of choosing this
gentleman, after what had transpired at Glasgow, in preference to
Messrs. C. Bell, Bennett, Mayo, and King, the other candidates
for the chair of anatomy ; and the fact, that Mr. Pattison, after a
somewhat severe discussion, had been admitted by the casting vote
of the Chairman of the Council, while they rejected with disdain the
silly proposal of one of the professional (proh pudor) members of
their body, instantly to adopt the suggestion of the haughty and
tyrannical Davis, wrote to Eisdell to inform him, that “ they could
not institute an examination into the conduct of a Professor upon the
representation of one pupil.”

At the same time, however, Eisdell was given to understand
privately, that neither the medical faculty as a whole, nor the Coun¬
cil were averse to the inquiry, though they wished to have more
plausible ground for its institution. Thus encouraged, and believing
the ONE, owing to these private hints, to be emphatic, what could
Eisdell do but consult with his friends ? He consulted with Mr.

438

Miscellanies.

Henry Cooper, who agreed with him, but hesitated to hazard big
name to a document that would drag him before the public. He
also asked my advice, and I recommended him to institute a general
inquiry into all the circumstances of the case, and if he found the
active and industrious portion of his fellow students coinciding with
him in opinion, to draw up a memorial, to be signed by all of
them, and forthwith presented to the Council, requesting an inquiry
into the conduct of Professor Pattison. This advice I gave him on
the very day I left town for Cambridge, the day of the distribution
of prizes to the medical classes, to undergo my examination for my
degree of M.B. I remained three weeks in Cambridge, during which
period I had no communication with any student of the London
University.

On my return I found that my advice had been adopted as soon as
given, and that a memorial had been signed by all the medalists,
excepting two, viz. by seventeen of the men who had been crowmed
with the honours of the University, many of whom had also at¬
tained honours at the close of the preceding session, while of the
remaining two, one has since declared, that “ he will never do any
thing at variance with his own immediate interest the other
signed most cordially the letter, for sending which I was first ex¬
cluded from the University.

Three weeks, then, had elapsed since the sending in of this me¬
morial, and three weeks more were allowed to elapse before any
notice was taken of it, because the coup d’etat portion of the Pro¬
fessors, and we have such a body among them, much resembling in
their humble delinquencies, the depraved and despotic counsellors of
Charles, urged their party in the Council (of course you are not sur¬
prised to hear of parties in so heterogenious a mass of milk and
water Aristocrats and Whigs as constitute the Council) to protract the
investigation, till such time as the students should have been sum¬
moned by their parents to the hospitable shelter of their homes.
These men well knew that if this were not done, the profession
would laugh at the force of presenting men with medals, and thus
calling the attention of the public to their uncommon talents and
superior acquirements, and then neglecting their representations or
insulting them, by retaining as their teacher a person, the ignorance
of whom had been most loudly complained of by those very pupils,
who had taken honoursin his own class . There was also another and
a deep design, which was to protract the period of investigation
beyond the annual meeting of the proprietors, lest these should attach,
in the honesty of their hearts, and in their deep desire for public
improvement, more importance to the document than certain mem¬
bers of the Council had done, particularly Dr. Birkbeck, who wras
instrumental in procuring the election of Professor Pattison, and
whose reputation, therefore, wTas implicated in proving the man he
had urged so strongly upon the notice of that body, in spite of the
moral and other objections urged against him, to be unjustly at¬
tacked, free from ignorance, replete with science, repentant for his
moral delinquencies, and the object of a malicious conspiacy.

Miscellanies.

439

Thus, then, this public meeting of the proprietors stole a march, by
the policy of these gentlemen, upon the indignant pupils, and in its
result furnished new matter to fret the old sore, as well as to open a
new one ; for, Dr. Birkbeck, full of his projects for varnishing the
character of his friend, in spite of the universal desire of the Coun¬
cil to pass by this business in silence, was ill-advised enough not to
only to bring Professor Pattison on the tapis; but, by eulogizing him
to the skies, to try and bring a sort of reflective praise upon himself,
for having almost insisted upon the election of so great and admira¬
ble a man, in spite of the moral scruples of the prudish dames of the
Council. I am told by those that were present, that, as soon as he
broached this topic, a blank astonishment and panic paleness, sat
upon the face of all the Council, but particularly on that of the War¬
den ; while the frowns and contortions of Mr. Brougham’s counte¬
nance, in his effort to stop the eulogistic zeal of the worthy Doctor,
were so frightful that they absolutely paralysed the energies of Drs.
Thomson and Turner, who had determined severally to answer his
observations. Had Dr. Birkbeck told the truth, that is the whole
truth, no ill could have arisen from his speech, but either intention¬
ally, or through a culpable ignorance, seeing that he was one of the
Council, he stated that this learned and amiable importation from
America had been charged with inefficiency ; but in a very impudent
manner by one student only, and that an ignorant student , meaning
Eisdell. Now, long ere his speech was made, the Council were in
possession of the complaint, signed by all the medalists ; and more¬
over, nothing could be more dastardly in Dr. Birkbeck than this
attempt to raise his friend’s reputation upon the ruin of Eisdell, who,
so far from being an ignorant man, is highly respected by all his fel¬
low pupils, and by all the Professors, who know him, on account of
his good acquirements, his industry, and his perseverance, of all of
which he gave most splendid evidence, when he succeeded in beating
Mr. Phillips, one of the present demonstrators, and Mr. Blackmore
and Mr. Garner, both excellent anatomists, in their contention for
honours in Dr. Grant’s class of comparative anatomy. The know¬
ledge of these facts, the deep conviction of the injustice of the
attack upon Eisdell, the indifference of the Council to the statement,
which had been almost solicited from the medalists, the designed
protraction of the period of investigation, disgusted the students, and
led many of them to retire to their summer destinations, leaving the
matter in the hands of those, who were left behind. Some of them
indeed, who had no intention of returning to town, but yet felt a
sort of lingering desire to see their alma mater flourish, remained a
few weeks longer, but to no purpose. In the mean time the Profes¬
sors took every occasion to blame the supineness of the medalists, to
make complaints personally to various members of the Council, to
cultivate the dissatisfaction of the pupils. Thus, it is well known,
that Drs. Thomson and Turner, and Professor Parrazzi, had many
conferences with Mr. Brougham and Lord Auckland upon the sub¬
ject, and stated explicitly to these gentlemen the absolute necessity
of the removal of Professor Pattison, for the success and welfare of

440

Miscellanies.

the, school. Mr,. Bell had already tendered his resignation, and had
explicitly stated, or had been understood to state, in his valedictory
lecture, that “ unless one teacher was removed from the school, he
should. not again have the honour and pleasure of addressing,, his
pupils.” Moreover, Mr. Bell took care to inquire sedulously of every
pupil, who went to him for a .certificate, what they thought of the
prospects of the school, and by every one was informed that there
were two requisites to its ultimate success — a more scientific Profes¬
sor of Anatomy and an Hospital. To such a height did this profes¬
sional desire for change arrive, that several Professors declared une¬
quivocally, publicly, privately, and unreservedly, that they would leave
the institution if Pattison remained; and one went so far as to say
to the . Clerk in the robing room, before all the menials of the insti?
tution, that unless Professor Pattison was dismissed, he, the. Clerk y
might consider his five shares as in the market. It was impossible
for the pupils, who were visiting in the Professors’ families, not to
perceive the feelings so congenial to their own ; and, ns they could
not remain longer in town, those, who had remained expressly for
the purpose, waited upon me in a body, and requested me, in their
absence, to watch for them the progress of the business, to give them
early information of whatever might be doing, and to insist, by every
honourable and upright means, on the division of the professorship
of anatomy, or the entire removal of the present Professor. To
aid me in this respect, they left with me the statements, of the
reasons of their objections, with a request to send them in, as soon as
called for by the Council. , I accepted this commission, not . because
I knew any thing of the merits of the ease, but because having been
president of the Medical and of the Literary & Phil : soc.:, of both of
which I was one of the founders,- I felt that the students, who were
my individual friends also, had a sort of claim both upon my ser¬
vices and. on my kindness, while 1 knew, from my intercourse with
the Professors, that the inquiry was most anxiously desired by them,
and by no means obnoxious to the more sensible and thinking por¬
tion of the Council. No sooner had these men left town than the
Council appointed a committee of investigation, who sent for the in¬
dividual statements of every one of the seventeen pupils. I imme-!
diately sent to, the Warden those which had been left in my posses¬
sion ; and the result was, that the committee determined on examin¬
ing personally as many of the seventeen as could be assembled by a
certain day. Only four,, however, could be found- in or near town, and
of these four, it unfortunately happened that all, with the exception of
Eisdell, were first years pupils,, and could not therefore be so. much
depended upon as those, who were more advanced in their studies.
Some discrepancy is said to have been found in the statements of
these four,, which .were confined, by desire of the Commissioners, to
mere matters of neglect, as they very conscientiously observed that
they were wholly unqualified to enter into matters of science.

The Commissioners, however, satisfied of the negligent and imper¬
fect nature of the course that had just been delivered, made then-
report accordingly ; and the Council prepared a reprimand, which is

Miscellanies.

441

Stated to have been so severe that not even Professor Pattis on could
have retained his chair under it. Upon this being intimated to the
friends of Professor P. he acquiesced in their advice, that he should
• divide his labours with Mr. Bennett. The Council consented, after
this proposal being made, to the suggested arrangement, and to mol¬
lify the language of their intended reprimand. Hence sprung the
arrangement, which was convented among the Council and Profes¬
sors, and nothing more would have been done by the pupils, had
Professor Pattison at once divided the professorship upon the return
of Mr. Bennett from the Continent, whither he had been for the pur¬
pose of recruiting his health, and where his kind hearted family had
taken care that he should not be harassed by the turmoils of the in¬
stitution. Professor Bennett, to whom I now took care to mention
the wishes of the pupils, was desired by the Council to meet Mr.
Pattison, in order to make arrangements for the division of the pro¬
fessorship. Several meetings took place, without leading to any re¬
sults, Professor Pattison having wished to make Mr. Bennett a
“ Supplemental professor,’* as maybe seen in the following letter to
myself : —

“ My dear Thomson, — I have substituted from my epistle to you
from Boulogne,* a certificate of my opinion of you. I fear it is too
weak ; I feel that you deserve that I should say more, but I am de¬
terred from doing so, by apprehending that more from so humble a
personage as myself might be construed into too much. However,
I shall re-write it if you wish. Paftison and I are still at issue ; he
proposes to make me a “ supplemental” Professor, at which I kick.
We are to arrange it, if possible, to-day with Lord Auckland. Your
father caused me to disappoint you yesterday, so you will excuse me.
This evening I shall let you know how the affair goes. In the mean
time say nothing, I pray you.

“ Your’s sincerely, J. R. Bennett.”

* The epistle from Boulogne contained a request to me to offer
myself for one of the demonstratorships at the London University,
instead of seeking for a situation in King’s College ; it was, as you
see from the foregoing, removed, because Mr. Bennett, who had not
heard of the disturbances while in France, was informed by me that
I should not offer myself for the situation, but was shewn to many
of my friends, who know that it not only solicited me to offer my¬
self, but promised me the utmost support of the writer. (A con¬
vincing proof this of my ignorance and want of connexion with the
institution, as stated in last week’s Medical Gazette.) If Professor
Bennett is angry at his letters being published, he must remember
that the f< galled jade will wince,” that when men conspire with
me another to gain an end (as the Professors have done) and then
lesert their tool, through a grovelling fear even of Mr. Brougham’s
hunder, he can only defend himself by turning king's evidence.

Vol. v. no. 29. 3 i

442

Miscellanies.

At last, an arbitration was consented to, as may be gathered from
the following, —

Wednesday.

“ My dear Thomson, — A thousand thanks for the pamphlets ;
you shall have them to-morrow, as I have not time to read them.

I have nothing to tell about the affair — It is ut anted. To-morrow,
Thursday, two friends from each meet, to try and settle the business.

“ Yours, &c. J. R. Bennett.”

So, Sir, you see I am not the only person, who felt a thousand
pleasures in seeing the pamphlets, for re-publishing -which my mo¬
tives have been called those of the foulest malignity. In fact, these
pamphlets had been circulated freely enough among the Council, had
been the cause of the exertions among the Professors to rid them¬
selves of their companion — wrere sent to Mr. Bennett, not by me,
who had never till then seen them, but by Alexander Shaw ; let me
ask for what purpose ? Was it to facilitate the pending negociation ?
Or was it an oblique missile, thrown slyly into the enemy’s camp,
with a hint from the physiological castle? At any rate, Mr. Bennett
did permit me to take a copy, and I now possess the original. More ¬
over, Mr. Bennett never objected to this pamphlet being re-published,
till he had stooped to shake hands with Mr. Pattison, and had donned
his new plumes, although he did not wish it to be known that I had
ffrst found this pamphlet, of which I had often heard, and that pri¬
marily from Parrazziat my father’s table, at his, Mr. Bennett’s house.
In fact he was “ male Pert max-” I shall here, once for all, state, that
my reasons for re -publishing that pamphlet was not to recal the Pro¬
fessor’s alleged adultery, but to show that, even in A m erica, hehad
been accused of ignorance, of a gross system of prevarication, and of a
silly attempt to arrogate to himself the discovery of Colles’s Fascia;
I must however, call upon all honest men, who love the safeguards of
British virtue, and upon all parents, whether they would not hesitate
in placing their sons under a man of talent, however splendid, whose
character wras publicly believed to be tarnished by a breach of one of
the most direct of God’s laws, one, on which society rests its comforts,
and founds its existence ?

The Arbitrators met, and abruptly parted ; and Mr. Bennett’s
friend recoftimended him to have nothing more to do with such a
man. Mr. Bennett informed me of this in the following epistle : —

“ Dear Thomson, — I had hoped within the last few days, that
some arrangement -would have been made between Mr. Pattison and
myself, in order to adjust present difficulties; I have now, however,
in reply to your enquiry on the part of the pupils, to state, that I see
no prospect of any arrangement being made, whereby any change
wrill take place in the delivery of the Courses of Anatomy. In fact,
things must go on as before.

“ Yotirs ever, J. R. Bennett.

“ July 29. — To Dr. Alex. Thomson.”

Mr. Bennett further informed me, “ that he had been to Mr.
Coates, and desired him to insert his name as mere demonstrator,’

Miscellanies

m

the arbitration between Mr. Jones Quain, on the part of Mr, Ben¬
nett, and Dr. Conolly on the part of Mr. Pattison, having been
broken off, because intruded upon by Professor Pattison, who was not
quite prepared at that time, at least, to voluntarily solicit his friend
Mr. Bennett, whom he had accused of giving his gold medal to
Mr. Phillips, because he was his house pupil, to accept of half of his
burdensome Professorship. Is it true then that the Professorship
was divided at the solicitation of Professor Pattison ?

Finding from this communication that all hope of arrangement had
been finally broken off, I proceeded to fulfil my commission for draw¬
ing up a strong memorial to the Council, embodying all the most im¬
portant charges contained in their separate statements, and demanding
the dismissal of Professor Pattison, of which a copy is subjoined to the
two following epistles, which are copies of two of the statements,
and from which it will be seen that I have scarcely expressed, in the
memorial, so much as I was authorized to do :

Second Letter of Mr. Eisdell to the Warden.

May 5th, 1830.

Sir, — I have to acknowledge the receipt of your letter, commu¬
nicating the decision of Council on mine of the 30th April, and
regret the necessity of having again to address }mu on the same
unfortunate- business; but, as the Council have thought proper to
decline, without assigning any reason, proceeding in an enquiry, I
am led to conjecture, either that they doubt the veracity of my
statements, and therefore think them unworthy of notice, or that
the charges I preferred against Professor Pattison were not sufficiently
specific to warrant their acting upon them. If the former were the
case, I beg now to state, that I can bring forward students, now in
the University, who can bear out my statements, and relieve me from
the imputation under which I might otherwise lie. If the latter be
the case, I proceed now to bring forward some specific imputations;
by \Vhich his ignorance will be exposed and his inability displayed ;
and if I am not myself able to substantiate these facts, there are in
in the University individuals who can : —

1 . Upon a student asking him what nerves pass through the rectus
extern us oculi, he was unable to afford the information.

2. In demonstrating the peritoneum, he maintained the foramen
of Winslow to be a hole in that sac.

3. When speaking of the motions of the wrist-joint, he says, that
pronation and supination are performed there.

4. He states the carotid artery and the nerves passing through
the cavernous sinus to be bathed in the blood of that sinus.

5. He brought into the theatre the heart of a frog to illustrate a
double circulation.

6. He neglected to give us the most interesting details of ana¬
tomy, viz. the developement of different organs. In fact, when
lecturing on the brain, from some of his remarks, he exposed his
ignorance of the researches of Tiedeman and others, on the
foetal brain ; at least some few of his expressions conveyed to
my mind as well as to the mind of an eminent professor, who
was present, that such was the case.

444

Miscellanies .

Other exposures might be made, had I stored my mind with his
mistakes. But, Sir, I consider them things in themselves most
trifling, except as connected with the evident want of science, which
his lectures constantly display. The anatomy he teaches is such as
may be found in Fyfe’s compendium, and there has been a general
deficiency throughout his whole course. He began this very course
with promises innumerable, but he has not performed them to the
satisfaction of the class. In fact, he did not demonstrate the
viscera till the last week of the session, and then in a most superficial
manner.

The number of the class usually in attendance, and the nature of
that class being chiefly of junior students, evince the estimation in
which he is held.

< I should not have troubled you with this communication, un¬
pleasant, irksome, and anxious task as it is, did I not feel assured
that if I were now to sacrifice public good at the shrine of public
feeling, I should be doing an injury to the University of London, as
well as to its eminent Professors and Students, and I believe that if
this affair be not privately settled, there will be a public call for it,
which would do great injury to the institution itself as well as to the
gentleman most intimately concerned.

For the reason I have chosen to address you privately, I have not
hesitated to avow my name.

I am. Sir, your obedient servant,

• N. Eisdell.

To L. Horner, Esq.

Warden of the London University.

Tranbv, near Hull, June 19th, 1830.

My dear Thomson, — I am much obliged to you for having given
me information on a subject, about which I began to feel rather
anxious, as well as for allowing me an opportunity of adding my
testimony to that of my fellow students in this important affair.

I do not think I can add to your stock of evidence any individual
instances of deficiency or negligence, as from my constant commu¬
nication with Eisdell, while in town, he is already in the possession
of all these facts. Indeed I have been witness of very few. I can,
however, substantiate the following : — his constantly using the mis¬
nomers, ductus communis choledoctus ; his having made that canal
open at the superior angle of the duodenum ; his giving a confused
description of the peritoneum ; having gone over the stomach, liver,
spleen, pancreas, and duodenum, in three-quarters of an hour, re¬
peating the demonstration twice ; constant misnomers wherever two
Latin names occur together, as membrani tympani, scali vestibuli, &c.
&c. (of great importance to a student in his examination); not
knowing the nerves which pass between the heads of the external
rectus ; describing the carotid artery and the nerves of the orbit, as
bathed in the blood of the cavernous sinus.

< These are a few instances which have fallen under my own obser¬
vation, and of which I have distinct recollection. After all, 1 cannot

Miscellanies. ■

445

help thinking, that these charges might seem to a n unprofessional
jury, frivolous and vexatious, and that we must mainly depend upon
more general accusations, well authenticated by the more respectable
and numerous body of the students. Such charges as the following
I shall be very ready to sign my name to.

That the demonstrations given by Professor Pattison are vague
and desultory, the relation of parts to one another being almost
wholly - omitted, and the external parts, to which they may be re¬
ferred, entirely ■ neglected ; that the intimate structure of most of the
organs is not given at all ; their developement never alluded to ; that
notwithstanding engagements entered into by Professor Pattison with
the students to assist and superintend, out of the lecture-room as
well as in it ; he is seldom about the premises, except during the
hour of lecture, and scarcely ever seen in the dissecting-rooms ; that his
attendants consist almost entirely of junior students, and that their
average number daily is not more than fifty, while Mr. Bennett is
attended by all the seniors in the school, and seldom musters fewer
than 1 20.

You will see that I have written down these charges hastily, but
I have not thought upon them the less on that account. You are at
liberty to make use of my name as ready to substantiate any charges
which will embody any or all the foregoing ; but there are, of
course, many others to which I Cannot personally vouch.

The report of Bell’s resignation will do us much injury ; and if
your father and Turner follow his example, and start a private
school, I should imagine we are dished, &e. &c.

Yours truly,

Henry Cooper.

To Alex. Thomson, M. B.

os'tfin r * * - ■ * > ;

Memorial from those Students of the University of London, who
wish for the Dismissal of Professor Pattison.

To the Council of the University.

Lords and Gentlemen of the Council,

As the charges already preferred against Professor Pat¬
tison, on account of his negligence, deficiency, inaccuracy, and evi¬
dent want of scientific knowledge, have not received the attention,
which we had anticipated, and, which their importance demands, we
feel bound to express our opinions in a more public and decided man¬
ner than, we have hitherto done. We have to lament, indeed, that
some of us from motives, of delicacy, lest Mr. Pattison’s reputation
might so severely suffer, as materially to injure his prospects, been led
to adopt a greater degree of privacy than appears to have been desir¬
able ; for, had we known that publicity would have been given to this
affair by Mr. Pattison and his friends, we should not have been so
delicate and tender of his interest. And, we feel confident that, had
Mr. Eisdell’s intentions been made known to the whole class, previ¬
ous to their separation, every senior student, as well as the majority
of the juniors, would have readily attested the statement, which has

446 Miscellanies.

been made by Mr. Eisdell, and corroborated by seventeen of his
fellow -students.

Although we appear before you in the character of complainants,
we are not blind to the ample and magnificent arrangements,
which you have so carefully provided for our instruction. In¬
deed, of all the medical professors, Mr. Pattison is the only one ,
who has disappointed our expectations, cast a damp over our spirits,
paralyzed our exertions, and rendered us thoroughly dissatisfied.
We neither met him at the dissecting table, nor at the dispen¬
sary, as, from his fair and ample promises, we had a right to
expect, We have paid freely all that you demand, and we expect
that you will provide, that your public and blazoned pledge of giving
much ampler instruction, on a better plan, shall be fulfilled. It is a
bona-fide contract between us, and that contract has been broken
by Mr. Pattison. He has, in fact, given us nothing, which, as a
Professor of Anatomy, he ought to have done ; he has neglected the
physiological linking of anatomical facts, and omitted to allude to
regional, functional, developemental, comparative and morbid ana¬
tomy.* What can his lectures be, then, but a dry detail, which we
can more successfully and infinitely more accurately acquire for our¬
selves in the dissecting-room ? They are almost wholly confined to
mere descriptive anatomy, and here he is so superficial and careless
in his demonstrations, as to fall infinitely below Mr. Bennett in the
clearness of his illustrations, and in the accuracy of his details. — -
Were we to assemble instances of his negligence, they would soon
fill our paper, and tire your attention. Enough has been already laid
before you ; suffice it therefore to remind you of a few instances.—
What can be said in excuse for his dividing one hour, and only one,
between the absorbent system (including lacteals and absorbents),
and a flowery, and therefore useless valedictory address, while the
farmer is one of the most important parts of the human economy.

The most important parts of anatomy have been neglected, 'i bus,
of the alimentary canal, the mouth, buccal cavities, teeth, pharynx,
and oesophagus, were never mentioned ; the stomach was superficially
treated of, and its connections and relations imperfectly illustrated.
Of the intestinal canal, the differences between the duodenum, je¬
junum, ileum, colon and rectum, were not clearly indicated ; and
the organization of the whole was neglected. The assistant chylo-
poetic viscera, with the exception of the lobes of the liver, were
scarcely touched upon. The relation of the abdominal viscera,
for the physician of the highest, and for the surgeon of no light im¬
portance, occupied the attention of this splendid anatomist exactly,
half an hour. Is not this robbery ? or, is it the quackery of ana-

* Which departments he kindly and condescendedly requested
Mr. Bennett to lecture upon, as “• supplemental Professor.” The
Council cannot be so ignorant of science as not to know that these
subjects are the only abstruse parts of anatomy, and alone demand
clearness of head. . . . - , . •„ - ^

Miscellanies .

447

tomical teaching- ? Mtist we eke out a certificate by dragging”
our attention through such a course ?

Into points of science, we understand, and with sorrow, that the Com¬
mittee, for the investigation of the conduct of Professor Pattison, have
refused to enter ; but, why ? Why, when we charge him with unusual
ignorance of old notions, and total ignorance of and disgusting indiffer¬
ence to new anatomical views and researches, do you prevent us from
vindicating this charge ? It is on these accounts, and on these chiefly ,
that we call, and that loudly, and with no friendly voice, for his dis¬
missal. He teaches that the ductus communis choledochus enters into the
superior angle of the right quadrature of the duodenum — that pronation
and supination are performed at the wrist-joint — that the peritoneum,
instead of being a sac having an hour-glass contraction, the maxi¬
mum of which contraction forms the foramen of Winslow, consists
of two true, uncontinuous, sacs, and, that the foramen of Winslow
is a real orifice in the peritoneum. Moreover, in making diagrams
of the peritoneum, he could not demonstrate how its inflections were
made. He has been asked more than once what nerves pass through
the two origins, or rather the bifurcated origin of the external rectus
muscle of the eye, but he has never yet given an accurate answer.
He asserts that the brain is not developed part by part, but all at
once — that the nerves and the carotid arteries, passing along the
margin of the cavernous sinus are bathed in the blood. We fearlessly
assert, that there is no anatomist in Europe, who would not reject a
pupil he was examining for such blunders, and yet, forsooth, we are
to be told of Mr. Pattison’s splendid attainments — splendid certificates.
Splendid, indeed, because signed by a splendid lawyer and some
American and unknown names — splendid, because Dr. Davies has
been most busily canvassing for opinions in favour of Mr. Pattison,
and has over and over again asserted to the discontented pupils that
there is no anatomist in Europe like this Mr. Pattison ! But Ame¬
ricans, and lawyers, and Dr. Davis, cannot, combined in one phalanx,
packed into one fasciculus, praise such latinity as' falls from the
worthy Professor, who commonly talks of the scali vestibuli, mem-
brani tympani', ductus communis choledocius.

We need not, however, urge fresh arguments for the truth of the
accusations made against Professor Pattison ; facts, indelibly im¬
printed on the mind of every pupil, and, in their hearts, a “ monu-
mentum sere perennius,” call but far too loudly against him. No
senior pupils attend his class, except to save appearances, and when
they do, they retire to the remotest corner of the theatre. Of the
juniors fifty only, and sometimes only thirty, of the one hundred and
eighty, who fee him as the head of the school, usually attend him,
while the majority of both classes indiscriminately absent themselves
from his examinations. And why ? truly, because he is ignorant,
or, if not ignorant, indolent, careless, and slovenly, and, above all,
ind:fFerent to the interests of the science.

We urge you, therefore, to remove Mr. Pattison, to seek for some
RfcAL anatomist for our teacher, no man supported by certificates
from interested lawyers, or transatlantic and unknown names, no man.

448

Miscellanies.

who will not give up his whole time to the cultivation of the science, no
man, who will plan cabals, no man, who will be afraid of the strictures of
his pupils, no man, who will promise what he never means to perform,
no man, who will be afraid of the demonstrator being his rival, no
man, who will take a mean advantage of his situation as examiner to
brand his discontented students, no man, who will lecture upon a
case as recovered, which may die the next day, no man, who will not
be frequently in the dissecting-room, ardent in his pursuit of know¬
ledge, eager to promote the interest of the institution, determined,
by his industry, to bind us more strictly to our alma mater, and
truly philosophical in his views of anatomy ! Should you, however,
neglect our prayer, we warn you that we shall publish this very appeal ;
shall lay bare the deep and unanswered malignity of the mis-state¬
ments attested by Dr. Birkbeck. ; the mean, party-spirited, wilful
duplicity by which he, as the supporter of Mr. Pattison, tried to
make the proprietors believe that one student only charged that
gentleman, and that an ignorant student. Could Dr. Birkbeck, a
member of the Council, a canvasser for Mr. Pattison, the head of
the party against our Warden, and the cultivator of these cabals,
could he say that he was ignorant of the seventeen pupils, including
the great majority of the medalists, who in a phalanx, charge Mr.
Pattison with a palpable dereliction of duty, and urge his dismissal ?
If so, why is he retained in the Council ? Did he know of these
facts, why then did he hide them ? — because he had an end to serve ?
Why, then, we boldly ask, is he retained a proprietor of the in¬
stitution ? Why has his mis-statement regarding Eisdell’s ignorance
— an insult, which we all consider personal to ourselves — -not been
officially contradicted ?

Is this the manly government you promised us ? Is this the
liberality which distinguishes you above the hitherto favoured in¬
stitutions of our land ? Is this “ Patens omnibus Scientia?”

Once more, and for the last time we urge you, by your pledges
voluntarily given to the public, by your desire for the success of
your school, by your hopes of beginning the next session amicably,
by your determination to benefit our country, by your love of virtue,
honourable feeling, industry, and moral worth, by the honours
which you have showered bountifully on ourselves, to dismiss this
inefficient, careless, indifferent Professor.

Signed by Alexander Thomson, M.B.

On the part of the seventeen Medalists not in town.

CN. Eisdell.

Signed also by< F. R. Taylor.

(^E. Seeward.

Immediately on this being read by the Council, Dr. Hogg, the
Apothecary of the Dispensary, with whom I was boarding, was sent
for, and desired by the Chairman, Mr. Milne, to tell me their de¬
cision, “ that Dr. Alexander Thomson be dismissed from, and
prevented visiting the Dispensary forthwith,” I, of course, instantly
left the Dispensary, but wrote several times, and sent friends to
procure some written order of the Council, which had desired my

Miscellanies .

449

exclusion from their institution. This, however, I was constantly
refused, and having been informed that the only members present
were Messrs. Milne, Sturch, and Wilson, I presume that there was
no written document, as these gentlemen could not form a quorum
of the Council. All I could now do was to send in a protest to the
Council, in which I individually demanded the dismissal of Professor
Pattison, on account of a very disgraceful surgical operation, which
he performed in my presence, and which I described in that protest.
That I Was not justified in doing so, on account of my not being in
any way connected with the institution, as stated by the Editor of
the fc Medical Gazette,” will best be answered by the following
extract from my protest, not to mention my belief as expressed in
the “ Lancet,” that I was a matriculated student, and my having
attended during the whole of the last session the lectures of Mr;
Bennett, Dr. Turner, Dr. Thomson, and Mr. Lindley. “I had a
right to expect from you at least moderation, because my character
is' as yet untarnished, because I have done all I can to promote the
interests of the institution. I have opened almost every body that
has been examined for the Dispensary; I have given instruction to
the pupils on morbid anatomy, and on its connections with pathology,
w"hich has not been attempted by any one officer of the institution.
There have been but few acute cases, which required visitation at
their own homes, that have not fallen under my care, and but two
or three of these have died, while more than one, who has been
given up by the physician, has been restored to health and brought
to thank him, with a happy and cheerful countenance.' During the
two months, in which I saw the portion of the patients, who ought to
have been seen by Dr. Conolly;* several patients, who had been months
under cure, one indeed thirteen, were dismissed recovered, and when
L handed over these patients to that gentleman, there was not one,
Who Was not convalescent. • •

These are facts, which modesty requires a man under ordinary
circumstances to veil, but for the truth of which I appeal to the
physicians themselves, to the apothecary, and individually to the
pupils, and to the patients, from many of both of which la tter classes
1 now possess letters, thanking me for my kindness and attention.
But this is not all. Who that has not been paid for it has added to
yoUr museum but myself ? I have given full fifty valuable pre¬
parations, the spirit for preserving which I have paid for at a great
and unusual cost, from the strength required, out of my own pocket.

v; - '.A .. . - ; c. is . y v w . -iV*

* Dr. Conolly resigned his situation in the Dispensary, for the
ostensible reason, that he was required to sign his name in a book at
every visit, a requisition which, while all sensible men must ap¬
prove of the check, it is calculated to exert upon the attendance,
both of the Pupils and of the Professors, (some of whom had pre¬
viously, grossly neglected their duty) he considered inconsistent with
the. character of a gentleman. The Council, however, made him
resume his situation, or resign his professorship. He chose the lesser
evil, and the Council consented to rescind the obnoxious resolution.

> ' * * * • • ■ r - • ^ • *. ■«* .r - • ,.r.

VOL, V. NO. 29. 3 G

450

Miscellanies.

I have gone to every part of London to open bodies, and I have
brought you the spoil. But this is not all. I have presented to you,
through Dr. Grant, a large and unexampled collection of flint fossils,
which took me three whole years to collect, another of Madrepores
from Torbay, together with upwards of a hundred specimens of the
shell of the Pholas, in a state of perfect preservation. I presented
you also with many fossil bones from Newmarket Heath. But this
is nothing. I have now to ask you, who framed and gave the first
spirit to your Medical Society, to your Philosophical Society ? Who
framed the laws of these societies ? who was one of the first presi¬
dents of both these institutions ? Lastly, I spent two whole weeks
in arranging your medical library, when you could get nobody else
among your officers able, or, if able, willing to work unpaid for
the good of science. Moreover, I have still a further claim upon you
in being the scientific editor of the first two numbers of the Uni¬
versity magazines, where all the scientific articles, including that on
a “ General Judgment,’ ‘ were the production of my own labour.
Finally, I have laboured in most of your classes, and gained the
esteem and the highest recommendations from all your good medical
Professors ; and I have in public and in private devoted my pen, my
heart, my tongue to your service. In Cambridge, I have endea¬
voured to make them believe that you have no want of religion,
but wish to strengthen its bulwarks, by preparing the mind to appre¬
ciate the value of the evidence collected in its favour, and I have
gained you friends in every quarter by my utmost efforts ; and for
these services, which, considering my age and opportunities, are,
I hope to be considered, not small, you have seized upon the first
moment to make me an example, an odium, a beacon for your
students !

The receipt of this protest was never acknowledged, although it
contained actionable matter, although it contained a most severe
attack upon Mr. Pattison. If the Council still refuse redress to the
pupils, still remain a star chamber, a Polignacian Council, I must
publish it, for truth is like the fairy elf that comes up from the
furthest deeps through the spiracles of the cumbrous mass that hides
her. I heard nothing more publicly of the business until a few days
before the Introductory Lecture, when, upon goingto the University,
I was prevented entering by the porter. I asked him if he had re¬
ceived any written order, and he said no. I now went to Mr. Coates,
the locum-tenens, and asked him when the Council planned this new
indignity, and whether he had not received orders to send me a
written communication on the subject. He said that the order for
my exclusion was passed at the same time as that for my dismissal
from the Dispensary, that there was no written record of either, that
he had not previously put the latter part of the sentence in force,
because HE did not think it necessary, and that he had only now
had recourse to it, because he wTas afraid I should make a disturbance
at the Introductory Lecture ; which means, of course, that he was
quite conscious that I had been illused, and that if he were in my
place, under such usage, he thought he should make a disturbance ;
and so this petit dictateur did not think it necessary to condescend

Miscellanies .

451

to let me know his dictation in writing. This is the march of in¬
tellect or the diffusion of useful knowledge !

I took no further steps till October 5th, 1830. When, at Pro¬
fessor Bennet’s suggestion, I sent the following communication to
the Warden : —

October 5th, 1830.

Dear Sir, — Professor Bennett informs me, that some person has
stated to you, that I have kept away pupils from the University of
London, or diverted them to other schools. I shall feel obliged to
you for the name of the slanderer ; for the statement is false. I
wonder yon can encourage such a report ; for it implies that you
think I have considerable influence with the pupils. It is at least
your interest, as one of the coup d’etat school, to pretend a perfect
indifference both to myself and to my acts. While I have my pen
in my hand, let me ask you, whether the Council desired you to tell
the Porter to keep me out, without any notification of their wish
being made to me in writing. It is a strange thing to expel a
freeman, by putting words in the mouth of a hireling slave.

I am, Sir, your obedient servant,

Alexander Thomson.

To Leonard Horner, Esq.

Warden of the University.

I immediately received the following letter from the Warden ; —

My dear Sir, — I have just received your note, and shall be
happy to see you, if you will favour me with a call, any time to-day,
between two and four o’clock. You will find no obstacle to your
admission to the gate or elsewhere. You can come direct to the
Council Room.

Yours very truly.

University, Leonard Horner.

Wednesday, 6th October.

So at last, my Lord is obliged to write, however cautiously. I
met him in the evening, when he refused to tell me from whom he
had heard the report, that I intended to make a riot (was it an in¬
vention of his own ? or a jesuitical apres gout?) stated that there
was no written order for my expulsion. In fact, that it was his own
act ; that after my assurance he should recal his order, but that he
must require me not to go to Professor Pattison’s class. I told him
that I would make no conditions. He then requested me not to
enter Professor Pattison’s class-room, a request with which I wil¬
lingly complied ; the more as I had heard from one of the Professors,
that he had told Professor Pattison that I intended to visit his class,
and that this worthy gentlemen turned quite pale, and seemed very
apprehensive. Wishing, however, after consulting my friends, to
have the Warden’s recantation, in black and white, I wrote him as
follows, on

October 9th, 1830.

Dear Sir, — I have been reflecting upon your communication,
which appears to me so extraordinary and contradictory to that

452

Miscellanies .

made by Mr. Coates, that. I beg you to answer my last note irt
writing. I understood you to say, “ that you had been informed by
somebody that I intended to make a riot at the Introductory Lecture,
delivered by Professor Conolly, and that you, following your duty
and taking care ‘ nequid caperet detrimenti respublica,’ had thought
proper to order my temporary expulsion ; and that in my case, as I
had been very troublesome, you did not deem it necessary to pay me
the common courtesy of communicating with me in writing, and
therefore gave your orders direct to the porter.” Am I, or am I not
right in my conception of the communication of the Warden of the
London University ?

Your obedient servant,

Alexander Thomson.

P. S. I hope you will answer me in writing. Truth needs no
evasion !

After this, Sir, to which, by the bye, I received no answer, I
packed away my papers, and as my intimate friends well know, had
made a determination never again to allude to the disturbances.
Accordingly I went, by permission, to my friend Mr. Bennett’s lec¬
ture, which I take this opportunity of saying, I have not heard
equalled in the whole course of my studies. After lecture, some
conversation between myself and a Mr. Wilson took place in regard
to an academical dress. The students agreed with me, that it would
be inconvenient, unnecessarily expensive, and, after all, an invidious
distinction. I was going, however, on the same evening, to the
Medical Society, when the porter again informed me, that I was
excluded. I was astonished, and requested permission to be allowed
to enter the society, promising to return in a quarter, or, at farthest,
in half an hour, for the purpose of apprizing them of this new in¬
dignity. The porter kindly granted my request. I w'ent to the
room of the society, told them what had happened, and asked them
to meet me at the University Hotel upon the morrow, with the view of
hearing the letters and documents which had led to my expulsion.
I then, after having been insulted (as Mr. Horner acknowledges)
by a listening, eaves dropping menial’s intruding himself into our
society, and haranguing the pupils on the excited state of my feel¬
ings) left them to their deliberations. At the advice of my friends,
I next morning once more wrote to the Warden a letter, of which
the following is a copy: —

October 11th, 1830,

Sir, — I have again, notwithstanding your protestation of friend¬
ship and sorrow for your former coercive measures, been insulted by
being forbidden the building by your hireling. In consequence of which
I have again asked the advice of my friends. Professor Bennett, Mr.
Thos, Wakley, Editor of the Lancet, and Mr. L. Estrange, a general
practitioner in our neighbourhood. By their advice, notwithstanding
your studied evasion of written communication, once more I write
to you to demand from Leonard Horner, Esq. that courtesy, which
one gentleman has a right to expect from another, viz. an explana-

Miscellanies.

453 “

tion of the reasons, which led him to send to me a repulsive message
by a servant verbally, and not in writing. Also to enquire what
may have caused you again to issue the obnoxious order, after pledge
ing yourself to me, to Professor Bennett, and to Professor Smith,
that it should be withdrawn.

Mr. Bennett suggests that my having spoken to-day in his theatre
may be the cause of your ill-tempered and hasty reversion of your
pledge. That you may be certified on this point, I shall repeat my
observations. A gentleman, whose name I do not know, but whom
I have since heard called by the nick-name of Mr. Pattison’s liga¬
ment, proposed that a deputation should wait upon the Council, for
the purpose of asking permission for the students being distinguished
from those of other schools, by the badges of a silk gown and tasselled
cap. I immediately asked him — f< Does this proposal. Sir, emanate
from a Professor or from yourself ? because I beg to assure you that
at Cambridge it is thought a great grievance to be obliged to wear
these trappings, to which no one, who is not obliged, will submit.
Moreover, I trust that in the present day the only distinction, which
medical pupils of one school will seek from those of another may
henceforth be placed solely in the depth of acquirement, the cultiva¬
tion of natural talent, the manly independance, and the gentlemanly
and scientific deportment, which ought to characterise every member
of our profession m particular.” Such, Sir, was the purport of my
address, which I humbly submit cannot be construed, even by malice,
policy, or jesuitical feeling into an offence against good discipline,
good manners, or decent society.

I regret that among my numerous papers I have lost that contain¬
ing the last part of this letter. Suffice it to say, that in the morning
I received the following notice from the pupils : —

Dear Thomson, — I have great pleasure in informing you that a
notice, the copy of which I send, has this morning been posted about
the University ; and I have the honour to request your attendance at
the time and place appointed.

Believe me, Yours very sincerely,

Charles Rob. Bree.

NOTICE.

The students of the medical school in the London University are
particularly requested to meet at the London University Hotel, this
evening at six o’clock, when a subject, which materially regards their
interests, and the welfare of this Institution, will be brought before
their notice.

Charles Rob. Bree.

B. CoPPERTH WAITE.

N. Eisdell.

Wm. Calvert.

Wm. Evans.

Three of the gentlemen, whose names are signed to this notice,
waited however upon me in the morning, by the request of the War¬
den, who wished me to accompany them to him. I did so, and he
informed me in their presence, that the reason of my second exclu-

454

Miscellanies .

sion from the University was, his having been informed by two pro¬
fessors that I had intended to make a riot in the medical society. All
my friends assured him at once that he had been misinformed, and of
their knowledge of my intention not to have recurred to these mat¬
ters, while I again assured him, that if he would give me the names
of the two informing Professors, I would bring all the papers and
correspondence that minute, and burn them in the presence of him¬
self and of the students. This, however, he refused ; but after a
long parley between himself and the three pupils, he consented to
allow me to lay all the documents before the pupils, and to explain to
them my conduct in the anatomical theatre, immediately after Mr.
Bennett’s lecture. I leave it to the students to say whether I said
any thing that was not true of any Professor ; I leave it to them to
say whether I used unnecessary violence, and whether, after an hour
and a half’s dead and silent attention, they did not rend the air with
their deafening shouts of applause ; whether they did not deeply feel
that my motives had not been personal — that their good had alone
actuated me — that I had been made a tool of the Professors, while
fulfilling the commission of my fellow pupils — that I had been basely
and ungenerously deserted by these Professors — that I had been
unnecessarily insulted by the Council — that I had been traduced by
a faction of three Professors — and that, in my person, every pupil had
been excluded from a patient hearing before the Council ! For this
Council had never inquired into my motives, into the reasons of my
connexion with the pupils ! They condemned me unheard — they
were at once my accuser and my judge ! ! ! And yet, Sir, these are
the cream of the men, who are the boasted and boasting advocates of
freedom of speech, of thought, and when free from licence, even of
action ! ! ! The motto over their gate is “ Patens omnibus scientia
their Jesuitical reservation is “at least so long as they are good
boys, that is so long as they complain of no Professors, point out no
abuses, and allow members of the Council to traduce the character
of their fellow pupils ! ! ! ”

For what has since transpired I refer to the Lancet ; and am your
obedient humble servant,

Alexander Thomson, M.B.

Of St. John’s Col. Camb. — of the Univ. of Edinburgh —

late of the Univ. of London, and late Pres, of the Med.

and of the Lit. and Phil. Soc. in the Univ. of Lond.

Copy of Letters inserted in the Lancet of Oct. 30 th. 1830.

University of London, Oct. 14.

Dear Sir, — We have great pleasure in enclosing the resolutions
agreed upon at the meeting yesterday, with only two dissentient
voices, and remain,

Dear Sir, yours very truly,

N. Eisdell, Chairman.

T. Howitt, Secretary.

Miscellanies.

455

At a meeting of the medical students of the London University,
held in their common room, on Wednesday the 13th of October,
1830, it was resolved, that

1. This meeting views with anxious concern the unmerited dis¬
pleasure of the Council, lately manifested toward their fellow student
Dr. Alexander Thomson.

2. Dr. A. Thomson having fully laid before the students of the
University, every particular of his late conduct in connexion with
that institution, and submitted to their perusal authentic documents
in support of his statements, this meeting begs respectfully to in¬
timate to the Council its unqualified approbation of the motives
Dr. Thomson acted upon in the transactions alluded to.

3. The students are fully aware of the deference they owe to the
ordinances of the Council, but cannot view, without apprehension,
the summary measure which has been put in force in the case of Dr.
A. Thomson, viz. his extraordinary expulsion from the University.
They conceive it to be a public institution, established on a system
of enlarged and scientific usefulness to society ; and, they think
themselves called upon to enter their firm protest against the dis¬
missal of a pupil from its class-rooms, without his having violated
any known law, any hearing of evidence, or even an official notice
of his dismissal. They are convinced that a proceeding so arbitrary,
irregular, and unjust, is incompatible with the best interests of the
University, and subversive of the liberal principles, to which it owes
its foundation and support.

N. Eisdell, Chairman.

Many of my fellow pupils have called upon me, and informed me,
that double the number of names would have been appended, had a
communication not been made from the office, stating that I was
not a matriculated pupil. As soon as 1 heard of this, I sent the
following letter to the Warden : —

Sir, — Having received a very gratifying communication from
ninety-six of my fellow students, approving of my conduct in regard
to Professor Pattison, and having been informed by many others of
them, who have not appended their signatures to this document,
that they have been restrained, by a communication from the office
affirming that I am not a matriculated student, from appending their
names to this document, the whole tenour of which they otherwise
approve ; I beg to express to you my surprise at such information,
and to inform you, that the moment I heard of it, I went to the
office and tendered my money for a library ticket, which was refused.
I assure you, that I have been attending the University under the
belief that I was a regularly matriculated student ; for, when I feed
Dr. Davis for his lectures, he informed me publicly, in the presence
of his class, that his share of the money at least would be remitted
to me from the office.* This money I have never received, although I

* There is an agreement among the Professors that they will receive no money
from their colleagues’ sons. But the Council do not sanction this agreement, and,
therefore, the sons are obliged to purchase a library ticket each year, as no one is

456

Miscellanies.

have more than once applied to Dr. Davis for it. I concluded, there¬
fore, that this money was left for me at the office, where I wished it to
remain, as my matriculation fee. Under this belief I attended many
of the lectures last year. Again, Sir, I wish to ask of you whether,
as a gentleman permitted by the Council, through courtesy, to attend
lectures in their institution, they give you authority to prohibit
my entrance without sending me any written document, and
through the mouth of the porter? Again, Sir, I wish to know
whether you can expel me from, or prevent me entering, the Me¬
dical Society, of which I was the founder, as well as the framer of
its laws, and am still an honorary member, having paid all my fees.
If I, an old pupil by your acknowledgment, am excluded in this
manner, of what use is it to me to have paid all my fees to that
society ? An answer to these queries will oblige

Your obedient servant,

(Signed) Alexander Thomson.

October 15th 1830.

To those Pupils of the University of London , who have signed the
Protest to the Council in favour of Dr. Alex. Thomson.

Gentlemen,— Allow me to return you my thanks for the kind
interest you have taken in my welfare ; I wish you had rather
had moral courage enough to have insisted upon your own rights,
and then- you would have been insulted by the Council,* * who after
reading your testimonial, sent me a letter, of which the following is
a copy : —

Copy of the Warden’s Letter to Dr. Thomson.

University of London, Oct. 15, 1830.

Sir, — I have, laid your letter of this date before the Council, and
I am directed to transmit to you the following resolutions of the
Council passed this day ; —

That Dr. Alexander Thomson be not permitted in future to
come within the precincts of the University, and that the - Warden
do give the necessary orders for carrying this resolution into effect.

“ That a copy of the preceding resolution be transmitted to Dr.
Alexander Thomson.

I am, Sir, your very obedient servant,
Leonard Horner, Warden.”

permitted to buy a library .ticket who does not intend to enter to a course of lectures,
to pay.thU part of the fee which goes to the University chest.

* It is better-, however, to observe to you, that not more than six members of
Council m6t.on this occasion, as I am credibly informed by two of the Professors.
Dr. Birkbeck and Mr. Sturch were I air also told, of the number.

Dr. Gordon Smith is preparing for publication a Syllabus of his own Lectures,
and an Abstract of Professor Chaussier’s work on Judiciary'- Anatomy.

List of Books in our next.

All Communications and Works for Review are to be addressed to the care of
Messrs. Underwood, 32, Fleet Street; or to the Editor, at his Residence, Gl,
Hatton Garden.

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

*

No. 30. DECEMBER 1, 1830. Vol. V.

CRITICAL REVIEW.

I. — Dublin Hospital Reports and Communications in Me¬
dicine and Surgery. Vol. V. 1830. — ( continued .)

We have given an account of the valuable contents of this
volume in our last, and now proceed to notice them in
detail.

The first paper is Cf a Clinical Report of cases in the
medical wards of the Meath Hospital, during the session of
1828 and 1829, by Robert James Graves, M.D. M.R. I.A.,
King’s Professor of the Institutes of Medicine, &c., and
William Stokes, M. D., Lecturer on the Practice of Medi¬
cine, & c.

The first section is “ on diseases of the arterial system —
arteritis,” illustrated by a case of gangrene and paralysis
of the right lower extremity, arising from disease of the
femoral and iliac arteries. It is as follows, and is ably
detailed : —

“ Patrick Magrath, aged 44, of a strong habit, was admitted on
the 7th of Feb. 1829, labouring under loss of power of the right lower
extremity.

“ For the last six months this man had been exposed to severe
hardships. In the beginning of Dec. 1828, he was first affected with
alternating sensations of cold and burning heat in the toes of the
right foot. The same sensations, soon after, were felt in the leg,
accompanied with formications, and diminished power of the limb.
Pains in the foot next supervened, and in the course of a month the
part became cold, and was totally deprived of sensation.

“ On the day of his admission he had attempted to walk to the
hospital, when the pain suddenly extended to the calf of the leg with
violence. From this time he lost all power of motion in the leg.

“ The constitutional symptoms since the beginning of this disease
were prostration of strength, anorexia, and constant thirst.

vol. v. no. 30. 3 H

458

Critical Review.

“ On admission his intellects were perfect, and the temperature of
the body, with the exception of the affected limb, natural. The pain
had extended to the thigh during the night ; pulse 96, small and soft.
On examining the limb we found its temperature to be about 58o of
Fahrenheit, and observed some oedema at the ankle and foot. There
was complete loss of sensation from the middle of the thigh to the
toes ; the patient could rotate the thigh slightly, but no other volun¬
tary motion of the limb was possible. The femoral artery appeared
like a hard cord ; it was painful on pressure, and no pulsation could
be felt in the vessel. We further discovered, by the assistance of the
stethoscope, that pulsation was wanting in the external and common
iliac arteries on this side, while that of the left iliacs was plainly
perceptible.

££ From these observations we came to the conclusion, that the
right common and external iliacs, and the femoral artery, were in a
state of permanent obstruction, which would account for the state of
the limb.

££ Warmth was applied to the limb, and opiates exhibited. In the
course of the night the limb became of the natural temperature, the
cedamatous swelling extended to the hip, purplish patches appeared at
the ham, and the thigh became painful on pressure. Leeches were
applied in abundance, and opium freely administered, On the 10th
the thigh was more swollen, and presented many vesications ; con¬
siderable tenderness ; temperature 88°. He died the following
morning.

“ Dissection. — No emaciation; the right lower extremity swollen
and of a purple colour.

££ The brain, lungs, and abdominal viscera, w*ere carefully ex¬
amined, but nothing remarkable wras observed, except that all these
parts were unusually exsanguineous. A few crude tubercles were
found at the superior portions of both lungs.

“ The heart presented the left ventricle in the state of active aneu¬
rism, with some thickening and opacity of the aortic valves. The
ascending portion and arch of the aorta were perfectly healthy, nor
could any disease be discovered in the carotid or subclavian arteries,
but in the innominata we observed some red patches where the lining
membrane was thickened and softened. The descending aorta was
healthy to within sixteen inches from its bifurcation ; here a slender
red fibrinous clot was found stretching nearly to the bifurcation ; be¬
neath this clot the lining membrane was of a deep red colour, thick¬
ened and soft.

££ The right common iliac, when viewed externally, appeared dis¬
tended and livid ; the left apparently healthy. On slitting down to
the bifurcation, we found that the former vessel was completely plug¬
ged up from its origin by a dark clot, which extended to the external
and internal iliacs, and also engaged the gluteal and obturator arte¬
ries. The same disease was found in the femoral and profunda, and
extended to the origin of the anterior and posterior tibial arteries,
which vessels, including the peroneal, presented a similar appearance
as far as they could be traced.

The Dublin Hospital Reports. 459

“ Along the course of the diseased vessels, the lining membrane
of the artery was found soft and thickened. It had a somewhat villous
appearance, and greatly resembled an inflamed mucous membrane.
In some portions the clot was separated from the vessel by a layer of
dark coloured puriform matter, in others it was adherent. The clot
in the tibial arteries was not red, and much firmer than in the femo¬
ral and iliac arteries.

“ In the left common iliac we found the lining membrane of a deep
red colour, and the vessel contained some portions of coagulable
lymph. The external iliac, and femoral arteries of this side were
perfectly healthy.

“ No disease whatever could be detected in the veins of the
affected limb.

“ A large portion of the vasti and rectus muscles was hardened,
and deprived of colouring matter. The cellular tissue oedematous ;
periosteum red but not softened.”

Two other cases are detailed— one of aneurism of the
abdominal aorta, the displacement of the heart, double
pulsation of the heart — sudden death. Dissection was not
allowed in this or the succeeding* one, of aneurism of the
ascending aorta ; and as the diagnosis of these cases must
have been difficult, obscure, and unsatisfactory, we pass
them by unnoticed. The following interesting comment is
offered on the case of Magrath : —

“ In the highly interesting case of Arteritis, it would appear,
that the disease had first commenced in the extreme branches of the
arteries of the foot, and had gradually extended from below upwards.
The symptoms are in favour of this opinion ; the numbness and
alternating sensations of heat and cold occurring first in the toes, and
afterwards engaging the foot and leg ; the extension of the pain up¬
wards, and the coldness of the foot, existing at a time when the thigh
preserved its natural temperature, all point out that the obstruction
did not, in the first instance, commence in the larger trunks.

“ But the appearances on dissection furnish a still more satisfac¬
tory evidence of the truth of this opinion. The consistence of the
clot decreased from below upwards. In the lower portions of the
arteries of the leg it was extremely firm and pale, while in the femo¬
ral and iliac arteries it was soft and red. Here also the lining mem¬
brane of the vessels shewed marks of recent disease, not observable
in the arteries of the leg, namely, redness, softening, and puriform
exudation. The existence of redness and softening, with the pre¬
sence of a coagulum in the lower portion of the aorta, and in the left
common iliac, make it highly probable that here was the latest effect
of the disease ; and that had the patient lived longer, the aorta itself
would have become obstructed.

“ The occurrence of coloured clots adhering to, and derived from
the inflamed portions of the aorta and left common iliac, in which the
current of the blood had flowed freely, is worthy of notice, and seems

460

Critical Review.

to suggest the idea, that the fibrinous coagulum found in inflamed
arteries differs from that of aneurismal sacs, and is not altogether
derived from the coagulation of blood arrested in its course in conse¬
quence of the obstruction. Indeed, it is highly probable that the
exudation of lymph from the inflamed internal tunic of the artery, is
the first cause of obstruction to the flow of blood through the diseased
vessel. In the smaller trunks it must very soon fill up the calibre of
the artery ; in the larger the continued clot probably results from a
double source, exuded lymph and coagulated blood.

“ In this case the extreme coldness of the limb pointed out, in the
first instance, that the circulation was obstructed. Coldness occurs
in some cases of paralysis from disease of the nervous system, but it
is slight : here the temperature of the affected limb was thirty de¬
grees below the natural standard. This great coldness, and the
slight and but little extended oedema observable on the admission
of the patient, shewed that the obstruction existed in the arterial
rather than in the venous system, and this was borne out by the
absence of pulsation in the femoral artery, as observed by the touch,
and in the iliacs by auscultation. The latter observation, which we
believe to be the first of the kind, was made with great ease and cer¬
tainty. Having traced the pulsation of the aorta with the stetho¬
scope, we followed the course of the vessel to the umbilical region,
where the pulsation could be distinctly heard passing to the left side
in the direction of the common iliac. This, however, was altogether
wanting in the course of the right common iliac ; and as no tumour
existed in this situation, it was plain that the absence of pulsation
denoted obstruction of the right common iliac artery.

“ One of the most interesting circumstances in the case, is the
occurrence of inflammatory action in the cellular tissue and skin of
the affected limb. It is evident, that as long as the current of blood
into the limb took place through the natural channels, the circulation
was diminished in proportion as the arterial ramifications became dis¬
eased; the extreme parts being first affected, and afterwards the
whole limb. During this state of things, the want of feeling and
coldness kept pace with the progress of the arteritis.

“ But when the inflammation had caused a total obliteration of all
the arterial trunks leading from the common iliac of the affected side,
nature appears to have made an effort, by means of anastomosing
branches derived from the healthy arteries of the opposite side, to
restore the circulation in the limb in the same way as happens in
cases wfiere the common iliac has been tied. That this effort was
successful may be inferred from the restoration of warmth and sen¬
sibility to the limb ; and it is worthy of observation, that in this and
similar cases, where a collateral circulation has been just established,
the danger to be apprehended appears to arise, as in frost bitten parts
too suddenly restored, not from a deficient, but an over active circu¬
lation in the affected extremity, which manifested evident symptoms
of inflammation, such as heat, pain, tenderness, oedema, vesications,
and superficial gangrene. The latter we consider in our case to have
been evidently the consequence of inflammation, and it is probable

The Dublin Hospital Reports .

461

that the gangrene observed in other cases of arteritis arises from the
same cause, and not, as Andral seems to think, from a deficient
circulation, as he compares it to gangrena senilis, from ossification of
the arteries.

“ If this view of the subject be correct, it evidently points out the
impropriety of continuing the application of warmth after we observe
that the collateral circulation has commenced, for the same reason
that such applications are improper or even dangerous in the case of
frost-bitten parts. Gentle warmth is in such cases at first advan¬
tageous ; but when the restoration of the circulation has commenced,
our efforts should be to moderate, not increase it ; a suggestion that
may prove useful after the operation for aneurism.

“ In the advanced stages of this disease the diagnosis is not difficult;
there is paralysis, but this has not been preceded by symptoms of
cerebral or spinal disease, and the intellects remain undisturbed. To
this, the feeble pulsation, or its complete absence in the arteries of
the limb, are to be added, and no difficulty will be experienced in
recognizing the disease.

“ In its early stages the diagnosis is more difficult. Here, how¬
ever, an accurate comparison of the temperature of both limbs, and
the force of the arterial pulsations, may perhaps lead to a discovery
of the disease soon after its commencement, and thus enable us to
arrest the progress of the inflammation. At all events the disease
might be checked, if not cured, so as to allow the anastomosing ves¬
sels time to take on the supplementary action.”

In the comments on the semeiology of the cases which
we have omitted, the most important statement, is, the dis¬
covery of the aneurismal condition of the aorta by the
stethoscope. TSiere cannot be more able advocates of aus¬
cultation than the authors before us ; and we must add, that
their reports are some of the best and most satisfactory
that we have ever perused. They account for every symp¬
tom with a degree of physiological accuracy seldom dis¬
played by most of the moderm pathologists. They are
intimately acquainted with the most recent doctrines of
this and foreign countries, and evince acute discrimination,
the most faithful observation, sound judgment, and exten¬
sive research.

Our authors next proceed to describe painful swellings
of the lower extremity, occurring from inflammation of the
saphena vein, after fever, and in the puerperal state, all of
which they consider analogous. These cases, with their
comments, deserve serious consideration, and throw much
light on the pathology of phlegmasia dolens. We give
them in full.

“ Painful swelling of the left lower extremity. Inflammation of the
saphena vein. Symptoms of intermittent fever. — During the month of

462

Critical Review.

Feb. 1829, when several cases of ague were in the house, a man
named Andrews was admitted, complaining of rigors, followed by a
hot and sweating stage, which came on every second day ; these he
stated had been preceded by continued fever.

“ Considering the case as an example of tertian ague, we ordered
the exhibition of sulphate of quinine in six grain doses daily. In a
few days the type of the fever was changed to that of quotidian, but
still, during the intervals, the patient was nearly free from fever. —
We now made a more accurate examination, and found that the left
leg and thigh were extremely painful and swollen, a circumstance
which the patient had concealed. Any attempt to extend the limb
produced intolerable pain, chiefly referable to the ham and calf of the
leg. The limb was extremely tender on pressure, particularly along
the course of the saphena vein, which in its whole extent could be
felt like a hard cord. No change could be observed in the tempera¬
ture of the limb.

“ The opposite leg appeared healthy. The saphena was indurated,
but not painful on pressure.

“ We now omitted the quinine, applied leeches freely to the af¬
fected limb, and at the same time exhibited calomel and opium. This
treatment proved successful, and the patient was discharged in three
weeks with the perfect use of the limb. The saphena having been
restored to its original state, that of the opposite side, however,
remaining unchanged.

“ Painful swellings of the lower extremities . — Eliza O'Donnel, aged
21, was admitted on the 3d of June, 1829, with symptoms of gastric
fever, and severe pain in the right side under the margin of the ribs.
Thirty leeches were applied to the painful part, and aperient medi¬
cines exhibited with relief.

“ On the 6th, convalescence appeared to have commenced, the
menses flowed scantily, and altogether, though great weakness ex¬
isted, her situation was satisfactory. On the 7th, however, without
any obvious cause, we found that she had been kept awake the whole
night by a violent pain in the calf of the left leg, which was swollen,
extremely tender, hotter than natural, and tense, but was not at all
red, neither did it pit on pressure. The tenderness, every where
great, was excessive along the course of the saphena vein, which felt
cordy throughout its whole extent. Some tenderness was complained
of in the pubic region, with scalding on micturition ; pulse 108,
hard ; tongue brown and dry ; great thirst.

“ Twenty leeches were applied along the course of the saphena ;
three grains of opium and ten of calomel, divided into six pills, were
given in the twenty-four hours, and a hip bath at night. Next day
she was greatly relieved, and in a few days her mouth was evidently
affected by the mercury, and the pain subsided in the limb, which
had decreased considerably in size, was less tense, and pitted on
pressure.

“ In this case a decided tendency to a recurrence of the affection
was observed, and the pain, tenderness, and swelling returned several
times, but in a less severe form, and generally yielded to the appli-

The Dublin Hospital Reports .

463

cation of leeches and stupes. The pain in one attack was greatest
in the calf of the leg, in another at the instep, and in a third at the
middle of the thigh. The disease in the left leg, after continuing
with intermissions for three weeks, subsided, leaving, however, the
limb considerably swollen, and the patient in st state of emaciation
and exhaustion.

“ On the 28th of June, a nearly similar train of local symptoms
commenced in the right leg, attended with so much constitutional
irritation and debility, that we were apprehensive of the result.

“ The violence of the symptoms, however, subsided after the ap¬
plication of twenty leeches, and the use of remedies hereafter to be
mentioned, so that, although her convalescence was tedious, the local
symptoms had disappeared before the middle of July.

“ It is worthy of remark, that when leeches were applied during
the swollen state of the limb, a very large quantity of serous fluid
flowed from their bites before any red blood made its appearance. —
During this state of the limb, the swelling too was by no means uni¬
form, varying from day to day as to the situation it chiefly occupied,
and not unfrequently to the touch simulating most perfectly , the fluc¬
tuation caused by an abscess immediately under the integuments.
The suffering from pain and want of sleep during the whole course
of the disease was extreme, and so soon reduced her strength, that
the exhibition of stimulating and tonic remedies was found neces¬
sary eight days after the commencement of the complaint, and were
continued, combined with narcotics and the use of stupes, until she
had so far recovered, both from the constitutional and local disease,
that we were able to pass to the use of mild diuretics and the appli¬
cation of bandages.

“ In this case the leg first attacked had not perfectly recovered
when the other assumed the diseased action. In the right leg the
corded and knotty state of the saphena vein, and the tenderness
along its course, so remarkable in the left, did not exist.

On the subject of the painful swelling of the limb, as observed in
the case of Andrews, we shall remark, in the first place, that it is a
striking example of the danger that may arise from neglect of accu¬
rate examination in any case however simple in appearance. If we
had not ultimately discovered the disease in this instance, the worst
consequences might have resulted. We shall mention another case
briefly, which illustrates the importance of general examination.

“ In a female patient much debilitated by fever, convalescence
had but commenced when she complained of want of sleep from
severe pain in the calf of the right leg. At this time we were not
familiar with the disease. On examination of the limb, the skin was
of the natural colour, and it did not appear increased in size or swol¬
len in the least. Narcotics were exhibited, but without benefit, and
on the following day, the pain being very severe, and occupying a
small spot on the leg, a moxa was applied. Next day, on taking
down the bed clothes, the left leg was accidentally uncovered, when
we were at once struck with the great difference of size of the two
extremities. The right, which we had supposed of natural size, was

464

Critical Review.

nearly twice as large as the left, which was emaciated from the long
continuance of the fever. It was plain, that in consequence of not
comparing both limbs, we had mistaken the swelling of the right leg
for its natural state, lost much time in the treatment, and employed
a painful and useless remedy. The patient ultimately recovered, but
the moxa produced a very troublesome ulcer.

“ These cases are good examples of the practical value of diagnosis :
so long as we had an erroneous idea of their nature the remedies em¬
ployed were injurious, but as soon as the real nature of the disease
was discovered, the measures adopted wrere followed by complete
success.

“ The intermittent fever in the case of Andrews, may be com¬
pared to that depending on urinary disease. There is a point of irri¬
tation in the system which appears to produce the rigors ; and to
cure the fever, we must remove its exciting cause. In this case, as
in that of urinary intermittent, the exhibition of bark aggravated the
symptoms, and we have had several opportunities of observing that
this symptomatic intermittent, although it be reciprocally cause and
effect, is exasperated by the above treatment. We have seen it in a
lady who had lately been confined, in whom there was a tendncy to
the formation of mammary abscess. Quinine was exhibited in large
doses for several days, and great aggravation of the symptoms of
intermittent followed.* In a case of phlegmasia dolens lately treated
in the hospital, the woman had daily rigors, followed by a hot and
sweating stage. In both these cases the treatment which proved
successful was local bleeding, and the use of draughts repeated daily,
consisting of the ammoniated tincture of valerian, opium, and sul¬
phuric ether. Indeed in the last mentioned case, whenever this
medicine was omitted, the rigors returned ; this happened three or
four times. The patient ultimately recovered.

“ An accurate observation of numerous cases, both of phlegmasia
dolens occurring after delivery, and of painful swelling of the extre¬
mities appearing during or after fever, f has satisfied us of the patho¬
logical identity of the two diseases. In both oedema occurs, unat¬
tended by redness, but accompanied by increase of heat, with great
tenderness and pain, and followed for a considerable time by impaired
motion of the limb.

“ In both diseases the swelling and other symptoms are frequently
not confined to any one portion of the extremity, but extend uni¬
formly over the leg and thigh. In both diseases, however, we have
also often observed, that the pain, heat, and swelling, occupied par¬
ticular parts of the limb, while the rest was comparatively free from

* In another patient we observed well marked tertian ague supervene during
the administration of large doses of sulphate of quinine. In a case of arthritic
rheumatism in a person previously healthy, an imprudent attempt at curing the in¬
termittent by still further increasing the dose of sulphate of quinine, induced a fatal
pneumonia ; in this case more sulphate of quinine had been exhibited antecedent to
the appearance of the tertian fever than would have been sufficient to cure three
ordinary agues.

f Dr. Tweedie, Edinburgh Medical and Surgical Journal. No. 97.

The Dublin Hospital Reports.

465

disease. Thus in some cases a portion of the thigh was intensely
engaged, while the leg and foot remained free, and after some days
the diseased action seemed to change its place, and successively
attacked the other portions of the limb, without, however, any pre¬
cise order in the mode of succession. In consequence of this, our
treatment has been directed to different portions of the limb, accord¬
ing to the situation of the disease ; and we constantly found that the
degree of swelling in the part attacked was proportioned to the ac¬
companying heat, pain, and tenderness. In some cases we have
observed this affection to be attended by a cordy and painful state of
the saphena vein, proving that it participated in the disease ; but as
this state of the vein, where it did occur, was in some cases subse¬
quent to the disease of the other parts of the limb ; and as in the
majority of our cases of phlegmasia dolens, and in the painful swel¬
ling of the extremity after fever in the male and female subject, no
such affection of the saphena occurred, we think that the latter cannot
in justice be considered as the cause of the disease. The occasional
occurrence of the swelling in the inferior portion of the limb in the
first instance, and its erratic nature, militate against the idea that the
disease proceeds from an affection of the large venous trunks ; and in
two instances we have seen the disease desert its orginal seat, and
concentrate itself in the knee joint, producing obstinate inflammation
of the part, which in one case, that of a male after fever, terminated
in anchylosis, and in the other, that of a female who laboured under
phlagmasia dolens after delivery, the same unfortunate result was
with difficulty arrested.

“ As the latter occurrence, and many obvious considerations, leave
little doubt concerning the inflammatory nature of the disease, it
remains to be considered what are the parts engaged. To us it would
appear that the subcutaneous cellular tissue is primarily affected,
sometimes generally, at others partially. It is not unusual to meet
with cases either of general or local anasarca evidently of an inflam¬
matory origin, accompanied by pain and heat, but unattended by
redness. The external and vascular layer of the corium remaining
uninflamed, will account for the absence of redness in this disease,
as well as in the inflammatory anasarca.

“ The cellular tissue seems to follow the same law as serous mem¬
branes. Moderately inflamed, it effuses an unusual quantity of its
natural secretion, serum. When the irritation is more intense, the
effusion is also altered ; it contains more animal matter, approaching
in its qualities to coagulable lymph, and sometimes it is of a puri-
form nature. It is to be remarked, that suppuration has occasionally
been observed in phlegmasia dolens when very intense, but usually
the effusion appears to be the result of an intermediate degree of
inflammation between that which produces puriform and merely serous
effusion. The swelling is consequently more apt to produce, by
means of the coagulable matter contained in the effusion, considerable
hardness arising from the consolidation of the cellular tissue. A
state of parts not observed in the beginning* or termination of the

Vol. v. no 30. 3 i

466

Critical Review .

disease, when the inflammation is more moderate, which we have
frequently pointed out to our pupils both in phlegmasia dolens and
the painful swellings of the extremity after fever. Did space permit,
further arguments might be adduced from considering the pathology
of Barbadoes leg, and the disease termed berri berri in Ceylon.*

* ‘ Concerning the treatment, the local antiphlogistic plan preserved
in with assiduity, the use of stupes, and after the disease has con¬
tinued for some time, the liberal use of narcotics, have appeared to
be the best means of subduing the disease, when in its acute form :
when more than usually obstinate, these means must be accompanied
by bandaging, tonics, and diuretics ; and when the knee is attacked,
frequent leeching, blistering, and the use of the inclined plane.

“ The utility of salivation appears to us questionable. In one
case we obtained no advantage from the liberal exhibition of iodine.
We have been informed by an experienced practitioner, that in seve¬
ral cases of phlegmasia dolens, he has observed marked advantage
from the repeated application of blisters to the affected limb ; a fact
evidently not inconsistent with our view of the pathology of the
disease.

“ Since the above pages were written we have met with a remark¬
able case, in which this peculiar swelling of the lower extremity
coincided with an inflammatory state of the vein.

“ A young man of a strong habit was employed for two succes¬
sive days in working in a ditch, and was consequently obliged to
stand in water above his knees during that time. On the following
day he became affected with lassitude, vertigo, and general weak¬
ness, and complained of severe pain in the right thigh. These
symptoms continued for seven days, when he was admitted into the
Meath Hospital.

“ On admission his countenance was anxious and depressed ; the
tongue furred ; thirst ; headache ; urine scanty, turbid, and high
coloured; pulse 96; skin mottled with petechia?. In addition to
these general symptoms his respiration was observed to be laboured
and unequal, with some cough ; face very livid. But his chief com¬
plaint was a severe pain in the upper and anterior portion of the
right thigh, which was greatly aggravated by motion or pressure.
He had also severe pain in the left hypochondrium, increased by in¬
spiration or cough.

“ At this time no swelling whatever of the limb could be detected;
but in the course of two days the upper portion of the thigh became
evidently swollen, the part being extremely tender, elastic, but not
at all red. The pain of the side continued, and extensive bronchial
and pneumonic inflammation was detected. General bleeding, and
very free leeching to the limb, was employed. The blood was not
inflammatory, and no relief was experienced by the patient. The
swelling of the thigh increased ; calomel and opium were freely ex-

* Dub. Hos. Reports, vol. iii. Ridley on Berri Berri.

The Dublin Hospital Reports.

467

hibited, but without any effect. The typhoid symptoms increased,
and the patient died on the fourth day after his admission.

“ On dissection we found the right lower extremity swollen, and
tense in its superior portion, while the leg and foot were slightly
anasarcous. The sac of the pericardium contained some sero-
purulent fluid, and that portion covering the auricles and great ves¬
sels was vascular, and in many places covered with coagulable lymph.
Both lungs were in a state of extreme sanguineous congestion, with
commencing solidity in their postero-inferior portion, and general in¬
flammation of the pleura, as shewn by a reticular exudation of coa¬
gulable lymph, which occurred in greatest quantity in the most
inferior portions. The bronchial mucous membrane was universally
red, and the tubes filled with frothy mucous. No disease could be
detected in the lining membrane of the heart. The right ventricle
contained a fibrinous coagulum of the usual appearance. The gastro¬
intestinal system appeared remarkably healthy, except in the great
extremity of the stomach, where the mucous membrane presented a
dotted red colour. The spleen enlarged, flabby and pale, was found
in a state of purulent infiltration, bearing some resemblance to the
lung in the third stage of acute pneumonia.

“ The vena cava contained a few portions of a substance of a
granular appearance, friable and of a yellowish -colour. These did
not adhere to the vessel, which otherwise appeared healthy. In the
external iliac vein, however, we found, just above Poupart’s liga¬
ment, a large concretion of a similar nature, nearly plugging up the
vessel, and extending into some of the minute collateral branches.
The lining membrane was red, and in one point adhered to the coa¬
gulum. No puriform matter could be detected. The femoral and
popliteal veins were healthy, as also the arteries. The cellular tissue
of the limb was pale and oedematous.

“ It cannot be denied that this case is strongly corroborative of
the opinion before entertained, and lately insisted on by Tommasini,*
that the phlegmasia alba dolens is in reality owing to phlebitis.

“ Here we find a young man previously in the enjoyment of good
health, after a long continued exposure of the lower extremities to
cold, becoming affected with symytoms of fever, and a violent pain
in the upper part of the thigh. These are succeeded by others indi¬
cative of obstruction in the circulation of the limb, and of visceral
inflammation, and in a few days the patient dies, with general pleuro-
pneumony, pericarditas, and splenitis ; and in addition to these the
vein is found in an unequivocal state of inflammation and obsruction.
It would, however, be unphilosophical to form certain conclusions as
to the disease in question from a single case. We have put our ex¬
perience of the disease now on record, and leave to our readers to
form their own opinion.” — p. 42.

Though the reasoning offered in this extract seems very
plausible, we can by no means admit it conclusive, as we

* See Journal Hebdomad. No. SI.

46S

Critical Review.

have repeatedly shewn in our last volume, that phlebitis
of the femoral and pelvic veins is not followed generally
by swelling of the extremity. This will be seen by refer¬
ring to our reviews of Mr. Arnott’s and Dr. Lee’s papers,
in the Med. Chir. Trans. 1830 ; of M. Dance’s and M. To-
nelle’s — papers which have not been mentioned by our
authors. But whatever may be the pathology of phleg¬
masia dolens, all agree in the mode of treatment. In our
original essay on the subject, we differed from the talented
Dewees, as to the use of narcotics, and we are pleased to
have the able physicians before us coincide in our opinions.

The remainder of the report of Drs. Graves and Stokes,
comprises an account of diseases of the chest and abdo¬
men, which we shall notice in our next number.

II. — Medico-Chirur gical Transactions. — Vol. XVI. Part I.
London, 1830. pp. 235. Two Plates: Longman & Co.

This volume contains some interesting papers, and in some
measure maintains the character of its predecessors. The
contents are as follow: — 1. Case of aneurism of the external
iliac artery, for which the femoral, and subsequently the
aorta, were tied. By J. H. James, Esq. — II. An account of
the removal of a tumour situated on the cheek. By James
Barlow, Esq. — III. A case of ununited fracture of the thigh¬
bone, cured by the application of a silver wire, between
the fractured extremities. By Dr; Somme, of Antwerp. —

IV. An account of a concrete oil existing as a constituent
principle of healthy blood. By B. G. Babington, M. D. —

V. Case of phlegmasia dolens, caused by inflammation of
the veins of the lower extremity, excited by malignant
ulceration of the cervix uteri. By William Lawrence, Esq.

VI. Case of extensive inflammation, and obstruction of the
veins of the right inferior extremity of a phthisical youth,
accompanied by a swollen state of the limb. By T. H. Hol-
berton, Esq. — VII. History of a case of stammering, suc¬
cessfully treated by the long continued use of cathartics.
By JohnBortork, M. D.— VIII. On the pathology of hoop¬
ing cough. By James Alderson, M. D. — IX. A further in¬
quiry into the comparative infrequency of calculous dis¬
eases among seafaring people, with some observations on
their frequency in Scotland. By A. C. Hutchinson, Esq. —
X. Practical observations on the healthy and morbid con¬
ditions of stumps. By George Langstaflf, Esq. — XI. A case

Medico - Chirur gical T vans actions.

469

of aneurism of the external iliac artery, in which a ligature
was applied to the common iliac artery. By Philip Cramp-
ton, M. D. — XII. On the glanders in the human subject.
By John Elliotson, M. D. — XIII. An account of the dissec¬
tion of the parts concerned in the aneurism, for the cure of
which Dr. Stevens tied the internal iliac artery, at Santa
Cruz, in the year 1812. By Mr. Richard Owen, Surgeon.

In our next we shall notice these valuable papers in de¬
tail, and are happy to add our testimony in favour of their
importance generally. We may merely observe, that the
most valuable to the practical surgeon, are those by Mr.
James, of Exeter, and Dr. Crampton, of Dublin, which
prove that the aorta and common iliac artery may be tied
with little difficulty, so far as the operation is concerned.

III. — A Demonstration of the Nerves of the Human
Body. Part I. The Cervical and Thoracic portions of the
Sympathetic, and the Nerves of the Thoracic Viscera.
By Joseph Swan. Plates. Folio. London, 1830: Long¬
man and Co.

IV. — Neurology of the Human Body. By Borremans,
revised and adapted to the English Nomenclature. By
T. King, late House Surgeon to the Hotel Dieu, Doc-
teur en Medicine de la Faculte de Paris, Member of the
Royal College of Surgeons in London. London, 1830.
Foiio. Ten Plates : Feuillet Dumus and Co. Leicester
Square.

Y. — Analytical Anatomy of the Great Sympathetic Nerve .
By P. J. Manec, M. D. P. London, 1830. One Plate,
Folio : Feuillet, Dumus and Co.

The zeal and indefatigable industry of Mr. Swan, as a phy¬
siologist and a minute anatomist, are universally known to
the cultivators of medical science. The various produc¬
tions of this author on the nerves, have been duly estimated.

He was perhaps induced to undertake the tedious dissec¬
tion of that part of the nervous system alluded to above,
as a candidate for a prize offered by the Royal College of
Surgeons ; and the splendid preparations presented by him
to the college, obtained for him the unanimous approba-

470

Critical Review.

tion of that body, and the approval of the profession at
large.

The fasciculus now before us represents the cranial, cer¬
vical and thoracic portions of the great sympathetic nerve ;
and eight plates are devoted to its accurate illustration.
Each view is shewn by two plates, with a difference in the
shading ; the second is a correct outline of the former, with
letters and figures referred to in the letter-press description.
It would be foreign to our purpose to enumerate the origin
and course of the cerebro-spinal nerves, more especially as
the succeeding plates represent them more fully. These
plates are very accurately executed, and so far as they ex¬
tend, are highly valuable. There are, however, two ob¬
jections to the work. The first is, the unnecessary number
of plates to illustrate the same subject ; and the second, the
great expense, which is nearly three times that of the second
work on our list, and eight times that of the third, though
either is far more complete and useful. The sum of two
guineas is much too high for a partial delineation of the
nervous system, and should the succeeding numbers be
equally expensive, the work will be placed beyond the reach
of a great mass of the profession.

Mr. King’s plates, when united, represent the body of
an ordinary sized adult. They not only delineate the whole
nerves, but almost all the tissues of the body. They are
invaluable to the student of descriptive anatomy, and con¬
sequently have had a large sale, which was greatly aug¬
mented by the lowness of their price, which is fifteen shil¬
lings plain, or thirty shillings coloured. The author has
published a description in sixteen pages, octavo, and with
such a manual the student can acquire an extensive know¬
ledge of the relative situation of parts ; especially of the
muscles, blood-vessels, and nerves. We strongly recom¬
mend these plates to all those engaged in the study of de¬
scriptive anatomy, and to junior practitioners. If placed
on canvas, they would be a great ornament to the surgery.
Mr. King is also engaged in preparing plates of the arteries,
of the same size. We wish him every success.

Manec’s plate illustrates the origin of the cerebro-spinal
nerves and their inosculations. There is an accurate de¬
scription in letter-press on each side of the figure. In one
plate, and one view, there is a complete delineation of the
great sympathetic, and at an expense of a few shillings.

Swan, King- and Manec, on the Nerve .

471

When we consider the immense importance of a knowledge
of the cerebro-spinal nerves, in explaining the functions,
sympathies, derangements of the different organs, and the
action of medicinal agents upon the living system, we can¬
not too strongly recommend the attentive study of this
plate to our junior friends. Without an accurate knowledge
of the various subjects which it embraces, directly or col¬
laterally, no man can comprehend the innumerable chain of
symptoms of disease, nor the therapeutical views which
influence the scientific practitioner. This plate well de¬
serves a place in every medical library.

%

ORIGINAL COMMUNICATIONS.

I. — Clinical Reports of the Richmond Hospital , Dublin.
By John Swift, Esq. M.R.C.S. London.

Case I. Trichiasis. — Miles Brennan, aged forty-three, ad¬
mitted on the 28th of September, with entropia of both
upper eyelids, chronic conjunctivitis, an opaque and thick¬
ened state of the membrane investing- the front of the
cornea, and considerable intolerance of light. The disease
had originated about six years ago, from inflammation of
the meibomian glands and tarsal conjunctiva, and had for
the last three months prevented him from pursuing his
occupation as a shoemaker.

30th. Dr. M’Dowel operated on the left eye, by pinching
up a fold of skin corresponding in extent to the inverted
cilise, and sufficient to produce the requisite eversion ;
through this he passed three single ligatures of strong silk,
one at each extremity of the fold, the third in the centre,
and having tied them firmly, fixed the ends on the forehead
by adhesive straps ; a wetted compress was then laid over
the eye and retained by a bandage.

On the 10th of October, the ligatures were detached by
ulceration, and the success of the operation was evident,
as the cilise retained a sufficient degree of excision, and the
cicatrices were not yet entirely healed. A poultice was
ordered to remove the scabs, which formed in the situation
of the ligatures. On the 14th the incrustations were re¬
moved, and the cicatrization of the parts completed. The
hairs remained permanently everted, the skin of the upper
lid, which before hung loosely, is thrown into horizontal

472

Original C ommunications .

folds, and the conjunctivitis and dimness of the cornea
disappearing' rapidly.

On the 6th of October, the right eye was operated on
in the manner recommended by Mr. Guthrie, by removing’
with the scissors an eliptic fold from the upper lid, and
dividing the tarsal cartilage at each extremity of the inverted
hairs. The ligatures being passed through the lips of the
wound, formed by the excision, were fixed to the forehead
in the manner before described. The patient complained
very much of the comparative severity of this operation.
The foimer operation has the advantage of being less pain¬
ful, of greater simplicity, and equally effectual.

Case II. Thomas Reilly, set. 49, admitted on the 6th of
October, with entropium of the left upper eyelid, of six
months standing. Four years ago, he had catarrhal in¬
flammation of the lids from lying on a damp floor, followed
in two months by inversion of right upper eyelid, severe
conjunctivitis and opacity of the cornea. About three
months ago, excision of about three-fourths of the tarsus
and cilise, was performed by Dr. Jacob, with some relief.
A few hairs near the punctum lachrymale, which were left
behind, became inverted, and continued to keep up irrita¬
tion in the organ. These have been restored to their proper
direction by a single suture, applied as in the former opera¬
tion. Mr. Guthrie’s operation was performed on the left
eye with success. The ligatures have been applied in ano¬
ther similar case with decided relief, since the above was
written.

Case III. iritis . — Return of inflammation while under
the influence of mercury. Bridget Cullen, aged forty, had
been in hospital for about a month, with idiopathic iritis
of the right eye, for which she had leeches twice applied,
a blister to the nape of the neck, and took calomel and
opium. She left hospital on the 7th of October, (her
mouth still tender) and on the same night was attacked with
iritis of the left eye, for which she was re-admitted on the
9th. The usual symptoms were present, viz. severe pain
in the eyeball and forehead, lachrymation, intolerance of
light. Sclerotic vessels injected, of a pink hue, and run¬
ning in straight lines towards the cornea, round which they
inosculated, forming a vascular zone, considerable irregu¬
larity of pupil, the iris being retracted towards the inner
and upper part of the eyeball. Eight leeches were applied
to the inferior palpebra, the extract of belladonna smeared
round the orbit, and Bj. of the following mixture to be taken
three times a day. R. olei terebinth, mucilag. acaciee aa.

\

Mr. Swift on Clinical Reports. 473

3j. aquae purae menthae aq. piper aa. ^iij. syrup, cort. au¬
ra nt. 5iv.

11th.. Pain still severe ; three leeches to the inside of the
lower lid ; a blister to the back of the neck.

13th. Considerable relief from the leeches ; complains
principally of soreness in the eye ; a blister behind the cor¬
responding’ ear; continue the mist, terebinth.

18th. Pain, intolerance of light, and lachrymation nearly
gone — vascularity of sclerotic subsiding. States that the
turpentine has produced slight nausea and headache, but
no other perceptible effects.

26th. Pain and vascularity of the eye removed; pupil
caq be fully dilated by belladonna ; two points of adhesion
to the lens nearly destroyed ; vision daily improving.

Case IV. Amaurosis . — James Kilty, a healthy labourer,
aged twenty, was admitted on the 27th of September, with
amaurotic symptoms, the right eye being principally af¬
fected. The pupil was considerably dilated, and exhibited
but little sensibility to light. He stated, that at the time
he first noticed the impairment of vision (last June), he had
been employed in mowing, and felt pain and heaviness in
the eyeballs and head while stooping at his work. He had
also about the same period an attack of cold, and pains in
the limbs, which lasted for a fortnight. He first observed,
on looking at objects, a cloud before his eyes, and after¬
wards motes and rings of a dark colour, which expanding,
broke up, and were succeeded by similar spectra. The
flame of a candle appeared considerably magnified, and of
a bright red colour. His sight is better in the shade than
in a full light, and from six to ten in the morning, than
during the rest of the day. Latterly he has been getting
worse, and can scarcely make his way through the streets.
His appetite is good, and he has never laboured under any
intestinal derangement. No pain in the eyeball or head.
Ordered to take submur. by drag. gr. ij. opii. gr. ss. ter die.
and to have a seton inserted in the nape of the neck.

Oct. 22d. Mouth affected ; vision considerably improved ;
can discern minute objects at considerable distances ; thinks
the left eye is as well as ever ; right eye not well, but much
improved.

Case V. Gonorrhoeal Ophthalmia. — Margaret Murphy, a
married woman, aged twenty-two, admitted on the 1 9th
of October, with purulent discharge from the conjunctiva,
pain, intolerance of light, impairment of vision, and tume¬
faction of the eyelids. She has been labouring under go¬
norrhoea for the last two months, but is not aw7are of hav-

3 K

. Vol. v. no. 30.

474

Original Communications.

ing applied .any of the matter to the eyes. The disease
first appeared in the left eye with severe pain, great redness
and profuse lachrymation. In two days afterwards the right
became similarly affected, and she went to Jervis Street
Hospital for advice, where she got mercurial pills, and a
wash to inject under the lids. She was bled in three or four
days after, once from the temporal artery, to the amount of
eight ounces. She became a patient of Dr. M’Dowel’s on
the 19th. She was ordered to continue her pills, and have
the conjunctiva brushed with a camel hair pencil, dipped in
a twenty grain solution of nitrate of silver.

21st. The solution had given her considerable pain, but
was followed by marked improvement ; to be repeated ; to
omit her pills, as her mouth has become affected.

23d. No discharge from the eyes; pain, intolerance of
light and vascularity removed ; sight improving ; mouth
still sore.

28th Discharged cured.

Case VI. Disunited fracture of the femur treated by the
seton. — Michael Flood, a healthy young man, aged twenty-
eight, residing in the country, where he was employed as a
labourer, came into hospital on the 18th of January, with
a false joint, formed at the junction of the middle and
lower thirds of the femur. He stated that about two years
and a half since, he had his thigh bone broken by a horse
which he rode falling on him. The fracture was simple, but
very oblique, and the shortening of the member consider¬
able. In some short time after the accident, he went into
one of the provincial hospitals, where the limb was kept in
the extended position on a softish bed for two months.
When allowed to get up, he found that the first time he
attempted to bear his weight on the limb, the fractured
portions were not united. He was again confined to bed in
the same position for three months, at the end of which
no union had taken place, and he was permitted to walk
about on crutches, and discharged, after twelve months
confinement in hospital, with a false joint. He had been in
Stevens’s Hospital subsequently some months, and had glue
bandages and splints applied, and was put under the in¬
fluence of mecury with some benefit. A seton was passed
between the fragments, which was followed by considerable
inflammation and a copious discharge. At the end of a
month it was removed, a complete union having taken place,
and in a few days the patient began to bear gently on the
limb, and was discharged cured, about six weeks after his
admission. He returned again on the 10th of July, with

475

Mr. Swift, on Clinical Reports.

the limb flexible, in the situation of the fracture, and unable
to sustain his weight. He stated that being1 discharged, he
employed it very much in digging1 and walking1, being, as
he expressed himself, so proud of his recovery, that he
thought he could not use the limb often enough. By the
aid of rest, full diet, a glue bandage, splints along the
limb, and the iodine lotion, the thigh is becoming1 gra¬
dually firmer. He is at present walking about with the
assistance of a stick.

5, Sackville Garden, Summer Hill.

II. — Case of Hydrophobia , from the bite of a dog that
had exhibited no signs of rabies , arising cit an unusually
early period, and terminating fatally in four days.

[The child was attended by Mr. Frankum, Surgeon, of
Lisson Grove, while the case was drawn up, and the ex¬
amination conducted by Alexander Thomson, M B., 70,
George Street, Euston Square.]

j Read to the Westminster Medical Society , Oct. 30, 1830.

The mother informs me, that at about half-past eight,
p. m. of Wednesday, 16th June, her child, a boy of about
seven and a-half years of age, wras playing before a stable
door in Lisson Grove, into which a groom, who was return¬
ing from the country with a nosegay in his hand, was about
to enter, when her boy, having begged in vain for one of
the attractive flowers, was suddenly bitten by a dog that
rushed out upon him, immediately upon the opening of the
stable door. She, at the earnest solicitation of some of her
friends, washed the wounded parts cautiously with brandy,
and then conducted him to the house of Mr. Coucher,
Surgeon, of Church Street, Lisson Grove, who was not at
home.

Half-past nine, p. m., exactly one hour after the accident,
Mr. C. being still engaged at a labour, his assistant attended,
and rubbed the wound well over with lunar caustic. The
child, however, became drowsy earlier than usual ; retired
to rest at about half-past ten, p. m., but had not been in
bed more than half an hour, before he became excessively
hot and feverish, in which state, harrassed by incessant
restlessness, and tossing himself about in various directions,
he remained till about half-past eight, a. m., when the

476

Original Communications.

mother again sought for Mr. C., and finding that he had
not returned, asked for an aperient powder.

After having taken the powder, the boy insisted upon
putting on his clothes ; became,, when he had dressed him¬
self, uncommonly lively, and appeared to be in better
spirits than usually, singing, dancing, and playing, but
soon afterwards became languid, which induced his mother
to send for Mr. Frankum, Surgeon, of Lisson Grove, who
furnished me with the notes, from which, with the mother’s
statement, the remainder of these remarks are drawn up.

June 17th, l,p.m. Mr. F. found the poor boy in bed,
though apparently not very unwell, with a wound on the
inside of the right leg, at a small distance below the knee.
It had evidently been cauterized, and was not complained
of as a source either of pain or of irritation. The boy, in
answer to the inquiry after his health, said, Very well, I
thank you, Sir,” in a somewhat languid tone. The rest¬
lessness of the past night was attributed, not without reason,
to the influence of the fright. The pulse wTas frequent, but
not hard ; the respiration slightly accelerated ; the skin
bedewed with a moderate perspiration, and the wound
roughish on the surface. The boy had been dozing during
the whole of the day, and seemed to consider every move¬
ment an annoyance. Mr. F. suspecting that the wound had
not been very carefully dressed, ordered a blister, rather
larger than a dollar, to be applied over it ; and a diet con¬
sisting of tea- sop, gruel, and barley water to be employed
with,

IV Hyd. submur. gr. ij.

Pulv. antim. gr. i. rq.

Ft. Pulv. j. Mitte vj.

Sumr. quarta quaque hora unus.

At about half-past eight, p. m. he passed a tolerably na¬
tural though scanty motion ; throughout the night con¬
tinued to doze, and to be annoyed by any attempt to move
him; and became, as the night drew on, intensely hot and
feverish. In about twelve hours the blister had risen well,
and at twelve, a. m. on Friday, 18th, was removed, and
replaced by a warm bread and water poultice.

Friday, 18th, I, p. m. Mr. F. found him still cheerful,
readily answering questions, and stating that he felt quite
tr ell, but continuing to breathe in a somewhat hurried man¬
ner, as if from a sense of oppression. He had rather dozed
than slept during the past night, and had had no evacuation
of the bladder or rectum since half-past eight last night.

Dr. A. Thomson’s Case of Hydrophobia.

477

The pulse, though compressible, varied from 96 to 100
beats iu a minute ; the tongue was rather dry and slightly
loaded ; the body was entirely free from preternatural
warmth, and the skin was moist. At about two, p. m. he
took f5iij. of castor oil in a draught, and had continued to
take the powders at regular intervals. At about seven, p. m.
the bowels had not yet been opened ; the face, hands, and
limbs became exceedingly cold ; the whole body was bathed
in clammy perspiration ; the hands swelled and became pur¬
ple. He had been much troubled by thirst from the com¬
mencement of the attack, and had drank plentifully of tea
and of toast and water, but had no appetite, and had
therefore taken no solid food. At this time he took another
draught, containing f3iij. of castor oil. The bowels were
not, however, relieved during the night, which was one of
great restlessness and irritability to the little sufferer. To¬
wards Saturday morning the restlessness, the irritability,
and the coldness increased.

Saturday morning. The bowels had not been relieved
during the night, and the patient became uncommonly rest¬
less, refused medicine, food, and drink of all sorts, and
violently opposed its administration by clenching the teeth.
An injection of salt, dissolved in warm wrater, was adminis¬
tered at about ten, a. m., and in less than a quarter of an
hour was followed by a copious discharge of fseculent
matter and of urine. At this period his mother put his
feet, which were very cold, into hot water, and kept them
there for about ten minutes. Mr. F. now returned to visit
him. Before twelve m. the bowels had been two or three
times well evacuated, and the patient about this period
began to be drowsy, and stated, though reluctantly, that
he was quite well, (his mother says he never complained of
pain). The pulse was weak and fluttering, and the skin
covered with a clammy perspiration. Wine and water, beef
tea, &c. were ordered, and offered to the boy, but refused.
At about two, p. m. his mother, after much persuasion,
succeeded in getting him to take one spoonful of mutton
broth. At about three, p. m., he began to be drawn forcibly
backwards, to utter piercing cries, and clench and gnash
the teeth ; he had been in convulsions of a similar kind,
but not so violent ever since taking the broth at two, p. m.
but the mother at first attributed them to efforts at vomit¬
ing. These convulsions much increased in frequency and
violence until four, p. m. when he was again visited by
Mr. Frankum, who found that every effort to produce de¬
glutition of fluids, whether by artifice, or by the endeavour

478

Original Communications .

of the boy himself, was instantly followed by a violent
paroxysm of convulsions, in which the head was violently
retracted, the muscles of the face and neck were fright¬
fully contorted, the back so bent or curved, that the abdo¬
men formed the prominent part of an arc. Some bottles,
containing boiling water, were now applied to the feet; and
some tent wine offered to be introduced into the mouth,
only produced a return of the convulsions. By each of the
paroxysms, which lasted through several minutes, the
strength of the patient was much reduced. About eight,
p. m. Mr. Frankum again visited the little sufferer, in
company with Dr. Conolly. Similar paroxyms had con¬
tinued to recur every five or ten minutes. The child, was
becoming very feeble and languid, so that these gentlemen
gave up all hopes ; after which the poor little child being
in a state of collapse, during which the breathing could
scarcely be traced for the space of half an hour, and at
the end of which period he died, without a groan or strug¬
gle. The child had taken no medicine or fluid since half
past four in the morning, with the exception of the
spoonful of mutton broth, which gave rise to the first con¬
vulsions. He had not passed urine or fseculent matter since
twelve m. The following observations of Mr. Frankum on
the case I think valuable : —

“ Candour,” he observes, ‘f obliges me to confess that
I was by no means prepared to expect so unfavourable a
result. There were no symptoms in the child of a striking
or direct, no positive inflammatory character. He was dis¬
turbed, and somewhat restless — free from pain, and yet
apparently oppressed with an uneasiness not to be de¬
scribed. He had received but a very superficial injury, and
the dog appeared in such a perfectly healthy condition, that
hydrophobia was the least to be expected; and were it not
for the peculiar nature of the fits, the difficulty of deglu¬
tition, and the extent of disease afterwards discovered in
the dog, amounting to a confirmed incipient state of rabies,
I should at the present moment be quite at a loss to account,
in a satisfactory manner, for the death of the child in so
short a period ; asdt is, I do not hesitate to declare my con¬
viction, that it was unquestionably produced by the in¬
fluence of a morbid poison, introduced into the system by
the bite of the dog, and that its early appearance, and
unusual characters, were owing to the susceptibility and
condition of the child’s constitution at the time the mischief
was done.”

Dr. A. Thomson’s Case of Hydrophobia. 479

MORBID APPEARANCES, 24 HOURS AFTER DEATH.

The body was that of a child of remarkable beauty, with dark
hair, regular well formed features, good proportions, and plump and
well formed limbs, with no blemish whatever on the body, except the
marks of the cupping instrument of old date, on either side of the an¬
terior of the thorax immediately below the clavicles, and the remains
on the left knee, to the inner anterior aspect of the limb, close to the
insertions of the sartorius and gracilis muscles of a blister of about
the size of a crown piece. Within the margins of this blister were
observable, two semicircular black marks, with the concave parts
opposed to one another, which I understood at the time, arose from
the marks of the teeth of the dog, the wounds from which had been
well rubbed over with lunar caustic, soon after the accident. On cut¬
ting through the integuments around this blistered part, and dissect¬
ing it off, we perceived considerable extravasation between the subcu¬
taneous lobules of fat, which themselves appeared to be rather redder
than is usual. But no evidence of deep laceration, or of inflammation,
no mark of bruise or deviation in colour or in texture, could be traced
on the subjacent superficial fascia. The wound, or injury therefore,
was not deep or extensive ; and would readily have admitted of the
excision of the whole of the wounded part, without danger to the in¬
dividual. We cannot dwell however too seriously on the fact, that in
this case little more than laceration of the cuticle was sufficient to
permit of the entrance of the seeds of this horrible disease, for we
draw this inevitable conclusion, that it is proper in all cases, however
slight the wound, however doubtful the state of the animal, to ex¬
cise the part fully and freely at first ; to cauterize the cut surface
may afford additional security, and can be accompanied but by slight
chance of danger.

The theca spinalis was found externally unusually dry, and the
veins of Breschet comparatively empty ; but when the theca came to
to be minutely examined, it was found that while it was much in¬
jected with florid blood, yet its posterior half was much more so, not
only in its fibrous but also in its serous membrane, which was beau¬
tifully covered with stellular ramifications of microscopically minute
vessels. This half of the theca of the spinal column was also very
much thicker than the other, quite opaque, and in several places ad¬
herent by its arachnoid lining to the true arachnoid of the spine. In
the upper part of the theca, however, near the region of the respira¬
tory nerves, the anterior half of the theca was also very much in¬
jected. Between the theca, and the arachnoid coat of the spine was
a considerable quantity of limpid serum, about two drachms alto¬
gether. The arteries of the posterior column particularly of the up¬
per third cauda equinas column, and of the superior third of the an¬
terior column, were much more injected than is natural. This was seen
by Mr. Hinde and others. The chord itself, as well as the medulla ab-
longata and pons varolii, were of a remarkably firm and hard consist¬
ence. The integuments of the head did not appear to be remarkably

480

Original Communications .

injected, The data mater adhered firmly to the cranium, and was
very much injected, particularly in its arachnoid layer throughout.
The true arachnoid presented no traces of inflammation. The veins
and sinuses were remarkably full of black blood, which even in the
veins was coagulated. This state of veins prevailed in every part of
the encephalic mass, even within the ventricles, in which though the
plexus choroides was destitute of arterial blood, its vein was re¬
markably turgid. The arteries throughout the brain were almost
empty, and exceedingly small, a fact which Mr. Frankum and Dr.
Conolly both perceived. The cerebrum and cerebellum had both lost
their elasticity, and yielded unresistingly to slight pressure of the fin¬
ger. The ventricles, however, were remarkably dry, and contained no
fluid whatever. The cerebro spinal axis, even until we came to the
medulla oblongata, had lost its consistence, and all the encephalic
nerves were peculiarly tender at their origins.

The chest, when cut into, presented the left lung adherent to
every part of the parietes of the cavity, by means of its pleural in¬
vestment to the diaphragm, to the mediastinal pleura ; the connecting
bands, though strong, were all recent and traversed by longitudinal
vessels, passing from the lung to the parietes of the cavity, or vice
versa paralelly arranged, and containing florid blood. The right lung,
which adhered by a recent band to the upper part of its cavity, had
between its lobes several bands of a recent formation, and densely
crowded with longitudinal red vessels, collapsed, owing to its parie¬
tal attachments upwards, and floated upon about a pint of serum, re¬
sembling the washings of recently cut muscles. The pleura of this
side costel, mediastinal, diaphragmatic, and pulmonary, was intensely
inflamed, and dashed here and there with petechial spots.

The pericardium occupied a space of about three times the usual ex¬
tent, expanding nearly equally round its own region; when cut into, was
found distended by a large quantity of greenish translucent serum,
containing in it ragged flocculi, of coagulable lymph, very much thick¬
ened and coated in every direction, with a sort of flocculent deposit
of coagulable lymph of about l-8th of an inch in thickness, not only
on its free or capsular surface, but over its cardial portion. This ar¬
tificial membrane adhered, however, very firmly to every part of the
capsular and cardial part, and connected these two surfaces together
by small transverse bands of irregular and ragged coagula. When
this artificial deposit was elevated from the pericardium, whether of
the capsular or heart, that membrane was in both cases found to be
most densely injected, and covered with irregularly distributed pete-
chise, and sent several fine and delicate stellulse of vessels here and
there into the new membrane. The cellular tissue connecting the
pericardium, with the mediastinal pleura, was most remarkably in¬
jected and thickened, so as to render the margin of a section of these
two membranes together about l-6th of an inch in thickness. The cel¬
lular tissue was, however, far more intensely injected in the course of
the phrenic nerves, the substance of which also had a fleshy appear¬
ance from the intensity of the injection of its vessels. The substance

Dr. A. Thomson’s Case of Hydrophobia .

481

of the heart itself was of a paler hue than usual, the cellular tissue
between the muscular fibres appearing to be thickened, all its cham¬
bers contained dark coagulated blood ; its lining membrane was
universally injected with red blood, its tricuspid and mitral valves
were denser than usual, and the lining membrane of the aorta was
also in the loculi of vesalius round the orifice of the coronary arteries,
covered with fine and delicate stellula of red vessels. This last ap¬
pearance was so peculiar and of such rare occurrence that I displayed
it to several friends, Dr. Hogg, Mr. Hinde, Mr. Huddlestone, &c:
I never before met with it, although, I think I remember to have
heard Dr. Mackintosh, of Edinburgh, describe such an appearance.

There were no apparent pustules or vesicles, such as have been
observed by some, under the tongue, but the vessels at the side of its
inferior surfaces were more than ordinary turgid with red blood, its
anterior was covered with a dense dry fur, of a brownish hue, the pos¬
terior part, together with the tonsils, velum pendulum and pharynx,
were considerably injected, but particularly the latter. The mucous
folicles scattered over the base of the tongue, and around the glottis,
together with those, constituting from their denser approximation ; the
tonsils were remarkably turgid, so as to present the appearance at
first of tubercles with ulcerated apices, but upon nearer inspection
proved to be clogged and turgid, with an opaque viscid secretion.
The oesophagus was considerably inflamed throughout, and about its
middle part, sent of a small fistulous orifice, that passed into an in¬
durated and suppurating bronchial gland; from this part downwards
the inflammation became more and more intense, till on the central
part of the mucous membrane of the stomach, it arrived at its maxi¬
mum, and adhered, giving rise to a few extravasations in th e form of
petechia; . The stomach in fact was of one nearly uniform scarlet
hue, throughout the surface of its mucous membrane, but more par¬
ticularly towards its cardiac end. This inflamed state of the stomach
by isolating the gastric glands, enabled us to see them with unusual
facility. They are collected irregularly, and arranged with nearly
equal proximity round the cardiac and the hyloric orifices, gradually
becoming more scattered in proportion as they are distant from these
orifices, till at last they may be traced passing in lines of single glands
longitudinally along the prominent part of the longitudinal ridges of
the stomach, from one orifice to the other. This beautiful and un¬
usual appearance rarely to be seen, may be traced in the preparation
preserved in the London University Museum. These are 1 suppose
the glands of Brunner, but I could discover no quincunx order, such
as that in which they are said by Cloquet to be arranged, as it is true
as asserted by that author and by the Dublin dissector, that they are
more numerous, or as the latter asserts chiefly confined to the greater
and smaller curvatures of the stomach ; for the truth of this state¬
ment, I refer to the preparation in the University Museum. I ought
not to omit observing that Mr. Mayo, in his physiology, describes an
arrangement of these glands, approximating more nearly to the truth
than that of Cloquet and others. He observes “ the glands of the

Vol. v. no. 30. 3 L

482

Original Communications.

stomach are largest and most numerous near its orifices. At the con¬
junction of the oesophagus -with the stomach, they form a distinct
thickening, from three to four lines in breadth.” See thePhys. p. 160,
second edition, 1829.

The nerves of the tongue, the glosso pharyngeal, the descendens
noni, the lingual nerve, the lingual branch of the fifth, were all of a
fleshy colour in the region of the pharynx, owing to injection with
blood. The margin of the glottis, the two faces of the epiglottis and
the whole of the interior of the pharynx, were in a high state of in¬
flammation, particularly the surface of the cricoid and of the aryte¬
noid cartilages. The laryngeal 'surface of the epiglottis was consi¬
derably swollen, owing to turgescence of its mucous follicles of the
same kind, as that which has been related of those of the base of the
tongue. The mucous membrane trachea also, and bronchial tubes
throughout their ramifications as far as they could be traced, were in¬
tensely injected, and in common with the larynx were remarkably dry,
as if destitute of the natural secretion. The cellular tissue surround¬
ing the tongue, larynx and pharynx was considerably injected, as was
also the thyroid body. The pneumo gastric nerves were not of a
very red colour, till it approached the thorax ; but as they passed the
clavicles, became intensely red and remarkably injected ; this con¬
tinued throughout their course within the thorax. I have already al¬
luded to the high state of injection of the phrenic nerves. The bron¬
chial glands were most of them very much enlarged, indurated, yel¬
low in colour, in some instances of a cheesy consistence, and several
in a state of suppuration. Between these, which had apparently been
some time in passing into their present state, the left pneumogastric
nerve, in its course to the arch of the aorta, had been very much com¬
pressed and flattened, and its fibres as it were separated one from
another. The substance of the lungs, but particularly of that of the
left side, was in a state of high recent inflammation, of the first stage.
There were no remnants whatever of ancient disease to be traced in
the lungs, saving a small cicatrix at the upper part of that of the left
side, which lay immediately beneath the attachment of the pulmo¬
nary to the costal pleura, already mentioned as seen in that quarter.

In the abdominal cavity, the liver appeared remarkably bright and
florid, its peritoneal investment being much injected. The gall blad¬
der was full of dark-coloured bile. The whole of the intestinal tube
beginning from the stomach downwards ; was very much inflamed,
both in its mucous and serous coat. The duodenum however, the
latter end for about a foot length of the ileum, the colon and the rec¬
tum, were remarkable for the intensity of the injection of their mucous
membranes. The mesentery, however, with the omentum majus and
gastero-hepatic omentum, were more injected than any other parts
of the peritoneum, saving that which covers the diaphragm.

The kidnies were in a very high state of injection, such as is rarely
seen, and the mucous membrane of their pelvis and of the ureters,
was intensely inflamed, and here and there dashed with petechial
spots. Finally, the bladder was remarkably distended.

Dr. A. Thomson’s Case of Hydrophobia .

483

remarks:

I think it certainly fair to conclude that all the parts more imme¬
diately connected with the nerves devoted to respiration, or sympa¬
thizing- with these, were in a very excited and inflamed condition,
while it may certainly be seen in the preparation of the spine of this
child, preserved in the University Museum, that there is more injec¬
tion at the upper part of the spinal column, from which the respira¬
tory system of nerves take their rise, than elsewhere. It may also be
noticed in the same specimen, how much more the theca of the pos¬
terior column, as well as its other membranes, was inflamed or injected
than those of the anterior, a circumstance which may be fairly pre¬
sumed to account for the enormous susceptibility of the whole of the
surface in this remarkable disease. That the prior part of these ap¬
pearances were found also in the dog, and with one or two others,
led Mr. Youatt, now well known to the profession for his ingenious
and accurate papers and lectures on this subject, as well as for the
extreme urbanity with which he invariably communicates his infor¬
mation to those who wish to give it, as his decided opinion that had
the dog been suffered to live, all the ordinary symptoms of rabies
would have developed themselves in rapid succession.

Morbid appearances in the dog a few hours after death.

The master of the dog, although he had been conjured by Mr.
Youatt not to kill the animal, did however hang it on the morning of
the 23d. The dog having hitherto displayed none of the ordinary
symptoms of hydrophobia, and indeed no symptoms of disease at
all, we were all anxious to ascertain what morbid appearances would
be found. The pharyngeal third of the superficies of the tongue was
injected and marked with a red blush. The papillee of the same por¬
tion were more enlarged than is usual. The mucous membranes of
the inferior surface of the epiglottis, along its median line of the mar¬
gins of the rima glottidis, of the interior of the larynx, and more par¬
ticularly of that part covering the body of the cricoid cartilage, of the
whole of the trachea, and of its larger ramifications, of the superior
part of the pharynx, of the inferior half of the (esophagus, of the
whole of the stomach, of the first portion of the duodenum, and of
the whole of the rectum, were intensely studded with minute red
vessels. In the stomach and rectum indeed, the studding was so
dense, that the whole superficies bore a dark red hue, which presented
the most minute and beautiful ramifications of vessels arranged in a
stellular form. The maximum of intensity occurred about the centre
of the greater curvature of the stomach, where, in addition to the
blush, were to be seen several extensive patches of effused blood
underneath the mucous membrane. The serous coverings of the
stomach and rectum were likewise intensely inflamed. In the pha¬
rynx, at the upper part, the mucous membrane was considerably in¬
jected, but was less and less so in descending the oesophagus, till
about the middle third of this pipe, from which spot it became more

484

Original Communications.

and more influenced, till it reached the maximum point already men¬
tioned, as occurring about the centre of the stomach. The stomach
contained a considerable quantity of gnawed bones, some fragments
of straw and of hair matted together into a ball, all of them en¬
veloped in a thick, viscid, dirty, blackish, brown, disagreeably
scented, liquid. The rectum contained some softish, crude, yellow-
coloured foeculent matter. The mucous membrane of the bladder
also was spotted over with stellular blushes of minutely injected
vessels.

The lungs were remarkably florid, and had their own pleura on
both sides minutely injected, but particularly that of the left side. —
The lungs themselves were engorged with florid blood, being through¬
out of a bright red colour, and had here and there on their surface
opaque and milky spots, about the size of a pea, consisting of coagu-
lable lymph, effused between the pleura and cellular sheath of the
lobules of the lungs. The costal pleura of the left side was most
intensely studded with vessels carrying red blood, and elevated here
and there from the subjacent parts by patches of effused blood, from
the size of a millet seed to that of a sixpence ; and on the diaphrag¬
matic and pericardial part, by small patches, flat, white, wavy, and
as thick at their margin as in their centres, of a consistence resem¬
bling fibro, cartilage, varying in size from that of a millet seed, to
that of a half crown piece, confluent in some instances into an irre¬
gular plate. Besides these, the whole of the mediastinal and diaphrag¬
matic portions of pleura on this side were studded with minute vas¬
cular spongy bodies, resembling organized granulations, sometimes
scattered and distant, but, along the margin of the diaphragmatic in¬
sertion at the side, accumulated into a mass so as to resemble both ex¬
ternally and internally a recent fungus, of florid granulations, and
constituting a medium of attachment between the pleura of the ribs,
or of the side and that of the diaphragm. The mediastinal pleura
was certainly more injected over the course of the phrenic nerve
than elsewhere, the pericardium was not inflamed, even in its me-
diastical part ; the heart itself was in no way unsound in its ap¬
pearance, except in having its systemic auricle, together with the
vessels leading to it, and the pulmonic ventricle, and pulmonary
arteries, gorged to distention with black blood.

The dura mater and brain presented no unusual appearance, nor
did the medulla oblongata, or any part of the cerebro spinal axis, ap¬
pear remarkably injected. The spinal marrow was not examined,
because Mr. Youatt had other engagements. None, who had pre¬
viously seen dogs that had died under hydrophobia, examined, failed
to recognize the marked resemblance of the appearances found in this
case to those they had previously observed. Dr. Connolly, Professor
Pattison, Mr. Frankum, Mr. Youatt, and myself, left the theatre
with the conviction, that had the master had humanity enough to
have followed the earnest intreaties of Mr. Youatt, we should have
seen the animal pass through all the stages of this dreadful malady.

Dr. A. Thomson's Case of Hydrophobia .

485

Prevention of Hydrophobia after the wound.

This case is one of those which clearly points out the invariable
necessity of excising the part, however slight may be the abrasion,
for here it was very slight, and the utility of the same operation,
whether the dog have or have not demonstrated symptoms of rabies,
because, as in this case the seeds, as well as the power of communi¬
cating or transplanting these seeds may exist, without giving, at
least in the present state of our knowledge, any evidence of their ex¬
istence ; for even Mr. Youatt observed none in the dog previous to
his death. Acting upon this principle, I have formed the determina¬
tion of never undertaking the care of a patient, who has been bitten
by any dog, at least during the months of June, July and August,
unless the patient will consent to submit to excision of the wounded
parts. The pain of excision is slight, and if the cut surface of the
part be very well rubbed over with lunar caustic, not of long duration,
while the wound resulting from it is soon healed, so that even sup¬
posing the dog not to have been mad, little inconveniencie is suffered
by the patient, while great security will accrue, provided it have been
performed in time, supposing the worst happens. I have already
guided by these reasons, excised parts since the date of this case,
without much inconvenience to the patients, both from the arm of a
man and of a boy at the London University Dispensary. I did not
in either case wait a moment to enquire into the state of the dog,
which in neither afterwards turned out to be rabid. But in both I
felt indifferent after the operation to what might have been the state
of the animal.

Proposed regulations in regard to dogs, with a view to the pre¬
vention of hydrophobia.

1st. — To require all dogs found abroad, without an owner, during
the months of June, July and August, to be shot, or otherwise de¬
stroyed by the police.

2nd. — To require under a fixed penalty, all dogs taken abroad by
their owners, during these months, to be muzzled with a basket or
wire gauze muzzle.

3rd. — To require all dogs, that may during these months have
bitten any person, whether they may or may not have already ex¬
hibited signs of rabies, to be taken by the police, or by their
masters to a veterinary surgeon, licensed for the purpose, and to be left
under his care at a fixed rate, until such time as they shall be de¬
clared by him to be harmless. .

4th. — -To exact a given penalty from any master, whose dog may
be found to be in a rabid state.

These regulations even would offer but slight security, and the
last would almost appear tyrannical ; but, as this disease if it do not
arise from, is certainly promoted by, a want of due attendance to the
health of this useful domestic animal, such a regulation might tend
to suppress the malady.

70, George Street, Euston Square.

[ 486 ]

III. — A Case of Tubercular Disease affecting the Perito¬
neum, with the result of the post mortem examination, and
observations. By A. Blake, M.D. Member of the Royal
College of Surgeons, and Surgeon to the 7th Regiment
of Dragoon Guards.

Regimental Hospital , 7th Dragoons , Canterbury .

Acting troop serjeant- major James Gourlay, of the Seventh
Dragoon Guards, a man of sober habits, and the bilio-san-
guineous temperament, aged 37 years, 18 of which he passed
in the service, and during the greater part of that time in
the capacity of paymaster’s clerk, commenced the duties of
a troop serjeant-major about five months ago ; in conse¬
quence of which it became necessary for him to repass the
ordeal of drilling indispensable to the formation of an effec¬
tive dragoon ; such as riding for several hours a-day with or
without stirrups, & c. &c. Previous to this change in his
pursuits, he led a very sedentary life, and latterly seemed
much disposed to obesity, but did not complain of ill health.
About three months ago, having then gone through two
months of his drill, he applied to me in consequence of a
painful sensation of weight, which he experienced in the
region of the spleen, and attributed to the exercise of riding.
On examination, I was unable to discover any unnatural for¬
mation in the part alluded to, which may have been owing to
a considerable deposition of fat, which existed in the abdo¬
minal parietes. I notwithstanding recommended to the
commanding officer, that the riding part of his exercise
should be dispensed with for a fortnight ; and as the biliary
secretions seemed defective, and the bowels sluggish, he
took blue pill, bitters, with alkalies, and occasional purga¬
tives. Under this treatment he improved rapidly, and was
enabled to resume all his military duties, which he continued
to perform until the middle of September ; at this period the
left side became again painful, and he was attacked with
dysentery. I was not then present with the regiment, but
the gentleman who performed my duties prescribed castor
oil, effervescing draughts, enemata and external fomenta¬
tions, as the symptoms indicated, without obtaining much
relief; a consultation was then held, at which an expe¬
rienced physician assisted, and it was determined, in addi¬
tion to the remedies already in use, to try the effects of calo-

Dr. Blake on Tubercular P eritoneum.

487

me! and opium, pushed so as to affect the system speedily,
and also to employ the warm bath, together with mercurial
and stimulating frictions, to the affected side. Under this
treatment, the symptoms mitigated somewhat, and the bowels
were quieted, but costiveness ensued, while the stomach con¬
tinued irritable. He also continued to suffer from uneasiness
in the left hypochondrium, but no direct inflammatory symp¬
toms manifested themselves. At this period also, the abdo¬
men began to tumify, as if from the presence of a mixture of
air and serum ; this additional swelling precluded altogether
the possibility of examining, in a satisfactory manner, the
subjacent viscera. On minute investigation, however, the
hand, when pressed on the abdominal parietes, seemed to
come down upon a hard substance, situated to the left of the
umbilicus, in nearly the situation of the stomach. When I
saw this patient on the 19th Sept. I found him in the state
above described, and learned that he had admitted having-
been without an alvine evacuation for nearly ten days , pre¬
vious to his having reported his indisposition, and likewise
that he had suffered uneasiness for several days from the
pressure of his sword belt on his left side. He also stated
that he had been annoyed by a dry short cough, which he
fancied depended on the state of his stomach, for some years
past. He at the same time endeavoured to palliate the im¬
propriety of his conduct, in not having reported his illness
sooner, by alleging his anxiety to become qualified for the
rank to which he aspired. Although the nature of his dis¬
ease did not indicate actual inflammation, I was induced to
bleed him, wishing to act on the safe side, and w7ith a view
to observe the effects of the loss of blood on the symptoms
generally; I did not however allow more than 12 ounces to
flow, as its loss did not afford any relief, and its quality pre¬
sented no marks of existing inflammation. Stimulating and
mercurial embrocations were then applied to the abdomen,
and the mercurial treatment recommended by Dr. Chisholm,
of Canterbury, who was kind enough to afford me in this
case the benefit of his long experience, was continued. Our
efforts were also directed towards allaying the irritability of
the stomach, and inducing the return of natural alvine eva¬
cuations. To accomplish these ends, effervescing draughts,
hydrocyamic, acid, opium, laxatives and purgatives, includ¬
ing croton oil, antispasmodics and emollients, were seve¬
rally resorted to, but with little better effect. The irritability
of the stomach increased daily; and at the same time the
nature of the matter ejected from it gradually degenerated

488

Original Communications .

in quality from that of ordinary food,, until it assumed more
decidedly the character of the black vomit of the yellow
fever, which it latterly resembled in every respect. At this
period the patient was harassed by an intense burning sen¬
sation in the stomach, accompanied by most distressing- sin¬
gultus, more particularly when he lay on either side, or in
the horizontal position. This latter symptom was in some
measure relieved by the occasional administration of magne¬
sia, opium, alum, and the mineral acids, employed in turn ;
but they did not succeed in removing it altogether. A large
quantity of mercury was used in this case, both internally
and by friction, but yet the gums were scarcely affected, nor
was the effusion in the peritoneal cavity apparently dimi¬
nished. It did not, however, increase much until within
two days of the fatal termination. Nor were the extremities
at any period affected with oedema. During the course of
the disease, the pulse was quick and irritable throughout,
after reaching 120 in a minute; but it did not possess any of
the characters indicative of membranous inflammation. The
tongue also was but little loaded, and its edges were gene¬
rally red, and remarkably clean. The bowels, when not
under the influence of purgatives, continued obstinate; but
the nature of the alvine evacuations, when attained, differed
very materially from the matter ejected from the stomach, in
as much as they did not possess that resemblance to cof¬
fee grounds, which the latter so exactly presented. On
the contrary, until within the last three days of existence,
the stools were bilious, and comparatively natural. At this
period the irritability of the stomach appeared to subside,
while the bowels became suddenly relaxed, and the evacua¬
tions assumed all the appearance of the matter termed black
vomit. About this time likewise, the distension of the abdo¬
men diminished, and the hard body already spoken of could
be distinctly traced in the direction of the transverse colon.
It communicated to the fingers the precise feeling which the
acute edge of an enlarged liver would afford ; indeed, the
fingers seemed to pass under its edge in so natural a man¬
ner, that it was impossible to imagine the tumour to be pro¬
duced by any other body.

As nature became exhausted from the want of nutrition,
general debility and relaxation ensued, the absorbents seemed
to lose their power, and serous exhalations accumulated
within the cranium and abdomen, inducing symptoms indica¬
tive of pressure on the brain, namely, strabismus, loss of
vision, stertor, coma, and finally death — a consummation

Dr. Blake on Tubercular P eritoneum.

489

devoutly to be wished for, in this most distressing- and
incurable affection. The fatal event took place on the 18th
instant.

The post mortem examination was made 24 hours after
death, in presence of Brs. Chisholm and Carter, and Sur¬
geons Renwick and Sicard, of this city.

The body generally appeared to have underg*one consider¬
able emaciation, while the abdomen was distended as if from
ascites. There was not, however, the slightest appearance
of oedema in the extremities. On percussion, the abdomen
yielded a well marked tympanitic sound, so as to render
problematical the presence of much water in it ; but a hard
* substance extending across the abdomen, and resembling
exactly in situation and feel the anterior edge of an enlarged
and indurated liver, was distinctly recognized by all present.
On opening the abdomen by the usual crucial incision, we
were surprised to find that notwithstanding the tympanitic
sound elicited by percussion, no air escaped, while at least
two gallons of a serous fluid rushed out with some violence.
After which the real nature of the disease was disclosed.
The indurated substance, which we had felt occupying the
situation of an enlarged liver, was found to be a tuberculated
mass, of cartilaginous hardness, and presenting the appear¬
ance of what Mr. Abernethy terms tuberculated sarcoma,’'
having an indurated and knotty structure, while its summit
was covered with red and granulated coagulable lymph.
This almost carcinomatous formation was fully an inch in
thickness, and in some parts four inches in breadth ; it occu¬
pied the base of the omentum in its whole extent, and was
closely attached to the arches of the colon and stomach.—
At the pyloric orifice of the latter viscus, this substance
stretched across to the liver, and nearly obstructed altoge¬
ther by its pressure, the passage of its contents into the duo¬
denum ; and in the course of the colon below the anterior
edge of the spleen, a circular band was also observed to
surround, and strongly constrict that intestine.

This disposition to tubercular formation, although it seemed
to have its principal seat in the omentum, was likewise to be
found wherever the peritoneum extended ; thus its entire sur¬
face presented a beautifully stellated appearance, being
literally studded with small white tubercles, of a cartilagin¬
ous hardness, similar in structure to the subcutaneous tuber¬
cle described by Surgeon Wood, in the Edinburgh Medical
and Surgical Journal, for the year 1812. The surface of the
liver, stomach, and the abdominal surface of the diaphragm,

Vol. V. NO. 30. 3 M

490

Original Communications .

were not free from these diseased productions ; and the
mesentery , in its entire course, was prodigiously thickened
and indurated by their presence, so much so as to impede
the vermicular or peristaltic motion in the intestines, and
thereby deprive them of the necessary means of propelling
their contents through them, in a direction oftentimes con¬
trary to the laws of gravitation ; hence their apparent loss
of tone in this affection. On examining the coats of the
stomach, they were found to be much thickened from inter-
stertiai effusion of coagulable lymph ; and its mucous lining
was dark coloured, soft, and easily detached; the whole of
the intestines, but particularly the coecum and appendix ver-
miformis, were also much changed in structure, being thick¬
ened and indurated. The liver presented a shrivelled, olive
appearance externally, and its interior resembled a nutmeg
in colour ; but its parenchyma did not seem to be materially
altered. The gall bladder was much distended, with black
and nearly inspisated bile. The remaining viscera of this
cavity were not diseased.

The thorax presented nothing very remarkable; no tuber¬
cles were discovered io it. These parasitic excrescences
seemed to have limited their habitation altogether to the
extent of the peritoneum. The lungs of the right side, how¬
ever, w ere observed to be adherent to the pleura costalis, ex¬
hibiting the effects of inflammation of some very ancient date ;
and the intercostal spaces were found to be remarkably wide,
owing po doubt to the efforts wrhieh nature would have made
to enlarge the cavity of the chest, in proportion to the incur¬
sion made on it by the abdominal contents. The head was
not opened, owing to the time which the other parts occu¬
pied in their examination.

A preparation, showing the diseased productions alluded
to, has been made and deposited in the Military Medical
Museum, established at Chatham, under the patronage of
Sir James M'Grigor.

REMARKS.

Cases, which very closely resemble the one just detailed,
may be found in the works of Morgagni and others. Baillie
also, in his Morbid Anatomy, speaks of scrophulous masses,
adhering to the peritoneum, and likewise of cancerous tu¬
mours adhering to that membrane, but no author that I have
read has described this affection with so much accuracy,
both with regard to its nature and symptoms, as Dr. Baron,
of Gloucester. The symptoms and result of his dissections
related in the cases contained in his work on “ Tuberculated
Accretions of serous Membranes,” so exactly coincide with

Dr. Blake on Tubercular Peritoneum.

491

the details of the present case, that I am induced to con-
sider the profession under considerable obligations to this
author, for having its attention so particularly directed to a
species of disease which evidently presents symptoms in a
remarkable degree peculiar to itself : and although we may
possess the melancholy assurance, that when the disease has
once attained a certain height, there is little or no hope of
preventing a fatal issue, it is both useful and satisfactory to
be enabled to form a just prognosis in such cases, and by
early attention to the diagnostic symptoms to discover the
real nature of the disease at its origin, at which period alone
remedial treatment can be prescribed with any hope of suc¬
cess. After this we must rest satisfied with the administra¬
tion of palliatives, with a view to sooth the extreme suffer¬
ings, which are but the tedious precursors of death.

The case detailed in the preceding pages appears to me to
have been of very long standing ; and it is more than pro¬
bable that had not ambition laid hold of the subject of it, and
induced him, at his comparatively advanced age, to change
his habits suddenly from those of a paymaster’s clerk to
the active life of a cavalry recruit, he might have been
alive still. The perpetual and violent jolting which riding'
exercise must have caused, no doubt tended to render the
growth of the diseased parts more rapid than it otherwise
would have been. This disease seems in its first stages to
be productive of but little inconvenience, for as long as the
parasitic tubercles, which are situated exterior to the viscera,
though behind the peritoneum, do not influence mechanically
the functions of ehylification and digestion, their presence
occasions no uneasiness. As soon, however, as they begin
to impede these important functions, either by their bulk and
general attachment to the intestines, or by making partial
pressure on some of the viscera, a consequent train of symp¬
toms is developed. The mere effect on the intestines of
being so surrounded and fixed by these tubercular masses,
as to have their peristaltic or vermicular motion impeded, is
quite sufficient to prevent them from having the power of
propelling their contents in a course, as I have said before,
which is oftentimes in direct opposition to the laws of gra¬
vitation ; hence costiveness follows, and very soon after
sub-acute inflammation of their mucous linings may be ex¬
pected as a natural consequence. Excreraentitious matter is
not meant to sojourn beyond a given period within the sys¬
tem ; after which its presence becomes a source of irrita¬
tion and subsequent inflammation, and ultimately of all the
symptoms met with in cases of this nature.

492

O r ig in a l Comm unicatio ns.

I must here offer my support to the assertions of Dr.
Baron, that the sensation of weight and burning heat,
referrible to the stomach, or what he emphatically terms
the feeling of “ broiling heat,y in that part, may be regarded,
when taken in combination with other symptoms, such as
vomiting matter, resembling coffee grounds, &c. &c. as a
pathognomic sign of this disease ; and its presence will aid
us materially in our diagnosis in these cases, which must
be extremely perplexing to those who have not had expe¬
rience oil this subject, and more particularly so, if they
shoukl happen not to have read Dr. Baron’s book with
attention. I have not ventured to attempt an explanation
of the origin or peculiar nature of these productions, which
in this case, when examined individually, resembled exactly
in structure the sub-cutaneous tubercle of Mr. Wood, already
alluded to. Dr. Baron considers them to have a hydatid
origin, and recommends a consequent plan of treatment,
for which I must refer to his work on the subject.

With regard to his Methodus Medendi, however, I must
sav that I perfectly coincide with him in the plan he recom¬
mends. I also think his views of the cause of the disease
ingenious, and probably correct ; but I do not feel myself
capable of giving a positive opinion with regard to it.

It only remains for me to beg the indulgence of my rea¬
der, for the perhaps unnecessary length of these details and
observations, which the severity and unrelenting nature of the
disease alluded to in them induced me to write.

Canterbury, 25th Oct. 1830.

Note by the Editor. — Dr. Blake need not make any apology for the
length of his interesting communication, or the scientific explana¬
tion he has given of the symptoms of the disease. His account is
accurate, concise, yet comprehensive, and bears ample evidence of
the cautious and judicious practitioner. His long and great expe¬
rience in the army, during a period of 26 years, and in opposite cli¬
mates, and his original views on delirium tremens, prove him to be a
man of a thinking mind, and of faithful observation. It affords us
much pleasure to notice contributions from army surgeons, which are
generally characterised by the most scientific and sound practical
views ; in fact, the clinical reports of our military surgeons are much
more graphic and scientific than those of civil practitioners ; and this
is easily accounted for, by reference to the excellent regulations of
Sir James M‘Grigor and his colleagues at the head of the Army
Medical Department.

[ 493 ]

IV. — Mr. Myers on Neuralgia.

O

Miss G- set 30, of a sanguine temperament, applied to me, labour¬
ing under a violent neuralgia of the right side of the face, along the
course of the branches of the fifth pair of nerves ; she had been under
the care of a physician, and had tried a great variety of remedies, but
without success ; for upwards of twelve months, prior to my seeing
her, she described the pain as a kind of electric shock or fluttering
sensation, her countenance was anxious, pulse 100 and irregular,
slight pain in the epigastrium, furred tongue, bowels relaxed, menstru¬
ation natural, no inflammation or alteration of structure of the parts
affected, perspiration natural. By the urgent solicitation of the pa¬
tient, who imagined that the pain originated in consequence of a
diseased tooth, I- was induced to extract it ; but finding no relief, 1 or¬
dered her to take the following pills.

Ext. cinchon, gr. xxxvj. sulph. quinin. gr. xviij. miscse fiat,
mass, et divid. in pil xij. capiat segra. ij. ter in die habeat, pil
hydrarg. gr. iv. alter nocte sum.

When I called next day, she was much the same as before ; I de¬
sired her to continue with the same pills, at the same time giving her
this anodyne draught — P. ipecac, comp. gr. x, tr. opii. m. xxx,
sy. 5ii> aquae ^ii.

Passed a better night than before, having slept two hours, but still
there remained a great deal of constitutional excitement, pulse 96,
much weaker than before. I ordered her milk diet, allowing to take
a glass of white wine daily, desired her to continue her pills and ano¬
dyne draught, and in addition ordered her to take an aperient draught,
with senna and salts, in the morning. She continued these means
for upwards of seven days, without any mitigation of pain or removal
of symptoms ; the bowels more regular than before. I then thought
of trying the carb. ferri. I immediately gave her the following pow¬
ders and mixture, ordering her to discontinue her other medicines ;

pulv. cinam, gr. iij. pulv. capsici, gr. \ carb. ferri. 3ij, the fiat
pulv. cujus sumat j ; 6 quaque hora. 5^ tr. aurant 5iij> tr. hyos-
ciam 5ii> tr. cinchon 3j, aquse sivss, rq cujus sumat, J part post
pulv. I called next day and found she had passed a pretty good
night, but in other respects no better ; she had three motions of
a very black colour, at which she appeared very alarmed, but after
having satisfied her on that point, I advised to continue the same me¬
dicines omitting the p. capsici and cinam, and increasing the carb
ferri gr. x, sing dos, c mist ut antea.

She continued these means for three days, and then told me, that
she had a great pain and uneasiness about the anus, which I found
to be hemorrhoids ; she had found a relief from the neuralgic pain,
and wished to continue her medicines ; she could now masticate her
food without being put to that excruciating agony she before endured,
while exercising that process ; I then ordered her to apply a lotion to
the piles, composed of alum 3ss, bruised, galls, ai, to be boiled in a

494

Original Communications .

pint of water, and strained when cold, to be used, and of Lac
sulph. in Bii> of which she was to take a table spoonful, every night
and morning. She continued these, remedies as well as the pulv. et
mist, for one week, when to my surprise she called upon me, it being
the first time she had been from home for upwards of three months,
and said that she was much better; her pulse was 80, her tongue moist.
I said she had better continue the same remedies, and reduced the
dose to 80 grains of carb. ferri, and gave the following pills, imme¬
diately ; ext coloc comp gr. vij, pil hydrarg gr. iij, p. capsici gr. rq
in pil ij, st sumend ; these pills produced two or three copious, dark
coloured motions, and she felt relieved from the pain in the epigas¬
trium, piles disappeared, and the facial neuralgia nearly well ; pulse
now was 80, complain of throbbing of temples, and nausea produced
by the carb. ferri; ordered to continue the same medicines for one
week, which she did, and was then all but well, when she complained
of palpitation of the heart, which might be seen and heard, quite dis¬
tinctly. I gave her the following pill, which had the powerful ef¬
fect of relieving her; — fy. ext. hyosciam gr. ij, pil hyd. gr. j, p. di¬
gitalis, gr. conf 8, s, fiant Pil iij, h, s, sumendse.

She continued taking the carbonate in doses of 100 grains, four
times a day, for three weeks, when she expressed herself as being
perfectly cured, and has had no return, although three months since.

V. — Medico-legal questions, relating to Ambiguity of

Sex, and to Utero- gestation. By M. Ryan, M. D.

Ambiguity of Sex. — Hermaphrodites . — There may be
malformation of the genitals in both sexes, but there is no
example of one individual possessing the perfect organs of
both. Again, the organs may not resemble those of either
male or female. There is no truth in the statement, that
hermaphrodites have married and propagated, the obstetri¬
cian is aware of the physical impossibility of a full grown
infant passing through the male pelvis. It is evident that
hermaphrodites must be impotent and sterile. The ancients
were of opinion that such persons might propagate ; even a
canonist went so far as to maintain one individual could
propagate within himself or herself — ■“ tanquam mas gene-
rare ex alio, et tanquam fcemina generare in se ipsa.” There
is no case on record of a perfect hermaphrodite, and no
truth whatever in the assertion that such class of beings
can propagate the species. I can see no difficulty in sup¬
posing that persons of both sexes, with malformation of the
genital organs may marry, when I recollect the curious and

Dr. Ryan on the Signs of Utero- gestation. 495

well attested case of a female who dressed in male attire,,
and assumed the name of James Allen, married another
female, and lived as a husband for several years without
detection. This case happened in London last year, and
was discovered when Allen died, and on dissection was
found to be a well formed female. Blackstone says, a
monster having deformity in any part of its body, yet if it
hath human shape may inherit, and every heir is male or
female, or hermaphrodite ; that is, both male and female,
and shall be heir according- to that kind of sex which doth
prevail, and accordingly it ought to be baptised. The same
is observed in cases concerning tenants by curtesy.” As the
brain is generally perfect in monsters, and the mind perfect,
it is clear that such persons ought to inherit property.
When twro perfect bodies are united at the chest or back,
as in the cases of the Siamese youths, lately exhibited in
this city, and the Hungarian sisters, exhibited in 1723, it
would be difficult to determine primogeniture, or right to
property.

Utero- gestation. — Pregnancy .

This is a subject which requires great attention from the
medical jurist, on account of the numerous relations it has
to civil and criminal proceedings. It affects the honor of
husband and w7ife — it arrests the administration of justice
when offered as a plea for reprieve — it aggravates an as¬
sault when abortion occurs, which renders the crime a
felony ; it may be pretended, and deception attempted on
the medical attendant, and others ; or the female may accuse
the person of causing abortion, it may be concealed, and it
may affect the honor and property of parents and children,
as in its protracted state, which involves legitimacy.

For the better understanding of this important subject,
it will be necessary to describe the signs of conception and
pregnancy, including spurious, extra-uterine, false, pre¬
tended and concealed utero-gestation, superfoetation or se¬
cond conception, abortion, natural and provoked, duration
of pregnancy, recent delivery, survivorship of parent or
offspring, viability of infant monsters ; and lastly, prolicide,
foeticide, infanticide. These and all other medico-legal
questions relating to obstetricy, I have fully discussed in my
work on Midwifery, a plan adopted by foreign writers; but as
yet neglected by the writers of this country. I shall notice
them as concisely as possible on the present occasion.

496

Original Communications.

Signs of ordinary pregnancy. — The signs of pregnancy
may be divided into rational and sensible. The first result
from the influence of the uterus on the moral and physical
systems of the female,, and these are disorders and derange¬
ments of the organic functions or vital properties. The
second result from the developement of the uterus, and the
presence of the foetus in that organ.

Rational signs. — It is a vulgar opinion professed by Hip¬
pocrates and Galen, that a fecundating copulation is ac¬
companied by more vivid enjoymentthan an ordinary coition.
The following signs usually occur after conception : — there
is a change in the moral and intellectual faculties, in the
temperament and constitution of the female ; the eyes lose
their vivacity, their brilliancy, and become languid ; the
eyelids are surrounded by a blackish, livid or leaden colored
circle ; the nose is elongated, the mouth is smaller, the
countenance is changed, the voice is stronger, the neck
fuller, transpiration more odorous, the character more de¬
cided, and the passions more violent ; the menses are gene¬
rally suppressed, the mamma? are firmer, more sensible and
more developed, sometimes secreting a thin, whitish serous
fluid ; the nipple is more prominent, the areola is enlarged
and of a browner colour. Immediately after conception,
the female experiences unaccustomed sadness, a tendency
to fainting or complete syncope, horripilations, colic, and
a vermicular motion in the uterus, which extends to the
abdomen, borborygmi, and rigors. There is sometimes
anaphrodisia, sometimes increased salacity. The pulse be¬
comes more frequent, weaker, or fuller and softer, the
temperature is increased, the transpiration is more abun¬
dant, the urine is more copious, turbid and cloudy, the
secretions are increased, there is often ptyalism, the hepatic
functions are disturbed, and there are spots and ephiledes
on the face and skin. The taste and digestion are depraved,
anorexia, nausea, inappetence and vomiting supervene, the
female desires innutritious or disgusting foods, as chalk,
cinders, putrescent animal food, vegetables, fruits, acid
drinks, and vinegar, & c. This inappetence and depraved
taste, are followed in a few months by a keen, voracious
appetite, but towards the last month of pregnancy, the
digestive functions become deranged, as the stomach is so
confined by the gravid uterus, that it can contain but a
small quantity of aliment.

The moral state is subject to numerous changes, some
women, naturally gay and amiable, become sad, melan¬
choly, and insociable, and vice versa. Many diseases ap-

Dr. Ryan on the Signs of Utero- gestation.

497

pear, others disappear, as hysteria, chlorosis, chorea, epi-
lipsv. The whole of these signs are seldom observed in
all cases, and are doubtful and uncertain. If all are present
they afford strong- proof of pregnancy, but never that posi¬
tive certainty which enables us to give decisive evidence
before magistrates.

Sensible signs. — These signs consist in augmentation of
the abdomen, in the active and passive movements of the
foetus, in the perception of the foetal and placental pulsa¬
tions by means of auscultation, in the evidence afforded by
the touch or vaginal examination, or ballottement , as to the
state of the os and cervix uteri in the different stages of
gestation, and the developement of the uterus. The most
certain of these signs are the touch or ballottement, and
auscultation. The touch consists of the introduction of the
finger into the vagina, and the application of the other hand
above the pubis, the uterus will be felt enlarged, and if
gentle percussion be applied above the pubis, the foetus will
be made to strike the finger, which cannot happen unless
there be a foetus and a fluid in the uterus. However, the
sign is not always conclusive, for it has existed in extra-
uterine fcetation. The sign can only exist about the fifth
or sixth month, and has led to mistake even at the approach
of parturition. (Capuron Malad. des Pem. p. 72.) The re¬
sults of auscultation exist, in some degree, when the foetus
is dead, and also in extra-uterine foetation. The changes of
the neck and body of the womb enable us to distinguish
pregnancy from hydropsy, tympanites, hydrometra, hyda¬
tids, moles, polypi, &c.

The spontaneous motions of the foetus take place about
the fifth month, but some women never perceive them dur¬
ing the whole period of gestation, others imagine them pre¬
sent, when there is no conception. Nervous and hysterical
women very frequently make the last mistake. The sponta¬
neous motions of the foetus and quickening, are not infal¬
lible proofs of pregnancy. Auscultation has been called
into action to enable us to decide this point. M. Le Ju-
meau de Kergaradec has applied the ear and the stetho¬
scope to the abdomen, and discovered the double motion of
the foetal heart, and also the pulsation of the placenta,
which' was synchronous with the maternal pulse. It is to
be recollected, that the first must change with the infant,
and consequently must be heard in different parts of the
abdomen, at different examinations. Dr. Kenedy, of the
Dublin Lying-in Hospital, has written in favour of auscul¬
tation, in the Dublin Hospital Reports, vol. v. 1830. — <

Vol. v. no 30. 3 N

498

Original Communications .

M. Velpeau has tried it in a great number of cases in vain.
Traite Elementaire des Accouch. 1829. Dr. Fergusson, of
Dublin, thinks it an unequivocal proof. Dub. Med. Trans,
vol. 1, 1830. From the preceding considerations, the fol¬
lowing conclusions may be drawn : —

1. That the foetal and placental pulsations, when disco¬
vered by auscultation, are positive proofs of pregnancy.

2. That in ad cases before the fourth month, the diag¬
nosis is extremely uncertain.

3. That during the five succeeding months, better evi¬
dence is afforded by the progress of uterine develope-

ment.

4. That there is no infallible sign of pregnancy, except
that afforded by auscultation.

Previous to the application of auscultation, it was held
by the following authorities, that there was no infallible
sign of pregnancy in the early months : — Hamilton, Burns,
Mahon, Fodere, Capuron, Farre, Male, Beck, Smith ; Edin¬
burgh Med. & Surg. Journ. 1823, vol. 19. Med. Chir. Rev.
1824. Med. & Phys. Journ. 1825. For exact references,
see my work on Midwifery.

Dr. Beck concludes, that it is impossible to decide on
pregnancy before the sixth month, but this opinion is refuted
by subsequent experience. We may derive advantage from
attending to the signs of the different epochs of pregnancy,
which are afforded by the developement of the uterus.
During the two first months the diagnosis is extremely
obscure, and cannot be attempted with any degree of cer¬
tainty. At the end of the third month, the fundus uteri is
developed, directed towards the sacral concavity, round,
gaping, and thickened ; the limbs of the foetus may be often
felt through the abdomen. At the end of the ninth month,
the uterus becomes depressed under the epigastrium, the
orifice of the uterus is more easily felt, rounded and often
open, the head of the infant can be readily felt. In women
who have had former pregnancies, the uterus does not
ascend so high as in first cases, as the abdominal muscles
have been relaxed, and it therefore inclines more forward.
In diagnosticating, in cases of doubtful pregnancy, we
should not forget to bear in mind the appearance of the
abdomen in ovarian dropsy, and here a careful history of
the symptoms will enable us to arrive at a correct conclu¬
sion. I have frequently known young' women affected with
let the hand be immersed in cold water, and suddenly ap¬
plied to the abdomen of the female ; and in cold weather,
let the hand be immersed in warm water and applied, when

Dr. Ryan on the Signs of Utero- gestation. 499

the motion of the infant will be distinctly felt. I have often
acted on these suggestions with success. It is also to be
remarked, that the cervix uteri begins to diminish in length
at this period, as well delineated by Gooch and Meygrier.
At the end of the seventh month, the uterus approaches the
inferior margin of the epigastric region. The abdomen
affords a dull fluctuation, which differs from that of ascites ;
percussion affords a dull sound, which is distinguishable
from tympanites or meteorism. At the end of the eighth
month, the uterus is in the epigastrium, the cervix nearly
on a level with the superior margin of the pubis ; at the end
of the fourth month, the uterus is in the hypogastrium, the
spontaneous motions of the foetus are perceived by the
mother, and the diagnostic styled hallottement , is afforded
to the obstetrician. At the end of the fifth month, the
uterus touches the inferior boundary of the umbilical re¬
gion, and the cervix uteri is elevated in the vagina. At the
end of the sixth month, the uterus is felt at the umbilicus,
and as this part projects, the motion of the foetus may be
felt by the practitioner. We can now avail ourselves of
auscultation. Morgagni proposed the following plan for
discovering the motions of the foetus. In warm weather,
this disease, to have all the appearances of pregnancy ;
the general health suffers little, and sometimes not at all ;
the catamenia are regular — the usual symptoms of preg¬
nancy are absent, and upon close inquiry, it will be found
that pain commenced in the ovary, and the tumour was first
in one side. In this, as in all other cases, a knowledge of
disease will alone enable us to diagnosticate correctly. This
knowledge is to be obtained by reference to the best sys¬
tems of obstetricy, and by actual experience. It would
far exceed the limits by which I am circumscribed, were I
to describe the various diseases which may be mistaken for
pregnancy. I must refer the reader to the standard works
upon this subject. After a luminous description of the
diagnosis in the case before us, and all its difficulties,
M. Velpeau concludes, <e but it is dangerous to forget that
there exist causes without number (of deception), and that
before the tribunals one ought never to give a decisivejudg-
ment, without having previously acquired a mathematical
certitude of the fact upon which he pronounces.” This is
the received opinion of the present time.

Dr. J. C. Fergusson has published five cases of concealed
pregnancy in the Dub. Med. Trans. 1830, in all of which
he was enabled to discover the pulsations of the foetal heart
'and bruit of the placenta. He says, I conceive it to be

500

Origiuat Communications .

sufficiently established, that either a placenta or foetal heart
being heard, constitutes infallible evidence of pregnancy ;
evidence upon which a medical man may, if required, con¬
scientiously and positively swear to the fact, which I believe
all admit, and our legal records show, could not be done
under ordinary circumstances. * * * * The absence of
these phenomena amounts, if not to positive, at least to
presumptive proof of the contrary.” I cannot agree with
these conclusions, because many practitioners may not be
sufficiently dexterous with the stethoscope to detect the pul¬
sations ; and as further evidence is required to warrant the
latter conclusion. It is very manifest, however, that aus¬
cultation ought to be employed in doubtful cases of utero-
gestation.

In cases of extra-uterine fcetation, should the Caesarean
operation, or rather gastro-hysterotomy be performed, the
infant cannot inherit property according to the laws of this
country. (Blackstone.) This is the only medico-legal point
connected with the subject. A point of much importance
to be decided is, whether twins be the result of one coition,
or of superfoetation. The decision will affect primogeni¬
ture. The question has not been discussed by any British
writer on forensic medicine except myself.

Superfoetation. — Physiologists are at issue upon the ques¬
tion of superfoetation, or that it is possible for a pregnant
woman to conceive a second time. According to Aristotle, a
female was delivered of twelve infants, and another of twins,
one of which resembled her husband, the other her lover.
Some writers maintain that superfoetation is possible during
the two first months of preg. ancv ; the majority hold it
possible during the first few days after conception, before
the uterine tubes are closed by the decidua. This is the
received opinion, though cases are on record which justified
Zacchias and other jurists, to conclude that superfoetation
might occur until the sixtieth day, or even later. Nothing is
more common than to see a full grown infant born, and
another of the second, third, fourth, fifth, or sixth month
expelled immediately after. I need not cite authorities upon
this point, as obstetric works abound with examples. But a
few examples may be given. Dr. Maton published an ac¬
count of a woman who was delivered of a full grown infant,
and in three calendar months afterwards of another, appa¬
rently at the full time. Trans. Coll. Phys. vol. iv. A woman
was delivered at Strasburg, the 30th of April, A 748, at ten
o’clock in the morning ; in a month afterwards M. L eric he
discovered a second foetus, and on the 16th of September,

Dr. Ryan on Superfoetation.

501

at live o’clock in the morning, the woman was delivered of
a healthy full grown infant. Manuel Complet de Med. Leg.
par Briand. Degranges, of Lyons, attests a case, the woman
was delivered at the fuil time the 20th Jan. 1780 ; in three
weeks afterwards she felt the motions of an infant, and her
husband had no intercouse with her for twenty-four days
after delivery. On the 6th of July, (five months and six¬
teen days subsequent to delivery) she brought forward a
second daughter, perfect and healthy. On the 19th Jan.
1781, she presented herself, and both infants, before the
notaries at Lyons to authenticate the fact. Fodere, vol, 1 .
These cases prove the posssibility of superfoetation, four,
five, and six months after conception. This may be pos¬
sible, as menstruation has occurred during pregnancy, (Mau-
riceau, Deventer, Heberden, Francis, Hossack, Dewees,
Capuron, Mayo.) Buffon related a case of a woman in
South Carolina, who brought forth a white and a black
infant, and on inquiry, it was discovered that a negro had
entered her apartment after the departure of her husband,
and threatened to murder her unless she complied with his
wishes. Dr. Mosely relates a similar case. A negress, of
Guadeloupe, brought forth a black and mulatto, having had
intercourse with a white and black man the same night.
Another negress produced a white, black, and a piebald
infant. A domestic of Count Montgomery produced a white
and black child at one birth, (Velpeau.) Gardien relates
a similar case on the authority of M. Valentin. A mare has
produced a foal and a mule, she having been impregnated
by a horse, and in five days afterwards by an ass. In
treating of this subject, in my work on Obstetrics, 1828,
1 made the following remarks : —

f‘ Another argument, which I have never seen, occurs to
me from analogy, which deserves mention ; namely, that
each dog will produce a distinct puppy — this no one can
deny ; for the offspring will resemble the different males
that fecundate the bitch in succession. If a number of
healthy vigorous men were to have intercourse in succes¬
sion, immediately after the first conception, I think it pro¬
bable and possible, that similar superfoetation would hap¬
pen. I am proud to say, that Dr. Elliotson is an advocate
of superfoetation. He explains Buffon’s case this way.
Magendie is of the same opinion. Medical men must
bear in mind, that women have had three, four, and five
children at one birth. Various cases of infants of different
sizes being expelled in succession, are recorded in our own
periodicals. Medical and Physical Journal, v. 22, p. 47. — -

502

Original Communications .

v. 24, p. 232. Medico-Chirurgical Transactions, v. 9. Phi¬
losophical Transactions, v. 60.

“ One of the Pennsylvania newspapers in 1827, recorded
the case of an Irish lady, who in eighteen months had at
three births twelve living children, all born prematurely.
She and her husband were healthy fresh looking people,
and only two years married. This case is not recorded as
yet, in any of the American Medical Journals ; but if it
prove to be authentic, it will be the most extraordinary case
of fecundity recorded in any country. Cases of twins, tri¬
plets, quadruple and quintuble births, are of very rare oc¬
currence ; but of these more particularly hereafter.” Dr.
Golding, of this city, delivered a woman of six infants
during the year 1829.

I am happy to add, that Professor Velpeau, of Paris, is
of the same opinion. He says, In according all pos¬
sible authenticity to these observations regarding their ex¬
actitude as demonstrated, the idea which prevails in phy¬
siology on generation, permits an easy explanation. Two
ovules can be fecundated one after the other, in a woman
who accords her favours to two or more men, the same day,
or in two or three days afterwards, that is to say, to the
moment when the excitation of the first coition causes the
effusion of coaguable lymph into the uterus, to form the
caducous membrane (decidua.) These ovules may not
descend through the uterine tube at the same time, and
may be differently developed. But he thinks superfcetation
impossible after the decidua is formed, op. cit. The closure
of the os uteri after conception, does not take place for
some days, weeks, or months (Dewees), but if the male
semen be absorbed from the vaginal surface, and conveyed
directly to the ovary, as in the elephant, cow, sow, (Gert-
ner) such closure is no objection. Twins have generally
but one amnois and placenta, but in cases of superfcetation,
each infant has its own membranes and placenta. I once
attended a female who was delivered of one infant on
Monday, the parturient action ceased, and on the following
Thursday, the membranes presented, and she was delivered
of a second infant. There was no haemorrhage, and the
placentae were united. My friend, Mr. Whitmore, sent me
a similar union of the placentae a short time ago. Whether
we suppose superfcetation or twins, the medical practitioner
ought to notice which was born first, male or female, when
the disposal of property or title depends upon the decision.
The question is, which was born first, not which was con¬
ceived first. Admitting superfcetation to be possible, and

503

Dr. Ryan on the Duration of Pregnancy.

it cannot be denied in the early weeks of gestation,, we
cannot decide paternity, unless perhaps, when one infant
is black or brown, and the other white ; but if both males
were of the same colour, the decision might be difficult,
unless some physical mark on the infant existed in one of
them. The following conclusions are admitted in cases of
pregnancy. It is now decided that a female may become
pregnant, and be ignorant of it until the time of labour.
(Fodere, and Sanders of Edinburgh). This may occur in
cases of idiots (Desgranges), when the female is in a state of
stupor, either from inebriation, narcotics, coma, syncope,
or during sleep. Fodere, Orfila, Beck, Hebenstreit, and
author’s work on Midwifery.

Duration of Pregnancy . — Legitimacy . — Hippocrates,
Aristotle, Galen, Pliny, Avicenna, Mauriceau, Riolan, La
Motte, Hoffman, Schenk, Haller, Bertin, Lieutaud, Petit,
Levret, Louis, Astruc, &c., maintained that pregnancy
usually terminates at the end of the ninth calendar month,
but might be protracted to the tenth, eleventh, twelfth, and
some of them said to the fifteenth.

It is also decided by a preponderating majority of the
profession, in all countries, that the term of utero-gestation
is not uniform ; in other words, not invariably limited to
nine months. This position is strongly attested by the
analogy afforded by the inferior animals, for it appears by
the extensive observations of M. Teissier, on the gestation
of heifers, mares, sheep, swine, and rabbits, that all these
animals exceed their usual periods of delivery. Trans, de
l’Acad des Sc. Paris, 1817- Further evidence is afforded
by the vegetable kingdom, in which we observe in the same
field, on the same tree, shrub, & c. different parts of vege¬
tables arrive at maturity with more or less celerity. Petit
informs us that many faculties of medicine, forty-seven
celebrated authors, and twenty-three physicians and sur¬
geons, concluded pregnancy might be protracted to the
eleventh or twelfth month. He cites a case on the autho¬
rity of Schlegel, in which pregnancy was protracted to the
thirteenth month ; the child was admitted to be legitimate,
on account of the probity and virtue of the mother, which
induced her shopman to marry her, and she bore two chil¬
dren by him, each at thirteen months. Tracy, a naval phy¬
sician, relates a case at the fourteenth month. Dulignac, a
French surgeon, positively asserts that his own wife quick¬
ened at four months and a-half, and on two occasions she
went to the thirteenth month and a-half, and on the third,
to the eleventh month. Desormeaux relates a case of a

504

Original Communications .

mother who had three children, who was maniacal, and
whose physician, after all means had failed, recommended
pregnancy. Her husband had intercourse with her once in
three months, of which he kept an exact account. She was
closely watched by her domestics, and she was extremely
religious and moral ; she was delivered at nine months and
a-half (Velp eau.) The last author attests a case which
went to 310 days.

The medical evidence in the Gardner Peerage cause,
tried before the House of Lords, in 1825 and 1826, throws
much light upon the subject. It is right, however, to ob¬
serve., that witnesses spoke from their personal experience,
lost all sight of physio iogical science, and of the numerous
opinions of ancient and modern writers, that one and all
have shewn an extraordinary ignorance on the principles of
evidence, will be conceded by every one who examines
carefully their testimony. But it may also be doubted whe¬
ther the question admits of better evidence than has been
already proved, or at least arrived at, by them and their
professional predecessors.” (Dr. Duncan, Edin. Med. and
Surg. JtJurn. 1827* v. xxvii.)

I have condensed this evidence in my work, so often re¬
ferred to, as follows : —

The majority of the medical men, examined in the
Gardner Peerage cause, were in favour of protracted preg¬
nancy, as Drs. Granville, Conquest, Blundell, Hopkins.
Hamilton, of Edinburgh, and Power. Dr. Granville proved
that his. own wife went to three hundred and six days,
even admitting pregnancy to have occurred the day before
the interruption of menstruation ; and there hundred and
eighteen days, if from the middle of two of the last and
expected periods. Dr. A. T. Thomson, who attended her,
was of the same opinion, that the child was ten months old
at birth. Dr. Granville knew other eases of two hundred
and eighty-five, two hundred and ninety, and three hundred ;
and one doubtful at three hundred and fifteen days. Dr.
Conquest knew two or three cases at the tenth month.

His patient was a most sensible woman, who had been the
mother of six children, and had engaged him and the nurse
to attend her at a certain time ; went five weeks after, and
four with the next. She had other children afterwards, at
the ninth month. Dr. Merriman knew cases, at 280, 285,
303 and 309 days, and thought the Gardner case possible ;
Drs. Blundell and Hopkins, 285 ; Dr. Power, eleven months;
Dr. Hamilton, ten calendar months; and Dr. Collins, of
Liverpool, published a case of eleven months soon after-

505

Dr. Ryan- on the Duration of Pregnancy.

wards, which occurred two years before. Edin. Med. Journ.
April, 18*26, v. 25. This is most worthy of perusal. I
know a delicate woman, who menstruated the last week in
February, 1826, quickened in July, and engaged me to
attend on her in November. She had spurious pains in No¬
vember, December, and January, 1827, and was delivered
on the 28th of February, 1827 ; nearly twelve months from
her previous indisposition. I had most serious business
from home in November, but by her entreaties deferred m v
journey in that, and even the next month, and of course I
then daily expected her delivery ; yet she went two months
later. The infant was a girl and of the ordinary size, and she
and all her friends thought she would be undelivered from her
protracted pregnancy ; yet her labour was only of two hours
continuance and perfectly natural. I shall ever have cause
to remember this case, as I nearly lost some property by
deferring my journey to attend upon it. It was a first preg¬
nancy. I most solemnly declare, that the case was a true
one, and not fabricated to support any particular opinion.
This is the longest instance of protracted pregnancy, which
has hitherto been recorded in British medicine. Another
argument in favour of generation is, that children often grow
more in one year than in seven years before, which would
prove the developement may not be the same in the womb.
The following accoucheurs were produced against the doc¬
trine of protracted pregnancy, on the Gardner Peerage
cause. Dr. Charles Clarke, who in twenty cases, never
knew one exceed the term of nine months. His evidence
does not controvert the opposite side of the question. Dr.
Blegborough had practised extensively for thirty-four years,
and never knew pregnancy exceed the ninth month. Mr.
Pennington contended for forty weeks and three or four
days ; and Drs. D. Davis and Gooch were of the same
opinion. It is a strange but positive fact, that these gentle¬
men who came forward to prove pregnancy to be immutable
and definite at a certain period, all admitted it might ex¬
ceed nine months, by four or six days ; hence the justice of
Dr. Duncan’s critical sneer at their evidence. In the case
under consideration, the claimant Jadis, otherwise Gardner,
was born eleven months after his father went abroad, and
his mother had cohabited with Jadis, the father, soon after
Lord Gardner had been absent. On his Lordship’s return,
he obtained a divorce against her, and married again ; and
the offspring of the second marriage, on claiming his father’s
title, was opposed by Jadis, who, at the adult age, took

-.•*4 ... ... Ji *4 _ 4

Von. v. no. 30. 3 o

506

O r ig in al Co mmu ni cations.

the name of Gardner ; and under these circumstances, and
contrary to the medical evidence of the majority of the
obstetricians, the House of Lords decided against him.
The evidence in favour of the legitimacy of Jadis was
founded on too few cases, to warrant a perfect confidence
in it, or to settle the question of protracted pregnancy.
The Edinburgh Medical Jurist justly concludes, by stating
that there was not a single new fact advanced by the me¬
dical men, in elucidation of the subject at issue ; and the
reviewer smiles and wonders at the want of knowledge of
the witnesses who appeared to be unacquainted with the
nature of legal evidence ; and neither* their evidence, nor
that of the other side, was sufficiently accurate, in not being
deduced from physiological science ; which, however, in
the present state of medical knowledge on the question,
could not perhaps be more accurate. On the whole, the
weight of the testimony was in favour of the advocates of
protracted pregnancy ; but the mother having cohabited
with another, proved her incontinence ; which fact influenced
the House of Lords against the legitimacy. After all, the
subject remains as obscure as before, and will require much
more scientific medical evidence to decide it one way or
the other.”

Dr. Dewees relates a case of a lady, whose husband was
absent on account of embarrasment of his affairs. He re¬
turned one night clandestinely, had intercourse with his wife,
whose menstrual period was expected within a week and
occurred, yet she was delivered in nine months and thirteen
days from the coition. Work, 1825. The question of pro¬
tracted gestation, and more especially the Gardner Peerage
case, was discussed at the Westminster Medical Society, in
Dec. 1829, when Dr. Granville adduced the following au¬
thors in favour of the affirmative side of the question : —
Among the ancients, Hostius (Horstius), Sylvius, Harvey,
Mauriceau, Levret, Lieutaud, Heister, Delignac, La Clo¬
ture, Benedietus, Petit, Smellie, and W. Hunter. Among
the moderns, are Osiander, Fodere, Schoreider, Lentos-
seit, Spregnel, Adelon, Bardt, Capuron, Orfila, Burns,
Desormeaux, Dewees, Hamilton, of Edinburgh, and Mer-
riman. I have already mentioned many others. On the
occasion in question, Mr. Chinnock related a case of a
female who menstruated Oct. 14, and had intercourse with
her husband on the 29th. She was delivered on the 20th of
February, a space of two hundred and ninety eight days
after the connexion, but labour commenced three days pre¬
viously. I mentioned the cases narrated in the extract from

Dr. Ryan on the Duration of Pregnancy . 50 7

my work inserted above ; and Dr. Ley and Mr. North took
the same side of the question. The whole of the society
were of the same opinion, with one or two exceptions.
Lond. Med. & Surg. Jour. 1830, v. iv. Med. Gaz. 1830,
vol. v. There is no doubt but the weight of medical autho¬
rity, in ancient and modern times, are in favour of pro¬
tracted pregnancy ; but in the present state of science it is
impossible to assign the exact limit. The law of this country
assigns no limit to utero-gestation ; the law of France
limits it to three hundred days or ten months, and allows
legitimacy to be contested after this period. (Velpeau.)

Abortion.

In judicial investigations relative to abortion, medical jurists
are required to decide the following questions: — 1. Has
there been abortion produced ? 2. Is abortion natural or

provoked ? 3. Has the foetus quickened ?

Signs of abortion. — To determine whether abortion has
taken place, we must always examine the product of abor¬
tion, and also the female who is said to have aborted. If
we do not see the substance expelled, we cannot give a
satisfactory, much less a decisive opinion.

Examination of the embryo or foetus. — During the two
first months of utero-gestation, we must be extremely cau¬
tious and take care not to confound the foetus with a mole
or false conception, or with a sanguineous concretion or false
mole. At this period, the embryo is enveloped in a capsule
formed by two membranes (the chorion and the amnois),
united to a spongy mass (the placenta), more voluminous
than itself. The first of these membranes is torn, and
allows the second to escape in the form of a membraneous
sac, to which is attached a clot of blood. On opening this
sac, a quantity of fluid escapes, and the embryo will be
found in an organized condition. It is a gross mistake in
many works on obstetrics, in which it is stated, that the
foetus cannot be recognized at this period. I have a pre¬
paration which shews it perfectly formed at two months and
a half. There is also an illustration of the embryo at the
forty-fifth day, in an organized form, in the excellent plates
of Meygrier. We seldom see the substance expelled in early
abortions, as it is generally destroyed by the female attend¬
ants ; and every obstetrician must have been embarrassed
by this circumstance, and must have seen cases of supposed
abortion, in w'hich the expelled substance was a clot of

508

Original Communications .

blood. Hence the necessity of washing' such substance,
when any doubt exists, in order to determine whether the
substance be blood, a mole, or a real conception. Weshould
also remember the frequency of catamenial obstruction for
two or three months, and how often women suppose them¬
selves pregnant when they are not so. In such cases the
want of coagulation in the menstrual fluid, proves it not to
be blood. In the cases before us it is absolutely necessary
to know the appearances of the foetus at the different
periods of gestation. The embryo is visible at the fifteenth
day (Meckel), and the ovum is six or eight lines in diameter.
It is piriform, elongated, curved, round, enlarged at one
extremity, which is the head, and attached to the membrane
at the other extremity, having a white cord, which is the spi¬
nal marrow. (Velpeau.) Towards the end of the first month,
the extremities begin to appear in the form of round tuber¬
cles, and the umbilical cordis seen attached to the intestine;
the liver is large and fills the abdomen. In the course of the
second month, the head is equal in sizeto nearly half thebody ;
the eyes are seen as two black spots ; the nose, nostrils, and
the ears are apparent ; the arms and legs begin to appear;
the toes and fingers are distinctly observable ; there are
many points of ossification in the frontal and maxillary bones,
the clavicles, ribs, and os ilium. The rest of the osseus
system is in a state of cartilage. The penis and clitoris
project, and the sex may be determined. The embryo is
little less than two inches long, and weighs nearly an ounce.
At three months, the foetus is about four inches long, and
weighs nearly three ounces. It is impossible to mistake it
at this period, and therefore it is unnecessary to describe its
developement any farther.

The law of this empire is extremely defective on abortion,
for it abounds with the greatest absurdities. Its intention is
humane and excellent, but it is based upon erroneous phy¬
siological principles. It enacts, for instance, that the em¬
bryo is not animated until after quickening, that is, until
half the period of utero-gestation has elapsed, though the
foetus is alive from the very moment of conception. I have
described its developement before the period of quickening ,
which I need scarcely observe, could not happen if it were
inanimate.

Again, a jury of matrons is to decide whether a woman be
pregnant or has quickened, questions which the whole faculty
of physic, in every part of the world, could not determine
in the early months of pregnancy. It would be as wise to
appoint a jury of infants to determine these questions. The

Dr. Ryan on Abortion.

509

law also enacts it felony to procure abortion before quick¬
ening,, and subjects the person who does so by any means,
or even advises it, to transportation for seven or fourteen
years ; and to death, if after quickening. Every man must
applaud this philanthropic legislation ; but it places the me¬
dical practitioner in a most dangerous predicament. Thus
in thousands of acute diseases, where life is in the greatest
danger, treatment must be employed which may produce
abortion ; and is the practitioner to allow his patient to die
without the benefit which his art affords ? In some cases
of uterine haemorrhage, the life of the female can only be
saved by extraction of the infant. Yet this is producing
abortion in the eye of the law. Again, if the woman is
so deformed, that a full grown infant cannot be born at the
full time, that is, at the termination of the ordinary period
of utero-gestation, without a fatal operation, is the medical
man to allow the female to be placed in this predicament
when he can save her life, and that of her infant, by indu¬
cing premature delivery ? If the infant arrive at the full
term of utero-gestation, it must be destroyed by nature or
by art ; and by the latter to save the life of the mother.
As the statutes now stand this is felony ; but a talented
legal writer observes, t( it may be presumed the operator
in such cases only commits justifiable homicide, and not
the crime of abortion.” (Cabinet Lawyer.) Surely the ope¬
rator can be influenced by no clandestine or sinister motive,
in endeavouring to save the lives of the parent and offspring.
But to resume the medical part of the subject. We should
examine the woman, to ascertain whether abortion has
really happened. It is impossible to determine this point
during the first two months of pregnancy, as the foetus is
too small to leave any trace of its passage. When it occurs
in the last months of gestation, the usual signs of delivery
will be present, which will be described hereafter. The
expulsion of moles, hydatids, or other morbid growths,
should not be lost sight of, and should be carefully ex¬
amined. The phenomena presented by the abdomen and
external genitals, can only be valuable in proof of abortion,
when conjoined with the following circumstances : — 1. When
there is a certainty of pregnancy, and a comparison made
between the developement of the foetus and the period of
gestation. 2. When the pregnancy is so far advanced that the
changes in the os and cervix uteri are appreciable. 3. When
examination is made, immediately after the abortion has
taken place.

510

Original Communications .

The practitioner should bear in mind the immense number
of causes which produce abortion; and therefore ought to
be extremely cautious in making a judiciary report in such
cases. Many of these causes are peculiar to the woman, as
excessive sensibility, and too great contractility of the neck
of the uterus, rigidity of the fibres of the body of the
organ ; or laxity or flaccidity of its neck ; habitual delicacy
of health, menorrhagic disposition, or debility of constitu¬
tion ; all acute, and a great number of chronic diseases,
fevers, continued and intermittent, inflammations of the
various organs, peritonitis, gastritis, enteritis, cystitis, hysteri-
tis, rheumatism, pleuritis, variola, scarlatina, haemorrhoids,
convulsions, pertussis, chronic catarrh, colic, cholera,
diarrhoea, dysentery, constipation, gonorrhoea, leucorrhoea,
scirrhus,* cancer, retroversion, poly pi, f dropsy, and va¬
rious diseases of the uterus, hydramnios, hysteria, moles
with the foetus, J &c. The diagnosis of these diseases
is easily established. When abortion depends on rigi¬
dity of the fibres of the uterus, it recurs at later periods in
successive pregnancies, as the uterus gradually expands ; but
when abortion is caused by laxity of the neck of the organ,
the laxity increases in each pregnancy, and the abortion
happens earlier. Among the ordinary or hygienic causes,
may be enumerated violent mental emotions, the impression
of strong odours, the fright caused by thunder, noise of
artillery, sight of extraordinary and frightful objects,
errors in diet, stimulating food and drink, abuse of spiri¬
tuous liquors, too much exercise, as walking, riding, danc¬
ing, running, the agitation of carriages or other vehicles,
accidental falls, or blows on the abdomen, wounds, tight
clothing, immoderate laughter, abuse of venery, surgical
operations of any kind, even the extraction of a tooth, &c.
Sometimes abortion depends on the death of the foetus,
fromd ebility, ill cured syphilis, monstrous conformation, dis¬
eases of the placenta, scirrhus, calculus, hydatis, its im¬
plantation over the neck of the uterus, &c. Again, we
know that a peculiar constitution of the atmosphere will
produce abortion, as an epidemic. (Hippocrates, Fodere.)
All powerful medicines, as emetics, purgatives, mercury, &e.
may cause the premature expulsion of the foetus. Venesec¬
tion has been employed to produce abortion, but it seldom
or never succeeds. A woman has been bled forty, and

^ Morgagni.

* Bonetus.

f Levret.

Dr. Ryan on Abortion.

511

another ninety times, and yet arrived at the full period.
(Mauriceau.) This remedy is successfully employed to pre¬
vent miscarriage, and has been repeated seventeen times in
a ease with success. Emetics and purgatives often fail to
produce the desired effect, and the latter often destroys the
female by inducing abdominal inflammations. Emmena-
gogues also fail in most cases. Various herbs are employed
by the vulgar, mentha pulegiura, sabina, secale cornutum,
artemisia rubra, & c. and unfortunately with effect. But
we must conclude that there is no medicine or abortive
means, which always produce abortion, and nothing but
abortion ; there is none which does not endanger the lives
of the mother and infant. Irritation of the cervix uteri by
mechanical means, and piercing the membranes, justify the
truth of the remark, Cf Soepe, snos utero quce necat, ipsa
peritA “ Every woman who attempts to promote abortion,
does it at the hazard of her life.” (Bartley.) There is no
drug which will produce miscarriage in women wrho are not
predisposed to it, without acting violently on their system,
and probably endangering their lives.” (Male.) It has fre¬
quently occurred,” says Dr. G. Smith, that the unhappy
mother has herself been the sacrifice, while the object in¬
tended has not been accomplished.”

When called on in courts of justice, to report on an
abortion, supposed to be provoked or criminal, wTe should
duly consider the causes already enumerated, the circum¬
stances which preceded it, whether the female has denied
her pregnancy, procured abortives, used drastic medicines,
applied to various practitioners without acknowledging her
real condition, and a variety of other inquiries, which will
suggest themselves to every well informed practitioner, be¬
fore we can decide that she premeditated the crime. If the
woman had died, we should examine the uterus to discover
wmunds, and also the abdominal viscera, as it often happens
death is produced by enteritis or peritonitis, though the
uterus may have been punctured a few hours before death.
This was the fact in a case tried at the Old Bailey, during
the last year; the medical witness for the prosecution
ascribed the cause of death to the punctures, wdiich were
not inflamed ; but the witnesses for the prisoner to enteritis.
According to the law of this country, the exhibition of any
medicine, for the purpose of causing abortion, renders the
accused liable to a prosecution for felony ; and therefore
those young men who vend medicines, ought never to commit
themselves by vending the most harmless medicine to appli¬
cants in the case under notice. Should the female acknow-

512

Origin al Communications .

ledge that a certain apothecary sold her medicine for the
purpose, he could have no witness to disprove her allega¬
tions, and consequently must incur the greatest danger to
his liberty or life. Too many young men forget that the
crime of abortion is the destruction of a human being ;
and hence they incautiously supply medicines, in general
harmless ones, without the slightest recollection of the
perilous situation in which they place themselves. I trust
that this caution may be useful to my junior readers.

Medical jurists designate criminal abortion, foeticide,
that is, destruction of the foetus in utero ; and apply the
term infanticide to the destruction of the new born infant.
Both terms are included in the word prolicide. Before we
consider this part of our subject, it is necessary to describe
the phenomena of parturition, and the viability of the
infant.

Of Delivery.

The medico-legal questions relative to delivery are, 1. Do
signs exist by which we can determine that a woman has
been recently delivered ? 2. At what period afterwards

can wefind traces of delivery? 3. Can a woman be delivered
unconsciously ? 4. When the mother and infant are found
dead, which was the survivor?

Signs of recent delivery. — The signs of recent delivery
are observable in the sexual organs, uterus, abdomen, the
lochial discharge, state of the breasts, and secretion of milk.
In the first days after delivery, the labia majora et minora
are dilated, red, turmfied, and often inflamed, the vulva is
open, the fourchette is partially or completely torn, the
orifice of the womb is so dilated as to admit the introduc¬
tion of one or two fingers into the cavity of the organ ;
the posterior lip is elongated and thickened ; both lips are
much thicker than during pregnancy. The womb itself is more
voluminous, can be felt above the pubis, or may be felt
enlarged by placing o:.e hand on the hypogastrium, and a
finger in the vagina. The size and flaccidity of the abdo¬
men, its wrinkled condition, the lochia and milk, are signs
of recent delivery ; but all may be present after the expul¬
sion of a mole or other morbid growth in the uterus.
The lochial discharge has a peculiar odour, and when pre¬
sent is a good sign, but it is liable to be suppressed from
a variety of causes, and is entirely absent in some natural
cases. Any one of these signs is not conclusive, and does
not prove recent delivery, but taken collectively, and above

513

Dr. Ryan on Delivery.

'all, if we can learn the history of the pregnancy or anterior
condition of the woman, we may arrive at a correct conclu¬
sion. We can only arrive at a proper conclusion during the
first six or eight days, for at the end of ten or fifteen’ days,
it is impossible to decide the reality of delivery. It is now
decided that a woman may be delivered without her know¬
ledge if completely intoxicated, if stupified by narcotics,
a case which I have recently witnessed, if attacked with
apoplexy, syncope, delirium or idiocy ; and this fact ought
never to be forgotten when we are called on to decide ques¬
tions of infanticide. Another question of great interest is
to determine the survivorship of the mother or infant, when
both are lost in parturition, for in some cases, if the infant
survives the mother, the father inherits the property he had
by his wife, and if the mother, the property passes to her
own family. This is the law of tenant by courtesy. It is
impossible to decide this question unless some person has
been present at the, delivery. It was decided by the Court
of Exchequer, in 1806, that the motion of the lips of the
infant proved its vitality. (Smith.) It is now universally
known to judiciary physiologists, that a still bom infant may
be resuscitated an hour after birth, and one case is recorded,
in which the infant was pronounced dead, and placed in a
corner of the apartment, and at the next visit, which was at
the end of twenty-four hours, it was found alive.

It is almost unnecessary to allude to the substitution of a
dead child for a living, as such cases are of rare occurrence.

Women have shewn dead children, to appease the
wrath of their husbands, who accused them of sterility.
Male’s Forensic Med. p. 211. Capuron, p. 110. Beck,
p. 99. A woman has substituted a living for a dead child.
For an account of the appearances of the womb after death,
during the first month, the reader should consult Burns,
p. 326. The lawT only requires, that the medical witness
shall prove whether the signs of conception were present or
not. An infant must be found, in order to bring the charge
of infanticide. A woman may be delivered unconsciously,
if labouring under coma, or the effects of narcotics. Fodere,
vol. 2, p. 10; and a woman, who died before delivery, was
placed on the bier for interment, when the child wras born,
op. cit. 11. These are exceptions to .the general rule, namely,
that healthy women must be conscious of labour. Dunlop
records an extraordinary instance of a lady having a child,
though she and her husband did not think she was pregnant.
Edition of Beck, p. 10f. Again, a woman without assist-

3 p

VOL, V. NO. 30.

514

Original Communications .

-ance, may have her child so suddenly on the floor, in the
street, or water closet, as not to be able to prevent its
death.

Circumstantial evidence on the incidents of time and
place, of situation and character, most generally guides the
decision.

With regard to the death of the child before or after
delivery, it is a question that may be agitated in civil and
criminal cases ; as when the succession to inheritance is
mooted, or when a pregnant woman has been maltreated,
and her child supposed to have died in consequence.

The life of the infant is inferred from the good health
of the mother, the progressive increase of the abdomen,
and the motion of the foetus. But healthy females may
bring forth dead children ; delicate females have produced
healthy children, and the increase of the abdomen may
depend on moles, hydatids, dropsy, &c. while the motion
of quickening has been caused by flatulence. A woman
may suppose she feels the motion of the infant, during
delivery, yet a putrid infant may be produced. Various
causes may act on the mother, and destroy the infant, as
unhealthiness of habitation, mode of dress, want of food,
or improper use of it, violent exercise, too great labor,
violent passions of the mind, venereal excesses, intemper¬
ance, haemorrhage, convulsions, syphilis, small-pox, falls,
wounds, and accidents, inordinate evacuations ; in fact, all
the causes of abortion, which were enumerated. Pressure in
difficult labors, may destroy the infant; improper use of
instruments, fainting and diseases of the placenta, will pro¬
duce the same effect. Yet the child may recover in despite
of most of these causes.

The following signs occurring during pregnancy are
indicative of the death of the infant — want of motion in the
child ; the womb feels as if it contained a dead weight,
which rolls according to the position of the woman ; the
navel is less prominent, the milk disappears ; the breasts
are brown, flaccid, the mother experiences a sense of lassi¬
tude and coldness, accompanied with head ache and nausea.
If actually dead, and long retained in the womb, putrefac¬
tion sets in, the membranes become black, and foetid dis¬
charges take place. Maceration of the body, presence of the
meconium, spots on the skin, violet or brownish blue colour
of the lungs, the mass sinking partially or entirely in water,
weighing about the seventieth part of the body, and the
mouth and throat being filled with a glary sanguinolent
fluid.

Dr. Ryan on Delivery. 515

Many of these symptoms are equivocal. The foetid
discharges and state of the skin and bones cannot be de¬
pended on. If the medical examiner be called immediately
after birth, he can distinguish these symptoms ; but he is
seldom called so early, and in general not for many days
afterwards. The skin will exhibit marks of putrefaction,
and will be of a purplish brown or red colour. The um¬
bilical cord is livid, soft, and easily torn. The cranium
and thorax are flattened, the sutures of the head are dis¬
united, the brain is almost fluid, and has a foetid odour.
If the death take place after birth, there will be characters
of viability and complete developement, signs of external
violence, fractures, bruises, perhaps omission of the liga¬
ture on the cord, developement of the pulmonary vessels ;
the arterial and venous canals are straightened or obstructed,
lungs spungy, rose colour, swimming in water, also after
compression of them ; but this happens, if filled with gas,
by putrefaction 5 but if the gas escape by compression, the
lungs will sink ; the lungs weigh about the thirty-fifth part
of the body. The lungs of an infant already dead, if in¬
flated by the trachea, will preserve the air, as if respiration
took place ; but they will not weigh more than compact
lungs. From the fourth to the eighth day after birth, the
cord desiccates and falls off, there is a slight desqua¬
mation of the epidermis, a yellow colour of the skin, dis¬
appearance of thrombus, ecehymosis, or inflammation, and
oedema of different parts ; on pressing the breasts of either
sex, a serous fluid appears. From the eighth to the thir¬
tieth day after birth, the navel will be healed, the foramen
ovale, arterial, venous, ducts and umbilical vessels will be
obliterated by adhesion, the sutures will be more solidified,
and the fontanels diminished.

Prolicide , Foeticide , Infanticide.

Medical jurists have employed the word prolicide, to de¬
signate the destruction of the offspring, and divided the
subject into foeticide, or the destruction of the foetus in
utero, and infanticide, or the destruction of the new-born
infant. I have already stated the law on this subject,
9 Geo. 4, c. 31, which makes no distinction between the
murder of an infant not viable, that cannot live, and one
that is viable. A woman who destroys her infant not likely
to live — for example, soon after conception, is assuredly
less criminal than one who destroys it at a later period.

516

Original Communications.

which, if left undisturbed; may become fully developed, and
arrive at maturity. The flri?t commits an act upon an im¬
perfect being-, which has not acquired the perfection neces¬
sary to durable existence — she acts almost on a dead body,
non homo estt qui non futurus est, the other acts upon a
perfect being, which nature destines to occupy a place in
the class of her family and of society. If the death of a non-
viable infant is less criminal than abortion, the punishment
of infanticide ought not to be inflicted, for this is inflicting
the greatest punishment for the lesser crime. But as the law
stands at present, the researches which the medical practi¬
tioner has to make in cases of infanticide are as follow : —

1. After having ascertained the external appearance of
the infant, its volume, length, and respective proportions
of its different parts, it is necessary to determine whether
there exists any original defect of conformation, or any
pathological condition which could induce the death of the
infant at the moment of birth, or whether it has not been
destroyed by pressure during a laborious parturition.

*2. After this examination, we should inspect the internal
organs, and decide whether respiration has been complete,
and consequently whether the infant has been born alive.

3. To determine how long a period has elapsed since
the infant was living ; and what was the cause of death,
whether natural or violent.

4. To determine whether the woman to whom the infant
is attributed, is really the mother.

The most important of these inquiries are the following : —
Has the infant died before delivery ? Has it died during
delivery ? Has it died at the moment of birth, in conse¬
quence of deformity of the mother, or congenital disease?
In the first place, we are duly to consider the various causes
of abortion, and the signs which indicate the death of the
foetus in utero. The former have been already enumerated ;
the latter are, the cessation of the motion of the foetus,
the perception of it in different positions by the motions of
the woman, the tumefaction or diminution of the breast —
signs which are extremely equivocal. But if during delivery
the foetus is not felt to move, the waters are black and
foetid, the scalp soft, placid, wrinkled, and easily excoriated,
if the cranial bones are more mobile than ordinarily ;
there is much reason to suppose that the foetus has been
deprived of life for some time. After delivery, the proofs
of the death of the foetus having taken place some days
previously, are the flaceidity of its limbs, desquamation of
the cuticle, the skin purple or brown in certain parts, a

Dr. Ryan on Prolicide, Foeticide , Infanticide. 517

Serous or sanguineous infiltration of the subcutaneous cel¬
lular tissue, especially of the scalp ; the umbilical cord soft,
flaccid, livid, easily lacerable, the thorax flattened, and its
viscera in a state which shews that respiration could not
have happened.

If the infant has been destroyed by pressure, by a pre¬
mature rupture of the membranes, there will be tumefac¬
tion of the superior part of the head from uterine pres¬
sure, the head is deformed, and the brain will be found
apoplectic ; or the last sign may depend on compression of
the umbilical cord, either by being round the neck or body
of the foetus, or by compression of the parts of the parent.
On the other hand, if the foetus has died from haemorrhage
during labour* in consequence of detachment of the pla¬
centa, rupture of the umbilical cord, the body will be of a
livid pale colour, the sanguineous system will be empty and
collapsed, and if there is rupture of the cord, its extremity
will be jagged or irregular.

It would far exceed my limits, were I even to enumerate
the various defects of conformation of the Woman, or mal¬
formation of the foetus, which may destroy the life of the
latter. I can only advise the practitioner to exert his know¬
ledge of anatomy, physiology, and pathology, in any case
on which he may be called upon to give his opinion. He
should most cautiously consider the defects of conformation
and pathological degenerescences, and which may impede
the functions of respiration. Though it will be seen here¬
after, that the proofs afforded by respiration are inconclu¬
sive, and that too much importance has been ascribed to
them.

Let us examine the degree of certainty of an infant being
born alive, which is prevented by signs afforded by the
anatomical examination of the foetus. Daniel considered
that the thorax was amplified by respiration, and this he
determined by measuring the cavity before and after respi¬
ration. (Comment, de infantum nuper natorum umbilico et
pulmonibus.) But the conformation of the chest is subject
to too much irregularity, to enable us to arrive at a satis¬
factory conclusion. Plocquet laid great stress upon the
position of the diaphragm, whether depressed towards the
abdomen, or elevated towards the thorax ; but artificial
respiration will affect these positions as well as natural.
The size of the lungs affords no positive evidence. Schmitt
has seen them fill the chest before respiration, and so much
compressed after that process had continued thirty-six hours.

i

518

Original Communications.

as to render it difficult to decide whether respiration had
been established. Besides, there may be uterine, vaginal,
and extra-uterine respiration before the complete expulsion
of the foetus, and death occur after the birth. The rosa¬
ceous colour of the lung's may or may not exist, and is
subject to great variety, so that no dependance can be
placed on this sign. It may exist in the foetus long before
maturity. The obliteration of the umbilical arteries and
vein, of the foramen ovale, and of the ductus arteriosus,
evidently prove that the infant has been born alive. But
this change does not happen at the moment of birth, nor
sooner than two or three days, and often not before the
first or second week ; and consequently this evidence, in
most cases, is of little value.

Plocquet instituted experiments to ascertain the weight
of the lungs before and after respiration, in comparison
with that of the whole body, and concluded that the weight
was 1 : 70 before, and 2:70 or 1:35 after respiration. The
accuracy of these conclusions is denied by Chaussier, Orfila,
and Schmitt, of Vienna. Daniel proposed to immerse the
lungs, before and after respiration, in a vessel of water, to
the side of which a graduated scale was attached to mark
the elevation of the fluid. He said that the condensed lungs
would occupy less space than after respiration ; this is true,
but more delicate instruments are required for the execu¬
tion of this experiment, before we are justified in adopting
it in the practice of legal medicine.

Schreger proposed the immersion of the lungs and heart,
the large vessels being tied, in water so far back as 1682 ;
and concluded that when they sunk, no respiration had
taken place, and if they floated, respiratory function had
been established. This is what is called the hydrostatic
test, or pulmonary docimacy, upon which no reliance is
placed in any part of Europe at the present period. Nu¬
merous objections may be made to this test ; 1, the infant
may respire before birth ; 2, it may respire and be de¬
stroyed before birth ; 3, an infant may be alive, and may
not have respired ; 4, the lungs may float before respira¬
tion ; 5, the lungs may not float after respiration. The
infant may respire before birth, and be born dead. (Hun¬
ter, Marc, Siebold, Capuron, Osiander, Sabatier, Mahon,
Hutchinson.) There may be intra-uterine respiration. Trans.
Royal Soc. of London, vol. xxvi. Edinb. Med. and Surg.
Journ. No. 73. Hufeland’s Journ. 1823. The foetus may
be asphyxiated, or remained enveloped in its membranes
and be alive, without respiration. (Buffon, Schurig, Le

Dr. Ryan on Prolicide, Foeticide, Infanticide. 519

Gallois.) A delicate immature infant may respire, and yet
the lungs will sink in water ; and the infant may be born
with pneumonia, pulmonary engorgement, or hepatization.
(Billiard.) In the two first cases, the air cannot arrive in
the bronchial vesicles, and consequently respiration will be
incomplete. In the last, we often find the subcutaneous
cellular tissue of the mouth and limbs gorged with san¬
guineous effusion, which induces some persons to suppose
violence has been employed. Billiard has pointed out this
error. The lungs may float before respiration, from putrefac¬
tion, (Orfila,) emphysena, (Chaussier,) or insufflation. (Mor¬
gagni. Dr. Bernt, of Vienna, has put an end to the ancient
hydrostatic test, and proposed a new one in its place, which
is equally objectionable, in consequence of the complica¬
tion of his instruments. (Programma quo nova pulmonum
doscimasia, hydrostatica, proponitur. Vienna, 1821.)

It is a matter of great importance to determine how long
it is since the infant was living ; or how long it has been
dead. If the skin be soft, and covered with the white
unctious matter, which is seen at birth, if the stomach
contains but a small quantity of mucous, the large intes¬
tines are filled with meconium, and the bladder with urine :
it is probable that life had ceased at or immediately after
birth. If on the contrary, the stomach contains any alimen¬
tary substance, and the intestines any matter except meco¬
nium, it is certain that the infant has lived for some time.
I have already described the change in the vessels peculiar
to the situation of the foetus. I may mention, however,
that the umbilical cord remains soft and humid for fifteen
or sixteen hours, and begins to desiccate about the fortieth.

To determine how long the infant is dead, we must con¬
sider the state of putrefaction, and all circumstances which
hasten or impede it. Warmth and humidity promote de¬
composition, and already putrifies more rapidly in running
than in stagnant water, or in humid earth, than in an argil¬
laceous, sandy or chalky soil.

The next question is, what has been the cause of death.
This is often involved in impenetrable obscurity, as lesions,
purely accidental, frequently present the appearances of
crime. We should endeavour to determine those that are
accidental or involuntary, and those that are criminal.

Death of the foetus from involuntary causes. — I have
already enumerated the most of the causes of the death of
the foetus in utero, and may now caution the young practi¬
tioner to bear them in recollection, for otherwise he may
commit the most serious errors in giving evidence on the

520 ' ' ' ' ‘ Original Communications .

question under notice! Let himrernember that diminution
or deformity of the pelvis, are preternatural presentations of
the foetus, may cause elongation of the head, tumefaction of
die scalp, fractures of the cranial bones, blackness of’ the
face, congestion of the brain, ecchymoses of different parts of
the surface of the body, fractures of the limbs and various
other lesions, which may be readily mistaken for the result
of external violence. Again, the twining of the umbilical
cord round the neck or the compression of the os externum,
may induce cerebral congestion, as well as marks of strangu¬
lation. If the appearances on the head are Caused by exter¬
nal injury, they will often exist in situations on which no
pressure could have been made. We must always bear in
mind the presentation ; and by so doing we can often distin¬
guish natural lesions from injuries.

In those cases in which the heck is compressed by the cord,
there will be no excoriation, or exoriation of the cuticle.
When there is rupture of the cord during labour, there will
be fatal haemorrhage, but if accident happens after birth,
that is, after exposure to the air, fatal haemorrhage will not
result. If the cord be lacerated by violence, its extremities
will be irregular, but the flow of blood will cease. The in¬
fant will not be destroyed by haemorrhage, unless the cord is
divided with a sharp instrument. Should the infant have
been destroyed by detachment of the placenta, the pale waxy
colour of the foetus, the discolouration of the viscera, the va¬
cuity of the heart and large vessels, explain the cause of
death. The infant may be expelled suddenly, and falling on
the floor or on any other hard substance, the skull may be
fractured, and the cord torn. Such cases are related by
many obstetric writers. I have narrated three examples,
and others are attested by Hamilton, ChaUssier, Henke,
Klein, Pasquier, Meirieu. Jour. Univ. des se Med. 1820
and 1823.- M; Klein collected a . hundred and forty three
observations1 on this point, and asserts there was not one in¬
fant in the kingdom of Wurtemburg, whose skull was frac¬
tured,' all Recovered* * Many fell upon the pavement,' two of
which were affected with momentary asphyxia. Though the
cord was lacerated, there was no fatal haemorrhage. When
sudden expulsion of the infant is alleged as the cause of
death^ it is necessary to examine all circumstances anterior
and subsequent, to compare the dimensions of the pel vis, and
the volume of the infant’s head, to consider the duration of
labour, the position of the woman when the infant has escaped,
the height of the fall, the substance with which tlie head
came in contact, and finally, the state of the umbilical cord

Dr. Ryan on Prolicide, Foeticide , Infanticide. 52.1

which ought to be ruptured at the placenta or umbilicus, but
not in the middle. The extremity of which ought to present
the sign of laceration.

When an infant perishes at the moment of birth, by choak-
ing of the air passages, and is afterwards thrown into wTater
or into the water closet, it may be supposed it has been de¬
stroyed by submersion or drowning. Every practitioner is
aware that infants have been precipitated into the latter situa¬
tion, and that it is extremely difficult to distinguish whether
the fluid in the *ur passages be mucossity, liquor amnii, or an
extraneous fluid introduced. When the fluid contained in
the trachea is frothy, we cannot positively affirm that the in¬
fant has respired, as insufflation would produce the same ef¬
fect ; or a morbid secretion of gas, or the evolution of air by
decomposition. If on the other side, the fluid is limpid and
free from air bubbles, we can affirm that the infant has not re¬
spired, but this is no proof that it was dead at birth, or at
the moment of submersion. The rigid examination of the
physical and chemical properties of the fluid, will alone en¬
able us to determine its real nature.

BIBLIOGRAPHY.

PRACTICE OF MEDICINE.

1. Real Bronchocele. — Real bronchocele, M. Larrey says, con¬
sists of one or several tumors filled with air, which during its forcible
compression in the upper portion of the trachea, the larynx, or the
mouth, has produced small hernise of the mucous membrane; Ihese
tumours rapidly increase in size, so as not unfrequently to exert a
violent pressure on the vessels of the neck. They are situated in
front, or at the sides of the larynx, bet ween the hyoid bone and the thy¬
roid cartilage, or between the cricoid cartilage and^jhe first tracheal
rin^, and are invariably produced by violent exertion, The most
characteristic symptom of this kind of bronchocele consists in the
disappearance of the tumor under compression. In Egypt we fre¬
quently observed this kind of bronchocele in the blind, who are very
numerous there, and who are employed by the priests to chaunt at
the top of the minarets. It generally happens, that after two or three
years, such persons became totally unfit ior this office, on account of

Vol. v. no. 30. ^ Q

522

Bibliography.

the occurrence and subsequent increase of these tumors. Since
M. L.’s return from Egypt, he has had the opportunity of observing two
cases of bronchocele in two subaltern officers, who had for a consi¬
derable time been employed as military instructors. One of them
had near the larynx two tumors, which were free from pain and cre¬
pitus on pressure. They were of equal size and globular form, and
the skin by which they were covered was rather tense, but without
any morbid alteration. Both individuals had almost entirely lost
their voice, being unable to make themselves understood by words,
except whilst forcibly compressing the tumors. They were also
obliged to breathe with their mouths wide open. In consequence of
the continued pressure on the vessels of the neck, the jugular veins
had become enlarged, and they suffered greatly from congestion
within the head. The application of bladders filled with ice, and of
graduated compresses with camphorated spirit and liq. ammon.
acetat. greatly reduced the size of the tumors, but did not prevent
their reappearance on the least exertion. — Clinique Chirurgicale.

SURGERY.

2. Case of Fungus Hamatodes. By Thomas Sewell, M. D. Pro¬
fessor of Anatomy and Physiology in the Columbian College, district
of Columbia. — The following case of fungus hscmatodes occurred in
the practice of Br. M‘ Williams, of this city, the same gentleman
whose name I have introduced in a former communication published
in this Journal. By the courtesy of Dr. M‘ Williams, I had an op¬
portunity of examining the case and marking its progress during the
life of the patient, and was afterwards requested by him to make the
post mortem examination, and draw up an account of its history.

The subject of the case was a Miss W - , of this city, about

twelve years old, healthy, active and intelligent.

In Nov. 1828, while in the enjoyment of her usual health, she was
attacked with slight pain and lameness in the left thigh. On exa-
ammation a hard tumour, the size of a walnut, was discovered on the
inside of that thigh, situated one-third of the distance from the hip
to the knee-joint. This was deep-seated and extremely obscure,
being under the. thickest part of the fascia lata, but by strong pres¬
sure it was found to be moveable and disconnected with the bone.
From the time of the first examination of the case, the tumour con¬
tinued to increase rapidly in size, and was attended with an almost
constant, heavy, obtuse pain, which was also extended to the knee
and ankle-joints, accompanied with an uneasy sensation in the whole
extremity, producing a frequent desire to extend the limb and to
change its position. The pain was always more severe and constant
in cloudy and damp weather ; but at other times would occasionally
remit for six or eight hours together. At the end of six months, the
tumour had acquired such a size as to disfigure the limb and to pre¬
vent the patient standing or walking, and the pain was more severe,
and accompanied with a sensation of great heat or burning.

Surgery.

523

During the last eight months, all the symptoms became aggra¬
vated. The tumour increased with greater rapidity than before — its
surface. became irregular, and exhibited a glossy appearance, inter¬
spersed with livid patches and superficial vessels greatly enlarged,
and when handled, presented in different parts very unequal degrees
of firmness, at some points appearing soft and yielding, as if suppu¬
ration had taken place ; at others, imparting to the touch a sensation
of almost cartilaginous hardness.

Ten days before her death, a rupture of the tumour took place,
accompanied by a copious discharge of acrid foetid sanies, and con¬
tinued without at all impeding its growth.

She died on the 22d of Jan. 1830, fourteen months from the com¬
mencement of the disease.

It should be remarked, that during the continuance of the disease,
till within two days of its termination, the appetite was good ; large
quantities of nutritious food were taken and digested without diffi¬
culty ; but as the parents justly observed, all the aliment she received
seemed to be expended in the development of the disease, rather than
in the nourishment of the body.

The treatment of the case consisted principally in topical applica¬
tions ; but these had not the slightest influence in arresting the pro¬
gress of the disease, or alleviating the sufferings of the patient.

The morning after the death of the patient, the following exami¬
nation was, made : —

The body was found in a state of great emaciation. The leg and
foot of the diseased limb were cedematous and considerably swoln. The
tumour, as to form, size, and colour, is accurately delineated in the
accompanying drawing. It involved the whole thigh, and extended
down over the knee-joint, measuring in length fifteen inches, in
diameter twelve inches, and in circumference three feet. By a hori¬
zontal section about one-third of the tumour was removed, by which •
its internal structure was clearly brought to view. On careful exa¬
mination, it was found that every tissue which entered into the struc¬
ture of the thigh, had undergone an entire change in organization,
and had assumed all the. characters of the morbid growth, except the
fascia lata, and this was greatly thickened. On the anterior "part of
the thigh a large cavity was found, containing about twenty -foutf
ounces of fluid resembling olive oil, its walls thick and cartilaginous#?
with osseous depositions. On the posterior part of the thigh, corre- 5
sponding with the cavity just described, was a hard tumour, several
inches in diameter, apparently composed of condensed cellular sub- •
stance, with cartilaginous structure and osseous matter. This, toge¬
ther with the cavity already mentioned, constituted about one-fourth
of the tumour. The remaining three-fourths resembled in colour and
consistence, the medullary substance of the brain, irregularly inter¬
mingled with cortical matter.

This mass was intersected by numerous membranous septa, formed
probably originally of cellular substance. There wrere also numerous
sinuses running in different directions, containing viscid sanies, ,and

524

Bibliography .

their walls formed of a dark-coloured membrane, apparently the
inter-muscular fascia, much thickened.

The shaft of the bone was also extensively diseased. It was en¬
larged, spongy, and flattened, and had many small spiculae projecting
from it. It was fractured about four inches from the head, which I
was informed happened after death, in attempting to move the limb.
The extremities of the bone were sound, and the structure of the hip
and knee-joints not in the slightest degree changed by the disease,
although the tumour enveloped both. — Amer. Jour. Med. Sciences.

3. On Strychnine. — These affections are often ascertained with
difficulty, and, therefore, cases may be viewed as such, though ari¬
sing from structural derangements of the interior of the organ of
vision. In these, as in others arising from severe or long continued
internal inflammation and other causes, strychnine, I apprehend, can
be of no possible sendee. The same thing may be said of amaurosis
depending on clots of blood, or tumors which press upon the optic
nerves. Where again, as is frequently the case, the disease is owing
to the absorption of the medullary portion of the nerve, it must be
allowed that nothing can be expected from it or any other medicine.
In fine, in my opinion, it is only in cases of paralysis of the optic
nerve, and those arising from congestion, that strychnine can be ad¬
vantageously employed ; and I think the preceding examples, and
those already published by Mr. Liston, Mr. Guthrie, and others, must
decidedly prove its efficacy in them. It is not immaterial to observe
that in such cases its beneficial operation is considerably aided by the
previous use of mercury, possibly either by exciting the nervous sys¬
tem, by rousing the energy of the capillaries, or by increasing the
powers of absorption, or by all three conjointly. Thus, in No. 5.
strychnine failed until mercury had been employed ; but on its appli¬
cation, and then only, vision was improved ; and in cases Nos. 7 and
9, its decided effects followed the use of that medicine.

I cannot positively say whether the effects of strychnine are lasting,
but I believe it in most cases to be so if properly used. I may safely
assert also, that in no case in which I have tried it has vision been
injured, where the disease existed in one eye only, or where sight was
not entirely destroyed. In no case did any constitutional evils arise
from its use* I am inclined also to believe, from one or two instances,
that it was beneficial in removing opacities of the cornea, probably
by its highly stimulating property occasioning rapid absorption.

In delicate persons, or where the system is affected by mercury, I
ought to add, the strychnine should be commenced in small doses, e.
g , not exceeding a quarter of a grain, and increased daily until it
produces sensible effects on the constitution, such as headache,
pricking pains over the body, or tremors, when it should be discon¬
tinued, and on resuming it, the dose should always be considerably
reduced.

„ Where unpleasant symptoms arise, I can suppose that camphor in
large doses, or an opiate enema, suited in strength to the violence of
the symptoms and the constitution of the patient, or, as recommended

Surgery.

by M. Lembert, the application of morphine in small closes, sprinkled
on the blistered surfaces, will be found to give relief ; but in no in¬
stance have I judged it necessary to employ any of them. .

Several of the cases here detailed, were attacked with erysipelas,
which strychnine seems prone to occasion ; but they were Invariably
relieved by simply rubbing about a drachm of mild, ointment or cold
cream over the diseased surface every four hours. — JEdin. Jour.

4. Impaction of a Foreign Body in the Ear, producing Inflamma¬
tion of the Brain, and terminating fatally , by Mr. Ingleby. of Birming¬
ham. — Master - , four years and a half old, the son of a medical

gentleman late of Birmingham, was observed by the nurse maid in the
afternoon of Monday, 4th June, repeatedly thrusting his linger forci¬
bly into his left ear, and on interrogating him, he replied that he had
put something into his ear, but could not tell when, nor what it was.
I saw him immediately upon this declaration, and attempted to ex¬
tract the substance with various kinds of forceps, for about fifteen mi¬
nutes, but without avail. I could distinctly feel a metallic body,
lying, as I believed, upon the tympanum. Mr. Woodson my failure,
employed with very great care and gentleness, every expedient that
he could devise, but ineffectually. The boy was then put to bed.
Various local remedies were applied: fomentations, poultices, lint
and warm oil, and the ear syringed with tepid water. A dose of ca¬
lomel was also given, he wTas very restless during the night, and
started frequently while asleep.

Tuesday, 10, a. m. — The boy appeared tolerably well and cheerful;
the calomel had operated. The internal ear was somewhat swollen,
and there was a considerable sero-sanguineous discharge from it. A
mild aperient medicine was ..ordered, and the local applications con¬
tinued. It was deemed expedient to make no farther attempt at ex¬
traction at this period.

6, p. m. — Same as in the morning.

Wednesday, 10, a. m. — The same as yesterday. At twelve o’clock
he became sick, and vomited once ; he refused food ; . he became
thirsty, and general listlessness prevailed ; the. .pulse remained good ;
his walk seemed unsteady. In the evening, his head dropped on his
shoulders somewhat suddenly, and from that time he lost all com¬
mand over progression. The right side of his body seemed to be
more particularly affected. . ^

Thursday morning. — Dr. Male and Mr. Jukes were called in. The
state of the patient wras now very alarming. During the night he. had
entirely lost the power over the right side, and become very comatose.
He now lay in a state of partial stupor, with the eyes half closed, and
a cadaverous countenance. Pulse irregular and. about 80. Discharge
from the ear continues as before. Mr. Jukes attempted the removal
of the body without success. : k

At noon he was attacked writh violent convulsions of both sides.
Mr. Hodgson being called in consultation at this period, attempted to
extract the body, but unsuccessfully. Opium by the mouth and per
anum was prescribed, and in the evening, a hot bath and purgative
injection. Pulse very intermitting and irregular.

526

Bibliography.

Friday, 5, a. m. — General and intense spasmodic action. A con¬
siderable quantity of purulent matter has been discharged, both by
the nose and mouth, which continued oozing till 7, a. m. when he
died.

I examined the body in the presence of Mr. Hodgson, Mr. Jukes,
Mr. Freer, and others. On removing the calvarium and dura mater,
the vessels generally were much injected, and the substance of the
brain was studded with vascular points. There was considerable ef¬
fusion between the membranes, and a deposit of yellow lymph at the
base of the brain, similar to what is obseivedin hydrocephalus acutus.
The plexus choroides were peculiarly turgid with blood. The exter¬
nal ear and integuments being divided and dissected back, the inter¬
nal ear was removed, by taking away a triangular portion of bone. A
piece of metal, having a shining silvery appearance, now presented
itself to view. It could not, however, be extracted, although it was
very moveable ; for being below the lidge to which the membrana
tympani is attached, the projection ('processus auditorius,) presented
an insuperable barrier to its removal. It appeared difficult to account
for the presence of this body in such a situation. When extracted by
a section, it proved to be a piece of lead, weighing 3ij. portions simi ¬
lar to which were in use at a workshop in his father’s yard, and the
child was seen in the shop a week prior to the detection of the acci¬
dent. The ossicula auditus wrere missing, except one which was found
loose in the cavity of the tympanum. The membrana tympani was
also destroyed, with the exception of a small ragged margin.

Observations. — The peculiar situation of the foreign body, and the
impossibility of extracting it until a section of the internal ear was
accomplished, accounted for our abortive attempts to extract it during
life — moveable as it not only appeared, but was actually found to be
on dissection. I am quite of opinion that the lead had been an entire
week in the ear, and was only detected when the body first began to
feel uneasiness. The sufferings of this little patient appeared to be
most intense. To the friends and attendants, the scene was truly dis¬
tressing, one of the most heaic-rending it has ever been my lot to
witness. — Mid. Rep.

6. Mr. Syme continues his valuable reports of the Edinburgh
Surgical Hospital in the Cctober number of our northern contem¬
porary. He commences his report b)r stating that the Royal College
of Surgeons of Edinburgh recognize the hospital and his clinical lec¬
tures (indeed we should be greatly surprized if they did not do so),
and that the sources from which he derived 800/. for the support of
the hospital, were fees for his clinical lectures, 400/. — board of two
house surgeons, 200/. — and cash paid out of his own pocket, 200/.
What a contrast does his generous conduct present, when compared
to that of the hospital surgeons of London and Dublin, who not ouly
do not expend a shilling in support of the institutions to which they
belong, but hoard up the immense sums which they derive from
students. The report comprises a period of three months, during
which 545 cases of surgical disease have been presented for relief,
and of these 82 have been admitted into the house. The first case-

Surgery.

527

detailed is that of a man, aged 30, bad constitution, whose elbow
joint was excised ; the operation was performed with that ability and
dexterity which characterise the narrator. The patient sunk five
weeks afterwards.

“ On dissection the abscess of the hip was found to extend
upwards among the muscles as high as the lumbar region. There
was an extensive abscess between the ilium and iliacus interims
descending into the groin. There were old adhesions between
the pleura pulmonalis and costalis on both sides, but especially on
the right. Upon the centre of the anterior surface of the left lung
lymph had been recently effused to a considerable extent, and about
eight ounces of sero-purulent turbid fluid lay in the pleura of the
same side. The lungs in several parts were indurated or liepatised,
and in some places suppuration had taken place so as to form depo¬
sits of the size of a walnut. On the surface of the brain the vessels
were more turgid than usual, and in some places there were small
ecchymoses. Great part of the wound was healed, but the ex¬
tremities of both the humerus and ulna were exfoliating.

“ This unfortunate man, whose thin emaciated care-worn appear¬
ance indicated an age not less than fifty, though it really was no
more than thirty, was certainly, as the result showed, a most un¬
favourable subject for operation. At the same time this is the only
one of ten cases of excision of the elbow-joint which has terminated
fatally ; and I sincerely believe, that any operation, however slight,
which had the effect of at all disturbing the constitution, would have
given rise to equally disastrous consequences. This extreme ten¬
dency to disordered action could of course be learned only when it
was too late.”

The following cases are highly interesting : —

“ David Forret, set 28, from Cupar-Fife, recommended by Dr.
Scott of Cupar, on account of a diseased elbow-joint, of which he
gave the following account : ‘ Nine months ago he began to be
troubled with a gnawing pain at the back of his right elbow, as
if between the ulna and humerus. There was then no swelling ; the
motion of the joint was somewhat impeded, but did not increase the
pain. In January, he observed a small tumour, about the size of a
bean, a little above the internal condyle, which broke two weeks
afterwards, and has continued to discharge ever since. Up to this
time he had not been incapacitated from working, the pain which he
felt being only moderate, and ascribed to rheumatism. But four
months ago, without sustaining any injury, the joint inflamed, be¬
coming red, swelled, and excessively painful, so as to render the
slightest motion intolerable. He was blooded and leeched repeatedly,
by which means the activity of the disease was subdued, and shortly
afterwards another opening made its appearance on the outside of
the olecranon. The constant discharge, gnawing pain, stiffness of
the joint, and general exhaustion consequent on this severe and pro¬
tracted disease, have made him extremely anxious to obtain relief,
and willing to submit to any measures necessary to afford it. He is
thin, pale, and evidently much reduced by his sufferings.’

528

Bibliography .

“ This case evidently required either excision or amputation.
My friend, Mr. Webster, Surgeon of the 4th Dragoon Guards, who
saw the patient on his admission, and who had not at that time
witnessed the operation of excision, declared that he would have no
hesitation in amputating the arm. Though there was evidently very
extensive disease of all the soft parts, 1 did not consider this any
objection to excision, and, accordingly performed the operation in
the usual manner, that is, by making a transverse incision from the
ulnar nerve to the external tuberosity of the humerus, close to the
olecranon, and then one upwards and downwards at both of its ex¬
tremities. All the bones entering into the articulation were very
much diseased, the cartilage being abraded and the surface carious.
The synovial membrane, being very much thickened and gelatinous,
was cut away as far as possible, one small artery of the integuments
was tied, and the edges of the transverse incision were stitched
together ; but the extreme softness of the diseased integuments
rendered it impossible to close the longitudinal ones in this way, as
the threads instantly cut their way out. Caddis and a bandage were
then applied.

“ The patient has done extremely well ; the swelling of the joint
is now almost gone ; the discharge has almost entirely ceased ; and
he has the prospect of being soon dismissed cured.

“ Elizabeth Johnston, ret. 16, from Falkirk. In the first of these
Reports, I mentioned the case of this girl, who entered the hospital
last summer on account of a diseased elbow-joint, which exhibited
the most formidable appearance of any that I have yet met with, but
which, nevertheless, wras completely cured by the operation of ex¬
cision. She returned home, and remained perfectly well, using the
arm for all ordinary purposes until December last, when, after
exerting herself too much, her wrist swelled and became painful.
Tartar emetic ointment was applied, and afterwards blisters ; but an
abscess soon formed, which opened, and has continued to discharge
ever since. A probe introduced into the sinus, which is situated
over the lower end of the radius, enters a large carious cavity of the
bone, and can be pushed downwards into the wrist-joint.

“ As amputation appeared the only resource, it was performed on
the 24th June above the elbow, by the method of double flap. She
recovered most favourably, and is now well.

“ The elbow being dissected, afforded a specimen of the union
which is established between the bones in such cases. When the
integuments and muscles were dissected off, the appearance presented
was wonderfully little different from that of a natural joint, owing
to a great mass of fibrous ligamentous-looking substance which con¬
nected the bones together. This connecting medium, which was
above an inch in length, and perfectly flexible, did not constitute any
thing analogous to an ordinary articulation, and more resembled the
structure that usually exists in the false joints that result from frac¬
ture of the bones. My friend and pupil, Mr. Charles Bell, made a
sketch of the preparation, which gives a very good idea of its ap-

Surgery.

529

pearance, and which, therefore, I have caused to be engraved to illus¬
trate this description.” — p. 226.

Mr. Syme next describes hip disease, knee disease, ankle disease,
elbow and shoulder disease, and employs these terms in preference to
the more scientific nomenclature of the German school, as some ma¬
tured contemporary has accused him of pedantry, for having used one
of the German terms on a former occasion. We must observe that
the accuser is one of those who delights in progress of moving back¬
wards, and we are surprised at a surgeon of Mr Syme’s eminence,
to be influenced or deterred by such a silly piece of absurdity. Why
should not British surgeons improve their nomenclature as well as
others, or why should they allow others to advance in this particular,
at least a century before them ? The terms proposed by Rust of
Berlin, for the diseasesin question, are as follow : — spondil-arthrocace,
or vertebral disease, cox-arthrocace, or hip disease, son-arthrocace,
or knee disease, om-arthrocace, or shoulder disease, olecran-arthro-
cace, or elbow disease. We too have been accused of pedantry, for
proposing a more correct nomenclature for obstetricy, which is now
adopted in France and Germany, and very generally in this country.
What classical scholar would not prefer the word obstetrician, to
accoucheur midwifer, or to the barbarism, physician man midwife,
which, as yet is employed by some old fashioned obstetric lecturers,
and practitioners in this metropolis, or gynaecology for midwifery,
gynsecotomy for anatomy of the female organs of generation,
gyncecophiosology for the functions of these organs, parthenosology,
for the pathology of these organs in the unimpregnated state, ge-
nescology or anthropogensy for procreation, embrysology for the de-
velopement of the foetus, encyonosology, for diseases of pregnancy,
tocology, for parturition, eutocia, for natural parturition, dystocia,
for preternatural parturition, chiragoticia for manual parturition, and
organikotocia, for instrumental parturition ; cochianosology for puer¬
peral diseases, and paidonosology for diseases of infants and children.
Dr. Blundell approved of the term obstetrician, while the Reuv. Me-
dicale, Francaise et Etrangere noticed the whole classification in these
words : —

M. Ryan vient de faire en Angleterre, pour les accouchemens,
ce que M. le professeur Duges et M. Tarvenier, avaient fait en France,
pour le rrieme branche de l’art et pour la Chirurgie **** ce professeur
pour supplier a quelques cunes qui existaient dans les ovrages du
meme genre, publie avant le sien, s’est attache a faire connaitre les
maladies des organes de la generation, celles qui se developpent pen¬
dant la grossesse, apres l’accouchement et enfinles affections propres
a l’enfant nouveau ne. Aux mots generalement, usites M. Ryan a cru
devoir substituer des expressions nouv elles, telles que gynoecotomie,
&c. &c. qui forment autant de chapitres dans lesquels il examine a
fond toutes les questions quis’y rapportent. Le manuel d’accouche-
ment de M. Ryan est un livre destine, a devenir classique, aussi
croyons-nous devoir le recommander aux etudians de Paris et de
Montpellier, qui veulent etre au courant des progr^s de cette partie

Vol. v. no. 30. 3 a

530

Bibliography.

de la Chirurgie, chez nos confreres d’outre Mer.” Such a testimony
from foreigners must be gratifying to the author, and humiliating
to the few, who have accused him of pedantry, not only on that oc¬
casion, but in introducing so many new terms of the foreign schools
into this periodical. Why should not British medicine keep pace
with science in other countries ? Are we to stand still while all other
nations are in rapid motion ? Certainly not; and we trust the scien¬
tific part of our profession, will be no longer tramelled by antiquated
usage, and miserably defective nomenclatures

6. Tumour on the Lumbar Vertebra, by Mr. Waldron, Surgeon,
Bath. — About the middle of April, 1829, I was requested to see
Master Peckover, a boy 12 years of age, whom I had attended two
months before, in an attack of acute hepatitis ; his complaint yielded
to the usual means of general and local blood-letting, blisters, aperi¬
ents, &c. ; but the highly inflamed state of his blood, jaundiced hue of
skin, morbid state of alvine evacuations, and tenderness in the re¬
gion of the liver, bespoke the severity of his attack, and indicated, in
a person at his early period of life, an unusual degree of disease in
that viscus. I was now consulted in consequence of a swelling hav¬
ing made its appearance on the lower part of the spinal column, be¬
tween the third and fourth lumbar vertebrae ; it was about the size of
a small hen’s egg, but little sensible when examined by the touch,
and accompanied with pain and uneasiness in the back and loins ; it
did not dilate upon coughing. At this period, the boy’s general state
of health was good : I at once suspected this to be a lumbar abscess,
but not being decided in my opinion, I determined, at all events, to
act with caution. I directed a calomel powder to be taken twice
a week at bed time, and the following drops to be taken : — Liq.
calcis mur. %is. Tinct. ferri mur. ^ss. misce fiant guttse. Capt.
1T[ xxx. bis quotidie a calice vitreo aquae. The following lotion to be
applied to the swelling : — Liq. ammon, acet. 5 iv • Liq- plumbi acet.
5ij- Aq. distillat. ^xij. misce ft. lotio constanter applicanda. This
plan was continued, but not with the utmost regularity, till the 1st of
September, when the father of the boy having, a few days previous,
learnt from me, that I considered the swelling in question to be capa¬
ble of removal by the knife, viz. that it was an encysted tumour; un¬
known to me, he took the boy to Mr. Hicks, of this town; this gen¬
tleman having expressed a wish to meet me on the case, we met, and,
in his own words, I will give his views of the case. “ He defined
the tumour to be an impulse of matter, and prescribed blisters to pro¬
duce absorption, with exhibition of internal remedies to improve the
constitutional defect. At the time Mr. Hicks saw the boy, the tu¬
mour was three inches and a half long, and in width about three
inches ; the integuments were perfectly healthy and free from all dis¬
colouration ; he suffered no pain, and his general health was good.
The tumour was firmly attached to the fascia of the tendon covering
the latissimus dorsi muscle. Mr. Hicks continued his plan till the
7th of November, when ulceration having taken place in the integu¬
ments, he pursued the following plan ; Mr. Hicks did not follow up

Surgery.

531

the efforts of nature, but selected the soundest part of the tumour,
into which he thrust an abscess lancet, and evacuated its contents.
He next directed thin tea-chest lead to be applied, with a view, as he
stated, to obliterate the remaining cavity, and produce adhesion.
After making trial of this plan for nearly three weeks, without success,
the boy was brought back to me, to be placed entirely under my care,
and in the presence of Mr. Soden, Mr. George Goldstone, and Mr.
Ormond, I laid the tumour open to its full extent, and exposed a cyst,
not merely of condensed cellular membrane, such as is found in chro¬
nic abscess, but thick and distinct, and capable of secreting its own
fluid in very considerable quantity. It became necessary, after three
weeks, to dilate a sinus which still remained, and kept up a discharge
and prevented the granulating and healing of the w'ound. This
being done, and the wound dressed with warm digestive dressings,
the whole of the cyst sloughed away, the parts granulated, and are
now, April 25, 1830, wholly healed.

Observations . — This case, which I have now briefly related, having
caused some little conversation with regard to its treatment, 1 "would
observe that it is the opinion of the three respectable surgeons whom
I consulted, when the boy was brought back to me, that the tumour
in question was an encysted one, and ought to have been removed at
an early period by the knife ; any further comment on the nature and
treatment of these swellings, would be quite superfluous, as the sub¬
ject is fully treated of by surgical writers, and generally understood by
every well informed surgeon, Mr. Hicks’ plan of treatment is most
assuredly novel, and as such I have stated it. To what extent it
will be followed by my professional brethren, time will prove.

7. Case of Ozena cured by the use of Chloride of Lime. By
W: E. Horner, M.D. Adjunct Professor of Anatomy in the Univer¬
sity of Pennsylvania. — The acknowledged difficulty of curing ozena
or chronic purulent discharge from the nostril, makes this disease in
the estimation of experienced surgeons one of the most untractable
that they are called upon to treat. Mr. Boyer, after most extensive
opportunities, admits that it is absolutely incurable, and this opinion
is sustained by other persons of equal celebrity, among whom I may
mention Dr. Physick. Under these circumstances, even a partial
observation of a remedy entirely successful, may be considered
worthy of attention, and subsequent trials will tend to establish how
far it may be relied upon in cases generally.

In October, 1828, Luke Johnson, a black man, aged about thirty,
of good constitution, was brought from Virginia by his master to be
placed under my care for ozena. At this period there was a large
discharge of intolerable foetid matter from both nostrils, most abund¬
ant in the morning after waking ; his nostrils were then filled with
it, and on blowing them, immense quantities would be discharged,
part being in a fluid purulent state, and the remainder dried into
tenacious yellow plugs ; during the night much of this matter ran
into his throat, and by its offensiveness produced severe sickness of
the stomach, and sometimes a loss of appetite the next day. The

532

Bibliography .

discharge also existed during the day, but as he could then keep his
nostrils clear of an accumulation, he suffered less at that period.
He occasionally had headaches, especially when the quantity of
the discharge diminished.

The following statement in a letter dated Sep. 16, 1828, from
his attending physician, the late Dr. Spence, marks the progress of
his complaint, and the mode of treatment which had been resorted
to : — “ Luke Johnson has for a long time laboured under a distres¬
sing pain in the head, and particularly in the frontal sinuses, with
a discharge of offensive matter from his nose. He has not long
been a patient of mine ; all the remedies he has used have been
unavailing. About three years since he first complained of pains in
his head, which he ascribed to sleeping in a damp cellar. A short
time before I took my last trip to your city, (August, 1828,) I was
consulted on his case. He then complained of severe pains in the
frontal sinuses, accompanied with a discharge of very offensive
matter from both nostrils. He had taken a variety of medicines,
chiefly, I believe, of a purgative nature, without benefit ; and he
was a good deal reduced in flesh. As he had a thick mass of hair
on his head. I directed it to be cut off, applied blisters to his fore¬
head, and put him on an alterative course of mercury combined
with a small portion of opium. When his gums became affected,
I advised him to leave off the mercurial pills. This course he had
commenced before I left Dumfries, and since my return he has
informed me his mouth has been sore ; the blister has drawn well,
but without affording him relief. He also used a weak solution of
sulph. cupri as a detergent wash, which he thought beneficial, as it
caused a free discharge of pus from his nose ; for when this dis
charge is checked he is almost distracted. He is a man of great
veracity, and assured me he never had had any syphilitic affec¬
tion.”

Desparing in this case of the efficacy of the usual routine of
practice, I determined to begin at once with the application of a
solution of chloride of lime. Dr. Physick’s advice being also taken,
with his characteristic candour, he acknowledged the inefficacy of
such remedies as he had been in the habit of using, and he readily
acquiesced in the plan of treatment proposed. I accordingly began
by putting about a tea-spoonful of the chloride of lime in a wine
glassful of water, and i injected each nostril with the clear solution.
This process was repeated twice a day for a week. During this
time it produced no important diminution of the discharge, but it
made the patient more comfortable by correcting the foetor. At the
expiration of the week, Luke went home with directions to perse¬
vere in the treatment. The sequel will be seen in the following
communication to me from Dr. Thomas M. Boyle, dated Dumfries,
Virginia, April 13, 1830.

“ On my return home, in conformity to your request I called on
your patient, negro Luke Johnson. He stated that by the use of
the chloride of lime, as recommended by yourself, his nasal affee-

Surgery.

53 3

tion was entirely cured in December last. Since then his general
health, which before did not suffer much, has been remarkably
good.”

I may further state, that since the occurrence of this case, the
chloride of lime has been used with evident advantage, in another of
a year’s duration, where the affection is confined to one .side ; but
the treatment has not progressed far enough for a positive and satis¬
factory result. In this case the application of the lime by snuffing
is followed instantly by a discharge of several drops of serum ;
afterwards, pure transparent mucous is secreted abundantly for the
day, attended with frequent sneezing and all the local symptoms of
influenza, with a perfect arrest for the time of purulent discharge.
The nostril is caused by the application to bleed frequently ; this
circumstance has made me hesitate in the regular application of the
remedy. I have also prescribed it in a very severe case of three
years duration, and on both sides, but of the result I am not yet
informed.

As cases of ozena do not frequently occur in the practice of an
individual, I trust that this suggestion of chloride of lime as a
remedy will be candidly tried by others, and their experience com¬
municated . W e have some accounts of its being used successfully
in caries of the bones of the nose, which will be an additional
incentive to a fair experiment of its value, in chronic purulent dis¬
charge from the nostril. — American Journ. of the Med. Sci . May,
1830.

8. Case in which a Foreign Body remained ten years in the Bron¬
chia before causing death. — As an instance how long foreign bodies
sometimes remain in the bronchia before causing death, M. Dupuy-
tren related the following case : — One of his friends, a robust young
man, whilst playing with some children, amused them by throwing
up a ten-sous piece, and catching it in his mouth ; at last, during
the moment of inspiration, the coin fell into the trachea. Violent
painful cough, accompanied by a peculiar noise, immediately en¬
sued, especially when the foreign body was, during expiration,
thrown up towards the glottis ; when it was not moved, as it some¬
times happened, for several hours, respiration was but slightly
affected. The patient being continually in hopes that the foreign
body would be thrown up through the glottis, decidedly objected
to an operation, and in this state continued for five years, during
which time he was much inconvenienced by cough, suffocation, &c.
After that period, however, the foreign body appeared to become
fixed, and for some time the patient felt almost quite well. Symp¬
toms of phthisis, however, gradually succeeded, and terminated his
life ten years after the accident ; the piece of money was found in
a tuberculous excavation. — Lancette Francois.

9. Strangulated Hernice, new mode of reduction. — Mr. Geoghe-
gan, an experienced surgeon in Dublin, has addressed a letter to
Mr. Abernethy, in which he makes some critical remarks on the
modern practice, and endeavours to disprove its correctness. He

534

Bibliography.

published a paper upon the subject in the Edinburgh Medical and
Surgical Journal, in 1811, vol. vii., which was unfairly censured
in the opinion of our author. The experience of later writers con¬
firms his views. The principal feature in his treatment of stran¬
gulated herniae, is the application of cold for an hour, which
“ evidently controuls inflammatory action, and abates sensibility,
a very material preparation for manipulation, and for the ulterior
operation.

<£ In the original publication, I have quoted verbatim the advice
of Munro, Pott, Bell, Cooper, and Lawrence, on the taxis in
strangulated hernia, a manipulation as described by them, in my
judgment not adapted to the cure of the disease on principle —
and calculated to aggravate it, to a dangerous extent, indeed so as
to occasion the obliteration we have been discussing.”

Our author enumerates several cases which required operation,
according to the opinions of many highly talented surgeons, and
were relieved by the application of cold. Sir Astley Cooper, in
his lectures in The Lancet, offers a sharp comment upon the pas¬
sage — “ that cold applications are useful in removing strangulation,
and gives instances of their success, but that it is an absurdity to
attribute this to diminishing the volume of air, and that if cold had
such a power, it would do no good, nothing could be gained by it,
that the principle is erroneous, diminishing can do no good, whilst
pressure is the same, it is of no use to empty the gut of its con¬
tents, &c* &c-”

The authorities, arguments, and facts stated, I hope will con¬
vince Sir A. Cooper, that the principle and practice he impugns,
are better founded than he imagined, and that if, as he observed,
he suffers such a calamity, which I hope may never happen, he will
avoid the practice he proposes for himself, namely, in the first in¬
stance the taxis for about fifteen minutes, then bleeding, tobacco
enema, and if they fail, operation speedily, and that he will reverse
the order of proceeding, and defer the taxis until bleeding and the
enema had been used, then danger from handling will be lessened,
and we know that the taxis increases inflammation when it fails ; he
would be still safer, I am satisfied, were cold applied first for an
hour, it evidently controuls inflammatory action, and abates sensi¬
bility, very material preparation for manipulation, and for the ulterior
operation. When cold succeeds, the tumefaction disappears as per
saltern with (a hissing noise caused by exit of the contents,) not
paullatim as the fingers are erroneously employed to accomplish.

“ The reasoning and facts advanced in this paper, and in my pub¬
lication, and much observation, perfectly satisfy me, that the in¬
dication of cure, and the manner of fulfilling it, as universally taught,
are at variance with all principle, not adapted to the cure, highly
dangerous, and ought to be abandoned, and the indication substituted
of abating inflammation, and removing tubular obstruction, which is
often effected by local and general remedies, as I have already

Surgery.

535

detailed, without handling the part, and should they prove ineffec¬
tual, the sensibility will be lessened so as to admit of manual
efforts with more safety. These efforts should be conducted
differently from the usual manner, their object being different,
namely, the return of the contents of the hernia, not the hernia itself.
This is to be effected by embracing it with the hand or hands, ac¬
cording to its size, and gently squeezing, so as to act upon the con¬
tents without disturbing the hernia much, or removing it from its
situation. If the contents obtain exit through the obstructed part of
the intestine, the strangulation will yield ; then the intestine being
reduced to a smaller size than the aperture, can be replaced with
ease : it is manifestly its bulk that constitutes the resistance ; a point
of incalculable importance on which to anchor. Should this practice
fail, the hernia will still be within the reach of operation, and those
fatal consequences arising from strangulation* within the ring, after
th£ replacement, can never occur.”

MATERIA MEDICA.

10. A second edition of Dr. Reece’s Essay on the effects of Lobe¬
lia Inflata has just appeared, in which he adduces the testimonies of
eminent physicians of America, Glasgow, &c. He observes, “ It
may be proper to add, that of the cases in which the oxy-syrup or
the ethereal tincture has been exhibited, neither of them failed to
afford the most essential relief ; in some, removing every symptom
of the malady in a few minutes. In order to ensure its full or
specific effects on the malady, the dose of either preparation should
be gradually increased till it slightly nauseates the stomach.

“ The author has added a concise account of the Chirayita herb,
the celebrated Indian remedy for indigestion arising from morbid
sensibility or nervousness of the stomach, attended with disorder
of the liver, a predisposition to gout, &c. which has lately been
administered in this country with great success in nervous or irrita¬
tive affections of the digestive organs, after other stomachics and
the blue pill had failed.”

The profession is indebted to Dr. Reece, for the introduction of
some valuable medicines into practice, and from the high testimo¬
nies in favour of these before us ; wre strongly recommend them to
the notice of the medical practitioner.

IT Ascites cured by the external application of Digitalis. — M. Rai¬
sin has cured two cases of dropsy by friction with the tinctures of
digitalis and squills. One of these patients was attacked at the
same time wTith quartan fever and gastritis — in the other the dropsy
had resulted from abdominal inflammation. The state of the gastric
passages would not permit any of the stimulating remedies proper
to excite the secretion of urine, to be taken,. M. R. had recourse
to the intraleptic method, which produced an abundant flow of
urine, and the ascites disappeared after a treatment of from two to
three months.

536

Bibliography.

M. Dan de la Vanterie has obtained a similar effect from the long-
continued application of the fresh leaves of digitalis bruised, to the
thighs and lower part of the abdomen. — Amer. Journ. of Med. Sci.

12. Ergot of Rye as a Febrifuge. — Dr. Mehlhausen, of Deutsch-
Eilaw, recommends, in the 29th Vol. of Rust’s Magazine, the ergot
as a remedy for intermittent fevers. In seven cases in which he
employed this remedy, five were cured. It must be confessed with
no great success. He gives the remedy in the dose of ten grains,
repeated three times in the two hours, which immediately preceded
each paroxysm. — Op. cit.

13. Arsenic in large doses. — We have received a communication
from R. Dakin, M.D. of Columbus, N. .T. in which he states, that
he has employed, at the suggestion of Dr. Budd, of Mount Holly,
N. J. arsenic in large doses, as a remedy for intermittent fever, and
with great success. He gives it in the form of pill, in doses of
one-fourth of a grain, four times a-day — in one case he says he
gave as much as five grains in three days. He says that he has
never seen any serious injury result from these large doses. — Ame¬
rican Journ. of Med. Sci.

14. Taste of Sulphate of Quinine. — M. Schweinsberg states in
Geige’s Magazin fur Pharmacie, for Oct. 1829, that the best mode
of correcting the bitterness of the sulphate of quinine is not to mix
it with syrup, but with an aromatic powder. The sulphate of quinine
is so intensely bitter that a mixture of one part of this salt with one
hundred and sixty parts of sugar is still sensibly bitter ; but if one
part of the salt be mixed with ten or fifteen parts of powdered vale¬
rian, fennel, aniseed, orange peel, &c. the mixture possesses scarcely
any bitterness.

CHEMISTRY.

15. Analysis of Copaiba. — M. Gerber, of Hamburgh, has ana¬
lysed the pale yellow copaiba, and obtained the following results : —
Volatile oil, 41; a brown resin insoluble in cold petroleum, 2.18;
a brittle yellow resin soluble in cold petroleum, 51.38; water,
5.44.

When the copaiba becomes old, it undergoes some changes,
according to M. G. ; a part of its volatile oil appears to be trans¬
formed into a brown resin ; thus the analysis of old copaiba fur¬
nished with the following results; — Volatile oil, 31.7; soft brown
resin, 11.15; brittle yellow resin, 53.68; water, and loss, 4.10. —
Apotheker, Archives des tom. xxx.

16. Purity of Balsam Copaiba. — The best test of this, according
to M. Gerber, is the caustic ammonia, which furnishes at once a
clear solution, whilst the solution with potash does not become clear
until after some time. The addition of a very small quantity of
fatty oil, renders the ammoniacal solution immediately cloudy and
thicker. — Ibid .

[ 537 ]'

MEDICAL POLICE.

17. - Respect shewn by the French Government to the Medical Pro¬
fession. — An “ ordonnance” has just appeared conferring the decora¬
tion of the Legion of Honour on MM. Rostan, Biett, Lallemand, An-
Mol fils, Chomel, andBarruel. Not many months ago several medi¬
cal men in Paris were created Barons. The document above-men¬
tioned is followed by a report from the Minister of the Interior to the
King, from which we subjoin an extract. “ Medicine is at once the
noblest of the sciences, and the most useful of professions — neverthe¬
less it offers but few resources to those who practise, or to those who
teach it. By the very nature of their pursuits physicians seem to be
in some degree excluded from the ordinary paths of ambition. It is
therefore just that the government should bestow upon them a large
share of the honours awarded to merit.”

ARMY MEDICAL DEPARTMENT.

18. Alterationsto the following effect have taken place in the Army
Medical Department : — All former rules and regulations respecting
the titles, rank, periods of service and pay of the medical officers of
the army have ceased, and the following are to be in force; — The
rank of Apothecary to the Forces, and that of Hospital Assistant
have been abolished ; the title of Physician to the Forces has also
been discontinued, instead of which, that of Assistant Inspector lias
been established. The army medical officers are to be distinguished
by the following ranks and titles ; Inspector General of Hospitals,
whose pay will be from 1Z. 16s. to 21. varying according to length
of service ; Deputy Inspector General of Hospitals, daily pay, vary¬
ing under some conditions, from 1Z. 4s. to 1Z. 10s; Assistant In¬
spector of Hospitals, daily pay, from 19s. to 1Z. 4s. ; Staff Surgeon,
daily pay, from 14s. to 1Z. 3s. ; Regimental Surgeon, daily pay from
1 3s. to 1Z. 2s. ; Assistant Surgeon, daily pay from 7s. 6d. to 10s.
The amount of pay between the highest and lowest terms, is in
proportion to length of service, which is fixed at the following
gradation ; — above 25 years actual service the highest pay, above
20 and under 25 years, above 10 and under 20 years, under the
lowest pay.

MEDICAL JURISPRUDENCE.

19. Agreeably to our promise, we subjoin a correct and original
report of the medical evidence at the trial of the notorious St. John
Long, which will be found more comprehensive than that of any
of our contemporaries. We think it unnecessary to insert the evi¬
dence of the other witnesses, which differed in no respect from that
given at the inquest. There is much room for criticism upon the
medical evidence, but we leave the reader to compare it with that
given at the inquest. Had the witnesses been properly cross-
examined by the prisoner’s advocates, no small discrepancy would

Vol. v. no 30. 3 N

538

M edic cd Ju r ispru dence.

have appeared, which, with the comments of Mr. Justice Park,
would have turned to no trivial account for the benefit of the ac¬
cused. A worse defence w7as never made ; in fact, there was no
defence at all. On referring to page 259, it will appear that the
medical evidence was discrepant at the inquest, and, on perusing it
below, it will be found perfectly accordant. Again, the treatment
employed in Miss Cashin’s case was the most inert, a fact that
would have afforded some palliation of the prisoner’s crime. The
fact was, the prisoner had no fears upon the issue— he was intoxi¬
cated with the support and patronage he received from the aristo¬
cracy and gentry — an influence which had no small effect in a
quarter in which it ought to have had none. It had no effect,
however, on the honest and intelligent jury, who, to their eternal
credit, contrary to the judge’s charge, brought in a verdict of guilty.
They could not have done otherwise, for it was as clear as the
meridian sun that the deceased lost her life by the gross ignorance
of the prisoner. On the announcement of the verdict, the surprise
of Mr. Justice Park, and of the nobility and gentry who sur¬
rounded him, was extreme, it was confusion — worse, confounded.
The sympathy for the gentleman at the bar,” a convicted felon,
was great, and his sentence was delayed, which finally was decreed,
a fine of £.250, and thus ended the farce of “ killing no murder.”
In one short month the prisoner is found guilty of another man¬
slaughter, and in consequence of the great public indignation, he
evades justice, though appearing at large under the eyes of the
civil authorities. Had he been a poor man, he would speedily find
a place in Newgate. It is clear, however, that his iniquitous career
is at an end, as it is beyond all doubt he can make no defence in
the case of Mrs. Lloyd ; and we are inclined to think that the
vox populi, will not be lost on the next judge who will try his
case.

Trial of St John Long, at the Old Bailey, Oct. 30.

Before Mr. Justice Park.

20. B. C. Brodie, Esq. I am a surgeon. I went on Monday, be¬
tween five and six o’clock, to the house of Mrs. Roddis, and saw
Miss Cashin — she was confined to her bed ; I examined her person,
and found her back very extensively inflamed — the whole of the
inflamed surface must have been as large as the whole of a common
plate, and in the centre of the inflamed part there wras a spot as big
as the palm of my hand, which was black, dead, in a state which
we call slough or mortified — she was also suffering from incessant
sickness ; I was informed that nothing wdiatever would remain on
her stomach — I prescribed some medicine for her, merely to allay
the sickness — nothing further could be done at that time ; I ordered
a poultice to be applied to the back — I believe it had been poulticed
before ; I desired it to be continued — I thought her very ill indeed,
though I did not at that time regard her to be in such very imminent
danger as she was.

Medical Jurisprudence.

539

Q. Had you any means of judging how the place on the back
had been produced? A, I should think some very powerful stimu¬
lating liniment had been applied to the back ; I called at the house
on the following afternoon, and found she had died in the morning —
in her state I should think it quite absurd to administer a tumbler
of port wine — it was impossible it could stay on her stomach.

Cross-examined by Mr. Gurney. Q. When you arrived at the
house, and heard the young lady was dead, I believe you were per¬
fectly astonished ? A. I did not expect her to die that day; Ido
not knowr that I expressed great astonishment — I saw the body ;
mortification had extended in the course of the night very rapidly
indeed — I did not examine the entire body.

Q. Is there a system among some of your profession of curing
disease by counter-irritation ? A. It is very common ; a blister
causes counter irritation.

Q. Will not the things which are made use of as counter irrita¬
tion have different effects on different persons ? A. Yes, they will ;
I have known cases where a blister will not disturb the system of
one person, and produce very great disturbance in another ; the
bad appearance in this wound would not alter after death.

Mr. Phillips, Q. Are there many means which may be used by
professional gentlemen to check counter-irritation, if it proceeds too
rapidly ? A. Yes, there are, and they require to be used with
discretion,

Q. Would you think it right to apply to a person in perfect
health, stimulating liniments, which would produce such a slough
and sore as you saw on this lady’s back ? A. Certainly not, and
I doubt very much whether any stimulating liniment, in com¬
mon use among the profession, would produce the same effects —
the same extensive mischief ; I mean by that to include the consti¬
tutional and local effects ; the sickness and vomiting were as much
the effects of wrhat had been done as the mischief — if the liniment
had not been applied to the back, there would not have been the
sickness nor the mortification.

Court. Q. Upen your judgment and experience, if a lotion of so
powerful a stimulating nature as to produce the effect you observed
on the person of the patient, was applied to a person of her sex
and appearance, being then in perfect health, was such an applica¬
tion likely to produce a derangement in the system, and to produce
disease and danger ? A. I think it would, and it has fallen to my lot
to see another case, exactly similar, since.

Q, Is there much difference in the constitution of persons, so
as for the effect to be different, according to the constitution ?
A. There is — it depends on the constitution, the thickness of the
skin, and other things ; it is not uncommon to apply stimulants to
the chest, blisters, for instance — I never knew stimulants applied
where there were no symptoms of consumption ; I did not know
the young lady before — when I saw her there was a black spot of
mortification in the centre of the wound, which extended during the

540

Medical Jurisprudence ,

night : the black spot itself was as large as the palm of my hand ;
wine would have been proper to administer if the stomach would
bear it.

Q. Why you say it was improper is on account of the stomach ?
A. The question put to me was whether a tumbler of wine would
be proper ; mulled port wine, administered in a proper quantity,
would not be improper, if the stomach would bear it — I was not
present at the post mortem examination ; the appearances I saw on
the back were quite sufficient to account for death— -I can say
nothing about what produced these appearances, except from what
I was told by Mr. Sweetman, Mrs. Roddis, and others in the
house ; I did not examine the back after the body was opened — I
saw a portion of the dead skin, which was taken from the back.

Dr. Alexander Thomson. I am a bachelor of medicine. I at¬
tended at Mrs. Roddis’ house, and saw the body of the deceased
there, stated to be Catherine Cashin, on the Sunday morning after
her death ; I examined the body, and the wound on her back —
(producing a memorandum) this wras not made by myself.

Q. Give us an account of the appearances of the body, as well
as you can, without referring to that ? A. I will endeavour to do'
so, but it is not usual for medical men to recollect these things —
we commit them to writing. I have heard Mr. Brodie’s evidence,
and concur in every thing he has stated, most certainly ; I went to
the tomb where she was buried ; I saw the same body there, as far
as I could possibly ascertain — it had similar appearances to the
body I bad seen ; I had sewn up part of it — it had the sewing
up which 1 had made, and also the incisions I made.

Mr. Thomas King. I attended the examination of the body of
the deceased, at the Roman Catholic Chapel, Moorfields, on the
24th of August ; Dr. Thomson, and various other surgeons were
present — there was a piece of dead or disorganized skin, which we
call an eschar, (which Mr. Brodie calls slough) between the shoul¬
ders, nearly the size of a crown of my hat ; the parts beneath the
skin were gorged with serum.

Q, What did the appearances you saw on (he back seem to you
to have been produced by ? A. If I was to hold a piece of hot
iron about a quarter of an inch from the skin, it would produce
such an eschar — we examined with a view to discern if there was
any latent disease ; we discovered none whatever — 1 examined the
brain and spinal marrow ; the muscles were in a tolerably healthy
state — they were in a state I should expect after laying some time
in the tomb.

James Johnson, M.D. I attended at the tomb, and was present
at the examination of the body — the limbs and breasts were plump
and fleshy, and so was the body generally ; there was no appear¬
ance whatever of disease, except where the wound was inflicted —
not of disease which could have preceded the infliction of the
wound ; I believe there was no disease existing previous to that —
there was no evidence of it whatever ; I examined the brain — it was
perfectly sound, and the spinal marrow was perfectly sound.

Medical Jurisprudence ,

541

Cross-examined by Mr, Sergeant Andrews. Q. Was this on the
Sunday after her death ? A. On the 24th, the Tuesday week.

Mr. John Hogg. I am a physician. I examined the body of
Miss Cashin, with the other gentlemen, in the tomb at Moorfields
Chapel — I observed the appearances on the back very particularly ;

I have heard the evidence of the other gentlemen — I differ a little
with Dr- Johnson’s description of the spine, but I agree in the
description of the wound on the back ; I should have supposed it
was produced either by fire or gunpowder- —it had that appear¬
ance.

Q. Can you conceive any state in which, in a healthy body, the
application of any thing which could produce such a sore could be
of service. A. Certainly not.

Court. Q. What do you not agree with Dr. Johnson about ?
A. It struck me the sheath of the spine was discoloured opposite the
external wound — the inference I should draw from that was, that
there must have been very great constitutional disturbance en¬
suing.

Q. Did you not state before the Coroner, that not having been
present at the first examination, it was difficult for you to ascertain
cause of death ? A. I said so, and that violence done to the ner¬
vous system was sufficient to cause death, particularly to a nervous
young lady.

Henry Goodeve, M. D. I attended at Moorfields Chapel, and
assisted in the examination of the deceased — I observed the wound
on the back ; I could discover nothing but what must have arisen
from that wound, that could have caused her death — I examined the
brain and every thing ; I looked at her breasts and limbs — they
seemed, as far as I could judge, as if she had been a very healthy
person ; I would not have inflicted such a wound myself.

Prisoner’s Defence (written.) My Lord and Gentlemen of the
Jury, — I am perfectly sensible, that in the situation in which I
stand, I should not benefit my case by the use of eloquence, even
if I possessed it ; I will, therefore, in few words, state simply and
truly all the facts I know respecting the unfortunate young lady
whose early death occasions the present inquiry. In August last.
Miss Catherine Cashin came to me, with her mother and sister, the
latter of whom was deeply affected with a pulmonary complaint,
and had, as they informed me, been given over by her physicians ;
the deceased was supposed to be afflicted with the same disorder,
and was, by her mother’s desire, put under my care for examination
and cure ; the means I used, and the mode of treatment I adopted,
were those, by which, in the course of the last four years I have
been enabled, under God, to restore to perfect health a great num¬
ber of persons of the first respectability and of high rank, after
their cases had been declared hopeless, and they had been given
over by some of the most eminent medical men of the present day ;
if the course of treatment by me in the case of the deceased hap¬
pened to fail, it was a dispensation of Providence, which human

542

Medical Jurisprudence .

means could not avert — it was such a failure as frequently occurs to
medical practitioners of the first repute ; I utterly deny that I have
in any way been accessory to the death of Catherine Cashin — had
I no human feeling, no religious principle, my interest would pre¬
vent me from purposely doing or negligently hazarding any thing
which could produce evil or even danger. In conclusion, Gentle¬
men, 1 will add one observation — I know that whilst this case was
under discussion before the Coroner, and even since, the public press
has been employed in endeavours to create a prejudice against me —
even since the bill on which I am now being tried has been found,
the substance of it, with comments, has been laid before the public ;
I am sure I need not entreat you not to judge or decide from .such
statements — I know you will be governed by your oath, and by that
alone ; but I intreat you, if possible, to dismiss from your memory
any thing you may have read or heard on this most distressing sub¬
ject. Gentlemen, I now leave the case in your hands, with hope
and confidence ; an intention to do evil no one will impute to me,
and it will be for you to decide whether a medical practitioner, be
his skill what it may, shall be criminally answerable for a fatal
event, which he could neither foresee nor avert. I am to be tried,
not by any fancied system of justice, but by the law of England,
constitutionally administered — to that law I make my firm and so¬
lemn appeal ; you. Gentlemen, will have it explained by the learned
Judge, and on his wisdom and your conscience, I place my firm
reliance. — Verdict — Guilty. Fine £250,

MISCELLANIES.

21. DISSENSIONS AT THE LONDON UNIVERSITY - LETTER FROM

PROFESSOR CONOLLY TO THE EDITOR.

University of London, November 15 th, 1830.

Sir, — I am sorry to be obliged to occupy any portion of your pages
with what merely relates to myself ; but I think it proper to inform
you, that the account, given in a note at page 449, of your Number
for the present month, of my reasons for withdrawing from, and sub¬
sequently resuming, my duties at the University Dispensary, is alto¬
gether incorrect.

I do not wish to revive the memory of the only personal difference
with the Council in which I have ever been involved, and which has
now for some time been entirely set at rest ; but I am called upon to
add, that the assertion, in the same page, that the Council of the
University offered me the alternative of returning to my Dispensary
duties, or of resigning my Professorship, is utterly without foundation.

I am. Sir, your very obedient servant,

J. Conolly.

NOTICES TO CORRESPONDENTS.

22. We received a communication from Mr. Whitmore, in which
he states he had not attended the female, whose case we published
under the title of “ Extraordinary instance of reproduction.” We
have made inquiry, and find Mr. W. is quite right ; but he attended
immediately prior to the period mentioned.

Miscellanies .

543

In reply to “ A Reader of the Medical and Surgical Journal,” we
beg to state, that we have fearlessly exposed the intrigues against the
medical attendants of His most gracious Majesty, while a Royal
Duke, and further to add, that with the exception of “ The Lancet,”
no other Journal has noticed the subject. It would serve no useful
purpose to resume this topic, as the professional odium attached to
it can never be wiped away. W e in common with all independent
members of the profession, deplore the existence of such conduct in
this enlightened age, and more especially that splendid services to
humanity, science and the fame of our country, should have been re¬
warded with neglect and apathy ; but we can perceive no redress, no
source from which condign punishment can reach those guilty of
such unprofessional and base behaviour.

23. Mr. C. Bell has resigned his professorship in the London Uni¬
versity This Institution is now placed on a firm basis, by the ele¬
vation of Mr. (now Lord Brougham,) to the office of Lord Chancellor.
It will have a charter.

LITERARY INTELLIGENCE.

Dr. Epps willshortly publish an Account of thelifeof John Walker,
M.D. late Director of the National Vaccine Establishment.

Mr. Curtis, Surgeon Aurist to His Majesty, has in the press a new
edition of his Treatise on the Physiology and Diseases of the Ear.

Communications have been received from Drs. Montgomery and
Cusack, of Dublin, Mr. Gregory and Mr. Swift, Dr. Tuthill, of
Halifax, Nova Scotia, Mr. Whitmore, Mr. Foote, Mr. Mitchell, Dr.
Stoker, Dr. Conolly, Dr. Alexander Thomson, Mr. Edward Browne,
and a Constant Reader.

ROOKS RECEIVED DURING THE MONTH.

•1. Dublin Medical Transactions ; a Series of Papers by Members of the Associa¬
tion of Fellows and Licentiates of the King and Queen’s College of Physicians in
Ireland, 1830. p.p. 38. 8vo. Three plates. Dublin. J. M. Leckie.

2 Elements of Surgery. By Robert Liston, Fellow R. C. S. in London and
Edinburgh, &c. &c. 1831 8vo. pp. 318. London. Longman and Co. Adam
Black, Edinburgh.

3. Medicine no Mystery ; being a brief Outline of the Principles of Medical
Science, designed as an Introduction to their general Study as a Branch of a liberal
Education; 2d edit. By John Morrison, M.D. and A. B.T.C.D. 1834. pp. 165.
London, Henry Washbourne ; Millikin and Son, Dublin.

4. Cases, illustrative of the Efficacy of various Medicines administered by In¬
halation, in Pulmonary Consumption, in certain morbid States of the Trachea and
Bronchial Tubes, attended with distressing Cough, and in Asthma. By Sir Charles
Scudamore, M.D. F.R.S, &c. &c. 1830. 12mo. pp. 113. London, Longman
and Co.

5. Pathological Observations, Part Third, on Typhoid, Inflammatory and
Symptomatic Fevers, with an Appendix, consisting of Cases to illustrate the Nature
and Treatment of Diseases. By William Stoker, M.D. Hon. Fellow of the King
and Queen’s College of Physicians in Ireland, &c. &c 8vo. pp. 133. 1830. Dub¬
lin, Hodges and Smith, and Millikin and Son.

6. A Practical Treatise on General or Partial Debility, either original or here¬
ditary, or from Age, Dissipation, Residence in a tropical Climate, &c. &c. or the
most effectual Means of preventing and curing Organic Disease, &c. by Diet, Ex¬
ercise, and the Round Leaf Cornel, where a Tonic Remedy is necessary. By
S. H. Robinson, M.D. and others. Highley, London.

544

Miscellanies.

«

7. Disputatio Medica Inauguralis de Cynanche Tracheali, Sambel MaUns, An-
glus. Edinburgh 1830.

*** A well written and able theses.

8. A Practical Treatise on the Anti- Asthmatic Properties of the Bladder-podded
Lobelia ; with Directions, &c. By Richard Reece, M.D. Fellow R.C.S. &c. &c.

9. Cases of Cancer Uteri; with Observations. By W. F. Montgomery,
A.M. M.B. M.R.I.A. See.

10. Report of the Wellesley Female Institution. By Samuel Cusack, A.B.
M.B. &c.

11. Farther Remarks on Hernia, in Explanation of the Nature of Strangulation,
and of Obliterated Intestine, and in Defence of Views and Suggestions towards
Improvement in the Treatment, By E. Geoghagan, M.R.C.S. &c. in a Letter to
John Abernethy, Esq. Hodges and Smith, Dublin.

12. Case of Ovarian Disease of a remarkable Character. By W, F. Mont¬
gomery, A.M. Two plates. Dublin, J. M. Leckie.

13. Description of a very remarkable Malformation in a Foetus, in which nearly
all the Abdominal Viscera and the intestinal Canal were external to the Body. By
W. F. Mentgomery, A.M. &c. Dublin, J. M. Leckie..

14. Report of the Coombe Lying-in-Hospital. By Richard Reed Gregory, Mem¬
ber R.C.S. in Ireland, &c .

15. An Address introductory to a Course of Lectures on the Principles and
Practice of Physic, delivered before the Members of the City of London Medical
and Chirurgical Society, By James Baker, Surgeon.

16. Lectures on Anatomy, interspersed with practical Remarks. Vol Second.
By Bransby B, Cooper, F.R.S. &c. 1830. pp. 308. 8vo. S. Highley, London.

*** These Lectures are concise, minute, and excellently Well written, and when
complete, will be exceedingly popular with students. ;

17. Appendix to a second edition of a Series of Observations on Strictures, &c
By R. A Stafford. 8vo. pp. 156. London, 1830.

18. A Treatise on Pulmonary Consumption ; its Prevention and Remedy* By
John Murray. Small 8vo. pp. 156. London, 1830.

19. Practical Remarks on the Nature and Effects of the expressed Oil of the Cro¬
ton Tiglium, &c. By Michael J. Short, M.D. 8vo. pp. 64, 1830.

20 Remarks on the Disease called Hydrophobia; Prophylactic and Curative.
By John Murray, F.S.A. &c. &e. 8vo. pp. 86. Longman & Co., 1830

2. A Short Tract on the Formation of Tumours, and the Peculiarities that ^are
met with in the Structure of those that have become Cancerous : with their Mode of
Treatment By Sir Everard Home, Bart. 8vo. pp. 98. Longman, 1830,

The various Periodicals, domestic and foreign, have been duly received.

ERRATA IN VOL. V.

Page 135, for “ morbid anatomy,” read “ average mortaliiy;” “due charges,”
read “ few charges “ rubefacients,” read “ sorbefacients.”

- 148, for “ Dr. Real,” read “ Dr1 Reade.”

* - - 156, four lines from top, for “ formerly,” read “ finally.”

- 164, twelve- lines from bottom, for “ quora,” read ££ quinia.”

- - 229, for £f judicial anatomy,” read ££ judiciary anatomy.”

■ - 250, six lines from bottom, for “do means,” read ££no means.”

- - 356, for C£ Medical Logical,” read ££ Medical Logic.”

: y , . .*'•

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

*** Title and Index in our next.

INDEX

VOL. V.

Page

A.

Abdomen, excision of, for removal
of Foetal Bones - 172

Abortion, causes of - - 510

Acites, cure of, by digitalis, exter¬
nally - 535

Accoucheur, Laws relating to - 315
Affection of the Heart, Mr. Dobson
on 305

Ague, Endermic cure of - 164

American Journal, North, Reply to 82

Anatomy, Judiciary Remarks on - 220

- , Morbid Vademecum of - 67

- , Pathological value of - 191

Aneurism, Hunter, Guthrie, and
Wardrop on - 99^

Animal Fluids and Solids, Dr. Stoker
on - 110

Aneurism of the Heart and Aorta,
relieved by Moxas - - 73

Apparatus, extraordinary Obstetric - 67
Apothecaries’ Company, regulations
of - - - 339

- , abuses of - 227

- , duties of,

towards Physicians - - 238

- , unqualified

- - - — . , penalties

against - - - 315

- , fees for at¬
tendance, legality of - 321

- , Irish Laws

relating to 329

Arsenic, large dose of - 536

Argenti Nitras, use of, in Diseases
of the Eye - 276

- , uses of, in Leucorr-

hoea - - 283, 289

- - use of, in Gonorrhoea 290

Army, Medical Department, rules of 537
Artery, internal Iliac Ligature on - 73

Arteries, irregular distribution of.

Dr. Green - - 65

- — , Mr. Guthrie on - 99

Page

Asylum lunatic, defects of - 98

Attendants, Medical, of his late Ma¬
jesty, intrigues against - - 352

Authors, medical Right of - 332

Autopsies of French Kings - 150

B.

Bath Warm, use of, in Delirium
tremens - - 162

Beale, Mr. on Deformities - - 30

Belladonna, use of, in Pertussis - 338

- , use of, in Phthisis and

Neuralgia - - - ib.

- , Iritis - - ib.

Bell, Mr. Charles, Resignation of - 85
Bites of Serpents, efficacy of Mur.
of Soda in

Blake, Dr. on tubercular peritoneum 486
Blane, Sir G., Biography of - 335
Blood, preservation of - 259

Bodies, Dead, Exhumation of. Law
on - - - 335

Bones, Discharge of, per rectum et
vagin am - 337

Botany, Mr. Castle on 339

Bright, Dr., Harvian Oration by - 75
Brodie, Mr., Evidence of - - 261

Burne, Dr., on Contraction of the
Intestines - - - 155

C

Caesarean Operation, Cases of - 300

Calculi, numerous, in Vesiculae Se-
minales, Mitchell Mr, on - - 401

Cancer, Pathology of Dr. Hodgkin
on 397

Carbutt, Dr., on Cure of Ague, by
endermic method - - 250

Carmichael, Mr., on 01. Terebinth
in Venereal and other Diseases of
the Eye - - - 281

Carson, Dr., on Animal Heat 247

546

INDEX.

Page

Cashin, Miss, Inquest on. Dr. Thom¬
son on - 406

- - Inquest on. Reply to

the Editor on the Medical Evi¬
dence - - 342

Castle, Mr. on Botany - - 338

Characters, Anatomical, of some
Adventitious Structures - - 397

Chevalier, Mr., on the Efficacy of
Quinine with Purgatives - - 75

Cheselden’s improved Operation of
Lithotomy, Yelloley Dr., on - 400

Children, Genital Discharges of - 20

Chlorine, Use of, in Phthisis - - 291

Cholera, Searle Mr., on - 177

Chorea, Cure of, by Cold Bath — M.
Dupuytren’s Method - - 70

- , Dr. Ryan on - - 71

Cinchona, new Substitute for. Dr.

Hancock on - - - 79

Coffee, Dandelion Root substitute
for - 176

Cold Bath, Use of, in Chorea - - 71

College of Physicians, Power of, to
suppress Quackery - 233 264

- - , in Dublin - 326

College of Surgeons, power of - 322

- - - in Dublin, power of - 328

Company of Apothecaries, new Re¬
gulations of - 339

Conduct, Profession in public and
private Practice, Remarks on 139
Conolly, Dr. on Insanity - 92

Conquest, Dr., on Puerperal Inflam¬
mation - - 1

Consultations, Medical Importance
of - 141

- , Propriety of Apothe¬
caries at - 147

Consumption, Chlorate of Potass in 297
Copaiba, purity of - - 536

Copland, Dr. on Rheumatism of the
Ovaria - - - 58

Coroners, Medical, Contest for - 264

- - - , Failure of - 353

- , fees for attending, in Ireland - 329

Costello, Mr., on Lithotrity - - 76

Croton Tiglium, Short, Dr. on - 252

Gastroenteritis, Tetanus, Constipa¬
tion, and Hydrocephalus externally
as an irritant - - 258

Court, Medical Appointments, Ex¬
posures of the Intrigues of - 352
Cure of Naevus Maternus, by Vac¬
cination, Mr., Marshall on 53

D.

Dandelion Root substitute for Coffee 17 5
Deformities, Mr. Beale on - 30

Page

Delirium Tremens, warm bath in - 162
Derangement Mental, Mr. Foote on 129
Dewees, on Practice of Medicine - 89
Discharge Purulent from infantile
genitals - - - - - 20

Diseases Chronic, Dr. Philip on 109

Disease, Symptoms of, inexplicable
by morbid appearances - - 189

Dislocations, treatise on - 251

Dispensaries, great utility of - 140

- - - abuses in - - - 141

Dissensions in London University - 435
Distribution irregular of arteries.

Dr. Green, on - - - 165

Divorce, Law on - 331

Dobson, Mr. on the Spleen - - 242

- , on affection and action of

the heart - - 305

Drop, Black, poisoning by - 128

Dropsy, Pathology of. Dr. Stoker, on 134
Druggists and Chemists, rights of - 315
Dublin, Faculty of 326, 329

Duelling, Danger of attending, by
Medical Men - 333

Dupuy, Dr. on the Autopsies of the
Kings of France - 150

Dupuytren’s Account of the wounded
during the Revolution in Paris - 335
Dysentery, Cure of, by Acetate of Lead
and Opium - - 250

Dysmenorrhoea, Pregnancy in - 313

Ear, foreign body in, death - 525

Ecchymoses, on new born children 516
Editor’s Rejoinder to Dr. G. Smith 342
Eisdell, Mr. Defence of - 435

Elephantiasis, Dr. Titly on - 165

Elliotson, Dr. on Diseases of the
Heart ----- 380

- on Pipirine in Ague - 70

Empirics, Petition of, J. D. Wil¬
liams, Esq. against - - 351

- - punishment of, by College

of Physicians - 175

Endermic Method, efficacy of 164 — 250
Ergot of Rye, efficacy of, in haemorr¬
hages - - - 388

- - , in ague - 536

Errata in Vol. V. - - - 554

Ethics, Dr. Ryan on - - - 136

Evidence Medical, at the inquest on
Miss Cashin, strictures on - 262

- rules of giving - - 344

Excision of poisoned wounds, new
proposals for - - - 73

Eye, 01. Terebinth, in Diseases of 139
- , Venereal Diseases, Mr. Law¬
rence on - - 269

INDEX.

547

Page

Eye, Diseases of. Gonorrhoeal, and
Syphilitic, Mr. Lawrence, on - 271

F.

Faculty, Medical etiquette of - 228 — 231

- piety of - - - 266

Fawdington, Mr. on Seton in Nsevus 251
Fees of the Faculty, exorbitance of 223

- of Physicians, Laws of - - 74

Femur, disunited fracture of, treated
by Seton ... 474
Fevers, various theories of - 209

- Dr. Tweedieon - - 200

- not inflammation - - 201

- Hospital Dublin, Dr. O’Brien’s

Report of - 174

- Mortality of, in London, Man¬
chester and Dublin - - 208

- - , efficacy of blood letting in - 205

Fevers puerperal, uterine phlebitis 11

- Mortality of, in Paris, in 1829 17

- - — treatment of - - - 156 '

- puerperal. Dr. Conquest on - 1

- cause of, M. Tonelle on - 9

Fischer, J. J. Rev. on the cure of
Hydrophobia, by table salt - 49
Fistula lachrymalis, new operation
for - 148

Fluids and solids. Dr. Stoker on - 100
Foetus, malformation of, in which
nearly all the abdominal viscera
were external to the body - - 390

- in utero, death of, from ill

cured syphilis - - - 28

- - developement of 507

- signs of death of, before and

after delivery ‘ - - 514

Foeticide, signs of - - 515

- objections to 517

- - causes of involuntary 519

Foote, Mr. on Intermittent head-ache 404

- - on poisoning by the Black

Drop - 404

• - - on Mental Disturbance * 129

Formulae, unchemical defence of, by
Dr. Paris - 127

Fractures, treatise on - - 251

- of thigh, use of Seton, in 474

France, Royal Institute, proceedings
of - 74

Fungus hsematodes, formidable case
of . . .522

- Medical Faculty of, fees of 226

G,

Gangrene of lower extremity from
disease of the iliac and femoral ar¬
tery - 457

Gannal, M. on inhalation of chlo¬
rine in consumption - - 293

Page

Gastrohysterotomy, recovery from 172

Generation, organs of, diseases of 413

General Practitioners, society of 311, 352
Geo. IVth, Autopsy of - - 129

Geoghagan, Mr., on Hernia - 533
Gestation uterine, medico, legal ques¬
tions relating to . . 495

Gonorrhoea, simple, produced by
numerous diseases - - - 21

- secondary symptoms

from, Mr. Travers on - 22

- cure of, by Mercury - 24

Gonorrhoea and Syphilis, identity
of, not a specific Disease - 20, 22

- Nitras. Argent, best

Cure for - - - - - 290

- Arthritic Form of - 278

Graves, Dr. on gangrene of the leg,
phlegmasia dolens, from phlebitis,

457, 468

Green, Dr. on Irregular Distribu¬
tion of Arteries - - - 65

Guthrie, Mr. on Arteries - - 99-

H.

Haemorrhages, Cure of, by Secale
Cornutum - 338

- from large Arteries,

Suppression of, by natural eftorts
or slight pressure - 104

Halford, Sir H., Exposures of, in
Court Medical Appointments - 352
Hancock, Dr., on Cinchona - 80

Handy v. Hension, Decision of - 321
Hart, Mr., on the Action of the
Heart ----- 394
Harty, Dr., on Purpura Haemor-
rhagica - - - - - 174

Hawkins, Mr., on Hydrophobia - 75
Head-ache, Intermittent, Mr. Foote
on ----- - 494

Health Public, Offences against - 333
Heart, Diseases of. Dr. Elliotson on 380

- - , Affection and Action of,

Mr. Dobson on - 305, 385

- , Action of, Corrigan, Stokes,

and Hart on 384

Heat, Animal, Dr. Carson on - * *42
Hermaphrodites, Law on 330

- account of . . 494

Hernia, new mode of reducing . 533
Hodgkin, Dr., on Anatomical Cha¬
racters of some adventitious Struc¬
tures - - _ - 397

Home, Sir E., on Tumours and
Cancer ----- 265
Hospital Reports, Dublin Reviews of 457
Hospitals, great utility of 140

Hospital, Norwich, Report of - 164

548

INDEX.

Page

Hospital, Opthalmic,St.Petersburgh,
Report of - 81

- Surgical Edinburgh Re¬
port of ... 525

- Richmond Dublin Reports

471, 474

- , Royal Westminster Opthal-

mic. Report of - - - 132

Houlton, Mr., on Protraction of Ve¬
getable Life - - - - 79

Hunter, John, correct Pathology of
Aneurism by - - - - 99

Hydrophobia, Mr. Murray and
Youatt on - 68

- , Mr. C. Hawkins on - 75

- , Mr. J. Kirby on - 280

- -, Dr. Thomson’s dissec¬
tions in . . 479, 493

— * - , suggestions for the pre¬
vention of 485

Hyosciamus, use of, in iritis . 280

I.

Iliac Artery, Disease of. Gangrene
from . . . 457

Impotence, Causes of - - - 413

Infants, Genital Discharges of - 20

Infant, Syphilitic, Cure of, by mer¬
curialising the goat which suckled

it . 257

- , Death of, before and after

Delivery, Signs of . .514

Infanticide, Causes of . . 515

- , Objections to Tests of . 517

■ - , Causes of involuntary . 519

Inflammation, Puerperal, Dr. Con¬
quest on - - - - 1

..... — - , M. Tonnelle on 9

Ingleby, Mr., case of fatal otitis, by 525
Innoculation for Vaccination, bar¬
barous mode of performing 74

Inquest, extraordinary, at Hampton 431

- — on Miss Cashin - - 261

Insanity. Dr. Conolly on - - 92

Insurance Life, Case of disputed,
on discrepant evidence of Sir E.
Home and Mr. Cline - - 268

Intermittents, Cure of, byPiperine 70

- - - - , by endermic

method - 164

- — — , by ergot of rye 536

- •, Cause of, by inflamed

saphena . • • 457

Intestines large, Contraction of - 156
Iodine, efficacy of, in enlarged Ova¬
ry and Uterus - - - - 288

Ireland, State of Profession in
Irish College of Physicians and Sur¬
geons, Laws of - 326, 329

Iritis, Syphilitic, Mr. Lawrencs on 279

Page

- — , Depletion and Mercury in¬
dispensable in - - - - 279

- , Recurrence of, during mer¬
curial ptyalim . .472

Iron carb. no mode of preparing 338

J.

Jackson, Dr., on Absence of the
Pulse .... 247

- - - , on Varieties of Pulse - 424

Jewell, Mr., on Leucorrhoea 282

Johnson, Dr. James, depletion in
Cholera first proposed by - - 181

Journal. Medical and Surgical, Lon¬
don, Address to its Readers - 83

- , North American, recla¬
mation of. Rejoinder to - - 82

Jury, complimentary Letter from, to
Dr. Thomson - - - - 41 1

K.

King, Mr., on Neurology . 470

Kirby, Mr., on Hydrophobia . 110

L.

Labia Pudendi, Disease of - - 419

Labour, induction of, justifiable ho¬
micide . . . 509

Lachrymal Sac, New Operation on 148
Lacing, Tight, injurious effects of - 413
Larrey, M. on Bronchocele 521

Lawrence, Mr., on the non-identity
of Syphilis and Gonorrhoea - 26

- • - , on the Venereal Dis¬
eases of the Eye - 269

- , Traite sur les Mala¬
dies des Yeaux - - - 373

Laws relating to the medical pro¬
fession . . 312

Lead, Action of Water on - - 175

Lee, Dr ., on Uterine Phlebitis and
Phlegmasia Dolens - 400

Legitimacy, Laws on - - 332, 502

Leucorrhoea, identity with Gonor¬
rhoea - - - - - 19

■ — ■ — , Nitrate of Silver in - 282

- of Infants - - - 20

- , Pathology of - - 287

Liberty of the Press - - 358

Ligature Distal, to Aneurism, fal¬
lacy of - - - - - 102

. - on Internal Iliac, Dr.

Crampton on - - - 468

- - , Mr.

James on

- on the External Iliac, Dr.

Stevens on -

Libel, Law on 332

Life, Vegetable, Protraction of - 79

Literary Property, Protection of - 332

INDEX.

549

Page

Lightning, singular Effect of - 175
Lime, chloride of in ozena . 531

Lithotritv, Mr. Costello on - - 77

Liver, Diseases of, use of Nitro-mu-
riatic Pediluvia in - - lb .

- , Cartilaginous State of - - 47

Lives of Medical Men, insurable - 332
Lobilia inflata, use of, in asthma 535
Long, St. John, Killing no Mnrder
by ----- - 260

- , Noble Dupes, Sup¬
porters of trial at Old Bailey 537

Longevity, Cases of 335

Lues, and Gonorrhoea, identity of 20, 22
Lunatic Asylums, Defects of - 98
Lungs, Insufflation of - - - 73

M.

Macbraire, Dr. on Nosology - 206
Machine, singular obstetric * - 67

Machinery, specimens of, for de¬
formities - - - - 39

Mackenzie, Mr. on diseases of the
Eye - - - . - 361

Malformation, singular case of - 391
Manec, M. demonstration of nerves,
by . . 470

Marriage, disqualifications for - 412
Marshall, Mr. on the cure of naevus

by vaccination - - - 53

Man-midwifery, notice of - 53

Matrons^ jury of, absurdity of in
cases of abortion . . 50S

Mayo, Mr. H. on Menstruation
during pregnancy - 501

Martinet, M. on Therapeutics - 91
Medals proposed by Sir G. Blane - 358
Memoir of Sir G. Blane - - 356

Medical Men, laws relating to - 314

- remuneration of - 318

- beneficial distinctions

among - 225

Medicine, Academy of, in Paris, ac¬
count of - - 73

Medicines, action of on the body - 119

- complication of - - 192

- quack, immense revenue

from r - - - 233

Medicine Forensic, Dr. Ryan on 233, 412

- - Practice, Dewees and Mar.

tinet on - - 89

- Malpractice of. Laws on - 315

Medicines, gratuitous, administration
of, violation of no law by 315

Medicine, state of, in England 313, 325

- in Scotland - - 326

- — in Ireland - - 327

— - - — in France . - 537

Page

Menstruation, protraction of - 335

Mercury, use of in Gonorrhoea 31

- specific for Syphilis - 35

Milk, of a syphilitic woman, effects
upon foetus - - ib.

Millfoil, use of in many diseases - 117

Mitchell, Mr. case by - 401

Moles, remarks on - 497

Montgomery, Dr. on Ovarian dis¬
ease - 3S6

- - on Monstrosity - 390

Murray, Mr. on Hydrophobia - 68

- on Consumption - - 117

N.

Nsevus, Mr. Fawdington, on - 267

- cure of, by vaccination - 52

Nerves, tumours of - 267

- demonstration of 469

Neuralgia, use of belladonna in - 338

- Mr. Myers’ case of - - 493

Neurology, Mr. King, on - - 470

Nosology, Dr. Macbraire on - - 216

O

O’Brien, Dr. on Fever - - 174

Offences against public health, law
on - - - 333

Oil of Croton, Dr. Short on - - 252

- * - danger from, in stric¬
ture of the intestines - - 161

- - turpentine in diseases of the

eye ----- 281
Ophthalmia. Mr. Lawrence on - 309
- - Purulent, Mr. Macken¬
zie on - - . - - 362

- of infants - 363

- Gonorrhoeal, depletion

in -----

- While blood can be

procured - 274

- Danger of this practice 273

- — - - Mr. Swift on - - 473

Opium, singular effect of 335

Organs, sexual, of the male

- diseases of - - - 414

— — — of the female - - - 419

Ovarian, diseases of 386

- enlargement of, cure of - 288

- - . rheumatism, cure of - 59

Ozena, cure of by chloride of lime 531

P.

Paralysis of leg from disease of fe¬
moral artery - 457

Paris, Dr. on unchemical formula; 127

- on the effects of water on lead 175

550

INDEX.

Page

Pattison, Professor, charges against 445
Pertussis, cure of, by belladonna 338
Phlebitis uterine, cause of Puerperal
fever - . 9

Phthisis, cure of, by belladonna - 338

— - by cholrine - - 291

- chlorate of potas - - 297

Pharmacopseias Supplement to - 117

Phlegmatia dolens. Dr. Lee on - 400

■ — Dr. Graves and Stokes on 464

Philip, Dr. on Chronic Diseases - 109

Physicians College, Meeting of - 75

- Moral Statutes of - 43

- Licence of - - 235

■ ■ - conduct towards Apothe¬

caries - - 230

- powers of - - 240

- privileges of - - 324

■ remuneration of, law on 320

— - character, protection of .321

- Irish, laws relating to - 326

Piorry, M. on Insufflation - 78

- - on the appearances of the

tongue - - - - 81

Pipirine, use of in agues - - 70

Potas chlorate, use of in Phthisis - 297

Potter, M. on Consumption - 291

Pregnancy extra-uterine - - 337

' ' ' — — symptoms fallacious ib.

- - symptoms, real discovery

of by auscultation . . . 497

- duration of . . . 503

Press, Medical, Liberty of - 358

Profession in France, respect shewn

to . 537

Puerperal Fever, Conquest, Dr. on 130

- — - M. Tonnelleon 155

Pulse, absence of . . 247

- modifications of. Dr. Jackson on 424

Q.

Quackery in London, shocking
effects of . . 259

Quacks, trials of . . 351

Quinine, substitute for . .74

- Correction of, taste of . . 536

- , efficacy of, with purgatives 75

R.

Rape, law relating to . . 334

Read, Dr. new theory of Vision, by 148
Reece, Dr. on Lobelia Inflata in

Asthma .... 535
Remuneration of Physicians . 320

- of Surgeons . 321

- of general practitioners

- of Apothecaries

Reproduction, extraordinary cases of 212
Respiratory Organs, remarks on 78

Page

Respiration, physiology of . . 81

- extra-uterine and vaginal,

proofs of . . . .518

Rheumatism of the Ovaria : 58

Royal Society, report of 76

Roupell, Dr. on piperine in Ague 70, 136
Ryan, Dr. on Duties of Medical Men
in questions of Infanticide •, 516

- , Proofs of the Death of the

Foetus in Utero - - - 516

- , impossible to enumerate

Causes of - 517

- , Tests of Daniel, Plocquet,

Schreger . . .517

— — — — , Fallacy of Hydrostatic Test 518

- , on the involuntary Causes

of Death of the Foetus in Utero,
and during Parturition . .519

- , Dr. on Medical Ethics 39

- , on the state of the Profes¬
sion . . . 223

- , on extraordinary Reproduc¬
tion . . .312

- , on Forensic Medicine — im¬
potence . . .412

- , on Chorea . .71

- , on the Laws relating to the

Profession in the United Kingdom

- , on Medical Evidence . 412

- , on the Rights, Privileges,

and Immunities of Medical Men 313
- , on state and Forensic Me¬
dicine . . . 329

- , on protection of medical

character . . . 321

• - , on the state of the Profes¬
sion in Scotland . . 326

- , in Ireland . . 327

- ., on cases in which Medical

Evidence is required — liability of
witnesses — duties due to society
and profession — reprieve — divorce

— legitimacy — duelling — public

health — rape • — defloration — ■. un¬
natural offence . 330, 335

- , on disqualifications for mar¬
riage — impotence and sterility,
various causes of, physical and
moral - 413

- , on reproduction — pregnancy

— signs of pregnancy — doubtful

sex — -steffi oscopic proof of preg¬
nancy decisive . , 333

— — — , on ambiguity of sex . 494

- — , account of latest writers on 500

- , on superfoetation, proofs of

- . on duration of pregnancy —

legitimacy . . . 503

- , on abortion, causes of 510

- — , on delivery . . 513

INDEX,

551

Ryan, Dr., on prolicide, foeticide,and
infanticide - . .515

Rye ergot, febrifuge, effect of . 536
- : - 9 use of, in heemorrhages 388

S.

Salicine, substitution of, for quiniue 74
Saphena vein, inflammation of,
causing ague . . 450

Sarsaparilla, efficacy of, weakened
by Heat - ,269

Scapula, Fracture of 464

Scirrhus, Pathology of - 398

Sclerotitis, Gonorrhoeal, Remarks on 277

* - , may be combined with

Rheumatism - - - 278

Scrotum, elephantiasis of - - 165

Searle, Mr., on Cholera - - 177

Secale Cornutum, use of, in Hae¬
morrhages - - - 338

- , in ague - - 536

Seton, use of, in disunited fracture
of femur . . .474

Serpen! s’ Bites, Cure of, by Table
Salt, Rev. J. J. Fischer on - 49
Short, Dr., on Croton Tiglium - 252

Short, Dr. on Stry chine . . 524

Smith, Dr-, Reply to the editorial
Remarks on the Medical Evidence
at the Inquest of Miss Cashin - 342
Society of General Practitioners, Ac¬
count of - - - 311

- of Metropolitan General

Practitioners - . - 352

- 9 Prospectus of 79

- - —, Royal, London, Paper on

Lithotrity, illustrated by Cases, by
Mr. Costello - - - 76

- , Medido-Botanical, Meet¬
ings of. Lectures by Drs. Glendin-
ning and Whiting, and Mr. Houl
ton - - - - 1

Soda, Muriate, efficacy of, in Ser¬
pents’ Bites and Hydrophobia - 49
Solids and Fluids, Dr. Stoker on - 100
Spider’s Web, sedative effect of - 256
Spillan’s, Dr., Supplement to the
Pharmacopoeias, by - - 1 17

- , on Action of Medi¬
cines on the Living System - 119
Spine Deformities of, Mr. Beale on 34

- , Mechanical Cure of - 36

Spleen, Mr. Dobson on - - 242

- — , Reservoir for the Blood after

Chylification - 244

Staphyloraphy, Cases of, by Mr.

Roux - - - - 73

State of the Medical Profession in
Dublin, byUnus Quorum - 308

Page

Statutes, Moral, of Royal College of
Physicians, Dr. Ryan, on - 39

Sterility, Causes of - - 413

Stethescope, Use of, in Diseases of
the Heart - - 383

- : - , in doubtful Cases of

Pregnancy - 497

Stoker, Dr., on Solids and Fluids - 100

- , on Dropsy - - 134

- , on Use of Millefolium in

Dropsy, Rheumatism, and Cuta¬
neous Diseases - - - 110

Stokes, Dr. Clinical Report of the
Meath Hospital, by . . 457

Strychine, use of, in amaurosis . 534
Superfcetation, evidence of . 500

Subjects, Anatomical and Artificial 66
Suppuration of the Joints, from Ab¬
sorption of Pus, in Variola - 70
Surgeons, Royal College of, Power
of, to suppress Quackery - 242

- , Fees of, and Charges for

Medicines, Legality of - - 321

- , Laws relating to - 322

- — , Irish, Charter of - 328

Swan, Mr. Demonstration of the
Nerves, by . . 469

Swift, Mr. Clinical Report of Rich¬
mond Hospital, Dublin, by 471

■ - — * on trichiasis

- - on entropium . . 472

■ - on iritis during mercurial

ptyalism . . . ib.

- on amaurosis . ,473

- on gonorrhoeal opthalmia . ib.

- on disunited fracture of the

femur, treated by Seton . 474

Syme, Mr. on Excision of the Joints 525
Syphilis in an Infant, cured by mer-
curealising the goat that suckled it 257

- - and Gonorrhoea, identity of 22

- - in infants and in foetus * 28

T.

Terebinth. 01. use of, in Diseases of
the Eye . . . 132

Therapeutics, Dr. Norton on . 91
Thetford, Dr. on the Cure of en¬
larged Uterus by Iodine . 288

Thomson, Dr,, Detail of the Morbid
Appearances as given in evidence
at the inquest of Miss Cashin . 408

- , Letter, complimentary from

Jury . . • .411

- , Testimonials of . 406

- , Rejoinder to Observations

on his conduct at the inquest of
Miss Cashin . . . 406

552

INDEX.

Page

Thomson, A. T., Professor, on the
Cure of enlarged Ovary . 2S8

Tiglium Croton, use of - 252

Titley, Dr. on Ephantiasis Scroti . 165
Tongue diagnosis, from appearance
of . . . .SI

Tonelle, M. on Puerperal Fever of
Paris in 1829 . . .9

Tonics, effects of, on the digestive
apparatus, and circulatory system

124, 197

Toy, Dr. Gastrohysterotomy, by 172
Transactions, Dublin Medical , 385

- - - , Medico Chirurgical,

Vol. XV. Part 11. . .394

fravers, Mr., on the Pathology of
Venereal Affections . .19

Tumours and Cancer, Sir E. Home
on ... 265

Turpentine, oil of, solidification of 337

U.

University, of London dissensions, in

85, 175

- , Expense of Education

in . . . 353

- - - , Mr, Bell’s Resignation

in . . .85

■ . . - , Memorial of Students

to, council of . . 445

Urethral discharge of in Infants . 25
Uterus, adhesion of to the abdomen ;
gastrohysterotomy . .172

- - , Enlargement of. Cure of by

Iodine : . . 288

V.

Vaccination, barbarous mode of
inoculation for . .74

- - , Universal Support of

Vademecum of morbid Anatomy 67
Vaginal Discharge of Infants . 20

Page

Vegetable Life, protraction of, curious

example of, by Mr. Houlton . 79

Venereal affections, pathology of . 19

Venesection, use and abuse of in
Gonorrhoeal Opthalmia 273, 456

Vertebrae lumbar, tumour of . 530

Vision, new theory of . ,. 148

- •, restored by lightning . 175

W.

Wakley, Mr. Candidate for Coroner 264
Warden, Mr. on chronic and ano¬
malous disease of the Liver . 47
Wardrop, Mr. Operation for Aneu¬
rism by, fatal objections to .102
Water, powers of, in dissolving Lead 175
Web Spider’s, sedative effect of - 258
Willcock, Mr. on the Laws relating
to the Medical Profession . 233

Williams, Mr. Petition of, against
Empiricism . . . 351

Witnesses Medical, Strictures on the
Inquest of Miss Cashin . 350

- , Confidence in, in an im¬
mense number of civil and crimi¬
nal proceedings . . 329

- •, liability of . . 330

- , cases in which their evi¬
dence is required

Wounded at Paris in the late Revo¬
lution, account of . . 336

Wounds poisoned, excision of new
proposals for . . 73

Y.

Yellowly, Dr. on Cheselden’s im¬
proved lateral operation of Li¬
thotomy . . . 400

Yeux maladies des traite pratique,
par le Doct. Lawrence, traduit
par C. Billard, D. M. . 379

Youatt, Mr. on Hydrophobia . 68

GUTHRIE, PRINTER, 15, SHOE I.ANE, FLEET STREET.

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