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THE

L O N D O N

MEDICAL AND SURGICAL

« > • j/v * •

JOURNAL;-

CONTAINING

REVIEWS OF ALL NEW WORKS, ORIGINAL COMMUNICATIONS, AND EXTRACTS
FROM ALL THE MEDICAL PERIODICALS, DOMESTIC AND FOREIGN.

EDITED BY

MICHAEL RYAN, M. D.

Queer ere Verum. Horace.

VOL. VI.

FROM JANUARY TO JULY, 1831.

LONDON:

PUBLISHED BY RENSHAW AND RUSH,

356, STRAND, NEAR EXETER HALL.

1831.

fiUTHRIK,

i%m\ ,

LONDON t

15, SHOE LANE, FLEET STRKKt .

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 31. JANUARY 1, 1831. Vol. VI.

CRITICAL REVIEW.

I. — Dublin Hospital Reports and Communications in
Medicine and Surgery „ Vol. V. 1830. — {continued. )

In accordance with our promise, we resume our analysis
of the truly valuable clinical report of Drs. Graves and
Stokes, which from its great length, and still greater im¬
portance, deserves the fullest notice and the most serious
consideration. The remaining part is divided into two sec¬
tions ; 1, on Diseases of the Respiratory Organs ; 2, on
Diseases of the Abdominal Viscera. It is difficult to speak of
either in sufficient terms of praise, on account of the great
ability evinced in the descriptions of disease, in the progno¬
sis, diagnosis, treatment and comments.' Suffice it to say, we
have seldom perused a report so ably drawn up, and so ex¬
ceedingly interesting, both in a theoretical and practical point
of view. Every page of it is replete with important informa¬
tion. It is therefore obvious that our notice of it must ne¬
cessarily be a lengthened one. Our authors commence their
details of “Diseases of the Respiratory Organs” inthe follow¬
ing words : —

The most frequent diseases of the respiratory organs, which
we have met with during the last year, were acute inflammations af¬
fecting either the pulmonary tissue, or the bronchial mucous mem¬
brane alone. Simple pleuritis, as far as our observations have gone,
appears to be a very rare disease in Dublin. On this disease, how¬
ever, we shall presently offer some observations.

“ The plan of treatment which we have found of the greatest effi¬
cacy, in combating simple pneumonia, is the use of the lancet and
the exhibition of the tartar emetic in full doses. As this latter forms
a mode of treatment not yet extensively adopted in these countries,
we shall put our experience of it on record.

“ The following is the common formula we have adopted.
vol. vr. no. 31.

Critical Review.

Ik Tart, antimon. gr. vi. Aq. cinnamomi. Biv. Syrupi, mucila-
ginis, a a Bh Tinctur. opii. acet. gs. xii. Of this half an ounce is
given every hour, or oftener if necessary.

“ The cases in which this treatment is most applicable, are those
where the disease is in the early stages, where it occurs in strong
constitutions, and lastly, where there is absence of gastric symptoms.
This is a point of great importance, and we shall refer to it presently.

“ It is during the existence of the first stage of the pneumonia, while
the crepitating rale is heard most distinctly, and before the affected
portion of the lung sounds dull on percussion, that we find the remedy
to answer best : six grains are generally administered the first day,
and the dose is increased by two or three grains daily, until fifteen
grains are exhibited in the twenty-four hours. Beyond this dose we
have never found it necessary to go ; but we have been able to persist
in the exhibition of the remedy at this rate for many days, and with
the best effects.

*• The cases in which we have found it necessary to continue this
treatment longest, are those in which an acute pneumonia has super¬
vened on a chronic catarrh. In one case of this kind in which the
pneumonia was double, one hundred and eighty grains of the tartar
emetic were exhibited at the rate of twelve grains daily. In this
case the tolerance of the remedy was completely established after
the second or third day. Indeed, towards the termination of the
disease, the patient’s appetite was excellent, although he was taking
the rate mentioned. This we have often seen in other cases, a fact
already observed by Lsennec.

“ We have very seldom observed abdominal irritation to follow the
exhibition of the remedy, even where large quantities have been
taken. In a few cases after the subsidence of the pulmonary disease,
colicky pains occurred, but these almost constantly yielded to stuping,
mild laxatives, and opiates. In one case, however, they were so se¬
vere as to require blood-letting ; the blood was cupped and buffed,
and the patient recovered perfectly.” — p. 52.

The testimony of two such able physicians as Drs. Graves
and Stokes, in favour of a plan of treatment as yet scarcely
tried in these countries, must convince the most timid prac¬
titioner of its perfect safety and great value. Our authors
combine the old and new plan of treatment, and thus differ from
the continental writers who exclude the former, and solely
rely upon the latter. Many eminent physicians have attested
the efficacy of tartarized antimony in large doses in pneu¬
monia ; among whom were Lcennec, Dumangin, Hellis, Ra-
sori, who revived it. Martinet, Dance, &c. and in this country
Drs. Smith and Tweedie, of the London Fever Hospital. In
our 4th vol. p. 147, will be found a memoir on the use of
large doses of tartarized antimony, in acute articular rheu¬
matism, by M. Dance. In this report, we find the medicine
was given in doses from four to eight grains, every hour or

The Dublin Hospital Reports.

every other hour, and continued from the period of eight
days to two months. It produced great irritability of the di¬
gestive organs, cholera morbus, violent vomiting, tormina,
colic, and upon the whole, was seldom borne in such large
doses. We throw out these hints, lest some of our readers
might be disposed to urge the remedy much further than the
authors before us. The following interesting case, with its
comments, shews the value of antimony, and also the differ¬
ence of opinion between our authors and Lsennec: —

“ Hepatization of the lung. Absence of many of the symptoms of

Pneumonia. Abdominal inflammation supervening during the use of

tartar emetic in large doses. Cure.

Steward Bowles, aged 17, of a strong habit. This patient was ad¬
mitted on the 1 7th of March, 1829. His illness commenced three
weeks previously with chilliness, followed by anorexia, pains in the
shoulders, and a stitch in the left breast. He had a trifling cough in
the morning and evening, followed by yellow mucous expectoration.

“ On admission the pulse was full ; he had a slight cough, but no li-
vidity of the face, and scarcely any acceleration of breathing : indeed
from his external symptoms it was impossible to conclude that he had
any serious affection of the lung.

“ On examination with the stethoscope, however, we detected a
complete hepatization of the inferior lobe of the left lung. In the
remaining portions of the chest, the respiration was puerile. He was
bled generally and locally, and put on the use of six grains of the tar¬
tar emetic daily. The blood was not inflammatory, and next morn¬
ing all external symptoms of disease had wholly disappeared. He
had no pain ; respirations sixteen in the minute ; the cough had
ceased, and the pulse had become small and regular. The patient
expressed himself perfectly well : there was, however, no change in
the stethoscopic phenomena.

“ The tartar emetic was continued for four days in the doses of eight
grains daily, which produced constant nausea. It was then omitted,
on account of the supervention of violent vomiting, diarrhoea, and pain
in the abdomen. These symptoms subsided under the use of a mix¬
ture of castor oil, mucilage, and opium ; the side was blistered. The
sound, on percussion, became clearer, and there was some return of
the natural respiratory murmur, anterior and latterly, but the bron¬
chial respiration posteriorly became much louder, and continued so
for some time before its ultimate subsidence. No crepitus of resolu¬
tion was observed. In two days the abdominal symptoms returned
with violence. Bleeding was had recourse to with relief ; the blood
was now inflammatory. Resolution of the hepatization went on ra¬
pidly, and the patient speedily recovered. But in cases where from
the commencement, symptoms of gastro- enteritis and pneumo&ia

Critical Review .

co-exist, we withhold the tartar emetic, as we have found that its ex¬
hibition under these circumstances is always improper. In the few
cases which have resisted the remedy, wTe have found disease of the
alimentary canal, particularly ulcerations of the small intestines. To¬
lerance in these cases is with difficulty established, and the remedy
does not appear to have nearly the same influence on the disease.
We cannot then subscribe to the opinion of Laennec, who believed,
that the existence of gastro enteritis is not a contra-indication to the
employment of the remedy. In such cases we rely upon general and
local bleeding ; and frequently we have, by means of a free applica¬
tion of leeches to the belly, removed the gastric symptoms, and then
commenced the use of the tartar emetic with safety.

‘ ‘ With respect to blood-letting in pneumonia we rely more on it as
a means of combating the inflammation than Lsennec appears to have
done. Except in cases of pneumonia combined with hypertro¬
phy of the heart, he considered bleeding more as a mode of prepar¬
ing the patient for the exhibition of tartar emetic, than as calculated
directly to remove the disease. We consider, on the contrary, gene¬
ral and local bleeding to be of primary importance, while the tartar
emetic is a very useful adjuvant. Thus, on any sudden exacerbation
of the disease, we do not trust to increasing the dose of the remedy,
but have at once recourse to general or local bleeding, as the case
may be ; and we may here remark, that in the treatment of acute
bronchitis and pneumonia, when occurring in the adult, local bleeding
has been too little practised in this country.

“ In some cases we find that the first dose of the remedy makes the
patient vomit freely, yet after a few more doses, the medicine is borne
well. But in the greatest number of cases a state of slight nausea,
without vomiting, is kept up, and continues for several days, and in¬
deed as long as the remedy is administered.

“ Sometimes we have found both vomiting and purging to follow at
first, but to subside after twenty-four hours. Diaphoresis is a rare effect,
and we have often witnessed cases where the patient was taking from
ten to twelve grains of the medicine daily, without vomiting, purging,
or sweating ; so that no effect could be observed, except a gradual
reduction of the symptoms, and stethoscopic phenomena.

“ We generallyfind, in cases of simple pneumonia, when the disease
is confined to the lower portion of one lung, that when we commence
with the exhibition of six grains in the day, and increase this at the rate
of a grain daily, we are able either to omit the remedy, or begin to dimi¬
nish it in the course of four or five days. W e seldom omit it suddenly, as
more than once, a severe relapse has followed this practice.” — p. 56.

There are two other remedies of great value, in removingpneu-
monic inflammation'in the opinion of our authors; tartar emetic
and the combination of mercury with opium. In pure pneu¬
monia with inflammatory fever in full robust habits, the first
remedy is to be preferred. In cases complicated with abdo¬
minal disease, low fever and great prostration of the powers

The Dublin Hospital Reports.

of life, the active use of calomel and opium, so as to affect
the gums, followed by the use of polygala and other stimu¬
lants have succeeded in the most remarkable manner.

<f Where circumscribed hepatization of the lung has taken place
previously to the patient’s being admitted into hospital, we have
found the mercurial plan assisted by local bleeding, and the use of
blisters, to be the means best calculated to remove the disease.
Under this treatment we have seen extensive solidifications of the
lung resolve with great rapidity. Indeed it appears that after the
disease has passed the first stage, the tartar emetic loses much of its
efficacy.” — p. 57.

“ In many cases of pneumonia, with great dyspnoea and lividity
of countenance, we have observed great improvement in the general
symptoms to follow venesection and the exhibition of tartar emetic ;
but on the following day no improvement in the portion of lung,
principally engaged, was discovered by the stethoscope. These
were all cases of partial pneumonia, with general bronchitis, and
the improvement wras owing to the beneficial influence of the reme¬
dies on the latter disease, while the patient, although greatly
relieved, was still in considerable danger, a fact of which it is
necessary to be aware in the treatment of pulmonary inflammation.

“ It is stated by Lasnnec, that in all cases of pneumonia the
bronchial mucous membrane is necessarily engaged in the affected
portion of the lung. We believe that this is generally true, but we
have met with one remarkable exception to this law. A woman,
aged thirty, was admitted labouring under the usual symptoms of
acute pneumonia. The stethoscope indicated commencing hepati¬
zation of the inferior portion of the right lung ; notwithstanding
very active treatment, she died on the seventh day of her illness.
On dissection we found the lower lobe of the left lung nearly in a
state of red hepatization, with effusion of lymph on the corres¬
ponding portion of the pleura. The bronchial mucous membrane in the
whole of the left lung, and in the superior portion of the right, was
inflamed, and the tubes filled with mucus, these parts of the lung
being crepitating and free from engorgement, while in the hepa-
tized portion the mucous membrane was perfectly white, and pre¬
sented no mark whatever of disease-” — p. 59.

In the case of Bowles it will be observed, that two inter¬
esting stethoscopic points appeared ; 1, the disappearance of
the phenomena of hepatization without the occurrence of
the crepitus of resolution ; and this our authors have fre¬
quently observed, especially when the solidification has been
recent, but where it is chronic, they regard it as a rare phe¬
nomenon : 2, the increase of bronchial respiration is not an
infallible sign of an extension of solidification. In this case it
was a sign of diminution of disease.

Critical Review.

The next disease noticed is pleuritis, two cases of which
were admitted into the clinical wards of Sir P. Dun’s hospi¬
tals, under the care of Dr. Osborne ; all the symptoms of effu¬
sion into the chest were present, and seemed to warrant the
operation of paracentesis of the chest, had not the operation
been contra-indicated by bronchial respiration, from which it
was inferred, that there was adhesion between the costal and
pulmonary pleuree. The appearances on dissection most sa¬
tisfactorily bore out the diagnosis.

“ A somewhat similar remark may be made with respect to the
sonorous rale, as an indication of the existence of bronchial in¬
flammation. In several cases of the worst catarrhal fevers, when
the patient was in a semi-comatose state, the skin covered with
petechise, the face livid, but the respiration not much hurried ;
nothing is often observable by the stethoscope when applied during
ordinary respiration, except that the respiratory murmur is very
feeble, or mixed with a very slight sonorous or mucous rale. On
the patient, however, making a deep inspiration, an intensely loud
sonorous rale becomes immediately audible, appearing to indicate
that the smaller ramifications of the bronchial tubes were, in con¬
sequence of the inflammatory turgescence of their mucous lining,
impermeable to air during ordinary respiration. Now we often
observed, that when these patients began to convalesce, the sonor¬
ous rale was loudly audible during ordinary respiration, a circum¬
stance obviously owing to a decrease in the intensity of the inflam¬
mation.

“ A great number of cases of catarrhal fever, with and without
typhoid symptoms, were admitted during this year. The cases
which did best, were those where the fever was inflammatory, and
in which blood-letting and tartar emetic were exhibited from the
outset. Several of these patients recovered rapidly, without the
disease passing into the second or more chronic stage in which the
mucous rale becomes the pathognomonic sign. In others, after
the use of these means for some time, they appeared to lose all
efficacy ; the expectoration became copious, and an extensive mu¬
cous rale was generally audible. At this period the change from
the antiphlogistic to the stimulating plan of treatment was often
followed by a rapid cure. The decoction of seneka, with the ad¬
dition of carbonate of ammonia, camphorated tincture of opium,
and some preparation of squill, was the remedy most commonly
used, in addition to which the regimen of the patient was improved.
But the mere fact of the disease having passed into the second
stage does not appear in every case to warrant the propriety of the
stimulating plan from the commencement of our treatment. We
have observed some cases where bad effects followed this prac¬
tice, and have come to a conclusion, which appears to us to be of
practical importance, that to render the stimulating plan of treat¬
ment decidedly successful, it will be frequently advisable to precede

The Dublin Hospital Reports.

it by the antiphlogistic, to prepare the patient for the exhibition of
stimulants. The disease then yields rapidly, and this is another
example of the pathological analogy of the disease of mucous
membranes and of the skin.

“ The chloride of lime has been administered by us in a case of
pectoral disease, with great fcetor of breath and expectoration, with
remarkable benefit. The patient, in a fit of intoxication, lay naked
on a stone floor for the whole of a night, and next morning had a
severe pain in the side on which he lay, followed by other symptoms
of an inflammatory alfection of the lungs. In the course of two
days his breath and expectoration became foetid, and after some
time he was admitted into our wards in a state of extreme debility,
with hectic fever, cough, with foetid expectoration*, foetor of the
breath, and hippocratic countenance.

“ It was determined to try the effect of the chloride of lime ; a
pill containing three grains of the salt and one of opium, was ad¬
ministered three times a day, and in the course of three days the
quantity was increased to twelve grains daily ; a small quantity of
wine was also allowed.

<£ The most rapid and marked amendment followed this treat¬
ment : in a few days the foetor of breath and expectoration had
disappeared ; no inconvenience whatever was experienced from the
remedy ; we also directed the covering of the bed to be sprinkled
with a solution of the salt ; the remedy was then omitted ; in two
days the foetor returned, and fever began to appear ; but these
symptoms again subsided with rapidity, on our resuming the em¬
ployment of the remedy. The patient was ultimately discharged,
greatly improved in strength and flesh ; he, however, sometime
afterwards relapsed, and died in the country.” — p. 64.

“ A very strong and uninterrupted adhesion extended from about
two inches below the clavicle of the affected side, in a line passing
through the middle of the mammary region, nearly to the bottom
of the anterior part of the lung.

“ This adhesion, about two inches in breadth, was very firm and
close, so as to form an intimate union between the pulmonary sub¬
stance and the anterior parietes of the chest, and extending nearly
from the apex of the lung to its base. Along this line the pulmo¬
nary tissue formed a plate of compressed lung, about two inches in
thickness, which, like a verticle partition, divided the pleural cavity
into two chambers, each filled with sero-purulent matter, and sepa¬
rated by the lung extending from its root to its anterior adhesions.

<£ It is to be observed that these two cavities communicated to¬
wards the clavicle, where the adhesion was wanting, and were
still further divided by other adhesions posteriorly, extending up¬
wards from the root of the lung to the superior lobe.

“ The lung forming these different partitions was red, com¬
pressed, and totally destitute of crepitus. The air cells were ren¬
dered impermeable by the pressure of the pleuritic effusion, but the
bronchial tubes were not obliterated, and could easily be traced to
within a line or two of the parietes of the chest.

Critical Review.

<{ We have stated that in no part of the affected side was there
an absolute nullity of sound during respiration. This may be ac¬
counted for by the great extent and intimate connexion of the
adhesion with the parietes of the chest, which not only made the
bronchial respiration audible in the parts immediately over them,
but by means of the ribs communicated the sound to parts even
remote from the adhesion itself.

“ In both patients there was severe cough and puriform expecto¬
ration ; and the bronchial mucous membrane was accordingly found
in an intense state of inflammation. In one of the patients, nature
had attempted the evacuation of the fluid by means of ulcerations,
which in several places had perforated the pleura and intercostal
muscles, and formed sinuous passages into the sub-cutaneous cel¬
lular structure.” — p. 68.

The diagnosis in this case proves the great value of auscul¬
tation, and ought to convince the most sceptical of its utility.
A curious fact is attested in the next paragraph, that in pleu¬
risy the superjacent integuments often become tender, swol¬
len and cedematous at the very commencement of the disease,
in consequence of the inflammation spreading to .those parts ;
and a similar occurrence has been often remarked in cases of
hepatic abscess. It is thus that a careful examination of the
integuments, sometimes reveals the suppuration of organs in
the subjacent cavities.

In the employment of percussion, our reporters confirm the
observations of others, that the patient experiences much
more pain on the diseased than on the affected side ; this they
observed in acute pleurisy and tubercular consumption. A
curious fact, and one hitherto unobserved, is related, that in
some cases in which percussion had been employed, after
each stroke of the ends of the fingers, a number of little tu¬
mours appeared, answering exactly to the number and situa¬
tion of the points of the fingers, where they had struck the
integuments of the chest. These having continued visible
for a few moments, subsided, but could be again made to
appear on repeating the percussion. In such cases the per¬
cussion produced a good deal of pain, and the tumours were
most apparent in the subclavian region and over the great
pectoral muscle. This appearance is ascribed to the con¬
traction of the muscular fibres in consequence of the irrita¬
tion of the blow. The following remarks on percussion are
worthy of recollection, as they afford evidence, which proves
the received opinion of the operation is liable to exception.

With reference to the value of percussion, we may remark,
that the dulness of sound on percussion is by no means constantly
proportioned to the extent of pulmonary disease. Thus in a patient

The Dublin Hospital Reports.

"who died of pneumonia, a great portion of both lungs was found
inflamed, and the inferior lobes approached to hepatization, yet
during life the sound on percussion had appeared to us clear, a
circumstance explained by the remarkable fact, that the greater
portion of the surface of the lungs had escaped disease.

“We have also observed several cases of phthisis, in which,
during life, the chest sounded every where well, and yet upon
dissection the lungs were found almost solid from general tubercular
developement.” — p. 76.

The next disease described is one of a formidable nature,
which has been very superficially noticed by writers in these
countries, namely, laryngitis. A considerable number of cases
in the chronic state were treated by our authors, some pro¬
duced by cold, many occurred in persons tainted with syphilis,
and these were the most obstinate and distressing. In some
there was spasm of the glottis, in others disease of the lungs.
In the latter the stethoscopic phenomena were sin
modified.

“ Thus, where the obstruction is so great as to cause the respi¬
ration to be long and painful, the expansion of the air cells is
often quite inaudible. We recollect once examining a patient,
labouring under laryngitis, in the Meath Hospital, in whom the
obstruction was so great as to require the operation of tracheotomy.
Previously to the operation, the chest sounded clear, but the respira
tory murmur was extremely feeble, so that the stethoscopic pheno¬
mena closely resembled those of emphysema of the lungs. When,
however, a free opening had been made in the trachea, the respira¬
tory murmur became at once puerile, and did not subside to the
natural intensity for some hours.

“ A knowledge of this fact is of great practical importance in
investigating the state of the lungs in persons labouring under chronic
laryngitis, an inquiry which ought never to be omitted, on account
of the frequent occurrence of tubercles in persons afflicted with
this disease ; for it will appear presently that mercury, one of the
most efficacious remedies in simple laryngitis, is inapplicable in
these complicated cases. In fact, it is scarcely credible how far the
existence of laryngeal obstruction tends to mask all the stethosco¬
pic phenomena, even in cases of extensive pulmonary disease.
Thus we have seen several cases of phthisis, in which extensive
excavations and numerous tubercles were found in the lungs on
dissection, and yet during life no unequivocal evidence of this state
of the lungs had been derived from the use of the stethoscope.
The extreme weakness, and altered tone of the voice in this disease,
deprives us of the assistance which the discovery of bronchophony or
pectoriloquism wrould give in forming our diagnosis, and the protracted
and gradual inspiration either prevents or renders very indistinct

V OL. vi. no. 31 .

gularly

Critical Review.

the valuable phenomena of crepitation, gargouillement, cavernous,
bronchial, and peurile respiration ; under these circumstances, the
general symptoms and percussion are our only guides, and we have
already seen how uncertain both these are.” — p. 81.

We are informed that the chief diagnostic symptom in chro¬
nic laryngitis, is hoarseness increased by exertion of voice ; but
this symptom may continue for years as we have repeatedly
witnessed in persons, and perfect health. The treatment re¬
commended is of course extremely judicious.

“ The most efficacious treatment consists in enjoining silence, a
point that cannot be too strongly insisted on ; next to this in value,
is the frequent application of a few leeches to the region of the
larynx ; we have also seen much benefit follow the exhibition of
mercury, so as to affect the gums slightly. When we wish to
employ counter -irritation, we prefer the tartar emetic ointment to
the employment of blisters. It should never be forgotten that this
disease is extremely liable to recur, to prevent which we have, in ad¬
dition to the usual means, recommended the habitual use of cold
washing of the throat night and morning. In chronic laryngitis,
the state of the fauces and pharynx should always be investigated,
as in many cases, where no soreness of these parts is complained
of, we have found, on inspection, that numerous small, irregular,
and superficial excoriations, (if we may so term them) bounded by
red lines, and of a greyish colour, occupied the upper portion of the
pharynx; and we have strong reasons for thinking that the dis¬
ease of the laryngeal membrane is of a similar nature, and has been
propagated from the pharynx, in the same way that acute laryngitis
not unfrequently originates in pharyngeal inflammation.

“ The repeated application of a strong solution of the nitrate of
silver, ten grains to the ounce, by means of a camel hair pencil, to
the parts within our reach, proves very serviceable ; after a slight
alterative course of mercury, the use of the compound decoction of
sarsaparilla, and the general tonic plan of treatment, will be found
most useful in such cases.

“ This complaint is much more obstinate and intractable, where
it occurs in persons who have used large quantities of mercury for
the cure of syphilis. In such broken down constitutions relapses
are of frequent occurrence, and the disease very apt to terminate
in ulceration of the cartilages. A nutritive diet, a seton in the
neighbourhood of the affected part, the decoction of sarsaparilla,
with the cautious use of corrosive sublimate or arsenic, the applica¬
tion of the nitrate of silver to the pharynx and rima glottidis, by
means of lint moistened in the solution already recommended, and
mercurial inhalations, have in some cases succeeded in removing the
disease ; although the inflammation may have subsisted for a con¬
siderable time, the occasional application of leeches should not be
nc , ,€d, particularly on any exacerbation of the complaint.

The Dublin Hospital Reports. 11

“ When a decided phthisical tendency accompanies chronic
laryngitis, the case is generally hopeless.

“ The application of belladonna plaster, or of one made of
Scotch snuff, as recommended by an American professor, to the
region of the larynx during the spasmodic exacerbations, has been
found by us of great utility. In many of our cases these attacks
of spasms frequently supervened, producing terrible difficulty of
breathing, which we have often found to yield with rapidity to the
pediluvium, and the exhibition of an antispasmodic draught, consist¬
ing of the ammoniated tincture of valerian, ether, and opium. We
cannot help suspecting that in chronic laryngitis, the operation of
tracheotomy is sometimes unnecessarily performed, and that the imme¬
diately distressing symptoms would frequently yield to this prac¬
tice.’" — p. 84.

The last case mentioned is one of peculiar interest.

“ A man about forty years of age died of tubercular phthisis.

“ The oesophagus, after passing through the usual opening in the
diaphragm, was found to re-enter the thorax by another very large
opening in the tendinous portion towards the left side. The sto¬
mach occupied the inferior portion of the left thoracic cavity, its
cardiac and pyloric extremities, both lying in the opening.

“ A considerable portion of the transverse arch of the colon was
also included in the left side of the chest ; these viscera loosely,
but permanently fixed by means of the serous membranes, all
rested on the convex surface of the diaphragm, and pushed the
heart and mediastinum towards the right side. The margin of the
unnatural opening in the tendinous portion of the diaphragm was
formed by a round tendinous cord about the thickness of a quill,,
which addad greatly to its strength, and was evidently of very
ancient formation. The lungs, small and tuberculated, did not
exhibit any signs of compression, and was not adherent to the
abdominal viscera. It may be easily conceived that the left pleural
cavity was continuous with the cavity of the peritoneum, and both
were lined by the one serous membrane.

“ This case is pregnant with interest ; we observe in the adult
a new cause of displacement of the heart, and a new source of
difficulty in stethoscopic ex amination ; for it is quite evident that
auscultation applied to the left side of the thorax would have fur¬
nished very fallacious information, and the sounds heard would have
varied according as the stomach and colon were full or empty, &c.
The same observation applies also to percussion ; and the fact is,
that during the life of this patient, those who examined his chest
could not reconcile the phenomena afforded by auscultation or per¬
cussion with those of any known disease of the chest- The respi¬
ration was heard every where, except inferiorly and anteriorly on
the left side, and here percussion gave a clearer sound than natural.
No rale was audible in this part of the chest, but borborygmi and
sounds resembling those produced by the motion of fluids in the
intestines were observed.

Critical Review.

“ This man vomited frequently while under observation in the
hospital ; now as the stomach was placed entirely out of the reach
of being compressed by the contractions of the diaphragm, and as
this contraction completely defended it from the influence of the
abdominal muscles, it is clear that in this case vomiting must have
occurred independently of compression, either of the diaphragm or
abdominal muscles. This fact, worth a thousand experiments,
completely decides the question, that vomiting may be produced by
the action of the stomach itself, unassisted by any external com¬
pressing force, notwithstanding what Le Gallois and late physiolo¬
gists have said to the contrary.”- — p. 87.

The second part of this report on abdominal disease,, we
shall notice in our bibliographical department.

Though it is our intention to notice all the papers in the
valuable work before us, we are inclined to place two in¬
teresting and instructive reports of the different new obste¬
tric institutions of the Irish metropolis before our readers.
The first is entitled., Report of the Wellesley Female
Institution, by Samuel Cusack, M. B. the second, “ Re¬
port of the Coombe Lying-in Hospital, by Richard Reed
Gregory, M. R. C. S. Dublin.” The pleasure and satisfaction
which we have derived from the perusal of these documents,
induce us to place them thus early before our readers.
Another motive influences us to do so, and which is, that
these are new and rival institutions, and though on a com¬
paratively small scale, when compared to the extensive
Lying-in Hospital of Dublin, their usefulness* and the
excellence of the practice pursued in them, are candidly sub¬
mitted to the profession, while the practice at present
employed in the latter has not as yet been recorded. For
the information of our readers in this section of the empire,
on the European Continent, and in America, we deem it
proper to make a few remarks on the support and manage¬
ment of the large obstetric hospital of Dublin. In doing
so, wTe must premise, that we neither directly, nor indirectly,
allude to its present medical officers. This institution is the
largest in Europe, except that of Vienna ; it is a magnificent
building, partly supported by an annual parliamentary grant,
and by voluntary subscriptions. It affords relief to more
than two thousand women annually. Its medical officers
are, a master and two assistants, all physicians ; it has also
its surgeons. The master is elected every seven years, and
generally by interest ; talent and merit are not recommen¬
dations. He goes out every seven years, and his income is

The Dublin Hospital Reports .

estimated at about £.2,000 a-year. The, assistants pay £.250
each for their appointment, though of late years they have
evinced much more talent and scientific attainments than
some of their principals. Nothing can be worse than the
farsical mode of election. Physicians have been appointed
masters, whose abilities were the most slender — whose names
were unknown beyond the precints of the Irish capital ; and
who, in candid truth and justice, had no claim whatever to
appointment. The consequence has been, that their lec¬
tures and principles were far below those of their contem¬
poraries. If proof were required of the truth of this state¬
ment, wre need only refer to the fact, that the perforator has
been preferred to the forceps ; nay, that the forceps was
condemned as a useless instrument. This will appear by the
able and valuable defence of the latter by Dr. Beatty, a
gentleman of great eminence, and a former assistant to the
institution, whose opinions we shall insert in a subsequent
article. Indeed, we can give our personal testimony in sup¬
port of our statement. Another serious defect in the insti¬
tution was, the great fee demanded of students for attend¬
ance ; namely, twenty guineas for extern, and thirty as
intern pupils for six months. Without wishing to institute
an invidious comparison between this and the new hospitals,
which have given rise to these observations, we can fairly
observe, that the defects of the former do not exist in the
latter ; and moreover that the principles and practice incul¬
cated in the new institutions, more accord with the received
views of the profession. In these remarks, we do not for¬
get the valuable papers of Drs. Beatty, Johnston, Breen,
AFKeever, Douglas, Fergusson, and Kenedy ; but all these
writers were assistants ; and what, let us enquire, has been
done by the masters, since the time of Dr. Clarke ? Why
is there not an annual report published ? Why are not the
vast opportunities of this great establishment rendered sub¬
servient to the promotion of science ? The answer is suf¬
ficiently obvious ; because the masters are appointed without
any proof of their qualifications, and because they must
retire at the expiration of seven years, when they have
acquired experience, which, instead of being useful to the
interests of the poor, or of the students, is henceforth to
be valuable to the affluent. Such being a fair sketch of this
magnificent institution, we need scarcely observe, that it
affords us great pleasure to witness the establishment of others,
with infinitely more claim upon the notice of the profession
and the public. Of the present medical officers of any of
these hospitals we know nothing, except by their contri-

Critical Review.

butions to science, and to all we say, amicus Socrates,
amicus Plato, sed magis arnica scientia.” Having1 premised
thus much, we hasten to insert the details of the reports
which led us into this exposition ; and have to observe,
that these papers are highly creditable to their authors.
The principles and practice maintained in them, are those
of the most eminent obstetric writers. Dr. Cusack’s gra¬
phic and comprehensive report claims great attention, both
from its extent, and the great variety of practical informa¬
tion with which it abounds. Mr. Gregory’s report contains
some points of great interest. It is impossible to abridge
the former, so that, we must give it in detail, as it attests
very practical points of considerable importance. The only
point in it which may be doubted, is the author’s reluctance
in admitting the efficacy of the ergot of rye. He has not
condemned it without a trial, and justly observes that its
failure ought to be ascribed to the careless .and improper
manner in which it is preserved by druggists. He should,
however, have borne in mind, that as yet it has no place
in the British pharmacopoeias ; and consequently that nine-
tenths of medical practitioners, and nearly all its venders,
are perfectly ignorant of its physical and chemical proper¬
ties, and of the best mode of preserving it. We have tried
in numerous cases, and have never known it to fail when
properly preserved ; we have no hesitation in declaring,
from extensive personal observation, that we have never
kn own it fail to produce its effects when properly preserved,
when judiciously administered ; it certainly cannot perform
impossibilities, and hence the outcry raised against it by
many recent writers, who were so simple as to expect that
it ought to effect delivery in cases of deformed pelvis.
Besides it, in common with all medicines — can never be
procured in a genuine form from the ordinary venders, whose
calling is a trade, and not a profession.

Dr. Cusack proceeds as follows : —

“ The number of labour cases attended since the opening of the in*
stitution up to the 31st of December, 1828, amounts to 398: of
those cases three required instrumental aid for their completion ; one
the forceps, two the perforator. Amongst the cases of preternatural
labour, which amounted to twelve, there were four cases of presen¬
tation of the upper extremities, and eight of the breech and lower
extremities.

“ The cases of presentation of the upper extremities (in all of which
turning was performed,) had uniformly favourable terminations, as
far as related to the mother. In two cases, however, the child was

The Dublin Hospital Reports.

not born alive ; in one the funis protruded with the arm ; in the other
the mother had alternately borne dead and living children, and for
some days previous to the accession of labour, had not felt any mo¬
tion of the child. > In three of those cases turning was performed
with facility ; in the fourth, on introducing the hand, uterine action
came on so violently, that it was considered expedient to withdraw
the hand. On administering 120 drops of tincture of opium in di¬
vided doses, the operation was performed with facility.

“ The cases in which the inferior parts of the body presented were
also favourable in their issue as far as the mother was concerned.
The only cases in which the children were not saved, were those in
which the head had been jammed in the pelvis by ill directed attempts
at extraction previous to application for assistance from the dispen¬
sary. These , cases were almost entirely left to themselves, till the
breech was expelled, when the usual attention was paid (when re¬
quired) to insure that the face of the child should be turned towards
the sacrum of the mother, and after the extraction of the arms the
chin was depressed by placing the finger in the mouth of the child in
the usual manner, so as to give the head the direction of the axis of
the pelvis, and to cause the biparietal, instead of the occipito-mental,
to be the moving diameter. In one case, in which the foot rested
against the perinceum, and the thighs were forced down so as to be
impacted to a certain degree in the vagina ; the feet were extracted
gently as far as the ankles, and the case was then left to the efforts
of nature.

“ Two face cases were not interfered writh, and the labours, al¬
though tedious, terminated favourably both with mother and child.

“ In five cases the funis was protruded. In some of these cases the
pulsation had ceased previous to application for assistance; in the
others none of the means recommended in such cases for the preserva¬
tion of the child appeared admissible. Of six cases of puerperal con¬
vulsions, two occurred between the fifth and eighth month ; in one
the fits were always induced by constipation of the bowels, and after
this cause was removed, did not re-appear. One case occurred after
parturition; the cause was similar to that of the preceding case.
The patient recovered under the employment of venesection, and pur¬
gatives ; of the remaining cases of convulsions, all of which occurred
during labour, one patient was delivered by turning, during which
operation the fits were suspended, but recommenced after delivery,
and carried the patient off. Another was delivered by the crotchet,
wrho recovered from the convulsions, but subsequently died of perito¬
nitis. In another case (a first pregnancy) the convulsions appeared at
the commencement of labour, the membranes were ruptured by the
finger, twenty ounces of blood taken from the temporal artery, cold
applied to the head, and injections and purgatives administered. The
fits however continuing, the forceps were applied when the head was
sufficiently low, and mother and child were both saved.

“ The convulsions appeared in one instance about twelve hours
after the birth of the first twin, the woman having been improperly

Critical Review.

allowed to remain undelivered of the second all that time. The for¬
ceps were promptly applied, and the second child extracted without
difficulty, but dead. In this case, instead of the patient being coma¬
tose between the fits, she exhibited all the symptoms of delirium fe-
rox, the birth of the second child not seeming to have any effect on
her condition, but after the extraction of the placenta she became per¬
fectly tranquil, and the fits did not again appear.

“ The opinion generally entertained as to the ineligibility of turn¬
ing for the relief of convulsions, might seem to be corroborated by the
result of those cases; however, without at all entering into the dis¬
cussion of the comparative value of these different modes of delivery
under such circumstances, it should be observed that the case in
which turning wras employed had been allowed to proceed to such a
length before assistance was sought for, that almost any kind of treat¬
ment appeared hopeless.

“ The author recently attended a case of convulsions with Dr. Ni¬
cholson. The patient was a short necked, full, plethoric female,
about eight months pregnant with her first child. She was attacked
with convulsionswhile dressing for dinner, and in the course of twrelve
hours had eight fits of well marked violent convulsions : on examina¬
tion per vaginam, the os uteri was found dilated to about the size of a
half crown, the head presenting, and membranes ruptured. By
means of copious venesections, shaving the head, and cold applications,
with the exhibition of calomel and scammonvby the mouth, and the use
of enemata, first of soap and subsequently of turpentine, the convulsions
were completely subdued, and the patient was delivered naturally of
a dead child after an interval of thirty hours, during which she re¬
mained quite rational.

“ This case contrasted with one already related, where the con¬
vulsions had ceased on the delivery of the patient by the perforator,
but in which fatal peritonitis supervened, would lead us to conclude,
that artificial delivery ought to be limited, except when the pelvis is
deformed, to those cases where the forceps can be used, and that
turning, or the perforator, should be employed only in those cases
where, from the condition of the parts, there appears no risk of ex¬
citing inflammation : indeed unless there be strong proof of the death
of the child, or we have to deal with a narrow pelvis, it does not seem
that under any circumstances is the use of the perforator justifiable.
There can be no doubt that convulsions will often cease on artificial
delivery being performed, even though in a rude violent manner, but
the result in such cases usually is the death of the patient by peritonitis.

“ Though fully aware that bleeding in some cases is a most
valuable and indispensable remedy, the author considers emptying the
bowels of no less importance, and the use of applications to the head
a powerful adjuvant : he is however of opinion, that there are cases
in which the disease being the result of nervous irritability rather
than of actual plethora, the too free abstraction of blood will only
hurry the disease to a fatal termination.

“ The author was requested to examine a female who had died.

The Dublin Hospital Reports.

during labour, of convulsions, whom however he had not seen during
life. The labour had made so great progress that the head of the
child was on the level with the external parts of generation ; he
examined the different cavities accurately, and found a tumour of a
cartilaginous consistence as large as a hen’s egg, occupying the optic
thalamus and the adjoining part of the brain of one side.

“ Hemorrhage occurred in six cases during labour, caused by the
attachment of a small portion of the placenta over the os uteri, and
in all it was arrested by the rupture of the membranes, either by
the hand or by uterine action.

“ The cases in which it was found necessary to remove the pla¬
centa by the introduction of the hand, amount to fifteen : a large
number, but which may be acccounted for by the circumstances
of several applications at the dispensary for assistances of several,
being made solely on account of the retention of the placenta, in
consequence of previous mismanagement.

“ Five of these cases of retention were caused by the irregular
or hour-glass contraction ; no difficulty was experienced in the re¬
moval of the placenta, except in one case, where, co-existent with
> the stricture of the uterus, there was violent uterine action, and
high excitement, both vascular and nervous existed ; previously to
any attempt at extraction, venesection and the exhibition of opiates
carried to the utmost extent, did not lessen in the slightest de¬
gree the difficulty of extraction, and the patient died in about ten
days afterwards of venous inflammation.

“ In five cases hemorrhage occurred previous to the delivery of
the placenta. Two of these cases were of hour- glass retention :
in one sudden death took place about six hours after delivery,
although the placenta had been removed without difficulty, and the
patient appeared to have completely recovered from the loss of
blood, which had not been at all extensive ; no hemorrhage oc¬
curred externally, nor on the post mortem examination did any
appearance present itself sufficient to account for her death. The
uterus had contracted well, and no coagula were found in its
cavity.

“ A few hemorrhages occurring after the delivery of the placenta,
were arrested by means of pressure over the uterus, by the applica¬
tion of cold, by quietude, and the access of air, &c. &c.

“ A considerable number of abdominal inflammations presented
themselves ; at particular periods they were exceedingly prevalent ;
at other times equally rare. The type of these inflammations varied
with the periods of their appearance. In December and January,

1827, 1828, the peritoneum seemed to be the structure most deeply
engaged, and the inflammation to be of a phlegmonous character.
In March the disease assumed the low typhoid character. In May,

1828, several cases were met with in which the intestinal mucous
membrane was the seat of disease : they were characterized by thirst.

VOL. vi. no. 31 .

Critical Review .

redness of tongue, or white coating with florid papillae inter¬
spersed, intolerance of light, headach, and obscure abdominal
tenderness.

“ Cases of abortion were exceedingly numerous. This accident
is of frequent occurrence amongst the poor of the city, and one in
general little minded ; the circumstances under which such cases ap¬
plied for relief were various. In some instances hemorrhage, in
others retention of part of the ovum ; in others derangement of the
general health consequent on abortion were the reasons for applica¬
tion. The hemorrhages in those cases were arrested by means of
cold applications, rest, cool air, avoidance of any thing stimulating,
&c. &c. ; excepting after the sixth month manual extraction of the
placenta was not attempted, enemata, purgatives, friction of the ab=
domen, and binding, being the means employed to promote its ex¬
pulsion. In a few cases of abortion, at an early period, plugging the
vagina was found advantageous in arresting the hemorrhage.

“ The sequelae of abortion consisted of vaginal discharges, occa¬
sional hemorrhages, and general constitutional derangement; these
affections were treated by improving the condition of the system, by
the occasional use of purgatives combined with bitters, by attention
to diet, air, exercise, &c. &c.

Amongst the most frequent of the diseases of females, were those
connected with the functions of menstruation. In the treatment of
these cases more attention was paid (with some exceptions) to the
constitutional, than to the local symptoms, and what are considered
specific or directly emmenagogue medicines were but rarely ex¬
hibited, and never found effectual. The catamenial derangements con¬
sisted in total suppression, in diminution, in excess, in irregularities
attendant on their final cessation, and in distressing accompanying
symptoms.

‘ £ These states were accompanied by two very opposite conditions
of the system, and plethora. In the former, the object principally
held in view was to improve, as much as possible, the general condi¬
tion of the system ; in the latter and less frequent condition, deple¬
tion, either topical or general, was employed.

“ Cancer of the uterus was frequently met with. In every in¬
stance, the disease was so extensive as to engage all the soft parts
in the neighbourhood of the os uteri, evidently shewing that
extirpation of the uterus was, at that period of the disease, totally in¬
applicable. In the only instance in which a post mortem examina¬
tion was permitted, the interior of the pelvis was so completely sur¬
rounded by scirrhous glands, that some difficulty was encountered in
removing its contents.

“ Some instances occurred in which the os uteri was tumefied, ir¬
regular, and tender to the touch, accompanied by a muco-sanguineous
discharge, by pain about the back and thighs, anasacra of the lower
extremities, loss of appetite, debility, and sallowness of the counte¬
nance. They were treated with alterative doses of the pil. hydrar-
gyri, followed by mild saline purgatives combined with bitters ;

The Dublin Hospital Deports. 19

strict attention was paid to their general and dietetic management,
and in. every instance a perfect, though in some a gradual, recovery
ensued.

“ The recovery of such patients should point out the necessity of
sufficient investigation, before we condemn cases as malignant, that
may be only obstinate or tedious, and thus submit patients to the
hazard of a dangerous, and often an unsuccessful operation.

“ Two cases of polypus uteri occurred, in which the patients were
reduced to a state of the most extreme debility ; the tumours were
removed by the ligature, and the patients recovered perfectly. One
polypus was of the hard, the other of the soft species ; the latter was
exquisitely tender to the touch, a circumstance worthy of remark,
and already noticed by Dr. Johnson in the Dub. Hos. Reports, who
points out the error of adopting a diagnosis between polypus and in¬
version of the uterus, founded uj>on the tenderness of the uterus in the
case of inversion.

“ In one case of polypus uteri, where the patient had been exceed¬
ingly debilitated, the pulsation of the large vessels about the neck
was visible at a distance for some months, so that, on a superficial
inspection, she might have been supposed to labour under disease of
the heart.

** The uterine displacements were confined exclusively to prolap¬
sus uteri. Some cases of prolapsus vesicse aad vaginse were also met
with. In one instance, a contracted state of the urethra giving rise to
all the symptoms of diseased bladder, was cured by frequent introduc¬
tion of the bougie.

“ In several instances, in which females applied early, with all the
premonitory symptoms of mammary abscess, the progress of that af¬
fection was completely arrested, by submitting the patient to the in¬
fluence of tartar emetic.

“ The remaining cases consisted principally of the diseases of
pregnancy, of puerperal diseases, derangements of health connected
with lactation, mammary abscesses, vaginal discharges, inflammations,
tumours and abscesses about the vagina and external parts of genera¬
tion, abdominal tumours, &c. &c,

“ From the end of December 28, to October 29, the number of
registered cases amounted to 303. Of these, six were cases of pre¬
sentation of the breech and lower extremities ; one of the superior
extremity ; one case of face presentation was not interfered with, and
the child was born alive. In two instances, the face was turnedtowards
the pubis. In five cases twins were born. The perforator was em¬
ployed three times, and three females were delivered by the forceps.
In one of these cases, the foetus was acephalous ; the labour had been
rendered tedious by the large size of the body of the child.

“ The secale cornutum was employed in upwards of twelve cases,
in six it produced no preceptible effect whatever ; the author is, how¬
ever, willing to believe that the ergot employed in those cases,
though procured from respectable druggists, had lost its peculiar
properties.

Critical Review.

“ In three instances, where it was employed in half drachm dosesr
substance as well as infusion being administered, symptoms of an apo¬
plectic nature supervened, such as a diminution in frequency of the
pulse amounting to from fifteen to thirty beats in a minute, stupor,
epastaxis, &c. &c.

“ In a case of breech presentation, in a female who had borne se¬
veral children, ten grains of ergot, given in infusion, were adminis¬
tered ; she had not had any pains for the entire of the preceding night.
Pains, however, came on so immediately after the adminstration of
the ergot, as to leave no doubt on the author’s mind of its efficacy in
that instance. Amongst other instances, a case was treated by Mr.
Dash wood, an extremely intelligent pupil, where the placenta, after
three hours’ retention, was expelled by uterine action consequent on
the administration of the ergot, though in the two preceding deli¬
veries of the same patient the placenta was extracted by the hand.

“ The author cannot forbear relating two cases, where, in conse¬
quence of the total absence of pains, he had determined on making
trial of the ergot ; in one instance, on returning to his patient after an
hour’s absence, he found, that on her taking an aperient draught,
which he had prescribed, though no purgative or griping effect had
been produced, uterine action had come on so violently as to finish
the delivery of the child and placenta before his arrival ; and in the
other case, before he could procure the ergot, which he had to send
for to some distance, such effective pains came on that he did not find
it necessary to administer the remedy when it arrived.

“ In seven cases, the placenta was extracted by the hand ; in
some of these the ergot had been previously tried, but ineffectually.

“ In four of these there was hemorrhage connected with the re¬
tention of the placenta. One of these cases terminated fatally, not¬
withstanding the hemorrhage had been completely arrested.

“ One case of polypus uteri was detected by examination per va-
ginam. The tumour, which was not larger than a walnut, was con¬
nected to the interior of the cervix uteri by a long cord-like pedicle^
It was extracted by the fingers, and exhibited vessels running through
its diminutive stalk. It was composed of a delicate membrane con¬
taining small vesicles, and a gelatinous substance, that could be
drawn out by the finger to some distance.

“ Notwithstanding the small size of the tumour in this case, the
irritation produced thereby was greater than the author had witnessed
in any other instance of this disease.

“ One instance of severe puerperal inflammation of the joints oc¬
curred. In this case, in consequence of hemorrhage, the placenta
was removed (without any violence) by the hand. The patient did
not seem to suffer much from the loss of blood, and was in a favoura¬
ble condition till the seventh day, when, a} onrently in consequence of
some irregularity, she was attacked with febrile symptoms, and in¬
flammation of the knee and ankle of one leg. The fever was of a
mixed character, accompanied with much gastric derangement and
acceleration of the pulse, without any increase of hardness. The

The Dublin Hospital Reports.

pain in the parts mentioned preceded the external symptoms of inflam¬
mation, but in a short time the joints affected became red and swollen.
The calf of the affected leg participated in the tumefaction.

<f The pain was of so violent a nature as to deprive the patient
completely of rest, and to require the use of large opiates.

“ The treatment consisted in the regulation of the patient’s •
bowels, the administration of calomel, combined with opium and
tartar emetic, till ptyalism was produced; frequent application of
leeches, and in the intervals a saturnine lotion, was kept constantly
applied, protected by a covering of oiled silk. In the progress of
the disease a mixture of sulphate of quinine and the compound
tincture of gentian was employed with apparently considerable
benefit. The inflammation of the knee yielded rapidly to the treat¬
ment ; that of the ankle was of a more obstinate nature ; superficial
abscesses formed over that joint. The patient, after some time,
was sent to the country, and is now quite recovered. In no stage
whatever of the disease were any symptoms of venous inflamma¬
tion discernible.

“ Two cases of hydatids of the uterus were treated ; both of the
the individuals were married, and one had previously children, and
experienced, with the exception of feeling the movements of the
child, the usual symptoms of pregnancy. One patient had a con¬
stant discharge of a yellowish colour : the other was free from any
vaginal discharge till a few days before the expulsion of the hy¬
datids, when there was a slight discharge of blood. In one instance
the hydatids were expelled without much accompanying hemor¬
rhage ; in the other there was a considerable loss of blood. The
patients were treated, after the expulsion of the hydatids, like
puerperal patients ; one of them had a considerable quantity of
milk in the breasts for a few days, and has since borne a living
child. The hydatids expelled in one case amounted to upwards of a
gallon ; they were of an elliptical elongated shape, connected toge¬
ther by delicate pedicles, and surrounded by a cyst, resembling the
decidua.

“ One patient, affected with a malignant tumor of the os uteri,
applied for relief at the dispensary. She was thirty-five years of
age, had borne five children within the last fifteen years, and
enjoyed good health till four months previously, when she became
troubled with constant shooting pains in the back and loins, and
the ordinary symptoms of malignant disease in this situation.
Her general health too, was proportionately affected,

“ On examination per vaginam, a tumor, as large in circum¬
ference as a dollar, but much thicker, was found growing from the
lower part of the cervix uteri. It was firm and elastic, and a portion
of the cervix uteri could be felt above the tumor, apparently free
from disease. After endeavouring as far as it was possible to im¬
prove the patient’s general health, a ligature was applied as high up¬
as the cervix uteri, by means of the common double canula.

Critical Review .

“ It may here be observed that the ligature employed on this,
as well as on other occasions, was composed of catgut, or silk
covered with silver wire, as sold at the music shops. Silk is con¬
ceived to be preferable to catgut, as the latter, when long exposed
to moisture, sometimes becomes rotten.

“ The degree of firmness and elasticity, which a ligature of this
description possesses, even when exposed to moisture, will be found
to facilitate its application materially ; and even where there is an
anticipation of difficulty in the application of the ligature from the
size of the tumor, the author would suggest the trial of the com¬
mon canula, before having recourse to a more complicated ap¬
paratus.

“ In the progress of the case the ligature was tightened occa¬
sionally, but on the sixteenth day the cervix uteri, not being com¬
pletely divided, was drawn down, and cut through with a blunt
pointed bistoury.

“ For upwards of a month the patient seemed to have recovered
from the disease ; recently, however, ulceration has commenced at
the place where the tumor was separated, and all the former dis¬
tressing symptoms have returned.

“ Though the result of this case was unfortunate, yet the case
itself is important, as shewing how far the uterus will bear with
impunity the application of the ligature, there being no threatening
of peritoneal inflammation or retention of urine during the entire
time that the ligature remained on the uterus ; and the case under
consideration, as well as those cases in which the ligature has been
applied on the inverted uterus, induces the author to question the
soundness of the advice given by Doctor Gooch, regarding uterine
tumors, in his recent work on diseases of females ; for while he
agrees with him that including any portion of the uterus in the
ligature, in cases of polypus, is worse than useless, he conceives
that the advice given at page 307, regarding what are there termed
fungous excrescences, is calculated to lead to most dangerous results,
as it is only by the complete removal of that part of the uterus
from which the tumor originates, that any reasonable expectation
can be formed of its not again returning.

“ Should the author again meet with a similar case, he would
prefer removing a portion of the uterus with the knife, to the ap¬
plication of the ligature.

“ The number of cases treated since October last, up to the
present time, have, in proportion, considerably increased ; but, to
avoid repetition, only a few of the more remarkable shall be here
noticed. One instance of spontaneous evolution of the foetus oc¬
curred at the seventh month ; the child was situated in the manner
usually met with, and born dead.

“ In one case of complete presentation of the placenta, turning
was performed, the mother was saved, the child born dead. The
most remarkable feature in this case, was the great advantage found

The Dublin Hospital Reports.

to arise from plugging the vagina ; the os uteri seeming, in the
first instance, too rigid to allow of turning being performed with
safety to the patient.

“ Two cases of hemorrhage after delivery, of an interesting
nature, occurred. In one case, application was made for assistance
nine hours after the birth of a first twin, in consequence of the
retention of a second.

“ The patient, a healthy young woman, was much excited,
apparently in consequence of having taken some spirits. Her face
was much flushed, pulse 130, full and strong ; enemata and ape¬
rient medicines had been administered without any effect, and no
uterine action existed. As the vascular excitement seemed the
result of a temporary cause, it was not deemed necessary to have
recourse to venesection ; and lest some untoward event should occur,
it was deemed advisable to deliver the patient ; accordingly turning
was performed, not without some difficulty, in consequence of the
height in the uterus at which the child was placed. It however
was born alive, and what was remarkable, very soon became a fine
child, while the infant that was born naturally died in a few
days,

<f Every means was taken to promote the safe expulsion of the
placenta, which in about half an hour was expelled naturally, and
the uterus became hard and well contracted. In a short time,
however, most violent uterine hemorrhage came on ; cold was
promptly applied to the region of the uterus, and pressure made
over that viscus, by which means the hemorrhage soon ceased.

“ In this instance the patient did not become at all faint, nor
was any internal stimulus employed except cold water, and the
only effect produced by the loss of blood was the production of the
pulse from 130 to 90, which also became proportionally soft ; a
very desirable result. This was evidently a case of hemorrhage
resulting from vascular excitement, and shews the necessity of
preventing, by attention to temperature, diet, drinks, &c. during
labour, so unfavourable a condition of the circulation.

“ The second case was one of quite an opposite nature, occurring
in a weakly female who had borne several children, and each time
had slight hemorrhage.

“ Lest a similar occurrence should take place on the present
occasion, the management of her labour was intrusted to a person
of some experience ; although however conducted most judiciously,
the birth of the child was followed by immediate hemorrhage.

“ This was arrested by means of cold applications, and pressure
on the uterus in the first instance ; as however it quickly recom¬
menced, the hand was introduced into the uterus, and the placenta,
which was found lying detached in that cavity, was withdrawn ;
the uterus contracted on the hand, and but a slight oozing of blood
continued.

“ The quantity of blood lost in this case was not great, nor did
the patient suffer complete syncope, yet for nine hours she lay as if

Critical Relieve.

•on the point of death; the face bloodless, extremities cold, pulse not
to be felt at the wrist, and but faintly in the larger arteries.

“ The patient was watched through the day ; opium, brandy,
and ammonia administered in small quantities ; she however re¬
jected every thing, and the first thing which she retained was a
raw egg beaten up with a cup of tea.

“ It might here be asked, if this was not a case in which trans¬
fusion would not have been recommended by the advocates for
that operation, and whether this operation might not have proved
fatal in this, as it was in other similar instances.

“ While on the subject of hemorrhage, the author wishes to
allude briefly to the subject of cold applications.

“ In the only instance of fatal hemorrhage which he witnessed,
he found the patient’s bed, when he arrived at the house, com¬
pletely drenched with cold water, herself apparently as much sink¬
ing from the collapse produced by the slovenly application of cold,
as from the loss of blood; so that he would caution his junior
brethren from applying cold in such cases to any part, except the
vicinity of the uterus, by arranging napkins so as to prevent the
part of the bed on which the patient lies from l>eing wetted ; and
when the heat of the extremities is below the natural standard, it
is obvious that applying heat thereto, while cold is applied to the
region of the uterus, will tend to equalize the general circulation.
The author would wish to allude to the bad effects resulting from
patients wiio are the subjects of hemorrhage, making any exertion
in bed, especially if deviating from the horizontal position.

<£ It is unnecessary to enter into the details of the case just
related, further than to state that the patients suffered for some
months from a train of nervous symptoms, but is now quite reco¬
vered.

‘ ‘ One case of polypus uteri wus treated by ligature ; it came away
the third day, and the patient is now quite well. At least a dozen
cases of prolapsus uteri were relieved by the introduction of pessaries.
The flat circular pessary was employed in preference to any ether.

“ Some of the cases of prolapsus uteri were of very long standing ;
in no instance however was there anv difficultv in the reduction of

y y

the tumour, nor any unpleasant effects resulting from the restoration
of the uterus to its natural situation.

“ One old woman who had a large prolapsus of the uterus for forty
years, on a pessary being introduced for the first time last winter,
expressed herself as being more comfortable, and in better health
than she had been for a number of years. The daughter of this
woman, who had both prolapsus of the uterus and of the rectum, was
also relieved by the flat pessary.

“ At the time she applied at the dispensary she had a large tu¬
mour corresponding to the situation of the right kidney. Its forma¬
tion, which took place two years before, was preceded by shiverings,
pain in the abdomen, & c. She appeared as if quite run dowm by hectic

The Dublin Hospital Reports.

hectic, having profuse diarrhoea, night sweats, &c. She passed in her
urine, which in other respects was natural, immense quantities of pu¬
rulent matter. The uterus was supported by the pessary ; light nu¬
tritious diet was administered, and medicines given calculated to
check the diarrhoea, merely with the expectation of alleviating symp¬
toms ; coutrary however to expectation, (the purulent matter still pas¬
sing with the urine,) the tumour gradually lessened, and at length
totally disappeared, and she is now in the enjoyment of perfect
health.”— p. 521.

Mr. Gregory gives a report of six hundred and ninety-
one cases, presenting the following varieties of labour : —

“ Natural presentations, 645; Face, 2; Breech, 14; Feet, 7 ;
Arm, 3; Shoulder, 1; Funis, 7; Twin cases, 12; Placenta, 0; —
Total, 691.

III. — Medico- Chirurgical Transactions. Published by the
Medieo-Chirurgical Society of London. 8vo. pp. *235.
Two Plates. Yol. XVI. Part 1, 1830. — (continued.)

Three papers on aneurism are inserted in the work before
us, and though they are not placed in succession, we shall
notice them at the same time. They are as follow : —

I. — Case of aneurism of the external iliac artery , in which
the femoral artery and aorta were tied. By J. James,
Esq. Surgeon to the Devon County Hospital.

The patient was a man aged forty-four, of a spare habit,
but not unhealthy, and was admitted into the hospital.
May 7th, 1829. tie had had disease of the hip joint, and
at the time of his admission, a supposed glandular tumour,
which was discovered to be aneurism. In June it enlarged,
and occupied the lower part of the abdomen. On the
2d of June, a ligature was applied about half an inch below
Poupart’s ligament. In the evening the bulk of the tumour
had decreased to about three quarters of an inch. On the
4th, some purulent matter was evacuated from the site of
the ligature, and the tumour had decreased one inch. From
this day the tumour began to increase, and on the 1 2th had
equalled its original size, and pointed at its lower and outer
part. On the 24th the integuments were tense, shining and
painful, and the patient looked very ill. A consultation was
held, at which it was determined to tie the aorta. The

Vol. VI. NO. 31.

Critical Review.

operation was performed at half-past three,, p. m, July 5th.,
in the presence of the medical officers of the hospital, and
of many other medical gentlemen.

“ The man wras placed on the table with his shoulders slightly
raised, the bowels having previously been thoroughly opened. I
made the incision rather lower than in Sir A. Cooper’s case, begin¬
ning it an inch above the umbilicus, and continuing it two inches be¬
low. I scratched through the linea alba below the umbilicus, and
then proceeded to open the peritoneum nearly to the same extent as
the external wound. This first part of the operation was somewhat
impeded by very copious bleeding from the vessels of the integu¬
ments.

“ As soon as the division of the parietes was effected, the viscera
protruded, and the efforts of the poor fellow continuing strong, I soon
found myself embarrassed with almost the whole of the bowels ;
nearly all the colon, and a great part of the small intestines being
pushed out, and presently quite distended with flatus, a circumstance
frequently remarkable in the operation for strangulated hernia. I
found the aorta without difficulty, pulsating strongly, but it was sur¬
rounded with dense cellular membrane, and a strong peritoneal cover¬
ing was likewise interposed between my nail and it.

I may remark that even in the dead subject, it is sometimes a dif¬
ficult matter to force the nail and finger between the aorta and the
spine ; in this case, embarrassed as I was by the coils of intestine,
in which my hand was buried, it was particularly so. I enlarged the
wound, but it was of little service ; to have obtained suffici¬
ent room to push aside those inflated intestines would have required
an incision of enormous extent ; and supposing this made, there
would hardly have been a probability of retaining them completely
within the abdomen by any mode of suture during the exertions
which the patient might make, and which it would probably be im¬
possible to prevent.

“ I endeavoured cautiously to get the point of the aneurismal nee¬
dle through, and succeeded ; but when it reached the other side it
broke at the handle, which in the one I had selected for its curve, was
unfortunately of wood. I had little anticipated occasion for so much
force. The broken part was so sharp that I was obliged to withdraw
it, for fear of injuring the intestines. With some additional difficulty
I got my finger, with Weiss’s instrument upon it, under the artery ;
but even after this was effected, it was by no means easy, with the
best assistance of my colleagues, to extricate the short needle bearing
the ligature, so much did the intestines interfere with every kind of
manipulation. When the ligature was underneath, I kept the intes¬
tines out of the way with the fingers of both my hands, and placed
one of my thumbs on the vessel, whilst Mr. Luscombe drew it, first
on my thumb, and then on the artery ; by this I prevented any thing
from being included, a caution which Sir A Cooper has particularly
dwelt upon. The ligature was then drawn tight, and the tumour

Medico-Chirur gical Transactions.

became flaccid ) a,t the same time the patient complained of deadness
in the lower extremities. The ligature was cut close.

“ From the tension of the muscles and the inflated state of the in¬
testines, they were not easily returned, but when they had been re¬
placed, five needles were passed through the integuments, and the
wound having been secured perfectly by the quill suture, large straps
and a bandage were added, and the man was put to bed.” — p. 51.

Great prostration of the vital powers occurred during
the operation., which was combatted with brandy and water,
opium, & c. He experienced great pain in the lower extre¬
mities, especially on the aneurismal side ; there was no
reduction of temperature until seven, p. m. when he ex¬
pired.

Autopsy. The tumour was considerably collapsed — there
was no discoloration of its surface — the wound measured
four inches. On opening the abdomen, a considerable quan¬
tity cf blood was found amongst the intestines, which was
ascribed to the incision through the abdominal parietes, and
also to the division of a small vessel in the mesentery. The
intestines were distended with gas, and were uninjured.
The ligature was firmly applied round the aorta, an inch
below the duodenum, five lines below the inferior mesen¬
teric artery, and eleven above the bifurcation of the com¬
mon iliacs. A small vein, which ran along the aorta to the
inferior mesenteric, w7as included in the ligature. The vena
cava was uninjured. No operation could have been more
dexterously performed. The cause of the failure of the first
operation was, the division of the external iliac artery above
PouparFs ligament, so that a free outlet had remained
from the lower part of the sac, by means of the profunda.
The operation, though unsuccessful, reflects great credit on
Mr. James, as a scientific and practical surgeon.

II. — Case of Aneurism of the external iliac artery, in
which a ligature was applied to the common iliac artery.
By Philip Crampton, M.D. F.R.S. &c.

A soldier, aged thirty, of good general health, was ad¬
mitted into the Military Hospital, Phoenix Park, Dublin,
July 8th, 1828, under the care of Mr. Crampton, surgeon-
general. The patient complained of a pulsating tumour,
which extended from about three inches below the umbi¬
licus, to the same distance below the crural arch, and w7as
divided into twTo parts, in the line of Poupart’s ligament.

Critical Review.

The upper portion presented the aneurismal thrill; the
lower had no such character. There was a pulsating’ tumour,
about the size of a small egg, in the right ham. There was
great pain in the thigh and leg, loss of appetite, pulse 100,
full and throbbing. He ascribed the complaint to a fall
received in wrestling, nine months previously, but continued
at his duty until the 20th of May. He was treated antiphlo-
gistically, and was ordered digitalis. On the 18th of July,
he was considered in a fit state for the operation, which was
performed in the presence of Professors Colies, Macartney,
and Wilmot, Mr. Stringer, the surgeon of the hospital.
Dr. Ramsay, of Dundee, and other gentlemen. The de¬
tails of the operation are thus given by the distinguished
operator : —

“ The' first incision commenced at the anterior extremity of the
last false rib, proceeding directly downwards to the os ilium, it fol¬
lowed the line of the crista ilii, keeping a very little within its inner
margin, until it terminated at the superior anterior spinous process of
that bone, the incision was therefore chiefly curvilinear, the conca¬
vity looking towards- the navel. The- abdominal muscles were then
divided to the extent of about an inch, close to the superior anterior
spinous process, down to the peritoneum : into this wound, the fore
finger of the left hand was introduced, and passed slowly and cau¬
tiously along the line of the crista ilii, separating the peritoneum
touching the fore -part, and the fascia iliaca the hack part of the finger.
A probe-pointed bistoury was now passed along the finger to its ex¬
tremity, and by raising the heel of the knife, while its point rested
firmly on the end of the finger as on a fulcrum, the abdominal mus¬
cles were separated from their attachments to the crista ilii by a single
stroke. By repeating this manoeuvre, the wound was prolonged until
sufficient room was obtained to pass down the hand between the peri¬
toneum and the fasia iliaca. Detaching the very slight connections
which these parts have with each other, I was able to raise up the pe¬
ritoneal sac with its contained intestines on the palm of my hand,
from the psoas magnus and iliacus internus muscles, and thus obtain
a distinct view of all the important parts beneath ; and assuredly a
more striking view has seldom been presented to the eye of the sur¬
geon ; the parts were unobscured by a single drop of blood ; there lay
the great iliac artery, nearly as large as my finger, beating awfully
at the rate of .1 20 in a minute, its 3mllowish white coat contrasting
strongly with the dark blue of the iliac vein which lay beside it, and
seemed nearly double its size : the ureter in its course to the bladder
lay like a white tape across the artery, but in the process of separat -
ing the peritoneum, it was raised from it with that membrane to
which it remained attached. The fulness of the Iliac Vein seemed to
vary from time to time, now appearing to rise above the level of the
artery, and now to subside belowr it. Rothing could be more easy

Medico-Chirurgical Transactions . 29

than to pass a ligature round an artery so situated. The fore finger
of the left hand was passed under the artery, which with a little
management was easily separated from the vein ; and on the finger,
(which served as a guide,) a common e}'ed probe furnished with a li¬
gature of moistened catgut was passed under the vessel. A surgeon’s
knot was made in the ligature, and the noose gradually closed, until
Mr. Colles, who held his hand pressed upon the tumour, announced
that c all pulsation had ceased !’ A second knot was then made, and
one end of the ligature cut off short. On examining the vessel after
it had been tied, it was found to be full, and throbbing above the li¬
gature, but empty and motionless below it. The external wound was
united by three or four points of suture, and supported by long straps
of adhesive plaster. The operation was completed in twTenty-two
minutes ; the patient, who was a firm minded man, made no com¬
plaint during the operation, not even when the ligature was closed
upon the artery. The tumour, immediately after the operation, was
diminished nearly one-third, the diminution being confined to the ab¬
dominal portion; ten minutes after the operation, the pulse was 96;
at 7 p. m. Mr. Stringer, finding the pulse full and bounding, took
20 ounces of blood from the arm; at 10 p. m. I found him tranquil,
no pain, pulse 88, the limb, with the exception of the toes, warm :
Saphena Vein full ; additional flannel was wrapped round the foot/’
— p. 56.

The following' day the toes were not so warm as those of
the other foot ; castor oil, with an enema, was given, which
produced no effect ; the former was repeated, with calomel
and the enema terebinth, which opened the bowels. On
the 21st, there was evident pulsation of the tumour, but
no thrill. There was no pulsation in the femoral or popli¬
teal arteries. The temperature of the affected groin was
98°, of the hams 9 7°, of the ankles 94°, of the right great
toe 87°, of the left and unaffected 87 — pulse 88. On the
22d, pulsation, accompanied by a slight thrill, and on the
24th, it was more distinct in the abdominal portion of the
tumour. He was bled to syncope, had fever diet, and 20
m. of tine, digitalis every third hour. 25th. Pulsation more
distinct, thrill very perceptible, no pulsation of the femoral
artery, the ligature came away — blood cupped and buffed,
v. s. ad. Bxij- 26th. On turning in bed, felt a severe pain
in the thigh and knee, as if the latter was tearing off; the
anterior part of the thigh was numb ; but in ten minutes
the pain subsided. From the recurrence and strength of
the pulsation, it was thought that an ordinary anastamosis
could not produce it, and it was feared that the catgut
ligature had been macerated and given away, a supposition
too well founded. 28th. Much better — wound nearly healed.
At six, p. m. while sitting in bed, violent haemorrhage

Critical Review.

issued from the wound, when he immediately expired. The
body was examined next day, in the presence of the dis¬
tinguished professors who had witnessed the operation, and
the following appearances were observed : —

“ The intestines being removed, the peritoneum raised, and the
great abdominal vessels laid bare, the common iliac artery, at about
three-fourths of an inch from the bifurcation of the aorta, was lost in
an oblong tumour, about three fourths of an inch in diameter, and one
and a half in length ; the tumour terminated upon, but did not com¬
municate with the, aneurismal sac. On cutting into the tumour,
about half an ounce of greenish pus flowed from the wound and dis¬
covered the artery, which appeared somewhat contracted at one part,
and its coats deeply indented, but not cut through, marking the place
where the ligature had been applied. On blowing into the iliac ar¬
tery from above, bubbles of air escaped freely from the external
wound from whence the blood had issued; water injected by a sy¬
ringe escaped by the same passage ; clearly establishing the impor¬
tant fact, that the ligature which was of cat-gut, had been dissolved
by the heat and moisture of the wound, and thrown off, before the
obstruction of the artery, or the coagulation of the blood in the aneu¬
rismal sac, had been completed. It further appeared that the dissolu¬
tion of the ligature had caused a small abscess to form in the place
which it occupied. On slitting up the artery, the internal and mid¬
dle coats were found to be completely divided in the whole circum¬
ference of the vessel, and small portions of lymph adhered to its in¬
ternal surface. The popliteal aneurism wTas far advanced towards a
cure ; the contents of the sac were quite solid, and the tumour was
reduced to about the size of about a walnut; the artery, for six
inches above the sac, was filled with a firm coagulum,” — p. 57.

The most important inferences to be drawn from this case,
are, in the opinion of Mr. Crampton, —

<<r 1st. That the operation of tying the common iliac artery
is not only feasible (when performed in the manner de¬
scribed in this paper) but is an exceedingly easy operation.
The difficulties which Mr. Mott encountered, and which
prolonged the operation to nearly an hour,’’ are clearly
referable to the circumstance of his incision having been
made too low. This, in the first place, brought him in
contact with the aneurismal tumour, from which he was
obliged, with great labour and considerable risk, to detach
the peritoneum ; then he had the whole mass of the tumour
between him and the artery, which he was to tie ; and lastly,
he had the intestines pressing down upon him, and produc¬
ing such a complication of difficulties, as I believe, few men

but himself could have encountered with success. All these

w' ♦

Medico- Chirur gical Transactions .

difficulties, however, might have been avoided, by getting
at the artery from behind and above the tumour ; in a word,
by an incision which should begin where Mr. Mott’s ter¬
minated.

2d. The question has often been proposed, ee whether,
under any possible circumstances, a surgeon could be
justifiable in passing a ligature round the abdominal aorta ?”
Without venturing to give a decided opinion upon this sub¬
ject, it may not be amiss to observe, that in several in¬
stances, aneurisms of the abdominal aorta have undergone
a spontaneous cure, in consequence of the obliteration of
the artery above and below the tumour.

I have given, in the second volume of the Dublin Hos¬
pital Reports, the history of a case of this kind, and the
preparation illustrative of it is no w in the museum of Guy’s
Hospital, deposited by Sir Astley Cooper, to whom I trans¬
mitted it in 1819. If such an operation should be deter¬
mined upon, I have no doubt that by a proceeding similar
to that which 1 have described in this paper, a ligature
could with great ease be passed round the abdominal aorta,
without interfering wTith the cavity of the abdomen.”

It is greatly to be regretted that Mr. Crampton had not
applied a silk ligature in the case before us, by which he
might have succeeded in effecting a cure, or at ail events,
a mitigation of the patient’s sufferings.

III. — An account of the dissection of the parts concerned
in the aneurism, for the cure of which Dr. Stevens tied
the internal iliac artery, at Santa Cruz, in 1812. Ry
Mr. Richard Owen, Surgeon.

Much scepticism existed as to the fact that Dr. Stevens
had really tied the internal iliac artery in the case above
alluded to, and on his arrival in this country, in the spring
of last year, he submitted the preparation to the inspec¬
tion of Sir Astley Cooper, Mr. Lawrence, and other emi¬
nent surgeons, who were all convinced upon the subject.
He deposited the preparation in the museum of the Royal
College of .Surgeons, the dissection of which was intrusted
to Mr. Owen, and the details of that gentleman remove
all doubt from the original statement of Dr. Stevens. It
will be recollected, that Dr. Stevens considered the gluteal
artery was aneurismal, but it appears from the account
before us, the ischiatic wras the artery affected. The woman

Critical Review.

was cured of her disease, lived for ten years, and died of
a pulmonary complaint.

We shall now pursue our analysis, in the order in which
the papers appear in the volume under notice. The first
paper is by Mr. James, and has been already described.

Th e second is by Mr. Barlow, of Blackburn, on the suc¬
cessful removal of a medullary sarcoma of nine years dura¬
tion, which occupied nearly the whole cheek, extended
anteriorly from the inferior edge of the right orbit, hanging
over the contour of the lower jaw, and laterally from the
angle of the mouth to near the tragus of the ear, being
remarkably prominent exteriorly. Idle integuments of the
cheek presented a pale glossy aspect, and the surface of
the tumour was covered with a net work of various veins.
The vicinal glands did not sympathize with the disease. The
operation consisted of an elliptical incision, which was
followed by such profuse haemorrhage and profound syncope,
that the patient (who was a female, aged 6G), seemed in
the greatest danger. Several arteries were secured, and the
patient was finally restored to health. Mr. Barlow adverts
to a most important point in operative surgery, namely, the
danger which arises in excision of tumours about the neck,
from air passing into the divided veins, and destroying the
patient. He details a case of this kind, which happened
to himself thirty years ago, and refers to the cases narrated
by Dupuytren, and Dr. Mott of New York. He shudders
at the risk he has run in such operations, and inquires whe¬
ther compression or ligatures ought not be employed on
the veins in the cases before us. No one can peruse this
paper, without a conviction that the author is a truly scien¬
tific* and a cautious surgeon. The operation is highly
creditable to his skill and dexterity, and proves him pos¬
sessed of a. degree of boldness which few practical sur¬
geons of the present day possess. If our position were
disputed, we need only refer to his successful case of Caesa¬
rean operation, which has a high place in the annals of
British surgery. His candour in acknowledging a fatal ope¬
ration, which happened to him so far back as thirty years,
reflects the greatest credit upon him as an ardent lover of
science, for few among our modern surgeons could be found
who would volunteer a similar declaration. In fact, we sel¬
dom find our great operators of this capital refer to their
cases of failure ; but their fortunate operations are as seldom
left unrecorded.

[ 33 ]

IV. — Oases illustrative of the efficacy of various medicines ,
administered by inhalation in Pulmonary Consumption, in
certain morbid states of the trachea , and bronchial tubes ,
attended with distressing cough , and in asthma . By Sir
C. Scudamore, M. D, F.R.S. &c. &c. London, 1830.

We opened this volume with a confident anticipation, that St.
John Long- had resolved to appeal to the ancient ordeal, of
trial by battle, to be decided, however, by the pen, instead of
the sword ; but that, not caring' to enter the lists in person (lest
he should be flayed by the critics, with as little mercy as he
has been accustomed to shew to his victims), he had selected
for his champion the doughty knight, whose name and ap¬
pendages make so gorgeous an appearance in the Jtitle page;
and that he had him equipped for the encounter with the de¬
fensive in armour of his illustrative cases.

But, alas! we were doomed to be disappointed. The age of
chivalry is past; or, as Lord Byron would have said, “ there
is no sprit now-a-days, unless it be the spirit of quackery and
fanaticism.”

The Doctor hibernice. Sir Charles, seems to have made up
his mind, that St. John, after receiving the crown of martyr¬
dom at the Old Bailey, to which he is justly entitled, will he
duly canonized by his votaries as a matter of course, and there¬
fore that it would be well to secure him for his patron saint,
and forthwith to erect a shrine in his own domicile, at which
his disciples might celebrate his mysteries in their genuine
spirit, when the law shall compel him to be absent in the body.
And doubtless a very pretty trade it will prove, to collect St.
John’s , instead of St. Peter’s pence, in Wimpole-street,so con¬
veniently near to the Temple in Harley street, where the saint’s
own miracles were performed, indeed so fixed does the wor¬
thy knight’s resolution to assume the office of high priest ap¬
pear to be, that we would strenously advise St. John Long,
should he yet again be spared to his agonized friends, expli¬
citly to disclaim all connection with any other house, except
in consideration of value received.

To be serious, however, it is deeply to be deplored that a
man like Sir C. Scudamore, whose former publications have
shewn that he might at least have assumed a station of re¬
spectable mediocrity in medical literature, should have com¬
promised his character by the production of the pamphlet be¬
fore us ; the very highest air of which is but ad captandum
vulgus ; literally to entrap the herd of titled and untitled pro¬
selytes of a detected impostor.

Vol. VI. NO. 31.

Critical Review.

As to the shallow pretence of performing a service to me¬
dical science and humanity, we would simply demand in what
degree will science be benefited by the information, that Sir
C. Scudamore is in possession of certain means of curing dis¬
ease, which he declines to impart to the profesion ? The plain
fact is, that the work is of no use whatever to medical men,
and was never intended for their perusal. We will cite some
of the internal evidence which is afforded, in proof of this as¬
sertion.

In the first place. Sir Charles in his preface declines entering
on the debatable question of originality, and in the very next
sentence declares, “ When I commenced my investigation of
the powers of iodine used in the way of inhalation, I had never
heard a suggestion on the subject, and in regard to most of
the other medicines, except chlorine, I am not aware that they
have, up to the present moment, been employed in this way
by any other individuals.' ” We would ask whether the name
of Dr. Sanders, of Edinburgh, and his suggestion of the in¬
halation of the vapour of aether, in combination with muriatic
acid, has never reached his ears.

The author subsequently alludes to the work of Dr. Murray,
of Belfast, on the inhalation of iodine, and also to the me¬
moirs presented to the Royal Academy of medicine in Paris by
M. Gannal on the use of chlorine, but as if for the express
purpose of attracting attention to the mode in which he has
attempted to conceal his disingenousness under the mask of
candour, bespeaks of them only as recently published, whereas
the memoirs were read in 1827, and Dr. Murray’s work issued
rom the press in the following year.

The first case with which Sir Charles has favoured us came
under his care in March, 1829, whence we infer that the em¬
ployment of iodine has been borrowed from Dr. Murray, and
the glass apparatus from M. Gannal. Indeed, we expect if a
second edition of Dr. Murray’s work should appear, that its
author will repay the strictures on his practice of diffusing the
vapour of iodine through the atmosphere of the apartments of
the sick, by including Sir C. Scudamore and his glass bottle
in the sarcasm, which he has already levelled against Dr.
r Mudge and his tin tea pot.

The last and most convincing proof which we shall adduce
that these cases are intended for the public, and not for the
profession, is furnished by the author’s refusal to give a for¬
mula for his inhalation, lest those into whose hands it may fall
should be tempted to employ it themselves to the manifest

Sir. C. Scudamore on the Cure of Consumption. 35

risk of their own injury, and the certain diminution of the
profits of the inventor.

We repeat, therefore, that it is imposible to suppose that
this work is published for any other purpose than that of sup¬
planting- Long, if he should be suffered to remain, or of succeed¬
ing- him if his career should be brought to a close ; and this
in a certain degree it will certainly answer, in spite of ail the
commentaries that criticism may offer. But we cannot help
thinking that the ungracious task w^hich the author has impo¬
sed upon us might have been spared, together with the cost of
publication to himself, and the annoyance of his readers, by
the waste of valuable time consumed in perusing his cases, by
the simple expedient of inserting an advertisement in the news¬
papers announcing, that Sir C. Scudamore, Knt. Doctor of
Medicine, &c. &c. residing at 6, Wimpole Street, Caven¬
dish Square, can cure consumption with the greatest safety,
and in half the time that Mr St. John Long can. Sir C. will
not longer enjoy his new calling, as Mr. John Smith, Lec¬
turer on Anatomy and Surgery, has announced a similar
work. O temporary o mores.

V, — Lectures on Anatomy , intersjjersed with practical
remarks. ByBRANSBY B. Cooper, F.R.S. Surgeon of Guv’s
Hospital, Lecturer on Anatomy, &c. &c : London, 1830.
Two Plates, Royal 8vo. Vol. it. pp. 308. Highley.

A work of this description, comprising general and descrip¬
tive anatomy, physiology, and surgical remarks, has long
been a desideratum in the medical literature of these coun¬
tries. General anatomy is in its infancy in our schools ;
indeed, it forms no part of education in the greater number
of them. Hence it is that the greater portion of students
are perfectly unacquainted wdth this very important branch
of science, without the knowledge of which they can never
form a correct opinion on the lesions produced by disease. It
affords us much satisfaction to observe, that examiners of
the Royal College of Surgeons are now accustomed to
test their candidates’ skill in this division of anatomical
science, a plan long since adopted by their contemporaries
in Dublin. It is really astonishing to think that the numer¬
ous class of medical practitioners in this section of the
empire, should have been allowed for so long a period to
enter on their professional duties without a knowledge of
the intimate structure or tissue of the various parts of the
body. It is a matter of no small surprize that this defect

Critical Review.

still exists in some of the large schools in this metropolis ;
but we cannot wonder much at this, when we consider how
lectureships are tilled up in these establishments. The time
has arrived when the appointment of lecturers must depend
on merit, and not on interest.

But to return to the work under notice.

The subject of this volume is the muscular system, which
very properly follows that of the former, which was the osse¬
ous ; the next will contain, the anatomy, with physiolo¬
gical and surgical remarks of the interior parts of the
body;” the fourth and last will he devoted to the brain,
nerves, and organs of the senses.”

This production is not of a kind which we can illustrate
by extracts ; but we can state with perfect confidence, it is
evidently compiled by a gentleman of sound sense, practical
experience, and a perfect knowledge of the subject, and
who, besides his high professional acquirements, possesses,
in no ordinary degree, the invaluable art of communicating
the truths of science in a clear, simple, precise and popular
manner. Another prominent recommendation to which we
shall advert is, that the information it contains is of the
newest kind, and that every part of the work has been care¬
fully adapted to the present improved state of medical
science. It is dicidedly one of the most useful works
which has yet been offered to the public, and when finished
will be extremely popular with the profession. The plates
are very clearly and beautifully executed. There is one
defect which we hope to see obviated in a future edition,
and that is, the exclusion of pathological anatomy. Had
the talented author appended this very important branch
of science, his work would be much more valuable, and he
one of standard authority and reference with all classes of
the profession. It differs from the productions of Dr. Cra-
gie, Mr. Grainger, Bayle and Hollard’s, by comprising de¬
scriptive anatomy. Neither [does it contain such reference
to the authorities as these which we have just named ; but
there is a good excuse for this, when we recollect that the
work consists of the author’s lectures, and every one knows
how confusing it is to the minds of those commencing their
studies in medicine, to have their memories loaded with the
names of writers, whose opinions only are worthy of a place
in their remembrance. Every opinion of standard authority
is given, but the experienced and practical physician or sur¬
geon would wish to have more ample references.

[ 37 ]

VI —^Elements of Surgery . By Robert Liston, Follow
of the Royal Colleges of Surgeons in London and Edin¬
burgh, Surgeon to the Royal Infirmary, Lecturer on
Surgery, &c. : London, 18-31. Part I. 8vo. pp. 318;
Longman and Co. and Adam Black, Edinburgh.

VII. — A System of Operative Surgery , containing a de¬
scription of the most approved plans of performing the
different Operations in Surgery on the dead body , with
remarks on their anatomy , and accompanied with prac¬
tical observations , being principally designed for the
use of students in surgery . By William Hargrave,
A. M. M. B. T. C. D., Member of the Royal College of
Surgeons in Ireland, Lecturer on Anatomy, Physiology,
and Operative Surgery, &c. : Dublin, 1831. l*2mo. pp.
533. Hodges and Smith.

Few really scientific members of our profession of the pre¬
sent day are satisfied, until they have contributed their share
to the records of medicine ; and, in fact, there is none of
the natural sciences which affords a greater scope for im¬
provement. After all that has been accomplished, the
domain of medical science is as yet unexplored, and all
that is known about it can be easily compressed into a
narrow compass. So rapid has been the progress of our
science, that our systematic and elementary works need
constant revision. It appears from the prefaratory remarks
of Mr. Liston, that the systems of Latta, B. Bell, and
Allan, which were the text books of North Britain, are far
behind the present state of surgical science, and therefore
he has ventured to supply the deficiency, by reducing the
heads of his lectures into a compendium or guide for those
students who resort to Edinburgh. Mr. Liston is well known
to the profession, as one of the best operative surgeons in
these countries, and is eminently well qualified to arrange
a compendium of his favorite science. He has executed
his task, as might be expected, in a very able manner. His
descriptions are simple, plain, concise, yet sufficiently co¬
pious, and his principles and practice such as every man of
science has sanctioned.

The subjects of which he treats in the volume before us,
are inflammation of the various tissues and its consequences,
suppuration, mortification, erysipelas, furunculus, anthrax,
inflammation of mucous, serous and synovial membranes,
inflammation of bone, caries necrosis, fragilitas, and molli-

Critical Review,

ties ossium, rickets ; inflammation of arteries and veins, and
other diseases of vessels ; tumours, wounds, ulcers, hos¬
pital gangrene, malignant pustule, ulcers of the genital
organs, scalds and burns. It is evident that a work of this
kind does not admit of analysis, of nothing more than an
opinion of its merits. The grounds upon which this work
founds its claims to approbation are, brevity, accuracy,
perspicuity, and the practical details with which it abounds.
It reflects great credit on the talents and industry of the
author, and will add much to his well-earned reputation.

Mr. Hargrave’s object is to place before the student,
the most approved plans of performing surgical operations,
and to present to his view the relative anatomy of parts
interested in operations, which has been almost excluded
from elementary works of this description. All the prin¬
cipal operations that can be performed upon the dead sub¬
ject are described, such as the tying of arteries, amputa¬
tions, excision of joints, extirpation of different organs,
laryngotomy, tracheotomy, cesophagotomy, lithotomy, ca-
theterism, hernia, trephining, &c. The operations on the
eye are omitted, as our author considers they ought to be
studied in conjunction with ophthalmic surgery, or on the
eyes of inferior animals in the closet. The anatomy of
the different tissues implicated in each operation, is de¬
scribed with the most exact fidelity. The operations are
graphically described, and the various standard works re¬
ferred to, and the latest improvements quoted. There is
not a single work of authority which our author has not
laid under contribution, and illustrated the tenets of each
writer upon the dead body. The minute descriptions of
general and relative anatomy, render this work the best
companion to the surgical student.

In this very important point it is unrivalled, and surpasses
every production of the kind hitherto published. In this it
far excels Averill’s and the other manuals of operative sur¬
gery. It is a work well adapted to the dissecting room, and
the best possible companion for the Dublin Dissector. It
ought to be in the hands of every anatomical student and
young surgeon, as it is an excellent guide to the dexterous
performance of every surgical operation of importance. It
is an accurate, well digested, well written work, evincing
great research, discrimination, deliberation, extensive observa¬
tion, judgment and fidelity. It is a work of great utility,
and cannot fail to be encouraged.

[ 39 ]

VIII.— Principles of Medicine . — By Archibald Bil¬
ling, M. D. Fellow of the Royal College of Pkysicans, Lec¬
turer on the Theory and Practice of Medicine, and on
Clinical Medicine in, and Physician to, the London Hospi¬
tal, &c. &c. London 1831. 8vo. pp. 131. T. and G. Un¬
derwood.

The work of Dr. Billing is a lucid commentary upon the
first principles of medicine, and comprises an interesting ac¬
count of the received doctrines of physiology and pathology.
It seems to us to consist of introductory lectures on the sub¬
jects of which it treats, in which the author evinces a perfect
knowledge of these branches of medical science. It has often
struck us as with surprise, to notice some of our lecturers on
the theory and practice of medicine in this metropolis, con¬
tent themselves with delivering an introductory lecture to the
study of medicine, and then commence the practical part of
their course with inflammation or fever. This perhaps arises
from the super-excellence of the London teachers, who deem
the study of the institutions of medicine a matter of no im¬
portance. This branch of medicine is taught however in all
universities ; and is assigned to a distinct professor, and we
may observe, embraces physiology, pathology, and therapeu¬
tics. Its first division is on life and health, its second, on the
general doctrine of diseases, its third on the prevention and
treatment of diseases. These subjects are scarcely touched on
by any other professor, but the candidate for the surgical dip¬
loma, or licence from the Apothecaries’ company, is to be
ushered into his career without the knowledge of the pulse
and of those other important principles, without which he
can never be a safe or successful practitioner. We speak ad¬
visedly when we declare, that not one in a hundred of those
who qualify in London, for surgery and pharmacy under¬
stand the characters of the pulse, or ever heard a word about
them during the course of their education. The truth is, the
police of the medical profession in this section of the empire
is in a most anomalous and absurd condition ; when a com¬
pany of druggists and a society of mere anatomists and sur¬
geons usurp the rights of the Universities and College of
Physicians, in granting licences to practise medicine, and not
pharmacy or surgery. There are no apothecaries or surgeons
in this country, all pseudo-physicians, men who are not ex¬
amined as physicians, men who confine themselves to the
study of descriptive anatomy, materia medica and surgery ; as

Critial Review.

to pathology , therapeutics, practice of medicine, clinical me¬
dicine or surgery , midwifery and diseases of women and chil¬
dren, chemistry or forensic medicine, they are seldom at¬
tended, forsooth as there is no examination upon such sub«
jects, or only partially attended, to procure the certificates.
As to the college of physicians which ought, and is in duty
bound to take cognizance of medical education and the con¬
servation of the public health, it is too dignified, too im¬
portant, to notice such subordinate matters. The lethargy
which the narrow laws of this body throw over the whole
profession, has extended to the public, and exercises its bane¬
ful influence to the fullest extent, at the present period. If
proof were required of the truth of this position, we need only
refer to the career of Mr. St. John Long, and the myriads of
his tribe who infest the metropolis. . Against complying with
the claims of moral justice, the college alleges a thousand
apologies ; all former arguments how'ever unsuited to the pre¬
sent state of opinion will be renewed, musty, fusty precedents,
the products of three centuries back, produced; but all will
not do, the interested veil of sophistry and monopoly is seen
through, and those that run may read. It would be super¬
fluous to offer serious arguments in proof of the expediency
of reform in the medical profession. The time has arrived
when another hydra, the lawr, will be suited to the wishes of the
public ; and medical abuses and defects will and must be
speedily removed. It is monstrous strange that a society, whose
meetings are attended by Dukes, Marquises, Earls, Arch¬
bishops, Judges, Legislators of both Houses of Parliament,
all members of the Government, cannot procure the pow er of
protecting and regulating the rights and interests of its mem¬
bers, and the interests of science and humanity. If the
members, the elect, of this corporation, be silly enough
to suppose, through their inordinate vanity, that they can
precede and excel the members of rival, and in their opi¬
nion, subordinate institutions, and that the public will sane-'
tion them, they suppose one of the most erroneous and
absurd ideas that can be imagined. They have woven a
web of delusion, which is exposed by daily observation and
common sense, and which they inanely labour to prove cor¬
rect. We shall not prosecute this subject further at present,
but dismiss it by observing, that the silence evinced by
most of our contemporaries, on the absolute necessity of
reform, is really inexcusable.

To return, however, to the work which has given rise

Mr. Swift’s Clinic Reports ,

14th. — Pulmonary affection relieved: bowels confined; to have
opening medicine.

15th. — Complains of being still teased with cough; less weak¬
ness ; neuralgic pains diminished ; feels much better. R. G. am¬
moniac. assafoetide, 3j. a a pulv. ipecacuanhas, gr. x in pill x ij divid ...
sumat, j. ter die.

17th. — Left hospital without permission. Neuralgic affection con¬
tinues, but is a little better.

V. — Enlargement of the Spleen, successfully treated by

Iodine.

James Laurent, aged thirty-eight, admitted on the 4th of August,
with considerable enlargement of the spleen, extensive disease of the
cervical and axillary glands, acute inflammation of both knees, and
severe pains affecting the larger joints, inflammation of the periosteum,
covering the middle part of the spine of the left tibia, a similar swel¬
ling situated on the right tibia, a little above the internal ankle,
cedema of the . lower extremities, general wasting, and adynamia.
About nine years ago, he had some disease of the liver, for which he
took mercury, under the care of a physician, at Mullingar ; three
years ago he was attacked again, with symptoms of enlargement of
the liver, and used calomel and mercurial plasters, by the advice of
Mr. Kirby, with considerable benefit. While under the influence of
the mercury, he had gone abroad constantly. He was soon after
attacked with pains in the knees and larger joints, and sometime
afterwards was admitted as a patient into Sir P. Dunn’s hospital, with
jaundice, and pain in the right hypochondrium. Here he was treated
with leeches to the side, calomel again, to salivation and warm baths,
by which the hepatic affection was relieved. About a year since, he
was treated by a surgeon for the pains in the joints, with calomel,
and mercurial friction to salivation, without any benefit.

At the time of his admission, the spleen was much enlarged, but
not painful ; one of the lymphatic glands below the clavicle on the
left side, and four in the cervical region of the right side suppurating,
knees swollen and painful, particularly the right. He also complained
of considerable tenderness of the ossa nasi. Hab. mist, colchici ^vij,
magnesias usto oj ; sumat 3j ter die. 5j of the ung. hydrarg. fort, to be
rubbed in every night over the region of the spleen.

9th. — Pains in the joints still continue ; right knee hot, tumid and
painful ; complains of great soreness of the nose, and offensive dis¬
charge. Ordered to continue his medicines, to syringe the nostril
with one part of supernitrate of mercury, and four of olive oil ; to be
cupped on the knee.

11th. — Right knee relieved by the cupping ; complains now of the
left, and of severe pains in the ankles; gets no sleep at night. 5iss

VOL. vr. no. 31.

50 Original Communications .

of tinct. opii to be added to his colchicum mixture, haust.
anodyn. h. s.

15th. — No diminution of the spleen ; diarrhoea, with griping ; severe
pains in the knees and ankles ; great prostration of strength. Haust
olei ricini tinct. opii m. x. x — omit ung. hydrarg.

23d. — Pains as before ; diarrhoea still continues. Haust. rhei
C. magnesia — repeat his medicines.

Sept. 2d. — Pain in the left knee increasing ; diarrhoea unchecked ;
a blister to the abdomen, which succeeded in checking the diarrhoea
almost immediately.

1 1th. — Has been placed under Dr. 1VP Dowel's care, who ordered
to have the left knee, which was swelled and very painful, cupped
to 5x, and his colchicum and anodyne repeated.

15th. — A portion of the ossa nasi exfoliated; pains still severe;
glands of the neck still suppurating; spleen undiminished; slight
return of diarrhoea ; diffused inflammation of the integuments and
cellular substance, extending from the inflamed axillary glands to
those above the clavicle. Cucurbit, cruent. genu sinistro.

17th. — Pain in the knee relieved by cupping ; other symptoms as
before ; ordered to have a blister over the inflammatory tumour, near
the clavicle, which is extending in the cellular substance ; lbj of the
decoct, sarsaparilla daily — Extract cicutse, gr. ij. o. n. et m — to omit
his other medicines.

20th. — Diarrhoea checked ; pains in the knees better ; sleeps badly ;
to repeat his medicines as on the seventeenth, and to have an anodyne
at night.

25th. — Feels stronger ; less pain in the joints ; discharge from the
glands lessened ; to continue the decoct, sarsaparilla, and have ten
drops of the tinct. iodinii, three times a day, half a drachm of the
ung, hydriod. potassee, to be rubbed over the enlarged spleen every
night. Haust. anodyn, h. s.

29th. — Improving ; less pain, but considerable stiffness in the knees
and ankles ; a warm bath.

Oct. 7th'— Strength rapidly increasing; cervical glands nearly
cicatrized ; spleen considerably diminished ; continue his medicines
as on the twenty-fifth.

12th. — Continued improvement ; no pains in the joints; stiffness
nearly gone ; moxa to be applied over the inflamed tumour, near the
clavicle.

1 8th. — Going on well ; inflammation arrested by the moxa, tumour
in the splenic region “ much lessened.”

VI. — Vesico-vaginal Fistula, successfully treated by actual

Cautery.

The patient, a young married woman, was delivered of her first
child, about eighteen months ago, after a labour of eight days dura¬
tion. The consequence was, sloughing of the posterior part of the

Mr. Swift on Vesico-vaginal Fistula. 51

urethra and neck of the bladder, (the opening readily admitting the
introduction of two fingers) with incontinence of urine in every posi¬
tion of the body. The ulcerated opening being considered too far
back to admit of the application of a suture, the actual cautery was
applied to it six times, by the aid of a speculum vaginae. From eight
to twelve days were allowed to intervene between each application,
and the pain which followed it, was speedily relieved by the warm
bath. From this treatment she has derived considerable benefit. The
incontinence of urine does not affect her while sitting, standing, or
in the recumbent position, and she can retain it for a few minutes
while walking about.

X. — Syphloid Gonorrhoea, a Papular eruption, Cure. — Peter Gaffney,
aged twenty, was admitted on the seventeenth of September, with
papular eruption, disease of the lymphatic glands of the neck, and an
indolent tumour situated at the upper and inner part of the thigh. He
stated, that he had a gonorrhoea about two years ago. The disease
appeared five or six days after connexion, with discharge of a greenish
yellow colour, and viscid consistence, accompanied by considerable
ardor urinrn. Nearly at the same time, a bubo appeared in each groin,
as was noticed by the gentleman to whom he applied for advice, in a
few days after he first observed these symptoms. The discharge was
removed in a fortnight by purgatives and balsam copaiba, and the
buboes, by the application of a refrigerant lotion. He then returned
again to drinking, from which he had observed a temporary abstinence,
and in two months afterwards, one of the glands of the neck sup¬
purated. Similar inflammatory affections took place last Christmas,
and a papular eruption came out, preceded by Severe pains in the
joints and head, which were relieved as soon as the eruption was fully
established. He had also, about the same time, a sore throat, which
got well in a fortnight, by the use of a gargle. Three months before
admission, he had been under the care of a surgeon, who gave him
twenty-four mercurial pills, which slightly affected his mouth, with
benefit to the eruption, but was obliged to discontinue the medicine,
in consequence of its injurious effect on the cervical glands. The
eruption occupies at present the trunk and upper extremities.
Successive crops of papulae have appeared, which become filled with
a small quantity of viscid purulent fluid ; this concretes, and forms
scabs, which scale off, leaving behind blotches of a dark red colour ;
after the disease has existed for some time, the papula, which, in the
beginning, are distinct, have a tendency to become confluent ; several
of them clustering together on the same inflamed base. He states,
that he never had chancre, nor is there any trace of it discoverable,
by the most careful examination.

He was ordered to take an ounce of the tartar emetic solution three
times a day, an anodyne at night, and a warm bath every second
night. Local applications to the affected glands, under this treatment,
the pains were relieved, and the eruption quickly faded away, and
the state of the lympjiatic glands improved ; he left hospital on the
29th of October. " ' ' * " " . ' • * “ ' • -

Original Communications .

VII. — Case of fatal Peritonitis in the last month of Utero~
gestation. By Samuel Malins, M.D. M.R.C.S.

At 5, p. m. on Wednesday, Nov. 24th, at the request of a messen¬
ger from Dr. Ryan, who had been hastily summoned in another di¬
rection, I visited Mrs. C., who was represented to be in labour, and
otherwise seriously ill. I found on arriving, that Dr. R. had bled
her from the arm, and directed the application of leeches, to be followed
up by warm fomentations to the abdomen, and a dose of castor oil ;
and on further inquiry it appeared, that she had been bled the preced¬
ing day by a general practitioner who had been in attendance, who
had likewise applied leeches to the abdomen, and a blister to the chest,
and from whom she had received some aperient powders. The com¬
mencement of her illness was dated from cold shiverings, with
which she was seized on Saturday morning last, since when she had
complained of pain in the abdomen and feverishness ; at present there
was unceasing pain in the abdomen, and exquisite tenderness over
the whole surface ; pulse very rapid and weak ; respiration hurried,
anxious, and short ; constant thirst ; brown furred tongue, and fre¬
quent vomiting. (No evacuation from the rectum having taken place
since Monday, a common aperient and emollient enema was ordered
to be administered.) The expulsatory pains of labour had commenced
this morning, according to the patient’s report, and had continued at
progressively decreasing intervals ever since. Now they were of fre¬
quent recurrence, though of brief duration, and as she expressed her¬
self, were stopped, and suspended by the greater violence of the
intestinal pain. It is right to mention that she was not at the full
period of gestation, two or three weeks being wanting according to
her computation. On examination per vaginam, the os uteri was
felt dilated to the size of about half a crown, and through it the child’s
head was distinguishable in its natural position at the brim of the pel¬
vis. The expulsatory pain regularly continuing, though checked
each time, and abbreviated by the overpowering intensity of the general
abdominal pain ; I continued with her several hours, and found that
the dilatation of the mouth of the uterus was gradually though slowly
increasing. About eight o’clock these expulsatory pains began to
diminish in frequency, and in the course of an hour had entirely
ceased. Shortly after nine, p. m. Dr. Ryan was able to repeat his
visit, and then it was that a more circumstantial inquiry was made into
the symptoms which had been present previous to our attendance
having been desired. The vomited matter was now for the first time
observed to assume a coffee coloured appearance, the frequency and
feebleness of the pulse were increased, the anxiety and hurry of respira¬
tion (a prominent symptom during the whole progress of the disease,
as far as we could learn) were more conspicuous ; cold and partial
sweats supervened, the extremities began to lose their vital warmth,
hiccup manifested itself, and the countenance began to present a
hippocratic appearance. The bowels had been acted upon through

Dr.Malins on Fatal Per itonit is during Utero- gestation. 53

enema, without any mitigation of the pain. The patient when strictly
interrogated (for she retained the most active use of her senses)
confessed, that at the moment of commencement of her labour pains
in the morning, she had felt “ something crack within her,” and at
the same time experienced a severe shivering fit, an occurrence which
the report of her nurse and attendants confirmed. The idea of rup¬
ture of the uterus having taken place, now suggested itself as a
probability ; though it must be admitted there was little direct evi¬
dence, excepting the sensation of something having given way, the
circumstance of the motions of the foetus not having been felt since
the preceding day, ( the coffee coloured vomiting, and an anomalous
vibratory jerking motion very manifest to the hand placed over the
epigsatrium in support of the opinion, for the abdominal tumour pre¬
served its equable shape and tenseness, the head of the infant had
not perceptibly receded from its position at the superior aperture of
the pelvis, and there was no discharge of blood per vaginam. Still it
was evident that the patient was sinking, and the grand question for
consideration was, whether delivery should or should not be attempted.
On the one hand, it was the moral duty of the attendants to preserve
the life of the infant, if it could be done without risk to the mother ;
while on the other, there was the great probability that the child
was dead ; and that even were it living, the employment of manual
or instrumental means of delivery, would prove a shock which the
decreasing energies, and exhausted condition of her system would be
inadequate to sustain. It was therefore decided not to interfere. At
this time hot turpentine was directed to be applied to the abdomen,
and cordial stimulant drinks to be given in such quantities, and at
such intervals, as the almost incessant vomiting would permit. At
one, a. jn. on Thursday, we visited her again. The application of the
turpentine had thrown the patient into a delirious state, by the im¬
mense irritation that it excited, from which however, she was now
recovered, and had resumed her former composure.

All the indications of the approach of a fatal termination were
become more decided ; the pulse was tremulous and intermitting,
the countenance perfectly hippocratic, the mouth encrusted with dark
and foetid sordes, the tongue loaded with a thick brown fur, singultus
was loud and frequent, the extremities were cold, the surface bedewed
with a clammy sweat, &c. She lingered for several hours in this
condition, till the supervention of low muttering delirium and con¬
vulsions ushered in the presence of death, which did not take
place before 6, p. m.) In this state she remained the greater part
of the day, her mind fully conscious and collected, but towards
evening delirium and convulsions supervened, and put an end to the
scene at 6, p. m. Permission to open the body was obtained on the
following morning ; the inspection was confined to the abdomen, the
parietes of which had already assumed a mottled discoloured ap¬
pearance, denoting the tendency to speedy decomposition, the uterus
was found entire. The peritoneum as well where it lines the
abdominal muscles, or where it is expanded over the uterus and

Original Communications .

reflected, around the large and sinall intestines, presented a dusky
opaque appearance, with a congeries of injected vessels scattered in
various parts of its surface, so that scarcely a square inch of its
extent had a healthy colour or transparency ; these marks of inflamma¬
tion were more intense on the anterior surface of the womb, and the
broad ligaments and ovaries were disorganized and in a state of gan¬
grene, being hard and lacerable with the greatest facility. A vast
quantity of a muddy fluid was effused into the cavity of the abdomen,
in which floated some flakes of coagulable lymph. The parietes of the
uterus had a thickness of three quarters of an inch, and it is remarked
en passant, that their structure bore no kind of resemblance to that
of muscle. The liquor amnii was abundant, of a brown colour,
but transparent ; the foetus, whose head had made some advance
into the parieties of the pelvis cavity, was a fully developed male.
Its cuticle presented a bluish aspect, and was readily separable from
the subjacent surface ; the placenta was large, and of a soft spungy
texture. The decidua, when stripped from the surface of the cavity,
-showed this to be dark- coloured, turgid and highly vascular ; the
cause of death was sufficiently evident — universal serous abdominal
inflammation. The points of interest and doubt in this case are
the occurrence of the sensation of disruption on Wednesday morning,
the almost sudden cessation of the expulsatory pains on the same
evening, and the peculiar oscillatory motion of the epigastriunn
It may be conjectured fairly enough, that the fancied and apparent
cracking or giving way,” depended on the last convulsive struggle
of the foetus, but for the cessation of labour pains, and the sudden
occasional movement of retraction felt in epigastrio, I am unable
to assign any efficient reason, or to discern any determining cause.

With respect to the exciting cause of this most unusual and exten¬
sive inflammation, it did not appear, from the account we could
obtain from the friends, that she had received any external injury, or
been subjected to the action of any individual unnatural force. But
her occupation as washer-woman and laundress, continually de¬
manded much mascular exertion, and frequent long- continued con¬
strained positions of the body ; after which she was accustomed to
complain of irregular shooting pains in the abdominal region.
Moreover, she had suffered about the third month of gestation from
what was described as an attack of peritonitis, since which the
abdominal uneasiness and soreness had been calm, when not induced
by her forced and unnatural exertion, pretty constant. The age of
this woman, it should have been noticed, was 33, and she had three
children living. Her habit of body was delicate and weak ; and
the digestive functions so decayed, that every solid meal taken
throughout her gestation was rejected, in a greater or less period of
time after its reception into the stomach, by the action of vomiting ;
this was totally independent of the sympathetic effects of pregnancy
in the stomach, which were present in a distinct but slight form,
during the • first two or three months. Are we to suppose in this
«ase, that -th£ -inflammatory process was proceeding during the whole

Dr.Malins on Fatal Peritonitis duringUtero-gestation. 55

interval between the first attack of peritonitis at the third month,
and the sudden accession of the fatal attack on the Saturday pre¬
ceding her death, that it was originally set up at the first mentioned
period, and was afterwards maintained by the series of rude disturb¬
ing motions, and the irregular violent pressure to which the uterus
was obnoxious during the period of its progressive enlargement.

What other supposition will explain so readily the occasional pains
and constant uneasiness, under which she indisputably laboured
throughout ? Is there any thing in the nature of inflammation, any well
ascertained and certainly defined phenomena belonging to its march
and consequences, which forbid our entertaining the belief that it was
present during this period, of from five to six months, working its latent
and insiduous course, and accumulating its force and intensity for'
the terrible display which it at last so suddenly manifested itself ?

Admitting the possibility of a latent or sub-acute inflammatory
state of such duration, how was it that it did not display itself till
the period we knew that it did ? Or rather why did it display itself
then in preference to any other period ? for the knowledge of neither
the patient herself, nor of her friends could supply us with any
unusual circumstance to be adopted for, or tortured into an exciting
cause.

Rejecting the possibility of inflammation existing so long without'
evidences of its presence, by more than transitory abdominal
pains, how, it may be asked, can they be better or differently ex¬
plained ? We had inflammation at the third month, pains and tender¬
ness are never absent up to the ninth month, we had then (without
any evident or unusual exciting cause) other inflammation proving
fatal in a short time. Here certainly was an inseparable claim, a
linked continuity of morbid action.

38, Kirby Street, Hatton Garden.

December, 1830.

Note by the Editor. — Dr. Ryan was of opinion, on seeing this
patient, that her disease was peritonitis, which he stated in the
presence of the midwife, and several other persons, before his friend
arrived.

There was intense pain on the slightest pressure, on every part of
the abdominal parietes, and also increased heat of surface* The
patient was bled from a large orifice to syncope, and the blood was
neither cupped nor buffed ; on the preceding day it possessed both
characters, when it was abstracted by a gentleman whom the husband
had dismissed, though nothing could have been more judicious than
his practice. He had blistered the chest, as there was a hard cough,
and difficult respiration.

Rupture of the uterus wras suspected, for the reasons already stated ;
and more especially, as every scientific obestetrician is aware that it'
might happen in any of the last months of pregnancy, from mental
emotion, (Percival, Underwood) from external injury, or preternatural
labour, and without any evident cause. The usual appearance of

Original Communications .

the abdomen, and the natural presentation at the brim of the pelvis,
in this case, disproved the possibility of its occurrence.

The grand question was, ought delivery to be effected or not? To
determine this important question, it was necessary to consider every
symptom of the case.

It will be recollected, that the peritonitis had preceded the sup¬
posed laceration, and must have been aggravated by the occurrence,
had it actually taken place. The motion of the infant had ceased
for some hours ; and under existing circumstances, there was the
greatest probability that it was dead. As the uterine action had
ceased, delivery could have been effected only by one or two opera¬
tions, both of which were unjustifiable, by forcible dilatation of the
os uteri (in peritonitis) or by gastrotomy. The first operation is
unsanctioned in all cases, until the womb is somewhat dilated ; an
axiom held by obstetric writers, in all countries ; and still more ob¬
jectionable for the extraction of a dead infant. Again, was not gas¬
trotomy as objectionable, when the vital power was so prostrate,
where abdominal inflammation existed, and where the patient might
have died under the knife, though there was no positive evidence of
uterine rupture, or of the life of the infant ? But suppose the infant
was extracted, living or dead, setting aside the risk of the mother,
of what benefit in her disease could delivery have been ?

Besides, it was reasonable and just to suppose, that the peritoneal
coat of the uterus, and perhaps the organ itself were implicated in the
disease ? — a supposition confirmed by the necrotomic appearances —
had delivery been effected by turning, which in the humble but firm
opinion of the writer, was unwarrantable in such a case, the patient’s
disease could not have been benefitted in the slightest degree. First,
the os uteri must be forcibly dilated, an unwarrantable proceeding in
all cases ; 2d. the infant was to be extracted ; 3d. the placenta, a fatal
proceeding, unless the uterus contracted, to stay haemorrhage ;
4thly, the decidua should inevitably be left behind, as there was
no uterine action to effect its separation — a most undesirable circum¬
stance, in such a case as an additional source of irritation. Those
acquainted with obstetric practice, will unanimously agree with this
statement ; such being the views of Dr. Ryan, and of his talented
and erudite friend. Dr. Malins, no operation was attempted ; and
though few practitioners could have been more anxious for the pre¬
servation of parent and offspring, or either the unfavourable results
afford a melancholy consolation in the positive proof of the validity of
their opinions and practice.

The dissection proves that human endeavours were all useless.

It is right to explain, when the warm turpentine was applied ; it
was for this reason, that it is highly valuable as a rubifacient — in
cases so urgent as not to allow time for the effect of epispastics. It
may be said, that the stethescope ought to have been applied to dis¬
cover whether or not the infant was living ; it was suggested by
Dr. Malins : but the symptoms left little doubt of the death of the
infant ; a conclusion also fully justified by the evidence afforded by

Dr. Bill mg' on First Principles of Medicine 41

to these observations, it affords us much pleasure to state,
that Dr. Billing lias rendered the student of medicine an
essential service, by this interesting and instructive volume.
We strongly recommend, not only the perusal, but the
study of it, to the student and young practitioner, and even
to the ablest and most experienced, who will gain both
information and knowledge from reading it. As a Compen¬
dium of the First Principles or Institutions of Medicine, it
is well worthy of the attention of the profession. Should
another edition of the work appear, of which wre enter¬
tain no doubt, we would suggest to the author the propriety
of giving a table of contents, and dividing the pages into
paragraphs, as at present their is no break or resting place
from one cover to the other.

ORIGINAL COMMUNICATIONS.

I. — Case of Fractures of the Cranium, removal of depressed
hones — recovery. — By Richard Tuthill, M.D. Assistant
Surgeon to the 52d Regiment, Halifax, Nova Scotia.

Daniel Callaghan, set 23, a labourer, of a stout muscular
habit, and sanguineous temperament, on the 9th of Septem¬
ber last, received a severe injury on the left side of the head,
from a stone weighing 121bs. which was driven into the air by
gunpowder, and fell from a considerable height. He was
knocked down by the force of the blow, and was rendered
senseless, in which state he lay for some time. Two distinct
fractures were produced, one of the centre of the parietal
bone close to the sagital suture, the other occupied a portion
of thp anterior part of the parietal, and the adjoining part of
the frontal bone; the former wras attended with considerable
laceration of the $galp, that exposed the depressed portion of
bone, which was partially buried under the inferior part of the
parietal bone in such a manner, that it could not be removed
without applying the trephine; the latter fracture was unac¬
companied with any laceration of the integument. Two
portions of depressed bone were removed at about the dis-

VOL. VI. NO. 31.

Original Communications.

tance of half an inch from one another, and immediately af¬
terwards he was restored to his senses, and did not suffer the
least deficiency of them afterwards. The hemiplegia of the op¬
posite side became evident after the sensibility was restored,
and gradually subsided in the course of ten days; the upper
extremity first recovered its functions, and then the lower
one. Two bleedings, of 32 ounces each, were performed be¬
fore and a few hours after the operation. As no symptoms
afterwards presented themselves, which required a repetition
of the bleeding, the medical treatment consisted of purga¬
tives, diaphoretics and a low diet. The pulsation of the
brain was very evident in this case. The wound healed by
the first intention, the pulsation gradually decreased, he was
perfectly restored to health and to his work, 21 days after
the accident had happened.

II. — Fracture of the Cranium, fungus cerebri.

Jacob Faden, set 22, a native of Halifax, Nova Scotia, of a
pretty stout muscular form and sanguineous temperament,
on the evening of the 22nd July, received a blow upon
the superior part of the left parietal bone, which produced
laceration of the scalp, and such fracture and depression of
the bone and laceration of the dura mater, as to occasion a
small protrusion of brain. Stupor or coma came on imme¬
diately after the accident had happened, and continued until
24 hours after the operation was performed ; it then ceased,
and did not return until a short time before his death. The
operation was had recourse to as soon as possible after the
wound was inflicted. When the circular portion of bone w as
taken away, one or two small depressed portions were ele¬
vated, and several small pieces that were driven into the sub¬
stance of the brain wrere removed, the lacerated portions of
the scalp were brought together by suture and adhesive
plaster, and the patient was left quiet in bed. But soon after
active cerebral inflammation came on, and was in a short
time attended with such violent delirium, as to require the
use of a straight jacket ; he was immediately bled to 24 ounces,
the day after to 16, the third day to 12, and the fourth day to 12.
Active purgatives were administered, followed up by diaphore¬
tics and opiates, and by these means the inflammatory action wras
subdued, and his natural senses were restored. A short time
after the operation had been performed, the brain put on a

Dr. Tuthill on Fracture of the Cranium . 43

morbid action,, and portions protruded, varying1 in size, which
were removed by the scalpel and ligature ; between four to
six ounces of the brain from first to last were removed, and
notwithstanding so large a portion of so vital an organ hav¬
ing been cut away, it is singular to observe, that his senses
and faculties were perfect to within a few hours of his death.
He was doing so well as to sit up and walk about the last
three weeks of his illness, without experiencing any inconve¬
nience ; his appetite improved, bowels were regular, and the
strongest hopes were entertained of his recovery. But that
unfavourable symptom, the profusion of brain, increased and
was removed every day for a week, besides at other periods,
without occasioning the least pain or any other bad symptom ;
pressure was made by pledgets of lint, wetted in lime water,
with a view of keeping down the morbid growth ; this gave
rise to hemiplegia of the opposite side without the least im¬
pairment of the intellectual faculties, which continued three
weeks, the period that the pressure was employed ; the mo¬
ment the pledgets were taken off, the functions of the oppo¬
site side wrere perfectly restored. On the 14th September,
rigors took place, and became constant until the day of his
death. On the 16th, the largest portion of brain, the size of
a large hen’s egg, protruded, muttering delirium began in the
evening, the day after the eyes were turned outwards and a
little upwards, the pupils were irregularly dilated, he became
insensible, incapable of even muttering or of making any ex¬
ertion, and on the 19th September, 56 days after the accident
had happened, he died without making any struggle. The
day after the upper part of the cranium was removed, the
dura mater was found firmly attached to the circumference
of the circular opening made by the trephine, and so united
to the pericranium by vessels passing from one membrane
to the other, that the edge of this opening presented a smooth
hardened edge, of a cartilaginous nature, but of a preterna¬
tural red colour. The brain about the wound was in a per¬
fectly decomposed state, mixed with a portion of purulent
matter. A. lage abscess, filled with matter, was found in the
left middle lobe under the wound, which communicated
with the ventricles and filled them with matter. The up¬
per surface of the tentorium, on the left side, was co¬
vered by a layer of purulent matter, which was found at
the base of the cerebellum. No other morbid appearances
Here discovered.

Original Communications.

III. — Case of C cesarean operation. — By John Stirling., Esq-

Halifax, Nova Scotia, communicated by Dr. Tuthill.

Sarah Munn, aged 42 years, of the height of four feet only*
although the head, neck, and trunk, as low down as the os ilium,
are of the size of those of a person of ordinary stature ; the
lower part of the pelvis, upper and lower extremities, being
so diminutive as to appear like those of a child of six or seven
years, was married in the year 1822 ; in the month of July,
1823, she was taken in labour, and my assistance was re¬
quested. — On examination I found the pelvis distorted, and
very much contracted ; the upper part of the sacrum pro¬
jected forward, so far as to overlap the symphysis pubis, the
labour pains at this time were slight, and 1 could not find the
os uteri. Under these circumstances I requested a consulta¬
tion, at which Messrs. Head, Hume, and Keegan, medical
practitioners in this place, attended, and after due examina¬
tion, it was agreed that as the shortest diameter of the pel¬
vis seemed about two inches, an attempt to extract the foetus
by embryulcia might succeed. The labour pains increased,
the os uteri was gradually dilated, the membranes gave way,
and the breech presented ; with great difficulty the feet were
brought down, and at last the body was brought through ;
but now finding it impossible to get the head into the pelvis,
and also impracticable to pass the fingers through the vagina
along the body, I was obliged to dislocate the upper cervical
vertebrss and elongate the neck, so as to make room for my
hand. I now introduced the perforator, and made two or
three perforations into the skull, and after incessant efforts
for six or seven hours, the head was at last extracted piece
meal. In the progress of this effort, it w7as necessary to loose
and remove separately each bone of the cranium, by means of
the fingers in utero, and 1 was even obliged to separate
the lower jaw and the spheniod bone from the bones of the
face, before these last could be removed. The consequences
of such violent and long continued efforts were severe inflam¬
matory fever, with sloughing of the soft parts in the pelvis,
in which the bladder participated, and an opening about an inch
in diameter remained, through which the urine continued af¬
terwards to pass into the vagina. She finally recovered, and
again becoming pregnant, miscarried in the second month, in
the year 1826.

In the month of Mav, 1828, she informed me that she was
again pregnant, and I endeavoured to persuade her to permit

Mr. Stirling on Ccesarean Operation. 45

me to use mechanical means to produce abortion,, which she
declined.

About three months afterwards, she had an attack of pneu¬
monia, which yielded to the usual mode of treatment, since
which time she has enjoyed pretty good health, with the excep¬
tion of some febrile attacks occasioned by the pain and irritation
produced by the urine passing into the vagina. On Satur¬
day evening, the 20th December, 1828, labour pains came on,
at first slight, but they gradually increased. On Sunday after¬
noon, in consultation with Mr. Grigor, surgeon, found, on exa¬
mination that the os uteri was loose and soft, high up above the
brim of the pelvis, and about one and half inches in diame¬
ter, the belly wTas pendulous, being projected wholly before
the os pubis, pulse 90. On Monday, at two, p. m. the os
uteri was nearly dilated, the membranes gave way, and the head
was felt to present high above the brim of the pelvis ; after
the rupture of the membranes, the pains diminished, and she
became restless and thirsty, pulse about 104. The soft parts
within the pelvis were highly irritable, and felt hot, and very
much thickened, every attempt at examination, even by a
single finger, occasioning excessive pain. — Under these cir¬
cumstances a full consultation of medical practitioners was
called at seven o’clock, p. m. when it was the general opi¬
nion, that an attempt to extract the child by embryulcia
would, from the thickened and irritable state of the soft parts,
probably be fruitless, and if successful, must end in the de¬
struction of the mother, and as the patient herself expressed
a resolution to submit to any risk rather than undergo the
sufferings she formerly experienced, it was revolved (after
explaining to her the great danger of the operation) to ex¬
tract the child by the Caesarian section.

At nine o’clock the same evening, the pains having nearly
ceased, the operation was performed ; the bowels had been
opened in the morning by a dose of castor oil, and at four,
p. m. an enema was thrown up, which emptied the large intes¬
tines. The room was heated to about 90°, the patient placed on
her back near the foot of the bed, and a broad swathe fixed
loosely under her. Theoperation w;as commenced by an inci¬
sion, beginninga little below and to the left of the umbilicus,
and extending in a line with the linea alba, about seven
inches towards the pubis, this laid bare the tendinous sheath
of the rectus ; a second incision exposed the peritoneum,
which was also divided and the uterus appeared closely em¬
bracing the child. A small opening was now made into the
uterus at the pubic end of the incision, and two fingers being
introduced, the uterus was laid open by a blunt pointed bis-

Original Communications .

toury, the membranes ruptured, and a living female child
with placenta removed without difficulty. Previous to the
removal of the placenta, not more than half an ounce of
blood was lost, and not more than six ounces in the whole.
The uterus contracted strongly, and the wound in its sub¬
stance was now only about two inches in length. The small
quantity of blood in the abdomen was removed by a soft
sponge, a fold of the ilium, which protruded was carefully
replaced, and the wound closed by five interrupted sutures
through the skin and muscles, with long slips of adhesive
plaster and a compress of lint, and the whole supported by
the swathe pinned moderately firm around her.

She did not appear exhausted by the operation ; her pulse
half an hour afterwards was 96, the child was strong and
healthy, and still survives.

On being placed in bed, an anodyne draught was adminis¬
tered, and she remained quiet for half an hour, when she was
seized with nausea, and vomited a part of the draught ; ano¬
ther was given, which she also rejected, after which she fell
asleep, and remained in that state, with two or three short in¬
intervals, during the night. After the vomiting, her pulse was
suddenly increased in frequency to 120, and during the night
there was a discharge of a bloody appearance, from the lower
part of the wound ; the discharge from the vagina in the or¬
dinary quantity.

Dec. 23. — 10, a. m. Abdomen soft, not tender on pressure,
pulse 130, rather sharp, slight thirst, bled her to 10 oz.
which produced some faintness, at 12, gave her a purgative
enema. At 5, p. m. the enema not having produced any ef¬
fect, gave her 1 oz. of ol ricini, which unfortunately again in¬
duced vomiting and it was rejected. At 10, p. m. slight
nausea, pulse 136, gave another enema, which produced one
scanty evacuation.

Dec. 24 — 10, a. m. Has passed a restless night, and
vomited frequently, there is some tumefaction of the ab¬
domen, no increase of pain, pulse 140, tongue clean andmoist,
has some thirst, no evacuation from the bowels ; during the
night there has been a considerable discharge of bloody
sanies from the lower part of the wround, chiefly during the
vomiting : ordered her calomel gr. iv. opii gr. i. to be repeated
in four hours, with an enema — At 5, p. m. had slept about an
hour, pulse 140,no evacuation frombowels, thirsty, belly tumid,
discharge from the vagina has ceased, repeated the calomel
and opium, with the enemata, the Vagina to be frequently
washed with warm water by means of a syringe ; at 8, p. m.
has not vomited since noon, pulse 140, thirsty, feels inclined

Mr. Stirling on Ccesarean Ojjeration,

to sleep, removed the swathe and compress, and applied
fresh straps, found the integuments close and adherent, except
a small space at the lower part, where there was a small co-
agulum lying, which was removed. Belly tumid, without
pain ; the uterus feels large, hard and painful on pressure ;
repeated the calomel and opium, and ordered a purging enema
to be repeated several times during the night, should no
purging effect be produced.

Dec. 25 — 8, a. m. Was restless and vomited several times
during the night, abdomen tumid, but soft and without pain,
uterus can be felt hard and swelled through the integuments.
Enemata produced two or three faecal evacuations, no lochial
discharge, pulse 150, small and weak. She gradually sunk,
and expired at three o’clock, p. m. being about 66 hours after
the operation.

Examined the body next day. On removing the stitches
and opening the wound, found three or four small coagula
adhering firmly to various parts of the ilium, at which spots
there were slight marks of inflammation. The peritoneum
had also two very small specks slightly inflamed ; the uterus
was large and hard, and from the wound in it, which was
open, there oozed a dark thin sanies, its colour, particularly
for some distance round the wound, was darker than natural,
the bladder was small, but healthy, in it was a small circular
opening about an inch and half from the sphincter, through
which the urine had passed into the vagina.

Dimensions of the Pelvis.

Soft Parts
removed.

In.

Short diameter from projection of

sacrum to the symph. pubis . 2. 1-1 2th

Long diameter of ditto .... 3^

Projection of sacrum to the point of

the os coccyx ...... 2^

From ischium to ischium . . . . 4|

From arch of the pubis to the re¬
motest part of the sacrum in the hol¬
low . * . . 2§

From superior spinous process of the ilium
to the other ....... 8^-

Whole height of the body . . . 4ft. ^inch.

6th Oct. 1830, >

Halifax. J

Soft Parts
not removed.

In.

3 6-8ths.

1 7

Original Communications.

IV. — Clinic Reports — Richmond Hospital , Dublin. — By
John Swift,, Esq. — M.R. C.S. — Cubito- digital Neuralgia

— Excision of the ulnar nerve . — (continued.)

John Kearney, aged 70, of active habits, and enjoying good health,
was admitted on the fourth of September, with neuralgic symptoms,
principally affecting the ulnar nerve. He stated, that the pain com¬
menced in a circumscribed spot, on the palm situated immediately
above the metacarpo-phalangeal articulations of the little and ring
fingers, and runs along the ulnar nerve as high as the brachial plexus.
Sometimes, but much less frequently, the pain runs in the course of
superficial nervous arch of the palm, towards that branch of the
median nerve, which supplies the outer side of the thumb, and then
proceeds up the fore arm ; pain periodical, and brought on by trifling
causes ; soreness felt on pressing the spines of the second and third
cervical vertebrae, and over the roots of the brachial plexus. The
principal uneasiness referred to the limited spot on the palm before
mentioned.

These symptoms first appeared about seventeen years ago, after
amputation of the fore finger of the affected hand. Moxa had been
frequently applied to the palm without effect.

Sept. 6th. — Dr. M‘Dowel excised about an inch of the ulnar nerve,
an incision two inches in length, was made through the integuments
in the lower third of the fore arm, over the nerve, not parallel to its
direction, but commencing above, close to its radial side, and termi¬
nating below, at the same distance from its ulnar, the aponeurotis
was then divided; the flexor carpi ulnaris drawn inwards with a bent
probe, and the nerve seen lying at the inner side of the artery, was
raised with a tenaculum, and divided. The operator then, to satisfy
himself, pricked the little finger on both sides, and the ulnar side of
the ring finger, without being felt by the patient, but on touching
the radial side of the latter, he complained of pain. The operation
did not occupy two minutes, and there was no difficulty experienced
in finding the nerve.

7th. — Has had no remission of pain since the operation ; it shoots
from the affected spot on the palm, and from the thumb, in the course
of the median nerve. Ordered, opii gr. iss. 8 vis. horis.

8th. — Pain continues undiminished ; a blister to be applied over
the cervical vertebrae, which are tender on pressure. Habt. ext.
cicutse, gr. ij. opii granum in pil, 6 tis. horis.

9th. — Slept better last night, and feels less pain.

11th. — Attacked on the preceding night with severe paroxysms of
coughing, attended with difficult expectoration, perspiration, and
tendency to syncope. Emplast. vesicat. thoraci. R. mist camph.
^vi, spirit, aether, oleosi yi. sumt. §j ter die.

12th. — Passed the night badly ; cough and weakness, as on the
last night ; the blister had fallen off his chest. Hab. empl. vesciat
inter scapulas — enema terebinth — fovr. pedes.

Dr. Malms on Fatal Peritonitis during Utero- gestation. 57

the dissection. It is important to state, that besides the morbid
appearances already detailed, the peritoneal covering of the small
intestines was inflamed, and all that portion of the uterus which was
in contact with the brim of the pelvis, The substance of the
organ was much redder than natural, and in many parts were
of a dark brown colour, through which the finger passed with great
facility. Both ovaries were much enlarged, brown, and softened,
and readily lacerable. On making several incisions in the uterus, there
was no evidence of phlebitis. The propriety and safety of incising
the abdomen in peritonitis, are as yet undetermined.

The reasoning of Dr. Malins against the possibility of chronic peri¬
tonitis for so long a period as already mentioned, is exceedingly power¬
ful, and apparently conclusive. But according to the French patho¬
logy, it may be questioned. Our Gallic contemporaries maintain that
“ sometimes the pain and alarming symptoms (of peritonitis) may
cease on the third day, the disease continues and becomes chronic, or
the disease may establish itself to continue indefinitely.” (Diet.
Abrege Des. Sc. Med. 1825, T. X — p. 465.)

“ The more the subject is lymphatic, feeble, the more chronic
peritonitis is obscure, less intense, especially at first, **** but it
almost always ends by dropsy, after having continued one or many
years;” Op. Cit. 468. It may become acute, and affect the brain,
pleura, pericardium, stomach, intestinal canal, &c. and is most
common to women, in whom it is especially observed after parturi¬
tion. Op. cit. It generally follows acute peritonitis, audits symptoms
are as follow: — The abdomen is sensible on pressure, but not pained ;
it is most so at night, or at irregular intervals, and without apparent
cause. The patient complains of flying pains in the abdomen, on any
slight exertion, on laughing, coughing, or riding in a carriage ; the
digestion is capricious, or there is nausea, thirst, constipation or
diarrhoea ; there is often cough, dyspnoea, especially on assuming
the recumbent position. Op. Cit. 466. M. Andral has published
cases, in which he thinks peritonitis has continued for forty days ;
and these opinions induced Dr. Ryan to reply in the affirmative to
a question put to him on a late occasion, at one of the Medical
Societies — could peritonitis continue for a few days or weeks ? The
great similarity between the symptoms of chronic peritonitis and
these detailed in the case before us, is exceedingly remarkable ; and
the great exertion made by the patient in the pregnant state, would
favour this pathology. The reader will form his own opinion on the
practice in the above case, and the critic will display his prowess ;
to both the words of the poet are applicable ;

“ si quid novisti rectius istis

candidus imperti, si non, his utere mecum,”

VOL. IV. no. 31.

[ 58 ]

VIII. — Hydatid of Liver and Gall Bladder.

London Hospital. — Enlargement of the liver extending
into the pelvis , hydatids, fistulous opening from the
(rail bladder into the bronchia.

Sarah Manning, set 35, widow, had never borne children, was
lately admitted into the London Hospital under the care of Dr.
Billing ; had complained for three years of dry cough and pains in
the right hypochondrium, without much disturbance of general health,
until within two months, when the cough increased with pain ex¬
tending up into the chest ; at that time a tumour pointed and broke,
half-way between the umbilicus and cartilages of the ribs in the
right hypochondrium, and there is still a fistulous opening, from
which a yellowish serous fluid escapes ; she is jaundiced, and ex¬
pectorates a large quantity of a frothy, thin, purulent looking matter ;
she is perpetually harassed by cough producing retching, and con¬
stant rejection of her food ; there is mucous rale, and bronchial
respiration in the inferior part of the right side ; she feels less oppres¬
sion of the chest, when the opening in the side discharges freely ;
pulse moderate, tongue clean, skin soft, much emaciation ; there is
a solid tumour in the situation of the liver extending down towards
the pelvis.

The treatment consisted chiefly of mild tonics, and nourishment
to support strength.

In a few days two or three membranous shreds (hydatids) the size
of large grape skins, were discharged from the opening in the side,
and she now mentioned that she had expectorated the same kind of
substances. She gradually sunk from emaciation and exhaustion,
without any urgent symptom.

Sectio cadaveris. — Upon opening the abdomen the liver occupied
all the cavity down to the pelvis, into which it had thrust the intes¬
tines, (this appearance was increased in consequence of the waist of
the woman having been unnaturally compressed by the tightness of
her dress;) it was not much increased in bulk, but elongated; the
lower part of it presented a hard tumour, very elastic, the size of a
man’s fist, containing one hydatid about three inches in diameter,
which had no young ones within it, but several granulations attached
to the inner surface. The gall bladder formed another tumour stuffed
with skins of dead hydatids, such as had been discharged through
the opening in the abdomen, and a director was then passed upwards
from the gall bladder in a fistulous channel, through the diaphragm,
and through the lung into one of the larger bronchial tubes, which
was wider than natural, thus forming a passage from the gall bladder
to the trachea wide enough to admit the point of the little finger; the
<?all duct into the duodenum was not obstructed. The other
viscera were healthy.

Dec. 18th, 1830.

-•"I

[ 59 ]

IX. — Medico-legal questions , relating to Infanticide.

By M. Ryan, M.D.

Death of the foetus from voluntary causes.— The new¬
born infant may be the victim of external violence wilfully
inflicted upon it, and it may also perish bjr the voluntary
omission of that succour which is necessary to it in the first
moments of its existence ; hence we distinguish infanticide
by commission , and infanticide by omission.

Infanticide by omission may occur from exposure of the
new-born infant to a temperature too cold or too warm, if
it be deprived of nourishment or respirable air, and from
umbilical haemorrhage, caused by disruption of the cord.
It is difficult to determine what thermometrical degree of
heat or cold would destroy life in these cases, but if we
find the body of an infant naked, or nearly so, stretched
on the ground, discoloured, the great internal vessels con¬
gested, and the external or superficial contracted, and
almost empty, and with evidence that respiration has taken
place, and at the same time there exists no trace of ex¬
ternal injury, there is every probability that death has been
caused by cold.

The defect of nutriment is generally combined with aban¬
donment of the infant ; and to this cause we should attri¬
bute death, when atmospheric temperature is not sufficiently
cold to be destructive, and when we find the alimentary
canal dry and contracted.

The neglect of tying the umbilical cord will expose the
infant to fatal haemorrhage ; but this is not always the case,
and does not afford sufficient evidence of mortal haemor¬
rhage, as the large vessels should be empty, there should
be paleness of the body, viscera and muscles, to prove that
death has been caused by loss of blood from the cord.
Again, death may take place from this cause, where it was
impossible for the mother to afford the necessary aid to the
new-born infant.

Thus in cases of placental presentation, the infant may
be destroyed by haemorrhage, but there will be manifest
signs in the woman under such circumstances ; she may be
in a state of syncope from this occurrence, and be unable
to save the infant from perishing. The foetus is often
destroyed from separation of the placenta during pro¬
tracted labours ; in both of these cases the placenta will
be attached to the umbilical cord. It has been said that
the mother, during convulsions, may possibly rupture the

Original Communications .

cord, or that this may happen from the motion of the
infant, or when the woman is delivered in the erect position,
tiie foetus having fallen on the floor. In the last case,
disruption may happen, but it appears very doubtful in
either of the former.

It will be recollected that M. Klein has recorded one
hundred and eighty-three cases of sudden labours, in many
of which the cord was ruptured near the abdomen, and in
twenty -one cases within the abdomen, yet there was no
fatal umbilical haemorrhage.

It is also to be remembered that the infant’s head, in its
passage through the external genitals, is so situated, that its
face may be in contact with the liquor amnii or blood, and
in this way may be deprived of air, or asphyxiated by
impure air ; or the head may be expelled, respiration esta¬
blished, the labour cease, and strangulation be effected
before delivery. This case is by no means unfrequent,
every practical obstetrician has met with it, and should it
happen in the first labour, it is evident, that from the igno¬
rance, pain, or syncope of the woman, the infant may be
destroyed. It therefore appears evident that we must duly
consider all these circumstances before we can safely con¬
clude there was criminal intention on the part of the
mother.

Infanticide by commission , is indicated by contusions,
wounds, luxations of the cervical vertebrae, fractures of the
extremities, torrefaction or burning, and asphyxia.

Contusions and wounds. — The ordinary effect of contu¬
sions is ecchymosis, which will be more extensive, accord¬
ing to the situation in which it may be placed ; but great
care must be taken not to confound this appearance with
the cadaverous lividity. We should also be cautious to
distinguish ecchymoses of the scalp, produced by parturi¬
tion, from those that result from violence. The former are
generally superficial, and situated most commonly upon the
vertex, occiput or parietal bones ; while those produced by
violence are deep and brown, and in various situations,
often on the temples. When caused by labour, the infant
cannot have respired, and this will be discerned in the
manner formerly mentioned. If considerable ecchymoses,
contusions, or tumours exist upon an infant that has respired,
there is just ground for the suspicion of criminal violence.

In some cases ecchymosis of the neck may be ascribed to
pressure of the orifice of the womb, or of the vulva, or by twin¬
ing of the umbilical cord round the neck, and present the ap¬
pearance of strangulation ; under such circumstances, the

Dr. Ryan on Prolicide , Foeticide , Infanticide. 61

respiration may be impeded or prevented, the infant de¬
stroyed, the lungs evince the signs of respiration, and the
case will be involved in great obscurity and difficulty.
Other facts must exist to warrant a correct conclusion.

Luxations of the cervical vertehrce. — When death is
produced by luxation of the cervical vertebrae, the ligaments
of the vertebrae will be torn, the spinal marrow will be
bruised or torn ; ecchymosis, and sanguineous infiltrations,
will indicate that the injury has been inflicted during life,
as these phenomena cannot exist after death. It is to be
recollected, however, that such luxation may be the effect
of injudicious attempts to extract the infant during labour ;
and it is therefore necessary to ascertain if the parturition
has been difficult, and whether any traction has been applied
to the infant.

Fractures of the bones or wounds often depend upon
parturition, or upon the violence offered by ignorant and
bad practitioners ; it is therefore necessary to keep these
facts in mind, in determining questions of infanticide from
such injuries. • • ,

Torre faction, or burning, is a horrible method resorted
to for the destruction of infants, a case which I grieve to
indite, has occurred in this city within a few days. Here
it will be necessary to examine all injured parts, and to
apply the ordinary proofs, to ascertain if respiration had
existed. In the case to which I have alluded, the coroner
(an attorney) was of opinion that a verdict of manslaughter
could not be received. The prisoner, a nursery maid, was
acquitted !

Asphyxia. — A new bom infant may be asphyxiated by
privation of respirable air, by mechanical obliteration of the
air passages, by strangulation, by submersion, or by the
action of the deleterious gas. The infant will be deprived
of air by being placed in a chest, or under the pallet, &c.
but as some minutes must elapse between its birth and
death, the usual tests will decide that it has respired.
Infants have been destioyed, whose nostrils and mouth
were filled with linen, hay, earth, &c. to the prevention of
respiration ; the presence of these substances will enable
us to form a proper opinion. Infants have also been de¬
stroyed by pressure upon the mouth and nostrils, trachea
and thorax, and by forcing the tongue into the fauces ; in
all of which cases a few inspirations take place, and the
pulmonary proof will be decisive.

In all these cases the rupture of the frcenum linguee, the

Original Communications .

ecchymoses of the neck, the marks of injuries upon the
chest, and in the interior of the mouth, with the signs of
cerebral congestion, afford very strong evidence against the
accused.

The introduction of. fluids into the trachea or lungs, is
another cause of suffocation ; the discovery of the nature
of the fluid by chemical analysis, enables us to arrive at
a positive decision against the accused. Submersion or
drowning is a frequent mode of infanticide. The pulmonary
evidence of respiration, and the similarity of the fluid found
to that which surrounds the dead body, enable us to de¬
cide that death was caused by submersion. In such cases
there is usually^ more or less fluid in the stomach. When
death is produced by strangulation, there will be ecchy¬
moses on the neck and face, with cerebral congestion. The
most frequent mode of infanticide, is the precipitation of
the infant into the water closet or privy, which may be the
effect of accident ; but the pulmonary docimacy will de¬
cide if the infant has respired. In the cases recorded by
Klein, the majority of the women were primiparous. I
have known a woman of low stature delivered of her first
child by a single pain, and I have recorded similar instances
in my work on obstetrics.

In all cases of infanticide, we must be certain that the
woman has been recently^ delivered, and that this event
coincides with the age of the infant. The signs of recent
delivery have been already enumerated. It is right to men¬
tion that infanticide has been effected by the introduction
of needles into the brain (Gui-Patin, Brendel, Belloc), and
into the temples, internal canthus of the eye (Brendel),
the neck, region of the heart (Fodere), and the abdomen.
Infants have been destroyed by poisons, which have been
applied by inhalation into the lungs, by commixture with
food, absorption through the skin, and by enema. Those
are to be discovered by the usual tests, which will be men¬
tioned hereafter.

Before concluding this subject, it is necessary to prove
the validity of the statement, that the hydrostatic test is
no longer considered conclusive. Some of our best jurists
cling to it with a degree of tenacity, which, to speak in the
mildest terms, is exceedingly remarkable. Drs. Beck and
Gordon Smith think it decisive, with due precautions, and
a reviewer in the Edinburgh Medical and Surgical Journal,
in 1826, perhaps Dr. Duncan, thinks it affords 'presumptive
evidence. The opinions of these talented and distinguished
professors are of course entitled to respect and much con-

Dr. Ryan on Infanticide.

fidence ; but it is to be recollected, that the judges of the
land will not receive the evidence afforded by this test.
This is not the place to discuss the propriety of this con¬
clusion. Whether the recent modification of the law on the
subject is a sufficient reason, lawyers only can determine.
As the law now stands in this country, the questions to be
decided in cases of infanticide are, has death been caused
by violence, neglect, or ill-treatment ? The same evidence
is required as in cases of homicide. The question of child
murder is still, however, interesting ; for if the infant has
been born alive, there is presumptive evidence against the
accused ; and, secondly, the^ decision of the question will
affect the disposition of property in cases of tenant by
courtesy, as already mentioned. The law in this United
Kingdom, Scotland excepted, and in almost all nations in
Europe, is, that a child is born alive, when it evinces the
slightest voluntary motion. A curious decision, made on
this point by the court of Exchequer at Westminster, has
been already recorded. According to the law of Scotland,
the infant, must cry to prove its vitality. This is manifestly
absurd, as asphyxiated infants have been resuscitated after
an hour and a half, as I have often witnessed; and infants
have been declared dead — the undertaker sent for, and every*
preparation in progress for burial, though resuscitation was
established after some hours.

In cases of still-born infants, I have more than once
succeeded in establishing the action of the heart, and one or
more inspirations, though complete respiration could not be
established ; and in such cases, no physiologist can doubt the
vitality of the infant.

Dr. Blundell and others have succeeded in resuscitating
infants, extracted by gastro-hysterotomy, a quarter of an
hour after the death of the mother ; and a case was recorded:
in the Lancet, where the infant was pronounced by the medical
attendant to be dead, it was placed as if dead, and on his
visit next day, it was alive.

The unanswerable objection to the hydrostatic and other
tests, is this, that when the infant breathes before delivery,
which every practical obstetrician can attest, not one of them
can prove it out-lived birth. Again, if we credit the records
of medicine, we can have no doubt but that there may be intra
uterine, vaginal and extra-uterine respiration before complete
delivery. Dr. Beck and other jurists seem to doubt the reality
of respiration in the first and second case ; but is it fair and
reasonable to inquire what object could influence those who

Original Communications.

have narrated such cases ? Europeans and Americans are
among the number.

Dr. Beck; who stands an ornament to his profession, and
an honour to his country, employed all his argumentative
powers against the probability of an infant, whose head was
expelled, and who had respired, losing its life during delivery.
His countryman. Dr. Hossack, has recorded a case in point.
But suppose the accused do not allege uterine, vaginal, or
extra-uterine, respiration, before a complete birth, are not the
judges warranted to temper justice with mercy, and to give
the prisoner the benefit of the reasonable doubt in such a case ?
Most decidedly.

To return to the hydrostatic test, from which I have so far
digressed ; I have to state in conclusion, that Drs. Duncan,
Beck, and Gordon Smith, maintain it may afford presumptive
evidence in infanticide.

But the following facts must be kept in recollection
1. the lungs of a still-born infant will sink in water, but float
on the sixth, seventh, or eighth day, when putrefaction has
commenced (Muyer in Schlegel), and so early as the third
day in warm weather (Beck.)

It is universally known, that the body of a drowned
person sinks at first, floats when putrefaction has gene¬
rated air, and rendered it lighter than water ; and sinks
again, after the extrication of the air so generated. When the
lungs of an infant are putrid, the air is near the surface,
(W. Hunter, Jaeger), and can be readily squeezed out by
pressure, when the lung will sink ; whereas, when respira¬
tion has taken place, no pressure will cause the lung to sink.
(Marc, Beclard.) The lungs are the last organs in the body
which undergo putrefaction (Camper, Mahon, Beck.) Marc
is of opinion that the lungs which have respired, and are
afterwards in a state of putrefaction, will always crepitate on
incision, which never happens unless respiration has occurred ;
secondly, on squeezing the putird lungs of a still-born infant,
they will sink, whereas those of a child born alive, will float.

2. Squeezing the lungs after artificial respiration, will not
cause them to sink ; in such cases, the lungs swam even with
the heart attached, and also when cut into pieces, and care¬
fully compressed (Mendel, in Hufeland’s Journal der Prac-
tischen Heilkunde, Aug. 1812 ; Bernt, Experimentorum
Docematiam Pulmonum Hydrostaticam illustrantium cen-
turia, Vienna, 1823 ; Merzdorff in Horn’s Archiv fur Me-
dezinische, Erfahrung, 1823.)

[ 65 ]

BIBLIOGRAPHY.

1. The Introductory Lecture to a Course of Natural
‘Philosophy delivered in the Theatre of the Medical
School, Brewer s-street , Golden-square, Nov. 3, 1830, by
Edward Broyvjne, F.L.S. Surgeon to the Farringdon Dis¬
pensary.

In the distribution of the several subjects, which enter into the course
of medical and scientific instruction delivered in this place, it has de¬
volved upon me, Gentlemen, to explain to you the principles of natu¬
ral philosophy, to point out the necessity of a knowledge of those,
for the successful cultivation of some other departments of science ;
and more especially to demonstrate the primary importance of this
knowledge to the student of medicine and surgery.

It is not however to the youthful aspirant for the honours of the
medical profession alone, that this science presents attractions, or of¬
fers more solid advantages ; indeed, while I regret that it should be
so, I fear we must admit that the members of our profession generally
are less familiar with this branch of philosophy, than many who pos¬
sess only that general knowledge of the sciences which constitutes
in the present day, an essential part of the education of a gentleman.

The progress of intellectual improvement is marked at present, by
a new and most important peculiarity — the diffusion of exist¬
ing knowledge amongst the mass of mankind. Can it be necessary
that I' should adduce any proof of this ? Need I remind you of the nu¬
merous Literary and Scientific Institutions with which this- metropo¬
lis abounds ? Institutions for the most part yet in their infancy,
some in their adolescence, but all promising a vigorous and perpetual
manhood, of which the fabled existences of the heathen mythology,
afford the only, but imaginary parallel. All intellectual prototypes of
Hercules in the cradle. The attacks of the serpent, error and of preju¬
dice, are all which they have to repel, and these are fast expiring
in their infant grasp, and unfolding those coils at their feet, which
have so long encircled the human intellect and enfeebled its exer¬
tions.

I feel that I cannot impress this fact too forcibly on the minds of
the junior portion of my medical hearers. They are no longer enter¬
ing a profession whose mysteries are sacred. They are no longer
shielded from the criticism of their employers, by the magical influ¬
ence of a license from Apothecaries’ Hall, of a diploma from the Col¬
lege of Surgeons, or even by the more dignified distinction of an Un-
versitv degree. Several cases have come to my knowledge, in which
patients amongst the educated classes of society have detected, the
want of physical and even of chemical knowledge in their medical

VOL. VI. no- 31.

Bibliography .

attendants. You will perceive therefore that ignorance of the sciences
collateral to medicine is no longer safe . The hour is fast approach¬
ing, if indeed it has not already arrived, when the half educated man,
will be unable to obtain even a subsistence amongst us.

The veil of the temple of knowledge, is rent in twain ! The arcana
of nature are no longer communicated through the dark and doubtful
medium of an oracle, but are accessible to all who will patiently
and diligently investigate them. The source of the waters of know¬
ledge is discovered, and you are invited to drink at the fountain-head-
The path which leads to it is that of experimental inquiry.

To point out this path to your footsteps, and to accompany you a
short distance on your journey, is the task which I have undertaken
to perform. To find you zealous and diligent in the pursuit of it, is
the highest reward I can enjoy. You will have an opportunity in this
place of becoming acquainted with the general principles of science,
and with so much of its details as are already generally known ; but
I charge you, my young friends, to reflect that the spirit of philosophy
requires that you should repay the pains bestowed upon your educa¬
tion by eliciting future discoveries. You are not to rest satisfied
with the information which you may obtain from others, but on the
contrary you are bound to contribute, though it be but your mite, to the
treasury of useful knowdedge. This the world will expect, this your
profession has a right to demand from you ; for it affords you facili¬
ties for the cultivation of every branch of knowledge, which can be
derived from no other source. A few words of explanation will suf¬
fice to convince you of this.

All the subjects on which the human mind can be employed, inde-
pendantly of revelation, may be referred to two general heads.
— Science or Philosophy and Natural History.

The first of these two fundamental divisions includes physics or
natural phylosophy, chemistry, which is sometimes called experimen¬
tal philosophy, physiology, or the science which explains to us the
laws of life, and metaphysics, or ontology, which embraces the consi¬
deration of the active and intellectual powers of the human mind.

Gentlemen, the course of your studies must include all these, or
your medical education will be incomplete. Natural philosophy, che¬
mistry, and physiology, are separately taught in all the schools of
medicine, except those established in this metropolis, where the
omission of the first imposes on the teacher of chemistry, the neces¬
sity of rmiking a brief exposition of its principles, introductory to the
proper subject of his course, and this omission is the more extraordi-
nory, as Great Britain is the only country in which the possession of
natural knowledge is implied in the very name of the physician.
Such, however, is the fact.

In the cultivation of these branches of science, reference is neces¬
sarily made to measures of number and dimensions, and hence has
arisen a secondary science, called mathematics of the science of
quantity.

I am not aware that the philosophy of the human mind has yet

Mr. Browne's Lecture on Natural Philosophy. 67

been made a separate article of medical education, but the reference
which must be made to the subject in the lectures on the practice of
medicine under the head of insanity, and the influence of the mind
upon the body, will convince you that it must not be altogether
neglected.

There is one subject which is considered as belonging to the
science of mind, to which I would call your attention more particu¬
larly, because the evidence on which it is supported is derived from
every department of science and natural histosy — it is natural theology.
The cells of the honey-comb are constructed upon strictly mathemati¬
cal principles, and who we may inquire instructed the bee to solve
problems of maxima and minima. The proofs derived from the
four fundamental departments of science are innumerable, and so clear
that he who runs may read, hence the medical man has no excuse for
being ignorant of them, and if, as I can scarcely conceive, there should
be one who can resist the conviction they are calculated to bring
home to the mind, it would be charitable to say of him “ quem Deus
vult perdere, prius dementat.”

We come now to the consideration of natural history, this division
of the objects of our study, refers to what have been termed the three
kingdoms oi nature, the animal, the vegetable, and the mineral; per
haps a more philosophical division would.be into the earth, of which
minerals may be considered as detached portions, and its inhabitants
endowed with animal or vegetable life.

To convince you of the necessity for making the study of natural
history a branch of medical education, I need only remind you, that
your therapeutical agents, the weapons with which you must encoun¬
ter disease, are supplied alike by each of its subdivisions.

It is not, however, as the members of a particular profession, exclu¬
sively, that you are interested in this subject, but as votaries of
science in general ; natural history provides us with the individual
examples by which the laws of natural philosophy, chemistry and
life are severally illustrated; and on the other hand, what will be the
extent of your knowledge of natural history without the aid of
science? How can you cultivate an acquaintance with mineralogy,
without reference to the physical properties, and chemical relations of
minerals ? — how will you prosecute the study of botany or zoology,
without some knowledge of the laws of vegetable and animal life ?
You may indeed accumulate a long list of the names of stones, and
plants, and animals, but this is all. The torch of science alone can
guide you to the “ ultima thula” of your search.

It is manifest then that the two great departments of human know¬
ledge — natural history and science, are intimately connected and mu¬
tually dependent on each other. They are twin sisters, and like the
interesting strangers, who have recently visited this country from the
banks of the Ganges, they may not be separated without serious, per¬
haps fatal injury to both.

This mutual dependence of the several departments of knowledge
on each other, gives to him who has taken a comprehensive view of

Bibliography.

the whole peculiar facilities for the cultivation of any particular
branch ; and hence the medical philosopher derives the vantage
ground on which he ought to stand. It is his privilege to exert the
highest faculties of the mind, for the noblest of all sublunary pur¬
poses — the relief of disease — the mitigation of the pangs of death,
while the very exercise of these privileges opens to him sources
of the most sublime gratification in the indulgence of the best and
kindliest feelings of his nature. To restore to his family and to his
friends, one who has been the subject of a painful operation, or of
a dangerous disease, is a pleasure peculiarly our own ; and even
when this is denied us, to smooth the descent to the grave, by
pointing to the brighter prospects beyond it, to soften the pillow of
death, and to console the widow and the fatherless survivors in their
affliction, are duties, which, however melancholy in their perform¬
ance, we may be grateful that we are permitted to share with the
ministers of Him who made us — of Him whose only earthly occu¬
pation it was to heal the sick — to cleanse the leper — to give sight to
the blind — and to say to the helpless cripple, Arise, take up thy
bed and walk !

This hasty glance at the intimate connexion of the several de¬
partments of knowledge, is all that we can be permitted to take at
present.

I must now proceed to point out the sources from which the
study of natural philosophy derives its interest, and the practical
application of its principles to purposes of utility, which invest it
with importance.

To those who are desirous of cultivating an acquaintance with
the sciences for their own sake, or as branches of general education,
it will be sufficient to shew that the laws of physics govern every
phenomenon of nature and art in which there is any sensible motion.
Over the majority of natural phenomena, they preside alone. Thus
they regulate the motion of the earth, the ebbing and flowing
of the tides, and the elevation of the waters of the ocean,
by the action of the sun’s rays, to form clouds, that impelled
by the winds, in obedience to the same laws, are scattered over the
face of the earth, again to descend upon it in refreshing showers,
clothing it with verdure and invigorating it with life — or in the form
of more violent rain of hail or snow, to take part in the warfare of
the elements, and to mingle with the horrors of the storm. It is
here that the principles of natural philosophy are developed in
their most sublime supremacy — here, where the uneducated man
sees nothing but confusion, the mental vision of the philosopher
penetrates the obscurity at once, and perceives established order
riding on the wings of the tempest, controuling its course, and
wielding the lightning of heaven.

If we turn to contemplate the products of human ingenuity, we
shall find that the civil and military engineer, the naval and terres¬
trial architect, the machinist and the manufacturer, the maker of
wheel carriages, and of the implements of husbandry, and those

Mr. Browne’s Lecture on Natural Philosophy . 69

who are employed in the use of them, are all guided in the pursuit
of their several occupations by the laws of natural philosophy.
Lord Bacon has justly denominated it the root of the sciences, and
of the arts, for it is by the study of its abstract principles in the
closet, and the subsequent application of them to purposes of prac¬
tical utility that the arts have been brought to their present state of
perfection. Sound theory is always in advance of practice, not only
because it is necessary that men should first perceive the possibility
of improvement before it can be carried into effect, but also because
their first efforts have been too often attended with disappointment,
even in those cases where the most brilliant success has ultimately
crowned their exertions. In proof of this, we may select as ex¬
amples, the repeated unsuccessful applications of the power of steam,
and the application of the Catenarian curve, once only a pleasing
mathematical exercise to the construction of suspension bridges,
connecting the summits of mountains with each other, or thrown
across a broad and rapid river, as we see at Hammersmith, or project¬
ing into the bosom of the ocean, as in the chain pier at Brighton.
I may mention these structures, because they will be familiar
to most of my hearers ; and the last is celebrated for the disasters
which attended its construction ; but it is now complete, and pro¬
mises to be as durable as it is elegant.

Surely such examples should prevent us from sinking into des¬
pondency with regard to any undertaking, whose progress is guided
by the principles of science ; and hence we may indulge a reason¬
able hope, that the most magnificent project of our nation and of
our age, the design of conveying an arched road way beneath the
bed of a deep and rapid river, which has already proceeded to a
considerable extent, in the case of the Thames Tunnel at Bother -
hitlie, will yet, at no distant period, be carried to a triumphant
termination, in despite of the untoward circumstances which have
hitherto retarded its completion. For it is inconceivable that the
people of England will allow it to be said, that a work of this
national character, is capable of exciting more interest among
foreigners, than among themselves, or that they will sit down
tamely under the imputation that they want the hand or the heart
to execute the achievements which their genius can conceive.

It is not only in modern times that the principles of physical science
have conferred benefits on mankind, or immortality on those who
have devoted their lives to the cultivation of them. The stupendous
aqueducts of ancient Rome, have transmitted to us the memory
of their founders, embalmed in the gratitude of their countrymen.
Their very ruins excite our admiration, and forcibly recalling to the
imagination the labours of the Titans, diminish our surprize that
the fables which described them should have gained belief. Would
you inquire how the want of these superb and costly structures is
supplied in our own cities ? It is by the unobtrusive and economical,
but far more effective arrangement of iron conduits, the material of
which was known, to the Roman architects only as an useless stone

Bibliography.

or earth — if, indeed, it was known to them at all ; for it is now
well ascertained that the building of the aqueducts was not resorted
to by them from ignorance of the law, in obedience to which water
seeks the Jevel of its source at whatever distance it may be led
from it, as some have supposed, but merely from the want of more
simple means of conducting it.

Over military affairs, too, this science held sway. Archimedes,
the master mind of antiquity, defended his native town against the
assaults of the Romans, entirely by the force of his mechanical
genius. Such was the terror inspired by his engines, that the
appearance of a beam with a rope attached to it, on the walls, was
at all times sufficient to drive the assailants from their posts, until
at length so strong a sense of security pervaded the minds of the
beseiged, that on the celebration of a public festival, the ramparts
were left undefended, the Romans entered the city, surprized and
subdued the inhabitants, and slew the philosopher in his study, in
opposition to the express commands of their general.

To this patriarch of science we are also indebted for the means
of ascertaining the specific gravities of bodies, by weighing them
when immersed in water, and comparing the weight of the water
displaced with the absolute weight of the body given, when
weighed in air. The idea appears to have struck him as he reclined
on the liquid support of the bath, and it is reported that he was so
transported with the feelings excited by his discovery, that he
instantly sprung from the water, and rushed home unmindful of his
nakedness, exclaiming, E vprjxa, E vpqxa, I have found it, I have found
it. His mind was intent upon the numerous and important uses to
which he foresaw it might be applied. Among more immediate,
but minor circumstances, it enabled him to detect the fraud com¬
mitted by a goldsmith, who, having been furnished by Hiero, king
of Syracuse, with a quantity of gold, for the purpose of making a
crown, purloined a part of it, and replaced it with an equal quantity
of silver.

The subject of specific gravities leads us directly to consider the
connection of natural philosophy with chemistry. Chemical mani¬
pulation consists entirely of a series of physical operations. Such
are the various processes by which masses are reduced to powder,
and the mode of separating the coarser parts from those which are
finer, by diffusing the whole through some fluid in which they are
insoluble ; the coarse parts presently subside, and the supernatant
liquid, in which the finer portion is still suspended, may be removed
by the action of the syphon. The phenomena of evaporation, and
the extent to which it may be modified, by the diminution or re¬
moval of the atmospheric pressure, which has been applied to a
considerable extent in some manufacturing processes, as in the
boiling of sugar, and in the preparation of the vegetable extracts em¬
ployed in pharmacy, are also examples of the fact. The chemical
agencies of light, heat and electricity are not less numerous and im¬
portant. In the first the genius of Wollaston has provided the

Mr. Browne’s Lecture on Natural Philosophy . 71

pharmaceutical chemist, with the ready means of testing the purity of
his essential oils by ascertaining their power of refracting the rays of
light. The influence of the second is all but universal, and the last,
in the hands of Davy, has almost erected chemistry into a new science.

I have already had occasion to mention, that in this metropolis the
medical student derives the scanty knowledge of natural philosophy,
which is accessible to him, for the preliminary explanations which
the teacher of chemistry is obliged to enter upon, before the proper
subject of his course can be made intelligible to his hearers. This cir¬
cumstance is a source of some inconvenience and obscurity. Students
frequently confound physical with chemical phenomena, and few of
them have a distinct idea of the mode in which a physical change
contributes to the production of a chemidal combination ; for example,
if alcohol be distilled with sulphuric acid, a compound called aether
is produced, and the student having prepared this substance, is con¬
tent to say, that he has performed a chemical experiment, without
once referring to the fact that the chemical combination of these
bodies has been merely favoured by the state of minute subdivision on
which they were presented to each other, while their elevation in the
form of vapour, and their subsequent condensation in the receiver
being mere changes of state, are strictly physical phenomena ; for if
the resulting compound be distilled again, the same physical changes
take place without at all affecting its chemical composition. I have se¬
lected this example on account of its simplicity, but there is scarcely
an instance in which any chemical union or decomposition takes place
without some concomitant physical phenomena ; and as such I conceive it
to be essential to your perfect comprehension of any complicated ope¬
ration of this kind, that you should have clear ideas of the nature of
the phenomena which they present, and be able to trace distinctly the
several stages of their progress, I propose to direct your attention in
a particular manner to the distinction between physical and chemical
action in those processes which involve them both.

You will perceive that a knowledge of natural philosophy, is requi¬
site to enable you to understand the phenomena of chemistry. An
acquaintance with both these sciences is necessary for the investiga¬
tion of the principles of physiology. Vital phenomena are the most
complicated which science can present to us ; take the function of
respiration for example, you will find that it embraces the phenomena
of physics, chemistry and life. But although some of the vital func¬
tions require the aid of chemistry for their illustration, there are others
in which phy sical and vital action only is concerned, as in the perform¬
ance of muscular motion, and some of which are referrible to natural
philosophy alone. I would recommend the study of these to you, in
the eloquent language of Dr. Arnott, as far more effective than any
persuasion which I could employ. He describes the medical man as
the engineer pre-eminently, and demands “ where shall we find to il¬
lustrate mechanics a system of levers and hinges, and moving parts,
like the limbs of an animal body, where such an hydraulic apparatus
as the heart and blood vessels, such a pneumatic apparatus as the

Bibliograjjhy .

breathing chest, such acoustic instruments as the ear and larynx,
such an optical instrument as the eye, in a word such mechanical
variety and perfection as in the whole of the visible anatomy.” We
shall also have occasion to shew that the philosophy of imponderable
substance is illustrated by the phenomena of animal heat, and by the
functions of the brain and nerves. You will most of you be aware
thet many physiologists have laboured to establish the identity of the
electrical and nervous fluids, and that on the other hand it has been
urged that we have not yet obtained sufficient evidence in support of
this position, to enable us to decide on its validity. I am not disposed
to go so far as those who have asserted that electricity and life are
modifications of the same principle, but I do believe it to be the me¬
dium through which the unknown principle of life acts upon the ma¬
terial structures of the body, and I hope to be able to lay before you
satisfactory evidence, derived from experiment, in support of the
opinion.

If then the sciense of chemistry be based upon natural philosophy,
it is equally evident that the superstructure of physiology is raised
upon both. From this it follows that a previous knowledge of phy¬
sical principles affords great assistance, to the student in the investi¬
gation of the more complicated sciences ; with it indeed he seems to
learn by intuition — the facts which are presented to his mind seem to
arrange themselves in their natural order under the several heads to
which they belong; whereas he who would study chemistry or phy¬
siology without such preparation, either fail to obtain clear ideas of the
subject at all, or loses more time in attempting to unravel the confu¬
sion they are involved in than would have served to obtain a know¬
ledge of the whole body of physics, which it may be observed offers
by far the greatest sum of knowledge, which a given amount of la¬
bour will suffice to accumulate.

It is obvious that the principles of natural philosophy can have no
direct relation to the science of mind, but inasmuch as we are indebted
to them for the instruments of our intellectual arts, such as writing,
printing, drawing, painting, music and sculpture ; and for our mathema¬
tical and philosophical instruments, it cannot be denied, thatitikat least
indirectly connected with this, as well as the other departments of
science.

Hitherto we have considered the study of natural philosophy in its
relations to the other departments of science, as part of an extended
scheme of liberal education, such as a man of rank and fortune would
wish to confer on his son, that his acquirements might be equal to his
station in society. It only remains that I should point out the im¬
portance of its applications to the practice of medicine and surgery ;
and here I may observe that it is by no means the least of the advan¬
tages which we derive from our profession, that it places us (in an in¬
tellectual point of view) on a level with the wealthy and the great. It
has been asserted, however, that this study is not of primary import¬
ance to a medical man; but after what has been said of its connection
with physiology, it can hardly be necessary, I imagine, to enter upon

Mr. Browne’s Lecture on Natural Philosophy . 73

a formal refutation of so palpable an error,. as far as regards the scien¬
tific information which is required of us. But I must remind you,
that our profession is an art as well as a science, and that in the com¬
mon routine of private practice you will have daily occasion to avail
yourself of the aid of physics. Are not all the instruments in the
hands of the surgeon, or of the obstetrician, really mechanical tools ?
If so, a certain degree of dexterity must be required for the manipu¬
lation of them, the acquisition of which should form part of a course
of medical instruction ; to place this point fairly before you, let us
compare it with some other mechanical occupation. If a carpenter
takes an apprentice, the first lesson he teaches him is to handle the
tools of his trade, whereas with us, I regret to say, that few of our in¬
struments are ever removed from their cases, except when they are to
be employed for the performance of an operation on the living body.
And what is the consequence of this neglect ? Those that can be per¬
formed with the scalpel, with which we become familar by dissection,
are well and dexterously performed, but when any other instrument
is required, alas! what a falling off is there. Let us take amputation,
for instance. How often do we see the bone splintered just as its di¬
vision is completed, and the blame attributed to the awkward and in¬
efficient manner in which the assistant supported the limb, when
it would be much more justly bestowed upon the surgeon for
the awkward manner in which he held the saw. Mechanical manipula¬
tion is indeed of the utmost importance to the surgeon, and may be
so easily acquired by some amusing work of carpentry, that it is folly
or idleness to omit it. Again, I presume that no one will venture to
deny that we should understand the construction of the instruments
we are constantly using ; and we shall find upon inquiry, that they
comprise all the simple machines or mechanical powers. These are
the lever, the wheel and axle, the inclined plane, the wedge, the
screw and the pulley. The punch for extracting the stumps of teeth,
is as complete and simple a lever as a common crow bar ; and the
tooth forceps, consist in fact of two levers, of which the rivet that
connects them is the common fulcrum ; this instrument well illustrates
the advantage of mechanical tools. In the first place, the tooth is
seized by the iron jaws of the forceps, instead of between fingers,
then it is grasped with the force of the whole hand, and lastly, this
force is multiplied many times by the difference between the length
of the claws and handles of the forceps. Wheel and axle find their
representative in the tooth key, for it matters not whether the wheel
be entire or reduced to a single spoke, its action is the same. The
inclined plane supports our fractures, our cutting instruments are
wedges, the tourniquet owes its power to the screw, and the pulley
is employed by us for the reduction of dislocations. Can it be said
then, that a knowledge of the principles upon which the usefulness
of these various instruments is founded, is at best but of secondary
importance to you ; or is there one amongst you who would be con¬
tent to use them without inquiry, merely because others have done so
before you ? If there be such a person, I have yet another argument
in reserve for him. The improvement of our instruments must be
VOL. IV. no. 31,

Bibliography.

effected by ourselves, and we cannot expect to improve what we da
not understand. Would you learn the extent of the benefits which
may be conferred upon suffering humanity by this means ? I refer
you to my esteemed colleague Mr. Costello, who has had the honour
of introducing to the notice of the profession in this country, the mode
of destroying calculi in the urinary bladder, which has long been
adopted in France, and thus saving the patient from the horrors of li¬
thotomy, avowedly the most formidable operation in domestic surgery,
which even Cheselden, whose mode of operating is yet unequalled,
never undertook without reluctance, approaching, according to his
own admission, to fear.

There is yet another point to which I would call the attention of
my medical hearers ; it has been asserted by some persons desirous of
underrating the value of scientific attainments, that they have a direct
tendency to contract the feelings, and impair the affections of the
heart. An anonymous satirist even goes so far as to suppose that if
he were to fall into a river, the uneducated savage would instantly
plunge in to his rescue, but that the scientific civilized man, viewing
him merely in the light of a projectile, and calculating the depth of
the water, the force and direction with which he impinged upon its
surface, and the resistance of the fluid medium, would probably point
out the precise spot in the mud at the bottom where his body might
be found.

To the medical philosopher it is entrusted to refute this calumny,
philanthropy is an essential part of his profession, and although 1
have dwelt upon this topic already, I cannot forbear to remind you
that it is your business to console no less than to cure, and that the
highest satisfaction your pursuits can afford, is derived from the ex¬
tent to which your feelings are interested in them.

In conclusion, I have only to allude to the arrangement which I
propose to adopt in the ensuing lectures. The course will be divided
into three parts. In the first part, we shall consider those subjects
which are comprehended by the term mechanical philosophy ; in the
second, we shall explain the philosophy of imponderable substance ;
and in the third, we shall direct your attention to the sublime pheno¬
mena of physical astronomy. Each of these principal parts will
be again subdivided into sections, at the end of each of which we
shall enumerate all the applications of the subject to the practice of
medicine and surgery of which it will admit, and then institute an
examination, for the purpose of ascertaining that the explanations
which have been given have been perfectly understood by the student.

SURGERY.

HOSPICE DE LA PITIE.

2. Cancer of the Nose — Extirpation. — G - , setat. 32, was ad¬

mitted in May last, with a carcinomatous affection of the nose ; the
disease was of about two years’ standing, and seemed to extend
over the cartilages of the nostrils and the septum, which had degene¬
rated into a large ulcerated tumour. After having watched the case
for some time, M. Lisfranc, who was of opinion that it was a

Surgery.

case of superficial cancer, performed the following operation : — Two
semi-elliptic incisions were made, by which the diseased part was
circumscribed ; the skin, with the subjacent cellular tissue, which was
found to be the principal seat of disease, was dissected off the surface
of the cartilages, scraped with a bistoury, and then touched with the
nitrate of silver, especially at those parts where the disease did not
seem to have been entirely removed by the knife. After a few days,
the eschar having come away, healthy granulation began to take
place, and cicatrization was completed within a short time.

HOPITAL BEAUJON.

3. Fracture of the Neck of the Thigh-hone and of the Os Pubis. — -
A young girl of robust constitution, but who had of late presented
symptoms of mental derangement, threw herself, on the 7th of Oc¬
tober, from a window on the second floor. On being taken up, she
was found to have a slight wound in the neck, and a violent contu¬
sion over the right hip. Twenty-five leeches were immediately ap¬
plied, and on the next morning she was brought into the hospital.
There was much swelling and ecchymosis at the upper and external
part of the hip ; the patient could not move the thigh, and complained
of violent pain whenever it was raised ; the limb was not shortened
or distorted in any direction, nor could any crepitation be heard on
motion. The limb was placed on a double -inclined plane, and the
patient ordered to be bled. During the following days delirium
acceded, with tenderness of the abdomen and tympanitis, and sup¬
pression of the urine and fseces, and she died on the 14th of October.
On examination, the muscles which cover the joint were found much
contused and infiltrated with blood ; the articular cavity was filled
with a thin reddish turbid fluid, and the neck of the thigh-bone, at
about three lines from the shaft, was obliquely fractured. The frag¬
ments being in close contact with one another, accounts for the
absence of distortion after the accident. The cellular tissue of the
pelvic cavity round the bladder and rectum was infiltrated with a
brownish matter, particularly at the right side, where the horizontal
branch of the os pubis was found fractured at the distance of about a
line from the spina pubis. The fragments were about three lines
distant from each other ; the external fragment being drawn upwards
and outwards. — Lane. Franc.

HOPITAL DE LA PITIE.

4. Lithotomy. — C - , aetat. 60, of a feeble constitution,, had,

during the last nine years, been labouring under symptoms of stone
in the bladder. Being admitted at the hospital under the care of M.
Velpeau, lithotrity had been tried, but without success ; the stone
being very large, M. Velpeau was rather disposed to perform the high
operation. M. Lisfranc, however, declared himself against it, and
the lateral operation was accordingly decided upon, and performed on
the 21st of October. After the incision in the bladder, the stone
was easily grasped, but proved to be so large, that all attempts at

Bibliography .

extraction failed, and M. Velpeau was obliged to enlarge the wound,
first in a lateral direction, and then by dividing the prostate. The
forceps being now re-introduced, the stone was again seized, and at
last, though not without violent efforts, extracted : it was of an oval
form, two inches and a half in its large, and two inches in its small
diameter. Contrary to what had been supposed from the previous
examination with the sound, no other calculous was felt in the blad¬
der, which was large, but healthy. On the 28th of October the
patient was going on favourably ; the hypogastric region was neither
tense nor tender ; the urine still passed through the wound. — Ibid.

Midwifery.

Hotel Dieu.

5. Obliteration of the Vagina. — Angel. Andre, setat.22, was admitted
on the 12th of August with violent colic pain, which she attributed
to a stone in the bladder, but which, on examining the genitals, was
found to be caused by the accumulation of menstrual blood in the
uterus, in consequence of the vagina being obliterated. She had
been quite well until about three months ago, when, in consequence
of great excesses in drinking and debauchery, she was seized with
violent inflammation of the genitals, which terminated in gangrene ;
the extremity of the clitoris, the nymphse, and part of the large labia,
went into mortification ; the vagina ulcerated, and, after the inflam¬
mation had subsided, was found to be completely obliterated. In
other respects the girl was quite well, but at the time of the menses
the blood accumulated, and caused a sensation of weight and sharp
colic pain in the hypogastric region. At the next menstrual period,
these symptoms returned with increased violence ; the colic pain, the
attacks of which curiously enough always began at noon and ceased
at about six o’clock in the evening, was very intense, and the patient
experienced great difficulty in making water, and passing the stools.
It was then only that she applied to a medical practitioner, who ad¬
vised her to go into the Hotel-Dieu, where the genitals were found to
be in the following state : The large and small labia, as well as the
extremity of the clitoris, were entirely wanting ; the orifice of the va¬
gina was very small, and terminated at about half an inch in a “ cul
de sac at the left iliac region there was a large tumour, which
could also be felt by the finger in the rectum ; it was of a globular
form, moveable, and exhibited distinct fluctuation, and no doubt was
entertained that it was the upper portion of the vagina distended with
blood. On the 10th of August the following operation was performed
by M. Duputryen : — a long trocar was passed into the contracted ori¬
fice of the vagina and plunged into the tumour, and the opening thus
made was enlarged in several directions with a bistouri, carried along
the canula of the trocar. A large quantity of dark, viscid, inodorous
blood was thus evacuated, and the cavity having been washed out by
the injection of warm water, a further examination of the parts was
made. The parietes of the vagina were found to be adherent to one
another for the space of about two inches, beyond which was a very
considerable dilatation which had contained the menstrual fluid ; the os

Midwifery .

\iteri appeared to be closed. A tube of gum elastic was introduced
into the vagina, and the patient went on well for a fortnight, when
she was attacked with pneumonia, which proved fatal in about nine
weeks. It is remarkable that the pain in the chest appeared to be re¬
lieved by the removal of the canula and increased by its re-introduc¬
tion. A similar case is related in a late number of the Lancette
Francaise by M. Patrix; the patient had, after delivery, been
affected with peritonitis and inflammation of the genitals, which
terminated in gangrene : a great portion of the external genitals
sloughed away, and the vagina became completely obliterated, al¬
though every thing was done to prevent it. By the continued use of
lint tents, however, M. Patrix succeeded in reproducing the former
canal ; the woman subsequently became pregnant and was safely de¬
livered.

In a case of congenital obliteration of the vagina, which was ad¬
mitted in 1829, M. Dupuytren evacuated, by the operation, more
than three pints of viscous dark-coloured, but inodorous, blood; the
patient was twenty-two years of age, and had, according to her state¬
ment, felt the first symptoms of menstrual congestion in her fourteenth
year. She got perfectly well after the operation. The blood was
submitted to chemical analysis by M. Thenard, who convinced him¬
self that it did not contain the least particle of fibrine or serum. —
Lane. Franc .

MISCELLANIES.

6, MEETINGS OF THE MEDICO - BOTANICAL SOCIETY.

To the Medico Botanical Society.

On the effects of the severe cold of the last winter, upon two indi¬
genous medicinal plants, viz. Hyoscyamus Niger, and Leontodon
Taraxacum, communicated by, Joseph Houlton, Esq. Read De¬
cember 14th, 1830.

The severe and protracted ccld of the last winter was very in¬
jurious to many of our more tender indigenous, biennial and
perennial plants. The effect of the season upon two very important
medicinal plants, the Hyosciamus Niger, and the Leontodon Ta¬
raxacum deserves notice; the plants of Hyosciamus in my gar¬
den, were all cut off by the frost, and but a very small quantity
of the Mature herb was brought into the market ; forty -two
shillings per hundred weight, was given by the wholesale trade
in Covent Garden Market ; I understood from different persons
connected with the trade, that it was not to be procured in sufficient
quantity, to meet the demand of the profession at any price. The
consequence has been, the substitution of the immature plant ; this
I can state with confidence from my personal observation. When
I had the honour to bring this plant before the notice of this
Scientific Society, during the last session, I mentioned some facts
which I considered important, and which I now beg leave to re¬
capitulate, because they are not all, as far as my reading extends, to
be found in books. Contrary to what is stated in most modem

Miscellanies.

works on Botany and Materia Medica, Hyosciamus Niger I assert
is a biennial plant, and is in a fit state for medical purposes in the
second year only of its duration, when in flower, or according
to the excellent general rule of the Royal College of Physicians
“ post quam Hores expassi fuerint; et antequam semina maturescant —
The leaves at this period differ very much from those of the first year,
their season is generally from the beginning to the end of June,
they are cauline, sessile, very clammy, and foetid, containing a large
proportion of extractive matter. The leaves of the first year are
plentifully brought to market in August and September ; they are
radical, petiolated, having very little clamminess, or foetor, and
containing considerably less extractive matter than those of the
second year. The tincture from the mature leaves is a deep
greenish brown and not clear ; the tincture from the first year’s leaf
is much paler and clearer ; the difference in their relative strength
is great.

The above observations may be very easily verified, their impor¬
tance must be obvious, when the value of the article of Materia
Medica is considered, and the fact declared, that large quantities of
the improper leaves are employed in this metropolis every year.

Leontodon Taraxacum suffered from the peculiarity of the sea¬
son in a curious manner. I have already stated to this Society
and to the public, that the bruised roots of this plant in the month
of August, yield by pressure, nearly a third of their weight of thick
cream coloured fluid, and that early in they spring the afford a less
proportion of their brown liquid. This year in the month of August,
some roots which I had fresh dug up for me, contained but a very
small quantity of juice, and that destitute of the more important
sensible properties usually found in it at that season ; therefore the
extract of the dandelion, prepared after my plan, cannot be obtained
of this year’s manufacture. It may be proper to state, we must not
depend too much upon the herb venders for these roots, as respects
their proper season : for they are kept in sand with their herbaceous
part removed ; if they remain long in this state, they will not answer
to the description I have given of them to this Society.

Grove Place,

December, 1830.

LITERARY INTELLIGENCE.

6, The Medical Annual , containing a practical estimate of the the¬
rapeutic value of all the remedies, which have been introduced into
the practice of medicine, within the last two years, an account of the
proposed arrangements for a priced catalogue of drugs, &c., list of
diseases, with references to the remedies that have been found most
beneficial in their use or palliation, by Reece, & Co.

On the 1st of January, 1831, No. 1, of the Monthly Gazette, of
Practical Medicine, containing a popular account of all the new dis¬
coveries in the art of preserving health, in curing diseases, and in
promoting economy, an exposure of quackery, and every species of
fraud.

Miscellanies.

BOOKS RECEIVED DURING THE MONTH.

1. The Works of William Cullen, M.D. Professor of the Practice of Physic in
the University of Edinburgh : containing his Physiology, Nosology, and First
Lines of the Practice of Physic : with numerous Extracts from his manuscript pa¬
pers, and from his treatise of the Materia Medica Edited by John Thomson, M.D.
F.R.S. L. and E. Lecturer on the Practice of Physic, consulting Physician to the
New Town Dispensary, and late Regius Professor of Military Surg3ry in the Uni¬
versity of Edinburgh. In 2 vols. 8vo. pp. 1420. T. and G. Underwood.

*** This is the most complete edition of Dr. Cullen’s works extant. It ought
to have a place in the library of every medical man in the kingdom. His
pathology of many disorders, which cannot be explained by morbid ana¬
tomy, has not yet been surpassed, nor even equalled.

2. A Supplement to the Pharmacopoeia, and Treatise on Pharmacology in ge¬
neral, including not only the drugs and preparations used by practitioners of medi¬
cine, but also most of those employed in the chemical arts ; together with a Collec¬
tion of the most useful Medical Formulae, Veterinary Drugs, Patent Medicines, and
other Compounds ; an Explanation of the Contractions used by Physicians and
Druggists ; and also a very copious Index, English and Latin, of the various Names
by which the articles have been known at different periods ; being a complete Dis¬
pensatory and Book of Formulae for constant reference in medical and veterinary
Practice, and Manual for retail Druggists. Fifth edition, considerably enlarged,
including the new French Medicines, and Selections from Foreign Pharmacopoeias,
and from the Formulae of British and Foreign Hospitals. By Samuel Frederick
Gray, Lecturer on the Materia Medica, pharmaceutical Chemistry, and Botany.
London. 1831. 8vo. pp. 576. Thomas and George Underwood.

*** Gray’s Supplement to the Pharmacopoeia has long kept its ground in
despite of the many abortive attempts made to imitate and supersede it.
This present edition is greatly improved and brought down to the present
state of science. Its value is much enhanced by the introduction of nume¬
rous formulae and of the new medicines. It excels any Supplement to the
Pharmacopoeias in our language ; and is a work we confidently recommend
to all classes of our profession.

3. First Principles of Medicine. By Archibald Billing, M. D. Fellow of the
Royal College of Physicians ; Lecturer on the Theory and Practice of Medicine ;
and on Clinical Medicine ; and Physician to the London Hospital, &c. &e.
London. 1831. pp. 131. Thomas and George Underwood.

*** This is an excellent commentary on the present state of science, and will
be perused with advantage by students and junior practitioners.

4. Observations, Chemical and Practical, on the Dublin Pharmacopoeia, with
a Translation annexed. By F. Barker, M D. Professor of Chemistry in Trinity
College, Dublin ; Honorary Fellow of King’s and Queen’s Colleges of Physi¬
cians, &c. ; and William F. Montgomery, A.M.M.B. Professor of Midwifery in
the King’s and Queen’s Colleges of Physicians in Ireland, and Member of the
Royal Irish Academy, &c. Dublin. 1830. 8vo. pp. 721. Hodges and Smith,
21, College Green. 1830.

*** The work of Doctors Barker and Montgomery is one of the best Treatises
on Pharmacology of modern times. It evinces great research, discrimi¬
nation, observation, and talent.

5. A System of Operative Surgery ; containing a description of the most
approved plans of performing the different operations in Surgery on the Dead Body ;
with remarks on their Anatomy, and accompanied with practical observations :
being principally designed for the use of Students in Surgery. By Wm. Hargrave,
A.M. M.B. T.C.D., Member of the Royal College of Surgeons in Ireland; Lec¬
turer on Anatomy, Physiology, and Operative Surgery, &c. &c. Dublin. 1831.
12mo. pp. 533. Hodges and Smith.

*** This work is executed in a masterly style, and supplies the place of
AverilPs production, which in consequence of the premature death of the
revered author, must have a new editor. Mr. Hargrave’s production is
inestimable to the Student, and is the best companion we know of for the
Dublin Dissector.

Miscellanies .

6. A new mode of ventilating Hospitals, Ships, Prisons, &c. &c. ; being an
efficient method of destroying Contagion, and of preventing the spreading of
infectious Diseases. By George Hawthorn, M.D. London. 1830. 12mo. pp. 84.
Longman and Co.

7. The Dublin Hospital Reports and Communications in Medicine and Surgery.
Vol. V. Dublin. 1830. 8vo. pp. 631. Eight Plates. Hodges and Smith.
Reviewed in our former Numbers.

8. Observations on the Use of Instruments in cases of difficult and protracted
Labour. By John Beatty, M.D., Licentiate of the King’s and Queen’s Colleges
of Physicians in Ireland. Dublin. 1831. 8vo. pp. 23. J. M. Leckie.

*** Doctor Beatty’s object is to advocate the use of the forceps in all cases in
preference to the perforator. He cites numerous eminent obstetricians in
support of his opinion, with ’which no scientific mau can dissent. This
essay reflects great credit on the eminent author as a man of sense, judgment,
and science. We shall notice it more fully hereafter.

9. Reflections on the present state of the Profession of Pharmacy in Ireland.
By M. Donovan, M.R. I A. Dublin. 1829. Svo. pp. 35.

*** Mr. Donovan is Governor of the Apothecaries’ Company in Dublin, and
a gentleman well known to the votaries of science. In accordance with
the universal spirit of improvement he advocates reform, which none but
the monopolist will oppose. This little essay does him great credit. We
shall notice it more fully hereafter.

10. Two Lectures on the Study of Anatomy and Physiology, delivered at the
opening of the Medical Session, 1830, in the Medical School, Aldersgate Street.
By James Quain, M.B., Lecturer on Anatomy and Physiology. London. 1830.
8vo. pp. 44. Simpkin and Marshall.

*** These Lectures abound with important information.

11. The London University Calendar for the Year 1831. London. 1831.
12mo. pp. 264. John Taylor.

*** The London University Calendar was much wanted, as there was no
medium of acquiring information on the rules and courses of education
pursued in that unequalled Institution but through pamphlets and detached
statements, which were se eagerly sought for as to deprive the greatest part
of the public of an opportunity of seeing them. We are happy to state,
that this work is a. complete history of the University, and contains the
fullest account of every point relative to it, and will be perused with infinite
pleasure by every lover of science, and by every friend of civil and religious
liberty. It is impossible to speak in too high terms of the execution and
typography of this volume — -it is more like one of our beautiful Annuals
than an ordinary book. In fine, it is a work that neither library nor
respectable family should be without.

12. Illustrations of Mr. S. Cooper’s Surgical Dictionary, published monthly ;
containing four Lithographic Plates, with Letter-press descriptions and References
to the Text. London. 1830. Part IV.

A Third Edition of Sir Astley Cooper’s Lectures, by Mr. Castle, has just
appeared, but has reached us too late for further notice.

ERRATA IN VOL. V.

Page 529, for “ embrysology,” read “embryology;” cochianosology,” read
“ lochianosology “ cunes,” read “lacunes;” “ ovrager,” read
“ ouvrages.” In article “ On Signs of Utero-gestation,” in our last,
page 498, fourth line from bottom, ending “ affected with,” read on
to twenty-two lines from the top of page 499, beginning “ this disease.”

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

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

«■ - >

No. 32. FEBRUARY 1, 1831. Vol. VI.

CRITICAL REVIEW.

I. — A Supplement to the Pharmacopoeia, and Treatise on

hmacology in general, including not only the drugs
tfibtid preparations used by practitioners of medicine, but
also most of those employed in the chemical arts ; to¬
gether with a Collection of the most usef ul Medical For¬
mulae, Veterinary Drugs, Patent Medicines, and other
Compounds ; an Explanation of the Contractions used
. by Physicians and druggists ; and also a very copious
* Index, English and Latin , of the various Names by
which the articles have been known at different periods ;
being a complete Dispensatory and Look of Formulae
■ for constant reference in medical and veterinary Prac¬
tice, and Manual for retail Druggists. Fifth edition,
considerably enlarged, including the new French Medi¬
cines, and Selections from Foreign Pharmacopoeias, and
from the Formulae of British and Foreign Hospitals.
By Samuel Frederick Gray, Lecturer on the Materia
Mediea, Pharmaceutical Chemistry, and Botany. London,
1831, 8vo. pp. 576. Thomas and George Underwood.

t • * 1

II. — A new Supplement to the Pharmacopoeias of London,
Edinburgh, Dublin, and Paris ; forming a complete Dis-
pensatory and Conspectus ; including the new French
Medicines and Poisons, with symptoms, treatment "and
tests, as well as herbs , drugs , compounds , veterinary
drugs, with the Fharmacopoeia of th e Ve terinary College,
patent medicines , perfumery , paints, varnishes and simi¬
lar articles, kept in shojjs, with their compositions , imi¬
tations, adulterations’, and medicinal uses, .being a
general book of formulae and recipes , for daily ref erence

Vol, vi. no. 32.

Critical Review.

in the laboratory and at the counter. By J. Rennie,
A.M.A.L.S. Lecturer on Chemistry, Natural History, and
Philosophy, &c. &c. London, 1829, 8vo. pp. 488. Bald¬
win and Craddock.

III. — Observations , Chemical and Practical , on the Dub -
lin Pharmacopoeia, with a translation annexed. By F.
Barker, M.D. Professor of Chemistry in Trinity College,
Dublin; Honorary Fellow of King’s and Queens Col¬
leges of Physicians, &c. ; and William F. Montgomery,
A.M.M.B. Professor of Midwifery, in the King’s and
Queen’s Colleges of Physicians in Ireland, and Member of
the Royal Irish Academy, &c. Dublin, 1830, 8vo. pp. 7*21.
Hodges and Smith.

The subject of pharmacology has rapidly advanced within
a few years, and principally through the admirable work of
Dr. Paris ; but it is as yet in its infancy, and has much need
of further cultivation and improvement. The dispensatories
of professors Duncan and Thomson, the pharmacologia of
Dr. Paris, and the work of Drs. Barker and Montgomery,
with the supplement to the pharmacopoeias, by Dr. Spillan,
and Gray’s Supplement, are our best works upon pharmaco¬
logy.

Pure coincidence has placed the works, whose titles are
inserted at the head of these remarks, in juxta position, for
though apparently synonymous, they are as dissimilar as
possible. The first on our list has long retained its popula¬
rity with the profession ; and this we believe induced the
publication of the second. These works, however, are
widely different in arrangement, and in extent of information.
Gray’s Supplement contains an immense mass of useful mat¬
ter unnoticed by its rival; it comprises an account of all
productions of the vegetable, mineral and animal kingdoms
employed in the practice of medicine, a large variety of ex¬
temporaneous prescriptions, which have been long approved
of in practice, and which have been selected from the phar¬
macopoeias of foreign countries, and from formulae used in
British and foreign hospitals. The present edition is con¬
siderably emended and improved, and is creditable to the
industry, research and practical knowledge of its editor. The
doses of medicines are accurately and faithfully given,
which wre regret to state is not the case in the other produc¬
tion. Though Gray’s Supplement is a very heterogeneous
production, a list of drugs, simples, nostrums, many of which

Gray’s Supplement to the Pharmacopoeia.

are useless, and long since banished from the pharmaco¬
poeias, yet the trade of newspaper puffing- is so very pro¬
fitable at the present period, and the gullibility of the public
being ample as ever, it behoves those engaged in the prac¬
tice of medicine to have some work of reference, for inform¬
ing themselves of the composition of the innumerable nos¬
trums, so ardently employed by their patients. The best
work for such reference is Gray s Supplement. It con¬
tains the- scientific names of all medicinal substances in
our pharmacopoeias, and in use ; the English and officinal
Latin names of all medicines, chemicals, &c. are given. The
vegetable medicines are arranged according to Jussieu. In
a word, it embraces every topic mentioned in its title page.
A very copious English and Latin index is added, which af¬
fords a ready reference. It contains nearly 200 pages more
than Mr. Rennie’s production. It is a work that ought to
find a place in every medical library, and affords a fund of inter¬
esting information to the general reader. We can state with
perfect confidence, that the effects of medicines are accu¬
rately described, and the doses correctly given, and, as a
system of pharmacology, it will be wrorthy of attention. It has
been revised and adapted to the present state of science, by
a physician of great talent and extensive experience.

Mr Rennie, though not a medical practitioner, has under¬
taken the task of publishing a supplement to the pharmaco¬
poeias, and has spoken upon the effects of medicines, with as
much confidence as if he was the president of the College of
Physicians. He has even dissented from Dr. Paris on the
effects of the superacetate of lead, and happens to be as
wrong as he possibly could be. However well-informed he
may be on the science of chemistry, we must candidly ob¬
serve he knows nothing of medicine. In proof of this asser¬
tion, we call the reader’s attention to the following statement,
as to the doses of tartarized antimony, given from grs. ij. to
oj.asan ordinary drink, or even 3i. diffused in oij. of water, p.28.
This dangerous blundering will of course beputto the account
of the printer, but such an excuse cannot be received; a mis¬
take so serious is unpardonable. We need scarcely observe that
Rasori, Eorda, and Laennec, recommended the medicine very
differently in inflammation of the lungs, as appears by our
analysis of the report of Drs. Graves and Stokes in our last.
Our anthor has made the following discoveries: — ei Prussic
acid is a tonic and antispasmodic,” oxalic acid is refreshing
and slightly diuretic, in doses of |||x. to tuxx. diluted with
water, in which form I have myself often used it as a com¬
mon drink,” This we believe is the first time that a solid has

Critical Revieic.

been measured by the minim glass, and also the first time
oxalic acid has been used internally as a common drink.
Again, “ Agrimony is subaromatic. ”

Chlorine (aqua oxymariatica) is used in syphilis, typhus
and scarletina not a word concerning its disinfecting pro¬
perties, or of its effects in hydrophobia, for which it is con¬
sidered a specific in Italy, (Brugnatelli, Valetta,) or in
phthisis. “ Argenti nitras, is used from gr. ij. or 5j. into 5\j -
of water, in fistulas, venereal sores, scrofulous, ulcers, &c.”
Liquor opii. sedativus, is composed of tartaric acid and dregs
of tine. opii. is a mild narcotic” (sedative.) It is generally
supposed that this preparation is an acetous solution of
opium, deprived of narcotine. It is far inferior to the old
black drop, and must be given in a much larger dose than
advised by its proprietor. We have found it so uncertain
that we have ceased to employ it, and we know a gentleman
who has exhibited 120 m. of it, to produce a sedative effect.
Unusual effects of lytta, “ when it is used to vesicate, it some¬
times produces strangury, hmmaturia, and inflammation of
the bladder and urethra, which ought to be treated with
warm bathing, fomentations, and emollient drinks.” Those
engaged in medical practice, scarcely ever observe effects
requiring warm bathing or fomentations. Among the many
good qualities of digitalis, it is prescribed ff in gonorrhoea.’ *
Here is a discovery with a vengeance. Hydrargyri oxymu-
rias is acrid, styptic, corrosive, stimulant alterative and an -
tisiphilitic , and is used as a powerful remedy in sip hi l is and
cutaneous disorders.” The dose of hydriodate of potas is
stated, but no disease is mentioned. ee Liquor opii sedati¬
vus is imitated by mixing siss. of opium with Bvx. of pure
water, and 5j. of pyroligneous acid; dose, six to ten drops or
more. (Dr. Epps.)” Here we have the testimony of Dr. Epps,
lecturer on chemistry and materia medica, in favour of the
opinion which we expressed above, and in opposition to the
assertion that tartaric acid is the menstruum of the sedative
liquor.

Our author has given the following directions as to the
employment of superacetate of lead : —

“ Internally it is a powerful, but unquestionably a ha¬
zardous astringent in protracted diarrhoea, and obstinate
haemoptysis, and internal haemorrhage of the lungs, uterus,
stomach, &c. In desperate cases it ought not to be omitted ;
but notwithstanding the authority of Dr. Paris, I must enter
a strong protest against its exhibition till every safer means
has been unsuccessfully tried. When it is resolved to give

Rennie's Supplement to the Pharmacopoeias , 85

it, opium must be conjoined with it, (say gr, ss each of
acetate of lead and opium in form of pill) to prevent
spasm and paralysis. Care must also be taken not to give
with it, nor after it, any acids, astringent infusions, sul-
phates, none in short of the incompatible substances, unless
it have been incautiously given in an overdose.” — p. 330.

Every practical physician can bear testimony in favour
of the efficacy and safety of superacetate of lead in haemor¬
rhages from the lung’s, stomach, bowels, (dysentery) and
uterus ; and thus Dr. Paris is amply supported by the pro¬
fession. Besides, Professor Thomson, of the London Uni¬
versity, has recently published the results of experiments
on the medicine ; and states, that the danger consequent to
its use, is to be ascribed to the conversion of the super¬
acetate into a carbonate. He therefore advises the use of
dilute acetic acid, either in combination with the remedy,
or immediately after it, and affirms that no bad effects can
supervene. We have already recorded our opinion in favor
of the extraordinary effects of superacetate of lead in the
diseases already named, but more especially in dysentery
and menorrhagia. We have commenced with small doses
combined with opium, and urged them until ten grains of
lead were administered. In obstinate cases of haemoptysis,
we have used the remedy in combination writh distilled
water, acetic acid, and tincture of opium, and urging it to
a scruple daily without any injurious effects. Its value and
safety, as an astringent, have been too often and so recently
attested, that it is unnecessary to notice them further. But
we cannot help thinking, that Mr. Rennie might have been
less strenuous in his protest against Dr. Paris’s opinion.
Our author, however, thinks otherwise, as he repeats his
dissent from the same eminent pharmacologist, in describing
potassee nitras. Dr. Paris surely mistakes, when he says
it is an inconsiderable diuretic.” Indeed, Mr. Rennie is truly
mistaken, as the remedy is seldom, if ever, used as a diu¬
retic, from its well-known inefficiency. <f Dr. Paris is
mistaken, in mentioning lime amongst the incompatibles,”
(with potas. sulphas.) at least, it is not so in its aqueous
solution, though barytes is so.”

A few of the characters of the secale cornutum are de¬
tailed, and, it is said, on good authority — it promotes tardy
parturition. The mode of exhibition is not mentioned ; but
we are informed that 3j. boiled in a quart of water, to
one pint, the half of which is given in divided doses during
one day, as an emmenagogue. This dose is much too large.

Critical Review.

and might be productive of serious results ; the maximum
dose being two drachms., even during parturition. In speak¬
ing of strychnine,, there is no mention made of the favor¬
able report of Dr. Bardsley, of Manchester. Had the
author been a medical man, he would not have omitted the
very valuable and highly important observations of that
talented physician. We shall not proceed further, and
dismiss the work by stating, that it contains many formi¬
dable errors. Whether these be typographical or not, we
cannot determine ; but certain it is, that they may be pro¬
ductive of great injury, should the work fall into the hands
of the uninitiated in our profession. The author must, or
ought to be aware, that he who is not a medical prac¬
titioner, should be cautious in quoting Mr. Brande, the
chemist, as a supporter of his own views on the operation
of medicines, against such eminent and experienced phy¬
sicians as Professor Thomson and Dr. Paris. He cannot
seriously suppose that the well-informed medical practi¬
tioner will agree with him in such a preposterous idea. We
would remind him of the old adage, te ne sutor ultra cre-
pidam.” We must also take leave to inform him, that his
conspectus of prescriptions in medicine, surgery, and mid¬
wifery, to which he so often alludes in the work before us,
is replete with errors ; in some parts we have observed the
^ for the 5, and in many parts the Latin quite barbarous.
As the advocates of humanity and science we make these
remarks, for we are ready to acknowledge both works
contain much information, disfigured by gross errors.

We now come to a work of sterling value, and have to
apologize to its authors for placing it in such bad company.
We have already stated our reason for doing so. Drs. Bar-
ker and Montgomery are very favourably known to the pro¬
fession by their valuable publications, and both eminently
qualified to execute the task they have undertaken. The
present conjoint production consists of two parts. The first,
by Dr. Barker, consists of observations, chemically and
practically, on that part of the last Dublin pharmacopoeia,
1826, devoted to the acids, alkalies, earths, alkaline, and
earthy salts, sulphurous and metallic preparations. The
second part, on the preparations, expressed oils, essential
oils, distilled waters, preparations of ether, spirits, tinctures,
medicated vinegars, wines and honies, confections and con¬
serves, syrups, inspissated juices, extracts, powders, pills,
electuaries, ointments, plasters, extemporaneous prepara-

Barker and Montgomery on Pharmacopoeia . 87

tions, and miscellaneous ’'preparations, is consigned to Dr.
Montgomery. Dr. Barker, , as an experienced physician,
and Professor of Chemistry, in Trinity College, Dublin, is
well qualified to perform the duty of commentator on the
chemical part of the pharmacopoeia ; while Dr. Montgomery,
also an experienced physician, and Professor of Midwifery,
in the King’s and Queen’s College of Physicians in Dublin,
is too favourably known to the profession to require an in¬
troduction from us. These are the men to write on phar¬
macology, and not mere chemists. But thanks to the Lon¬
don College of Physicians — all who please may assume
the title and character of physician, and instruct the faculty,
in this city of cities, in the science of therapeutics, while
they deride the framers of the College pharmacopoeia,
notwithstanding the order of the king and council in its
favour made and obtained. Such is the respect shewn col¬
legiate dignity and royal authority in this age of intellect.
It is said the Schoolmaster is abroad,” and it is ardently
hoped, and a consummation devoutly to be wished,” he
may, in the course of his perambulations, stumble upon
our tottering medical corporations, and crumble them to the
dust, for their outrageous insolence, and utter disregard to
the wishes and wants of the great body of their ill-treated
and indignant members. Viewing with heartfelt pleasure,
the career of this potent personage in every other direction,
and the mighty changes he is about to effect in all anti¬
quated and defective institutions, we are confident that
those in question will very speedily be carried along with
the universal progression of improvement. The hour has
not yet expired, which is favourable for the exertion of
liberal views, by those who ought to feel an interest and a
pride in promoting good feeling in the profession ; but the
ignoble spirit of monopoly and of abuse, renders them
insensible to the loud calls of moral justice. They hesitate
to lose their tawdery and puerile ascendancy ; but surely
they cannot suppose their members are insensible to the
superior position in which the faculty is placed in other
nations. If we look to the history of the London College
of Physicians, and especially to that part which relates to
their pharmacopoeia, we find (and we indite it with sorrow,
but with truth) they have ever been in the rear of the march
of science. If our contemporaries had only spirit to speak
the truth, and that openly, the medical rulers m England
would cease to be behind all their contemporaries in other
nations, and would occupy that superior position* which

Critical Review.

their country has proudly and honorably maintained for
ages, in science, literature, and the arts. Enough ; we are
grieved to be obliged to make these remarks, but they have
been elicited by the lamentable fact, that the profession of
medicine amongst us stands still, while in most other coun¬
tries it has been allowed to precede us.

The Dublin Pharmacopoeia is the latest which has been
published in these countries, and, unlike those of London
and Edinburgh, it has kept pace with science, and embraces
many potent remedies omitted in the London code of 1824.
It is still further enhanced by the very valuable observations
of the commentators before us. They have added the most
recent opinions of British and foreign writers, and also
attested many facts by their personal testimony. We hasten
to insert some extracts, to afford the reader strong evidence
of the value of this publication, and of the able manner
in which it has been executed.

“ Distilled Vinegar. — Take of wine-vinegar by measure, ten parts.
• — Distil with a slow fire, by measure eight parts. In the distillation
glass vessels should be employed, and the first portion which comes
over, in quantity amounting to one part, rejected.

“ The specific gravity of this acid is to that of distilled water as
1005 to 1000.

“ Remarks. — The preparation here directed is that of acetic acid
largely diluted with water.

“ Vinegar, a product of acetous fermentation in a vinous liquor, is
an impure compound, containing, with acetic acid and water, also
vegetable mucilage, gluten, sugar, extractive matter, often some
malic and tartaric acids, and a minute portion of tartar, with a small
quantity of alcohol and pyroacetic spirit. Microscopic insects are ge¬
nerally present in wine-vinegar.

“ To obtain the diluted acetic acid, detached from impurities, and
to obviate the decomposition which vinegar when long kept, under¬
goes, is the object of the present process. Of the different ingredi¬
ents of vinegar, some are volatile, and rise when the fluid is heated
to near 212°. The volatile ingredients are alcohol, pyroacetic spirit,
acetic acid, and water. Of these the alcohol and pyroacetic spirit are
the most volatile, and when vinegar is distilled, rise w'ith the first
portions of vaporized compound. For this reason we are directed to
reject the first portion, or of the whole fluid employed one tenth part,
as this contains the alcohol and pyroacetic spirit. By proceeding
with the distillation, and distilling seven parts more, we obtain a
large proportion of the pure acetic acid united to water. The pro¬
cess is then to be stopped, lest the impurities should pass over and
contaminate the distilled vinegar ; this will happen if the heat rises
to the degree which occasions decomposition, in which case an em-
pyreumatic flavour will be given to the product.

Barker and Montgomery on Pharmacopoeia.

“ A stronger vinegar is obtained from wine than from liquors
merely saccharine, or produced by fermented malt ; for which reason
the vinegar of wine is directed in this process. White wines are
found to afford the strongest vinegar.

“ In the pharmacopoeia of 1807, six-tenth parts of the vinegar em¬
ployed were distilled over, the first tenth part being rejected; but ex¬
periment proved that on continuing the distillation, the diluted acetic
acid which then came over was as strong as that which had preceded
it, and equally free from empyreuma : it was therefore thought ad¬
visable to increase the proportional quantity to be distilled over, leav¬
ing a smaller residue in the retort, and rendeiing the process more
productive.

“ In this process the use of glass vessels is directed, as the vine¬
gar would dissolve a portion of a metallic vessel if composed of the
metals usually employed, lead, iron, or copper. Lead dissolved in
the vinegar may he detected by the addition of water impregnated
with sulphuretted hydrogen, and by a solution of sulphate of soda:
the first of these re-agents producing a brownish coloured precipitate
of sulphuret of lead; the second a white precipitate of sulphate of
lead. Iron is ascertained to be present by a solution of prussiate of
potash, which gives a blue tinge to the acid, or affords a blue preci¬
pitate. The presence of copper is indicated by a clean plate of iron
immersed in the acid, a rose-coloured coating of copper appearing on
the surface of the iron. Copper is also discovered by adding water
of ammonia till the alkali predominates in the mixture, in which case
an azure blue colour appears.

“ Properties and tests of its purity. — Distilled vinegar should have
an agreeable acid smell and taste. It should form soluble salts with
the alkalies and alkaline earths and with the oxide of lead ; but with
protoxide of mercury, a salt of sparing solubility.

“ Vinegar is often adulterated by means of sulphuric acid. This
may be detected by the addition of a baiytic salt, which will afford a
precipitate insoluble in nitric or muriatic acid. This impurity is often
present, as the preparer is allowed to mix one thousandth part of sul¬
phuric acid with the vinegar. Whether the sulphuric acid detected
by the barytic salt exists in the vinegar in a disengaged state, or in
combination with a fixed alkaline base, may be ascertained by eva¬
porating the vinegar to one-seventh or one-eighth of its original
volume; dividing the residue into two portions, neutralizing one of
these with pure carbonate of lime, separating the liquor from the un-
dlssolved part of the mixture, and having ascertained whether the
base of the salt contained in the dissolved part is potash or soda, de¬
compounding the solution by addition of a dissolved barytic salt, the
precipitated sulphate when collected, dried, and weighed, making al¬
lowance for the sulphate of lime which is present, indicates the quan¬
tity of sulphate of potash or soda. The quantity of free sulphuric
acid in the other portion, may be determined, by adding an
aqueous solution of a salt of baryta sufficient to throw down the

Vol. VI. no. 32.

Critical Review.

whole of the sulphuric acid; the difference between the weight of
this and of the former precipitate when dried, will give the quantity
of disengaged sulphuric acid.

“ Muriatic acid is detected by adding nitrate of silver, which pro¬
duces a white precipitate assuming a pearl colour on exposure to light
and dissolving in water of ammonia.

“ The presence of nitric acid may be ascertained by addition of a
mixture of diluted sulphuric and muriatic acids, through which gold
leaf has been diffused ; for if nitric acid is present, on applying heat
the gold will be dissolved, the liquor will acquire an orange yellow
tinge, and afford a purple precipitate with fresh prepared muriate of tin.

“ Sulphureous acid is sometimes present in distilled vinegar.

“ An impure vinegar of a brown colour and strong empyreumatic
smell, is prepared by exposing wood to heat in large iron cylinders ;
it is commonly named pyrolignous acid. From this a pure acetic
acid, exceeding in strength the vinegar of commerce, is obtained.
Different means are employed for this purpose. The following was
practised with advantage. An acetate of lead was prepared with the
impure acetic or pyrolignous acid, and the salt, purified by crystalli¬
zation and dissolved in water, was decompounded by a solution of
sulphate of soda. The acetate of soda thus obtained in aqueous so¬
lution, and separated from the sulphate of lead was mixed with sul¬
phuric acid, and the diluted acetic acid obtained by distillation of the
mixture in glass vessels.

‘ ‘ Specific gravity is an insufficient test of the strength of common
vinegar, which varies in its specific gravity from 1010 to 1025. A
part of this increased specific gravity, in common vinegar, is derived
from mucilage and saline matter; on the other hand, the specific gra¬
vity of distilled vinegar is not unfrequently diminished by the pre¬
sence of that peculiar fluid named pyroacetic spirit, into which acetic
acid, when united to a base, and exposed to heat is convertible. Py¬
roacetic spirit is known by these characters : it is of specific gravity
786, when rectified from dry muriate of lime; it boils at 138° of
Far.; it is combustible, burning with a blue flame and a peculiar
smell, and it unites in every proportion with water, alcohol, the fixed
and volatile oils.

“ The specific gravity of both common and distilled vinegar may
also be diminished by the presence of alcohol. Hence it is evident
that specific gravity is not a rigidly accurate test of the strength of
these acids. It has been ascertained that neither pyroacetic spirit nor
alcohol are present in any sensible quantity in the distilled vinegar as
obtained by the process of this pharmacopoeia. The most certain
test of the strength of distilled vinegar is the quantity of carbonate of
lime or dry carbonate of soda required to neutralize a known wreight
of the acid, it being premised that 50 parts of real acetic acid neutralize
50 parts of carbonate of lime, and 54 parts of dry carbonate of soda.

“ 100 parts of distilled vinegar, of specific gravity 1005, require 5.2
parts of dry carbonate of soda for neutralization, and therefore con¬
tain 4.81 parts of real acetic acid.

Barker and Montgomery on Pharmacopoeia. 91

“ Uses. — Pharmaceutical. Distilled vinegar is employed in the
preparation of several of the acetates ; of potassse acetas, sodse acetas,
hydrargyri acetas, plumbi subacetatis liquor, and in the preparation
of the compounds included in the class of aceta medicata; viz. aci-
dum aceticum camphoratum, acetum colchici, acetum opii, acetum
scillse.

“ — Medicinal. It is sometimes given internally as a refrigerant,
and mixed with water may be used as a diluent drink in cases of in¬
flammatory fever; but for this purpose common vinegar is preferable,
its flavour being more grateful than that of distilled vinegar. Acetic
acid, either as distilled vinegar or in the more concentrated form, in¬
creases the solubility of acetate of lead in water, and may be added
to solutions of this salt, to prevent the decomposition which arises in
neutral acetate of lead from exposure to carbonic acid. Either dis¬
tilled or common vinegar is supposed to produce some anti-narcotic
effect; on the contrary, Orfila found it to increase the activity of
opium taken into the stomach ; this might be expected from the na¬
ture of those principles on which the powers of opium depend; their
solubility and action being increased by union with the acetous acid.

“ In cases of diseased digestive and urinary organs, attended by a
deposition of the phosphate of lime or of the ammoniaco-magnesian
pyhosphate in the urine, diluted acetic acid is beneficial. In obstinate
constipation, vinegar is administered with advantage as a glyster. It
is also a useful fomentation in cases of burns or sprains. Its vapour
is inhaled with benefit in putrid sore throat, and it has been pro¬
posed on obvious principles for removal of the dust of lime from the
eyes.

“ Dose. — Of distilled vinegar, from one drachm to half an ounce.”

— p. 26.

All the acids are treated with the accuracy and fidelity
apparent in this extract. After a description of the rationale
of the formula, and changes effected in the formation of
nitric acid, its medicinal properties are thus detailed : —

“ It is given internally as a tonic, and is supposed to have consi¬
derable efficacy in restraining the progress of syphilis. With this in¬
tention it was first given by Dr. Scott of Bombay, who found that its
action on the human system resembled that of mercury, in producing
soreness of the gums and salivation. That it is useful in restraining
the progress of venereal ulceration, and restoring the strength,
when broken down by the use of mercury, is certain, although it will
not effect a radical cure of syphilis. In some liver diseases, as these
appear in India, it is deemed benefical, and given much diluted with
water, so as to form an acidulous drink, it was found useful by Dr.
Duncan in the low typhous fevers that occasionally prevail in the su¬
burbs of Edinburgh.

“ Its fumes disengaged from nitre by strong sulphuric acid, are
supposed efficacious in destroying the contagious effluvia of typhus or

Critical Review.

other febrile diseases. Dr. Carmichael Smith received from the
British Parliament £.5000 for the introduction of this mode of disin¬
fection. It may be put in practice by passing into aflat earthen ves¬
sel, placed in hot sand, half an ounce of nitre reduced to powder,
and pouring on this about half its weight of strong sulphuric acid or
oil of vitriol; the nitrous fumes are immediately disengaged, and are
not so offensive to the inmates of the dwelling as other vapours are,
more especially those of chlorine. Dr. Duncan asserts, in his last
valuable edition of the Edinburgh Dispensatory, that the above men¬
tioned quantities of nitre and sulphuric acid will fill with vapour a
cube of ten feet; therefore by increasing, in proportion to the size of
the room, the number of vessels containing the fumigating materials,
the acid vapours may be completely diffused through every part of
the open space of an apartment, but unless with particular care, the
fumes can scarcely be brought into contact with clothes shut up in
drawers or boxes, or with the interior of bedding, and to such arti¬
cles contagion is supposed, and with a high degree of probability to
adhere. That the vapours of nitric acid, as some physicians have
supposed, are altogether inefficacious, can scarcely be admitted when
we bring to mind that infectious effluvia are probably, in composition,
similar to other animal substances, and on these nitric acid has a
powerful action, and completely alters their chemical qualities. But
although we should concede to nitrous fumigation the power of di¬
minishing contagion, its superiority over ventilation and cleansing is
by no means established, and it should not supersede the use of these
preventives when practicable. Nitric acid has been used as an es-
charotic, and proposed as a good application to the part bitten by a.
rabid animal, with the intention of destroying the animal texture and
altering the poison ; whether this practice should be preferred to ex¬
cision, experience alone can decide, for on its first application it may
accelerate the absorption of the poison, and in this respect prove
rather injurious than serviceable.” — p. 52.

The following remarks on prussic acid are highly im¬
portant : —

“ Prussic acid. — Take of cyanuret of mercuiy, an ounce, muriatic
acid, by measure, seven drachms, water, by measure, eight ounces.

“ Distil into a refrigerated receiver, eight ounces by measure, to be
kept in a well corked bottle, in a cool and dark place.

“ The specific gravity of this acid is to the specific gravity of distil¬
led water, as 998 to 1000.

“ Remarks. — In this process the cyanuret (or cyanide) of mer¬
cury is decompounded by the muriatic acid ; the hydrogen uniting
with the cyanogen, and changing it into prussic acid which rises and
passes over into the receiver ; the corrosive muriate or chloride of
mercury remains in the retort, and as the residual liquor cools, de¬
posits its usual spicular crystals. The changes which take place in

Barker and Montomery on Pharmacopoeia.

this instance, and the atomic quantities transferred, are represented
in the following scheme : —

Materials.

1 Mercury —

200

2 Chlorine

= 72

2 Cyanogen =

2 Hydrogen

= 2

1 Bicyanide of Mer¬
cury =

2 Muriatic Acid

252

Products.

= 74

2 Cyanogen =

1 Mercury

= 200

2 Hydrogen =

2 Chlorine

= 72

2 Prussic Acid Vapour =

1 Bichloride of Mer¬
cury

= 272

“ On reference to the tables of muriatic acid, it will be found that
74 parts of muriatic acid gas are contained in 229.8 parts of liquid
muriatic acid, of specific gravity 1160; consequently 480 grs. or one
ounce of cyarunet (bicyanide) of mercury, will require 437 grs. of the
same liquid acid for complete decomposition, which is but a little less
than the quantity directed in the pharmaceutical process ; the weight
of 7 drs. by measure, of muriatic acid of specific gravity 1160, being
462.8 grs.

“ An experiment was made in which equal weights of cyanuret
(bicyanide) of mercury and muriatic acid were employed. The
prussic acid yielded by this process reddened litmus paper, and gave
a precipitate with solution of nitrate of silver. The quantity of mu¬
riatic acid used in the latter case, is more than sufficient for the de¬
composition of the bicyanide of mercury. The quantity of liquid
prussic acid, formed by the process of the pharmacopoeia as above
given, amounted to about 7 oz. 5 drs. It had the specific gravity of
998 and was consequently much diluted with water, which, with an
agent of such great activity, is an advantage, as its dose can be ap¬
portioned with more exactness than if the acid were stronger. By
several other processes it may be obtained of much greater strength,
but no advantage is thereby gained, as it cannot be administered in
the concentrated state, but must in every case be diluted. The main
object is to obtain the -whole of the hydrocyanic acid from the ma¬
terials, and of a certain fixed strength, whilst the dilution with water
assists the exact regulation of the dose.

“ Tests of its purity. — The pure liquid acid is limpid and colour¬
less. It has a strong smell, which causes much irritation in the nos¬
trils, with a peculiar sensation extending downwards into the trachea ;
and if inhaled incautiously, and in large quantity, producing giddi¬
ness or faintness. The latter effect is, however, more likely to arise
from a strong acid than from the dilute acid of this pharmacopoeia.
Its taste is peculiar, resembling that of bitter almonds or laurel leaves.

Critical Review.

The attempt to taste it should be made with great caution, as it is a
most active poison.

“ The specific gravity of water is diminished by absorbing prussic
acid vapour, in which respect this acid resembles ammonia. There¬
fore specific gravity affords an estimate of its strength; the less the
specific gravity the stronger the liquid acid. But according to the
experiments of Dr. Ure, specific gravity is not a rigorously exact
criterion of the strength of liquid prussic acid. He states that liquid
acid at specific gravity 996, contains about double the quantity of real
acid which it does at specific gravity 998. Dr. Ure proposes as a
more accurate mode than specific gravity, for determining the quan¬
tity of real prussic acid in water, the use of the red oxide of mercury
prepared by nitric acid ; the nitric oxide of mercury of this pharma¬
copoeia. To apply this test, some of the oxide should be reduced to
fine powder, dried with a moderate heat, and about forty or fifty
grains of this powder carefully weighed : one hundred grains by mea¬
sure , of this acid, of specific gravity previously determined, passed
into a glass tube, and the pulverized red oxide gradually added, which
on agitation readily dissolves so long as any disengaged prussic acid
is present; the difference in the weights of the residual red oxide
and of that originally taken gives the weight of the portion dissolved
by the prussic acid.

“ The real prussic acid, corresponding in quantity to the red oxide
of mercury dissolved, is found by viewing the changes thus ; a bicya¬
nide of mercury is formed, as given in the preceding scheme ; two
atoms of the oxygen contained in the peroxide of mercury, uniting
with two atoms of hydrogen in the prussic acid to form water, and
two atoms of cyanogen with one of mercury, to form bycianide of mer¬
cury. Hence it follows, that every 216 parts of peroxide of mercuiy
indicate 54 parts of prussic acid vapour, or that the prussic acid is ex¬
actly l-4th of the weight of the peroxide of mercury, and therefore
for every four parts of red oxide of mercury dissolved, one part of
prussic acid existed in the liquor.

“ Dr. Ure observes that specific gravity is a criterion of greater
nicety than can be conveniently used by the majority of practitioners,
and he proposes to substitute for it the above application of peroxide
of mercury. He has constructed a table, in which, as may be infer¬
red, the quantity of real prussic acid contained in the strong liquid acid
of specific gravity 9570, was ascertained by means of the peroxide of
mercury ; and with which strong acid, by addition of successive por¬
tions of water, mixtures of decreasing specific gravities, each contain¬
ing the known quantity of real prussic acid, were prepared.

“ The prussic acid of this pharmacopoeia should have the sensible
qualities above described, and 100 parts of it by weight, should dis¬
solve a little less than 6.4 parts of red oxide of mercury, reduced to a
fine powder; and therefore contain 1.6 of real prussic acid.

. “ An exact mode of detecting small quantities of prussic acid is
of great importance, more especially when the acid has acted as a
poison. In water it may be detected, according to Dr. Ure’s expe-

Barker and Montgomery on Pharmacopoeia, 95

riments, by making the liquid containing the prussic acid slightly al¬
kaline by potash, adding a few drops of a solution of the sulphate of
copper, and then sufficient muriatic acid to re-dissolve the excess of
oxide of copper. The liquid will appear more or less milky, accord¬
ing to the quantity of hydrocyanic (prussic) acid present. A quan¬
tity of this acid in water, not exceeding a 1 -20000th of the mixture,
may be discovered by this test.

‘ ' Should the prussic acid be contaminated by muriatic acid, which
will happen if too much of the latter acid was used in the process
of preparing the prussic acid ; this can be ascertained by neutralizing
the liquor with ammonia, and evaporating with a heat, at the end of
the process not exceeding 212°. If muriatic acid was present, mu¬
riate of ammonia will remain.

“ Prussic acid may be purified from muriatic acid, by adding a
small quantity of bicyanide of mercury, and re-distilling the mix¬
ture.

“ Uses. — Pharmaceutical. It is not applied to any pharmaceuti¬
cal use, according to this pharmacopoeia. In the Parisian codex me*
dicamentarius, a syrup is directed to be prepared with prussic acid ;
but it seems injudicious to multipply preparations of a medicine so
active as prussic acid.

“ — Medicinal. — In the dilute state it is recommended as a re¬
medy in phthisis pulmonalis, and is reported to allay irritation and
diminish the frequency of cough, but its curative efficacy in this
disease is very doubtful. In simple dry cough, apparently connected
with spasm, it is said to be beneficial, and accordingly it is found oc¬
casionally useful in spasmodic asthma. In hooping cough it also af¬
fords some relief. It has been reported to calm the irritability of
the uterus even in cases of cancer, and to moderate the morbid acti¬
vity of the heart ; and it appears to have some specific action on mu¬
cous surfaces.

“ It may be useful here to advert to its poisonous qualities, for the
purpose of reminding the prescriber of the great caution to be ob¬
served in the use of this remedy. When applied in its concentrated
form to the tongue, fauces, eye, or even to the external surface, by
spreading it over the skin, it acts as a most virulent poison ; and in
the quantity of one or more drops, varying with the strength of the acid,
vigour of the individual, and his previous habits in respect to its use, it
causes immediate death. A single drop of a very strong acid passed
into the throat of a strong dog has caused it to drop dead, and an
animal is instantly killed by drawing a feather dipped in the strong
liquid acid across the eye ball. Scarcely any irritability can be de¬
tected in the muscles of animals poisoned by prussic acid. A suffi¬
cient dose of the more diluted acid of this pharmacopoeia would also
be destructive of human life ; the prescribe should immediately
desist from its use when giddiness, vomiting, pain and sense of
tightness at stomach, faintness, stupor, or sensations of weight at
the top of the head comes on.

Critical Review.

“ As remedies for the effects of this poison, when the quantity
swallowed is small, Orfila recommends that full vomiting should be
excited by twelve grains of sulphate of zinc, dissolved in a glass
of water, or by three or four grains of sulphate of copper ; then
strong coffee, prepared by infusion for ten minutes, a quart of boil¬
ing water on eight ounces of coffee, and then straining : three or
four table spoonsful of oil of turpentine mixed with the coffee, to
be given at intervals of half an hour. If stupor and insensibility
have come on, the immediate application of the stomach pump
should be had recourse to.

“ Dose. — From two or three drops to half a drachm, by measure.
The smaller dose to be commenced with, and gradually increased,
a sufficient time being suffered to elapse between each dose.” —
p. 63.

Dr. Barker gives an elaborate review of all the formulae
for the preparation of tartarized antimony, and proves
satisfactorily that the Dublin method is preferable to every
other. His comments on this article occupy six pages, and
are concluded by an account of its medical properties.
He observes,

“ In a moderate dose it acts as a diaphoretic or sudorific ; in lar¬
ger dose as an emetic and sometimes as a purgative. The first effect
is produced by this remedy, when given in doses below one-fourth of
a grain ; the second when the dose amounts to one, two, and three
grains. It has latterly been given, particularly in Italy and France,
in very large doses, amounting to from thirty or sixty grains or more,
dissolved in the merely sufficient quantity of water, restricting the
patient from the use of all drink whilst under its operation. In these
doses it is said to exert a sedative action, and to be a useful remedy
in inflammatory cases. It is much to be wished that those who have
given it in this manner, had stated the purity of the salt, determined
by experiments similar to those above described as tests of its purity ;
for if the salt employed was impure or adulterated, serious conse¬
quences might arise from the same application of a pure salt. The
effects seem to vary much, according to the constitution of the pa¬
tient. Twenty grains, or a little more, in some instances acted as a
poison, according to the testimony of Orfila. Dr. A. Duncan, of
Edinburgh, has found it to act as a sedative, and with good effect,
when given in doses of five grains where the powers of life were too
feeble to admit of blood-letting. When taken in large quantity, and
acting as a poison, it produces much vomiting and cramps in the
stomach ; Orfila recommends copious draughts of water sweetened
with sugar ; and if the pain should continue, a grain of opium re¬
peated two or three times, at intervals of a quarter of an hour. It
is decompounded by infusion or decoction of bark ; and Orfila recom¬
mends this also as an antidote to its effects. Dr. Duncan tried with

Barker and Montgomery on Pharmacopoeia. 97

advantage a solution of sulphuret of potash for the same purpose. —
Thus it appears, that in very small doses not exceeding one-fourth part
of a grain, it acts as a diaphoretic, in doses of from one to four grains
as an emetic, and in doses not exceeding five grains, but in general
much below this quantity, its action is sedative ; but in these large
doses it should be used with caution. To cause vomiting, the most
effectual mode is to give it in half grain doses, repeated at intervals
of ten minutes until vomiting is produced. As an emetic, it is fre¬
quently given with advantage at the commencement of febrile attacks ;
as a diaphoretic also, it is given, oftentimes beneficially in such cases:
as a sedative, it is considered useful in cases of pneumonia or bron¬
chitis. It is also sometimes used as an external application, and then
it has the effect of producing a pustular eruption.” — p. 218.

The last extract which our space will allow us to make,
is the following : —

“ Taken internally, acetate of lead acts as a sedative astringent;
it is sometimes given in cases of hemorrhage from the lungs, and is
much used in France for this purpose. In dysentery also it has been
frequently prescribed, but the writer has often tried it in the advanced
stages of this disease, with but little benefit; in these cases it is
generally given combined with opium. It is said to have been em¬
ployed successfully in the treatment of epilepsy.

“ Although acetate of lead is poisonous when its use has been long
continued, yet some peculiarity of constitution or unknown external
circumstance is required to give it activity, for, large quantities have
been accidentally swallowed without any bad effect. That it is
poisonous, the production of saturnine colic from the use of wines
containing salts of lead abundantly proves. Its poisonous nature is
also established by experiments on lower animals. Orfila asserts,
that dogs on whom its action in the solid form was tried, die in con¬
sequence of the corrosion it produces in the digestive canal, and that
when taken in the liquid form, having remained in the stomach a
time sufficient for absorption, its fatal effects depend more upon its
action on the nervous system than on the inflammation it occasions.

“ Acetate of lead is a useful external application; made into a
poultice with crumb of bread, its aqueous solution is often applied to
moderate inflammatory action. It is also frequently used as a colly -
rium. The decomposition which takes place in its solution in conse¬
quence of the absorption of carbonic acid from the atmosphere, may
be prevented by the addition of a quantity of distilled vinegar suffi¬
cient to produce a slight excess of acid in the liquor.

“ Dose. — From half a grain to two grains.” — p. 304.

We have now enabled the reader to form his opinion
upon the manner in which Dr. Barker has executed his task ;
in our estimation he has done much credit to himself, as
well as to the university to which he belongs. Like a true

VOL. VI. no. 32.

Critical Review.

votary of science, be has avoided all personality, and merely
contented himself by defending the principles maintained
in the pharmacopoeia, which he assisted in preparing.

He has displayed no special pleading, but a truly sci¬
entific view of every subject he has discussed. We part
with him on terms of high respect, and congratulate him on
the candour, research and ability he has evinced in treating
of subjects so much disputed. He has contributed his por¬
tion to an exceedingly interesting work, and afforded ample
proof of his sound practical knowledge as a physician, and
his very great acquirements as a scientific and practical
chemist. He is intimately acquainted with the most difficult
chemical manipulations, and is quite conversant with the
recent opinions on this branch of medical science. His fre¬
quent citations of the opinions of his venerable predeces¬
sor, Dr. Percival, will be exceedingly agreeable to his pro¬
fessional brethren in Ireland, as paying a just tribute to the
profound knowledge, indefatigable industry, and genuine
talents of that eminent individual. Dr. Good has also done
him justice in his imperishable work ; and never was there
a physician who had fairly arrived at the summit of his pro¬
fession, in a large city, more entitled to the esteem and
veneration of his profession. He has long since retired from
the practice of medicine, and is no longer sensible to praise
or censure. We are not much in the habit of lauding the
faculty, but we are ever ready to pay a just and well
merited tribute of respect to the few who deserve it. We
give to Caesar what belongs to Caesar. We have not the
honour of Dr. Percival’s acquaintance — we speak of him as
his estimable merits deserve. He was the Baillie of Dublin.
We therefore return our best thanks to Dr. Barker, whose
benevolence needs no eulogy from us, for his allusion to
that universally respected individual.

We shall now exhibit specimens of the manner in which
Dr. Montgomery has executed his part of the work, and,
we think, convince our experienced readers that the pro¬
duction before us is well worthy of place among our best
treatises on pharmacology. The latest improvements have
been added, so that in fact this is the most recent work upon
the subject. Had the commentators included the London
and Edinburgh pharmacopoeias, then Dublin might boast
of as good a dispensatory as any extant. The work, how¬
ever, in its present shape, is one of great utility to the
pharmaceutists in Ireland, and will be referred to with ad¬
vantage by every man engaged in the practice of medicine

Barker and Montgomery on Pharmacopoeia. 99

in these countries. We strongly recommend it to every
class of our readers. The following extracts will afford
evidence in corroboration of our opinion : —

“ As the croton tiglium is now for the first time admitted into the
list of the materia medica of this pharmacopoeia, it appears proper
to notice here the expressed oil obtained from that plant, now much
used, and known by the name of Croton oil.

“ Remarks. — The plant yielding the seed from which croton oil
is obtained, is a native of the Molucca Islands,

“ The seeds which are contained in trilocular capsules, are about
the size of a large coffee bean, and very much resemble in form the
castor oil nut, and the plants belong to the same natural family.
The seeds were formerly much used in medicine under various
names ; they are the nucula cathartica of Geoffrey, by others they
were called pinei nuclei Moluccani purgatorii, and still more fre¬
quently grana Molucca, or grana tiglia ; but they fell into disrepute,
owing to their violently drastic effects, and were almost forgotten
until attention was again directed to them by Dr. Ainslie, in his
Materia Medica of Hindoostan. 100 parts of the kernels of the
seeds, when bruised, yield 60 parts of acrid oil, and 40 of farina¬
ceous matter.

“ Qualities. — Croton oil is of a pale reddish brown colour. Its
taste is hot and acrid ; it is soluble in ether and oil of turpentine.
Alcohol takes up two parts out of three, and the solution possesses
the active properties of the oil ; much of what is taken up by the
alcohol is fixed oil. From the experiments of Dr. Nimmo, croton
oil is composed of 45 parts, of an acrid purgative principle, and 55
of fixed oil resembling the oil of olives, and not possessed of any
cathartic property.

“ Dr. Nimmo has also shewn that this acrid principle is resinous,
and soluble in alcohol, sulphuric ether, volatile and fixed oils, and
that ether and purified oil of turpentine dissolve the whole of the
oil ; from the knowledge of which fact we are enabled, by digesting
the kernels of the seeds in these menstrua, to obtain the oil in as
genuine and apparently in a more uniform condition, than by the
processes of torrefaction and expression practised in India.

“ M. Caventou obtained this oil by means of the action of alco¬
hol, at 100° Fahr. upon the kernels of the seeds reduced to a paste.
He allowed it to macerate for 48 hours, and then filtered ; he then
poured a second and a third quantity of alcohol upon the paste,
which he afterwards submitted to strong pressure ; the alcoholic
macerations were then placed in an alembic, and the alcohol drawn
off by distillation. The oil which remained in the alembic was
filtered through paper, and preserved in a stopper bottle.

“ MM. Vauquelin and Pelletier have made some experiments for
the purpose of isolating the active principle of this oil, but without
success. Dr. Paris thinks, that it bears a strong analogy to elatin

100

Critical Review.

and from the experiments of Caventou, it appears that it is not
identical with the j atrophic acid, as was supposed.

“ Adulterations, and test of its purity. — From the high price at
which croton oil is sold, it is frequently adulterated with the cheaper
fixed oils. Dr. Nimmo has suggested the following means of de¬
tecting these adulterations.

“ Pour into a phial, the weight of which is known, 50 grains of
the oil ; add alcohol which has been digested on olive oil ; agitate
well, and having poured off the solution, add more alcohol of the
same kind, until the dissolved portion is diffused in such a propor¬
tion of the alcohol, that each half drachm measure shall contain
equal to one dose of the croton oil for an adult ; by placing the
phial near a fire to evaporate what remains of the alcohol in the
bottle, if the remainder be to that abstracted by the alcohol as
55 to 45, the oil is genuine. If it be adulterated with olive oil or
any other, little soluble in alcohol, the residuum will be larger ; if
with castor oil, it will be smaller than in the genuine oil, but it is
evident, as remarked by Dr. Duncan, that this test will fail if it be
adulterated with a mixture of olive and castor oils.

“ Medical properties and uses. — It is a powerful hydragogue pur¬
gative, and from the smallness of its dose, it can be given in cir¬
cumstances where other effectual medicines cannot be swallowed.
As in cases of coma, apoplexy, mania, or convulsions. It has been
found useful in delirium tremens, dropsy, and intestinal tympanites.
It is usually given made into pills, with crumb of bread ; but the
tinctura tiglii as proposed by Dr. Nimmo, seems a decidedly pre¬
ferable form for its administration ; every half drachm of which
contains somewhat more than a drop of the oil ; the following is
the formula which he recommends :

Tinct. tigilii 5ss.

Syrupi simplicis.

Mucilag. gum. Arab, a a 5ii-

Aquae distillatae 3ss. M — ft. haustus.

And in order to obviate the uneasy feelings likely to be produced in
the mouth and throat, he advises, “ after swallowing a little milk
to take the draught very quickly, and wash it down with repeated
quantities of the same diluent.” A drop may be given on a lump
of sugar : hut where there is no dislike to oil, one drop of croton oil
with half an ounce of castor oil is a most effectual purge. Besides
the effect produced on the alvine evacuations by this oil, the secre¬
tion of urine appears to be considerably increased.

“ In India it is used as an emmenagogue, and it is said with
excellent effects, and as an external application in rheumatism.

“ Rubbed on the skin it sometimes produces its effects actively,
and nurses who have been employed to rub it on the abdomen of
patients, have been in several instances severely purged. Mr. Con-
well states, that the odour of this oil, several times respired over a

Barker and Montgomery on Pharmacopoeia. 101

bottle containing sixteen ounces of it, was sufficient to purge a young
girl ; while an adult having made the same experiment, suffered only
from nausea.

“ The solution of this oil in oil of turpentine, is said by Dr.
Thomson to produce a pustulous eruption when applied to the skin.
Dr. Copland gave a combination of these two oils with great
advantage in a case of tetanus.

“ Great care should be taken in the administration of this medi¬
cine, as an over dose will produce most dangerous hypercatharsis.
Mr. Houlton mentions a case, in which three drops were given to
a strong young man labouring under obstinate constipation ; it pro¬
duced evacuations in the course of fifteen minutes, and soon after¬
wards his sight failed him, and he became quite blind ; in four or
five days he recovered the sight of one eye, the other was not
restored for a fortnight from the time of taking the oil.

<£ In order to obviate the inconvenience arising from the variation
in the size of drops, M. Caventou has proposed the use of a soap,
prepared by triturating together two parts of the oil, and one part
of liquid caustic soda of the French pharmacopoeia, without heat ;
when the compound has acquired a sufficient consistency, it is
poured into paste board moulds, after a few days, the soap is to be
taken out in slices, and placed in a stopper bottle with a large mouth.
This soap given in doses of two or three grains, diffused in water
or in the form of pills, produced the same effect as the oil.

“ Dose. — From half a drop to two drops.” — p. 332.

Since the above was written. Dr. Short, of Ratcliffe
Highway, has published an interesting essay on this remedy,
which he found of great value in hepatitis, gastro- enteritis,
tetanus, constipation, and hydrocephalus. For a review of
his work, we refer to our last vol. (V.) p. 252.

“ Oil of turpentine. — Take of common turpentine, by weight,
five pounds — water four pints.

“ Distil the oil from a copper alembic ; yellow resin will remain
after the distillation.

“ Remarks. — In the list of materia medica prefixed to this phar¬
macopoeia, the pinus sylvestris is the species named as the source
from which to obtain turpentine. In France, at Bordeaux, in the
Landes, it is from the resin of the pinus maritima, that the volatile
oil of turpentine is extracted, 250 parts of turpentine yielding from
50 to 60 of oil.

‘ ‘ Oil of turpentine differs from the other essential oils in being very
sparingly soluble in alcohol, for although it dissolves in hot alcohol, it
separates again in drops as the spirit cools. Whereas the turpen¬
tine whence it is obtained, dissolves with facility in that menstruum.
It is limpid and colourless ; very light, volatile, and inflammable,
and soluble in six parts of sulphuric ether. Its specific gravity is
stated by Mr. Brande to be 8700, and by Dr. Paris to be only

102

Critical Review.

792°. If a stream of muriatic gas be passed through it, a resinous
deposit is produced, resembling camphor in some of its qualities,
but differing from it in not being soluble in weak nitric acid ; nor is
it precipitated by water from its solution in strong nitric acid.

e< Oil of turpentine has a peculiarly strong and nauseous flavour,
-which renders it intolerable to many as an internal medicine ; for
the correction of this, either of these two methods mav be prac¬
tised ; agitate eight parts of the oil with one part of the strongest
alcohol ; let them settle, and when a separation takes place, pour
off the alcohol, repeat this three or four times, and the oil will
become almost tasteless and without smell, and if evaporated will
leave no residuum ; but it speedily returns to its original condition.
The same effect may be more speedily produced by distilling it over
quick lime, but it is to be doubted whether its medicinal efficacy is
not thereby impaired.

“ The stimulating application known by the name of Whitehead’s
Essence of Mustard, is composed of camphor and spirit, or oil of
rosemary dissolved in oil of turpentine, with a little flour of mustard
added to it.

“ Medical properties and uses. — It is stimulant, cathartic, diuretic,
and anthelmintic ; extemallv it is an efficacious rubefacient. In
doses of from half an ounce to two ounces it has been found to act
almost as a specific in causing the expulsion of the tape worm. As a
purgative it frequently succeeds when all others fail ; and is parti¬
cularly efficacious in the form of glyster. Its utility in epilepsy has
been established upon numerous authorities. It is a popular remedy
in rheumatism, and Dr. Cheyne, in his essay on gout, recommends it
as a specific in sciatica; a commendation which, unfortunately, expe¬
rience has shewn it does not merit.

f‘ In gout in the stomach Dr. Mason Good speaks of it in very
high terms, as being “ the best aperient, and at the same time stimu¬
lant medicine in such a case, for which the dose should be about six
drachms swallowed un mixed/’ vol. ii. 687-8.

“ In puerperal fever its administration internally, and its applica¬
tion externally to the abdomen, has been found in many instances
productive of the happiest results. From its effects in this disease,
and in some others, oil of turpentine appears to have a specific influence
in arresting inflammatory action, when administered in repeated doses;
a very happy application of this power has been lately made by Mr.
Hugh Carmichael of this city, in the treatment of iritis, by oil of tur¬
pentine, given in drachm doses three times a day.

“ In America, oil of turpentine in doses of a drachm every hour or
two, has been successfully administered in cases of yellow fever, in
which, says Dr. Chapman, it appears to be soothing in its effects, re¬
moving the sense of heat and irritation in the stomach, subduing the
force of vascular action and general excitement, and inducing at once
a state of more comfort and security.

“ It has been recommended by Mr. Colies, as an useful applica¬
tion to wounds received at the dissecting table.

Barker and Montgomery on P harmacopoeici.

103

“ Oil of turpentine is a valuable application to scalds or burns in
tbeir recent state, and particularly in the form of liniment composed
of it and linseed oil, or with ointment, of yellow resin, which latter
combination constitutes the linimentum terebinthinse, which see.

“ Oil of turpentine has been used with success in the treatment of
purpura hemorrhagica. See Edinburgh Medical Journal , vol. xviii.
p. 540.

“ It has the singular property of communicating the odour of
violets to the urine of those who take it, or who even expose them¬
selves for a short time to its effluvia.

“ Dr. Copland recommends the addition of tincture of capsicum to
correct the nauseating effects which the oil frequently produces on the
stomach. The ancients administered turpentine freely in coughs and
various pulmonary affections.

f< Dose. — As a diuretic, ten drops to a drachm; as a purgative two
drachms to an ounce, with the addition of an equal quantity of castor
oil/’— p. 353.

“ Tincture digitalis. Medicinal properties and uses. — Itis diuretic and
sedative ; as a diuretic, digitalis acts by diminishing arterial action,
and so increasing that of the absorbents, by which means diuresis is
promoted ; with this intention digitalis is given in ascites and other
kinds of dropsy, particularly in hydrothorax, some of the most distress ¬
ing symptoms of which it palliates independently of its diuretic ef¬
fects. It is best administered in conjunction with other diuretics, as
squill or nitrous spirit of ether, see page 373. If it purge or vomit,
its diuretic effects are greatly impaired.

<f As a sedative it acts more directly than any remedy we are ac¬
quainted with, possessing great power in controlling the action of the
heart and diminishing the impetus of the blood, on which account it
is beneficially administered in aneurism and hemorrhages, particu¬
larly those from the lungs or uterus. Its effects in phthisis were
much vaunted, but experience has not confirmed its utility in this
complaint. The change made in the pulse by its use is very re¬
markable. Dr. Baildon informs us, that he reduced his own pulse
from 110 to 40 by the use of digitalis, taken by gradually increased
doses to the extent of six grains in the day. ITe late Dr. Halloran,
of Cork, speaks very highly of its effects on persons afflicted with
mania, for which he gave the tincture in doses of 60 to 120 drops
three times a day; and the correctness of his observations have since
been confirmed by the experience of others. In cases where there
appears to be some organic affection of the heart or large vessels,
the most decided benefit has resulted from its use.

“ The effects produced in some constitutions by the use of digi¬
talis are so remarkably violent, that its administration demands our
utmost circumspection and attention to the state of the patient ; . and
should there occur intermission of the pulse, vertigo, indistinct vision
or nausea, with vomiting or purging, wTe should immediately discon¬
tinue the medicine, as its further administration under such ciroum-

104

Critical Review.

stances, will almost certainly give rise to a train of the most alarm¬
ing symptoms, terminating in death.

“ The effects of an overdose are best counteracted by the admi¬
nistration of cordials, as brandy and water with tincture of opium, or
aromatic confection, mint tea, &c., and the application of a blister
to the pit of the stomach.

“ Dose. — Ten drops cautiously increased to forty.” — p. 409.

“ Tinctur opii. Medical properties and uses. — Similar to those
of crude opium. In small doses stimulant, in large ones power¬
fully narcotic and sedative, and anodyne both internally and exter¬
nally. This tincture is a most convenient and eligible form for the
administration of opium, as it affords a means of apportioning the
dose with great facility and certainty. It was long known and pre¬
scribed under the name of Thebaic tincture , because the ancients
considered the opium brought from Thebes in Egypt as superior to
any other. It was so named in the last edition of this pharmacopoeia.

“ Under certain forms of combination, opium becomes a most
valuable auxiliary to many important medicines, by acting as a corri-
gent of some of their qualities or effects ; and so rendering their action
more complete. Thus, it will prevent mercurial alterative remedies
from running off by the bowels, before they can produce their effect ;
in combination with certain sudorifics, as antimonials and ipecacuan,
it increases the sudorific effects, and will at the same time act as an
anodyne. Combined with diuretics, as digitalis and squill, it corrects
their tendency to cause vomiting and purging, which would in a
great degree defeat their diuretic operation ; but it would far exceed
the limits proposed in this work, to enter at length into a detailed
account of the numerous effects ascribed to opium, or of the diseases
in which it is administered or recommended; for as Dr. Paris ob¬
serves, “ in combination, the medical powers of opium are wonder¬
fully extended, so that there is scarcely a disease in which it may not,
during some of its stages, be rendered useful.”

“ I shall therefore confine myself to a few observations on its most
important effects and forms of administration ; and with respect to the
latter subject, it appears as before stated, that the sedative power of
opium depends on a peculiar substance contained in it called morphia ,
while the excitement and other disagreeable effects are caused by the
principle which has been named narcotine ; hence it follows, that
these preparations which contain the greatest quantity of the former
with the smallest proportion of the latter, are to be preferred where
the sedative effect is the object aim.ed at.

“ Thus, the acetum opii and vinum opii, which contain an acetic
solution of morphia, its most active form, and the extractum opii
aquosum, which contains only a very small proportion of narcotine
and very little resin, produce their beneficial effects with compara¬
tively little of the general disturbance of the system, which so gene¬
rally follows the use of crude opium or common laudanum. The me¬
dicine known by the name of black drop, is also for the same reason

Barker and Montgomery on Pharmacopoeia. 105

an eligible form for administering opium. See acetum opii. Rous¬
seau’s drops are somewhat similar to the black drop.

“ With respect to its effects, and the proper circumstances under
which it ought to be administered, it has been long regarded as a
general rule, that “ its use is contra-indicated in all cases where
inflammatory action prevails,” and this to a certain extent is true ;
but the exceptions are very numerous, as it is found to produce the
most beneficial effects in several highly acute and inflammatory dis¬
orders. Practitioners in the hotter regions of the earth, and espe¬
cially in India, have long been in the habit of giving opium freely
in acute diseases, and even in tropical inflammation, after, or in com¬
pany with venesection, and generally in combination with calomel.
“ The utility of this practice,” adds Dr. Johnson, “ has been long
established in those climates, and is now making its way in this
country, with some little variety in the modus.” — See Med. Chir.
Review, June, 1824.

“ Dr. Armstrong, of London, enjoins this practice very strongly ;
and in a paper which he published on the subject, he recommends
the exhibition of opium in some most acute inflammatory affections,
as acute inflammation of the peritoneal covering of the stomach,
intestines, and uterus ; in such cases, after a copious venesection,
he -administers three, four, or even five grains of good opium in
the form of a soft pill. “ The effects,” he says, “ of opium thus
administered, are to prevent a subsequent increase in the force or
frequency of the heart’s action, and a return of the abdominal pain,
while it induces a tendency to quiet sleep and a copious perspira¬
tion over the whole surface.” To the correctness of this statement,
I can bear testimony from the decidedly beneficial result of such a
mode of treatment, in some cases of puerperal peritonitis, which
came under my observation ; and no remedy so effectually relieves
the excruciating pain of acute rheumatism, which generally makes
its attack at night, as a pill containing gr. iss. of opium, combined
with gr. iss. of calomel, and gr. ^ of tartarized antimony. In
swelled testicle, accompanied by a high degree of inflammation,
the administration of a full dose of opium, after the application of
leeches, is productive of the best effects.

“ In intermittent fever, opium, combined with brandy, and given
during the cold stage, will often put an end to it ; or if given before
its accession, will prevent it. The value of opium in the treatment
of tetanus, is almost universally acknowledged, and in diabetes it is
very generally regarded at present, as the most effectual remedy for
alleviating the symptoms of that distressed and almost incurable
disease. In the case related by Mr. Mooney, in the 5th vol of the
Med. Chir. Trans, it reduced the quantity of urine passed in the day
from twenty-five pints to seven ; but in both this disorder and teta¬
nus, in order to produce the good effects of opium, it must be given in
quantities much exceeding the ordinary, even to the extent of twenty
to thirty grains in the course of the twenty-four hours. Dr. Currie

Vol. vi. no. 32.

106

Critical Review.

gave five ouiices of the tincture in the course of the day in a case of
tetanus.

“ After surgical operations a full opiate is generally given, and
with good effect ; it soothes the pain, calms the patient’s feelings,
induces sleep, and so tends to prevent the fever which so often comes
on under such circumstances.

“ In dysentery and diarrhoea, after the exhibition of purgatives,
opiates give great relief ; in the former disease by relieving the tor¬
mina and tenesmus, and in both restraining the excessive discharge.

“ The vomitings which sometimes so distress nervous persons or
pregnant women, are often quieted by opiates better than by any
other remedy: and cases have occurred where it produced this effect,
applied by rags wet with laudanum over the region of the stomach.

“ In cholera and in pyrosis opium is a valuable remedy. It is also
frequently introduced into the rectum, either in form of a suppository
or as an enema.

“ As an external application in the form of liniment or otherwise,
opium possesses considerable anodyne effects, particularly if combined
with acetic acid. The following liniment is recommended as useful
in convulsive or spasmodic affections : —

1^. Tincturae Opii 3 ss.

Olei Olivarum ^ i.

Vitelli Ovi. q. s. ut fiat linimentum.

“ The quarter of this to be rubbed on the thighs or legs twice or
thrice a day.

“ Opium is often applied with good effect to the surface of sores,
from which it is readily absorbed into the system ; Sir Astley Cooper
mentions “ a case, in which a tetanic affection was produced in a
child, whose leg had been amputated, and where the application of
opium to the stump gave more immediate relief than I ever remember
to have witnessed. It relieved the spasms, and, as I believe, saved
the child;” and he adds, “ if opium, applied to the surface of sores,
be absorbed into the system, it produces excessive costiveness, extreme
pain in the head and torpor of the system, which is only to be re¬
moved by the frequent administration of active purgatives.’'*

“ The torpor of the intestines caused by opiates, in consequence of
their paralyzing for a time their muscular fibres, may be best coun¬
teracted by aloetic purgatives, which have a directly contrary effect,
that of increasing the peristatlic motions.

“ The administration of opium is frequently followed by clay co¬
loured stools, shewing that the biliary secretion into the intestines
has been interrupted ; this may be best obviated by combining mer¬
curials, particularly calomel, with the opium, or giving them shortly
afterwards, either alone or in combination with aloetics.

“ It is often productive of considerable benefit in threatened abor¬
tion, and in tedious labour where delivery is impeded by rigidity of
the os uteri or other soft parts. Opium should never be given to in¬
fants if possible to avoid it, as it is apt to produce very untoward

Barker and Montgomery on Pharmacopoeia. 107

effects in them. Nor should it be given to mothers who are giving
suck, at least without cautioning them not to suckle their child for
some hours after. A case came to my knowledge a short time since,
in which a woman, who was nursing her child, took twenty drops of
laudanum to procure sleep, which had been disturbed for some nights
by the pain of a sore breast ; the infant sucked a great deal during
the night, and was so affected in consequence, that it remained for
'nearly twenty-four hours in a state of complete torpor almost resem¬
bling death, from which no effort could rouse it, though every means
were used for the purpose. It however ultimately recovered.

Some of the oriental nations use opium habitually as a cordial sti¬
mulant, and as such, take it frequently in the day, to an amount which
would appear almost incredible. Dr. Smith mentions, in the philo¬
sophical transactions, that being at Smyrna, he saw a man who took
every day three drachms of opium, half in the morning and half after
dinner, to prevent him from falling asleep ; this habit he continued
for twenty-four years, and had begun with a grain ; but Dr. Smith
says, that the consequence was premature old age. The Turks eat
opium when going into battle, to excite them and rouse their courage,
but this habitual use of opium completely blunts both the mental and
corporeal faculties. I knew a person who every day took from thirty
to sixty drops of laudanum to cheer him and prevent low spirits, which
it did effectually ; but whenever accident prevented the habit from
being indulged in, the consequence was a state of the most pitiable
depression and misery of mind and body. Russel observes, that the
effects of opium on those addicted to its use, are at first obstinate
costiveness, succeeded by diarrhoea and flatulence, with loss of appe¬
tite and a sottish appearance ; the teeth decay, the memory fails,
and the unhappy sufferer prematurely sinks into the grave.

“ Of crude opium, from half a grain, to a grain and a half, and
from ten drops to sixty or more of the common tincture, are the
quantities which may be considered as constituting a general dose for
an adult; for children, particularly infants, the dose should be very
small, not exceeding a drop or two ; but under particular circum¬
stances these doses may be greatly exceeded, as in some spasmodic
affections, particularly tetanus, and in diabetes ; in cases attended by
great bodily suffering, very large doses may be taken without any
very sensible effect being experienced, but it sometimes happens that
one-fourth of a grain will produce an effect in one person which ten
times the quantity will not produce in another. I know a lady whom
so small a dose as five drops of laudanum would throw into a state
of delirium.

“ In case of an overdose being taken, a full emetic of the sulphate
of zinc or copper, dissolved in a very small quantity of water, should
be immediately given, and the stomach well evacuated by vomiting ;
after this is accomplished, vinegar diluted, and other acidulous
drinks, should be given ; drowsiness should be prevented by keeping
the patient in motion, giving ammonia, brandy, or strong coffee ; or,
by immersion in a tepid bath. Bleeding is sometimes necessary to

108

Critical Review.

relieve the vessels of the brain, and may be best performed in the
jugular vein. When the overdose taken is a fluid preparation, the
stomach pump affords an expeditious and certain means of withdraw¬
ing from the stomach its poisonous contents.

“ Dose. — Ten drops to sixty or more.” — p. 434.

“ Belladonna. Medical properties and uses . — Belladonna is power¬
fully narcotic, diaphoretic, and diuretic. It excites all the excretions,
and has been found serviceable in neuralgia, used internally, and ap¬
plied externally in the form of a plaster. — See belladonna plaster .

“ MM. Schaeffer, Hufeland, and Wetzler, have declared it al¬
most a specific in hooping cough, and to its efficacy in this complaint
Dr. A. T. Thomson also bears testimony. Wetzler succeeded in
curing all his cases within twenty days from the time the patients
began to use the belladonna ; the greater number were cured, from
the eighth to the fifteenth day. In two cases in which I administered
it for this complaint, it appeared to succeed completely, and removed
the complaint from one child in a fortnight, and from the other in
about three weeks. 1 used the extract dissolved in cinnamon water,
and sweetened with syrup.

“ On the continent, belladonna was for a time much extolled as a
preventive of hydrophobia ; but recent failures, in cases where it was
fairly tried, have invalidated, if not annulled its claim to such a power.

“ It is also upheld by many, particularly of the continental physi¬
cians, as a preventive against the infection of scarlatina, during epi¬
demics of that disorder ; and its pretensions in this respect are sup¬
ported by so many respectable authorities, that we can hardly doubt
of their being well grounded.

“ Dr. Berndt, of Custrin, who was the first to make a connected
series of experiments on the subject, says that in the epidemics of
scarlatina which prevailed throughout that city in 1818 and 1819, he
used the belladonna as a preservative in children under fifteen years
of age, who were freely and continually exposed to the contagion ;
that out of 195 cases, only fourteen were infected; and that when he
afterwards used a stronger preparation of the drug, every one escaped
the disease. Koreff, professor at Berlin, affirms, from a very exten¬
sive experience and observation of sixteen years, that the most inti¬
mate intercourse may be kept up with patients affected with scarla¬
tina, provided the belladonna be taken in the proper doses for eight or
nine days before exposure, and be continued till the period of desqua¬
mation; on this subject he has lately addressed to M. Laennec, in
which, he says, “ it was not till I had received the authority of the cele¬
brated Soemmering, who informed me, that he obtained the most sa¬
tisfactory results with it when the disease raged epidemically, that I
determined to employ it ; and he adds, “up to the present time,
April 1824, neither season, nor locality, nor any other circumstance,
has appeared to diminish the preservative effect of this plant.” In
addition to these testimonies, maybe added that of Hufeland, who says
in the Journal de Practischen Heilkunde, Nov. 1825, that “ it gives

109

Barker and Montgomery on Pharmacopoeia.

him great joy to be able to confirm, by the results of fresh experi¬
ence, the efficacy of belladonna as a preventive against scarlet fever ;
and he adds, that having repeatedly used the medicine in his own
practice, be has never seen it fail in a case where it had been pro¬
perly tried.” To these might be added, if necessary, the opinions of
several others to the same effect.

“ The preparation employed was a solution of two or three grains
of the extract in an ounce of cinnamon water ; of this two or three
drops were given twice a day to children under a year old ; one drop
more was added for every year above that. The principle on which
it is given is, that diseases are to be combated by the exhibition of
remedies which produce symptoms similar to those of the disease for
which they are given, and on this principle belladonna was first sug¬
gested as a preventive of scarlatina in 1807, by Dr. Hahneman, of
Leipsic.

“ Belladonna has been long used as an application to the eye pre¬
vious to performing the operation of cataract ; the extract is rubbed
freely over the eye-lids and eye-brow, and in about an hour after¬
wards, if there be no adhesions of the iris to other parts, a full dila¬
tation of the pupil takes place, bringing the whole of the cataract dis¬
tinctly into view, and thereby materially facilitating the operation.
Belladonna was also applied by the late Mr. John Cunningham
Saunders, after the operation, with a view of preventing the iris from
becoming adherent to the edges of the torn capsule. This practice
is also adopted by.Dupuytren under similar circumstances. Mr.
Saunders also strongly recommends a similar application to prevent
obliteration of the pupil occurring as a consequence of inflammation
of the iris. “Happily,” says he, “we are furnished in the extract
of belladonna, with a perfect specific for this purpose.” — See his
Treatise, page 63.

“ The action of this substance in such cases, appears to be limited
to the radiated fibres of the iris. M. Segalas read a paper before the
Royal Academy of Medicine in Paris, on the manner in which bella¬
donna acts when applied to the eye. Having placed on the eye of a
young cat, a grain of the extract of belladonna, he saw the dilatation
of the pupil begin fourteen minutes afterwards. Having in a second
experiment placed a grain on the pleura of a cat, of the same age and
the same height, the dilatation commenced in eight minutes. Lastly,
in a third experiment, having injected a grain into the bronchial ves¬
sels, the dilatation appeared in two minutes after, that is to say, seven
times quicker than after the direct application of the substance to the
eye.

“ It would seem then, says M. Segalas, that the dilatation of .the
pupil is quick in proportion as the belladonna is applied to a surface,
possessing a greater or less degree of absorbing power ; from which it
would result, that the belladonna only acts on the eye after being ab¬
sorbed and carried by the blood to this organ. It is to be regretted
however, that his experiments were deficient in such a degree of ac¬
curacy as would warrant a very precise inference.

110

Critical Review.

“ Dupuytren, after a continued use of belladonna internally for the
space of ten years, is perfectly convinced of its efficacy in long stand¬
ing cases of scrofulous ophthalmia.

“ In parturition, rendered lingering by rigidity of the os uteri,
Chaussier recommends the application of the extract to the part, as
tending to produce relaxation; and in a small pamphlet on the
subject, he has published some cases in which it was successfully
used. His formula is the following : —

Extracti Belladonna; drachmas duas
Cerati Simplicis unciam. — Commisce.

“Dr. Conquest, of London, says he has seen decided benefit result
from such a practice. I have never seen it tried for such a purpose.
I was lately informed of a case of impaction of a calculus in the gall
duct, in which instantaneous and complete relief was given by rubbing
belladonna over the seat of the pain; it induced spasms in the face,
which soon subsided ; the preparation used, was an infusion of a
drachm of the powdered leaves diffused through an ounce of water.
Dr. Paris informs us, that an ointment composed of equal parts of the
powdered leaves and of lard “ rubbed over the penis prevents pria¬
pism, and relieves chordee more effectually than any application
which has been proposed.”

“ Great caution is required in the administration of belladonna, as it
is likely to bring on most distressing and alarming symptoms if in¬
judiciously or incautiously given, or when it is taken for a consider¬
able time, even in small doses, it is apt to induce a dryness and
stricture of the fauces, pharynx, and oesophagus ; vertigo, dimness of
vision and dilated pupil ; upon the occurrence of any of which
symptoms its use should be discontinued for the time. The root of
the plant produces somewhat similar effects, but of a milder character,
and resembling intoxication ; this is alluded to by Shakspeare in his
Macbeth ;

“ Or have we eaten of the insane root
That takes the reason prisoner.”

*e When an overdose has been taken an active emetic of sulphate of
zinc or copper, should be given, purgatives administered, and after¬
wards vinegar; the influence of belladonna on the stomach is so
paralyzing that it is often impossible to excite vomiting ; in such
cases, vinegar is recommended in the first instance, after which
emetics are said to be more likely to produce their effect.

“ Dose. — One-fourth of a grain gradually increased to five grains.”
— p. 484.

r .1

Time nor space will not permit us to make more extracts,
but enough has been given to shew the value of the work.

[ 111 ]

IV. — A Treatise on Pathological Anatomy. — By G. An-
dral, Professor to the Faculty of Medicine of Paris,
&c. Translated from the French by Richard Townsend,
A.B. M.D. M.R.I.A. and William West, A.M. M.D.
M.R.I.A. Vol. II. 8vo. pp. 808 : Dublin, 1831. Hodges
and Smith.

It affords us much pleasure to inform our readers that
M. Andral’s Pathology is now to be had in the English lan¬
guage, and on terms almost as reasonable as the French
edition. This work is the best extant, and is of course a
standard authority. Its justly celebrated author has been
placed whh unanimity at the head of the pathologists of
the French school, and may be considered the chosen organ
of that body. His qualifications cannot be better described
than in the language of Dr. Townsend.

“ He has himself made, perhaps, a greater number of post mor¬
tem examinations than any other pathologist in Europe ; accordingly,
his work is unrivalled in the number of original observations it con¬
tains, and I can assert from experience, having myself made within
the last few years a very considerable number of dissections, that
nothing can exceed the accuracy of his descriptions. But, M. An-
dral has not confined himself to the irksome task of enumerating
the various physical alterations that take place in our organs ; he has
likewise endeavoured to investigate the origin of these alterations,
to explain the mechanism of their formation, and to trace their
mutual relation and order of succession. In his investigation of
these important points, he has laboured to restrict the influence of
inflammation within rational limits, and successfully combats the
absurd doctrine, that every alteration of the living structure de¬
pends on an exaltation of its vital powers. He also examines the
influence of these local alterations in the production of disease, and
endeavours to point out how far the knowledge of these lesions may
serve to aid us in determining its seat and nature, and to afford us
certain data for the rational treatment of it. In short, he has
attempted to combine pathology with morbid anatomy, and to de¬
duce from their combination such conclusions as may serve to fur¬
nish us with more correct ideas of the nature of disease, and more
fixed and rational principles for its treatment. In pursuing this
investigation, he does not allow his judgment to be warped by any
favourite theory. He admits the influence of the solids in producing
the phenomena of disease ; but he likewise accords considerable
importance to the alterations of the fluids : he admits that local
disease is capable of producing general or constitutional disturb¬
ance ; but he likewise maintains that those general agents, the
blood and nervous influence, may be primarily affected, and that

112

Critical Review.

in this way general disease may precede the existence of any local
affection. These few instances may serve to shew that the work is
written in the purest spirit of eclecticism ; indeed it appears a con¬
stant object of M.Andral’s solicitude to reconcile the jarring interests
of adverse doctrines, to select what is of real value from every
theory, and thus to profit by them all, without wedding himself to
any. The value of a treatise on morbid anatomy written on these
principles, by an author so eminently qualified for the task, is too
evident to require demonstration.” — Preface, p. ix.

He has evinced indefatigable industry in his investiga¬
tions, his research has been the most extensive, and his
arrangement of the facts described by preceding writers,
has been effected with fidelity. A standard work on morbid
anatomy has long been a desideratum in the medical litera¬
ture of this country. During the last thirty years we have
had the works of Baillie, Farre, Hooper, Abercrombie,
Armstrong, Hodson, Hodgkin, Bright, Sir A. Cooper,
Hooper, Craigie, and the Yademecum of Morbid Anatomy,
with a host of essays in our periodicals, but no systematic
treatise adapted to the present state of the science. This
want is now supplied by the perfect production before us.
It embraces every part of the subject, and is a work of
infinite value to every class of medical practitioners. It is
a source from which every medical man, when called to
elucidate questions of judiciary medicine, can obtain cer¬
tain data on which they can form a correct opinion, in dis¬
criminating between the natural appearances of disease, and
those produced by criminal means. Had it contained no
other information, it would be a work of infinite value.
But it is not confined to this alone, it embraces the principles
of pathology, and the indications of treatment. We are
happy to state that the translation is faithfully executed,
and is highly creditable to Drs. Townsend and West. There
is no scientific member of the profession in these countries
who will not possess himself of this work, as the very best
extant.

This volume is devoted to special pathological anatomy,
and is arranged as follows: — digestive, circulatory, respira-
toty, secretory apparatuses, apparatuses of generation and
innervation. There is no morbid appearance observable in
any of the tissues which constitute the organs in this cata¬
logue that is not minutely described. Many of the lesions
enumerated have been discovered, though no symptoms indi¬
cated their existence during life. The accuracy of this
statement is well attested by the following observations: —

113

[

M. Andral on Pathological Anatomy .

xi Of the alimentary canal in the healthy state. — There has been
hitherto so little agreement on the subject of the natural appear¬
ance of the stomach and intestines, that I consider it indispensable
to determine accurately what is the anatomical condition of the
alimentary canal in the healthy state. Perhaps one circumstance
which has long been an obstacle to the ascertainment of this point,
is the great frequency of gastro-intestinal alterations. As there
are very few subjects in which some of these are not met with,
anatomists had become accustomed to consider them as belonging to
the natural state of the parts ; and they seemed the more warranted
in doing so, as, until very lately, the symptoms produced by these
alterations were either totally unknown or ill understood. •

“ If we examine the internal surface of the stomach or intes¬
tines in a living animal, that is not struggling, and whose circula¬
tion is not disturbed, we find it of a red tint, somewhat deeper than
that of the mucous membrane of the cheek in a healthy man. If
we examine the same animal after death, we find that this red tint
has disappeared, and that the surface is now uniformly pale, or, at
most, very slightly rose coloured. In order that the experiment
should afford these results, the animal must be deprived of life in
such a manner as not to lose too much blood, on the one hand, as
the natural paleness of the intestines would then be increased ; or
to die in a state of asphyxia, on the other, as the mucous mem¬
brane would then be mechanically injected ; which, though not a
morbid, would yet not be the natural state.

“ I think we may conclude from this experiment that after death,
the mucous membrane of the stomach and intestines, tends to lose
its colour like the skin.

“ There have been frequent opportunities of examining bodies
in cases of accidental death, where the individual was apparently
in the enjoyment of perfect health a few minutes previously. In
most of these cases, also, the alimentary canal has been found free
from any red tint.

“ Sometimes, however, different degrees of injection have been
observed on the internal surface of the stomach or intestines, as
well in animals supposed to be sound, that were sacrificed to phy¬
siological experiments, as in men in cases of accidental death. To
this it may be answered in the first place, that if the alimentary
canal has been found oftener without any redness, under the same
circumstances, it is very probable that in the cases where the redness
was observed, it arose from disease. But, besides the appearance
of the parts that were found injected should have been described
with more care and precision ; and a detailed account should have
been given of the kind of death the animals suffered, and of the space
of time that had elapsed between the accident and death in the
other cases. •

*'* There are, in fact, certain circumstances under the influence
of which the alimentary canal, though free from disease, may yet

VOL. VI. no. 32.

114

Critical Review.

present various degrees of red coloration in the dead body. Of
these circumstances, some may have operated a certain period
before death, others only during the last moments, and lastly, others
either soon or at some length of time after the cessation of life.

“ Of the causes which operate before death, some are physiological
and others pathological. Thus, it is an undoubted fact, that, during
the process of chymification, the internal surface of the stomach
acquires a considerable degree of redness ; as well as that the small
intestine does the same wThile the separation of the chyle is taking
place in it : any one may convince himself of the truth of these
assertions by examining living animals. But, besides, it has been
ascertained by observation, that this redness that is produced by
digestion continues after death ; so that on opening the body of any
individual that has died while chymification or chylification was going
on within him, we shall find those portions of the alimentary canal
in which the process had been taking place of an unusually high
colour.

“ The pathological causes are all such as act by presenting some
obstacle to the free return of the venous blood from the gastro-intes-
tinal parietes to the right cavities of the heart. There happens then
to the mucous membrane of the alimentary canal what happens to the
skin in persons who die of asphyxia ; in such cases we observe the
cutaneous surface long before death acquiring a constantly increasing
colour from the venous blood ; now, what takes place in the skin must
also take place in the intestine. We may assure ourselves directly
of this by examining a coil of intestine in an animal who is slowly
suffocating, when we shall find that, as the respiration becomes more
difficult, the coil assumes a more intense and uniform red hue.
Lastly, if, as Bcerhaave did long ago, we prevent by a ligature the
circulation of the blood in the trunk of the vena portse, we shall
observe the whole of the internal surface of the intestines assuming a
fine red tinge, which is compared by Morgagni to the colour of
cochineal ; and sometimes, even blood transudes through the parieties
of the distended vessels, and fills the intestine. These facts being
known, it is only drawing the conclusion from them to establish that,
every time the blood cannot return freely from the capillaries of the
intestinal mucous membrane to the venous trunks, that membrane
will continue coloured after death. Hence arise the various shades
it presents in cases of strangulated hernise, for instance, or of obstruc¬
tions of the liver, of tumours situated on the course of the principal
divisions of the vena portse, of obliteration of the vein itself by old
coagula, and lastly, of organic affections of the heart. If, however,
there was but little blood in the body, wdiether through defect of
sanguification, or in consequence of recent copious bleedings, a con¬
siderable obstacle to the venous circulation would produce a less in¬
tense coloration of the alimentary canal, than that which would arise
from a slighter obstacle existing in a person whose vessels contained
a great deal of blood a short time before death.

*■* The red coloration of the gastro- intestinal parieties in conse-

M. Andral on Pathological Anatomy. 115

quence of some mechanical obstacle to the venous circulation, pre¬
sents various degrees of intensity. In the lowest of these, the sub¬
mucous cellular tissue alone is coloured, but not in its capillary net¬
work ; it is traversed in various directions by bluish veins of pretty
large calibre, which cease to be injected on arriving at the mucous
membrane, while their other extremities are continuous with the
mesenteric veins, which are themselves equally gorged with blood.
In a higher degree of injection, depending quite as much on mecha¬
nical causes as the preceding, the mucous membrane itself begins to
assume a tinge, and, according to the size, number, and relative
situation of the injected vessels perceptible to the naked eye, it
exhibits either simple branches separated by large colourless intervals,
or ramifications of greater or less extent, produced by the injection
of the smaller vessels, or, lastly, a redness considerable enough to
produce a complete opacity of the parietes wherever it exists.
According as these various shades of colouring are extended or
circumscribed, the result will be either a diffused redness of the in¬
testine without any precise limits, or else streaks, stripes, patches
or mere points. In fact, there is not one of these appearances that
may not be produced by a simple injection from a hypersemia either
mechanical or passive ; and he would be strangely mistaken who
should imagine that the dotted redness, for instance, more necessarily
announces an active hypersemia, than does the simple congestion of
some of the submucous veins. In these different cases, on attentively
examining the injected parts, we may perceive that the injected
vessels are directly continuous with the great veins subjacent to the
mucous membrane, just as these latter are continuous with the
mesenteric.

“ If the obstacle to the return of the blood from the intestines to the
heart is still more considerable, or if, what comes to the same thing,
the obstacle not being increased, there is an increase of blood in the
vessels, that fluid escapes from them, and becomes effused either into
the submucous cellular tissue, where it forms ecchymoses, or into the
cavity of the intestine itself, where it communicates a reddish tint to
the bile, mucus or other matters, that happen to be contained in it.
The facility with which a liquid or gaseous injection may be made to
penetrate into the intestinal cavity when driven into the mesenteric
veins from the trunks towards their branches, explains how, under
the iufluence of a considerable congestion of the same veins, a part of
the blood contained must have a tendency to escape into the interior
of the alimentary canal.

“ Thus, on summing up all that we have learned both from simple
physiological reasoning, experiments on animals, and the examination
of dead bqdies, we are led to conclude that the gastro-intestinal
mucous membrane may be indifferently white or red, without either
of these colours necessarily indicating that the membrane had been
in a morbid state ; it is either white or red, of various shades,
according as there has existed before death some one of the conditions,
mechanical, organic, or vital, which we have endeavoured to explain.

116

Critical Review.

Now, as those which produce the red coloration exist the most
frequently, it follows that, in the dead body, we should more
frequently find the alimentary canal injected than colourless. But
that is not all ; after life has ceased, new causes arise which tend to
produce new modifications in the colour of the intestines, and to in¬
ject some parts of it much more strongly than they were at the
moment of death. The causes of redness produced after death, may
be reduced to two principal ones ; one, the weight of the blood, and
the other, its transudation through the parietes of its vessels.” — p. 14.

M. Andral adduces proofs from the experiments of MM.
Trousseau and Rigot, that parts will be reddened in various
positions, in which the law of gravitation will exert its
greatest influence. This fact has been much dwelt on by
medical jurists, in forming a diagnosis between cadaverous
lividity and ecchymosis. Thus “ the coils of the small in¬
testines, which are more dependent than the rest — those, for
instance, which are sometimes found sunk in the hollow of
the pelvis, are also more strongly injected.” Our author
further remarks —

“ It becomes a question whether this coloration from hypostasis
can occur in the small intestine only ; it certainly can occur with
more facility there than elsewhere, by reason of its disposition, and
of that of the vessels distributed to it. I am, however, strongly
inclined to think that, in certain cases, the redness observed on the
great extremity of the stomach, and on its whole posterior surface in
general, that being inferior in the subject,) results in like manner from
this accumulation of blood by hypostasis. I am the more disposed
to this opinion, from finding it mentioned in my notes that, in a case
where a body had been laid upon the abdomen a short time after
death, preparatorily to opening the spinal canal, and remained several
hours in that position, the anterior part of the stomach was injected,
and dotted with red, while the posterior part was pale. At the time,
I imagined it to have been caused by gastritis ; but I should not be
apt to think so now.

The redness of the intestinal parietes that is produced, wholly after
death, by injection from hypostasis, the reality of which I have just
now proved, presents various degrees or shades, like the redness from
conjestion, either mechanical or passive, that had been previously
under consideration. Thus, we may find the villi highly coloured,
and even blood effused into the interior of the intestinal canal. This,
however, very seldom happens, except in experiments on animals
that are strangled, and kept in the vertical position for several hours
after death. In such cases, in fact, every thing is most favourably
disposed, for the blood’s being drawn in the greatest possible quantity
to where it is attracted by the law of gravitation. Nothing similar
has ever been observed in the horses killed by pithing, or by knock¬
ing on the head ; and, in the human subject, the determination of the

M. Andral on Pathological Anatomy.

117

blood towards the most dependent parts of the alimentary canal, most
commonly produces in it only an injection more or less strong of the
mucous membrane, or of the subjacent cellular tissue ; which may
produce either a diffused tint, with an appearance of ramifications or
circumscribed blushes in form of points, spots, streaks, &c.

“ Injection from hypostasis begins to take place immediately after
death acquires its highest degree at the end of some hours, and ceases
to be continued as soon as the blood having cooled, begins to coagu¬
late. Hence it follows, that in subjects whose temperature is long
kept up, either naturally or artificially, and in which the blood con¬
tinues fluid, the injection of the intestines from hypostasis will be
much more decided than under the 'opposite circumstances. It will
also be more considerable, when after acute diseases, a great deal of
blood still remains in the system ; and when, in consequence of a slow
death, or of obstacles to the circulation, the intestinal veins were
gorged with blood at the moment of the cessation of life.

“ As soon as a certain space of time has elapsed after death, a
new cause of coloration begins to act ; as soon as putrefaction
begins to seize upon the body, the blood contained in the vessels,
both large and small, of the gastro-intestinal parietes, exudes through
the membranes of those vessels, and is effused in variable quantities
into the surrounding tissues, especially into the submucous cellular
tissue. On this extravasation of the blood depend, for instance, the
red spots almost always observed in the stomach along the veins of
its great extremity, when the body is opened more than six and
thirty or forty hours after death. These spots, thus assembled along
the course of the vessels, are sometimes isolated, and sometimes
grouped together and running into one another ; and in this manner
mark the surface of the stomach with streaks and bands of various
figures. If after having observed the stomach in this condition, we
leave it, and examine it again at a later period, we find that the red¬
ness has increased, and that, moreover, it appears in a new form :
it no longer exists solely along the vessels, but the whole surface of
the stomach presents a tinge which has a constantly increasing ten¬
dency to become uniform ; and a period at last arrives, when all the
membranes, having become soaked with blood, are equally red ; they
may then have a tint almost similar to that which we observe on the
internal surface of the arteries when stained by the contained blood.
This kind of redness formed after death, cannot, however, proceed to
such a high degree, unless in cases where a certain quantity of blood
existed in the vessels of the stomach at the moment of death ; and
as, from the effects of gravitation, that fluid accumulates towards the
great extremity of the stomach in particular, it follows that it is there
we should see the redness from transudation most strongly marked.
It would be useless to attempt to fix precisely the period at which
this transudation should commence : for, in order to do that, we
should fix precisely the period at which putrefaction commences.
Now, that period is very variable, as it depends, 1, on certain con¬
ditions relative to the body itself ; such as the kind of death, the

118

Critical Review.

nature of the disease that produced it, &c. ; and, 2. on certain
external circumstances, especially on the thermometrical and hygro-
metrical states of the place in which the body is. Accordingly,
when, in summer time, we open bodies that have been kept, since
death, in warm beds, and in rooms of a temperature at least as high
as the external air, it is usual to find, so soon as after four and
twenty hours, very evident marks of transudation in the alimentary
canal ; in such cases, for instance, I have often found all the mem¬
branes of the great extremity of the stomach of a uniform red tinge.
Under similar circumstances, the colouring matter of the blood may
likewise transude, spread over the internal surface of the canal, and
mix with the fluids contained. 1 have ascertained this to be the
case in most of the bodies I had occasion to examine in the very
warm summers of 1825 and 1826.” — p. 21.

The stomach may have its parietes discoloured by tran¬
sudation of blood from the spleen, which, upon the whole,
is a rare occurrence. If we plunge a bladder filled with
blood into different gases, the blood becomes singularly
altered in its colour. It follows, that whenever similar
gases are developed in the intestines, they must affect the
blood similarly through the parietes of its vessels. It also
appears that scraping the mucous membrane with the back
of a scalpel, a redness sometimes follows, and extravasa¬
tion may even be produced. The effusion of bile into the
stomach may be followed by imbibition, and a yellow tinge
produced, which cannot be removed by ablution. Our
author deduces the following inferences from this part of
his investigations : —

“ To sum up ; the gastro -intestinal mucous membrane is not of
one constant and invariable colour in the healthy state. It is per¬
fectly white only in a very small number of cases, which I have
mentioned. Besides these it offers, without ceasing to be sound,
different degrees of colouring depending; 1, on the passive hype-
rsemia which has always a tendency to take place in the last mo¬
ments of life in the parts abounding in capillaries ; 2, on mecha¬
nical obstacles to the venous circulation formed at a longer or
shorter period before death; 3, on the hypostatic accumulation of
blood towards the dependent parts ; 4, on the transudation of the
blood through its vessels ; 5 , on another kind of transudation which
may take place, in some cases at least, through the capsule of the
spleen ; 6, on the presence of different gases in the alimentary canal
at the moment of death ; 7 , on the developement of other gases, at
a longer or shorter period after death ; when putrefaction takes
place ; 8, on the combination of the yellow matter of the bile with
different parts of the gastro-intestinal mucous membrane ; 9, and
lastly, on the accidental introduction into the alimentary canal of

M. Andrai on Pathological Anatomy.

119

different colouring principles that may stain its internal surface, and
thus produce a colour more or less perfectly resembling the result
of a morbid state. .

“ Of the colours produced by these different causes, some cannot be
in any way confounded with that resulting from inflammation ; others
differ from it only by characters which are often but feebly marked ;
and, lastly, others, especially those mentioned under the heads 1 and
3, as also some varieties of those under the heads 2 and 4, exactly
resemble the colour that would result in the alimentary canal from
the irritation artificially produced in it by the introduction of a mineral
acid sufficiently diluted with water to inject, without disorganizing,
those portions of the tissues with which it comes in contact.

“ It is, besides, important to observe, that caeteris paribus, the
colour of the gastro- intestinal mucous membrane presents some
shades, according to, 1, the part examined; 2, the age; and, 3,
whether the process of digestion was going on or not in the stomach
or in the duodenum and jejunum at the moment of death. Thus,
in those cases in which the mucous membrane is found colourless in
the adult, we may observe, as M. Billard has shewn us, that it is
whitish in the stomach, of an ashy white in the duodenum and
jejunum, that the ashy shade diminishes towards the end of the
ileum, and that, finally, in the great intestine, the mucous mem¬
brane resumes its dead white colour. With respect to age, we learn
from the valuable researches of M. Billard, that the gastro-intestinal
mucous membrane is rose coloured in the foetus and in the infant,
and of a milky and satiny whiteness in young persons ; that, in the
adult, it assumes a slight ashy shade, especially in the duodenum
and commencement of the small intestine ; and lastly, that in old
age this ashy shade becomes more decided and general, whilst the
submucous veins, being dilated and filled with blood, lift up and
impart a colour to the membrane covering them. At other times,
however, in old persons who die in a decrepit and bloodless state,
the mucous membrane is remarkable for its extreme paleness. I am
even persuaded, that it is in old persons, and in very young children
that had died of merasmus, that I have observed the internal surface
of the alimentary canal in the most perfectly colourless state.” —
p. 26.

A curious attempt is made to measure exactly the relative
thickness of the different portions of the mucous membrane
of the stomach and intestinal canal. This will vary accord¬
ing as the patient dies of acute disease, or of marasmus.

“ The consistence of the gastro-intestinal mucous membrane is in
general directly in proportion to its thickness. It is much more
considerable in the pyloric portion of the stomach than in its splenic
portion ; in the colon, where the thickness of the mucous membrane
is at its minimum, its consistence is also very slight. In the sto¬
mach, We may allow the mucous membrane to be of the natural

120

Critical Review.

thickness, when, on making an incision in it, taking care not to cut
the subjacent tissues, especially the nervous, or more properly, the
membranous coat, we can easily detach pretty considerable shreds
of it with a forceps ; the shreds should be larger in the pyloric
than in the splenic portion. In the duodenum its nature is such as
not to admit of such considerable shreds being detached as in the
stomach. In the rest of the intestines, the rectum excepted, the
mucous membrane, even in its natural state, breaks and tears when¬
ever we attempt to detach any portion of it. In these various parts,
however, the same physiological conditions which produce a varia¬
tion in the thickness of the membrane, such as the quantity of blood
supplying it, and the general state of the nutritive powers, produce
a variation in its consistence. Thus, at the same time that this
membrane becomes thinner, it tends also to grow' softer, without the
previous or present existence of any process of irritation.

** The mucous membrane of the alimentary canal may, after
death, be modified in its consistence, as we have already seen it to
be in its colour. This kind of softening has been observed prin¬
cipally in two cases ; 1 , long after death, when there were already
signs of putrefaction in the body ; in 2, a very short period after
death.

“ In the first of these cases the membrane loses its consistence
but slowly. I have more than once found it not in the slightest
degree softened in bodies of persons that had been from eight to ten
days dead, in which the intestines were green and distended with
gases, while there was exudation of blood into them, together with
ecchymoses in the substance of their parietes, and in many parts,
emphysema under the membrane. After the tenth day its con¬
sistence diminishes, and it then softens gradually ; from the fifteenth
to the eighteenth day it becomes like pap, and from the twenty-fifth
to the thirtieth it becomes quite undistinguishable.

“ This membrane, when exposed to the air, softens much more
rapidly. M. Billard, after opening an intestinal canal, left it
extended on a table for twelve days ; the temperature of the room
was ten degrees above zero, and the son shone into it every day.
The mucous membrane did not begin to soften until the sixth day,
at which period putrefaction was already advanced ; on the tenth day
it was of a pultaceous consistence ; and, on the eleventh, it was
reduced to a very fetid greenish pulp.

On the contrary, this membrane, when removed from the influence
of the atmosphere by being placed under water, softens but very
slowdy. M. Billard, after leaving a portion of intestine for two
months in the same water, and not till then, found its mucous mem¬
brane perceptibly softened, though it still retained a certain degree
of consistence. It was not till three months had elapsed, that it was
found to be so softened as to resemble merely a kind of very fetid
purulent layer.

It follow's from these facts, that the post mortem softening of the
gastro-intestinal mucous membrane does not occur until the putre-

M. And ral on Pathological Anatomy.

121

faction is pretty far advanced, and after the usual period of opening
bodies in most cases. It would appear, then, that we should not con¬
sider the very evident softening of the mucous membrane of the
stomach, that is sometimes observed at from twenty to four and
twenty hours after death, to have taken place after that event. How¬
ever the solution of this question is embarrassed, if I may say so, by
some cases in which the mucous membrane of the stomach has been
found completely softened, in dogs killed in very good health, and
opened shortly after death. Similar facts have been observed by
M. Bretonneau. M. Trousseau, who gives an account of them in the
Archives de Medecine, (tom. xii. p. 345) adopts an opinion of
Hunter’s, who has numerous followers in England at the present day,
and attributes this kind of softening to the solvent action of the juices
secreted by the stomach. According to several English physicians,
the softening might even extend to all the coats of the stomach, and
produce a perforation of thatviscus after death. — p. 22.”

Our author next adduces all the facts in favour of Mr.
Hunter’s theory, “ but he thinks they are neither suffi¬
ciently numerous nor circumstantially detailed, for us not
to wait for new observations on the subject, to confirm or
contradict the conclusion drawn from them.” — p. 35.

Much interesting information is given on the follicles of
the alimentary canal. These are most manifest round the car¬
diac orifice of the stomach, and in the duodenum they are
more developed in children. Thus in them we often find
without any indication of intestinal affection, on the internal
surface of the small and large intestines, small round
bodies, of a white or greyish colour, and with a central
orifice, the circumference of which is very often of a deep
grey, which are nothing but follicles. Again, they are often
congregated, often occupy an extent from one to three feet
of small intestine. In the centre of each follicle, is often
found a point of a blueish grey or black. As these exist
without any indication of intestinal disease, our author is
of opinion they do not constitute a morbid state in a child.
They are often observed in persons labouring under diarr¬
hoea and adynamic (typhus) fever, especially near the end
of the ileum ; but they are also found in bodies where there
was intestinal disease. These follicles are also found in the
bodies of dogs, sheep, and horses.

A great deal of stress has been laid on these enlarged
follicles, by some writers on fever in this country ; and it
appears, from the preceding testimony, without much rea¬
son. We have now afforded the reader an opportunity of
forming his own opinion, on the value of Professor Andral’s

Vol. vi. no. 32.

122

Critical Review.

Pathological Anatomy, and we think he will agree with 11s,
in considering it a most valuable contribution to medical
Science. It is a w?ork which stands a splendid monument
of learning, industry, and talent, and has no equal in our
annals of medical literature. This translation renders a
valuable work accessible to every man engaged in the prac¬
tice of the healing art, and is executed with much ability
and judgment. It is one of the most able and satisfactory
works which modern times have produced.

Y. — Medico-Chirur gical Transactions, Vol. XVI. Part I.

London, 1830. Longman and Co. — (continued.)

In accordance with our promise we resume our analysis
of the work before us. The third paper is entitled, A
case cf ununited fracture of the thigh-bone, cured by the
application of a silver wire between the fractured extremi¬
ties.” By Dr. Somme, of Antwerp ; communicated by J. H.
Green, Esq. F.R.S. &c.

The patient was a healthy subject, between thirty and
thirty-five years of age, and the fracture had remained
ununited for five months. The operation was as follows: —

“ The patient being placed on his back and supported, I passed a
long trocar and canula at first downwards on the inside of the upper
fragment, and made it pierce the skin behind, and a little to the out¬
side' ; the trocar was then withdrawn, and a silver wrire passed
through the canula, and out at the posterior opening. The canula
was then withdrawn, and being replaced on the trocar, they were in¬
troduced again above on the outside of the lower fragment, and made
to pass out the same opening behind. The trocar having been re¬
moved, the other end of the wii^ was passed through the canula, so
that both ends wrere in contact behind, leaving a loop in front. I
then made an incision in front, from one orifice to the other made by
the trocar, and drawing the extremities of the wire through the
wound, brought the loop between the fractured ends of the bone, and
approximated the edges of the skin with sticking-plaster.”

The wire was drawn tighter at each dressing, so as to
depress the loop more and more in the flesh. It was with¬
drawn in six weeks before it had divided the flesh, as the
bone had completely united. The limb was kept in the
fracture box six wreeks longer.

Medico-Chirur gical Transactions.

123

The fourth paper is, te An account of a concrete oil,
existing as a constituent principle in healthy blood.” By
Dr. B. G. Babington. Many physiologists have noticed oil
in the blood, but generally it was considered a morbid pro¬
duction. Hewson, Traill, Christison, and Pretty, at the
London Medical Society, last year, are those who have
noticed it in this country. Dr. B. asserts that it is found in
the healthy blood of man and animals, and may be sepa¬
rated in the manner following : —

‘ ‘ It may be procured by very gently agitating a quantity of serum

with a third part of ether, and separating and evaporating the

latter after four or five days, and when it has become of a yellow

colour. The oil thus obtained (which forms about. 3 of the serum

1000

of the blood), “ is of a deep yellow hue, is semi-solid, and melts at a
temperature of 90° Fahr. The specific gravity is .918 From its so¬
lution in ether it crystallizes, by very slow evaporation, at a low tem¬
perature, in radiated tufts. It burns with a brilliant light, has a
faint and peculiar odour, resembling that of a wet bladder, and in its
general characters resembles other animal oils. It is uniform in co¬
lour, in general appearance, and in all its properties, from whatever
kind of serum obtained.”

The fifth paper is on “ Phlegmasia Dolens.” By Wil¬
liam Lawrence, Esq. F.R.1S. &c. It was a case consequent
to cancer uteri, in which the lower extremity was swollen,
painful, the lower part of the leg and foot pitting on pres¬
sure. The pain was principally along the course of the
iliac and femoral vessels ; the saphena presented a hardened
and knotty feel, and great relief was afforded by the appli¬
cation of leeches along the course of the vessel.

The woman died suddenly from uterine haemorrhage, and
the limb presented the following appearances : —

“ The cellular and adipose tissue round the lower part of the
uterus and neighbouring portion of the vagina were thickened and in¬
durated, particularly on the right side. The hypogastric vein in¬
volved in this diseased mass, was closed in consequence of previous
inflammation of its coats ; and the same change had occurred in the
internal iliac, the common iliac, the external iliac, the femoral and
profunda veins, as well as in the internal saphena, all of which were
completely impervious. The affection terminated above at the in¬
junction of the common illiac vein with that of the opposite side, the
latter vessel and the inferior cava being quite natural. The saphena
was closed for a length of about four or five inches, beyond which it
was natural. The profounda was cut through near the femoral vein,
and the latter was divided as it passes the tendon of the triceps. The

124

Critical Review.

disease extended in both these vessels beyond the’ situations where they
had been divided, but its inferior limits were not ascertained ; the
right spermatic vein was closed in its lower half. The coats of the
affected vessels and the surrounding cellular substance, were a little
thickened, and their cavities were plugged by a closely adherent and
tolerably firm substance of a light-brown colour. At some parts the
vessels and their contents were of a dark livid hue.”

This w as clearly a case of eruritis, but not of phlegmasia
dolens. The most eminent obstetric writers of this and
other countries, affirm that the true phlegmasia dolens of
puerperal women is scarcely ever fatal. We have cited a
host of authorities in proof of this opinion, in an original
article, on the real disease, in the fourth volume of this
Journal, 18 SO.

The sixth paper is on Cf Swelling of the lower extremity,
in a lad, aged seventeen, who died of this phthisis.” By
Mr. Holberton. A second case is narrated of a woman,
aged thirty-five, who died of phthisis. Here the swelling
was much less, the limb was occasionally cold, and upon
the whole, it bore not the slightest similitude to phlegmasia
dolens. The author did not designate it such. The left

# o

common diac contained lymph, the same was observed at the
union of the left internal iliac, with the former vein ; the
remainder of the vessels wras healthy. The left external iliac
was healthy, except at its lower portion, where it was com¬
pletely blocked up by coagulum, adherent at one part only.
The coagulum was found to extend along the two upper
thirds of the femoral vein.”

The seventh case is one of Stammering, successfully
treated by the long continued use of cathartics. By Dr.
Bostock. The defect of articulation came on suddenly,
when the boy was three years old, and was much relieved
by purgatives, which were indicated by his plethoric habit.
Whenever the remedy was omitted, the defect increased,
and again diminished by the use of medicine. A vegetable
diet was also recommended. The complaint recurred at
the twelfth year, when the boy was sent to a public school,
and again removed by purgatives. He is now in his fifteenth
year, and may now be said to be free from the complaint.

The eighth paper is on the pathology of Hooping Cough.
By Dr. Alderson. The author states that the cause of
death in hooping cough is hepatization of the lung, and that
he has found great benefit from cupping glasses to the chest,
which are preferable to leeches, which are too slowr in their
operation. Calomel and James’s powder arc also useful.

Medico-Chirur gical Transactions.

125

He throws no new light on the subject, and even omits
many recent opinions upon the pathology and treatment of
the disease. Thus the continental writers consider that there
is great danger of cerebral congestion in the disease, and
pay close attention to the head, lest convulsions should
supervene. Hence leeching the temples or nape of the neck
is frequently resorted to, and also the application of counter-
irritants to the chest.

The ninth paper is on the infrequency of Calculous Dis¬
eases in seafaring persons. By Mr. Hutchinson, and confirms
the author’s former statement on the subject. He adds a
second paper, on the frequency of Calculous Diseases in
Scotland, and clearly shews that these are more frequent
than in England. He says the proportion there is one in
80,000, and he only includes cases from the principal towns ;
while in England, according to Dr. Yelloly’s account, it is
one in 108,000. Mr. H. thinks this frequency of the dis¬
ease may be ascribed to the more sedentary habits of the
Scottish people, and in some measure to the nature of the
lower orders.

The tenth paper is entitled, (f Practical observations on
the healthy and morbid conditions of Stumps.” By George
Lanstaff, Esq. The author gives a graphic account of the
healthy and morbid action in stumps, and illustrates his
remarks by describing preparations in his own museum.
There is nothing novel in his paper — nothing unknown to
any scientific surgeon.

The eleventh paper is by Mr. Crampton, of Dublin,
which, with the tenth, by Mr. Owen, we noticed in our
last.

The twelfth paper is on Glanders in the human subject.
By Dr. Elliotson. Two cases were admitted into St.
Thomas’s Hospital, of typhoid fever, purulent discharge
from the nostrils, abscess in different parts of the extremities,
pustules on the alee nasi, which terminated in gangrene. Both
patients died. Our talented author was at a loss to account
for the cause of the disease, but suspected the absorption of
some morbid poison.

In a few days after the death of his patient, he saw an ac¬
count of ee a fatal case of glanders in the human subject,” on
the cover of the Medical Gazette, which at once led him
to think he had discovered the cause of the disease for which
he had been unable to account.

With that zeal for the interest for science which characterize
that physician, he repaired to the residence of the father of

126

Critical Review .

one of his patients at Lambeth, and learned that the unfor¬
tunate youth had patted a glandered horse on the head, and
was in the habit of wiping his eyes with the back of his hand,
and for some time had been troubled with pimples upon the
forehead and nose.

He also ascertained that his other patient had been infected
by glanders. On speaking to Mr. Parrott, of Clapham, he
learned the history of another case ; and, on applying to Mr.
Coleman, at the Veterinary College, who did not believe in the
possibility of contagion in such a case, he was referred to Mr.
Traver’s Work on Constitutional Irritation, by Mr. Jewel.
Dr. Elliotson, also obtained from Dr. Kind, of Finsbury
Square, who is a native of Germany, an account of two si¬
milar cases, translated from Rust’s Magazine, of the Healing
Art, and which are published.

The profession are deeply indebted to Dr. Elliotson, for
elucidating this important subject, and this paper will add
much to his well earned reputation.

ORIGINAL COMMUNICATIONS.

r ' . . '

I. — Medico-legal questions , relating to Infanticide.

By M. Ryan, M. D.

All authors are now agreed, that there is not any difference
between natural and artificial respiration in the cases under
notice, (Edinb. Med. and Surg. Journ. 1820. v. 26 — “ and
the hydrostatic test can never prove positively that the child
was still-born, but only that it had not breathed.” Op. Cit.
p.389, ie at the same time, it will yield strong presumptive
evidence.” Cf On the whole, then, it follows, from the pre¬
ceding statements, that when due precautions are observed,
and when certain exceptions and corrections are made, the
floating of the lungs afford at least stron g presumptive evidence
that the child out-lived delivery.” — p. 374.

Dr. Beck arrives at the following conclusions on this point:

1. — That when the lungs float in water, it must be from
one of these causes ; natural respiration, putrefaction, the
artificial introduction of air.

2. — As the lungs may float from other causes beside respi¬
ration, their mere floating is no proof that the child was born
alive.

3. — As whenever it is possible to discriminate between the
floating of natural respiration and of that which is the result
of other causes, it follows.

Dr. Ryan on Infanticide.

127

4. — That with due precautions, the floating of the lungs
may be depended upon as a safe and certain test that the
child has been born alive. The same distinguished jurist
arrives at the following conclusions, on sinking of the lungs
in water : —

1 . — That when the lungs sink in water, it must be from
one or other of the following causes : the total want of respi¬
ration, feeble and imperfect respiration, some disease of the
lungs, rendering them specifically heavier than water.

2. — As the lungs may sink from other causes than the
absence of respiration, their mere sinking is no decisive proof
of the child’s having been born dead.

3. — As, however, the sinking from the want of respiration,
may easily be distinguished from that which is the result of
other causes, it follows,

4. — That with due precautions, the sinking of the lungs is
a safe test that the child was not born alive.

It is very evident, from the preceding statements, that a
great degree of caution is necessary in every case, before a
decision can be given with confidence ; and from the diffi¬
culties of the subject, a few practical rules may be laid down
for the guidance of physicians and surgeons, when called on
to give evidence in cases of infanticide.

The general appearance and condition of the body, should
be carefully noted, as also the situation in which it had been
found, all instruments which might be used criminally ; the
size, wreight, and length of the infant, the proportion of
different parts ; the degree of developement, the signs of
putrefaction, desquamation of the cuticle, the appearance of
the navel, and of eveny part of the body. We should examine
whether there be contusions, ecchymoses, excoriations, and
be careful not to confound them with cadaverous lividity : if
any lesion is found, its precise situation and extent must be
described. If wounds exist, their form, length, breadth,
depth, must be accurately noted. The appearances of the
head must be observed, and care taken not to confound those
which are produced by parturition with those produced by
external injury. We should ascertain, whether or not there
be foreign bodies in the ears, nose, eyes and mouth, or marks
of injury upon the neck, dislocation of the cervical vertebrae,
whether the chest be arched or flattened, and when com¬
pressed, if a fluid escapes from the mouth or nose; whether
the abdomen be soft or tense, if the umbilical cord be flaccid,
dry, moist, detached, cut or lacerated, and its exact length,
or if the navel be red, in a state of suppuration or cicatriza¬
tion; if the testicles have descended, and finally, whether there

128

Origin cu C ommtin ic at ions .

are dislocations or fractures of the superior or inferior ex¬
tremities.

Such are the principal points to be attended to, in the in¬
spection of the external condition of the body ; all appear¬
ances should be taken down in writing-, and the document
carefully preserved, as the witness may produce it at atrial,
or refresh his memory from it ; whereas he cannot use a copy
in either case, especially in this country. The next part of
our duty is to examine the external parts of the body, and here
also the appearances are to be recorded.

Autopsy-Dissection. — Medical jurists are notagreed upon
the method of dissection, in cases of infanticide. Drs. Beck
and Smith think it most convenient to commence the dissec¬
tion with the mouth and cavities leading to the chest.
MM. Chaussier, Renard, Briand and others, commence
with the spinal canal, then proceed to open the head, thorax,
mouth, pharynx, and passages to the chest and abdomen,
and the abdomen. The former mode is more convenient,
and I think the better. It is briefly as follows : —

The neck is to be placed on a block of wood, so as to
render its anterior surface prominent. It is right to observe,
whether the mouth be open or closed, if the tongue be pro¬
truded, or turned back into the fauces. An incision is then
to be made from the lower lip to the upper extremity of the
sternum ; and another along the lower edge of the inferior
maxillary bone, the integuments are to be dissected back, and
all marks of violence, ecchymoses, &c. noted. The lower
jaw is now to be divided at its symphisis, the parts attached
to its internal surface divided, the tongue should be depressed,
when there will be a complete view of the mouth and pharynx.
We should carefully observe whether there be any foreign
body or sanguinolent appearance, and if the glottis and epi¬
glottis be natural, and if there be fluid in the larynx or tra¬
chea ; — the abdomen is next to be examined, an incision is to
be made from the sternum to the spine of the ilium on each
side, the flaps turned back, and the umbilical vessels observed
and tied. We are next to observe the appearances of the
abdominal viscera, and to note every thing unusual. We
should ascertain if the umbilical vessels be empty, or contain
coagulated blood, if cut or lacerated, if the ductus venosus
be permeable or obliterated. The size of the liver should be
noticed, its large vessels tied, and the organ be removed
and weighed; but previous to its removal, the gall bladder is
to be inspected, the colour of its bile noted, or whether it be
entirely empty. The stomach should be removed, after its
apertures having been tied, and its contents, if any, care-

Dr. Ryan on Infanticide.

129

Fully examined. We should further observe whether the in-
terstinal canal contains meconium, fasces or other matter,
or present any sign of disease ; and lastly, if the bladder
be empty, or full of urine.

The cavity of the thorax may be opened in the ordinary
manner, but on dissecting the integuments, every appearance
of lesion is to be noted, and a minute examination instituted,
in order to discover if the chest have been punctured. The
cartilages of the ribs are to be divided with a scissors, in pre¬
ference to a scalpel. We should next examine the size and
colour of the lungs ; if of a dull red or rosaceous, if these
organs fill the thoracic cavities, and if the tendinous centre
of the diaphragm be depressed. We are to take into
account the size of the heart, the dimensions of its cavities, if
they contain blood, the colour of its tissue, the degree of
opening or closure of the foramen ovale and ductus arteriosus,
the presence of fluid or coagulated blood; always recollecting
that, the most dependent portion of the lungs, is engorged with
blood andbrownish, and that the site of this engorgement will
vary according to the position in which the body had lain
while becoming cold, and that this appearance will be
greatest in proportion as the patient has not lost blood. After
having examined the oesophagus and trachea, and noted their
appearances, the large vessels are to be tied, the lungs and
heart removed, and the former subjected to the hydrostatic
and other tests, in the manner hereafter mentioned. In
examining the vertebral column or spine, an incision is to be
made from the occiput to the sacrum, the integuments and
muscles carefully removed, and the annular portion of the
vertebrae divided with a strong scissors, which may be intro¬
duced under the fifth lumbar vertebrae. During this exami¬
nation, we must observe all lesions, ecchymoses, dislocations,
fractures, wounds and punctures ; but we must not consider
the congestion of the spinal veins or the presence of limpid,
yellow or viscous serosity, the effect of violence ; as these
are ordinary occurrences, and will be found in such situations
as the posture of the body favours.

The best mode of opening the head, is to make an incision
from root of the nose to the third or fourth cervical vertibra,
and another from ear to ear, the integuments are to be dis¬
sected back, and all lesions carefully examined and noted,
wounds, punctures, fractures, &c. A small opening is to be
made with a scalpel, through the anterior fontanelle, and the
sutures divided by a scissors, great care being taken not to
wound the sinuses or larger vessels : the bones of the cranium

Vol. VI. no. 32.

130

Original Communications.

can be easily separated in this manner. We are now to ascer¬
tain if there be blood in the ventricles,, or on the base of the
brain, to remove the cerebrum and cerebellum, and carefully
dissect both.

The examination of all the organs having been completed,
the inferences to be drawn will be evident, after a careful
perusal of the statements made in the course of this work.
But to render the information as complete as possible, it is
necessary to describe the method of instituting the hydro¬
static test.

The water in which the lungs are to be placed, must not
be too hot nor too cold, but of the temperature of the atmos¬
phere; it should contain no salt. If these precautions are
observed, the lungs, with the heart, will float or sink in
water ; if they float, it is proper to notice, whether upon or
under the water ; if they sink, whether gradually or rapidly.

The lungs are to be taken out of the water, the large
vessels tied, the heart separated, and the organs then weighed
to ascertain the proportion they bear to the weight of the
body. They are to be immersed again, then the lobes sepa¬
rately, and lastly, each to be cut in small pieces ; on incising
it, we should note if there be crepitus, the tissue compact, or
in a morbid condition. Should the fragments float, they are
to be firmly squeezed in the hand, and again placed in the
water. The inferences to be drawn from these experiments
are the following, according to Dr. Beck. When there is
nothing on the body of the infant to account for its death
during delivery, the lungs untouched by putrefaction or
artificial respiration, affording a crepitus on incision, floating
entire or ip segments on the surface of the water, and if the
segments float after firm pressure, then the evidence is
irresistible that the infant was born alive, and enjoyed perfect
respiration. If only the right lung, or its pieces float, the
respiration has been less perfect. If some pieces only float,
while the greater number sink, respiration has been still less
complete. If neither the entire lungs nor any section of them
float in water, the evidence is decisive that the child never
respired.

It is right to mention, that Professor Bemt is of opinion
that Ploucquet’s test affords decisive evidence in a few cases,
and no more than presumptive evidence in the rest. It is
scarcely necessary to remind the medical jurist, that he should
ascertain if the woman has been recently delivered, and learn
the whole history of her case. The signs of recent delivery
have been already enumerated. He should inquire whether

131

Dr. Ryan on Infanticide.

the labour was sudden, in what position it took place, if the
infant was born immediately after the rupture of the mem¬
branes, or how soon after ; if delivery took place without
assistance, or what assistance was afforded ; if there was
haemorrhage before, during, or after delivery; on what day
and hour did labour commence, and did the birth take place ;
if the woman was insensible before, during, or after delivery ;
if the infant respired, if not, what attempts were made to re¬
suscitate it. All these questions should be put in a mild
manner; the solemn duty of the medical jurist being to
ascertain fact, and to take no interest in the prosecution or
acquittal of the accused ; he should confine himself solely
to the duties of his profession, and strenuously avoid putting,
what lawyers call “ leading questions,” or intimidating the
accused, or violating one of the best principles of our
humane laws, by extorting a confession, or inducing a sus¬
pected female to criminate herself. His sole duty is to give
the received opinion of his profession, regardless of conse¬
quences, but on all doubtful cases, leaning to the side of
mercy.

In the foregoing dissertation I have only discussed the
principal points which claim attention, in cases of infanticide ;
as many more particulars will be found in the course of this
work, more especially in the article on homicide, where the
danger and mortality of wounds, contusions, and fractures,
will be duly considered. Enough, however, has been said to
warn the practitioner against committing errors, which have
but too often led to the execution of innocent women : I
might illustrate this assertion from the authority of Dr. W.
Hunter, but his opinions are too well kiiown to require ex¬
pression in this place.

Medico-legal questions, relating to violation of

Women.

In a preceding article d have stated the law upon this subject,
and it now remains to consider the questions which may be
submitted to medical jurists for their decision. These are as
follow : — 1, Are there certain signs of defloration ? 2, Can we
distinguish between forcible violence against the consent of
the accuser, and whether the signs of violence be not attri¬
butable to the introduction of other extraneous bodies into
the external sexual organs ? 3, And whether a woman can be
violated without her knowledge ? And 4, whether pregnancy
can follow violation ?

132

O rig in a l Co mm uni cations .

1, Are there certain signs of defloration? To determine
this question, we must decide whether there be certain signs
of virginity. We have to refer to anatomical and obstetric
works, for a description of the external genitals in a virginal
state, to enable us to form a correct decision upon this ques¬
tion. The external genital organs are those connected with
the subject, and these I have minutely described in my work
on Midwifery: a brief description, however, is necessary in
this place.

In virgins, the external labia are thick, firm, elastic, and
internally of a vermillion or rosaceous colour, their edges in
apposition, so as to close completely the orifice of the vulva.
They are soft, pale, and separated in women accustomed to
venereal enjoyment. But these characters are not to be de¬
pended on, as women of strong constitutions may have the
signs of virginity ; and virgins the latter signs from leucor-
rhoea, or fluor albus. In fact, no positive conclusion can be
deduced from the state of external or internal labia. The
same must be said of the froenum labiorum ; it may or may
not be ruptured during coition, and every obstetrician of or¬
dinary experience, can attest its perfect condition during par¬
turition. Besides, it may be ruptured by falls, external inju¬
ries, or by the passage of solid morbid growths. The ori¬
fice of the vagina is usually narrow, but it may be relaxed
by leucorrhoea, or may be larger in a virgin, than in a woman
who has been violated. In some women it is particularly
closed by the hymen, a membrane long held as the surest
sign of virginity.

It is now universally known, that a great variety of
causes, besides coition, may destroy this membrane, as sudden
exertion of the lower extremities, leucorrhoea, masturbation,
excoriation, confined menstrual fluid, and various morbid
growths, both solid and fluid. It does not always exist even
in infants, and does not entirely close the vagina at puberty,
so that the introduction of the penis may be effected, if not
disproportionate, (Teichmeyer,Brendel, Severin, Pineau, &c.)
Indeed women have been in labour, and the hymen perfect.
(Mauriceau, Ruysch, Pare, Meckel, Walter, Baudelocque ,
Smellie, Capuron, Nsegele, &c.) It is therefore no infallible
sign of virginity, nor is its absence alone a positive proof of
defloration. The carunculae mvrtiformes were long consi-
dered as the remains of the hymen, but this is denied by
Hamilton, Conquest, and Velpeau. They have been seen in
infants and virgins, and are no proof of defloration, because,
like the rugae of the vagina, they are only effaced by repeated

Dr. Ryan on Violation of Women .

133

coition. Dr. Beck admits, that many of the above signs are
equivocal, but if taken in connexion with one and other, he
thinks it cannot be possible that all mentioned in the chaste
state, can be absent without a strong suspicion against the
female. I cannot assent to this conclusion, as I think ex¬
perience has proved that all the physical signs of virginity
are equivocal, and all may be absent from causes already
enumerated, without room for a full grounded suspicion
against the female. From my own experience and the result
of my researches, I can arrive but at one conclusion, that
there are no positive signs of virginity, and consequently
these of defloration are extremely uncertain ; this, I find, is
the opinion of the faculty of Lepsig, Metzer, and of Mor¬
gagni. The presence of the reputed signs of virginity afford
no decisive proof of chastity, nor their absence no decisive
proof of incontinence. If all the reputed signs described
above exist, the female feels offended at the examination, or
rather displays evidence of shame ; if her morals, age, and
education have been good, then there are strong grounds for
supposing her in possession of her chastity ; and if all the con¬
trary signs exist with a suspected reputation, and an equi¬
vocal virtue, then there is reason to pronounce a contrary
opinion.

It is necessary to recollect the habit of body and age of
the patient, as signs of virginity are most perfect between
puberty and the twenty-fifth year, after which period they
become more equivocal.

When defloration of any young female has recently taken
place, the signs are very evident. The laceration of the
hymen (if it exist), the presence of its remains covered
with clotted blood, the contusions of the labia, majora, and
minora, of the clitoris, and carunculee myrtiformes, the
redness and tumefaction, or laceration of all the external
genitals, leave no room to doubt. But almost all these
marks will generally disappear in three or four days. They
disappear almost instantaneously in chlorotic and leucorrheic
females. (Briand, Manuel de Medicine Legale.)

Second question — Can we distinguish between defloration,
the result of voluntary carnal commerce, or that which has
been effected by violence, or by the introduction of a foreign
body into the vagina ?

It is extremely difficult to determine this question in a po¬
sitive manner. Many medical jurists are of opinion, that
contusions, lacerations, inflammation of the vulva, thighs,
arms, breasts, and other parts of the body, prove that vio-

134 Original Communications.

lence had been used, and that the female did not consent.
But- it is to be recollected that many women will not consent
without some force, and also that injuries of the genital
organs may follow a first congress, when the sexual organs
are disproportionate.

Every person knows, says a French jurist, that at the
epoch of puberty, young girls of an erotic temperament,
employ foreign bodies for the gratification of their desires,
and may cause laceration or contusion of the external
genitals ; and who does not know that these excesses have
brought on delirium, and who is ignorant of the deplorable
effects of onanism. (Briand.) Again, women have injured
the organs for the purpose of accusing an innocent man of
rape. (Fodere.)

In all cases of defloration we must consider the age,
strength, and state of mind of both parties. When this
Crime is perpetrated on children of a tender age, the dispro¬
portion of the organs will be followed by the marks of injury
already enumerated. On the other hand, a strong woman
may accuse a delicate man, or boy, or one who is impotent.
It is held by most jurists, that it is almost impossible ; at all
events exceedingly doubtful that one man can violate an
adult female. (Mahon, Farr, Fodere, Capuron, Beck,
Briand, &c.) The exceptions to this rule are, when the
female labours under insensibility from violence, syncope,
or fainting, narcotics, intoxication, and, according to the fa¬
culty of Leipsic, when she is asleep.

It is indispensably necessary to examine the sexual organs
of both parties. The man may be impotent from the causes
already described ; the penis may have been destroyed by
sloughing or cancer, &c., or the organ may be so small as
to cause no pain on its introduction into the vagina. Zac-
chias mentions a singular case of this last kind. The woman
may labour under a variety of malformations which preclude
the generative act. A speedy examination should be made
in all cases, for the reasons stated in a preceding paragraph.

The state of mind of the woman must be kept in view, as
an idiot at twenty or upwards can make less resistance than a
girl of fourteen.

Venereal infection is a proof of violation, when it coincides
with the time at which the crime is alledged to have been
perpetrated, that is, if it appears from the third to the eighth
day, and, above all, if the accused is affected with the dis¬
ease. Every well-informed practitioner is aware tha?t gonor¬
rhoea or syphilis cannot manifest itself immediately after

Dr. Ryan on Violation of Women.

135

congress* and therefore* if found on the female* it is a
strong proof against her.

Every well-informed physician and surgeon is conversant
with the purulent discharge of female children of scrofulous
and delicate habits* from the period of dentition to the age of
puberty ; such discharge is seen almost every day in dispen¬
sary and hospital practice among the poor. It is described
by John Hunter* Hamilton* Astley Cooper* Dewees* Jewel,
and the author himself, and is often mistaken by ignorant
practitioners for gonorrhoea.

There is no fact better attested than this* that purulent
discharge from the genital organs of both sexes* from the
period of infancy upwards, may arise from causes purely
physical* chemical, or specific. Venereal excess between
two persons whose organs are healthy* may cause a dis¬
charge more or less intense in one or both ; but still the
symptoms are not so violent as in gonorrhoea. Even children
of both sexes are subject to genital discharge before and
during dentition* from worms* or from local injury of the
sexual organs, as in cases of defloration of female children.
The last fact is one of great importance to those who are
called on to give evidence before magistrates, or in courts
of justice* in charges of rape. The accused may be free
from gonorrhoea* and declare that if the child is infected it
is not by him. The medical man should ascertain the
lesions, and discriminate between purulent discharge the
consequence of violence and inflammation* and that arising
from infection. The history of the case will enable him to
form a correct opinion in the majority of instances* and he
ought to ascertain whether the child has not been subject to
discharge previously to the supposed offence. In a case in
which I was consulted, and which is recorded in the Lond.
Med. and Surg. Jour. 1830* vol. v. the girl had laboured
under purulent discharge five years before, and was then ten
years old, and exceedingly delicate. On that occasion I
afforded abundant evidence of the liability of female infants*
and of girls to the age of puberty, to purulent discharge from
the vagina. We know that equitation, injury on the peri¬
neum, calculus in the bladder* stricture of the urethra* hae¬
morrhoids* gout* rheumatism* certain cutaneous diseases, as
herpes, impetigo, serpigo* lepra, &c.* the terebinthinate me¬
dicines* lytta* spices, diuretics, sexual intercourse during the
catamenial or lochial evacuations, the introduction and long
retention of a bougie in the urethra* irritation in different
parts of the alimentary canal, constipation, certain aliments

136

Original Communications .

and medicines, as new beer, asparagus, &c. — in a word, dis¬
eases of organs which strong! 3' sympathize with the genito¬
urinary system ma3T cause simple gonorrhoea. Cases are
recorded in which gastro-enteritis, diseases of the respirator}7
system, cor}7za, cynanche, pneumonia, and asthma, had ter¬
minated by a copious discharge from the urethra. It is
admitted that there is a reciprocity of action between the
mucous, serous, fibrous tissues, the digestive, respiratory
systems, the urinary apparatus, and the urethra, and uterine
system, and that none of these systems can be irritated or
inflamed without affecting the urethra or uterine apparatus.
So also the latter organs cannot be affected without impli¬
cating the former tissues in various degrees. Dr. Titley re¬
lates a case in which he supposed venereal gonorrhoea' existed
for a period of three days, and for which he prescribed the
usual remedies, but before the patient had taken the medi¬
cine, he was seized with a smart attack of gout, and in a few
hours the urethral discharge had vanished.

Capuron was consulted in a supposed case of defloration,
in which a purulent discharge escaped from the vagina ; the
external genitals w ere ulcerated ; but that able physician
ascribed it to the cause under notice, and the girl was soon
restored to health. M. Biessy, of Lyons, relates a case in
which all the surgeons of that town certified a child had
been violated in consequence of the presence of a discharge.
He denied it, which induced the Ma}7or to request five phy¬
sicians to examine the child separately, without knowing the
application to each other, and the}7 all agreed that she onty
laboured under a simple mucous discharge. (Manuel Me¬
dico-Legal, &c.)

The following case is related by the revered Dr. Perc-ival,
in his admirable Ethics : —

Jane Hampson, aged four, was admitted an out-patient
of the Manchester Infirmary, Feb. 11, 1791. The female
organs wrere highly inflamed, sore, and painful; and it was
stated b}7 the mother, that the child had been as well as
usual, till the preceding dav, when she complained of pain
in making water. This induced the mother to examine the
parts affected, when she w?as surprised to find the appear¬
ances above described. The child had slept tw o or three
nights in the same bed with a boy fourteen }*ears old, and
had complained of being very much hurt by him during the
night. Leeches and other external applications, together
with appropriate internal remedies, were prescribed ; but the
debility increased, and on the 20th of February the child

Dr. Ryan on Violation of Women.

137

died. The coroner’s inquest was taken ■ previous to which,
the body was inspected, and the abdominal and thoracic vis¬
cera found free of disease. From these circumstances, Mr.
Ward, the surgeon attending1 this case, was induced to give
it as his opinion, that the child’s death was caused by ex¬
ternal violence ; and a verdict of murder was accordingly re¬
turned against the boy with whom she had slept. Not many
weeks elapsed, however, before several similar cases occur¬
red, in which there was no reason to suspect that external
violence had been offered, and some in which it was abso¬
lutely certain that no such injury could have taken place. A
few of these patients died. Mr. Ward was now convinced
that he was under a mistake in attributing the death of Jane
Hampson to external violence, and informed the coroner of
the reasons which induced this change of opinion. Ac¬
cordingly, when the boy was called to the bar at Lancaster,
the judge informed the jury, that the evidence adduced was
not sufficient to convict; and that it would give rise to much
indelicate discussion, if they proceeded to the trial ; and
that he hoped, therefore, they would acquit him, without
calling witnesses. With this request the jury immediately
complied. The disorder in these cases, says Dr. Percival,
had been a typhus fever, accompanied with a mortification
of the pudenda.”

Mr. Kinder Wood relates cases of a disease somewhat
similar, in which there is fever for three days, inflammation
of both labia, clitoris, nymphee and hymen, followed by
sloughing and death. The mortality was ten in twelve, and
the disease considered a peculiar kind of eruptive fever.
(Med. Chir. Trans, vol. vii.)

I have already recorded a case of a delicate scrofulous
girl, aged eleven years, who had purulent, or rather mucous
discharge from the external genitals, and accused a young
man of eighteen, whose genitals were developed in an ex¬
traordinary degree, of having violated her person. Two
apothecaries swore the girl had been violated, a rape com¬
mitted, and gonorrhoea communicated. Dr. Gordon Smith,
Mr. Whitmore, and myself, were of a different opinion.
The froenum labiorum was perfect, the hymen absent, a dis¬
charge without any sign of inflammation the day after the
alledged intercourse, and a small dark spot, observed by
Dr. Smith only on the thigh. The examinations of the me¬
dical men were made at different times. The case was
grievously mismanaged for the prisoner ; the only evidence
in his favour was Dr. Smith’s, which was contrasted with that

VOL. VI. no. 32.

138

O rigin ul Communications’

of the two medical witnesses for the prosecution. The man
was found guilty, and sentenced to six months imprisonment,
and lectured by the chairman of the Middlesex sessions (Mr.
Const) on his good fortune — that he was not hanged. The
mother had informed Dr. Smith that her daughter had had
the discharge since she was five years old. The medical
witnesses for the prosecution declined examining the person
of the prisoner, though those on his side had assured them
he had no discharge from the urethra, nor had not had any
for six months previously. The case was tried in November
sessions, 1829. When the girl was examined at the trial, and
asked why she did not tell the domestic who disturbed the
parties during the alleged intercourse, she replied, “ she
forgot it.” A girl of eleven years old, violated by an adult,
forget it ! Cases like the present are unfortunately of too
frequent occurrence, and are attested by Sir A. Cooper in
the following impressive language: —

There is a circumstance which I am exceedingly anxious
to dwell on, — I allude to a discharge from young females ;
and I hope that there is not one here this evening but will
be strongly impressed with the importance of the subject.
Children from one year old, and even under, up to puberty,
are frequently the subjects of a purulent discharge from the
pudendum, chiefly originating beneath the preputium clito-
ridis, the nymphse, orifice of the vagina, and the meatus
urinarius, are iif an inflamed state, and pour out a discharge.
The bed linen and rest of the clothes are marked by it. It
now and then happens, to a nervous woman, to be alarmed at
such an appearance, and she suspects her child of having
acted in an improper manner ; and perhaps, not quite clear
herself, she is more ready to suspect others, and says dear
me, (if she confesses,) it is something like what I have had
myself. She goes to a medical man, who may unfortunately
not be aware of the nature of the complaint I am speaking of,
and he says, f Good God ! your child has got a clap.’ (A
laugh.) A mistake of this kind, gentlemen, is no laughing
matter ; and, though I am glad to make you smile some¬
times, and like to join you in your smiles, I cannot do it on
the present occasion, for it is too serious a matter. I can as¬
sure you a multitude of persons have been hanged by such a
mistake. I will tell you exactly what takes place in such
cases ; the mother goes home, and says to the child, f Who
is it that has been playing with you ? who has taken you on
his knee lately?1 The child innocently replies, ‘ No one,
mother; nobody has, I declare to you.’ The mother then

Dr. Ryan on Violation of Women. 139

T» • < i ’ , j * , .

says, * Oh, don’t tell me such stories ; I will flog' you, if you
do.’ And thus the child is driven to confess what never hap¬
pened, in order to save herself from being chastised : at last
she says, ‘ Such a one has taken me on his lap.’ The person
is questioned, and firmly denies it ; but the child, owing to
the mother’s threats, persists in what she has said. The man
is brought into a court of justice ; a surgeon, who is ignorant
of the nature of the discharge I am now speaking about,
gives his evidence ; and the man suffers for that which he
never committed. The mother is persuaded, if there be a
slight ulceration on the parts, that violence has been used,
and a rape committed : she immediately says, f What a hor¬
rid villain must he be for forcing a child to such an unnatural
crime, and communicating to her such a horrible disease ! I
should be glad to see him hanged.’

“ If I were to tell you how often I have met with such
cases, I should say that I have met with thirty in the course
of my life. The last case I saw was in the city : a gentleman
came to me, and asked me to see a child with him, wTho had
a gonorrhoea on her. I went, and found that she had a free
discharge from the preputium clitoridis. I said that there
was nothing so common as this. There was considerable in¬
flammation, and it had even proceeded to ulceration, which I
told him would soon give way to the use of the liquor calcis
with calomel. f Do you tell me so V (he replied ;) why,
suspicion has fallen on one of the servants ; but he will not
confess. If he had appeared at the Old Bailey, I should
have given my evidence against him ; for I was not aware of
what you have just told me.’ I told him that, if the man had
been hanged by his evidence, he would have deserved to be
hanged too. /

“ I am anxious that this complaint should be known by
every one present, and that the remarks which I have made
should be circulated throughout the kingdom. When a child
has this discharge, there is a heat of the parts, slight inflam¬
mation, and this sometimes increases, and goes on to ulcera¬
tion. This disease sometimes occurs in children at the time
of cutting their teeth.” — Lectures on Surgery.

Dr. Dewees, the eminent professor of midwifery, in the
University of Philadelphia, has also given an excellent ac¬
count of the morbid discharge under notice, in his Treatise
on the Physical and Medical Treatment of Children, pp. 326,
435. He says, a We occasionally find that very young chil¬
dren have a discharge from within the labia of a thin acrid
kind, or of a purulent appearance. When this occurs in very

140

Original Communications .

young subjects, it almost always proceeds from a neglect of
cleanly attention to these parts, either by withholding a fre¬
quent use of lukewarm water, or permitting the child to re¬
main too long wet. * * * * Children, however, of a more
advanced age, have also discharges of a purulent character,
that seem to arise from a morbid action of the mucous
membrane of the vagina or labia. This frequently shews
itself about the fifth year, and may continue, if neglected,
to almost any period. Parents, therefore, cannot be too
much on the alert when this discharge is discovered on their
children ; nor too early in the application of suitable reme¬
dies for its removal. It is in a great measure owing to this
neglect, that fluor albus or whites become so common, and
of such difficult management in adult age. If not inter¬
rupted in the beginning of its career, it is apt to continue
until the period of puberty over the phenomena, of which
it but too often creates an unfriendly influence.”

Orfila gives a table to enable medical jurists to discrimi¬
nate in all cases of stains on linen, wffiether by spermatic,
leucorrhceal, gonorrhoeal, lochial, mucous and salival fluids.
The evidence afforded by this table, is far from being posi¬
tive, and I therefore omit it.

Third question. — Can a woman be violated without her
knowledge ? Decidedly she can, if under the influence of
insensibility from violence, fainting, asphyxia, narcotics, or
intoxication. I have recorded a case in which a female was
impregnated during inebriation, and w as of course unconscious
of it during1 the first seven months of uterogestation. She
felt much offended, when I hinted my suspicions as to her
being pregnant, but soon afterwards her paramour revealed
the secret to me. Though it is difficult to suppose a woman
can be violated during sleep, yet under some circumstances it
seems to me very possible. A married woman who hasliad chil¬
dren, w hose sexual organs are dilated, may be violated dur^
ing sleep ; but a virgin could not be deflow'ered without her
being awToke. Drs. Beck, Gordon Smith, Bartley, Fodere,
and Capuron, doubt the possibility of a married w oman being
violated during sleep.

Fourth question. — Can violation be follow ed by concep¬
tion? It has been long decided in the negative, as it was sup¬
posed that w omen who w ere influenced by the depressing pas¬
sions could not conceive, (Bartley and Farr.) Capuron, Fodere,
Beck, Good, & c. agree with the majority of the profession,'
that conception may happen, and is not accelerated or pre¬
vented by the volition of the sexes. This is the received

Dr. Ryan on Violation of Women. 141

and only rational opinion. How many women anxiously
wish for children and have none, and vice versa. I have
discussed this question very fully in my work on Midwifery.
From the foregoing* observations, it is evident that medical
science does not furnish positive proof of any of the questions
discussed in this article, but merely probable and presump¬
tive evidence. I may observe in conclusion, that the proba¬
bilities are greatest when a child of 5, 7, 9, or 10, is the ac¬
cuser, after due consideration, of the sexual diseases of this
period of life. Her age excludes all appearance of consent*
as she cannot have desire, her organs being undeveloped,
as stated in the section on disqualifications for marriage,
nor is it likely any foreign body will be introduced. The
base will be stronger attested by any other marks of* vio¬
lence. However, great caution is required in these cases, as
depraved mothers have induced their children to make ac¬
cusations against innocent persons.

The only other medico-legal question connected with
morals is sodomy. In these horrible cases it is said, there
will be inflammation, excoriation, or syphilitic ulceration, di¬
latation of the sphincter, scirrhus of the rectum, haemorr¬
hoids. It is to be recollected that syphilitic excrescences are
often seen on the perineum and about the anus, caused by
disease from the genitals, where no suspicion can be enter¬
tained ; “ no man,” says Dr. Beck, ought to be condemned
on medical proofs solely.” The physician should only deliver
his opinion in favour or against ah accusation already prefer¬
red — Zacchias. The law on this subject has been already
stated.

Medico-Legal Questions relating to attempts against

Health or Life. — Homicide by Contusions and Wounds.

Under this head we have to consider, 1, contusions,
wounds, and homicide by them ; 2, homicide by asphyxia,
strangulation, suffocation, submersion or drowning, asphyxia
by non-respirable gases, or by deleterious gases ; 3, homi¬
cide by poisoning.

Of homicide by contusions and wounds .

In a former article I stated the law on this subject, and
need only remind the reader, that by Lord Lansdowne’s Act,
9 Geo. 4, c. 31, contusions are classed with wounds, and
under this statute we have to comprehend, ecchymoses, con-

142

Original Communications .

cussion or loss of power of organs, distortions, disloca¬
tions, fractures, bums, wounds of fire arms, and wounds
in general.

Contusion is an injury, and sometimes a wound, inflicted
by a hard, blunt instrument, without loss of substance, or
wound of the skin, but with laceration of the cellular tissue
and extravasation of blood, either diffused or congested, to
a cellular extent : if the skin be divided, it is designated a
contused wound.

Ecchymosis , or blackness, is an extravasation of blood by
rupture of capillary vessels ; and hence it follows contu¬
sion, but it may exist as in cases of purpura haemorrhagica,
scurvy, and other morbid conditions without the latter ; and
we often see persons arise from sleep with numerous eechy-
moses, which are sugillations, and called by the vulgar,
“ dead men's pinches."

When ecchymosis is caused by injury, it generally ap¬
pears in a short time, or in a few hours, but sometimes not
for days. The part appears red and bluish, then black or
lead colour, violet and yellow, and is marked most in the
centre. Its progress and duration will be modified by age
and constitution.

It may be produced in deep-seated org’ans, as in the
muscles of the thigh, &c. in the aponeuroses of the hands
and feet, on the spinal marrow, whose membranes may be
lacerated, without any blackness of the skin, or it may
not appear before ten or fifteen days. Again, the viscera
in the chest, abdomen and pelvis, may be ecchymosed from
external injury, though the integuments are discoloured.
It is easy to distinguish ecchymosis from lividity, consequent
to acute or chronic exanthematous diseases, vesication, in¬
flammation or gangrene, bv recollecting the successive
changes of colour, and the absence of all symptoms cha¬
racteristic of these maladies. It sometimes occurs, that
intense vomiting causes rupture of minute vessels in the
stomach, intestines, diaphragm and lungs ; and, on dissec¬
tion, we find black spots of various sizes, which are often
mistaken for gangrene. In such cases these spots are soft,
and easily detached, while the membranes that enclose the
blood in a recent ecchymosis are firm. If we make a free
incision through an ecchymosed part, we can readily wash
out the effused blood, but ablution will not remove the
changes effected by gangrene.

It too often happens that ecchymoses are confounded
with cadaverous lividities, which are more or less extensive.

Dr. Ryan on Violation of Women.

143

of a brown, black, red or violet colour, forming rapidly
after death, particularly on the back, thighs, sides, anterior
surface of the body, upon those parts upon which the body
has lain while it has been becoming cold. These also
appear where pressure is made by the cloths, and from
their resemblance to the injuries caused by flagellation with
rods, are called by the French r ergetures. A more ap¬
propriate term is, cadaverous lividity or sugillation. These
are frequently observed in the most dependent parts of the
lungs and abdominal viscera. Professor Andral's remarks
upon this subject are deeply interesting, and may be seen
in the second volume of his Pathological Anatomy, trans¬
lated by Drs. Townsend and West. These sugillations will
be modified by age, constitution, state of the weather,
process to putrefaction, & c. They cannot be confounded

with ecc-hvmoses, as there is no effusion or infiltration of

•»

blood in the cellular tissue.

The term commotion or concussion , is the shaking of an
organ bv a blow or fall, more or less remote, which causes
inaction of an organ. Thus a blow or fall on the head, feet,
knees, or body, causes concussion of the brain, which may
be followed bv slight stunning. bv haemorrhage from the ears,
nose, or eyes, or by immediate death. Concussion of the
spine may or may not affect the brain, and if violent, will be
followed by paralysis of all the parts, whose nerves arise
below the site of the injury. Hence there may be para¬
lysis of the lower extremities of the rectum, bladder and
generative organs. The organ likely to be affected next
to the brain and spinal medulla is the liver, which may be
followed by hepatitis, icterus, rupture, hcemorrhage, and
death. Every scientific practitioner is aware that a violent
blow upon the stomach, will suddenly extinguish life, by
injury of the nerves and paralysis of the whole nervous sys¬
tem, and yet no mark of injury can be observed on dissec¬
tion. I have known a want of knowledge of this fact to be
the cause of acquitting a man who killed his victim by a
blow of a mason's hammer on the epigastrium. The medi¬
cal witness was ignorant of the danger of contusion on this
part, and the judge reprimanded him very severely for not
having opened the body. The practitioner was satisfied the
blow was the cause of death, as the sufferer died almost
immedately, but he was unable to account for the result
to the court. Sir Astley Cooper mentioned a case in his lec¬
tures, where a man received a blow on the stomach from
a friend, which caused instant death.

144

On ctisl il 0 crmmcL. me .1

LtOtcn on i* a seritns ixrnrj followed. fcj en^crg^neirt .
which will not be dissipate! 'for w ecfcs or months. isecrd-
in^ to the hah:: end eotstitclicn c: tie safert: Sonjetiioes
‘here is sheet ess of the joints . *omettne^ relaxation o: tie
Lrmaeats. which is to be ascribed to a serofeon- or mietiv
disc oeidim.

Z'. ;m bn ere generallr free front cat i e r the :rh tier

_ « _

mat he fcllowed Lt paialvsis ext arrettv :h:n the n tarr of
a nerve.

F ~aerar i4. if simple ere not dao-zeroo*, bet if c-ompoaDd

Of commmpted, espeerkuiv it, or tear joists, ttev ere sextons

eel c::et fetal. I an greatlT ear: "x-t at the French arts ts

v- ho give a table to see = the terit-a et which fret tares will

be cosaolkleted. ns everv teee cf science neat be cotvii>:ed

c: the kaceiraCT cf at 7 fixed pc-rioa far consolidation whl

be completed so oxer or later according to the age, censtm-

titt aed state of health of tie patient.

For e rate tie, tte same eti of fracture ariil be Intel a

t~ettr hers n et iararr n thertv or forrr in et ahalt atl m
• a ^ ^
fifty or six:: n at age! person or t*ernaps t it et e L a • e n

TTch-niomei tratmoaer nest a tree with ne it tonic a.

M. m — X ^

that e goaty, sartfaiocs, eareemas. or venereal: hat : mol-
lities -tr irtgebtas cos: an. will modify tte period o: ossizea-
tioo it framres, atd p-ove the fan it c ail txea periods.
The venable remarks of the lastngnnaei eta era me e i¬
ther g: the Surgical Dictionary epet these paints anzlv at¬
test the tmh of this pesitioii.

Bum, present three degrees c: ntensetp . 1, There there
is irrhaticL or sheet nearer, nan of the stir : where

there is Teseatien . 3. where teere is nstreennat-on c: the
skit, tehne: nenbraze erntre deep-seated psart~.

It the first ael second case mere is Ltt e danger, aeless
the it; a r v is ext nsire. or comp os pens endowed htV greet
senshlhv ; it enteral both ere eared it e few lavs. It tee
third case there is great laager, as tte degree of cot -na¬
tional britatkz is cotslierabde end often proves fatal to
Tt atn end niiile aged persons, etl to those advanced in life
hj profuse suppuration or gmgrene. Even these oases net

te mi tale ravooraolv. hat with tree: dettmitv.

« * — -• ^

dksj ear rx/undt. are severally latsrerotts her: here also
we most be gmdni it our prognosis by the habit et 1 coa¬
st: t^titt g: the pati-ett. It tte w this of Hemet, S. Cooper,

Guthrie, Larrev Tt onset, Badna-all atd ah others —

« — -

we lean that the bravest net Lave lost their lives
ct the fell cf battle, fcv prostration of the v.tai powers.

Dr. Ryan on Homicide by contusion and wounds. 145

who were only grazed by cannon and musket balls. In
other cases, the bravest have lost their lives by haemorrhage,
inflammation or gangrene, or have been disabled by
atrophy of the injured limbs, or have recovered while a
foreign body has been lodged for months and years in the
brain and other parts of the body. Sometimes stiff joints
are formed, or interminable fistulae, which may extend to re¬
mote parts. The judicious and scientific surgeon will be
cautious in forming a prognosis in these cases.

From the preceding remarks, it must be obvious that an
attempt to classify wounds into mortal and non-mortal, is use¬
less, and indeed impossible. I cannot therefore assent to the
classification of Marc, Biessy and others, as I believe the
constitution and habit of the sufferer will modify all external
injuries to an illimitable extent. I am inclined to think that
every well-informed surgeon will assent to my position, that
wounds and external injuries will be more or less fatal ac¬
cording to the part or organ they occupy, and according to
the constitution of the patient.

The majority of medical jurists agree, that penetrating
wounds of the great cavities, or in other words, of the brain,
heart, lungs, and digestive organs, are generally fatal.

Wounds of the head. In all these cases we should con¬
sider the degree of concussion, the site of the wound and
the tissues which are injured. Wounds of the head are in¬
flicted with cutting or blunt instruments. If there is contu¬
sion of the occipito-frontal aponeurosis, there is danger of
erysipelatous inflammation of the scalp and meninges of the
brain, and of course the prognosis is very doubtful. The
most unfavourable appearances have terminated favourably,
as attested by Sir A. Cooper, and by myself in my work on
Midwifery. If a cutting instrument penetrates obliquely to
the cranium, union may take place (Boyer,) but there is
much more probability of erysipelatous inflammation or of
exfoliation of the cranium. Many of these penetrating
wounds terminate favourably. If the wound penetrates the
brain, there may be immediate death, or it may happen in a
few days ; and in such cases the danger is exceedingly
great.

Incised wounds of the scalp, if judiciously treated, usually
terminate favourably. Perpendicular wounds of the scalp
may terminate favourably and speedily by proper manage¬
ment, but penetrating oblique wounds are tedious, and often
followed by exfoliation. If a wound penetrates the brain,
there is danger of haemorrhage and inflammation ; and these

Vol. VI. no. 32.

146

Original Communications.

wounds are highly dangerous when a blunt instrument
strikes the head perpendicularly ; a soft puffy tumour is
produced^ which is resolved in five or six days by proper
treatment, or concussion may cause death.

When the blow is inflicted obliquely, blood is extravasated
in a sort of cavity, caused by the laceration of the cellular
tissue, which is more tedious, and sometimes requires to be
opened. In cases where the pericranium is detached, exfo¬
liation of the bone generally follows. I have known a case
in which the integuments of the forehead were torn by a gun¬
shot wound ; they hung over the face, and were excised by
an apothecary’s apprentice, who was amazed when I ex¬
plained to him the error he had committed, and the certainty
of exfoliation taking place sooner or later, as the bone was
denuded, and the lips of the wound so far distant, that it
was impossible to approximate them. A piece of bone, the
size of a crown, was thrown off by exfoliation three months
afterwards. The countenance of the patient, an interesting
young woman, was greatly deformed, and she became subject
to epilepsy. The old surgeons considered wounds of the scalp
and fractures of the skull highly dangerous for three weeks,
and never declared the patient out of danger until after the
lepse of that period. The rule is not a bad one, but the
period of danger may be later and undefinable.

Fractures of the cranium must be produced by injury, ca¬
pable of causing concussion of the brain, and hence they are
properly considered highly dangerous. A blow upon the
crown of the head will cause fracture at the base of the
cranium ; a blow upon the superior lateral part will cause
fracture on the orbitar vault, and a blow upon the occiput
may fracture the frontal bone. The danger of fractures and
other injuries of the skull are so ably described in all recent
works on surgery, that I need not dwell further upon them in
this place.

Wounds of the Face. — Contusions and wounds of the
eyebrows and lids are generally free from danger, though
they may cause blindness. Penetrating wounds of the globe
of the eye, of the optic nerve, and causing fracture of the
orbitar plate, are dangerous, as the brain may become af¬
fected. In some habits all or any of these injuries may be
followed by erysipelas of the scalp, and consequently be
highly dangerous. Contusions of the globe of the eye may
induce various disorganization of the complicated and deli¬
cate tissues of that organ, which, though indestructive to
life, are generally destructive to vision, and therefore pro-

Dr. Ryan on Homicide by contusions and wounds. 147

ductive of great personal injury. Contusions and fractures
of the nose are attended with little danger, and total ablation
of the organ is no longer an irremediable deformity,, as ap¬
pears by Mr. Liston’s two successful operations for supply¬
ing its place from the integuments of the upper lip. (Edin¬
burgh Medical and Surgical Journal, Jan. 1831.)

Fracture of the anterior wall of the frontal sinus is not
dangerous ; but not so of the posterior, from its contiguity
to the brain. Slight fracture of the anterior wall of the max¬
illary sinus is not dangerous ; but, if produced by a violent
contusion, as a gunshot, fistulous openings are apt to be
produced, as also considerable deformity.

Fracture of the superior maxillary bone or zygomatic
arch is not dangerous, unless in syphilitic or scrofulous ha¬
bits, when caries may occur. Luxations and fractures of the
inferior maxillary bone are speedily cured, as also wounds
of the cheeks and lips. Wounds of the tongue are easily
remedied by suture ; but total ablation of the organ renders
mastication, deglutition, taste and pronunciation, defective.

Wounds of the neck are highly dangerous, from the num¬
ber and importance of the vessels, nerves, and other organs
situated in this part. Too many young surgeons are unmind¬
ful of the danger of injuries and wounds of the neck, as they
consider these very slightly, when the carotids are undivided.
It is to be recollected, however, that a blow of a blunt in¬
strument on the posterior surface of the neck will cause con¬
cussion of the spinal cord, fracture of the vertebrae, or dis¬
location of the odontoid process ; while a deep wound on
the anterior surface of the neck may divide the phrenic nerve,
and in an instant paralyse the diaphragm and muscles of in¬
spiration, or divide the pneumo-gastric or par vagum, and
paralyse the stomach, impede respiration and the action of
the heart. It seldom happens that the nerves on both sides
on the neck are divided, and hence the wonderful escape
from immediate death. If the trachea or oesophagus is fairly
divided, the wound is considered mortal by medical jurists,
as recovery seldom happens in such cas^s. When the inter¬
nal jugular vein or carotid artery is divided, death is inevi¬
table in a few minutes, unless ligatures are applied ; and it
appears, from the testimony of Briand, that in nineteen such
cases nine were saved by ligatures. The section of the prin¬
cipal nervous trunks, such as the great sympathetic and tenth
pair, are mortal, by depriving organs essential to life, of a
proper supply of nervous influence: the division of the recur¬
rent nerve will cause aphonia, and punctured wounds of any

148 Original Communications.

of the principal nerves will be followed by inflammation in
all parts which they supply, and often by death. Lastly,
the cutting’ instrument may pass between the cervical verte¬
brae and wound, or completely divide the spinal marrow.

Wounds of the chest. — Contusions and wounds of the
chest may be followed by pleuritis, pneumonia, and various
disorganizations of the lungs, pericardium and heart,
and are therefore considered very serious injuries. Con¬
tusions on the female breast may ind le cancer ; on the
ribs, caries or necrosis. When a penetrating cutting* instru¬
ment divides the mammary or intercostal arteries, there
will be effusion of blood into the chest (haemathorax),
which will produce death. Section of the axillary or sub¬
clavian arteries will be generally fatal, unless a ligature is
speedily applied.

Luxation of the sternal extremity of the clavicle requires
the immobility of the limb for twenty or thirty days, while
that of the humoral extremity is followed by deformity.

Fractures of the ribs are generally unattended with dan¬
ger, but by wounding the pleura or lungs, may, of course,
induce serious diseases of these parts. Fractures of the
sternum, though very rare, may injure the subjacent organs ;
those of the acromion, and coracoid process and neck of the
scapula, are not dangerous, but may produce defective mo¬
tion of the arm or shoulder joint, or atrophy, or paralysis
of the limb.

Fractures of the vertebrce , are usually complicated with
concussion, or other injury of the spinal marrow, and con¬
sequently of paralysis of the inferior extremities, and of
some parts of the abdominal viscera ; and these affections
may occur after the lapse of months, when no trace of the
former injury remains.

The prognosis of penetrating wounds of the thorax is
uncertain, as there will be haemorrhage into the chest, and
likewise the introduction of air, both of which will com¬
press the lung, induce inflammation, suppuration or indura¬
tion of some part of the organ. In general, wounds of the
lungs, pericardium, heart, aorta, pulmonary vessels, venae
cavae, vena azygos, and thoracic duct, are to be considered
mortal.

Wounds of the abdomen. — Contusions on the abdomen
will cause concussion or commotion of the subjacent vis¬
cera, or rupture, haemorrhage or death, though there may
be no appearance of injury on the abdominal surface. The
.muscles may lose their contractility, and hernia be pro-

Dr. Ryan on Homicide by contusions and wounds. 149

duced. Wounds of the abdominal parietes are highly dan¬
gerous, as they almost generally cause peritonitis ; and
should any of the large vessels, aorta, cava, &c. be di¬
vided, immediate death must follow. Wounds of the ner¬
vous centres (solar plexus), which supply the abdominal
viscera, will be followed by a mortal paralysis. Effusion
of bile, blood, urine, food or faeces, is fatal, in consequence
of inducing peritonitis, which cannot be cured. Hence
wounds of the stomach, liver, intestines, spleen, kidneys,
uterus, bladder, when distended, and thoracic duct, are
generally fatal.

tVounds of the Organs of Generation. — Contusions and
fractures of the pelvis are not dangerous, unless the latter
are considerable, or unless some vessel of importance is
wounded. Wounds of the spermatic arteries and veins of
the male are necessarily fatal, as beyond the power of art ;
but they rarely exist independently of other lesions equally
unfavourable. Wounds of the scrotum are not dangerous,
unless a large quantity of blood be effused into the tunica
vaginalis ; those of the vesiculse seminales are not mortal,
but are a cause of absolute sterility. Section of the penis is
not dangerous, as haemorrhage can be easily arrested ; the
wound cicatrises ; but there will be incomplete erection on
the injured side of the organ. Total ablation of the penis
will prove fatal, unless the arteries are secured. Contusions
of the testicles may induce scirrhus, which will require cas¬
tration.

Lesions of the generative organs of women. — Contu¬
sions and wounds of the external genitals are not dangerous,
unless inflicted during menstruation, when serious conse¬
quences may result. It is very evident that the uterus in the
unimpregnated condition can scarcely be injured by external
violence. In the gravid state, when it ascends above the
pubes, it may be seriously injured by blows, falls, &c. in¬
ducing fatal inflammation or rupture of the organ, detach¬
ment of the placenta, and death of the foetus. If the organ
be punctured, the wound must be considered fatal, if fol¬
lowed by inflammation or gangrene, to both the mother and
the foetus. The organ may be inflamed and gangrenous, com¬
plicated with peritonitis and enteritis, in the last month of
pregnancy, and without any external violence, or even any
evident cause ; a case of which is narrated by Dr. Malins,
of Liverpool, and myself, in the Lond. Med. and Surg. Jour.
1831, vol. vi. p. 52. In cases of prolapsus of the organ, its
total removal has been effected by ignorant midwives ; and

150

Original Communications .

the fatal injuries inflicted by ignorant male obstetricians, by
manual and instrumental operations in difficult parturitions,
are unfortunately too notorious, of late, to require further
comment.

Within the last year medical men in this country and in
France, have been found guilty of manslaughter, and very
justly, for the rashness and violence of their operations were
more characteristic of illiterate savages, or of the darkest
ages, than of men acquainted with the principles and prac¬
tice of obstetrics at the present period. Like all ignorant
and bad practitioners, the delivery of the woman seemed their
only object, and as to the consequences of contusions and
lacerations of her organs and their fatal results, they were
totally forgotten.

Lesions of the extremities. — Contusions, dislocations,
fractures and wounds of the superior and inferior extremities
are seldom fatal. The loss of a member or part of a mem¬
ber by external violence, accompanied with laceration, may
destroy life by intensity of pain, prostration of the vital
powers, by inflammation, profuse suppuration, gangrene, or
sloughing. The divisions of the large vessels and nerves of
the extremities, are mortal wounds, unless timely aid be af¬
forded. Here we must recollect the danger of comminuted
fractures, especially in or near joints, wounds of joints, in¬
flammation, suppuration, hectic fever, constitutional irrita¬
tion, habit of body, &c.

* *

II — Mr. Searle on Cholera — Reclamation.

[We readily insert this reply to our Review of Mr. Searle’s work
on Cholera : 1st. because it is written temperately and to the point ;
2dly, because it is on a subject of vast interest at present; and, 3dly,
because we are anxious to convince its author, that we could have no
object in animadverting upon his opinions, but the interests of science.
In the discharge of our editorial duty, we speak of works as we find
them, uninfluenced by name, station, partiality, favour, or self-in¬
terest ; ours is the cause of science and of truth, and no base, ignoble,
motive will ever dissever us from our principles — no cringing, crouch¬
ing, gross adulation, or unmerited censure for us. We admit that a
more accommodating line of conduct, and a closer eye to self-interest,
would be more in accordance with the modern spirit of reviewing, and,
perhaps, with worldly wisdom. It is our merit or demerit — which
ever the reader may chuse to designate it — to prefer the principles we
have adopted.

We have as yet no reason to be dissatisfied with our course.
Authors, whose productions we have been obliged to censure, at first

Mr. Searle on Cholera — Reclamation.

151

felt offended, then admitted the justice of our remarks, and finally
became our friends. Even Mr. Searle has made one step in this
march of reconciliation, when he partly admits the justice of our
remarks. He must be well aware of the utter impossibility for an
independent journalist to please authors and publishers. He must also
acknowledge, that a medical man, whose duty it is to peruse all new
and old publications of this and other countries, must be as competent
to offer an opinion, more especially when it is that of the majority of
the profession, and be as likely to arrive near the truth, as an author
who broaches a new hypothesis. Such is the relative position of
Mr. Searle and ourselves on the present occasion. However ingenious
his views, and they are very much so, we cannot assent to them.
Much more proof must be offered, before they can be received as legi¬
timate. At so advanced a period of our publication, we cannot de¬
vote further time to this subject at present ; but remain perfectly
satisfied in referring our review and Mr. Searle's reclamation to the
judgment of our readers. — Ed.]

To the Editor of the London Medical and Surgical Journal.

$ir, — Being on the Continent at the time your review of my work
on the Cholera issued from the press, it escaped my notice, and it
was by mere accident I came to a knowledge of the circumstance, a
few days ago. This explanation, I trust, and your impartiality, will
give me claim to a hearing on the subject, even at this distant period,
it being in the September Journal when your review appeared.

With respect to the composition and style of the work, I am but
too sensible that your strictures are but just. But far different do I
consider your animadversions on the subject matter of the work, and
your condemning in toto, all that I have advanced on the pathology
of cholera and of fever, because I have presumed to differ with what
may be the more generally received opinion, as to the primary operation
of malaria on the system, in producing disease. My opinion being,
that by inhalation, it is received into the circulation, in common with
other serial fluids ; and thus, in common with many other poisonous
agents of the sedative class, which I assume malaria to be, con¬
taminating the blood ; it primarily operates on the organic structure or
functions going on in the capillary system ; and thence its influence
on the brain and heart, in torpifying or arresting their functions, and
•by consequence the secretive, and in short, all the functions of life.
A position which, to my judgment, is quite as rational, and I main¬
tain too, as tenable (although you have thought proper to designate
it unphilosophical) as the more prevalent opinion, that the primary
operation of malaria and other poisonous agents, is upon the nerves
and brain ; and by no means incompatible with the experiments of
Messrs. Morgan and Addison, to which you have alluded.

That as you have commenced your review with the profession,
that you will endeavour to detail faithfully my views, on the nature
and treatment of this but too formidable disease, I beg leave to state.

152

Original Communications.

and appeal to the candour of any one, that your differing in opinion
with me in the above instance, is not a justification of your condemn¬
ing me unheard, and injuring my publication in the opinion of the
public, in the manner which you have done : and suppressing, in the
following words, what has been acknowledged by all to whom I have
shown the work, as exceedingly ingenious views, if not altogether a
satisfactory explanation of the symptoms of cholera, and of fever also ;
to which I have made it appear cholera is allied. “ Mr. Searle
endeavours to explain the semeiology of the disease agreeably to his
theory, but as his premises are untenable, it is unimportant to hear
his conclusions.” Now, really this is a very hard sentence, to say
the least of it ; and thus am I condemned to silence in all that I con¬
sider interesting in the work, or principally so ; and whatever my
faults are, rendered most glaringly conspicuous. A mode of review¬
ing, upon which I shall make no comment, hoping this will be un¬
necessary ; and trusting, that my having pointed it out, will obtain
for me the only reparation in your power, by allowing me to pre¬
sent to your readers, in your next journal, what are my views of this
disease, and the real nature of the publication. When, if you have
any objections to advance against my reasoning, I shall be happy to
meet you in an open, candid discussion ; which, at this particular time,
cannot be without interest, seeing that the disease, in its devastating
course, has already extended to Russia, and may very possibly, at no
distant period, make its appearance in this country. But, whether
as an epidemic, it does so or not, is sporadic and endemic ; instances
are already known to occur in this country, in proof of which, I need
only instance the disease which occurred at Mr. Day’s school at Clap-
ham, a year and a half ago, to justify me in the assertion, that the
subject is meriting every attention which can be bestowed upon it.

Sincerely believing this to be the case, and confiding, Sir, in your
sense of justice, I shall proceed to give as concise an analysis of the
work as is consistent with the comprehension of the subject.

The work first presents the reader with a general description of the
disease ; the nature of the attack, the progression of the symptoms,
the state of the functions, the condition of the blood, and so forth.
This is extracted principally from the Report of the Madras Medical
Board, as being better testimony on this head than my own ; and
the same obtains of the appearances noticed on post mortem examina¬
tion, which is the subject of the next chapter. This is followed by
my own case, it having been by strictly attending to the progression
of the symptoms in an attack of the disease in my own person, which
led me more particularly to the views I have taken of the disease, as
I have explained in my preface. At the same time, it was the
circumstances attending this attack, which led me to the cause ;
which I assume to be, some terrestrial exhalation of the nature is not
identical with malaria, as the poultry about my house and premises
at the time of attack, were dying in great numbers, of an analogous
affection ; and this view is supported by numerous quotations, which
are strikingly corroborative of the opinion. There is one, however.

Mr. Se&rle o?i Cholera — Reclamation.

153

to which I should more particularly wish to draw the attention of my
readers, as it almost amounts to demonstrative evidence ; this is the
disease of precisely the same character which occurred at Mr. Day’s
school at Clapham, which attacked twenty out of twenty-two boys,
in the course of a morning, and of which number two died. This
was unquestionably attributable, upon the evidence of Drs. Latham,
Chambers and fepurgin, whose assistance was called in upon the
occasion, to malaria, arising from the contents of a cesspool, which
had a few days before been thrown upon the garden adjacent to the
play-ground, to the effluvia of which the boys were fully exposed.
That these, in conjunction with the several other instances adduced
in the work, will, I think, leave no doubt on the mind of the reader,
that malaria is the cause of this disease, as well as of fever, to which
I have made it appear that cholera is nearly allied, observing, in
the 47th page, “ The connection between the two diseases is very
intimate, for the fact is undoubted, that fever has not unfrequently
succeeded, or has been conjointly prevalent with cholera during its
epidemic visitations, though, for a certainty, it has not been of usual
or common occurrence.” And, in an after page, it is observed, “ In
the primary actions of disease, the resemblance in all the essential
characters that exist between cholera and fever is most striking, so
much so, that it has been noticed by several practitioners in India,
that the former appeared to them a protracted or continuance of the
first or cold stage of the latter, which, in its essential character, I
believe it to be ; the efficient cause or causes giving rise to the
affection, operating with greater intensity or virulence, so depressing
to the vital functions, that reaction of the system but seldom, or very
partially takes place. Whereas in fever, the energies of the system
not being equally depressed, excitement becomes developed to its pre¬
servation. In fine, the resemblance between cholera and the con¬
gestive typhus of Armstrong, is so strong in all the leading features
of the two affections, that they present to my mind but one, or modi¬
fications of the same disease.”

The next question which arises, is, what is malaria ? This, we have
replied to, by stating, that as it is the gaseous production of organized
substances, in a state of decomposition, we may fairly infer that it is
some compound of carbon, hydrogen and nitrogen, as these are the
principal constituents of animal and vegetable substances ; and as
such of the gases are known to be highly deleterious to animal life,
and produce effects in common, there can be no difficulty in con¬
ceiving the thing, although endiometrical experiments have hitherto
failed in determining the point ; and reasoning by analogy that it is
so, from the effects induced upon animals by experimental exposure
to such of the noxious gases, and to the appearances which have pre¬
sented themselves upon the dissection of the bodies of those who have
died from exposure to memphitic exhalations.

We proceed next to observe, ** The next question presenting itself
is, upon what parts or textures of the body are the primary operations
?of malaria exercised ? Now, as the skin and the lungs are the organ*

uoL-iv.. no. 3*2..

154

O r i o; in a l Commu nic at ion s .

more particularly exposed to its operation, indeed, we may say
exclusively so, a doubt can hardly arise upon the subject, especially as
regards the lungs; and little objection, I think, can be made against
the operation of the same influence on the skin, the experiments of
Jurine, Spallanzani and Abernethy, having unquestionably proved
similarity of function ; the imbibition of oxygen, and the exhalation
of carbonic acid gas, by the capillaries exposed to serial influence on
both surfaces ; and the same is inferred, by the experiments before
quoted ; the effects upon the system being the same from sulphuretted
hydrogen, whether inhaled, or left sometime in contact with the sound
skin. It remains then but to determine, whether this agency operates
on the nerves and capillaries exposed to its influence, in arresting their
function ; or, whether as a poisonous agent, it is imbibed and received
into the circulation. The latter, I think, it will be acknowledged,
the most reasonable conclusion, as it offers an explanation why
diversity of effect, and variety in disease is induced, by variety or
difference in the composition of the memphitic vapour or malaria ; and
thus fever is the product in one case, and cholera in another. This
view meets too with support, in the experiments with the noxious
gases upon animals, which are found to exercise beyond the exclusion
of oxygen, a positive noxious influence upon the system ; and this we
find, differing somewhat in effect, according to the particular gas
which is employed ; as is the case with the various other poisons, both
of the animal and vegetable kingdoms ; effects which are presumed to
take place in most instances, from the absorption of these substances
and the blood’s contamination.”

“ Indeed, the office of the lungs would appear quite of a passive
character, in relation to the changes effected on the blood by respira¬
tion ; the conversion of black into red blood, which is the simple
effect on the one hand, of the exhalation of the ready formed carbonic
acid gas, which the experiments of Mr. Brande proved it to contain,
from the ramifications of the pulmonary artery distributed over the
air-cells ; and on the other, of the imbibition of oxygen with the
returning blood, by the pulmonary veins, which being connected by
their trunks, with the left auricle of the heart, is thus absorbed by its
dilitation ; hence it is, as was proved by the experiments of Professor
Mayer, that absorption goes on from the lungs more energetically
than from any other part of the system.”

“ We are borne out in these views of the respiratory function, by
analogy with both Spallanzani’s and Abernethey’s experiments on
the skin. The first was completely satisfied, that air in contact with
the skin, is changed exactly in the same way as by respiration.
When atmospheric air was employed, oxygen disappeared, and car¬
bonic acid was produced. He was of opinion, the oxygen employed
had no share in the immediate production of the carbonic acid gas,
because it was equally great, when the animal was exposed to gases
containing no oxygen ; and he therefore concludes, that the carbonic
gas was exhaled, and the oxygen absorbed ; and Mr. Abernethy’s
experiments warrant the same conclusions.”

Mr* Searle on Cholera — Reclamation.

155

“ That any appreciable direct influence, arising out of the inhala¬
tion of malaria, if it exercised any on the nerves of the part, the che¬
mical it would appear, living but secondarily subject to such influence,
would be, on the mechanical function of respiration, and which were
it thus to operate, would give rise to symptoms so characteristic,
that they could not have escaped notice.”

“ That I believe we may safely conclude, that malaria is received
into the system by absorption, and thence its influence is exerted ;
though I may add, when very virulent it may simultaneously affect
the capillary vessels exposed to its influence, whether cutaneous, or
pulmonary, or both; but of this I shall speak hereafter.”

“ Assuming then, that the noxious influence of malaria is induced
by the blood’s contamination, I shall, after a short digression I am
constrained to make, in pursuance of the inquiry, trace its effects on
the system in giving rise to the symptoms of the disease.”

“ It is an established fact in chemistry, that the decomposition of
a compound, or the formation of a new one, is attended with an al¬
teration in the electrical capacities of the products. The change
manifesting an increase or loss in this respect, it becoming either plus
or minus, latent or evolved. Now as the process of acretion, assimi¬
lation and secretion, constituting the change or conversion of arterial
into venous blood, at the termination of every arterial ramification
throughout the system, is a chemical process ; this conversion is not
only attended with an evolution of caloric, but it will not be unfair
to add, with electricity also ; hence from the first, the body’s tem¬
perature, and its equal diffusion ; and from the second, its nervous,
or electrical excitement or vitality. The latter or electrical evolution,
which I believe to be in a ratio with the calorific and chemical
change that has taken place, having its source in the capillary cir¬
culation, explains the reason why, vitalit}?- goes on in these vessels
for a considerable time after the apparent death of an animal ; and
the irritability of muscular fibre after the appearances more particu¬
larly denoting life have ceased. And it explains also the reason why
the arteries after death are found empty, capillary circulation still
continuing as long as the arterial trunks furnish blood for their ex¬
citement.”

“ Another argument that may be adduced, favouring this view of
the body’s electrical generation, is the known fact, that a capillary
tube is quite impervious to the passage as a fluid, but under the
excitement of electricity, admits its passage freely ; now, as the
capillary vessels of the accessorial system are so minute, that they
are not discernible by the naked eye, but by a powerful glass, the
free circulation of the blood is to be seen through them ; we are
warranted in our analogy, in supposing them to be excited by the
same means. As it has been proved by experiment, that it is no
impulse of the heart, or action of the arteries, that carries on the
circulation in these vessels ; as it still goes on long after the heart
has been removed from the body. And further, it has been proved.

156 Original Communications

that the excitement of these vessels is not derived from the brain and
nerves, bv removing both brain and spinal marrow.''

" That there can be little doubt of the origin of the nervous or
electrical £nid of the body being in the way suggested. The electri¬
city thus generated- I am of opinion, is transmitted by the most per¬
fect conductors of the animal textures, the nerves, to their source, in
the common acceptation of the word, and its receptacle, the brain and
spinal marrow ; from whence it is again transmitted by tae nerves, at
the pleasure of volition, in the several actions of muscular contrac¬
tions : excites the sensorium to tne various operations of the mind ;
and tne organs of sense to their respective functions ; or is transmitted
by the par vagnm to the gTcar secretive processes of the stimach and
other organs to which these powers are transmitted : and hence, the
intimate connection and remarkable sympathy existing uetween the
head and stomach : and an explanation why mental emotions so
immediately derange digestion, and the functions of the several organs
to which these nerves are transmitted. For further particulars and
arguments in illustration of these views, see the Essay in the
Appendix/'

From the previous considerations, the following inferences are
deduced : — That the noxious influence of malaria is induced by the
blood s contamination, and operates in torp living or arresting: the
chemical functions which take place in the general cap illaries of the
system, by which there is a diminished evolution of caloric and electri¬
city, and in consequence, debility of all the functions. And it is
probable, in the same way the venom of the serpent and the various
other sedative poisons of both the animal and vegetable kingdoms
induce these e meets : for it has been observed, by several persons, of
cholera, “ that there appeared a sudden depression of every vital
energy, and those who died had more the appearance of persons
labouring under the bite or sting: of some poisonous reptile , or the
e meets of some narcotic pcison than of disease.”

“ Another argument that may be adduced in favour of my views,
is, the feet before adverted to, that in animals killed by exposure to
the noxious gases, as well as in persons who have died by the like
or mepnltic exhalations, there has not only been this blackness and
fluidity of the blood noticed, but annihilation of the contractility of
the muscular fibre : both of which are noticed by Dr. Davy, in the
subjects of cholera ; the latter, however, if not so fully expressed,
being fairly imp lied. Tne experiments of Sichattoo, on the respira¬
tory mnetion in animals may be adduced, as bearing: upon the subject,
wno concludes his numerous experiments bv observing. — We con¬
clude tuen in general terms, and without attempting to determine
how this takes place, teat the heart s action ceases, when the chemical
pnenomenon of tne lungs are interrupted ; because the black blood
which penetrates its muscular fibres, is not capable of keeping up
their action. 5 And, the same he savs of the brain, and finally
observes, “ The circulation of black blood carries to every part de¬
bility and death, the organ; ceasing to act, because they receive no

Mr. Searle on Cholera — Reclamation •

157

red blood*” I have only to add, how well do the views I have taken
of the capillary circulation, explain all this ; and render it, I am of
opinion, apparent, that the primary operation of malaria, not only as
a cause of cholera, but of fever also, is not upon the brain and spinal
marrow, as it has been supposed, and asserted by Dr. Southwood
Smith in his late work on fever, but are effects secondarily induced,
as I have already partially, and shall more particularly explain here¬
after ; with the majority of symptoms in common to the two affec¬
tions, which I repeat, are but modifications of the same disease/’

“ If my views are correct as to the course and operation of that
cause, the symptoms which ensue, are necessarily referable to the
defective excitement of the heart and brain, or principally so, these
being the two principal organs, and on which the functions of the
others are dependent. The first I shall notice will be that of the
heart, in a ratio with its defective power, in its twofold capacity of a
forcing and sucking pump, which the experiments of Barry and
Majendie warrant us in the conclusion that it possesses, will accumu¬
lation of blood take place in the veins, which accumulation or con¬
gestion will necessarily be to the greatest extent at those points of
the circulation the most remote from the heart’s influence ; which
obtains to by far the greatest extent in the mesenteric, gastric and
splenic veins, forming the roots of the vena portae ; as the propelling
action of the ventricle ceases in the arteries, and the sucking power
of the auricle’s dilitation has to operate through the additional and
protracted route of both the hepatic veins and vena portae. Hence,
the distention of the mesenteric and gastric veins, and sense of pre¬
cordial oppression, the first symptom experienced by me, when I was
the subject of the disease, as noticed in my case.”

Further, as it has been proved by the experiments of Home,
Majendie and others, that these vessels in health absorb fluids from
the stomach and bowels, and which it may be presumed, is effected
by the heart's sucking agency, it is fair to suppose, the permeability
of these vessels, which admit of absorption in health, under their
present state of engorgement, and condition in which the sucking
agency is withdrawn, or rendered comparatively nugatory, would
admit of exudation ; and hence the sero-mucous or conjee water-like
evacuations, either from the stomach or bowels or both ; but par¬
ticularly from the latter, as the natural exit of the contents of the
former is through them. That sickness or vomiting, in the early
stage, 1 think rather attributable to the stomach’s defective excite¬
ment, from diminished energy of the brain, as we see so often
exemplified in cases of debility, on the patient’s removal from the
recumbent to the erect position ; and particularly from the sudden loss
of blood, the patient becoming giddy and sick from defective arterial
distention and excitement of the brain. And this explains the
giddiness and sense of weakness that so generally attends an attack
of cholera, and has been so frequently complained of, as the first
symptom the patient was sensible of or noticed.”

158

Original Communications .

“ In a ratio with the defective excitement of the heart and brain,
will be that of the glandular system ; hence, the diminution or sup¬
pression of the secretions of bile, urine, &c.

“ Inflammation and spasm come next to be considered ; and are
as readily accounted for, by pursuing the same chain of reasoning,
adding to the consideration, difference of temperament, idiosyncracy,
state of the individual at the time of attack, a greater or less intensity
of the cause and treatment pursued.

“ Thus, I would say, if the exudation from the mesenteric and gastric
vessels do not take place, or is not equal to the relief of the distended
veins, free egress of blood is not admitted from the capillar}7 arteries,
and the consequence is, they become irritated by distention, and
excited into inflammatory action. And hence the sense of burning
heat, pain, extreme restlessness, and desire for cold water, and
irritability of stomach : symptoms specifically denoting inflammation
of the stomach and bowels.”

“ It is worthy of notice, that these organs being primary in the
scale of animal existence, derive their nervous influence principally
from the sympathetic : which originates in twigs given off by every
collecting nerve, proceeding to the spine and brain, that they may
be little influenced by causes operating on the latter ; hence it is, the
stomach and bowels retain their irritability to the latest period of
existence, even after the apparent vitality of ever}7 other organ has
long ceased. And from which it may be inferred, that these organs
would be proportionably more susceptible of inflammatory excitement
than any others ; and hence it is in this disease, the leading features
of which may be said to be the very reverse of inflammatory, that
these organs have been found almost exclusively the seat of in¬
flam mation.”

Spasms come next to be considered ; they are for the most part of
the clonic kind, or primarily so in all cases, dependent, I believe, on
congestion in the spine, at the origin of the affected nerves ; and the
tonic kind, to which the European is more frequently the subject,
dependent on the same, but having developed a certain degree of in¬
flammation on the part.”

“ Having completed an explanation, which appears to me satis¬
factory, and the whole phenomena of the disease,* I have, in con¬
clusion of the subject, but to ask, are not those sudden and con¬
centrated attacks, which destroy the patient, without the develope-
ment of the usual and more characteristic symptoms of the disease ;
like a resistless apoplexy, resulting from the overwhelming congestion
of the brain, annihilating its functions and all the powers ? * Mr-

Finlayson, observing, of some cases, which happened often in Bengal,
that the operation of the morbific course was so violent as to destroy
life in a few hours, without any other characteristic tokens of the
disease, except the extreme prostration of strength. In these cases.

* For the symptoms not enumerated I must refer to the work.

Mr. Searle on Cholera — Reclamation.

159

there was such congestion of blood in the brain, that it had the ap¬
pearance of being enveloped in a layer of dark coagulated blood, or
by a diffuse and general ecchymosis, and in some cases, when it was
cut into, large quantities of dark coagulated blood gushed from it,
and from the theca of the spine. In the ordinary form of the disease,
this appearance was wanting, the blood being principally collected
in the abdominal viscera.’ And the Bombay Medical Board observes,

‘ That those who are most intimate with the disease, will be struck
with the great similarity between it and the congestive typhus of
Armstrong. And dissections they state, abundantly prove, that
venous congestion constitutes the principal change that takes place
during life.’

“ Having represented the connexion as most intimate between
cholera and fever, it may be necessary that I say a few words on their
distinctive characters. The former I have represented as a disease,
marked by the subduction of power, or in which, symptoms of excite¬
ment are but seldom evinced, beyond what are resulting from topical
inflammation ; whereas, the characteristics of fever in general, may
be said to be the very reverse of this ; increased action and general
excitement. The way in which this is brought about in the adynamic
or typhoidal order, I believe to be somewhat analagous to that by
which I have previously represented cold to have operated in the pro¬
duction of the synochal order. The depressing cause, being of less
virulent character than in cholera, operating but to the extent of pro¬
ducing that degree of congestion which comparatively little interferes
with the functions of the brain ; and but of resistance to the blood’s
egress from the arteries, that distention in these trunks and excite¬
ment ensues. To which, we may add, that in proportion to the
severity of the cause, and susceptibility and so forth, of the patient,
will topical engorgements and inflammation be concomitant. Which
inflammation will be seated in those parts, for reasons already enu¬
merated and assigned to them in cholera ; which being in the stomach
and bowels more particularly, and the head, explains how both
Clutterbuck and Broussais were individually led to the mistake of
assigning to these organs the exclusive seat of fever.”

“ We have analogical illustration of this cause of excitement, in
the operation of other sedative agents on the system ; opium may be
mentioned, small doses producing primarily a certain degree of excite¬
ment ; whereas, a large one, induces an opposite effect, or at least
the excitement is so transitory, that it cannot be calculated upon, and
this is followed by overwhelming cerebral congestion.”

We have next divided the disease into three species, adding, how¬
ever, “ that the distinctions here made, although not without use,
will not often be found so well defined in practice, as the species not
only run into each other by insensible gradations, but are variously
modified, by constitutional idiosyncrosy, temperament and habits of
the patient ; and by numerous other circumstances of a local
character ; for after all, they are but one and the same disease, modi-

160

Original Communications .

fxed by these circumstances, and a greater or less intensity of the
morbific influence.”

“ We shall now present the reader with the symptoms of the
most frequent form of the disease, our second species, or cholera
congestion, as we have thought proper to denominate it in preference
to spasmodica, as spasms are by no means uniformly present, whereas
congestion, I believe, is always so.”

“ The patient is usually suddenly seized with giddiness, borbo-
rygma and purging ; or the latter, with a sense of weakness, and
symptoms of indigestion have been for some hours, or even days
duration ; these are followed by vomiting, which with the evacuations
from the bowels soon assume the conjee or barley water-like appear¬
ance, succeeded by great prostration of strength, tremor or twitching
of the extremities — alias clonic spasm ; a sunken ghastly counte¬
nance, ringing noise in the ears, cold damp skin, feeble pulse, and
prsecordial oppression. From the sense of preecordial oppression,
heat sooner or later becomes developed, and the patient complains of
inward burning, attended with great thirst and insatiable desire for
cold water ; the irritability of the stomach is now usually increased,
and there is extreme restlessness. The pulse becomes now sharp,
frequent and wiry ; while the extremities are cold, and in general
damp. With the developement of this partial excitement, tonic
spasms or cramps usually set in, commencing in the feet and legs, and
gradually increasing, or extended to the upper extremities, and occa¬
sionally involve the muscles, also of the belly and chest. The ex¬
hausting influence of these spasms, or sense of inward anguish,
singly or conjointly, is soon succeeded by collapse. The stomach
and bowels, which continued before irritable, now retain whatever is
poured in them ; the spasms cease, the skin is livid, covered with cold
sweat, and the fingers shrivilled ; the eyes are suffused with blood,
or covered with a dense film, half open, inanimate, and countenance
death-like ; coma and dyspnoea ensue, and life gradually leaves its
frail tenement without a struggle.”

“ Nothing, perhaps, can be of more practicable consequence than
to note accurately the various stag^ of acute diseases from their com¬
mencement to their termination ; for unless this be done, the disputes
may be endless about the modes of treatment, which must corres¬
pond to the leading phenomena of each stage. This erudite and just
observation of Dr. Armstrong is particularly applicable to the disease
under consideration ; and it has been the want of its observance that
has occasioned the discrepancies that at present prevail in practice.
I shall therefore offer a few observations on this head. Each species
is made up of an assemblage of the three following stages : — The
first stage of torpor or oppression ; the second of general or partial
excitement ; and the third of collapse.”

The second species or congestive, combining the whole. In the
first instance oppression, bounded by the tonic spasms, or other
symptom denoting the partial or topical excitement of the second

Mr. Searle on Cholera - - Reclamation.

161

stage ; which terminating in the least of collapse, is evinced by the
spontaneous cessation of the vomiting, purging, and spasms ; accom¬
panied with the loss of pulse, coma, and profuse cold swTeat.”

“ The indications of treatment resulting from thus viewing the
disease, are obvious — to remove the hist stage of oppression, which
our explanation attributes, both to suppression of power and ve¬
nous congestion, by remedies both stimulant and evacuating ; then
follows on its supervention, the moderating or removing the second
of excitement, by remedies more part ieularly evacuating ; bearing
in mind at the same time, the nature of the disease, that the powers
of life may not be by the means employed in this, fatally subdued in
the event of the third of collapse ensuing ; in which stage, the indi¬
cations are, to allay irritation, restrain every debilitating evacuation,
to restore the natural secretions, and at the same time to husband
and support the remaining feeble powers of existence.”

“ The laws of nature and of living matter being immutable, it is
only to understand aright the operation of diseased action, and the
same of our remedies, to enable us to lay down determinate rules of
treatment.”

This calls upon me for the following observations, in reference to
the indications of treatment, and to the modus operandi of our prin¬
cipal remedies : —

“ The immediate cause of the disease1, being, torpor of the ge¬
neral capillaries of the system, by which the chemical changes in
the blood are hut imperfectly effected, and as a consequence of dimi¬
nished evolution of vital temperature and nervous energy that be¬
comes debility of all the functions — and hence the congestions and
stage of oppression which ensue ; the primary indication of treat¬
ment is obviously the restoration of exciement to these vessels on
which the whole phenomena of the disease depends. To accomplish
which, stimulants are expressly indicated, and of chief among their
number, might perhaps be mentioned, the inhalation of oxygen
gas ; but as this is a remedy so seldom available, it is well that we
have another that is always so, and whose ope ration, I believe to be,
specific on these vessels ; this is mercury, for of this remedy I ex¬
pressed my opinion some years ago, to the following effect, which
every day’s experience confirms me in the belief, is a most just one.’*

“ The effects of this remedy being so multifarious in the cure of
disease, its operation must be very general on the system ; its pri¬
mary action, I believe to be on the capillary vessels, exciting them
to increased action ; hence its renowned deobsturent powers, and its
operation on the glandular system in increasing the various secretions.
Its more obvious effect on the hepatic function, is probably owing to
its primary direct influence on this organ, by its absorption from the
stomach and bowels by the veins from these points forming the roots
of the vena portarum. Its operation in exciting the capillary arte¬
ries, necessarily removes congestion from their venous terminations
and obstruction from the exhalents ; hence its accredited action on

VOL. VI. no. 32.

1(V2 Original Communications .

the absorbents in removing the various exudations. Its power of
increasing vascular action is further evinced by the febrile commotion
it excites in the system, and the buffed blood under its influence ;
effects, however, when they occur, that evince its contra-indication
in practice.

“ In thus viewing its operation, its employment in cholera, would
appear in various points of view, we might almost say, specific in the
cure of this disease, and which I believe it to be, aided of course, by
such remedies as circumstances require to further its action ; and in
the removal of symptoms, as effects, arising out of the continuance
of the disease. With the first of these intentions, both local and
general, the more ordinary stimuli are indicated ; such as external
heat and friction, aided by the recumbent posture ; and of internal
administration, ammonia, warm spirit and water and the like. And
with the second intention, stimulating saline clysters, with the view
of increasing serous exudation, and by consequence, the removal of
congestion from the mesentric and gastric vessels, as well as from
the brain ; and thus aiding absorption of our remedies from the sto¬
mach and bowels. The experiments of Majendie having proved, that
absorption from all the surfaces, went on in the inverse ratio with
vascular distention ; and they may be resorted to with the further
intention of tranquilizing the stomach. With the same intentions,
added to some others, blood-letting becomes a remedy of great im¬
portance ; it would appear, by the removal of oppression from the
capillary vessels, to afford direct aid in their excitement, or neces¬
sarily to increase the emulation through them, as verified in daily
experience, the blood flowing in common phlebotomy, becoming after
a certain loss, of a brighter colour ; which can only happen, from the
removal of resistance from the veins, to its ingress from the arteries.
It is hardly necessary to add, the more obvious indications for blood¬
letting in the second stage of the disease. It must, however, in the
employment of this remedy be carefully borne in mind, that one of
the essentials to the heart’s action, would appear to be a certain de¬
gree of distinction ; that in a disease like the present, after its ope¬
ration a certain period of time, from the congestions that ensue, there
remains but little blood circulating through the heart ; hence the
small weak pulse, which clearly prohibits its use, as I know by fatal
experience. That it is an object with Europeans in general, I am of
opinion, and the more robust among the nations of India, wherever
there is no absolute prohibition to its employment, to practise it, at
the earliest stage of the disease, whilst the pulse admits of it ; as it
is a remedy judiciously resorted to, that general experience leaves
most ample testimony in favor of ; and which is most obviously indi¬
cated with the intentions specified. But in saying thus much in its
favor, I must add, my most solemn protest, not only against its indis¬
criminate employment, but in any one case, usque ad deliquium,
which has been the advice of some, or to an extent bordering thereon.
That to adopt it successfully, we should draw it from a small orifice.

Mr. Searle on Cholera. — Reclamation.

163

the patient being in the recumbent posture, at the same time with
our finger on the pulse, that its effects may be carefully watched,
carrying it to an extent limited alone, by the constitution of the
patient on rising of the pulse under its loss ; or arresting it, should the
pulse flag under the operation.”

“ As theory and successful practice both operate in my mind
against what I believe to have been too common, the exhibition of
opium in this disease ; this becomes next the subject of consideration,
and the indications for its employment are pointed out. A detailed
treatment follows : in support of which, numerous cases are recorded
in the Appendix. Added to which, is an Essay on the Vital Tem¬
perature and Nervous Energy, in which, we have endeavoured to
show the nature, source, and distribution of the latter ; and the con¬
nexion existing between the mind and the body.”

“ In submitting the above extracts, which may be considered a
pretty fair outline of the work, I shall content myself ; leaving the
merit of the publication to the attention and to the judgment of your
readers. I have only to add, that I was constrained to its publication
by a sincere and conscientious belief, that I could throw much light
upon a benighted subject; having not only had a great deal of expe¬
rience in the treatment of the disease during twelve years, but from
having also been the subject of its attack more than once during that
time. And I may notice, recovered from it, which has not been the
lot of many in the profession, nay, without arrogating any particular
merit to myself, be allowed to have attained to a degree of experience,
which others who have written before me on the subject, can lay no
claim to.

“ With which observation I shall conclude,

“ Subscribing myself, Sir, your most obedient Servant,

“ Charles Searle.”

106, Great Russell-street, January 12th, 1831.

BIBLIOGRAPHY.

MIDWIFERY.

1 . On the follicular origin of some vaginal tumors. By George
Oakley Heming, Esq. Member of the Royal College of Surgeons,
London. — Sir Astley Cooper has, in a very interesting paper, shown
that some encysted tumours consist in enlargement of cutaneous fol¬
licles; and in the course of his work upon hernia, that gentleman has
described a similar tumour originating in enlargement of a mucous
follicle, situated just below the meatus urinarius in women.

It has not, I believe, been hitherto conjectured that some of those
tumours which are known occasionally to occupy the pelvis and ob¬
struct parturition, have a similar origin. This fact appears, however,

164

Bibliography .

to be distinctly established by cases which have fallen , under my ob¬
servation; and it is the more important, because it immediately sug¬
gests the propriety and safety of the treatment by free incision.

I have carefully examined the bodies of two women in whom I
found tumours of this description projecting into the vagina; in one
there were two of these tumours, in the other there was a single one
as large as an egg. On a minute examination of their internal
structure, it was evident that they consisted of obstructed lacunse,
which had thereby become dilated into a cyst, and distended by a
gelatinous fluid. I was enabled 1o trace distinctly in the smallest
tumour a continuation of the mucous membrane of the vagina into
the tumour, and a reflection of this membrane forming the lining to
the latter. I can have no doubt that the tumour in Mrs. Hollings¬
worth, the particulars of which I am about to detail, was of the same
nature. Mr. Vincent as .well as myself was convinced of this fact;
and it is probable that the greater number of those tumours which
obstruct parturition, and wdiich have been described by the authors
who have written on this subject, weie of similar origin. If this be
the case I think no one would doubt that when they existed in la¬
bour so as to obstruct the descent of the child, the best practice is to
evacuate, and thereby diminish them by a very free opening.

This view of the subject is further confirmed, if that were neces¬
sary, by the history of the cases of this kind which are recorded.
Perfect, Denman, Park, Merriman, Davis, and Drew, have each de¬
scribed cases in which tumours were found between the vagina and
the rectum at the commencement of labour, which, from their bulk,
afforded greater or less impediment to the passage of the child. Some
of these tumours were proved by examination after death to have
been diseased ovaries; others were concluded to have been ovaries,
although sufficient proof of this fact was wanting. But in others the
histories of the cases show that they cou’d not have been ovaries; but
they leave the nature of the tumour in Cvmiplete obscurity.

Some which were not opened disappeared spontaneously after de¬
livery, leaving the practitioner to conjecture what they could have
been. Others which were opened through *the vagina or through the
rectum, discharged a bloody serum w ith membranous flakes, and
became thereby collapsed; others, dui mg ?„n attempt to lift them
above the brim of the pelvis, disappeai ed with a sensation of burst¬
ing; and one, an account of which is given by Dr. Drew in the first
volume of the Edinburgh Medical and Surgical Journal, was extir¬
pated by an incision in the perinmum. In this doubtful state of our
knowledge concerning the nature of tumours which are not of unfre¬
quent occurrence, which, when they* do occur, occasion so material
an impediment in the process of parturi ion, and about the nature
and treatment of which the minds of practitioners are so very unset¬
tled, it is important to establish the fact of the follicular origin, and
safe treatment of some of them by incision.

Besides the proof of the first of these facts already given from dis¬
sections, I am enabled to add that of the second by a case which fell
under my care some time ago.

Midwifery.

165

Mrs. Hollingsworth came to me in April 1822* with a tumour in
the vagina, which a surgeon whom she had previously consulted told
her was prolapsus uteri. I found an oval tumour situate between the
vagina and the rectum , its attachments to either of these parts were so
loose, that I could, by putting my finger beyond it, hook nearly the
whole of it out of the vagina. It could not b q prolapsus, for the neck
of the uterus could be felt above it in its natural situation ; and the
same circumstance, together with the absence of the symptoms of
pregnancy, proved that it could not be retroversion of the uterus. As
the tumour, from its situation and bulk, was. very inconvenient,, the
patient wished to have it removed ; but before doing it, I advised her
to consult Mr. Vincent, who agreed with me in thinking that this
might be done with safety. I therefore proceeded to perform the ope¬
ration. On cutting into the tumour, I found that it consisted of a cyst
containing a considerable quantity of glairy fluid. This was eva¬
cuated, the cyst was left in its situation, and the patient was well in
a few days. Three months elapsed, at the end of which time the pa¬
tient came to me again, stating that the tumour had returned ; that
it was considerably larger than the first time she applied to me ; and
that she wished 1 could remove it entirely. This I did by simply
dissecting it out. The operation was attended with very considerable
haemorrhage, which, however, was stopped by plugging the vagina
with lint, and in three weeks she was quite well.

The great point is the diagnosis. This may be distinctly esta¬
blished by carefully tracing the origin of the tumour. The con¬
duct of the practitioner may then be both prompt and confident. A
free incision at the period of parturition, and excision at any other
time, will safely relieve or cure the patient. — Edin. Med. $ Sur „ J.

SURGERY.

2. Operation for restoring the Columna Nasi . By Robert Liston,
F. R. C. Surgeon, one of the Surgeons to the Royal Infirmary, Lec¬
turer on Surgery, &c. — Case I. More than seven years ago 1 was
consulted by Mr. M., then aged 16, on account of deformity occa¬
sioned by loss of the columna nasi, of the cartilaginous septum, and
of part of the osseous septum, in consequence of external injury. At
that time I proposed, as soon as the discharge had ceased, to furnish
him with a new columna from the upper lip, and had several conver¬
sations with him and his friends on the subject. The proposal, how¬
ever, was not acceded to, and I lost sight of Mr. M. till the begin¬
ning of 1828. In July 1828, I performed the operation as originally
planned. The patient’s head being held backwards, the under sur¬
face of the point of the nose was pared, so as to present a raw and
concave surface; a bistoury was twice passed through the upper lip,
close to the root of the original columna, and each time carried for¬
wards to the mouth in a straight direction, and with little sawing
motion, so as to include a slip about a quarter of an inch in breadth.
This slip, composed of skin, mucous membrane, and the interposed
tissues, was then deprived of its prolabium, and elevated without

156

Bibliography .

twisting, so that its oral margin was placed in contact with the raw
surface on the tip of the nose ; and in this position it was retained by
a point of convoluted suture, a pin being passed obliquely through the
point of the nose and the upper part of the new columna. The raw
edges in the wound of the lip were brought into accurate apposition
by two points of twisted suture, as in the operation for harelip.

The pins and ligatures were removed after a few days, and adhe¬
sion was found to be completed. The lip, which before was too full
and dependent in the centre, had united with very little mark, and
was materially improved in appearance. The union of the upper por¬
tion of the slip was also perfect ; and by supporting this part by a
small round compress, and carefully plugging the nostrils, so as to
distend the alse, the patient’s appearance was totally changed. The
point of the nose could not fall downwards ; the alse were not shrunk
and approximated to each other, but tense and natural ; and the
cavity of the nostrils was not exposed, presenting the appearance of
a dark and foul sore, but hid and protected by the firm and fleshy new
columna. The patient, instead of being constrained by horrid de¬
formity to confine himself to his house and surrounding grounds, was
able to mix in and enjoy society, without its being observed that any
operation had been performed to improve his countenance. That
part of the membrane of the mouth forming the outer surface of the
new columna, remained reddish for some time, but by exposure gra¬
dually assumed the same colour, and apparently the same structure,
as the surrounding skin.

Case II. — Anna Riley was admitted into the Royal Infirmay on
the 10th of August 1828. There was very copious and foetid dis¬
charge from the nostrils; the triangular cartilage and columna nasi
were completely destroyed ; and the inner surfaces of the alae exten¬
sively ulcerated. The point of the nose had become quite flat and
depressed, from the loss of its natural support. The disease was of
six months’ duration, and commenced without evident cause.

“ On the 7th of October, ulceration had ceased, and I formed a
new columna, in the same manner as has been already described.
The parts united by the first intention, and the operation succeeded
perfectly.

“ On the 27th she was dismissed with her features greatly im¬
proved.

“ Case III. — Mary Anne Love, aged 11, was admitted about
eighteen months ago, labouring under lupus. The alse of the nose,
the upper part of the lip, and the inner surface of the nostrils pre¬
sented one continuous surface of angry ulceration. The columna nasi
and part of the cartilaginous septum were destroyed, and the point
of the nose was flattened and depressed. The discharge from the
ulcer was acrid and highly offensive, and the countenance was very
much disfigured.

The disease had existed for six months previously to her ad¬
mission ; and during that time various applications had been em¬
ployed with the view of checking the ulceration, but without effect.

Surgery .

167

** In the Infirmary means were taken to improve her general
health, and the sore was touched occasionally with spirit of turpen¬
tine. Under this application the ulceration seemed to be arrested for
some time, and the aspect of the sore began to improve ; but the
benefit was temporary, and the liniment, having lost its influence
over the irritable surface, was disused. A solution of the nitrate of
silver was then employed, and that also, though at first beneficial,
gradually became inefficacious. Solutions of the sulphates of zinc
and of copper were afterwards had recourse to ; and by changing
the above applications, according as each became inactive, the sore
was brought into a healthy state, and the process of reparation com¬
menced. The topical remedy which all along proved of most ser¬
vice, and under the use of which the parts were ultimately brought to
cicatrize, was the spirit of turpentine.

By the middle of last May, cicatrization was almost complete,
and I prevailed on the patient to have her deformity removed by the
formation of a new columna. The operation was performed in the
same manner as in the preceding cases, and adhesion was completed
in both the nose and lip in two or three days. The columna was
supported by compress and bandage, and the alee were kept distended
by dossils of lint.

Ulceration has not returned ; and the margins of alee, which were
not quite healed previously to the operation, are covered with thin
crusts, and apparently cicatrizing. The change in her appearance
is very flattering, and promises to be still more so when oedema leaves
the part.

Case IV. — In the summer of 1827, I performed the Indian opera¬
tion for restoration of the nose on Charles Thorne, and gave some
account of his case in the 92d number of this Journal. I then stated
that the operation had completely succeeded, except in the columnar
part, and that I intended to repair that deficiency as soon as the
patient would submit to farther procedure. To this, however, he
was averse, and left this part of the country.

In August last he again presented himself, and was now anxious
that the operation should be performed, as the point of the nose had
necessarily fallen much down from want of mesial support. I made
him a new columna (the third he had had) from the upper lip, hav¬
ing previously elevated the point of the nose as much as possible.
The parts adhered quickly and firmly, and he left the Infirmary much
pleased with the support and improved appearance which the new
feature of his countenance had obtained .

Case V. — Mr. R. H. enjoyed good health till April 1827, when
he had a smart attack of tertian ague, which yielded to the use of
sulphate of quinine. In the following August, after severe mental
exertion, he complained of pain in the head and general indisposition.
He was advised to abandon professional pursuits for a season, and
went to Brighton, where he was seized with violent pleurisy. Early
in October he had another attack of tertian ague, with severe pain in
the right side of the head. Aguish symptoms continued to harass

168

Bibliography.

him till December, after which he remained well till April 1828,
when he was again affected with ague, pain of the head, debility, &c.
and these symptoms returned in January following.

“ In July, 1829, he was sent to Leamington, and while there
encrustations began to form in the nostrils, and on the separation
of the crusts foetid discharge occurred. The discharge continued
till the latter end of September, when he went to London. There
his case was pronounced to be one of secondary syphilis, though
the patient declared then, and declares still, that he never had pri¬
mary symptoms ; and, accordingly, he was ordered blue pill, sarsa¬
parilla, and eventually mercurial friction. His mouth soon became
affected, and the salivation was very profuse. In October the bones
of the nose and palate began to exfoliate, and the patient became
much reduced. Early in November severe inflammation of the eye
and of the side of the face supervened ; and Mr. H. was bled,
purged, and starved. The inflammatory action was soon subdued,
but was followed by a violent attack of diarrhoea, which brought
the patient very low. From this time he regained strength gradually,
and now he enjoys excellent health.

“ He applied to me in August last. The exfoliation has been
extensive, and caused apparently by the abuse of mercury. In the
posterior part of the palate there is a large deficiency, which the
patient is obliged to supply by a metallic substitute ; and the lower
part of the osseus septum is destroyed.

“ The cartilaginous septum and columna nasi were gone, and
the nose lay quite flat on the face, with its wrinkled alee sunk on the
floor of the nostrils, and its point adhering to the upper lip, where
the root of the columna had formerly been.

“ The first thing to be done in this case was to prepare the parts
for the columnar operation ; and accordingly, I divided the attach¬
ment between the point of the nose and the lip, removed the ruin¬
ous remains of the columna, and separated some adhesions within
the nostril that had formed during the cicatrization, raised the apex
of the nose, and distended carefully its alae. By these means even,
the appearance of the patient was much altered, and he began to
be satisfied with what had been done. He was persuaded, however,
to get a more durable and elegant support for the parts than dossils
of lint, and underwent the columnar operation on the 31st of
August.

In this case, as in the others, union took place by the first
intention ; and, I need scarcely add, that the result is very satis¬
factory. — Edinburgh Medical and Surgical Journal.

(Literary Intelligence, Books for Review, &c. in our next.)

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

THE LONDON

. - ■& y \ t
. b. v v a,

MEDICAL AND SURGICAL JOURNAL.

No. 33.

MARCH 1, 1831.

Vol VI.

CRITICAL REVIEW.

I. — The Dublin Hospital Reports and Communications in
* Medicine and Surgery. 1830, Vol. V. — ( continued .)

We resume, with much pleasure, our analysis of this very
important work, every page of which is replete with valu¬
able information. We have noticed some of the papers in
our preceding1 numbers, and now proceed to place the suc¬
ceeding ones before our readers. The paper which stands
next in order is entitled, Practical Observations on certain
Diseases of the Anus and Rectum.” By A. Colies, M. D.
Professor of Surgery in the Royal College of Surgeons in
Ireland.

This essay is one highly deserving of attention and study,
as it is the production of a gentleman of the highest emi¬
nence, and the most extensive experience, both in private
and in hospital practice, and especially as it controverts the
general idea as to the frequency of stricture of the rectum.
We are glad that a surgeon of such great celebrity as our
author, has arrested the extravagance with which certain
writers have of late referred every disease to stricture of
the rectum. He also states that bougies seldom, if ever,
cure the disease, and are used in numerous cases where no
such disease has existed, and with fatal effects in some in¬
stances which had fallen under his own extensive observa¬
tion. His remarks are so important that we cannot but give
them at length, as they cannot fail to render science and
suffering humanity a great benefit.

“ Organic stricture of the rectum. — This disease spares neither
sex nor rank ; it most frequently attacks those who are about the me¬
ridian of life ; sometimes, however, it afflicts children as early as the
seventh or eighth year of their age. I have not met with any in¬
stance where it attacked a person at or beyond sixty years of age.

VOL. VI. no. 33.

170

Critical Review.

“ In some few cases the patient appears to be aware of the mo¬
ment of the first attack of this disease ; for he tells us, that without
any previous illness the bowels at a certain period suddenly became
costive ; that for the purpose of relieving them he took large and re¬
peated doses of physic for three, four, or five successive days ; that at
length his bowels suddenly gave way and a very severe purging took
place, which having continued for a day or two, was then succeeded
by those symptoms which attend the disease when fully formed.

“ Many patients, however, cannot give any account of the first
approach of this disease ; they merely state that they have been for
many weeks, months, or years, subject to it ; that the symptoms
from the commencement were pretty much the same as those they
now labour under, but perhaps not quite so severe and urgent.

“ When organic stricture is fully formed (by questioning him,)
we learn from the patient, that in the course of each day he has many
and sudden calls to stool ; that at each of these he is obliged to strain
very much, and that the straining, which is not followed by any
severe pain, produces a discharge of not more than a table spoonful of
mucus, which is sometimes streaked with blood, and very rarely
mixed "with a small quantity of feces ; that these evacuations are
generally attended with a copious discharge of wind, and that as soon
as the evacuation has taken place, he feels free from pain or uneasi¬
ness : the remission however is of short duration, as he is soon again
compelled to undergo the same unavailing distress. The number of
these discharges are seldom less than from seven to twelve during
each day and night ; they do not take place at regular intervals, but
generally a considerable number occur in quick succession, and then
are followed by a pretty long interval of ease. The greater number
of these evacuatious are devoid of feces ; a feculent stool is passed
perhaps once in two or three days ; the feces are then found passed
in short pieces and of very reduced dimensions, not larger than a full-
sized cathether, and in quantity not equal to what is passed in an
ordinary evacuation by a person in health, yet after each feculent
stool the patient feels much relieved.

‘ ‘ There is not the slightest prolapsus ani with any of these eva¬
cuations.

The bladder is in some cases slightly affected ; the patient then
complains of a little difficulty or delay in passing his urine.

In some cases a fistulous opening forms in the nates or the peri-
nseum, which will admit a probe to pass into the rectum ; it yields a
moderate quantity of healthy pus. The fistula undergoes little or no
change from the time of its first appearance, even until the death of
the patient. In some cases, especially in females, I have known the
number of these fistulous openings to amount to twelve or twenty.
The majority of cases of stricture of the rectum, however, are unat¬
tended by fistufe.

Although this state of daily suffering proceeds with the most
unvarying regularity, not only for weeks and months, but even for
manY years, yet the constitution of the patient does not seem tosym-

The Dublin Hosjntal Reports.

171

pathize- in the slightest degree for a long time ; not only do his colour
and appearance proclaim the enjoyment of good general health,
but even the most strict examination cannot discover in any of the
functions the slightest deviation from health, except those above men¬
tioned.

“ After a lapse of time, however, which is very different in differ¬
ent cases, a peculiar paleness of countenance and wasting of flesh
announce an inroad on the constitution ; those symptoms are soon
followed by night-sweats, and now the patient complains of uneasi¬
ness about the sigmoid flexure of the colon, which soon extends along
the left colon.

“ In this stage of the disease, it too frequently happens in females,
that a communication is formed between the rectum and vagina,
which causes the greater part of the entire of the faces to pass
through the latter. In men, but more rarely, a similar communica¬
tion is established between the rectum and bladder.

“ As the disease draws towards a close, the patient begins to suf¬
fer much more serious distress from the state of the rectum, for in
addition to the frequent unavailing efforts to discharge the bowels, he
is troubled on the slightest exertion, such as coughing, sneezing, or
voiding urine, with an involuntary discharge of a thin brownish fluid
of a muco-purulent nature. After some time this peculiar discharge
comes away in the morning, the moment the patient rises from his
bed. In the last stage of the disease, this discharge comes away
unceasingly without the consciousness of the patient, and the faeces
will not pass unless in a perfectly liquid state.

“ This aggravation of local distress is accompanied by a corre¬
sponding decline in the general health ; his appetite fails, thirst be¬
comes very urgent, emaciation proceeds rapidly, hectic fever becomes
fully formed, though more marked by profusenight sweats than by mid¬
day or evening exacerbations ; and now the patient, extenuated to
the last degree, seems to be carried off as much by the exhausted
state of his constitution as by the torments of the local disease.

“ Sometimes in the advanced state of this disease, the patient is
seized with symptoms of peritoneal inflammation, wdiich puts a
speedy termination to his sufferings, and he is suddenly carrried off.
In such cases, on examination after death, we discover that the pro¬
cess of ulceration had opened the intestine immediately above the
stricture, and that through this opening a portion of faeces had passed
into the cavity of the abdomen.

“ In some very fewr patients, the hectic fever seemed to have
been arrested by the warmth of summer weather, but only to run the
remainder of its course with unusual precipitancy on the approach of
winter.

“ Among a considerable number of patients afflicted with this
disease, I have had an opportunity in two instances only, of meeting
with it in its incipient state. In both of these, the patient complained
of different symptoms of irritation of the rectum, frequent stools, dis¬
charges mixed w ith mucus, and certain feelings of uneasiness : on

172

Critical Review.

examination by the finger, a thickening and slight projection of the
gut was felt at a small spot on one side ; this morbid alteration
spread gradually round the entire of the canal, and extended along it
only to a small distance ; hut until the morbid derangement of struc¬
ture had almost entirely performed the circle of the intestine, the
patient did not exhibit those symptoms which I consider as the com¬
mon and inseparable attendants on stricture of the rectum. How¬
ever constant in their attendance, or unvarying in their course, may
be the symptoms of this disease, yet will the surgeon desire to be
confirmed in his opinion by manual examination. Proceeding to
make this examination, we often observe at the orifice of the anus the
following appearance, which is indeed almost always present when
the disease is seated near to the external sphincter, namely, at each
side of the anus a small projection, which on its external surface
appears as a mere elongation and thickening of the skin, but in¬
ternally presents a moist surface, not exactly like the lining mem-
brane of the gut, nor yet can we say that it is ulcerated ; these two
projections lie close together below and divaricate above, presenting
a resemblance to the mouth of an ewer. Whenever this external
appearance exists, I feel almost certain of finding a stricture of the
rectum before the finger is pushed as far as the second joint into the
gut. In some cases, however, this external mark has not been
present.

“ When the stricture is situated pretty high up, the portion of
gut interposed between it and the anus is found to be in a perfectly
healthy state ; but when the finger arrives at the stricture, it is
arrested by the narrowness of the canal, which will barely admit
the point of it ; if now a slight degree of force combined with a
boring motion be employed, the finger may be pushed through the
thickened and indurated part, and will then (as well as its benumbed
condition permits it to feel) find that the gut just above the stricture
is in a very healthy state. The extent of the stricture, however, is
very variable ; sometimes it is little more than a mere ring, but at
other times, it extends along the canal as high as the finger can reach.

“ I have not yet met with any instance in which the intestine was
strictured, only by means of bands thrown across its canal ; such
cases I presume must be very rare.

“ In a few instances the stricture has been seated so high in the
gut that it could be barely touched with the point of the finger,
until the patient was desired to “ force down,” and then a satisfac¬
tory examination of it could be made.

Cases of this disease examined after death, present all the
coats of the intestine veiy much thickened, except the peritoneal
tunic, which when closely inspected is found to retain its healthy
structure and appearance ; the muscular, cellular, and mucous coats
are much thickened, the latter is moreover hardened and raised into
irregular ridges, or folds, but without any ulceration.” — p. 139.

The Dublin Hospital Reports.

1 73

The diagnosis between this disease and those of the pelvic
visera is graphically given. Cancer of the rectum possesses
many of the symptoms of the affection under notice, but
the leaden colour of the countenance and examination of
the rectum, enable the surgeon to make a proper distinc¬
tion. In cancer, the same hard feel is often perceived, but
if the examination is made after the lapse of some weeks,
a certain portion of the hardened wall of the intestine will
be found destroyed. In a rare form of scirrhus of the uterus
and vagina, in which the latter passage is almost obliterated
by the thickening of the parietes, a train of symptoms not
unlike those before us is observed, but examination of the
finger will remove all doubts ; the same test applies to en¬
larged prostate gland. Again, ulcer of the rectum may be
detected, if low down, by expanding the anus, or by the
finger, and a tumour in the pelvis can only press upon the
canal laterally, and that the coats of the bowel are soft and
healthy. Lastly, the calibre of the gut above the sphincter
may be filled up with folds of the lining membrane, and in
such cases the health is perfectly good. This fact is further
attested by Mr. Houston in a subsequent paper, in which he
describes four such folds, and illustrates them by well-
executed engravings. We now arrive at the treatment of
stricture of the rectum, which, for the gratification of those
who cure it so effectually, we must insert. For ourselves,
we can only observe, that the testimony of such an able
and justly celebrated practitioner as our author, weighs
more with us than ten times that of those who entertain the
opposite opinion.

“ The treatment, by bougie, usually recommended in this dis¬
ease, appears to be well calculated to alleviate the sufferings of the
patient. I feel confident, however, that a perfect cure of the organic
stricture of the rectum has not been effected by any plan of treat¬
ment hitherto employed. I have paid great attention to the use of
bougies, and yet I must candidly declare that hitherto I have not
been so fortunate as to have effected a permanent cure in a single in¬
stance ; nor have I had the good fortune to meet with any patient
whom I knew to have been afflicted with this disease, who had been
cured by another surgeon. No man can he more ready to proclaim
and boast of our control over diseases, and therefore I trust that this de¬
claration will be received by my brethren as it is intended, viz. that
it will cause them to consider the history and nature of this intracta¬
ble disease, and to engage themselves earnestly in discovering some
other plan of treatment which will gain the object of our anxious
wishes.

174

Critical Review.

" I have not been contented with applying the bougie simply;
I have often made it at the same time the means of conveying ^va-
rious applications to the seat of disease. For this purpose I have
employed bougies, with a deep groove running spirally their whole
length, so that the ointment employed should not be rubbed off the
instrument by the tightness of the anus and its sphincters.

“ I have nothing cheering to offer on the treatment of this disease;
I have given the fullest and fairest trials to various internal medi¬
cines.’’ — p. 143.

Mercury., arsenic, hemlock and iron, were repeatedly
urged to the fullest extent, without any benefit. Large
quantities of mucilage, blue pill, with double the quantity
of pulv. ipecac, c. have occasionally afforded a temporary
alleviation. The puffing of certain members of the profes¬
sion on the frequency of the disease, and their infallibility
in curing it, is rank empiricism, and highly disreputable to
the dignity of true science. Dr. Colles next alludes to
spasmodic stricture, which is so confidently described by
modern authors, which the}7 so effectually cure by bougies.
As his practice is the first in Dublin, and has been for many
years, and probably more extensive than that of the whole
writers on the subject before us, his opinion is entitled to
confidence and respect. And here it is, gentle reader —

“ I must, however, frankly declare, that in the course of a pretty ex¬
tensive practice, the most extensive for the last twenty years, I have not
been able to discover a single case of a disease corresponding to the de¬
scription of the spasmodic stricture of authors. I therefore feel a
considerable share of scepticism on this point. Indeed I not only
doubt the existence of any such disease, but I can recollect many
cases in which this suspected condition of the rectum has yielded to
the ordinary means for improving the state of the stomach and
bowels, especially when combined with positive assurance to the
patient that no such disease had existed : by this assurance alone we
can sometimes remove all his anxiety and apprehension on this sub¬
ject.” — p. 145.

The symptoms which are stated by authors to indicate these
diseases of spasmodic stricture, or of organic stricture seated beyond
the reach of the finger, will, upon investigation, be found very falla¬
cious ; even supposing all those enumerated should be found combined
in the same individual : — thus, we are told, that in such cases we
arrive at a knowledge of the existence of these diseases by examina¬
tion with a soft bougie, by the very diminished diameter of the faeces
and by the admixture of blood or mucus with the stools.

The soft bougie, however, may, and very generally will receive
an impression irom the projecting ridge of the sacrum ; for it is by

The Dublin Hospital Reports.

1 75

no means an easy matter to pass a rectum-bougie so that it shall
not be arrested at this point, and consequently receive an impression
from the projecting bone.

“ The diminished diameter of the faeces too, may be produced by
any irritation in the rectum, which will cause it to act frequently,
and with increased contraction ; this is often experienced even in per¬
fect health.

“ The admixture of mucus or blood with the faeces, is also fre¬
quently met with in other and very different affections of the bowels.

“ To prove the futility of these symptoms as a discriminating test,
and the danger of being misled by them, I shall briefly state the out¬
lines of one case only.

“ Mr. - , aet. ann. 36, who had lived rather fully and freely,

applied to me six or seven years ago under the following circum¬
stances : — he said that he had been, for the last two years, affected
with stricture of the rectum ; that in the preceding year he had an
attack of dysentery, and that since that time he found the stricture
worse ; the diameter of the faeces diminished, calls to stool more fre¬
quent, and seldom passing without an admixture of blood and puru¬
lent mucus : he was losing flesh rapidly, his appetite and rest were
very indifferent, and his mind was miserable. Having examined the
rectum by the finger, I expressed to him my hopes that he was not
affected with such an intractable malady, by which I very nearly
forfeited his confidence,; for he told me that he had applied to a very
eminent physician in the north of England, and then to another in
London, both of whom assured him of the existence of this disease ;
and lastly, he had been under the care of the late Mr. White of
Bath, who furnished him with the bougies he was then using, and
immediately introducing one, he shewed me the mark which the
stricture impressed on it. My most urgent remonstrances could at
this time only obtain from him a promise that he would not use the
bougie as frequently, or for as long a period as usual. By small doses
of blue pill, combined with compound powder of ipecacuanha and an
enema of olei oliv. cum subacet. litharg. liquor, the irritation of the
bowels was mitigated in the course of eight or ten days. Availing
myself of this favourable change, I again urged him to lay aside the
bougie, and with some difficulty obtained a truce for ten days ;
within this period it fortunately happened that he passed one con¬
sistent motion, in which the faeces were of a large diameter ; after
this I had but little trouble in prevailing on my patient to lay aside
altogether the use of the bougie. By persevering in the internal use
of mild bitters and bark, and injecting every night an enema, con¬
sisting of ol. oliv. and unguent, supernitrat. hydrargyr. into the rec¬
tum, his disease was finally cured, and since that time his bowels,
though sometimes deranged by ordinary complaints, have never suf¬
fered from a return of the former affection, and he has enjoyed very
good health.

“ When we consider the irritable state of this patient’s bowels,
the wasting of his flesh, and the wretchednes of his mind, we may, I

176

Critical Review.

think, reasonably believe that a further perseverance in the use of the
bougie would have rendered his disease eventually fatal; yet here
were present all those symptoms which are said to indicate stricture
high up in the rectum ; the event has proved that no such disease
did exist. And here let it be remembered, that serious mischief has
occasionally been committed by rude attempts to dilate a supposed
stricture at the top of the rectum or termination of the colon, for I
have known two cases where peritoneal inflammation and death
speedily ensued ; and I have heard, on the best authority , of two
similar instances . ’ ’ — p . 149.

Our author considers spasmodic stricture of the sphincter
ani a very rare disease. He met with only one case, which
was pronounced stricture of the rectum, by an eminent
provincial surgeon, another in Dublin, and a third in Lon¬
don. The patient had suffered from two to three months
at a time, and then he enjoyed immunity from it for
four months. By a minute examination, our author was
satisfied it was only a spasmodic condition of the sphincter ;
and to convince his patient that his fears were unfounded,
he passed a wooden globe, three inches and a half in cir¬
cumference, mounted on a rod of whalebone, et ten inches
up the sctotum, without having met with any obstruction.”
Here is a salutary lesson for those worthy surgeons who
would have tortured this unfortunate patient to the brink of
the grave, had he had the misfortune to submit to their prac¬
tice. That stricture of the rectum occasionally occurs,
every man of science will acknowledge, but that it is the
fons et origo malorum, as certain interested individuals lead
the public to believe, is a species of knavery which merits
the indignant reprehension of every scientific practitioner-.

Dr. Colies next describes f,r vascular tumours of the rec¬
tum,” or, what are denominated “ haemorrhoidal excre¬
scences,” a term he deems objectionable. He describes
their pathology in these words : —

I had an opportunity of examining the structure of these
tumours in a patient who had died of another disease. On slitting
up the rectum I saw three blood vessels, each as large as a crow-
quill, running for some way down the intestine, and then dividing
into a number of branches ; these vessels ramified very profusely,
and each seemed by interweaving of its branches to form one of
these tumours. The trunks and branches were covered only by the
lining membrane of the intestine.”

With respect to the treatment, he prefers excision to liga¬
ture, as the latter may be followed by tetanus, and the
haemorrhage from the former can be readily controlled. His

The Dublin Hospital Reports. 177

mode of operating and suppressing haemorrhage is extremely
judicious : — ■

“ The following mode of operating I have found to be uniformly
and permanently successful, and it is considerably less severe than
that generally recommended. The tumours having been made to
protrude by means of a purgative injection, I direct my assistant
to pass a hook or common tenaculum through one or two of the
largest, while I seize another lengthwise with a polypus forceps,
then drawing the tumour a little towards the axis of the gut, with a
large pair of scissors passed behind the forceps, I cut off all that
portion which is engaged between its blades. I then proceed in the
same manner to remove those tumours which the assistant holds
transfixed by the hook. By fastening and drawing out the tumour
with the forceps, we much facilitate its removal by the scissors ; pro¬
ceeding in this way, I guard against these tumours being drawn up
within the sphincter, as soon as the first had been removed. I do
not think that any case will require the removal of more than three
of these tumours, and not unfrequently the cure will be ensured by
cutting off only two of them. When the operation is finished, the
protruded parts generally lie within the sphincter ; should any part
remain out, it must be completely pushed in with the finger. In
order to guard against the danger of hsemorrhage, I take care not to
prolong my incision higher on the bowel than what I conceive will,
when replaced, lie within the sphincter ; for if wre cut the gut higher
up, this part, when returned, may bleed freely, from not having any
surface closely opposed to it. Besides, we know that by cutting
higher up we are in danger of cutting the trunk of the vessel, instead
of confining our incision to the tumour which is composed solely by
the convolutions of its very minute branches.

“ I should be afraid to adopt Mr. Hey’s method of cutting away
all the protruding tumours, together with the skin at the verge of the
anus, lest the patient should afterwards occasion the distress which a
too contracted state of this outlet must occasion ; for in one case,
where for the purpose of extirpating warts, a ring of skin at the verge
of the anus, had been cut away along with these excrescences, the
condition of the patient was rendered truly miserable.”

He terminates his paper with an account of a <( peculiar
kind of ulcer,” which he treats as follows : —

“ The remedy for this disease is, to introduce into the rectum a
convex-edged scalpel, and make an incision through the entire length
of the ulcer, continuing it through the sphincter and dividing the
verge of the anus ; as soon as this wound has got into a state of sup¬
puration, we should dress it and the ulcer, with some stimulating
ointment introduced on a dossil of lint. The case goes on without
interruption, although it is rather tedious and slow of healing. I
need hardly say, that the final cicatrization will be promoted by the
occasional application of the nitrate of silver.”

VOL* IV. no. 33.

A A

178

Critical Review .

The succeeding paper is by Dr. Houston, entitled <e Ob*
servations on the Mucous Membrane of the Rectum.” It is
an excellent appendix to that we have just concluded. The
author, who is demonstrator and curator of the Museum of
the Dublin College of Surgeons, in preparing specimens of
the pelvic viscera, which he has well delineated in an ano¬
ther work, discovered valvular folds in the rectum, which he
supposes are destined to support the weight of the faeces,
and thus preventing too much pressure on the sphincter.
His pathological views are well worthy of attention, and the
anatomical description is as minute as possible. We regret
that our space prevents us from noticing’ his remarks in de¬
tail, but we must confine ourselves to those on the patho-

logy.

“ Considered in reference to disease, the valves or shelves thrown
across the cavity of the intestine are fraught with still more import¬
ance. They may possibly become the most frequent seat of that
morbid alteration of the inner membrane termed stricture. I have
not, however, examined the subject with a view towards determining
this question, but there are several facts which give probability to the
conjecture. In the first place, this disease is generally confined at
its commencement to a portion of the circumference of the gut; and,
secondly, the seats of this occurrence correspond very much to the
places where these valves are most frequently found, viz. near the
orifice, about three inches up, or at the top of the rectum. There is
still another more weighty reason why the surgeon should bear in
mind the existence of these folds, that he may not mistake them for
strictures in the gut, a mistake which, it is to be feared, has often
happened to those who have reported such numerous cases of this
disease, and which, by leading them to the frequent practice of
bougies, may have brought on the very malady which their instru¬
ments were intended to remove/’

Our author and Mr. Crampton propose a spiral bougie in
such cases.

The next paper is deeply instructive, as it shews how
liable the most eminent and talented men are to mistake.
The report is entitled A case of Aneurism of the Abdomi¬
nal Aorta, with dissection and observations,” by Thomas
R. Beatty, M. D. &c. The patient was a gentleman aged
33, of a robust frame and temperate habits of life, who was
subject to lumbago. He complained of pain in the back, as
if it were between the bowels and spine. This was increased
by making a false step or any irregular motion. The pain
soon extended round the abdomen, and tympanites appeared.
Drs. Cheyne, Graves, and Boisragon, of Cheltenham, and

The Dublin Hospital Reports.

179

Author, employed numerous remedies, with only temporary
relief ; Dr. Oolles was consulted, and also Mr. Fitzpatrick, of
Woolwich. The patient was next under the care of Mr.
Brodie, and finally he visited Paris, where he consulted
M. Andral, in conjunction with Drs. Graves and Townsend,
who happened to be there at the time. The father of French
pathology pronounced the case “ neurose intestinale.”
Dr. Wilson Philip was next consulted, and pronounced the
case one of indigestion. The unhappy sufferer finally re¬
turned to Dublin, and placed himself under the care of
Drs. Graves, Townsend and Beatty. He was now attacked
with violent spasms of the back and side, which forced him
to cry out, and leaping from his chair, he threw himself flat
on his face in bed, which afforded him temporary relief. His
daily dose of black drop at this time was from 150 to 200
drops, yet he was never drowsy, nor narcotised, and once he
took 285 drops. A singular effect was produced by the opium,
and this was retention of urine, which required catheterism.
Death at length closed the scene, and the autopsy was as
follows : —

“ The body was examined on the following day in the presence of
Dr. Cheyne, Dr. Graves, Dr. Townsend, Dr. Wm. Beatty, Dr.
Greene, Mr. Harris, and myself. On exposure, the emaciation ap¬
peared extreme. Before proceeding to the dissection, we wished to
let some of the gentlemen present, who had not attended him, feel
the enlarged liver, but we were much surprised to find that no tu¬
mour could be perceived ; this, though at the time inexplicable, was
afterwards satisfactorily accounted for. The thorax was now opened
and the right lung was found healthy, but in the left cavity of the
pleura a large effusion of blood, partly coagulated, presented. The
lung was compressed, and the inferior border appeared slightly car-
nified, leaving the rest of the organ healthy. The incision being car *
ried into the abdomen, disclosed the viscera contained in it, the ex¬
ternal appearance of which was natural, the longitudinal fibres of the
large intestine were strongly developed, the stomach adhered to the
diaphragm by a small band of membrane, and the liver, which dur¬
ing life had appeared so much enlarged, was found very little in¬
creased in size, and in structure quite healthy, but the outer convex sur¬
face was marked by deep indentations corresponding to the ribs, as if
it had been subject to strong pressure against them. When the in¬
testines and liver were removed, a large firm tumour was discovered
about the size of the head of a child a year old, lying upon the three
last dorsal vertebrae, its transverse diameter being a little longer than
the perpendicular, and extending with a curved outline to the kidney
on both sides, having the aorta passing down before it, in a sort of
groove on the anterior surface. The artery was cut across at the
bifurcation, and slit up above the tumour, by which a round well

180

Critical Review.

defined hole, as large as a shilling, was exposed on its posterior surface*
a little above the origin of the coeliac artery, communicating with the
tumour, which thus proved to be an aneurism of the aorta. On exa¬
mination it was found that it was covered by the crura of
the diaphragm, which were expanded and stretched tightly over
its surface, forming an outer coat for it, on which many fila¬
ments of nerves were observed to run. In removing the tumour, an
irregular opening was discovered at the upper and left part, through
which the blood found in the thorax had escaped. The aneurismal
sac was deficient at the back part, and its place was supplied by the
three last dorsal vertebrje on which it lay. The bodies of these were
deeply eroded, but the intervertebral cartilages remained sound and
entire, forming prominent white rings between the destroyed verte¬
brae. At the left side of the eleventh dorsal vertebra, an opening
large enough to admit the end of a finger was found, leading into the
spinal canal. The heart was small ; there was concentric hypertro¬
phy of the right ventricle, the walls of which were thicker than those
of the left. The stomach and intestines were slit open through their
whole extent, and with the exception of partial softening of the mu¬
cous membrane, were quite healthy. The course of the symptoms in
this case, although strange, and at the time inexplicable, can be ac¬
counted for by the position and growth of the tumour, and its influ¬
ence upon the parts with which it was connected. In the com¬
mencement, when it was yet small, it produced the dull fixed pain
that was mistaken for rheumatism ; and this may be considered the
first stage of the disease. As it advanced in size, it gave origin to
the train of symptoms in which this case differs from any that I have
found recorded ; I allude to the severe suffering of pain and spasm in
the tract of the alimentary canal ; this, as far as I know, did not oc¬
cur in others, but in this it was so great, that for several months it
formed the whole subject of complaint, and the attention wras directed
entirely to these organs ; this can be satisfactorily explained by a
reference to the situation of the tumour ; it was placed in the neigh¬
bourhood of the solar plexus, and the pressure exerted by it upon this
great nervous centre, at once £>roduced irritation in the whole of the
organs supplied by filaments from it, and caused the ‘ ‘ neurose intes-
tinale” of Andral. The obscurity in the diagnosis was caused in a
great measure by this class of symptoms, but from what I have observed
on the situation of the disease, it will appear they were accidental,
and therefore are not to be expected in similar cases, unless the tu¬
mour occupies the same position : this may be said to constitute the
second stage. The third and last stage commenced when the tu¬
mour, having by its pressure destroyed the vertebrae, opened a com¬
munication with the spinal canal ; it is marked by the occurrence of
the pain and spasms of the external muscles, and parts supplied by
the spinal nerves indicative of irritation of the medulla spinalis.

“ It might be expected that the pulsation of so large a tumour
would have been perceptible, and thus the nature of the disease have
been developed. But it is evident it was not so in this case, else some

The Dublin Hospital Reports.

181

of the many physicians who examined him must have discovered it.
Andral, amongst others, made a most minute examination of the ab¬
domen ; his expression on the occasion was, <c il faut vous Men palper
monsieur yet he detected no pulsation. In fact, the situation of the
tumour entirely precluded the possibility of ascertaining its existence
by the touch, firmly bound down to the spine by the crura of the
diaphragm, and protected on the sides by the ribs, it lay secure from
observation. A few days before death I perceived a pulsation in the
epigastrium, which, on examining more closely, I found to be that of
the artery, but I could discern nothing of tumour or diffused pulsa¬
tion, and as it is usual to be able to feel the beating of the aorta in
these persons, I took no more notice of it. I regret much that we
were not led to employ auscultation to the spine, as I think it very
probable the disease would have been thus discovered, but as there
was not the most remote suspicion of the existence of such a disease,
the examination was not made. The chest was examined on two
occasions, before death, by two most experienced and successful
stethoscopists, Doctors Graves and Townsend, and no lesion was dis¬
covered. Auscultation affords a ready means for the diagnosis of
aneurisms in the limbs, in those cases in which there is no percepti¬
ble pulsation. The “bruit de soufflet,” heard on applying the ste¬
thoscope, is very striking, and points out the nature of the disease ;
and it is fair to suppose that this indication would have been af¬
forded had the instrument been used along the spine.

“ The intermissions seem to be the most inexplicable part of the
case ; they formed part of the grounds upon which Andral and others
founded the opinion, that the disease was in the nerves; but although
so remarkable a circumstance, the case is not singular in this respect,
for Scarpa relates one in which there was a complete suspension of
suffering, at a period of four months from the commencement of the
disease.” — p. 192.

Here we must conclude our analysis for the present, and
however tedious it may appear to some of our junior readers,
we believe all engaged in practice will be deeply interested
in these highly instructive reports. The remainder of the vo¬
lume is equally important, and will appear in a future notice.

II. — Dublin Medical Transactions. 1830,

( continued.)

A paper, entitled Observations on the Use of Instru¬
ments in cases of difficult protracted Labour, by John
Beatty, M. D. &c. &c. claims especial attention, from its
great importance and value. It has often struck us with sur¬
prise and astonishment, that the Dublin and London obste¬
tricians should have been so extremely fond of performing

182

Critical Review.

craniotomy. The general and universally received axiom is,
that the forceps or lever should be preferred to the perfora¬
tor. In Dublin the latter is generally preferred to the for¬
mer, and this has led Dr. Beatty, an able and eminent obste¬
trician, to oppose this unjustifiable practice. In justice to the
profession in the Irish capital, we must state that it is chiefly
among the older practitioners craniotomy is preferred, for it
appears by the recent reports of Dr. Cusack and Mr. Gre¬
gory, which we have noticed, the practice is not sanctioned
by the rising portion of the profession.

Few physicians are so well entitled to discuss this question
as Dr. Beatty. He has been forty-two years in extensive
practice, during the first five years of which he was assistant
to the late much respected Dr. Clarke, in the great Lying'-
in-hospital in that city. He informs us that he has delivered
III women in private practice with the forceps or lever,
never observing any unpleasant result.

“ None of the mothers died — none of them had their perinseum
lacerated, nor any of those evils, which are set forth as the effects
of the forceps ; and still more, all the children that we had any rea¬
son to think were alive at the commencement, were bom living, and
none of the whole number had any injury or mark whatever inflicted
by the instrument. From this extensive experience of the value of
the forceps, I think I am justified in saying, that the opinions of the
authors already quoted, are fully supported by the facts.” — p. 12.

And he cites the works of Lamotte, Deventer, Chamber¬
lin, Smellie, Chapman, Sir Fielding Ould, the first Professor
Dease, Merriman, Dewees, Denman, Burns, Millot, May-
grier, Lachapelle and Osborne, in favour of the forceps.

Indeed he might have quoted the best obstetricians of all
countries in favour of the practice he advocates. We be¬
lieve the profession have been deceived by the sophistry and
metaphysical reasoning of Dr. Osborne, in his defence of the
perforator and embryotomy, opinions so ably and so justly
criticised by Dewees ; and which are in direct opposition to
those received throughout Europe at the present period.
We confidently affirm, that the weight of authority is in fa¬
vour of the forceps or lever. If we examine the records of
obstetric institutions, we find that the perforator is very
rarely necessary, and yet a very large majority of modern
practitioners are constantly detailing cases of craniotomy.
We could narrate cases in which this operation has been un¬
necessarily performed, and even by lecturers on midwifery
in this metropolis. The day is not far distant, when more
scientific obstetricy will and must prevail, for at length

Dublin Medical Transactions.

183

those who regulate medical education have enforced its
study ; the salutary effects of which will be a powerful
check to unnecessary and unjustifiable operations. The ris¬
ing’ race of obstetric practitioners will discover and expose
the blunders of their contemporaries and seniors, and huma¬
nity will be the gainer. Having premised these few remarks,
we hasten to introduce our author’s judicious observations to
the notice of our readers ; he says —

“ In every case of midwifery, the chief object to he attained by
the practitioner, should be the preservation of the lives of both
mother and child entrusted to his care. The great majority of cases
require no extraordinary assistance, and the duty of the accoucheur
consists principally in watching the progress of the efforts which
nature makes, and guarding against any unfavourable accident, or
deviation from the ordinary course. Unfortunately, however, some
few cases do occur, in which from particular circumstances, instru¬
mental aid is required, and while we may lament the necessity for
such interference, it is our duty diligently to inquire into the merits
of the means proposed to assist delivery, and to select those that we
find most likely to effect the purpose already mentioned, that of
preserving our patient and her offspring.

£< It is of importance that every man practising midwifery should
avoid as much as possible the use of instruments in delivery ; for it
is certain, that if he suffers his patience to be too readily exhausted,
or yields too easily to the suggestions and alarm of the patient, or
her friends, he will frequently be induced to promote delivery too
soon, very much to the injury of the patient, and consequently to his
own character. On the other hand, he has an important duty to
perform in judging of the necessity, and the proper time for using
instruments, and the kind suited to each particular case, for as much
or more mischief may be done by delaying their use when absolutely
required, as by having recourse to them too soon. In fact, in this,
as in most other situations, the man who has patience to watch,
judgment to discriminate, and firmness to act, will be the best qua¬
lified to perform the duties required of him.

“ Having endeavoured, during a long and actively employed life,
to regulate my practice by such principles, I have formed the fol¬
lowing conclusions respecting the comparative value of the different
instruments used, in long protracted or difficult labours. And I am
induced to give a faithful account of my own experience, and of
such means, as I have occasionally employed, because I have reason
to know that my opinions on the subject, differ from those of some
of the most eminent, and justly esteemed members of the profession
in this city.

“ I do not propose to enter into a detail of the causes and nature
of long protracted and difficult labours ; these are so fully treated
of, and explained in all works on midwifery, that it would be use¬
less to repeat them at present ; but I may observe, that the cases in

184

Critical Review.

which mechanical assistance is required, may be comprised in two
divisions ; 1st, Those where there is a disproportion between the
head of the child, and the passage through which it must come ; and,
2dly, Those in which, although no mechanical impediment exists,
the expulsive powers of the mother are not sufficient to accomplish
the delivery.

“ Under the former 'will be found those caused by the deformity
of the bony parietes of the pelvis, and by disease or rigidity of the
soft parts, as well as unnatural size of the head of the foetus, face
presentations and transverse position of the head. And under the
latter, those in which delivery is delayed by general weakness of
the patient, haemorrhage, frequent faintings, convulsions, great ex¬
haustion, fever, &c.

“ To assist delivery under such circumstances, two classes of in¬
struments have been devised ; 1st, Those by which extraction may
be effected without injury to either mother or child ; 2dly, Those
by wffiich the life of the latter must necessarily be sacrificed. I need
scarcely remind the members of an enlightened and humane pro¬
fession, that the adoption of the latter alternative, is a step calling
for the most serious consideration, and one that involves an awful
and heavy responsibility. The value of human life is not to be
estimated by the age, nor is there in the eye of the law, either
human or divine, any distinction between that of the octogenarian
and the child unborn.

It matters little, therefore, what the nature of the situation is,
in which a fellow-being committed to our care is placed, whether it
be a fever striking him in the prime of life, or a disease requiring
the performance of a capital operation, or the perils attending his
first entrance into the world, it is our bounden duty to employ such
means as will best insure his safety.

“ Let it not be imagined that by these observations I would
inculcate, that the well-being of the mother is to be overlooked in
endeavouring to save the child ; far from it, the very nature of the
sentiments points out the contrary ; but what I desire to maintain
is, that the life of the child in utero, is as sacred as if it had
breathed, and walked, and that its destruction can only be con¬
scientiously resorted to, when every other means by which it and its
parent might be saved, have been fairly tried and found inefficient.”
— p. 4.

Our author describes the usual mode of applying- the for¬
ceps, which need not be inserted here, and proves the safety
of the operation. He next proceeds to show' how unneces¬
sarily the perforator is employed. Every man of eminence
in this branch of practice could corroborate his statements.
I he blunders made in obstetricy are little known to those
who do not engage in this branch of medicine. The follow¬
ing remarks deserve serious reflection

Dublin Medical Transactions.

185

“ I have been called upon in several cases of protracted labour,
some of them of first children, and in women advanced in life, to
give sanction to deliver}’ with the perforator and crotchet, and have
found the instruments ready prepared for the operation, when I have
recommended a trial with the forceps, and fully succeeded in bring¬
ing into the world living children, with very little, if any trouble to
myself, no risk to the mother, and no inj urv to the child ; this is
well known by several most respectable practitioners in Dublin, who
have been witnesses to the result.

“ When I contrast the feelings created at such a moment, in the
operator, the patient, and her friends, with those experienced, when
the body of a child (of whose previous life the mother had no
doubt), is dragged mutilated into light, I confess that I cannot un¬
derstand why the latter should ever be adopted, without the fullest
certainty of the impracticability of the former. What adds to the
horror of the perforator is, that it is no uncommon circumstance to
have a child bom alive and cry, whose head had been opened, and
the brains partially destroyed. Doctor Burns says, “ by the rash
and unwarrantable use of the crotchet, living children have been
drawn through the pelvis with the skull open, and have survived, in
this shocking state, for a day or two.” Deventer, Chamberlain,
and others, give instances of women delivered by the crotchet of
dead children, as “ they supposed, when to their great surprise, the
miserable infants filled their ears with cries.” Mr. Dease states,
“ that he has seen instances where the child has been miserably
dragged alive into the world, with a great part of the brain eva¬
cuated.”

“ Similar instances have (I understand) occurred in this city, in
one of which humanity prompted the accoucheur to plunge the child
into a vessel of water, to put an end to its existence and cries.

“ I can never forget a scene of horror to which I was a witness in
the year 1800. I was called upon to see a very young lady, in
labour of her first child, who was under the care of one of the
oldest and most eminent practitioners in this city, (since dead) ; her
labour was most violent, which she bore with great impatience and
noise. The head had been down on the perinseum (he said) several
hours ; I proposed to give more time, and an opiate, not doubting
the powers of nature, or to try the forceps, which he declined, on
account of its being her first child, and the apprehension he enter¬
tained of her being exhausted ; and finally, he opened the head.
The operation, as it always does, excited extraordinary uterine
action, and before it was well concluded, or the brain evacuated, so
as to lessen the bulk of the head, the child was propelled into the
world alive and crying.

“ The old gentleman whose patient she was, was a person of very
fine feelings, and the reader may imagine his sufferings on viewing
the effect of a rash and ill-judged operation ; he declared no earthly
consideration should ever induce him again to witness the applica¬
tion of the perforator,” — p. 15.

vol. vi. xo. 33.

B B

1 sc

C ncai R?r - ...

When convulsions supervene. Dr. Beat tv strongly insists
upon the necessitv o: first trying the forceps, which, does not
occupy so much nine as the perforator, and should the at¬
tempt fail, it is ease to have recourse to the latter. That
this principle admits of practical application, the following
ease testifies : —

In the year IS 14, a gentleman, residing eirhteen miles from
Dublin, called cm me, to request I odd accompany him with all
expedition to see his wife, who had been soddenlv seized with labour
of her hrst child, attended with convulsions before he left heme.

~e reached his house in about hve henrs from the time he left it.
I found the lady lying on the parlour floor, labouring' under severe
convulsions, and quite insensible . in which state she had remained
during her husband s absence. On examination- the head was found
to he kw in the pelvis, and the os nteri dilated. Without re marring
her I introduced the forcers, and in a few minutes succeeded in
extra: ting a female child alive. The mother was now removed to
bed : the convulsions cessed in a short time : her senses were
restorec. ana me recovery was as speed- as if no untoward circum¬
stances had occurred. I may observe that the gentleman had no
more children, and the child then bom is now alive, and heiress to
his large estates . a consolation cf which he mast have been de¬
prived. had I rashly erotic red a destructive hnstmment. If I had
experienced much difficulty in this case. I would have thought
myself justiflanle . nay, called upon, to sacrifice the child T but cer¬
tainly net until I mew it w^s unavoidable : and I state it to show
that in the worst cases, the render means may be resorted to with
considerable prospect of success.” — p. 19.

Our author farther Informs us. that since 1504. he has
used th- crotchet hut three times, daring which period the
majority of his Ill forceps eases occurred, and he con¬
cludes with these impressive words —

In conclusion I win observe, that nothing short of the most
imperative necessity can w-nrmnt the use of the destructive instru¬
ments, and no case can be considered as demanding them until
every means ay which both mother and child roizht be saved have
been pot onto recur::: : r. . and fairly tried. Let ns ask with Dewees,
v a at is to be reared from a proper attlic&ticn o: the forceps ? Is
moor r :*de of action snen as to do injury to either mother or child,
v - v- directed : C ertaini- net. Then there is nothinn to he

a: q ten ended mom their structure, application., and mode of action,
since they neitaer cut nor contuse mother cr child when well
directed, i ney n aimer create unnecessary p ain, nar inordinately
augment tnat which may o>e present ; but are tralv ealoulated. in
hae mo. gunge c: Dr. Denman, tc supply the ins ‘am: i enow cr want of
labour pmns. If tons be so, and it is admitted by Dr. Demnan

Dublin Medical Transactions.

187

himself, why should they be condemned, because in common with
every thing we possess, they may be abused. I repeat it, the object
of the practitioner should be to preserve both mother and offspring ;
if, unfortunately, he should ultimately fail in this endeavour, he
must then decide between the two, and sacrifice the child. To be
driven to such an extremity, is one of the most painful situations in
the practice of midwifery : it forces a man to perform an operation,
differing in principle from every one in use among medical men. All
others are done with a view to the ultimate benefit of the sufferer :
this alone tends to his immediate destruction. Such a consideration,
together with the heavy responsibility a man incurs, by becoming
the voluntary destroyer of a human being, should, make us pause
ere we lightly reject means, by which results so lamentable and
awful might be avoided.” — p. 23.

We fully assent to the opinion so ably maintained in this
paper, which is consonant with science, judgment and expe¬
rience. Every practitioner, with a spark of humanity in his
breast, must shudder at the idea of destroying a fellow crea¬
ture, and we know no law, human or divine, which justifies
such a proceeding.

In a subsequent paper. Dr. Beatty relates a case of (t Cancer
Uteri,” attended by the usual symptoms, and presenting ex¬
tensive disease in the viscera and linings of the pelvis. He
then relates a case of incipient cancer of the cervix, which
was examined by two of the most eminent physicians in
Ireland. Both were of opinion that the lady should live
absque marito ; but our author has long observed that the
disease in general occurs to those whose connubial inter¬
course had been interrupted at an early period of life. He
therefore suggested that the lady should be restored to
her conjugal rights, and that her disease might be arrested.
The idea was new to his colleagues, but they readily
acceded to the proposal. The result was the birth of a
healthy child in less than a year. A perfect restoration
of health followed, and has now continued for fourteen
years.

That pregnancy may happen in incipient scirrhus uteri, is
well known to ail obstetricians, but that the disease should
be arrested in consequence of the proposed measure, is
certainly a new and a singular observation.

Dr. Collins, the master of the Lying-in Hospital, Rutland
Square, relates two cases of “ Laceration of the Uterus and
Vagina,” which terminated favourably. The treatment con¬
sisted in purgation and repeated leeching the abdomen,
warm baths and fomentations. About the end of the fourth.

188

Critical Review

or in the course of the fifth day, all abdominal tenderness
was removed. Our author cautions the practitioner against
allowing the child to escape into the cavity of the abdomen,
and he recommends pressure to be made on the abdomen,
to prevent the head from receding when the perforator is
applied. He observes, that in some rare cases rupture
occurs before the dilatation of the os uteri, and here the
operation of gastrotomy is the only chance of success. No
instance of this kind occurred during the mastership of
Dr. Clarke. Though this recommendation is made by most
obstetric writers, we very much doubt the propriety of acting
upon it. In the majority of such cases, the child is dead,
and in every case the vital powers of the woman are ex¬
tremely depressed immediately after the occurrence of the
rupture This, perhaps, mainly depends upon the loss of
blood consequent to such an accident, which may be so
copious as to destroy life. It is to be recollected that the few
instances in which gastrotomy was successfully performed,
the vital powers were allowed to rally from one to eighteen
hours after the rupture. Besides, the only other danger
that can arise to the woman is the supervention of enteritis
or peritonitis, neither of which can occur instantaneously,
nor very speedily, when the vital powers are prostrate. It
is therefore evident that time ought to be allowed the con¬
stitution to rally, that the operation ought not to be in¬
stantly performed after the rupture, as excision in such
cases of prostration might extinguish life. Few surgeons
would be willing to perform so serious an operation when
the vital powers are prostrate in any considerable degree.
A little sober reflection on these objections must convince
the most sceptical of their validity. The fact is, writers in
general have erred on this point ; for the facts on record are
too few to warrant their conclusion.

The next paper is on the “ Value of Auscultation in Pul¬
monary Apoplexy,’' by Dr. J. C. Fergusson. The author
very satisfactorily proves that the true nature of this dis¬
ease cannot be discovered by the symptoms, and that prac¬
titioners unacquainted with the stethoscope, will be in ge¬
neral deterred from employing depletion to the necessary
extent, as it seems to be contra-indicated by the usual symp¬
toms. The value of auscultation is now so well established,
that we need not continue our notice of this paper. We
have only to state that Dr. Fergusson is an able stetho-
scopist, as more fully appears in a subsequent paper.

Dublin Medical Transactions .

189

entitled “ Auscultation, the only unequivocal evidence of
Pregnancy.”

Every man engaged in practice must admit that an infal¬
lible diagnosis of pregnancy, whether there be a foetus in
utero, and whether it be living, would be highly important
in forensic and private practice.

Our author thinks he has made this important discovery ;
he says, “ I have had opportunities of testing the value of
auscultation in such cases above one hundred times, and in
every instance, with but one exception, I could detect either
pulsation of the foetal heart, or placentary noise, generally
both, after the patient had passed the fifth month of gesta¬
tion, and in many, and indeed in the majority, before that
period.” He makes the examination when the patient is
placed in a chair, and no part of the dress removed. He,
however, prefers the horizontal posture. The only error
of which he is aware, and into which we are liable to fall
in making this examination, is where the pulsation of the
iliac arteries are accompanied by a bruit de soufflet.”
But this noise will be heard at both sides in the groin,
whereas the noise of the placenta is heard over a space of
some extent, perhaps three or four inches square. The
foetal heart may be heard in almost every region of the
abdomen, though it, and that of the placenta, may be heard
in the same side, or even in the same spot, yet generally
they are to be met with in the opposite sides, in the iliac
regions. The double pulsation of the heart is usually felt
in one spot, it may vary, and is double that of the mother.
He detected the two sounds in a foetal heart, not larger than
a hazel nut. Drs. Corrigan and Hunt were present at the
examination. He then relates cases of concealed preg¬
nancy, which he detected, and which will be found in a late
original article on forensic medicine in this Journal. Our
readers are aware of the objections made to the infallibility
of auscultation, by Dr. Nagle, in the Lancet.

Dr. Law describes cases of “ Putrefactive Disorganization
of Lungs.” He commences with a description of the re¬
ceived opinions on gangrenous inflammation, and then de¬
tails his cases. He says that the disease may exist for a
year ; that the lung will be reduced to a blackish, softened
substance, not unlike the broken, dissolved condition of the
spleen after protracted ague. The autopsies of his cases
warrant his conclusions.

190

Critical Review.

The first patient was a lad, aged nineteen, who was ad¬
mitted into Sir P. Dunn’s Hospital, labouring under severe
haemoptysis, with foetid breath. The usual remedies were
tried with success ; the haemorrhage was arrested, but he
finally sunk.

Autopsy . — The right lung adhered to the ribs, was studded
with tubercles, and its parenchyma in a sloughy state. The
left lung was similarly affected, but not to so great an ex¬
tent. Three similar cases are detailed. The author denies
the reality of dyspeptic phthisis, and asserts, that had Dr.
Philip employed the stethoscope, he would not have
broached such a doctrine. He also cites a case, which dis¬
proves the curability of phthisis, by the suppuration of the
glands in the neck, as attested by the same author ; and
states that mercury will rapidly excite the softening of pul¬
monary tubercles.

He relates two cases of hsematemesis, in which the gas¬
trointestinal mucous membrane was blanched, but the liver
tuberculated, and quotes the authority of Frank in support
of this pathology. He has also observed that when young
females are affected with this disease, whose catamenia are
irregular, an uneasy sensation is experienced in the spleen,
which he thinks may arise from the organ disgorging itself
of its contents. This is a further proof of Mr. Dobson’s
theory, and illustrates the pathology of the pain in the left
side, which is so troublesome in such cases, and which has
lately been so much noticed by writers on neuralgia and
hysteria. These papers are highly creditable to the attain¬
ments and judgment of the author.

Dr. Collins relates an interesting case of Extra-uterine
Foetation.” A tumour was felt between the vagina and
rectum, which Dr. Labatt considered enlarged uterus, and
Dr. Colles fungus haematodes of the organ. The os uteri
was examined, but no trace of membranes could be found.
After much pain in the lower part of the abdomen and
pelvis, the woman sunk. On dissection, the pelvic cavity
was found filled with blood — the tumour contained a foetus
of about two months, the sac had burst, the intestines were
infiamed, and both Fallopian tubes were impervious — not a
vestige of them remained in the uterus. The author thinks
the foetus must have been formed without the uterus. This
case favours the doctrine of seminal absorption from the
vagina, as stated by Gartner and others.

Dublin Medical Trans auctions.

191

The next paper is on “ Hydrophobia,” by Dr. Purdon.
It contains nothing worthy of attraction.

A case entitled Anomalous Labour,” is related by Dr.
Fergusson. It was a footling or pedal presentation, which
proceeded favourably until the base of the skull presented.
Here unusual difficulty was experienced, which was found
to arise from the presence of the head of a second infant,
occupying the pelvic cavity. The first infant, which was
partly expelled, was alive, and remained so for a consider¬
able time, but the head of the second was first expelled,
accompanied by that of the first. The first infant was dead,
the second living. Our author intended to have perforated
the vertex of the second infant, but fortunately he had no
instruments, and was refused the loan of them by some
humane practitioners. It was his intention to save the life
of the infant that was partly expelled, but nature decreed
otherwise, and preserved that of the other. The author
refers to three cases somewhat analogous, but differing
widely in their peculiar circumstances, which are recorded
in the Med. Chir. Trans, v. 12. We may observe that such
cases are noticed in almost all the French works on ob-
stetricy.

Dr. Harty describes two cases of Polypus of the
Heart,” one of which was witnessed by Dr. Colies, the
other by Mr. Crampton, the Surgeon-General. The latter
is now in the museum of Dr. Montgomery. Our author
details the symptoms of both his patients with great minute¬
ness, but we think no diagnosis could be formed from them.
He, however, predicted the existence of the disease before
the second autopsy took place. He refers to the opinions of
the numerous writers on cardiac affections, and shewrs these
are not against the possibility of the occurrence of the
disease.

III. — Oulines of Physiology , with an Appendix, contain¬
ing Heads of Lectures on Pathology and Therapeu¬
tics. — By William P. Alison, M.D. F. R. S.E. Professor
of the Institutes of Medicine, in the University of Edin¬
burgh. Edinburgh 1831, 8vo. pp. 452. William Black¬
wood.

The author deems it necessary to apologize for the publi¬
cation of a work on physiology, which contains no new

192

Critical Review.

facts, after the appearance of productions of such value on
the subject, as the System of Dr. Bostock, the Outlines of
Mr. Mayo, the Translation of Blumenbach’s Physiology by
Dr. Elliotson, and of Magendie by Dr. Milligan.

“ My apology is, that it appears to be important for a teacher of
any branch of science to follow the arrangement which seems to his
own mind the most satisfactory ; and important likewise for the stu¬
dents attending any course of scientific lectures, to have in their
hands a text-book arranged on the same plan, and containing the
same views. The following pages have been written, therefore, for
the sake of the medical students of this school. My objects in writ¬
ing them have been, first, to state the facts which appear to be ascer¬
tained, and the inferences which appear to be fairly deducible from
these, in regard to the functions of the living human body ; and
secondly, to arrange these facts, as far as possible, in the order in
which the functions, as existing in the living body, in the adult state,
are dependent on one another.

“ I entertain a hope, that some of those, already conversant with
the science, who may look into the following pages, may approve of
the attempt to give a more systematic form to the subject than has
been usual in most recent publications ; while I am aware that others
do not think the science sufficiently advanced to be taught with good
effect on such a plan ; and may not approve of the views, as to the
connexion of the nervous system with other parts of the animal frame',
and particularly with the functions of organic life, which are here
stated, and which appear to me to justify the present arrangement.

rt In justification of such views on these subjects as may appear to
some erroneous or premature, I can only say, that they seem to me
the most legitimate inferences from the facts that are known, and to
involve less of hypothesis than those to which they are opposed ;
and that, in manyr of the medical writings of the present day, I think
there is a want, not so much of facts in Physiology, as of principles
by which these facts ought to be connected, and by which the recol¬
lection and useful application of them may be best secured.

I have thought it right to enlarge, in these outlines, not on the
subjects which occupy the largest portions of the lectures, but on
those where, without such assistance from a text-book, the state¬
ments made in lectures may be the most easily misapprehended ; and
on this account, I fear that some of the subjects here discussed may
be thought more abstruse than I should have wished them to appear.

By the publication of these outlines, I expect to be able to abridge
considerably the time occupied in the first division of the Lectures on
the Institutes of Medicine in this University ; and, for the conveni¬
ence of students, I have added an appendix, containing the Heads of
the Lectures on Pathology and Therapeutics. These I hope to be
able to enlarge, at a future time, into another volume, similar to the
present.” — Preface, p. 10.

Dr. Alison on Physiology.

193

The work consists of seventeen sections, arranged as follow :
1. Preliminary observations. — II. Of the laws of vital con¬
tractions. — III. Of the circulation. — IV. Of the composition
and properties of the blood. — V. Of nutrition, exhalation,
and secretion in general. — YI. Of absorption. — VII. Of the
properties of the textures and secretions formed from the
blood in the living body, as bone, cartilage, tendinous and
fibrous substances, serous and mucous membrane, glands
and secretions, substance of the lungs, skin, muscular and
nervous substance.— VIII. Of the animal functions in gene¬
ral.— IX. Of respiration. — X. Of animal heat. — XI. Of
digestion. — XII. Of the external sense, common sensation,
smell and taste, sight, hearing. — XIII. Of the mental facul¬
ties. — XIV Of voluntary and instinctive motion. — XV. Of
the physical effects of emotions and sensations. — XVI. Of
sleep. — XVII. Of generation; and XVIII. Of the peculiari¬
ties of age, sex and temperament. The appendix contains
Heads of Lectures. Part I. On Pathology. Part II. On
Therapeutics.

The author commences with an inquiry on the pheno¬
mena of life, which he treats in an able, concise, and simple
manner, as appears by the following extract :t—

In treating of physiology, we first consider the living human
body when fully formed, in the adult state, and in the full enjoyment
of health ; and endeavour to deliver the history and explanation, so
far as is yet possible, of all that takes place in it, different from what
takes place in the dead body. Afterwards we explain the manner,
in which the body gradually attains to the state of perfection in
which we first considered it.

“ In order to have a distinct understanding of the kind and degree
of explanation of which facts in physiology admit, and to avoid the
misapprehensions and controversies which have obscured the first
principles of the science, it is necessary to attend to the following
considerations.

“ The word life, as commonly used, does not denote an indivi¬
dual fact, nor a simple idea, and cannot, therefore, be defined. It is
applied to a certain assemblage and succession of phenomena, which
are seen in a great variety of the objects that surround us, and dis¬
tinguish them from the other objects of our senses. When these
phenomena are examined throughout the whole of nature, it is found
that the most general and characteristic of them is, the continued ap¬
propriation and assimilation of surrounding matter, which we call
nutrition ; a process which maintains a certain definite structure
called organization , — which originates in all cases that can be satis¬
factorily observed by generation, — and terminates by death.

vol. vi. no. 33;

c c

194

Critical Review „

“ Having given this general description of what are called living
bodies, we next observe, that many of the phenomena exhibited by
these bodies have been found to be not only inexplicable by, but
manifestly inconsistent with, the mechanical and chemical laws that
regulate the changes, and have been inferred from the observation of
other departments of nature. In so far as we can ascertain this to
he the case, we say that these phenomena are effects of the vital
principle, or of vitality, and that is our definition of these terms;
They are the general expression for those of the changes occurring in
living bodies, which we judge to be peculiar to them ; and stand in
the very same relation to the science of physiology, as the terms
chemical affinity, electricity, gravitation, to other departments of
physical science.

“ Thus defined, the notion of vitality is not only admissible in
physiology, but is that which entitles it to the name of a separate
science. Those physiologists, accordingly, who object to the sub¬
stantive term, vitality, or principle of life, are obliged to use the
adjective vital, which conveys the very same idea.

“ This notion of vitality, extending to all classes of organized beings,
has no connexion whatever with the notion of mind, as distinguished
from matter. The latter is the characteristic mark of the animal
creation only ; and requires the admission into the physiology of
animals, of a class of facts, and a kind of evidence, that have no place
in any other physical sciences. Neither does any opinion, or con¬
jecture, that can be formed concerning the essential nature of vitality,
affect the conclusions in natural theology, which are drawn from
physiological facts ; because these conclusions do not rest on the
mode in which vitality is thought to be communicated to living
beings, but simply on the observed adaptation of means to ends, in
the economy of living beings.

“ As the phenomena of life are seen only in bodies more or less
organized, it has been conjectured that they depend merely on orga¬
nization ; but when we inquire how organization has been effected,
we find that it implies in every instance, where we can observe it, the
previous existence of vitality ; and therefore must be regarded as one
of its effects, not as its cause.

“ On the other hand, the supposition entertained by others, of a
material substance, such as an ethereal or subtile fluid, superadded to
organization during life, and producing the phenomena of life, is both
unsupported by evidence, and useless in the explanation of facts.

Setting aside both these hypotheses, we hold that all physio¬
logical inquiries are intended only to ascertain the conditions, under
which the various phenomena of life take place, and naturally termi¬
nate in a reference to certain laws of vitality, or ultimate facts in this
department of nature ; just as the investigation and explanation of
phenomena in the inanimate world terminate in a reference to cer¬
tain laws of motion, of gravitation, of chemical affinity, &e. Of such
first principles in science we can give no other account, than that
they depend on the will of the Author of Nature ; but the deter-

Dr. Alison on Physiology.

195

mination of such first principles is the main object, and the applica¬
tions of them constitute the details, of all sciences; and every
science is thus mainly conversant with principles peculiar to itself.

“ In this, as in other sciences, these general laws of nature can
only be ascertained analytically, i. e. by the slow process of observa¬
tion and comparison of individual facts ; but when they have been
ascertained, even partially, in this way, the information acquired is
more quickly and easily communicated to others, by stating some of
these principles in the outset, with short and simple illustrations, and
then tracing the facts which constitute the details of the science syn¬
thetically, as originating, in part at least, from the operation of the
laws first laid down, and then related to each other as physical causes
and effects. The science of physiology appears sufficiently advanced
to be taught on this plan. The physical causes, or conditions requi¬
site for the performance of each of the functions, will thus appear,
in part at least, from the subjects discussed immediately before it,
and its final causes or uses, from those discussed immediately after-
it; and several advantages seem to arise from this arrangement,
particularly in a course addressed to students, who have already
acquired a considerable knowledge of physiology in the course of
their anatomical studies ; but have not been accustomed to regard
the functions of the living body systematically, or as connected with
a perfect whole.

“ The explanation of many of the phenomena of living animals is
still very imperfect : but enough has been done to shew, that the
principal laws regulating these phenomena must be ranked under
three heads ; I . Those of vital contractions, by which the visible
movements of living animals are chiefly effected ; 2. Those of vital
affinities, by which the chemical changes peculiar to living animals
are determined, and their physical structure maintained ; 3„ Those of
nervous actions, by which the physical changes in living animals are
placed in connexion with mental phenomena, and subjected to the
control of mental acts.

“ Of these, the vital affinities are perhaps the most general and
the most fundamental ; but they are the least understood, and, in the
higher animals at least, their exercise is dependent on internal vital
contractions ; and the laws of these contractions are, therefore,
properly to be considered first.

“ The most important division of the phenomena of living animals
is into the departments of organic and animal life, as distinguished by
Bichat ; i. e. into those which do not imply the intervention or con¬
sciousness of the mind, and those in which some act of the mind is
essentially concerned ; and the former are obviously subservient to
the latter. This distinction will always be kept in view, but cannot
be strictly observed ; the more complex functions (such as respira¬
tion and digestion) comprehending phenomena which come under
both heads.

“ The most general of the laws which regulate the economy of
animals appear to extend throughout the whole range of creation ;

196

Critical Review.

and all the vital functions, as occurring in man, may be illustrated
by the corresponding functions, at least in the different divisions of
the vertebrated animals.” — p. 6.

We have now afforded the reader a fair specimen of the
manner in which the work is executed, and we think he will
agree with us in opinion, that it is very favourable to the
high reputation of the author. Instead of spreading out the
subject to a great length, he has condensed the principles of
physiology into a simple concise form, and thus afforded the
student and young practitioner an excellent text book.
The style is good, the information complete, and the work
rendered at a moderate expense. It is a work of great inte¬
rest and utility, and cannot fail to have a place in every me¬
dical library. We hope soon to have the pleasure of no¬
ticing the promised volume on pathology and therapeutics,
and we know few so well qualified to execute the task as
Dr. Alison.

IV — A Manual of Surgery , founded ujjon the principles and
practice , lately taught by Sir Astley Cooper , Bart. fyc.
and Joseph H. Green , Professor of Surgery , in the
King's College, fyc. Third edition considerably en¬
larged, containing many additional notes from the writ¬
ings of other distinguished surgeons. Edited by Thomas
Castle, F. L. S. of the Queen’s College, Oxford, &c.
London 1831. 12mo. p.p. 515. E. Cox.

This wTork is published with the express permission of Sir
A. Cooper and Mr. Green, and is a compendium of the lec¬
tures on surgery, delivered by these eminent teachers. Mr.
Castle has compressed the opinions of lecturers, and added
some important extracts from the best surgical works. We
think he should have distinguished his annotations from the
text, as most readers would prefer a line of demarcation.
The work is an excellent manual for students and younger
surgeons ; it has rapidly passed through three editions, a fact
which affords the best proof of the degree of estimation
in which it is held by the profession. It is one of the best
text books extant, and ought to be in the hands of surgical
students. It has a large sale, and it wrell deserves it.

[ 197 ]

V. — Two Lectures on the Study of Anatomy and Physio -
logy, delivered in the Medical School , Alders gate-street.
By Jones Quain, M. B. Lecturer on Anatomy and Physi-
olog-y. London, 1830. 8vo.pp.44. Two plates. Simp-
kin and Marshall.

These lectures bear strong evidence in favour of the talents
and attainments of the author. He displays the most inti¬
mate acquaintance with the sciences of anatomy and physi¬
ology, and his descriptions elevate the mind to the most
sublime conceptions of the beneficence of the Author of
nature. A spirit of religion, as well as philosophy, breathes
through every page, which reflect great credit on the author
and the man. We select a passage to show the truth of our
position, and which must convince even the sceptical that
the most enlightened part of our profession is not, and cannot
be, affected with the poison of infidelity.

“ The personal I is confessed a permanently being ; every indi¬
vidual acts as if he were one and identical ; and such he is invari¬
ably considered by others, notwithstanding the admitted fact, that
the material components of his body are subject to a perpetual
mutation; for, over this ceaseless cycle of change presides that
power, which altogether suspends the ordinary play of affinities in
the first moments of foetal existence, modifies and controls them
during the succeeding stages of life, and allows them to come into
action, only when it is withdrawn at death. “ I had rather,” says
Bacon, “ believe all the fables of the Legend, the Talmud, and
the Koran, than that this universal frame is without a mind. When
the mind of man looketh to second causes scattered, it may some¬
times rest on them, and go no farther ; but when it beholdeth the
chain of them confederate and linked together, it must needs flee
to Providence and to Deity.” How strangely then do those men
* argue, who contend that all the phenomena of living beings, and
all the functions which they perform, are results — the necessary
results of their organization ; and that their structure is produced
by an aggregation of particles, according to the laws of chemical
attraction. We have seen, however, that such is not the rule of
their formation ; so far from it, they are formed by a process the
very reverse of this ; which is a conclusive evidence that there is
some other power at work, besides that of attraction. But, were
we, for a moment, to admit that the form and structure of organized
bodies are determined by attraction, then we could have no grounds
for expecting to find evidence of design or forethought in their con¬
formation. This at once prompts us to enquire, (and surely it is an
interesting subject of enquiry) whether they do not exhibit incon-

198

Critical Review.

testable evidence of both, in whatever point of view we examine
their habits and capabilities, or investigate their structure.

“ It is a favourite opinion with many that all our knowledge is
derived from the senses ; as well might it be said that all arts and
manufactures are derived from the doors and windows of the houses,
into which the raw materials are brought to be subjected to the
skill and dexterity of the workmen. Again, as our senses exist
before we have acquired any experience, we have sufficient grounds
for questioning another assertion, which is frequently put forth,
namely, that all knowledge comes from experience. There is a sort
of knowledge which is prior to experience, and acts quicker than
reason, and which exhibits itself for the most part in prompting
measures for self preservation. Thus young animals seek the breast
from which their nutriment is derived ; and, in after life, the dif¬
ferent tribes of living beings select different sorts of substances for
their food ; some feed on herbs, and every part of their conforma¬
tion marks them to be fitted and intended for digesting that kind of
food. Others live on animal substances, and as we saw yesterday,
when examining the structure of carnivorous animals, the confor¬
mation of their teeth, jaws, stomach, limbs, adapt them for the
habits that have been impressed on them. Some become torpid
during winter, and choose places of security whilst in that state ;
others, as the swallow, enjoy a perpetual summer, by migrating
from one country to another, and their conformation enables them to
fulfil their destination. The bee and the wasp lay up stores for win¬
ter, and, strange to say, the comb which the bee builds is always
placed vertically, that of the wasp, horizontally. Moreover, the
cells are all constructed on strictly geometrical principles ; for each
of them is a hexagon, terminated by a pyramidal base. In the
execution of their work they give a practical solution of a very
difficult problem. “ A quantity of wax being given to form out of
it, similar and equal cells of a determinate capacity, but at the same
time so arranged, collectively, as to occupy the smallest possible
space, whilst each individual cell possesses the largest possible area
in proportion to the quantity of matter employed.” If they were
cylindrical, vacant spaces must exist between each three contiguous
cells : if they were square or triangular, they would require more
material, and be altogether unsuited to the form of the bee’s body.

Is it from instruction — is it from their senses — is it from expe¬
rience, that these creatures execute their work with the precision
and method of the most accomplished artist ? No one, I believe,
would answer in the affirmative ; each group of living tilings has its
special aptitudes, its peculiar habits.

Dente lupus, cornu, taurus petit ; unde nisi intus

Monstratum ?

Their habits and their aptitudes are stamped upon them at the
first moment of their being, and constitute them so many agents
fashioned for the execution of a purpose, — so many means devised

Mr. Quain on the Study of Anatomy

199

for the attainment of an end; as such, every one of them bears
upon it the impress of design and contrivance. Observe some of
these groups attentively, note the peculiarities which characterise
them, and then pass on to an investigation of their internal struc¬
ture and conformation, you will not fail to find abundant evidence
of their perfect adaptation to their different spheres of action — their
various modes of life.” — p. 36.

VI. — The Life of Sir Humphry Davy, Bart. L. D.D. late
President of the Royal Society , fyc. fyc. By John Ayr¬
ton Paris, M. D. Cantab. F. R.S. &c. Fellow of the
Royal College of Physicians. 4to. London. Colburn and
Bentley, 1831.

Of all the philosophers who have contributed by their ge¬
nius and labours to exalt the scientific character of the mo¬
dern world, no one deserves better than Sir H. Davy, that
his life and actions should be attentively considered. The
peculiarity which entitles the biography of Davy to this dis¬
tinction consists in the important circumstance that even his
most surprising discoveries were attained not by any fortu¬
nate accident, not by chance medley in the laboratory — but
by a deliberate and well adjusted process of reasoning—
which operated among some of the mysteries of nature as
successfully as the faculty of intuition itself. The more
then we reflect on this fact, which so forcibly puts into con¬
trast the career of Davy with that of Galvani and other dis¬
coverers, the more we shall be convinced of the utility of
handing down to posterity such examples as the former, for
assuredly no man can peruse the annals of such a progress
as Davy’s, without feeling all his noblest impulses, — all his
propensities to industry, invigorated and quickened. —
Viewed then through the medium of such a description as
is given to us by a writer like Dr. Paris, one who, from his avo¬
cations, is enabled so well to appreciate them, the labours
of Davy become not only a valuable record of important
events with regard to the past, but also a history very much
calculated to “ teach by its example” with respect to the
future.

The subject of this memoir was born in Penzance, on the
17th December, 1778. His parents were respectable, although
Davy himself was the sole founder of his own fortune.

200

Critical Review.

After receiving a good education, he was bound apprentice
to a surgeon-apothecary named Borlase, in his native town.
The youth however displayed so strong an attachment for
chemical inquiries, as to justify the fear at a very early pe¬
riod of his life, that he would do but little at the profession
in which he had been initiated. Dr. Paris gives many plea¬
sant anecdotes illustrating the fondness of Davy for his
favourite employment, and showing the natural energy and
ingenuity of his mind. To some influential persons with
whom he became acquainted during his apprenticeship, but
especially to the patronage of Mr. Thomas Giddy and Mr.
Gregory Watt, he owed those recommendations which
gained him some public notice, and finally secured him the
situation of assistant in the Pneumatic Institution of Dr.
Beddoes, at Bristol. Before this event, Davy, by several
beautiful compositions in verse, proved himself to be pos¬
sessed of a fine imagination, and of a forcible and elegant
vocabulary. Whilst in the capacity of assistant at Bristol,
young Davy performed some of his most dangerous experi¬
ments. Those on the respirability of nitrous oxide, are some
of the most memorable acts of temerity which a love of
science has ever succeeded in impelling any of her suitors to
commit. Having found that this gas served as a stimulus
when inhaled, the philosopher was resolved to try its effect
in increasing or modifying the intoxicating power of wine.
He, for this purpose, swallowed a bottle of wine in a few
minutes, which soon produced on one so very abstemious as
Davy always was, complete drunkenness.

“ While I was drinking,” he says in one of his letters, “ I per¬
ceived a sense of fulness in the head and throbbing of the arteries,
not unlike that produced in the first stage of nitrous oxide excite¬
ment ; after I had finished the bottle this excitement increased, the
objects around me became dazzling, the powers of distinct articulation
was lost, and I was unable to stand steadily. At this moment, the sen¬
sations were rather pleasurable than otherwise ; the sense of fulness
in the head however soon ' increased, so as to become painful, and in
less than an hour I sunk into a state of insensibility. In this situa¬
tion I must have remained for two hours, or two hours and a half.
I was awakened by head ache and painful nausea. My bodily and
mental debility was excessive, and the pulse feeble and quick.”

These experiments were followed by one still more hazard¬
ous, and indeed scarcely justifiable, to ascertain the possibi¬
lity of respiring carburretted hydrogen gas . Upon this
subject Dr. Paris has the following observations: —

Dr. Paris’s Life of Sir Humphry Davy.

201

“ The scientific and medical world are alike indebted to Davy for
this daring experiment, (breathing carburetted hydrogen gas), and,
if the precaution it suggests be properly attended to, it may become
the means of preserving human life. The experiment is also valu¬
able, as affording support to philosophical views with which the
author was probably unacquainted. In the first place, it may be
necessary to apprise some of my readers, that the hydro carbonate
here spoken of, differs very little from the gas now so generally used
to illuminate our streets and houses. We have just seen how deadly
are its qualities, and that, even in a state of extreme dilution, it will
affect our sensations. The question, then, naturally suggests itself,
how far this gas can be safely introduced into the interior of our
apartments ? Did we not possess any direct evidence upon the sub¬
ject, the answer would be sufficiently obvious, since it is impossible
so to conduct its combustion, that a portion shall not escape unburnt.
Such is the theory ; but what is our experience on the subject ?
That pains in the head, nausea, and distressing langour have been
often experienced in our theatres and saloons by persons inhaling
the unburnt gas ; that the atmosphere of a room, although spacious
and empty, will, if lighted with gas, convey a sense or oppression
to our organs of respiration, as if we were inhaling an air contami¬
nated with the breath of an hundred persons. In the next place,
Davy’s experiment is important, inasmuch as it proves, that in cases
of asphyxia, or suspended animation, there exists a period of danger
after the respiration has been restored, and the circulation re¬
established, at which death may take place, when we are least
prepared to expect it. Bichat has shown that, when dark coloured
blood (venous) is injected into the vessels of the brain, by means of
a syringe connected with the carotid artery, the functions of the
brain become disturbed, and in a short time entirely cease. The
effect is precisely similar, whether the dark coloured blood be
transmitted to the brain by the syringe of the experimentalist, or
by the heart itself. Thus, to the case of asphyxia, the dark coloured
blood which has been propelled through the vessels during the sus¬
pension, or imperfect performance, of respiration, acts like a narcotic
poison on the brain ; and no sooner, therefore, does it extend its
malign influence on that organ, than deleterious effects are produced,
and the animal, after apparent recovery, falls into a state of stupor,
the pupils of his eyes become dilated, the respiration laborious, the
muscles of the body convulsed, and it speedily dies — poisoned by
its own blood. In the experiment which has given origin to these
reflections, (adds Dr. Paris), Davy distinctly states, that after hav¬
ing recovered from the primary effects of the carburetted hydrogen
gas, and taking a walk with his friend, he was again seized with
giddiness, attended with nausea and loss of sensation. The imper¬
fectly oxygenized or dark coloured blood had evidently affected the
brain, and his life, at this period, was probably in greater jeopardy
than in any other stage of the experiment.

VOL. VI. no, 33.

D D

202

Critical Review.

Sir H. Davy had already acquired a considerable degree
of celebrity as a chemist, when the establishment of the
Royal Institution in London opened a field of employment,
to which it was likely that the ambition of the rising philo¬
sopher would direct him. Davy’s abilities were well appre¬
ciated by Count Rumford, the director of the new Institu¬
tion, so that no difficulty stood in the way of his engagement,
except what arose, strangely enough, from the prejudice
which the first appearance of the young chemist produced in
the mind of the Count. The following anecdote, perhaps as
forcibly as any description could do, serves as a criterion of
the rustic state of Davy’s personal address at this time. —
Dining one day amongst a large and select company, he
ventured to differ with Fuseli upon Milton’s poetry, which
the latter affected to love with enthusiasm ; Davy observed
that there were passages in the works of that great poet
which he at least could not understand — Very likely. Sir,”
replied the artist, with an unfeeling' arrogance quite charac¬
teristic of him — “ Very likely. Sir, but I am sure that it is not
Milton’s fault.” Davy had been but a short time lecturing
at the Royal Institution, when he became a general favourite.
By his abilities and address he made chemistry a fashion, or
rather a rage , so that Albetnarle-street was as much fre¬
quented by the countesses of bon ton as Fop’s Alley in the
Opera Flouse is this moment by the dandies. It is stated by
our author that a lady, now of some celebrity in literature,
sent Davy a poem, full of compliments, and accompanied by
a pretty pendant suited for a watch, wffiich she requested he
would wear at the next lecture. He was welcomed in the
highest circles, and became, even in the most exclusive
coteries of the West end, a lion of no minor interest and
value. Nevertheless he pursued, with redoubled exertions,
his favourite employments.

In 1806-7, Davy favoured the world with an account of his
Electro-Chemical Theory, which from its importance merits
a few words : — Volta proved that electricity was developed
when certain metals were placed in contact with each other.
Such, for example, as copper and zinc; the demonstration
ol this fact is, that these metals, when separated after con¬
tact and insulated, are found oppositely electrified. The
conclusion which Sir Humphry drew from his experiments
was, that one of the metals became positively electrified, and
the other negatively electrified. But this power of disturbing
the equilibrium of electricity resident in bodies, was not pos¬
sessed by metals alone, for Davy showed by experiment, that

Dr. Paris’s Life of Sir Humphry Davy. 203

alkaline earths may be deprived of their electricity by the
contact of metals, nay even, that acids may undergo the same
change by the contact of alkalies, both being in the dry
state. Sir Humphry even went farther than this, and main¬
tained, that when the atoms (those who are acquainted with
Dalton’s theory will understand us) of two different bodies
are in contact, one of the atoms renders up its electricitv
to the other ; wherefore, by reason of the positive electricity
of the one atom, and the negatively electrified state of the
other, both atoms cohere, and unless there be adequate
counteracting causes, they wrill remain together, forming an
entirely new compound. The whole phenomena of chemical
affinity or attraction are accounted for, therefore, according
to Davy’s theory, by the opposite states of electrical excite¬
ment in which the concurring particles are respectively found.
The essence of the theory of Davy then is, that all com¬
pounds consist of elements which are oppositely electrified ;
and he necessarily inferred that if these elements, which were
thus held in combination, could be placed in the same elec¬
tric condition, the bond of union would be forthwith broken,
and the particles would retire from one another. The truth
of this theory was demonstrated on a cup of water. This
liquid, it is well known, is a compound of oxygen and
hydrogen; in other words, it is constituted by the union of
two elements, each in an opposite state of electricity. Davy
showed, that if water be exposed to the power of atoms, which
have a greater attraction for its separate constituents than
is the attraction that keeps those constituents in union, then
the elements are separated ; and this is the whole theory of
the decomposition of substances by means of galvanism. By
the aid of such an agent, Davy was able to show that several
simple ingredients entered into the formation of what hitherto
had been deemed in itself simple. He, for the first time, de¬
composed alkalies and earths, and astonished the world by
producing the metal potassium . As connected with this
theory, although the subject is not noticed until a much later
stage of his work, by Dr. Paris, we must mention Sir
Humphry’s plan for protecting the copper sheathings of
ships’ bottoms from oxidation by sea water.

Upon an elaborate investigation of the phenomenon of the
destruction of these sheathings, it was inferred that the
corrosion occurred in this way : — The atmospheric air is
constantly dissolved in water ; the oxygen, which is a part of
this air, is taken up by the copper ; the oxide of copper formed
by this junction, takes up the muriatic acid which was in

204

Critical .Review.

. f .

combination with soda and magnesia in the sea water* and
thus the formation of submuriate of the oxide of copper is
constantly going on. In plainer phrase* the copper is under¬
going a permanent process of decay. Now Davy argued*
that if the copper did not oxidize* it would have entered into
no combination with the muriatic acid* and consequently*
that by forbidding the union of the oxygen and copper, he
would afford to the latter the fullest protection. How was
this to be done ? He reverted to his original theory of the
union of two different bodies* and referring the combination
of oxygen and copper to the fact, that their contact had
created the disturbance of the electrical equilibrium (the
copper becoming positively and the oxygen negatively elec¬
trified)* he concluded that to render the copper negative, or
in fact* to reduce them both to the same electric condition*
no union would take place* and consequently none of the
effects resulting from that union.

The practical experiment dictated by this reasoning
proved triumphantly successful. A piece of zinc was placed
in contact with the copper* it drew off a sufficient portion of
the electricity of the latter, and thus what Davy ascer¬
tained to be the source of union between them* namely* the
opposite state of their electricity being changed, the oxygen
and the copper no longer coalesced* and the latter remained
perfectly free from corrosion. Mr. Babbage* in his able
work on the Decline of Science,* says that Laplace con¬
sidered this as Davy’s greatest discovery. We are ourselves
of the same opinion* inasmuch as the result was an induction
which could have been foreseen only by the most delicate
and accurate application of the principles of reasoning. The
remedy was but too successful, for in such a perfect state did it
keep the surface of the copper sheathing, that an evil of an
opposite kind was induced; marine animals and vegetables*
which before could not live in contact with the submuriate of the
oxide of copper* now clung in such abundance to it, that in
order to get rid of an inconvenience so much greater than
the corrosion of the copper* the remedy was abandoned.
But though the plan was found to be unfortunately imprac¬
ticable for the reasons stated* the genius and intelligence of
the inventor merit all the applause which a successful inven¬
tion should receive. That which he promised he performed*

* Reflections on the Decline of Science, &c, by Charles Bab¬
bage, Svo.

Dr. Paris’s Life of Sir Humphry Davy. 205

and his method was invalidated not by any inefficiency of its
own, but on account of a misfortune which was only contin¬
gent on the very perfection of its succcess.

In the midst of all his cares,, Davy proved himself an
enthusiastic fisherman. To relieve the seriousness of our
narrative, we shall give an account of his sporting cos¬
tume —

“ His whole suit consisted of green cloth, the coat having sun¬
dry pockets for holding the necessary tackle : his boots were made of
caoutchouc, and for the convenience of wading through the water,
reached above the knees. His hat, originally intended for a coal-
heaver, had been purchased from the manufacturer in its raw state, and
died green by some pigment of his own composition ; it was, more¬
over, studded with every variety of artificial fly which he could re¬
quire for diversion. Thus equipped, he thought, from the colour of
his dress, that he was more likely to elude the observation of the fish.
He ‘ looked not like an inhabitant of the earth, and yet was on’t; ’
nor can I find any object in the regions of invention with which I
could justly compare him, except, perhaps, with one of those grotes¬
que personages who, in the farce of the Critic, attend father Thames
on the stage as his two banks.

“ I shall take this opportunity of stating, that his shooting attire
was equally whimsical : if, as an angler, he adopted a dress for con¬
cealing his person, as a sportsman in woods and plantations, it was
his object to devise means for exposing it ; for he always entertained
a singular dread lest he might be accidentally shot upon those occa¬
sions. When upon a visit to Mr. Dillwyn, [of Swansea, he accom¬
panied his friend on a shooting excursion, in a broad- brimmed hat, the
whole of which, with the exception of the brim, was covered with
scarlet cloth. ”

The latter statement is curious., particularly when con¬
sidered in reference to what we must call a superstition of
Davy’s, we mean a horror which he always showed to any
person crossing his knife and fork at dinner in his presence.
It is said that when De Humboldt innocently adjusted the
implements of dinner in this way, Davy manifested the most
serious displeasure. Such are the strange contradictions that
unite, even in the characters of the most intellectual men;
he who was ready to expose his life in the inhalation of de¬
leterious gases, and approached in a rash moment, as near
as ever a healthy being did to the precincts of death, he was
constantly afraid of being shot in his sporting excursions,
and became horror struck at the sight of a crossed knife at
the table where he sat !

The next great discovery which we have to notice, and
indeed that by which he is most extensively known, and by

20G

Critical Review.

which he will be longest remembered, is his invention of the
safety lamp. Here again we have a magnificent result
from his powers of induction. This invention is well known,
and to those who wish to be well acquainted with its origin,
progress, its principles and nature, we recommend an atten¬
tive perusal of the elaborate and accurate account of the
history of this lamp by Dr. Paris. We cannot however
refuse ourselves the pleasure of inserting from the work the
following recapitulation : —

“ He commenced with ascertaining the degree of combustibility
of the fire damp, and the limits in which the proportions of atmos¬
pheric air and carburetted hydrogen can be combined, so as to afford
an explosive mixture. He was then led to examine the effects of the
admixture of azote and carbonic acid gas ; and the result of those
experiments furnished him with the basis of his first plan of security.
His next step was to enquire, whether explosions of gas would pass
through tubes ; and on finding that this did not happen if the tubes
were of certain lengths and diameters, he proceeded to examine the
limits of such conditions, and by shortening the tubes, diminishing
their diameters, and multiplying their number, he at length arrived
at the conclusion, that a simple tissue of .wire-gauze afforded all the
means of perfect security ; and he constructed a lamp, which has
been truly declared to be as marvellous in its operation as the storied
lamp of Aladdin, realizing its fabled powers of conducting in safety
through ‘ fiends of combustion/ to the hidden treasures of the earth.
We behold a power which in its effects, seemed to emulate the vio¬
lence of the volcano and the earthquake, at once restrained by an
almost invisible and impalpable barrier of net- work. We behold,
as it were, the daemon of fire taken captive by science, and minister¬
ing to the convenience of the miner, while harmlessly fluttering in
an iron cage. And yet, wonderful as the phenomenon may appear,
his experiments and reasons have demonstrated, that the interruption
of flame by solid tissues permeable to light and air, depends upon no
recondite or mysterious cause, but simply upon their cooling powers,
which must always be proportional to the smallness of the mesh, and
the mass of metal. When it is remembered that the security thus
conferred upon the labouring community is not merely the privilege
of the age in which the discovery was effected, but must be extended
to future times, and continue to preserve human life as long as coal
is dug from our mines, can there be found in the whole compass of
art or science, an invention more useful and glorious ?”

The blot on Davy’s character was his conduct in France,
in the company of the French philosophers. In his inter¬
course with them, he showed the most extraordinary con¬
tempt of the common courtesies of life — and that too, whilst
the Savans made even sacrifices in order to show their esteem

Dr. Paris’s Life of Sir Humphry Davy.

20 7

for Davy. Dr. Paris is very candid on these points, and
endeavours to excuse his hero with infiniteJy more good
nature however in our opinion, than success. The following’
laughable anecdotes will appear almost incredible, when we
remember that Davy was a man of so much imagination as
to be able to gain reputation as a poet, and that he always
showed a genuine relish for beauty, wherever it was visible
in the works of art, as well as of nature.

“ He was conducted to the Louvre by Mr. Underwood. The Eng¬
lish- philosopher walked with a rapid step along the gallery, and, to
the great astonishment and mortification of his friend and Cicerone ,
did not direct his attention to a single painting ; the only exclamation
of surprise that escaped him was — “ What an extraordinary collection
of fine frames !”

“ On arriving opposite to Raphael’s picture of the Transfiguration,
Mr. Underwood could no longer suppress his surprise, and in a tone
of enthusiasm he directed the attention of the philosopher to that most
sublime production of art, and the chef-d’oeuvre of the collection.
Davy’s reply was as laconic as it was chilling — “ Indeed, I am glad
I have seen it and then hurried forward, as if he were desirous of
escaping from any critical remark upon its excellenciess

“ They afterwards descended to a view of the statues in the lower
apartments : here Davy displayed the same frigid indifference towards
the higher works of art. A spectator of the scene might have well
imagined that some mighty spell was in operation, by which the order
of nature had been reversed : — while the marble glowed with more
than human passion, the living man was colder than stone ! The
apathy, the total want of feeling he betrayed on having his attention
directed to the Apollo Belvidere, the Laocoon, and the Venus de
Medicis, was as inexplicable as it was provoking ; but an exclama¬
tion of the most vivid surprise escaped him at the sight of an Anti-
nous, treated in the Egyptian style, and sculptured in alabaster.
1 Gracious powers,’ said he, ‘ what a beautiful stalactyte !’ ”

“ What a strange, what a discordant anomaly in the construction
of the human mind do these anecdotes unfold ! We have here pre¬
sented to us a philosopher, who, with the glowing fancy of a poet, is
insensible to the divine beauties of the sister arts ! Let the meta¬
physician, if he can, unravel the mystery, — the biographer has only
to observe, that the Muses could never have danced in chorus at his
birth.”

Sir Humphry Davy spent the last years of his life chiefly
on the continent. He married a Mrs. Apreece, by whom he
had no issue ; but who brought him a fortune that enabled
Davy to be indifferent to the pecuniary results of his great
discoveries. This circumstance however does not detract
from the noble liberality with which he communicated the

208

Critical Review.

produce of his labours to the world — and for the most
splendid of which the philosopher never received any state
reward or acknowledgment beyond the sterile dignity of a
patent of baronetcy. In giving an account of his death,
Dr. Paris relates,

“ In addition to his will, he left a paper of directions, which have
been religiously observed by his widow. He desires, for instance,
that the interest arising from a hundred pounds stock may be annu¬
ally paid to the master of the Penzance Grammar School, on condi¬
tion that the boys may have a holiday on his birth-day. There is
something singularly interesting in this favourable recollection of his
native town, and of the associations of his early youth. It adds one
more example to show that, whatever may have been our destinies,
and however fortune may have changed our conditions, where the
heart remains uncorrupted, we shall, as the world closes upon us, fix
our imaginations upon the simplicities of our youth, and be cheered
and warmed by the remembrance of early pleasures, hallowed by
feelings of regard for the memory of those who have long since slept
in the grave. . v

“ With that restlessness which characterises the disease under
which Sir Humphry Davy suffered, he became extremely desirous of
quitting Rome, and of establishing himself at Geneva. His friends
were naturally anxious to gratify every wish ; and Lady Davy there¬
fore preceded him on the journey, in order that she might prepare
for his comfortable reception at that place. Apartments were accord¬
ingly in readiness for him at L’ Hotel de la Couronne, in the Rue du
Rhone ; and at three o’clock on the 28th of May, having slept the
preceding evening at Chambery, he arrived at Geneva, accompanied
by his brother, Mr. Tobin, and his servant.

“ At four o’clock he dined, ate heartily, was unusually cheerful,
and joked with the waiter about the cookery of the fish, which he
appeared particularly to admire ; and he desired that, as long as he
remained at the hotel, he might be daily supplied with every possi¬
ble variety that the lake afforded. He drank tea at eleven, and hav¬
ing directed that the feather bed should be removed, retired to rest
at twelve.

His servant, who slept in a bed parallel to his own, in the same
alcove, was, however, very shortly called to attend him, and he
desired that his brother might be summoned. I am informed that,
on Dr. Davy’s entering the room, he said, * I am dying,’ or words
to that effect ; ‘ and when it is all over, I desire that no disturbance
of any kind may be made in the house ; lock the door, and let every
one retire quietly to his apartment.’ He expired at a quarter before
three o’clock without a struggle.”

We conclude by reminding’ our readers that we have not
in this review affected to give any thing like a consistent
account of the life and labours of Sir H. Davy. Our ambi-

Dr. Paris’s Life of Sir Humphy Davy. 209

tion was limited to the mere duty of presenting* to the pro¬
fession, such samples from the pages of Dr. Paris,, as would
fairly represent the manner in which the whole composition
is executed : and if we succeed in inducing any of cur
readers to desire a better acquaintance with the able and
well written work from which we have made our extracts,
our aim and our wishes will be alike answered*

ORIGINAL COMMUNICATIONS.

I. — Mr. Mitchell on Disease of the Hip-joint.

To the Editor of the London Medical and Surgical Journal.

Sir, — I have enclosed a very protracted case, which I have
detailed briefly. If you find it worthy of insertion, please
to give it a place in your valuable Journal, and you will
oblige

Your most obedient servant,

Charles Mitchell, Surgeon.

J. B. eet. 38, a painter, of a scrofulous habit, had, twenty
years ago, rigors, much constitutional disturbance, and pain
of the right hip-joint : an abscess formed, the contents
escaped, and the cavity contracted. The shiverings recurred
shortly afterwards, followed by fresh collections and con¬
sequent discharges of matter, sometimes scanty, and in other
instances profuse.

January, 1829, he had a slight attack of fever, attended
by head-ache, thirst, aching of the limbs, dull countenance,
quick breathing, hot skin, quick pulse, sickness, loss of
appetite, white tongue, and urine high coloured. These,
however, rapidly subsided, under the use of an emetic,
followed by salines and occasional purgatives. He had
another febrile attack in April (but symptomatic), with the
subsequent formation and evacuation of matter. During the
febrile attack the hip was inflamed ; two caustic issues were
applied, fluctuation soon became apparent, cataplasms were
applied, the sympathetic fever increased, the secretions
lessened, diarrhoea ensued — he became exceedingly debili¬
tated. The diarrhoea resisted rhubarb, combined with chalk
and opium, but was restrained by opiate enemata.

VOL. VI. NO. 33.

E E

210

Original Communications .

The general health improved amazingly ; bark, diluted
sulphuric acid, porter, nutritious diet, soon effected rapid
amendment.

The secretion became more puriform from a thin acrid
sanies, and the pain and inflammatory nature of the abscess
subsided.

April, 1830, had an attack of pneumonia, which was sub¬
dued, by a strict adherence to antiphlogistic regimen. The
irritation and discharge of the hip became again aggravated ;
a clyster was applied, ultimately a moxa, but they rather
increased than alleviated the irritative action ; several ulce¬
rated openings formed immediately opposite, in the neigh¬
bourhood of the trochanter major, the discharge became pro¬
fuse, the pain settled in the knee ; by his own desire a blister
was applied to each side, which certainly afforded him con¬
siderable relief, aided by repeated doses of the pulv. ipecac,
c. ; he continued much in this state during the months of
July, August and September. In October, the hectic be¬
came more permanently established ; colliquative sweats
ensued, followed by roughness and dryness of the skin ; a
renewal of the diarrhoea, which became of a most incessant
and irritating nature. The pulse became small, frequent,
and weak, finally wiry, — the voice failed, the masculine fea¬
tures shrunk and disappeared — the countenance pourtrayed
a most afflicting and aggravating gloom, the stomach lost its
retentive powrer, the eye acquired a pearly appearance,
the skin became of a yellow' hue, ultimately shrivelled and
contracted — the non-naturals wrere almost annihilated ; to¬
ward the middle of November, the fatal catastrophe hap¬
pened ; thus terminated a deplorable and irremediable course
of suffering, which extinguished the miserable afflictions of
this poor victim’s ill-fated career.

It of course became necessary, in order to alleviate the
harassing nature of these symptoms to administer opiates
freely.

Sectio cadaveris. — Upon laying open the chest, the
lungs were found tuberculated; adhesion to a considerable
extent had taken place. The centre of some of the tuber¬
cles contained small quantities of purulent matter. The
lower extremity of the left lung wras inflated, forming a bag
larger than an ordinary clenched hand, which Dr. Parr
assigned to absorption, in consequence of having viewed it
repeatedly in other parts not at all connected with the
respiratory action ; but it appeared more plausible, judging
from the lax and strumous habit, that it arose, in the first

Mr. Mitchell on Disease of the Hip-joint. 211

instance, from rupture of one of the cells, and that at each
inspiration, the quantity collected was imperfectly expelled ;
hence from the compressible and dilatable nature of the reti¬
cular substance, we had the gradual evolution of the cavity.
If we were to reason from analogy, the imperfect expulsion
of air in some obstinate and fatal cases of asthma, and the
consequent enlargement of the cells, form a most convinc¬
ing proof of its rectitude. Vessels extended through the
empty cavity unsupported.

The liver was pale and granular.

Through the course of the colon, one half of its villous
tunic was absorbed, which rendered it extensively ulcerated,
in some places deep, but for the most part superficial ; its
calibre was considerably contracted, some of the smaller
vessels were injected, forming red streaks, but by no means
numerous. The discoloured skin surrounding the four large
ulcerated openings, on the upper and outer part of the thigh,
was tense. Upon introducing the finger into the largest
opening, which was three inches long, and seven in dia¬
meter, numerous elastic spiculse of bone were adherent,
and moveable with the muscular substance to which they
were attached. They were more distinctly exposed upon
dividing the skin, arranged in the form of laminae, which
adhered through the medium of tough fibrous substance ;
the ossific parts of which had been absorbed. The mus¬
cles were exceedingly pale.

In dividing the gluteal muscles inserted into the tro¬
chanter major, half an ounce of dark coloured matter issued
forth. The trochanter was enlarged, softened and perforated.
The capsular ligament was entire. The head of the os
femoris encircling the lig. teres, was ulcerated, as much as
would admit an ordinary sized hazle nut. Two inches from
their insertion, the gluteus med and minim were altered in
their structure, having become of a fatty, fibrous consistence.

There were some places in the cervix of a dark appear¬
ance; there was likewise a dark fissure extending from the
cervix to the centre of the head of the bone, the perichon-
drial covering of which was denuded, although it had a
shining lustre. At the outer and lower side of the trochanter
major, there was a depression, with elevated and irregular
margins. The periosteum at the edges of these had a cor¬
roded appearance, leaving little doubt from whence the-
sequestra had proceeded.

Lamb’s Conduit Street,

Feb. 18, 1831.

212

Original Communications .

[This case possesses many interesting features,, and shows
the dangerous effects of hip-joint disease and of scrofula
upon the constitution. We are much obliged to Mr.
Mitchell for its narration. — Ed.]

II. — Mr. Searle on Cholera.

To the Editor of the London Medical and Surgical Journal.

Sir, — The ready compliance, on your part, with my request,
by the insertion of my reclamation, claims not only my ack¬
nowledgment, but a walling assent to the principles which you
state to actuate you in your editorial duties — the cause of
science and truth, uninfluenced by name, station, partiality,
favour, or self-interest — a line of conduct much to be la¬
mented, but little in accordance with the modern spirit of
reviewing. Difference in opinion, when expressed in
becoming language, is what no one can object to, and par¬
ticularly when it bears reference to a new hypothesis, which
you are pleased to consider mine. Expressing, at the same
time, your sense of the exceedingly ingeniousness of my
views ; a circumstance which encourages me to hope, that I
have not made altogether a wrong estimate in supposing' the
work to have some little claim to the attention of the pro¬
fession.

I have only to add, that in your insertion of my reclama¬
tion, I am sorry to have to notice some typographical errors,
but as fewr readers would be at the trouble of correcting
them, it would be of little avail to point them out.

I am. Sir,

Your most obedient servant,

Charles Searle.

Great Russell-street, February 7th.

[Mr. Searle must remember, that his manuscript was not
the most distinct, and that it bore marks of hasty composition.
It was printed exactly as sent us, as we considered he might,
complain had we made some verbal changes which seemed
to us to be necessary.

Mr. Searle on Cholera.

213

We agree with him, that the spirit of modern reviewing is
very far from what it should be, but the evil will be removed
by the good sense of the profession. We believe Mr. Searle
to be influenced by no other motive than the wish to eluci¬
date an obscure and difficult point in etiology ; and if he
has not convinced the whole profession of the soundness of
his views, he must, not be surprized. His work evinces con¬
siderable research, much original and ingenious thought, and
many valuable practical precepts. It deserves a place in the
libraries of those whose future destiny may place them in our
East Indian possessions. — Ed.]

III. — Case of Chronic , Peritonitis, without much pain —
delivery — death . By John Rees, Esq.

- Warren, eet 28, a married woman, of a slightly

florid complexion, middle stature, and of regular habits.
She had a living child, about three years ago, her labour
was natural. She has always enjoyed very good health.
Her husband (a butcher,) left her about six months ago ;
this circumstance did not appear to have greatly affected her
mind. The person that she had lodged with for the last
fortnight told me, that she always appeared in good spirits ;
yet (added she) her husband, i think, is always uppermost
in her mind.”

On Saturday, January 29, the liquor amnii was discharged
without being attended with any labour pains, and on Mon¬
day evening, January 31st, uterine action came on. The
labour proved of a very lingering nature, slight bearing
down pains occurring occasionally, which would continue
tolerably regular for a few minutes; and during the interval
of the pains she w7ould complain very much of aching pains
about the lower part of the abdomen and small of the back.

At 8 o’clock on Tuesday morning, the os uteri had be¬
come dilated to about the size of the mouth of a wine glass,
it was soft and yielding, and the parts were abundantly lubri¬
cated with mucus. She had now given her 3fs. of the secal.
cornut. in decoction, with no other effect than that of in¬
creasing the aching pains in the back and abdomen. The
labour went on in the same lingering way during all
Tuesday. She took in the evening of the secal. cornut.
in decoction in two doses, with the same effects as attended

214

Original Communications .

the dose in the morning'. By about 8 o’clock on Tuesday
evening*, the head had advanced as far as nearly to bear on
the perineum. Uterine action having been for some time
quite suspended, the patient being now (10, p. m.) very rest¬
less and much exhausted, and the pulse being frequent,
small and weak ; the forceps were applied, and the foetus
was extracted in a short time and with tolerable ease, al¬
though the child (which was dead) was a very large one.
The catheter was introduced, to relieve the bladder, twice
during the labour.

The uterus being in this torpid state, the hand was intro¬
duced into its cavity with the intention of exciting uterine
action, for the expulsion of the placenta. This course of
proceeding had the wished for effect and the attending loss
of blood was very trivial.

February 2nd. A. m. Has been very restless all night,
says she feels very weak, face is flushed, feels very sore
about the parts ; there is pain in the lower part of the abdo¬
men increased on pressure ; tongue white, pulse small, weak
and about 120. Bladder and bowels have not been eva¬
cuated. T. Hyos. 5ij. spr. sether, nit. 5iss. m. eamph.
Bviij. m. cap. cocb. ij. amp. ter. hora.

Ten, p. m. Did not get the mixture till six o’clock. Has
not made water, no evacuation from the bowels, says she is
very sore. Pulse 140, very intermitting, ordered to apply
warm fomentations to the hypogastrium and external geni¬
tals.

3rd. Was called up at 5 this morning, J found her
greatly troubled with hiccup, much exhausted. Pulse very
feeble, very intermitting and about 143. There has been no
evacuation from the bladder or bowels.

She had brandy given her immediately, which was re¬
peated till the pulse got tolerably regular, and stronger. I
drew off by the catheter about iss. of high coloured urine,
and ordered her an enema of gruel every quarter of an hour
till the bowels should be acted upon, and after alvine evacua¬
tion to take the following draught, L. opii. sedat. mxii.
mis. camp. Siss. iq. ft. haustus.

Seven, p. m. Has had four glysters without the desired
effect, she is very restless, tongue brownish, hiccup less distres¬
sing, pulse 140 and regular. Bladder was relieved by the
catheter. Ordered to have two glysters Bss. of ol. ricini in
each, one immediately and the other in an hour if necessary ;
and should the bowels not be opened, to take 3ss. of ol.
ricini and another half in three hours if necessary.

Mr. Rees on Chronic Peritonitis.

215

4th, a. m. Has had the glysters, and has taken the ol. riein.
without giving rise to alvine evacuations. Has been very
restless all night, say she is weaker. Abdomen is painful
on pressure, pulse 140, regular. Has vomited some black
adhesive fluid. Urine was drawn by the catheter.

R. ol. crot. m. iss. in pil. 2 c. ext. gent. capt. i. stat. et
aliam post duas horas si opus sit.

Nine, p. m. She omitted the pill; Mr. Jewel ordered her a
glyster, which gave her one stool, highly offensive and of a
black colour ; has not been much troubled with hiccup to¬
day ; has again vomited some black fluid ; has been dosing
this evening. Pulse 120, regular and tolerably strong, can
take only a little tea ; has been observed this evening, to
turn up frequently the white of her eyes.

5th, a. m. Has been speechless and insensible since three
o’clock this morning. There have been involuntary evacu¬
ations from the bowels, which were highly offensive.
Tongue brown, pulse intermitting and very weak. She lin¬
gered in this manner till 6 o’clock on Sunday morning the
6th, when death closed the tragic scene.

Sect, cadav. 6th horis post mortem.

The body appeared to be that of a person who had en¬
joyed good health, but had been cut short by some acute
disease. The muscles were firm, the abdomen was not
unusually large.

All the thoracic viscera were perfectly natural. The head
was not opened. Abdomen — The omentum was highly in¬
flamed, being of a brownish red colour, and at several parts
it was adherent to the anterior surface of the uterus. The
small intestines in the neighbourhood of the womb were
greatly inflamed, and several parts of them adhered to the
fundus uteri. The peritoneum lining the lower parts of the
abdominal muscles, was in a state of high inflammation, and
there was ulceration of some portions of it. The inferior
part of the uterus had contracted strong and extensive adhe¬
sions to the adjacent parts. On the right side of the uterus
and anterior to the coecum was observed a kind of a sac,
which appeared to be bounded externally by the peritoneal
coat of the uterus, and internally by the uterine parietes.
The anterior of this sac, which contained gas, also black
and highly offensive matter, communicated by an opening
(sufficiently large to admit the passage of the thumb,) with
the cavity of the uterus. The fundus uteri was in a natural
state excepting its peritoneal coat, which was highly vascular,
but more so on the anterior than posterior pari. The ante-

216

Original Communications.

rior part of the uterus was in a gangrenous state. There was
a white muddy fluid in the peritoneal cavity. The descend¬
ing colon, and ccecum presented marks of great inflammation.

February 8th, 1831.

[This was clearly a. case of chronic peritonitis, in which the
symptoms were obscure, and in many points bear a close
resemblance to that narrated by Dr. Malins in our January
number. We are much obliged to Mr. Rees for the history
of this case, as it strongly attests the views we took of that
just alluded to. We earnestly hope that the details of both
cases may attract the attention of practical obstetricians to a
subject of such vast importance. We have only to observe
in conclusion, that the unwearied attention bestowed by Mr.
Rees, affords no slender proof of that anxiety which charac¬
terises the majority of our profession. — Ed.]

IV. — Popular Summary of Vaccination. By John

Marshall, Esq.

Mr. Editor,

The publication of the history, perhaps, of the following experi¬
ments upon the cow, although unsuccessful, yet, in conjunction
with some other collateral relation concerning vaccination, &c.
may become somewhat interesting to your numerous readers, through
the medium of your excellent and widely circulated Medical and
Surgical Journal, which will be gratefully acknowledged by your
obedient and obliged servant,

John Marshall,

53, Jermyn Street, Jan. 22, 1831.

TO THE READER.

The principal object of the present essay, is to promote the views
already promulgated in my former publication, relative to the prac¬
tice and causes of failure of vaccination ; and, I trust my extended
practice has enabled me to elicit some further information upon the
important subject of security. In drawing up my statement, I have
carefully avoided all technical expressions, as it is my anxious wish
to give as general a currency as possible, to opinions which must
carry comfort and satisfaction into the bosom of every family.

Mr. Marshall on Vaccination.

21 7

The cow-pox, though harmless, no doubt requires the most careful
manipulation, in order to secure ulterior protection ; but there is the
satisfaction of knowing that there does not exist any difficulty in
comprehending the sources of failure. Although it may be remarked
that the operation of cow-pox has been simplified beyond the bound¬
ary of safety, for it is deeply to be regretted that numerous cases
have unfortunately from time to time, and recently occurred, of
small-pox, after vaccination, among families of the highest rank, as
well as of middle classes of society. But these instances are attri¬
butable to various causes, but above all to the palpable error of a
solitary vesicle , which has been far too generally adopted ever since
its promulgation. In short, its prophylactic power is only to be
obtained, by forming, in all cases, a plurality of vesicles ; this
principle is founded upon irrefragable facts, and it is strongly re¬
commended to be adopted in the first, second, and either annual or
every repetition of the process.

Some baseless theories are yet upheld against vaccination’s durable
hold upon the human frame, which have arisen from mere defi¬
ciency of information ; such doctrines are wholly untenable, they
are neither to be supported by reasoning, nor countenanced by facts.
In this country, and, I believe, in most others, as yet, there is nei¬
ther decadency nor deficiency in the pristine power of vaccine
lymph, nor is such an event likely to happen, since man is to all
intents as well capable of ensuring its successive production as
the cow.

It may be observed, that some remarks on this subject are similar
to those which I have already published, but I may be allowed to
repeat them, since further experience has brought to light additional
evidence in their support.

Some experiments are recorded wherein I have inoculated the cow
with both distinct and confluent small-pox matter, in its most viru¬
lent state, with the hope of ascertaining whether such a source gave
rise to cow-pox, by the accidental application of the disease on the
hands of the milkers to the nipple of the animal. The unsuccessful
result of these trials is fully exemplified. It may, however, be here
remarked, that facts implicitly recorded in every branch of science
are pithy things, which in all instances ought to present the shield
of protection against unwelcome reproach. If this experiment, at
all events upon the cow, in more able hands, can eventually be
found to succeed in England, I shall not only be most readily open
to conviction, but even highly delighted and richly gratified. It is
therefore surmised that the trial could be accomplished upon a larger
scale, with far greater facility, among the herds of liberal graziers
of our dairy counties, than the fastidious herdsmen of London.
This hint is given with a sincere wish that it may be the means of
stimulating some gentlemen of the faculty, residing in the country,
who may have perchance perused this friendly challenge, since they

VOL. VI. no. 33.

E E

21S

Original Communications .

must be fully aware of the state of doubt in which the question is
left, which evidently forms a physiological desideratum.

By way of concluding this address, I embrace this opportunity of
recording a singular, and perhaps novel reality, which has been
lately made to me by an all-talented physician. That all persons of
both sexes, who are freely pitted with the small-pox, generally pos¬
sess, e consequential a pallid complexion (with the occasional excep¬
tion of free livers). This extraordinary phenomenon is ascribable to
severe inflammation, which vents its force upon the features pending
the disease, and by thus obliterating the faciei cutaneous colouring
vessels. .Such an alteration, however, of the countenance but rarely
occurs when small-pox succeeds non-eflicient vaccination.

The merits of vaccine have been simply elucidated by practical
documents throughout my studies, and wholly divested of theoretical
reasoning.

SECTION I.

The origin of Cow-pox considered. — Description of the genuine vaccine
purple Scab upon the teats of the Cow. — Intelligence from Egypt ,
France , Scotland and England, relative to inoculating the Cow with
Small-pox matter . — Eleven quadrupeds vaccinated at Utrecht, and
similar operations upon Cows in the British empire .

It is readily admitted that in all branches of scientific inquiry, the
labours of an experimentalist, whether for or against the subject of
pursuit, may, peradventure, contribute to aid the cause, since nega¬
tive are equal to positive proofs, and may be the means of stimulat¬
ing others towards lending their aid, by either establishing or con¬
futing the theorem.

I have undertaken the task of inoculating three cows with the
most active small-pox virus, on the back of their udders, with nu¬
merous punctures, thereby with the hope of establishing the momen¬
tous question respecting such a cause being the rightful origin of the
genuine disease of cow-pox. From this affection, peculiar to the
cow, has sprung one of the highest benefits to mankind, by its lead¬
ing to, and forming the source through the medium of the milker,
of the discovery and practice of vaccination. This opinion, ever
since its rise and promulgation, has been unremittingly entertained
by celebrated philosophers, both at home and abroad ; namely, that
its origin is ascribable to small-pox matter conveyed to the cow ;
wThile many others have maintained with equal ardour, that the
grease of the horse was its true base. But after all these cogent
arguments, I am more than ever inclined to think that the disease
will ultimately resolve itself into one which is naturally incidental
to, or the sole offspring of the cow. Moreover, should this opinion

Mr. Marshall on Vaccination.

219

be found to be hereafter established, it goes far to corroborate the
doctrine I have premised in the first section of my publication, a
Popular Summary of Vaccination, with the causes of failure, &c.
wherein these words occur, which may perhaps eventually be proved
to be prophetically correct, that “ the disease, however, of the cow,
is probably sui generis, and is propagated alone in that animal.”

So recently as on the 13th instant of November, 1830, for the
first time in my life, I had the opportunity of witnessing, among a
very numerous herd of cows kept at Knightsbridge, the remaining
vaccine scabs of the genuine cow-pox, on the various nipples of four
of the animals. This visit was made as soon as reported, with the
hope of obtaining a specimen of recent vaccine virus, but the vesi¬
cles on the teats were all perfectly dried up by the termination of
the active symptoms of the disease ; and all the necessary precau¬
tions were adopted by the herdsman, bearing the name of Dexter,
to check its further progress, together with the immense trouble
it occasioned among his milkers, during the indispensable operation
of emptying the udders. On inquiry, 1 learned that the re¬
spective vesicles had been each surrounded with the circumam¬
bient inflammation, which fully proved that the genuine cow-pox
had prevailed. The scabs were so remarkable in shape and appear¬
ance, that they are deemed worthy of describing. The colour re¬
sembled a mulberry about two-thirds ripe, of a deep reddish purple,
edges jagged, of irregular shapes, and varying in size, the largest
about an inch and a quarter in length, approaching indefinitely the
figure of a triangle, placed carelessly topsyturvy, and here and
there touching each other by its angular apex. A very fine cow,
which had suffered the most, had large and very white teats, which
ground, so suddenly contrasted with the zig-zag purple edge of the
vaccine crust, formed a very grotesque appearance, which forcibly
struck me at the moment to be very unlike any thing else that
could possibly be effected by either grease or small- pox matter.

The intelligence collated from Egypt, France and Scotland,
about to be described, seems highly plausible, by supporting both
the theory and practice of such an origin, but nevertheless I am
as yet free to confess, since candour is my object, prompted by the
rules of experience, that I am disposed to doubt the fact of obtaining,
by so eligible a mode, a supply at command of recent vaccine
lymph in the climate of England. Previously to entering upon the
detail of my own trials upon the cow, it seems incumbent upon me
to lay before the public the several documents just alluded to,
which, if they are still capable of realization, would no doubt afford
a cause of delightful gratification to the enlightened world, to find
that cow-pox is neither more nor less than a mitigated small-pox.
I may, however, be permitted to premise, that pending the foreign
experiments upon the animal, that in each cas'i they might possibly
have been simultaneously affected by the accidental visitation of the
genuine cow-pox ; and if such a casualty can be admitted, it might,
perchance, have led to an inference grounded on fallacious prin-

220

Or igin al Com m un icat io ns.

ciples. It is painfully conjectured, that occasionally in medical works
and others, theoretical cases are published, which have been figured
in the study, free from truth and experience, but reprehensibly de¬
signed for betraying the unsuspicious. Such measures stint the
advancement of science by fading the growth of its fruit.

In the year 1829, at one of the evening meetings so generously
given to the faculty and literary members of learned institutions,
by the Royal College of Physicians, under the patronage of its
learned President, Sir Henry Halford, Bart, and the rest of its
enlightened Fellows, a very interesting and elegantly written paper
on vaccination, was read from the rostrum by the Registrar, Dr.
Machmichael. By the liberal permission of the President, I have
not only been honoured by the loan of this classical document, but
also permitted to cull the following partial extract, which is closely
allied to the subject : —

“ But a letter from India, with the perusal of which I was
favoured yesterday, contains the following remarkable statement,
which seems to me deserving the greatest attention : —

“ It appears that from the vaccine matter having lately failed in
Egypt, in a great many instances, medical gentlemen were led to
institute certain experiments, by which it has been discovered, that
by inoculating a cow' with small-pox matter from the human body,
fine active vaccine virus is produced. At the time the letter was
written, there was a Greek child at Mocha that had been success¬
fully vaccinated with matter direct from the cow, produced as above
mentioned ; and the virus taken from its pustules had acted with
the best effect on several other children at Suez, where former
attempts had failed.”

“ Now if this shall be found upon further trial to be really true,
it will prove one of the most important facts connected with this
interesting subject, for henceforth we need no longer fear that we
may be deprived of the means of combating the small-pox, since
that baneful contagion will furnish its own antidote.”

A question may fairly be asked, what cause can have given rise to
the paradox, that vaccine lymph “ has lately failed in Egypt in a
great many instances,” while in England, and all other countries,
we are as yet strangers to such a phenomenon.

The concluding paragraph of the learned author contains, from such
a document, the most appropriate inductions that could be drawn ;
which, peradventure, it is hoped, may yet be found capable of con¬
firmation. It must, therefore, be strikingly evident that the subject
may still require the attentive investigation of English physiologists,
and that the truth of this doctrine is worthy to be put to the test
of further experimental trials, and more especially since the dis¬
ease in the cow has ever been considered by experienced graziers
as of rare occurrence.

Another parallel extract, equally interesting, and apparently fully
confirming the foregoing quotation of the transmutation of variola
into vaccina, bred through the medium of the constitution of the

Mi*. Marshall on Vaccination.

221

cleanly cow, is also extracted from the London Literary Gazette,
dated March 20, 1830.

“ M. Robert, a physician at the Marseilles Lazaretto, has made
a number of experiments, from which he concludes that the vaccine
eruption had no other origin than the accidental transmission of the
variolus virus of man to the nipple of the cow, and its consequent
mitigation. He thinks that this discovery will diminish the number
of opponents of vaccination ; as it will shew that the vaccine
virus does not proceed from any impure and disgusting animal
malady, but is simply a mild and local small-pox.

In consequence of the seemingly faithful relation of the antece¬
dent foreign experiments in two quarters (but since the discovery
of Australia, what is now called by the literati, two-fifths) of the
globe, Asia and Europe, they each demand our respect, which, in
the opinion of many, may yield an impression of truthful conviction.
A practical query may possibly arise, however, by the trial failing
here and succeeding there, that warmer climates are probably more
congenial towards aiding the full characteristic developement of the
inoculated small-pox upon the system of the cow. It is universally
admitted, from time immemorial, that warmth greatly increases the
morbid effects of variolus miasmata, as proved by the immortal
Sydenham. Suffice it to say, that since this is the truth, the im¬
portant subject under contemplation becomes a pathological problem,
that still merits solution by further inquiry. Hence I have resolved
again to repeat the experiment upon the cow during the prevalence
of the hot weather, usually occurring in the vernal months, other
reasons may be also assigned for choosing this period of the year ;
namely, the animal is then deemed by all experienced graziers to be
in the highest state of health, and more generally attacked by
genuine cow-pox, which opinion is confirmed by Jenner, in con¬
junction with many other authors.

Again, Dr. Paterson has done me the honour to communicate
orally the following additional and highly interesting intelligence,
which is intimately connected with this point of discussion : —

About thirty years ago. Dr. P. while practising medicine at Ayr,
in the West of Scotland, having, for the first time, introduced vac¬
cine inoculation into that part of the kingdom, he was impressed with
an idea, that cow-pox originated from small-pox matter being commu¬
nicated to the nipples of cows by the milkers ; under this impression.
Dr. P. inoculated nine milch cows on the lower part of the udder, in
two different stables, with matter taken from a case of confluent small¬
pox. In a few days pimples had been produced on each of the animals,
with one exception, which pimples continued to increase and form
matter, with which this gentleman was very desirous to inoculate chil¬
dren, in order to discover what disease might follow. But this was
unfortunately prevented by the impossibility of inducing any parent
to allow their children to be inoculated with such matter.

Surely the large proportion of successful inoculation, in the ratio
of eight to one, affords a striking, and even an encouraging stimulus

222

Origin al C om mu ni cat ions.

towards reiterating the scientific attempt of confirming this im¬
portant question, by further experimental search. And again, I
repeat, that thus encouraged by the sanction of Dr. P. on whose
integrity and veracity the utmost confidential reliance is placed,
to reiterate the experiment.

The following extract on vaccination may also prove additionally
interesting to the physiologist, by exemplifying the effects pro¬
duced by vaccinating eleven quadrupeds, widely differing in zoolo¬
gical classification. Many of these trials being original and de¬
scribed in a strain of truth and simplicity, they are worthy of com¬
municating. But more especially since the information has been
conveyed to this country by so highly a respectable source, the Lon¬
don Literary Gazette, July 4, 1829. These cases prove that even
the mild lymph of cow-pox, is fully capable of producing its vesicle
in all these animals, with only one exception, namely, the rabbit.
Many of the facts recorded and seemingly established, are truly
remarkable, which may be said to afford some very scientific and
curious points, worthy the consideration of the pathologist : —

“ M. Numan, a veterinary surgeon at Utrecht, has recently made
several experiments with the vaccine matter, upon the following ani¬
mals — the cow, bull, horse, ass, camel, sheep, pig, ape, dog, and
the rabbit. He states as the result of these, that the vaccine virus
taken from man, reproduces the original effect when applied to the cow
and the bull ; but that the action of the virus so applied to these ani¬
mals, is only for a single time ; on the horse and the ass it produces
pustules, and when applied from them to the cow, its action is more
intense than that of the primitive virus. The camel receives it
easily by inoculation ; but when taken again from the camel and
applied to the cow, it produces little effect. Applied however from
that animal to the goat, it is quite efficacious ; but both the goat and
camel are susceptible of its effects only once. The sheep does not
yield readily to its influence ; and the virus from this animal has no
effect upon any other. On the ape, the effect is nearly the same as
upon man. The pig may be vaccinated, but the virus cannot be
subsequently propagated. The dog is more difficult than the sheep,
and the rabbit is quite inaccessible to the influence of the vaccine
matter.

It is rather whimsical, that the effect of vaccine virus upon the
ape comes the nearest to man.

So many principal animals recorded in the list of M. Numan,
namely, the cow, bull, camel, and goat, that are subject only a single
time to the vaccine disease, and first and foremost the cow, is readily
granted; because, in England, this particular subject has been long
known as an established fact in our dairy counties. For whenever
it has been retaken by the animal, further proofs of its capability of
resisting its former virulence has been invariably confirmed, first by
the harmlessness of the vesicle, and secondly, its rapidly dying away ;
thereby strictly resembling a case of re-vaccination in man, who has
already derived full protection from a former operation. This re-

Mr. Marshall on Vaccination.

223

markable circumstance, I think, if memory does not mislead, is re¬
corded in the works of Jenner. M. Numan is entitled to the
thanks of the public, for prosecuting the experiments with so much
ability and zeal. The successful management so largely diversified
from one animal to another, must have occasioned considerable toil
and difficulty. By succeeding also with vaccine lymph, which being
comparatively less virulent than small-pox matter, it is fair in jus¬
tice to infer, that each operation must have required in its manipu¬
lation a high degree of experience and intelligence, and proves that
he is a truly expert and zealous vaccinator. But nevertheless it re¬
mains to be a subject of doubt whether these animals would have
been, either collectively or individually, alike susceptible of small¬
pox matter by inoculation.

It is likewise a well-authenticated fact, that in England, the vac¬
cine lymph derived from the vesicle in the human subject has been
from time to time inserted into the udders of heifers, and milch
cows, by surgeons in London and its vicinity, as well as in several
parts of the British empire. The vaccine vesicle, thus produced in
the animal was found by following up vaccination, to give back to
man a genuine and unalloyed specimen of the vaccine disease, in all
its wonted bearings.

With the exception of Dr. Paterson’s experimental cases, thirty
years ago, of small-pox inoculation upon the cow before mentioned,
it appears that the only similar trial, perhaps, which has ever been
since attempted, and recorded in this country, was performed in the
year 1829, by W. Sewell, Esq. assistant professor to the Royal Ve¬
terinary College. I am permitted also by this scientific gentleman,
to state, that the variolous matter was freely inserted by inoculation
into the teats and udder of a fine healthy milch cow, two calves, two
lambs, and a couple of rabbits. But I greatly regret to be com¬
pelled to state that his praiseworthy intentions, of realizing this re¬
markably interesting phenomenon, entirely failed in these seven
animals. Such negative proofs go far, as yet to confirm my own
unsuccessful efforts, and casts a sombrous shadow over the ray of
future hope.

It excites however my surprise that this influential subject for ex¬
perimental investigation, so apparently and originally connected
with the question of the disease in the cow, and its valuable power,
so auspiciously ordained for the relief of mankind, should have re¬
mained in a comparative state of relinquishment among the nu¬
merous scientific, members of the faculty, during an epoch so pre¬
eminently distinguished by the rapid advancement of scientific dis¬
coveries. I deeply regret that this important object has devolved
upon myself, because in abler hands it would have been adorned with
superior physiological illustration, which would have caused a more
forcible claim to public attention.

224

Original Communications ,

SECTION II.

A general Detail of Experiments tried upon three Cows by

Small~pox Inoculation .

After surmounting numerous impediments and anxious delays, aris¬
ing from objections made to the proposition of trying the experiment
upon the property of herdsmen, both within and without the metro¬
polis, at length however, I am enabled to announce a series of trials,
which, although successless, may probably be deemed somewhat in¬
teresting, inasmuch as they may become useful to others, who may
be induced to perform the like.

On September, the 16th, 1830, I obtained a supply of small-pox
matter, of the distinct type in its most active state, on the eighth day
from a young man of good stamina. On the same day, in a cow-
pasture at Kilburn, the variolous matter was introduced by inocula¬
tion into the udder, between the legs, of a healthy milch cow, five
years old, which period is deemed by farmers the prime, in full milk,
and which had calved about six weeks; sixteen punctures were made
with armed lancets and needles, from which resulted twelve red spots
or blotches, — :they all became distinctly visible on the second day ;
on the fourth, they were each progressing, and accompanied with
a circumambient ring of inflammation ; on the fifth, increasing
simultaneously in size ; but on the sixth day, they all suddenly dried
up, and degenerated into a brown coloured scab, corresponding with
the relative dimensions of the rose coloured spots ; three were ovi¬
form and the rest circular, and each about a quarter of an inch in
diameter.

A question may possibly arise, how came it that matter was not
taken from such a numerous sprinkling of what has been styled
blotches, before they resolved themselves into a crust ? Because
there was not the smallest approach made in either, towards the for¬
mation of matter ; and thus decidedly differing from either small¬
pox pustule or vaccine vesicle, when obtained by inoculation upon
the human subject. In fact, they were all, strictly speaking, neither
more nor less than simply a red blotch, without the slightest eleva¬
tion or distention of the epidermis beyond the cutis vera, although
the lump projected above the surface in the form of a plano-convex
lens. Hence they were unworthy to b.e called by the name of either
pock, pustule, vesicle, or pimple. A slight areola oftentimes ac¬
companies a blotch upon the human skin, and this momenclature is
more significantly adapted to the appearance on the udder than any
other can express in the vocabulary of our language.

The sudden stoppage of the vesicles was at the time, for want of
experience, attributed to the probability of the animal having pre¬
viously undergone the genuine cow-pox.

Before commencing inoculation, the cow was secured by a rope
round its horns, and fastened to a gate post ; the hind legs were

Mr. Marshall on Vaccination.

s 225

also bound by a rope above the tarsus or hock ; this mode of
precaution is called hobble, by herdsmen ; but in restive animals two
ropes are necessary, one as before, and the other round the pastern
or fetlock, which is technically named double-hobbling. Milkers
rarely keep the hobble-straps, which are used in operations by vete¬
rinary surgeons to guard against accident. It will presently be
made to appear that the hobble straps, being thongs of leather, had
better be used than inferior tackle. Since the temper of animals,
especially that of cows, is known greatly to vary, and the effects
even of this slight operation cannot be prejudged ; it is therefore
more prudent, in every instance, to be protected from danger.

The udder had been recently milked, which renders it far more
manageable than while in a state of spherical distention.

On the score of humanity the nipples were purposely avoided,
by preventing the sufferings of the animal, and the risk of injuring
the pustule, during the frequent repetitions of milking ; and in an¬
ticipation of checking the supposed liability of the unpleasant con¬
sequence of extending the disease by the hands of the milker to the
rest of the herd.

But further trials have been made upon two more cows, which
moreover shew the precariousness awaiting the means of pursuit.
These animals were selected from a numerous herd, being the
healthiest and finest among them ; one yielded daily eleven quarts
of milk, and the other nearly as much. On Saturday, November
the 6th, 1830, they were each inoculated, by well armed lancets and
needles, with confluent small-pox matter, taken from a lad on the
seventh day of eruption. In the first cow fifteen punctures were
made upon the hinder part of the udder, with every possible delibe •
ration and cautious manipulation, but no proofs of effect of any
sort or kind was ever afterwards perceptible. The other animal
became so extremely restive and viciously inclined, that she broke
her ropes, and remained for a time almost ungovernable ; the herds¬
man, milkmen, and self, were compelled to run by a speedy retreat,
to escape her long and powerful strides ; under such untoward cir¬
cumstances, only two inoculations could be effected. These, how¬
ever, took an effect by exhibiting, on the second and third day, two
red circular blotches, which dried up, and partly disappeared on the
fourth day, when only a dry cuticular scale distinguished the spots.

It may be remarked that these experiments seem to involve in
considerable doubt the questionable hope of ulterior success. The
most active variolus virus of the distinct and confluent type has
been freely employed, and the effect has fallen far short of realizing
the project, which appears thus far to be consigned to mere theore¬
tical speculation, unaided by useful facts. Suffice it to say, that these
failures are truly appalling, and serve to stagger hope and faith.

The cow, however, is capable throughout the seasons of equally
displaying all the phenomena of the progressive changes of the vesi¬
cle by vaccination as perfectly as her genuine cow-pox, while the
highly virulent small-pox matter, only exciting a temporary spot of

VOL. VI. no. 33.

G G

226

Original Communications .

inflammation, goes far to prove that her constitution seems to pos¬
sess an innate power of resisting its specific action.

SECTION III.

Hereditary Cases of Secondary Small-pox , #c.

It is much to be lamented that the small-pox has raged epidemi¬
cally with great severity throughout London, and its vicinity, also in
divers parts of the country, during the last two years, but at the
present period, although the depth of winter, it has become more
rife than ever ; this fact is corroborated by the teeming instances of
small-pox, after undue vaccination, not being followed up among
the rising generation ; then may a further diffusion of my endea¬
vours be effected by repelling the prevailing evil. About thirty
cases have been reported from various parts of the British empire, of
the variolous miasmata having recurred to those who had had it
before, either naturally or by inoculation. About eighteen years
ago, my attention was drawn, by my late revered friend Col. B.
to an hereditary and secondary case of small-pox, which had been
exemplified in father and son. The singular anecdote connected
with the history of these cases is worthy of record. The father,
during infancy, caught the small-pox naturally, and his face was in
consequence ever afterwards severely pitted. In early manhood, on
the morning fixed for the solemnization of this gentleman’s mar¬
riage ; as bridegroom, however, he was prevented meeting his bride
at the altar, by a severe attack during the night of the eruptive
fever of secondary small-pox ; who, when slowly recovered, from
a hair breadth escape of the confluent type, the marriage was
happily consummated. The son and heir of this gentleman, while an
infant, had been inoculated, and his face, like his father’s, bore ample
testimony of its severity ; who, when arrived at the age of manhood,
during a visit to London, he again imbibed the small-pox. I saw
him repeatedly, while alarmingly ill and blind with confluent variola,
of which attack, however, he also slowly recovered.

Such hereditary cases of small-pox, appear to me to have been
but rarely noticed by medical authors, but left to be communicated
by tradition. Upon inquiry, however, among many of my profes¬
sional colleagues, I have been enabled to glean some further intel¬
ligence, orally, upon this curious deviation from the general laws
of nature, which, by surpassing the instinctive faculty of man, bids
defiance to pathological explanation. A whole family of an English
baronet, have been long known to be liable to secondary and here¬
ditary attacks of small-pox ; from motives of delicacy the name is
suppressed, which wras imparted to me by a friend who has long
attended the family. Some other gentlemen of the faculty, whom
I have long known, have also met with similar instances in the
course of practice.

Mr. Marshall on Vaccination.

227

In all such cases, it would be unreasonable to expect entire pro¬
tection from vaccination, yet it is highly consolatory to find, that
even in such cases of constitutional peculiarity, whenever small- pox
does recur after genuine vaccination, that the antecedent operation
is frequently found to controul its threatening danger, by preventing
the accession of the secondary fever. Hence, although this pheno¬
menon, in the opinion of the inexperienced reader, may appear para¬
doxical, yet it is a well known fact to the faculty, that small-pox,
by recurring, even after the lapse of a large portion of life, is more
severe in its secondary visit, as exemplified by the foregoing cases,
and oftentimes fatal.

These comments may contribute towards confirming the compa¬
rative merits of the vaccine disease, and also that it is in every
instance, and on every account infinitely more prudent and wise to
vaccinate than to inoculate. If, however, doubts of security con¬
tinue to exist in the mind of the timid, from either hereditary or
casual causes of failure, the patient had better be annually re¬
vaccinated, until its effects are capable of banishing the alarming
impression of casual small-pox.

It ought to be universally known that vaccine lymph is specifically
free from the contamination of the seeds of all other diseases ; and
also that it remains identically the same in our own and many
other climates, both in force and efficacy, after the long periodical
test of thirty-one years. This circumstance admits of comparison
by a new light. The rising generation who are now entering into
the cares of the world, having been vaccinated, I have a right to
suppose in early infancy, full twenty years ;'go, were consequently
vaccinated when the lymph was proportionably new ; therefore it
brings to conviction that one of the principal causes of failure is
infinitely more attributable to a solitary vesicle than to decadency.

SECTION IV.

Some further Remarks derived from ocular Observation , which go
far to enforce the necessity of forming a plurality of Vaccine

Vesicles.

Several opportunities have recently occurred, by tracing and ob¬
taining a more enlarged insight into the public and private practice
of vaccination. To fearlessly expose the reasons of failure, founded
on the principles of experience, truth and candour, has been my
object, yet wholly divested of feelings, either of rancour or scur¬
rility, but merely with a view of upholding this striking object of
humanity. It grieves me, therefore, to be constrained to announce
the following facts, which, impelled by public duty, ought not to be
repressed, as a general salvo re-vaccination in all doubtful cases has
already been strongly recommended. By so doing, I am well
aware that my professional colleagues, by being called upon to

228

Orig in al Commu n ication s .

reiterate vaccination in numerous instances, to correct the omissions
of others, have had no feasible reason to complain. On this point
of practice, I have also appealed to the warm affections and lively
sympathy so unremittingly pourtrayed by all intelligent parents, in
every family, towards the health and welfare of their offspring.
Lest, however, these prefatory remarks may be deemed either
tedious or superfluous, I shall now proceed forthwith to illustrate
this topical subject of contention ; which, though far from personal
reflection, it has been, alas, too general. These practical hints are
therefore given with the hope of more certainly insuring the pro¬
phylactic power of vaccination.

During the last eighteen months, at various periods of life, from
childhood to manhood, among the high and wealthy classes, as well
as the middle and lower ranks of society, who had been vaccinated,
in town and country, I have detected a very insufficient mode of
vaccinating, by carefully examining both arms previously to repeat¬
ing the operation ; when only a solitary scar, very rarely two, and
three never as yet found ; while many others, not having a ves¬
tige left, by escaping the power of naked vision, and even when
assisted by the help of a double convex lens. But what is more
remarkable, the cases of one cicatrix far outnumbered the average
of the rest ; the consequence, however, that followed was still
worse, because among those a larger proportion were found unpro¬
tected ! But my astonishment of such a discovery was cautiously
suppressed, because many had been thus Vaccinated by gentlemen
of high professional rank, to use a vulgarism, “ at the top of the
tree,” many of whom have long ceased to exist, and others who
are now in full practice ! It is a well known axiom, that the fear
of overdoing this disease by a plurality of vesicles, is groundless.
The praiseworthy example of triplet vesicles in each arm, is coeval
with the commencement of the practice in the year 1799, in this
metropolis, which highly prudential mode has been ever since, down
to the present era, faithfully observed and encouraged by all the
patronized vaccine institutions of this vast emporium. This prece¬
dent, it is fervently hoped, has been generally adopted throughout
the British empire, in all the charitable establishments which adorn
the state ; and should it also be further proved that the faculty else¬
where have been equally regardless of this valuable precept, it is
never too late to mend ; the mind of the enlightened is readily open
to the conviction of error.

During the epoch of variolous inoculation, from the fickleness of
the matter, more especially in adults, by its venom producing reci¬
procally either confluent or distinct small-pox, a single pustule was
deemed sufficient. But on account of the perfect harmlessness and
comparative definite effects of vaccine virus, it possesses a diminished
degree of force, and if so, it consequently requires a freer admini¬
stration for the purpose of effecting future protection ; and also by
thus creating a wider expansion of surface for absorption, the
system necessarily becomes more efficiently saturated.

Mr. Marshall on Vaccination.

229

The following trite remarks, if faithfully and universally adopted,
will go far to insure a signal success to the cause. The vaccine
lymph, obtained from a well- conditioned vesicle, if timely and freely
employed, affords lasting protection. These emphatic data, pointed
out by italics, may be said to comprehend the pith and marrow of
the practice of vaccination.

Solely with a view of corroborating the laws and practical effects
of vaccination, I may be permitted to give a summary view, free,
it is hoped, of the unwelcome stigma of either vanity or boasting,
which is founded on the basis of honour and ingenuousness. Among
the thousands recorded in my public and private list, not a single
case of subsequent small-pox has ever as yet occurred to my know¬
ledge. Numbers of whom, at various periods of life, have been
since severely and repeatedly exposed to the contagion of variolous
miasmata. The following additional statement contributes to con¬
firm the foregoing inference, namely, from the willingness of my
public patients, assisted by the ignorant, to impugn the practice of
vaccination. Three instances at lengthened intervals have hap¬
pened, wherein the children have been brought to me at six, eight,
and fifteen months after genuine vaccination, with the eruption of
varicella or chicken-pox, and each of these cases were unjustly
denominated small-pox, two of which had been so misjudged by
chemists ; these, however, were fortunately confronted and contra¬
dicted by the accidental presence of Mr. Stone, in one instance,
and Mr. Tupper in the other.

But it fully appears that all impediments to the advancement of
vaccination are rapidly subsiding, by its vast extension throughout
the habitable world.

Hence from the foregoing arguments, it may perhaps be made
evident that this innocent disease, while under the guidance of
genuine principles of practical management, offers the feasible
prospect of protection. It therefore constitutes a source of happi¬
ness to man, by defending him from the loathsome ravages and
perils of small-pox ; its enfeebling inroad upon the human constitu¬
tion too frequently occurs, which lurks throughout the destined
period of mortal existence. Whereas the faculty are strangers to
any malady which can possibly be imputable to the gifted powers
of vaccine, which fortuitously shields and nurtures the blessings of
health, strength and beauty.

SECTION V.

Some original Events , illustrating the History of Inoculation and
Vaccination , by those who were unconnected with the Medical Art ;
namely, Mr. Benjamin Jesty, and two illustrious personages. Lady
Mary Wortley Montague, and Viscountess Strangford.

With a view of informing the reader, who has not seen my former
pubUcation on the practical causes of failure of vaccination, and to

230

Original Communications .

elucidate one important branch of this section, it appears to be
somewhat expedient to give a succinct sketch of my fourth sec¬
tion, and more especially since its contents are original, by having
never appeared before (it is surmised) in any other regular work of
vaccination. The intelligence was chiefly obtained at the dinner
table of the late Dr. George Pearson, who honoured me with an
invitation expressly to meet at his hospital board Farmer Jesty,
and the medical staff, who at that early period belonged to the
Original Vaccine-Pox Institution.

A farmer, bearing the name of Benjamin Jesty, determined to try
the effects of vaccine inoculation on himself, his wife and two sons,
who accordingly armed the needle from the vesicle on the teat of a cow,
and operated on the back of the hand near the knuckle of the fore
finger, which left a cicatrix. This experiment took place in 1774,
at least thirty years before Dr. Jenner. In 1804, Mr. Jesty and
one of his sons came to London, at the request of the Board. On
being asked why he did not persevere in his plan of inoculation, he
replied, “ That he was so laughed at and ridiculed by the inha¬
bitants of the village, for introducing a bestial disease into his
family, that he gave it up, and thought no more about it ; notwith¬
standing, however, he rejoiced to find that it was taken up by the
faculty.” A question was asked (which I have since remembered)
what induced him to make the trial ? “ By having known, through¬
out his life, that all the milkmaids who had taken the disease from
the cow, never afterwards caught the small-pox,” In order, how¬
ever, to ascertain whether they were secure after the lapse of thirty
years, Jesty and his son were re- vaccinated. The operation I seve¬
rally witnessed, which was followed by premature irregular pimples,
attended by itching, which died off in a few days. Farmer Jesty
was then in his seventieth year, who, on being asked how often the
disease prevailed among cows, replied, to our mutual surprize,
“ That it was by no means a common or frequent occurrence ; he
had only seen the complaint three times during his life, and that
it happened about once in two or three and twenty years, or
thereaway.”

It may be here remarked as somewhat surprising, by the acknow¬
ledged freedom with which the story got wind among the tittle-
tattle scandle of the village gossips, aided by the satirical weapons
of peevish old maids, that some juvenile medical spark residing in
the purlieus, did not embrace the fit opportunity of crowning him¬
self by taking a hint, and snatching the laurel from the brow of Jesty.

A hundred years ago, Lady Mary Wortley Montague was Am¬
bassadress to the Sublime Ottoman Port of Constantinople, by
whose elegant epistolary correspondence, a vast improvement in the
treatment of small-pox was introduced to Old England, by mitigat¬
ing the deadly attributes of natural variolous by inoculation, which
is fully described, in vol. ii. fifth edition, 1805, of her Ladyship’s
works. For the amusing intelligence of the reader, a compendious
abstract follows. By the pressure of modern works, and the lapse of

Mr. Marshall on Vaccination.

231

a century, this subject may have been partly forgotten by the public*
but never by the faculty.

“ A propos of distempers, I am going to tell you a thing that will
make you wish yourself here. The small-pox, so fatal and general
amongst us, is here entirely harmless, by the invention of ingrafting ,
which is the term they give it. There is a set of old women, who
make it their business to perform the operation every autumn, in the
month of September, when the great heat is abated. People send
to one another to know if any of their family has a mind to have
the small-pox ; they make parties for this purpose, and when they
are met, the old women come with a nutshell full of the matter
of the best sort of small-pox, and ask what vein you please to
have opened. She immediately rips open that you offer to her
with a large needle (which gives no more pain than a common
scratch), and puts into the vein as much matter as can lie upon the
head of the needle, and after that binds up the wound with a hollow
bit of shell, and in this manner opens four or five veins. The
Grecians have commonly the superstition of opening one in the
middle of the forehead, one in each arm, and one on the breast, to
mark the sign of the cross ; but this has a very ill effect, all these
wounds leaving little scars, and is not done by those that are not
superstitious, who choose to have them in the legs, or that part of
the arm which is concealed. The children or young patients play
together all the rest of the day, and are in perfect health to the
eighth. Every year thousands undergo this operation, and the
French ambassador says pleasantly, that they take the small-pox
here by way of diversion, as they take the waters in other countries.
You may believe I am well satisfied of the safety of this experiment,
since I intend to try it on my dear little son.”

It appears, however, by other travellers, who have stated that the
part principally selected for inoculation by the Turks, is between
the thumb and finger.

Another authentic . memorial, outvieing the former in value,
affords an eligible subject for concluding this section. The com¬
munication, however, far exceeding in extent of utility, yet serves
to elucidate a parallel line of association, by each acting in return or
correspondence to the other. This memorable reciprocation, at all
events of superior advantage to man, richly merits our admiration,
and becomes an honour to England,

The vaccine disease was propagated in the following manner,
from our native shores into the Turkish dominion, which completely
absorbed the untoward impediments in the medical art, which had
been hitherto fostered by the superstitious doctrines of the Koran.
By the powerful influence of this regal example, many other coun¬
tries rapidly adopted vaccination, situate in the eastern climates ;
namely, Egypt, Arabia, Syria, and Abyssinia. This reminds me
of the anecdote told of Louis the Fourteenth, who banished, in one
day, the mistaken objections made by his subjects against the

232 Original Communications .

potatoe, by wearing at court a blossom of the plant in his button
holes, as a bouquet.

Vaccination was primarily communicated to the juvenile princes
of the august Mahometan family, of the grand monarch of the
Turkish empire, residing in the sumptuous Seraglio of Constanti¬
nople, through the medium of one of the illustrious offsprings of
our Lady Ambassadress, Viscountess Strangford.

This striking coincidence of mutual benefits imparted from Con¬
stantinople to London, and vice versa, by two lady ambassadresses
of exalted rank and talent, must be for ever hailed as a remarkable
reality by the inhabitants of both nations, which will live for ages in
the annals of history and natural philosophy.

SECTION VI.

The highly important Subject of the Decadency of Vaccination , together
with Cow-pox Lymph, separately considered.

The chief aim here intended is to uphold the aspect of good faith
and simplicity, but above all the cause of humanity, assisted by
practice.

An almost uninterrupted succession of opinions are yet prevailing
among the faculty and public, with regard to the durable power of
cow-pox. This subject appears to demand further investigation.
Some there are who tenaciously cling to an opinion that vaccina¬
tion looses its protective property upon the human constitution after
a conjectural number of years, varying despotically from five, seven,
to fifteen years ; such a line of demarcation, however, I have never
as yet been able to discover ; and probably this tact in reality may
puzzle the acumen of the most profound pathologist ; but never¬
theless this prophetical doctrine is supported by many with a degree
of sang-froid which is somewhat surprising. Again, others are of
opinion that decadency, or failure of vaccine lymph, is owing to its
gradually wearing out. But this principle is also equally untenable,
because the various evolutions of the vaccine vesicle in England
progresses unalterably, as it did originally. I am unable to discover
any ostensible reason for adopting such theories. These important
heads are proposed to be separately elucidated by practical data ;
but it is first deemed necessary to give a cursory history of small-pox
virus upon the human frame. The change from a better to a worse
state of small-pox miasmata, has never as yet been heard of among
the annals either of ancient or modern authors, it remains un¬
changed by the hand of time. It has been, however, at all times
subject to the influence of the floating temperature of climate, the
changes of relative seasons either increasing or diminishing its

Mr. Marshall on Vaccination.

233

malignity, the mode of treatment, and by a peculiarity of con¬
stitution varying in families.

But whether it has been either mild or virulent, the same lasting
effect remains, with the exception of those ungovernable attacks
of secondary cases.

The weighty question of vaccine lymph possessing a prophylactic
force, constitutes the sheet-anchor of the merits of this national
discovery, and throughout its career, this point of view has invited
my untired labours of research ; cow-pox appears, by manifold
results, to require a considerable degree of circumspection in its
administration, which is the only means of securing its action.

By way of exemplification, a few hints may go far to strengthen
the position, by tritely alluding to my former statement. Numerous
mothers, who had been early vaccinated, have been tested in after
life from the cow-pox vesicle of their sucking babes, with exemplary
proof of protection. Milkmaids, after imbibing the matter of
genuine cow-pox from the animal, become for ever invulnerable to
small-pox. Numbers of men and women among the humble classes
of society, who have long surpassed the adult age, by the test of
re- vaccination, have been found protected. Such proofs go far to
upset the opinion of decadency of vaccine upon the constitution
of man.

The second division of this subject remains to be explained ; the
fading of vaccine lymph, still in use throughout the British empire,
appears to rest upon a false foundation ; the discrepancy of small¬
pox virus might as well be granted with equally physical truth.
It appears, however, by some foreign reports from Egypt and
Bengal, that the fervid heat during the torrid zone has impaired its
efficacy ; while on the contrary, by intelligence received from the
English faculty practising in our West India Islands, it has not
suffered an iota in diminution ; — thus the western report presents a
flat contradiction to the eastern. The European inhabitants residing
at the presidency of Calcutta, prefer the cooler months of Novem¬
ber, December, and January, for vaccinating during' the prevalence
of the north-east monsoon.

If the opinion upon the declining state of vaccine lymph at home,
after the lapse of thirty-one years, becomes an admissible fact, by
such reasoning, those patients, it would be fair to suppose, who were
vaccinated with its infant tymph, ought to have evinced a more
forcible or lasting effect, and the scale of decadency must have
been governed by the revolving of time. But it is useless to defend
such misconceived notions ; the decading property of the vaccine
lymph has been rejected by the highest authorities at home, by
patronised institutions on the continent of Europe. After eight
years trial of the identical source of lymph. Dr. Jenner prognos¬
ticated this encouraging doctrine, which has been strongly defended
by numerous authors. But another all-powerful defence of the
non-decadency of cow-pox lymph remains to be quoted, which sus¬
tains the argument down to the present epoch, by positive illustra-

VOL. vi, no. 33. h H

234

Original C ommunicati ons .

tion. I performed the operation during the summer of 1830, upon
the ncevus maternus, or mark of the mother, situate in the arm of a
child, which was wholly obliterated by the united combination of nu¬
merous vaccine vesicles. This subject alone brings home to convic¬
tion that the pristine force of the lymph remains in statu quo. This
merciful result has been also recently testified by surgeons of acknow-
ledgjd rank and talent.

The sequel, however, of such defalcation is easily accounted for ;
the alarming attacks of small-pox after vaccination, are primarily
attributable to a parsimonious vesicle, by wounding the same when at
its height of perfection, to administer its ripening c ontents to others ;
also employing it after the by-gone period of activity and perfection,
or by some untoward accident arising by either rubbing, scratching,
or crushing by pressure.

These circumstances, by occurring in a vesicle, are not unfre-
quently so slight or trivial, that they evade detection even among a
group of six or more ; if it happens to be solitary, it beguiles the sur¬
geon and patient. The antecedent adverse chances comprise the
fundamental causes of failure, and exonerate the genuine lymph from
blame. It is therefore hoped to be made to appear that the balance
of justice springs high in its favour.

SECTION VII.

The discovery of Vaccination derived from Milkmaids, and whether
Cow-pox is also attributable to the same class of peasantry.

It is universally admitted, that mankind is wholly indebted to the
discovery of cow-pox by English milkers resisting small-pox con¬
tagion, after imbibing the genuine disease from the nipples of the cow.

The blithsome milkmaid rising in the morn, beholds with awe
Aurora’s purple eastern beams, who tramps in verdant lawns and
pastures wild, bedecked with

Rosy cheek and sparkling eye,

Beauty, health, and symmetry.

But it becomes a questionable subject, to understand whether or no
the disease in the teats of tire animal has likewise originated by their
hands and fingers being infected by small-pox pustules during the
operation of milking. An apparent solution of this intellectual
difficulty is not satisfactorily to be met with in any author ; it appears
at all events, for want of due deliberation, to have been by many too
hastily adopted ; an attempt will, therefore, be made to refute this
notion, by practical observation, assisted by the laws of pathology.
Would it not be repugnant to the feelings of philanthropy, even for a
moment to conceive that a poor humble individual, sorely afflicted by
a loathsome eruption of pustules extending all over the body to the

Mr. Marshall on Vaccination.

235

fingers’ ends, accompanied by fever, debility and blindness, to be con¬
veyed in such a plight to a pasture field to perform the functions of
her calling ? Such a sight would accord with the tragical scenes of
Melpomene. Reduced by disease, the patient requires recumbent
rest, medicine, and nourishing diet to recruit her stamina, long after
the drying-up of the pock and separation of its scab. These remarks
prove the needful absence of the patient from the cow, and may per¬
haps suffice to carry conviction home to the breast of the sceptic.
Many slighter cases of natural small-pox may readily be quoted to
strengthen opposition to this groundless doctrine, e. g. frequently the
disease in various constitutions is mild, and accompanied by a slight
sprinkling of pustules, which are chiefly confined to the face, with
but few or none either upon the body or hands. But modified speci¬
mens, among milkers and others, have been more frequently effected
by inoculation, whereby the venom is often confined to a few pocks
either within or hard by the scope of the surrounding inflammation
of the original pustule obtained by the lancet, with pain in the arm-
pits and transient fever, while the patient is announced to be safely
protected. By the general adoption, however, of vaccination through¬
out our country, this speculation must speedily fall to the ground.
The cases which occurred last November, 1830, among cows at
Knightsbridge, could not be ascribed by the herdsman, Dexter, to
small-pox prevailing among his numerous helpmates. Has ever an
authenticated case been heard of from any dairy county, wherein the
animal became affected by variolous matter by the hands of the
milker? Dr. Jenner, it is well known, practised many years in the
dairy county of Gloucestershire, who never adduced such an instance ;
so far to the contrary, I have already proved at length, that his judg¬
ment was diametrically opposed to this origin.

This subject, after all, may be said to rest upon a fanciful basis,
which by analagous experiments upon the cow, I am prompted to
reject as a phantom. Suffice it to remark, that a plausible tale fre¬
quently involves matter of fact into a mist of obscurity. The late
Dr. Hawes, pending the meetings of the debating society, held in the
theatre of Guy’s Hospital, who whenever a student indulged too
largely in theory, he used to call him to order by this appropriate
address that, “ a drachm of practice is worth a pound of theory.”

[For Mr. Marshall’s Cases of N atvus Maternus, we refer our rea-
dear to our Number for July last.]

A COROLLARY.

It may be here observed, by way of corollary, that the small-pox has
been ascribed by ancient authors, to owe its origin to a disease in the
hoof of the camel ; a theory, however, during the lapse of some
thousand years, a period sunk into oblivion by the revolving darkness
of ages, has never as yet been proved experimentally upon the human

236

Original Communications .

being ! At present, therefore, it strikes the author, that the cause
of cow-pox is inveiled in a somewhat similar perplexing mystery. It
appears also to have been equally impracticable to produce any
decided affection upon the cow, by the grease of the horse. It may
be asked, while the cow is always amenable to mild cow-pox by
vaccination, all the year round, how is it that she is at any time
capable of resisting the effects by inoculation of virulent variola.

Here follows a trite metaphorical illustration, in three alternate
sentences ; of natural small-pox, inoculated small-pox, and vacci¬
nation.

Man, in a state of nature, forded the river, and thousands of his
fellow creatures wertf drowned.

The savage, impelled by instinctive reflection, constructed a raft
and boat, by which fewer companions were lost.

As civilization advanced, however, the skilful architect designed a
bridge, where all pass over in safety !

53, Jermyn Street , February , 1831.

V. — Judiciary Examination of Wounds.

By M. Ryan, M. D.

According to the law of this country, the surgeon must
describe the length, depth and situation of wounds, also state
whether they be mortal or not. He is to examine the orga¬
nic state of the wound, and ascertain whether it be in a
healthy or morbid condition. Thus a slight blow may cause
rupture of a vomica or an aneurism, strangulation or gan¬
grene in a hernia, or rupture of a varicose vein in the leg.
A person who inflicts a wound or contusion in such cases can¬
not be responsible, as he did not foresee the danger, and the
injury he inflicts is independent of his will. We must exa¬
mine the state of the constitution and habit of body , as
wounds are greatly aggravated, when the patient is of a weak,
enfeebled constitution, or is labouring under a chronic
disease, or is of scrofulous, venereal or cancerous habit.
We must bear in mind the personal conduct of the patient,
as his refusal to submit to proper treatment or a necessary
operation, his removing* bandages, his inattention to regimen,
his use of aliment or ardent liquors, interdicted by his con¬
dition, may render a wound not necessarily mortal, highly
dangerous or fatal. The conduct of the attendants must
be observed, as their opposition to the proper treatment.

Dr. Ryan on Judiciary Examination of Wounds 23 7

their excitement of strong* emotions in the sufferer, may cause
death. W e should also remember the state of the weather,
or insalubrity of situation, as an atmosphere too warm or
cold, or that charged with putrid emanations, or that of hos¬
pitals, may render a wound mortal. The occasional occur¬
rence of hospital gangrene, and epidemic erysipelas, such as
has been lately present in the London Hospitals, and well
known to scientific surgeons, may of course render a wound
not dangerous, after infliction, ultimately fatal. Lastly, we
should consider whether the treatment had been scientific.
Here we must be exceedingly cautious in giving an opinion,
and always recollect that the greatest diversity of opinion,
both as to the nature and treatment of, by far the greatest
number of diseases exists, and that the authority of eminent
men may be quoted on both sides of the question. On
the other hand, when gross ignorance is displayed and fatal
injury follows, such conduct richly deserves exposure. This
rule was laid down by Dr. Percival, and ought to be fol¬
lowed. It would, however, be an ungracious task to volun¬
teer an opinion on the practice of a respectable contempo¬
rary, even for the promotion of the ends of justice. But no
honorable practitioner would violate the etiquette and fra¬
ternal feeling which have invariably characterised the pro¬
fession, by exposing or censuring the practice of another
from private pique or jealousy, and for no public advantage.
Every man who does so, will be despised by the profession,
and indeed by the sensible and thinking part of the public.
He violates the golden rule of ethics, <f do unto others as
you would they should do unto fyou.” All medical prac¬
titioners, like their fellow mortals in all stations, are fallible;
whoever is without this imperfection, may throw the first
stone. Every man engaged in practice meets with bad and
fatal cases, and may make mistakes, but it would be unjust
and unwarrantable in a brother practitioner to expose him
to public censure, unless the interests of humanity and
science demanded it. As the law now stands, the president
of the College of Physicians or College of Surgeons is as
liable to be criminally indicted for unsuccessful practice as
the veriest empiric in this land of empirics ; such was
the opinion lately laid down by Judges Park and Garrow,
at the Old Bailey, in Long’s case ; but they went further and
declared no man, regular or irregular, can be subject to a
criminal information. Lord Coke held a felony for an irre¬
gular person to undertake a cure and allowed to die. Sir
Matthew Hale thinks this an error, and Judge Blackstone

238 Original Communications .

sides with the former ; Mr. Justice Bayley holds it man¬
slaughter— -Will cock on the laws relating to the medical
profession, p. 2 27. Such is the discord among the judges
upon this point ; but common sense and justice are in favour
of the profession and against empirics. From the preced¬
ing statements it is evident, that one medical man should be
cautious in condemning the practice of another, unless
under the circumstances mentioned.

The rules to be followed in making an autopsic examina¬
tion for juridical purposes have been in a great measure de¬
scribed in the article infanticide. Other points are to be
kept in view, as the posture of the body, whether it be
naked or covered, if it be in contact with any hard sub¬
stance, if it be so situated that putrefaction may be retarded
or promoted; how it is situated relative to surrounding
objects, and particularly with respect to weapons of all de¬
scriptions. Every part of the body is to be examined, and
all marks of violence carefully noted, when a weapon is
found in the hand of the deceased, if this really produced
death, or was so placed by a homicide. We should com¬
pare its dimensions with those of wounds, and consider the state
in which the body has been found, and before removing it,
ascertain the site, direction and extent of lesions, and finally,
to avoid confounding the derangements which may be caused
by removal with those produced by former violence. We
should also notice whether the instruments have pierced,
cut, or contused any part, and if deceased could have made
resistance. It is also necessary to note the apparent age,
muscularity, condition of the body, whether full or ema¬
ciated, the colour and quantity of hair, and in a word, every
feature which can prove identity. It is right to observe the
dress, all* papers, money and other matters found about the
person of the deceased.

Having accomplished these things, the body may be re¬
moved, washed, and every mark of injury, contusion, ecchy-
mosis, wound, fracture, dislocation, carefully examined, and
we must take care not to confound cadaverous lividity with
ecchymoses. If the body is that of a female, we must ex¬
amine the mammae, abdomen and reproductive organs, in
order to ascertain signs of recent or former delivery.

After all these considerations on the external state of the
body, we are next to examine all the outlets, observe all
fluids contained in them, and sometimes analyse the latter.

The body may be examined in the manner laid down when
describing the examination for infanticide, or as recommended

Dr. Ryan on Judiciary Examination of Wounds. 239

in the recent manuals of practical anatomy. The most
minute examination of all internal organs should be made,,
and all marks of disease carefully noted.

A question has arisen, whether an autopsic examination
ought to be made when putrefaction has set in ; and it has
been decided in the affirmative. Orfila was charged to ex¬
amine a body, which had been buried twenty-nine days ; the
external surface was generally in a state of putrefaction, and
exhaled an insupportable odour, which required the use of
disinfecting agents ; but the digestive organs, liver and
spleen, pancreas, bladder, heart and lungs, were unaffected
by decomposition, and traces of poison were found in the
stomach and bowels. A case was lately recorded in one of
the French journals, where poison was discovered fourteen
years after the interment of the body.

The brown, green or blackish colour of the skin should
not prevent the examination of the body, and the fetid odour
and all danger arising from effluvia, will be obviated by a
free use of the chlorate of lime, in the proportion of six
ounces to fifteen pints of water. Orfila strongly advises this
solution when exhumation is to be effected, and says some
pints of it are to be poured on the earth, when the labourers
approach near the coffin, and also when the latter is un¬
covered before raising it from the grave. The labourers
should apply a handkerchief, dipped in vinegar, to the lips
and nostrils, as in some cases instant death has been pro¬
duced by opening a grave.

It is indispensably necessary to open the head, chest and
abdomen in all cases ; to state all morbid appearances as
concisely and as intelligibly as possible, avoiding technical-
ties whenever we can, and observing generally that all parts
were healthy, with the exceptions which may be found. The
object of a coroner’s inquest in these countries is to ascertain
the cause of death, and not to hear a tedious and unintelli¬
gible detail of the natural appearances of every tissue in the
human body. The questions are the morbid appearances
observed sufficient to account for death, and were they pro¬
duced by natural disease or by violence ? I shall consider
all the bearings of this position in my remarks on the man¬
ner of giving medical evidence.

When the body is mutilated externally, we should examine
all the cavities, especially the intestinal canal, as cases are
recorded in which poison was detected under such circum¬
stances.

Can we distinguish wounds inflicted before and alter
death 1

■ •

240 Original Communications.

In describing* wounds, I have endeavoured to point out
the diagnosis between ecchymoses and cadaverous lividity —
a point of the greatest importance.

When a wound is inflamed, in a state of suppuration or
cicatrization, it must have been produced before death.

If it is inflicted in the last moments of life, its edges are
more or less retracted and tumid, it is covered with a clot of
blood, there is a sanguineous infiltration in the cellular tissue.

When a w ound is made some hours after death, its lips are
retracted as if inflicted during life, but its lips are pale, not
tumified, without any trace of blood ; the cellular tissue is
not infiltrated, unless a large vein has been divided.

But when a wound is made immediately after death, it is
impossible to draw a distinction ; it will possess all the
characters of a wound inflicted in the last moments of life
Much stress has been laid on the presence of blood stains
upon clothes, and deadly weapons found upon or near the
deceased, or in the possession of the accused, but we must
be fully convinced of their existence, before we give a posi¬
tive opinion. Evidence upon this point has too often proved
fatal to innocent persons. When such stains are sworn to,
the prisoner usually ascribes them to the blood of animals,
or to effusion of blood from the nose, an accidental wound
or an ulcer; but other facts generally disprove his assertions.

Can we distinguish by dissection whether death is the
effect of homicide or suicide ? A careful examination of the
situation of a wround, may perhaps enable us to determine
this question in the affirmative. If, for example, a fatal,
incised, or punctured wound, exists on the back of the head
or chest, if the hand or hands of the deceased are also
w ounded, it is evident resistance had been made, and murder
generally proved, though there may be some exceptions.
In general a suicide inflicts wounds on the anterior surfaces
of the face, chest, and abdomen, and almost always in an
oblique direction from right to left: those made by an
assassin are from left to right; but though this difference is
conclusive with some jurists, I think it far from being* posi¬
tive or satisfactory.

Fodere is of opinion that the expression of the physi¬
ognomy of the suicide is more tranquil than that of the victim
of homicide ; but this distinction is far too nice to be de¬
pended upon.

Before we arrive at a final conclusion, w^e must consider
the age, physical and moral constitution, the season and
constitution of the atmosphere, &c. In general, suicide is

Dr. Ryan on Judiciary Examination of Wounds. 241

very rarely committed before puberty, generally from the
age of 20 to 50, and rarely after this period. It is said that
persons of a sanguine temperament commit suicide in an
instant of passion, and the melancholic after long delibera¬
tion. It is proved by late writers, that this dreadful act is not
so much influenced by climate as was formerly imagined,
and that it is as common in Paris as in London. The human
frailties and passions are to be found in all nations ; and
hence we observe, that the hope to serve a country, parent
or friend, the respect for religion, for the laws, the belief in
a certain religion, political dogmata, philosophical princi¬
ples, prejudices, usages, pain, moral or physicial, chagrin,
weariness of life, impotence, delirium of passions, acute
diseases and mania, are the motives and causes of suicide in
all civilized countries.

Reflection has convinced me that the moral as well as the
physical defects of the human family throughout the face
of the globe, are not so very dissimilar, as national jealousy
had at one time determined.

Dr. Powell, who was secretary to commissioners for
licensing lunatic asylums, published an account of the num¬
ber of lunatics from 1775 to 1809 inclusive, in which he
concluded the malady was on the increase in this country.
This conclusion is disputed by Dr. Good, who says, “ cal¬
culating with Dr. Powell, that the number of lunatic pau¬
pers, and those received into public hospitals, which, under
the act of parliament, are not cognizable by the commis¬
sioners, together with those neglected to be returned, com¬
pared with the returns entered into the commissioners’
books, bear the proportion of three to two, which is pro¬
bably far above the mark, still the aggregate number of
insane persons for the year 1800, contrasted with the gene¬
ral census for the same year, will only hold a ratio of about
1 to 7300 ; while if we take, with Dr. Burrows, the propor¬
tion of suicides committed in foreign capitals as a test of
the extent to which insanity is prevalent in the same
towns, which is nevertheless a loose mode of reckoning,
though it is not easy to obtain a better, we have reason
to conclude, that insanity is comparatively far less fre¬
quent among ourselves, than in most parts of the continent:
the suicides of Paris, Berlin, and Copenhagen, as drawn
from tables collected by Dr. Burrows for this purpose,
being, in proportion to the relative population of London,
as 5 to 2 for the first, 5 to 3 for the second, and 3 to 1
for the third.”

VOL. vi. no. 33.

i i

242

Original Communications,

Sir Andrew Halliday maintains, that the number of the
insane in England has been tripled during the last twenty
years. — Letter to Lord Robert Seymour , 1829.

i . 'i-

BIBLIOGRAPHY.

MEDICINE,

1. Phthisis in its last stage , terminating favourably. — I was
requested to see a post-boy, who had been long ill with cough, and
had emaciated considerably ; I found him, as I thought, in a hopeless
state of pulmonary phthisis. He was a victim to the dark catalogue
of ills which characterize the last stage of that complaint. His
emaciation was extreme. He had, alternately, colliquative diarrhoea
and profuse sweating. The mouth was aphthous ; the cough har¬
assing, and the expectoration profuse. The ankles were oedema-
tous, and the countenance pale and cadaverous. The breathing
quick and laborious. The disease had come on insidiously . I re¬
garded it as a lost case, and so spoke of it to the friends, ordering
merely a mixture of chalk and laudanum to restrain the diarrhoea ;
and after visiting him a few times, abandoned him to his fate. To
my no small surprize, the man recovered by continuing the chalk
mixture, and has resumed his station as a post-boy, which employ¬
ment he has continued for the last three years : but there is mani¬
festly still existing great mischief in the lungs. His breathing is
short, and he is never without a cough ; moreover, his appearance
is cadaverous, and gives proof that he is still a prey to some disor¬
ganizing process in the important viscera of the chest. Notwith¬
standing all this, he has so far recovered as to be able to follow his
avocation, and is exposed to all the hardships which attend the life
of a post-boy.

What shall we say, then, of this case ? Is chalk mixture a cure
for pulmonary consumption in its last stage ? Dr. Hastings. — Mid¬
land Med. and Surg. Rep. Feb.

2. Impotence and Sterility. Dr. Harrison has published an essay
on the powerful influence of the spinal nerves over the sexual organs,
and through them upon the general state of the body, which was
added to an appendix to the Monthly Gazette of Practical Medicine-
The author relates some curious cases of spinal disease which pro¬
duced impotence and sterility, which finally gave way to his plan of
treating the original disease. We believe there are few practition¬
ers in this country so successful in the treatment of spinal curvature
as Dr. Harrison, and we have in an original editorial observation, on
impotence and sterility published in this Journal, adduced ample

Medicine .

243

evidence of the possibility of these affections depending on the causes
under consideration.

We are sorry to observe a gross and personal attack, in the last
Monthly Gazette of Practical Medicine made by Dr. Fosbroke of
Cheltenham, on a highly respectable and regularly educated surgeon
of this city*— Mr. Darwin. Granting every merit to the writer for his
unbounded zeal in attacking empiricism, of which few more highly
approve than ourselves, we would recommend him to be a little
more cautious in naming individuals in future. We might expa¬
tiate further on this topic, but we shall decline to do so. Neither
shall we remiiid the parties of an old adage, which will naturally
suggest itself, if not to them, to every other practitioner who views
their position.

3. Proposed Nottingham Dispensary .■ — We have been favoured
with a well written historical sketch of the Medical Charities of Not¬
tingham, by Mr. Thomas Jewett, surgeon of that town, where, among
the fullest particulars of these Institutions, we find to our utter asto¬
nishment “ the exclusion of the medical faculty from the committee
of the proposed dispensary.” This piece of imbecility and pre¬
sumption on the part of the governors, naturally aroused the profes¬
sion to assert its dignities, and led to several meetings of the whole
faculty, which were conducted in that decorous manner, characteristic
of our profession. A remonstrance was unanimously adopted against
the nominal cause of exclusion, “ it was not desirable to place medi¬
cal gentlemen on the committee from the danger of exciting profes¬
sional jealousy and of giving undue influence to individuals, who
might afterwards wish to become medical officers of the charity.”
It clearly appears to us, from the evidence before us, that the exclu¬
sion of the physicians and surgeons was a preconcerted plan on the
part of the governors, and that they were perfectly justified in re¬
monstrating and resenting the indignity offered to them. We are
truly surprised that the governors should be so blind to the interests
of the intended institution, as to exclude those best qualified to afford
information on the best manner of managing it. They might have
looked to their Hospital, Lunatic Asylum and other Institutions, for
the benefits conferred by the medical committees ; and if they still
doubted, they might have inquired how is this affair managed in the
metropolis. They would then have learned that there is not a Dis¬
pensary in London, that has not its medical committee, a body to
which the general committee looks with the greatest respect for in¬
formation as to the best mode of conducting the institution. We
should have doubted the possibility of the occurrence of such &T piece
of absurdity, had we not been convinced of the fact, that Dr. Mars-
den, the senior physician of Nottingham, and twenty six other medi¬
cal gentlemen had signed the remonstrance. As soon as the sage
governors had their eyes opened by the medical meetings, they
struck their colours, and expressed themselves, ready, willing and
“ happy to receive them (the medical practitioners) into their body.”

244 Bibliography.

These worthies ought to be henceforth designated, “ The Wise Men
of Nottingham.”

PRACTICE OF MEDICINE.

4. State of Medicine in Turkey. — “This gentleman was bom at
Zagori, a district not far from Ioanina, famous throughout the Levant
for its breed of itinerant quacks. The male population consists
solely of M.D.'s; Zagoriot and doctor being synonymes ; and indeed,
the medical profession becomes, in their hands, so lucrative, as en¬
tirely to supersede the necessity of any other. An idea of their
wealth may be formed from their houses, which are well built,
spacious, and the best furnished in Turkey. When at home, they
live like gentlemen at large. It may not prove uninteresting to those
who wish to ascertain the state of medicine in Turkey, to hear some
particulars relative to the education and qualifications requisite to
obtain a degree at this singular university. The first thing taught
to the young men is the professional language ; a dissonant jargon
composed purposely to carry on their business, hold consultations,
&c. without being understood by any being in existence but them¬
selves. They are then taught reading sufficiently to decipher the
pages of their i<rT£o<To(pi, or manuscript, containing a selection of
deceptive formulae, for all possible diseases incident to human nature.
When a candidate has given before the elders proofs of his profici¬
ency in these attainments, they declare him to be dignus entrare in docto
nostro corpore ; and he then prepares to leave Zagori. The Zagoriots
generally travel about Turkey in small bands, composed of six or eight
different individuals, each of whom has a separate part to perform,
like strolling players. One is the signor dottore. He never enters
a town but mounted on a gaudy- caparisoned horse, dressed in long
robes, with a round hat and neckcloth; never opening his mouth but
ex cathedra, his movements are performed with due professional
gravity, and he is at all times attended by his satellities. One is the
apothecary ; the second the dragoman ; for it is the doctor’s privi¬
lege not to comprehend a syllable of any other language but the Za¬
goriot : a third is the herald, who, endued with a surprising volubi¬
lity of tongue, announces through the streets and in the public
squares, the arrival of the incomparable doctor ; enumerates the
wonderful cures he has performed ; and entreats the people to avail
themselves of this providential opportunity : for, not only does he
possess secrets for the cure of actual diseases, but of insuring against
their future attacks. He possesses the happy talent too of ingravi-
dating the barren, and leaves it to their choice to have male or female,
&c. &c. He is skilled in the performance of operations for the stone,
cataracts, hernia, dislocations, &c. Two others, who pass under the
denomination of servants, employ their time in going from house to
house in quest of patients ; and as, from their menial employment,
they are thought to be disinterested, credit is the more easily given
to their word. Thus they journey from town to town, hardly ever

Practice of Medicine .

245

remaining more than a fortnight in any place. After a tour of five
or six years, they return for a while to their families, and divide in
equal shares the gains of their charlatanism. On a second journey,
they all change parts, in order to escape detection. The dottore
yields his dignity to the servant, and does the same offices to him as
he was wont to receive; the dragoman becomes herald, the herald
apothecary, &c." — Literary Gaz.

SURGERY.

5. — Case of Fungus Hcematodes of the Thigh, cured by Amputation.
By William M ‘Do wall. Surgeon, Kirkcudbright. — William Carson
is a lad of about 23 years of age, in the village of Twynholm, near
Kirkcudbright. He had about nine years ago been seized with a
swelling and inflammation a little above the right knee joint, upon the
inside of the thigh, accompanied with fever and swelling all over the
thigh, and an abscess formed, which, as described to me, had broke of
itself, and discharged a great quantity of matter from three different
openings above the knee. It continued to discharge matter occasion¬
ally till about the end of September 1829, when I was called to see
him. The thigh was then swelled from the knee to near the groin.
The tumour was found soft, and had the appearance of fluctuation
bqt not very distinct, like a deep-seated abscess. I called two days
afterwards and opened the tumour, with an abscess lancet, but no
matter came out ; thinking that I was not deep enough to reach the
matter, I opened it more deeply with a scalpel, but nothing appeared
except a white fatty substance and a little discharge of blood from the
cut. From that opening of the integuments, a large fungous white
tumour began next day to advance, and every day it gradually shot
out larger and larger. I enlarged the opening of the integuments of
the thigh to see what size the tumour would grow to. It continued
to enlarge till it measured about twenty inches the one way over the
top, and nineteen inches the other way, and the circumference at the
base measured about twenty-five inches. It had much the appear¬
ance of a large melon, and blood began to ooze from it, as if pressed
from a sponge. There was no way of stopping the bleeding, but by
fine tow or lint applied dry over the surface ; upon the top it began
to mortify, and emitted a very foetid smell. The lad was anxious to
have this tumour removed. For this purpose, he was taken out of
bed, and placed upon a table, and when the tumour was cut into, its
substance appeared to be soft and pulpy like brain. It was removed
down to the bone of the thigh, and was found to penetrate under the
integuments and betwixt the muscles ; I was obliged in a great
measure to push it out with my fingers, for, on account of its soft¬
ness, it would not separate well from the muscles by cutting.

There was a great loss of blood in the removing of the tumour,
which took much longer time than I had anticipated. The lad was
nearly an hour under the operation ; and from these causes, when the
wound was dressed he fainted away, and I was much alarmed for his

246

Bibliography,

recovery from the faint ; but by cordials and applying heat to his feet
he gradually recovered. The sac and wound seemed to get clean, and
began to fill up with new granulations. The matter got better ; his
appetite and strength seemed to recruit for about two or three weeks ;
and we were hopeful that the wound would have healed, but the
appearances did not continne long. Five fungus tumours began to
advance out of the sac of the wound. Every day they enlarged, and
they at length assumed heads as big as the largest apples, and indeed
appeared very like a cluster of apples upon a tree. When this se¬
cond fungus growth was advancing, a sharp point of bone was felt
by the finger just over the head of the fibula. It had separated from
the inside of the thigh bone, and had passed into the situation just
mentioned, where it was cut out with difficulty. As soon as it was
removed, a large fungus tumour just of the same appearance with
the others began to advance. That fungus bled profusely ; and
when the lad moved his limb, or upon the tumours being dressed, I
observed the blood oozing out of the top of them all, like water
pressed from a sponge. He went on in this way for several weeks ;
and from pain and loss of blood he was reduced to the last state of
human distress and misery. His pulse was upwards of 125, his
face pale, and his appetite nearly lost, and he was affected with
diarrhoea. It was now about ten weeks from the time I had first
seen him, and it was suggested that the only chance he could have
of recovery was by the amputation of the limb. To this, although
he had previously objected, he now readily submitted ; and on the
10th December, 1829, after consulting with James Watson, Esq.
surgeon in Gatehouse, I performed the operation by amputating the
limb above the diseased part. The lad stood it well, and there was
not above half a cupful of blood lost in the operation. The place
where the patient lay was a poor cottage, which being badly lighted,
and the day being dark, we were obliged to use candles in taking
up the vessels — this caused the operation to occupy a few minutes
longer. It is unnecessary to relate the different steps of the opera¬
tion, but the limb was taken off very high up, about four inches
below the trochanter major. The pulse came down, and the general
health improved every day after the limb was taken off, and in
about a month the stump was quite healed, and the poor lad had
quite recovered his strength. I may mention, that I met him on the
road upon the 10th day of April, 1830.

After the limb was removed, it was dissected and examined, when
it was found that the piece of bone measuring five inches in length,
which was cut out near the head of the fibula, had been detached
from the femur, and had left the cavity of that bone open to the
marrow. From this opening the fungus hmmatodes had proceeded.
The whole of the muscles near the knee joint were turned into
cellular substances and had lost their action, and there was very
little motion of the joint. The cavity of the joint seemed to be

Surgery.

2 47

sound, but the thigh bone above the knee on the inside where the
piece of bone had exfoliated was in a curious state a long way up.

MATERIA MEDICA.

6. Dr. Reece has published a Medical Annual for 1831, con¬
taining an account of the latest discoveries and improvements in me¬
dicine of real practical utility, in which the author has executed his
task in a concise yet comprehensive manner. He has added a selec¬
tion of prescriptions of established efficacy, a catalogue of diseases
and their treatment, with a list of drugs, their doses and numerous
auxiliaries to medicine. This work contains much valuable and
recent information, and will be perused with great advantage by the
general as well as the junior medical reader.

MIDWIFERY.

By Mr. J. Greening , Surgeon, Worcester.

7. I was requested to call upon Mrs. O. aged 35 years, of
a spare habit. She complained of acute pains over the lumbar
region, which were increased upon taking a deep inspiration, or from
over exertion. The bowels were regular ; she had not menstruated
for the last five or six months ; she believes herself to be pregnant ;
the palpitation of her heart is so strong, as to be visible ; the carotid
arteries are quickly pulsating. She had been troubled with this
complaint for several years, and had taken the opinion of the best
informed medical men in this part of the country, whose opinion was,
that she should be occasionally bled. At times, she seemed to have
lost the use of her arms ; but, upon grasping any thing firmly, she
was relieved. The pulse is regular and full ; she is troubled with
leucorrhcea. Fiat venae sectio ad Sxvi. Low diet.

28th. — The blood is buffed. She is better.

29th. — I saw her again about half-past nine, p. m. She had been
with a person whom I delivered the day before, the best part of the
day. After her return home, she was seized with acute pains in her
bowels, coming on at intervals, like labour pains 2 There is no dis¬
charge. Yy tinct. opii nfxx. mist, camph. 5iss- m. ft. Haust. statim
sumend. Eleven o’clock. The pains still continue.

30th. — 1 o’clock, a. m. — A foetus was expelled at the sixth month.
The placenta was thrown off by the efforts of the uterus. The child
was so small and feeble, that I requested the nurse to put it by, for
I thought it could not possibly live. I am confident it would go into
a quart jug.

July 1st. — She had a very restless night; she is thirsty; her
bowels are' costive. Sumat ol. ricini, §ss. Milk is secreted in her
breasts. The discharge continues. The pulse is hard and frequent,
not so full. The child is alive, and takes gruel,

9 o’clock. — The oil has operated ; she is restless ; the pulse is
soft, and 80 in a minute ; the skin is dry ; there is much pain over

248

Bibliography.

the lower part of the belly and right iliac region ; pressure gives pain.
Ap. hirad. xii. part, affectse. Liq. ammon. acet. §iss. Pot
nitrat. 5i. Liq. antimon. tart. 5iss. Aq. menth. §iv. ss. m. Sumat.
coch. mag. iii. 4tis. horis.

2d. — She is much better.

3d.— -She had occasional pains in the night. The pulse is 75 ; the
tongue is clean ; the skin moist. Capt. ol. ricini. ^ss. statim. The
child takes the breasts.

4th. — She is sitting up, and complains of nothing but weakness.
The child improves.

31st. — Up to the present time they are both well. I again
questioned her respecting the time when she last menstruated, and
she assured me she had not since January.

April 30, 1830. — She engaged me to attend her again in her lying-
in, which she expected to take place at the latter end of July of the
present year.

June 13tH. — I was sent for from Malvern, about three o’clock,
p. m. She had been in labour for some hours. She was delivered
at five o’clock. The labour was natural. The child was betwixt
the seventh and eighth months, and very feeble. Brandy was
administered to it, and the warm bath used. This child was much
larger than the last, but the nails were wanting.

14th.-—' The child is living, and the mother is doing well.

The foregoing cases do not abound with much novelty ; still it
seems worth while to note the occurrence of two children born at so
early a period of pregnancy, and both of them thiiving and doing
well. Dionis, Portal, Chapman, and other authors of a more recent
date, who have written upon midwifery, have given numerous cases;
but I do not remember any of them describing a case in any respect
like these.' — Midland Med. Rep. Feb.

MEDTCAL JURISPRUDENCE.

8. Trial of St. John Long, for Manslaughter. Before Baron Bayley,

Justice Bosanquet and Baron Bolland. Old Bailey, February 19.

The indictment against the prisoner charged him “ with having,
on the 6th October, 1830, committed an assault upon Mrs. Colin
Campbell Lloyd, the wife of Edward Lloyd, and on divers other
days between that and the 12th of same month, by administering
certain noxious unwholesome vapours and a certain inflammatory,
corrosive, and dangerous liquid which was applied to the chest and
breast of deceased, by washing, sponging and rubbing, whereby
•she -received and procured one mortal sore and ulcer, of sixteen
inches in length, nine inches in width, and two inches in depth ; in
consequence whereof she lingered to the 8th of November follow¬
ing, when she died.”

The deceased was forty- eight years of age, and had no complaint
except globus hystericus. The husband had first seen the pri-

Medical Jurisprudence .

249

soner at the inquest of Miss Cashin in August, and deemed it right
to have his advice. It appeared that the deceased inhaled, and was
rubbed on the 6th of October, and on the 8th her breast was
sloughing and in excruciating pain, and the prisoner said “ that
every thing was well and going on just as he wished.” He even
proposed to repeat the external application, which deceased
refused. Mr. Campbell was now called in, as also Mr. Vance,
both of whom considered the patient in great danger, and she
ultimately expired. Such is a condensed view of the facts stated
in the opening speech for the prosecution.

Captain Lloyd substantiated this evidence, and stated, that on
the 3d of October his wife had applied a blister about the size of
half-a-crown to her throat, as was her usual practice, and this was
nearly healed on the 6th. She called on the prisoner on the 7tli,
8th, 9th and 10th, and then complained of a violent burning across
her chest, there was great redness, darker in the centre than at any
other part ; she also complained of great shivering and cold ; the
edges round the spot became white and puffed up, there was a
whitish thick discharge from the centre ; these symptoms increased
when the redness stopped ; there were blisters on the skin ; wherever
the discharge had gone the skin was irritated, in the end wherever
the discharge had gone, the part mortified. Thirst, restlessness,
vomiting and feverishness were urgent. At this time the prisoner
said there was no danger, as these appearances were generally the
case in the first instance. During this state of things, a cabbage
leaf was applied by the advice of the prisoner, but it having pro¬
cured no relief, deceased threw it aside, and applied a simple
blister and dressing. The prisoner applied a towel to absorb the
moisture ; or, as he said, to rub it out. He said greasy plasters
were injurious, and old linen the best. He was dismissed; Mr.
Campbell called in, as also Mr. Vance and Mr. Brodie. The pri¬
soner sent a strange person to see Mrs. Lloyd, but he was refused,
and referred to the medical gentlemen in attendance.

Mr. Campbell described the deceased as suffering great pain
from an extensive wound covering the whole anterior part of the
chest, the skin was destroyed and lay separated in folds on the
chest, the cellular membrane under the skin was partly destroyed,
and there was a considerable discharge from the whole wound,
which extended from nearly one armpit to the other, above the
throat, to the bottom of the chest ; the skin was nearly off both
breasts ; the centre of the wound was darker in colour than the
other parts, cabbage leaves were applied, which witness removed,
and substituted spermaceti ointment. When Mr. Vance came, he
approved of the treatment, and advised some calamine powder with
poultices. The patient had saline aperients, quinine and mineral
acids. Mortification commenced about a week after witness’s
attendance. The wound on the breast was the cause of death ; it

VOL. VI. no. 33.

K K

250

Medical Jurispru deuce .

was not necessary to produce it for the disease in the throat or for
any disease. On cross-examination, Mr. C. admitted the known
injurious effects produced by blisters, had apprized the sister of
deceased of her danger, did not recommend a consultation, as the
family were satisfied with his ability.

On re-examination, witness said, though he apprehended danger,
he believed he understood the treatment perfectly, and after the
body was examined, he saw no reason to think he was mistaken ;
the injury was not similar to that produced by common blisters.
The simple dressing was calculated to reduce inflammation ;
rubbing would have increased, and would not in any way have
benefitted the. treatment.

Mr. Vance corroborated the testimony of last witness; was called
on 21st October, when Mr. Lloyd described the patient as suffering
from extreme soreness in her mouth and throat, and attributed it
to the inhalations of Mr. Long ; there was a sloughing ulcer on the
chest, the wound was 17 or 18 inches long, and 10 or 12 broad, the
dead parts were separating from the living ; the friends were
apprized of the certainty of her death : the mortification was the
cause of death. No man of common skill or prudence would have
produced such a wound in two or three days ; such practice is the
greatest proof of rashness and ignorance. Mr. CampbelFs account
in court of his treatment, corresponded with his statement to me.

Mr. Brodie confirmed the evidence of the last two witnesses ; he
never, in the whole course of his practice, knew such inflammation
as in the case of Mrs. Lloyd, produced by any external application,
prescribed by a medical man.

Mr, Richard Franklin, a surgeon, agreed with the former
witnesses. This was the case for the prosecution.

It was contended on behalf of the prisoner, that there was no
felony committed, that both regular or irregular practitioners were
placed in the same situation in the eye of the law, and that there
was no case to go to the jury.

Mr. Baron Bayley held, that any man presuming to meddle with
what he did not understand, unacquainted with principles, ventur¬
ing to prescribe for the sick, incurred a heavy responsibility, and
indisputably, in some cases, was guilty of manslaughter. Thus, if
a man were to say laudanum is an exceedingly good medicine, no
one could question his assertion ; but were he to administer a tea-
cupful of laudanum, was there any man in his senses would say
that such a person was not guilty of manslaughter? Surely then,
the person who would so deal with that valuable medicine, a deadly
poison, for it was the one or the other, according to the quantities
in which it was administered, would in the eyes of all men, be guilty
of a most criminal act, and would be pronounced by cverv lawyer,
to have committed the offence of manslaughter. The same obser¬
vation applied with equal force to any misapplication of any medi¬
cine, when the party misapplying it, had neglected previously to

Medical Jurisprudence

251

make himself acquainted with its properties. The consent of the
patient in the present case, did not prevent it to be an offence
against criminal law.

The prisoner was then called on for his defence ; the principal
points of which were the following : that when he ceased to attend
Mrs. Lloyd, there was no mortification ; the flesh was red and
healthy, and no injury appeared for eight days afterwards. He
knew nothing of any blister ; how could the medical men state the
cause of death, without the examination of the head and spine, the
case was riot his hut Mr. Campbell’s ; and the only remedy
employed to cure mortification was spermaceti plaster. He could
show by the testimony of hundreds of witnesses, that his process of
inhaling, is attended with the most complete success ; he prescribed
for the deceased on tfle Sunday, and she was taken out of his
hands on the Tuesday, and then her death attributed to him.
Could it be supposed that he, wTho had cured so many hundreds,
should all at once be deprived of his skill, and should be accused,
when having prescribed but once, not only of a total failure, but
of a felonious intention ? Mr. Campbell followed a particular line
of practice, evidently absurd and insufficient, and why should he be
responsible for the act of another ? He could produce gentlemen
of known learning and character, who would prove he had sufficient
knowledge to prescribe as he had done ; he had cured consumption,
liver complaint, diseases of the hip-joint, small-pox, insanity, and
a number of other maladies, and he never lost a patient, except
those who had been previously in the hands of regular practitioners.
This proceeding originated with the physicians and surgeons of this
Metropolis, though he had spent more money on his education than
any ten physicians in that court. He reminded the jury, that he
stood there upon the same terms as the President of the College of
Physicians ; he could produce hundreds in that court, whom he had
saved from the jaws of death.

An immense number of highly respectable witnesses bore testi¬
mony in the strongest and most unqualified terms to the assiduity,
skill and humanity of the prisoner, in the practice of the healing
art, and to the high character which he bore amongst those who had
been placed under his care, and to the extraordinary success which
had uniformly attended him.

Mr. Baron Bayley summed up the evidence in the most luminous
manner, and told the jury, if they were satisfied that the prisoner
acted with a felonious intention, they must find him guilty. But,
on the other hand, they were to remember, that persons with the
best intentions, might be sometimes mistaken as to the effects of
the remedy they might administer; and God forbid that felony
should be imputed in all cases where ill success took place ; the
chief question for the jury was, whether or not the prisoner had
in the present case, acted with due caution, and been previously
aware of the nature and effects of the substance he was applying,

252

Medical Jurisprudence .

and also whether he had shown sufficient skill and knowledge to
estimate the effects of such a remedy upon the individual constitu¬
tion of Mrs. Lloyd ; if they thought that he had betrayed gross
ignorance, gross rashness, or want of thought, they must find him
guilty. It was clear enough, that subsequently to the application
of the remedy, he was not guilty of any negligence ; but the question
was, whether in the first instance, he was rash, ignorant and unskil¬
ful. The learned judge then gave an historical account of the evi¬
dence, and told the jury, that if they should be of opinion that the
death of the deceased took place from the wound, they must give the
verdict against the prisoner, but they must be fully satisfied that
the death arose from that alone. If, however, they entertained any
doubt about it, then they would give the benefit of that doubt to the
prisoner ; they should also consider, whether the remedy applied
was of an improper nature to administer, for if it were not, then
the prisoner could not be charged with any bad intent ; if they
were of opinion that the prisoner was rash in making the applica¬
tion, then he had been guilty of a felonious act ; the two points,
therefore, he begged to remind them of were, had the death of
Mrs. Lloyd proceeded from the wound, and was the application
that caused that wound of a felonious nature.

The learned judge then commented upon the evidence of the
prisoner, and said it afforded him an excellent character for skill,
general care and humanity ; the jury must be satisfied as to what
was the exact state of the wound when taken under the care of
Mr. Campbell, and how it had been in the early stages of the tran¬
saction ; if, on due consideration of all these circumstances, the
jury had a perfect conviction produced in their minds that there
was a want of care and improper rashness in using the application in
question, and that the use of that was the cause of Mrs. Lloyd’s
death, then the prisoner was liable to be found guilty, and ought
to be found guilty ; but if they did not feel that full conviction,
then the prisoner was entitled to that doubt, on the points that he
had already brought before their notice.

The jury retired for an hour, and then returned a verdict of
• — not guilty.

A more extraordinary verdict than this was never returned in a
court of justice. A clearer case of manslaughter, according to the
law laid down by the learned judge, could not be recorded. It
was stated by the judge, that if the prisoner were considered guilty
of rashness, he must be found guilty ; and if the wound caused
death, a like verdict must be returned. It was proved by all the
medical witnesses, that the man who would produce such a horrible
wound as that described, afforded the best proof of rashness and
ignorance, and this evidence was unimpeached and unimpeachable.
This would be the evidence of all the Faculties of Medicine in
existence. The deceased lost her life by the infliction of the injury
or by the treatment pursued ; the medical witnesses proved the

Medical Jurisprudence.

253

latter to be judicious, and therefore she lost her life by the injury.
As to the defence made by the prisoner himself, it was all assertion ;
and the medical part of it the grossest nonsense ever uttered. The
very words, terms and phrases used by this rash and audacious
quack, prove his utter ignorance of the slightest acquaintance with
medical science.

Who ever heard of spermaceti plasters, of rubbing a suppurating
or sloughing ulcer with a towel ; of curing incurable diseases ?

The presumption and impudence of this man is unequalled in
the annals of empircism. It was no wonder he should influence a
common jury by such a tissue of plausibility and nonsense, who
decided in this instance directly contrary to the charge delivered
them ; they have rendered the State a service in allowing him
to resume his vocation ; but had he been a poor, illiterate, half
starved mechanic, he w *uld have found little sympathy. There
must have been a few thick headed persons on this jury, and we
most strongly advise them to have some of Mr. Long's innocent
liniment applied to their scalps as early as possible, lest at a fu¬
ture sessions they perchance might again be called upon, of course,
to lend their lucid minds to the consideration of another death,
accidentally caused by his remedies, not manslaughter. If Mr.
Long have a spark of humanity in his composition, let him peruse
some work upon local and constitutional irritation, and open his
eyes to the dangerous and fatal practice he employs indiscrimi¬
nately and extensively in all ages, constitutions, habits and tem¬
peraments.

Had he been aware of the danger of slight local irritation in
certain habits of body, and how speedily it will destroy life, he
would shudder at the rashness and presumption with which he
applies his external remedies. We are firmly convinced in our
own minds, indeed as much so as we are of our existence, that
both Miss Cashin and Mrs. Lloyd lost their lives by his remedies ; •
and any candid, honest and scientific member of our profession,
must arrive at this conclusion. If Mr. Long pursued a practice,
not indiscriminate, not dangerous to human life, we should never
waste aline about him. We should consign him, with his innumerable
brethren in this metropolis, to silent contempt. We should not
blame him to gull the public, “ nine tenths of which are fools,"
and his supporters chiefly of this class ; for if lords, ladies and
gentlemen choose to stultify themselves, they cannot be prevented.
But when we see a man cause a painful ulcer of the magnitude in
Mrs. Lloyd’s case, and persist in declaring it safe and as he wished,
and what was usual, no punishment could be too great for such a
fell destroyer of society ; for upon his own showing he must be
guilty of sacrificing human life to an extent little imagined by the
public. Can any scientific practitioner deny this fact ?

If 1000 patients were subjected to the same injury as Mrs*
Lloyd, we would ask how many could recover? Perhaps not five*

254

Medical Jurisprudence.

not even one. Well might Mr. Vance and Mr. Brodie condemn
the desperate practice of producing such a formidable and fatal
injury. Mr. Long, like all pretenders to physic, entertains a most
erroneous and absurd idea, that he can cure all diseases by one
remedy. He of course can form no idea of the difference of tissue,
of structure or of functions of different organs, nor no notion of the
fact, that when a part becomes disorganized, or its natural struc¬
ture destroyed by disease, such an organ can never be restored to
its natural condition. In the last stage of consumption one or both
lungs may be disorganized in part by tubercles, by purulent mat¬
ter or the various other morbid changes, known to the educated
practitioner ; and it would be as sensible of Mr. Long to assert he
could substitute a new lung for a diseased one, as to say he can
cure consumption. So also with regard to all other organs. We
throw out these observations as we know they will meet his eye,
otherwise we should apologise to our readers, for stating facts so
well known, but we hope humanity may be the gainer.

MISCELLANIES.

9. Asbestos — In a communication recently made to the French
Academy by M. Aldini, with reference to his fire-proof dresses, he
states that some experiments, which have been made at Milan, seem
to shew that garments, composed of asbestos, will supersede the
necessity of metallic dresses. A manufactory for asbestos cloth has
already been established at Valleline ; and a paper maker has it in
contemptation to employ it instead of cotton or linen in the fabrica¬
tion of paper intended for theatrical scenery. Asbestos may be
easily imported from Corsica, where it is found in great plenty, and
of excellent quality. It exists also in several other countries of
Europe, in which no use is at present made of it. — Literary Gaz.

10. King’s College. — We have at various times reported progress
in what concerns this interesting Institution, and have now to add
to the several appointments mentioned on preceding occasions, those
of N. W. Senior, Esq. to the chair of political economy ; J. J. Park,
Esq. English law and jurisprudence ; the Rev. Henry Moseley,
natural and experimental philosophy; Joseph Lowe, Esq. lecture¬
ship of commerce ; the Rev. J. R. Major, A. M. head master of the
High School, attached to the upper department.

11. We are glad to learn that the typhus fever, which has for some
time past been raging with great violence at Warwick Bridge, is
now considerably abated. The greatest exertions have been used
by the Messrs. Dixon to arrest the progress of this dangerous dis¬
order ; and to these, added to the skilful treatment of the patients
recommended by Dr. Barnes, may in a great measure be attributed
the decidedly favourable turn 'which it has already taken. Printed
regulations and directions, drawn up by Dr. Barnes, in which clean¬
liness, ventilation, fumigation, and immediate separation of the sick
from the healthy, were insisted upon, have been strictly enforced

Miscellanies.

255

among the operatives ; and the more effectually to carry them into
effect, a temporary hospital, to which all access was shut out, excepts
by permission, was erected, and a person appointed to fumigate and
whitewash the houses, and to see the regulations attended to.
Owing to these excellent precautions, the fatality of the fever has
been comparatively trifling. There have been a few deaths among
persons in different occupations in life ; but it is worthy of remark
that not one person in Messrs. Dixon’s cotton-works has died,
although upwards of one hundred cases of this fever have occurred,
— a circumstance which speaks loudly in favour of the preventive
and remedial system adopted in that establishment.

12. Extraordinary Productiveness. — In the month of September,
there were sown, in a garden near Silberberg, in Silesia, 287 grains
of wheat. At the ensuing harvest, they actually produced 117,644
grains, fully and perfectly matured ! There were two ears, amongst
the rest, one of which contained 1055, and the other 1077 perfect
grains. The longest halm measured six feet two inches in length,
inclusive of the ear, and some of the leaves were two feet and more
in length.

13. Paracentesis cranii. — Dr. Conquest has performed this opera¬
tion in seven cases of chronic hydrocephalus, in four of which a
complete cure has been effected. We trust a full detail of these
important cases will be speedily laid before the profession.

BOTANY.

14. Guaco. — At a late meeting of the Medico-Botanical Society, a
paper on guaco, by Mr. Hermann, was read ; in which numerous facts
in proof of the efficacy of this plant as an antidote for the bites of
serpents were adduced. Dr. Sigmond informed the meeting, that
Mr. Tegart had the plant in full perfection in his garden. It was
also stated by the noble and scientific president, Earl Stanhope, that
the Society will furnish any practitioner with this remedy by apply¬
ing to the secretaries. Dr. Sigmond, 24, Dover Street, and H. Gibbs,
Esq. 47, Half-moon Street. We communicate this information, as
Dr. Whiting observed, that the remedy seemed to procure some
beneficial effects in a case of hydrophobia.

The anniversary address of the noble President was delivered on
Wednesday, the 2d ultimo, at eight o’clock in the evening, and
was numerously attended by some of the most eminent physicians
and other scientific characters. Sir H. Halford addressed the meet¬
ing, and eulogized the able address of the noble President, and
moved that it be printed for distribution among the members of the
Society. It affords us much pleasure to observe the progress of
this Society, as it is the only one in this metropolis devoted to
investigation of therapeutics. The next meeting of the Society
will take place on the Pth instant, and we are happy to state that
all medical students are allowed admission to the discussions and
lectures on materia medica, botany, toxicology and chemistry, by
application to one of the secretaries.

256

Miscellanies.

BOOKS RECEIVED DURING THE MONTH.

1. Outlines of Physiology, with, an Appendix, containing Heads of Lectures on
Pathology and Therapeutics. By William Pulteney Alison, M. D. F.R.S. E. Pro¬
fessor of the Institutes of Medicine in the University of Edinburgh. Edinburgh.
1831. 8vo. pf). 152. Blackwood.

2. A Manual of Analytical Chemistry. By Henry Rose, Professor of Chemistry
at Berlin. Translated from the German, by John Griffin. London. 1831. 8vo.
pp. 454. Tegg.

3 Physiology of the Foetus, Liver, and Spleen. By George Calvert Holland,
M. D. Lecturer on Physiology, and Joint Lecturer of the Practice of Physic in the
Sheffield Medical Institution. London. 1331. 8vo. pp. 229. Longman and Co.

4. The Effects of the principal Arts, Trades and Professions, and of civic states
and habits of living, on Health and Longevity ; with a particular reference to the
trades and manufactures of Leeds ; and suggestions for the removal of many of the
agents which produce disease, and shorten the duration of life. By C. Turner
Thackrah. London. 1831. 8vo. pp. 126. Longman and Co.

5. Appendix to the Second Edition of a Series of Observations on Strictures,
&c. &c. By R. A. Stafford, Esq.

6. Arteriology of the Human Body. By Borremans ; revised, and adapted to
the English Nomenclature, by T. King, Professor of Anatomy and Surgery.
London. 1830. 8vo. pp. 15. Feuillet, Dumus and Co.

7. Medical Zoology ; or Illustrations and Descriptions of the Animals and
Minerals employed in Medicine, and of the Preparations derived from them ; com¬
prising their generic and specific characters ; English, provincial and foreign
appellations; a copious list of Synonymes; natural history; physical, chemical
and medical properties and uses ; including also a popular and scientific account of
animal, mineral, atmospheric and gaseous Poisons ; with figures coloured from
Nature, intended to serve as a continuation or supplement to the Author’s, and
other works on Medical Botany,” and Materia Medica. By John Stephenson,
M.D. F. R. S. London, 1831i Published monthly by Wilson.

8. A few Observations on the Subject of Medicinal Composition, with a view to
the establishment of an improved form of Aperient Pill, for domestic purposes ;
addressed to dyspeptic Invalids, Amateurs in the Practice of Medicine, and the con¬
sumers of popular Pills, styled “ Antibilious and recommended to ' the attention
of country clergymen and benevolent ladies, who interest themselves in the welfare
of their poor and afflicted neighbours ; to which are added, some remarks upon the
St. John Long’s principles of Practice ; the whole accompanied by numerous expla¬
natory notes. London. 1830. 8vo. pp. 32. Miller.

9. The Companion to Post Mortem Examinations ; illustrated by six plates.
London. 1831. 8vo. pp. 24. Rose. White, &c.

10. Illustrations of Mr. S. Cooper’s Surgical Dictionary, published monthly,
containing four lithographic plates, with letter-press descriptions, and references to
the text. London. 1830. Longman and Co.

11. The Nottingham Dispensary; its necessity, origin, objects and history;
historical and statistical inquiries into the Nottingham General Hospital, St. Mary’s
Medical Establishment, and other provisions for the sick poor of Nottingham ;
their resources, expenses, supporters, privileg.es and government ; the nature and
extent of their assistance, and other useful information ; a correct narrative of the
proceedings relating to the proposed Dispensary ; full particulars of the exclusion
of the Medical Faculty from its Committee; correspondence; the meetings and
resolutions of the Medical Profession ; and other proceedings arising from that
measure; opinions and comments, &c. &c. ; the whole drawn up from authentic
sources. By Thomas Jowett, Surgeon. Nottingham. 1831. 8vo. pp. 42.
Bennett &c.

12. A Letter to John Bull, on the Dissection of his Body. By Gracchus. 1829.
8vo. pp. 19. London. Eccles, &c.

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

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 34. APRIL 1, 1831. Vol. VI.

CRITICAL REVIEW.

1. — * Change of Air, or the Pursuit of Health ; an Autum¬
nal Excursion through France, Switzerland and Italy,
in the year 1829. By James Johnson,, M.D. Physician
Extraordinary to the King. London, 1830. 8vo. pp. 294.
G. Underwood and S. Highley.

It is long since we passed an evening so pleasantly, as in
the perusal of this very amusing and instructive volume.
Every page of it reminds us of the “ Sentimental Journey,”
and in referring to that imperishable production for the list
of travellers, we could find none so applicable to the able
author before us as that of Yorick — namely, the Sentimental
Traveller. Like its prototype, this work, is so spirited,
so sentimental, so full of sound moral reflection, so correct
and so impartial, that we scarcely know where to look for
its equal. It may be said to contain all the information
relating to the countries named in the title, which can be inte-
resting to the whole circle of travellers, — whether simple,
idle, inquisitive, lying, proud, vain, splenetic, and we may
add philosophical. It is a classical and philosophical tour,
in which the characteristic features of every district are
sketched with fidelity and effect ; and allusion is made
to every remarkable person or event, connected with the
locality described. In addition to extensive reading and
research, the author has travelled over many countries in
collecting his materials. The work is full of entertainment
for all who love history, topography, the description of
beautiful scenery, the traditionary legends of country, and
the antiquarian accounts of the remains of historical monu¬
ments. To travellers and invalids it is an amusing’, instruc¬
tive and invaluable companion. It is impossible to dip into
any part of it, without having the attention rivetted, and

VOL. vi. no. 34.

L L

258

Critical Review.

the fancy pleased. Of this production we need only say,
it is worthy of the accomplished author. It is written with
elegance, accuracy, and an impartial spirit of philosophy,
and will add to his high literary and professional reputation.
Had he wsitten but this volume, he would have ranked
among the best topographical writers of the day, for his
descriptions cc of men, manners and countries,” are seldom
equalled, and scarcely surpassed.

In justification of these remarks, we must place a few
specimens of the work before our readers, though there is
little medical matter to be laid under contribution. The
following extract is partly of the latter description : —

“ Moral Effects. If abstraction from the cares and anxieties of
life, from the perplexities of business, and, in short, from the opera¬
tion of those conflicting passions which harrass the mind and wear
the body, he possible under any circumstances, it is likely to be so
on such a journey as this, for which previous arrangements are made,
and where a constant accession of new and interesting objects is
presented to the eye and understanding, that powerfully arrests the
attention and absorbs other feelings, leaving little time for reflec¬
tions on the past, or gloomy anticipations of the future. To this may
he added, the hope of returning health, increased, as it generally
will be, by the daily acquisition of that invaluable blessing, as we
proceed.

“ One of the first perceptible consequences of this state of things is
a greater degree of serenity or evenness of temper, than was pre¬
viously possessed. There is something in the daily intercourse with
strangers, on the road, and at the table-d’hote, which checks irri¬
tability of temper. We are not long enough in each other’s society
to get into argumentation, or those collisions of sentiment which a
more familiar acquaintance produces, and too often raises into alter¬
cations, and even irascibility, where the mind and body are pre¬
viously irritable. These short periods of intercourse are the honey¬
moons of society, where only good humour and politeness prevail.
We change our company before we are intimate enough to contra¬
dict each other, and thus excite warm blood. Besides the conversa¬
tion generally turns on scenes and subjects with which we are
pleased and interested on the road — while political and religious dis¬
cussions are studiously avoided by all travellers, as if by a tacit but
universal compact. One of the best remedies, then, for irritability of
temper, is a tour of this kind. A few hundred pounds would be wrell
expended, annually, by many of our rich countrymen, in applying
this pleasant remedy to the mind, when soured and unhinged by the
struggles after wealth, rank, or power ! •

“ I have already pourtrayed the influence of bad health, and especi¬
ally of disordered states of the digestive organs, in producing depression
of spirits, or mental despondency, far worse to bear than corporeal

Dr. Johnson on Change of Air .

259

pain. • For the removal of this kind of melancholy, there is no other
moral or physical remedy of half so much efficacy as a tour conducted
on the plan which I have pointed out. It strikes directly at the root
of the evil, (as I shall presently shew, when speaking of the physical
effects of travelling,) by removing the causes on which this sombre
and irritable state of mind depends. It is true that, in some cases of
confirmed hypochondriacism, no earthly amusement, no change of
scene, no mental impressions or excitement, no exercise of the body,
can cheer the gloom that spreads itself over every object presented
to the eye or the imagination ! With them, change of place is only
variety of woe — ccelum non animum mutant. Yet, from two or three
instances wdiich have come within my knowledge, of the most inve¬
terate, and apparently indomitable hypochondriacism being miti¬
gated by travelling, (though the mode of conducting the journey was
far from good) I have little doubt that many cases of this kind, which
ultimately end in insanity, or at least in monomania, might be greatly
ameliorated, if not completely cured, by a system of exercise con¬
ducted on the foregoing plan, and urged into operation by powerful
persuasion, or even by force, if necessary. The change for the bet¬
ter, in such cases, is not perceptible at the beginning of the tour ;
but when the functions of the body have once begun to feel the salu¬
tary influence of the journey, the mind soon participates, and the
gloom is gradually, though slowly dispelled. Where the mental
despondency is clearly dependent on disorder of the digestive organs,
and has not yet induced any permanent disease of the brain, an
almost certain cure will be found in a journey of this kind, for both
classes of complaints. It is hardly necessary to observe that benefi¬
cial effects, to a greater or less extent, will be experienced in other
sombre and triste conditions of the soul, resulting from moral causes,
as sorrow, grief, disappointment, crosses in love, &c. by a tour con¬
ducted in such a manner as strongly to exercise the body, and cheer¬
fully excite the mind.

“ In a former part of the work has been shewn the powerful influ¬
ence of moral causes in deranging the functions of the body through
the medium of the intellectual functions. The same functions may
be made the medium of a salutary influence. In the greater number
of nervous and hypochondriacal complaints, the attention of the indi¬
vidual is kept so steadily fixed on his own morbid feelings as to
require strong and unusual impressions to divert it from that point.
The monotony of domestic scenes and circircumstances is quite
inadequate to this object; and arguments not only fail, but abso¬
lutely increase the malady, by exciting irritation in the mind of the
sufferer, who thinks his counsellors are either unfeeling or incre¬
dulous towards his complaints. In such cases, the majestic scenery
of Switzerland, the romantic and beautiful views in Italy and the
Rhingau, or the keen mountain air of the Highlands of Scotland or
Wales, combined with the novelty, variety, and succession of man¬
ners and customs of the countries through which he passes, abstract,
the attention of the dyspeptic and hypochondriacal traveller (if an

260

Critical Review.

- thing can) from the hourly habit of dwelling on, if not exaggerating,
his own real or imaginary sensations, and thus help to break the
chain of morbid association by which he is bound to the never-ending
detail of his own sufferings. This is a paramount object in the treat¬
ment of these melancholy complaints : and I am convinced that a
journey of this kind, in which mental excitement and bodily exercise
are skilfully combined, would not only render many a miserable life
comparatively happy, but prevent many a hypochondriac and dyspep¬
tic from lifting his hand against his own existence. It would
unquestionably preserve many an individual from mental derange¬
ment.

“ This principle was well understood long before medicine was
established as a science. At the extremities of Egypt were two tem¬
ples dedicated to Saturn, and to these the melancholics or hypochon¬
driacs of ancient days were sent in great numbers. There the priests
worked on the body as well as the mind by the pretended influence
of supernatural, and the real influence of medicinal agents. The con¬
sequence was, that miracles, or at least miraculous cures were daily
performed. The Romans sent their invalids to Egypt for change of
scene ; and Hippocrates has distinctly recommended those afflicted
with chronic diseases, to change the air and soil' — ‘ In morbis longis
solum mutare. ? It would be going out of my province to speak of the
benefits of travelling in any other moral point of view than that
which is connected with the restoration of health : I shall, therefore,
proceed to a consideration of the effects of this combination of men¬
tal and corporeal exercise on our bodily functions.

“ Physical Effects. — The first beneficial influence of travelling is
perceptible in the state of our corporeal feelings. If they were pre¬
viously in a state of morbid acuteness, as they generally are in ill
health, they are rendered less sensible. The eye, which was before
annoyed by a strong light, soon becomes capable of bearing it with¬
out inconvenience; and so of hearing, and the other senses. In
short, morbid sensibility of the nervous system generally is obtunded,
or reduced. This is brought about by more regular and free expo¬
sure to all atmospheric impressions and changes than before, and
that under a condition of body, from exercise, which renders these
impressions quite harmless. Of this we see the most striking exam¬
ples in those who travel among the Alps. Delicate females and sen¬
sitive invalids, who, at home, were highly susceptible of every
change of temperature and other states of the atmosphere, will
undergo extreme vicissitudes among the mountains, with little incon¬
venience. I will offer an example or two in illustration. In the
month of August, 1823, the heat was excessive at Geneva and all
the way along the defiles of the mountains, till we got to Chamouni,
where we were, at once, among ice and snow, with a fall of 40
or more degrees of the thermometer, experienced in the course of a
few hours, between mid-day at Salenche, and evening at the foot of
the Glaciers in Chamouni. There were upwards of fifty travellers
here, many of whom were females and invalids ; yet none suffered

Dr. Johnson on Change of Air.

26!

inconvenience from this rapid atmospheric transition. This was
still more remarkable in the journey from Martigny to the great St.
Bernard. On our way up, through the deep valleys, we had the
thermometer at 92o of reflected heat for three hours. I never
felt it much hotter in the East Indies. At nine o’clock that night,
while wandering about the Hospice of the St. Bernard, the thermo¬
meter fell to six degrees below the freezing point, and we were half
frozen in the cheerless apartments of the monastery. There were
upwards of forty travellers there — some of them in very delicate
health ; and yet not a single cold was caught, nor any diminution of
the usual symptoms of a good appetite for breakfast next morning.

*e This was like a change from Calcutta to Melville Island in one
short day ! So much for the ability to bear heat and cold by journeying
among the Alps. Let us see how hygrometrical and barometrical
changes are borne. A very large concourse of travellers started at
day-break from the village of Chamouni to ascend the Montanvert
and Mer de Glace. The morning was beautiful; but, before we
got two -thirds up the Montanvert, a tremendous storm of wind and
rain came on us, without a quarter of an hour’s notice, and we were
drenched to the skin in a very few minutes. Some of the party cer¬
tainly turned tail ; and one Hypochondriac nearly threw me over a
precipiece, while rushing past me in his precipitate retreat to the
village. The majority, however, persevered, and reached the Cha¬
let, dripping wet, with the thermometer below the freezing point.
There was no possibility of warming or drying ourselves here ; and,
therefore, many of us proceeded on to the Mer de Glace, and then
wandered on the ice till our clothes were dried by the natural heat of
our bodies. The next morning’s muster for the passage over the
Col de Balme shewed no damage from the Montanvert expedition.
Even the Hypochondriac above-mentioned regained his courage over
a bottle of Champagne in the evening at the comfortable ‘ Union,’
and mounted his mule next morning to cross the Col de Balme.
This day’s journey shewed, in a most striking manner, the acquisi¬
tion of strength which travelling confers on the invalid. The ascent
to the summit of this mountain pass is extremely fatiguing ; but the
labour -is compensated by one of the sublimest views from its highest
ridge, which the eye of man ever beheld. The valley of Chamouni
lies behind, with Mont Blanc and surrounding mountains apparently
within a stone’s throw, the cold of the Glaciers producing a most
bracing effect on the whole frame. In front, the valley of the Rhone,
flanked on each side by snow- clad Alps, which, at first, are taken for
ranges of white clouds, presents one of the most magnificent views
in Switzerland, or in the world. The sublime and the beautiful are
here protended before the eye, in every direction, and in endless,
variety, so that the traveller lingers on this elevated mountain pass
lost in amazement at the enchanting scenery by which he is sur¬
rounded on every point of the compass. The descent on the Mar¬
tigny side, was the hardest day’s labour I ever endured in my life —
yet there w7ere three or four invalids with us, whose lives were

262

i Critical lie view.

scarcely worth a year’s purchase when they left England, and who
went through this laborious, and somewhat hazardous descent, slid-
ing, tumbling and rolling over rocks and through mud, without the
slightest ultimate injury. When we got to the goat-herds’ sheds in
the valley below, the heat was tropical, and we all threw ourselves on
the ground and slept soundly for two hours — rising refreshed to pur¬
sue our journey.

“ Now these and many other facts which I could adduce, offer
incontestible proof how much the morbid susceptibility to transitions
from heat to cold — from drought to drenchings — is reduced by tra¬
velling. The vicissitudes and exertions which I have described would
lay up half the effeminate invalids of London, and kill, or almost
frighten to death, many of those who cannot expose themselves to a
breath of cold or damp air, without coughs or rheumatisms, in this
country.

“ The next effect of travelling which I shall notice, is its influ¬
ence on the organs of digestion. This is so decided and obvious,
that I shall not dwell on the subject. The appetite is not only in¬
creased ; but the powers of digestion and assimilation are greatly
augmented. A man may eat and drink things while travelling,
which would make him quite ill in ordinary life.

“ These unequivocally good effects of travelling on the digestive
organs, account satisfactorily for the various other beneficial influ¬
ences on the constitution at large. Hence dyspepsia, and the thou¬
sand wretched sensations and nervous affections thereon dependent,
vanish before persevering exercise in travelling, and new life is im¬
parted to the whole system, mental and corporeal. In short I am
quite positive that the most inveterate dyspepsia (where no organic
disease has taken place) would be completely removed, with all its
multiform sympathetic torments, by a journey of two or three thou¬
sand miles through Switzerland, Germany, or any other country,
conducted on the principle of combining active with passive exercise
in the open air, in such proportions as would suit the individual con¬
stitution and the previous habits of life.

“ There is but one other effect of travelling to which I shall
allude, before I close this section ; but I think it is a very important
one — if not the most important of all. It is the influence which
constant change of air exerts on the blood itself. Every one knows
the benefits which are derived from change of air, in many diseases,
when that change is only from one part to another, a few miles sepa¬
rated. Nay, it is proved, beyond all possibility of doubt, that the
change from what is considered a good, to what is thought a bad air,
is often attended with marked good effects. Hence it is very rea¬
sonable to conclude, that the mere change of one kind of air for
another has an exhilarating or salutary effect on the animal eco¬
nomy. It is true, that we have no instruments to ascertain in
what consists this difference of one air from another, since the com¬
position of the atmosphere appears to be nearly the same on all points
of earth and ocean. But we know, from observation, that there are

Dr. Johnson on Change of Air,

263

great differences in air, as far as its effects on the human frame arc
concerned. Hence it would appear that the individual, confined to
one particular air, be it ever so pure, languishes at length, and is
bettered by a change. This idea is supported by analogy. The
stomach, if confined to one species of food, however wholesome, will
in time, languish and fail to derive that nutriment from it, which it
would do, if the species of food were occasionally changed. The
ruddy complexion then of travellers, and of those who are constantly
moving from place to place, as stage-coachmen, for example, does
not, I think, solely depend on the mere action of the open air on the
face, but also on the influence which change of air exerts on the blood
itself in the lungs. I conceive, then, that what Boerhaave says of
exercise, may he safely applied to change of air. ‘ Eo magis et
densum, et purpureum sanguinem esse, quo validius homo se exer-
cuerit motu, musculorum.’ It is to this constant change of air, as
well as to the constant exercise of the muscles, that I attribute the
superiority of the plan of travelling which I have proposed, over that
which is usually adopted — where health is the entire object. On
this account, I would recommend some of my fair country-women,
(who have leisure as well as means) to improve the languid states of
their circulation, and the delicacy, or, more correctly speaking, the
pallor of their complexions, by a system of exercise in the open air,
that may give colour to their cheeks, firmness to their muscles, tone
to their nerves, and energy to their minds.” — p. 30.

Another section of the work, f<r on the medicinal effects
of Italian climate on consumption,” is deeply interesting' to
the medical practitioner. The author satisfactorily proves,
that the supposed advantages of residence in warm climates
for the cure of phthisis, have been very much over-rated.
This is also the opinion of Dr. Clark and others. He insti¬
tutes a comparison between this and warmer climates, shews
the superiority of our own, and, in other words, expresses
the sentiments of Sterne, “ where, then, my dear country¬
men, are you going ?” He observes —

“ The sum total of our knowledge, then, on this important point,
appears to stand thus : — I. In delicate health, without any proof of
organic changes in the lungs — in what is called a “ tendency to
pulmonary affection,” a journey to Italy, and a winter’s residence
there (under strict caution), offer probabilities of an amelioration
of health : — IL In cases where there is a suspicion or certainty of
tubercles in the lungs, not softened down or attended with purulent
expectoration, an Italian climate may do some good, and may do
much harm, the chances being pretty nearly balanced : — III. Where
tuberculous matter appears in the expectoration, and where the
stethoscope indicates that a considerable portion of the lungs is
unfitted for respiration, a southern climate is more likely to accele-

264

Critical Review.

rate than retard the fatal event — and takes away the few chances
that remain of final recovery.

“ If this be a correct estimate (it is at least an honest one) of
the influence of an Italian climate on constitutions disposed to, or
affected by pulmonary consumption, it shews that medical men
incur a fearful responsibility in proposing to the parents and friends
of invalids, a measure which is fraught with danger, involved in
uncertainty, and too often attended by the most destructive sacri¬
fices of the feelings, as well of the finances of the parties concerned.

“ Those who have not witnessed lingering illness and death-bed
scenes in distant climes, can form no just conception of the tide of
mournful emotions which daily rushes over the mind of the dying
stranger in a foreign land. Death is deprived of more than half his
terrors by the sympathy of friends, and the consciousness that our
ashes shall be deposited in the land that gave us birth, near those
whom, in life, we cherished, loved, or revered ! This may be a
prejudice — perhaps even a weakness ; yet it is natural — it is instinc¬
tive — and the instincts of nature can seldom be entirely repulsed,
even by the most philosophic minds.

Expellas naturum furca tamen usque recurrit.”

“ But the sigh of sorrow, perhaps of regret, is not always buried
in the grave of the sufferer, on these occasions. The companion,
who counts the tedious hours of protracted disease, and closes the
eyes of the departed friend in a foreign country, undergoes a terrible
ordeal, always harrassing to the feelings, and not seldom hazardous
to life ; while the surviving relatives, at home, are subject to the
painful anxiety of suspense— -sometimes to the poignant stings of
remorse, for having suffered the victim of an irremediable malady
to expire on a foreign shore !

“ Heaven forbid, that on such a momentous question as this,
involving the lives of my fellow creatures, I should throw the
weight of a feather in the scale against the preservation, or even
the prolongation of human existence ; but I have lived too long,
and seen too much, not to know the errors of discrimination and
the fallacies of hope, that send pulmonary invalids from the gloomy
skies, but comfortable abodes of England, to lands where comfort is
unknown, even by name, and whose atmospheres cannot work
miracles, whatever their saints may do. The balance, indeed,
between permanent benefit and blighted expectation, or even actual
injury, is so nearly poised, that a breath may turn the scale. —
That breath is as often one of error as of judgment. The conse¬
quences are obvious.

“ But there is a large class of complaints which resemble con¬
sumption, and which, I have no doubt, contribute much to the repu¬
tation of southern climates, for the cure of that terrible scourge.
These are bronchial affections, viz. — chronic inflammation or irrita¬
tion of the mucous membrane of the lungs. The journey to Rome,
or to Pisa, and the mild air of the winter in those places, with care

Dr. Johnson on Change of Air. 265

to avoid sudden transitions, often cure or greatly relieve these com¬
plaints, and the individuals are said to be saved from tubercular
consumption. The greatest care — sometimes considerable power of
diagnosis, is required to discriminate the bronchial from the tuber¬
cular affection — and yet, upon this discrimination, often hangs the
fate of the patient, or, at all events, the propriety of migrating to a
southern clime. The science of auscultation, now so ardently cul¬
tivated, will prevent much injudicious advice being given by the
profession, and much serious injury being sustained by invalids.

“ It is also probable, that in some cases where there is a very
partial or circumscribed tuberculation of the lungs, (the rest of
the apparatus being unaffected) a winter’s residence in Rome, Pisa,
or Nice, might be beneficial. This is the opinion, at least, of
Dr. Clark ; but here the greatest care is to be taken, in examination
with the stethoscope, to ascertain that the expectoration comes
from a very small excavation, the lungs being elsewhere in a sound
state.

“ There are several other infirmities, for the cure or mitigation
of which, the climate of Italy is recommended. One of these is
chronic rheumatism, and we have the testimony of Dr. Clark and
others, that benefit is often derived, in this complaint, from a resi¬
dence of some duration at Rome or Nice. This is probably the
case ; since the cold winds of Italy are dry, and the hot winds are
moist — circumstances rather favourable to rheumatism. But it
should be remembered that rheumatism is very closely allied to
neuralgia, and produced, not seldom, by the same cause — malaria.
We shall probably therefore be no greater gainers by depositing
rheumatism in the eternal city, and bringing back tic douloureux,
or some other malarious disease in its stead. Whatever advantage,
then, the rheumatic invalid may derive from the climate of Rome
or Nice, during the winter, one position may be safely laid down,
that he should avoid those seasons and those places where malaria
obtains, in other words, that he should quit Italy in summer.”—
p. 271.

A curious fact is mentioned with respect to a susceptibility
to nervous and spasmodic complaints among the residents
of Rome, which is ascribed by many writers to luxurious
habits, and by our author to the filth of the eternal city,
which, he says, is the dirtiest in Europe, except Lisbon. Both
ladies and effeminate gentlemen often faint, on perceiving
the odour of the most pleasant flavour. If compelled
to answer the cause of this, I would say that it is the
habituation to stink of the Roman streets, which prevents
the sensibilities of the olfactory nerves, renders them unac¬
customed to decent smells, and throws them into convul¬
sions on contact with a perfume.” In disorders of the
digestive organs, comprising indigestion, bilious, stomach

VOL. vi. no. 34.

M M

266

Ct diced Review .

affections, our author thinks a journey to Italy of advantage,
buthe will neither assert confidently, nor peremptorily deny,
whether a permanent residence be beneficial.

Such are some of the medical opinions of this work,
from which few well-informed physicians can dissent. The
other parts of the. volume are not fit for our pages, but we
most strongly recommend the work to all classes of our
readers. It is one of the most interesting productions which
modern times have produced.

II. — The Effects of the Principal Arts, Trades and Pro¬
fessions, and of Civic States and Habits of Living , on
Health and Longevity . By C. Turner Thackrah : Lon¬
don, 1831. Longman and Co. Leeds, Baines and Co.

This is an exceedingly instructive essay, containing much
valuable information on hygiene, a branch of medicine totally
neglected in this country. It is the production of a man
intimately acquainted with the medical sciences, and is the
only work in our language upon the subject. In other
countries, the influence of arts, trades and professions, and
of civic states, and habits of living, on health and longe¬
vity have been duly considered ; but thanks to the antiquated
rules of our universities and medical colleges, a matter of
such vast importance has been excluded from the educa¬
tion of the cultivators and practitioners of medicine in this
part of the world. We trust the day is not distant, w:hen
reform will and must be effected in our profession — when
the vile absurdities of three centuries’ date, will be con¬
signed to well-merited oblivion. We have repeatedly ex¬
posed the imperfect state of medical police in this empire,
and thereby excited the ire of our medical corporations ; but
we console ourselves with the idea, that one and all of them
deserve exposure, as well as the indignation of every inde¬
pendent and zealous friend to science. The day of mono¬
poly and insolent tyranny is gone by, and no longer shall
the few lord it over the many. The voice of the many
will, shall, and must prevail — the whole body of our pro¬
fession will arouse from that lethargy into which they have
been thrown by the sordid and corrupt imbeciles whom the
law has placed over them, and whose base and iniquitous
career draws fast to a termination. The insolent treatment

Mr. Thackrah on Health and Longevity . 267

and arrogant manners of all our medical corporations,
destroy a friendly intercourse or close connexion between
their respective members, parties who live by wrong, and
fatten upon the vitals of their profession. We turn from
such preposterous conduct with disgust, to the pleasing
duty of placing the inestimable value of our science to
mankind before our readers. The talented and erudite
author, after describing man in his several relations, as the
most interesting subject for examination and reflection,
observes —

“ If we turn our view from man to his works, we see the wilder¬
ness converted into towns and cities, roads cut through mountains,
bridges carried over rivers and even arms of the sea, ships which
traverse the globe, lakes converted into corn fields, forests made
into pasture, and barren rocks covered with timber ; in a word, we
see the face of the world changed by human will and human power.

“ If we look immediate^ at home, we observe the wonders
which science and art have effected. We see large buildings,
manufactures of almost every kind, and substances so changed,
reformed and combined, that nature could scarcely know her own
productions. We admire the inventions of science, alike in their
minuteness and their size, their accuracy, and their extent of opera¬
tion. We see wool converted into cloth, in establishments so
numerous and extensive as almost to supply the civilized world :
we see the slight blue -flowered product of the field formed, in the
same mill, into the thread which passes- through the eye of the
needle, and into the canvass which bears our ships to every region
of the globe : we see rough and massive minerals drawn from the
bowels of the earth, converted, on the one hand, into instruments
which surpass in power the united strength of the largest animals,
and on the other hand, formed into the finest and most delicate
pieces of mechanism.

“ These, and works like these, are assuredly wonderful. But
while we admire, let us examine. What are the effects of these
surprising works — effects, I mean physical and moral ? I say no¬
thing of the wealth they produce or have produced, for wealth is
good or evil according to its application. I refer to the health of
fifty thousand persons, who spend their lives in the manufactories of
Leeds and its neighbourhood, or in allied and dependent occupa¬
tions. I ask, if these fifty thousand persons enjoy that vigour of
body which is ever a direct good, and without which all other
advantages are comparatively worthless ? I ask, if the duration of
life is as great here as in the agricultural districts ?

“ To the first inquiry, the mere appearance of our population
affords a reply. Take indifferently twenty well-fed husbandmen,
and compare them with twenty manufacturers, who have equal
means of support, and the superiority of the agricultural peasants in

268

Critical Review.

health, vigour and size will be obvious. Medical men, moreover*
have daily proof of the ill effects on the human constitution, which
our employments produce. They find a number, a variety, and a
complexity of diseases, which are little known in country practice,
and which, though not directly fatal, greatly reduce the powers of
life.” — p. 3.

Our author satisfactorily demonstrates the destruction
of 150 persons annually in Leeds,, from the injurious
effects of manufactures, the crowded state of population,
and consequent bad habits of life. He argues that the
impaired health, the lingering ailments, the premature
decay, mental and corporeal, of nine-tenths of the survi¬
vors, cannot be a subject of indifference. “ Assuredly/’
says he, an examination into the state of our manufac¬
tures has long been demanded, alike by humanity and by
science.” This position cannot be disputed, but the cul¬
tivation of public medicine is scarcely tolerated, and
certainly not fostered in this section of the empire, except¬
ing the novercal protection of that wise and enlightened
body, the worshipful Company of Apothecaries. The medi¬
cal student never hears a word upon the subject during his
education, and he is expected to illumine judges and juries
on all points relating to public and legal medicine. What,
an absurdity ! He is about as well qualified to perform
this task, as he is to enlighten the judge upon thel common
and ever changeable statute law of the country. Such is
the condition of nine-tenths of the profession, and if proof
were demanded in support of this conclusion, we have
merely to refer to the public press for the amplest evidence.
No day passes without presenting us with the humiliating
evidence of some practitioner stultifying himself in courts
of justice — the most eminent as well as the most insigni¬
ficant.

In further illustration of this argument, we may add,
that our author reminds us “ his subject is new, and that
scarcely any thing has been published even on the employ¬
ments common to England at large.”

For the convenience of the inquiry, our author divides the
inhabitants of Leeds into four great classes: 1, operatives;
2, dealers; 3, master manufacturers and merchants ; 4, pro¬
fessional men. He commences with the operatives, who
approach nearest to the perfection of the physical state.
They are men of active habits, and whose employments are
chiefly in the open air.

Mr. Thackrah on Health and Longevity .

*269

“ Butchers stand at the head of this division. They are much in
the open air, and take strong exercise. Most of the masters ride on
horseback to the neighbouring markets, and often traverse the sur¬
rounding country to buy cattle. They are well known to ride fast,
and to take often long journies. Drovers of cattle for the butchers,
though their action is generally less violent, have great distances to
travel. They walk twenty, thirty, or forty miles a day. Butchers,
and the slaughter-men, their wives, and their errand boys, almost
all eat fresh-cooked meat, at least twice a day. They are plump
and rosy. They are generally also cheerful and good-natured.
Neither does their bloody occupation, nor their beef eating, render
them savage, as some theorists pretend, and even as the English law
presumes. They are not subject to such anxieties as the fluctua¬
tions of other trades produce ; for meat is always in request ; and
butchers live comfortably in times as well of general distress as
of general prosperity. They are subject to few ailments, and these
the result of plethora.

“ The atmosphere of the slaughterhouse, though sufficiently
disgusting to the nose, does not appear to be at all injurious to
health. The mere odours of animal substances, whether fresh or
putrid, are not apparently hurtful ; indeed, they seem to be often
decidedly useful. Consumption is remarkably rare among the men
employed in the slaughterhouse. If we see a phthisical youth in
the fraternity, we shall generally find that his parents, aware of an
hereditary disposition to consumption, brought him up to the busi¬
ness with the hope of averting this formidable malady. The atmos¬
phere of the slaughterhouse, imbued with a foreign admixture, is
moreover less susceptible of those natural changes, which produce
epidemics. From this circumstance, conjoined with their diet and
habits of life, butchers are less subject than other trades to cholera
and dysentery. To the same favourable combination, we attribute
their comparative exemption from diseases, considered as infectious
or contagious. Of five hundred and twenty patients taken to the
House of Recovery in this town, during the last year, only one was
a butcher, and his was a case not of typhus, but of simple fever.

“ Notwithstanding the favorable circumstances in which butchers
are placed, longevity is not greater in them, than in the generality
of employments. I suspect it is even shorter than among most
other men, who spend as much time in the open air. Butchers in
fact live too highly, not too highly for temporary health, but too
highly for long life.” — p. 9.

Cattle and horse dealers lead an active life in the open
air, and would be healthy were it not for the habit of drink¬
ing. They are liable to diseases of the stomach and liver.
Our author thinks cart drivers, labourers in husbandry, sand
leaders and road makers, would be healthy had their wages
been higher. They are subject to disorders of the diges¬
tive organs, and suffer greatly from epidemics. Brickmakers

270

Critical Review.

have full muscular exercise in the open air, and though half
naked, and with their bare feet in the puddle all day, are
not more liable to catarrh, pneumonia and rheumatism,
than men who work under cover and are dry. Persons of
great age are found at this employ.

“ Chaise drivers, postilions, stage coachmen, and guards of
coaches, with an equal advantage of fresh air, are differently
situated in reference to exercise. Postilions, of course, have great
and continued exertion ; but the kind is objectionable. Their posi¬
tion on the saddle is bad, and they use the arms unequally ; hence
curvature of the spine. They are moreover said by Morgagni to be
particularly subject to aneurism of the aorta. The drivers of chaise
and hackney coaches have more moderate and equal exercise ; but
their position subjects them to popliteal aneurism. They, as well
as postilions, suffer from irregular living, and the habit of frequent
potation. They are subject to disorders of the head and the stomach.
Still worse is the state of stage coachmen and guards. With an
equal or greater degree of intemperance, they have less muscular
exercise to counteract its effects. In addition to morning sickness,
and other affections, indicating gastric disease, they have venous
congestion of the abdomen ; then of the head ; finally apoplexy
and palsy.

“ The atmospheric vicissitudes to which all drivers are exposed,
are thought to produce rheumatism and inflammation of the lungs.
I conceive, however, that these diseases would rarely occur to
abstemious men. It is intemperance which gives the susceptibility to
such maladies ; and it is intemperance which produces much greater,
the fatal affections which we have just mentioned. I scarcely need
add, that the whole class is short-lived. They generally die before
they reach the age of fifty. Among all the Leeds men, we could
find only three individuals who are old, and two of these have the
character of great temperance.

" Gentlemen’s coachmen often suffer from excess of nourish¬
ment ; they eat more than they work. Having often to wait for
their masters, to use Dr. Good’s phrase, “ They fill up their time,
by filling up their stomach.” They also take ale too frequently:
And from these united causes, they become plethoric, have the
venous systems congested, and the secretions consequently impeded.
The fault of these men, though much less than the dram drinking
practised by their brethren of the stage, certainly tends to the pro¬
duction of gout and serious affections of the brain.” — p. 12.

Coach builders, carpenters, joiners, wheelwrights, mill¬
wrights, coopers, ropemakers and paviors, are generally
healthy when they are temperate.

Our author adverts to the unnatural state of the air of
Leeds, which he considers deteriorated by on excess of car¬
bonic acid, and says “ our skins and linen prove an abundant

Mr. Thackrah on Health and Longevity .

271

admixture of charcoal itself.” Ammoniacal and other va¬
pours from manufactories, sewers and places of refuse, add to
the general impurity. This state of the atmosphere affects,
in a greater or less degree, all the inhabitants. He thinks that
not ten per cent, of the inhabitants are in full health — the
complexion is pallid, and the tongue shews that digestion
is disordered and imperfect. Alas! what must be the fate
Of the residents of the modern Babylon, on whom the
advice of the medical poet is lost: —

Fly the rank city, shun its turbid, air.

Breathe not the chaos of eternal smoke
And volatile corruption, from the dead.

The dying, sick’ning, and the living, world
Exhal’d, to sully heavens transparent dome
With dim mortality.

However true this picture may be, it is now universally
admitted, that the progress of phthisis is much less in
smoky towns than in purer air of the country. Still it
must be granted that the impure atmosphere of crowded
streets with imperfect ventilation, is highly injurious to
health and longevity. This fact is well illustrated by the
pale and emaciated countenance of the sedentary mechanic,
which proves the presence of formidable encroachments
upon health. The truth of this position is amply attested
by daily observation. It is not air, which has reeked back
from a million lungs inquinated by rank exhalations from
“ all obscene, corrupt, offensive things,” that can be bene¬
ficial to health. Of the persons employed in a confined
and impure atmosphere, tailors are placed first.

“ Sitting all day in a confined atmosphere, and often in a room
too crowded, with the legs crossed and the spine bowed, they can¬
not have respiration, circulation, or digestion well performed. The
employment, we must admit, produces few acute diseases. But
disorders of the stomach and bowels are general, and often obsti¬
nate. Pulmonary consumption is also frequent. Some of the men
state their liability to pains of the chest ; but the majority make no
complaint. It is nevertheless apparent,- even from observing only
the expression of countenance, the complexion, and the gait, that
the functions of the stomach and heart are greatly impaired, even
in those who consider themselves well. We see no plump and rosy
tailors ; none of fine form and strong muscle. The spine is gene¬
rally curved.” — p. 16.

Not one of the workmen employed in Leeds attained the
age of sixty. The evils attendant on the employment, are

272

Critical Review.

in many cases greatly aggravated by bad habits, as these
people who are physically depressed, often seek comfort
from ale and ardent spirits. Our valued correspondent,
Mr. Dobson, informed the author of the following facts: —

“ Shultz and Co. tailors, of London, employ three hundred and
thirty-four men. Of these six are above sixty years of age ; four¬
teen about fifty ; and the greater number of the remainder about
forty. Three men of the above six above sixty have curvature of
the spine. They are so subject to anal fistula that they have a
4 Fistula club,’ Their most common affections are dyspepsia,
diarrhoea, and dull headache, with giddiness, especially during sum¬
mer. They attribute their complaints to two causes ; one of which
is, the posture, the body bent for thirteen hours a day ; the other,
the heat of the shop. I examined the temperature of the rooms on
Monday, the 7th June, 1830. It was 98°, while in the open air the
thermometer stood at 76°. On Tuesday it was 108°, and in the
open air 84°. Tailors are the most intemperate set of men in Lon¬
don. A large proportion died annually of phthisis.” — p. 17.

To correct these evils, the author suggests a plan which
might be easily adopted.

“ The position of the tailor might be amended. He now sits
cross-legged on a board ; because in the ordinary sitting posture he
could not hold a heavy piece of cloth high enough for his eyes to
direct his needle. Let a hole be made in the board of the circum¬
ference of his body, and let his seat be placed below it. The eyes
and the hands will then be sufficiently near his work ; his spine will
not be unnaturally bent, and his chest and abdomen will be free.
I am aware that old workmen will be unwilling to regard this or
similar suggestions ; for every man is formed to his habits. If how¬
ever masters and medical men would urge an alteration, and if
especially boys apprenticed to the trade were taught to work in the
posture recommended, tailors would assuredly become much more
healthy. The practice of drinking might also be easily reduced, if
masters discharged from their employ every man who absented him¬
self a day without proper cause.” — p. 18.

The evils which affect milliners, dress makers and straw
bonnet makers, arise from crowded apartments, and improper
length of time in which these persons are employed. They
are often employed from six in the morning until twelve at
night. The bent posture in which they sit injures the diges¬
tive, circulatory and respiratory organs. Hence fresh look¬
ing country girls soon become pale and thin. The constant
direction of the eyes to minute organs produces ophthalmia
or amaurosis. The respiration is affected very much by the
sulphurous gas evolved in the process of stoving straw

Mr. Thackrah on Health and Longevity. 273

bonnets. It induces cough, and finally pulmonic disease.
This gas might be absorbed, in a great measure, by plac¬
ing water in a shallow dish, or prevented by having the
operation performed in a small out building. The other
remedies for the evils attendant on these trades, are ventila¬
tion, reduction of the hours of work, and exercise in the
open air. The great cause of ill health of dressmakers is
the lowness of their wages, which oblige them to work in
excess. They are subject to pain in the left side, constipa¬
tion, dyspepsia, irregular menstruation, and probably from
neuralgia, arising from slight curvature of the spine, or at
least from the unnatural position of that column.

<f Weavers have a confined atmosphere, and, though the limbs are
fully exercised, the trunk is kept comparatively fixed, and the chest
is not expanded. This stooping however, is somewhat diminished
by the mode of casting the shuttle with a string, instead of the
hand. W hen weaving is carried on at home, the rooms are often
small and ill ventilated ; and among the Irish we find a sad want of
cleanliness. Fever is rather frequent among weavers, but other
acute diseases are rare : the men, however, seldom enjoy health.
Digestion is imperfect, asthma and other affections of the chest are
common. They complain of the smell from the oil-lamps. This
no doubt annoys the lungs, but their reduction of health is attri¬
butable chiefly to the confinement. The susceptibility of fever may
arise from the frequent defect of proper nourishment. The weavers
of stuffs have low wages, and are often out of employ. There are
more old men in the occupation of weaving than in most others.”- —

p. 21.

Our author describes the injurious effects of all trades,
but we must confine ourselves to the most common.

“ Shoemakers, it is well known, are placed in a very bad pos¬
ture — a posture second only to that of tailors. The abdominal
viscera, and especially the stomach and liver, are compressed. Lads
put to this employ, often suffer so much from headache and general
indisposition that they are obliged to leave it ; and men who have
been able to bear it for years, lose appetite and strength. Digestion
and circulation are so much impaired, that the countenance would
mark a shoemaker almost as well as a tailor. We suppose that,
from the reduction of perspiration and other evacuations, in this
and similar employments, the blood is impure, and consequently the
complexion darkened. The secretion of bile is generally unhealthy,
and bowel complaints are frequent. The capacity of the lungs in the
individual examined we found to average six and one-third, and the
circumference of the chest thirty-five inches. In the few shoe¬
makers who live to old age, there is often a remarkable hollow at
the base of the breast bone, occasioned by the pressure of the last.

VOL. vi. no. 34.

N N

274

Critical Review.

Are shoemakers subject to popliteal aneurism? Morgagni asserts
this ; hut I am not aware that a similar observation is now made.
Much as posture injures shoemakers, bad habits injure more. Work¬
ing late on Saturday night, they often lie in bed all Sunday morn¬
ing, lounge in listlessness all the afternoon, drink all Monday, are
sick and taking physic on Tuesday, and return to work on Wednes¬
day. Surely the interference of the masters might prevent half the
disease and wretchedness for which the shoemaker is remarkable.
Exercise in the open air is urgently required for the relief of this
as well as other employments, which we have yet to examine ; but
to prevent repetition I shall make some general remarks on this sub¬
ject at the close of the paper.

“ Curriers and leather-dressers are subjected to no injurious
agent, except the bent posture in the process of “ shaving.” This
affects the head. The smell of the leather produces no disagreeable
effect. The men are generally very healthy, and a considerable
proportion live to old age.

“ Saddlers are obliged to lean forwards, and are confined to this
position. Hence they are subject to headache and indigestion.

“ Printers are kept in a confined atmosphere, and generally want
exercise. Pressmen, however, have good and varied labour. Com¬
positors are often subjected to injury from the types. These, a
compound of lead and antimony, emit, when heated, a fume which
affects respiration, and are said also to produce partial palsy of the
hands. Among the printers, however, of whom we have inquired,
care is generally taken to avoid composing till the types are cold,
and thus no injury is sustained. The constant application of the
eyes to minute objects gradually enfeebles these organs. The
standing posture long maintained here, as well as in other occupa¬
tions, tends to injure the digestive organs. Some printers complain
of disorder of the stomach and head ; and few appear to enjoy full
health. Consumption is frequent. We can scarcely find or hear
of any compositor above the age of fifty. In many towns printers
are intemperate.

“ Bookbinders and pocket-book makers are similar employments.
The work is remarkably easy, and keeps no muscles fixed, nor
demands excessive action from any. The workmen suffer no annoy¬
ance, except occasionally from close atmosphere, and from the smell
of the putrid serum of sheep’s blood, which they use as a cement.
The selection of this substance is unwise, since white of egg or
other albuminous matter would answer the purpose, without offend¬
ing the senses. The pocket-book makers have high wages, and are
not compelled to keep hours. Hence they are often very dissipated.
One master informed us that several of his people have died from
consumption. This, however, I should attribute, not to the employ,
but to intemperance.

Carvers and gilders are kept in a confined atmosphere, and
often for long periods in a leaning posture. Hence they sometimes
suffer from headache. Though the pallid appearance, general among

Mr. Thackrah on Health and Longevity. 1275

these workmen, indicates a reduction of health and vigour, life is
not abbreviated in a marked degree.

“ Clockmakers have little objectionable in their occupation ; for
though the making and fitting up are carried on in the house, the pos¬
ture is varied, and the men are frequently travelling to repair clocks
in the country. They are generally healthy, and attain often advanced
life. Watchmakers have a much worse employ. They sit all day
with their trunk bent forward. The digestive organs almost always
suffer, and the lungs are sometimes affected. The close and con¬
tinued application also greatly injures the eyes. Many youths
apprenticed to watchmaking are obliged to leave the employ, and
the individuals who remain rarely live to old age.

ft Smiths have an employment remarkably conducive to muscular
power. The use of the large hammer powerfully excites all the
muscles, and especially those of the arms, throwing on them a large
supply of blood, and consequently producing their enlargement.
Exertion like this, moreover, has a considerable effect on the circu¬
lation in general, and the functions with which it is connected. For
youths of strong constitution, no labour is better than than of the
smith. For those, however, naturally delicate, the exertion is too
great, and young men of scrofulous constitution are particularly
liable to sink under the employ. Smiths are subject to high tempe¬
rature, and frequent changes of temperature, but with no obvious
injury. They are rarely affected with rheumatism and catarrh.
The employment subjects the eye to the annoyance of smoke,
and to excitement from the glow of the heated iron. But our
examination of the smiths in this neighbourhood does not prove
them subject to ophthalmia; nor does it show that vision is impaired
by the excitement of the retina. When smiths are ill, the cause is
most frequently intemperance. They do not however arrive at great
age. We could hear of but one old smith in the town of Leeds.

“ Cabinet-makers are generally healthy, though employed within
doors. The labour is good ; and there is no hurtful accompaniment,
with the exception of the dust, which is produced by sawing certain
kinds of wood.

“ Patten- makers are subject to no other inconvenience from their
employ, than the bending posture required in cutting the sole or clog.

“ House-servants, from their confined situation in a smoky town,
are rarely in full health. We find them often affected with disorder
of the digestive organs and of the head ; the latter particularly fre¬
quent. Girls from the country soon lose their ruddy complexion,
and suffer more than the natives of the town. Kneeling produces in
housemaids a swelling of the bursa, near the patella, which produces
considerable inconvenience, though seldom serious disease. Foot¬
men, who stand long behind carriages, are said to be frequently
affected with hydrocele.

Waiters at inns, irregular and dissipated in their habits, are
generally unhealthy. They die comparatively young.

276

Critical Review.

III. — A Brief Statement of the Progressive Imp>rovement
of the Health of the Royal Navy, at the end of the
eighteenth and beginning of the nineteenth century ;
together with practical illustrations , and a narrative of
some historical incidents connected with the subject. By
Sir Gilbert Blane, Bart. M.D. Physician to the King,
&c. & c. London, 1830. pp. 55.

We are much indebted to a medical officer of the navy, for
the two tracts on the subject at the head of these remarks,
as their perusal has afforded us great satisfaction, and as
the information they contain is so highly important, we
hope our esteemed correspondent will excuse us for making
a few extracts, though the productions have not been pub¬
lished.

Any one acquainted with the naval history of this country
for the last fifty years, must reflect w7ith pain on the great
mortality of seamen before that period, and must feel sin¬
cere pleasure at this sort of improvement which has taken
place in the health of seamen. This mighty change was
effected by Sir Gilbert Blane, Bart, by whose exertions
alone, are the wooden walls of England enabled to rule
the waves at all seasons, and in all climates, for an indefi¬
nite length of time. Such are a few of the benefits con¬
ferred on science and humanity by this humane and talented
physician, of whose career we gave an imperfect sketch in
a former number. The first essay before us was presented
to his most gracious Majesty at New York, at the date of
its publication, and the second is now respectfully dedicated
to the same illustrious and universally beloved sovereign,
whose paternal love for the welfare of all classes of his
people, is the theme of the first admiration of his devoted
subjects.

These tracts are highly instructive, and exceedingly
interesting. They cannot be perused without impressing
the reader with the most favourable opinion of the head
and heart of the author ; for an ardent love of science, of
country, and of humanity, is displayed through every page,
which is calculated to make a deep impression upon the
minds of every class of readers. We hasten to illustrate
our statement by a few extracts.

“ In the course of the year 1780, my first year of service as
physician to the fleet on the windward station, I found from my
own returns and from examining the records of the hospitals, that

Sir G. Blane on the Health of the Royal Navy. 2 77

the annual loss of lives from disease previous to our arrival, and
some time after, had been at the rate of one in seven ; nor was this
alarming rate of mortality imputable to the prevalence of the pecu¬
liar epidemic of the climate, for there were then very few cases of
yellow fever ; and as the principal causes of it were such as seemed
to me to be removable by practical and attainable means, I was
anxious to state these circumstances at the source of authority. I
found that in a fleet, of which the complement of men was 12,109,
the mortality in one year had amounted to 1,518, besides 350 ren¬
dered unserviceable, a number more than equal to the equipment of
three ships of the line. When this is duly weighed by a considerate
mind, as it affects the most important interests of the state, together
with the great difficulty and expense of replacing these valuable
subjects by fresh recruits, and when the calamitous sufferings of the
individuals themselves are brought home to our feelings, no case
could be conceived more calculated to awaken sentiments of patri¬
otism and humanity.

“ No opportunity occurred of effectually removing these deplor¬
able evils till the autumn of 1781, when I attended Sir George,
afterwards Lord Rodney, to England, whither he went in order to
procure reinforcements, foreseeing that the windward station in the
West Indies would become the great theatre of war. It was then I
made such representations as brought about a total change in the
state of health of the fleet.

<f In a memorial to the Board of Admiralty, I stated the causes
of disease to consist in : —

“ 1st. The neglect of cleanliness, ventilation, and dryness in the
interior economy of ships.

“ 2ndly. The want of the supply of an article, which had been
found, by the most unequivocal experience to be infallible in pre¬
venting and curing scurvy, one of the most destructive scourges,
and the most peculiar to the sea service, of any class of disease.
The remedy alluded to is the juice of lemon or limes.

“ 3rdly. The abuse of spirituous liquors, not merely as the most
common means of intemperance, but as the habitual beverage of
seamen, even when diluted. I recommended the substitution of
wine, and, I ought to have added, of strong malt liquor.

“ 4thly. The want of adequate nourishment and comfort for the
use of the sick and convalescent on board of their own ships.

“ 5thly„ The want of proper bedding and of soap ; so that along
with the suitable articles of diet, the means might be afforded of
curing men on board of their own ships, the hospitals on that station
being at that time too small, ill arranged, and extremely expensive ;
the men by going ashore being also exposed to the epidemic and
endemic of the climate, and to the most pernicious temptations,
from the facility of procuring the means of intoxication.

“ 6thly. The want of a gratuitous supply of medicines, as well
as necessaries to the surgeons, in order to enable them to cure as
many as possible without sending them to hospitals.

278

Critical Review.

•* 7th. As hospitals are, to a certain degree, indispensable at the
principal stations, especially for the relief of ships in which con¬
tagious diseases prevail, new regulations of them in point of space,
separation, ventilation, and cleanliness, were also recommended.

“ Though all the recommendations here specified were not at first
complied with in their full extent, enough was done to evince their
expediency, and to lead to great future improvements. I had the
immediate and high gratification of succeeding in the recommenda¬
tion of wine, and of being an eye witness of its almost incredible
benefit in the new reinforcement which accompanied the admiral on
his return.” — p. 22.

“ There are so many public advantages as well as sentiments
dear to the heart of every good subject and good man, that they
cannot be too much recommended, cherished, and dwelt upon. Of
these subjects of reflection none seems of such magnitude as the
consideration that, in consequence of the great improvement of
health the efficiency of the navy is doubled, and the national trea¬
sure husbanded to an incalculable amount. What a consolation it is
in the present state of the public finances, that in case of any future
war, it can be carried on at sea with so great an abatement of trea¬
sure, and consequent burdens on the nation ! For it does not
require any deep thought to perceive that at a time when a fleet, as
we have seen, could not keep the sea for more than ten weeks with¬
out being rendered unserviceable by scurvy, and that national pro¬
tection required that when the channel fleet has been constrained to
return into port in so short a time, another naval force, as nearly
equal as possible, ought to be ready to replace it, for repelling inva¬
sion, or baffling the expeditions of the enemy. I was in the habit
of saying that at present there was as much service in two ships as
formerly in three ; but one of the most distinguished sea officers
that ever lived, declared to me, that it was his conviction that two
ships now are equal to four of former times. How must every young
man’s breast therefore exult, when, from the moment he enters the
service, he feels conscious of his contributing to these splendid
results, while at the same time their hearts are swelling with pride
that they belong to a country, which almost in their own memory,
or that of their fathers, have made such displays of skill and gal¬
lantry as are unequalled in the history of the world, namely, the
conflicts of the 12th of April, 1782, near Dominique, under Lord
Rodney ; that of the 1st of June, 1794, on the confines of the Bay
of Biscay, under Lord Howe ; that of the 14th of February, 1797,
under Lord St. Vincent ; that of Camperdown, on the 11th of Octo¬
ber, of the same year, under Lord Duncan ; that of the 1st of
August, 1798, at the mouth of the Nile, under Lord Nelson ; and
that of the same great commander on the 2d of April, 1801, at
Copenhagen; that of July, 1801, under Sir James Saumarez ; and,
to crown all, that of the 21st of October, 1805, at Trafalgar, under
the immortal Nelson.” — p. 17.

Sir G. Blane on the Health of the Royal Navy . 279

Our author deemed it expedient to enlighten the com¬
manding- officers of the navy, regarding the most effectual
means of maintaining the health and vigour of the men, of
preventing the invasion of disease, and of doing justice to
the sick.

“ I felt it therefore as a matter of impervious duty to explain
myself fully on this subject to the commanding officers of the fleet;
This I did in a printed tract, 1780, which was distributed among
the flag officers and captains. In this I endeavoured to set forth
how much the health of the men, particularly with regard to the pre¬
vention of disease, depended on the good judgment and exertion of
officers, who alone could establish and enforce the regulations
respecting ventilation, cleanliness, and discipline. This was ex¬
tremely well received ;* and it is not for me to say what share it
may have had in the great alteration in the conduct of the officers
of the navy regarding these duties, and how far it may have con¬
tributed to the revolution which has taken place in later times in
the whole system of the medical management of the navy. There
can indeed be no situation in which there is more room for genuine
virtue, praiseworthy conduct and address none to which there
attaches more grave and solemn responsibility; none on which there is
a more imperious claim on the conscientious discharge of duty, than
that of a naval commander. The men are cast on his humanity and
discerning judgment under various aspects. A ship in the middle
of the ocean is a little world in itself, at the arbitrary disposal of an
individual — seamen and marines are subjected by martial law to a
more despotic exercise of power than the constitution of the state
authorizes in civil life, or even in the army — naval officers can, at
their single arbitrary discretion, inflict such a summary and severe
punishment as cannot be inflicted in the army without the solem¬
nity of a court martial. Englishmen surrendering from considera¬
tions of public expediency what they hold most dear, and that of
which they are most jealous — their liberty, becoming thereby the
greater objects of grave decision and considerate feelings. All sea¬
faring people, especially those employed in war, are exposed to
peculiar and unavoidable privations, hardships and dangers, which
ought to be mitigated, as far as is practicable, by those at whose

* The author has in proof of this, not only the innumerable
testimonies of personal regard which he has experienced during
the after part of his life from these distinguished persons, but their
interposition on his behalf on the conclusion of the war, when they
unanimously made application, through the Admiralty, for a reward
to him in peace, no half-pay being then established for physicians
to fleets. In compliance with this, his majesty was pleased to grant
him a pension for his services.

280

Critical Review.

absolute will they place their lives and limbs ; it is in their character
to be unthinking and careless of their own welfare and interest,
requiring to be tended like children, and, like children, are entitled
to a parental tenderness from the country they protect and the
officers they obey.” — p. 29.

Scurvy has been prevented, subdued, and totally rooted
out, by the general use of lemon juice, since 1795, and has
remained so, and fevers are entirely extinguished.

These improvements have extended to the naval services
of all countries, and entitle their author to a place among
the best friends of science and of mankind.

IV. — The Life of John Walker , M. D. Graduate of the
University of Leyden, Licentiate of the Royal College
of Physicians of London , and late Director of the
Royal Jennerian and London Vaccine Institutions.
By John Epps, M.D, Graduate of the University of Edin¬
burgh, Lecturer on Materia Medica and Chemistry, Di¬
rector of the Royal Jennerian and London Vaccine Insti¬
tutions, &c. & c. London 1831, 8vo. pp. 342. Whitaker,
Treacher & Co.

The subject of this biography was one of the most strenuous
supporters of the Jennerian discovery, and diffused its bles¬
sings among mankind under a variety of circumstances and
in opposite climes. The career of this extraordinary and
eccentric character, abounds with features replete with inte¬
rest. It would be foreign to the tenour of this Journal, to
introduce a full account of the life of this worthy physician,
more especially as it contains his literary, political and reli¬
gious opinions, which would be misplaced in a journal of
this description.

His biographer and successor has done him ample justice,
and executed his undertaking with much ability and judg¬
ment. His dedication is so singular, that it must be quoted.

“ To the World,

" To thee, thou mass of civilized and uncivilized intelligence, I
present this work, containing truths of the highest importance.
The individual whose life this is, devoted his existence to thy good ;
and that thou wilt look to the promotion of his good (in the person
of his widow) in return, in promoting the interests of this offering,
is the hope of the biographer.

John Epps.

Dr. Epps’s Life of Dr. John Walker.

2S1

To those who knew the Doctor, that is the whole profes¬
sion in London, a few anecdotes of him cannot be void of
interest. Dr. Walker was born in the borough of Cocker-
mouth, in July, 1759. His parents were humble and indus¬
trious, and took great care to procure the blessings of edu¬
cation. While at the grammar school with his fellow
townsman Dr. Woodville, it appears he had no great love for
learning or the learned, as the following' anecdotes amply
testify : —

“ While there, Walker exhibited that vagariousness of disposi¬
tion, which formed a constant feature in his life. At his tasks he
was the idlest of boys; at his amusements the most active. His
guilty looks, on repairing to school after an holiday, sufficiently
evinced that the whole time had been spent in play. When obliged,
however, he could write with considerable expedition his Latin
themes, which were so well finished as to obtain for him considerable
praise. Frequently he went to his master’s desk four or five times
in the day to repeat his lesson in Virgil or Ovid, depending, espe¬
cially after his master’s dinner, upon the soporific influence thence
arising. Cultivating this dependance, he learned generally only two
or three of the first lines, and a few at the end of the lesson.
Before completing the few he knew, the master began to nod.
Young Walker kept his eye fixed upon the sleeper, keeping up, at
the same time, a humming sound, without articulating a syllable,
till the master, giving a greater nod than usual, awoke, when the
young rogue repeated the last line of his task and went to his seat.
When the honest pedagogue was sufficiently on the alert, the defi¬
ciency was detected, and Walker flagellated, was sent to his form.”
— p. 5.

Having received a limited education, he became weary of
the pursuit of his father, which was that of a blacksmith, and
determined to go on board a privateer in the Bay of Dublin.
On his arrival in the capital of Ireland, he was astonished at
the splendour and elegance of the public buildings, a full
and faithful account of which is given in his Universal Gazet¬
teer, published in 1795. ffThe attentions and familiar man¬
ners of his new acquaintances made him feel very soon at
home.” He failed however to accomplish his object in
going to sea, and was greatly reduced in circumstances,
when chance threw him in contact with an engraver, named
Esdale. With this worthy man he remained for four years,
and in the year 1780 published Walker’s Hibernian Magazine.
He had the use of a good library with his friend, and readily
availed himself of its advantages, devoting all his leisure

VOL. vi. no. 34.

o o

282

Critical Review.

hours to acquiring* the knowledge of Greek, Latin and
mathematics.

He now determined to become a schoolmaster, and braved
the difficulties which at first appeared insurmountable to this
accomplishment of his wishes, by adopting the axiom, Cf pos-
sunt, quia credunt posse;” in other words, “ they must conquer
who will.” He soon discovered, however, that this motto
did not remove his difficulties ; he was scarcely able to meet
his slender expenses, and was so distressed that he could
not afford himself candlelight during the winter’s nights. This
however arose from his expending* every penny he possessed,
after the discharge of his bills, in the purchase of books at
the auctions in Dublin, which are always numerous. On
leaving these marts of literature, he often wished he could
enjoy the light of the street lamps in his chamber, to enable
him to prosecute the drawing and etching of a set of plates
for a Latin edition of Euclid, then publishing by the Univer¬
sity. Such were the privations which this worthy lover of
literature and the arts wras doomed to endure. Influenced by
the motto we have inserted above, he discharged the duties
of his little school with unwearied zeal, and was so fatigued by
his calling that he was obliged to retire to bed after his
labours were over at 5 p. m. and slept until midnight, when
he arose to prosecute the arrangement of his geography and
Gazetteer, which originally consisted of the substance of a
course of lectures he delivered to his pupils, in his mathema¬
tical and classical academy on Usher’s Island. These
works, so well known to the public, were finished in 1788.
Time rolled on, he acquired many friends, his scholars in¬
creased to a hundred, so that in 1792, he was able to publish
the quarto edition of his works. Here we must mention a
curious feature in his scholastic discipline; he had no corpo¬
real punishment, very little coercion, and so far did he cul¬
tivate a familiarity of address with his scholars, that they
always called him by his sirname. No man could be more
interested with his vocation. A second edition of his works
were called for, and as his resources did not enable him to
incur the expenses of publishing*, he determined to com¬
mence a tour through England, Wales and Ireland, to solicit
subscriptions, having committed the care of his school to
competent assistants. These peregrinations conluded, he
gave up his school to Mr. John Foster, author of the
r‘ Moral Essays,” and repaired to the great metropolis of the
world. He now entered himself a student at the medical
school, Guy’s Hospital, where he became acquainted with
Sir Astley Cooper and others, who have since attained con-

Dr* Epps’s Life of Dr. John Walker.

283

siderable eminence. He there acquired a knowledge of ana¬
tomy and physiology, and was so fascinated with these
branches of science, that he prefixed a sketch of the latter to
his own work. The success of this production need not be
mentioned ; its rapid sale enabled him to prosecute his medi¬
cal studies in London, Paris and Leyden. He remained
three years in the celebrated school in the Borough, and in
1797 repaired to Paris, in further pursuit of knowledge. At
this period the revolution raged in that city, which led our hero
into some awkward embarrassments. Though not an ortho¬
dox Quaker, for he was never regularly admitted into the
society of friends, he was one in garb and principles, and in
support of the peculiarities of his sect, he refused to wear
the national cockade, or to take off his hat in the council of
the ancients. So strange did this conduct appear, that the
news boys in the Palais Royal offered papers for sale, voci¬
ferating, among other remarkable events of the day, (t voila,
citoyens ! voila le grand detail d’un homme assez singulier
qui ne voulait pas oter son chapeau au tribunal du conseil des
anciens. Voila le grand detail.”

In 1799, Dr. Walker obtained his medical degree at
Leyden, and returned to England to complete a tender
engagement under which he had been for some years. This
subject, os well as the numerous incidents which occurred to
him in Scotland, and more especially with the Edinburgh
professors, we must pass over, with one exception, which
was the assistance he received from Professor Campbell,
author of The Pleasures of Hope,” in correcting the
second edition of his Thesis, which he composed at Leyden,
and also his Dissertation on the Structure and Functions of
the Heart.

In the year 1800, he was appointed to accompany Dr. Mar¬
shall, who was sent to Naples to introduce vaccine inocula¬
tion. During the voyage, the protective influence of vacci¬
nation was exerted at Minorca, Malta, Gibraltar, Naples
and Sicily ; and at length, we find the fleet before Alexandria.
Here the victorious French were on one side and the
invincible British on the other, and both looked with anxious
suspence at the result of the conflict.

** The troops were ordered to land. The hostile shore bristled
with bayonets. The carnage is terrific. One boat is sunk. Others
are in danger. The admiral, not wishing to destroy his men in
what he considered a fruitless attempt, ordered a return. The sig¬
nal was not, in the moment of excitement and confusion, noticed.
The British persevere ; they land ; the battle is fought ; the shout

284

Critical Review.

of victory is heard, mingled with deep-toned grief at the death of
Abercrombie. Dr. Walker grieved for Sir Ralph, and says of him,

‘ * he was not more distinguishable for his bravery than for his huma¬
nity and generoshy,” a very appropriate description.

“ The fact above noticed is rather interesting, and was never, it
is believed, recorded till by the subject of this memoir. How extra¬
ordinary are the turning of events ! Benevolence led the admiral
to hoist the flag of return, The confusion prevented its being per¬
ceived. Perseverance was the consequence, and success was the
result. Had the order been noticed, Buonaparte might, perhaps,
have extended even farther than he did his gigantic strides.

“ While our troops were using the weapons of destruction, Dr.
Walker was busily employed in saving life. His work of vaccina¬
tion being completed, he attended the sick of the British navy and
of the Turkish army. The word “ weariness,” while engaged in
these works of mercy, he seems hardly to have known ; being
assisted therein by his excellent friend, General Sir John Doyle, in
prosecuting these labours of goodness. He was much pleased with
the cleanliness of the public hospitals, being in this respect, and in
that of attendance, better provided than the European ; each patient
having a comrade (putting aside poetical augmentation) “ to fan
him when he sleeps, and wait on him when he wakes,”

“ Foreigners, and it is grievous to mention it, appreciated his
services more than the British government. From the Pacha at
Rosetta, a town situated on the western branch of the river Nile,
about twenty-five miles N. E. of Alexandria, he received a present,
with an apology for its smallness, in the declaration that the French
had diminished the resources of his country. The services, how¬
ever, which Dr. Walker rendered to the British seamen ashore, (no
part, be it remembered, of his proposed duty) were not attended to
by the British government. The government did not even refund
the money he laid out for providing his suffering patients such
necessary refreshments as the commissary’s stores could not supply.
In making this provision he was authorized by the Inspector-
Generals. It is right, however, to state that Dr. Walker believed
that the Admiralty gave orders that his and his colleague’s disburse¬
ments should be paid ; an order which, from the changes in this
department of the government at the time, has never been attended
to. The sum voted was comparatively trifling ; being from the
Admiralty only £.100, to be divided between Drs. Marshall and
Walker ; and from the War Office £.100 each, and this simply
from the kindness of the Duke of York. This sum did not equal a
fourth of the expenses which they had to experience. And even
this sum was not awarded until letters upon letters were written
to the principal members of the various ministries which have
existed since the time,

“ The declaration has escaped Dr. Walker in conversation that
the neglect rests with a late secretary, who, having since been pro¬
moted, seems not likely to trouble himself more about the matter.

Dr. Epps’s Life of Dr. John Walker.

285

The Doctor, too, not being a vindictive creditor, pocketed the loss,
and endeavoured to find the best of all remuneration for his painful
services, and his passing his nights on the hard ground at the camp
before Alexandria, in the recollection of his usefulness — in the

“ Mens sibi conscia recti.”

“ This neglect, however, should no longer be allowed to remain,
and the widow of Dr. Walker should receive, from the hands of the
government, what her husband had a right to claim ; more especi¬
ally as the following testimonial from Major-General Hutchinson
proves how diligently the now defunct laboured in the promotion of
the cause of his countrymen : —

“ ‘ Dr. Walker accompanied the expedition, with the approbation
of the Commander-in-Chief, to Egypt, and introduced the new
practice into the army in general, which was found effectual in
arresting the ravages of the small-pox, those soldiers escaping it
who submitted to his operation, and doing their duty as usual ;
while a few, who neglected the opportunity, were laid up. We
now experience his services in another way, he having consented to
be associated with the surgeon of the brigade of seamen on shore ;
and, from Sir Sidney Smith finding it necessary to have the attend¬
ance of the surgeon at a distance from the camp, the medical care
of the whole brigade falls upon him. Major-General Hutchinson
feels a sincere pleasure in recommending Dr. Walker to his Royal
Highness the Duke of York, who ever takes so lively an interest in
whatever renders the situation of the soldier comfortable.’

“ Camp, four miles from Alexandria.

“ 8th of April, 1801.’

“ It is to be added, in order that mankind may appreciate the
zeal of Dr. Walker, that Dr. Walker never received any salary from
government. He went out without any expectations, except from
the benevolence of individuals. He had no government funds at his
command ; not even when on board his Majesty’s vessels. It was
by permission, not by command, that he went with the fleet to its
different stations. He was the apostle of vaccination.” — p. 53.

It will be an indelible blot on the page of English history,
that the benevolent and highly important services of Dr.
Walker should have been unrewarded by the government of
this country, while his aged and helpless widow should be
left in a state of utter destitution. We sincerely trust, that
some of our readers may exert themselves in behalf of a
person who has such strong and just claims upon the govern¬
ment. Many who peruse these pages could effect the desired
object, and ameliorate the forlorn condition of the relict of
a brother practitioner. Let them remind those in power ot

286

Critical Review .

the millions of public money squandered upon pensioners
who have no claim upon the public ; and upon the strong
claims of the helpless individual whose cause we advocate.
Leaving* this painful subject, we return to the Doctor at
Gizeh, where we find he encountered a curious adventure.

“ Dr. Walker had, as the reader will have perceived, the courage
to be singular. He allowed, while in Egypt, his beard to grow, so
as to look very like a learned Jew. One of the young and thought¬
less friends of his mess drew in chalk the French insignia, so hateful
to the Turks, the fleur-de-lis, on his big white hat. Rising from
dinner, the hat was put on, and falling into one of his musing moods,
the bearded sage wandered through Cairo without any uniform.
Conceive his astonishment, when, in the midst of his meditations,
some Turkish soldiers fell upon him with great violence, believing,
notwithstanding all his assertions to them, in an unknown tongue,
that he was “ Inglese” — him to be a Frenchman. And let Britain
be ashamed of her sons (many of them now, it is true, no longer
able to abuse the name of their God), when they read the fact, that
the Turks, in order to satisfy themselves whether Dr. Walker was

or was not a Frenchman, uttered the oaths “ God d - -,” “ by

God,” inferring that, if the subject of this memoir was an English¬
man, he would understand a language which they had heard so
generally used. Dr. Walker, horrified at the oaths they uttered,
especially as coming from strange lips, instead of smiling assent,
as they expected he would were he “ Inglese,” shook his head.
This they understood as a mark of his not understanding them, and,
consequently, that he could not be an Englishman ! And the Arn-
haut, who had applied this test, smiled triumphantly on his com¬
panions at his skill in detecting the Frenchman. They therefore
seized him, and took him to prison to the citadel. The prison doors
were before him ; and Dr. Walker, thinking that he might be put
into one of the dungeons below, where he would, most likely, be
never more thought of, gave himself up as one no more to enjoy
the delights of home and its social pleasures. Much to his hap¬
piness, however, they bade him ascend a staircase, running their
bayonets into him and knocking him with the butt ends of their
muskets behind as he ascended. While thus maltreated, and in such
peculiar peril, an English patrole happened to be passing, who
informed the commanding officer who the bearded philosopher —
imagined by the soldiers to be a French savant — was, and Dr. Wal¬
ker once more experienced the sweets of liberty, after enjoying the
delicious dish called killaw, with the officer and the Mussulmans,
who accommodated the unbeliever with a low stool and wooden
spoon, while they sat cross-legged and with naked hands helped
themselves to the savoury mess.” — p. 58.

Though one would think this occurrence must have excited
caution in future, we learn that our erratic and eccentric

Dr. Epps’s Life of Dr. John Walker.

287

philosopher failed to profit by it. He pursued his tour
through the interior of a dangerous country, and exposed
himself to a series of dangers, which few men of ordinary
minds would choose to encounter. Among these, were a
miraculous escape from drowning and starvation. At length
he returns to his native country, where he experiences further
troubles. On the arrival of the vessel El Carman, at Spit-
head, quarantine was strictly enforced towards the ship’s
crew, with the exception of Sir Sydney Smith and Colonel
Abercrombie, who, with their servants, immediately left for
London. Dr. Walker exposes this distinction with success.

“ Whatever fomites of * the pestilence that walketh in darkness,
or of the destruction that wasteth at noon day,’ (Psalm xci. 5, 6)
might be lurking in our clothes and luggage, certain officers in scarlet
and blue — Sir Sydney Smith, from the shores of Egypt, and Colonel
Abercrombie, from the interior thereof — with their servants, who
had attended them in that ancient house of bondage, set out, * bag
and baggage,’ on the instant of our arrival at Spithead, to that spot
where the greatest number of British subjects are assembled toge¬
ther ; buttoning and unbuttoning, going to bed and getting up, from
day to day, without a dream or a suspicion of the possibility of the
plague again, through desolation of the inhabitants, causing the
green grass to grow up in the streets, no longer crowdedly trodden
by the busy feet of men.

<f Ihe prohibitions connected with quarantine, were, in respect to
these remaining behind, so strictly observed, that even boats, con¬
taining refreshments, were not allowed to approach the vessel.
Well might Dr. Walker exclaim on the occasion — “Ah, ca .”

“ The prohibitions, all can see, if applicable to one, are so to all.
Why, then, this distinction ? The great are allowed to carry the
plague ; the poor must be prevented. It is absurd, and John Wal¬
ker could see it so.” — p. 70.

The time allotted for the performance of quarantine having1
expired, Dr. Walker landed at Portsmouth, and proceeded
alone to Stonehouse to meet the object of his affections.
Even on this occasion his eccentricity continued, as we learn
from his biographer.

“ He arrived at the village towards the close of the day, and
there rested a short time ; the house where Mrs. Walker and her
friends resided being at some distance from the village. On this
and other accounts, prudence dictated that they should, early in the
evening, lock the door, and take other precautionary measures in
respect to the wanderers and to thieves.

“ The door was locked; the shutters were closed. The watch
dog had received his honoured station of in-door protector, and the

288

Critical Review.

friends were musing, in rather a melancholy mood, on their absent
objects of affection. This cast of melancholy had arisen from the
circumstances, that though notice in the papers had been taken of
the El Carmen’s arrival, no letter had been received from Dr.
Walker. While in this pensive state, a loud single knock at the door
was heard. For fear, no one answered it, save the barking of the
dog. After some delay, the servant determined to look out of the
window, when a voice utterred — “ A letter under the knocker!”
The letter would have received the dews of night, had not an old
servant, who was often employed in the shrubbery, shortly after
requested admittance. When admitted, he, Avith all the language
of astonishment written on his face, said that a strange-looJcing man ,
with a crape over his face, had come into the village that night.
The wonder of all was actively excited ; and Mrs. Walker deter¬
mined to takg advantage of the man’s arrival, to go to the front
door for the letter, cherishing, at the same time, the affectionate
hope that this strange man might be her dearest friend, and that the
letter might be from him. The hand-writing was his. The joy
almost overpowered her, and no doubt would, had not the sound of
his voice met her ear as she moved with agitated steps back through
the shrubbery. Soon she found herself in his embrace ; yes, in the
embrace of a man with a long beard (the crape of the country
people.) The doctor cheered the domestic circle for some time with
the enumeration of the various incidents of his tour, and again the
brow cast aside its mantle of care to put on that of peace.'*’- — p. 71.

He commenced his labours as a vaccinator in Lombard-
street, in August, 1802, and was stimulated in his laudable
exertions by the melancholy fact, that many bodies destroyed
by small-pox, were in the dissecting rooms throughout the
metropolis. He now proposed to establish a public institution,
an idea approved of by many medical friends, and speedily
acted upon by the formation of the Jennerian Society. For
full particulars relating to this useful institution, we refer to
the interesting work before us. The Doctor was appointed
Resident Vaccinator, but from his eccentricities and manners,
“ his dress and address” was loudly complained of, and was
finally obliged to resign. The London Vaccine Institution
was established, over which he was again elected as chief
vaccinator. This was a popular establishment, was well
supported, while the former gradually declined, and finally
was abandoned. Vaccination was now patronized and pro¬
moted in every civilized nation in the world, as appears from
the correspondence inserted in the volume under notice. The
description of the Doctor at the vaccine stations, is faithfully
and graphically given, with the exception of his personal
appearance, which we shall add to complete the picture.
He was a thin spare person, far advanced in years, dressed in

Dr. Epps's Life of Dr. John Walker.

289

a snuff brown suit, with all the simplicity of his adopted sect
His manners were rough and repulsive, and highly injurious
to the promotion of the object he had in view. This will
appear from the following extract, for the accuracy of which
we offer our personal testimony: — -

“ Any person who wished to see Dr. Walker in his most extraor¬
dinary condition, went to one of the vaccine stations for the sight.
There was beheld the man in all the activity of his natural disposi¬
tions — his self-complacency, at the same time, exercising a modify¬
ing influence over all the operations of his mind, being called into
activity by the conviction of the dignified situation in which he was
then placed. He there experienced the exalted pleasure of perceiv¬
ing the appreciation of his labours ; of feeling that confidence was
placed in his superior judgment. In fact, at his stations, he was
the great Dr. Walker. He was there, truly speaking, the director ;
and any obstacle in the way of his plans did not long remain in an
opposing condition.

“ The first thing that Dr. Walker looked to, when entering the
room, was the table on which he expected to see his books. If any
mother had put the child’s bonnet, pelisse, or any other person, his
hat thereon, they were immediately swept away to the floor. If any
woman stood in the way, he pushed her back, and would make her, if
much irritated, stand up in the corner, as if she were a naughty child.
He then marshalled his numerous company, and, having put them in
their several ranks, gave a short, but very potent address to the mothers
on the protection afforded by the vaccine inoculation. Having gone
through these preliminaries, the director then issued the order for the
children’s names, places of habitation, and age to be told ; and the
individuals were exhorted to take care to speak plain. From the influ¬
ence of that state of mind, that makes its possessor believe that what
he knows well himself others know equally well, the parents very
often muttered out the names of their children, of their places
of habitation, and their ages. This disturbed Dr. Walker very
much. He often made the offending woman spell her child’s
name ten or twelve times over, adding at the conclusion, “Now,
thou wilt learn to speak plain.” Often at the constant tor¬
ment of being obliged to ask, over and over again, what the parents
said, he became quite angry, and made the offender wait till the last.

Having collected all the names, the next process was commenced.
This was to obtain some vaccine ichor for the purpose of vaccinating
the children, not as yet protected. Here often was a great struggle.
The “gemitus infantum” had now commenced. The few mothers
that had the courage to bring back their children for examination
were frightened, and looked towards the door with an anxious desire
for escape. Some one, perhaps, attempted to fly ; Dr. Walker
leaped to the door, and barracadoed it with his body, saying, “Thou
foolish woman, if thou wilt not do good to others, I will bless thy

VOL. VI. no. 34.

p p

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little one,’* and forth witli drew his lancet, to gather the rich ichor,
the produce of what he called his “ vaccine roses.” The screams of
the terrified child, the complaints of the excited mother, and the
apprehension written on the countenances of all, did not intimidate
the courageous soul of the director. He finished his operation, and
then, laying aside the frown of offended authority, and putting on
the smile of benevolent delight, addressed the poor mother, “ Thy
child is safe : fear not : fare thee well.”

“ The children always claimed Dr. Walker’s sympathy, although
that sympathy was met on their part by a scream. This may readily
be conceived, when it is remembered that young Astyanax, Andro¬
mache and Hector’s child, cried, when his brave father, helmeted,
took him in his arms. Dr. Walker’s lank and long physiognomy,
his broad-brimmed hat, and his tout ensemble, were sufficient to call
forth the greeting of a scream, when he offered the welcome, even of
the kindest feeling. The cries of the children (for children being
imitative beings, when one commenced, the rest joined) were, some¬
times, to those not aware that children often cry from imitation with¬
out being hurt, truly terrific. Dr. Walker was used to it, and, con¬
sequently, regarded not tears, or cries, or screams, or threats, all of
which he had daily to meet with.

“ He, it may readily be conceived, could not be interfered with,
occupied as he was sometimes with the vaccination of perhaps fifty or
sixty “ little Londoners” at one station. Towards the conclusion of
his life, if any one disturbed him in the regularity of his plans, it
vexed him very much. Sometimes a medical man would speak to
him about something not at all important, and break the course of his
proceedings. “ Cannot thou keep thy peace ? I will attend to thee
last” — was the result of the disturbance, and the offender had the
misery of looking foolish until every one else was supplied.

“ The vaccination for the day wras often concluded by a lecture,
after which the mothers went away, saying, “What a cross old
man !” 4‘ What a strange man!” “ What a curious old fellow !” “ I
will not go again — such a cross old stick !” and many singular vulgar
remarks. However, the mothers did go again; for there was a lurk¬
ing something in the “old Doctor,” as he was called, that enticed them
back ; and also, then they had the satisfaction of hearing expressed,
with the greatest confidence, by the director, “ Thy child is safe.”

“ The medical men, who came for supplies of matter, he always
kept to the last, unless wanting their lancets charged, and then it
was absolutely necessary that they should present the lancet properly
opened and properly guarded (that is, so fixed that the ichor when
put upon the lancet, could not be wiped off). If not so given, he
would return it, often not saying a word. If a servant brought the
lancet unarmed, he usually told him, “ Go to thy master, and tell him
to send me his lancets properly, and then I will supply him.” If any one
ventured forward before his turn, he was sure to be supplied last.
Many young students who had not yet received sufficient rebuffs in life
to teach them humility, came into the stations with all the impudent

Dr. Epps’s Life of Dr, John Walker .

291

arrogance of conceit, saying, “ I want these lancets armed.” “ Dost
thou ?” with a peculiar expression of dignified contempt and pity
combined, " stand back there!” was all the Doctor said. On some
of these occasions, when Dr. Walker had to do with such children of
puppyism, an artist would have found the highest entertainment in
the general expression of the old and venerable man.

“ It is due to Dr. Walker to state, that any medical student who
was quiet, and sought proper occasions to obtain information, was
sure to meet with kind attention. He delighted in diffusing the
knowledge of vaccination, and was ever glad to have any to instruct in
such a good cause.

“ Dr. Walker, in other words, was the monarch at the vaccine
stations. His was the despotism of knowledge ; and he delighted in
the exercise of this kind of despotic power as much as the autocrat of
the Russians does in his. Thus gratified, and impelled likewise by a
sense of his duty by the delight of doing good, and also by the plea¬
sure of cherishing a cause of which he was the principal support, it
is not a matter of wonder that he should have never a missed a day,
from the time when he was appointed till within a week or two of
his death, in visiting the stations. It is becoming that these stations,
at which he attended, should be noticed, in order to shew to the
public the immense amount of service he contributed to the general good.
At nine, a;m. Dr. Walkerwas to bemet with at 215, Strand; at a quar¬
ter past nine, 337, Strand; at half past nine, at 29, Haymarket ; at a
quarter to ten, a. m., 27, Lisle-street; at ten, a. m., at 3, Broad-street,
Bloomsbury; at a quarter past ten, at 144, High Holborn ; at half past
ten, at 63, High Holborn. From that station he went to one of the prin¬
cipal stations, at 1, Union Court, Holborn Hill (still retained by the
Society), at eleven ; from this he proceeded, at about a quarter to
twelve, to 4|, Salisbury Court, Fleet-street, and then returned to his
own house, at 6, Bond Court, Walbrook, where he vaccinated at two,
p. m. Besides these journies, on every Monday, he went to the
vestry of St. John’s Church, Horsleydown, kindly granted for the use
of the Society ; thence to the Lancaster Royal Free School,
5, Thomas -street, Borough Hospitals ; and thence to the South Lon¬
don Dispensary, No. 1, Lambeth Road.

te Such was the life of this man of benevolent industry. Day after
day he went his round. Sunshine or rain, it mattered not. Vacci¬
nation was the longing of his soul ; and nothing was sufficient to
draw him from his course.” — p. 125.

He toiled in this way for nearly twenty-eight years, and
continued to perform his duties till illness put a period to his
existence.

The Report of the London Vaccine Institution for 1831,
paid him the following just tribute : —

“ Doctor Walker was a man whose life was a continual activity in
the pursuit of good ; who, day after day, month after month, and

292

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year after year, watched, with the care of a parent, the cause of
which he was so experienced an advocate ; who was willing to know
nothing but the object of his early love, vaccination ; who persevered,
through good report and through bad report, in diffusing the bless¬
ings of vaccination ; who, for upwards of a quarter of a century, never
omitted one lawful day going his rounds to the numerous stations of
the institution ; and who, it may be said, almost ended his life with
the lancet in his hand, for he went round to the stations two days
before he died.” — p. 131.

The remaining part of the volume embraces the religious,
moral and political opinions of Dr. Walker, with which we can
have no concern. His defence of Napoleon, in regard to the
poisoning of the sick troops at Jaffa, is satisfactory, and is a
complete refutation of the assertions of Sir Robert Wilson
and others. Indeed, this was scarcely necessary, after all
that has been written by his medical attendants and staff at
St. Helena ; but the testimony of such an upright and honest
man as Dr. Walker, must carry conviction to the mind of the
most sceptical.

We now conclude our remarks, by thanking Dr. Epps for
the amusing and interesting facts he has so happily arrayed
in this production. His task was difficult ; blit it has been
ably executed. He has undertaken it for the benefit of an aged
and distressed fellow-creature, a sufficient motive to induce
the affluent members of our profession to afford their patron¬
age. The work is as interesting as a standard novel ; it will
be perused with pleasure by the medical and the general
reader.

V . — Physiology of the Foetus , Liver and Spleen. — By
George Calvert Holland, M.D. Batchelor of Letters of
the University of Paris, Lecturer on Physiology, and Joint
Lecturer on Practice of Physic in the Sheffield Medical
Institution. London, 1831, 8vo. pp. 229. Longman & Co.

The author of this work is very favourably known to the pro¬
fession by his “ Experimental inquiry into the laws which
regulate organic and animal life,” a work evincing research,
industry and much originality, and one which refutes many
of the conclusions of John Hunter, Wilson Philip, and
Edwards of Paris. It is obvious therefore that its author
is eminently qualified to execute the task which he has
undertaken on the present occasion.

Dr. Holland on Physiology of the Foetus , tfc, 293

In an exceedingly well written introduction, he describes

the causes which have retarded the attainment of sound
principles in physiology.” He observes —

“ An inquiry into the nature and extent of those causes which
impede or arrest the progress of science, must be a subject of inte¬
resting speculation, not only to the philosopher, but to very one who is
engaged in the pursuit, or interested in the advancement of useful
knowledge. Such an inquiry, if skilfully conducted, by detecting
the fallacy of assumed principles, and exposing the errors of popular
systems, would diminish that undue veneration for antiquity, and
that servile reverence of great names, which have so frequently pre¬
vented the discovery of truth ; and by thus liberating the mind from
the restrictive bonds of prejudice, would leave it free and unincum¬
bered to pursue its onward course, in the paths of scientific research.
It is only when the fetters of authority and system have been cast off
by a powerful and superior understanding, that any great advances
have been made in the spacious fields of science, in which, instead of
exploring new tracts, the philosophers of our age have generally been
content with walking servilely in the footsteps of their predecessors,
or, if they have dared to depart from them, it has too often been
under the misguiding influence of some imaginary notion, rather than
the sure direction of those sound principles which were likely to lead
to any valuable discoveries. To this cause we must attribute the
slow progress of physiological investigation. On no other principle
can we account for the extraordinary fact, that so many centuries
elapsed before any knowledge had been acquired of the circulation of
the blood, the connexion between the powers of the mind, and the
development of the brain, the exact states of the body which pro¬
mote or retard the generation of animal heat, and the true mode in
which the foetus is nourished. These secrets might have been made
known, long before the period of their actual discovery, by any man
of ordinary capacity ; if, instead of being misled by prevailing opi¬
nions, he had carefully examined the phenomena which nature pre¬
sented to his view. Any thing intensely bright is seen more dis¬
tinctly by the eye through a coloured medium, but the objects of
mental contemplation are apt to be distorted, and rendered obscure,
when viewed through any other medium than that of plain and sim¬
ple facts, actually ascertained to exist, by careful and repeated expe¬
riments. He who recollects this truth will not be surprised at the
slow progress of the science of medicine.

“ The ancients, though possessing much less general knowledge
than ourselves, and not having nearly so accurate an acquaintance
with the human frame, were almost as successful in the treatment of
most diseases ; since their superficial knowledge of the constitution
of the body, and their entire ignorance of many of its organs and
operations, reduced them to the salutary necessity of close observa¬
tion, and a strict adherence to those means of cure which experience
had discovered ; but, amongst the moderns, speculation too frequently

294

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occupies the place of experiment, facts are disregarded in an eager¬
ness to establish some favourite hypothesis ; and the instructive voice
of sage experience is not heard amidst the loud exclamations of noisy
partizans, contending for the truth of new theories, and ever varying
doctrines. The ancients were generally more practical, the moderns
are more theoretical ; the former may, therefore, be sometimes safely
followed, the latter seldom : but it would be dangerous to rely
implicitly on either ; the ideas of the one being often crude and ridi¬
culous, those of the other visionary or imperfect. It has been justly
asked, with reference to the present backward state of medical
science — What has medicine yet effected in increasing the bodily
powers of man, in remedying his diseases, or in lengthening life,
which can bear a moment’s comparison with the prodigies effected by
education, in invigorating his intellectual capacities ; in forming his
moral habits ; in developing his sensitive principles ; and in unlock¬
ing all the hidden sources of internal enjoyment ?” — p. 13.

He adverts to the law which held it a serious crime to
question the correctness of the philosophy of Aristotle, or
the medical dogmas of Galen, and he praises that spirit
which has led men to disregard opinions and systems, how¬
ever consecrated by age or revered by mankind ; but he pro¬
perly contends, that the existing dogmas in medicine have
been too often wholly received or rejected, after too super¬
ficial a consideration. We are next favoured with remarks
upon the works of Darwin, Brown, Broussais, Clutterbuck,
Lobstein and Abernethv, in which the merits of these distin-
guished writers are justly estimated. He holds that some
have advanced our science by facts, others by theories ; but
upon the whole its advancement has been retarded by the
multiplicity of its expounders. He justly observes that it
is much easier to write on medicine than on the other
sciences; to compose a work, even of a very humble kind, on
natural or moral philosophy, requires superior intellectual
powers, strengthened by much previous study, and long’
exercised in abstract speculations or experimental pur¬
suits, whilst such a work, even when creditably executed,
does not bring its author either much reputation or profit.
The medical practitioner, with a very ordinary understanding,
few acquirements, and but little mental application, may
easily compile a treatise on some branch of the profession,
availing himself of the labours of his predecessors, drawing
his matter from existing stores of medical knowledge, which
he has only to arrange in a new form and slightly modify,
to secure both considerable fame and emolument. He soon
enjoys the confidence of the profession and public, until some
new work appears, which throws him into the shade. This

Dr. Holland on Physiology of the Foetus , Sfc. 295

is a faithful picture of modern medical writers. Our author
adduces further facts in illustration of the retardment of me¬
dical science, and the difficulties to be encountered by its
cultivators. He says —

“ In investigating the operations of nature, the inquiring mind is
perplexed by studying them through the medium of these ever vary¬
ing systems, which involve the most important subjects of medical
and physiological inquiry in almost impenetrable obscurity. There
are scarcely any truths in medicine, like the axioms in geometry, or
the first principles in philosophy, so universally allowed, and fully
established, that the student of this science can rely on their cor¬
rectness ; it is, therefore, absolutely requisite, amidst so many dis¬
crepant theories, clashing opinions, and opposite conclusions, drawn
from the same experiments, to put every thing to the test of the most
elaborate and tedious examination. Another cause, which has
retarded the progress of medical knowledge, is an almost exclusive
attention to experiments — p. 19.

He examines the claims of the most eminent physiologists,
of Haller, Bichat, Richerand, Magendie, and points out their
defects with great candour and impartiality. He offers satis¬
factory evidence that these illustrious men arrived at many
erroneous conclusions. He contends that physiologists
must exercise the mind even more than the hand and eyes,
and patiently refer every hypothesis to the test of experiment.
He turns to the systematic writers, and argues that they have
attempted too much and adopted fanciful notions, assumed
premises and false conclusions. This will be admitted when
we consider the low state of medical science in the last cen¬
tury. His criticism on Good’s Study of Medicine is worthy
of citation.

“ The Study of Medicine, by Mason Good, affords the clearest
evidence of the advancement of this science in late years ; but I
am disposed to think, that the merits of this treatise have been much
overrated. It cannot be denied that it displays considerable learn¬
ing, and contains many important facts and useful observations ;
but the value of these is much lessened by their being very frequently
blended with false doctrines and physiological errors. The work is,
indeed, enriched with a vast fund of knowledge, brought from almost
every quarter ; but to render that knowledge really useful, it ought
to be much more carefully examined and scientifically arranged.

“ The author would have conferred a much greater benefit upon
society, if his plan had been more limited, if it had been confined to
some particular branch of medicine, instead of embracing the whole
of the sciences, the departments of which are too numerous in their
present imperfect state, and too full of errors to be comprehended by

296

Critical Review.

one mind, or to admit of generalization. No system of medicine can
indeed, be formed with advantage, till its principles are more
thoroughly understood, and firmly established ; in the meantime, the
best method of leading to a more perfect acquaintance with them, is
for individuals to apply themselves to the study of those particular
branches of the profession which circumstances afford them an
opportunity, or nature gives them an inclination to investigate. The
indefatigable industry and extensive knowledge of Mason Good fitted
him for the task of compilation, and his Study of Medicine is cer¬
tainly an elegant and learned production : but his numerous and
diversified acquirements were not calculated to render him practically
useful as a physician, or eminently serviceable as a writer on medical
subjects. The mind is, indeed, enriched by abundant stores of infor¬
mation, but the judgment is not proportionally strengthened ; and the
time spent in the acquisition of varied and extensive learning, must
necessarily be taken from that which ought to be wholly devoted by
the medical practitioner to the exclusive studies of his profession. A
general knowledge of many subjects, being almost necessarily
received without due examination, is seldom exact, or correct ; this
is particularly true of medical knowledge which does not admit of
accurate calculation, and the correctness of which can be ascertained
only by the long and tedious process of individual observation,
accompanied by a spirit of candid and patient enquiry, unbiassed by
prejudice, and seeking only for truth.” — p. 31.

The concluding' remarks of our author are manly and
candid, and reflect much credit upon him, as a zealous and
ardent friend to science. He says—

” In these introductory remarks, I have fully attended to those
causes which appear to me to have principally retarded the advance¬
ment of the science of medicine, and in the following pages, with
equal freedom, I have attempted to refute what I conceive to be the
erroneous opinions of preceding writers, on a very important and dif¬
ficult subject of physiological investigation. I am well aware that
with those, who are strongly attached to popular systems and pre¬
vailing notions, the freedom of my observations will, probably expose
me to the charge of bold presumption : but the candid and intelligent
reader will, I trust, acquit me of such presumption, when he con¬
siders that the most pernicious errors can be removed only by a fear¬
less refutation, and that it is the duty of every member of the medi¬
cal profession, to expose whatever is connected with it, that in his
estimation, is either false in theory, or injurious in practice. I claim,
however, no infallibility : and, if in attempting to correct the mis¬
taken opinions of my predecessors, I should myself have embraced
others equally erroneous, I shall not only be most thankful to any
one, who will candidly point them out, but be the first to reject them
on a sufficient proof of their fallacy.” — p. 32.

Dr. Holland on Physiology of the Fcetns, <fc. 29 7

He commences the body of his work with an examination
of th q physiology of the liver and spleen, and after admit¬
ting the difficulties of the subject, adverts to the opinions of
Dr. Stukely, published °in 1723 and of Moresehi of Pavia,
in 1803, tff that the spleen is an organ appropriated to the
digestive function, supplying' blood according to its de¬
mands.” He thinks this view correct.

“ When the capacity of the stomach is enlarged by the food
which is received, it is supposed to press upon the body of the spleen,
so as to diminish the accumulation of blood in the splenic artery,
and thereby to augment the action of those vessels which are distri¬
buted upon the stomach. This view, with slight and immaterial
modifications, is the one proposed by both authors. The necessity
of a vigorous circulation during the process of digestion can scarcely
be called in question. This state of the sanguiferous system is to be
regarded as indispensable, and the views which support it are much
more consistent than the ideas at present entertained with respect to
the efficiency of the nervous system.” — p. 2.

After a just compliment to Dr. Wilson Philip, for his
numerous and well conducted experiments, he denies that
they warrant the conclusion, that digestion ceases on the
division of the eight pair of nerves from the immediate loss
of nervous energy belonging to the stomach. He observes,

“ In a work, which I lately published, it was satisfactorily shewn
that the division of the eight pair of nerves is injurious to the
digestive powers of the stomach, in proportion only to the disorder
induced in those of respiration and circulation.* When these were
protected by the introduction of a small tube into the divided trachea,
which enabled the animal to breathe with facility, digestion pro¬
ceeded as correctly, although a portion of the nerve on each side was
excised, as when the nerves were left entire ; the trachea alone being
separated, and a tube attached, as in the preceding instance.” — p. 3.

We cite authorities which prove, that the spleen may be
partially or totally removed, and in some instances does not
exist, and still digestion is effected. He notices the experi¬
ments of Sir E. Home, Malpighi and Assollant,in corroboration
of the fact, that the spleen has been removed from animals,
without injury to digestion, absorption, circulation, respira¬
tion, voice, secretion, nutrition, locomotion, sensibility, the
instinctive faculties, and reproduction. He arrives at the con-

* See an Experimental Inquiry into the Laws which regulate the
Phenomena of Organic and Animal Life.

Vol. VI. no. 34.

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elusion, that the spleen is not necessary for the functions
which has been ascribed to it, “ for if it were indispensable
to the perfect digestion of food, this process would be
impeded or destroyed, whenever the stomach was deprived of
its assistance, which, however, is not the case.” He thinks
the office of the spleen is not as yet discovered. We are
much surprized at his silence on Mr. Dobson’s experiments
and conclusions on this subject, which we noticed in our last
volume ; and which appear to be more satisfactory than any
hitherto offered. These views were not promulgated by the
Medical Journals so extensively as they merited, and hence
we may excuse our author for not having noticed them.

He states, that the physiology of the liver is as obscure as
that of the spleen, and denies the legitimacy of the conclusion
that the venous blood forms the bile.

“ From what has been previously explained, it is evident that the
hepatic artery is regarded as the source of bile ; and believing the
production of this to be only one function of the liver, it is my inten¬
tion to account for the great quantity of venous blood transmitted to
it and the spleen. Both organs are well adapted to receive a great
share of sanguineous fluid, whether we consider the texture as com¬
posed of blood vessels or of cells.

The' function of the spleen, as well as that of the liver, inde¬
pendently of the secretion of bile, is considered a diverticulum of
the system. If the veins* which form the vena porta had passed directly
to the vena cava inferior, a thousand accidents, arising either from
mental or corporeal disturbance, would have continually placed the
life of an individual in imminent danger. Every passion, whether
of an exciting or depressing character, and every general and local
disease, if severe, whether chronic or acute, would have been liable
to have deranged the lungs and heart. 1 have already endeavoured
to shew, that passions, of a depressing nature, bring the blood in
greater quantity than usual from the inferior and superior extremi¬
ties, and also from the surface of the body to the chest ; and I have
also stated, that the abdominal viscera participate in this engorge¬
ment. Since the body is continually liable to such changes, baneful
effects would follow, unless nature had provided organs, whose
situation, function and organization, enable them to diminish the
burden imposed upon those, whose constant and almost regular
action is indispensable for the maintenance of life. This object is
beatifully answered by the liver and spleen. The organs within the
chest must be regarded as possessing vital functions. If the lungs
were surcharged with blood, or in a condition approaching to it, the
properties and distribution of this fluid would be immediately dis¬
ordered, and with this primary derangement every part of the body
would quickly sympathize.

Dr. Holland on Physiology of the Foetus, Sfc. 299

“ The liver and the spleen, from being placed close to the thorax,
are calculated to relieve the congested lungs and heart, or rather to
protect them from sudden and violent commotions ; and are also
favourably situated to protect in the same manner the stomach,
whose action is scarcely less vital.” — p, 20.

He reminds us of the minute ramifications of blood vessels
in the liver and spleen, which prevent the sudden flow of
blood to the lungs, an occurrence inevitable and fatal, had
not these organs been wisely interposed. Man could seldom
arrive at maturity, unless the constitution were endowed with
these organs.

It has been long held, that the melancholic temperament
is by far the most frequently characterized by disease, or
augmentation of the liver and spleen. Our author endeavours
to prove the validity of this position.

“ The greater pari; of the ancients supposed, that these organs
were the seats or causes of this temperament, and although it is
impossible to grant that any viscus or viscery of the abdomen can
fashion the peculiar constitution of the mind, still the universal lan¬
guage of mankind proves, that these organs were generally large or
diseased in individuals of this temperament. We very rarely find
persons so constituted take constant exercise ; their habits for the
most part are sedentary, and instead of enjoying the gaiety and
hilarity of convivial parties, they generally prefer solitude, or are
occupied in brooding over real or imaginary evils. In the chapter
on the physiology of the passions, already alluded to, the manner in
which the body suffers from a disorder in the powers of the mind
is fully discussed ; and as the feelings of melancholy are considered
to operate in the same way, as those which were referred to the
division of mental sedatives, there is little further to add on the
present occasion.

“ A life of inactivity, or one abounding in disagreeable sensa¬
tions, tends to determine the blood internally, and those organs
which are best adapted to bear this determination, or state of con¬
gestion, will suffer to the greatest extent. The liver and spleen
being formed in every respect, to receive the principal share, they
will necessarily exhibit symptoms of derangement or disease, as if
they were the only disordered organs, but in this state of the system
we also remark, very frequently, if not constantly, acute headache,
palpitation of the heart, sometimes cough and difficulty of breathing,
or abberration of the mental faculties ; and unless the two abdo¬
minal viscera had been so constituted and placed, the whole train
of the latter effects would have become too prominent for the exist¬
ence of the animal economy. If these principles are allowed to be
correct, the treatment of nervous diseases must be considerably
modified.” — p. 23.

300

Critical, Review.

After a variety of arguments in further proof of the
doctrines already cited, our author arrives at the following
conclusion as to the functions of the spleen, which is by no
means satisfactory : —

“ If it be removed, and the individual recovers his wonted ener¬
gies, these may exist for a series of years; because their exercise
does not depend upon the spleen, but upon the proper action of
organic laws, which are equally independent of the same organ in
the undisturbed state of the system. Its office is not to contribute,
every moment, to the maintenance of life ; but only, on trying
occasions, to develope the full powers of its functions, and, in con¬
junction with those of the liver, to protect the vital principle from
destruction.” — p. 30.

If the conclusions of Mr. Dobson be legitimate, and they
are deduced from experiment, the function of the spleen is
exerted after digestion, a direct contradiction to the doctrine
of this extract.

Our author deduces several arguments from comparative
anatomy, in corroboration of his statements, but the insertion
of these would be uninteresting to most of our readers.
Though he has displayed much originality in this article, he
has not adduced many authorities that might be quoted. We
cannot overlook these omissions, as the work is ably
executed. It is at once literary, scientific, and instructive,
and well deserves a place with the first physiological pro¬
ductions of the day. We shall resume our analysis of the
remaining part, on the physiology of the foetus, in our next.

VT. — A Manual of Analytical Chemistry. By Henry Rose,
Professor of Chemistry at Berlin. Translated from the
German by John Griffin. 8vo. pp. 454. London, 1831 :
T. Tegg.

Though we have many excellent works on chemistry, we
have not one which can be considered a perfect guide to
analysis, and therefore a production of this description is a
great desideratum. Few chemists are so justly celebrated
as Professor Rose — as an analyst, he stands unequalled in
the German schools. The translation of his work will be
esteemed an advantage by every scientific practitioner. It

Mr. Rose on Analytical Chemistry .

301

is singular that the various German systems of chemistry,
which are seldom equalled, and certainly not surpassed,
should not have been translated into English. It is not easy
to account for this apathy. The present specimen is well
calculated to induce our countrymen to direct their attention
to this branch of German literature. The accuracy and
fidelity of this translation reflect much credit on Mr. Griffin.
To the operative chemist this work will be invaluable. It
is a production of great practical utility, and cannot fail to
be encouraged. It is only fit for those who are versed in
chemical science. It does not admit of analysis, and its
arrangement only can be introduced. This appears in the
author’s preface.

“ The first part contains instructions on qualitative chemical
examinations. I have treated therein of the detection of those sub¬
stances only which occur most frequently. I have restricted myself
thus, not only because these substances are of greater interest than
those which seldom occur, but especially because the description of
the analyses would have been rendered too difficult to follow, had
I started with the supposition that the compounds to be examined
could contain all possible constituents. The behaviour of rare sub¬
stances with reagents is described in the systems of chemistry, among
others, in the system published by Berzelius. Every one, there¬
fore, who is sufficiently exercised in the qualitative examination of
the substances which commonly occur, will experience no difficulty
in detecting those which seldomer occur, providing his inquiries are
directed by the information thus obtained.

“ The second part contains instructions for quantitative analysis.
To every simple substance, oxygen excepted, a distinct section is
allotted. In each section, I first describe the quantitative determi¬
nation of the simple substance and its compounds with oxygen.
I then treat of the separation of this substance or its oxides from
those which are treated of in every preceding section. In the
beginning, come the simple bodies which, combined with oxygen,
constitute bases ; then follow the bodies whose compounds possess
acid properties. This order appeared to me to be the most advis¬
able, since it permits one to trace, without much difficulty, the
particular steps of a process chosen for any quantitative analysis
which may be presented. Only in a few places, and then but to
avoid repetition, have I departed from this arrangement. By fol¬
lowing the plan, it has been rendered possible to treat of the sili¬
ceous substances which occur in nature under silica, of the simple
and compound, factitious or native sulphurets under sulphur, and of
nearly all the gases under hydrogen.

“ In order still farther to facilitate reference, an index has been
added to the work.

302

Critical Review .

The description of the practical contrivances employed in analy¬
tical chemistry, is almost entirely passed over. For the introduction
of most of these contrivances, and for the greatest improvements
they have received, we are indebted to Berzelius. He has accurately
described them in the fourth part of his system of chemistry, with
the translation of which (into German) Professor Wohler is now
occupied. It appeared to me, therefore, to be unnecessary to
describe them in this manual. In a few places only have I depicted
by wood cuts some apparatus employed in quantitative analyses.

“ The chemical nomenclature is precisely the same as that em¬
ployed by Berzelius in his System of Chemistry. — Preface, p. xii.

ORIGINAL COMMUNICATIONS.

I. — Observations on Spasm of the Colon. By Felix
W. Lyon, Esq. Surgeon.

I have presumed to offer the following remarks on a dis¬
ease, which I conceive to he spasm of the colon, in conse¬
quence of its more general cause (or at least that which
I believe to be usually so) producing effects when the dis¬
ease has existed for some days, which may, I think, render
it liable sometimes to be mistaken, so that effect alone
might possibly be attended to, and the symptoms which at
this period are present, be treated without inquiring minutely
into the pre-existing ones.

The disease, so far as I have observed, is one to which
females are more particularly liable, apparently from the
simple fact of their utter carelessness in procuring daily
alvine excretions. The symptoms are as follow : — The
bowels are in the first instance costive, then pain comes on,
that is, there are slight and sudden attacks of it, which
continue to increase until occasional fits of violent spasms
occur, but between these attacks there is never a total
remission of pain ; the pain is usually referred to the trans¬
verse and descending portions of the colon, occasionally to
the left iliac region. [This latter situation of the pain I
have seen in women often declared to be indicative of
disease of the ovarium, leeches have been applied to the
affected part, and various things done without much benefit,
when, on the exhibition of a few brisk purges, the symptom

Mr. Lyon on Spasm of the Colon .

303

has vanished,, and the patient recovered her accustomed
health]. The abdomen is flaccid., pressure relieves the
suffering., nausea and vomiting are sometimes present, but
the latter is less frequent : out of ten or twelve cases I saw
last year, I believe I met with it in only one, and in this it
proved inconvenient rather than distressing ; neither was it
followed by any unfavourable consequence — the tongue is
usually moist, and covered with a white crust, the pulse
rarely exceeds eighty-five in the minute — it is full, but
compressible, there is but little thirst, the heat of the skin
is slightly increased, and it is usually dry.

When the disease has existed for some days, in addition
to the symptoms just mentioned, the patient is attacked
with purging ; it is at this period, in my opinion, that the
attention is most likely to be drawn from that which I con¬
ceive to be the more general cause of the disease, and
which also produces the relaxed state of the bowels (viz.
scybala), and the affection at this period to be treated as
one of simple diarrhoea ; in one strongly marked case, I
had an opportunity of proving the truth of the fact I have
now advanced. 1 was requested to see a man who had
diarrhoea, and had been attended for some days by a practi¬
tioner, whose treatment consisted in the administration of the
compound powder of kino and other astringents, which only
aggravated the disease ; on inquiring the symptoms he then
had, and also into the previous history of his case, I found
that he was then suffering from diarrhoea, and had for some
time experienced attacks of spasms, and the other symptoms
I have already noticed, wdiich induced me to consider the
diarrhoea as arising from a very different cause to the one
which had been ascribed to it by his previous attendant, and
1 was fully borne out in this opinion by giving him purgatives
rather than astringents, under which mode of treatment he
speedily recovered. When diarrhoea supervenes, the attacks
of spasm are less violent, and on the whole less frequent,
perhaps, than they are in the first instance ; the evacuations
consist of liquid faeces, and among them scybala ; mucus is
also frequently mixed with them, and they are occasionally
streaked with blood ; these appearances of the evacuations,
conjoined with attack of spasm, and inquiring into the
previous history of the disease will, I think, sufficiently
point out its nature, and the plan proper to be pursued for
its cure.

The foregoing symptoms being present, induced me to con¬
sider the disease, spasm of the colon, as arising from indu-

304

Original Communications .

rated faeces. The objects I had, therefore, in view, were to
relieve the spasm, and to procure free evacuations of the
bowels, which were accomplished by the exhibition of
aperient medicines combined with opium, such as the fol-
lowing- :-r-

R Magnes. sulph. 5iss*

Infus. sennae, 5xi*

Tinct. opii. mj. viii. nt. f. haustus tota quaque
hora sumendus.

This I have usually repeated, until the stools put on a
natural appearance. If, however, the disease had continued
some time, and the bowels were relaxed, the evacuations
being mucous and bloody, I have usually substituted small
doses of castor oil, (5iss. or 3ii.) mixed with the mucilage
of gum arabic, for the infusion of senna, and sulphate of
magnesia, repeated at intervals of six or eight hours, until
the stools became healthy, and the following powder on
going to rest : —

Hydrarg. cum creta gr. v.

Pulv. ipecac, compositi gr. viii. rrp f. pulvis.

These modes of treatment I have always found attended
with success, and as soon as scybala. have ceased to appear
in the evacuations, the pain and other unpleasant symp¬
toms have left the patient ; I then usually order some slight
bitter infusion, with small doses of the sulphate of mag¬
nesia, to restore a proper degree of tone to the bowels,
and a strict caution to the patient of the necessity of pro¬
curing daily evacuations for the future.

22, Dean Street, Soho,

March 6th, 1831.

II. — Rupture of the Liver— Ignorance of Lawyer
Coroners. By Dr. Tuthill.

Four cases, in which death was produced by rupture of the
liver, spleen, and an intercostal artery occasioned by vio¬
lence. Reported by Richard Tuthill, M.D. Assistant Sur¬
geon, 52d Regiment.

The night of the 27th of last July, I was called upon to
visit a female named Anna Kelly, who was reported to have

Dr. Tuthill on Rupture of the Liver.

305

been very ill ; upon reaching' her house I found that she had
died a few minutes previously, in consequence of severe
blows inflicted upon the body by her husband. Sixteen
hours afterwards I examined the body in presence of two
medical g'entlemen. The liver was torn to the depth of an
inch or more at the inferior and posterior part of the trans¬
verse fissure ; the rig-ht lobe presented two deep ruptures,
one near the inferior edge, the other within about two
inches of the superior thick edge. Between two and three
quarts of venous blood were found in the inside of the peri¬
toneum diffused around the intestines and between the lay¬
ers of the great omentum. The liver was tolerably firm, a lit¬
tle paler than what is usually observed, the remaining abdomi¬
nal, as also the pelvic viscera were healthy. The integuments
of the thorax and abdomen presented in several places, marks
of bruises produced by some instrument, the skin was not
broken in any place, no communication with the interior of
the cavities could be discovered. 1 was examined by the
coroner, and after stating that the above appearances were
found, gave it as my opinion, in answer to his question, that
the ruptures of the liver and the quantity of blood effused,
were sufficient causes to have produced death, and that such
injuries and their effects must have been occasioned by great
violence. The case having been twice in the supreme court
of this city, the 29th of October, I was called upon to bear
testimony to the evidence given before the coroner : after
having been sworn I recapitulated the above statement,
respecting the appearances of the body and the cause of
death, and I was submitted to the following examination by
the council for the defendant:— -What are the functions of
the liver? Is not the liver attached to the stomach by an
elastic ligament — is it not attached by a peculiar ligament to
the diaphragm ? Alluding to the ligamentum teres, is not the
liver thrown into action in vomiting? How does the dia¬
phragm affect the liver when vomiting occurs ? Is not rum a
poison ? Might not the liver be torn in the manner described dur¬
ing the act of vomiting? Does not rum produce in this country
a peculiar disease, not generally known in England ? The
learned gentleman had in view the delirium nervosum ebrio-
sitatis, and he appeared somewhat astonished, when told
that this disease was not uncommon in Europe, and that it
was occasioned by porter, ale, gin, brandy and other spirits,
as well as rum. Was the liver altered in its appearance — was
it so changed, as to render it the more easily to be torn by
any preternatural excitement of the neighbouring parts ? It

VOL. VI. no. 34.

R R

306

Original Communications .

will appear evident from the nature of the above questions,
that an answer in the negative must have been given to
almost every one of them.

Mr. Gibson, surgeon of the 52nd. Regiment was sworn,
and after corroborating the statement I gave, was cross-
examined by another counsel. One of the questions was, is
not the liver surrounded by the diaphragm ? This alone suf¬
fices to shew the necessity of an anatomical course of study,
for the lawyer as well as the medical man, and it is to be
regretted that the more modern works on legal medicine
should not contain a sketch of the various parts of the body,
with a general description of them, and also more reference
to the standard works on law and the modern chemistry,
when the subjects connected with these are under considera¬
tion. The Nova Scotia newspaper for the 4th November,
in which a full statement of the case may be seen, speaks
thus. “ Both gentlemen underwent a cross-examination by
the counsel for the prisoner, the object of which was to
induce a belief that the ruptures of the liver were occasioned
by violent retching ; nothing appeared to give colour to the
supposition. Both gentlemen agreed in their description of
the state of the body, and both gave their decided opinion
that outward violence alone could have produced the inward
appearances, and that such violence as the witnesses had
described would have been sufficient.”

On the 13th October last, James Small, set 38, a carpen¬
ter, received a blow with the fist above the centre of the left
chest, by which an oblique fracture of the seventh rib was
produced. The fracture was not discovered until after death.
About ten minutes after it had happened, he became faint
and lay down, he complained of uneasiness about the pre-
cordia, accompanied with dyspnoea, which gradually in¬
creased to laboured inspiration ; he became so restless, from
general uneasiness, that he could not remain a moment in any
position ; the pulse became gradually very quick and so
feeble as at last not to be perceived. About six hours after
he received the blow, death had occurred, and twelve hours
afterwards the body was examined. The sac of the left
pleura contained about a gallon of blood, which was partly
coagulated, its colour was redder than venous. The inferior
edge of the seventh rib was found fractured to about the
extent of three lines, and a small foramen was discovered in
the artery, which would admit only the point of a probe.
All the viscera were healthy, and no other mark of injury could
be traced. A coroner’s inquest was held, at which Mr. Stirling,
the medical gentleman in attendance, was requested to state,

Dr. Tuthill on Rupture of the Liver.

307

what he had seen without any examination. A verdict of
accidental death was the issue.

When stationed at Sierra Leone in 1827, I had charge of
the regimental hospital of the African corps ; two European
soldiers, patients in the hospital, had a dispute, one struck
the other with a pewter pot over the spleen, which left a semi¬
circular mark in the integument, and gave rise to a rupture
of some of its vessels, an immediate effusion of blood into
the abdomen took place, and death ensued in the course of
about ten minutes. Half an hour afterwards I examined the
body and found a large quantity of fluid blood in the abdomen.

Some time after this a similar accident had occurred — two
other European soldiers had a boxing match, one gave the
other a blow with his fist over the spleen, which occasioned
almost sudden death. The body was examined, and as
large a portion of blood was discovered in the abdomen, as
appeared in the preceding case. The spleen was ruptured
wThere the vessels enter into it. In each of those cases a
coroner’s inquest was held, at which I attended, and had
merely to state what I had seen, without any further inquiry.
In addition to the opinions lately published on medico-legal
science, and connected with it, these few cases shew the
necessity of a medical coroner. In making this observation,
I do not mean to find fault with those gentlemen holding
that situation with whom I came in contact, but the duty
of a coroner is of such vital importance to the interests of
society, that it must be evident to any man whose mind has
been directed to the subject, and witnessed the evils arising
from its being filled by a person ignorant of medicine and
surgery, that no doubt can remain for the necessity of the
office being occupied in all parts of the world by a medical
man. The coroner’s examination should be as minute as
possible, and unless Te have a knowledge of the structure
of the human frame, and of forensic medicine, can he
judge of those alterations to which the various parts of the
human frame are subject, or of the effects of such sub¬
stances as are most likely to come in contact with it, if
unacquainted with the animal machine, and the laws that
influence it ? His ignorance in these important points, sub¬
jects which none, generally speaking, are acquainted with
but medical men, may be the cause of his passing over very
important matters; the culprit consequently has a much less
chance for the escape of his life, and much less for the
freedom of his person.

Halifax, Nova Scotia,

17th Dec. 1830.

308

Original Communications ,

III. — Observations on Homicide by Asphyxia.

By Dr. Ryan.

Asphyxia is the suspension of respiration by a mechanical
obstacle to the passage of the atmospheric air into the lungs,
as by submersion or drowning, strangulation, suffocation, by
gases unfit for allowing the necessary oxygenation of the
blood in the lungs, or heematose, as hydrogen, nitrogen, car¬
bonic acid, or deleterious gases, as carbonic oxide gas, sul¬
phuretted hydrogen, nitrous acid gas, sulphurous acid gas,
ammoniacal gas, chlorine, &c. Asphyxia may be momen¬
tary, and respiration may be restored ; but when it is pro¬
longed, it is fatal. Various injuries and diseases may produce
it, as division of the spinal marrow, formation of false mem¬
brane in the larynx or trachea, and syncope, &c. ; but with
these causes the medical jurist can have no concern. I shall
therefore describe those which claim his attention.

Asphyxia by submersion . The cause of death in all forms
of asphyxia, is a want of oxygenation or haematose of the
blood. This fluid passes through the lungs without any
change, it possesses the characters of venous blood and is
unfit for sustaining life ; the brain suspends its action, the
muscles lose their nervous supply and cease to contract, the
chest becomes immoveable, the blood accumulates in the
lungs, and as the arterial is more contractile and elastic than
the venous system, the latter becomes distended, as also
the right cavities of the heart, and pulmonary artery, while
the left cavities and aorta contain little blood or are empty,
and the fluidity of the blood is characteristic, though some¬
times white fibrous clots are observed in the heart. In some
cases apoplexy or syncope may occur from fear at the
moment of immersion, and death will not be caused by want

bronchi.

In those destroyed by submersion, the face is red and
tumid, the pupil dilated, the eyelid partly open, the eyes
glassy, the tongue projected beyond the lips, a frothy fluid
escapes from the mouth and nostrils, the skin of the trunk
and extremities is remarkably pale, the trachea, and some¬
times the bronchi contain an aqueous sanguinolent froth,
according to Louis, Goodwin, Berger, Orfila, and others,
and this is formed during life (Piorry), as it cannot be pro-

309

Dr. Ryan on Homicide by Asphyxia.

duced by immersion of a dead body ; and is only a secondary
cause of death, according’ to Orfila. The chest and epigas¬
trium are swelled, the fingers are deprived of skin, there is
earth under the nails varying according to the soil of the
bank near the water ; the brain is engorged, the epiglottises
straightened, the lungs are dilated and crepitant, containing a
certain quantity of froth. All these signs however are not con¬
clusive. Thus the pale colour of the skin might occur, if a
person, destroyed by severe haemorrhage or inanition, was pre¬
cipitated into the water. The colour and tumidity of the face
will not be present, should the submersion be effected rapidly
and have caused syncopal asphyxia, or anger or drunkenness
mightinduce it. The external appearances of the body will vary
according to the length of time they have been in the water ;
so that the indications afforded by them are illusory The
frothy matter maybe seen in apoplexy, convulsions, epilepsy,
in certain cases of poisoning ,and after strangulation or putre¬
faction. The states of the eye and eyelids are equivocal.
The distention of the right side of the heart will be present in
all cases where the circulation of the blood is suddenly sus¬
pended. The fluidity of blood is observed in scurvy, in
those destroyed by electricity, and in many species of cache-
xiee. The engorgement of the brain is still more uncertain,
and may arise from a variety of causes. The condition of
the lungs and elevation of the thorax arise from various
causes. The presence of water, or any other fluid in which
the body has been found in the stomach, is a strong proof ;
as such fluid does not enter the organ, unless the body is in
the erect position when immersed, and a body might be
injected with water or fluid after death.

Considering all signs, we can seldom decide indubitably
that the person perished by submersion. It is also impos¬
sible to decide whether the person has fallen into the water
by accident, or has thrown himself in, or is the victim of
homicide. Here we must recollect that persons intent on
suicide have wounded themselves without causing death and
then thrown themselves into the water. We should inquire
whether the deceased was short sighted, affected with ver¬
tigo or insanity, and examine the state of the bank, marks of
footsteps and various other circumstances. When there are
ecchymoses on the neck or wrists, or traces of poisoning, we
may suspect assassination, and in the former we must be
careful in distinguishing ecchymoses from cadaverous livi-
dity, in the manner already described in treating of wounds.
We can generally distinguish wounds inflicted before and

310

Original Cdmmunications.

after death, though a person may fall against a stone and
receive a wound in the water which can scarcely be distin¬
guished from one inflicted before immersion. When new
born infants are drowned, we must discover whether they
were born alive or not, by the proofs stated in the article on
infanticide.

Asphyxia by strangulation, suspension, or hanging ,
is effected by mechanical pressure on the neck by a cord,
cravat or any other means, which prevents the passage
of the air to the lungs, and thus causes asphyxia. In sus¬
pension or hanging, there is strangulation, and often dislo¬
cation of the upper cervical vertebrae, causing pressure on the
spinal marrow, paralysis of the respiratory nerves, paralysis
of the thorax, and instant death. Laceration of the verte¬
bral ligaments, dislocation or fracture of the vertebrae, is
caused by the modern mode of hanging, as the body is pre¬
cipitated, and its weight produces these effects. Are these
certain signs indicative of death by strangulation? Can we
distinguish when suspension is made before or after death,
or whether strangulation be voluntary or criminal ?

The signs laid down by writers that strangulation has
caused death are the following: the skin of the neck on
which the cord has been applied is of a yellowish black
colour, is dry and resembles parchment. These effects
however are found when strangulation has been produced
before or soon after death ; the existence of ecchymoses is
very rare (Esquirol. Arch, de Med. 1823), in general
where there is no effusion of blood in the subcutaneous cellu¬
lar tissue. When real ecchymoses are observed, the stran¬
gulation was produced during life. On the other hand stran¬
gulation may be caused, and this sign be absent, or it may be
deep-seated in the muscles. Its absence on the skin is no
proof that death has not been caused by this means. There
is an apoplectic condition of the brain indicated by tumefac¬
tion and great redness of the face and lips, by the swelling
of the eyelids, and lividity or blue colour, by the redness
and prominence of the eyes, which appear as if starting from
the sockets ; there is the livid engorgement of the tongue
which is thickened and projected between the teeth ; there
is a sanguinolent froth in the throat, mouth and nostrils ;
the lungs and heart are gorged with black blood ; the extre¬
mities are violet, the fingers contracted, there is erection of
the penis and seminal emission, or the latter without the
former. The lividity of the face and congestion of the brain
may exist, but disappear before the autopsy, or may be pro-

311

Dr. Ryan on Homicide by Asphyxia.

duced some hours after death, but not after twenty hours,
(Esquirol): a vertical position will cause them to disappear
or a declivity of the head of a dead body will produce them.
The signs afforded by the eyes, eyelids and tongue are of
little value. The presence of froth in the air passages, the
conditions of the lung's and heart are seen in all species of
asphyxia, and are of course inconclusive. The erection and
seminal emission may not happen. The luxation and frac¬
ture of the vertebrae may happen before or after death, and
unless accompanied by ecchymosis, superficial or deep-seated,
are equivocal: there may be effusion of blood into the ver¬
tebral column.

Upon the whole, when strangulation or suspension causes
death, there may be ecchymosis without any sign of putre¬
faction, and the certainty is complete, if there is lividity of
the face, froth in the air passages, and the clothes stained
by a recent seminal evacuation. But should all these signs be
absent, there is no just ground for denying that strangula¬
tion has happened. To decide that strangulation has hap¬
pened after death, we must find wounds, fractures, contu¬
sions of the cranium, or other important organs or traces of
poison in the intestinal canal : where none of these signs is
present, we must conclude that strangulation was caused
during life. Devaux met a case in which there was no sign
of strangulation, except discoloration of the face, which
fact led him to examine the body closely, when he dis¬
covered a small penetrating wound of the heart, which might
have been overlooked, upon a superficial examination. It is
difficult to decide between suicide and homicide. A person
may wound himself, if he swings himself among surround¬
ing bodies. When blood is observed upon the individual,
we may in general decide it a case of suicide ; but homicide
may occur under such circumstances. In real strangulation,
we have grounds for supposing it homicide, for an indivi¬
dual who intends to destroy himself in this way, generally
wants the power to effect his wicked purpose. Such per¬
sons usually tighten the ligature by some instrument, as a
piece of iron or wood. It is equally difficult to distinguish
suicide from homicide in the case of suspension. Fracture
or dislocation of the cervical vertebrae may occur in volun¬
tary as well as criminal suspension. Orfila, Chaussier,
Pfeffer, Ansiaux. Orfila, however, concludes, that in general
such lesions of the vertebral column are not the result of
suicide. In all these cases we should consider, the habitude,
morality, and intellectual state of the individual ; but it is

312

Original Communications ,

foreign to my purpose to introduce in this place all the
causes of suicide.

Asphyxia by Suffocation. — Suffocation is different from
strangulation,, it being produced by the introduction of some
foreign body into the throat, or larynx and pharynx, which
prevents respiration. Infants, and adults when intoxicated,
are often smothered, the former by what is called overlay¬
ing, as when the bolster or bed clothes press on the mouth,
and obstruct respiration. New born infants are often de¬
stroyed in this manner, as already described in the article
on infanticide. Various foreign bodies, as cotton, tow, earth,
sand, wood, &c. will be found in the pharynx, and may be
introduced after death. When these bodies are hard, they
will produce ecchymoses, excoriations and lacerations. In
these cases death is caused by the prevention of the circula¬
tion through the lungs, these organs will be found gorged
with blood, or contain some frothy mucosity, the brain will be
congested; but these morbid conditions may be produced in
the different species of asphyxia, and consequently afford no
conclusive evidence. We must attend to the circumstantial
evidence, which is the principal or only means to assist us
in forming an opinion.

Asphyxia by non-respirable gases ~ Two divisions of
gases ar$ described, which have seldom existence in practice
as many are the products of art, and cannot be often applied.
Some of these gases are non-respirable, and possess a direct
deleterious influence on man, and kill, by causinga defect of
oxygen producing the same morbid appearance as result
from asphyxia by want of air : these are nitrogen, hydrogen,
protoxide of nitrogen, carbonic acid, carbonated hydrogen,
oxide of carbon, poisoning by charcoal. These and fol¬
lowing g'ases must be included in the second species, called
deleterious gases, sulphuretted hydrogen, nitrous acid gas,
the gas evolved in privies, ammoniacal gas, chlorine and
hydrochloric acid gas. Many of these are only to be
encountered in the chemical laboratory. Professor Christi-
son divides gases into irritants and narcotics. The irritant
gases are nitric oxide gas and nitrous vapour, muriatic
acid gas, chlorine, ammonia, sulphurous acid, and others
of little consequence ; the narcotic are sulphuretted hydro¬
gen, carburetted hydrogen, carbonic acid, carbonic oxide,
nitrous oxide and cyanogen.

Nitrogen gas. — This gas is found in cellars, in which
substances are placed, which have a strong aflinity for
oxygen, as oils, & c. and sometimes in privies. The signs

313

Dr. Ryan on Homicide by Asphyxia.

of asphyxia from this cause, are pallidity or a greenish cast
of skin, extreme anxiety, large and frequent respiration,
and death occurs in a few minutes without any lesions of
the nervous system. The arterial system is full of black
blood. The effects of hydrogen gas are nearly similar,
and can only be produced by chemical experiments.

Asphyxia by carbonic acid gas occurs from the com-
busition of charcoal, common fuel, or in cellars, from fer¬
mentation of wine or malt, and from lime kilns, from coal
pits, and draw wells. Brewers’ men are often destroyed by
this gas, when they descend into large vats for the purpose
of cleaning them, unless they use proper precaution. It is
usual to lower a candle into the vat, which will be extin¬
guished as soon as it encounters the acid, which, from its
greater gravity than atmospheric air, falls to the bottom of
the vessel. I have been called to two persons who were
destroyed by inattention to this precaution. The effects of
the non-respirable gases are similar to those arising from
want of renewal of air. This was well exemplified during
our East Indian wars, by the horrible incarceration of our
countrymen, by their savage opponents at Calcutta. One
hundred and forty-six persons were confined in a chamber
of twenty-four feet square, having only two small windows.
The first effect on these unfortunate persons was abundant
and continued perspiration, insupportable thirst, succeeded
by great pain in the chest, and a difficulty of respiration,
amounting to suffocation. They were attacked with fever,
which increased every moment, and after four hours most
of them were dead. Many became stupid, lethargic and
delirious, and only twenty-three escaped alive. In those
destroyed by want of air, the right cavities of the heart, and
the venous system are filled with very black blood.

The symptoms produced by carbonic acid , or fumes of
charcoal , are heaviness of the head, intense headache, which
impels the sufferer to compress the temples, cerebral conges¬
tion increases and causes vertigo, drowsiness or profound sleep,
tingling of the ears, impeded respiration and circulation,
dazzling, the muscular power ceases, profound coma ensues,
and death seems apparent. During the development of
these symptoms, some persons experience a general feeling
of pleasure, and the excretions are discharged involuntary.
In these cases, the body remains warm for a long time ; the
extremities flexible, the muscles are softened, the colour of
the surface is congested, pale, leaden or violet, the face is
red or flushed, the lips of a vermillion hue, the eyes ar«

VOL. vi. no. 34.

s s

3 1.4

Original Communications.

bright, the tongue is swelled, the epiglottis is raised, the
veins of the brain and lungs are congested with very black
blood, the stomach and intestines are red, the mucous sur¬
faces are ecchymosed, the blood remains fluid, and ail the
lesions characteristic of asphyxia, are apparent. It is not
as yet determined whether this gas is deleterious, or acts
negatively, by causing asphyxia ; Dr. Christison thinks it
positively poisonous; but it has been injected into the veins
and produced slight effects, such as feeble muscular action,
which disappeared spontaneously in a few days. (Nysten).

Asphyxia , by deleterious gases. Sulphuretted hydrogen,
is known by its odour, which resembles that of rotten eggs,
and causes a black precipitate in solutions of lead, copper,
bismuth, silver, &c. A small quantity of it causes death,
and even serious accidents, when mixed with atmospheric air.
It is disengaged from the putrefaction of animal and vegetable
substances. Its effects are great prostration of muscular
power, oppression of the chest, with difficulty of respiration,
headache, nausea, and marks of oppression of the nervous
system, and probably a change in the blood.

After the death, the mucous membranes of the nose and
bronchi are lined with a thick bluish mueosity, the blood
vessels are filled with a blood of a similar colour; a colour
which is observed in the brain, lungs, kidneys, and all organs
and vessels. The muscles have lost their contractility, all
the soft parts are easily laeerable, exhaling a fetid odour,
and speedily becoming’ put rifled.

Asphyxia, produced by gas evolved in privies and drains.
This is the hydro-sulphate of ammonia, mixed with a great
quantity of air, is composed of twTenty-four parts in 100 of
nitrogen, one or two of oxygen, four of carbonic acid and
subcarbonate of ammonia. It is designated plomb , by the
French jurists, and arises from privies of a peculiar form.

The symptoms produced by this poison, are headache,
nausea, paleness of face, dilatation of the pupil, a frothy
sanguinolent fluid in the mouth, constriction of the throat,
sardonic laugh, violent cries, convulsions of the muscles of
the chest and jaws, sometimes tetanic spasms, articular pains,
coldness of the skin, irregular and embarrassed respiration.
At other times, there is stupor, the visage is violet, the eyes
glisten, the pulse is small and frequent, the breathing con¬
vulsive, the extremities are relaxed. At the approach of
death, all the symptoms are aggravated, the sufferer roars
loudly, the body is bent backwards, as in opisthotonos. The
morbid appearances are similar to those observed by sulphu-

315

Dr. Ryan on Homicide by Asphyxia.

retted hydrogen or hydrosulphuric acid gas. This was said
to be the cause of the fatal cholera at Clapham, which is
denied by Christison.

Asphyxia, by sulphurous acid gas , nitrous hydrochloric ,
ammoniacal , arsenical gases, hydrogen, carbur etted hydro¬
gen, muriatic gas, and chlorine. — All these gases are irritant,
inducing cough, suffocation, vivid pains in the chest, some¬
times hoemoptysis, and always mucosities in the bronchi.
They act negatively, or by a defect of oxygen. When death
approaches, there is hiccup, rale, great pain in the diaphragm,
convulsive motions, delirium and inexpressible agony. The
cause of death is irritation of the mucous membranes of the
bronchi. The nitrous oxide, or laughing gas, protoxide of
azote, destroys life in this manner.

There are many other gases which are destructive to life,
which I have not described ; but these cannot become the
subject of forensic investigation, as they produce their
effects upon experimentalists, who may avoid them. A full
account of them will be found in Dr. Christison’s elaborate
Treatise on Toxicology, a work which ought to be in the
hands of every medical practitioner. Vegetable emanations
may produce syncope or asphyxia, either by the extrication
of carbonic acid, or by the odour of their flowers, which can
only be accounted for by peculiarity of constitution or
idiosyncrasy. The descriptions of these cases cannot be of
interest to the medical jurist.

Homicide by combustion. — The medical jurist is seldom
called on to pronounce an opinion on a body destroyed by
combustion, as murder is seldom perpetrated by burning.
The records of legal medicine afford but few illustrations of
homicide by combustion. When such cases occur, medical
evidence may be required, as stated in the remarks upon
burns or torrefaction. it is now admitted on the continent of
Europe, though disbelieved in these countries, that spon¬
taneous combustion is possible, though its cause is as yet
inexplicable. It is said to occur most commonly to aged
females, who have long indulged in the abuse of alcoholic
potations. Generally speaking, some matter of ignition, as a
lighted candle, a pipe, &c. has been found pear the remains
of the body; but cases are attested in which no ingneous sub¬
stances were discovered. Lecat, Kopp and Marc refer to
the fact of spontaneous combustion having on the surface of
the earth, and as friction on the extremities of certain per¬
sons, elicit electric sparks, why should not these excite
inflammation or ignition of the alcoholic fluid, or of a gas

316

Original Commit n i cat ion $■.

contained in the cellular substance of onr organs ? In spon¬
taneous combustion, the flame is like that of certain meteors,
and is extinguished with difficulty. The walls in the chamber
in which this happens are covered with an unctious fetid
humidity, such as results from the combustion of hydrogen
gas. It rarely happens but some of the bones of the limbs
remain, but the trunk is consumed, probably as it is con¬
nected with the large cavities, and on account of the laxity
of the cellular tissue, and the evolution of hydrogen gas in
the intestines. When the individual does not perish at the
instant of the accident, sphacelus sets in or commences
rapidly after death. If life remains for four or five days, an
insupportable odour is exhaled, the nails are detached, and
worms are generated. These characters cannot be confounded
with accidental combustion, or burns ; in these the redness
of the blisters and the eschars leave no doubt on the nature of
appearances, and accidental combustion seldom destroys the
whole body without extending to surrounding objects; all
jurists admit the possibility of spontaneous combustion.
The reader will find references in the works of Beck,
G. Smith, Briand, Sedillot and others.

Death by inanition or hunger. — It seldom happens that
homicide is committed in this manner, though it is well
known that cruel and unnatural parents, step-fathers and
step-mothers occasionally destroy children and young per¬
sons by famine or starvation. The ancient and modern his¬
tory of Ireland affords ample evidence of the destruction of
life by this cause. Besides, persons may be found dead,
when it will be important to inquire whether life has been ex¬
tinguished by cold, hunger, poison, &c. It is therefore i m-
portant to state what are the signs of death by starvation.
The body is emaciated, the eyes are red and open, the
tongue, throat and buccal mucous membrane, are very dry,
the stomach and intestines are contracted and empty, there is
no fceculent matter in the bowels, the gall bladder is full,
and bile tinges the stomach and bowels, and all the blood¬
vessels are empty. Many of these signs are different from
those which characterise other causes of violent death.

[ 31? ]

IV. — Dr. Malins’s Introductory Lecture .

Gentlemen,

Established custom requires, that previous to commencing the
exposition of a subject connected with science or art, a sufficient
historical account of it shall be given, to enable the student to form
some accurate general ideas of its origin, and the manner of its
advancement to the state in which it is found at the present time.
It is this preliminary measure which it is now proposed to fulfil with
regard to Midwifery — a term, which in its ordinary acceptation, is
held to denote a link only of the extensive chain of occurrences,
which fall peculiarly within the notice of the obstetric teacher and
practitioner ; for if the just definition of this important branch of
medical science be, that it is the amount of our information relative
to the perpetuation of the human species,* it will at once appear
how comprehensive must be the studies belonging to it, and how
wide a field of inquiry it opens to the philosophic mind. Nor can
it be less evident, from its connexion with the subject of population,
that a knowledge of its doctrines and resources is worthy the atten¬
tion of the politician and economist ; and, from its being conversant
with the concomitant circumstances of prolicide, or the destruction
of the human offspring, that a strict alliance obtains between it and
some of the most usual and difficult points, which it is the office
of the medical jurist to investigate.

It is then a self-evident proposition, that the art of midwifery
took its rise, and is coeval with the existence of mankind ; to assign
it any other origin, or to institute an inquiry into the date
of its origin, would be equally absurd. The parturient pro¬
cess, in its liability to morbid interruption and dangerous com¬
plication, must have been essentially the same in all ages and coun¬
tries from the beginning of the world ; an assertion in proof of
which, besides the convincing arguments deducible from the struc¬
ture of the human frame, we may adduce the positive declaration
of the Deity to the first woman, that in sorrow she should bring

forth children.

In tracing the progress of midwifery from the creation of the
world down to the present day, the sacred writings, as being both
absolutely and' relatively the most ancient documents in existence,
come first to be consulted. The information supplied from these
records is, as might be expected, from its being only contingent,
scanty and imperfect, and consists in not more than several inci¬
dental allusions. The earliest reference made to the subject of
midwifery is in the 35th chapter of Genesis, where we learn that

* Velpeau.

318

O r ig inal Co mmu nictations.

Rachel, the wife of Jacob, died in giving birth to a son, although
assured by the midwife that she need not fear. The second allusion
is contained in the latter verses of the 38th chapter of the same
book, and presents the description of a rare occurrence in the practice
of midwifery. It is a case of twuns, and one of them presenting by the
arm, on which, to distinguish it as belonging to the first born, the
midwife tied a scarlet thread ; but the arm afterwards receded — the
second child came down, and was eventually expelled first. From
the next passage, which is part of the first chapter of Exodus, we
learn that the Hebrew women were accustomed to be delivered
sitting on stools, and that probably their labours were quickly
terminated. It is to be noted that this circumstance is one of
probability only, for though the midwives declared to king Pharoah,
by whom they had been commanded to kill all the male children, that
the Hebrew women were not as the Egyptian women, inasmuch
as they were lively, and delivered ere the midwives came in unto
them ; yet when we recollect that the declaration w7as urged in
defence and extenuation of their not having complied with his cruel
commands, it is not incumbent on us to attach truth to its literal
and direct interpretation. A fourth testimony, relating to the obste¬
tric art among the Hebrew people, exists in the fourth chapter of
the first book of Samuel, where we are informed, that through grief,
premature labour, terminating fatally, wTas brought on in the wife
of Phinehas, the high priest’s son. The same consolatory remark
of fear was not applied to her by the midwives, as in the other fatal
case, and from the construction of the sentence, may be as reasonably
deemed a customary form of congratulation on the occasion of a
birth under any circumstances, as an indication of ignorance in
misapprehension of danger. The last citation from the holy wuitings
to which allusion must be made, refers to the treatment of the
umbilical cord, the division of w7hich, termed omphalotomy, was,
without doubt, the first surgical operation performed, and may
challenge the records of pure medicine for an instance of equal
antiquity. Much futile, vain discussion, even among estimable
authors, has taken place as to what was the management of the
umbilical cord of the first infant Cain, but it is not my intention to
occupy your time by the relation of their frivolities. It is at the
beginning of the sixteenth chapter of Ezekiel, wrhere w7e read of
the comparison of Jerusalem to a w7retched infant, whose navel was
declared to be uncut on the day of its nativity,, that the first
express mention of omphalotomy occurs ; and the inference drawui
from it has been, that the Jews were in the habit of dividing, but
not of placing, a ligature on the cord. This may have been the
case, but the point is an inconsequential one ; and it appears from
the simultaneous mention of salting and sw7addling, that if the cord
w7as not secured by tying, at least other means were had recourse
to for stopping the effusion of blood. Since also Ezekiel w7rote in
tbe year of the world 3840, at a time w7hen the Jews had been in
frequent and durable intercourse with other nations, it cannot be

Dr. Malins’s Introductory Lecture.

319

more than probable that section, though then in use, was the mode
of separation that had been employed from the beginning.

Nothing of particular interest is made known to us by these
passages, excepting that midwives seem to have been uniformly
engaged in obstetric practice among the Hebrews, and that the as¬
sistance of men was never demanded, perhaps even not for a moment
imagined. Such at least is the natural and legitimate conclusion
to be derived from the fact, that male practitioners are never alluded
to, either in the Old Testament, or in the writings of the Jewish
historian, Josephus ; but there are not, on the other hand, wanting
either writers or reasons inclining us to admit, that from a certain
period of their national existence and in perilous labours, the
Hebrews did resort to the aid which professors of the healing art
could alone be supposed capable of affording. It must be confessed,
however, that the belief is entirely conjectural, and rests on slender
grounds. There is a passage in Herodotus, giving presumption to
suppose that the eastern nations had recourse to the assistance of the
physicians in the difficult labours of their women. Now, it was by
these eastern people that the Jews were for so long a time held in
captivity, and as conquerors have generally imposed their laws and
customs on the vanquished, and moreover as constant intercourse
between nations (not to mention the temporary assimilation which
happened in the case under consideration) is known to induce the
adoption of similar manners and usages, it is inferred that the
Jewish people, from the time of their return from the second or
Babylonian captivity, to that of their dispersion over the world, did,
among other institutions of their conquerors, imitate that of
employing male practitioners in all cases of difficult or impeded
parturition.

From the consideration of the state of midwifery among the
Jews, let us pass to that of its condition among the next most
ancient people, the Egyptians. In the absence of direct testimony,
it is only by reasoning on the few facts that we possess bearing on
the question, that any conclusion can be arrived at ; and even then
it is not entirely satisfactory or decisive. All that can be affirmed
is, that there is a high probability that the profession of accoucheur
was not unknown to the Egyptians ; for, in the first place, Hero¬
dotus distinctly states, that there was a subdivision of labour in the
medical profession among them — that individuals attached them¬
selves to the treatment of particular classes of maladies, or the
affections of particular organs, whence there were oculists, dentists,
aurists, chiropodists, &c. — in the next, the Egyptians are known, by
the monuments and relics which they have left behind them, as well
as by the testimonies of the earliest profane historians, to have
been a highly ingenious, inventive, and wise people ; — and lastly,
they had continual commerce with the Greeks, who, as will be pre¬
sently mentioned, did employ accoucheurs during at least some
periods of their history, and in the more cultivated states. From
this combination of facts, — that other branches of the art of medicine

320

Original Communication s .

were distinctly exercised ; that the people were learned, polished
and sagacious ; and from their frequent communication with a
country in which they could see and observe the good effects
resulting from the practice being in the hands of men, it does, I
think, become very probable, and it is not a mark of credulity to
believe, that among the Egyptians the office of accoucheur was
known, and recognized as a distinct branch of medical pursuit.

The Greek and Roman authors occupy the next place, in a pic¬
ture of the progress of the obstetric art. At this era we first obtain
authentic and often copious details of its practice, and are enabled to
treat the subject altogether with more certainty and in the exact
order of time. The origin of all medical knowledge, its separation
from a superstitious philosophy, and its establishment as an inde¬
pendent science, depending for extension of its boundaries on exact
observation, faithful induction, and ingenious experiment, are to be
dated from the epoch of these classic writers, who as they are the first
we are acquainted with in respect to their antiquity, seem also to
have been more accurate observers than any who have succeeded
them. As the notice of their opinions must necessarily be tedious,
and yet cannot be dispensed with, I will commence their brief con¬
sideration without further introductory remark ; and in the first
place, with those of the prince and father of medicine, Hippocrates,
who was born in the Island of Cos in the Archipelago, and flourished
and practised in different parts of Greece in the fifth century preceding
the Christian era. Among the writings of this great man which have
descended to us, there are four books on obstetric subjects, which
are respectively entitled de nature pueri, de morbis mulierum, de exsec-
tione foetus mortui, and de superfcetatione ; these being the earliest
express records of midwifery which are known, their venerable author
is rightly considered and termed the father of midwifery, as well as
of physic. It is immaterial to the purpose to settle the contested
point whether or not Hippocrates practised midwifery ; his precepts
and observations alone claim our attention, and if he did not, as is
commonly supposed, actually officiate during parturition, he yet dis¬
plays an extraordinary and intimate acquaintance with the details,
both of the process and of its remedial or guardian art. His opi¬
nions on the particular branch of medicine we are considering present
the same compound of sagacity and superstition, of justness and error,
which are so conspicuous throughout his whole writings ; but, as far
as relates to the mechanical management of labours, the erroneous
views and directions greatly predominate. Thus, the only presenta¬
tion of the infant by which delivery should ever be attempted he con¬
siders to be that of the head, and into it he directs all other presen¬
tations to be if possible converted. Presentations of the lower extre¬
mities he says are dangerous, and generally fatal to the mother or
infant, or to both ; and in nearly the same terms transverse positions
of the child are spoken of, being ingeniously likened to an olive im¬
pacted and lying across the neck of a narrow-mouthed flask. Em¬
bryotomy, or the extraction of the child piece-meal, he directs to be

Dr. Malin’s Introductory Lecture. 321

performed whenever it is so swollen that it cannot pass, or the mal-
presentation cannot be altered. In both these cases Hippocrates
thought the child must be dead, and his directions to have recourse
to embryotomy seem to refer therefore to dead children only, who,
according to the belief then prevalent, could not be bom unassisted,
inasmuch as it was considered that the act of parturition was consti¬
tuted by the voluntary efforts of the foetus seeking its way into the
world. But when we recollect how uncertain and fallacious the
signs indicating the death of the foetus are, it may be fairly enough
supposed, that embryotomy, performed in all cases either of great
swelling or ineducible wrong position, was as frequently the means
of destroying living, as of extracting dead children. The instru¬
ments described as proper for the operation are six in number, and
are variously intended to cut, comminute, and extract. The
management of the placenta after the plan recommended by him,
would be now considered not less improper than adherence to his
precepts for conducting the birth of the child. Its removal, he said,
was to be accomplished immediately after the expulsion of the child,
and the methods of effecting this which he advises are, making for¬
cible straining efforts with the breath retained, the administration of
sternutatories and a farrago of stimulant emenagogues, raising the
bed from its head, so that the weight of the foetus might drag down*
wards, placing the woman on a high stool and attaching weights to
the umbilical cord ; or, if the child should be dead, allowing it to
depend from the parts, but to rest at the same time on the surface
of new wool or bladders filled with water and spread over with wool,
by the puncture of which with needles the water would be gradually
evacuated, and the infant subside slowly, so as to exert an equable
and not too violent degree of traction. Notwithstanding the absurdity
and danger of many of the practices of Hippocrates in the conduct of
labours, he has left us some unequivocal memorials of his accuracy and
exactness of observation. Such are the remarks that too early rupture
of the membranes protracts the duration of labour — that venesection is
useful in lingering labours when the habit of the patient is full — that
implication of the funis about the neck or shoulders of the infant fre¬
quently destroys its vitality — and that in uterine hsemorrhage the
application of cold water to the abdomen by affusion, cloths or sponges,
and the plugging of the vagina, are essential means of checking it.

Of Aristotle, who was born at Stagyra, 384 years before Christ,
and was tutor to Alexander the Great, it will not be necessary to say
much. He has written little or nothing on the practice of midwifery,
but in his Historia Animalium, has treated very profusely on concep¬
tion and generation. Some of his opinions are substantially correct,
but the greater number of them are crude, hypothetical and super¬
stitious.

About 480 years after Hippocrates, or A. D. 35, Celsus flourished
at Rome, and is the first author after the father of physic, who, as
far as we know, has written on medicine, or given any directions on

Vol. VI. no. 34. t T

322

Original Communications .

obstetric subjects. Though for the most part a copyist of Hippo¬
crates, Celsus has modified and deviated from his precepts in several
important particulars. He advises that the feet of the child should
be brought down in those cases of transverse presentation where
they can be more readily seized than the head, and observes that ex¬
traction by the feet can be effected without much difficulty. Celsus
gives judicious directions for dilating the os uteri when requisite, for
conducting the extraction of the placenta, and for performing embry¬
otomy. In describing the proper modes of using the crotchet or
hook (two kinds of which he describes) he notices that convulsions
and imminent danger are produced by the slipping of the instru¬
ment, so as to lacerate the contiguous parts of the mother.

Moschion is the author to be next mentioned. He wrote in Greek
expressly on the diseases of women, but at what time is uncertain.
Some have considered that he lived before the commencement of the
Christian era, while others having assigned him a date so low as some
part of the third century. It is however probable that he did not
write till after the period of Celsus, and it is nearly certain that his
was the first book written specially on midwifery. The only other
work which contests the honour of priority with it, is that de utero et
pudendo muliebri of Soranus Ephesion, a writer who lived in the
reigns of Trajan and Adrian, in the second century. Moschion
ventures to recommend delivery by the feet with less reserve than
Celsus, though he is by no means to be considered the originator of
the operation of turning under the circumstances which in this
country are now universally held to demand its performance, for with
the exception of knee and breech presentations, he first attempted to
reduce all others to that of the head, before resorting to extraction
by the feet. And this plan is now adopted and recommended by
several professors in Germany and France.* Moschion speaks of
parturition rendered difficult by disease and deformity of the infant’s
body, by presentation of the head in a wrong position, and by
obliquities of the uterus ; from which it appears that he must have
been an able and experienced accoucheur. Among those which
would in the present day be considered bad practices, the worst per¬
haps was that which he advocated, of assisting delivery as soon as the
head of the infant is protruded into the world, by grasping it and
employing lateral tractive motion — a custom even now too prevalent
among female practitioners, and a fertile source of that irregular action
of the uterus, which produces the hour-glass contraction. f

Pliny, who was destroyed through his imprudent curiosity during
the great eruption of Mount Vesuvius in the first century, is here

* Flamant, Ossiander, Siebold and others.

f Moschion has likewise given us a description of the chair or stool which was
employed by the ancients in parturition, which he says is like a barber’s stool,
having a lunar-shaped foramen cut in it, for the foetus to fall through.

Dr. Malin’s Introductory Lecture. 323

mentioned, not because he was a physician, or said any thing new on
obstetric subjects, but from his stating among his paraphrases or
copyings of the writers on midwifery who preceded him, that from
the circumstance of children presenting by the feet being so seldom,
or with so much difficulty born alive, they were called by the name
of Agrippse, as if eagre parti. Hence Pliny thought that such positions
should be always rectified.

The medical writer next following Moschion, or perhaps his con¬
temporary or predecessor, is Galen, who lived about 600 years after
Hippocrates, and is principally famous for his diffuse commentaries
on his great master’s works. Galen makes some excellent remarks
on the diseases of women and children and has the reputation of
being the discoverer of the Fallopian tubes ; but he achieved nothing
worthy of notice in the art of midwifery.

Towards the termination of the fourth, or, according to some, of
the fifth century, iEtius a Greek, and the first Christian physician of
whom we have any knowledge, flourished in high repute at Alex¬
andria. He is a voluminous but not an original writer on midwifery,
confessing candidly that he has compiled from the works of his pre¬
decessors ; and indeed, it is principally because he makes us
acquainted with the modes of practice of otherwise unknown obstetric
professors — particularly of the noted midwife Aspasia, and of Phi-
lumenus — that his writings are interesting. AEtius treated uterine
haemorrhage by styptic injections, astringent pessaries, and ligatures
round the limbs ; makes a distinction of head presentations into
natural, when it descends straight forwards, and preternatural,
when - it is turned to the right or left side of the uterus ;
alludes to, without minutely describing a dilator somewhat
analogous to the modern speculum, and dissents from Hippocrates,
holding similar opinions to those of Celsus and Moschion, with
respect to pedal presentations and delivery. From Aspasia,
who is supposed to have lived before the time of Hippocrates, and to
have been the mistress of several Persian monarchs, iEtius cites very
precise means for remedying obliquities of the uterus, and presents
us with a copious list of substances for causing sterility or abortion,
besides minute directions for the management of puerperal women.
Of Philumenus, it is reported that he always in cases of locked
head, endeavoured to turn before resorting to the performance of
embryotomy — that one of the instruments employed by him in this
operation was a forceps, armed with teeth for comminuting and
extracting portions of bone — and that in adhesions of the placenta to
the surface of the uterus, he attempted the separation, not by the
forcible violent means then usually had recourse to, but by gentle
efforts exerted in a lateral, rather than a straight direction, in order
that there might be no risk of producing what he calls a prolapsus,
but what would undoubtedly have been an inversion of the uterus.

Paulus Aginata follows next in chronological order to AEtius, and is
the last of the Greek medical authors whose works have descended
to us, but it is neither known where he flourished nor whether he

324 Original Communications .

lived in the fourth or seventh century. Dr. Friend inclines to the
latter epoch, and to place his residence at Alexandria, since learning
and learned men were already at that period banished from Europe ;
while Le Clerc considers that it was in the fourth century that he
wrote, and if so, it probably was from the eastern part of Europe.
He was the first man to whom an appellation corresponding to our
modern term accoucheur was applied — the Arabians calling him vir
obstetrix, or obstetricus, but there is little doubt that others who
preceded him merited the name equally well, though never given to
or assumed by them. The writings of Paulus are for the most part
transcripts from the works of his predecessors, and it is not therefore
surprising to find that they are contradictory or inconsistent . From
this circumstance also, he has been pronounced by some as a sagacious
practitioner, while by others he has been denounced as rash and inju¬
dicious ; and, seeing that he advises the lower extremities of an infant
to be amputated when they cannot be returned into the uterus, it
would appear that the latter party are in the right.

It will be convenient to pause in this place for the purpose of
taking a review of the state of the art In general among the ancients,
and in particular with reference to its practitioners and professors.
The concurrent testimony and allusions of all the old authors render
it indisputable, that women were in the commencement the chief, if
not the sole practitioners in midwifery, and that they likewise exerted
the privilege of treating the diseases peculiar to their sex, as well
during the pregnant and puerperal states, as at other times. Those
persons therefore, who in the present day, raise an outcry against
the employment of male practitioners, and are so fond of appealing
to the customs and usages of the ancients for confirmation .of the
propriety of their opinions, should extend their objections to the
management, and, if themselves physicians or surgeons, should be
prepared to relinquish the treatment of the diseases of females under
any circumstances or conditions, for by doing so they would be
enabled to fulfil, without at all exceeding the desires and directions
of the people, whose usages they adduce. Peculiar names, indica¬
tive of their occupation and duties, were appropriated to the ancient
mid wives, answering to the terms grandmother,* female physician,
and cutters of the naval string in our own language. That they were
held in considerable estimation seems probable from Socrates pro¬
claiming, with evident satisfaction, that he was the son of one, called
Phainareta, whom he terms “ generosa et gravis obstetrix,” and from
the circumstance of another having obtained the name of Sotira
— “ salvatrix or conservatrix,” from the felicitous success of her prac¬
tice. The sister of the doubting philosopher Pyrrho seems likewise
to have been a midwife. Besides superintending the process of par¬
turition, it was a part of their office to negotiate and assort marriages.

* Me *j«i, ictrpofjMictt, larpivotC, o/^af,olo/j,ot

325

Dr. Malin’s Introductory Lecture .

and to. teach their employers, as we learn from Plato, the art of pro¬
creating beautiful and healthy offspring ; and they were further in
the habit of administering medicines to produce sterility or abortion,
and were believed to have the power of controlling or exciting labour
pains, and of preventing, as well as inducing abortion by their medi¬
cines and charms. A famous practitioner among these time-honoured
matrons both for alleviating disease and for the invention of receipts
and cosmetics, was a certain Cleopatra, whom some of the older
writers, in their zeal for the honor of the art, have endeavoured to
identify with the voluptuous queen of Egypt; but their assumptions
do not rest on a better foundation than that a treatise on so mere¬
tricious a subject as the care of the complexion might naturally be
expected from one who had so repeatedly profited by her personal
charms. Their readiness to provoke miscarriage at the will and con¬
venience of their mistresses does not, however, appear to have been
universal, for Pliny relates that Lais (not the renowned courtesan of
that name, but a highly respectable midwife of Athens) strenuously
opposed what she thought so unnatural and impious a practice, and
presented in that laudable respect a remarkable contrast with an emi¬
nent rival, named Elephantis. That the custom very generally pre¬
vailed may be reasonably inferred from the precautions which we find
to have been specially directed against it ; thus Hippocrates, in the
oath which he obliged all who became his disciples to take, expressly
condemns and exacts from them by its solemnity, the declaration that
they will never be guilty of attempts to frustrate the designs of
nature in this respect. Yet the venerable patriarch of our profession
confesses that he did on one occasion designedly cause a singing girl
to miscarry, an action that forms an unfortunate commentary on his
rigorous precept; but which it is customary to reconcile, by consider¬
ing that he spoke in one instance as a philosopher, contemplating in
the practice only an outrage and offence against the laws of nature,
and acted in the other as a citizen of the world, in which capacity the
deed might be justified to him by the prevailing practice and notions
of others. But to return from this digression. — Of the particularities
of practice of these midwives we have had transmitted to us little or
no direct account, the only circumstance being that mentioned and
approved by Aristotle, that before tying the umhilical cord they were
accustomed to compress and urge the blood of its vessels into the
abdomen of the foetus, with the view of rendering it vigorous and
strong. But were it worth the task, it would not be difficult to
accumulate a sufficiency of circumstantial evidence to shew that their
proceedings were often reprehensible and dangerous. Some testi¬
mony of this kind will be presently afforded . Hysteria was one of the
affections which they were more frequently called upon to treat than
others,* and indeed received its name from them; and we know that

* Martial alludes to this circumstance in lib. i. of his Epigrams.
Hystericam vetulo se dixerat esse marito .

Protinus accedunt medici, niedicaeque recedunl.

326

Original Communications .

the relation of the etymology of the term to the cause of the complaint
is for the most part well founded and correct. But though estimated
from necessity, and prescribing from custom and prejudice for the
accidents and disorders incidental to their sex, the midwives of
Greece and Rome were not distinguished for sagacity or good
behaviour; for we find Socrates likening himself to them in being bar
ren or destitute of wisdom, and Terence not disguising the fact that
they were addicted to wine, rash, and not worthy of being entrusted
with the important charge of at least a first confinement.

Sane pol ilia temulenta est raulier et temeraria :

Nee satis digna, cui committas primo partu mulierern.

Andriae, Act 1

Yet there is every reason to believe that the ordinary practice of
the art was in Greece, with a transient interruption, and throughout
the Roman empire, from its commencement to its termination in the
west, entirely in their hands ; and that male practitioners, who were
the regular medical men, were looked upon as referees in extraordi¬
nary and difficult cases, and summoned only when the ability and
strength of the midwife were inadequate te effect delivery. And it
may be stated by anticipation, of the Arabians, the subjects of the
eastern empire, and of the Europeans in general during the dark
ages, that similar usages obtained amongst them.

In proof of such having been the case, we have, as far as male
practitioners are concerned, the direct testimony of their writings,
evincing a knowledge of the subject that could be derived only from
experience ; — the nature of the operations so frequently described,
which, it may be safely supposed have always demanded more
anatomical skill, and physical, as well as moral resolution, than
females can in general have possessed ; — and the fact that the instru¬
ments employed were inventions of men, and so not likely to be
resigned altogether to the use of women. There are these positive
and negative proofs that medical men were always engaged in the
practice of midwifery, in cases of doubt and emergency ; while that
females were previously and commonly employed, is abundantly
evident also from their writings, and from the allusions contained in
the works of the physicians, historians, poets, and philosophers,
who were their contemporaries ; and moreover, would have been a
natural and legitimate inference a priori, when the low ebb at which
human knowledge comparatively stood, the state of society, and the
circumstance that preceding and foreign people had principally
employed women, were taken into account. In addition to the
confirmations already given, may be mentioned the incident recorded
by Suetonius concerning Livia, the wife of the emperor Augustus,
to whom, after she had suffered a long time from lingering labour,
the court physician, Antonius Musa, was called for the express
purpose of hastening her delivery — “ pro partu accelerando,” are
the words used by the historian. That it was always the physician

Dr. Malin’s Introductory Lecture. 3 27

or surgeon (for the distinction of office in the profession was not in
those times established) who was called upon in cases baffling
female skill, is clear, from the term “ medicus,” always used by
Celsus, to denote the individual to whom his directions were in¬
tended to apply.

I said that in Greece the fair sex did not maintain their monopoly
of midwifery practice uninterruptedly, and I now proceed to relate
the occurrences connected with the suspension of their functions,
as described by Hyginus, who wrote about the commencement of the
Christian era. For some reason which does not appear, probably on
account of the impoverishment of the state of its subjects in conse¬
quence of the inefficacy and unskilfulness of the midwives, the
Athenians — that ingenious and polished people, whose name, even
in the present day, is held to be typical of all that is elegant, intel¬
lectual and refined — enacted a law, prohibiting females and slaves
from studying or practising any of the branches of medicine, among
which midwifery was of course included. The direct tendency of
this edict was to throw all the obstetric practice into the hands of
men, or to deprive women of all assistance during parturition.
Reduced to this alternative, many Athenian ladies (such was their
high, but mistaken sense of modesty) preferred to perish in giving
birth to their offspring, rather than admit the succour of male
practitioners. In consequence of this unfortunate state of things,
and moved either by motives of sympathy or cupidity, a young
female named Agnodice, was led, after removing her hair and
assuming male attire, to attend the lessons of an obstetric teacher,
Hierophilus, in order that she might gain sufficient skill to admi¬
nister to the sufferings of her sex, in their hour of travail and
difficulty. So extensively was she sought after, that the accou¬
cheurs, finding their interests to be greatly injured, and suspecting
something to be wrong, caused her to be charged before the areopa-
gus, with being an eunuch and corrupting men’s wives. Brought to
trial on this accusation, she discovered her sex to the court, on
which the accoucheurs became still more virulent and urgent for her
punishment, and this would no doubt have been severe, but for the
intervention of the most distinguished ladies of the city, who
pleaded so eloquently and pertinently in her behalf, that she was
not only liberated, but the obnoxious law was also rescinded, and free
permission thenceforth given to females, both to practise the obstetric
art, and to treat all the diseases peculiar to the female constitution.
After this time, the male and female practitioners acted concurrently,
the former being consulted in all probability only when their services
were indispensably required.

The state of midwifery among the Greeks and Romans having
thus been considered, let us transport our imaginations to its condi¬
tion among their successors in science and literature, the Arabians; for
after the repeated irruptions of the northern hordes upon the fair and
fertile regions of the south during the third and following centuries,
the lights of learning and knowledge were soon extinguished in the

328

Original Communications.

west of Europe. It was then that the Goth and the Vandal vied
with each other in the work of devastation and destruction, and the
monuments of ancient glory and art were pitilessly defaced and con¬
signed to ruin, that the Huns emulated their sacrilegious and ferocious
deeds, and that all the barbarians conspired to sweep away every
vestige of intelligence and trace of human dignity from the face of
the earth. The mental darkness in which Europe remained plunged
for 1000 years followed; and as long as it continued, the grossest
ignorance and superstition universally prevailed, and an entire check
was given to the cultivation of art or science of any kind. The
mists which enveloped the human mind, and clouded all the opera¬
tions of reason during this fearful and eventful period, were but too
prolific in engendering errors and evils, that have scarcely yet passed
away. But these mournful consequences must gradually vanish
before the dawn of true wisdom and philosophy, and will at length
be irrevocably dissipated by the piercing and radiant beams of that
heaven -born knowledge, which aims at uniting mankind in firm and
fraternal bonds of harmony and love.

The progress of mental cultivation, though arrested in the western
parts of Europe by the overthrow of the empire, was not so com¬
pletely suspended in the east, where the arts still continued to
flourish, though languidly and feebly, and to receive the counte¬
nance, in some measure, of the Greek emperors, but in a more zea¬
lous degree of the Arabian caliphs. It was about the year 640, that
the Saracens, in overrunning Egypt, obtained possession of the
books in the Alexandrine library, all of which they took care to
consume, with the exception of those on medicine, from which they
probably expected to derive some advantage, and accordingly pre¬
served. These were carried away and translated into the Arabic
tongue, or at least, were copiously copied and borrowed from by
those Arabian physicians whose writings have reached us.

Of these paraphrasing authors, the earliest Serapion, says nothing
worthy of repetition.

The next, Rhares, who flourished at Bagdat towards the end of
the ninth century, and gave the first description of small-pox,
notices that in premature parturition the crural presentation is most
common.

Aviceuva lived about A. D, 1000, and treats in detail of mid¬
wifery and the diseases of females. In the management of pro¬
tracted natural labour, by which a vertex presentation was implied,
he first directs assistance to be afforded by the hand — if that is
unavailing, by the application of a fillet or tape — if the additional
power thus obtained does not suffice, forceps are to be used, instru¬
ments not like the forceps of the present time innocuous to the
foetus, but destructive of its life — and if the forceps fail, the head
is to be opened, and its bones comminuted in the customary way.

(To be continued.)

[ 329 ]

BIBLIOGRAPHY.

ANATOMY.

1. — I. Explanation of the Anatomical Atlas of Professor Weber,
of the Royal Prussian University of Bonn. London. 1831. 8vo.
Parts 1 and 11, pp. 127. A. Schloss, Southampton Buildings,
Chancery Lane.

II. Anatomical Demonstrations, or Colossal Illustrations of Human
Anatomy. By Professor Seerig. London. 1831. pp. 1, pp. 34.
A. Schloss.

III. Arteriology of the Human Body. By Borremans, revised
and adapted to the English Nomenclature, by T. King, Professor of
Anatomy and Surgery, &c. &c. London. 1831. Feuillet, Dumus and
Co. 1, Leicester Square.

Of all the Anatomical Plates we have hitherto seen, with the
exception of Mascagni’s, which are unequalled, these are the best
and cheapest. They are of natural size, and are executed with
the greatest fidelity. The expense of the whole is a sum which
can be spared by any medical student. If anatomy could be
learned by plates, a facility is afforded by those before us. We
strongly recommend them to every member of our profession.
The publisher is entitled to the support of every friend of medical
science. Professor Seerig’s views of the skeleton, are the most
faithful hitherto published. Mr. S. has also a splendid collection of
anatomical preparations in wax, which have received the approba¬
tion of the Medical Press as well as of the Royal College of Physi¬
cians, and the various other scientific societies of this metropolis.

We have already noticed the neuralogy of Borreman’s with our
warmest commendations. The arteriology is still a more interesting
plate to the practical surgeon and anatomical student. It is well
executed. Both plates ought to have a place in every anatomical
museum and lecture room in the United Kingdom. The publication
of such valuable illustrations of the structure of the human body,
facilitates the labours of the student, and refreshes the memory of the
established surgeon on points of the greatest importance, which must
be always fresh in his recollection.

MEDICINE.

2. On Oleum Terebinthince as a remedy for Salivation. By E. Ged-
dings, M. D. Lecturer on Anatomy and Surgery, Charleston, S. C. —
It was not until the winter of 1828 and 29, that we became acquainted
with the efficacy of 01. Terebinth, in the treatment of this distressing
affection. We were attending a young gentleman of the medical
class, who became severely salivated from a small dose of calomel.
A highly intelligent young gentleman, Mr. J. E. Pierson, at that time
one of our pupils, now a respectable physician of Fairfield District,

VOL. VI. no. 34.

u u

330

Bibliography.

proposed the turpentine, which was accordingly employed, and
afforded speedy relief. Since that time we have used it extensively,
in both hospital and private practice, with the most satisfactory results.
It has also been much employed by several of our medical friends,
whose testimony in its favour, we are happy to state, fully sub¬
stantiates our good opinion. We usually direct two drachms of
turpentine to eight ounces of gum arabic mucilage, with wdiich the
patient is required to gargle frequently in the course of the day. We
have, however, in some cases, employed the undiluted turpentine
with the same happy effects. It usually occasions, at first, consider¬
able smarting, which, however, is of only temporary duration, and
becomes less and less at each successive application. Indeed, in many
Cases, the smarting is succeeded in a short time by a soothing impres¬
sion, similar to that which attends the use of the turpentine in cases
of burns and scalds.

We will say nothing of the modus operandi of the medicine in cases
of salivation, but will merely recommend a fair and impartial trial of
it as a remedy for that distressing affection. — American Journal of the

Medical Sciences, Nov .

3. Case of Colica Constipata removed by inflation. By John King,
jun. Surgeon, Irvine. — The importance of inflation as a remedy for
obstruction of the bov/els, appears to me not to be sufficiently appre¬
ciated at the present day. It was first recommended by Hippocrates
for the removal of intestinal obstruction ; in more modern times, it
has been resorted to by Hoffman and Haller ; and notwithstanding the
neglect it has since experienced, I cannot but regard it as worthy of
an eminent position in the list of therapeutic agents. The treatment
usually prescribed in cases of ileus or colica (without inflammation) is
very discordant, as witness — warm baths, fomentations, injections of
warm water and oil, rubefacients, and blisters ; contra, cold effusion
and immersion, freezing lotions, pounded ice and snow ; not to men¬
tion emetics, purgatives, and mechanical distention by warm fluids,
quicksilver, gold and silver balls, &c. ; and when all these remedies
have failed, blood-letting, tobacco, in infusion and smoke, and lastly,
gastrotomy. Yet this simple means of inflation, although probably
the most powerful, and the least dangerous, is entirely overlooked.
It paralyses, as it were, the constricted fibres of the bowels, and may
be used in the following cases, if not with complete success, at least
with advantage, viz. the various kinds of colic, proceeding from torpi¬
dity, spasmodic constriction, viscid meconium in new-born infants,
impaction, bezoards, and other intestinal concretions, volvulus or
intus-susceptio, and some cases of hernia. It was a happy thought
of those who hit upon this means in the hour of danger, after all
their other efforts had proved nugatory. For although tobacco,
which is often used as a last resort, sometimes is successful, it is not
uniformly so, and it too often happens, that the patient, rather than
undergo a repetition of it, beseeches to be allowed “ to die in
peace/’ We may also observe the hesitation with which the prac¬
titioner has recourse to it, not only because of its doubtful efficacy.

Medicine.

331

but on account of the danger there is of greater exhaustion being
produced by it. I take the liberty of giving one case, as I conceive
it may give some idea of the power of inflation.

In September, 1829, I was requested to visit Mrs. G. set. 26, of
rather delicate frame. On the night previous to my visit, she
experienced an uneasy sensation in the region of the stomach ; for
which she took eight grains of calomel, combined with a half¬
drachm of compound powder of jalap, without any impression on
the bowels. During the night this uneasiness increased to an almost
intolerable pain, accompanied with obstinate vomiting; which con¬
tinued till the evening, when I saw her. In the course of the day
she took two doses of castor oil, and received five injections. When
I entered the apartment, she was sitting near the fire, and her body
bent forward ; the face was wan, sallow, dejected, and of a dingy
yellow colour ; the surface of the body and extremities inclihing to
cold. Pulse 80, soft and much compressed — tongue, at the back
part, covered with a brownish coloured mucous — she had obtained
no alvine solution for six days. She took no notice of my being
present, or any thing going on around her, but informed me, when
questioned as to the seat and kind of pain, that it was of “ a violent
screwing nature, working between the stomach and navel/' coming
on in paroxyms, and ending in, or producing vomiting. I ordered
the warm bath, and gave a teaspoonful of laudanum with compound
spirit of lavender, which was soon afterwards vomited. Upon this,
an effervescing mixture was given, then five drops of croton oil with
some laudanum, and in about three quarters of an hour, five drops
more without laudanum; but each in its turn was rejected, with a
quantity of yellow coloured fluid. It was at this time, I first thought
of inflation. For this purpose, I procured a pair of common bellows,
and securing the bladder of a glyster bag to the nozzle of the bel¬
lows, the pipe was introduced into the rectum, while the patient lay
on her right side, and the bellows was commenced being wrought.
As soon as the air entered the rectum, the effect was immediate and
satisfactory ; the countenance lost its anxiety, the eye brightened,
and the patient said she felt quite relieved. A gurgling noise was
heard in the bowel, with an escape of foetid air ; and in about a
minute from the time the air began to enter the rectum, she requested
to be allowed to go to stool. She had a copious dejection, and a good
night’s rest ; and next morning complained only of being much'
enfeebled, but was otherwise well.

I was deeply impressed, about five years ago, with the fatal result
of a case of intus-susceptio, in a fine robust infant, six months old,

. which was supposed to proceed from the effects of half a teaspoon¬
ful of some syrup of poppy, made, as is commonly done, with opium,
given for the purpose of procuring sleep during the period of teeth¬
ing. About eight hours after it was given, the child began to cry
vehemently, having appeared restless and uneasy for several hours
previously. Early in the forenoon, it passed a very scanty stool,
streaked with blood ; soon after this, vomiting commenced, which

332

Biblio gr apk y .

continued until the little sufferer sunk. Is it unreasonable to imagine
that if inflation had been used in this case, the result would have
been otherwise ? I was hereby shown the necessity of seeking more
powerful means, than fluid injections, et ceetera, And I hope, as I
firmly believe, that inflation with common air is the necessary desi¬
deratum, I conclude with Dr. Cheyne, that “ a man dying of ileus,
presents one of the most pitiable sights in nature ; and a leading
object of this paper is to remove a part of the horrors of the scene,
by withholding many of the bitter doses, which are forced upon him
by the solicitude of his friends, and the officiousness of his phy¬
sician1” — Glasgow Med. Jour. Feb.

4. In an interesting paper in our esteemed contemporary, the
Midland Medical and Surgical Reporter, Dr. Hastings, of Worces¬
ter, has narrated some highly important cases of incipient tubercular
phthisis which terminated favourably, on which he makes the fol¬
lowing comments : —

“ Since the above cases and remarks were composed, the work of
Sir Charles Scudamore, on consumption, has fallen into my hands.
In this work, I see none of the facts brought forward in support of
the process of inhalation, which at all militate against the position
taken up in the foregoing paper, that we have hitherto not discovered
any remedy for tuberculous consumption. Out of the sixteen cases
related by Sir Charles Scudamore, four were fatal, from tuberculous
degeneration of the lungs. Of the successful cases, it appears to me
that the bronchial membrane, in most of them, may be supposed to
have been the principal seat of the disease ; and there is nothing
extraordinary in such cases recovering under the use of the remedies
that have been long had recourse to in this species of disease.

“ But I cannot help expressing my astonishment, that a knight
and a physician of eminence, who supposes he has made important
discoveries in the mode of treating a very intractable class of diseases,
should not have been very particular in giving a full and precise
description of the manner of applying the remedies : concealment, in
such circumstances, is not calculated to produce a favourable impres¬
sion of the author, who thus cannot fail to call upon himself the cri¬
ticisms of his professional brethren. Nor will the reason that is given
for withholding this necessary information, be considered a sufficient
apology for such an omission, viz.; “from an apprehension that
patients themselves might be tempted to undertake the treatment of
their own cases, with the great risk of receiving injury instead of
benefit, I have avoided the introduction of formuke of the remedies for
inhaling.”

“ By this omission. Sir Charles Scudamore has run a risk, not
very favourable to his medical reputation ; for in consequence of it,
some persons may be induced to regard his work, rather as a species
of direction for the reader to his residence, in Wimpole -street, than
as a praiseworthy offering upon the sacred altar of medical science.”
— p. 388.

Medicine.

333

It affords us much satisfaction that a physician of such high talents
as Dr. Hastings coincides in the opinions we offered in our review of
Sir C. Scudamore’s work, which clearly demonstrate the justness of
our strictures.

5. Cases of Congenital Incontinence of Urine. By John C. Otto,
M. D. one of the Physicians to the Pennsylvania Hospital, North
American Medical and Surgical Journal , October.

[Read before the College of Physicians, June ‘24th, 1830.]

Case 1 . — When visiting a young gentleman, in the latter part of
September 1827, my attention was directed by his mother, accidentally
in appearance, to his younger brother, a lad ten years of age. He
laboured under incontinence of urine, and as it had continued from his
birth, his parents had presumed it was a natural defect, that was
beyond the reach of medicine, and had not spoken to me upon the
subject, although I had been their family physician many years ; nor
had any other person ever been consulted. Possessing very delicate
feelings, it was supposed his sense of shame might be addressed to
some purpose, but it was in vain ; and very moderate correction was
resorted to without any advantage. Nothing further had been
attempted by his parents, except restricting him somewhat in his
drink, especially in the evening. He had arrived at a period of life
when his deplorable state was obvious to him, and lamented bitterly
his situation. He was strong, of a florid complexion, and had ever
been remarkably healthy in other respects ; his desire to make water
had always been very frequent and urgent, and he discharged but a
small quantity at a time. After he was four or five years old, he
never wet himself in the day time, if he could retire immediately to
a suitable place to void his urine, as soon as the desire occurred, for
the urgency was always very great, and his powers of retention small
and of short continuance. He passed very rarely a night without
wetting his bed, and never two in succession, although great attention
was paid to his making water when he went to bed, again when the
family retired, most commonly once during the night, and always
very early in the morning. After being made acquainted with the
whole case, I told his mother, as no medical means had been employed,
it ought not to be considered incurable, and should every attempt to
give relief fail, he would not be in a worse situation than at present ;
that -he might be essentially benefited, but should there be a want of
success, she would have the consolation of having used such remedies
as were supposed best calculated to cure him. She seemed much
gratified on learning there was still some reason to hope, and placed
him immediately under my care. I directed an ounce of the leaves
of the uva ursi to be simmered in a pint of boiling water five minutes,
of which he was to take a wine glass full four times a day ; and in
order that the virtues of the medicine should be principally extracted,
it was to be prepared twenty-four hours before giving it, and decanted
as used. He was likewise to take fifteen drops of the muriated

334

Bibliography.

tincture of iron three times a day, in a sufficient quantity of water,
and to have a gallon of cold water dashed on the perineum and nates
morning and evening. He improved rapidly under the treatment,
having wet his bed for the last time on the 18th of October, not
having done it for the previous eleven nights. The cold water, on
which I had placed some reliance as a tonic, was not used at all ; it
was omitted at first from causes that were not satisfactory to me, and
as he had become so much better when I was informed of it, the
employment of it was not pressed. The urgency of making water
gradually lessened, and the power of retention improved, so as to
become natural in both respects. Although he was entirely restored
in so short a time, the treatment was continued three months alto¬
gether, as the incontinence was congenital, and he has remained ever
since free from his distressing malady.

The author has related four similar cases, in which in addition to
the above treatment, a blister to the sacrum and a decoction of the
rhus glabrum or sumach, an ounce of the leaves to the pint of water,
the dose half an ounce three times a day, afforded great relief, and
almost cured the disease. His object was to give tone to the urinary
system. Should this plan succeed in other hands, it will be a great
improvement in therapeutics.

SUKGEKY.

6. Treatment of Umnited Fractures by Seton. — Dr. Hays, one of
the talented editors of our much esteemed contemporary, the American
Journal of the Medical Sciences, comments in his number for Nov.
on a sentence in one of Mr. Lawrence’s Surgical Lectures, extracted
from our valued contemporary the Medical Gazette, which is as fol¬
lows : — “ I believe it may be said that there are two or three instances
recorded, in which, after some weeks and months confinement, with
a good deal of pain and danger, the union has been effected in this
way, but in other cases the introduction of the seton has failed/’

“We confess ourselves at a loss how to notice this summary and
contemptuous dismissal of a method of treating ununited fractures,
and one which, contrasted with the painful, and sometimes fatal
operation for which it was proposed as a substitute, it appears to us,
can hardly be too highly extolled.

The apparent accuracy with which the lectures are given in the
Gazette, seems to forbid our ascribing so material a mis-statement to
an error of the reporter — the high character Mr. Lawrence has
hitherto sustained for fairness and candour, equally prohibits the
imputation of intentional misrepresentation on his part, and yet it is
impossible to suppose that Mr. L. who is distinguished for extensive
erudition, should be ignorant of cases published in the Medico-Chirur-
gical Transactions of London, the Edinburgh Medical and Surgical
Journal, the London Medical Repository, the Medico-Chirurgical
Review, the London Medical and Physical Journal, the London

Surgery.

335

Medical and Surgical Journal, the Dublin Hospital Reports, Charles
Bell’s Operative Surgery, and Cooper’s Surgical Dictionary, in which
no less than thirteen different cases of ununited fractures success¬
fully treated by the seton are related. Be the case, however, as it may,
the statement has been put forth as coming from Mr. Lawrence, and
until disavowed, subjects him to the charge of ignorance or want of
candour ; we therefore think we are performing an act of kindness to
him in calling his attention to this subject, that it may be explained ;
and at the same time as an act of justice to the eminent surgeon who
devised the method of cure under consideration, we shall give a brief
summary of such cases of ununited fracture successfully treated by
the seton, as we find in the works in our private library, not having
time at the present moment to have recourse to more extensive
sources of information. /

7. Case of Excision of the elbow joint. — Mrs. Rogers, set. 46,
November, 20, 1829. The left elbow-joint is increased in size, and
the integuments have a soft and puffy feel. There are four distinct
openings discharging matter, through each of which the bone can be
felt bare. Two of these openings are situate over the inner con¬
dyle of the humerus, the third over the external, and the fourth over
the anterior part of the joint, besides the tendon of the biceps
muscle. The motion of the joint is exceedingly limited, and she
cannot .move it, or attempt to shut the hand without great pain.
Her health has fallen much off within the last six weeks, and she
was troubled very recently with a severe bowel complaint. This
complaint began in March, with severe shooting pain in the region
of the joint, generally increased during the night, and always aggra¬
vated by motion. After the pain had continued for some time,
swelling took place, and afterwards the sinuses formed, and have
continued to discharge matter constantly for nearly two months.
Various remedies have been tried, but without any relief.

As her general health had always been good till the beginning
of this complaint ; as the soft parts were not much diseased ; and as
the caries appeared confined to the extremities of the bones, I
thought it a fair case to try excision of the elbow -joint, and was
happy to find that Sir George Ballingall had the same opinion.

On the 26th November, the operation was performed in the fol¬
lowing manner. : — An incision was begun on the back of the arm,
about three inches above the joint, and carried in a straight line to
about two inches below it, over the point of the olecranon process
to the edge of the ulna, taking care to avoid the ulnar nerve. At
each extremity of this incision a transverse one was made about two
inches long, and the flap on the radial side was dissected back,
exposing part of the humerus, radius, and ulna. The flap on the
inside was next made, taking care not to cut the ulnar nerve.
The olecranon process was found carious at its upper part, and
slightly adhering to the humerus. It was easily removed by the
cutting pliers, as also a small piece on the back of the ulna, that did
not appear sound. The insertion of the brachialis muscle was not

336

Bibliography .

disturbed. The humerus was much diseased on its radial side, both
in the joint and shaft of the bone. As about one-fourth of the articu¬
lation of the humerus on the ulnar side was sound, an oblique incision
was made by the saw, so as to include three-fourths of the articula¬
tion, and extend about two inches up the shaft of the bone, and in¬
clude all the diseased parts. The cartilage was removed from the
sound part of the humerus, as also from the top of the radius, which
was not in the least diseased. No artery required to be tied. The
parts were secured by stitches, and the arm put in a slightly bent
position. The greater part of the wound healed by the first inten¬
tion, and in three weeks she could move her fingers without any pain,
which she had not done for nine months before. By the end of
December, the wound was entirely whole, and she was walking about,
and moving slightly the joint, without any pain.

At this time, however, her general health began to suffer from
repeated attacks of bowel complaint, and several abscesses formed in
different parts of the cellular substance of the fore-arm, which pre¬
vented her from moving either the hand or the elbow-joint without
considerable pain. These abscesses continued to trouble her con¬
stantly for nearly three months, notwithstanding a variety of con¬
stitutional treatment ; but at the end of March her health began to
improve, and she has continued free from any complaint since that
time. Her arm remains now in a slightly bent position, and cannot
be put in a straight line with the shoulder ; but she can bring her
hand to her mouth, and is in the daily habit of using the arm in all
her domestic duties, and can carry with it a large iron fender without
any pain. She says she is very sensible that the strength of the joint
has increased within the last three months, and that it is still
improving. The connection of the radius with the humerus does not
appear so firm as that of the ulna. ■

To Sir George Ballingall, I feel myself under many obligations,
not merely for his attention in this case, but for his valuable advice
and assistance in a great many others. — Edin. Medical and Surgical
Journal.

8. Cases of Lithotrity , or examples of the stone cured without inci¬
sion , followed by a description of the first symptoms of the disease.
By Baron Heurteloup. London. 1831. 8vo. pp. 54. G. Underwood.

Since the introduction of lithotrity into England, by Mr. Costello,
the colleague and pupil of its justly celebrated discoverer, Dr. Civiale
of Paris, we have watched its progress with keen anxiety, so that full
justice should be done to its merits. We accordingly read with
attention, the different documents of the controversy which arose on
the occasion of its introduction, between our countryman Mr. Costello
and a foreigner, styling himself the Baron Heurteloup. This con¬
troversy, which was most ably and victoriously maintained by the
former, exhibited in the clearest light, the claims of Dr Civiale to
this truly valuable invention, the admirable simplicity and efficacy of
the instruments which this gentleman, and his really scientific pupil,
employ with such signal success, and the emptiness of the pretensions

Surgery.

337

to improvement of the lithotritic instruments and operation which
M. Heurteloup so pertinaciously asserts. As we have sufficiently
shewn in our views of medical Ethics, we shall at all times set our
faces against every attempt at conferring for covert views of private
advantage, upon any therapeutical instrument or agent, a reputation
of superiority to which it has no just claim. As honest journalists,
it is our duty to expose such attempts, as have for their object an
undeserved popularity, acquired at the expense of truth, justice, and
the true interests of science. Lithotrity, which, in the hands of
Civiale and Costello, has restored to health upwards of two hundred
sufferers, stands in no need of equivocal auxiliaries. It requires no
air ad captandum to be thrown over it. It possesses sufficient intrinsic
merit to spurn all charlatannic efforts to fix its footing as triumphantly
in England as it has done in France. We thought that the clear and
able statements made by Mr. Costello, about eighteen months ago,
had fully and satisfactorily proved the futility of the pretended im¬
provements of M. Heurteloup ; and thinking so, we are at a loss to
conceive the obstinacy which again obtrudes these pretensions upon
public notice, when the same overwhelming refutation awaits them.
We confess, however, that we do not regret this, seeing that this
refutation cannot be withheld, and that it must be now ample, com¬
plete and final, indeed we are aware, that the subject has been already
taken up.

The subject of our present criticism is a thin pamphlet, the more
ready and convenient for a publication, for the lucubrations of the
numerous herd of pretenders to public notoriety, and the easy resource
of persons of a certain stamp. It contains a series of cases, twelve
or fourteen in number, the details, purposely or otherwise, are con¬
sidered of too little importance to science to be given, and it terminates
with an expose of the symptoms of the calculous affection. Now and
then we are told that the three-branched instrument of Civiale and
Costello was employed for the operation, and that failing, the author’s
own instruments are employed, and these in their turn failing,
Civiale’s instrument is again employed, and both these failing, his
brisecoque is employed, the ne plus ultra of instrumental perfection ;
follow these, an artillery of pincers, forceps, virgules, scoops and
sounds, surrounded by which, M. Heurteloup revels in his arsenal of
machines, enjoying the pure beatitude of lithotritic eclectism. Thus
armed cap a pee, he knows no difficulty, or if he should meet any,
that will not yield, “ he proceeds incontinent to discover a new
machine.” But, amongst all his apparatus, the brisecoque is his most
distinguished favourite. Civiale’s instrument, he thinks, may now
and then be useful in pulverising spherical calculi, but he finds, that
it is altogether useless in cases of flat stone, and this he takes the
liberty of proving, by his want of success when he employs it in such
cases. “ Four, five, six times, nay oftener in the same person, says
he, I employ Civiale’s instrument to break down a flat stone ; but,
alas ! no result. Now, let us ask, have Civiale or Costello had no

von. vi. no. 34.

x x

338

Bibliography „

cases of flat calculi, occurring in the vast number of patients whom
they have relieved ? Have all the flat calculi been reserved for
M. Heurteloup ? Oh, fortunate brisecoque, thus to have your
triumphs blazoned ! Neither Civiale nor Costello can meet with one,
in failing to destroy which, they might at last open their eyes to the
silliness of adhering to the use of a simple and safe instrument. We
pity these men. All the flat stones are for Heurteloup and his
brisecoque.

But, supposing, as M. Heurteloup will have it, that flat calculi are
refractory to comminution by any other instrument than the brise¬
coque, still the whole question, with regard to the invention of this
piece of mechanism, presents itself again, M. Heurteloup very
quietly, and with becoming modesty, asserts in his pamphlet, that he
is the sole inventor of it. Now, however much our confidence in his
statements may have been shaken, we might, on account of the bold¬
ness with which he has persisted in this claim, have admitted it, but
that we find in a work published on Lithotrity, pp. 41-42, by Dr.
Civiale, ere yet M. Heurteloup was a lithotritist, the parent idea of
this instrument. Speaking of fragments and small calculi, Dr. Civiale
describes this instrument as follows : — “ It was for cases of this sort,
that I had made at the same time (1822) several forceps with two
branches, of different sizes and forms, and an instrument, which may
be called a brise-pierre, This instrument consists of two blades of
steel, rounded on one side, and flat on the other, slightly curved by an.
extremity which terminates in the form of a serpent’s head, and pre¬
senting at the other extremity, two rows of teeth, those of the upper
blade destined to receive a cogged wheel, by which the movement of
this blade was regulated, those of the lower blade, to render it im¬
moveable, by means of a clavette or stop. These two blades are
received separately, first the upper, then the lower blade, into a
canula of the same length and diameter as the ordinary lithotrite.
This canula serves as a sheath, and bears at one of its extremities,
the wheel destined to move the blades together or separately, accord¬
ing to the effect intended to be produced.” Here, then, is a brise-
pierre, with which M. Heurteloup must have been acquainted before
he made his own, and differing in no essential from any of the dozen
brisecoques that have been constructed by Amussat, Rigal, Colom-
bat, &c. M. Civiale, whom we presume to be as good a judge of the
value of such an instrument as any man living, used this instrument ;
and as he affirms from experience, that it has no advantages over the
ordinary or three-branched lithotrite ; and further, that from the
absence of a central piece, he could not accurately ascertain the nature
of the substance seized within the bladder, we are content to adopt
his reasons for abandoning the use of it.

In one of the cases contained in this pamphlet, that of Mr. Castle,
he admits, that five operations or applications of Civiale’s instrument,
were made without any result. Five fruitless sittings ! ! ! We find
nothing like this in Costello’s or Civiale’s numerous cases. Now, in

Surgery.

339

perfect seriousness, we would ask, does this arise from M. Heurte-
loup’s want of tact, or, are we to consider these five sittings as so
many attacks made on the calculus, with the view of preparing easy
work for his favourite brisecoque, and thus giving it the merit of a
triumph, more the result of calculation than skill ? This case is given
to shew the superiority of the brisecoque over Civiale’s three-branched
instrument ; and here his coolness, in taking the conclusion, is admi¬
rable, “ for, let it be remarked,” he says, “ that this instrument was
only employed when we discovered the almost utter impossibility of
curing the patient with the perce-pierre;” he then says, “ in future
1 shall be more on my guard against those flat stones, and shall begin
the operation at once with the brisecoque, and thus spare my patients
“ the slow and useless attempts made with the perce-pierre slow
and useless in M. Heurteloup’s hands, if you please, hut far different
in the hands of the creator of lithotrity. Dr. Civiale, or in those of his
pupil, Mr. Costello ! ! !

In another case, that of a Greenwich pensioner, a considerable
number of operations were performed, and almost at each of them a
new instrument was employed. We recollect very well, when the
improvements in the lithotritic instruments were first spoken of by
this gentleman, nay, even eighteen months since, he assured the
world, that his modifications were so vastly superior to every thing
of the sort that had yet appeared, that a large stone, instead of being
reduced by successive perforations, according to Civiale’s plan, would
be pulverized in one sitting. Now', how has this promise been kept
to the sufferers, or to the world ? His first attempt to cure in one
sitting was unsuccessful ; for we find, that it required ten very long
sittings to effect a cure, which, after all, was due to Civiale’s instru¬
ment. Now, here was a fine opportunity to redeem his pledge. Yet
how many sittings took place ? We are not told ; but we know they
were wofully many ; we are sorry that want of space prevents our
giving any lengthened extract from this case. This one must suffice.
“ In a word, this case (the poor pensioner’s) was converted into a
sort of study, by which all the medical gentlemen who w7ere present
at the different operations, were enabled to form an idea of the means
now existing in science for curing patients of the stone without in¬
cision.” Here we have realized the “ fiat experimentum in corpore
vili.” Yes, poor fellow, he served M. Heurteloup’s purpose, to in¬
culcate on the minds of the medical gentlemen whatever opinions he
thought proper. He served to shew his fertility as a modifier and
borrower, without acknowledgment of Civiale’s instruments ; but he
did not serve to prove that M* Heurteloup possessed the tact of
Civiale. We shall terminate our reflections on this case, by observ¬
ing, that M. Heurteloup himself, as it w'ere, vi veritatis victus, here
makes an admission, which, considering his opinions elsewhere
expressed, we must look upon as involuntary, namely, that the perce
pierre is on some occasions, a tolerably good instrument.

There are scattered through this pamphlet, here and there, asser¬
tions which force a smile from us Reviewers. This, however, may

340

Bibliography.

be very wrong, seeing that the whole performance is addressed more
to the world at large, than to men of science. For instance, it is
stated, that stones of a certain size, are seldom destroyed by means
of Civiale’s instrument, and that, in flat smooth stones, it can never
effect a cure. To this, the two hundred cases of Messrs. Civiale
and Costello give an overwhelming answer. In another place, the
composition and shape of the calculus is pretended to be ascertained
by simple catheterism. A flat stone is thus distinguished from one
of any other shape, unerringly. But, really the flat stones and the
brisecoque are M. Heurteloup’s hobbies. In fourteen cases, four of
the calculi are flat shaped, nearly one-third of the whole. Now, if
it be true, that the three-branched instrument cannot destroy this
refractory calculus, and that this form of calculus had presented itself
with the same frequency to Messrs. Civiale and Costello, nearly sixty
patients must have submitted to the operations of these gentlemen in
vain, and subsequently sought relief from the brisecoque. What a
pretty round number this would have made for M. Heurteloup? It
is asserted, that it is for this kind of calculus, he invented the brise¬
coque. This has been said so often, that we must pass it by propter
nauseam. Why, we know more of his powers of invention than we
choose to state now, but we may yet enforce the maxim, suum cuique.
These assertions prove abundantly, that this performance was not
intended to throw any additional light upon the subject of lithotrity,
for the benefit of medical men. Its destination lays quite another
way. We shall mention the naive manner in which its real end and
purpose is manifested. The symptoms of the calculous disease are
detailed, the right of authorship is renounced, and the Society for the
Diffusion of Useful Knowledge is invited to take advantage of so much
disinterestedness, and to publish this invaluable premonition for the
use and benefit of all those whom it may concern. This really over¬
steps every thing of its kind, with which we happen to be acquainted.
What is it after all, but an emendation of the old version, try Dr.
Eady. One proof more, that this work is beneath the level of
science, and we have done. In speaking of the inflammatory affection
of the testis, in the last case detailed, it is stated that the testis had
inflamed before the operation was performed, and that this inflamma¬
tion never re-appeared, during or between the applications of the
instrument. “ This circumstance, it is added, is a convincing proof,
that when lithotrity is well performed, it will never produce inflamma¬
tion of these organs.” This sentence exhibits proof of ignorance of
the structure of the kidneys, ureters, bladder, vasa deferentia, and
urethra. Is there not communication between all these parts, by
means of the mucous membrane which lines them, and are they not
further connected by sympathies, by which the irritation existing in
one part, may be rapidly transferred to another ? If this phrase is
not uttered in ignorance, then it is dictated by a disposition to attri¬
bute to his own great tact, the avoidance of unfavourable consequences
whenever they happen not to occur. From the exhibition of such
vanity, we turn away with feelings bordering on disgust, and we call

■Surgery.

341

on Mr. Costello, the pupil of Civiale, and the partner of his immortal
labours, to put an end to this silliness, by stating the truth on this
subject, for we now see that it is vain to expect any information upon
which we may rely, on the subject of this valuable operation, from
such a quarter.

MISCELLANIES.

9. London College of Medicine. — Many of our readers are aware
that a numerous meeting of surgeon apothecaries, with a few pure
surgeons, has taken place within a few days, for the purpose of
organizing a society, to be entitled the Newr London College of
Medicine. Joseph Hume, Esq. M. P. presided as Chairman. — It
was resolved, that the institution was to be founded upon the prin¬
ciple of admitting all legally qualified physicians, surgeons, and
apothecaries, who are to enjoy the same rights and privileges, and to
be entitled Doctors. According to this arrangement, there would be
an annihilation of the Universities and Colleges of Physicians and
Surgeons, and Society of Apothecaries in England, which obviously
cannot be accomplished.

We are as sincere friends to medical reform as any member of the
profession, but cannot agree to the plan before us ; because, it
appears to us that it cannot be carried into effect. The proposers
of this measure should have confined themselves to their own branch
of their profession, and should have adopted the sensible and only
practical course recommended them by Mr. Hume, to endeavour to
improve and reform the present College of Surgeons, but not to
propose a new one. We regret that this advice was not adopted
and acted upon, and that instead of proposing a new institution, the
meeting did not petition both houses of Parliament against existing
abuses, and seek redress in the only way in which it is to be
obtained.

They cannot seriously suppose that the government or legislature
of this country would commence reform, and destroy the rights of
the universities and corporations, without first consulting or remon¬
strating with the distinguished and influential heads of these esta¬
blishments, the result of which must be a death blow to the scheme
of the reformers, as ample and repeated experience very fully
attests.

Neither would the nobility and upper ranks of society, even con¬
sent to the union of the three branches of the profession, or employ
the same individual as physician, surgeon, apothecary and obstetri¬
cian. In no country in the world is such a union tolerated, nor
cannot in this, where our literary and scientific institutions are
esteemed and almost venerated. It ought to be recollected that the
members of both houses of Parliament, and the Government, are
men who received their education in the universities, and -who
cannot consent to the suppression of a single right possessed
by these establishments. This is well exemplified by the difficulty
which exists, from the hostility of these bodies, in obtaining a

342

Miscellanies.

charter for that great and splendid institution, the London Univer¬
sity. When we consider that the Lord Chancellor, and of course the
present ministry, are the patrons and best friends of that establish¬
ment, and find it difficult to incorporate it, from the opposition of
rival institutions, what chance can the proposed college have of
success in obtaining the like privilege ? Besides, it must not only
encounter this opposition, but the hostility of all the medical cor¬
porations.

Were the prospects of the intended college in the most favourable
position, the influence of the medical corporations alone must blight
them ; and we are convinced that the great majority of all classes
of the profession must be against them. The indiscriminate admis¬
sion of all legally qualified apothecaries could not be tolerated by
physicians and surgeons, as the largest proportion of them in this
section of the empire, are druggists and oilmen, who were in prac¬
tice before 1815, who received neither a good general education, nor
any medical education whatever. These men are surely not entitled
to rank with licentiates in pharmacy, or with regularly educated
physicians or surgeons. Such a union would be objected to by all,
and can never be effected. No doubt it would be very agreeable to
the surgeon apothecaries, or, as they are unclassically termed, gene¬
ral practitioners, pure apothecaries, pure surgeons, the druggists and
oilmen who rank as apothecaries, and medical students, all of whom
could have no objection to enjoy the rights and title of those who
consumed their time and talents in universities, and complied with
the regulations of the medical corporations, and whose general and
scientific acquirements are infinitely superior to those of the above
classes of medical men. No man who has studied in the medical
and surgical schools of Scotland and Ireland, but must coincide in
our opinion. Every man who has taken a surgical diploma in Dublin
or Edinburgh, must acknowledge that the examinations are much
more minute and severe in these places than in London, and it is
well known that candidates who are rejected by the Dublin College,
immedi ately proceed to Lincoln’s-inn Fields, and procure the diploma
as a matter of course. Hence it is, that the members of the London
College, who practise in Ireland, and they are a numerous body, are
looked on with contempt by members of the Irish College, who will
not meet them in consultation, and who will exclude them from
hospitals, dispensaries, and all public institutions. The course of
education required by the Edinburgh College of Surgeons, is also
more extensive than that of the London College, and the course of
education for the degree in medicine, is much more extensive than
that for the diploma in Surgery, and yet the New College proposes
to admit all members of the profession upon the same terms, and to
include pure apothecaries, who know little or nothing of medicine or
surgery. We might adduce many other objections, but enough have
been advanced to convince any member of the profession, who will
only reflect upon the subject, that the proposed College cannot pos-

Miscellanies.

siblys ucceed. It has opponents, who never will allow it a legal foun¬
dation. Let its friends follow the judicious advice of the Chairman,
to endeavour to reform the old institution, but let them not indulge in
the vain hope of demolishing all the medical institutions in the
country. The idea is Utopian. Let it not be said, that we are enemies
to reform, we triumphantly refer to the pages of this Journal in.proof
of our sincere advocacy in its favour, in which will be seen, we pro¬
ceeded to the lengths in exposing corporate monopoly and abuse,
which no other physician in this kingdom Lad courage to attempt ;
but in which reform or improvement in existing institutions, and not
their suppression was defended. In offering thesej remarks, and
declaring our opinions, we may incur the displeasure of the friends of
the proposed institution, but in common, with the privileges of British
subjects, we claim the right of freely expressing our opinions. We
are not the advocates of any of the existing Medical Corporations, we
have repeatedly proved all of them defective, and requiring reform.
Having acquired the highest honours from four of the most respect¬
able of them, we may, we think, offer an opinion upon their rules,
regulations and constitutions, which affect us individually, much more
than any one who advocates the new measure.

10. Medico Botanical Society. — The gold medal of the Society is
offered for the best essay in the English, French, German, or Latin
language on the question, “ What is the vegetable substance which
could be employed with success in the cure of hydrophobia V* And
that the silver medal of the society should be offered for the best essay
“ on the medical qualities and uses of any indigenous plant which is
not yet sufficiently known, or on new uses and applications of any
other indigenous plants/’ provided that such essay possesses sufficient
merit ; and that they should be received till the close of the year, and
that the medals should be bestowed at the next anniversary.

That each essay shall be accompanied by a sealed paper, contain¬
ing the names and address of the author, and marked in the same
manner as the essay ; and that each essay to which a medal is not
awarded, shall, according to the wish of the author, be restored to him
or submitted to the council, in order to its being read at a general
meeting.

11. London University .— W e are happy to inform our readers upon

the best authority, that the Government has determined to advise
and recommend his Majesty to confer a charter on the London Uni¬
versity. The power of granting degrees in medicine and surgery on
the plan of the University of France, will be given, and thus that
salutary change or reform in the medical profession so long and
so justly called for, will be established. Much opposition was given
by the other Universities, but we need scarcely remind our readers
that the present excellent and unequalled Ministry will not be deter¬
red from reforming whatever is found defective in the Institutions of
the Country. • t

344

Miscellanies.

LITERARY INTELLIGENCE.

12. Dr. Uwins is preparing for the press a treatise on Mental
Derangement, in which the subject of insanity will be considered in
all its bearings, Statistical, pathological, preventive and curative.
In this work Dr, U. will treat generally on nervous ailments and
their connexion with disorders of the stomach and other organs.

BOOKS RECEIVED DURING THE MONTH.

1 Lecture, introductory to the Course of Medical Jurisprudence, delivered in
the London University, on Friday, Jan. 7th, 1831. By A. T. Thomson, M.D.
F. L. S. Professor of Therapeutics, &c. &c. Loudon. Taylor.

2. Address of Earl Stanhope, President of the Medico-Botanical Society, for
the Anniversary Meeting, Jan. 16th, 1831, 8vo. London. Wilson.

3. Explanation of the Anatomical Atlas of Dr. M I. Weber, Professor at the
Royal Prussian University, Frederick William, at Bonn, 8vo. 1831. London.
A. Schloss.

4. Anatomical Demonstrations, or Colossal Illustrations of Human Anatomy.
By Professor Seerig. Translated from the German, Part 2, 8vo. 1831. London.
A. Schloss.

5. Lecture, introductory to a Course of Clinical Surgery, delivered to the Stu¬
dents of the Glasgow Royal Infirmary. By M. S. Buchanan, M. D. Member of
the Faculty of Physicians and Surgeons, Glasgow, and one of the Surgeons to
the Royal Infirmary, &c.

6. Professional Morality in 1831, or the Lawyer’s Defence of Medical Quackery,
in which John St. John Long’s Discoveries are examined, and his claims to the
confidence of the British Public, are criticised. By a Graduate of the University
of Edinburgh, and a Master of Surgery and Arts, 8vo. 1831. Wilson. London.'

7 Proceedings at the Twelfth Anniversary Meeting of the Hunterian Society,
held on the 16th of February, 1830, with the Report and List of Officers arid’
Members, &c. &c.

8. We beg to acknowledge the Receipts of Dr. Kennedy’s Tracts on the state
of the Profession in India, which we shall notice in our next Number.

Books Received in Exchange.

The American Journal of the Medical Sciences, for Nov. 1830

The North American Medical and Surgical Journal, for Oct. 1830.

The Medico Chirurgical Review.

The Edinburgh Medical and Surgical Journal, for January, 1831.

The London Medical Gazette.

The Glasgow Medical Journal for Feb.

The Midland Medical and Surgical Rep.

We have received the National and Foreign Journals, with the exception of

some ot the french, which perhaps, may be accounted for by the state of Politics
of our Contemporaries.

9. The best Surgical Plates we can recommend to Tyro, are the excellent illus¬
trations of Cooper s Surgical Dictionary, now in course of Publication by Mr
Cocks. J '

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

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

No. 35. MAY 1, 1831. Vol VI.

CRITICAL REVIEW

L — Physiology of the Foetus, Liver and Spleen. By
George Calvert Holland, M. D. Bachelor of Letters
of the University of Paris, Lecturer on Physiology, and
Joint Lecturer on Practice of Physic in the Sheffield
Medical Institution. London, 1831, Svo. pp. 229. Long¬
man and Co. — ( continued .)

* - ’ ' . m t - •*

\j k - . - . - ■ ^ • •

Dr. Holland commences his physiology of the foetus with
an account of the various opinions concerning its nou¬
rishment but a fevr, of these however, are detailed. He
gives extracts from the works of Hippocrates, Galen, Harvey,
Darwin and Bonetus, which prove that these writers sup¬
ported the theory of foetal nutrition by means of the mouth
and umbilical vessels. He notices the opinion of Hoffman
and Monro, primus , that the placenta was the chief source
of nutrition, and then that of Mayow, Abernethy and Bos-
tock, which is, the placenta was to the foetus what the
lungs are to the adult.” Wilson Phillip’s hypothesis is next
adduced, that the uterus generates a fluid similar to galva¬
nism. He next quotes the views of Geoffroy-St.-Hilaire,
from the series of this Journal in 1824; next the doctrine
of Buffon and Van-den-Bosch, which teaches the absorption
of the amniotic fluid by the skin of the foetus, and lastly, the
hypothesis of Dr. Lee, which will be noticed more fully in a
subsequent article. Such are the writers referred to by our
author; but they are only few who have discussed the sub¬
ject. This remark is verified by the following quotation
from a work not expressly devoted to the physiology of the
foetus.

vol. vi. no, 35.

Y Y

346

Critical Review.

“ Of all the questions of physiology, this has been the most dis¬
puted. Some have placed the source of nutrition in the water of the
amnios, more than in the placenta, some in the vesicula umbilicalis
and allantoides, others in the gelatin of the cord, and some in the
decidua or epichorion.

“ Harvey and Diemerbroeck considered the water of the amnios
highly nutritive and lacteous : and with Rudbeck, Haller, Darwin, La
Courve, maintained it passed by the mouth to the stomach; while
Alcmeon, Boheraave, Buffon, and Van-den-Bosch alleged it was
absorbed by the skin. These opinions are refuted by the fact, that
in cases of imperforation of the oesophagus, in acephalous monsters,
and when the infant is born with all the outlets impervious, it is fully
developed. It is foreign to the nature of this manual to notice all
the physiological reveries upon this and other parts of my subject:
but I cannot help inserting a few more upon this point. Lobstein
held the fluid was partly absorbed by the genitals ; Osiander, Oken,
and Muller, that it was absorbed and modified by the mammae, then
conveyed to the thymus gland, and finally to the thoracic duct : while
Schurigiqs, David, Rcederer, Scheele, Winslow, Heroldt, Beclard,
and Geoffroy-Saint-Hilaire believe it to enter the trachea and bron¬
chi, and to be there elaborated for the purpose of nutrition. The
general and received opinion of almost all physiologists is, that the
placenta is the source of nutrition to the foetus. It has been said
that the placenta is a respiratory organ to the foetus, and supplies it
with oxygen.

“ During the early period of intra-uterine life, the embryo is
nourished by the umbilical vesicle, which is continuous with the
intestinal tube, which absorbs the fluid, which is carried by the
omphalo -mesenteric vein to the heart of the embryo. The analogy
of these vessels to the yolk of the egg renders this opinion probable.
The absence of the meconium in acephalous cases (Elben), which,
according to others, was the residuum of digestion, was considered an
argument in favour of the passage of the amniotic fluid into the
stomach. This fluid does depend upon the bile, and is absent when
the liver is wanting. (Tiedemann.) The female nourishes her
offspring with her blood, through the medium of the placenta; while
the foetus possesses an organ for the further depuration of the blood,
and the liver is that organ. (Bichat and others.) Tiedeman and
Gmelin considered it the same in the adult. The researches of Dr.
Stoker of Dublin, in his Pathology upon this point, are exceedingly
interesting and satisfactory. — p. 82.

“ It has long been supposed that the great size of the liver in the
foetus served some purpose, and, it is said is the organ which ef¬
fects certain changes in the blood. Lobstein thinks it the organ
which effects certain colour of the blood (hematose) : Fourcroy, that
it causes a decarbonization and a deshydro-genisition : and Stoker, a
change in the hydro- carbonous principle of the blood; Prevost and
Dumas, that it forms the globules of blood in the foetus; Geoffroy-
Saint-Hilaire, that it secretes a large quantity of bile, which passes

Dr. Holland on Physiology of the Foetus, 8pc. 347

into the small intestines, and there determines the formation of an
abundant quantity of mucus, which the foetus digests, and on which
its developement depends. Dr. Robert Lee has endeavoured to
prove, that the liver secretes an albuminous nutritive matter, which
he found in the hepatic duct, duodenum, and small intestines; while
he found an acid fluid in the stomach, and meconium in the large
intestines. All these theories require further corroboration before
they can be admitted.” — p. 86. Dr. Ryan s Manual of Midwifery
or Compendium of Gynaecology, Third Edition, 1831.

Notwithstanding our author’s omissions, he evidently pos¬
sesses an intimate acquaintance with recent works on embry¬
ology, as appears by the following remarks : —

“ The striking difference that exists between the circumstances in
which the human embryo is placed, as well as the degree of deve¬
lopement it attains during the first few weeks after conception, and
those of the completely organized foetus, are of sufficient importance
to form an essential distinction between embryotic and foetal life. —
The term embryo is employed here to designate a being yet so imper¬
fectly constituted that few of its organs are formed, whereas, foetus is
a denomination given to a being possessed of the principal organs
which the animal exhibits when arrived at a state of maturity. — To
a neglect of this distinction must be attributed the discrepant opinions
which have, from time to time, been adopted to explain the nutri¬
tion of the foetus.

“ Those, who endeavoured to shew that it is entirely supported
by the maternal blood, found a difficulty in accounting for its nourish¬
ment and growth during the time previous to a connexion being
established between the uterus and the chorion; others, who ad¬
vanced a different opinion, were inclined to think that the foetus is
altogether indebted for its nutrition to the fluids in which it is im¬
mersed. In support of the latter supposition it is stated, that these
exist at a period when it cannot possibly have other means of suste¬
nance.” — p. 68.

“ The ovum which is found in the uterus immediately after
impregnation, possesses within itself not only the principles of vita¬
lity, but fluids which are appropriated to the purposes of organiza¬
tion. The way in which these are modified, so as to assume a deter¬
minate form, is one of the secrets of nature, with which we are, and
probably shall ever be unacquainted, but it cannot be denied that the
diversified forms they assume are the result of vital operations. A
vascular connexion, at this time, with the uterus, would be of no
service to the embryo, because there are no internal organs suffici¬
ently developed to receive and distribute the blood, until the rudi¬
ments of a circulatory system exist; the sanguineous or any other
fluid which might be derived from the uterus could not be applied
to the formation of the embryo, but the warmth and moisture which

348

Critical Review.

the uterus possesses are perhaps as essential to its growth as the
warmth communicated to the egg during incubation. When the
vital actions have proceeded so far in the organization of the foetus,
as to create, although imperfectly, the heart, the vena porta and the
aorta, the umbilical cord may be distinctly perceived, and it very
soon establishes a connexion between the chorion and the uterus.*
When this union is fully established the embryotic is changed into
foetal life, and the latter is exclusively nourished by the arterial
blood of the mother” — p. 70.

This explanation of foetal life is not sufficiently clear or
satisfactory,, or accordant with recent opinions. The im¬
pregnated ovum does not immediately descend into the
uterus ; for it was found three days after conception in the
uterine tube of rabbits, by Cruickshank and De Graafe j
and, about the sixth or eighth day, in bitches, by Prevost
and Dumas. Besides, it was held by W. Hunter, Chaussier,
and almost all physiologists, that the decidua is formed
immediately after conception, and becomes united to the
chorion after the descent of the ovum into the uterus, about
the fifth day after impregnation, according to Meckel, and the
eighth according to Sir E. Home. The amnios has been
injected from the mother by Monro and Weisberg, and from
the foetus by Chaussier. Our author has also forgotten the
existence of the vesicula umbilicalis, between the chorion
and amnios. (Wolff, W. Hunter, Oken, Bojanus, Meckel,
Pockels, Tiedemann, Duges and Velpeau, with its arteries
and veins (the ompholo-mesenteric), a vesicle which nou¬
rishes the embryo for the first two months, by the albumin¬
ous fluid it contains. Professor Velpeau contends that the
placenta is formed as soon as the ovule descends into the
uterus. Elem. des Aecouch. 1829. According to this ample
evidence, there is a vascular connexion between the uterus
and embryo, before the organs of the latter are sufficiently
developed to receive and distribute the blood.

Dr. Holland proceeds to disprove the opinion that the
amniotic fluid, which he very strangely denominates the
amnios, nourishes the foetus, and he occupies too much
space in refuting an opinion which nobody of the present
age maintains, neither need he take the trouble of exposing
the fanciful hypothesis of Geoffroy-St.-Hilaire, that the
aminios evolved respirable gas, which was absorbed by the

* Adelon, Physiologie del ’Homme, vol. IV. p. 345.

Dr. Holland on Physiology of the Foetus, <$fc. 349

cutaneous veins of the fcetus. This was also the opinion
of Lassaigne, which was long since satisfactorily refuted by
Chevreul. Our author observes —

“ That the amniotic fluid contains a respirable gas, is a fact
proved, according to the statement of Geoffroy-Saint-Hilaire, by
experiment. Is it not more than probable, that analytical processes
to ascertain the exact composition of a fluid, discover not only what
it possesses in its natural condition, but likewise disengage gases
that were previously in combination with its different chemical prin¬
ciples ? If it were even allowed, that the amnios contains a respira¬
ble gas, insuperable difficulties are connected with its production and
mode of action. It is imagined to be taken up by the pores of the
skin, which act like so many tracheas. If these have sufficient
energy to absorb, the skin must also be able to secrete : the two
functions must coexist. What becomes of the secretions? As they
are necessarily poured into the amniotic membrane, they must con¬
tinue to accumulate from the commencement of foetal life to its com¬
pletion; and therefore, it is improbable to suppose, that a pure
oxygenating principle could exert any influence under such circum¬
stances.” — p. 83.

The next point upon which our author comments, is the
universal opinion that the placenta is capable of oxygenat¬
ing the blood it receives. This is the opinion of Bostock*
and almost all physiologists. Objections are urged against
this doctrine.

“ The placenta does not exhibit one single property which can
justify the physiologist in comparing it with the lungs. Its texture
is widely different, and its situation and relations are as dissimilar,
as it is possible for those of any two organs to be. Is an extraordi¬
nary galvanic or nervous influence connected with the placenta, and
exercised in a mysterious manner during gestation ? Unless we
believe in the existence of such an influence, it is absurd to suppose
that the placenta is capable of aerating the sanguineous fluid. It
may be stated, as a universal law, that whenever venous becomes
arterial blood, air is received directly from without, and whatever is
excrementitious is expelled directly from within. If venous blood be
placed in a bladder, it becomes florid in appearance. In this case,
oxygen disappears, and carbonic acid is formed. But how can the
placenta improve the qualities of blood, without oxygen, and the con¬
currence of those organic adaptations which characterize the respi¬
ratory organs throughout the animal and vegetable kingdoms ! Can
the blood act upon itself and cause such an effect? If the placenta
oxygenate the blood, whence does it derive the necessary power, and
how does it remove the excrementitious product? If it be acquired
from the arterial fluid circulating in the uterus, whence does it derive
the properties of nutrition ? The observation of Sir E. Home seems

350

Critical Review.

to imply, that air only is received from the mother. “ The foetal
blood,” he says, is close enough to that in the vessels of the uterus,
to have the air communicated to it.” It ha‘s been remarked, in the
preceding pages, that venous does not become arterial blood, merely
from the influence of oxygen, but from its qualities being continually
renewed by chyle.” — p. 86.

There is a good deal of force in this reasoning, but we
must bear in mind how very superficially the function of
the placenta is described in this extract, and how very ques¬
tionable both the author’s premises and conclusions must
appear on a minute consideration of the subject.

“ The circulation of the placenta is also differently explained. Some
say, the foetal arteries deposit the blood in the cells of the placenta,
whence it is absorbed by the maternal veins, is carried to the mater¬
nal lungs to be vivified, and afterwards brought by the arteries to the
placenta. Others maintain, that a portion of the blood deposited by
the umbilical arteries is absorbed by the veins of that name, and
returns to the foetus. M. Velpeau raises a formidable objection to
the first opinion. He says, if the blood of the umbilical arteries is
deposited in the placental sinuses, it must evidently mix with that of
the uterine arteries, which is effused in the same place ; it is there¬
fore necessary to suppose that the absorbent mouths of the umbilical
vein have the faculty of choosing the arterial blood from this mixture,
as the uterine veins do not take but the venous (arterial) blood.
On the other hand, an injection will pass with the greatest facility
from the arteries into the veins of the placenta, without effusing
itself upon the uterine surface of that body; therefore the blood
of the foetus is not taken up by the uterus. The reader should
refer to the remarks upon the placenta in a former page for
solid objections against this reasoning, where he will find strong
arguments against this conclusion. M. Velpeau is inclined to sup¬
pose that the arterial blood of the foetus undergoes its changes by a
molecular action in the placenta, which though inexplicable may be
still correct. He thinks it may be compared to the capillary system
after birth : to what takes place in secretory organs, and in the lung
itself. The fluids of the ovum are in mediate contact with those of
the woman; but a change may take place analogous to that in the
lungs between the atmospheric air and the venous blood. However
ingenious this hypothesis appears on paper, it is decidedly erroneous.
It is only necessary to reflect upon the utter impossibility of suppos¬
ing the foetus to form its own blood, that is, to grow and daily
increase in size without a supply from the mother. Again, every one
at all conversant with obstetrics is aware of the innumerable vessels
which pass from the uterus to the placenta, and the haemorrhage con¬
sequent to their rupture. It is really astonishing that a physician so
intimately acquainted with obstetrics, and every branch of medical

Dr. Holland on Physiology of the Foetus , fyc.

351

science, as Professor Velpeau is, could seriously suppose such a doc¬
trine.” — p. 86. L )r. Ryan, ut supra.

The last hypothesis noticed by our author isDr.Lee’s, which
is “ the liver of the foetus secretes an albuminous fluid,
which is absorbed by the smaller intestines, and contributes
to the support of the system.” Phil. Trans. Part I. 1829.
Upon this hypothesis our author comments with great force
and reason.

“ In examining impartially the merits of this hypothesis, we shall
find it as unphilosophical and untenable, as those opinions which
have hitherto been entertained on the same subject. 1st. In regard¬
ing the liver as an organ secreting the albumen, Dr. Lee does not
appear to take into consideration the absurdity of attributing to an
organ, two such opposite functions, as the secretion of albumen one
moment before birth, and of bile the next moment. The peculiar
secretion of an organ is not regulated by the quantity of blood it
receives, but by its structure. Every organ, throughout the animal
economy, has an independent and exclusive function. The differ¬
ence between the properties of albumen and those of bile, is as great
as between any two secretions of the body ; and to say that the liver
can secrete both, is as absurd as to assert that there is no necessary
connexion between the quality of a fluid, and the structure of an
organ which determines the nature of it.

2dly. It is allowed by the first authorities in physiology, that the
umbilical vein carries to the foetus arterial blood: the silence of Dr.
Lee on this point, and the importance which he attaches to the blood
circulating in the liver, lead one to infer that he entertains the same
opinion. If the blood received from the uterus is arterial, what occa¬
sion is there for its being converted into albumen, in order to nourish
the foetus ? It might just as reasonably be supposed that the arterial
blood of the adult, produced by digestion and oxygenation, cannot
contribute to the nutrition of the body until it has been converted
into albumen. If arterial blood, possessed of its ordinary properties,
be communicated to the foetus, it requires no further change to render it
fit for the purposes of nutrition ; if it be venous blood which is received,
we have no evidence at all, that the system ever is or can be sup¬
ported by it, and still less that an organ furnished with it can secrete
albumen. As albumen exists in the blood, it would appear, if the
ideas of Dr. Lee were correct, that nature is not very consistent in
her operations, while she, at one moment, draws from the blood
nutritious properties, and, at another, absorbs them to convey them
into the same fluid.

3dly. If the liver secrete albumen, its presence, it may be further
observed, ought to be indicated by the same general appearances that
prove the secretion of bile ; of the existence of the latter we have the
strongest evidence. The gall-bladder and ducts contain, at all times
a considerable quantity of it; but, during foetal existence, the gall-

352

Critical Review.

bladder is so far from being filled with albumen, or exhibiting the
least appearance of it, that it contains bile; and instead of the
hepatic and common ducts manifesting unequivocal traces of it, “in
general,” Dr. Lee says, “the hepatic and common ducts of the liver
have been found empty, or have contained too minute a quantity of
fluid to be collected for chemical investigation ; but in the two
instances above mentioned, it existed in unusual abundance, and was
pressed out upon a plate of glass without mixing with the bile of
the gall-bladder.” Dr. Lee examined above' twenty foetuses, and
yet, in two only, found a sufficient quantity to be pressed out upon a
piece of glass !

“ 4thly. If the liver be an organ which secretes albumen for the
support of the foetus, how, I would further ask, is its nutrition to be
explained in those cases of malconformation, in which the organ is
entirely wanting ? Many instances of this kind are on record, Mr.
Brodie relates a case, in which no liver could be found ;* others are
mentioned by M. Mery,f Dr. Le Cat,f and Dr. Clark. §

Dr. Holland describes the functions of the placenta, and
notices the opinions of Harvey, Fabricius, Prevost and
Dumas, Magendie, Monro, primus, Adelon, Bostock, Bro¬
die, Sir E. Home, and arrives at the following' conclu¬
sions : —

“ 1st, The foetus derives its blood exclusively from the mother.

“ 2dly, The placenta is an organ incapable of producing che¬
mical changes in the blood.

“ 3dly, The foetus has not in activity any organs that can in the
least oxygenate the blood it receives.

“ 4thly, Venous blood cannot support organic life.” — p. 95.

He agrees with the general opinion, that there is no
direct communication between the uterus aud foetus. He
holds the absorption of the maternal blood by the umbilical
vein, and that of the foetus by the uterine veins. In fact,
he has not added a single new idea to this disputed point
of physiology. He compensates for this deficiency by a
most ingenious view of the causes u of the temperature of
the foetus.”

“ There are certain points connected with the consideration of
the present subject, that have not as yet been fully explained, and
which are intimately related to the views already proposed, concem-

* Lond. Phil. Trans. Part I. 1809.
t Histoire de l’Academie Royale des Sciences, 1720.
X Ibid, 1740

$ Lond. Phil. Trans. 1793.

Dr. Holland on Physiology of the Foetus, §c. 353

mg the nutrition of the foetus. It has been proved by experiment,
that the temperature of the foetus is seldom above 92° or 95° Farh.
It is said to be higher when the foetus lies dead in the uterus. “ If
this fact is correct,” observes Magendie, “ the foetus must possess
some means of lessening the temperature that does not exist after
birth.” If according to the principles previously stated, we regard
the foetus as receiving arterial blood from the mother, we shall find
few difficulties in attempting to render these phenomena more intel¬
ligible. It is satisfactorily ascertained that the sanguineous fluid
loses a portion of its animal heat, as it recedes from the centre of cir¬
culation. The foetus is supplied with blood from the spermatic and
uterine arteries, and as this fluid in its passage to the placenta is con¬
siderably removed from the source of its oxygenation, it is reasonable
to imagine that its temperature is slightly diminished, when it reaches
this organ.

“ It will indeed scarcely be denied, that such a change is likely to
be produced, when it is absorbed and conveyed to the foetus, which
possesses no means of generating animal heat. Although the foetus
is incapable of contributing to its own support, by renewing the vital
qualities of the blood, yet, as the process of assimilation is active,
and as the excretory functions of the skin are carried on in a modi¬
fied degree, those causes are in operation which must tend to
diminish the temperature of blood circulating in the foetus. There
is undoubtedly a great difference in the state of the sanguineous fluid
in one body, in which it is continually renewing its heat, and in
another, in which no similar change takes place.

“ There is another reason, which, in conjunction with the above,
seems sufficient to account for the low temperature of the foetus.
The whole of the adult blood passes once, every two or three minutes
through the lungs, and is, consequently, completely acted upon by
atmospheric air, but when the foramen ovale continues open after
birth, the temperature is several degrees less than natural. This dif¬
ference arises evidently from the imperfect oxygenation of blood.
The whole blood of the foetus is not exactly renewed in the same
time as that of the adult, and on this account, the temperature of the
foetus will be less. The arterial blood conveyed to the vena porta
and the vena cava inferior, is mixed with the venous blood of the
vena cava superior in the right auricle of the heart, and, therefore,
the arterial blood of the foetus is not so purely arterial as that of the
adult. It is not difficult to explain why the temperature of a dead
foetus is higher than that of a living one. In the former, none of
those functions are in action which diminish 1 he heat of the blood,
as circulation, assimilation, and excretion from the skin, all of which
exist in the latter.

“ If the dead foetus be regarded as a mass of inorganic matter, the
degree of its temperature will illustrate a common law in physics,
that heat has a tendency to diffuse itself through contiguous bodies
until an equality of temperature is established. The warmest give

VOL. VI. no. 34.

z z

354

Critical Review.

out, and the coolest receive, until they have attained a uniform
degree of heat. It is, therefore, manifest that as long as the dead
foetus remains in the uterus, it will be of the same temperature as
the mother. If this explanation is considered satisfactory, it is
obvious that the conclusion of Magendie is fallacious, viz. that “the
foetus must possess some means of lessening the temperature that
does not exist after birth.” — p. 128.

The remaining chapters are on “ the origin of the liquor
amnii and meconium ;” “ the nutrition and peculiarities of
the foetus;” ft the brain, spinal cord, stomach, liver, pan¬
creas, and intestines not essential to foetal life tf of the
functions of the liver, supra-renal capsules, thymus and
thyroid glands in the foetus;” “ the mode of nourishment
in the oviparous and ovo-viviparous animals, and on the
influence of the mother’s imagination on the developement
and constitution of the foetus.”

The whole of these subjects are ably discussed, and the
author is exceedingly powerful in his refutation of the
erroneous notion of the influence of the mother’s imagina¬
tion upon the foetus in utero. The work evinces much origi¬
nality, extensive research and powerful reasoning, and will
be highly interesting to the physiologist. It will add to the
well-earned reputation of the author.

IJ. — The Effects of the Principal Arts , Trades and Pro¬
fession s, and of Civic States and Habits of Living , on
Health and Longevity. By C. Turner Thackrah :
London, 1831. Longman and Co. Leeds, Baines & Co. —
( continued.)

We resume our analysis of this very important and instruc¬
tive little work, as its contents will be perused with advan¬
tage by young practitioners. The author observes —

** Colliers have considerable muscular labour, chiefly in the sitting
or kneeling posture, and with the body bent over to the greatest de¬
gree. They work in an unnatural atmosphere, and with artificial
light. They are exposed to changes of air, and occasionally they
work with their feet in water. Perspiration at other times is so great
as to cause them to be almost naked. They generally work from four
a. m. to four or five p. m. and take little food while in the mine. —
Colliers are generally spare men, the spine is almost always curved,
and the legs are often bowed. The skin, of course, is loaded with

Mr. Thackrah on Health and Longevity .

355

dirt ; and when this is removed, the complexion seems sallow and
unhealthy. Their eyes appear small, affected with chronic inflam¬
mation, and intolerant of full light. Colliers are subject to disorders
of the head, muscular pains, particularly in the back, to rheumatism
and asthma. They are well known to be liable to severe accidents
from the fall of parts of the mine, and to much more dreadful effects
from the explosion of the carburetted hydrogen. The air they com¬
monly inspire is adulterated with hydrogen and other gases. That
of carbonic acid has, in certain circumstances, been so largely deve¬
loped by the accidental burning of the coal as to produce fatal or
dangerous effects.*

“ Boys enter the pits at the age of six or seven, and are employed
in opening the trap-doors, driving the horses, propelling the trucks, &c.
and finally, when of sufficient age, they become colliers. Sickness
and vomiting sometimes affect persons at their commencing the em¬
ploy ; and many, after a few years’ trial, are obliged, by the injury
which their health has sustained, and especially by the weakness of
their eyes, to leave the mines. Colliers are not habitually intempe¬
rate ; but in this neighbourhood they have a periodical debauch, for¬
merly once a fortnight, now once a month. They do not generally
exceed the age of fifty, though many exceptions are to be found. We
saw one asthmatic individual, seventy years of age, who had worked
fifty years in the mine.

“ The prevention of danger in coal-pits is so well known as to
require no detail. I need only mention the use of the safety-lamp,
the examination of the state of the air, especially in pits re-opened,
and the practice of ventilation. If the overseers and workmen prac¬
tised what they know, accidents would be comparatively rare.

“ Well-sinkers have great labour, and are frequently obliged to
respire carbonic acid and other gases found in wells. While working
in such impure atmosphere, they feel dizziness and a sense of suffo¬
cation, and if the injurious agency be in great degree, animation is
suspended, and sometimes destroyed. By a less degree, when con¬
tinued for some time, health is affected. The men complain of head¬
ache, sickness, and loss of appetite, and are unable to work for days
or weeks.

“ The evils of the employ, care would in a great measure obviate.
Every workman knows that a light will not burn in the foul air : yet
the simple experiment is often neglected. The introduction of fresh
air by bellows into wells, thus found to be dangerous, has but a par¬
tial effect . A more promising plan is recommended in Rees’s Cyclo¬
paedia, Art. Well . — p. 29. >

* See in the Edinburgh Medical Journal , vol. 32, a short but interesting paper
by Mr. Watson, of Wanlock Head, on a case of this kind Headache, giddiness,
tingling of the years, vomiting, tremor, with extreme debility, succeeded to the par¬
tial or general insensibility, which the gas had produced. Three or four individuals
appeared afterwards in a state of intoxication.

Critical Review.

Mr. Thackrah next considers “ employments which pro¬
duce dust , odour, or gaseous exhalations He adverts to
operatives whose employments connect them with animal
and vegetable substances, who are all subject to atmospheric
impurity. The effects of animal substances are not deemed
important enough to require consideration, and the odours,
exhalations and dust, produced by vegetable matters, are
then noticed.

“ Starch -makers are exposed to a fetid acetous odour, which rises
from the fermenting wheat, or rather from the water in which the
wheat has been steeped. The rooms are wet and cold. The men
do not apparently suffer from the employ.*

Rectifiers of spirit, and men engaged in wine and spirit vaults, are
subjected to a vapour which, though it sensibly affects those who are
not accustomed to it, does no evident injury to those who inhale
it daily.

“ Bricklayers, and particularly their labourers, are exposed to lime
dust. This frequently excites ophthalmia and cutaneous eruptions,
but not internal diseasef.

“ The remark applies also to lime- workers and leaders of lime.

“ Plasterers and whitewashers, who are also of course exposed to
lime -dust, suffer from it no sensible injury. They are, however,
more pallid and less robust than the men last noticed. They com¬
plain of the ammonia, cal gas evolved from the glue ; but I doubt its
injurious effects.

“ Woolsorters are occasionally annoyed with dust from the lime,
which in some kinds of wool is employed for separating the fleece
from the skin. No sensible effect is produced on health.

“ Turners, when employed on bone, receive into the throat and air
passages a considerable portion of dust. This, however, is said to be
rather grateful than noxious.

“ Tobacco-manufacturers are exposed to a strong narcotic odour,
and in the stoving department to an increase of temperature. Yet
the men appear healthy. Here, as well as in several other employ¬
ments, we admire the agency of that conservative principle, to which
I lately referred. Men breathe an atmosphere strongly impregnated
with a poisonous substance, yet become insensible to its influence.
The only ill effect we can find is from the heat of the stoving depart¬
ment, which all men cannot bear.

“ Snuff-making is more pernicious. The fine dust of the tobacco,
combined with muriate of ammonia, and other substances, produces
disorders of the head, the air-tube, and the stomach/’ — p. 33.

* I state of course what we observed : but the number of starch-makers in Leeds
is comparatively small. Merat says that if the odours be in great quantity, they
produce cough, difficulty of breathing, paleness, and emaciation.

. f We hear an adage in the mouth of the workmen, that “ bricklayers and plas¬
terers’ labourers, like asses, never die.”

357

Mr. Thaekrah on Health and Longevity.

Our author next describes employments in which the
substances or odours evolved,, are generally or partially
beneficial ; and these he illustrates by the following ex¬
amples : —

“ Rape and mustard- crushers inhale a peculiar odour from the
seeds which they grind. This seems to act as a stimulant on the
nervous and circulatory systems : for men fresh to the employ find
their appetite and vigour increased. The heat of the room is con¬
siderable, often reaching 80° in summer. Though addicted to in-
temperence, the men employed in oil-mills are generally healthy. *
We remarked one man between 70 and 80 years of age, who had
been all his life at the employ, and was remarkably strong and
robust.

“ Brush-makers have a sedentary occupation, but their arms are
actively exerted. Some dust arises from the bristles ; and some ¬
times carbonic acid gas is rather freely evolved from the charcoal fire
which heats the pitch. But the chief peculiarity of the employ is the
vapour of the pitch. This has a sanative effect in bronchial affec¬
tions, as chronic catarrh, and in some forms of asthma. The work¬
men are generally free from disease. Several in Leeds have been at
the employ for thirty years ; and instances are mentioned of brush-
makers reaching the ages of 80 and 90.

‘ ‘ Grooms and hostlers daily inhale a large quantity of ammoniacal
gas generated in the stables. This appears beneficial rather than
injurious. They have, moreover, full and varied muscular exertion;
and if they took a more moderate diet, would be almost universally
robust. Hostlers, porters, and under-male servants at inns, are
generally sickly, and labour under congestion of the vessels in the
abdomen and head. Their state evidently results from the ale and
spirits they take so frequently.

“ Glue and size-boilers are exposed to strong putrid and ammo¬
niacal exhalations from the decomposition of animal refuse. The
stench of the boiling and drying rooms is indeed well known to be
highly offensive, even to the neighbourhood. Yet the men declare
it agrees well with them — nay, many assert that on entering this
employ, they experienced a great increase of appetite and health.
All the glue and size boilers we saw, were remarkably fresh-looking
and robust. Though exposed to frequent and considerable changes
of temperature, to sudden changes also from an atmosphere of hot
vapour to the dry cold air, they are not subject to rheumatism, pul¬
monary inflammation or catarrh. The only complaints we could
hear of, were occasional pains in the loins and limbs, attributable to
posture and exertion.

* At one mill we were informed that, rheumatic affections are frequent, and
that men a day or two absent from work are particularly subject to pains in the
joints, but we did not find this observation confirmed at other places.

358

Critical Review.

“ Buckram-manufacturers are exposed to the odour of the glue.
This is well known to be so great as to offend the neighbourhood of
the manufacture. Yet the men make no complaint of ill-health, and
reach considerable age. Of the seven men employed at the Buck¬
ram-house, in Water-lane, one is 51, another 58, a third 68, and
the fourth 7 6 ; and these individuals have been at the employ from
an early age.

“ Tallow-chandlers, subjected to an offensive animal odour, enjoy
health, and attain a considerable age. During the plague in London
it was remarked that this class of men suffered much less than
others.

“ Tanners, it is well known, are subject to disagreeable odours.
They work in an atmosphere largely impregnated with the vapour of
putrifying skins, and this combined with the smell of lime in one
place, and of tan in another. They are exposed constantly to wet
and cold. Their feet are scarcely ever dry. Yet they are re¬
markably robust ; the countenance florid ; and disease almost un¬
known. Tanners are said to be exempt from consumption ; and the
subject has of late been repeatedly discussed in one of the medical
societies of London. We have carefully inquired at several tan-
yards, and could not hear of a single example of this formidable
disease. We do not find old men actually in the employ ; and the
reason assigned is, not the decline of health, but the inferiority of
men past middle age, in undergoing the labour of the process.
Persons, however, in advanced life, yet healthy, are found in other
occupations, who have before been for many years in the tan-yards,
and have not apparently suffered from the long continued exposure
to their offensive odour. Hence we may infer that this employ,
while it invigorates the constitution in youth and middle age, does
not sensibly shorten life ; does not, in other words, give temporary
health at the expense of premature decline.

“ Ramazzini tells us that at Padua the tan-yards were permitted
only in the suburbs. Here also, as the stench would be considered
a nuisance, tan-yards are at the outskirts. As a matter of medical
police, however, we see no occasion for their exclusion from the
town.

“ The observations under this head apply also to slaughter-men,
but their employ was mentioned with that of the butchers.” — p. 37.

fe Employments producing a dust or vapour, decidedly
injurious ”

“ Corn-millers, breathing an atmosphere loaded with the particles
of flour, suffer considerably. The mills indeed are necessarily
exposed to the air, — the number of men is comparatively small, and
the labour is good. Yet millers are generally pale and sickly ; most
have the appetite defective, or labour under indigestion ; many are
annoyed with morning cough and expectoration ; and some are
asthmatic at an early age. The average circumference of the chest

Mr. Thackrah on Health and Longevity . 359

in ten men, whom we measured, was 36 2 -5th inches ; and the
quantity of air thrown out by a full expiration was somewhat less
than seven pints. Though we found several who had borne the
employ from boyhood to the age of 50 or 60, the individuals were
by no means robust ; and we could not find an instance of an aged
and healthy miller. The preceding statements do not apply to the
men who drive the corn and flour carts, nor to the porters who un¬
load the grain. These persons are little exposed to dust, labour
chiefly in the open air, and are generally selected for their muscular
power. They are, however, like other men who carry great
weights, subject to hernia.” — p. 37.

“ Maltsters are exposed to much dust, particularly in the grinding
and screening departments, and to sulphurous fumes from the coke.
The heat of the kiln is of course great. We have found the at¬
mosphere in the drying-room above 80°, and the malt on the floor
14U°. The men are frequently affected with bronchial inflammation,
and many become asthmatic for life. The exertion is so great that
it obliges some to leave the employ at an early age, and it is much
too severe for the old. Hence we find no labouring maltster ad¬
vanced in years.

“ Tea-men, in removing tea from the chest, are much affected by
the dust, especially by that from the green. But as this annoyance
is occasional only, we can scarcely suppose it capable of producing
permanent injury either to the nervous system or the lungs.

“ Coffee-roasters are affected by the odour, which the heat elimi¬
nates from the berry. And those who have been thus employed for
years, are said to become asthmatic. The vapour is greatest when
the coffee is stirred or shaken during the time of cooling. The heat
of the process is of course great, and leads often to immoderate po¬
tation. Men, when they enter the employ, complain of oppression
at the chest, difficulty of breathing and cough,— of headache and
indigestion.” — p. 39.

Snuff-makers, rag sorters, paper makers, willyers in cloth
mills, and workers of flax, suffer severely from dust, and
are liable to bronchial affections. Our author makes many
ingenious suggestions for substituting machinery for the
performances of the work in many of these trades.

“ Cabinet-makers suffer from the dust, when they saw African,
cam, rosewood, and Spanish mahogany. The first of these is most
injurious. Its dust produces sneezing, headache, sickness and some¬
times vomiting. This wood, however, is rarely used. The other
kinds are more frequently worked. They occasion indigestion, and
sometimes diarrhoea.

“ Turners of wood suffer from the dust of the species just men¬
tioned, but are not annoyed by that of common timber. The

360

Critical Review.

removal of wood-dust would not, I conceive, be difficult. A cur¬
rent of air might be made to take it out of the building. See the
plan suggested for the expulsion of flax dust.

“ Masons inhale particles of sand and dust, which arise from
chipping the stone. They often use great muscular exertion in
lifting weights ; they are exposed also to vicissitudes of the weather ;
they are addicted to intemperance. We promptly find the effects
of these circumstances on their physical state. From their exertion
in the open air, their face has colour, and the figure is muscular and
robust : inhaling dust, the bronchial membrane is often in a state of
chronic inflammation : dissipated in their habits, they become sus¬
ceptible of atmospheric changes, and hence are frequently affected
with pains in the limbs : finally, from the combination of these in¬
jurious agents, dust and dissipation, and the mutual reaction of
morbid states thus induced, masons are short-lived, dying generally
before they attain the age of 40.” — p. 48.

III. — An Introduction to the Study of Human Anatomy.
By James Paxton, Member of the Royal College of
Surgeons, Author of the Notes and Illustrations of Paley’s
Natural Theology, with Illustrations. London, 1831, 8vo.
pp. 414. Sherwood, Gilbert and Piper ; and J. Vincent,
Oxford.

This work contains a clear and concise demonstration of
the human body, and embraces graphic and descriptive
anatomy on the same page. The author’s object is to
furnish the student with sufficient directions for cultivating
this branch of science in the shortest and most successful
manner ; and for this purpose, a correct drawing, and an
exact description of the parts, are given on the same page.
The work is ably executed, and affords the student the
greatest facility in acquiring information on anatomy. It
contains two hundred and eight drawings, all of which are
most faithfully executed. It is a work of great utility to the
medical student and all scientific persons, as it illustrates
human anatomy with great accuracy and fidelity. It has
a great sale, and it well deserves it. It is a beautiful spe¬
cimen of typography ; the wood-cuts are executed in a
superior style; the descriptions are simple and scientific;
and the work, upon the whole, is interesting to the general
and medical reader.

361 ]

IV. — Introductory Lecture, delivered at the Hull General
Infirmary , Nov. 12, 1830. By James Alderson, M.D.

Fell ow of the Roval College of Physicians, London, &c.
Hull, 1831 : Wilson.

In this lecture the author gives a popular account of the
physiology of the animal and vegetable kingdoms, and such
as need not be inserted here, as it is familiar to our readers.
He illustrates his positions by several well- executed wood
cuts, and affords much interesting information to the general
reader. He then concludes his lecture by making some
excellent remarks on the ethics of our profession, which
are well worthy of attention.

“ I here conclude my brief outline of one of the branches of
physiology, which I have entered upon only slightly, rather as a
specimen of the fund of beauty and interest which may be drawn
from a closer investigation, than to furnish you with an entire view
of the subject, for which the space of many lectures would be
insufficient. The young medical student will see, by this introduc¬
tory sketch, that he is not entering into a dry and uninteresting
course of study, but one replete with evidences of the most perfect
design, and objects calculated at every step to call forth feelings of
gratitude and admiration, and to impress his mind with the great
truth, that the Creator of nature does all things wisely and for the
best. So far we may rather consider his progress through this
branch of study as a delightful recreation. In the pleasure at¬
tending his pursuit, he must not, however, lose sight of the object
he has to attain. In the words of Locke, I may remind him that
“ the end of study is knowledge, and the end of knowledge prac¬
tice or communication.” It is not merely in the light of a profes¬
sion, considered as a means of living, that the practice of medicine
ought to be regarded, but as a happy means of benefiting his fellow
creatures, of administering comfort, and of prolonging life. And in
the long and laborious process of qualifying for the performance of
its duties, there are many branches of tedious and difficult study to
be encountered, many where doubt and obscurity might almost dis¬
courage him, had he a less important object in view.

“ The value of medical science, even as a branch of general
education, is strikingly set forth by one of our first moral philoso¬
phers, who, in speaking of the early studies of a still greater man,
bears this testimony to its importance : — “ No science,” says Dugald
Stewart, “ could have been chosen more happily calculated than
medicine, to prepare such a mind as that of Locke, for the prose¬
cution of those speculations which have immortalized his name ;
the complicated, fugitive, and often equivocal phenomena of disease,

3 a ' ;

VOL. VI. NO. 35.

362

Critical Review.

requiring in the observer a far greater portion of discriminating
sagacity than those of physics, strictly so called; resembling, in
this respect, much more nearly, the phenomena about which meta¬
physics, ethics and politics are conversant.”

“ The primary principle which influences the conduct of the
upright medical man is, a desire to benefit his fellow-creatures by
his profession ; unremitting diligence to attain the utmost height of
scientific truth and practical information, is the means by which he
acquires power to pursue this purpose ; and a careful cultivation of
all the charities and courtesies of life enables him to give full value
to his power of relieving, and to render his exertions .not only salu¬
tary but soothing and gratifying. I believe that I have here com¬
prehended all that comes under the head of Medical Ethics.

“ Zeal, and activity, and an entire devotion of time and intellect
may reasonably be required for a profession which is not to be easily
learned, or carelessly practised. When we consider that one error
may never be retrieved, and may involve the life of a patient, an
awful responsibility presents itself, and we may perceive an impera¬
tive obligation to bring every energy we possess to bear upon the
duties of our calling.

‘ ‘ There is no qualification more valuable to the medical man than
the power of coming to a prompt and rapid, though not hurried,
decision. In many cases, indecision is as dangerous as bad prac¬
tice ; for while hesitating about the course to be pursued, the time
for acting with effect may pass, never to be regained. He should
therefore cultivate a habit of concentrating his reasoning faculties
and his store of acquired knowledge, so as to apply them as promptly
as possible to the exigencies of the case before him.

“ Obstinacy and prejudice are the attributes rather of a weak
than of a vigorous intellect ; and consequently the man who is most
active in drawing from the resources he already possesses, will also
be most ready to receive and work upon any new suggestion from
..others, which his candid judgment will acknowledge to be valuable.
The quack and the half-learned are alone averse to receive informa¬
tion, whether it proceed from their own brethren or from others ;
and the plain good sense of the patient, and not unfrequently of the
anxious and devoted friend who watches him, will sometimes sug¬
gest hints which the ablest physician may not disdain to improve.

“ It is of the first importance to the medical man that, in his
intercourse with society, he should preserve a character of unble¬
mished purity. Moral obligations are in reality equally binding
upon all, but to those in most other situations, the penalty of infring¬
ing them is comparatively remote, while to the medical man, repu¬
tation may be considered as a means of existence. He is placed in
a situation of the utmost trust and confidence, and there is a peculiar
delicacy attached to his character, which makes the breath of slander
as dangerous to him as to the dearly-prized reputation of woman.

“ Indulgence and excess are known to be detrimental to intel¬
lectual as well as to bodily strength — they not only draw largely

Dr. Alderson’ s Introductory Lecture.

363

on the time which should belong to better things, but deprive the
medical man of the power of always preserving that gentlemanly
and appropriate demeanour which ought to distinguish him. He
should always be at his post ; always in a fit state to attend to the
responsible duties of his station. There is a delicacy both of senti¬
ment and of manner, which the sensualist never can preserve, and
without which no man is fit to be admitted into the confidence of
his patient.

“ The medical man, whose darling object is popularity, and who
seeks from the hands of the public the reward of his labours, will
often be disappointed. With him, patience is a lesson which will
have to be frequently studied ; for the ignorance, the caprices, and
the prejudices of society will all unite to destroy his equanimity.
Every person conceives himself capable of giving an opinion on
medical subjects, and of canvassing the merits of the practitioner ;
and as we are sometimes made indignant by ignorant and unjust
censure, we are, at others, no less humbled by blind and misplaced
eulogium. But I shall not dwell upon the trials of our profession.
Though we have all difficult and distressing parts to act occasionally,
we have also many delightful and gratifying circumstances attending
the practice of our calling ; — and, besides the happiness of being
the means of restoring health and comfort, we have, in most cases,
the satisfaction of meeting with the best feelings of kindness and
gratitude.

“ The last requisites that I shall mention are gentleness — benevo¬
lence — sympathy. In a sick room, rough and noisy manners are
peculiarly inappropriate ; mildness and tranquillity should alone pre¬
sume to enter there. It has been asserted, though I hope unjustly,
that constant familiarity with disease renders the medical man less
alive than he would naturally be, to feelings of compassion ; the
contrary ought to be the case, When the spirits of the patient are
weakened by disease and anxiety, the feelings are acutely sensible
of the value of kindness and sympathy, — of

“ The graceful tear that streams from others’ woe.”

AKENSIDjJ,

A manner which indicates benevolent concern for the sufferings of
the patient, is sure not only to give consolation, but, by strengthen¬
ing the physician’s influence, to increase his power of being useful.
Benevolence, like mercy, is “ twice blessed, — it blesseth him that
gives and him that takes and we may be thankful that we belong
to a profession which affords such constant opportunities for its
exercise.

“ I here cannot refrain from giving you one more quotation,
because it contains the most perfect, and I hope well-deserved, com¬
pliment to those already in the profession ; and, at the same time,
affords the strongest encouragement to those who are about to
enter it.

364

Critical Review.

“ ‘ And here,” says the elegant and moral author of De Vere,
“ let us not refuse to pay a tribute to this most amiable profession,
which it deserves beyond all others ; that it contributes (and indeed
cannot be exercised in perfection without it) to the moral happiness
as well as the bodily sanity of mankind. Other professions have
their evident importance ; and from requiring all the great virtues,
are rewarded with wealth and honour. But none like this, winds
itself into an intimacy with the secret heart of man, and thus
obtains his confidence and acquires his love. Indeed it must be so,
since half our diseases spring from mind ; and the cure of these
depends more upon benevolence, kindness, and discretion, than
upon medicine itself. Hence we may, I think, observe, that while
the distinguished in other professions are more outwardly honoured,
the friend of the sick room is most personally loved.’ ” — p. 30.

V. — Du Degre de Competence des Medecins dans les ques¬
tions judicaires relatives aux Alienations Mentales , et
des Theories Physiolgiques sur la Monomanie Homicide,
etc. Par Elias Regnault, Avocat a la Cour Royale de
Paris. Paris and London, 1830, 8vo. pp. 361. J. B.
Bailliere.

On the Competency of Physicians in Judiciary Questions ,
concerning Mental Alienation, and also the Physiolo¬
gical Theories on Homicidal Monomania, fyc. By
Elias Regnault, Advocate of the Royal Court at Paris,
&c. &c.

The author of this work is editor of the Journal Hebdo-
medaire, from which we have repeatedly made extracts
during the last year. He adduces all the contradictory
opinions of his countrymen on mania, and concludes that
physicians know nothing of mania until delirium appears ;
and even then, that ordinary persons can form as accurate
an opinion. He quotes M. Costa in support of this con¬
clusion, who says, any man of sound judgment is as com¬
petent as M. Pinel and M. Esquirol, and has, moreover, an
advantage over them, being a stranger to all scientific pre¬
judice. Unfortunately physicians have taken too seriously
the civility of the courts ; and, in examining questions sub¬
mitted to them, they too often substitute the ambitious ig¬
norance of the schools for the natural light of reason’’ —
Journ. Univer. des sc, Med. t. xl. m. Juillet, 1826. “ This

passage,” says our author, <e full of force and truth, would
dispense with my entering further into the question, if

M. Regnatilt on Mental Alienation. 365

several physicians had not believed that this concession at¬
tacked their right and skill. M. Georget, however,, opposed
this doctrine in very strong terms, and is in turn attacked by
our author. “ The sophistical reasoning,” says the former,
te of M. Costa will deceive no one, who will believe that
a person who is perfectly acquainted with an object, is less
capable than another, who has never seen it, of recognizing
it, and of distinguishing it from those with which it may be
confounded.” — Arch. Gen. de Med. t. xxiii. M. Costa was also
condemned by the profession in America as appears by our
northern contemporary.” — Amer. Med. and Sur. Journ.
1828. M. Regnauit replies, that this is affirming what he
ought to prove ; but what is M. Costa’s dictum — is it not the
most gratuitous assertion which cannot be proved? Have
not the most emiuent medical jurists of all countries
opposed it? Our author, however, is not dismayed, but
proceeds to examine “ if madness presents any special and
particular symptom so distinct, that the physician can
determine the existence of this disease when it is still con¬
cealed to every one else • for it is in this case only, that his
presence is necessary in the courts. When madness is
evident, we have no need of a savant, the physician is only
needed when there is doubt, and he comes to dissipate it.”

Our author, when he penned this passage, forgot that
there was such a thing as malingering ; and that all diseases,
madness not excepted, may be so feigned that unprofessional
persons may be readily deceived, and even medical men
themselves.

He divides the symptoms of madness into classes. 1st. The
disorders of the mind, of the thought, which constitutes
delirium (delire). 2d. The disorders which supervene on
the or ganic functions, such as cerebral irritation, increased
action of the heart, disorders of the alimentary canal, heat
of the skin, &c. Of these two classes he leaves the last
only to the doctors, because they alone can recognise it.

In regard to the symptoms of the first class, every man,
even the least instructed, can discover them. Who cannot dis¬
cover the disease of an unhappy peasant, who, in the insula¬
tion of misery, should discourse of his armies and courtiers,
and who should count imaginary treasures on a mattress ?
So that every time that there is general or partial delirium,
it is useless to have it declared by a physician, as every
sensible man can discover it as well as himself.

We have now remaining the symptoms of the second
class. If there is a single one which belongs exclusively or

366

Critical Review.

especially to madness, so as to indicate it infallibly, then we
must have recourse to the physician, who, as we have
already observed, can alone recognise and judge the symp¬
toms. I appeal to every physician of good faith. Let him
tell me, if he dare, before the delirium has shewn itself,
decide that madness exists because the pulse is vibrating ;
the tongue white or slightly yellowed, the skin dry, because
there is present insomnia, head-ache, because the patient is
losing his embonpoint , or in woman, suppression of the
menstrua. Let him assemble all these symptoms, or let
him isolate them, there is not a single one w'hich does not
accompany numerous other affections. So that the phy¬
sician must wait before he can pronounce his fiat ; and as
soon as the delirium appears, we can discover as speedily as
himself. Still more, not only are not these symptoms cha¬
racteristic of madness, but they often do not accompany it ;
and their absence does not prevent the existence of the
disease.

What need have we of physicians to discover the disorders
of the mind ? If madness is evident, every man can re¬
cognise it by its extravagance and by its fury. If there is
a doubt, this doubt exists equally for the physician.

If the physicians could indicate to us the precise seat of
madness, they would then claim with more justice the right
of interfering in criminal cases, where doubt existed on the
moral state of the accused. Let us examine rapidly the
opinions given as to the nature and seat of madness. This
will suffice for us to appreciate the point to which medical
science has reached.

The humoral physicians, such as Galen, Boerhaave, Van
Swieten, Stoll, ( les animistes ) with Stahl, Vanhelmont, have
each raised their systems according to the ruling ideas;
some in the bile, the blood ( the black bile, clots of blood
from piles J, or the mucous pituite; some in the soul, in the
vis naturse or archeus of Van Helmont, the vital principle
or animal spirit.

Chrichton pretends that it is a disease of the nervous fluid.
Pinel expresses himself thus : ef the prelude of the invasion
and of the return of the attacks of madness may be very
various ; but it seems that in general, the first seat of mad¬
ness is in the stomach and intestines, and it is from this
centre that is propagated, as by a kind of radiation, the
disorder of the mind. M. Esquirol says, sometimes the
extremities of the nervous system, and of the seat of
sensibility in different regions, sometimes the digestive

M. Regnault on Mental Alienation. 3GT

apparatus, sometimes the liver and its dependancies are the
first seat of the mischief.

M. Fodere considers the vital principle as the seat of the
disease ; the blood he regards as the vehicle of this vital
principle, and hence of madness.

M. Georget assures us that madness is an affection of the
brain; acknowledging at the same time, that the nature of
the organic lesion is unknown to us ; finally, M. Voisin says
that it is an affection proper to the brain.

Here are surely a sufficiency of contradictions to
authorize us to repulse the especial competency of physi¬
cians. But two works which have appeared lately, confirm
this opinion by the singular contrast they present. M. M.
Bayle and Calmeil, after having studied the disease under the
same masters, in the same places, and perhaps on the
same patients, have published the result of their observa¬
tions. They write on that kind of alienation which is pre¬
ceded, accompanied or terminated by paralysis ; and they
have arrived at different conclusions.

M. Bayle — this alienation depends on chronic meningitis.
M. Calmiel contends it is caused by encephalitis ; according to
M. B — the paralysis depends on the confusion exercised on
the encephalon, at first by the injection of the pia mater and
its sanguineous congestion, and afterwards by the secretion
of serum, which takes place.

According to M. C. the paralysis depends on an especial
disease of the brain ; it is absolutely distinct from the para¬
lysis, sanguineous congestion, or effusion, from acute ramol-
lessement, or any other known alteration.

Bayle says, that the species of madness, of chronic
meningitis, is the ambitious delirium, that is the first
symptom ; the second is the general or partial paralysis.

M. C. asserts that in the madness of palsy, it has not
always the same form or character ; in the greater part it
presents the characters of ambition or noisy joy ; but, in
others, it offers that of grief, melancholy, and the most
sombre thoughts. Finally, M. Guerin de Mamers has pub¬
lished a treatise on mental alienation, in which, uniting
metaphysics to physiology, attributes madness to the dis¬
order of thought, followed speedily by disorder of the organ
of thought ; and it is only lately, that by the continuance of
the madness, those profound lesions, which we discover on
opening the bodies of lunatics, are formed. According to
him, when we think there is an excitement of the brain when
madness appears, a super-excitation; when the lesions are

368

Critical Review.

formed irritation ; this being1 the effect of madness, whilst all
physicians have reg-arded it as the cause of the disease.
Let us apply these reconciliations to other affections depen¬
ding on madness. Many physicians have considered suicide
as a variety of mental alienation ; admitting for an instant
that it is really a disease, I would ask the physicians, which
organ is injured, since there is no disease without lesion of
organs? It is evident M. Regnault is ignorant of the
distinction between disorder and disease. Some will reply
that its seat is in the abdomen, without fixing any thing-
precisely; others in the spleen; a third in the biliary organs.
Betz attributes it to a bilious plethora. M. Falret thinks it
has its seat only in the brain ; M. Esquirol says, we must
not expect one seat only for suicide, since this phenomenon
is found in very opposite circumstances, and that it is more
often secondary than idiopathic.”

I could continue thus for each of the other species of
alienation ; hypochondriasis is to the person a disease of
the abdomen ; with another, a gastritis ; with a third, a
disease of the encephalon ; for a fourth, a bilious plethora ;
Sydenham says it depends on an ataxia, or disorder of the
animal spirits.

Stoll ascribes it to an increase of the irritability of nerves
and muscles ; and to a rarefaction of the mass of humours.

Hoffmann places its seat in the stomach and intestinal
canal. From this diversity of opinion, our author deter¬
mines that all is darkness, and that medical men are lost in
conjecture.

Our author having determined that le delire is the only
evident sign of madness, attacks first the name formerly
given to monomania or partial madness, of madnes without
delirium (manie sans delire), or the other name of reasoning
madness (folie raisonnante). How can we form an idea
of reasoning madness when madness is only the absence of
reason ?

M. Esquirol,” he says, fe appears to have perceived the
ridicule of this term, when he proposed the word mono¬
mania.” . This writer says the species of monomania take
their name from the object da delire. Thus we say hypo¬
chondriacal monomania when the delirium has for object the
health of the patient ; religious monomania when the de¬
lirium is on religious subjects ; erratic monomania for the
amorous passions ; suicidial or homicidal monomania, ac¬
cording to the ruling passions.

Thus M. Esquirol proceeds, although the first definition

M. Regnault on Mental Alienation .

369

refused delirium to the madness ; and attributes all to de¬
lirium, or rather he mistakes delirium of the passions for that
of madness.

According to this system, every weakness, every vice,
every bad action will become monomania. Where then is the
delire of a man, who pushing too far the fear of suffering,
of disease, or of death, takes extreme care of his health,
and views himself with continual precautions, and combats
diseases which do not exist by anticipated remedies. I
see in this conduct that of a weak and pusillanimous spirit.
In vain I seek for traces of madness.” The Brachmans
who passed entire days standing on one foot, in the burning
sands, with eyes turned to heaven, were not madmen, but
ignorant fanatics, who believed that they merited heaven by
tortures. The excess of these sentiments may perhaps
cause such a disturbance in the intellectual faculties, that
madness may declare itself, but it will itself by other acts ;
it will proceed further than merely taking care of their
health, &c. : it will shew itself in other acts, and very fre¬
quently the impression which caused it is lost, and the acts
of extravagance are on entirely different subjects. We can
then see no longer in them monomaniacs, since monomania
is madness on one point. So that they are monomaniacs so
long only as we have occasion to reproach them with push¬
ing a taste or a passion too far. It may indeed happen,
that this madness being on one idea only, seems to be ex¬
clusively occupied by that one idea ; but M. Esquirol’s
definition is not more exact for that. Thus a man, given up
to extreme devotion, owing to communicating with heaven in
his thoughts continually, may imagine himself to be an angel,
an aerial breath. His delirium will be no longer on re¬
ligious objects, but on his own nature. His madness will
no longer be a religious monomania.

M. Esquirol says that homicidal monomania occurs from
a lesion of the will — une lesion de la volonte. Our author
denies this, and says it is because the desire of destroying,
overcomes the desire of obeying the laws. But, say they,
the monomaniac has no interest in destroying his victim, it
is an idea which governs him, a desire which draws him
along. Is pecuniary interest then the first or the only
interest? He who slays to have money, does it to satisfy his
need or his passions. He, who slays for the pleasure of
slaying, is satisfied immediately by his action : the enjoy¬
ment is direct.

3 B

VOL. vi. no. 35.

370

Critical Review.

The publication of the murder committed by Henriette
Cornier, caused several other women to commit similar
crimes. This power of imitation, says M. Esquirol, is a
frequent cause of madness. This M. Regnault cannot
allow. Every action which is beyond the ordinary, even
crime, excites man to imitation, because he is the friend of
the marvellous, in evil as well as in good, but this imitation
is not madness. The aspect of a bold criminal inspires
frequently more curiosity than horror, more respect than
hate, sometimes even admiration, and this admiration is not
far from imitation, which will speedily act on a weak mind,
though it will only glide on a powerful spirit.

Th is influence of the extraordinary is so powerful, that
in religious sects, those which speak most to the imagina¬
tion, either by extravagant practices, or by torture, gain
most proselytes. If Mahomet had not been epileptic he would
not have acted so powerfully on the minds of his contem¬
poraries. And the Quakers (Trembleurs) would be less
numerous in England, if their religious ceremonies were
not a rite of inordinate motions, shrieks and convulsions .

From these reasonings, our author will not admit even
monomonia sans delire. As there is not delire, there is a
knowledge of evil ; if there be this knowledge, there is
the power of choosing between the homicidal idea which
draws him along, and that of duty which retains him — and
this power is nothing else but liberty. He who placed
between good and evil, can distinguish one from the other,,
and chooses the last, can find no excuse in the violence of
the motive or the desire.

Our author allows of monomania avec delire, or with
extravagance of word or deed, but not otherwise. Surely
medical men need desire no more.

Georget reckons nostalgia monomania, on which our
author exclaims, (( a man, who, far from his native country,
abandons himself to grief, shall be designated by the same
name as a man who believes himself to be a cock.” Evi¬
dently, all ought to be confusion in a science where such
different manners of being are comprehended under the
same denomination.

It would not be difficult to fix what monomania is. A
man thinks he carries his valet de chambre in his elbow, and
finds him a very inconvenient weight. Another thinks him¬
self composed of ice, and dares not expose himself to heat,
for fear of melting: yet they reason perfectly well on every

M. Regnault on Mental Alienation.

37 i

^ther subject. These are real monomaniacs — their madness
is concentrated on a single point.

M. Regnault arrives at the following conclusions : —
Physicians have improperly given the name monomania to
excess of the passions. But there is no monomania without
delirium. When there is knowledge there is liberty ; liberty
excludes madness. Homicidal monomonia can scarcely exist
in nature ; 1. where delirium consists , in many erroneous
ideas, and then it is not monomania ; 2, where it consists
of one idea anterior to murder, but this obviously depends
on a pre-existing erroneous idea; the idea of homicide does
not constitute the disease, it is only a symptom and a con¬
sequence ; 3, when the dilirium manifests itself in the act of
homicide, and was hidden previously.

The author again extracts from M. Urbain Costa, having
previously written several pages to prove that suicide is a
religious, not a legal crime.

M. Costa says, <e suicide is often the effects of a disease.”
If it always be the effect of disease, it would be pleasing
for society to think so, and most persons, deceived by their
own love of life, bear this judgment.

M. Costa appears reviewing', or at least attacking M.
Palret. He thus quotes him.

M. F. tells us that the word suicide does not regard those
maniacs who destroy themselves intentionally, as well as
without knowledge of what they do ; those are only acci¬
dents from mental alienation, and he only recognizes suicide
when there is a knowledge of the action, and that it is the
result of the will.

This distinction (says M. C.) is, without doubt, well
founded, but in spite of it, M. F. considers suicide as the
effects of mental alienation ; so that suicide from mental
alienation is not the one of which he treats, and yet the
suicide of which he speaks takes its origin from alienation.

I know not, if he can easily prove, to save this apparent
contradiction, that in the species of alienation which causes
suicide, the will survives the reason. I think alienation and
the will are two irreconcileable ideas. Certainly M. F. under¬
rates the absence of all moral liberty, when he says, some
maniacs destroy themselves without a conscience of their
action, and without this action being the result of the opera¬
tion of the will.

The faculties of a maniac obey a blind cause, as the mus¬
cles of one who is attacked by chorea, obey an irresistible
impulse ; alienation is the chorea of the mind.

372

Critical Review .

From this reasoning*, M. Costa thinks he has reason to
propose the following* dilemma to M. Falret : —

Either your suicide is the effect of disease, and in conse¬
quence an effect as necessary as fever, or else it is voluntary,
and constitutes as such an act of liberty. But you cannot
sustain that your suicide is at once the result of alienation,
that is to say, of the alienation of the will itself, and also
the result of the will.

In case of hallucination of one or more senses, the will
is deceived by false motives, but it is not less free, and it is
not the will itself which suffers. Pascal did not become
mad after his accident at the Bridge de Neuilly ; but he
thought he beheld continually an abyss open at his side.
If Pascal had preferred a voluntary death to the torture of
such a life, could we have said that his suicide was the
catastrophe of alienation, of a disease? Would he not have
immolated himself for certain motives, and after delibera¬
tion?

The hallucination of these senses is then completely
distinct from the alienation of the mind, although it may
induce this alienation.

The most reasonable and most tranquil man may feel a
desire, I might say almost the necessity, of ending with the
evils of life — such a thought may occupy his mind for a
long time, without his being mad. This idea of suicide is
not less familiar with madness ; but there is this difference,
the madman is sick, a being who dreams in a state of wak¬
ing, and immolates himself to his visions. Suicide is then
most frequently a free act of notions, which however, does
not prevent its being frequently also an act of madness,
and that the penchant to suicide may not be frequently the
ruling idea of a madman. I content myself with observing,
that when there is knowledge of the action, and this action
is the result of the will, it is no longer, it can be no longer
the phenomenon of disease, the effect of a physical and ne¬
cessary force.

M. Regnault agrees perfectly with M. C. and proceeds
that a man, who kills another, in order to die by the hands
of the executioner, deserves his death doubly — much more
so than any other murderer, as it requires some courage to
destroy life for a few crowns, or for the love of vengence,
having the scaffold before his eyes, while the other is doubly
a coward, for, not daring to face death, he arrives by tor¬
tuous paths and strikes another, because he dare not strike
himself : he fears to live, and dare not die.

f 373 ]

V. — Prevalence of Dysentery in Scotland. From the Glas¬
gow Medical Journal, Feb. 1831.

Though much has been written on the etiology of dysentery
and cholera, it must be admitted that the conclusions arrivea
at by the profession are far from being satisfactory ; and
therefore we are induced to reprint the following interesting
article from the pen of Dr. Buchanan, one of the editors of
our esteemed contemporary. We regret that want of space
prevents us from inserting the whole essay.

“ We regard dysentery, cholera, and the numerous varieties of
intermittent and remittent fever, many of them frequently verging
into the continued type, as diseases belonging to one great family,
being the products of the same morbific agent, variously modified by
the circumstances we are about to indicate. The same evidence by
which we infer any one of those diseases to be occasioned by exhala¬
tions from the soil, is alike applicable to all of them. As they come on
and again subside at certain fixed periods in the course of the year, it
is clear that they are connected, in some way or other, with the
vicissitude of the seasons. The first idea which this coincidence
naturally suggests, is, that the diseases in question are the effect of
the peculiar physical states of the atmosphere, which follow with
more or less regularity in the train of the seasons. The probability
of this opinion with respect to dysentery, we have already discussed,
and we need only further say, that our objections to it are tenfold
greater when it is brought forward to explain the origin of the whole
diseases mentioned above. Considering, therefore, the physical
states of the atmosphere as only of secondary importance, we turn
our attention to the revolutions in the vegetable kingdom, which
accompany the seasons with still more invariable certainty. As regu¬
larly as the spring returns, the principles of vegetable life are
awakened from their torpor and rise into activity ; as the year ad¬
vances the process of vegetation goes on till it is completed by the
maturation of the seed destined to perpetuate the species ; vegetable
life is then again suspended, and the herbage and foliage, the pro¬
ducts of the completed year, are resolved by the reaction of their
own elements into the soil from which they sprung. Now, it is the
last part of this series of events that demands our particular attention
— the spontaneous decomposition of vegetable substances. By this
process of decomposition, to which chemists have applied the name
of putrefactive fermentation, the more fixed parts of the substance decom¬
posed are converted into vegetable mould, while those of a volatile
kind are diffused through the atmosphere, constituting what physici¬
ans have named miasmata, and have in almost every age, although
with views more or less distinct, regarded as the causes ef epidemic
disease.

374

Critical Review.

“ Like every other fermentative process, that of which we here speak
is regulated by the nature of the substances decomposed, and by the
degrees of heat and moisture under the influence of which it is car¬
ried on. According to these circumstances, the volatile products
differ in nature, just as spirits and vinegar differ, although produced
by processes that are perfectly analogous, and only modified by cir¬
cumstances which we have learned by experience to adjust, and can
thus regulate the products at pleasure. It is true, that the difference
of the volatile products here in question is not equally palpable. We
are not only unable to discriminate them by chemical tests, but we
are even unable to demonstrate by such tests the existence of any
one of them. It unfortunately happens that the delicate organiza¬
tion of the human body is the only reagent which we yet know of
sufficient nicety to be capable of being affected by these subtle
exhalations, and thus detecting and discriminating them. It was
by the observation of certain effects on the body, and the application
of the general reasoning employed above, that physicians were first
led to recognise the existence of such invisible morbific agents.

“ Now, if that reasoning be admitted as legitimate, the diversity of
the observed effects must in like manner be admitted to prove a differ¬
ence in the nature of those agents. The diseases which physicians
believe to be engendered by exhalations from the soil being infinitely
diversified in character, that difference can only be attributed to a
corresponding difference in the causes from which they flow.

“ If the principles just stated be admitted as correct, and we
believe few physicians of the present day will be disposed to contest
them, it is easy to deduce an explanation of many of the laws by which
this interesting class of diseases is regulated. It will be easily
understood, for instance, how every different climate and country,
and frequently even different districts of the same country, should be
infested with diseases differing in kind, or at least marked by a pecu¬
liar physiognomy. In such cases we have a difference in the nature
of the soil, or of the vegetation, or of both : and what is still more
important, the degrees of heat and moisture are different, under
which the process of decomposition is carried on. In such different
circumstances, different morbific exhalations are evolved, and there
is necessarily a corresponding diversity in the diseases which they
engender. Perhaps of all such morbific exhalations, those inducing
dysentery are the most generally diffused and the least apt to vary,
the disease being the common scourge of every quarter of the world,
varying rather in degree of severity than in more essential characters.
The range of cholera is also extensive, but there is less uniformity in
the nature of its exciting causes, as we are entitled to infer from the
greater diversity of the aspects which it assumes. The exhalations
inducing fever arc most apt to vary. Widely diffused over the globe,
they differ in almost every region where their influence is observed.
Hence the great diversity of character in the disease which they excite
— mild, intermittent, and protracted, among the fens of Lincoln —
remittent and continued in its course, and more violent in its symp-

Prevalence of Dysentery in Scotland.

375

toms, in Holland and Italy — still more rapid and intractable along
the shores of Africa, at Batavia, and the mouths of the Ganges — and
attaining its maximum of virulence and destructiveness in the yellow
fever of the West Indies and America.

“ The same principles serve also to explain, how in a country sub¬
ject to the visitation of this class of diseases, they should vary in
character at different periods of the same year. The dryness of the
atmosphere and intense heat at the end of summer, invaribly gene¬
rate the poison of cholera. The presence of moisture in the atmos¬
phere seems essentially necessary to the generation of the poison of
dysentery; and hence that disease generally begins to prevail when
cholera is on the decline, after rain has fallen, or after the commence¬
ment of the wet season in countries subject to periodical rains. Dur¬
ing the winter, the process of decomposition is suspended: it recom¬
mences, however, in the spring, and continues during the summer,
and being now carried on under different circumstances, the diseases
generated differ in character from those that prevailed in the fall of
the preceding year, as in the well known instance of the vernal and
autumnal intermittents. It is exceedingly difficult to determine,
how long the decomposing vegetable matter retains the power of
generating noxious exhalations. It is well known, that, in warm
countries, the vegetable mould itself is far from being innoxious, and
that, in consequence, the turning up of the soil is one of the most
dangerous of all employments. Among ourselves, again, from the
less degree of heat, such exhalations are unknown, and the profession
of a husbandman is looked upon as highly salubrious.

“We come, now, to a subject more intimately connected with our
present inquiry. The principles here assumed serve to explain, how
the diseases occurring in any particular country, although they pre¬
serve for the most part a unity of character corresponding to the
more usual qualities of the climate, should nevertheless vary, more or
less> according as particular seasons, remarkable for the predomi¬
nance of heat, moisture, or other physical states of the atmosphere,
may impress a corresponding peculiarity of character upon the vege¬
tation of the country, and upon the process of vegetable decomposi¬
tion. Such deviations from the usual course of disease are observed
in all countries : diseases of an unusual kind taking the place of those
more generally prevalent. It is thus that the yellow fever is ob¬
served, from time to time, in the place of the bilious remittents of
Spain, and that dysentery, in our own country, takes the place of the
more usual autumnal affections. The diseases, that thus spring up
unexpectedly, are regarded, as anomalous, by persons ignorant of the
history of the country, where they appear. It will, however, be
generally found, on investigation, that they have had their antetypes,
at periods more or less remote, and, most probably, that they return
at certain intervals, according to the usual rotation of the seasons.
The reality of this rotation of the seasons has been long belived
in by practical meteorologists. Their observations have not

376

Critical Review.

indeed afforded results so certain as to be subject of calcula¬
tion, but they are generally admitted to be founded in fact,
and if so, there must also be a corresponding rotation of diseases.
This idea was suggested by Sydenham, who professes himself, how¬
ever, unable to determine its accuracy. “ Haud equidem satis scio,
an diligentius examen (quali rite instituendo vix unius hominis brevis
setas par esse videatur) nos edoceret, epidemicorum alios continue
quadam serie, ceu facto circulo, alios semper excipere.” It may
appear presumptuous in us to offer any opinion as to a point, which
this greatest of all medical philosophers, upon a field of discussion
pre-eminently his own, has left undecided ; we do, however, think it
probable, that the reality of the rotation of diseases suggested by
Sydenham, would be established by observations continued during a
long series of years, in a country not at the time undergoing any
remarkable physical revoulution.” — p. 12.

“ From the same considerations, which lead us to believe that any
disease which has once appeared will return at some period more
or less remote, if the face of the country undergo no remarkable
change, we infer, also, that no disease, belonging to this family, will
appear, which is totally new, and unheard of at any preceding
period. We must, therefore, beg to express our dissent from the
opinion, lately promulgated by the learned gentlemen of the Medical
Society of Westminster, that there is reason to expect we are, in
this country, to receive a visit from the Indian cholera, which, after
having travelled over land from Hindostan, is now approaching the
shores of the Baltic. Such a disease was never heard of in these
kingdoms, and if we may trust to the constancy of nature, there is
no reason to apprehend so terrible a visitation. We believe cholera
to be no new disease in the countries where it now prevails. It was
at first described as altogether new even in India, but more accurate
researches have shown that opinion to be erroneous, and we have no
doubt, similar researches, if there are documents on which to found
them, will establish that the disease has also prevailed, at former
periods, in all the countries, which have been the theatre of its late
devastations. We extract, from the Scottish Register, an account
of the disease, as it occurred at Astrachan, from which our readers
will perceive, that this is not the first occasion on which it has
visited the shores of the Caspian. We believe the Indian cholera,
like every other disease depending on exhalations from the soil, to
have fixed limits, which it will not pass. Whatever diseases have
prevailed at any former period, in this country, we believe may
return. That the livid face of plague may be again seen in the
land, we hold to be perfectly possible, and if from the ravages of
war, or any other cause, the country were to relapse into its primi¬
tive state of rudeness, we should look upon that event as reasonably
to be expected ; but that we are to be visited by the Indian cholera,
we entertain no apprehension, as we consider such an opinion to be
inconsistent with the observed analogy of nature in our western
hemisphere.

[ 335 -j

ORIGINAL COMMUNICATIONS.

f. — Dr. Malins’s Introductory Lecture.

(Concluded front page 328 J

The last and greatest Arabian author is Albucasis, a distinguished
practitioner, who lived in the eleventh or twelfth century. He has
particularly described and illustrated by figures numerous obstetric
instruments for every imaginable purpose. The most interesting of
these are two kinds of forceps, about which, from their being dif¬
ferently represented in different editions of his works, a discrepancy
of opinion exists. They are called misdach and almisdach, and
according to some are both of a circular shape and filled with teeth,
while others say the misdach is straight and armed with teeth, but
that the almisdach is circular, and calculated to extract without
injuring the foetal head. The former opinion is the better sup¬
ported, and therefore the more probable, and successfully impugns
the notion that the Arabians were acquainted with any instruments
designed to bring living children into the world.

From the greater strictness with which the oriental nations have
ever preserved their women, it is probable that the Arabian accou¬
cheurs were allowed to interfere still less frequently than those of
Greece and Rome, in the management of parturition. It would
seem that they only gave counsels and directions, and that females,
to whom all the precepts contained in their works are addressed,
always officiated manually. And this exclusion was not limited to
the obstetric branch of surgery — it extended to all the operations
connected with the sexual apparatus, and hence Albucasis notes,
that one of the greatest obstacles to the success of lithotomy in the
female, is the difficulty of finding a medical woman , who is com¬
petent to perform it. When such is the case, he says that a chaste
and prudent medical man should be procured, in whose presence,
and by whose directions, the incisions should be made. Surgery in
general was held in discredit and contempt by the Arabians, and the
operations were left to be performed by slaves, so that a kind of
dishonour attached to its exercise — a mis -estimation of which Rhares
in particular bitterly and justly complains.

Though during the period that elapsed from the fall of the western
empire to the revival of letters in Europe, the progress of human
cultivation was impaired, and knowledge stood still, the communi¬
cations of the Saracens with the northern shores of the Mediterra¬
nean, and their conquests in Spain, could not fail to disseminate
what little information they possessed. The Arabian doctrines of
medicine were taught in those schools which then existed, and some
glimmerings of knowledge were occasionally discernible in the midst

vol. vi. no. 35. v 3d

386 Original Communications .

of the general obscurity which overspread the earth. The chief of
these colleges was that of Salernum, in the south of Italy, founded
by Charlemagne, about the year 802, but no writing on midwifery
emanated from its precincts at ‘all deserving of notice, excepting a
book, “ De Arte Obstetricia, ” by a celebrated female, Trotula, who
lived some time in the thirteenth century. A book on the diseases
of women, dedicated by its author, Priscian, to an eminent midwife
named Salviana, appeared in the eighth century, and these two are
the only works relating to our subject, which appeared in Europe
during the middle ages. From them, in combination with the cir¬
cumstance recorded by Marcellinus, that an empress once bribed
a midwife to slay, by some negative means, the child of a detested
rival, we infer that females, during the dismal period referred to,
were, as in former times, the principal obstetric practitioners.

On the capture of Constantinople, and the extinction of the
eastern empire by the Turks in 1453, learning took its flight back
into Europe — the ancient manuscripts were conveyed to their ori¬
ginal birth-places, and from the discovery about the same time of
the art of printing, a new impulse was given to the minds of men,
and facilities wrere afforded for the acquisition and spread of infor¬
mation, which operated favourably on every branch of knowledge,
and on none more than the manual division of the medical art.
Like authors on every other subject, these on midwifery now began
to increase and multiply, and are so numerous from that period to
the present, that it will be possible only to mention the most dis¬
tinguished — those who by their talents or discoveries, or some
peculiarity of circumstance, have an especial claim to be noticed
in this sketch of the history of the art.

It was at this early period that, according to the authority of
Haller, the C cesarian operation was first and successfully performed
since its reputed origination ; but there are no details given by
which to judge of the accuracy or inaccuracy of the report.

Ambrose Pare was born in 1509, and is to be considered one of
the first and greatest improvers of the practice of midwifery. He
taught that the head presentation alone was natural, and that in
every other case the child, after being when necessary turned,
should, be brought into the world by the feet. The credit, however,
of being the first to lay down this valuable precept belongs to
Pietro Trauco, the original proposer of the high operation for stone,
who distinctly indicates its propriety in all cases of transverse pre¬
sentation. In many respects the practice of Par6 was not different
to that recommended by the ancients, whose errors he either had
not sufficient discernment to detect, or what is more likely, sufficient
courage to expose ; for at the time he wrote the prevalent notions,
which, like error in general, were adhered to with a tenacity pro¬
portioned to their absurdity, were those of Hippocrates and Galen.
Even the judicious, but imperfect modifications of practice proposed
by Celsus and Moschion were, it is probable, but little attended to,
since, in the work of Eucharius Rhodion, published at Frankfort, in

Dr. Malins’s Introductory Lecture. 387

1548, it is stated that when the feet present, attempts should always
be made to bring down the head in the natural position, and what
is still worse and more gross, this natural position is affirmed to be
with the face of the child towards the ossa pubis and abdomen of
the mother. The work of Rhodion is otherwise remarkable, as it
afforded materials for the first book published in the English lan¬
guage on midwifery, which was by Dr. Raynalde, in the year 1 565.
He translated from the Latin copy, but informs us that the original
of Rhodion was written in Dutch, and had been besides converted
into French and Spanish, from which it would appear that it was a
book in considerable repute, notwithstanding its disfigurement by
the dangerous absurdities before mentioned. In the latter part of
, the sixteenth century, much discussion was excited in France by the
publication of the work of Rousset, on the operation then for the
first time called Caesarean. Rousset advocates its performance in
an ingenious and scientific manner, and relates many cases where it
succeeded, but the weight of authority was opposed to him and
Pare. Guillemeau, and at a later period, Mauriceau hesitated, from
experience of its fatality, to sanction its recommendation.

Guillemeau was born in 1560, and was a disciple of Pare, whose
erroneous views he rejected, and whose improvements he adopted, ex¬
tended, and confirmed. Thus, he directs turning to be performed where
there is profuse uterine haemorrhage, though the labour is natural
as far as the infant is concerned, and also when convulsions super¬
vene. Guillemeau was strongly averse to using the crotchet before
the death of the foetus, and was a no less sound than conscientious
practitioner ; but he seems to have been endued with fastidious
delicacy, in wishing to confine the practice of midwifery as much as
possible to the sage femmes.

The name of the distinguished practitioner in midwifery, which
occurs next in the progress of our descent towards the present time,
ought never to be pronounced without the profoundest veneration —
nor by an Englishman without feelings of pride : it is that of
Harvey, who lived, and lived for so many noble purposes, during
the first half of the seventeenth century. Of his peculiar opinions on
points connected with our present subject, the most singular relates
to the cause of parturition. During the whole course of gestation he
considers the foetus to be continually swimming about in the liquor
amnii, which at the end of the ninth month, is supposed to acquire
some vicious irritating quality, urging and stimulating it to escape
from the contact, and compelling it at length to quit its tenement
and seek some other abodes It is this attempt at departure, and
the resulting movements of progression, which constitute the pro¬
cess of labour. If the foetus were not an active agent, how, he
asks, could it be born during a fit of coma or hysteria, or, as it is
sometimes known to be, after the death of the mother ? The posi¬
tion is supported by reference to the analogy offered by the young
of birds, who break the shells in which they are confined with their
beaks, and to the tediousness of those labours in which the infant is

388

Original Commun i cat ions.

expelled dead. In the latter instance, however, cause and effect are
confounded, for the death of the child rather results from, than pro¬
duces, the unnatural duration of the process. Harvey believed
likewise that super-foetation was possible, and that utero-gestation
might be protracted beyond the term of nine months ; and is the first
medical man of distinction who pratised midwifery in this country.

Between 1650 and 1700, lived several eminent accoucheurs, both
at home and abroad. In France, Mauriceau, Clement and Pen
were the principal.

Mauriceau’s writings were fuller than any which had previously
appeared, especially on the diseases of females, and contain many
excellent suggestions and observations. He invented an instrument
to extract the head of the foetus after it had been opened and
emptied, called a “ tire-tete,” but was ignorant of the forceps.
He erred too, in denouncing the Caesarean operation as an inevitably
fatal one, but on the whole is to be deemed an illustrious master
in the obstetric art.

Clement was employed secretly to attend the mistresses of Louis
the Fourteenth in their accouchemens ; to the first of which he was
conducted blind-fold, while the king was concealed among the bed
curtains, and the face of the lady enveloped in a net-wmrk of lace.
The circumstance of these ladies employing Clement, principally
contributed to bring male practitioners into fashion — the court
hastened to imitate the examples of those who presided over it —
the rest of the nobility and gentry were swayed by a practice that
came so powerfully recommended to them, and the bourgeois or
citizens could be but too happy in adopting or humbly copying any
of the usages of their betters. The name of Accoucheur was now
invented to designate this class of practitioners, whom it became so
universally the mode to employ. The contagion of the example
soon spread into neighbouring countries, and the custom, however
whimsical or trifling in its origin, or resisted and opposed in its
progress, is now generally established, conferring, beyond all doubt,
great and daily benefits on the community.

Peu, who comes last in order of the French practitioners of the
17th century, is notable for his aversion to too frequent digital
interference during parturition — for his opposition to obstetric opera¬
tions in general, and for his just discrimination of spurious from real
uterine pains.

*In England during the latter half of the 17th century, the most
famous and successful obstetricians were the Chamberlins, father and
three sons, who enjoyed very extensive practice in London, from
being in possession of a secret method of expediting delivery in
difficult cases, which afterwards turned out to be the forceps. One
of the brothers translated Mauriceau’s work, and in a note appended
to the latter’s description of his “ tire-tete,” declares that his family
possessed a better contrivance for the purpose of supplying the sus¬
pension of the natural efforts in the expulsion of the head, but what
this was, remained unknown till Chapman described the forceps

Dr. Malins’s Introductory Lecture.

389

in 1733. Dr. Denman thought their instrument rather a lever than
the forceps ; but the discover of the original models about fifteen
years since, in a chest concealed beneath the floor of a closet in a
mansion were Chamberlin resided in Essex, has shown his supposition
to be incorrect. It may be remarked that male practitioners were
employed as early in England as in France, and that therefore the
usage did not come to us recommended as a foreign novelty, as has
been observed in ridicule and depreciation. The introduction of
French manners and customs in his court, by Charles the second, in
consequence of a partiality derived from long residence on the conti¬
nent, may have had some influence in causing its adoption ; but a
more efficient reason must be assigned in the extension of luxury and
the progress of refinement and intelligence, which, by rendering
females more sensible and susceptible of the precarious and hazar¬
dous condition, in which parturition and its sequences place them,
would render them at the same time naturally desirous of securing
such assistance as would be competent to avert or remove danger.

The other British authors and practitioners who figured during the
epoch under consideration were Culpepper, who published a ‘‘Directory
for Midwives Woolveridge, the title alone of whose work I have
been able to find, which is “ Speculum Matricis Libernicum a Dr.
Salmon, who had a share in the composition of the infamous work
now so generally known and circulated among the lower order as
Aristotle’s ; Willoughby, one of whose customs was to affect to
liberate an impacted foetal head, by pressing outwards the os coccygis
and manoeuvring with two fingers on the back of the pelvis ; Thomson ;
and Jerman, physician to Charles the second.

The chief practitioner of this period on the continent, not French,
was the celebrated Dutch anatomist, Ruysch, who expresses himself
severely on the conduct of those midwives who precipitately
extracted the placenta. He advises that its expulsion should almost
always be left to nature.

In briefly mentioning the authors on midwifery after the periods
already considered, I will confine myself still more closely to the
distinguished among them, rejecting those of ordinary eminence, in
order that the tediousness of the recital may be as much as possible
diminished.

In 1701, appeared at Leyden, the work of Deventer, exhibiting,
as its title page informs us, “ a new light to midwives.” However
that may be, he has so admirably described the causes, conse¬
quences, and means of remedying obliquities in the position of the
uterus, of which he has likewise given numerous plates, that
although allusions to such pathological states are scattered in the
writings of the ancient authors, he is come to be considered the
earliest as well as best authority on the subject, and that in despite
of the sneers of the experienced Smellie.

Lamotte was a French country practitioner of great modesty and
excellent judgment, who was largely engaged in midwifery practice
during forty years, and published in 1718. He turned in difficult

390

Oiginal Communications .

cases of head presentation when practicable, and so averse was he
to the use of instruments, that for thirty years he had recourse to
the crotchet but twice. Of the existence of the forceps he does not
seem to have been aware.

A new, and since generally adopted method of exerting compres¬
sion on the uterus, when it refuses to contract, and there is haemorr¬
hage after delivery, was contained in a pamphlet published in 1722
(but never extensively known), by Dasse, a surgeon-accoucheur of
Paris. The method alluded to consists in rolling the abdominal
parietes with a due degree of force, in different directions over the
uterine surface, so as to bring all the fibres under the stimulus of
the pressure.

The first teacher of midwifery in this country lectured in Bond-
street, and was a Dr. Maubray, who lived about the year 1723, and
wrote two books, both of which were plentifully and justly abused
by the critics of the day. He opposed the use of the forceps, and
wished to rectify all malpresentations and accelerate all lingering
cases solely by manual means.

De Gorter, who wrote in 1731, deserves notice, as having par¬
ticularly insisted on the necessity of sufficiently and uniformly
supporting the abdomen after the expulsion of the child. He
invented and described an under garment proper for the purpose.

The second British teacher of midwifery was Chapman, whose
observations were published in 1735. He is the first who depicted
and presented to the public the short forceps invented by Cham¬
berlin, and was very partial to their employment, though aware of
their inapplicability when the head is situated high in the pelvis.
He exclaims strongly and in unmeasured terms against the crotchet,
by which many children were, according to his knowledge, mur¬
dered. Haller says of Chapman, that he was “ vir bonus, candidus,
qui neque nimis sibi tribuit.”

A Mr. Giffard, whose cases in midwifery were about this time
given to the world by Dr. Hody, had been in the habit of using
forceps before the invention of Chamberlin was publicly promul¬
gated, and if we do not suppose that he obtained private informa¬
tion of its nature, a point to the unravelling of which no clue exists,
he must participate in the honor of having been among the first to
devise and apply that description of instrument.

Sir Fielding Guide, of Dublin, gave, in 1742, the first description
of the mode of passage of the child’s head through the pelvis, and
was inventor of a perforating instrument called “ terrebra occulta,”
the disqualifying qualities of which are smallness and weakness.

In 1747, a Dutch surgeon-accoucheur communicated to the pro¬
fession the account of an instrument very famed in Holland, which
had been secretly used, and never divulged by its inventor, Roon-
huysen. It had however long been in the hands of some other prac¬
titioners, though it was known, even after its publication, by the
name of “ the Roonhuysian secret.” This instrument was a simple
lever, though of very different construction and dimensions to that
now in use.

Dr. Mai ins’s Introductory Lecture.

391

Levret, who is perhaps the greatest French obstetrician, wrote
about this time. He illustrated in a scientific manner the mechanism
of parturition, gave ample details on every thing relating to the pla¬
centa, the implantation of which over or near the os uteri he wras
the first to teach, would inevitably produce haemorrhage, described
and distinguished uterine polypi, and invented the long forceps, and
other less useful instruments. He is a prolix though valuable writer,
and was continually engaged in controversy and dispute.

Roderer, professor of medicine at Gottingen, published the first
of numerous obstetric works in 1750. We are indebted to him for
a series of good plates of the gravid uterus, and for confirmation of
many points of practice of previous doubtful propriety, but he is to
be condemned for too great a partiality to the use of instruments,
and it is singular, that after all his labours and researches, he should
have arrived at the conclusion that the ligature of the umbilical cord
was not a necessary measure.

An important era in the history of midwifery is that of Smellie,
who joined to very extensive experience, in his time a rare event,
an eminent degree of sagacity and solidity of understanding, rare
at all times. The first volume of his work was published in 1751,
when he had been many years in practice, both in Scotland and
London, and, as he himself informs us, had had more than nine
hundred pupils to his lectures, exclusive of females. But he does
not mention what Dr. Douglas opprobriously charged him writh —
the crime of suspending a paper lantern over his door, having
legibly inscribed upon it this announcement, “ Midwifery taught
here for five shillings.’" Smellie’s chief merit consists in his having
applied the laws of mechanics to the relation between the osseous
excavation of the pelvis and the form and mode of passage of the
foetal head. From considerations of this kind he deduced improved
and safer rules for the application and use of the forceps, which
before his time were attached in any way that was possible or most
convenient to the operator, and then used forcibly and quite at
random. He considerably modified the form and dimensions of
Chapman’s forceps, and brought them very near to the common
straight short forceps of the present day ; and likewise altered
advantageously the perforating scissors used in craniotomy, by giving
them a projecting rest, calculated to limit the extent of their intro¬
duction. The plates he published have served as models for all
that have appeared since, either in this or foreign countries.

Contemporary with Smellie was Dr. Burton of York, the original
of Sterne’s Dr. Slop. He was a skilful accoucheur, tainted with
the foible common to many of his predecessors as well as successors,
of being too fond of employing instruments. Besides a treatise on
midwifery. Burton published a virulent letter, criticising and con¬
demning most of Smellie’s opinions and directions, which was
answered by Dr. Watt, in his “ Reflections on Slow and Painful
Labours.” It is worth remarking of this latter publication, that
the cause of tedious labour is held to be want of irritation in

392

Original Communications .

the orifice of the uterus — an idea that in our own times has
been assumed as original and propounded so ostentatiously by
Dr. Power.

Smellie’s opponents were not limited to his medical brethren, for,
in 17 60, a most violent diatribe against him and all other accou¬
cheurs, was issued by a Mrs. Nicol, the follies and impertinencies
of which proved a complete antidote to the effect intended to be
produced ; and though at the time the book was extolled as pro¬
digiously clever, and was translated into French, it is now unheard
of, and unknown.

As the practice of midwifery since the time of Smellie, has been
principally in the hands of the medical profession, writings on it after
this date, become more numerous and frequent. To enumerate these,
would be a tiresome task ; but to indicate the new suggestions they
contain, to point out their merits and defects, and to give even the
succinct account of them that has been presented, of the older writers
on the art, of those who assisted it in its infancy, and laboured by
their assiduity, and from their conviction of its importance to the
good of mankind, to enlarge its narrow boundaries, and extend the
sphere of its operations and benefits, when these were circumscribed
by prejudice and ignorance, and restricted by a spurious and even
cruel moral code ; to lay before you, gentlemen, equally brief par¬
ticulars of the improvements of more recent and living authors, would
be, as well as an unwarrantable trespass on your patience and time,
to exceed the limits of my present design, whose object has been to
trace the steps by which midwifery has risen from a neglected, to the
state of a cultivated art, and has emerged from a degraded to the level
of an ennobling, because an inestimably useful pursuit. Having
brought the account of it down to the period of its admission among
the legitimate objects of preliminary pursuit, and of its practice having
become to many members of the profession an affair of primary atten¬
tion and care, I am not solicitous to continue its history up to the
present moment. A reference, however, to the existing condition,
and some of the more recent triumphs of the art, and a slight demon¬
stration of its dignity and utility, will be neither superfluous nor
misplaced.

Passing, then, over the names of the illustrious and judicious
William Hunter, of whose discernment and industry we possess
such splendid relics; of the sophistical and ingenious, but misjudging
Osborne ; of the benevolent, candid, and cautious Denman; of Rigby,
whom fruitful experience and well-directed labour enabled to worthily
fill up an important void in obstetric literature ; and lastly, of the
morbidly sensitive and eminently intellectual Gooch, whose premature
loss science must ever deplore ; passing over, I say, this array of
bright and honoured names, and arriving in the midst of the living,
coming to consider the art as it actually is known and taught, what
is the spectacle this branch of medical science exhibits ? What are
its claims on the philanthropist’s applause, the legislature’s protection,
the possession of public esteem ? It may be unhesitatingly affirmed.

Dr. Malins’s Introductory Lecture.

393

that he who is merely a well-wisher to the progress of human improve¬
ment, will be as gratified and delighted as the cultivator of science,
when he looks around him and contemplates, though cursorily, the
approaches to perfection which it has attained ; and that on every
rightly constituted mind, it has as powerful claims for regard, and as
just a title to consideration, as it has on legislative and corporate
bodies for fostering and support. Connected, as a discharge of its
duties is, with the most sacred earthly interests of society, and the
nearest ties of domestic attachment, can there be a doubt that its
cultivation should be recommended, urged, nay enforced ? And yet
so far from this having been the case, it is well known, that until
within a few months previous to the urgent remonstrances and forcible
representations of the obstetric society formed in London, none of
the corporate medical bodies of this kingdom exacted any knowledge
of its principles from their candidates. While, in other countries,
no person, either male or female, can undertake the practice of mid¬
wifery without examination and licence, in this there is no law or
restriction to prevent the most ignorant from assuming it. Two of
the chartered institutions of the metropolis do certainly now' require
certificates, but to this equivocal demand the guarantees to society,
that unqualified and improper persons shall not be let loose upon
them are limited ; no inquiry into the proficiency of the candidate is
instituted, and the consequence is, that the study, not being com¬
pulsory, is too often either totally neglected, or but very carelessly
and indifferently pursued. When so lamentable a state of things is
considered ; and that it is lamentable, must surely force itself on the
conviction of any one who looks at the question without bias or pre¬
judice, and examines it solely on the broad principle of general utility
and public expediency ; it is almost impossible to suppress our rising
feelings of indignation at the supine conduct of those privileged and
dignified bodies, who have been entrusted with so much power, but
have exerted their control to the effecting only of such partial good.
But I must request your excuse, gentlemen, of this digression, while
I intreat you to allow the importance of the subject to justify the
irrelevancy of its introduction in this place.

The existing condition of midwifery in this country, was about to be
glanced at. The achievements of modern obstetricians have un¬
questionably been rather of a negative than a positive kind, but they
are not on that account the less worthy of admiration, the less indi¬
cative of ability, or the less momentous to the welfare of the com¬
munity. To remove the accumulated rubbish of ages, flanked and
fortified by hereditary and almost intuitive prejudices, and by clear¬
ing it away, to reduce the practice of an art to clear and definite rules,
requires no ordinary merit and no common capacity. The efforts and
labours of most of the professors of midwifery, during the last half
century, have been directed to the simplification of its practice ; to
the abolition of absurd and pernicious customs ; and to the diminu¬
tion of necessity for instrumental aid. They have comprehended

Vol. vi. no. 35. 3 E

Original C ommu n ications.

nature, whose intentions, when salutary and beneficial, the older
practitioners did but too frequently thwart and oppose ; they have in¬
culcated that knowledge, and by precept as well as example, recom¬
mended a close study of the natural operations, injudiciously dis¬
regarded, because they were natural and simple, not only as the surest
means of understanding and appreciating deviations from them, but
also as affording the best lessons against that ofliciousness and
meddlesome intrusion, which are so often practised, and as generally
resented by some untoward and harassing occurrence. If, as is
universally agreed upon among the reflecting and honest, the pro¬
duction of reform in other sciences and on other subjects, involves
numerous points of difficult and delicate consideration, and requires
to be approached on the one hand without rashness or presumption,
and on the other, with uncompromising vigour and resolution ; why
should the merit of having effected a salutary change in the practice
of midwifery be depreciated ? Why should the honour of having
judiciously rejected, cautiously but decidedly deviated, not un¬
sparingly nor yet unreasonably condemned, be denied to the teachers
of its doctrines and rules ? It would be neither invidious with
respect to others, nor adulatory with respect to the individual, to
assert that the precepts of the eminent professor of midwifery in the
University of Edinburgh, have contributed in an especial degree to
induce this revolution . Thatpatriar chal practitioner has most certainly
exerted an important influence by means of his admirable preelections
on the modes of practice throughout the empire, and has assisted,
not in a secondary manner, in maintaining the lustre and upholding
the high character of the renowned institution to which he belongs.

The sound opinions, the results of mature reflection and personal
observation, which characterize the wTritings of professor Burns, are
to be estimated in a no less valuable light, as bearing the impress of
that diligence in observing, and care in weighing facts, and that
sobriety in forming deductions from them, which every disciple of
our art should study, assiduously and unceasingly to imitate.

Nor should the quaint and plain-spoken Dewees be forgotten, in an
enumeration of living men of eminence. The vein of strong original
good sense which runs through his works, and the independent, un¬
prejudiced spirit of observation which has dictated his effusions, and
guided his pen, render his works prominent and honorable specimens
of the improved state of practice which now prevails.

But let it not be inferred, that the results of the zealous labours
and active ingenuity of modern practitioners, have induced none but
negative improvements ; for the reverse obtains, and the fact is far
otherwise. Physiology and surgery have shed two of the most brilliant
rays on obstetric subjects, and have supplied, from their fertile and
constantly enlarging sources, remedial means which it has been the
office of the obstetrician to apply successfully to the alleviation of
human suffering and distress. Through the assistance of one, by
which I would allude to the revived operation of transfusion, effects
the most marvellous and gladdening have been produced. By its aid.

Dr. Malins’s Introductory Lecture „

395

the tottering and flickering spark of vitality, ready finally to depart
from the frame which it animated, has been restored to stability and
permanence ; its flight has been arrested, and its faint expiring glow
at first gently supported, and afterwards fanned by degrees, into the
full flame of life, and vigour, and joy. When all has seemed desperate,
and death was apparently on the point of receiving his victim, when
the powers of life have been drained, and its energies were about to
succumb, by the influence of this wonderful remedy, the whole scene
has been changed, the almost vanquished sufferer has been snatched
from the jaws of death, to which she seemed inevitably doomed, and
rescued from the brink of destruction, on whose verge she was
trembling ; distressed relatives, spared the infliction of the pangs and
wretchedness hovering around and threatening them, have been
brought back to consolation and hope, and the house of mourning has
suddenly been transformed into the house of gratitude and delight.
Such is an outline of the benefits promised and afforded by timely
recourse to transfusion ; how illustrious, then, ought its second
inventor to be considered ; how distinguished his name among those
of the benefactors of mankind ; how proud may not that science justly
be, which numbers a Blundell among her votaries, and can claim him
for her own.

The other important suggestion flowing from an enlightened sur¬
gery, and adapted to the relief of one of the most distressing maladies
to which human nature is liable, is the removal, either totally or in
part, of the womb. The honour of the origination of this great and
terrible operation is not due to any of our countrymen, neither to any
of our rival neighbours, but to the distinguished German, Osiander ;
and though the question of its expediency has been somewhat acrimo¬
niously discussed, and by many its performance is considered unjus¬
tifiable under any circumstances, there is on record in the annals of
medicine, both at home and in other countries, a sufficient number
of successful cases to render it a feasible, and sometimes even an
imperative step, on the part of the practitioner. Indiscriminately
performed, it would deserve the strongest reprehension, and prove a
greater bane and curse than the formidable disease, whose ravages it
is intended to stay ; but resorted to in select instances, it is capable
of answering the desired end of relief, which, previous to its intro¬
duction, was never attained, and, from the. utter inefficiency of all
known remedies, had come to be considered hopeless and unattain¬
able. Surely it is better to make an attempt to rescue a sufferer from
a state of misery, than to rest satisfied with fruitlessly lamenting and
idly deploring the inadequacy of the resources of art ; and as surely
must it be preferable to submit to a temporary increase of pain, with
the prospect of future exemption and a chance of recovery, than to
linger slowly onwards with accumulating distress to a certainly fatal
and deplorable termination.

396

Original Communications .

TI. — Remarks on Obstinate Intermittent. By Medicus.

Joseph Graves, aged 21 years, was admitted on the first
of September into the hospital at Antwerp, with intermittent
fever ; he states the treatment followed was the application
of ten leeches behind the ears, which caused great hemorr¬
hage for sixty hours, and induced much debility ; a blister
was applied to the left hypochondrium, and kept discharging
twenty-eight days ; the bowels were regulated by castor oil,
and he took white powders, which were tasteless ; the
fever was quotidian, and he had twenty-one accessions after
his admission. Two days after the application of the
leeches, and while suffering from great debility, he was
seized with a fit ; his body was much convulsed and his in¬
tellect disturbed. The attendants put him in a strait jacket,
and confined him in his bed during two days. In five days
he had a second fit similar, and was subjected to the same
restraint ; at unequal periods after, he had eight more fits ;
his stay in hospital was about eighty days, which he left
much emaciated, and feeling very ill ; but he was obliged to
make way for more urgent cases. He remained in Antwerp
three weeks, during which time he had no return of fits, and
he regained strength. He has had since the first fit trouble¬
some cramps, and a heavy pain over the forehead. He
applied to me on the 13th January, complaining of head¬
ache, pain in his limbs, loss of appetite, and general debility.
His pulse was natural, rather slow, there was a marked
wildness of manner ; his bowels were irregular in their
action, but generally constipated. I ordered him Bii com¬
pound infusion of gentian, with Bij infus sennse, to be taken
at two draughts during the day. On the next evening he
was attacked with fever, and when I saw him in the morn¬
ing he was very desponding, fearing, as he said, such a spell
as he had at Antwerp. I directed he should take, just as
the cold fit was coming on, a draught, composed of five
grains of camphor, one drachm of T. opii, and By* Aq. cin-
nam ; and should obviate constipation the following morn¬
ing by taking as many pills, at intervals of an hour, as would
answer the purpose ; he had to this end two drops of the
croton tiglium oil, divided into six pills. The draught had
the effect of producing re-action very quickly, and he slept
wrell, but rose with great pain across his forehead ; he took
during the morning five of the pills, and had a free evacua¬
tion of the bowels. At six o’clock p. m. of the 16th, he fell

Remarks on Obstinate Intermittent.

397

down in a fit, his body was greatly convulsed. I did not
see him till ten p. m., he was then quiet, his pulse was full,
not above eighty, his face suffused, head very hot, and he
looked exceedingly wild ; his tongue was rather white,
breathing oppressed. He endeavoured to give a rational
account of his feelings, but had great difficulty in collecting
himself, and said he felt crazed.

I considered this case at this moment requiring active
treatment, but the previous debility and the first accession of
these fits having come on while labouring under the effects
of haemorrhage, I was disinclined to abstract blood ; I also
had thought the continued pain in the head and unequal dis¬
tribution of nervous influence, might have arisen from effused
fluid, or a diseased state of the membranes of the brain ; and
intended, if relieving the alimentary canal was unproductive
of benefit to mercurealize the system , but the accession of
the fever and the recurrence of the fit, which I consider
brought on by the narcotic, obliged me to modify my plan;
I therefore desired to produce a diversion by depletion
through the mucous surface of the bowels, and for this pur¬
pose ordered two drops of the croton tiglium oil to be given
immediately, and repeated in two hours ; and directed the
whole vertebral column to be rubbed for half an hour with
two drams of the ung. hyd. fort, in which was incor¬
porated ten drops of croton tiglium oil. The medicine had
produced eleven or twelve copious watery stools. He com¬
plained of great pain along the spine, pain in the head
relieved ; I directed two other doses of the oil as yesterday,
to be taken in the course of the day, and the inunction to be
repeated at night. 10 a. m. 18th, medicine has kept him in
motion all yesterday and during the night ; has had no return
of fever or fit, complains of bad taste in his mouth ; on ex¬
amination found the gums inflamed, head-ache slight, mental
faculties improved, feels himself altogether better. 20th,
has no complaint but that induced by mercury ; appetite
good but cannot masticate ; health generally improved ; he
has only taken afewaloetic pills since the 18th. My object
in sending to you this case is not from any value 1 attach to
it per se,” but to prove the system may be brought under
the influence of mercury, <f malgre,” very active evacuation
taking place from the bowels. Where it is desirable to bring
the system quickly under the influence of mercury, as in the
yellow fever, and it is of equal moment to evacuate the ali¬
mentary canal of the vitiated secretions, so abundantly formed
in that malady, might not such a practice lead to a favourable

398

Original Communications.

termination ? Cynanche trachealis is also a disease, in which
the use of mercury has been ably advocated, and I think
justly, if there was time to carry its powers into the system ;
indeed the arguments brought by its opponents are chiefly
relative to the period necessary to bring the system under
its influence; a powerful one in its favour in this disease,
its property of preventing the formation of fibrine, its use in
this disease need not preclude general blood-letting and
evacuations from the bowels ; and admitting it did not affect
the system, I am confident rubbed on the part three or four
times in twelve hours, a better effect than a vesicatory will be
produced, therefore nothing could be lost by its trial in this
disease, and benefit might rationally be expected to accrue.
A fear of rendering this paper too prolix has prevented my
enlarging on many parts, but I trust enough is advanced to
excite the attention of practical readers.

TIL — Mr. Mitchell on Stricture of the Urethra and

Gall Ducts.

To the Editor of the London Medical and Surgical Journal .

Sir, — By inserting the enclosed observations on stricture
in your valuable periodical, if of sufficient importance, you
will oblige, your most obedient servant,

r Charles Mitchell, Surgeon.

March , 1831.

As much controversy still exists regarding the possible pro¬
duction of permanent stricture from spasmodic contraction,
I shall detail two cases illustrative of its sequence, or at
least what I have viewed as a consequence of the frequent
repetition of that action.

Case I. — August, 1827, a man applied on account of
difficulty in voiding his urine, which required some time and
effort to accomplish ; he considered the impaired state to
have been approaching for the seven previous months,
during the course of which and for some time prior, had
suffered immediately upon evacuation of the urine, severe
grasping and painful contraction in the perineum : he was of
a costive habit, and troubled occasionally with irritation in
the neighbourhood of the anus ; when constipated pain in

Mr. Mitchell on Stricture of the Urethra.

399

going to stool, the stream of urine was considerably di¬
minished. The prostate was suspected, but upon examina¬
tion it did not seem to be materially affected. A bougie, as
large as the orifice of the urethra would admit, was introduced,
but its progress was arrested upon approaching the bulb; some
degree of force was employed, but it became more impeded
and impacted with some difficulty experienced in its removal.

He was put into a warm hip-bath, took two grains of
opium, and had administered an emollient enema, rest was
at the same ‘time strictly enjoined. The next morning he
took one ounce of castor oil, it operated mildly. In the
evening a small white bougie was introduced without en¬
countering any obstacle ; while it remained he complained
of pain, which greatly subsided before it was withdrawn.
The part of the bougie placed towards the floor or inferior
part of the canal was marked longitudinally, apparently
by irregular protuberances, a circumstance noticed by the
celebrated Mr. J. Hunter. The bougie was introduced daily,
and its size gradually increased, which effected rapid ab¬
sorption of the callous deposition, aided by aperients, the
bath, and horizontal posture. Nothing appears, therefore,
more probable than that the longitudinal muscular fibres
(which have been observed) should, from some irritating
cause, contract spasmodically consequent upon their great sen¬
sibility and irritability. The man attributed the spasms to the
imperfect expulsion of the urine from the urethra; nothing in
fact appears more plausible than the lodgment of a small
quantity at the bulb, exciting irritation and consequent con¬
traction to which I have been repeatedly subject, more
particularly when the muscles of the pereeneum have been
extended (resulting from posture), although they did not
seem to participate in the contractility, for the perineal por¬
tion of the urethra was reduced to the consistence of a cord
of considerable solidity, rendering me unable to move
until its subsidence.

I examined the body of an old man about a year ago, who
died of jaundice. He had suffered from repeated attacks,
which were subdued by emetics, purgatives, opiates, emol¬
lients, local depletion and blistering. The whole body was
deeply tinged yellow, the marrow as well as the cancelled
structure of the bones. The ductus communus eholedochus,
throughout its whole course, was almost obliterated and
reduced to a white cartilaginous cord ; the canal admitted
with some difficulty a delicate needle. From this analagous
circumstance, therefore, we are naturally led to infer that

400

Original Communications .

spasmodic action must have been primary, and the depo¬
sition secondary, of course not produced by any contractile
power of the contingent parts, consequently we must be
excused for assigning constriction of the vesical fourth of
the urethra, to be independant of the neighbouring muscles,
unless we from hypothesis, deduce as a natural consequence
of rough particles of calcareous concretion, lacerating, irri¬
tating and inflaming the delicate lining of the duct, thereby
inducing the deposition.

Case II. A man applied nine months ago*, had been
subject to spasm in the perineum, without being able to
assign any cause, excepting the imperfect expulsion of the
urine ; the stream at the comntfencement was forked, but as
it flowed the division coalesced. The introduction of a large
sized bougie was once attempted, but with no satisfactory
result. A regular succession of sizes produced no better
effect, for the first had excited a resistance not to be imme¬
diately overcome. He was allowed to remain quietly in bed
for two days, took a purgative, and had administered three
hours before the next attempt, three grains of opium. I
commenced by attempting the introduction of one above
the middle size, after retrograding, one entered with some
difficulty; and with as much, removed in consequence of a
slight degree of spasmodic contraction. The impression was
broad and distinct, involving the whole calibre. The daily
introduction of a bougie for one month, rest, and occasional
aperients effected the salutary removal of the impediment.
Caustic, I have every reason to believe, has cf late become
too frequent an application in the treatment of stricture ;
indeed it appears to have been a great and obvious error
in the practice of Mr. J. Hunter, but more so in that of Sir
E. Home, for he details a case where it was had recourse
to nearly five hundred times, a case which might have soon
yielded to judicious management by dilatation. If Sir E. had
properly ascertained the extent and form of the stricture, by
means of a graduated white bougie, he would have been better
enabled to establish a more efficient and less dangerous
course of practice than that produced in many instances,
besides the uncertainty of its application, severe febrile
paroxyms, false passages, ulcerative action, retention of
urine, independant of the eschar, hsemorrhage, corrosion,
and inflammation of the sensible lining of the urethra, fis-
tulee, and exquisite pain. I must confess, however, that I
have found and seen its application indispensably necessary,
after leeches to the perineum the administration of opiates

Mr. Mitchell on Stricture of the Urethra. 401

and the warm bath to allay inordinate andexcessive irritability,
spasm, and pain in the bladder, with inclination but inability
to pass urine. The alleviation of these by one or two appli¬
cations of the caustic, rendered practicable the introduction
of a metallic instrument or bougie, a safer and more suc¬
cessful course, adopted with more propriety and with less
detriment to the constitution.

The basis of strictures are considerably broader than their
Organized productions, and of course less influenced by
escharotics, therefore it becomes absolutely necessary in many
instances to have recourse to the sound or bougie after the
caustic, to aid in removing the organized and callous base.

Lamb’s Conduit-street,

March, 1831.

IV. — Homicide by Poisoning. By M. Ryan.

The name of poison is given to all substances, which, when
applied to the organs of the body, cause death. In order
to give judgment in cases of poisoning, the medical jurist
should be acquainted with the different poisons, their phy¬
sical and chemical characters, their effects on the animal
economy, the means of distinguishing them from all matters
with which they may be confounded or obscured, or in
their combinations with the various tissues. These studies
are indispensable to medical men, so that they may act with
honour and conscience in accomplishing the exigencies of
science and justice. We shall, therefore, consider the vari¬
ous bearings of this subject as concisely as possible, but yet
as comprehensively, as the present state of science permits.

Mode of Action of Poison on the Economy. — Every
poison possesses peculiar effects upon the body, and is
characterised by peculiarities which indicate the species
to which it belongs. It may be employed in various ways,
by being introduced into the stomach or bowels by the
anus, or it may be applied to the mucous surfaces of the
various outlets, to the serous and cellular tissues, to the
lungs by respiration, as in cases of asphyxia, or it may be
inserted under the skin by inoculation, or injected into the

3 F

VOL. vi. no. 35.

402

Original Communications .

veins. It is scarcely necessary to mention, that all poisons
do not act in the same doses, or through the same tissue.

It was long held by physiologists that poisons were ab¬
sorbed by the veins or lymphatics ; but there is every reason
to conclude, that all act in the first instance on the nerves,
as incontrovertibly proved by Morgan and Addison. — ( Essay
on the Action of Poisons, fyc. 1829.) These experimenters
admit with Fodere, Tiedemann, Gmelin, Magendie, Brodie,
Wilson Philip, Barry, Laissaigne, and others, that absorp¬
tion takes place, but that death may be produced by the
same poisons solely through the nerves ; and that this oc¬
curred when they divided all the tissues in a limb, except
the nerves. The presence of poisons in the fluids of the
body as repeatedly observed in the blood, urine, &c. does
not invalidate the opinion, that their fatal results took place
through the medium of the nerves of the vessels which con¬
tained them.

General Indications of the means of detecting poison¬
ous substances. — There is no subject which requires such
minute precautions as the discovery or detection of poisons,
from their varied combinations with the fluids and solids
of the body. Hence the process for detecting them are
exceedingly numerous. This will appear from a reference to
the works of Orfila, Christison, and of other toxicologists.
To the first illustrious professor we are indebted for a clas¬
sification of poisons which is now generally received, and is
as follows : —

1, Irritants; 2, narcotics; 3, narcotico-acrids ; and, 4,
septic or putrefiants. This arrangement is adopted by
Christison, and differs from those proposed by Paris and
Beck, and is decidedly the best.

Class I. Irritant Poisons. — The poisons comprised in
this class belong to the three kingdoms of nature. The
symptoms produced by irritant poisons, when taken into the
stomach, are violent irritation and inflammation in one or
more divisions of the alimentary canal.

There is a sense of heat and burning in the tongue,
mouth, throat, gullet and stomach, the pain is acute and
extends to the abdomen ; it is increased by drinks and the
respiratory movements, the heat is acrid and corrosive, the
breath is foetid, nausea is often an early symptom, there is
vomiting of a tough mucous or of a brown, blackish,
sanguilent matter, or clots of pure blood, which cause
a sense of bitterness and acridity in the mouth ; the
smallest quantity of drink is rejected ; sometimes the bowels

Dr. Ryan on Homicide by Poisoning. 403

are constipated^ but generally there are copious, foetid and
bloody alvine dejections ; there is hiccup ; the skin is pale,
cold, and bedewed with a cold, clammy perspiration ; the
extremities become cold ; painful eruptions appear ; the
face is pale, or leaden coloured, affected with convulsive
contractions ; great prostration occurs ; the pulse is small,
irregular and weak ; the agony and anxiety are extreme ;
there is a desire to pass urine, which cannot be gratified ;
sometimes the intellectual faculties are unimpaired, and
the sufferer is conscious of his horrible pains and approach¬
ing fate ; or the nervous system is stupified, and death
occurs without much agony. In some cases the stomach is
affected without the mischief extending to the intestinal
canal, but generally both are implicated ; in bad cases, the
whole tube from the mouth to the anus is affected at the
same time. In some instances there is irritation in the wind¬
pipe and lungs, and urinary organs.

When poisons are applied externally they cause redness,
or blistering, or sloughing, by corroding the tissues chemi¬
cally, and some of them induce inflammation of the cellular
membrane, which may be diffused between the muscles.
Others are absorbed, especially if applied to a wound or
ulcer, causing lesions of the nervous system, the lungs,
heart and digestive tube. Hydrophobia, syphilis, small¬
pox, poisoning by narcotics, are examples of the last mode
of action.

Lesions of Tissue. Autopsy. — There will be inflamma¬
tion of the mucous membrane, of the cheeks, throat, gullet,
stomach and intestinal tube ; sometimes there will be only
congestion, but generally there will be black spots on the
stomach, caused by effusion of blood between its mem¬
branes ; at other times there will be ramollisement or soft¬
ening of its mucous, or muscular, or serous tunic, or com¬
plete perforation of the three coats. In some cases the small
intestines are untouched, while the stomach and large intes¬
tines, especially the rectum, are highly inflamed. These
phenomena are explained by the rapidity with which the
poison passes through this part of the digestive tube, while
it is delayed longer in the stomach and rectum. It is to be
remembered that the effects of many natural diseases are
easily mistaken for those of poisons ; and these are disten¬
tion and rupture of the stomach, inflammations of the
stomach and bowels, spontaneous rupture of the stomach
and duodenum, bilious vomiting and cholera, effects of drink¬
ing cold water, hernia or rupture, melsena hsematemosis.

404

Origin al C ommu nications ,

colic, iliac passion, and inflammation of the peritonaeum.
The diagnosis in these cases is often extremely difficult, and
is often exceedingly doubtful. Distention and rupture of the
stomach may be caused by gluttony, and produce sudden
death from congestive apoplexy, or from an impression on
the stomach itself. The appearances on dissection will,
according to Christison, enable us to form a correct con¬
clusion in such cases, and in simple rupture of the organ.

Drinking cold water, when the body is over heated, has
caused sudden death from the compression on the nerves of
the stomach (Duncan), or from inflammation of the organ,
followed by gangrene (Haller.) Ices or iced water in hot
summers, produce similar effects. (Bull, des se Med. v. 6.)

The symptoms of cholera are exceedingly like those pro¬
duced by the poisons under notice. In some cases it is im¬
possible to distinguish them. Dr. Christison offers the fol¬
lowing diagnosis in cholera: — the sense of acridity in the
throat never precedes the vomiting; there is no sanguinolent
vomiting, and in this country et death within three days is
very rare indeed.” Death from irritant poisons is seldom
de laved beyond two days and a half. Dr. Mackintosh and
Mr. Tatham have known cholera fatal in a less period than
that above mentioned ; the latter in twelve hours. Edinb.
Med. and Surg. Journ. v. xxviii. Dr. Christison concludes
that cholera in this country very rarely proves fatal, as early
as irritant poisoning (work 1829), that is within two days
and a half; while Dr. Mackintosh states (in his Practice of
Physic, 1828,) that several fatal cases within this period have
been reported to him. Idiopathic gastritis may perhaps
exist, but inflammation of the stomach is usually caused by
poisons, and the burning in the throat, if present at all,
does not precede the vomiting. The symptoms and morbid
appearances in enteritis and peritonitis are widely different
from those induced by poisons. Spontaneous perforation of
the stomach has been often confounded with effects of
poisoning ; but it occurs after scirrhus, simple ulceration, and
softening, or ramoilisement, or gelatenization (Christison.)
The last form is ascribed by John Hunter and most British
pathologists to the gastric fluid after death ; but the last
author named as well as Andral (pathology) questions this
conclusion. Mr. Allan Burns however found a perforation
in the stomach of a girl who died of diseased mesenteric
glands ; he sewed up the body, and after two days he dis¬
covered another opening. Edin. Med. and Sur, v. vi.

It appears from the testimony of Christison, that perfora-

Dr. Ryan on Homicide by Poisoning

405

tion of the alimentary canal by worms, colic, melaena, ileus
and obstructed hernia, can scarcely be confounded with
effects of poisoning1.

Irritant Mineral poisons. — The poisons of this class are
sulphuric acid ( vitriolic acid, vitriol, and oil of vitriol.)
Nitric acid ( aqua fortis ) hydrochloric acid (muriatic acid,
and spirit of salt,) phosphorus cadine, liquid chlorine, potassa
with lime, oxalic acid, nitrate of potas, soda, lime, barytes,
liquid ammonia.

Mineral Poisons. — It has happened of late years that
infants have been destroyed by the barbarous practice of
pouring sulphuric acid into the mouth ; and the countenance
has been disfigured, vision destroyed, by throwing this acid
upon the face. The latter crime is a felony.

When mineral acids (especially the nitric acid) are ap¬
plied to the skin, they produce irritation, inflammation, and
corrosion. They act by the transmission along the nerves
of their local impression. The inside of the mouth is
generally shrivelled, white, yellow, if from nitric acid ;
brownish from sulphuric, and often more or less corroded ;
there is intense burning pain in the throat, oesophagus, and
stomach, which is followed by eructations of gases evolved
by the chemical decomposition of the coats of the stomach,
and the pain is much more intense than in ordinary gastritis.

The matter vomited is brownish, black, or mixed with
shreds of membrane, or consists of coagulated mucus ; the
patient is affected with tenesmus and urgent desire to eva¬
cuate his bladder ; the breathing is laborious, as the move¬
ments of the chest increase the pain in the stomach. The
pulse is generally weak, but may be natural ; and sometimes
there is no uneasiness or torture produced even after a large
quantity of the poison. In some cases there is an eruption all
over the body. The fatal effect from poisoning by acids occurs
between half a day and two or three days, it has happened
in two hours, and has been prolonged to fifteen days. The
patient may linger for eight months; there may be imperfect
or perfect recovery. Christison thinks that death may occur
from inflammation and spasm of the glottis and larynx with¬
out the poison reaching the stomach or the gullet. In these
cases the clothes shew red or yellow spots, when nitric or
sulphuric acid has been taken.

Autopsy. — The lips, fingers, and other parts of the skin
will be spotted or streaked from disorganization of the
cuticle by the acid ; these marks are brownish or yellowish
brown, and present, after death, the appearance of old

406

Original Communications.

parchment, or of a burn, or of vesication. The mucous mem¬
brane of the mouth is generally hardened, whitish or yel¬
lowish ; the pharynx is in the same state or very red, the
gullet is often lined with a dense yellow membrane, the
subjacent tissue is brown or red. The muscular coat of the
mouth, throat, and epiglottis is sometimes exposed, and oc¬
casionally the gullet is unaffected, though the mouth and
stomach are severely injured ; the peritonaeum is generally
inflamed, but not always. The stomach, if not ruptured, is
commonly distended with gases, and contains a quantity of
yellowish brown or black matter, and is lined with a thick
paste of disorganized tissue, blood, and mucous. The py¬
lorus is contracted, the mucous membrane is not always
corroded. When the acid is diluted, the coats of the stomach
may escape corrosion ; but there will be excessive injection,
gorging and blackness of the mucous membrane with or
without softening. Again, there may be perforation of the
stomach ; the duodenum is affected with the other appear¬
ances of the stomach. In the second or chronic variety the
stomach and intestines are greatly contracted, the latter to
the size of a quill. The pylorus is so contracted as barely
to admit a probe. There are red spots on the surface of the
stomach, and its coats may be attenuated, especially where
adherent to surrounding organs, on separating which per¬
forations become apparent. When sulphuric or nitric acid
is injected into the anus after death, there is no sign of in¬
flammatory redness, the mucous membrane is yellowish and
brittle, the muscular and peritoneal coats are white, as if
blanched. — (Orfila). When all the appearances already
described exist. Dr. Christison is of opinion that we may
conclude without chemical evidence, that poisoning has been
caused by mineral acids.

Treatment of Poisoning by the Mineral Acids. — The
immediate exhibition of chalk or magnesia, or if these cannot
be had, of any mild fluid, milk or oleagenous matters, and
then a free use of diluents to facilitate vomiting should be
employed. Should inflammation commence, it is to be
treated as ordinary gastritis

Tests for Mineral Acids. — Under this head we shall
merely describe the tests which interest the jurist, taking
it for granted he is informed on the physical and chemical
properties of the acids in a pure and diluted state. Thus
the jurist has to determine whether sulphuric acid exists
in the vomited matter, and when it is supposed to cause
stains on the clothes.

Dr. Ryan on Homicide by Poisoning. 40 7

Sulphuric Acid. — The process is simple, for the detection
of the acid in alimentary matter. The suspected matter is
to be boiled for a few minutes, and after filtration, sub-car¬
bonate of lime added ; the mixture agitated when sulphate
of lime is obtained, which is to be dissolved in boiling
water, and tested by a salt of baryta, the product is to be
calcined with charcoal, and this gives a sulphur, from which
sulphuretted hydrogen will be evolved by a few drops of
nitric or hydrochloric acid. (Sedillot, 1830.) Dr. Christison
describes this process more minutely when diluted.

When diluted, it is to be tested with litmus and tasted.
An acid having thus been proved to be present, a little nitric
acid is to be added, and subsequently a solution of the
nitrate of baryta. If a heavy white precipitate falls down,
it can be nothing else than sulphate of baryta, because no
acid but the sulphuric, forms with the barytic salts a white
precipitate insoluble in nitric acid. The phosphate and car¬
bonate of baryta are both soluble in nitric acid. In apply¬
ing this test care must be taken to employ nitric acid entirely
free of sulphuric, — an admixture which the common nitric
acid of the shops almost always contains.

The test now mentioned is alone sufficient to indicate the
presence of sulphuric acid, combined or uncombined. But
as the duty of the medical jurist is to supply not only satis¬
factory evidence, but also the best evidence which his science
affords, it is advisable in a criminal case to establish the
nature of the precipitate still farther by the following pro¬
cess: —

“ Collect the precipitate on a filter, wash, dry, and remove
it. Then mix a little of it (not more than two grains) with
a small proportion of dry charcoal powder ; and subject the
mixture for two or three minutes, in a covered platinum
spoon or in a fold of platinum foil, to the flame of a spirit-
lamp enlivened with the blow pipe. A portion at least of
the sulphate is thus converted into sulphuret of baryta. To
prove this, put the powder with a little water in the bottom
of a small glass tube, add a littl e hydrochloric acid, and then
hold within the tube, without touching the matter below, a
bit of white paper moistened with acetate or nitrate of lead.
Sulphuretted hydrogen gas is disengaged, which will darken
the paper, and likewise often betray itself by its singular
odour.” — (Chrristison.)

This process is to be applied for the detection of stains,
the cloth or other solids being boiled, &c.

Nitric acid. — The process proposed by Christison for

408

Or iginal ( ommu ni cations.

detection of nitric acid when mixed with food, consists of
neutralizing1 the acid with potass, evaporating to dryness,
and ascertaining by the addition of sulphuric acid and the
application of heat, whether nitrous fumes are evolved.
Sedillot, who is one of the latest and best French writers,
recommends a different plan, namely, saturate the suspected
mixture of animal substance and acid, with saturated car¬
bonate of potass, filter and evaporate the fluid, and crystals
of nitrate of potass will be obtained. Dr. O’Shaughnesy,
an able analysist and jurist, objects to these tests, and
after a satisfactory exposure of their fallacy, proposes an
entirely new re-agent, namely, morphine, which, when
brought into contact with nitric acid, in the minutest quan¬
tity, immediately produces a brilliant Vermillion colour. The
mode of experimenting requires attention. st A capillary
tube should be used to absorb the minutest drop of the sus¬
pected liquid, which should then be gently expelled on a
particle of morphine, placed on a white porcelain surface,
when the characteristic tint is instantly produced.” (Prac¬
tical Commentaries on Dr. Christison’s Processes for detect¬
ing Poisons. Lancet, 1831, vol. I.)

Muriatic or hydrochloric acid , seldom comes under the
cognizance of the medical jurist as a poison. No chemical
evidence can be valuable when applied to the contents of
the stomach ; since free acid and muriates have been
detected in the secretions of that organ, by Prout, Tiede-
mann, Gmelin and Greaves. This acid is known by its
peculiar vapour, and by the white fumes formed by its
mixture with ammoniacal gas, on the approach of the open
mouths of two bottles containing these substances. The
precipitate caused by nitrate of silver is to be filtered, dried
and heated in a tube. It fuses at the point of redness, is
not decomposed at a red heat, and on cooling forms a
translucent mass, which cuts like horn.” (Christison.)

Dr. O’Shaughnesy objects to the test of ammoniacal gas,
as he says it will produce a similar result, though of a less
degree, by exposing strong, nitric, sulphuric or acetic acids
to it. He says a portion of the acid should be diluted,
and to one part nitrate of silver, and to another nitrate of
baryta is to be added : if a precipitate occurs in the former
and not in the latter, the evidence of muriatic acid cannot be
disputed. The former writer says that a similar precipitate
is caused by the same test with many other acids and their
salts. Work on Poisons, p. 121.

Phosphoric Acid. — The plan for detecting this is by eva-

Dr. Ryan on Homieids by Poisoning .

409

porating the suspected solution to dryness, saturating with
ammonia and precipitating it by hydrochlorate of lime ; in
treating the phosphate of lime with a little charcoal in a
glass tube, phosphorus will be obtained. Poisoning by
phosphoric acid is exceedingly rare, and is the only case
recorded by Christison, in which there was no aphrodisiac
effect produced.

Liquid Chlorine. — This substance is detected by its green
yellow colour, and a peculiar odour, which can scarcely be
mistaken ; it discolours all vegetable substances, evolves
gaseous chlorine by elevation of temperature, and with
nitrate of silver a white curdy precipitate, insoluble in nitric
acid and soluble in ammonia, is produced.

Iodine. — When urged too far, is a violent poison, as it
may accumulate in the system like digitalis and operate
suddenly. The symptoms which follow it in ordinate use,
are loss of appetite, pain in the stomach, vomiting, purging,
rapid and extreme emaciation, absorption of the breasts and
testicles, small frequent pulse, great constitutional disturb¬
ance and violent spasms. Orfila found small yellow patches
and ulcers on the mucous membrane of the stomach of a
dog. In one case there was intense peritonitis, adhesions of
the intestines, enlargement and pale rose red colouration of
the liver. There was effusion into the peritoneal cavity and
chest. (Christison.) Dr. O'S. comments upon this account,
and says, “ we believe that wherever death occurs later
than sixty hours after poisoning by iodine, it will be
sought in vain in the alimentary canal, whi,le it may have
been readily detected during life in the urine.

Iodine, when taken into the alimentary canal, remains
there but a very short time in a free condition. If the
poisoned animal have recently eaten bread, potatoes, or other
amylaceous matters, the iodine is almost immediately con¬
verted into the iodide of starch, and this again is, by some
inexplicable digestive process, transformed into the hydrio-
dic acid. So rapidly do these changes take place, that in
one instance in which we administered a drachm of 'solid
iodine to a dog, though vomiting took place in fifteen
minutes, yet not a trace of free iodine could be detected by
starch in the rejected matters, though hydriodic acid was
found in large quantities.

“ Again, the hydriodic acid once formed, is rapidly elimi¬
nated through the several excretory channels. In forty
minutes we have found it in the urine, in which, in the dog
just alluded to, it was detected occasionally for five days;

VOL. vi. no. 35. 3 G

410

Original Communications.

viz., on the first and second, and on the fourth and fifth,
when he died. Strange to say, though the same process
was performed with every precaution on the third day, it
gave no indications whatever of any compound of iodine. We
found it, however, in the saliva, which was secreted in
immense quantities on that day. After death not a trace
existed in the contents of the alimentary canal. It is also
worth recording that in this instance and four others, no
trace of inflammation existed in the intestines, with the
exception of a few ulcerations of the glands of Peyer and
Brunner ; but the air-cells of both lungs were infiltrated with
pus, and their substance was preternaturally soft.”

In Dr. Christison’s observations on the iodine poisons,
these facts are entirely omitted as far as the analysis is con¬
cerned, and a mode of detecting the hydriodates is proposed,
which would inevitably lead to total failure if applied to any
complicated mineral fluid, such as the urinary excretion.

He sets out in his chemical examination, on the supposi¬
tion that some combination of iodine has been taken. In
order therefore to ascertain whether any free iodine is pre¬
sent, the contents of the alimentary canal are triturated with
a little cold solution of starch, which would immediately
cause the mixture to assume a blue colour. If the blue
colour appear, the mixture is, if necessary, diluted with
water, and exposed to a current of sulphuretted hydrogen,
by which the iodide of starch is decolorised and converted
into hydriodic acid. If no blue colour have been produced,
the mixture ie merely boiled with water and filtered. If the
filtered fluid redden litmus paper, it should be neutralised
with caustic potassa, and then reacidulated with acetic acid.
He next adds the solution of the chloride of platinum, which
with the most minute quantities of hydriodic acid, either
causes a dark-red precipitate, or changes the fluid to a port-
wine colour. It is then to be agitated with an ounce of ether,
which dissolves the iodide of platinum, and separates it from
the other fluids swimming on their surface, from which it
may be removed by a suction tube. The ethereal solution is,
finally, to be evaporated to dryness, and the iodide of pla¬
tinum heated by the spirit-lamp flame in a smalL glass tube,
when the iodine is disengaged in its characteristic violet
vapour, and condenses on the sides of the tube in dark den¬
dritic crystals.

The above process we have found to be extremely delicate
and easy of execution. It is especially applicable to the
urine or saliva. Occasionally in the urine, the simple addi-

Dr. Ryan on Homicide by Poisoning. 411

tion of cold solution of starch and sulphuric acid will strike
the peculiar blue colour, which may be considered sufficient
evidence. This experiment, however, is by no means so
delicate as that just detailed, and it is, moreover, exceedingly
liable to be interfered with by the animal matters which the
urine contains.” — Ut supra.

Hydriodate of potass is preferred to iodine, as less inju¬
rious to the stomach and constitution as a medicine, but as
yet no case of poisoning* by it has been recorded.

Oxalic acid. — This substance, when mixed with lime,
gives a white precipitate, which is with difficulty soluble in
hydrochloric acid, though very soluble in nitric acid ; the
oxalate of copper, of a whitish blue colour, is also insoluble
in the first named acid. The nitrate of silver causes a white
precipitate of oxalate of silver ; if dried and heated on the
point of a spatula, it burnishes its edges — it fulminates with
a white fume. *

Dr. Christison’s process is as follows

f£ In determining the medico-legal tests for oxalic acid, it
will be sufficient to consider it in two states, — dissolved in
water, and mixed with the contents of the stomach and
intestines or vomited matter. If the substance submitted to
examination is in a solid state, the first step is to convert it
into a solution. In the form of solution its nature may be
satisfactorily determined by the following process : — The
acidity of the fluid is first to be established by its effect on
litmus paper. This being done, the re-agents might be
applied at once. But it is better to neutralize the acid
previously with any alkali, for then they act with greater
delicacy. The remainder of the process consequently applies
not only to oxalic acid itself, but also the soluble oxalates,
which will presently be proved to be likewise active poisons.
The tests are the hydrochlorate (muriate) of lime, sulphate
of copper, and nitrate of silver.

Hydrochlorate of lime causes a white precipitate, the
oxalate of lime, which is dissolved on the addition of a
drop or two of nitric acid, and is not dissolved when similarly
treated with hydrochloric acid, unless the acid is used in
very large, proportions. The solubility of the oxalate of
lime in nitric acid, distinguishes the precipitate from the
sulphate of lime, which the present test might throw down
from the solutions of the sulphates. The insolubility of the
oxalate of lime in hydrochloric acid, on the other hand, dis¬
tinguishes the precipitate from the tartrate, citrate, carbo¬
nate, and phosphate of lime, which the test might throw

412

Original Commun icatio n s .

down from any solution containing1 a salt of these acids.
The last four precipitates are re-dissolved by a drop or two
of hydrochloric acid ; but the oxalate is not taken up till a
larger quantity of that acid is added.

iC Sulphate of copper causes a bluish-white precipitate,
which is not re-dissolved on the addition of a few drops of
hydrochloric acid. The precipitate is the oxalate of copper ;
it is re-dissolved by a large proportion of hydrochloric acid.
This test does not precipitate the sulphates, hydrochlorates,
nitrates, tartrates, citrates ; but with the carbonates and
phosphates it forms precipitates, resembling the oxalate of
copper. The oxalate, however, is distinguished from the
carbonate and phosphate of copper, by not being re-dis¬
solved on^he addition of a few drops of hydrochloric acid.

Nitrate of silver causes a dense white precipitate ; the
oxalate of silver, which, when collected on a filter, dried
and heated, becomes brown on the edge, then fulminates
faintly, and is dispersed. The object of the supplementary
test of fulmination, is to distinguish the oxalate of silver
from the numberless other white precipitates, which are
thrown down by the nitrate of silver from solutions of other
salts. The property of fulmination, which is very charac¬
teristic, requires, for security’s sake, a word or two of ex¬
planation in regard to the effect of heat on the citrate and
tartrate of silver. The citrate, when heated, becomes alto¬
gether brown, froths up, and then deflagrates, discharging
white fumes, and leaving an abundant ash-grey, coarsely
fibrous, crumbly residue, which on the further application of
beat, becomes pure white, being then pure silver. The
citrate also becomes brown and froths up, but does not even
deflagrate, white fumes are discharged, and there is left
behind a botryoidal mass, which, like the residue from the
citrate, becomes pure silver when heated to redness. Ano¬
ther distinction between the oxalate and tartrate is, that the
former is permanent at the temperature of ebullition, while
the latter becomes brown. The preceding process or com¬
bination of tests will be amply sufficient for proving the
presence of oxalic acid, free or combined, in any fluid which
does not contain animal or vegetable principles.

“ Of the modifications which are rendered necessary by
the admixture of such principles, none are of any conse¬
quence, except those acquired in the case of an analysis of
the contents of the alimentary canal or matters of vomiting.
Here a word or two must be premised on the changes which
the poison may undergo, in consequence of being mingled

Dr. Ryan on Homicide by Poisoning

413

with other substances in the stomach or intestines. There
may either be organic principles contained in the body, or
substances introduced into the body as antidotes.

As to animal principles. Dr. Coindet and I have proved
that oxalic acid has not any chemical action with any of the
common animal principles, except gelatine, which it rapidly
dissolves, and that this solution is a peculiar kind, not being
accompanied with any decomposition either of the acid or
the gelatine. Consequently oxalic acid, so far as it con¬
cerns the tissues of the stomach or its ordinary contents, is
not altered in chemical form, and remains soluble in water.
In such a solution, however, a variety of soluble principles
are contained, which would cause abundant precipitates with
two of the tests of the process — sulphate of copper and
nitrate of silver; so that the oxalates of these metals could
not possibly be exhibited in their characteristic forms. The
process for a pure solution, therefore, is inapplicable to the
mixtures under consideration; but changes of still greater
consequence are effected in the poison by exhibiting antidotes
during life. It is now, I believe, generally known, since the
researches of Dr. Thomson, and those of Dr. Coindet and my¬
self, that the proper antidotes for oxalic acid are magnesia
and chalk. Each of these forms an insoluble oxalate, so that
if either had been given in sufficient quantity, no oxalic acid
will remain in solution, and the proof of the presence of the
poison must be sought for in the solid contents of the sto¬
mach, or solid matters of vomiting. The following process
for detecting the poison will apply to all the alterations
which it may thus have undergone : —

“ The first object is to procure a solution. If an antidote
has not been given, the contents and tissues, or vomited
matter, are to be boiled, distilled water being added if
required ; the acid is then to be neutralized with potass,
and the whole filtered. If magnesia or chalk has been
given as an antidote, the insoluble matter is to be separated
by filtration, and boiled for twenty minutes in a solution of
carbonate of potass, in eighteen or twenty parts of water.
A double interchange of elements takes place between a part
of the carbonate of potass, and a part of the oxalate of
lime or magnesia, and in consequence, some carbonate of
lime or magnesia is thrown down, wffiile some oxalate of
potass will be found in solution. The fluid after filtration
is to be acidulated with pure nitric acid, oxalic acid being
now in solution, whatever may have been its original state ;
the next step is to separate it from the animal and vegetable

414

Original Communications .

matter dissolved along with it. I have tried various plans
for this purpose, but have found none to answer so well as
precipitation with the muriate of lime, so as to procure an
oxalate of lime, which, after being well washed, is to be
decomposed by boiling it in a solution of carbonate of
potass, as before. i\n oxalate of potass will again be found
in solution. The excess of alkali is finally to be neutralized
with nitric acid. The fluid is now to be tested with the
three re-agents for the pure solution of oxalic acid.”

The other vegetable acids, tartaric, citric, malic and
acetic, are seldom or never used as poisons, and conse¬
quently do not require further notice.

Fused potass , sub carbonate of potass. — These substances
attract moisture from the atmosphere and deliquesce ; they
turn the syrup of violet green, and litmus paper blue, and
are saturated by acids. Watery solutions of them are not
decomposed by subcarbonates of soda and ammonia ; hy¬
drochlorate of platina causes a yellow' precipitate, composed
of potass, oxide of platina and hydrochloric acid.

Nitrate of potass, nitre, salt petre. — When this substance
is thrown on burning fuel, it ignites with a crackling noise.
If concentrated sulphuric acid is poured upon this salt nitric
acid, vapour is disengaged. The indigo test proposed by
Liebeg, is not decisive. Orfila proposed to mix some parti¬
cles with water and copper filings, and add a few drops of
sulphuric acid, when the orange fumes of nitrous acid will
be evolved. The morphine test mentioned, when speaking
of nitric acid, is the last that has been proposed, and
perhaps the most certain.

Soda , lime and baryta, are seldom, if ever, used as poi¬
sons, and need not be further noticed.

Ammonia and its salts are discoverable by a peculiar
odour, and by tests known to every medical practitioner.

Preparations of mercury . The oxymuriate of mercury ,
deutochloride , bichloride corrosive sublimate, is the com¬
monest preparation of mercury employed as a poison. The
mode of detection laid down by Dr. Christison, is considered
almost infallible. The suspected substance is to be boiled
in distilled water, and a small portion filtered for the trial.
On addition of protochloride of tin, a pretty deep ash-grey,
or greyish black colour is effected. This preparation of
tin is prepared by boiling tin powder in strong muriatic acid,
until the metal ceases to be dissolved ; the liquid should
then be preserved in a closely stoppered bottle. The che¬
mical changes effected in this experiment are as follow : —

Dr. Ryan on Homicide by Poisoning.

415

The protochloride of tin strongly attracts more chlorine,
thereby removing one atom of it from mercury, and reducing
the latter to a protochloride (calomel) which is also deprived
of its one remaining atom, metallic mercury, being preci¬
pitated in the form of a dark minutely divided powder.

Corrosive sublimate, when thrown on burning coals, is
volatised in the form of thick irritating fumes, which tarnish
copper. If the mercury, mixed with potass, in a glass tube,
shut at one end, and sublimed, the mercury will appear in
the form of globules on the sides of the tube. If a watery
solution of the corrosive sublimate is mixed with potass or
lime water, a yellow precipitate occurs, a white one by
liquid ammonia, a black one by the soluble hydrosulphates,
and finally, the ferruginous hydrocyanate of potass causes a
white deposit, which soon becomes yellow, then more or
less blue, from the formation of Prussian blue. If a plate
of copper is immersed in a mercurial solution, it becomes
covered with a slight coat of the metal, when oxymuriate
of mercury is mixed with animal or vegetable substances in
solution, and the re-agents produce no effect ; ether should
be added, the mixture agitated, filtered and distilled with
gentle heat, when a residue will be obtained, which, mixed
with water, affords a pure concentrated solution. A fourth
part of ether should be added, which has the power of
abstracting the salt from its aqueous solution. After agita¬
tion for a few minutes, and allowed to rest for thirty seconds
or more, the etherial solution rises to the surface and mav
be removed ; it is then to be filtered, evaporated to dryness,
and the residue treated with boiling water, which afforded
the evidence already mentioned, on being tested with pro¬
tochloride of tin. This preparation of mercury may be de¬
tected in vomited matters, by drying them in a sand bath,
mixing them with a solution of potass in alcohol, and cal¬
cining them at a red heat, when the metal will appear in
globules in the neck of the tube.

The following mercurial preparations — the sulphate, sub-
nitrate, red precipitate, acetate and cyanuret, when mixed
with organic matter, may be decomposed, and the mercury
separated by boiling with fused or caustic potass for an
hour, an excess of nitric acid is to be added, which preci¬
pitates caseous and albuminous matter ; filtration is then to
be concentrated by evaporation. If a slip of gold, bound
round with a harpsicord wire, be plunged into the fluid, an
amalgam of gold and mercury will be formed ; this is to be
scraped off and sublimed in a glass tube, when globules
of mercury will appear.

Original Communications.

416

When the corrosive sublimate is applied to a wound
or ulcer* it is absorbed* and causes inflammation of the
heart, inducing- brownish black patches on its internal mem¬
brane* as well as on that of the intestinal canal. When
taken into the stomach* it produces greyish white patches,
which do not result from any other poison. The best anti¬
dote is white of eg g, which reduces the salt to calomel.
The ordinary symptoms of irritant poisoning will be pre¬
sent, and they have been already described. If the nitrate
be the poison* the best antidotes are muriate of soda and
carbonate of ammonia. The various oxides of mercury are
less virulent poisons than the sublimate. The sulphate and
cyanuret have induced death, but are seldom employed.
Dr. Christison’s chapter on poisoning by mercury, and of
the effects of that medicine on the body* is one of the best
ever written, and ought to be maturely considered by every
medical practitioner.

Compounds of arsenic.— Metallic arsenic has an iron-
grey colour, is fragile and brilliant, when recently broken.
It oxidates in air, water or alcohol. When exposed to air,
it becomes rapidly tarnished, and forms a black powder.
It sublimes at 356°. Farh. and in close vessels it condenses
unchanged ; but in open air it rises in white fumes* wdth an
alliaceous odour, and becomes white oxide, which consists
of one atom of metal and two of oxygen, or of thirty-eight
parts of the former* and sixteen of the latter. Metallic
arsenic has a strong affinity for oxygen, which it rapidly
extracts ; when two acids are formed* the arsenious and
arsenic* the former appears in brilliant octohedral crystals.

The principal compounds which are formed by arsenic*
are the arsenious acid or white oxide of arsenic, the arsenite
of copper or mineral green, the arsenite of silver, the arse¬
nite of potass* the arsenic acid, the arseniate of potass, the
yellow sulphuret or orpiment* the red sulphuret or realgar,
and the impure sulphuret termed king’s yellow ; there is more¬
over a black compound termed fly powder* little known in
this country* composed of the metal and arsenious acid.

“ The arsenious acid, when newly prepared, exists in the
form of white transparent, vitreous lumps, which gradually
become opaque by keeping. It is usually sold as a white
powder ; when heated to 380° Fahr. it is sublimed, and con¬
denses unchanged in minute octahadres. The taste of arse¬
nic has been disputed, but Dr. Christison inclines to the
belief that it is entirely insipid, and that the peculiar taste
sometimes attributed to it, depends on the irritation which

Dr. Ryan on Homicide by Poisoning. 41 T

It quickly causes in the part. In this opinion we altogether
coincide. The arsenious acid of the shops is soluble in
boiling water in the proportion of 115 to 1000 parts,, and
twenty-nine parts are retained on cooling ; temperate water
again takes up, in thirty-six hours, 12-5. The solubility of
the acid in water is impaired considerably by the presence
of various organic materials, such as mucous, albumen, or
astringent matter.

te The arsenious acid forms salts with the various salifiable
bases, of which the most remarkable are the arsenites of
silver, copper, lead, lime, potass and ammonia, all of which
may be prepared either by bringing the arsenic acid into
direct contact with the base, or by decomposing a salt of
the base (such as the muriate of lime, nitrate of silver,
acetate of lead or sulphate of copper), by means of a soluble
neutral arsenite. Arsenious acid, added by itself to one of
these salts, produces no decomposition, since its affinity for
the base is weaker than that of the acid with which the base
was previously associated. This fact is of the utmost im¬
portance, and deserves to be attentively studied.

<£ The arsenite of copper is a green compound, formed
by adding the arsenite of potass, soda or ammonia, to the
sulphate of copper. The arsenite of silver is yellow, and
formed with the nitrate of silver in the same way. The
arsenite of lead and lime are both white.

The arsenic acid never comes under the notice of the
toxicologist in its free state, but it frequently occurs in
combination with potass, as the arsenite of that alkali.
This compound is formed by deflagrating arsenious acid
with nitrate of potass, by which it obtains another atom of
oxygen. Arsenic acid is produced, which unites with part
of the potass, forming a neutral salt ; the nitrate of silver
added to the salt (both in solution), causes the precipitate
of a brown-red arseniate of silver.

Of the sulphurets of arsenic, two only aie of toxicolo¬
gical importance, namely, the pure orpiment and the impure
king’s yellowT, the former occurs abundantly as a natural
product, and is artificially produced when sulphur is treated
with arsenious acid, or when sulphuretted hydrogen is
passed through a solution of that substance. Both these
sulphurets of arsenic are exceedingly soluble in alkaline
solutions.” — (O’Shaug'hnesy, op. supra cit )

Treated with potass and charcoal, in the manner hereafter
mentioned, metallic arsenic will be produced. Arsenious
acid is dissolved in boiling hydrochloric acid, and precipi*

3 H

VOL. vi. no. 35.

418

Original Communications .

tates on cooling-. It is very soluble in water, and an addi¬
tion of hydrosulphuric acid, which causes a precipitate of
yellow sulphur of arsenic, which is entirely soluble in am¬
monia. The ammoniacal deuto-sulphate of copper, causes
a green precipitate. On boiling this acid with potass, a
yellow precipitate takes place by nitrate of silver. When
white oxide of arsenic is mixed with vegetable and animal
matters, the following processes are recommended for its
detection : —

A small quantity of these substances is to be boiled for
fifteen or twenty minutes, filtered and tested with the various
re- agents already mentioned. The hydrosulphuric acid or
soluble hydrosulphates, to which a few drops of nitric acid
are added, are the best tests, as the yellow sulphate of
arsenic is detected with difficulty ; when such suspected
matter is much coloured, it will not be easy to recognize
the precipitates ; and then a concentrated solution of chlo¬
rine should be added, and by this means the arsenious will
be converted into arsenic acid, which is very soluble. On
filtering the liquor, we are to observe if it give a white
precipitate with lime water or baryta, a whitish blue with
acetate of copper, a brick red with nitrate of silver. If this
liquor is boiled with hydrosulphuric acid, the yellow sulphur
of arsenic is formed.

When the liquor obtained by the first operation contains
animal matter, which prevents the deposition of precipitates,
it is to be evaporated, an excess of nitric acid is to be added
and carried to the boiling point, which will destroy the
animal matter ; the excess of acid is to be saturated with
potass, a few drops of hydrosulphuric acid gives a precipi¬
tate of yellow sulphur of arsenic.

The contents of the stomach may contain arsenious acid
in a solid or fluid state ; when solid it may be mechanically
mixed, and subside on simple decantation. If the quantity
amount to a grain, it is said to be large, and is to be divided
into three portions ; the first is to be mixed with charcoal
or black flux, prepared by deflagrating one part of nitrate
of potass with two of supertartrate of potass, and sub¬
limed in the manner mentioned by Dr. Christison in the sub¬
sequent extract ; the second part should be boiled in dis¬
tilled wrater until dissolved, and a drop or two of the solution
placed on three different watch crystals; nitrate of silver
should be added to one, when a yellow precipitate takes
place ; sulphate of copper and ammonia to the second, when
a deep green deposit occurs ; and sulphuretted hydrogen

Dr. Ryan on Homicide by Poisoning .

419

should be brought in contact with the third, when a yellow
precipitate or stain will be produced.

Dr. Christison examines the tenth of a grain in the fol¬
lowing manner : —

“ The only instrument which should be used by the inex¬
perienced, and the instrument which the chemist will always
prefer when it is at hand, is a glass tube. When the quan¬
tity of the oxide is very small, it should not exceed an
eighth of an inch in diameter.

“ The proper material for reducing the oxide of arsenic
is freshly -ignited charcoal. With this substance the whole
metal of the oxide of arsenic is disengaged. The black
flux, which is usually recommended, is ineligible, if the
quantity of oxide is very small ; for only a part of the
metal is disengaged, the remainder continuing in the flux,
probably in the form of arseniuret of potassium. If the
quantity operated on is large, it should be mixed with the
charcoal or flux before it is introduced into the tube ; if on
the other hand it is small, a better plan is to drop it into
the tube and cover it over with charcoal. The materials
are to be introduced along a little triangular gutter of stiff
paper, if the tube is large ; but with a small tube it is pre¬
ferable to use a little brass funnel, to which a brass or silver
wire is previously fitted, for pushing the matter down when
it adheres. In either of these ways the side of the tube is
kept quite clean, which is a point of great consequence,
especially when the black flux is used. In delicate experi¬
ments the material should not be closely impacted in the
tube. By far the best method of applying heat is with the
spirit lamp, at first suggested by Mr. Phillips. The upper
part of the material ought to be heated first, and with a very
small flame. Afterwards the heat should be applied to the
bottom of the tube, the flame being previously enlarged by
drawing out the wick with a pair of forceps. A little water,
disengaged in the first instance, should be removed with a
roll of filtering paper, before a sufficient heat is applied to
sublime the metal. Whenever the dark crust begins to form,
the tube should be held quite steady, and in the same part
of the flame. By these precautions a well-defined crust will
be procured with facility, even by a mere tyro in practical
chemistry, as I have ascertained by repeated trials.”

[ 420

BIBLIOGRAPHY.

ANATOMY.

1 . On preserving Anatomical Preparations in Spirits. By Alex¬
ander Watson, Esq. M.R.C.S.E., &c. &c. — After enumerating the
various causes by which an evaporation of the spirit employed takes
place, Mr. Watson proposes, in order to obviate these inconveniences, to
have glass-stoppers accurately ground to fit the preparation-bottles ;
the stopple itself being hollow, with a rod across it, to which the
threads, suspending the preparations, are to be attached, thus re¬
moving the inconvenience of the threads being brought over the neck
of the bottle, in which case they frequently act as a syphon, and always
cause a small crevice, which materially aids in the evaporation of
the spirit. The mouths of the bottles should be as small as possible.
Mr. W. also, employs a weaker spirit than the one in common use
for preparations, as, “ after the preparation has been properly ma¬
cerated and prepared by repeated changes of water and spirits, a
much weaker spirit than is commonly used is not only sufficient,
but is in reality much better for preserving it by being less subject
to evaporation.” The stopper is to be rubbed with lard before it is
inserted, and melted wax poured over it afterwards ; it likewise
appears a cheaper method than the one at present employed. —
Edinburgh Med. and Sur. Journ. April.

SURGERY.

2. Sixth Report of the Edinburgh Surgical Hospital, from August
1830 to February, 1831. By James Syme, Esq. Fellow of the Royal
College of Surgeons, London and Edinburgh, and Lecturer on
Surgery, Edinburgh.

Fractures. — It appears that, altogether, since the hospital was
opened in May, 1829, upwards of 140 cases of fracture have come
under treatment.

From observation, and from some dissections which tend to throw
light on the mysterious process of the re-union of bone, Mr. Syme has
formed some opinions on that process, which are, we believe, some¬
what different from those entertained by the generality of surgeons.

Breschet, from his experiments on dogs and pigeons, concludes,
that the formation of callus consists in the following steps : — “ 1st.
In effusion into the surrounding soft parts, and gradual ossification of
a layer of these exterior to the bones. 2d. In effusion into the
medullary canal, and subsequent ossification of it. 3d. The forma¬
tion of an intermediate substance between the fractured surfaces,
which, in course of time, it might not be until months had elapsed,
became converted into perfect bone.

Mr. Syme proves that the bones are not merely united by the
ossification of their periosteum, “ by cutting them through longi-

Surgery.

421

tudinally when the ends are found firmly united together, and even
the medullary canal filled with osseous matter.” He states, how¬
ever, that at an early period the fractured surfaces are ununited ;
and hence Duhamel, whose observations did not extend beyond the
fifteenth day, was confirmed in his error.

Mr. S. formerly believed, “ that the new bone or callus resulted
entirely from the old one ; being first, a gelatinous effusion becoming
more and more firm, then cartilaginous, and at last identical with
the tissue from whence it proceeded.

He acknowledges that analogy and the appearances of bone, some
time after the fracture, tend to prove this, but he thinks that some
facts afford unquestionable evidence against its truth.

In treating fractures of long bones, we find the mobility continues,
generally for the best part of three weeks, during which period the
crepitation is quite distinct ; it usually ceases very suddenly, and the
limb all at once gains a degree of firmness sufficient to support its
own weight : when such fractures are dissected within the first two
or three weeks, the ends of the bones are found quite separate.
These facts, Mr. S. thinks, are quite opposed to the idea that the
process consists entirely in a deposit between the broken portions,
in which case the mobility should cease gradually.

He gives two dissections of fractures in the early stage.

Case I. Catherine Adam, set 52, oblique fracture of the right
thigh, at its lower third. She died, in about a fortnight, with symp¬
toms of oedema of the glottis.

On dissection, the fracture was found to extend obliquely from
near the middle of the bone down to the external condyle. The
muscular fibres and cellular substance in the neighbourhood of the
injury were altered in colour as well as in consistence, by the
effusion of gelatinous matter into their texture. A kind of bag or
capsule was there formed, embracing the whole extent of broken
surfaces, and containing two or three ounces of fluid blood. The
parietes composing it were in some parts connected with the very
edge of the bone, but in others they became adherent to it at a dis¬
tance of an inch or more from the extremity, leaving a space to this
extent uncovered, and apparently denuded of periosteum. When
carefully examined, this exposed portion was ascertained to be
covered by a thin layer of gelatinous substance, which did not
possess the toughness or other characters of a membrane ; and the
respective surfaces of the bone had a covering of the same kind.
The medullary membrane was very vascular, and more distended
than usual.

In examining the structure of this bag, I endeavoured to ascertain
which of the natural tissues entered into its formation, and in what
parts of it, if any, ossification had commenced. On tracing the
periosteum from the sound bone, I found that where the bag adhered,
that membrane became thick and evidently continuous within its
walls. It seemed probable that where the membrane had been stripped
off the bone, as already mentioned, it might assist to form, in some

422

Bibliography.

small part, the sac in question ; the great extent of which, howrever,
was evidently constituted by the neighbouring tissues, whatever
they happened to be, muscle, tendon, fat, or cellular substance, all
being reduced to the same appearance internally, by vascularity of
the surface, and the same consistence, by the interstitial effusion of
organizable matter.

On introducing my finger into the bag, so as to feel if there were
any indications of ossification, I perceived some small grains or specks
of bone, which, when minutely examined, presented a stellated
appearance, and were ascertained to be in the substance of the cap¬
sular membrane. When examined in the same way near its con¬
nexion with the bone, it was found to contain much larger masses
possessing osseous firmness. In order to ascertain the precise seat
and origin of which, I carefully dissected the membrane where they
existed, and then found that they lay completely imbedded within it,
having a covering from it on both sides ; also that they did not ad¬
here to the bone, being separated from it by a thin layer of the mem¬
brane, so as to admit of a slight degree of motion ; but at these
parts, the shaft itself had begun to shoot out a growth of new bone.”

It would appear from this, that not only arteries supplying the
periosteum and the bone itself, can take on that action, but likewise
the arteries of the surrounding parts. This dissection is a most im¬
portant and highly interesting one, and has been described and per¬
formed with Mr. S.’s well known skill and attention.

As we have devoted so much space to this case, we can only give
an extract of the case which follows: — Mary Donaldson, set 70.
A compound and comminuted fracture of the left leg, close to the
ancle. The patient was admitted on the 27th September, on the
25th of October the cure appeared complete, and on the 5th of
November she was discharged cured. About ten days afterwards
she died, and Mr. S. procured permission to examine the leg. The
bones on being freed from the muscles appeared nearly natural,
but after maceration the tibia appeared composed of thirteen pieces,
which constituted merely a skeleton, the central cavity remaining
vacant. On examining the internal surface, ossification was ob¬
served to have been going on all over it, and Mr. S. has no doubt
it would have become solid in time. The fibula presented similar
appearances.

Mr. S. promises to return to the subject again at the first oppor¬
tunity. We expect it with impatience, as every fact of such a nature
is of great value, to determine this point.

Four additional cases of excision of elbow joint are added, making
fourteen in all ; three were successful : in the fourth, the disease for
which it was performed was very extensive. Amputation was finally
done, but the patient died the day after.

Urinary Calculus. — The next subject treated of, of consequence,
is this disease.

In Mr. S.’s last report, he mentioned a case of stone that occurred
in private practice, in which he extracted two large stones from the

423

ery.

urethra. Some uneasiness remained after the operation, supposed to
be caused by a stricture of the urethra which existed, more especially
as great relief was experienced by the use of bougies. When the
stricture was cured, however, the uneasiness still remained, and in
consequence an instrument was passed into the bladder, and a cal¬
culus detected. The stricture being situate in the anterior part of
the urethra, the bougies were never passed beyond it, for fear of dis¬
turbing the healing process in the wound, through which the calculi
were extracted. Mr, S. proposed its removal, but met with great
opposition from one parent ; it has since been extracted.

This case shews, in the first place, how careful one ought to be in
removing stones from the urethra, near the neck of the bladder, to
ascertain at the time whether or no there are any in the bladder itself.
Otherwise the patient will have all the horrors of two operations,
and be ready to listen to any suggestions against the skill of the
surgeon.

As it is impossible to ascertain the existence of the calculus pre¬
vious to the operation, and as it frequently happens that the first
time of passing the sound, the stone is not felt, it would be better to
divide the prostate so as to admit the finger, and make a complete
scrutiny over the whole of the bladder.

A very curious case of stone follows ; in which, owing to the
extreme suffering of the patient from the stone, he had been accus¬
tomed to take about sixty-two grains of opium daily.

The operation of lithotomy was performed with considerable fa¬
cility, and a small oval stone about the size of a pigeon’s egg ex¬
tracted. The question of what quantity of opium should be allowed
him was then mooted ? If the quantity previously taken, danger was to
be feared from it, the cause of the irritation requiring it being removed.
On the other hand, a sudden discontinuance of his natural stimulus
was likely to do considerable harm. In this dilemma, the patient’s
feelings were allowed to be the guide, (by far the best that could be
chosen) and he took in each of the first six days, from six to eight
hundred drops of ladanum ; his bowels were opened by injections,
which were and had been for some time indispensable.

On the 6th Sir G. Ballingall and Mr. S. thought the opium might
be diminished. In the evening, he complained of exhaustion and
general uneasiness, pulse had risen, tongue was dry. Laudanum was
given in large doses, but he gradually sunk, with symptoms of chest
affection. The day before his death, he complained of violent, in¬
cessant, and excruciating pain in the left lumbar region, which con¬
tinued until he died. On dissection, the lungs were gorged with
mucus ; in the abdomen the only morbid appearance was an extreme
contraction of the colon, exactly at that part where the agonizing
pain was felt ; all the parts concerned in the operation were in a
most satisfactory state.

Mr. S. ascribes the patient’s death to suddenly removing .a source
of irritation in a very irritable system. In ordinary cases this dimi¬
nution of irritation counterbalances the irritation of the operation.

424

Bibliography.

But the previous irritation was excessive, while that from the opera¬
tion was comparatively mild, from the facility with which it was
performed ; and hence the function might be thrown into disorder,
and produce death. He is not, however, certain of this, and leaves
it to the practical reader to explain as best pleases him.

Cancerous Sores of the Face. — When they can he eradicated,
should be removed freely with the knife, as owing to the looseness of
the surrounding integuments, cicatrization readily occurs. Some
cases are given in point. A case of lacerated wound of the vagina
is detailed, but from our long extract, it is impossible to do justice
to it.

An attack of peritonitis ensued, which was combated by bleeding
and tartar- emetic. The patient was cured in about three weeks. —
Op. cit.

We cannot take leave of Mr. Syme without returning him our
sincere thanks for the excellent paper we have just perused.

3. New operation for stricture. — Mr. Stafford observes : — “ I
have myself now operated on upwards of forty cases of perma¬
nent stricture of the worst description, without a single failure. In
no instance, has there been a false passage made, nor has the cutting
through the contracted part either caused pain, haemorrhage, inflam¬
mation, or any other unfavourable symptom ; the hardened structure
which composed the stricture has always been absorbed ; and I have
never as yet heard of a return of the complaint after this treatment.
In addition to the unvaried success in the use of these instruments in
stricture, I have on two different occasions divided through an enlarged
third lobe of the prostate gland, which in the one had caused total,
and in the other, partial retention of urine. In both of these cases
the disease subsided, and the patients recovered the complete power
of the bladder.

It cannot but be gratifying to the profession to know, that although
the employment of these instruments is not necessary in every case of
stricture, yet when such cases do occur, and there appears to be but
little hope left to the patient from any other remedy, he may be re¬
lieved, not merely without danger, but with very trilling inconve¬
nience. I say trilling inconvenience, because I have not always found
it necessary, as I formerly recommended, to confine my patients, to
apply leeches, or to leave the catheter after the operation in the
urethra. They have, on the following day, usually gone about their
occupations, and it has only been necessary to pass a bougie daily
for a short time, and afterwards three times a week, until the cure has
been completed. — Appendix to Work on Stricture.

4. Browne on Tracheotomy , in cases where a foreign body lies in
one or other bronchus. — In the greater number of cases, the foreign
body is in the right bronchus, which according to Cloquet, is more a
continuation of the trachea than the left, and is also larger, and a lit¬
tle more forward.

From Mr. Key’s experiments, which have been repeated by Dr.
Browne, it would appear, first, “ that a shilling could be forced, for

Surgery.

425

the distance of an inch, into the right bronchus, but not at all into
the left : while a sixpence passed freely into either bronchus, but
farther within the right : secondly, if a long slender forceps was
passed into the trachea, without giving it any particular direction, it
went invariably into the left bronchus : and lastly, that bones, six¬
pences, &c. could be extracted with equal facility from either of these
tubes : as by inclining the handle of the forceps towards the leftside,
the transverse direction of the right bronchus was, in a great measure,
counter- acted.”

The irritation produced by these foreign bodies most frequently
caused pulmonary consumption, and the patient’s death : though
occasionally cases have been recorded, in which, after suffering for
years from apparent disease of the chest, the patients have expelled
the irritating cause : but these must be regarded as exceptions to the
general rule, and though the operation is not unattended with danger,
yet it offers the best chance of safety for the patient, more especi¬
ally if performed early.

Dr. Browne draws these conclusions from his observations.

1 . That the existence of foreign bodies in one or other bronchus
can be ascertained by the use of the stethescope : by the seat of the
pain, and other uneasy sensations : and by the previous history of the
case.

2. That since by producing irritation, etc. they most commonly
cause death, sooner or later, it is incumbent on us to attempt their
extraction with the least possible delay.

3. That small round bodies move freely from the bronchus to the
trachea, and the best way of promoting their expulsion, is by an
opening in the trachea.

4. That sharp, angular substances generally become fixed, but
may be extracted by forceps or other suitable instruments, passed
through an opening in the trachea.

5. The sooner the operation is performed, the greater the chance
of success.

This most interesting paper is followed by the description of a case
of pulmonary abscess, caused by a chicken bone in one of the bron¬
chi, by Dr. Gilroy ; this case exemplified Dr. B’s paper, and in fact,
caused the researches of the learned doctor to be directed to that par¬
ticular branch of surgery, in exploring which Mr. Key has led the
way.

On examination after death, the bone was found in the right bron¬
chus, close to the bifurcation.

In the present number, there are several cases illustrating the use
of acupuncturation : one of that painful affection termed tic doulou¬
reux, or by our continental neighbours, neuralgia faciei ; if this remedy,
which Dr. Banks, the narrator, says causes little pain, should prove,
successful in other hands in that most distressing complaint, it will
prove an invaluable addition to our means of treating that disease. —
Edinb. Med . and Surg. Journ. April.

vol. vi. no. 35. 3 i

426

Bibliography .

MATERIA MEDICA.

5. Observations and reflections on the employment of strychnine in
the treatment of paralysis- By E. Geddings, M. D. Charleston,
S. Carolina, &c. — The able author has paid a just compliment to the
talents of that distinguished physician Fouquier, for the use of
strychnine in paralysis, “a disease, which, under all circumstances is
exceedingly difficult to manage, and too often baffled the best
directed efforts.” The first case that the author used it in was one
of hemiplegia of the whole of the left side. The patient was a male,
aged 50. He was placed under Dr. G’s care in July 1829, and it
appeared that he had been suddenly attacked, a month previously,
while cutting wood, with violent pain in the head, the left arm and
leg were insensible, to which succeeded loss of sensation and motion
and double vision. The treatment principally consisted of active
cathartics combined with jalap, head shaved and blistered, and sinap¬
isms to the legs, cups to the nape of the neck, and to be covered by a
blister stimulating friction to the paralytic members, and the strych¬
nine was actively and judiciously employed. The first day he gave
vi grains of the medicine in ^i. of alcohol, six drops morning and
evening ; second day, he increased it to ten drops ; fourth, to fifteen
drops ; ninth, to eighteen drops, three times a day ; tenth, to twenty
four drops ; at the expiration of which, his leg was quite cured, but
his arm remained diseased. The author has employed strychnine
successfully in several similar cases, which are narrated; and in chro¬
nic irritation of the alimentary canal, and in' habitual constipation
with success. — Amer. Journ. of the Med. Sciences , Feb.

CHEMISTRY.

6. On the Analysis of Elaterium. By Mr. Morries. — Having made
an infusion of fifty grains of good elaterium, Mr. M. found that
eleven grains had disappeared. From the remaining quantity, ten
grains were removed by alcohol ; this tincture being evaporated to
the consistence of oil, and allowed to cool, numerous masses of small
spicular crystals were observed, these were washed with sulphuric
ether, and dried. The rest of the extract was boiled in aqua potassse,
to free it from the elatine or colouring matter, which Mr. M. con¬
siders as synonymous. After a few minutes, a small quantity of
white crystalline matter fell down, this was likewise washed with
sulphuric ether.

It may be obtained in greater purity, by evaporating the alcoholic
tincture to the consistence of a thin oil, and then while warm, throw¬
ing it into boiling water, when a copious white precipitate ensues,
increases as it cools. This is the elaterine : it is extremely bitter and
styptic, insoluble in water and alkalies, soluble in alcohol, ether, and
in hot olive oil, sparingly in dilute acids ; it is decomposed by the
strong acids ; it is by no means distinctly ascertained to be alkaloid.
By experiments it appears not to exert any purgative effect on
animals, but in doses of a tenth, twelfth, or even of a sixteenth of a

Chemistry. 42 7

grain (when acidulated) has Been found to exert a powerful effect on
the human system,

Mr. M’s formula is as follows :

Elaterinse gr j., alcohol ^i. acid nitrici gtt. iv.

Solve : sumat a 5 ss. ad gtt xl. in aquse
cinnamomi ^ss.

From Edinburgh Med. and Surg. Journ. April.

MIDWIFERY.

7. Observations on Tetanus Infantum, or Lock-jaw of Infants.
By John Hancock, M. D. — This disease happens to infants under
nine days, seldom later. It appears to be very fatal in the West
Indies.

Dr. Hancock attributes this disease to an “ irritative impression
made on the nervous system by the compression of the umbilical
chord, caused by the ligature which is applied to it at birth, a
custom |which, to say nothing of its destructive tendency, is entirely
unnecessary and uncalled for. It is one of those useless customs which
has arisen from the doing of old women, or officious accoucheurs, who
fancy that nothing can be well done unless they put their hands to
it ; and most practitioners treading in their steps follow their ex¬
ample to the destruction of thousands.” From this specimen, it is
evident Dr. H. is neither an obstetrician nor a jurist. An irritative
impression on the nervous system by tying the umbilical chord ; surely
the learned Doctor must have made a mistake, and in those cases he
alluded to, the spermatic chord must have been cut down on, and tied.

Joking apart, how is it possible for the nervous system to be
irritated by the tying of a chord, in which it is universally acknow¬
ledged no nerves exist? In fact, if nerves did exist, so far from being
confined to the warmer climates, the disease must pervade the whole
world, wherever the tying of the chord is practised ; and, we think,
that Dr. Hancock will not assert that such is the case. Besides, the
tying of the chord never produces pain in either the mother or the
infant.

We would like also to ask Dr. Hancock on what he grounds his
assertion, that the ligature is unnecessary : not surely on the certain
consequence, namely, fatal hsemorrhage.

In all probability the disease arises from that which Dr. H. con¬
siders merely as one of the efficient causes, namely, the purging plan
so commonly pursued, especially as in those warm climates, the
constitutions are so much debilitated. In fact, infants when not too
much fed, require little or no medicine, and the irritation produced
by the free employment of calomel and castor oil may readily cause
this disease ; in which opinion, we are confirmed by the remedy em¬
ployed to cure, namely, laudanum, which Dr. H., going on the rule
that “ prevention is better than cure,” recommends should be given
from the second day, gradually increasing its dose until the day of

428

Bibliography *

danger is past. Dr. H. proposes, instead of a ligature, the application
of the actual cautery. This, we presume, would cause as much ir¬
ritation ; and besides burn down half the houses, in London, accord¬
ing to the present practice of dividing the chord ; and, of course,
searing it (unless we wished the child to die of haemorrhage) under the
bed-clothes. In concluding, we advise the Doctor to “ tak tent.” —
Edinb. Med. and Surg. Journ. April. ' 10. :v?jrx:

8. Ergot in Menorrhagia. — Dr. John Bellinger, of Charleston
S. C. informs us that he has tried the ergot in one case of menorr¬
hagia, as recommended by Marshall Hall, and that the haemorrhage
was increased, and the sufferings of the patient greatly aggravated
by the treatment. — Amer. Jour, of Med. Sci. Nov. 1830.

9. Case of Caesarean Section. By Dr. Mc.Kibbin. — Anne M.
aet. 26, apparently well formed, seized with labour pains for the first
time, on the evening of Sunday the 27th September 1829; On
examination on Monday, the left side of the pelvis was found to be
occupied by a large exostosis, filling up the hollow of the sacrum,
and extending forwards to within a quarter of an Inch of the left ramus
of the pubis, on the right side, the diameter at the widest part was from
It? to If of an inch, and the long diameter from pubis to right sacro
iliac synchondrosis, was calculated at from 2>\ to 4 inches. The
patient entered the Belfast Lving-in-Hospital, on the Tuesday even¬
ing, when on consultation, the Caesarean section was decided on, as it
was evident, that embryulcia would prove as dangerous to the mother
as the Caesarean section, while by this last operation there was a
chance of saving the child, of whose death doubts were entertained :
accordingly the operation was performed by Dr. M’Kibbin at a quar¬
ter to eleven p. m. the same night. The child was dead; in spite of
the greatest attention and skill, this unfortunate woman gradually
sunk, and died the next day, seventeen hours after the operation. —
Edin, %Med. and Sur. Journ. April.

Thus adding another to the list of unsuccessful cases of this ope¬
ration by British practitioners ; its unsuccessful termination is evi¬
dently owing to delay, when the patient has been so far exhausted
by the continuance of labour, as to be incapable of withstanding such
a severe operation : in the present instance, however, the delay was
attributable to the friends, and not to the medical men.

MISCELLANIES.

- ' , ' , ')!■. 1 , ' . .jt ■ ■ A. *. k i - A.

PROFESSOR PATTISON.

10. To the Editor of the London Medical Gazette. — Sir, I have
read from time to time with no little surprise, and not without incre¬
dulity, the accounts you have given of disturbances in the Anatomi¬
cal Theatre of the London University. I suppose, however, it is
best to be surprised at nothing. It will only be fair if I admit, at
once, that I am in some degree interested in the reputation of the
professor of anatomy, from having been his pupil in Glasgow fifteen

Miscellanies.

429

or sixteen years ago. As I have always considered him to be an
accomplished anatomist, I am necessarily slow in my belief of his
recently discovered incompetency.

It was in 1812, if I am not mistaken, that Mr. Pattison, on the
death of Allan Burns, whose demonstrator he had been and intimate
friend, succeeded to the vacant chair in College Street. I am able
to speak with confidence respecting the estimation in which he was
held during three successive courses of lectures, of six months each,
which he delivered in the winters of 1814, 15, and 16. His class¬
room accommodated, but with some difficulty, 128 pupils. I well
remember that there never was one seat unoccupied in a single lec¬
ture. My impression is, that he was regarded by the students gene¬
rally as being by far the best teacher of anatomy in Glasgow : at a
period, too, when, besides the University professor, Dr. Jeffrey, he
had the late Dr. George Monteith as a competitor. He was parti¬
cularly noted for minute and accurate acquaintance with anatomy,
and especially for his surgical anatomy. His demonstrations on the
neck and face are not likely to be forgotten by those who had then
the privilege of witnessing them.

Mr. Pattison’s manner as a lecturer was inferior to that of his
opponents. Monteith was a handsome man, with a graceful deli¬
very ; while the other, professor Jeffrey, is (or was) one of the best
looking men I have seen, and remarkable in his physiological dis¬
courses — a branch to which he devoted too much of his course — for
dignified and most attractive eloquence. Pattison spoke with a lisp,
and his delivery was peculiar and somewhat monotonous, but, I speak
in the past tense, for I have not seen him for more than fourteen
years — his language was sufficiently fluent, distinct, and impressive :
and those who were attentive to the matter which he so zealously
uttered, as all the students I believe were, had no fault to find with
the manner. 1 i . .. 7j ' in ..

Mr. Pattison is still a young man, in the full vigour of his days.
Of course I cannot pretend to say that he may not be changed from
what he was when he so honourably filled the chair of Allan Bums.
Years, it has been said, teach wisdom. It is strange if he have
indeed gone backward in attainments, when the young gentlemen,
his auditors, few of whom, perhaps, are half his age, are so forward
in knowledge. This is a mystery too profound for me to solve.
Perhaps, but I speak with the greatest diffidence, there is one way of
accounting for his recent incompetency as a lecturer. Sixteen years
ago students were less precocious and enlightened than they are now.
They were modest, diligent, and many of them ardent, in the pursuit
of professional knowledge. They formed themselves into clubs, it is
true, but it was for literary and scientific purposes. They were then
too simple to think of forming “ Committees,” in order to control
and manage the affairs off their teachers. It certainly, at that period
did not occur to them that they knew as much as their instructors.
On the contrary, there were very many who lamented their

430

Miscellanies.

ignorance, and who trimmed the midnight lamp that they might
satiate their thirst for that honourable knowledge, which, in the case
of several, with whom I am proud to claim acquaintance, has con¬
ducted them to eminence in their profession, and no less to deserved
estimation as members of society. This simplicity of theirs — this
dawn of intellect, in comparison of the noon-day intelligence of our
present illuminated order of students — is doubtless the reason why,
in 1815, those who had sat at the feet of Allan Burns could, when
he was removed, still listen with deep interest to the accurate anato¬
mical instructions of his friend and successor.

Believe me, Sir, to be, with humility.

Yours,

Manchester, March 31, 1831. S.

12. King’s College. — The following professors have been appointed.
Head Master, Rev. J. K. Major, A.M. Professor of Chemistry,
J. F. Daniel, F.R. S. Of Mathematics, Rev. T. G. Hall, A.M.
Natural and Experimental Philosophy, Rev. H. Mosely, A. M. Na¬
tural History, James Rennie, A. M. Political Economy, N. W,
Senior, Esq. Jurisprudence, J. J. Park, Esq. Principles and Prac¬
tice of Commerce. Joseph Lowe, Esq. Anatomy, Herbert Mayo,
Esq. F. R. S. Surgery, J. H. Green, F.R. S. Theory of Physic.
B. Hawkins, M.D. Practice of Physic, F. Hawkins, M- D. Mid¬
wifery, R. Fergusson, M. D. Botany, G. T. Turner, Esq.

13. Longevity. — Russia is the country for wronderful longevity. In
the year 1827, there died in Russia 947 persons above a hundred
years old, 202 above 110, 98 above 115, 52 above 120, 21 above
125, and 1 above 135 !

14. Prize JMedal . — The Hunterian Society offer their medal often
guineas value for the best “ essay on unnatural growths and depo-
sites of bone.” Dissertations must be sent to the Secretaries on or
before the 14th of Dec. They must not be in the handwriting of the
author, and his name must be contained in a sealed packet. Candi¬
dates need not be members of the society. Unsuccessful papers will
be returned if required.

15. Statistical Medicine. — The Rev. Charles Oxendon, Bishop-
bourn near Canterbury, has evinced great zeal, taken great trouble
and incurred considerable expense in arranging a statistical report of
the principal provincial hospitals in England computed to the latest
annual returns of the respective Institutions. He has generously cir¬
culated the result of his labours among the medical officers of the
establishments to which they refer : and afforded much valuable infor¬
mation free of expense. He solicits repqrts from all quarters, and
hopes the love of humanity and science will stimulate the medical

Miscellanies.

431

attendants on hospitals to transmit him regular reports, which he will
arrange and publish annually ; great praise is due to this benevolent
gentleman for his good intentions, but we fear his wishes will not be
gratified. He must not feel disappointed, for we must inform him that
our hospital physicians and surgeons, are too indolent and lazy to
give annual reports even of disease, much less of the various pecu¬
niary matters relative to the management of the institutions with
which they are connected.

NECROLOGY.

16. Death of Mr. Abernethy. — It is with unfeigned feelings of
regret that we record the death of the justly celebrated and renowned
surgeon, J. Abernethy esq.; of whose talents and important contribu¬
tions to science, as well as of his great popularity, it is obviously
superfluous to speak. We trust that some of his eminent disciples
will place his character in a just light before the profession and pub¬
lic. He expired at Enfield on the 18th ult.

17. Library of the Royal College of Surgeons. — This splendid
library is now open to the members from 10 a. m. to 5 p. m. except
on Saturdays, when it closes at 1 p. m. Catalogues may be had by
members or articled pupils at the cost price; The council have
acted wisely in affording every facility to the best collection of medi¬
cal literature in this empire ; they also have it in contemplation to
establish conversations two or three times a week.

18. Resignation of the Warden of the London University. — It has
been rumoured, that Mr. Homer resigned in consequence of reduc¬
tion of his salary. This is incorrect. He has voluntarily relin¬
quished £200 a year of his salary, and resigned, as he was deprived
of that influence and authority which were deemed necessary to a
due and efficient exercise of the duties of Warden, and the main¬
tenance of proper discipline.

19. National Vaccine Establishment. — Copy of the last report from
the National Vaccine Establishment to the secretary of state for the
home department.

To the Lord Viscount Melbourne, secretary of state for the home
department, &c. &c. &c. — My Lord, it has required all our industry
and zeal to supply the numerous demands which have been made
upon us for vaccine matter from all quarters of the Empire since our
last report.

We have furnished the means of protection to the army and navy,
to every county in England and Scotland, to Ireland, to the colonies,
and moreover to several of the capitals of Europe; and nearly 12,000
of the poor of the metropolis and its immediate neighbourhood have
been vaccinated in the course of the last year.

Whilst this affords an undeniable proof of the great diffusion of
vaccination, and is a strong argument for the value of this institution.

432

Miscellanies.

it diminishes our satisfaction to be obliged to confess, that, if Parlia¬
ment should determine that enough had now been done to establish
the superior merit of vaccination above every other security against
the danger of small pox, and that it should be left henceforward to
the discretion and good sense of the nation to continue the practice
from the resources of individuals, such a determination would find the
country unprepared and unprovided with the means of defence, and
that a great mortality from small pox would be an early consequence
of the breaking up of this establishment.

It is our constant care to admonish those to whom we send
Lymph, of the propriety of taking advantage of the opportunity of
providing a further supply for themselves. But it would seem, from
the incessant applications which continue to be made to us, either
that our warnings are not sufficiently attended to, or what we believe
to be the fact, from the replies constantly made to us, it is imprac¬
ticable to keep up a continued supply any where but in the capital,
where numerous appointed vaccinators assist and support each other.

The result of another year’s experience is a confirmation of the
value of vaccination. We have evidence before us of persons being
exposed to the severest trials of its power of protection in the midst
of the contagion of the small pox, with impunity ; and though some
constitutions do admit a secondary disease, yet this is almost always
a safe one, though severe in some instances in first attack, and it is
not so common as the chicken pox used to be after small pox given
by inoculation.

We have the honour to be, my Lord, your Lordship’s obedient
servants,

(Signed) HENRY HALFORD,

President of the Royal Coll, of Physicians.

Robert Bree, M. D. Censor.

George L. Tuthill, M. D. Censor .

ROBT. KEATE,

President of the Royal Coll, of Surgeons.
JOHN P. VINCENT,

Vice President of the Royal Coll, of Surgeons.

Clemt. Hue , M. D. Registrar.

National Vaccine Establishment,

14th March, 1831.

20. The March of Intellect. — A respectable correspondent assures
us, that at the comer of Percival- street, Wellington-street, Islington,
is the following pithy inscription; “John Sutton, dealer in tea,
coffee, pepper, &c. and is also a midwife and on a brass plate in
large letters, “ Mr. Sutton man midwife and accoucheur.” This
worthy amateur sells fruit in the streets, and has actually received a
certificate from a respectable midwifery lecturer in this city, who
admitted him to his lectures on the usual terms. Well may we
exclaim; O Lucina, fave ! novus ingreditur tua templa sacerdos.

Miscellanies.

433

22. Defence of the professional skill of Mr. St. John Long, con*
victed felon and illiterate quack . — By Francis H. Ramadge, M. D.
Oxon. Fellow of the Royal College of Physicians, Lecturer on Medi¬
cine, &c. &c.

It affords us much satisfaction that a Fellow of the College of
Physicians, should become the defender of one of the most illiterate
and incorrigible empirics that ever figured in this country of quacks*
and that no licentiate, none of the minus docti, the alieni homines ,
could be found to disgrace the dignity of our profession such a dis¬
reputable line of conduct. No, it is a fellow who, par excellence , is of
a superior caste, one of the elect, one of the by -legal heads of the
faculty, who has achieved this great event. Shades of Linacre, of
Sydenham, of Mead, of Baillie, what say you of this ? Here is a
convincing proof of the utter absurdity, the consummate folly, and
gross injustice of placing fellows above licentiates, above men, who
are with few exceptions their superiors, in talent, in science, and in
public estimation. If proof were required of the truth of this state¬
ment, it is only necessary to refer to the list of fellows and licentiates,
where we find there is scarcely a fellow, Paris and Elliotson
excepted, whose name is known in the annals of medical science,
while the fame of the medical literature of this empire is almost
entirely maintained by the licentiates — by the aforesaid minus docti
and alieni homines, who are not allowed to enter their own college
without special invitation from the illustrious and renowned fellows.
But the licentiates have to blame themselves for the arrogance,
haughtiness and insolent disdain with which they are treated; for
had they shewn proper resentment, and petitioned the legislature
against the assumed and illegal usurpations of their rivals, they might
have obtained redress ; and never was there a more auspicious period
than the present, when a wise, and magnanimous, and really popular
Monarch, with a real representative Parliament* governs a grateful
people, and is sensitively alive to the wishes and wants of his
subjects. The age of humbug has passed — never to return, the
welfare of the people is the sovereign law, and why should the con¬
servators of public health be degraded ? Let the licentiates and all
regularly qualified graduates unite, and an opportunity will be
speedily afforded them ; and petition the new parliament against
the imbecility of the College of Physicians, and the unlimited ravages
of quackery, and medical reform must keep pace with the universal
progress of reform in this country. We have been imperceptibly led
into this digression by the perusal of the extraordinary production
before us, which roused our indignant feelings against the corrupt
and illegal code of by-laws, which destroys all friendly feelings and
close connexion between the members of the college ; and according
to a late legal writer, the division into fellows and licentiates is con¬
trary to the charters and statutes relating to this institution, and
the College has full power to suppress quackery. See Willcock on
the Laws relating to the Medical Profession, London, 1830.

Vol. vi. no. 35, 3 k

434

Miscellanies .

We cannot express our surprize at the defence of Long, by any
respectable or scientific physician or surgeon, of a man who has been
proved, beyond all possibility of doubt, to be utterly ignorant of a
single ray of medical science, to be a rash and desperate person,
whose very opinions are contrary to those of the principles and prac¬
tice of medicine ; a man who publishes to the world — he cannot only
cure, but prevent the most incurable diseases. See his humbug Dis¬
coveries in the Art and Science of Healing, passim. And this is the
man defended by a fellow of the college, and in a common news¬
paper! “ 1 know you, says Dr. R. to be far from the ignorant and
illiterate person whom your illiberal and invidious traducers wished
the public to believe — * * * — and to my knowledge having in an
anatomical school where I lectured four years ago (without any per¬
sonal acquaintance with you at the period) purchased dead bodies,
at a considerable expense, for the purpose, as I believe, of dissection,
and study of visceral anatomy in particular/’ Now, it is passing
strange that this evidence, which could of course be corroborated by
the anatomical teacher, was not produced on either of the trials for
manslaughter ; and now comes before the public for the first time.
Again, if " this guiltless and cruelly persecuted individual,” possess
the slightest knowledge of anatomy, how, we beg to ask, could he
have published a tissue of the grossest nonsense, when he declares
he can cure and prevent the most fatal diseases ? He knows as much
about the structure and diseases of the human body, as he does of the
logic of the man in the moon. We are totally unable to account for
the preposterous conduct of Dr. Ramadge, in his publishing his
advocacy in favour of such a person, more especially as he stands
alone, the opponent of the whole profession. Doubtless he is right,
and the faculty are in error.

The origin of his defence arose from a letter addressed to our
author by the scientific and infallible Mr. Long, requesting his opi¬
nion on the practice of that enlightened personage in the cases of the
unfortunate Miss Cashin, and the infatuated Mrs. Lloyd. This epis¬
tle bears date March 26th, and the Dr. replies through the medium
of a newspaper, called the Sunday Times, March 31st, where he not
only defends his correspondent, but exposes the mistakes, of ancients
and moderns, more especially of Mr. Brodie, whom he grossly mis¬
represents, but also of Sir Astley Cooper, Sir Henry Halford, the
fellows of the college, and divers other hospital physicians and sur¬
geons, in a manner the most unprofessional and unjustifiable on such
an occasion. He has the modesty and good sense to compare the
practice of these with Mr. Long’s, and argues that one is just as good
as the other. Was there ever such unprofessional conduct as this
displayed by a respectable member of any of the medical corpora¬
tions in these kingdoms ? Is such conduct to be tolerated by the
profession, or sanctioned by the college ? Should the college tolerate
such a gross insult to the dignity and honour of the profession, it
richly deserves the contempt of every respectable physician, not
only in the empire, but in the woild.

Miscellanies.

435

In justification of these remarks, we request the reader’s atten¬
tion to the following defence of the opinions and practice of Long
in the case of Miss Cashin. But first, we must premise that Drs.
Johnson, Thomson, Mr. Brodie, Mr. King, Mr. Hogg and others,
swore at- the inquest and trial, that there was no disease of the
lungs ; that there was intense inflammation, mortification and slough¬
ing on the back, which caused death. Our author, who was not
present at the autopsy, and who perhaps forgets that the body was
that of a person destroyed in rude health, thus proceeds : —

“ The post mortem examination of Miss Cashin satisfactorily
proves to me the correctness of your judgment, as to the existence
of pulmonary disease, and which, in my opinion, fully justified you
in the steps you took, in the hope of suspending or removing an
affection of such a fatal tendency ; and, whilst she was without
fever or marked local uneasiness, to employ counter-irritation, as
well as inhalation. I cannot possibly conceive how the same reme¬
dial agents, after having been used by numerous individuals, with¬
out their sustaining the least injury, can in any degree be assigned
as a cause of what afterwards took place. Most ample experience
in medicine has shewn me, how easily effects may be attributed to
inadequate causes. For among all the months in the year, August is
noted for those affections of the stomach and alimentary canal,
which often appear spontaneously, and in females particularly,
inasmuch as we find the former organ in them to be a great sym¬
pathiser. And I do in truth assert, that in some cases, owing to
the continued irritability of the stomach, the vital powers have
failed, and unexpected death has followed; leaving, upon the most
minute dissection, nothing satisfactory for the fatal change.

“ Since such may take place, can we not easily imagine that a
case of this kind might unfortunately occur in your’s, or any other
person’s hands ? But when we find, on perusing the evidence
against you, the great quantity of plums and purple grapes, eaten
by the lady alluded to, and presuming that she had a great and
natural solicitude for her sister’s sufferings, our surprise lessens
whilst there existed such causes for local and general irritation —
namely, that a high state of fever should supervene, and that what,
without it, would have remained a trifling insignificant sore upon
her back (it being merely an abrasion of the cuticle or scarf-skin),
should give origin to so much pain, and subsequently assume those
appearances, respecting which such a strange diversity of opinion
was exhibited by the professional witnesses against you, and which I
fear will contribute more than any thing in modern times, to shew
the unstable grounds upon which, unfortunately, the art or science
of medicine is founded.

“ Whilst the stomachic irritability kindled up constitutional fever,
a sore of the most harmless nature might become highly inflamed,
and even be the cause through sympathy for those violent retchings
that took place afterwards, and might impair the vitality of that

436

Miscellanies .

prgan, through a diminution of which deaths occasionally occur,
examples of which are at times seen in cases of spasm occurring
through gout seizing the stomach, a violent blow upon that
organ, &c.

“ To me, who have had for more than eleven years past, un¬
equalled opportunities of treating, and where death has taken place
of investigating, numerous affections of the chest, I do not exag¬
gerate when I say that I have opened more than a thousand bodies
of consumptive persons alone. It has always appeared to me, and
the same opinion has been entertained by the principal modern
continental pathologists, that the imperfectly formed cicatrices, one
of which was found in the summit of each lung in Miss Cashin
(though contrary to the statements made by some medical men who
examined the body of the deceased), had been formed from tuber¬
culous matter (the presence of which constitutes consumption),
which having undergone a softened state, and in this way being
expectorated, allowed the cysts which remained to heal up like any
ordinary abscess. I have numerous specimens in my museum, shew¬
ing the progressive changes which tubercles undergo, until their
place becomes supplied with condensed cellular membrane.

“ With an observation or two more, I shall conclude my remarks
upon the morbid appearances which were found at the expiration
of six days from the time of Miss Cashin’ s death, by which means
her disease was attempted to be satisfactorily ascertained.

The appearances in the chest, abdomen, and about the spine,
might easily be met with in any individual, who had died of very
little or no apparent injury whatsoever. The deep-seated muscles of
the back, as every person who has had the treatment of fever, par¬
ticularly in neglected cases, can bear testimony, are susceptible of
undergoing more extensive disease, by gangrene and actual mortifi¬
cation, than the medical witnesses against you wished the public to
believe, and yet in this case these might not have been the proxi¬
mate cause of this young lady’s death, nor have been followed by
fatal injuries of the spinal marrow, or its investing membranes.
Hence it follows that even if the symptoms of the patient had been
of a more aggravated nature than they are described to have been,
still, ip my opinion, she might have lived. The natural gravitation
of the fluids to the back, combined with a trivial previous irritation,
would produce most of those which were regarded as signs of most
extensive mischief. In common fairness, a much greater stress ought
to have been laid upon the rapid decomposition which was every
where going on. In fact, had I had as an impartial person a share
in the post mortem examination, it would have been my bounden
duty to have warned the friends of the deceased, to have placed,
under existing circumstances, but a very moderate reliance on the
expected results of such an investigation. Under any diminution
of health for some time, no matter from what cause produced, I
have every reason to believe that new crops of tubercles would have

Miscellanies.

43 7

appeared* and most probably, sooner or later have terminated her
existence.”

It appears by this extract that the above named practitioners,
every one of whom is much better known to the medical public
than their critic (for all have contributed more or less to science),
do not know sloughing or gangrene from abrasion of the cuticle.
Again, this is the first time that plums and purple grapes have been
discovered, which is rather singular, when' Mr. Long is so well
acquainted with the causes of disease. We refer to our report
of the trial for the most incontrovertible evidence of the fact, that
the practice of Long, in treating the eschar on the back, was the
most injudicious, dangerous and fatal. The gravitation of the blood
to the back, might cause cadaverous lividity, but not ecchymosis,
or abrasion of the cuticle, which could only be induced by putre¬
faction, which had not taken place. We challenge our author to
adduce the authority of one medico-legal writer in opposition to this
opinion. If there was merely abrasion of the cuticle, why take so
much trouble to explain the signs of the most extensive mischief ?

We must pass over the unequalled opportunities of opening dead
bodies, by merely observing, that it is certainly marvellous such
should have occurred in a city where the aid of Mr. Long was to
be procured, which could infallibly prevent such a tremendous mor¬
tality. Our author disposes of Mrs. Lloyd’s case, by making it ill-
managed erysipelas : here again he contradicts Mr. Brodie and Mr.
Vance. The following piece of ethics deserves attentive perusal -

“ A few years ago some of my pupils informed me, that high
operations for the stone were performed at St. George’s Hos¬
pital, by Mr. Brodie ; the events were most unfortunate ; and, I
believe, commented upon pretty freely, by more than one anato¬
mical lecturer in this metropolis, and the failures were ascribed to
the want of necessary precautions in guarding the cellular membrane
at the summit of the bladder from destructive urinous infiltration, by
making a counter opening inferiorly, as advised by that successful
operator, for the same disease, Mr. Carpue. The precocious deduc¬
tions of Mr. Brodie on points of experimental physiology, are, many
of them, as I have myself ascertained, quite fallacious; and the
few recently published facts, by a Physician and Surgeon of Guy’s
Hospital, shew clearly, at all events, how much mistaken he has
been on the action and effects of morbid poisons in the animal
ceconomy.”

Mr. Brodie never performed the high operation for lithotomy, and
never recommended it. — Letter in the Sunday Times, 24 th ult.

Passing over a case which was supposed to be similar to that of
the late king, and mistaken by two royal physicians and a Univer¬
sity professor, and its real nature discovered by our author, we are
next favoured with the following fraternal and benevolent exposure
of medical abuses : —

438

Miscellanies .

“ Judging from a conversation I had with you, for the first time
after the inquest upon Miss Cashin, you induced me to think chat as
professional merit, under the present corrupt system of patronage,
witnessed in the various responsible appointments to our universi¬
ties, colleges, court, hospitals, infirmaries, &c. was overlooked, you
had no chance of fair competition ; and as nearly one-half the medi¬
cal profession are unlicensed, and practise under the names of sur¬
geons, accoucheurs, chemists, &c. you saw no reason why you
should not act as a medical practitioner, having early had a taste for
medicine, and also, to my knowledge, having, in an anatomical
school, where I lectured some four years ago (without any personal
acquaintance with you at that period), purchased dead bodies, at a
considerable expense, for the purpose as I believe of dissection, and
of studying visceral anatomy in particular. You seemed perfectly
aware of the low condition of medical practice in this country ; for
a man ninety years of age, or in a state of dotage, might, in Lon¬
don, be a surgeon to a public hospital. You seemed perfectly to
understand that a titled surgeon publicly stated, that wherever he
turned his eyes in two adjoining hospitals, he saw nothing but the
abusive exhibition of mercury, even in cases where it is nowr univer¬
sally admitted by medical men to be perfectly useless. To the best
of my recollection, I replied, that about two years ago, I formed
one of a dinner party with two physicians (besides myself), and
more than double that number of surgeons, and that one of them
(himself a surgeon to an hospital), stated, I believe with a view to
exonerate himself, that his relative (the accuser), rarely visited his
own wards for a particular class of diseases, and that the nurses
thereby being uncontrolled, regularly salivated each patient in order
to entitle themselves to an additional gratuity of sixpence.

“ You complained to me much of the persecution you had endured
from the medical profession, and you seemed to think, as I do myself,
that had you not been very fortunate in gaining the confidence of the
public, you never would have been the victim of their envy and
malignity, however great your want of success might have been ;
and you said, that if they did not prefer their own private advantage
to the public, they would have long since turned their attention to
the defective state of our hospitals, and other eleemosynary institu¬
tions, where frequently men without any apparent ability, provided
they are near relatives or intimate friends of some influential medical
officer, obtain appointments (some of them having been bargained for
previously by bonds in heavy penalties) ; and also if the public health
lay so heavy at their hearts, they would have recommended that
more than one day in the week should be appointed by themselves
for seeing their unfortunate out-patients , and also more than one day
in the same space of time for the, admission of in-patients, accidents
excepted. The value of medical opinion you spoke very lightly of,
for you mentioned Dr. Brown of Edinburgh, who never practised
himself, yet he wrote a work in favour of injurious stimulant agents,
and that almost the whole profession eagerly embraced, for many

Miscellanies.

439

years, his doctrines, which generally led to the death of thousand*
and even tens of thousands.

“ To shew the value of the concurrent testimony of medical men,
you stated that a few years ago some medicines, and particularly the
antimonial powder, and its prototype, that of the late Dr. James,
were universally believed to be sovereign remedies in the cure of
febrile and various other affections, and that there are numerous
cases published of the efficacy of these medicines, which almost
every practitioner of an unbiassed judgment now-a-days confidently
believes to have never been otherwise than inert agents. To shew
still further the value of medical opinion, you stated, that had you
been old enough to have commenced practice twenty years ago, with¬
out completely salivating in particular disorders, after the fashion of
the times, you most likely would have been persecuted as now,
although your patients would have escaped many painful secondary
affections, or perhaps the complete ruin of their health.

“You know that the late Dr. Armstrong was rejected by the College
of Physicians in London as an incompetent practitioner, yet he was
supported by the public, and hardly half a dozen years elapsed,
before he realized a larger annual income than the resident, or any
of the fellows who had rejected him, or in fact any physician
attached to our metropolitan hospitals or dispensaries; to add to
which, he was enabled to boast of having the largest class of medical
students in the metropolis.

“ If you are accused by the profession of ignorance, you may with¬
out difficulty comprehend what degree of anatomical information is
necessary to be a distinguished physician attached to one of our hos¬
pitals, and the adulatory protege of an old influential medical man,
when I state that three medical friends of mine examined not long
ago the body of a person supposed to have been destroyed by poison,
who after removing the stomach and sewing up the body, it was
re-examined, at the wish of some of the deceased’s friends, by the
physician I allude to, who pronounced that death was not occasioned
through poison, but that the stomach was ulcerated sufficient to
cause the decease. However, I must add that this organ was in the
possession of one of the previous examiners, and that the learned
Doctor mistook a portion of large intestine which he opened for that
viscus/’

In these extracts we have the quack consulted upon medical
abuses, and his opinions held in high estimation. Now, is it not
the highest presumption, in such a man as this, to presume to offer
an opinion on the subject ? But he thinks very differently, for he
has just published a half guinea octavo, in which he reviews the
whole theories of physic, in past and present ages, or rather they
are reviewed for him, for he knows nothing about them ; abuses Sir
Astley Cooper, Mr. Brodie, indeed, the whole profession, and winds
up the whole with Dr. Ramadge’s letter. This production, which
has just appeared, is entitled “ A Critical Exposure of the Ignorance
and Malpractice of certain Medical Practitioners,” in which we have

440

Miscellanies.

an account of the “ monopoly of the faculty, their too extensive
and improper employment of poisonous medicines, the size of the
irritation, (! ! !) erroneously and unjustly called a wound.” Mr.
Brodie’s unscientific treatment of Miss Cashin, disgraceful prejudices
of the faculty, fatal operation by Mr. Brodie, abuse of Mr. Law¬
rence, and Mr. Copland Hutchinson, for enormous scarifications in
erysipelas, abuse of the medical attendants of the Duke of York,
with other examples ; and lastly. Dr. Ramadge’s Letter.

It grieves us to see a respectable physician connected with such a
production as this, which must inevitably ruin his character with all
ranks of the profession.

Had Dr. Ramadge boldly exposed medical abuses in a legitimate
manner, he would have acquired much popularity in the profession ;
but his doing sq now, will be of little use to him, as it will be said he
is influenced by personal feelings, more especially should the College
enforce their obsolete moral statutes, and deprive him of his fel¬
lowship. Imbecile and lethargic as this body is, it cannot overlook
this conduct, and should it do so, another proof will be afforded of
the gross partiality and insolent behaviour of the managers of this
Institution.

23. Apothecaries Company v. Ryan — The report of this tyrannical prosecution reached
us too late for notice this month. We are delighted that the partial conduct of these
insolent pharmacopolists were censured by the Judge, and their verdict set aside by the
King’s Bench.

LITERARY INTELLIGENCE.

In the Press. — A Manual of State and Forensic Medicine, com¬
piled from the best medical and legal works ; comprising, — I, The
ethics of the medical profession, ancient and modern, moral statutes
of the British universities and colleges ; — II, The charters and sta¬
tutes relating to physicians, surgeons, apothecaries, obstetricians,
chemists, druggists, and empirics in the British dominions ; — III,
The rights, privileges, and immunities of the faculty ; — IV. The
civil and criminal cases in which medical evidence is required ;
V, All medico-legal questions, with the latest decisions ; being an
Analysis of a Course of Lectures on Medical Jurisprudence, annually
delivered in London, and intended as a compendium for the use of
barristers, solicitors, magistrates, coroners, and medical practitioners.
By Michael Ryan, M. D. Member of the Royal College of Phy¬
sicians in London; Lecturer on Practice of Medicine and Medical
Jurisprudence, at the Medical Theatre, Hatton Garden, near St.
Bartholomew’s Hospital, &c. &c.

Mr. Wallace, Surgeon to the Charitable Infirmary, and to the
Infirmary for Diseases of the Skin, Dublin, will shortly publish the
History and Treatment of V enereal Diseases of the Skin, including
the Primary Symptoms and Eruptions ; illustrated by Delineations
as large as life, and coloured after nature.

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

THE LONDON

MEDICAL AND SURGICAL JOURNAL.

. - • V C*

No. 36. JUNE 1, 1831. Vol. VI.

CRITICAL REVIEW.

I. — Elements of Medical Jurisprudence. By Theodoric
Romeyn Beck, M.D. Professor of the Institutes of Me¬
dicine, and Lecturer on Medical Jurisprudence in the
College of the Western District of the State of New York,
&c. &c. Third Edition, brought down to the present
time. By John Darwall, M.D., London, 1829. 8vo.
pp. 640. Longman and Co.

II. — Manuel Complet de Medecine Legale Consideree

dans ses Rapports avec la Legislation Actuelle , ouvrage
particulierement destine a MM. les Medians , Avocats ,
et Jures. Par C. Sedillot, Docteur en Medicine de la
Faculte de Paris, 1830. 18mo. pp. 511. Crochard, Rue

de Sorbonne, No. 3,

A Complete Manual of Legal Medicine , considered
in its relations with Actual Legislation ; a work par¬
ticularly intended for Physicians , Advocates , and
Juries. By C. Sedillot, M.D. of Paris. Paris, 1830,
18mo. pp. 511. Crochard, Rue de Sorbonne. London,
J. B. Bailliere.

There can be no second opinion on the value of Beck’s
Jurisprudence, it is decidedly the best work in our language.
It stands a splendid monument of learning, industry, and
talent ; and is unequalled in the annals of our literature.
The present edition, however, scarcely differs from its pre¬
decessors, the annotations of its editor are exceedingly few
and of little importance. Dr. Darwall has by no means
brought down the work to the present time, and has taken

• : -• : . >v--i J *» * " • . ’• •

Vol. vi. no, 36. 3 l . v

442

Critical RevieuO.

very little trouble indeed in the execution of his task. We
deem it right to give this information to those who possess
the second edition by Dunlop, which we may say has been
merely reprinted. This work ought to be in the possession
of every man engaged in the practice of the healing art,
for the period has now arrived when a knowledge of forensic
medicine is indispensable to all classes of the profession.

M. Sedillot has condensed all the facts in leg-al medicine
into the smallest compass, and has embodied every recent
opinion, more especially of his countrymen. He has evinced
great tact in selecting from all sources, but in many places he
is much too concise, and not sufficiently explicit. He prefixes
the law to each article, in imitation of M. Briand, in his more
diffuse and excellent Manual of Legal Medicine, 1828, and
has divided his work into the following chapters: — Part I.
Legal dispositions relating to the practice of medical men- —
judiciary and administrative reports — reports of estimation
or on professional etiquette — certificates — medico-legal con¬
sultations. Part II. Of marriage, disqualifications for, nul¬
lity of, divorce — of pregnancy — delivery, viability of infants
—slow births- — abortion— exposure, desertion — substitution
of infants — of infanticide — outrages against decency — ex¬
amination of spermatic stains — of mental affections, som¬
nambulism, inebriation, delirium, epilepsy, idiocy, dementia,
mania, monomania — deafness and dumbness — simulated and
dissimulated diseases. Part III. Of inhumations, medico¬
legal autopsy, putrefaction — of age and identity — asphyxia
— spontaneous combustion — death by inanition — medico¬
legal history of wounds — detection of blood stains — medico¬
legal history of poisoning — classification of poisons — Class 1.
irritant poisons, their action on the animal economy. Class
2, narcotic poisons. Class 3, narcotico-acrid poisons. Class
4, septic and putrifiant poisons — adulteration of alimentary
matter. Part IV. Certificates in all medico-legal cases
— certificates in medical police for exemption from juries
and various other civil offices.

It must surprise the reader that so many subjects can be
discussed with any success in a single 18mo, when pon¬
derous volumes are devoted to the elucidation of even a few
of them. We can state with truth, however, that M. Se¬
dillot has amassed a great deal of information, indeed all
that exists upon every topic introduced, and we should
illustrate this statement by extracts, had not the greater part
of the matter been published in this Journal during the last
and present year. We strongly recommend this Manual to

M. Coster’s Operative Surgery.

443

every, class of our readers, as its conciseness and brevity
will save them much trouble in sudden cases, in which little
time is allowed for reference to the more voluminous works.
We have long- thought that a manual of this kind would be
a valuable addition to the medical library, and under this
impression we have arranged one which will speedily appear.
It was arranged in 1829, and almost on the plan of that
before us, but the introduction of Medical ethics, and of all
the laws relating to the medical profession in this empire
wrill be a new, and it is hoped a valuable addition to legal
medicine. In this country the medical corporations are ex¬
ceedingly slow in adopting improvements in science ; and
this is well exemplified by the inattention they have paid to
the study of medical jurisprudence. This branch of me¬
dicine which, in fact, comprises the whole circle of the
medical sciences, and embraces an immense variety of im¬
portant facts, which are never taught by lecturers on me¬
dicine, surgery or obstetricy, and so indispensably necessary
to modern medical practitioners, is not as yet required by
the Royal College of Surgeons in London, though required
by the Colleges of Edinburgh and Dublin, and only a three
month’s course is enforced by the Apothecaries’ Company.
Why really one would think that these bodies are ignorant
of the nature and extent of the subject, which every one
knows, would require at least two six months’ courses to
comprehend it ; and had not that noble institution, the Uni¬
versity of London, appointed a professor of medical juris¬
prudence, we have every reason to believe it would not have
been required at all.

III. — Manual of Operative Surgery ; translated from the
Third Edition of the French of J . Coster, M.D. By
George Fife, M.D. Surgeon to the Northern Public Dis¬
pensary, Edinburgh, &c. &c. Edinburgh, 1831, 12mo.
pp. 408, Maclachan and Stewart, and Baldwin and Crad¬
dock, London.

The translation of M. Coster’s Manual would have been a
great boon to students and young surgeons, as it contains a
concise description of all surgical operations as performed in
Paris, had not the works we shall immediately notice ap¬
peared. This valuable work has gone through three
editions in a few years, and cannot be spoken of but in

444

Critical Review.

terms of the highest respect, still it is superseded by the
productions of Averill and Hargrave. The last is the best
compendium of practical surgery in the English language ;
it contains every fact in either of its predecessors, besides
the relative anatomy of all parts concerned in surgical ope¬
rations. It must have been arranged at the time Dr. Fife
was engaged on the production before us ; and this coinci¬
dence affords strong evidence of the want of works of this
kind. Though Coster’s Manual is concisely and graphically
written, and well deserving of patronage, yet it is deficient in
one very important particular, that the methods of operating
by British and American surgeons are omitted. The other
works under notice, have a decided advantage in containing
such valuable information. Coster’s Manual of Surgery
founds its claims to approbation upon the grounds of brevity,
accuracy, and portability. It contains a great deal of in¬
structive matter in a small space.

IV. — An Essay on the Influence of Temperament in modi¬
fying Dyspepsia or Indigestion. By Thomas Mayo,
M.D. Physician in Ordinary to His Royal Highness the
Duke of Sussex, Fellow of the College of Physicians, &c.
&c. London, 1831, pp. 144. Fellows, Ludgate-street.

The author of this essay very ably proves that no single
plan of treating dyspepsia can indiscriminately succeed. He
censures the gastromania of the moderns, and indirectly
alludes to the puffing of some eminent writers on indigestion.
He proceeds to shew, that temperament has been almost en-
t rely forgotten by many writers on this subject. He first
considers temperament, then the symptoms of indigestion ;
thirdly, the influence of the former upon the latter. In
describing the common symptoms of indigestion. Dr. Mayo
examines the opinions of Paris, Philip, Johnson, 1 Aber-
nethy, and Hamilton, and concludes that many of them are
untenable. This part of the work deserves quotation on
many accounts.

“ There is a remarkable diversity in the methods in which
medical writers have respectively undertaken the history of indiges¬
tion. In the three able writers, whose works justly enjoy the highest
present reputation on this subject, Dr. Paris, Dr. Wilson Philip, and
Dr. Johnson, I find but little reference to temperament or constitu¬
tion, as any ground of pathological distinctions. Dr. Wilson Philip

Dr. Mayo on Indigestion.

445

furnishes a very masterly description of the disease. He has looked
at his subject analytically, and he places his reader in full possession
of his view of it. But this view is, in fact, just such a one as might
be expected to occur to a clear medical eye, after a careful abstrac¬
tion of those differences which a consideration of temperament would
suggest. It will, I trust, appear in another part of this Essay, how
necessary it is that such distinctions should be entertained and ad¬
mitted, with a view to the complete development of Dr. Philip's
subject. It is indeed curious, that he should not have applied such
distinctions to indigestion, considering the avowed object of his
treatise, * to give arrangement to the affections termed nervous
and bilious, and to ascertain the nature of the disease on which they
depend.’

“ Without establishing any such division of the subject. Dr.
Johnson’s admirable work furnishes a much larger stock of materials
for it, than that of Dr. Philip. The principal difference between the
views of these two writers is, that Dr. Philip places before us a
definite complaint, — Dr. Johnson describes a morbid habit. The
first delineates an attack of dyspepsia, and follows this to its termi¬
nation ; the second draws from the life many characteristic features
of a dyspeptic person.

“ Now it will be expedient to consider the ordinary form of the
dyspeptic disease, as given by Philip, and the ordinary features of the
dyspeptic patient, as pourtrayed by Dr. Johnson. This will form a
useful basis for the more immediate subject of this Essay, the inquiry
into those influences, by which temperament modifies the common
phenomena of indigestion.” — p. 38.

The symptoms of indigestion are next minutely detailed,
chiefly from the works of Drs. Philip and Johnson ; and our
author inclines to agree with Dr. P. and argues against Dr.
Johnson’s statement, that there is pain on pressure of the
epigastrium. Here we must remind bur author, that Dr.
Johnson’s work is universally allowed by the profession in all
countries to be one of the best ever written. Indeed, it alone
is now sought for by the profession and the public, which is
a strong proof of the high estimation in which it is held.
On the other hand it is to be recollected, that a very small
portion of the profession assent to the divisions of dyspepsia,
maintained by Dr. Philip. Dr. Johnson holds that purga¬
tion and mercury, without withdrawing the cause of irrita¬
tion from the stomach, will not prevent indigestion ; and here
he happily exposes the opinions of Hamilton and Abernethy,
which are in fact seldom adopted to the extent advised by
these talented individuals. As Dr. Johnson’s formula for
an habitual aperient may not be generally known to our
junior readers, we shall insert it.

446

Critical Review.

fy Ext. colocynth, comp.

- rhei aa gr. xv,

Pil. hydrargyri 3ss,

Pulv. ipecacuanhse gr. ij,

Saponis Venetianse gr. iij,

Olei caryophyllor gts. iij,
m. ft. pil. x. capiat i. ij. vel iij. hora somni vel
statim ante prandium.

After alluding to the influence of the liver on digestion,
our author remarks, that persons biliously predisposed will
have the influence of this organ proportionately augmented.

“ On the other hand, the inconveniences which indigestion pro¬
duces to the phlegmatic and the sanguine, are far milder than those
occurring to the biliously constituted. And the symptoms of the
nervous form of the disorder, though intensely severe, are in their
apparent position often distant from the place really affected, and
thus either lose entirely their character as symptoms of indigestion,
or are traced with difficulty to that source. But in bilious indiges¬
tion, every bodily symptom is either an abdominal sensation, or so
closely linked with, so immediately springing out of, one, that its
connexion with processes of the digestive organs cannot for an
instant be doubted. Few again, who have ever felt the moral and
intellectual symptoms of bilious indigestion, are long in discovering
by their sensations the strict alliance in which these symptoms are
placed with some morbid state of the digestive organs.

“ The extreme importance of these moral symptoms would of
itself justify my present principle of division. For they are con¬
nected with indigestion, not simply as indigestion, but as the in¬
digestion of the bilious temperament ; and are accordingly liable to
receive very inappropriate treatment, if this distinction is not kept in
view ; or in other words, if they are associated with a form of the
disorder, with which in truth they have no alliance.

“ Nor is this indeed a groundless precaution. No mistake is
more common, than that of imputing to bilious melancholia the
tendencies and corresponding treatment of the nervous temperament,
and thus improperly subjecting the patient to nervous medicines,
antispasmodics and stimulants.

“ The question, to what extent moral defects may be subjected to
medical as well as moral discipline, has a most immediate reference
to the above distinctions. Thus, when such defects coexist with an
arrested or vitiated state of the bile in any one, much more in the
biliously predisposed, they claim, on their own account, the fullest
and most careful application of those medical agents, which tend to
restore the free passage, and the healthy state of the secretion ;
otherwise, the intellectual powers want the material condition re¬
quisite to their healthy operation.” — p. 57.

Dr. Mayo on Indigestion .

447

Our author very properly maintains that the treatment, of
what he terms bilious and nervous indigestion, or rather
indigestion in persons of a bilious and nervous tempera¬
ment, should be widely different. Every experienced and
sensible practitioner must agree with this opinion.

“ Bilious indigestion may perhaps be most usefully contrasted with
the nervous. In the latter class of cases, it will be observed, that
stimulants, stomachics, and tonics, are generally useful ; that ape¬
rients are only valuable as they are unavoidable ; or rather that the
good which they confer must generally be measured against some
corresponding evil. It would appear, that in removing nervous in¬
digestion, the stomach itself, in its sympathies and antipathies, must
be primarily consulted. But in the bilious temperament, both the
sympathies of the stomach, and also its antipathies, must occasionally
be disregarded in the treatment of indigestion. Thus, instead of the
direct application of strengthening and soothing medicines, we are
here obliged often to exclude them. While, in managing nervous
indigestion, we avoid irritation, sometimes at the expense of allow¬
ing constipation, by withholding aperients, on the other hand, in
controlling bilious indigestion, we must assume, that the immediate
comfort which may be derived to the stomach from cordials and
stimulants, will be overbalanced by the mischief ultimately accruing
to the whole system, from an over-stimulated liver. Thus dinner
pills have given a dangerous and deceitful comfort to many a bilious
sensualist.

“ Again, in nervous indigestion we shall have occasion to observe,
that the question of local congestion is of very secondary importance.
The fact of its occurrence is rare. The circulation in this tempera¬
ment is over-active, rather than sluggish. But in bilious indigestion,
we have, at every point, to defend our patient against local conges¬
tion. Here, indeed, the diagnostic of Dr. Philip, namely, tenderness
in the epigastric region, is extremely indicative of the practice which
he recommends, when congestion is verging upon inflammatory
action. Whereas, if we should apply leeches to the epigastric region
of the nervous dyspeptic every time that he expresses slight or even
acute tenderness at that point, we shall be inflicting constant
mischief.

“ But of all the measures by which the bilious dyspeptic may
obtain both immediate relief and protection against the severer symp¬
toms of his disorder, the frequent use of mild aperients is the most
important. A very ill-founded prejudice is entertained against the
continuous use of aperients. It is assumed that this practice implies
an unnatural and artificial procedure, calculated as such to end in
mischief. Those who hold this doctrine forget what are the prin¬
ciples on which the action of the bowels is maintained, where no
medicine is used. In such cases, it is the daily food which excites
the peristaltic movements, and elicits the secretions of the intestines,
and thus occasions their requisite action. Now aperients do precisely

448

Critical Review.

the same thing ; and it will be difficult, by any reasoning, to make
good the supposition, that small portions of aloes, of rhubarb, of
ipecacuanha, or of compound extract of colocynth, have generally a
more unwholesome purgative effect, than cabbages, potatoes, and
turnips. Of this point I feel certain, that the state of the intestinal
canal in many nervous persons, who are so far from requiring ape¬
rients, that a tendency to irritation is constantly besetting them, pos¬
sesses a more morbid character than the opposed condition of the
bilious temperament. In the latter case, digestion may be very well
performed, provided the aperients are well selected. In the former, or
nervous case, it must frequently be hurried.” — p. 63.

The admirable work of M. Lorry, De Melancholia et
Morbis Melancholicis,” is quoted in illustration. Melan¬
choly, combined with the formidable class of symptoms,
attendant on bilious dyspepsia. Lorry’s semeiology is cer¬
tainly good, but his humoralism must of course be dis¬
carded. It would be a useless task to insert this author’s
words, as they would have little weight with modern readers.
Dr. Mayo cannot agree with Dr. Johnson, that “ indigestion is
by no means essential to hypochondriasis. He thinks the onus
probandi lies with Dr. Johnson. In describing the treat¬
ment of melancholy, combined with bilious indigestion.
Dr. Mayo gives our modern mercurialists of the intestinal
school, a very important lesson, when he details his ex¬
perience of the indiscriminate use of their favourite panacea.

“ With regard to the treatment of melancholia, viewed as an
advanced stage of bilious indigestion, it must from the outset of that
treatment, be remembered, that the state of the patient has by that
time become a very debilitated one.

“ The bilious temperament is not essentially a feeble one, but he,
in whom the mental disease has supervened upon dyspepsia, has
become asthenic. If his powers of receiving food are not greatly im¬
paired, his powers of obtaining nourishment certainly are. Food,
except when taken in the smallest quantities, generally oppresses him
from the moment at which he has taken it, until some rapid aperient
has freed him from it ; and this state has, in most cases, continued
long before the mind obtains attention as a seat of disease.

,f The risk of depletory measures, as tending to convert this se¬
condary affection into an almost incurable state, the demence of the
French writers, has accordingly become extreme. The lancet has
no place here. The use of mercurials requires perseverance indeed,
but caution and moderation. I have seen them, when pushed to
salivation, change perversion of intellect into hopeless fatuity. This
caution is the more required, in regard to our present subject, because
melancholia or hypochondriasis, when a primary disease, and not
the sequel or advanced stage of dyspepsia, bears on the whole more

Mr. Mayo on Indigestion .

449

active depletion, than that acute and noisy form of insanity which
belongs to the nervous temperament.” — p. 73.

Our author confesses a serious error into which he fell
in a former publication, when he inculcated the necessity
of depletory measures in certain forms of mental derange¬
ment. Experience has long since convinced him of the
danger of this practice.

The following case will be read with interest, though its
comment is to us unintelligible : —

c£ A gentleman of a highly nervous temperament, placed in a
situation of continued mental exertion, and much responsibility, in a
West India island, was subjected, for some bilious symptoms, which
were viewed without any reference to the predominant character of
his constitution, to a severe mercurial treatment. He, at the same
time, suffered from hemorrhoids, occasioning profuse discharges.
His strength broken ; his circulation so disturbed that apoplexy at
one moment, heart affection at another, seemed closely to impend;
his skin constantly arid and giving no relief by perspiration to these
last symptoms, he returned to this country. It is not my present
purpose to detail the subsequent treatment of this case ; I wish to
call my reader’s attention to the fact, that it was found necessary, in
the course of his treatment, to allow a far longer suspension of the
action of the bowels than accorded with the general principles of
practice, or than was comfortable to his own feelings, rather than
expose him to the intense nervous excitement and exhaustion, which
was occasioned by the process of fsecal evacuation, even when con¬
ducted in the mildest way. The relief, indeed, from feelings of ob¬
struction, which purgatives were calculated to give him, his bowels
being always in a confined state, was completely overborne by the
attendant aggravation of all his other symptoms, such as flatulence,
violent palpitation at the heart, with sense of approaching syncope,
and vertiginous feelings in the head. All these sensations ensued
upon the action of aperients so mild and so carefully chosen, as to
imitate strictly the operations of nature, and yet to unload the bowels
completely. Time, a patient endurance on his part of symptoms
of which it was hazardous to attempt the complete relief, and
a persevering abstinence on the part of his physician from such
measures as might relieve present symptoms, and yet increase ex¬
haustion ; and, finally, a very cautious use of bark, ultimately
restored him to health. The decisive and complete evidence of his
recovery wTas, according to his own remark, the power of perspiring
freely.

“ Now I do not adduce this case as an instance of dyspepsia, but
as remarkably illustrating the effect of the nervous temperament in
occasioning the ordinary functions of digestion, those indeed which we
are usually compelled to excite and encourage in obviating morbid

Vol, vi, no. 36, 3 M

450

Critical Review

states of the digestive organs, to become, even in their moderate per¬
formance, a source of mischief through exhaustion.” — p. 78.

We are totally unable to comprehend the last paragraph,
and must leave the reader to draw his own inference. The
treatment of nervous and bilious dyspepsia deserves atten¬
tion.

“ If a nervous person bring on an attack of dyspepsia by
excess, a diarrhoea often supervenes, or a very mild aperient achieves
the same purposes ; the peccant matter is hurried away, and the
disorder is far more easily pacified than in the bilious indigestion.
But though the disorder is itself removable on far easier terms, and
more promptly in the nervous than in the bilious subject, the severity
of the shock, which it has inflicted upon the former constitution, is
far greater. It is true that the bilious constitution may have re¬
quired a severer and more prolonged discipline for the removal of its
dyspeptic symptoms ; but these measures leave the patient not only
cured of his complaint, but in health ; while the relief given by the
spontaneous diarrhoea, or the aperient, to the nervous person, leaves
him shaken enfeebled, and yet excited : so that it has been often
found expedient, as in the case above quoted, to let the immediate
dyspeptic symptoms linger, by delaying the process that would
afford them relief.

“ The relief of dyspepsia by spontaneous diarrhoea is not in¬
frequent in the bilious any more than in the nervous habit ; and in
the first it is a source of immediate comfort. In each a deficiency of
bile in the feeces often constitutes a sequel to this diarrhoea. And
here a difference in the treatment required deserves to be noticed.
In the bilious temperament it may be assumed as a principle, that,
until the feces have resumed their healthy hue, the use of purgative
and mercurial medicines cannot be safely discontinued. But in the
nervous, such a deficiency constitutes no necessary ground for a
repetition of such medicines. The return of an adequate secretion
may often be securely left to the irritability of the patient’s system,
which has more to fear from action than from torpor. Here indeed
a purgative treatment might reproduce diarrhoea.

“ The above remarks illustrate the general influence which an
excitable state of the nervous system may exert over indigestion,
modifying the symptoms of the disorder and influencing its treat¬
ment. Now, pursuing this line of investigation, we may classify the
general symptoms by which the nervous temperament produces this
effect, under six heads, in most of which it is strongly contrasted
with the bilious temperament.

“ First, The irritability of the nervous temperament renders it
liable to diarrhoea, and at the same time renders this symptom a
source of uneasiness and exhaustion. The relief is not wanted, as
no excess of bile is supposed. On the other hand, bilious diarrhoea
is a source both of benefit and of comfort to the bilious in temperate

Dr. Mayo on Indigestion.

451

climates, when the discharge is moderate. Accordingly purgatives
do more good, and disagree less readily in bilious than in nervous
cases.

“ Secondly, Pains in the head in nervous indigestion are acute,
pungent, and limited in the space which they occupy, often attended
by a bursting sensation that seems to proceed from within outwards.
Pains in the head are in the bilious a dull heavy sensation, accom¬
panied with external tightness. A sense of heat is, I believe,
common to both temperaments when the head suffers.

“ Thirdly, Acute neuralgic pains are readily produced at various
points by the dyspepsia of the nervous constitution.

“ Fourthly, The symptom of flatulence, which exists nearly in an
equal degree in the nervous and the bilious, in the former excites
various forms of irregular action, besides the sensation of distended
intestines, which is its direct result. This fact is indeed amply il¬
lustrated by the multitude of cases simulating organic affection of the
heart, which are brought before the physician, and cured by him
upon principles which his acquaintance with the nervous tempera¬
ment has established.

“ There is nothing inconsistent with this view in the fact that the
medicines most applicable to the cure of these symptoms are often
mercurials and aperients. The symptoms are, in fact, often the
evidence of bilious obstruction or of simple constipation occurring in
nervous constitution. The medicines, therefore, must be such as
relieve obstruction, allowance being made for the character of the
temperament in the mildness of the quantities administered.

“ Fifthly, It may be presumed that the various forms of hysteria
must attend upon nervous dyspepsia. On this point, a wide field of
useful information is laid open by the researches of Dr. Whytt, on
the subject of nervous affections.

“ Sixthly, The inappetency, or even aversion, in regard to food
which belongs to nervous dyspepsia in its more aggravated forms, and
into which in all cases it seems liable to lead the patient, if it once gain
ground in his constitution. But I shall reserve the subject of nervous
atrophy until I shall have occasion to compare it with another class
of symptoms equally deserving the generic term of atrophy, which I
shall have to consider under the head of serous or phlegmatic indiges¬
tion. The inappetency of the bilious differs from the above in this
material point, that it strictly accords with the other phenomena of
the case. The bilious person loses his appetite for food, because he
is generally ill, and only so far as he is so. The nervous person
drops into this state out of vigorous health, and without any definite
cause.

“ The above remarks, on the subject of nervous indigestion, apply
to that branch of the temperament to which I have given the name,
physical nervousness. They presume the existence of that bodily
state, which Dr. Johnson terms a morbid sensibility of the stomach
and bowels, as the basis of the disease. The other two forms, under
which the nervous temperament may display itself now deserve some

452

Critical Review.

consideration. I allude to what I have termed, moral nervousness
and intellectual nervousness.” — p. 86.

Dyspepsia in the sanguine temperament is next alluded
to, and our author dwells more upon the nature of consti¬
tution, and the inattention of physicians to it, than upon
any plan of treatment. There is nothing worthy of notice
in this chapter. The next chapter is entitled, “ Indigestion
of the Serous or Phlegmatic Temperament.” He considers
there are two forms of this habit, one characterised by
relaxation, the other by feebleness, having in common a
liability to disorders of congestion and a freedom from
feverishness ; the former is capable of great indurance,
while the asthenic is easily exhaustible.

“ Now these two forms of the serous, or phlegmatic temperament
differ remarkably in the treatment, wThich their incidental disorders
require. Very active purgation, and at the same time very active
stimulation, are generally found to suit the relaxed habit. It can
bear, indeed it can profit by, profuse serous discharges. To the feeble
temperament this, or any other lowering treatment, is absolutely
inappropriate.

“ In bearing with advantage copious purgation under dyspepsia,
the relaxed branch of the serous temperament has much affinity to
the bilious, with, however, one remarkable distinction, namely, that
the immediate union of tonics and aperients is highly suitable in the
relaxed constitution ; whereas the more bilious his temperament, the
less readily can the dyspeptic bear the constrictive effects of tonic
medicines. This distinction is remarkably applicable to the use of
steel. Mercurial medicines, used temperately, both relieve and
excite the relaxed habit : in either effect they are beneficial.

“ All that class of applications, which promote activity of circula¬
tion on the surface of the body, are applicable to this temperament ;
such as friction with liniments, or the flesh-brush, and cold affusion,
or the shower-bath. The feeble or asthenic are sometimes depressed
by these remedies ; the sanguine may be over- stimulated, the nervous
may be irritated by them : but the relaxed habit is simply braced and
invigorated by their use.

“ That persons thus predisposed should be moderate in their diet,
so as not to overload sluggish organs of digestion, is a point of obvious
importance. But I have had occasion to observe, that the system of
dividing the allowance of food into small meals, with brief intervals,
is, in this class of cases, an extremely bad one. The most whole¬
some of stimulants, namely hunger, is thus withdrawn, where it is
most wanted, and a substitute must be found in an increased quantity
of wine and cayenne pepper. Besides, I have reason to believe, that
the relaxed stomach, when roused by a meal as large as it will bear,
is in a much more efficient and vigorous state, than the same stomach,
when inadequately supplied. Let the patient, however, in order that

Dr. Mayo on Indigestion.

453

this rule may not be abused, keep one other constantly in his mind ;
namely, that he should always rise from his meal with an appetite.

It is with persons of the relaxed temperament, that a cautious
economy of liquid food under dyspepsia has been found so valuable,
as to have given to such abstinence the authority of fashion, in a
very mischievous degree. The dry stimulating food thus supplied
to the mucous membrane of the stomach, compelling it to secrete its
juices freely, and to perform its contractions forcibly, may well be
conceived to suit the state of atony, which I impute to it. On the
other hand, this dry stimulating food is calculated to inflict the
severest mischief on a stomach differently constituted ; one, for
instance, in which the phenomena of indigestion coexist with a
nervous irritability of membrane in the intestinal canal.

The same remark applies forcibly to the childish extension of the
use of the white mustard seed. If this remedy be efficacious in any
case, it must also be mischievous in those cases to which it is in¬
applicable, namely, in the same class of cases as would be injured
by the dry system of diet.

Patients labouring under a tendency to scirrhous disease of the
stomach, treated with this kind of diet, and this of stimulants
for dyspepsia, have rapidly proceeded into the ulcerative stage of
their disease.” — p. 101.

We have now given a fair specimen of this work, and
think it proves the author to be a physician of sound judg¬
ment and great discernment. Had he described the treat¬
ment of the different forms of dyspepsia more minutely,
his work would be much more valuable. Still the work
will be perused with interest by the scientific physician,
though by no means sufficiently explicit for the student or
young practitioner. It is a sharp commentary upon the
standard works on indigestion.

V. — La Manoeuvre de tous les Accoucliemens contre
Nature reduite a la plus grande simj)licite, et precedee
du Mechanisme de V Accouchement natural. Par Jules
Hatin, M. D. &c : Paris, 1829. 18mo. pp. 311.

The Management of all Preternatural Labours, reduced
to the greatest simplicity , preceded by the Mechanism of
Natural Labour. By Jules Hatin, M.D. &c. Paris, 1829.
Henry Leclercq.

The object of M. Hatin is to describe the management of
preternatural labours, and to this duty he has chiefly con¬
fined himself. He has extracted from all the standard
obstetric works of France, and enriched his production by

454

Critical Review.

copious original observations. We need scarcely state
that the French practice differs very materially from our
own ; and we think we shall render the medical student or
junior surgeon a service by placing it before him.

M. Hatin commences with a description of natural labour,
in order that the management of preternatural cases may
be better understood. The reader must bear in mind that
our Gallic contemporaries include breech or natal, knee and
pedal presentations, under the term natural labour. This
manual is so concise that we must quote it at length. The
reader will not be a loser, though we are convinced that
the British practice is by far the better. To the intelligent
and experienced surgeon, we say, utrum horwm magis
accipe.

Of the Management of Preternatural Labours.

The management of preternatural labours, has for its
object the extraction of the foetus from without the parts of
generation. This extraction is performed sometimes by the
aid of blunt instruments ; lastly, at other times by means of
operations performed on the mother or child. After this
simple exposition, it is clear that preternatural labours
should be divided into three classes, according to their
manner of termination.

In the two first classes, the parts are generally well
formed ; and the obstacle to the termination of delivery
depends often on the want of proportion between the dia¬
meters of the pelvis of the mother and those of the foetus.
It is therefore highly important, in order to distinguish this
kind of impediment, and to obtain a suitable remedy for it,
to know in detail the mechanism of natural labour.

To understand perfectly this mechanism, it is necessary
to have a complete knowledge of the kind of bony canal
which the pelvis of the mother presents on its interior parts,
and the principal parts of the foetus at birth, such as the
head, the shoulders and the breech. It is, in fact, on the
relation of these numerous different parts to each other that
the mechanism of natural labour depends.

PART THE FIRST.

Of the Pelvis of the Mother.

The pelvis is a kind of bony canal, situated at the base of
the trunk, between the vertebral column, which it supports
on its posterior and middle part, and the thigh bones,
which are articulated with its middle, lateral, and anterior
parts.

Dr. Hatin on Preternatural Labours . 455

It is divided into an external and internal surface, a base
and a summit.

We shall here simply treat of the internal part,, since a
knowledge of it alone is sufficient for explaining the pro¬
cess of natural labour.

The internal surface of the pelvis, comprehends the brim,
the superior strait, the cavity of the pelvis, and the inferior
strait.

Brim. — The brim is divided into four regions, an anterior,
a posterior, and two lateral.

Anterior region.- — It exists only in the fresh subject, and
is formed entirely by the abdominal parietes.

Posterior region. — It presents in its middle, the end of
the vertebral column, and on its sides, the mark of sacro¬
iliac symphisis.

Lateral regions. — They are formed by the internal iliac
fossae, which are filled in the recent subject by the psoas
and iliaeus muscles.

Dimensions of the Brim.

Width . — From the middle of one iliac crest to that of
the other, is about ten inches ; from the anterior superior
iliac spine to the other, about nine inches ; from the anterior
inferior iliac spine to that of the opposite side, about eight
inches.

Depth. — About three inches and a half from the middle
of the crest of the ilium to the superior strait; about three
inches to the level of the anterior superior iliac spine.

Size , from before backwards.— The size of the brim can¬
not be determined in this sense, on account of the capa¬
bility of the abdominal parietes being extended more or
less considerably.

Superior strait . — It is formed by that bony ridge which
separates the brim from the outlet.

Shape. — Its shape is various, mGre generally it is elip-
tical.

Dimensions. — The superior strait is measured by four
diameters, viz. an antero-posterior , wdiich extends from the
sacro-vertebral angle to the symphisis pubis : a transverse ,
which extends from one side of the pelvis to the other,
and two oblique , which extend from the sacro-iliac sym¬
phisis of one side to the linea ileo-pectinea of the opposite.

The antero-posterior diameter measures four inches. The
transverse in the skeleton five inches ; but in the fresh sub-

456

Critical Review*

ject it is about half an inch less, on account of the situation
of the psoas and iliacus muscles ; so that in reality it pre¬
sents to the obstetrician a diameter of four inches. The
oblique diameters are about four inches and a half.

Inclination . — When the woman is standing-, the superior
strait is not situated horizontally, but its posterior part is
much more elevated than the anterior ; so that it is directed
obliquely from above downwards, and from behind for¬
wards. The inclination which it then presents, is from
about thirty-five to forty degrees.

Axis — The axis of the superior strait may be represented
by an imaginary line, commencing at the umbilicus of the
woman, and directed towards the inferior part of the sa¬
crum, passing through the centre of that strait.

Cavity of the Pelvis. — The hollow of the pelvis is
divided into four regions, an anterior, a posterior, and two
lateral.

Anterior region. — It is slightly concave on each side, it
presents the posterior part of the symphisis and of the
body of the pubis, more externally and on each side ; the
infra pubic opening filled by the internal obturator muscle.

Posterior region. — The posterior region is formed by
the anterior part of the sacrum and coccyx. It is concave,
and presents transverse lines which mark the points of union
of the different pieces of which the sacrum and coccyx are
composed. It also presents the anterior sacral foramina,
which give passage to the nerves of the same name.

Lateral regions. — The lateral regions are almost smooth,
inclining from above downwards, and present the sciatic
hollows, converted into foramina by ligaments of the same
name ; a square surface which answers to the cotyloid
cavity ; and higher the ischiatic spine, which, projecting
further into the interior of the pelvis than the parts situated
anterior and posterior to it, forms by this disposition on
each side two inclined planes, an anterior and posterior one.
These are the inclined planes which give to the head the
rotatory motion necessary to place its anterio-posterior
diameter in apposition with the largest diameter of the
inferior strait. The anterior plane of the one side, causes
that part of the head which is directed forward to glide
under the arch of the pubis, and the posterior one of the
opposite side, causes that part directed backwards to slip
into the hollow of the sacrum.

Dimensions of the Cavity of the Pelvis.

Ant ero- posterior diameter. — From the middle of the sym¬
phisis pubis to the middle of the sacrum, measures about five

Dr. Hatin on Preternatural Labours.

457

inches ; caused by the curve of this last bone, which pre¬
sents a depth of one inch.

Transverse diameter. — At the top of the hollow about
four inches and a half.

This extent diminishes in proportion as we approach the
inferior part of the pelvis.

Depth. — The anterior partition about eighteen lines,, the
posterior four inches and a half, without following its
curve ; the lateral three inches and a half.

Direction. — The hollow of the pelvis represents a canal
very much curved anteriorly, and perpendicularly divided
by its axis at its extremities.

Axis. — The axis of the hollow of the pelvis may be
represented by a curved line, which, passing through the
middle of the canal, follows almost the direction of the
curve of the sacrum.

Inferior strait. — The inferior opening of the pelvis is
thus named. Its appearance is bony before and on its sides,
whilst posteriorly it is almost completely ligamentous.

Form. — Very irregularly round.

Dimensions. — The inferior strait, like the superior one,
is measured by four diameters. An antero-posterior, which
extends from the point of the coccyx to the inferior part of
the symphisis pubis ; a transverse which extends from one
ischiatic tuberosity to the other ; two oblique, which ex¬
tend from the ischiatic tuberosity of one side, to the middle
of the sacro-sciatic ligament of the opposite ; all these dia¬
meters are generally four inches in extent; but the antero¬
posterior may be increased even to five inches by the retro¬
cession of the coccyx.

Direction of the inferior strait — Its posterior part, even
to the tuberosities of the ischium, is inclined backwards and
forwards, whilst its anterior part is directed downwards and
forwards. This last part constitutes the arch of the pubis.

Dimensions of the Arch of the Pubis.

Breadth. — Above, from fifteen to twenty lines ; in the
middle, two inches and a half ; below, four inches.

Depth . — About two inches.

Axis of the inferior strait. — The axis of the inferior strait
may be represented by an imaginary line drawn from the
sacro-vertebral angle to the centre of the strait.

Of the Principal Parts of the Foetus.

The principal parts of the foetus, connected with parturi¬
tion, are the head, the shoulders, and the breech. But the

Vql. vi. no. 86. 3 n

458

Critical Review.

intimate knowledge of these different parts not being neces¬
sary for the explanation of the mechanism of natural labour,
we shall therefore at present confine ourselves to that which
relates to their form and size.

Of the Head of the Foetus.

The head of the foetus, when separated from the trunk,
is of an oval form, slightly flattened in different parts.

Division. — We generally divide it into five regions and
two extremities.

The regions are, the vertex or summit, the base, the face
properly so called, and the temporal regions.

The two extremities are represented, the one by the
occipital tubercle, and the other by the chin. The summit
of the head presents parts with which it is important for the
obstetrician to be acquainted.

The principal are the anterior fontanel, the sagittal suture
and the posterior fontanel. The basis of the cranium never
presents, unless the head be separated from the trunk.*

The face offers characters so striking, that it is difficult
not to recognise it.

The temporal regions offer the sutures and fontanels ;
but when they themselves present, they are to be distin¬
guished by the presence of the ear.

Dimensions of the Foetal Head.

The foetal head has five diameters and two circum¬
ferences.

Of the Five Diameters.

The first extends from the occiput to the chin, and is
called occipito-mental or oblique. Its extent is four inches
and a quarter.

The second extends from the occiput to the forehead,
and is named occipito-frontal. Its extent is four inches and
a quarter.

The third extends from one parietal protuberance to the
other. Its extent is three inches and a half.

The fourth extends from the summit of the head to the
basis of the cranium. Its extent is three inches and a half.

The fifth extends from the mastoid process of one side
to that of the other, and thus measures the breadth of the

* The author should have added — or in pedal presentations. — Ed.

Dr. Hatin on Preternatural Labours.

459

basis of the cranium. Its extent is from two inches and a
half to three inches.

Of the two Circumferences .

The first divides the head perpendicularly into two late¬
ral hemispheres. Its extent is from fourteen to fifteen
inches.

The second divides the head perpendicularly into two
halves, the one anterior, the other posterior. The extent of
these circumferences is from ten to eleven inches. The
foetal head is composed of two very distinct parts ; the one
superior, which is named the arch of the cranium ; the other
inferior, and is named its basis.

The first of these parts is formed by bony pieces, sepa¬
rated from each other by intervening- membranes, which are
called fontanels and sutures.

This disposition causes the arch of the cranium, when it
is compressed, to diminish in size, by the approaching or
overlapping of the different bones which compose it.

The basis of the cranium is incapable of diminution.

Movements of the Head on the Trunk.

The bead of the foetus may be bent forwards upon the
superior part of the chest, backwards on the back, inclined
on the one or the other shoulder. It may also describe a
fourth of the rotation.

Of the Shoulders of the Foetus.

The shoulders of the foetus, considered relatively as to
labour, present nothing worthy of interest but their size.

Measured transversely, they present a diameter of four
inches and a half; but their structure permits a considerable
reduction, and it has been remarked, that by simple pres¬
sure, the extent of this diameter can be diminished one
inch.

The breech of the foetus, similar to the shoulders, is des¬
titute of interest, except as relates to its dimensions, yet its
size never presents a real obstacle to the termination of
labour, even when it is double the natural volume. It is
moreover composed of fourteen bony pieces, separated by
cartilages, the yielding of which may facilitate labour.

Conclusions deduced.

1st. From the comparison of the diameters of the pelvis
of the mother, with those of the principal parts of the foetus ;
2d, from the different direction of the axis of the pelvis of

460

Critical Review.

the mother; 3d, from the difference of the length of its
anterior and posterior walls.

1st. The largest diameters of the foetus exceed the extent
of the smallest diameters of the pelvis of the mother ; but
the greatest diameters of this last, exceed the extent of the
greatest diameters of the foetus ; from whence we must
necessarily conclude, that to obtain a natural termination to
labour, it is indispensable that the largest diameters of the
foetus always correspond to the largest diameters of the
pelvis of the mother.

I 2d. The largest diameters for delivery, at the superior
strait, are the oblique; whilst at the inferior strait, the
greatest is the antero-posterior ; it follows, therefore, that
the largest parts of the foetus, placed obliquely at the supe¬
rior strait, must undergo a rotatory movement, in order to
be suitably placed at the inferior strait.

3d. The three axes of the pelvis represent a curved line,
the concavity of which answers to the pubis, the convexity to
the sacrum ; the foetus, in disengaging itself, must neces¬
sarily follow this direction.

4th. The posterior part of the cavity of the pelvis is five
inches in extent, whilst its anterior part is but 18 lines. This
difference of length explains why the occiput escapes first
in labour by the summit of the head ; the two first positions
are much more favorable than the two last ; since in the
first case, the occiput to escape has to traverse but eighteen
lines, whilst in the second it must follow an extent of nearly
five inches.

Of the Mechanism of Natural Labour.

Labour may terminate naturally by presentation, of either
the head, of the feet, of the knees, or of the breech.

Of Natural Labour by the Head.

Natural labour by the head may take place in the four
positions, which correspond to the oblique diameters of the
pelvis ; the position of the woman on the back.

First Position . Principal Relations. — The occiput answers
to the left cotyloid cavity, or acetabulum, and the forehead
to the Tight sacro-iliac symphisis. The posterior surface
of the foetus looks forwards, and to the left, the anterior
looks backwards and to the right — the feet are towards the
fundus of the uterus.

Mechanism. — Pressed by the contractions of the uterus,
the head is bent forward on the chest, and its occipito-

Dr. Hatin on Preternatural Labours.

461

mental diameter becomes parallel to the axis of the superior
strait. It thus traverses the whole hollow of the pelvis ;
but arrived near its inferior strait, it meets with the inclined
planes, which give to it the rotatory motion, by means of
which the occiput is at length placed under the arch of the
pubis, and the face in the hollow of the sacrum. Then the
largest diameter of the head is in conformity with the
largest diameter of the inferior strait, and there is no op¬
position to the escape of this part of the child, but the
resistance from the external parts of generation. Con¬
tinually pressed by the contractions of the uterus, the head
advances further and further, and thus gradually effects the
dilatation of the vulva ; but after each pain it re-ascends
more or less into the cavity of the pelvis.

At length, after a labour more or less protracted, the
resistance from the external parts of generation being over¬
come, the head escapes through the genital fissure. At this
moment the occiput ascends under the arch of the pubis,
and the different points of the face appear in front of the
posterior commissure. Having become free, the head re¬
sumes its natural relations with the trunk; the occiput is
directed towards the groin of the left side, and the face
towards the posterior and internal part of the right thigh.
This movement of replacement has nothing in it surprising,
since the trunk has not participated in the movement of rota¬
tion which the head has experienced in order to escape the
inferior strait.

The shoulders, obliquely engaged at the superior strait,
traverse the cavity of the pelvis, and when they are arrived
at the inferior strait, they meet with the inclined planes which
give to them the same rotatory motion as to the head.
The right shoulder is brought under the arch of the pubis,
and the left into the concavity of the sacrum. At the same
time the head changes its relations ; the face gradually
turning to the middle and internal part of the right thigh,
and the occiput to the middle and internal part of the left
thigh. The shoulder, which is behind, constantly receiving
the contractions of the uterus, soon appears at the vulva,
which it passes, whilst that which is under the pubis serves
as a point of support.

When once the shoulders are without, the rest of the
body is expelled with great rapidity, which is easily ex¬
plained, since the parts of the foetus become smaller, and
as the passage has been dilated by more voluminous parts.

462

Critical Review .

Second Position. Principal Relations.

The occiput answers to the right cotyloid cavity, and the
face to the left sacro-iliac symphisis. The posterior sur¬
face of the foetus looks forwards and to the right, and the
anterior backwards and to the left ; the feet are to the
fundus of the womb.

Mechanism. — The mechanism of the second position is
completely the same as that of the first, with the exception
of the movements of rotation being in an inverse sense.

Third Position. Principal Relations.

The occiput answers to the right sacro-iliac symphisis,
and the forehead to the left cotyloid cavity. The posterior
part of the infant is directed backwards and to the right,
and the anterior forwards and to the left. The feet are to
the fundus of the uterus.

Mechanism. — The mechanism of natural labour in this
third position, differs but little from the mechanism of the
first, since the same diameters of the foetus are found to cor¬
respond to the same diameters of the pelvis of the mother.

Thus, at the superior strait, the head is bent on the chest,
the occiput escapes first into the pelvic cavity. Arrived
near the inferior strait, the head meets the inclined planes,
which give to it the rotatory motion ; the occiput glides on
the posterior and right lateral inclined plane, in order to
place itself in the hollow of the sacrum, whilst the face slides
on the anterior and left lateral plane, to place itself under
the arch of the pubis. The occiput then receiving all the
contractions of the womb, traverses the hollow of the
sacrum, of the coccyx and perineum, at the same time that
the face re-ascends into the pelvis, and is bent further forwards
on the chest. The occiput soon appears at the vulva, which it
gradually dilates ; after each pain it re-ascends more or less
into the hollow of the pelvis.

At length the resistance offered by the external parts of
generation being overcome, the occipital region of the head
escapes through the genital fissure, the forehead resting on
the posterior commissure, and the different points of the face
disengage themselves from beneath the symphisis pubis.

Having become free, the head of the foetus resumes its
natural relations with the trunk ; the occiput answering to
the posterior and internal part of the right thigh, and the
face to the groin of the left side.

The shoulders obliquely engaged at the superior strait,
traverse the cavity of the pelvis. Arrived near the inferior

Dr. Hatin on Preternatural Labours.

463

strait, they meet with the inclined planes, which give to them
a rotatory motion. The right shoulder is placed in the
curve of the sacrum, and the left shoulder under the arch of
the pubis. The head, at the same time changes its rela¬
tions ; the face looking directly towards the middle part of
the left thigh, and the occiput to that of the right thigh.

The shoulder, which is behind, receiving all the contrac¬
tions of the womb, escapes the first, whilst that situated
under the pubis serves to it as a point of support.

The shoulders being without, the rest of the foetus follows
without difficulty.

Note. — This third position is sometimes naturally changed
into the second; this favourable change takes place when
the rotatory motion, impressed on the foetus, is suitably
directed.

Fourth Position. — Princip>al Relations.

The occiput answers to the left sacro-iliac symphisis, and
the face to the right cotyloid cavity. The posterior part of
the foetus is directed backwards, and to the left and anterior
part forwards, and to the right. The feet are to the fundus
of the womb.

Mechanism. — The mechanism of the fourth position is
entirely the same as that of the third, if it does not happen
that the rotatory movements are made in an inverse sense.

Note. — This position may naturally change itself into the
first.

Of the natural Labour by the Abdominal Extremities of

the Foetus.

Positions of the Feet. — The feet present in four principal
positions, which correspond to the oblique diameters of the
pelvis. In these positions, the foetus is disposed in such a
manner that the thighs are bent on the pelvis, and the legs
on the thighs, the heels applied to the breech.

First Position. Principal Relations. — The heels cor¬
respond to the left cotyloid cavity, and the toes to the right
sacro-iliac symphisis. *

The posterior part of the foetus is directed forwards, and
to the left, and the anterior backwards and to the right.
The head is to the fundus of the womb.

Mechanism. — Pressed on bv the contractions of the womb,
the feet escape without difficulty through the hollow of the
pelvis and inferior strait. The breech is not long in en¬
countering the inclined planes, and undergoing the rotatory
motion, by w hich the left hip is soon placed under the pubis

464

Critical Review.

and the right in the hollow of the sacrum. (This rotatory
motion does not take place when the pelvis of the mother is
of a certain size, and in that case the breech goes out
obliquely).

The hip, which is behind, receiving the whole contractions
of the womb, comes out first, whilst that which is in front
serves to it as a point of support. The breech , after having
escaped, resumes insensibly the position which it occupied
before meeting with the inclined planes.

The shoulders are engaged obliquely at the superior
strait, at the same time that the arms caught in a manner by
this strait, ascend on the lateral parts of the head. Arrived
at the inferior strait, the shoulders are placed perpendicu¬
larly, and that which is behind escapes first.

The head is engaged obliquely at the superior strait,
the chin is bent on the chest. Arrived at the inferior strait,
it experiences its rotatory motion ; the face being placed in
the curve of the sacrum, and the occiput under the arch of
the pubis.

The chin then traverses the whole extent of the curve
of the sacrum, of the coccyx, and of the perineeum, and
soon presents itself at the vulva. The different points of
the face disengage themselves at the front of the posterior
commissure, and the occiput escapes at the same place.

Second Position of the Feet — Principal Relations.

The heels correspond to the right cotyloid cavity, and
the toes to the left sacro-iliac symphisis. The posterior
region of the child is directed forwards, and to the right and
the anterior backwards, and to the left. The head is to the
bottom of the womb.

Mechanism. — The mechanism of the second position of
the feet is completely the same as that of the first position,
with the exception that the movements of rotation take
place inversely.

Third Position of the Feet — Principal Relations.

The heels correspond to the right sacro iliac symphisis,
and the toes to the left cotyloid cavity. The posterior part
of the child is directed forwards and to the right, and the
anterior forwards and to the left. The head is to the fundus
of the uterus.

Mechanism. — The mechanism of natural labour in this third
position, differs but little from the mechanism of the first,
since the same diameters of the foetus are found to corres¬
pond to the same diameters of the pelvis of the mother.

Dr. Hatin on Preternatural Labours. 465

Thus the feet pressed on by the contractions of the
uterus, burst without difficulty through the hollow and in¬
ferior strait of the pelvis.

The breech arrived at the inclined planes, is placed
straight, or else it escapes obliquely, if the pelvis of the
mother is very large.

The shoulders break through in an oblique direction at
the superior strait, and are placed in a straight line at the
inferior one.

The head is engaged obliquely at the superior strait, the
chin is bent on the chest ; arrived at the inferior strait it
experiences the movements of rotation, by means of which
the occiput is placed in the curve of the sacrum, whilst the
face arrives under the arch of the pubis.

The occiput then traverses the whole hollow of the sacrum
of the coccyx and perinseum, whilst the face re-ascends into the
pelvis ; but after a short time the neck deriving support from
the posterior commissure, is turned backwards, and the face
disengages itself from beneath the pubis. The occiput
escapes last.

Note.-—' The spiral movement impressed on the breech of
the foetus, wrhen it arrives at the inferior strait, may be
sufficiently strong to convert this third position into the
second. This change is favourable to the termination of
labour.

Fourth Position of the Feet — Principal Relations .

The heels correspond to the left sacro-iliac symphisis, and
the toes to the right cotyloid cavity. The posterior region
of the foetus looks backwards and to the left, and the anterior
forwards and to the right. The head is to the fundus of the
womb.

Mechanism. — The same as in the third position, except
that the rotatory movements take place in an inverse sense.

Note. — This fourth position may change itself naturally
into the first.

Positions of the Knees.

The knees, like the feet, may present themselves in four
principal positions, which correspond to the oblique dia¬
meters of the pelvis. The foetus is disposed in such a
manner, that the legs are bent on the thighs, and these
stretched over the pelvis,

Vot. vi, no. 36, - 3 o

Critical Review.

4(J0

First Position. Principal Relations.

The anterior part of the legs corresponds to the left coty¬
loid cavity, and the anterior part of the thighs to the right
sacro-iliac symphisis. The posterior region of the foetus
looks forwards and to the left, and the anterior backwards
and to the right.

Second Position. Principal Relations.

The anterior part of the legs answers to the right coty¬
loid cavity, and the anterior part of the thighs to the left
sacro-iliac symphisis. The posterior part of the foetus looks
forwards and to the right, and the anterior backwards and
to the left.

Third Position. Principal Relations.

The anterior part of the legs corresponds to the right
sacro-iliac symphisis, and the anterior part of the thighs to
the left cotyloid cavity. The posterior part of the foetus
looks backwards and to the right, and the anterior forwards
and to the left.

Fourth Position. Principjal Relations.

The anterior part of the legs corresponds to the left
sacro-iliac symphisis, and the anterior part of the thighs to
the right cotyloid cavity. The posterior part of the foetus
looks backwards and to the left, and the anterior forwards
and to the right.

Mechanism of the Four Positions of the Knees.

The mechanism of natural labour in the four positions of
the knees is altogether the same as in the corresponding
positions of the feet, with the exception that the knees pre¬
sent first.

Positions of the Breech.

The breech, in the same manner as the feet and knees,
presents in four different positions. The foetus is disposed
in such a manner that the thighs and the legs are raised, and
placed on the anterior surface of the trunk.

First Position. Principal Relations.

The posterior part of the sacrum corresponds to the left
cotyloid cavity, and the posterior part of the thighs to the
right sacro-iliac symphisis. The posterior region of the
foetus is directed forwards and to the left, and the anterior
backwards and to the right. The head is to the fundus of
uterus.

Dr. Hatin on Preternatural Labours .

467

> Second Position. Principal Relations .

The posterior part of the sacrum corresponds to the
right cotyloid cavity,, and the posterior part of the thighs
to the left sacro-iliac symphisis. The posterior part of the
foetus is directed forwards and to the right, and the ante¬
rior backwards and to the left. The head is to the bottom
of the womb.

Third Position. Principal Relations .

The posterior part of the sacrum corresponds to the right
sacro-iliac symphisis, and the posterior part of the thighs
to the left cotyloid cavity. The posterior part of the foetus
is directed backwards and to the right, and the anterior
forwards and to the left. The head is to the fundus of the
uterus.

Fourth Position. Principal Relations.

The posterior part of the sacrum corresponds to the left
sacro-iliac symphisis, and the posterior of the thighs to the
right cotyloid cavity. The posterior part of the foetus is
directed backwards and to the left, and the anterior forwards
and to the right. The head is to the fundus of the uterus.

Mechanism of the Four Positions of the Breech.

The breech is engaged obliquely at the superior strait of
the pelvis. Arrived at the inferior strait, it experiences a
rotatory movement, by means of which one of the hips is
placed in the hollow of the sacrum, whilst the other is
placed under the arch of the pubis. The hip which is
behind escapes first, whilst that which is under the pubis
serves to it as a point of support. The trunk bursts through
without difficulty, although the abdominal extremities be
bent on its anterior region ; at length the axillse obliquely
present at the superior strait, the arms are raised upon the
sides of the head, and the labour terminates in the same
manner as in the corresponding position of the feet.

[Here we shall pause for the present, and allow our junior
readers a little time to digest the very able directions incul¬
cated by M. Hatin in the preceding pages. The doctrines
inculcated are correct, though somewhat different from those
of our countrymen. Obstetricy is now a science, and must
be studied as such. — Ed.]

[ 468 ]

V. — Distinction without Separation. In a Letter to the
President of the College of Surgeons on the present
State of the Profession . By Joseph Henry Green,
F. R. S. F. G. S. Professor of Anatomy to the Royal
Academy, Professor of Surgery at King’s College,
London, one of the Surgeons of St. Thomas’s Hospital,
&c. London, 1831, 8vo. pp. 47. Hurst, Chance & Co.

This is rather a singular title ; it certainly leaves the reader
to surmise its meaning. Mr. Green means that the dis¬
tinction between physicians and surgeons does not and
cannot really subsist, and argues, that the disunion of the
departments of the profession has been highly injurious. He
rapidly glances at the origin and purpose of the medical
corporations in this part of the empire, examines the
grievances of the members of the College of Surgeons,
defends the powers that be,” considers objections to these,
delusive and fallacious, points out the evils of popular elec¬
tions, admits a want of sympathy between the Council of
the College and the general practitioners, proposes a
remedy, and offers suggestions for the constitution of one
medical faculty for uniting all the departments of the pro¬
fession ; and finally, he describes the conduct and character
of medical men in society. Such are the contents of
this production. Mr. Green argues strongly in favour of
the present state of management of the College of Surgeons,
and has zealously endeavoured to prove his case ; he then
suddenly turns round, and advocates in the strongest terms,
the necessity of a complete reform in that body, and ab¬
solutely suggests a most obnoxious plan for the purpose.
We are greatly surprised that a surgeon of Mr. Green’s
standing and talents should treat the matter in this way.
If he be a sincere advocate of the present state of things at
the College, how can he with any consistency propose a
thorough reform ? This kind of pleading reminds one of
Mr. Serjeant Eitherside, or rather of Mr. Serjeant Bothsides ;
but we must take leave to inform Mr. Green, he most pro¬
bably will discover that he has pleased neither side.

“ We are gravely told that the general practitioner has no equit¬
able grounds of complaint ; yet as exclusion, even where it is not
reasonable, is too natural a source of dissatisfaction, it might per¬
haps be possible so to modify the charter, as to satisfy the excluded,
and thereby strengthen the college without interfering with the prin¬
ciple of its foundation.

Mr. Green on Surgical Reform.

469

“ It is in this spirit, then, and solely with this view, that I would
propose for consideration the following modifications of the charter,
in regulating the administration of the affairs, and suggestions for
the improvement of the regulations of the College of Surgeons. —
p. 38.

Before we insert the proposed modifications, we beg to
inquire, has the general practitioner no equitable ground
of complaint against the College V* We answer in the affir¬
mative, and ask Mr. Green, can any member of the College
who is excluded from all place in the institution, be said to
have no reason to complain ? What privileges or rights have
the general practitioners received ? Is there any class of
medical men so badly treated, so unprotected, so infringed
upon, as this ? No equitable ground for complaint indeed !
Are they not fleeced by chemists, druggists and empirics ?
Verily they should immediately convene, and confer some
signal mark of their estimation on the author before us.
But we hasten to insert his exclusive and insulting panacea
for the general practitioner.

“ 1. That the Government of the College should be vested in a
President, a Supreme Council, and a General Council.

“ 2. That the Supreme Council should consist of the President and
twenty members, who should have the entire management of the
affairs of the College, and the conducting of examinations.

“ 3. That the members of the Supreme Council should appoint
its own members from the General Council, and consist only of those
who do not practise midwifery, nor dispense medicines.

“ 4. That the General Council should consist of the members of
the Supreme Council, and of forty additional members, twenty of
whom should be under the obligation not to practise midwifery nor
dispense medicines,and the remaining twenty of general practitioners
- — making the total number of the General Council sixty-one.

“ 5. That the General Council should appoint its own members.

“ 6. That the General Council should choose auditors of the
accounts, and might suggest to the Supreme Council at their meet¬
ings any measures for the benefit of the profession. And further,
that all public acts of the Supreme Council should be communi¬
cated to them.

“ 7 . That the eligibility of that class of members of the General
Council, under the obligation of not practising midwifery, nor dis¬
pensing medicines, should be further determined by proofs of a longer
course of study, and of superior capability, evinced by severe examina¬
tions. 1. On entering the profession, they should produce certificates
at the College of having been instructed and undergone examinations
in Latin, Greek, Mathematics and Logic. 2. That they should
have devoted at least five years to the study of their profession, and

4TQ

Critical Review.

produce certificates of having attended lectures on anatomy, physi¬
ology, chemistry, materia medica, botany, practice of medicine,
medical jurisprudence, comparative anatomy, midwifery, and that
during that time they have attended a public hospital. 3. That
they undergo three distinct examinations ; the first on anatomy and
physiology, the second on pathology and therapeutics, and the third
on surgery; and that they write a thesis on a given subject, in a
closed chamber, without the aid of books.

“ 8. There should be a class of honorary members of the General
Council, men of distinguished merit in provincial towns, the army,
navy, or colonies.

“ 9. That general practitioners who have given up the practice
of midwifery and the dispensing of medicines, should be eligible to
the first class of the General Council.

“ 10. That teachers of anatomy and surgery should not only
have undergone the examinations of the first class, but should have
given public proofs of their capability to teach by delivering a lec¬
ture, the preparation for which should not occupy more than twenty
minutes.

<( 11. That effectual means should be taken of enforcing the
duties of masters to their apprentices or articled students, by a pre¬
scribed and definite course of instruction.

*' 12. In the provisions of a new charter, it should be impera¬
tive that no one should be allowed to practise surgery who was not
a member of the College. Since without this check upon ignorance
and empiricism, it is impossible that the College can exercise one of
its most important functions- — that of protecting the public from the
arts and practices of dishonest, unskilful, and incompetent pre¬
tenders.

“ 13. And lastly, that the charter should distinctly define, ex¬
press, and declare, the power of expelling all those who, by disho¬
nourable practices, have rendered themselves unworthy the charac¬
ters of members of a liberal profession, whether it be by the use of
secret remedies, by advertising, by partnerships in trading concerns,
by calumnious reports of their professional brethren, breaches of
professional confidence, or whatever else may be considered deroga¬
tory to a professional character.” — p. 40.

There is scarcely one proposition in this extract which is
not highly objectionable, as must be obvious to any man
acquainted with the feelings of the profession. The author
even admits, that were he a minister of state, he would
pause before he granted such an enlarged charter.

“ For I should be led to reflect on the state of the whole medical
profession, and considering its vital importance to the state, its
objects and purposes, I should come to the conclusion, that however
desirable it may be for its practical administration, that its depart¬
ments should be distinguished, yet that from the unity of its cha-

Mr. Green on Surgical Reform

471

racter and purposes, they could not be divided. Instead, therefore,
of any partial alteration or regulation, I should advise that one
faculty of medicine be constituted, with such powers and administra¬
tive regulations as would render it efficient in promoting the science,
and controlling the practice of medicine in all its branches, as a great
interest of the state. Of this faculty, the colleges of physicians and
surgeons, as representing the great leading distinctions of the pro¬
fession, would naturally form the co-ordinates. In order to the
admission of candidates to either, it might be required that they
should have passed through the same course of study, which should be
upon the most extended plan of a liberal and professional education,
and that the examinations for ascertaining their proficiency, should
be conducted by both ; and that then from the candidate expressing
his wish to enrol himself in either, as intending to devote himself
practically to one or other branch pre-eminently, whether medicine
or surgery, such additional proofs of competency might be required,
as might shew that he was entitled to the desired privilege, and thus
the practical distinction between medicine and surgery would be
acknowledged, whilst their scientific unity would be preserved.

‘ f Out of both would then naturally arise a third department, par¬
taking of the character of each, — that of midwifery. This might
have its separate board or institute, and the candidates for admission
having the same basis of general education, would follow a similar
rule for the enrolment of its members, by requiring a special skill
and knowledge in this department of the profession.

“ Next, as conjoining the functions of all three, the class of general
practitioners would find its place : their institute forming a department
of the faculty, which would in like manner regulate the admission of
candidates, their education and qualifications, and watch over the
affairs of their particular branch of the profession.

“ Lastly, from the colleges or institutes of medicine, surgery,
midwifery, and general practice, might be formed a medical convo¬
cation, for the purpose of deliberating on all matters relating to the
profession at large. And thus a body would be constituted in the
service of the state, with whom the government might consult, and
to whom the country would look for advice and assistance in all
matters appertaining to the health of the community, and to whom
all questions relating to epidemics, laws of quarantine, the health of
the army and navy, the building of hospitals and prisons, punish¬
ments, drainage, sewers, nuisances, — in fine, all questions of medical
jurisprudence and police might be referred. And to a faculty of
medicine so constituted, might be entrusted the government and
supervision of the practical departments of the profession, and that
not only should none practice medicine, surgery, or midwifery, with¬
out their sanction, but that all keepers of houses of reception for
lunatics, all druggists and chemists, dentists, cuppers, should be
obliged to have their licence for their several callings. And if the
government would render the benefit complete and national, they

472

Critical Review.

would root up the detestable upas-tree of quack and patent medicines.
And thus, Sir, we might at length see a profession flourishing in
this country, the motto of which would be Distinction without
Separation.” — p. 44.

We fully assent to these views, and ardently hope that
the day is not far distant when this union of the faculty will
take place.

This desirable event may soon arrive, because it is utterly
impossible that the present defective anomalous and anti¬
quated condition of the medical corporations in this empire
can be longer tolerated. Reform must take place, but
those who live by monopoly and corruption, will, like the
fallen and despicable Tories, oppose it to the last. An au¬
spicious period for medical reform now exists. The London
University will have a charter, and in this the union of the
faculty might be easily accomplished. Why not make the
Colleges of Physicians and Surgeons departments of this
Institution? Why not imitate the University of France, and
have the various corporations under a national institute ?
That, London pre-eminent in wealth and splendour, and in
all the advantages which the commerce of the world confers
upon her, the Queen of cities, the emporium of the world,
the chief seat of civil and religious liberty, should not have
a university, while our minor towns and cities possess such
institutions, is a defect — is an anomaly, which any man of
scientific or literary attainments must desire to have removed.
Yes, the time has arrived when an enlightened and wise
government has forcibly and successfully assailed every form
of corruption, and achieved inestimable benefits for the
people, and will not stop in the middle of its splendid
career, but will proceed prosperously to reform every thing
that needs it, and the medical institutions must be included.
The last part of this essay is powerfully arranged, and the
whole a good example of a bold nervous style.

VI. — The Effects of the Principal Arts, Trades and Pro -
fessions , and of Civic States and Habits of Living , on
Health and Longevity. By C. Turner Thackrah :
London, 1831. Longman and Co. Leeds, Baines and Co.
— ( continued .)

The information contained in this volume, is so instructive
and valuable that we cannot refrain from placing more of
it before our readers.

Mr, Thackrah on Health and Longevity . 473

The subject which succeeds that noticed in our last, is
the condition of miners. These persons, we are told, rarely
work more than six hours a day, yet they seldom attain the
age of forty. They take immense quantities of ardent spirits,
to drown the distressing* idea that they are doomed to pre*
mature disease. In the village of Arkendaie, during* the
last year, there were not less than thirty widows under thirty
years of age,

“ A parallel case to that of the miners occurs in the grinders of
Sheffield. Dr. Knight, in the North-of-England Medical Journal,
states that the fork- grinders, who use a dry grindstone, die at the
ages of 28 or 32, while the table-knife grinders, who work on wet
stones, survive to between 40 and 50.

“ Machine-makers are divided into several departments. The
founding produces only the slight and temporary annoyance of dust
from the charcoal sprinkled on the mould. The men, in Leeds at
at least, are generally healthy. Dressing the iron, technically called
f< fetling,” seems to be equally innoxious.

“ Turning, boring , and grooving wrought iron present nothing re¬
markable. But the turning of cast iron is so laborious, that the
men can scarcely bear it for the wThole of the day. The particles of
iron cast off in the process are large, and do not consequently affect
the lungs in a sensible and great degree.

“ Draw-filing cast iron is a very injurious occupation. The dust
is much more abundant, and the metallic particles much more minute,
than in the filing of wrought iron. Does this difference arise from
the texture, the degree in which the particles are united in wrought
and cast iron ; or does it arise from the manganese and magnesia
contained in the latter ? The particles rise so copiously as to blacken
the mouth and nose. The men first feel the annoyance in the
nostrils. The lining membrane discharges copiously for some time,
and then becomes prseternaturally dry. The airtube is next affected.
Respiration is difficult on any increase of exertion ; and an habitual
cough is at length produced. At the same time, the digestive organs
become impaired ; and morning vomiting, or an ejection of mucus
on first rising, is not infrequent. The disorder varies of course with
the constitution of the individual ; but the common termination,
when men pursue the employment for years, is bronchial or tubercular
consumption. The frequency of these fatal diseases is easily ex¬
plained. The sensitive membrane lining the airtube and aircells is
irritated by the particles of iron inhaled at every breath : chronic in¬
flammation becomes established ; the constitution is seriously injured
by the quantity of muco-purulent matter which is discharged, by the
want of a full purification of the blood, and by the exhaustion which
habitual cough produces : hectic fever and emaciation succeed.
More certainly fatal is the case, where there exists in the constitution

3 p

Vol. VI. no. 36*

474

Critical Review.

a predisposition to the tubercular form of the disease. The researches
of the French pathologists, as well as our own observations, prove
the cartilaginous bodies, called tubercles, to be very frequent in the
human lungs, to be slow in assuming a destructive character, and
often to remain crude or latent for an indefinite period. The subject
of the present paper scarcely requires a detail of the progress of
these bodies, as affected by external agents and internal excitement,
their augmentation, coalescence, change of hue, softening, the final
purulent expectoration, b)r which successive masses are. removed, and
the effects produced on the lungs, the airtube, and the constitution.
Suffice it to urge, that a great proportion of our population is bom
with tubercles, or a disposition to the formation of these bodies ;
that various agents in civil life tend powerfully to excite their de¬
velopment, and none more than irritation of the bronchial membrane.
This membrane is affected by gaseous agents; but much more by palpable
substances. Dust of every kind irritates, but not in an equal degree.
Much, I conceive, depends on the size and figure of the particles
which enter the airtube. The dust from the roads produces no ap¬
parent mischief, while the mason’s chippings from the stone occasion
serious and often fatal injury to his lungs. The dust from old iron,
which is thrown off so copiously as to deposit a thick brown layer on
the dress of the dealers in this article, produces no inconvenience ;
while the less apparent detachment of particles by the file, is de¬
cidedly baneful to the workers in iron. It is then the form rather
than the material, the spiculse, the angular, or pointed figure of the
particles detached, which we conceive the chief cause of injury. The
bronchial membrane is mechanically irritated or wounded ; and from
the daily repetition of this injury, the lungs at length become
seriously diseased.

“ On examining the chest of 17 machine-makers, we found the
average circumference 3 8 -5 -three-fourth inches, and the average
quantity of air expired at an effort 7-13-six- eighth pints. The
figure of the chest, and the power of its muscles, do not therefore
appear to suffer from the employ. Machine-makers seem to suffer
only from the dust they inhale, and the consequent bronchial irri¬
tation.

" The filers are almost all unhealthy men and remarkably short¬
lived. One instance only in this neighbourhood can we find, of a
man’s following the employ for 20 years. At two of the principal
machine-manufactories of Leeds, there are only two filers of the age
of 48 ; and in neither case, I believe, has the individual pursued the
labour uninterruptedly from boyhood. The mortality among ma¬
chine-makers is not the result of intemperance ; for the men, in this
neighbourhood at least, are generally steady. It is not the result of
error in diet, clothing, or exercise. It can be ascribed only to the
nature of the employ, and the train of baneful effects to which I have
adverted.

" What can be done to prevent this lamentable waste of life ?

Mr. Thackarh on Health and Longevity.

475

Magnetic mouth-pieces, which attract the particles of iron inhaled in
respiration, and thus greatly diminish the quantity which would enter
the air-tube, wrere many years ago introduced in Sheffield, and ought
ere this to have been tried in Leeds. But there is a strange apathy
both among the men and the masters. Though very intelligent, and
conversant not only with the science of their manufacture, but often
also with knowledge in general, they are remarkably thoughtless on a
subject which most deeply concerns them. Man after man dies of decay
in the prime of life, and no warning is taken by the survivors.
Machine-makers, indeed, are generally unwilling to admit the fact of
excessive mortality. They naturally dislike the idea of being more
subject than their neighbours, to disease and death. They will
rarely admit that they labour under disorder, till consumption is
established, and its effects apparent to every observer. To our ge¬
neral questions they reply, “ We are all pretty healthy.” And it is
only by examining each workman that we find the deception. Had
they the providence and the courage fairly to examine this impor¬
tant subject, some measures would be devised for correcting the
evil. Magnetic mouth-pieces, or some contrivance still more effectual,
would be speedily adopted. Though their own knowledge is much
more likely to avail than any suggestion of mine, I would ask, if a
change can be made in the smelting of iron, or advantage obtained by
further purification ? The working of wrought iron we find to be
much less injurious to health, than that of the cast. Could wrought
iron be used for all purposes ? It is well known to be most suitable
for common implements. Would it serve for large wheels, cannon,
and the like ? Does the comparative softness of this substance pre¬
sent an objection ? The expense, however, I apprehend to be the
great obstacle.

“ The grindstone used by machine -makers produces much dust.
This, though it occasions little inconvenience to the young and
healthy, greatly affects the aged and asthmatic. Some cover the face,
with a handkerchief, but a more effectual plan might probably be
adopted, viz. that suggested for the flax- spinners. A channel might
be made under the floor, with one end opening beneath the grind¬
stone, and the other outside the room, and through this channel the
dust be conveyed.

“ The preceding remarks apply chiefly to the iron- work in the
making of machines. The brass work must also be noticed. The
founders suffer from the inhalation of the volatalized metal. In the
founding of yellow brass in particular, the evolution of oxide of zinc
is very great. It immediately affects respiration ; it less directly
affects the digestive organs. The men suffer from difficulty of
breathing, cough, pain at the stomach, and sometimes morning
vomiting. We did not find one brass founder more than 40 years of
age ; though we have since been informed that there are two brass-
founders in the neighbourhood, of the ages of 60 and 70, who have
continued at the employ from boyhood. The turners, filers, and
dressers of brass do not seem to be more unhealthy than the

476

Critical Review.

generality of our townsmen. We observe among the filers the hair
of the head changed to green.” — p. 55.

Braziers are subject to noxious exhalations from the sol¬
der, but their employments are so varied as to preclude
injurious effects, as they are not exposed for a considerable
time at once.

Coppersmiths are injured by the fine scales which arise
from the imperfectly volatized metal, and by the fumes of
the spelter or solder of brass. They are liable to the same
diseases as brass founders.

Tin plate-workers are annoyed by the fumes of muriate
of ammonia and sulphurous exhalations from coke, which
they burn. Tinners are subject to inconvenience from the
fumes of soldering.

Plumbers are exposed to the fumes of volatized oxide of
lead, which frequently induce vomiting. These artisans are
pale and sickly, and very seldom exceed the age of forty.

House painters are affected as the plumbers, and suffer
during the process of “ flatting,’' or finishing dead colours
with turpentine. The usual symptoms are dizziness, colic
and palsy. Are the effects,’’ says our author, pro¬
duced by an impression on the cutaneous nerves, and
through them on the nerves in general ? Many painters
imagine there would be no danger w7ere it not for the tur¬
pentine. If this be true, some other article ought to be
substituted for it. We have known painters in this metro¬
polis who suffered severely from the effects of lead, and
afterwards obviated its bad effects by admitting free currents
of air into the rooms in wdiich they worked, and by ob¬
servance of cleanliness, more especially in manual ablution.

u Chemists and druggists are exposed to various odours, and the
evolution of gases, many of which are injurious. Hence the persons
employed in laboratories are frequently sickly in appearance, and
subject to serious affections of the lungs. They are often consump¬
tive. Few old men are found in laboratories. Care on the part of
the men, and ventilation practised as much as possible, would con¬
siderably diminish the effect of the baneful agents.

“ The men employed in the manufacture of gas for lights, are not
aware of any injury resulting from the process. Even the individuals
engaged in the purifying department, and exposed consequently to
abominable evolutions of sulphuretted hydrogen, say they are well
and hearty. The manufacture, however, being of a comparatively
recent origin, does not afford us the opportunity of seeing its full
and ultimate effects.

Mr. Thackrah on Health and Longevity. 477

“ The men employed in cleaning sewers are often affected by the
fetid gases, and sometimes so severely as to suffer suspended ani¬
mation. They are not, however, as far as we could ascertain, subject
to any serious disease : nor are they short-lived.” — p, 57.

Our author next adverts to the principal occupations
which affect the health through the medium of the skin.

Potters suffer from the lead used in “ glazing.” Their hands
are immersed in a strong solution of this mineral, which
produces constipation, colic and palsy. Intemperate men
suffer most severely. The use of lead in glazing’ might be
discontinued, or the process might be effected by a machine.
It is well ascertained that the glaze of common earthenware
is soluble in animal oil, and more copiously in acid fruits
when assisted by heat ; and there is every reason to think
that visceral diseases of the poor are greatly to be attri¬
buted to this cause.

Hatters have their hands excoriated from constant immer-

iich is employed in
and fingers are ex-

Grocers are subject to eruptions, principally impetigo
and eczema, from handling sugar. Lime produces the same
diseases on the hands of bricklayers. Flour irritates the
skin of bakers, and causes psoriasis.

Chimney-sweepers suffer from cancer scroti, inflammation
of the eyes, and bronchial irritation. These diseases are
aggravated by intemperance, and the subjects of them are
craving liquor at every house in which they are employed.
This unnatural and shocking* occupation ought to be abo¬
lished.

Our author dwells with his usual ability on the necessity
of cleanliness, by ablution and bathing, in all cases in
which the skin suffers from dust.

He next describes the effects of wet and steam on the
human body, and illustrates his remarks by describing these
on the following artizans : — scourers of wool, dyers, brushers
of cloth by steam, millers of cloth, giggers, hatters, brewers
and paper makers. He also refers to men who are in the
open air, and subjected to frequent and sudden transitions —
as husbandmen, milkmen, cart-drivers, drovers, butchers,
coachmen, postboys, &c.

“No men, however, exhibit more strongly the agency of wet in
the open air, than brickmakers. We have adverted to their state
under another head (page 11), as well as to that of husbandmen,
coachmen, &c.

sion in a solution of sulphuric acid, wh
the process of t( felting.” Their nails
coriated and sore.

478

Critical Review.

*4 Whether we examine the agency of moisture on men in the open
air, or those under cover, we find it much less than common opinion
would expect. In this country almost all our maladies are ascribed
to the agency of wet, or to “ taking cold.” Medical men adopt this
notion. It is constantly heard in their expressions ; it constantly
appears in their writings. The people of course have gradually adopted
the medical doctrine, and carry it further than even its founders.*
A reference, however, to the history of cases attributed to wet and
cold, and an examination of the reasoning of the patients, are
enough to expose the insufficiency of the evidence and the incorrect¬
ness of the inference. We might show, moreover, that persons most
‘ careful in avoiding cold/ protecting themselves with every variety
of clothing, and shrinking at every change of weather, are not
exempt from the evils which they fear. In fact, they are far more
subject to catarrh, to pulmonary inflammation, and other disorders
commonly attributed to * cold/ than persons who habitually expose
themselves. Finally, a reference to the situation and employment of
several classes of society, decidedly shows that wet and cold, without
other agencies, do not produce the disorders ascribed to them.
Look at the brickmaker, who is subject neither to rheumatism nor
catarrh, though his bare legs are immersed all day in a puddle, — at
the dyer, on a wet floor, and subject to great atmospheric changes
both of humidity and temperature almost every moment, — at the
bricklayer, who is exposed to every vicissitude of weather, and is
generally careless of protection, — at the paper-maker, one hour per¬
spiring at the strong labour of the press, in an atmosphere of warm
vapour, the next, standing in the same dress, in a room open on
both sides to the wind, and merely putting up sheets of paper to
dry, — at the wool scourer, the miller of cloth, and men in similar
employments. Individuals, indeed in these departments, sometimes
complain of pains, which they call rheumatic. But such complaints

* If a man suffer to-day from headache and sickness, the effects of yesterday’s
debauch, he ascribes them to the cold he took in returning home. If bis bowels
be irritable from the annoyance of undigested aliment, he has te taken cold.” If
he suffer from an epidemic, he is sure it arose from <f sitting with his back to an
open window.” If he have an attack of gout, it was from “ going out in a hazy
day,” Nay, the unhappy victim of hereditary consumption, ascribes his illness
to <c sleeping in a damp bed.” This subject is surely important in Preventive
Medicine. If we err in the causes of disease — if we attribute our disorders to
agencies which could not produce them, we overlook the agencies which do pro¬
duce them. A man who believes his stomach-complaint "to arise from cold, is
not likely to correct that dietetic fault, which has occasioned the disorder. He who
ascribes the affection of the head, which from its recurrence and severity threatens
to produce at length serious disease, to his standing in the warehouse without his
hat, or some such petty exposure daily committed with impunity, will not surely'
be disposed to forego that excessive application of mind, which is really the cause
of the cerebral excitement.

Old Parr, we are informed, was in the habit of sleeping in wet sheets as his
cure for a cold.

Mr. Thackrah on Health and Longevity .

479

we find in all occupations and classes of men. The nature of these
pains is obscure. They appear to be affections of the muscles. True
rheumatic inflammation of joints is not frequent in any of the em¬
ployments I have mentioned. Though we find instances, these are
not more numerous than among corn-millers, and less than among
croppers. In our examination of the several classes, we have par¬
ticularly asked, ‘ Are the men, so much exposed to wet and cold,
frequently laid up with rheumatic fever ?’ The answer has always
been a negative. Of other acute diseases ascribed to cold, as in¬
flammation of the lungs, pleurisy, &c. the men generally appear
quite ignorant.

“ lam far, however, from maintaining that vapour, wet, and cold
never produce disorder. In certain circumstances, and when long
continued, they certainly do. The re-action that ensues advances
to fever or inflammation. But cases of this kind are rare. I contend
that in the daily instances of common life, cold is not the great
cause of disease, and that even in those which are considered as ex¬
hibiting indisputable evidence of its effects, a morbid predisposition
has generally been formed by the person’s habit of life, as influencing
the state of the circulation and secretions. Rheumatism, I presume,
is the malady which the believers in the common opinion would
adduce as the strongest objection to my views, it is the malady which
I most readily adduce as affording the strongest support to these views.
The men who are subject to rheumatism, are not the active and tem¬
perate, heedless of wet ground, and out in all kinds of weather, — but
the indolent, the comparatively sedentary, or men who habitually or
frequently take more liquor than the constitution requires, and
especially fermented liquor ; — men with a large abdomen, and a
feeble and sluggish circulation. Such persons are constantly pre¬
disposed to disease : they are constantly open to the influence of
atmospheric changes. And wet or cold may excite in them, rheu¬
matic inflammation of joints, as readily, perhaps more readily than
catarrh or pulmonary inflammation. I conceive, therefore, that the
state of the constitution is the predisposing , — wet, cold, or atmos¬
pheric vicissitude the exciting cause. The observation is probably
applicable to a few other maladies besides rheumatism, but by no
means to the bulk of diseases which are supposed to be the effect of
wet or cold. I would urge my conviction, that in nine-tenths of
these diseases, wet or cold is no more the cause, even the exciting
cause, than Tenterden steeple of Goodwin sands.

" The inferences, then, from our examination of particular em¬
ployments and classes of men, as well as those deduced from general
practice, are 1st, that f wet and cold/ as they occur in ordinary life,
are rarely adequate to the production of disease. And 2nd, That in
the few cases in which they have such agency, they are only the
exciting causes of disease.

“ In reference to the agency of mere aqueous vapour, — of steam,
I mean, without frequent and considerable changes of temperature,
our best subjects of observation are the men and boys employed in
brushing cloth. See page 63. That this vapour should affect

480

Critical Review.

principally the stomach and bowels, is a circumstance which we
should not have expected.” — p. 69,

T* , . ■

Our author next examines the health of those exposed to
a high temperature , or to great variations of temperature .
His observations upon this subject are deeply interesting- to
medical men. In fact, there is not a medical practitioner,
or a manufacturer in this empire, who should not possess
this work. It is replete with information, equally valuable
to the one as to the other. It reflects great credit on its
author as a scientific, laborious, zealous and philanthropic
individual. We trust the day is not far distant, when some
other physician will investigate the Effects of the Principal
Arts, and Professions, and of Civic States and Habits of
Living on Health and Longevity, in this metropolis. To
resume our analysis, we have to mention that our author
next notices the health of bakers. These men are generally
pale and unhealthy. The temperature to which they are
exposed is seldom below 80<>, and often as high as 10CK The
heat of the oven is about 180°. These men are subject to
disorder of the stomach, to cough, and rheumatism. The
twro former arise from dust, which is largely inhaled. It is
supposed that as these persons reverse the order of nature,
by working during night and sleeping by day, and thus in¬
jure their health. But watchmen, coachmen and others,
do not suffer from this mode of life. Cooks and confec¬
tioners suffer from headache and indigestion.

Wool-combers are exposed to heat, but the lungs suffer
from dust. They live to a good age. Men engaged in dry
houses of cloth, are subjected to a hot dry atmosphere,
ranging from 110° to 130°. They are half naked, and in¬
cessantly walking, carrying cloth from one room to another,
and raising the iron tenter frames. They complain of lan-
gour, drowsiness, dizziness, perspiration, thirst and defect
of appetite. Fresh men soon lose their colour, and their
digestion soon becomes impaired. These persons, though
incautiously, passing into the cold air, seldom suffer from it.

Glass-workers are affected with catarrh, but not with
pleurisy and pneumonia. Our author does not mention that
these men are subject to amaurosis, which is generally
known.

The following summary of the effects of high tempera¬
ture, concludes the author’s observations on the labouring
classes, and must terminate our present notice : —

**' The high degree of temperature, which the human body can
sustain without injury, is surprising. I scarcely need refer to the
Well-known experiments of Blagden and Fordyce, Tillet, &c.

Mr. Thackrah on Health and Longevity .

481

<c A part of the subject, of more practical importance, is an ex¬
amination of the effects of heat long continued and alternated with
cold : an examination of the state of men, who have for years been
half the day in a temperature considerably above that of the atmos¬
phere, and the rest of their time exposed, like other men, to the
ordinary cold and vicissitudes of our climate. From my observations
on persons thus situated in this neighbourhood, I may draw the fol¬
lowing inferences : —

“1. That operatives habituated to high temperature, daily feel
effects similar to those felt by persons who occasionally place them¬
selves in this temperature. Habit seems to have little power in
rendering the body insensible to heat. The men daily have an
excitement of pulse, — perspiration proportionate to the degree and
continuance of the heat, and its complication with muscular labour,
thirst, and langour. The complexion is rendered pale ; and the
digestive functions are impaired.

“2. Persons exposed by their labour to great and frequent va¬
riations ©f temperature, are not more subject to inflammation of the
lungs, or of the bronchial membrane, to pleurisy, or fever than other
men. Even the founders and dryhouse-men, who many times a-day,
make sudden transitions of temperature, equalling often 100°, or
120°, are neither sensible of inconvenience at the time, nor subject
to pulmonic disorders.

“ 3. Affections termed rheumatic are, I think, frequent in this
class. If the exciting cause of such complaints be referred to great
and sudden changes of temperature, may not the predisposing cause
be attributed to the unhealthy state of the abdominal viscera, induced
by the excessive potation of fermented liquor ?

“ 4. Though the digestive functions are impaired, and perhaps the
muscular power reduced, organic disease does not speedily result.
Men working in high temperature are not often incapacitated for
work.

“ 5. Is life shortened by habitual exposure to great heat ? I cannot
yet form a decided opinion. Though the operatives of this section
do not live as long as husbandmen, they do not, on the whole,
appear to be shorter-lived than the bulk of townsmen.

“ The remedies which may be suggested for the evils referred to
in this section are,

“ 1. Diminution of the muscular labour, which is performed in
hot rooms. Raising the iron tenter-frames in the dry -house ought
to be effected, and the hot plates of the stuff-pressers conveyed, by
machinery. These, and similar modes of relief, are more worthy of
mechanic ingenuity, than most of the ends to which this ingenuity is
devoted. The men, moreover, should be less active, and carry
lighter weights. In other countries, heat is considered a sufficient
cause for the reduction of labour; while in England, operatives
employ all their strength, as well in a temperature equal to that of
the tropics, as in the open air of our winters. 2. The drinking

3 Q

Vol. VI. NO. 36.

482

O r io’ in al Communication s .

lemonade, or other diluent during the time of labour, rather than the
noxious compound called ale. 3. The use of stimulants with the
food, after labour. 4. The reduction of the period of labour.” —

p. 81.

ORIGINAL COMMUNICATIONS.

1.- — Dr. Short on Cholera in Russia.

To his Excellency Prince Lieven, fyc. fyc. fyc.

Sir,

Haying read in the Lancet of this day, of the rapid progress
of the cholera morbus in Russia, and the similarity it bears
to the Indian epidemic, I hasten to lay before you a few
remarks on the nature and treatment of that formidable
enemy to the human race, thinking, at the present crisis, a
brief statement more valuable to the physician than a more
elaborate treatise at a distant period. My acquaintance
with the disease has resulted from a long residence in India,
where I had frequent opportunities of closely observing the
progress of the malady, of trying the various remedial
agents, and of obtaining the opinions formed of it by the
most experienced practitioners, and also from having suf¬
fered by the invasion of the disease in my own person. The
conclusion l have drawn from these sources is, that the
disease is produced by a peculiar state of the atmosphere,
that the disease is not contagious ; that it affects the nervous
system primarily, producing collapse of the external capil¬
lary vessels, deranging the sanguiferous system, and induc¬
ing congestion of the internal organs. I beg to refer to
pp. 50, 51, of the accompanying pamphlet, on the croton tig-
Jium oil, published by me during this year, where I have
alluded to this disease, when engaged on the subject of
bilious cholera, a very different complaint, though bearing
the same name. The indication of cure, is to relieve as
early as possible the internal surface, and the vital organs
of the oppression, which will be best effected by the cautious
and slow abstraction of blood from a vein. The caution to
be observed in drawing blood in this disease, is the imme¬
diate effect produced on the circulation ; it will therefore be

Dr. Short on Cholera in Russia.

483

requisite the operator keep his finger on the pulse, and if he
finds it increase in fulness, he may fearlessly reduce the
quantity of the circulating- fluid. If, on the contrary, the
pulse sinks after the loss of a few ounces, it is evidence
against the further abstraction. When this operation has
been performed, give four drachms of the following mix¬
ture every hour, or more frequently, according to the
urgency of the symptoms. “ Take four drachms of tinc¬
ture of opium, made according to the London pharmaco¬
poeia, two ounces and half of compound tincture of car¬
damoms mix.” The restoration of the capillary circulation
should be aided, by either the hot vapour or water bath,
assisted by friction, or where these are not to be procured,
friction over the body with warmed flannels. The stomach is
generally so irritable in this disease, that fluids in any large
quantity will be rejected ; even the above form of medicine
will not always rest in the stomach sufficiently long to
exert its beneficial influence. Opium, in its solid state, must
then be had recourse to, and two grains may be given every
hour during the urgency of the symptoms. Calomel has
been found a valuable auxiliary in the hands of the practi¬
tioner, but to obtain its sedative influence over the irritable
stomach in this alarming disease, it must be used boldly ;
if given in smaller doses than twenty grains, it had better
be dispensed with altogether, as disappointment will be the
result. Opiate enemata, and opium as a suppository, will
be available in this disease. The urgent symptoms being
abated, the cure will be perfected by the use of mercurial
purgatives, assisted by a combination of rhubarb and the
tartrate of potass, or other laxative ; but as the peculiari¬
ties of constitution are almost infinite, the treatment must
be various. In every case of epidemic cholera, the hepatic
function is arrested, the use of mercurial purgatives is there¬
fore forcibly indicated.

I have the honour to be. Sir,

Your obedient, humble Servant

M. J. Short, M. D.

Extract from letter addressed to Dr. Short, by G. Benk-
liausen. Esq. Russian Consul General at London.

March, 23, 1831.

te The Medical Board at St. Petersburgh, I am informed,
have found in your pamphlet, besides the remedies therein

484

Origin at C ornmuni cations

stated, different useful and new observations, which, in the
opinion of said board, will deserve the attention of the
medical men who will have to treat the cholera.”

[It affords us much satisfaction to notice the flattering
manner in which the Russian Medical Board has spoken of
Dr. Short’s Essay, a production of which we spoke in just
terms of praise in a former number of this Journal. The
testimony of a physician who has extensively observed the
disease, and who has repeatedly suffered from its dreadful
ravages in his own person, is entitled to great consideration.
We strongly recommend the original Essay on the Croton
Tiglium Oil to our readers, both for the very valuable evi¬
dence it contains on the nature and treatment of cholera,
and on the varied therapeutical uses of the Croton Tiglium.
—Ed.]

II. — Dr. Blake on the Injurious Effects of Belts and

/Stays.

A paper on the danger of the custom so generally adopted
of compressing the abdomen, by means of a belt or stays,
as tending to the production of Hernise. By Andrew Blake,
M. D. Member of the Royal College of Surgeons of Lon¬
don, late Surgeon to his Majesty’s Seventh Regiment of
Dragoon Guards, and author of a Treatise on Delirium
Tremens, &c.

The prevalence of the affection termed hernia, or rupture,
among the inhabitants of all civilized nations, and the suf¬
ferings, as well as danger to life, which it entails on those
who have the misfortune to be afflicted with it, are so
familiar to medical men, as to render it unnecessary for me
to offer an apology for calling their attention to one of its
predisposing causes ; namely, to a very general practice
which prevails in almost all classes of society, and which, in
my mind, disposes in an eminent degree to the production
of this loathsome complaint ; I mean the custom so gene¬
rally adopted of compressing the abdomen by means of a
belt or stays. The comparative ease with which persons
are enabled to take violent exercise when assisted by this
application, owing to the relief it affords to the lungs, by

Dr. Blake on the Effects of Belts and Stays. 485

the pressure of the abdominal contents against the dia¬
phragm, and the consequent diminution of the thoracic space,
at a moment when these organs are called upon by a quick¬
ened circulation to hurry their action, and make exceed¬
ingly short inspirations, may have first Jed to its adoption ;
and the idea that it must restrain the disposition to embon¬
point in these parts, which is so frequently the consequence
of advancing years, tended not a little to render its use still
more universal, and a mistaken supposition that the support
given by a belt to the abdomen diminishes the liability to rup¬
ture may likewise be numbered amongst the causes of its adop¬
tion. Thus we find individuals amongst all classes of society,
from the fox hunter to the effeminate town dandy, alike
endeavouring to rival the boarding school miss, in the
degree of compression applied to the waist.

Cavalry soldiers are also constantly exposed to this cause
of hernia, owing to their heavy sword being suspended
from a broad leathern belt, which encircles the waist, and
which they are obliged to tighten as much as possible, in
order to preserve it in the horizontal position. It was this
circumstance, and the prevalence of the affection alluded to,
amongst even young dragoons, which directed my attention,
as a cavalry surgeon, to the consideration of this subject.

The floating viscera of the abdomen, and the abdominal
integuments or parietes, which retain them in their natural
situation, may be compared to two forces. The one active
and the other passive. Scarpa says, In the healthy state,
the abdomen, considered altogether, is submitted to two
opposite forces, which reciprocally balance each other. One
is the pressure of the viscera against the abdominal parietes ;
the other is the re-action of these same parietes upon the
viscera which they contain. If these two forces were in
perfect equilibrium in all individuals, and under all the
circumstances of life, we should not be in the least subject
to hernia. If, when the equilibrium has been broken, every
point of the parietes of the belly were to yield equally to
the impulse of the viscera, an increase of the volume of the
whole abdomen would be the consequence ; but a true
hernia would never happen.”*

* Vide translated quotations from Scarpa, in Cooper’s Surgical Dictionary,
Sixth Edition, p. 641.

486

Original Communications .

In another part of his work on hernia, the same ingenious
author says, “ But there are certain points of the abdo¬
minal parietes which present much less resistance than
others, and which re-act with much less power against the
pressure made from within outwards by the abdominal
viscera.”

The points alluded to are too well known to require a
particular description here. From what has been advanced,
a very little consideration will, I trust, serve to explain, at
least to all persons acquainted with the laws of natural
philosophy, how much the application of a tight belt or
stays, embracing the abdomen, must tend to destroy the
equilibrium between the twTo forces already spoken of, and
how, by preventing a large portion of the parietes of the
abdomen from yielding equally to what may be termed the
contre-coup from its contents. The conjoined forces will
be directed to those points which are naturally weak, and
at which hernia generally appear. The belt or stays act
by compressing the superior regions of the abdomen, and,
by preventing them from yielding, direct the entire impulse
given to the viscera, against its naturally weak points, the
rings, which are known to be situated at the lateral and
inferior part of the abdomen, and to which points such
artificial support does not extend.

The consequence of all violent exertion, such as leap¬
ing, &c. &c. under these circumstances will, in all proba¬
bility, be the production of rupture ; but should the impulse
against the weak points not be sufficient to overcome the
resistance offered by them, they must, at least, yield a little,
and by frequent repetitions of the impulse, they will ulti¬
mately lose their tone, and allow the impelled viscera to
protrude through them.

All persons who take much exercise on horseback, are in
particular exposed to these consequences. I need scarcely
advert to the repeated shocks experienced during the plea¬
sures of the chase, in all of which the impulse given to the
intestines, is directed by the pressure of the belt or stays
towards the inferior and weaker points of the parietes of
the abdomen. The cavalry soldier, whose constrained and
almost perpendicular position on horseback, resting well on
the perinseum, and oftentimes without the support of stir¬
rups, must necessarily, while trotting, day after day, round
a riding school, expose the rings to all the possible effects of
gravitation, in addition to those arising from a tight, un¬
yielding belt, placed round the waist just above these

Dr. Blake on the Effects of Belts and Stays . 487

points. Hence, although the strength and elasticity of fibre
consequent to youth, will resist for a time the violent shocks
to which dragoons are exposed, yet numbers of them are
lost to the service from the gradual dilatation of the rings,
and the ultimate formation of hernise. Gutta cavat lapi-
dem non vi sed ssepe cadendo.” On the same principle,
while the parietes of the abdomen are prevented from
yielding generally, by the pressure of the waist belt, the
fibres entering into the formation of the rings, against
which the whole weight of the viscera is propelled, gra¬
dually yield, and each succeeding jolt increases the breach,
until, in a given time, sooner or later, according to the
texture and construction of the parts concerned, it admits
of the passage of the intestines, and the formation of the
affection in question.

To prevent then, such consequences in all classes of per¬
sons, I would strongly recommend that the pernicious
custom of compressing the abdomen should be altogether
abandoned, a somewhat unsightly appearance from rotundity
of the abdomen, is far preferable to the possibility of being
afflicted with an artificial anus in the groin.

With regard to the cavalry soldier, I would take the
liberty of submitting, for the consideration of the Com-
mander-in-Chief, the propriety of substituting a sword belt,
suspended across the right shoulder, instead of the unphi-
losophical and injurious waist belt at present in use. By
doing so, the dragoon would have a more uniform appear¬
ance, as the pouch belt would cross it ; and by such a
change, I am thoroughly convinced, he would be rendered
less liable to an affection, which, when it exists, incapacitates
him from cavalry duty, and thereby deprives the country
of the services of an individual, whose instruction alone is
attended with very considerable expense.

Much has deservedly been said concerning the injurious
effects of tight stays and lacing to the female frame, and
were I disposed to lengthen the present paper, I might
take advantage of such observations; but my object is to
confine myself to the consideration only of their influence
in the production of hernia, and should I have succeeded
in explaining the danger attending the unnatural custom
alluded to, and thereby have attained the object I contem¬
plate, I shall feel highly gratified at having given publicity
to my reflections on the subject, however incongruously
they may be expressed.

Lent 071, Nottingham, May, 1831.

488

Original Communications .

[It is almost unnecessary to direct the attention of the
Army Medical Board to the very important suggestion of
our talented and experienced correspondent. We are per¬
fectly satisfied that any hint which is valuable, for the pre¬
vention of disease among our invincible troops, will be duly
estimated in the proper quarter ; which is distinguished by
an ardent desire, and the utmost readiness on the part of
the Director General and his esteemed colleagues, to pro¬
mote the comforts and welfare of that branch of the public
service over which they preside. The opinion of such an
able medical officer of the army as Dr. Blake, is entitled to
attention and respect. — Ed.]

III. — Report of the Royal Westminster Ophthalmic
Hospital. By Mr. J. Foote, Jun.

Purulent Ophthalmia.

This disease (the evil effects of which, under the treatment
at present pursued by medical men, are constantly exempli¬
fied by unhappy infants, who have lost one or both eyes,
being brought to this hospital at a period of the complaint,
when it is no longer in the power of surgery to afford them
any relief) has never been known to resist the plan of treat¬
ment employed at this institution. This disease may attack
the offspring* of the most virtuous as well as of the most
depraved : a simple weakness, as it is termed, in the mother,
being as capable of producing it as the most virulent gonorr¬
hoea ; although the complaint, when arising from the latter
cause is more dangerous, and more likely to run its course
in spite of the remedies employed. This being the case,
the disease, when unchecked, or, what is exactly the same,
when treated by the simple and inefficient means most fre¬
quently employed by practitioners, more especially those of
the old school, proving so fatal to the eyes, and causing our
institutions for the blind to be crowded with unhappy objects of
our compassion, depriving these unfortunates even from their
infancy of the blessed light of heaven, debarring them from
participating in the pleasure all mankind feel in beholding*
and admiring the wondrous w'orks of the all-wise, rendering
them objects of the contempt and sometimes even of the
hate of ignorant and foolish beings, making their lives a
burden to themselves, and, if paupers, on every one else.

Mr. Foote, Jun. on Purulent Ophthalmia. 489

who partakes of the spirit of real charity ; such being the
case, is it not astonishing that in spite of the numerous cases
published, attesting the signal benefits this peculiar mode of
treatment ensures, that practitioners can be found, who
disdain the new light thrown upon the darkness which has
enveloped the study of ophthalmic medicine until lately, and
determine to go on in the old routine way of practice, despite
common sense and humanity, and careless of the injury they
inflict. These remarks have been drawn forth from witness¬
ing the numberless cases that attend this hospital, having lost
one or both eyes from this complaint. The rationale of the
treatment adopted is as follows : —The disease of the eyes,
producing a purulent discharge, whence the name, is an un¬
healthy inflammation, first involving the conjunctiva, finally
extending, by contiguity of substance, to the cornea, and
other parts of the eye. The ung. argent, nitr. is applied, on
the old principle, that no two diseases can exist at one and
the same time: it, being a powerful stimulant, excites a
greater , a more healthy, and at the same time a more tran¬
sitory degree of inflammation than that already existing:
and as the effect of one application is going off (which it
generally does in a day or two, to be judged of by the re¬
currence of the previous symptoms), is to be repeated, so
as to keep up the action, and, by this means, overcome the
disease ; the purulent discharge acting as an unhealthy sti¬
mulus to the eye, keeps up the irritation, and, consequently,
the disease. This should be washed out every hour, or even more
frequently, as it accumulates ; and this is best done, by
syringing it out from beneath the eyelids with an elastic
syringe and a solution of alum ; which clears away the dis¬
charge, while the alum tends to constringe the vessels : the
solution generally employed is, a drachm to a pint.

Case I. — Purulent ophthalmia, dependant on gonorrhoea in
the mother — both eyes lost. Lydia Alderwood, aged one
month. Admitted June 22, 1830.

About three days after birth, the eyes became inflamed,
but no discharge appeared until the 7th, when the lids
became much tumefied, and the discharge appeared in con¬
siderable quantity, thick and yellow.

At present, the discharge is not so great, the lids are
still extremely swollen, highly injected, and are easily
everted.

Both eyes are lost : the corneae are much diseased, being
ulcerated and ruptured.

3 K

Vol, vi. no. 36.

490

Original Communications .

Her medical attendant has latterly syringed the eyes four
or five times a day, and has twice applied the ung. nigr. :
in consequence of which the discharge was lessened , and
the eyes improved. The previous treatment was very inert,
consisting of 7nilk washes , and so forth.

The child’s health is pretty good, bowels open.

App. hirud. j. cantho extern, sing, oculi.

Lotio. aluminis ter quaterve die usurpand.

Pulv. alter, ss. nocte et mane sumend.

23rd. The leeches, applied last night, bled so freely, that
they sent for a surgeon to stop the haemorrhage.

The lids are less tumefied ; but the nurse says the discharge
is greater.

App. ung. argent, nitr. ocul. sing.

Rep. pulv.

Lotio aluminis 2 da hora post applicationem ung. et tunc omni
hora utend.

The child opened her eyes last night, and kept them open
for half an hour.

24th. The child opened her eyes last night, and kept them
so for two hours. The discharge is still very great, but not
so much as it was : the lids are by no means so tumefied.

Rep. pulv. et lotio aluminis.

25th. The child is considerably improved, and the dis¬
charge is much lessened — the lids are also considerably less
tumefied. The eyes may now be examined without difficulty ;
they are both staphylomatous.

Rep. medic.

29th. Is going on well. Discharge lessened.

July 1st. The inflammation seems on the increase; the
discharge is in greater quantity, and secreted more rapidly.

Rep. medic.

5th. The discharge is not great; the child is improving.

App, gutt. argent, nitr.

Rep. pulv. et lotio.

13th. Discharge very slight. Cont. omnia.

22d. Going on well.

Quinse. sulph. gr. ss.

Sacch. pur. gr. v.

Ft. pulv. bis die sumend.

Cured.

Mr. Foote, Jun. on Purulent Ophthalmia. 491

This case, which has chiefly prompted the remarks already
made, exemplifies the use of this highly valuable remedy.
It is very melancholy, that from the neglect of this com¬
plaint in the commencement, this unfortunate child should
be doomed to a life of darkness, one who can feel the sun,
but cannot behold its cheering rays, nor the wonderful
effects it produces — whose future existence can be only a
blank — a dark and dreary life, unblessed by hope, and ren¬
dered miserable by the physical if not moral darkness which
surrounds her. It is mournful that all this, which might
have been prevented at first by due and proper treatment,
should have occurred by the negligence (not to call it by a
harsher name) of her medical attendant to passing events.

Case II. — Purulent Ophthalmia: from Leucorrhcea. Henry
Williams, aged nine weeks. Admitted June 8th, 1830.

Purulent ophthalmia, attacking both eyes, which appeared
three days after birth.

His mother observed his eyes to be rather red on the
second day: on the third, the lids were swollen, and a
purulent discharge in great quantity took place : for this she
consulted a surgeon, who gave her powders and lotions for
the eyes. Under this treatment, the tumefaction and the
discharge diminished.

At present there is a central opacity of the right cornea :
the left is muddy, but not opake, attended with considerable
discharge and chronic inflammation ; bowels open, good
appetite. The mother owned, though with reluctance, to
having leucorrhcea.

The discharge was previously well syringed out , and then
the ung. arg. nitr. applied, and freely diffused over the whole
of the eye by rubbing the lids.

Pulv. alter, ss. nocte et mane sumend.

9th. Is going on well.

Habeat lotionem aluminis

10th. Discharge very slight. Is nearly well.

Rep. lotio.

12th. There is still some discharge from the right eye ;
the left eye is entirely free from it.

App. gutt. arg. nitr. ocul. dextr.

Rep. lotio, — et pulv.

14th. There is still some slight discharge.

App. ung. arg. nitr. ad dextr.

492

Original Communications .

16th. Is well, with the exception of the opacity of the
right eye. The left is quite bright.

This case strongly marks the benefit derived from the
black ointment; the discharge from the right, it appeared,
would not yield to the lotio aluminis alone, or in conjunc¬
tion with the gutt. arg. nitr. ; but when the ointment was
applied, it effected a cure as if by magic.

The cases which follow are marked H, and were commu¬
nicated to me by a highly intelligent and industrious student
at the hospital, they having been under his own care.

Case III. Mary Piley, aged three weeks. Admitted
April 26th, 1830.

Three days after birth, the child’s eyes began to discharge
purulent matter, which has continued ever since with great
inflammation and thickening of the lids : the mother has a
gonorrhoea , which she got from her husband in November
last, and is not yet cured.

When admitted, there was a great cloudiness of cornea,
with a large speck on that of the right eye, a thick and
granulated state of the lids, with considerable discharge of
matter.

App; ung. arg. nitr. ocul. dextr.

Lotion, alum, sinistr.

Calom. gr. j

Sacch. gr. iij. m. ft. pulv. j. nocte et mane sumend.

28th. The right eye appears to have improved under the
application of the ointment : discharge less: no improvement
in the left: ordered to continue the treatment.

29th. No improvement in the left eye.

App. ung. arg. nitr.

May 1st. A large ulcer still appears in the cornea of the
right, which is likewise very muddy, with much inflammation
and swelling of lids.

Rep. ung.

6th. No great improvement in either eye: discharge
great.

Rep. ung.

9th, There appears a gradual improvement in both ej/es ;
cornea clearer : ulcer decreasing: inflammation lessened.

Rep.

27th. The child has been kept away for some time.
When brought back to-day, the complaint .was considerably
aggravated.

Mr. Foote, Jim. cm Purulent Ophthalmia.

493

The ointment was applied, and the use of the lotio
aluminis directed ; but the mother never brought it back.
— H.

Case IV.— Gonorrhoeal ophthalmia.

Ellen Nicholson, setat. 34. Admitted June 17th, 1830.

Is a married woman, with one child. About a fortnight
since felt some pain in the lower lid of the right eye, which
in the course of a few hours swelled very much, with very
great inflammation of the conjunctiva of the ball. She had
previously enjoyed very good health; says^she has never
perceived any discharge from the vagina, or felt soreness
about the genitals, though her husband has since told her
that he had a gonorrhoea, of which he is still uncured.

When admitted to-day, there was great inflammation of
the conjunctiva of the ball, with chemosis, some opacity of
the cornea : ulceration round the edges of the lid : great
discharge of purulent matter : no pain in the head, but little
in the eye.

On examination there appeared some slight inflammation
of the labia and round the vagina, and meatus urinarius ;
she has felt some slight burning on making water.

App. ung. nigr. lotio. aluminis.

Pil. cal. et opii. gr. ij. ter. in die.

22d. Discharge of purulent matter less : ulceration round
the edges decreasing.

Rep. ung. lotio. et pil.

26th. Continues improving ; chemosis gone ; cornea
clearer, sees quite well, no intolerance of light ; mouth
very sore from the calomel — ordered to discontinue it.

App. ung. nigr.

28th. Very great change for the better: ulcerations
healed : mouth still sore.

Rep. ung.

This patient gradually got well, and was ef discharged,
cured.”— H.

Case V. — Muco-purulent opthalmia, from accident to the
right eye, the left soon becoming involved in the disease.

John Hawkins, setat. four years. Admitted Nov. 9th,
1830.

On Saturday, the 6th instant, the child met with an acci¬
dent, to which the mother attributes the complaint : a small
piece of coal flying into the right eye whilst looking on at
the breaking of some large coal : during the day the lids

494

Original Communications .

became tumefied and discoloured ; he complained of pain
with great lachrymation. In the evening the bit of coal was
removed, but he did not sleep well : on the morning of the
7th, a yellowish discharge was observed, and all the symp¬
toms aggravated ; in the evening the lids were highly tume¬
fied, he could not open them, and he complained of great
pain, attended with considerable discharge ; the left eye
became affected in the course of the evening. This state of
the eyes has continued ever since with considerable aggra¬
vation of the symptoms.

At present the right eye is the worst : there is considerable
yellow thick discharge, lids inflamed, highly injected, and
tumefied ; cornese clear. The left eye is not quite so in¬
flamed as the other ; he sleeps badly ; appetite failing since
the commencement of the attack ; tongue clean, pulse
quick; bowels open.

App. ung. nigr. ocul. sing.

Warm fomentations to the eyes frequently during the day.

Pulv. alter, j. nocte et mane.

11th. The left eye is nearly well ; the right very much
better : there is no longer any tumefaction, and the pain has
disappeared : discharge very slight from the right ; none
from the left.

App. ung. nigr. dextr. tantum.

Rep. pulv.

13th. Discharged, cured.

Case VI. — Pustular inflammation from injury.

Mary Kennedy, setat, 14. Admitted 8th June, 1830.

About a fortnight since, while nursing, she received a blow
from a piece of wood in the hands of the child, a small
splinter entered the outer canthus, and penetrated nearly to
the ball of the eye : it remained there neglected for some
days, when severe inflammation having come on, it was
extracted.

She presented, when admitted, very great inflammation of
the conjunctiva of the ball and lids : very great pain in the
eye : sight a good deal affected — intolerance of light :
cornea quite clear : no pain in the head — several small
pustules forming round the cornea : great lachrymation.

App. ung. nigr.

K pil. hyd. gr. iij. nocte: sulph. magn. 3 ss. mane.

June 12th. No very great improvement : large red vessels
running across the conjunctiva : great pain in the head.

Mr. Foote, Jan. on Ophthalmia from Lime. 495

Rep. ung. nigr. — Hirud. ij. nocte applic.

Pulv. cal. gr. iv.

Pulv. jalapse. gr. x. — M. ft. pulv. statim sumend.

14th. Some improvement is manifest.

Rep. ung. et hirudines. — Pulv. jalap, c. 3j. mane.

15th. Still continues to improve : vision much better : no
pain in the eye or head.

Rep. hirud. et ung.

20th. Very nearly well : inflammation removed.

App. vin. opij.

Discharged, cured. — H.

Case VII. — Inflammation, with slight sloughing from the
application of lime.

Thomas Clarke, setat. 89. Admitted 8th June, 1830.

Whilst walking in the streets about five days ago, some
mortar fell into the eye. He washed it well with warm
water, and has fomented it frequently since.

There is an eschar formed on the edge of the lower lid,
and on drawing the lid down, another, rather larger, may be
perceived in the folds of the conjunctiva, where it com¬
mences the covering of the sclerotic. The cornea is per¬
fectly clear ; he does not suffer any pain ; vision rather
impaired.

Applic. ung. nigr.

Ik pulv. jalap c. 5j* mane sumend ex aqua.

10th. Is much better — the inflammation is lessened : he
remains free from pain- — the sloughs of the lid have sepa¬
rated.

Rep. ung. et pulv.

Complains of pain in the head and giddiness. The pow¬
der to be taken every morning.

12th. Is much better. Continue.

17th. Complains merely of an itching sensation in the
eye.

Rep. ung : usurp, ung. flavum hora somni.

22d. Rep. — Discharged, cured.

Case VIII. — Ophthalmia from lime.

Philip Thomas, setat. 26. Admitted October 21. A
plasterer by trade.

Whilst at work yesterday he received a blow upon the eye
from a lath covered with mortar, a quantity of which got in

496 Original Communications.

the eye ; some of his companions washed out the eye, and
got away all the lime that could be seen.

When he presented himself at the hospital, there was
great chemosis of the eye, conjunctiva of the eye and lids
in a high state of inflammation, extremely painful, great
lachrymation, tears hot and scalding: lower lid enormously
swollen ; vision gone : no pain in the head : a poultice was
applied last night,

C. C. ad Bxiv. tempori
Pil. hydrargyri gr. v. nocte
Sulph. magn. 3 ss. mane

22d. Eye free from pain this morning: chemosis has
nearly disappeared : swelling of the lower lid much les¬
sened.

hyd. submur. gr. ij.

P. opij. — gr. J. ft. pil. ter. die sumend.

23d. Inflammation much lessened : pain in the eye en¬
tirely gone: vision still indistinct: very little lachrymation.

Rep. pil.

Of this case the notes were no longer taken ; the mouth
was rendered sore, and he gradually recovered. When he
was dismissed, the cornea was clear and vision good. — H.

Case IX. — Albugo : cured by insufflation.

William Sanson, eetat. 53. Admitted May 6th, 1830,
with a large albugo, covering nearly the whole of the cornea,
of a milk white appearance, resembling lime.

Insufflatur pulv. sacch. c cal. in ocul.

11th. A great deal better.

Iteretur insufflatio.

13th. Improving; says he sees much better: the albugo
does not cover one-third the space it did.

Rep. insufilatio omni die.

20th. The albugo has nearly disappeared. Rep. —

Cured.

Case X. — For this case of amaurosis, cured by the antim.
tart. & sulphate of magnesia, I am indebted to Mr. Nice, an
intelligent student at this hospital.

Elizabeth Curman, setat. 49. Admitted April llth, 1831,
suffering from an amaurotic affection of the right eye, which
she considers to have arisen from a nervous attack, under
which she has been labouring for some time previous.

Mr. Nice on Amaurosis.

49 7

This complaint (the amaurosis) commenced on Saturday
week; she now complains of slight giddiness unattended
with pain, but complains of the appearance of a web, as it
were, floating over the eye ; sight imperfect.

R. magn. sulph. 3j.

ant. tart. gr. ij. — h. s. s.

The gutt. vin. opij. to be dropped in the eye directly.

13th. The emetic operated briskly, and the giddiness is
much relieved; the web is still present.

18th. Much improved on the whole; but having caught
cold, a slight catarrhal inflammation was the consequence;
for which the ung. hyd. nitr. oxyd was directed to be used,
and the other remedies still continued, as the dimness of
vision was going off.

20th. Still improving ; the ointment has lowered the
inflammation. The drops were omitted, but the rest of the
medicines still employed.

22d. The misty appearance returning again slightly ;
the drops and other medicines continued.

25th. Considerable improvement visible as well as felt ;
the drops were applied, but the ant. tart, diminished one
grain.

27th. Still improving; the ant. tart, did not operate as
an emetic, but combined with sulph. magn. acted very
briskly as a purgative.

Rep. vin. opij. et ant. tart.

May 2d. Much better. Rep. medicament.

9th. Improving. Rep. ant. tart. The drops changed to
a solution of the nitras argenti.

13th. Is rapidly improving.

16th. Discharged.

[We are much indebted to Mr. Foote, Jun. and his zealous
colleag’ues for the narration of the above cases, which can¬
not fail to be instructive to our junior readers. The senti¬
ments expressed on the great injury produced by inefficient
treatment of purulent ophthalmia are just, and reflect much
credit on our esteemed correspondent. It is a notorious
fact that some public lecturers in London broadly assert,
that no disorganization of the cornea follows the disease
under notice ; and some of the auditors of such teachers
seemed quite astounded, when we referred them to the
various ophthalmic institutions for melancholy proof of the
fallacy of such an erroneous assertion. — Ed.]

3 s

VoL. VI. NO. 86.

498

Ori gin al Communications .
&

IV. — Dr. Ryan on Homicide by Poisoning ,

Observations on Arsenic. — ( continued .)

The appearances of the arsenical crust, formed by the pro»
cess stated in the concluding- paragraph of the last article,
are, according to Dr. Christison, imitated by no substance in
nature. This is a most important conclusion, as Dr. Paris,
Dr. Smith and Dr. Beck, have questioned the accuracy of
the test by reduction. If any one persevere in denying the
value of this test, the following process is considered cer¬
tain — indeed, almost infallible. It consists of oxidation by
heat, according to Dr. Christison : —

“ The best method of applying this part of the test is to
heat the ball containing its flux deprived of arsenic, to
attach a bit of glass tube to the end, and to draw it gently
off in the spirit flame, taking care to prevent the flux being
driven forward on the crust. This being done, the whole
crust, or, if it is large, a portion of it, is to be chased up
and down the tube with a small spirit lamp flame till it is
all converted into a white powder. In order to show the
crystalline form of the powder distinctly, let the flame be
reduced to the volume of a pea by drawing in the wick, and
let the part of the tube containing the oxide be held half
an inch or an inch above it. By repeated trials sparkling
crystals will at length be formed, which are octahedres, —
the crystalline form of arsenious acid. The triangular
facettes of the octahedres may be sometimes seen with the
naked eye, though the original crust was only a fiftieth of a
grain or even less ; and they may be always seen with a lens
of four powers, the tube being held between the eye and
a lighted candle, or a ray of sunshine, either of which is
preferable to the diffuse daylight for making this observa¬
tion. For the success of the oxidation test it is indispen¬
sable that the inside of the tube be not soiled with the flux,
if the flux contained an alkali ; because the alkali would
unite with the oxide. It is also requisite not to heat the
tube suddenly so as to redden it before the oxide is sub¬
limed ; because then the oxide unites with the glass, form¬
ing a white, opaque enamel.

Such is the best and only process I should recommend
for the detection of arsenic when in its solid form.”

When arsenious acid is mixed with the contents of the sto¬
mach, we should remember that various animal and vegetable

Dr. Ryan on Homicide by Poisoning .

499

principles are present, such as albumen, mucus, tannin,
and caseum. To separate the acid, we must add silver,
copper, lime or sulphur, which will form a compound, from
which the poison can be subsequently disengaged. But
Dr. Christison has proved the fallacy of these tests. He
has shewn that nitrate of silver will cause a yellow preci¬
pitate with animal matter, similar to that produced when
arsenic is present. A similar effect resulted from the sul¬
phate of copper. He recommends the following experiment
in preference to all liquid re-agents. His object is to pro¬
cure sulphuret of arsenic, which he accomplishes by trans¬
mitting sulphuretted hydrogen through the solution. Acetic
acid is to be first added in excess to the suspected liquor,
for the purposes of neutralising any alkali that may be in
the stomach, and of precipitating animal principles. The
fluid is filtered, and a stream of sulphuretted hydrogen is
passed through it for a quarter of an hour, when, if arsenic
is present, a lemon coloured precipitate is thrown down ;
or if the quantity is small, it is suspended in the fluid ; in
both cases it is necessary to boil the fluid, in order to expel
any excess of sulphuretted hydrogen, which would other¬
wise retain the sulphuret of arsenic in solution. This test,
discovers arsenious acid in one hundred thousand part in
water. The sulphuret of arsenic is to be mixed with recently
ignited charcoal and carbonate of soda, and reduced in a
tube as already described. The following mode of defla¬
grating the sulphuret of arsenic is recommended, in pre¬
ference to those proposed by Berzelius and Christison, by
the Commentator, on the processes of the latter, in the
Lancet : —

About a scruple of powdered nitre should be melted
by the heat of a spirit lamp in a green glass tube about six
inches long and half an inch in diameter ; the impure sul¬
phuret of arsenic should then be dropped into it in minute
particles, one by one ; in this manner the decomposition of
the organic matter usually takes place without flame, or at
most with minute scintillations, and the sulphuret of arsenic
is converted into the sulphate and arseniate of potass ; the
tube should then be allowed to cool, and boiling water
added to dissolve the saline mass ; the solution should then
be filtered. Instead of lime water, we would now add the
nitrate of silver, which causes a brown red precipitate of
the arseniate and sulphate of silver, which is exceedingly
insoluble in water. Finally, this precipitate should be dried.

500

Original Communications' .

mixed with recently ignited charcoal, and reduced in a
tube.

“ We feel confident that this method will succeed in ex¬
perienced hands in many instances in which the complex
precipitations of animal matter by the nitrate of silver,
would frustrate the analyser’s expectations.”

The following’ information as to the detection of the
other preparations of arsenic, by the same writer, are so
valuable that I place thenr before the reader: —

“ Such are the several modes of proceeding in our search
for arsenious acid. As we before observed, however, there
are many other arsenical poisons which would elqde this
mode of analysis : we may particularize the arsenite of cop¬
per (Scheele’s green), and the yellow sulphate of arsenic,
orpiment : or King’s yellow. The two last, being entirely
insoluble in water, remain undissolved in the solid contents
of the stomach ; it will be recollected also, that the arse¬
nious acid, on the one hand, is liable to be converted into
the yellow sulphuret by sulphuretted hydrogen in the sto¬
mach, or in the alimentary canal ; and, on the other, that the
orpiment of the shops almost invariably contains the arse¬
nious acid.

After the boiling and filtering, therefore, which consti¬
tute the first step in Dr. Christison’s process for the arsenious
acid, the solid matter should again be collected, introduced
into a stoppered phial, and some weak ammonia added,
which will take up either orpiment or Scheele’s green. After
a few hours the mixture should be filtered, and acetic acid
added to the fluid which passes through, when, if it contain
the arsenite of copper, a green precipitate is slowly formed ;
if it contain the sulphuret of arsenic, a yellow precipitate
is soon deposited. If the precipitate be green, we have to
seek for two metals in it, arsenic and copper. The first is
recognised easily, by mixing the powder with charcoal and
dried carbonate of soda, and heating it to redness in a tube,
when the metal is reduced and sublimed, leaving behind it
the copper, which may be detected by dissolving the resi¬
duum in dilute nitric acid, evaporating to dryness, mixing
the dried mass with an equal quantity of borax, and acting
on it with the blowpipe on charcoal. In the exterior flame,
it forms a globule of beautiful green glass, which in the
interior flame is coated with metallic copper, though the
quantity be not more than the 500th part of one grain.

Dr. Ryan on Homicide by Poisoning . 501

For directions on the use of the blowpipe, see the article
on lead.

If the deposition from the alkaline solution be yellow,
it should be reduced in the manner already detailed, which
it is superfluous now to repeat. It is here, however, neces¬
sary to re-dissolve the residuum in the tube, in water, and
add a drop or two of a solution of the acetate of lead,
which becomes blackened, both experiments indicating that
the yellow precipitate is the sulphuret of arsenic.

The arsenical poison may also have been the arson iate
of potass. Orfila has besides very recently asserted, that
the arsenious acid is liable to be converted into the arse-
niate of ammonia, when the body in which it is contained
has long' been exposed to decay. A portion of the fluid
prepared with acetic acid, according to Dr. Christison’s
plan, should, therefore, before transmission of sulphuretted
hydrogen, be touched with nitrate of silver, which in any
solution will show the presence of the arseniate. Should a
brown precipitate occur, it is to be collected for reduction
with charcoal. The remark, however, applied to Dr. Vena¬
bles’ proposal, must be remembered here. Great difficulty,
arising from empyreuma, will occur in the reduction ; a diffi¬
culty which, as yet, we have not been able to overcome.

“ How far the additional step of examining the solids
is actually necessary in this country, it may be difficult to
determine. Dr. Duncan has seen one case of poisoning by
Scheele’s green, which he detected in pills, and a second
of poisoning by orpiment, which had been mixed with tea.
At any rate the additional experiment turns the solid sub¬
stances to account, which in Dr. Christison’s analysis are
altogether neglected.” — Lancet , 1831, vol i.

Sediilot informs us that thereare two sulphurets of arsenic,
the orpiment and realgar, from which, if heated with potass,
metallic arsenic will be obtained by sublimation. MM.
Geizer and Reiman, digest the mixture for some time wTith
liquid ammonia, it is then filtered, and hydrochloric acid
added in excess. If a yellow precipitate occurs, it is an
indication of arsenic; but when there is no precipitate, we
cannot pronounce negatively ; the fluid is to be evaporated
to dryness, more ammonia is added, and the admixture is
saturated as before with hydrochloric acid ; on adding a
few drops of hydrosulphuric acid, a yellow precipitate takes
place, if arsenic is present.

Arseniates of potass, soda and ammonia, when projected
on live coals, volatilise in the form of arsenic acid. Mixed
and heated with charcoal, metallic arsenic will be obtained.

502

Original Communications .

Action of arsenic , and the symptoms it excites in man. —
Arsenic acts in two ways, most commonly by inducing in¬
flammation of the gastro-intestinal mucous membrane, or by
lowering or arresting the action of the heart. Again, its
effects may be purely narcotic. It may destroy life, and
leave no mark of disease to account for death. It proves
deleterious when applied to wounds, and sometimes even to
ulcers, and when injected into the vagina or rectum.

To whatever part it is applied, unless death speedily
follow, it almost always produces inflammation of the sto¬
mach ; even this inflammation is in some instances more
intense when the poison is applied to the external surface
of the body. From the experiments of Morgan and Addi¬
son, all poisons appear to act through the nerves. Dr.
Christison thinks farther experiments necessary to confirm
this conclusion ; but he has not offered a valid objection to
this opinion.

Medical witnesses are often asked what is the smallest
dose of arsenic which proves fatal ? This question cannot
be answered but vaguely. The quantity is not as yet deter¬
mined ; and of course a great deal must depend on the state
of health, age, habit, diet, in a word, on concomitant cir¬
cumstances. Hahnemann thinks four grains will prove fatal
in twenty-four hours. Christison has related a fatal case
of a child four years old, in which death took place in six
hours, from four and a half grains in solution. The smallest
fatal dose of solid arsenic he has read of was thirty grains.
He thus describes the order of symptoms of poisoning with
arsenic : —

The symptoms of poisoning with arsenic may be ad¬
vantageously considered under three heads. In one set of
cases there are signs of violent irritation of the alimentary
canal, and sometimes of the other mucous membranes also,
accompanied with excessive general depression, but not with
distinct disorder of the nervous system. When such cases
prove fatal, which they generally do, they terminate for the
most part in from twenty-four hours to three days. In a
second and very singular set of cases there is little sign of
irritation in any part of the alimentary canal ; perhaps trivial
vomiting or slight pain in the stomach, sometimes neither;
the patient is chiefly or solely affected with excessive pros¬
tration of strength and frequent fainting ; and death is sel¬
dom delayed beyond the fifth or sixth hour. In a third set
of cases life is commonly prolonged at least six days, some¬
times much longer, or recovery may even take place after
a tedious illness ; and the signs of inflammation in the ali-

Dr. Ryan on Homicide by Poisoning, 503

mentary canal are succeeded or become accompanied about
the second or fourth day or later by symptoms of irritation
in the other mucous passages, and more particularly by
symptoms indicating a derangement of the nervous system,
such as palsy or epilepsy. The distinctions now laid down
will be found in practice to be well defined, and useful for
estimating in criminal cases the weight of the evidence from
symptoms.”

It is now ascertained that persons to whom arsenic is
criminally administered, combined with food, do not expe¬
rience that acrid burning taste in the mouth and throat, so
long considered characteristic of this poison. The first
symptoms are usually sickness and faintness, which gene¬
rally commence in fifteen minutes, though in some cases
they do not happen — indeed, no symptom has been ob¬
served for five hours (Orfila). The patient commonly sur¬
vives twenty-four hours, seldom more than three days, but
may be destroyed in three hours, or survive for weeks. The
symptoms commence in a few minutes, and this is a point
of great importance to the medical jurist, as it enables him
to detect persons who allege they had not felt them for some
hours after the supposed poison was exhibited. In general, we
observe in a few minutes after the sickness has commenced,
there is intense burning pain in the stomach, which is greatly
aggravated by pressure. Retching and vomiting ensue,
especially when drink is taken, there is often a sense of
dryness, heat and tightness in the throat, exciting a desire
to drink ; but this train of symptoms may be absent. The
powers of swallowing and speech are greatly diminished,
and there is often a sense of suffocation. The fluid which
is vomited is yellow or green, and sometimes streaked with
blood. There is sometimes diarrhoea or bowel complaint,
or a sense of burning heat, or actual inflammation along
the digestive tube from the mouth to the anus. In other
cases, the large intestines do not suffer. Again, the genito¬
urinary organs of both sexes may be irritated or inflamed,
and of course their functions deranged. In consequence of
the intense pain or inflammation in the stomach or bowels,
the diaphragm cannot act freely, and the respiration will be
more or less impeded. There are convulsive twitchings of the
trunk and extremities, violent cramps of the legs, the pulse
is small and soon imperceptible, the extremities cold,
clammy and livid, the countenance is pale and sunk, the
tongue and mouth are dry, and often covered with white
ulcers or aphthse, delirium supervenes, and death closes the
scene. In some cases the person expires calmly, in others

504

Orig inal Communication s.

with convulsions. When the sufferer survives for days or
weeks, the body may be covered with eruptions of various
kinds, sometimes resembling small-pox, petechiee, miliaria,
&c. In some cases a remission of all suffering takes place
on the second day ; but this is delusive, as all the bad symp¬
toms usually return with increased force.

These are the chief symptoms of poisoning by arsenic,
but it is to be always recollected, that man}' of them may
be absent, others less violent, and that they are not all
present in every case, in a former number of this Journal
{Med. Repository , vol. ii.). Dr. Yelloly, of Norwich, re¬
lated the case of a lad aged sixteen, who died in twenty
hours from having taken half an ounce of the white oxide —
he never complained of pain, though gastro-intestinal in¬
flammation was indicated by sickness, vomiting and purg¬
ing. Another extraordinary circumstance in this case was
the slowness of the pulse, which was 40, and after some
time only 30. Upon the whole, however, the symptoms of
poisoning by arsenic are in general very uniform.

In some cases, when the patient dies within four or six
hours, there is not sufficient time for the development of
the symptoms related above. Here we have faintness
amounting to syncope, stupor, coma or convulsions. There
may be slight vomiting, but the symptoms of narcotism are
prominent. In these cases, though half an ounce of arsenic
may be found in the stomach, this organ will be healthy.
Yet the patient has been destroyed in eight hours. The
poison is supposed to act on remote organs, of course by
nervous sympathy. Morgagni, Chaussier, Orfila and Chris-
tison cite examples of poisoning by arsenic, in which the sto¬
mach and bowels were healthy. Again, the inflammatory
symptoms may disappear, or nearly so, and nervous symp¬
toms supervene, as coma, palsy of the arms or legs, hysteria
or mania. These occur when the patient has taken a small
quantity, or from having vomited soon after, or when death
takes place after a protracted illness. Delirium, tetanus,
convulsions and coma, may be produced by the poison under
notice. The preceding remarks contain, I believe, all that
is absolutely determined of the effects of arsenic, when
swallowed, on the human subject. I have drawn informa¬
tion from all sources, and very largely from Professor Chris-
tison, whose language I have often condensed. Every fact
stated might be corroborated by authorities, many of which
will be found in his erudite and standard work. The object
of these essays is to inform the student and young prac¬
titioner of the exact state of science on all topics discussed,
and not to load his memory by references.

[ 505 ]

BIBLIOGRAPHY.

PHYSIOLOGY.

1. — On the Structure and Motions of the Heart, and on the Indi¬
cations of the Pulse. By Dr. Burne. — Dr. Burne premises a slight
account of the anatomical structure of the heart, but combats the
opinion of Behrands, that the muscular substance of the heart is
not supplied with nerves ; he asserts that though scantily supplied,
and small in size, the nerves are fully sufficient, as they are not
covered by neurilema, and hence their influence will be as great
as many larger nerves, which are composed in a great measure of
neurilema.

Of the Order of Contraction , — Dr. B. considers, from his own ex¬
periments of the rabbit, and from experiments by Haller, by Dr.
Knox also, in the heart of the shark, that the general opinion, that
first the auricles contract simultaneously, and are immediately suc¬
ceeded by the ventricles, which contract simultaneously also, and
then follows the period of repose, is not exactly right ; as he thinks
from his experiments, that the contraction of the auricles is not
simultaneous, but a successive action of the muscular fibres, the con¬
traction commencing in the sinus venosus, and ending in the appen¬
dix or proper auricle.

This order of contraction in the auricle is an additional example
of the wonderful and wise provision of nature, in the mechanism of
the human body ; for by it, the mouths of the great veins are closed,
and regurgitation prevented, so that the whole force of the action of
the auricles is thus brought to bear on the propulsion of the blood
into the ventricles. It will account, also, for the absence of pulsa¬
tion in the large veins, when the heart has not been disabled by
disease.

When speaking of the motions of the heart. Dr. B. writes thus : —
“If the stethescope is applied to the cardiac region, the ear is
slightly raised by the motion of the heart, and accompanying this is
a sound somewhat dull, but distinct and gradual : immediately after,
and without any interval, is heard a sound more sharp, and analo¬
gous to a valve raised, the crack of a whip, or the lapping of a dog ;
but no motion sensible to the ear accompanies this sound. During
this second sound, or succussion, the heart is felt to retire suddenly
deep within the chest, which accords with the retiring of the heart
from a diminution of its volume, by the contraction of the ventri-
- cles,”

Of the Indications of the Pulse. — Notwithstanding the pulse is
mainly produced by the action of the heart, it does not always cor¬
respond with that action. The action of the heart will sometimes
be impetuous and strong, while the pulse is small and weak ; as in
a narrowing of the orifice of the mitral valve from cartilaginous or
osseous deposit.

Vol. vi. no. 36. 3 T

506

Bibliography.

The various characters o# the pulse may be represented by the
following designations : — It may be strong, weak, hard, soft, wiry,
sharp, harsh, grating, jarring, vibrating, falling back, fleeting; or
full, large, small, thready ; or yielding, open, contracted, tight ; or
rapid, frequent, accelerated, slow ; or it may be quick, free, equal,
unequal, regular, irregular, hesitating, labouring, intermittent, flut¬
tering.

Each of these terms designates some notable peculiarity of the
pulse ; and as they are numerous, and as most of them cannot be
measured except by the sensation produced in the mind, it follows
that the accuracy of this measurement must depend on the skill of
individuals, and hence the difficulty of an acquaintance with the
science of the pulse. But although the task is difficult, it may be
accomplished by diligence and perseverance. The ready use of the
stethescope, requires the ear to be educated ; and an education of
the touch is necessary to a correct judgment of the pulse.

If time can be profitably spent in acquiring a knowledge of me¬
diate auscultation, much more may it be so spent in acquiring a
knowledge of the pulse ; because the pulse is one of the most pro¬
minent signs in disease, and one of the most certain indications in
the treatment. Without the assistance of the pulse, we cannot ad¬
vantageously, or even safely, employ blood-letting, which is the most
powerful of all our remedial agents, the most beneficial when judi¬
ciously prescribed, the most fatal when prescribed in error.

The characters of the pulse are produced by three causes ; the
heart, the volume of blood, and the artery ; and as these causes
always operate, it follows that every given pulse must have several
characters. Thus, the same pulse may bev strong, full, and firm ;
the strength resulting from the heart, the fulness from the volume
of blood, and the firmness from the tonicity of the artery.

Of the terms already specified, some belong to the heart, some to
the volume of blood, some to the artery, and some to these causes
combined.

Those which depend upon the heart are, strong, weak, sharp,
jarring, rapid, frequent or accelerated, unfrequent, quick, slow,
equal, unequal, regular, irregular, hesitating, labouring, intermittent,
fluttering.

Those which depend upon the volume of blood are, full and small.

Those which depend upon the artery are, contracted, tight, yield¬
ing, open, harsh, grating.

Those which depend upon the above causes combined are, hard,
soft, wiry, vibrating, falling back, fleeting, thready, large, com¬
pressible.

The pulse, in health, beats about 72 strokes in the minute, or there¬
about, and the number varies a little in the course of the day and
night, being rather more than 72 in the evening, and less than 72
before rising in the morning. Its natural character is, equal, regu¬
lar, soft, and of moderate strength and volume.

Physiology.

50 7

The pulse of irritation is frequent, its stroke is quick, short, rather
sharp, but not strong- ; the impression on the finger being rather
smart, but not lasting. Its volume may be small or otherwise, but
not full.

The pulse of pneumonia, pleurisy, apoplexy, compression, con¬
cussion, adhesion of pericardium, valvular disease of heart, after
sudden haemorrhage, &c. are diagnostic.

The haemorrhagic pulse is frequent and open, and the stroke is
quick and rather smart, but short and falling back, and leaves but a
slight impression on the finger. This open character is sometimes
mistaken for a full pulse, and the quick and rather smart stroke
construed into strength, which may tempt a practitioner to extract
blood, while the symptoms are already produced by the loss of
blood; but the slight impression upon the finger, and the sensation
of falling back after every stroke, will at once determine that there
is a deficiency of strength and volume of blood.

In ascertaining the nature of the pulse, we must be circumspect,
and take care that we are not led into error by any accident or
idiosyncracy : for instance, any inflammation of the finger, or rheu¬
matism of the wrist, will affect the pulse of the affected arm ; or if
one arm has been lying out of bed, while the other has been covered,
the pulse in the two arms will differ exceedingly ; or there may be
a naturally vigorous stroke of the heart, which is usually attended
with a thick strong artery, and so on. — Midland Medical and Sur¬
gical Reporter, May.

PRACTICE OF MEDICINE.

2. On the Use of Tartar Emetic in large doses in Pneumonia.
By M. Lades, D.M. Escoupens, Tarn.

Dr. Lades has written a long paper, detailing several cases in
illustration of the use of this medicine in inflammatory affections of
the chest. He has administered it only after bleeding, either general
or local has been employed, and sometimes in conjunction with it. He
recommends that it should be tried alone, without any other medicine.
We think this would hardly suit dohn Bull’s temperament, he is
rather too plethoric ; yet we know a case in which an incipient
pleurisy was stopped, by keeping the patient under the influence of
the ant. tart, for several hours. The author thinks himself justified in
concluding, from the cases he has narrated, that “ the tartar emetic,
in large doses, has a powerful action in the resolution of peripneu¬
monia, that when there is no irritation existing in the gastro-intestinal
canal, it does not cause any, and much less does it give rise to an
attack of the “ gastro-enterite,” that its action is not due to its
evacuant properties ; that a great general excitement does not con¬
tra-indicate its use ; that it sometimes acts as a real sedative ; and
that it is a highly useful remedy in the adynamic pneumonia, in
which it is impossible to employ bleeding ; and in those cases in
which bleeding can be pushed no further, and the disease still con¬
tinues, the practitioner may have recourse to this remedy, in the

508

Bibliography.

full hope of rescuing at least some of his patients from an almost
certain death.” — From the Revue Medicate , Francaise et Etrangere.

We have lately used this medicine in the manner recommended by
M. Laennec, in cases of pneumonia, with the greatest success. Ve¬
nesection was first employed freely. — Ed.

3. On the Operation of Physical Causes upon the Constitution, the
Health, and Diseases of Man. By Edward Florens Rivinus, M.D.

This is one of the most interesting papers we have perused for
some time ; but from its nature, does not admit of analysis. With
one or two extracts we must, therefore, be content, and refer the
inquiring reader to the Journal itself in which the paper appears. It
shows great research and talents on the part of the learned writer.

“To the seasons correspond the zones of the earth, to each of
which, by virtue of the same law of nature, its peculiar climate is
allotted. The hot zone, where perpetual summer is modified only by
periodical rains, generates bilious, nervous, and putrid disorders ;
proofs of which are the cholera morbus of south-western Asia, and
the yellow fever of the West Indies, and the Spanish Main. In con¬
sequence of the prevailing heat, a more active determination to the
skin is induced in the living system, and the fluids are carried in
greater abundance to the extreme vessels on the surface of the body.
These facts authorize the watchful practitioner to look upon hot
climates as the cradle as it were, of the majority of all contagious,
as well as of the most dreadful cutaneous diseases ; hence lepra,
elephantiasis, &e. are natives of tropical countries.

“ The cold zone, where an almost perpetual winter produces a
poor, dwarfish, and weakly construction of parts, invites the patho¬
logist to look for diseases of a more lymphatic and cachectic type,
such as dropsies, marasmus, atrophy, &c. It is only in the more
moderate regions that man attains the highest degree of perfection,
both as to his physical construction and intellectual powers. And
here the climate of the hot and the cold zone being blended, the
diseases peculiar to both seem to take leave of each other, and
changing with the seasons, the changes themselves give rise to many
other maladies of an intermediate character, such as catarrhal, rheu¬
matic, and inflammatory affections.” — p. 390.

“ Numerous diseases depend upon particular occupations. Scurvy,
for example, is most frequently met with amongst sailors ; and the
colica pictonum is peculiarly the inheritance of painters, glaziers,
manufacturers of white lead, &c. ; psoriasis diffusa occurs in different
shapes, most frequently in bakers, grocers, and washerwomen ; shoe¬
makers have the psoriasis palmaria locally, from the irritation of the
wax they so constantly employ. In braziers, tinmen, silversmiths,
&c. it seems to be produced by handling cold metals ; whilst flax-
dressers, according to Morgagni, and manufacturers of muriatic acid
are said to be particularly subject to phthisis pulmonalis.” — p. 396.

Whilst speaking of the almost lethargic indifference of the Turks,
in respect to that scourge of their Eastern paradise, the plague, our
author has these expressions, —

Medicine.

509

** The Turks, whilst displaying an unaccountable apathy in some
points, are, however, not such thorough-going fatalists as to neglect
every means of precaution. They are well aware of the facts, that
meat, animal substances in general, fresh bread, silk, cotton, cat’s
hair, &c. are very apt conductors of the plague, while wood, water,
and oil resist the infection. Oil is considered an antidote ; and it has
been observed, that the carriers and venders of oil are rarely, if ever,
attacked. Nobody touches with impunity any coin which has been
in circulation for a long time. Therefore, the waiters and attendants
in coffee-houses and shops never take the money immediately out of
the hands of their customers, but receive it first on a wooden
plate, after which they put it in a vessel filled with water, from
whence they pick it up without any further danger. In like manner
is meat always immersed into water, before the inhabitants receive it
inside of their houses. Silks and woollen commodities, such as
shawls, which cannot be immersed, are always more or less exposed
to the action of the air, especially the night air, in open sheds,
erected on the tops of their dwellings.” — p. 398.

These extracts will serve to shew the reader, that this paper will
form an excellent addition to Thackrah on “ Employment.” It is,
indeed, high time that the attention of the profession be directed to
this interesting branch of “ the healing art” — that “ prevention is
better than cure.” We take leave of Dr. Rivinus with every sen¬
timent of respect. — American Journal of the Medical Sciences, Feb .

4. Pleuro -pneumonia without stethoscopic signs, discovered by
mediate percussion. — A young man was admitted into the Hotel Dieu
with cough, hurried respiration without any rale, and with no particular
resonance of the voice. Percussion, by means of the plessimetre,
elicited a difference of sound to the left and behind. This partly
disappeared when the patient lay on his belly, and was less sonorous
on the left side. The disease was considered pneumonia, and was
removed by the antiphlogistic treatment. M. Laherge is of opinion,
that tubercles are discoverable by percussion when the stethoscope
fails to afford aid. — Journ. XJniv. Hebd. de Med. et Chir. ut supra.

5. — Case of Tuber o-Carunculoid Liver. By Thomas H. Wright,

M. D. &c. (From the American Journal of the Medical Sciences.)
A man of large person, middle age, and vigorous constitution, was
admitted into the Baltimore Alms-house Infirmary, in November
last, with acute pneumonitis of twelve days standing. The diagnosis
was suppuration in inferior lobe of right lung, probably participated
by the liver. The patient lingered and died thirteenth day in Hos¬
pital. . .

Dissection. — Thorax. Left lung sound throughout. Right lung
totally extinct. In place of lung texture, the right pulmo-pleural
sac was completely filled with a light-coloured, cream-like, inodorous
pus ; no vestige of parenchyma. The cyst, (pleura) of this great
abscess was entire every where, and its substance very much
thickened.

510

Bibliography ,

The liver proved to be entirely free from decay. It was enlarged
one third more than the usual bulk, but not sensibly morbid. The
total surface of this viscus exhibited a group of eminences about the
size of garden peas, individually distinct. On the concave surface
they were more remarkable. They represented the small pox, in the
first period of pustular maturation, they were regularly rounded, ob¬
tuse, and conoid. There was nothing palpably morbid in these ele¬
vations. They appeared to be healthy, and consist of the common
pulp or parenchyma, and were all covered by the delicate, peritoneal,
tunic of the liver. The colour of the liver and eminences was
natural.

SURGERY.

6. Remarks on Morbus Coxarius, with an account of Dr. P. S.
Physick’s method of treating this Disease. By J. Randoph, M.D.
&c. &c.

The author of this paper informs us, that Dr. Physick has suc¬
ceeded in curing recent cases of morbus coxarius, where disorganiza¬
tion has not taken place. It is now decided that the cartilage of the
hip-joint is the part primarily affected, and in ordinary cases, this is
found to be in a state of ulceration. The author then notices the
opinions of Messrs, Brodie and Ford, which we need not insert.
The plan of treatment proposed by Dr. Physick consists of the re¬
cumbent posture, leeching and daily purgation, by means of the
pulv. jalap comp.

“ Having pursued the above treatment for a few weeks, and ac¬
customed the patient to his confinement to bed. Dr. Physick next
proceeds to the application of the remedy, which he considers to be
the most important and efficacious one that has ever been employed
in the treatment of morbus coxarius. This consists of a splint
properly carved so as to be adapted to their regular size, shape, and
position of the diseased hip-joint, thigh, knee, and leg. It must also be
carved so as to fit the principal part of the same side of the trunk.
The whole must be long enough to extend from the middle of the
side of the thorax, nearly as far down as the external malleolus, and
it should be wide enough to extend nearly half way round the
parts to which it is applied. In those cases in which the thigh is
bent upon the pelvis, and the leg upon the thigh at the knee-joint,
the surgeon must by no means attempt to force the limb into a
straight splint. On the contrary, the splint must be made angular
at those parts so as to adapt itself to the exact position of the limb,
however crooked it may be. After the patient has worn a splint of
this shape for some time, the inflammation and swelling become so
much relieved, that the limb can be placed in a much straighter
position ; and now it becomes necessary to have a second splint con¬
structed which will adapt itself to the altered position of the parts.
It seldom happens that more than two splints are required in the treat¬
ment ; it has, however, occurred to Dr. Physick, to be obliged to
have recourse to three and even four. The inside of the splint must

Surgery.

511

be carefully wadded, in order to prevent it from excoriating the skin,
and it must be retained in its proper situation by means of two
rollers, one of which should be attached to the upper end of the splint,
so as to secure this part to the thorax and hips, whilst the other is
applied to the splint and limb from the ankle to the top of the thigh.

“ The length of time which may be required for the performance
of a cure, varies in general from six months to two years, though the
usual period is about twelve months. During all this time the splint
should be kept steadily applied ; the surgeon, in fact, should not
remove it until sometime after all the symptoms and appearances of the
disease have entirely subsided. As soon as there is sufficient reason
for believing that the disease is completely cured, the exercise of the
limb may be resumed in the most cautious and gradual manner.

“ When the splint is first applied, the child in general is restless
and uneasy, and frequently complains so much that it becomes ne¬
cessary to remove it for a short time, in order to pacify him ; after a
few days, however, he gets completely accustomed to the splint, and
experiences so much relief from pain, that he is extremely unwilling
it should be taken off, even for a short time.

“ It may be said that this treatment is not applicable to cases of
morbus coxarius occurring in patients of a decidedly scrofulous con¬
stitution ; so far from this being correct, however, in several instances
complete cures have been effected in such patients.” — p. 306.

7. Cancer by Ncevus twice excised , four times cauterized, and
finally cured by methodic compression. — M. Recamier, one of the
editors of the Revue Med. Franc, et Etrang. relates a singular case of
nsevus, or what he has designated as above, which was finally cured
by compression. He has succeeded in curing several cases of cancer
by this method, and thinks it has failed in the Middlesex Hospital,
from being injudiciously applied. He has proved that it cannot be
used indiscriminately.

8. Cure of Gonorrhoea and Leucorrhcea by Iodine. — A man, aged
28 years, was treated in the ordinary way for a gonorrhoea without
success. He was ordered 12 drops of tinct. iodinee, m. n. and cured
in eight days.

His wife took 8 drops twice a day in cold water, and was cured of
leucorrhcea in ten days. — M. Broglia inAnnali Universali di Medicina
Gennajo, 1831.

9. Treatment of Neuralgia. — When this disease depends on the
brain or spinal marrow, it will be relieved if not cured by tartarized
antimony ; but when it depends upon the nerves, mercury is the best
remedy. — Heldenhrand in same work.

10. — Dr. Buchanan’s Surgical Report from the Glasgow Royal In¬
firmary, for the Summer of 1830. — Among other cases, Dr. B. de¬
scribes a case of change in the colour of the skin, from the internal
use of the nitrate of silver. He conjectures the man used two ounces
of this deadly poison in twenty months.

It is of very little consequence, for a bachelor of 39, by trade a
steam engine moulder, and six days of the week, like his neighbours

512

Bibliography.

as to complexion, to be thus changed ; but reverse the portrait, only
let the masculine, hard, and stern features of this blacksmith, be
converted, by supposition, into the soft, feminine, and angelic smile
of virgin beauty, whose bodily and mental constitution, it may be,
has been in a similar condition to that of Hattrick, and who, incau¬
tiously, may have- made use of the same medicine, — she by this
means, it is true, has got rid of her disease, but I fear, that practi¬
tioner’s cred’t, who counselled the use of the medicine in such a
case, will cease the moment the negress is developed.

It is not my intention in the present communication to go into the
subject of the cause, or seat of colour in the skin of the various
tribes of human beings, so amusingly and eloquently detailed by
Le Cat, nor do I mean to inquire (as Mr. B. Cooper has lately at¬
tempted to prove) whether the rete mucosum, the generally supposed
seat of colour, is composed of congeries of right angular veins, or
acute angular arteries, such disquisitions on the history of the spe¬
cies, and such microscopic anatomy, being foreign to the object
which I have at present in view, of shortly stating what trials were
made use of to change this patient’s skin, and the result ; and though
I cannot refer to the Journals of the house for the details, my notes
are equally to be relied on.

Amalgamation by means of quicksilver, exhibited in the form of
blue pill, was my first empirical attempt, and this I proposed to my¬
self, not only from its chemical action on the silver, but more parti¬
cularly as a general stimulant to the whole absorbent system ; for I
am of opinion, that the rete mucosum is not the only texture influ¬
enced by the nitrate of silver, when internally administered, but
that various internal organs and textures are permeated by it, either
through the medium of the arterial or nervous systems. In this way
alone, can we account for the marked effects produced by it in cases,
like this, of epilepsy, or chorea, and mania ; where often structural,
as well as functional derangement is strongly indicated. I cannot, it
is true, affirm, that it has been found in the interior of the body, on
inspection, but neither has mercury, and yet, who would hesitate to
say, that this medicine does not pervade every the most minute part
of the animal machine ? Again, it is no proof, in my opinion, that
this medicine has not become generally diffused through the system,
that the scalpel of the anatomist, or analysis of the chemist, has not
detected it after death, for by neither manipulation could it be exhi¬
bited to the senses in the delicate and reticulated mucous tissue,
unless light had, through the transparent cuticle, during life, dis¬
played its decomposition.

Gentle salivation was in about eight days produced, and this was
persevered in for a fortnight, but without producing the least change,
or if any, the poor fellow thought to the worse. Iodine and chlorine
were thereafter successively made use of, both externally and in¬
ternally, but wTith the same result. I need scarcely say that their
use was problematical, as wras that also of large doses of sulphur,
and the external application of nitric, muriatic, and nitro-muriatic

Surgery.

513

acids. These all, it may well be said, were empirical remedies ; but
what medicine exhibited for the removal of any internal disease, is
not, in some measure, of this nature, from the most sovereign spe¬
cifics for intermittents, as arsenic and quinia, to the heterogeneous
and discordant nostrums for gout, phthisis, and dyspepsia, which
have disgraced the pharmacopoeas both of modern and ancient times.

In the West Indies, it is often remarked, that the skin of the
negro, when blistered extensively and severely, assumes a dusky hue,
and, in some instances, is even changed into a dirty white colour ;
following out this observation, I first tried, on his arm, the effect of
powerful vesication by cantharides, and thereafter had a solution of
chlorine applied to the vesicated surface ; but still, after cicatriza¬
tion was accomplished, there could not the slightest difference be
detected, between the sound and lately blistered portion. The pa¬
tient having become tired at so many successive failures to alter his
outer man, resolved to submit to no more experiments, unless I
could give him some better grounds to expect a change ; this I at
once declared 1 could not, entertaining, as I did, the opinion, that
his black face would accompany him to the grave ; but having heard
from Dr. Thomson, that my friend Mr. Rainy had some experience
in lunar caustic cases, I held out some hope to him, that what had
benefited others, would be the most likely means in his case also.
I found, however, that it was the external application of this me¬
tallic salt, upon which he had been experimenting, and that, like most
of my other medical friends, he had never seen, far less treated, an
artificial mulatto. He suggested at the same time, but with his
usual caution, as to its probable want of success, the external appli¬
cation of ammonia, complete seclusion from light, and thereafter,
that chlorine should be used to the vesicated parts. I felt anxious
to give this last application a full and fair trial ; for this purpose I
dipped a thick piece of caddis in ammonia, and clapped it over
the whole cheek; the patient bore it most manfully, and though
vesication was extensively produced, the most complete darkness
visible adopted, during the whole of next day, and the chlorine with
the greatest assiduity applied — he remained in statu quo. — Glasgow
Medical Journal. May.

1 1. — On Old Dislocations ; being an Essay read before the Glasgow
Medical Society, 1st Feb. 1831. By James Laurie, M. D. Professor
of Surgery in the Andersonian University. From the Glasgow
Medical Journal for May. — Dr. Laurie states, that when the primary
effects of a dislocation have subsided, the separated extremities of
the bone form new connections with the neighbouring parts. These
connections are modified by various circumstances, by the nature of
the joint. 1st. In hinge or ginglymoid joints. As an example of
this let us take a complete dislocation of the radius and ulna back¬
wards. The immediate injury done to the ligaments and muscles I
need not specify : the ultimate connexions are nearly the following.
Posteriorly, the ends of the ulna and radius form cellular connexions

Vol. IV, no. 36.

514

Bibliography .

with the posterior muscles of the arm, and anteriorly the condyles
and articular surface of the humerus become intimately attached to
the muscles of the forearm. Here each of the articulating surfaces
forms connexions with the soft parts, and before such a dislocation
can be reduced, both of their connexions must be destroyed. Be¬
sides this, from the nature of these joints there must always be more
or less riding of the bones, and either from the first date of the in¬
jury, or soon afterwards, in consequence of the absorption of the
intervening soft parts, the bones come into actual contact, and when
v osseous matter is effused, and anchylosis is the result. Hence
the well known fact, that joints of this description are very soon
difficult to be reduced, and before long impossible.

2. In orbicular joints, the nature of the connexions varies accord¬
ing to the situation of the end of the dislocated bone. When it is
thrown into a mass of cellular or muscular substance, the connexions
are at first cellular, fibrin is effused and becomes organized, and the
end of the bone forms for itself a bed in it, and the soft parts among
which it has been thrown.

1st. When it comes in contact with a mere point of bone away
from its original socket, the articular surface and the point on which
it is thrown are changed. The former is altered in shape, its carti¬
lage is absorbed, and new bony particles are secreted and organized.
A somewhat similar change is effected on the point of the bone upon
which it presses. It rarely happens in such cases, that permanent
osseous union takes place between the approximated points. Of this
kind of orbicular dislocation we have an instance in dislocation of
the humerus inwards, under the coracoid process and clavicle.
2d. When thrown on a flat bony surface. Here great changes take
place. As regards the flat surface, a portion of it is absorbed, new
bony matter is effused round its edges, and a socket is formed, rude,
no doubt, and imperfect, but still closely resembling the one from
which the displaced bone was ejected. The head of the bone itself
is changed, its cartilage is removed, and in consequence of new de¬
position, the natural appearance of the end of the bone is destroyed.
It is obvious that the degree of motion which such new joints admit
of, must depend on the shape of the new socket. In general, it
cannot be great.

The muscles become changed in appearance, and in direction, and
frequently lose all power. The arterial, nervous, and venous trunks
have frequently their course changed.

Having thus premised, we come to the important question, at
what distance of time do old dislocations admit of reduction ?

Mr. B. Bell does not consider a dislocation “ old, until the sixth
month;” he has reduced them at four months. Desault never at¬
tempted them after the third month. Sir A. Cooper limits us to
three months for the shoulder, and two for the hip. M. Marx re¬
lates the practice of the Hotel Dieu during several years. The oldest
dislocation he relates, as reduced, was at ninety-eight days, of the
hip at seventy- eight ; both were reduced with considerable ease;

Surgery.

515

out of twenty-seven cases, twenty-six were reduced without any
permanent bad consequences, and one only was found irreducible.
This argues well in favour of attempts at reduction. — Rep. Gen.
1829.

In attempting the reduction of old dislocations, we must be guided
by the nature of the joint (ginglymoid joints sooner become anchylosed
after dislocation than the orbicular), also by the condition of the
joint. If it is easily moveable, it is favorable ; it is also favorable,
when the head of the bone dislocated, is thrown among soft parts, as
the connexions formed are cellular, and may be overcome. Incom¬
plete dislocations are unfavorable, from the end of the bone resting
on the edge of the old socket, there exciting irritation, causing a
new socket to be formed, and the old one to be destroyed, so that
there is no cavity to receive the bone in, when reduced. In disloca¬
tions of the shoulder into the axilla, when the artery has followed
the bone, and can be traced adherent to it, attempts at reduction
may cause its rupture, or the formation of an aneurism.

Age, sex, and muscular energy exert great influence over these
accidents, and must be particularly attended to, previous to attempts
at reduction.

Manner of Reduction. — Position must vary with the different dis¬
locations, but, as a general rule, for the upper extremities, the sit¬
ting, the recumbent posture for the lower extremities.

The patient should not lie on the floor, as it will be found incon¬
venient to the surgeon, requiring as it will, the bent posture. The
chair or table must be immoveably fixed, nailed to the ground, and
the patient’s body should be firmly fixed on it. The counter-extend¬
ing force must be so applied as to prevent the muscles which are to
undergo extension being compressed.

In regard to the extending force, the English employ pullies, the
French assistants. The use of assistants allows the axis of the ex¬
tending power to be changed without relaxing it. We will here,
however, allow Dr. L. to speak for himself.

I have bestowed some attention on the means of combining the
power and steadiness of pullies with the mobility of assistants, and
being no great mechanician, I have called in the assistance of my
friend and pupil, Mr. Graham. Each of us has proposed a method
applicable to hospital practice, in which its employment is princi¬
pally required. Mine appears simple ; its efficacy remains to be
proved.

Let a table be fixed in the centre of any room, round part of
which the segment of a circular rod of iron is passed on the same
plain with the table. Care must be taken that the centre of the
table be the centre of the circle of which the rod is a segment. To
prevent the rod from yielding to the extending power, it must be
attached to the wall by short rods so curved, that the point of attach¬
ment be on its outside. The hook of the pulley will thus pass with¬
out interruption along the rod.

By this simple and cheap contrivance the direction of the limb

516

Bibliography.

may be changed while the body remains fixed, without relaxing the
extending power. The objection to this is the resistance which the
friction of the iron surfaces would probably oppose to moving the
hooks. Were the surfaces smooth and oiled, I do not suppose that
the force could be so great as to resist the elforts of one or two
assistants.

Mr. Graham proposes a more scientific but more expensive method,
the principle of which is to move the pelvis on the thigh instead of
the thigh upon the pelvis. This is accomplished by means of a
table fixed to the floor by a central point, with a revolving body like
a demonstrating table. On this the patient is laid ; the sound joint
opposite to that to be reduced is made the central point, and fixed
over the centre of the table. He is then strapped down in the
manner recommended. The table is very easily moved, and a very
slight turn makes a great change on the angle formed by the limb
and pelvis. It might be possible to combine a table of this kind
with the excellent operating table which Mr. Graham has already
contrived.

By way of adjuvant, Dr. L. recommends keeping up severe sick¬
ness and relaxation, by means of tartar emetic or tobacco. He con¬
demns bleeding at first, but recommends it at the latter part, for the
purpose of increasing relaxation and warding off inflammation.

Before concluding with Dr. L/s paper, we must beg to offer some
remarks on the off-hand manner in which he gets rid of M. Flaubert’s
excellent paper, published in the Rep. Gen. for 1827. He acknow¬
ledges he has never seen it ; and can merely speak from an abstract
he perused in the paper of M. Marx, a paper professedly written in
favour of attempts at reduction, while M. Flaubert’s was written
against it.

Notwithstanding Dr. L. never beheld the paper, he has not any
objection indirectly to accuse M. F. of not declaring all the circuim
stances of the cases described in the first, the pectoralis major,
shorthead of biceps, and the axillary artery torn across : the
patient died. In consequence of the duration and mode of extension
not being mentioned, he declares roundly, nay, he asks if it can be
doubted for an instant, that the patient was killed, ( alias murdered ')
by too sudden and powerful exertions. Alas ! for the profession,
if the magnates, if the hospital physicians and surgeons, thus forget
themselves, what must we expect from the minores ? If the great
men, who, it is but fair to suppose, cannot have any interested
motive, especially when the broad ocean rolls between them, if they
act in so unprofessional, so unjust a manner, what can we expect
from our juniors in the profession, who have to toil up the weary
road to eminence, and who can only hope to gain the summit by
industry or else covertly undermining their professional brethren.
This is the first time we have heard of a paper having been reviewed
without being even seen ; we hope it will be the last.

Then quoting another case on the same authority, he adds, what
surgeon, not lamentably ignorant of the first principles of his profession,

Surgery .

51 7

would force a dislocated humerus of seven or eight weeks (only seven
at the utmost) by his own shewing, but we presume the eighth was
added for the sake of the tautology) standing into its place, after
seven or eight minutes extension. He is here again wrong on his
own statement ; two attempts were made, and, of course, with an in¬
terval between them, surely quite long to tear cellular connexions of
seven weeks’ duration ; hardly seven weeks, as the connexions as¬
suredly did not take place on the very day that the accident
happened.

Our author has been unreasonably severe, more than severe, un¬
just, to M. Flaubert, and he must not complain of our notice. Our
motto is, JUSTICE TO ALL.

The writer of these remarks is acquainted with M. Flaubert,
and witnessed some of the cases and their reduction, which he has
described. He can aver, and fearlessly also, despite Dr. Laurie and
M. Marx, that there is not a more talented surgeon, a better ana¬
tomist, a more skilful operator, nor, though last not least, nay, what
we attribute to him as the greatest part of his character, a more
humane man to his pauper patients. M. F. is and has been for
several years, surgeon to a larger hospital than any in London ; it
contains above 1,200 beds. And we have frequently seen the hos¬
pital so crowded, that double rows have been obliged to be laid.

M. F. bears a great reputation in Rouen, both for his humanity
and his skill : it is needless to say, that he is in consequence much
beloved. On one occasion, we recollect perfectly well, a deputation
from the garrison, waiting on him to thank him for his humanity to
some soldiers (the hospital being military as well as civil) in a severe
and dreadful accident which befel them. It was in the year 1827.

In conclusion, however, we beg to thank Dr. Laurie for attacking
M. Flaubert under his own character, and not anonymously, as is,
we regret to say, too often the case at present.

Altogether, the paper is excellent, and were it not for the great
blot we have noticed, it would bear the palm.

We fear that the medical profession will be long ere it is raised to
that rank in society which it merits : complaints are continually
made of the manner in which we are regarded, and of the rapid
progress downwurds, which we are making in the eyes of the un¬
professional public ; but can we wonder at it, when detraction,
calumny, scurrility, and all the ignoble passions characterize a large
portion of the faculty in an age so enlightened as the present ?

Had we been disposed to be cynical towards Dr. Laurie, we need not
do more than refer him to the excellent report of surgical cases
which occurred in the Glasgow Infirmary, among which he will
observe an account of a case entitled “ Hernia punctured by mistake
for hydrocele, death, inspection,” and this by a surgeon who resides
within five miles of Glasgow. Dr. M. S. Buchannan, who published
the report, refrains from disclosing the name of this enlightened
Esculapian, and evinces more sense, judgment, and professional
etiquette by so doing, than by calling him a murderer, as Dr. Laurie

Bibliography ,

538

has thought fit to designate one of the most scientific anatomists
and surgeons of another country. If he takes the trouble to peruse
modern medical literature, he cannot fail to discover, that fallibility
is the lot of all practitioners; he will discover, that “ to err is human,
to forgive divine.”

1*2. Case of Axilliary Aneurism , in which the Subclavian Artery was
successfully secured in a Ligature. By Valentine Mott, M.D.

William Hines, aged twenty-eight, of Smithville, Virginia, came
to New York, August 24th, 1880, and became my patient.

The account he gave of his case was, “ that about seven weeks
ago he received a violent strain while carrying a canoe on hand-bars
across the arms, which was followed by an extensive discoloration of
the skin of the right arm, extending to the chest, and attended with
considerable pain. It, however, yielded to the usual remedies in
such cases. Three weeks subsequent to the accident he observed a
swelling about the size of a pigeon’s egg under the right arm,
which had rapidly increased.”

On examination, I found a tumour about the size of a goose egg,
and decidedly an aneurism of the axillary artery. His general health
being good, 1 directed him to keep quiet, to be bled, and to take
some purgative medicines; and fixed on Monday, the 30th, for tying
the subclavian artery.

At 11 o’clock, a. m. he was placed upon the table, with the
shoulders elevated and inclined to the right side. An oblique in¬
cision was made, two inches in length, through the integuments and
platisma myoides muscle, and corresponding to a middle line of the
triangular interval formed on the inner side by the scalenus muscle,
on the outer by the omo-hyoideus, and below by the clavicle. The
cervical fascia was next divided to the extent of an inch, and ’with
the forefinger and the handle of a knife, the adipose and cellular
tissues were put aside, and the artery readily exposed as it passes
from between the scaleni muscles. After denuding the artery a little
of the filamentous tissue with a knife rounded at the point, and cut¬
ting only at the extremity, a ligature was conveyed around it, from
below upward, by the American needle , and the artery tied a little
without the scalenic muscles.

No other ligature was required. The patient lost less than two
tea-spoonsful of blood. The operation lasted about fifteen minutes,
and was performed, with the assistance of Drs. Vache and Nosacks
in the presence of Drs. Barrow, Kissam, Rogers, and Wilks. The
wound was closed by two stitches and adhesive straps ; the arm
was immediately wrapped in cotton wadding ; no diminution of tem¬
perature took place.

8, p. m. Found the patient comfortable; says he has less pain in
the arm than before the operation ; heat rather more than natural ; a
faint pulsation in the right radial artery ; pulse 88.

31st. Morning. Passed a comfortable night after taking fifteen
drops of the sol. sulph. morphine, which was given to allay the pain
about the elbow, and which he considered rheumatic, having had

Surgery.

519

more or less of it for some time previous to the operation. This pain
was no doubt caused by the pressure of the tumour upon the brachial
plexus. Pulse 70 ; skin natural ; says that he feels very comfortable.
— Evening. Complains of head-ache ; directed a saline cathartic ;
pulse 90 ; skin pleasantly moist ; pulsation in the right radial artery
occasionally very distinct and regular ; temperature of the right arm
a little higher than that of the left.

September 1st. Pain of the arm obliged him to sit up most of the
night in an easy chair — after the operation of the salts, took again
fifteen drops of the morphine, and slept quietly about five hours.
Feels at present very comfortable ; pulse 75 ; not the least evidence
of febrile disturbance in any of his symptoms.

2d. Feels much more comfortable than yesterday; slept composedly
all night ; little or no pain in the arm : pulse 80 ; removed the
wadding from the arm, and enveloped it in flannel, which keeps it
very comfortable.

3d. Slept well all night after taking his dose of morphine, and
feels very well to-day ; pulse 74 ; pulsation of the right radial more
regular and distinct,

4th and 5th. Continues to improve.

6th and 7th. Every way comfortable; right radial pulsates regu¬
larly, though more feeble than the left.

9 th. Dressed the wound and removed the stitches ; mostly healed,
except where the ligature from the artery passes out. Pain in the
arm for some days past has not been felt ; makes no complaint ;
pulse in the radial artery very distinct and regular with the actions
of the heart.

1 1th. Dressed the wound, which looks remarkably well ; every
thing appears very favourable.

14th. On removing the dressings to-day, the ligature came away ;
all promises well.

20th. Wound being just closed, permitted him to walk about the
room, and to take his usual allowance of food ; aneurismal tumour
much diminished in size, and very hard.

27th. Left the city to-day on his return by water to Virginia.

When I reflect on the disease for which this operation was per¬
formed, and upon the situation, importance, and size of the vessel
which was tied for its removal, it appears to me almost incredible
that but twenty-seven days should have been required for its cure.
That it should have succeeded is particularly grateful to my feelings,
inasmuch as it was first successfully performed by an American sur¬
geon, and is an additional proof of the triumph of surgery over
disease and death. — American Journal of the Medical Sciences,
Feb. 1831.

13. — Illustrations to Mr. S. Cooper’s Surgical Dictionary. — Each
Part contains four lithographic plates, with letter-press descriptions
and references to the text. These illustrations are published monthly,
and eight parts have now appeared. Such a work as this has long
been a desideratum, both to the student and established surgeon.

520

Bibliography .

Though nominally illustrations of the Surgical Dictionary, these are
really delineations of every other system of surgery. The plates
are faithfully executed, many of them beautifully coloured after na¬
ture, and so very cheap as to be within the reach of students. We
wish the author that success which he so well deserves, and con¬
scientiously recommend his work to every class of our readers.

14. — The Surgical Anatomy of the Principal Vessels of the Head.
Published by John Wilson, Princes Street, Soho. — This is an ex¬
ceedingly well executed delineation of the arteries and veins of the
head, face, and neck in the adult, and deserves place in the collec¬
tion of plates of every anatomist. It is useful in explaining the
danger of wounds of the parts which it represents, and facilitates
the labours of the dissector, in this important piece of human ana¬
tomy. It reflects great credit on its author.

15. — Views of the Pelvis, shelving the natural Size, Form, and Re¬
lations of the Bladder, Urethra , Rectum , Uterus, Sc. Sc. in the Infant
and in the Adult, taken from Preparations made for the Museum of the
Royal College of Surgeons in Ireland. By John Houston, M.D.,
Curator of the Museum, and Demonstrator of Anatomy in the Royal
College of Surgeons in Ireland, &c. — These views illustrate the
relative situation of the pelvic viscera in the male, female, and in¬
fant, and will be referred to with advantage in the anatomy and
pathology of these important Viscera. The lithotomist and obste¬
trician will find them well worthy of notice.

16. — Observations on Distortions of the Spine, with a few Remarks
on Deformities of the Legs. By Lionel Beale, Member of the Royal
College of Surgeons, &c. 8vo. pp. 102. — This is an Appendix to
the author’s work on Deformities, which is now out of print. In
reviewing that excellent work a few months ago, we spoke of it, as
we do of all works that come before us, as it deserved ; and it affords
us satisfaction to find our high opinion of it now amply confirmed.
The essay before us is replete with instructive information on the
various subjects enumerated in the title. We have no space, at this
late period of the month, to make extracts ; but we assure our junior
readers that this production is worthy of their attention. If it con¬
tained nothing more than the section on deformities of legs of weakly
children, and the judicious advice for the management of these
alarming though harmless complaints, it ought to have a place in
every medical library. It contains a good account of spinal irrita¬
tion, inflammation, and curvature, with cases in illustration. We
shall notice it fully in our next.

17. — The Art of Cupping- being a brief History of the Opera¬
tion, from its origin to the present time-, with a Description of the
various Instruments employed, Sc. Sc. By George Frederick Knox,
Cupper at the Westminster Hospital, Central Infirmary, &c. &c. —
The young practitioner will find this work of great service, more
especially if he is not a practical cupper, and even the established
practitioner will peruse it with advantage ; of course we speak of
that part of the work which relates to cupping itself : we cannot

Surgery.

521

speak so well of that part which relates to medicine ; but this de¬
traction is to be ascribed to the conciseness of the work. Mr. Knox
forgets that, when recommending cupping in certain diseases, he
should specify the particular states which require it ; or he may lead
(perhaps) young practitioners into very serious mistakes. It is not,
we believe, the practice at present, and it requires facts to prove
its utility before it is recommended, to cup in cases of anasarca ,
huho, cephalalgia , catarrh , hernia humoralis, hydrocephalus, nodes,
phthisis , ptyalism, &c. Our readers will perceive that many of
these affections are more frequently symptoms than diseases, and
symptoms even of very different diseases, so that a general rule for
prescribing cupping in these complaints must be followed with great
caution. As an excellent and cheap manual for the study of cup¬
ping, this production cannot be surpassed.

Mr. Knox describes a torch for exhausting the glass, which we
believe is not in common use. We subjoin his account of it. “ It is
nothing more than a brass or silver tube, abut six inches in length,
containing as many folds of common lamp cotton as can be tightly
pulled through by means of a piece of twine : one end of the tube
is bevelled from the edge on one side to about three quarters of an
inch, to allow of the better spreading of the cotton; to the other end
is screwed on a piece of tube, about half an inch long, which is at¬
tached to a ring an inch in diameter, for the purpose of slipping
over the finger, or for holding conveniently in the hand. A flat
plate of the same dimensions would be equally serviceable.

The end of the cotton should project about half an inch beyond the
tube, and be trimmed round with the scissors into something like a
mop shape ; and in its use care should be taken, after it has been
saturated in the spirits of wine, to squeeze it tightly against the
neck of the glass as it is withdrawn, and to draw the lower edge
over a towel. The object of this is to guard against the spirit in its
inflamed state dropping upon the skin, which would otherwise hap¬
pen when the torch was moved with rapidity, or if the torch were
grazed along the skin in its wet state. — p. 34.

He likewise mentions the glass-leech of Dr. Fox of Derby, by one
application of which he has abstracted thirteen ounces of blood, and
frequently eleven ounces. The scarificator, after being used, should
always be sprung through a bladder of lard or some such substance
to preserve the lancets in proper order.

Cupping on the temple is the most difficult and the most painful :
a branch of the temporal artery should be selected, as the blood will
flow more readily ; should it be necessary, the artery may be com¬
pletely divided afterwards with a lancet, to arrest haemorrhage or to
prevent aneurism, which occasionally happens. After applying the
glass, the lower edge should be gently and slowly raised to remove
the pressure from the vessels, as, until that is done, the wounds will
not bleed. On the back of the head, the part must be cleanly shaved,
or the rough hair will raise an edge of the glass and admit air. The
large scarificator should be used behind the ear, and on the throat ;

Vol. VI. no. 36.

522

Bibliography .

the oval glass and the temple scarificator are best. The position
most favourable for cupping on the throat, is the recumbent, with
the head bent towards one side.

“ Those who calculate the pain incurred in cupping by comparison
with a cut finger, are very much deceived : in fact, there is rarely
any pain felt in this part of the operation, nor is any inconvenience
suffered from it afterwards.”

This is not always the real circumstance of the case. We know
from personal experience, that when cupped in the contrary direction
to the fibres of the muscles on the chest, whenever the arm was
moved, the pain was very severe, resembling the drawing of a blister,
as also when cupped on the deltoid. Upon the whole, we pronounce
this a highly useful publication. It contains every information that
can be desired for the successful and judicious performance of the
very important operation of which it treats. It ought to be in the
possession of every medical student and young surgeon.

MATERIA MEDICA.

18. On Peruvian Bark. Dr. Carpenter, of Philadelphia. In this
paper Dr. C. describes a species of bark from Maracaibo, which
is much superior to the Carthagena bark, containing more than
double the quantity of cinchonia and quina, and also more extracts ;
it bears the same price in the market. It is more compact than
the Carthagena bark, breaks with a short and clearer fracture,
and is more intensely bitter. It has only appeared within a year or
two in the market. — American Journal of the Medical Sciences, ut
supra cit.

19. On the Utility of Strychnia in certain forms of amaurosis . —
If a person be suffering from loss or diminution of the power of
vision from an atonic state of the retina, or other part of the nervous
apparatus of the eye, or of the system generally, the local use of
strychnia (applied in the following manner) — will be, in my opinion,
the most likely means of removing the defect, more especially if it
be of recent occurrence. But it will, in many instances, be found
necessary to institute a most rigid examination, before deciding upon
the necessity or propriety of the treatment : for instance, the history
of the patient must be closely investigated, and the eye subjected to
the most attentive examination, and if the result of this enquiry and
examination lead to the opinion that the defect does depend on the
atonic condition of one, or all the parts to which I have just alluded,
he may, with safety, be subjected to the very tedious and somewhat
painful plan of treatment it remains for me to explain; but it will be
readily admitted that if this examination be not conducted in the
most careful manner, it will be impossible to discriminate, with any
approach to certainty, the particular conditions of the retina, and
other parts of the nervous apparatus of the eye, productive of amau¬
rosis, which admit of alleviation or removal : nor can the trial of
strychnia, without such a preliminary investigation, be viewed, as
otherwise than a rash and criminal procedure ; a procedure which is

Materia Medica.

523

more likely to destroy the power of vision for ever, than to yield any
prospect of relief.

The manner of employing it is as follows : — Place a narrow
blister over each eye-brow, which must not extend beyond a line
drawn upwards from the external canthus ; when it has risen
sufficiently, cut away all the cuticle, and apply, for half an hour,
a piece of linen, to absorb the serum, which is apt to be discharged
in large quantities, for a short time after the removal of a blister,
then dust the remedy chiefly in the situation of the supra-orbitary
nerve, but not so thickly as to prevent the entire absorption of the
whole layer of the powder, at the time of the second dressing, which
should be, as nearly as possible, twenty-four hours afterwards;
twenty-four hours between each dressing is a proper and necessary
interval ; cover the blistered surface with a piece of linen very thinly
spread with ung. cetacei, for, if much greasy matter be mixed with
the powder, it is less easily and quickly absorbed; but, unless a
little be applied, the linen adheres to the wound, and occasions great
pain in its removal. Increase the dose of strychnia very gradually,
until the state of vision is improved, or symptoms indicative of the
injurious agency of the remedy occur. If there be much local pain
excited by the application of the strychnia, dilute it with flour, or
mix it with opium ; and if that does not succeed, suspend its emplo}^-
ment until the stomach and bowels be improved, by a plan of treat¬
ment instituted expressly for their benefit, and then resume its use ;
if severe pain in the head, convulsive muscular twitchings, great
general nervous excitement, or other symptoms, denoting the inju¬
rious agency of the strychnia upon the constitution, supervene, and
the condition of vision be not improved, it must be discontinued
altogether ; as it would appear probable that in such case it was not
likely to exert a favourable influence upon the disease, at the same
time, that, from some peculiarity of constitution, it was calculated
to do important general mischief.

This paper is highly interesting, in regard to its pointing out the
particular cases in which the strychnia is serviceable — it will be
found important to the practical reader.-— Mid. Med. # Surg. Rep.

MIDWIFERY.

20. Accidents caused by allowing a pessary for years in vagina
related by M. Ricord. — The unfortunate subject of this case was
aged 61 years, and had a pessary passed in 1825, since which time
it had remained. M. Lisfranc divided the perinseum, in order to
effect extraction of the instrument : death ensued, and there existed
cancerous vegetations and gangrenous perforations in the bladder and
rectum. — Journ. Univ. et Hebdomadaire de Med. Chir. Pratiques.

This case affords a salutary lesson to those surgeons who maintain
that a pessary may be left in the vagina for an indefinite period,
without producing mischief. Such is the sapient doctrine supported
at our debating societies, and by those engaged in teaching ob¬
stetrics. The truth is, that we have lecturers on all branches of

524

Bibliography ,

medical science in London, who promulgate as ridiculous opinions as
students of three months’ standing. This defect is at length per¬
ceived by the constituted authorities, who now deem it necessary to
require strong proofs of the teacher’s competency to warrant his re¬
cognition. On the occasion to which we allude, it was held to be
quite unnecessary to withdraw a pessary once a week, for the purpose
of cleaning it ; that the speaker had known a case in which one was
worn for three years without removal or inconvenience. Now any
medical practitioner, of the most ordinary comprehension, must, on a
moment’s reflection, see the utter fallacy of such statement, when he
remembers that the presence of a foreign body, on a mucous surface,
must inevitably induce irritation, and inflammation, and ulceration
in a shorter period than two or three years. It must be unnecessary
to dwell farther on a matter so obvious. The negative assertion was
one of these false facts with which the faculty is so redolent at the
present period.- — Ed.

21. Signs of Pregnancy before the fourth month. — M. Bescaria
informs us in the Italian Journal, from which we have already quoted,
that there is a circumscribed pain in the occipital region, or according
to Gall in the reproductive organ, soon after conception ; somnolence
soon supervenes, and pains return daily at the same hour.

CHEMISTRY.

22. — On a New Process for -preparing Medicinal Prussic Acid. By
W. Thomas Clark. — It is of the highest importance that a medicine,
so powerful in its operation, so sudden, and so transient, should be
of an uniform strength, and as it is impossible to rely on the manu¬
facturer’s preparing it in such a manner, Mr. Clark has been induced
to give a formula for its preparation by the apothecary ; it appears
easy, and, if generally adopted, will obviate such, at least, of those
objections to the use of the hydrocyanic acid which arise from the
uncertainty of its dose.

Take of

Tartaric acid - - 72 grains.

Cyanide of potassium - - 32 do.

Distilled water - - 1 ounce.

In an ounce phial, furnished with a cork or stopper, which should
by previous examination, be ascertained to be sufficient, dissolve the
tartaric acid in the water. Then add the cyanide of potassium, and
immediately thereafter insert the cork or stopper, which for a little
must be preserved firmly in its situation by the finger. Meanwhile
agitate, keeping the vial immersed in a basin of cold water, in order
to repress the heat produced in the process. When all action has
ceased, set the phial aside in a cool and dark place for twelve hours,
in order that the cream of tartar formed may subside. Afterwards
decant the liquor, which preserve in a phial in a cool and dark place.

A decomposition ensues, and cream of tartar and hydrocyanic acid
are formed : the supertartrate of potass is precipitated in a great
measure, and is to be removed ; a small portion (about one-fifth of a

Chemistry .

535

grain in a dose, supposing the ounce to contain twenty-five doses,)
remains dissolved, but it is so inconsiderable as to require no atten¬
tion to be paid it. Indeed, chemical purity is often obtained at the
expense of medicinal uniformity.

The ounce contains about thirteen grains of hydrocyanic acid —
somewhat similar to Vauquelin’s prescription. Mr. Clark antici¬
pates that when this process is generally adopted, the cyanide of po¬
tassium will be supplied by the manufacturers ; but we incline to
think, with all due deference to Mr. C., that it is something like
“mettant la charuce devant les bceufs.” We think the cyanide of
potassium must be freely obtained, before this process will be put in
use by the apothecary.

The method of obtaining the cyanide of potassium is rather too
complicated for any gentleman at all engaged in practice to employ.
It is to be obtained from the prussiate of potash of commerce, which
consists of one part of water, two of cyanide of iron, and five of
cyanide of potassium. In this process —

The water is to be driven off by moderate heat, the residue to be
finely pounded, and again moderately heated, by which we obtain
a white powder, weighing seven drachms.

Now, out of every seven drachms which remain, two are cyanide
of iron, and five are cyanide of potassium ; and these two cyanides
are very different, in this respect, that if exposed to heat the cyanide
of iron is entirely decomposed, but hot so the cyanide of potassium,
at least in close vessels : I say in close vessels, because if the cyanide
of potassium were strongly heated in contact with oxygen, or with
steam, it also would be liable to decomposition. Therefore put the
dried powder (to the extent of forty or eighty ounces, if you choose)
into a wrought iron bottle, such as apothecaries get mercury in. This
bottle must be furnished with an iron tube, which must screw into
the bottle, in the place of its iron screw stopper. This tube should
also be bent in a curve at a few inches from the bottle, so that while
the bottle is perpendicular the straight part of the tube may be
horizontal ; and to the open end of this tube one more flexible must
be joined, so that the open end of the latter may be immersed in a
cup of water. Now-a-days nobody can have any difficulty in getting
such tubes ; for the people who fit up gas pipes have them in abun¬
dance.

The iron bottle, thus filled and thus furnished, is to be put on a
smart fire, and to be kept there so long as gas is evolved. Cyanide
of potassium remains intermixed with iron and charcoal, resulting
from the decomposed cyanide of iron. We dissolve out the cyanide
of potassium by water ; we filter ; we concentrate by evaporation ;
we set aside for crystallization ; we concentrate again the mother
liquor ; and thus continue till we entirely separate the cyanide of
potassium. This salt being deliquescent, is to be dried at a gentle
heat, and to be kept in bottles well corked.

It is likewise considerably cheaper. — Glasgow Med. Journal. May.

[ 526 ]

MISCELLANIES.

23. Expulsion of Dr. Ramadgefrom the London Medical Society .—
The Medical Society of London, the oldest and one of the most
respectable in this metropolis, expelled Dr. Ramadge, for his advocacy
of Long, the Quack, and his abuse of the medical profession. We
have been informed, upon the best authority, that the College of
Physicians will adopt a similar proceeding.

24 — Dr. Ramadge’ s Reply to the Editorial Remarks on his Defence
of Long the Quack. — It is almost unnecessary to make a single com¬
ment on the following letter, which is no reply whatever to our
strictures on the impropriety and unprofessional conduct of any re¬
spectable physician or surgeon, in defending such an illiterate humbug
as this empiric. The London Medical Society has confirmed our
opinion, which indeed must be that of every respectable member of
the profession. We have no wish to prolong this painful discussion,
but may inform Dr. Ramadge that we know much more about it
than he imagines. It appears he did not send the letter to the Sun¬
day Times ; but any man of common sense must see it was intended
for the public eye. He next endeavours to escape from his assertion,
that there was only abrasion of the cuticle in the eschar on the back
of Miss Cashin, though it was proved in evidence by Mr. Brodie,
Mr. King, and others, there was a sore or eschar the size of the
mould of a hat, or of a supper plate, and a large slough in the
centre. Dr. R. labours under a mistake, when he supposes we have
not seen an account of the autopsy. He will find it at length in our
fifth volume. As to the extracts quoted by him, we have never
denied nor contradicted them ; and our only regret is, that he to
whom they applied should descend from his high station to bring
them to his aid in defending a notorious aud incorrigible Quack. We
leave the reader to form his own opinion on the value of the fol¬
lowing very polite letter : —

To the Editor of the London Medical and Surgical Journal.

Sir, — As it is impossible for me to reply to the numerous unmanly
and mendacious attacks made upon me in some of the medical jour¬
nals, and in yours among the rest, I shall here confine myself to
noticing one or two errors under which you appear to labour.

In the first place, it is not true that I sent any letter to Mr. Long
through the medium of the Sunday Times. The letter in question
was addressed by me to Mr. Long in answer to one in which he
appeals to me as an honorable man to give a candid opinion on the
cases of two ladies who had previously been under his care, but who
died in the hands of Mr. Brodie and Mr. Vance. It first appeared
in Mr. Long’s last publication, and from thence found its way into
the newspapers.

In the next place, it is not true that Miss Cashin had no disease of
the lungs, or never was consumptive. In proof that the contrary of
what you state is the fact, I beg leave to refer you to the report of

Miscellanies .

52 7

the post-mortem examination by the medical witnesses, which docu¬
ment you do not appear to have seen, as well as to my letter inserted
in the London Medical Gazette of the 14th of this month. You are
pleased to assert that there was no abrasion of the cuticle from the
effects of putrefaction, which last you say had not taken place.
This is false ! The commencement of the report runs thus : “ An¬
teriorly over the abdomen and thighs the skin peeling, apparently
from the effects of decomposition. The skin of the neck, shoulders,
and face covered with green reticulations in the course of the blood
vessels, the neck above the clavicles swelling and puffy, feeling
when pressed as if containing air ; likewise all the cavities of the
heart were in a state of effervescence and decomposition.”

To your illiberal remarks, and the ridicule you wish to excite
against me respecting the opportunities I possess of examining dead
bodies, I shall merely reply by quoting your own words, which I
extract from your Manual of Midwifery. At page 53, you observe,
“ my much respected friend Dr. Ramadge, whose opportunities of
opening dead bodies are unequalled, and whose industry has been in¬
defatigable in the pursuit of morbid anatomy for many years, has
a beautiful specimen of disease under consideration in his select and
valuable museum, a part of which can be seen at the Central In¬
firmary, Greville-street. I am deeply indebted to the kindness of
that able pathologist ; the result of whose labours l am happy to say
ere long will be submitted to the profession, as the work of Dr.
Baillie is universally acknowledged to be defective.” At page 92,
is the following : — “ Dr. Ramadge has a most extraordinary specimen
of diseased uterus; the organ weighed ten pounds, and contains
various structures, as cancer, schirrus, calcareous depositions, mus¬
cular thickening, fungus and bone.” Moreover, in speaking of
ovarian disease, in your preface you speak of the museum of “ my
able and talented colleague Dr. Ramadge.”

How you can reconcile these your former observations with the
sentiments you express towards me in the last number of your
Journal, it is not for me to determine ; but on these points I have
much pleasure in reflecting that your readers are competent to form
an opinion of their own*

To conclude, I have only to state, that whether the opinion I have
given in the two cases referred to, be or be not palatable to the me¬
dical profession, is to me a matter of perfect indifference. I know
enough of the subaltern membeis of the faculty, to be able to ap¬
preciate their factious and illiberal proceedings. I have seen enough
of their acts and deeds to be convinced that he who wishes to arrive
at eminence and be useful in his vocation, must disentangle himself
from their petty cabals, and those orgies where ignorance is a virtue,
and passive obedience a duty.

Requesting the insertion of this letter in your next number,

I remain, Sir,

Your obedt servV

F. H. RAMADGE, M. D.

21s£ May, 1831,
Ely Place.

528

Miscellanies.

25.— London University. — Dr. Elliotson has been appointed Pro¬
fessor of Practice of Medicine in the London University ; and it is
said that Mr. Quain, the distinguished anatomist, of Aldersgate-
street School, will be the successor to Mr. Bennet. There are few lec¬
turers more popular than Mr. Quain, as he possesses the rare qualities
of eloquence and sterling talents. His appointment would be highly
advantageous to the University, and very satisfactory to the profes¬
sion. ' -

LIST OF BOOKS RECEIVED DURING THE MONTH.

1. Illustrations of Mr. S. Cooper’s Surgical Dictionary, published monthly.
Parts VII. VIII. IX. X. XI. and XII. each containing Four Lithographic Plates,
with Letter-press Descriptions and References to the Text. London, Longman
and Co. 8vo. 1830. See our present number.

2. Views of the Pelvis, shewing the natural size, form, and relations of the
Bladder, Urethra, Rectum, Uterus, &c. &c. in the Infant and in the Adult, taken
from Preparations made for the Museum of the Royal College of Surgeons in
Ireland. By John Houston, Curator of the Museum, and Demonstrator of Ana¬
tomy in the Royal College of Surgeons, Ireland, etc. Dublin, Hodges and Smith,
and Leekie; T. and G. Underwood, London; and Maclachlan and Stewart,
Edinburgh. 1829, 4to. Noticed in this number.

3. Surgical Anatomy of some of the principal Vessels of the Head. Wilson,
London. See a proceeding page.

4. The Art of Cupping ; being a brief History of the Operation, from its origin
to the present time ; its Utility ; minute Rules for its Performance ; a List of the
Diseases in which it is most beneficial, and a Description of the various Instru¬
ments employed, &c. &c. By George Frederick Knox, Cupper at the Westmin¬
ster Hospital, the Central Infirmary, See. & c. Dedicated, by permission, to the
Physicians, Surgeons, and Pupils of the Westminster Hospital. London, T. and
G. Underwood. See our present number.

5. Lectiones Celsianse et Gregorianee ; or Lessons in Celsus and Gregory, con¬
sisting of Passages from those Authors syntactically arranged, with copious Obser¬
vations explaining the Difficulties of Construction, and a Lexicon of the Words.
To which is added, a succinct and comprehensive Grammar, written and adapted
for the work. For the Use of Medical Students. By W. Cross, Teacher of the
Classics, and Medical Latin. Wilson, London. l2mo. 1831.

6. The Art of preventing the Loss of the Teeth ; with Instructions calculated
to enable Medical Practitioners, Heads of Families, and others, travelling or re¬
siding in distant parts, to adopt the Author’s Practice of treating the Diseases of
the Teeth and Gums; including the stopping of decayed Teeth, and curing of
Tooth Ache, by the Use of the Anodyne Cement, &c. See. Also stating the
Improvements in fixing Artificial Teeth, and a Description of the Sciliceous Pearl
Teeth, and Teeth Renovator ; with Testimonials from their Majesties’ Physicians
and Surgeons. By Joseph Scott, Dentist. London, Simpkin and Marshall. 8vo.
1831.

NOTICE TO CORRESPONDENTS.

We have been informed that Dr. O’Shaughnessy is not the author of the Com¬
ments on Toxicology, to which we referred in our last ; but we were led to think
otherwise by the accuracy and profound knowledge displayed in these essays—
qualities which characterize all his productions on the detection of poisons.

Mr. Pereira will find the matter in our next.

ERRATA IN OUR LAST.

Page 370 — 20th line from top, for “ rite,” read “ series.”

- 373 — 2d line from bottom, between “distinct” and “ regarded,” insert

“ been.”

- 402 — 3d line from bottom, for “ sanguilent,” read “ sanguinolentrJ’

- 405 — 7th line from top, for “cadine,” read “iodine.”

- 412 — 16th line from bottom, for “ citrate,” read “ tartrate.”

- - 426 — 16th line from top, after “ blister,” add a comma.

All Communications and Works for Review are to be addressed to the care of
Messrs. Renshaw and Rush, (near Exeter Hall,) 356, Strand; or to the Editor,
at his Residence, 61, Hatton Garden.

I N D E X,

VOL. VI.

Page

A. •

Abernethy, Mr. death of. . . 431

Acids Mineral, poisoning by . 414

- - poisoning by. Dr.

Ryan, on . 404

- symptoms, and au¬
topsies..... . 405

■ - treatment of . 406

- - - tests for .

- sulphuric & nitric, tests for 407

- hydrochloric (muriatic)

phosphoric . 408

- oxalic . .411, 414

Acupuncturation, Dr. Banks on ... . 425
Air, change of. Dr. Johnson on. . . . 257
Alderson, Dr. introductory lecture

by . 361

Alison, Dr . outlines of physiology

by. . 191

Alienation mental, M. Regnault on 364
Albugo, case of, by Mr. Foote. . . . 496
Amaurosis, case of, by Mr. Nice .. . 496
Amaurosis, case of strychnine, in .... 521

Anatomical atlas, by Weber . 329

Anatomy, Mr. B. Cooper’s lectures on 35
Anatomy, Dr. Quain’s lectures on. . 197
Anatomy, Mr. Heurteloup’s know¬
ledge of . 328

Anatomy, Mr. Paxton on . 360

Anatomy, surgical of the head . 520

Andral’s Pathology, by Townsend

and West . . Ill

Aneurism of the abdominal aorta . . . 178
Aneurism of the axillary and sub¬
clavian arteries . 518

Aneurism of the external iliac, case of 25
Aneurism of the common iliac. .... 27

Aneurism of the gluteal artery, liga¬
ture on the internal iliac, by

Stevens . 31

Annual Medical, by Dr. Reece .... 247
Antimony, tartrite of, large doses

of, in pneumonia . 2, 507

Antimony, tartrite, use of in neu¬
ralgia . . 511

Aorta, ligature on, by James and
Crampton . . . 25, 27

Page

Apoplexy of lungs, value of ste¬
thoscope in . 188

Argenti nitras, colour of skin from. 511

Arsenic, effects of as a poison . 416

Arteriology, Borreman’s, bv Mr.

King . . ‘ . 329

Asbestos, M. Aldini’s dress of .... 254
Asphyxia, Essay on by Dr. Ryan. . 30S

Atlas, anatomical, by Weber . 329

Autopsy mode of in infanticide .... 126
Auscultation, value of in diag¬
nosis . . 6, 188

Banks, Dr. on acupuncturation .... 425
Barlow, Mr. on fungus hcematodes. 32

Beale, Mr. on deformities . 520

Beatty, Dr. on aneurism of the aorta 178
Beatty, Dr. on instruments in diffi¬
cult labours . 181

Beatty, Dr. on cancer uteri, cure of

by coition . 187

Beck’s Jurisprudence, by Dr. Darwall 441
Billing, Dr. on principles of me¬
dicine . 39

Billing’s, Dr. case of hydatids in

liver, lungs, &c . 58

Blake, Dr. on bad effects of tight

lacing . . . 484

Blane, Sir Gilbert, on Naval me¬
dicine . 236

Browne, Dr. on tracheotomy .... 424
Browne, Mr. E. on natural phi¬
losophy . 65

Buchanan, Dr. on dysentery . 373

Burne, Dr. on the motion and
' structure of the heart . . 505

Calculous diseases, Mr. Hutchinson

on . • * • • . 125

Calculus urinary, Mr. Syme on ... 422
Cancer of the nose M. Lisfranc on. 74

- - uteri, cure of, by coition 187

- cure of, M. Recamier on 511

Castle’s, Mr. Manual of Surgery . . 196
Cautery actual, cu^ of vesico-va-

ginal fistula, by . 50

530

INDEX.

Page

Cerebri Fungus, by Dr. Tuthill ... 42

Csesarean operation, by Mr. Stirling 44

- - - by Dr. McKibbin 428

Change of air, Dr. J. Johnson on 257
Charter of London University ...... 343

Chemistry, Rose’s, by Mr.. Griffin 300
Chest Diseases, of Drs. Graves and

Stokes on . 1

Chlorine, poisoning by . 409

Cholera, Dr. Ryan on . 212

— - Mr, Searle on . 404

- Dr. Short on . . 482

Cock’s, Illustrations of Surgery . . . 519

Clarke, Mr. on new mode of pre¬
paring prussic acid . . 524

College, Ring’s, appointments at 254, 430

- of Surgeons, regulations of,

relating to their library . . 431

Colies, Dr. on diseases of the rectum 170
- - on vascular tumors . 176

- - - hsBtnorrhoidal excrescence. . 11

Colica constipata, cured by inflation,

by Mr. King . 330

Collins, Dr. on lacerated uterus, &c. 187

- - on extra uterine foetation 190

Colon, transverse, found in the chest 11
Congenital incontinence of urine, by
Dr. Otto .... ............... 333

Consumption, Sir C. Scudamore
on the cure of, by inhalation .... 33

Cooper, Mr. B. on anatomy . 35

Coster’s Manual of Surgery, by Fife 443
Cornea, .sloughing of, from lime,

by Mr. Foote, junr . 495

Crampton, Mr. on tying the com¬
mon iliac . 27

Cranium, Fractures of, by Dr. Tuthill 41
Croton, Oil, efficacy of in inter-

mittents . 396

Cupping, Art of, by Mr. Knox . . 520
Cusack, Dr’s. Report of the Wellesley
Lying-in Hospital . 12

Davy, Sir H. Life of, by Dr. Paris. 139
Defence of St. John Long, by

Dr. Ramadge . 433

Defloration, Female, medico -legal

questions on . . . . 132

Deformities, Mr. Beale on . 520

Demonstrations, anatomical, by

Seerig . 329

Dislocations, old. Dr. Laurie on . . . 513

Dissection, mode of, in infanticide . . 126

Dublin Hospital Reports . 1, 169

Dublin Lying-in Hospitals, account

of. . 12

- - Medical Transactions . 181

Dupuytren’s, operation for obli¬
teration of vagina . 76

Page

Dysentery, causes of, by Dr.

Buchanan . 373

Dyspepsia, Dr. Mayo on . 446

Elaterium, analysis of . 426

Elements of Surgery, by Mr. Liston 37
Ellioison’s, Dr. Appointment to the
Chair of Medicine in the London

University . 528

— - on Glanders in human

subjects . 125

Emetic tartar in pneumonia . 1, 507

Emetic tartar in neuralgia . 1, 511

Enlargement of the Spleen, Mr.

Swift on . 49

Epps, Dr. Life of. Dr. Walker, by 280

Ergot of rye in menorrhagia . 428

Excision of the elbow-joint, Mr.

Syme on . 335

Expulsion of Dr. Ramadge from the
London Medical Society . . . 526

Femur, fracture of neck, &c . 75

- shaft, cured

by wire seton . . 122

Ferguson, Dr. J. C. on pulmonary

apoplexy . . . 188

- on anomalous labor 191

Fistula, vesico-vaginal, cure by actual

cautery . ; ....... i < 50

- cases from pessary . 523

- Recto-vaginal, by same .... 523

Foetation, extraordinary case of . . . 255
Foetus, Physiology of. Dr. C. Hol¬
land on . . . 292, 345

Follicular origin of vaginal tumours 163
Foote’s, Mr. Junr. Report of the
Westminister Ophthalmic Hospital 488
Foote, Mr. Junr. on the cure of

purulent ophthalmia . 489

- Cases of purulent

ophthalmia from gonorrhoea . 489

- - - . leucorrhoea. 491

— - - •gonorrhoeal ophthalmia 493

- - muco-purulent . 493

- pustular inflammation .. 494

- ophthalmia from lime. . 495

- - sloughing of conjunctiva

from lime . 495

- - - albugo, cure of . 496

Fosbroke, Dr. versus Mr. Darwin.. 243
Fractures of crainum. Dr. Tuthill on 42

■ - - — femur and pelvis . . 75, 122

Fungus cerebri. Dr. Tuthill on ... . 42

Fungus hsematodes, Mr. Barlow on 32
Fungus hsematodes, cured by am¬
putation _ . * . 245

INDEX.

531

Page

Gall-bladder, hydatids of . . 58

Geddings, Dr. on ol. terebinth in

salivation . 329

- — .on strychnia in

paralysis . 426

Glanders, in man cases of, by Dr.

Elliotson . 125

Gonorrhoea syphiloid, Mr. Swift on 51

Gonorrhoeal ophthalmia, Mr. Foote,

Jun. on . 492

Graves, Dr. on diseases of the chest 1
Gray, Mr. Supplement to the Phar¬
macopoeia . 81

Green, Mr. on distinction without

separation . . . . 468

Greening, Mr. case of infantine

survival at sixth month . 247

Gregory, Mr. Report of the Coombe

Lying-in Hospital . 12

Griffin’s, Mr. Translation of Rose’s

Chemistry . 300

Guaco, effects of in hydrophobia . . 255

Hsemathorax, Dr. R. Tuthill on . . 304
Hancock, Dr. on trismus infantum 427
Hargrave’s, Mr. operative of surgery 38
Harty, Dr. on polypus of the heart 191

Hastings, Dr. on phthisis . 332

Hatin, M. on difficult labours . 453

Hays, Dr. on ununited fractures . . 334

- criticism on Mr. Lawrence 334

Head and neck, surgical anatomy of 521
Health and disease, operation of

physical causes on . 508

- - pursuit of. Dr. J. Johnson on 257

- and longevity, Mr. Thac-

krah on . . 266, 354, 472

- of the Royal Navy, Sir G.

Blane on . 276

Heart, polypus of. Dr. Harty on . . 191

- Dr. Burne, on the motion

and structure of . . 505

Hernia, produced by tight lacing . . . .484
Heurteloup’s claims to improvements

of Civiale’s instruments . 337

- knowledge of anatomy 338

Hip-joint disease of . 209, 510

Holberton, Mr. on swelling of the

lower extremities in phthisis . 124

Homicide, Medico-legal questions on 142
Holland, Dr. on the physiology of

the foetus, &c . 292, 345

Hospital, Dublin Reports, review of 12
Hospitals, Dublin Reports of, 1,24, 48
Houlton, Mr. on the effects of cold

on plants . 74, 75

Houston, Dr. on valves in the rectum 178

Page

Houston, Dr. on views of the pelvis . . 520
Hunterian Society, Prize Medal of 430
Hutchinson, Mr. on calculous di s-

eases . 125

- appendix to the same. 125

Hydatids, case of in liver, lungs
and gall-bladder, by Dr. Billing 59
Hydrostatic test, value of, in infan¬

ticide . 63

Hyosciamus, Mr. Houlton on de¬
terioration of . 77

I. J.

Impotence and sterility. Dr. Harrison

on . 242

Incontinence of urine, congenital... 333
Infanticide, various causes of. Dr.

Ryan on . 59

Influence of temperament, in dys¬
pepsia, Dr. Mayo on . . 446

Insanity, M. Regnault on . 364

Intellect, march of . 432

Intermittents, Medicus on . 396

James, Mr. ligature on the external

iliac and aorta, by . 25

Iodine, in enlargement of the spleen 49

- in gonorrhoea and leucorrhoea 511

- poisoning, by tests for . 409

James, Mr. on tying the aorta _ 25

John Long, Trial of, for man¬
slaughter . . 248

- defence of, by Dr.

Ramadge . 433

Johnson, Dr. on change of air .... 257

King, Mr. on arteriology . 329

King, Mr. J. on colica constipata 330
King’s College, appointments at . . . 430
Knox, Mr. on cupping . 520

Lacing tight, injurious effects of . . . 484
Labours difficult, management of . . 453
Laryngitis, acute and chronic cases of 9
Law, Dr. on gangrene of the lungs 189
Lawrence, Mr. on phlegmasia dolens . 123
Leucorrhoea cure of by iodine .... 511
Lithotomy, lithotrity, Velpeau on.. 75
Lithotrity, claims of Civiaie, Costello

and Heurteloup to . 336

- - Heurteloup’s success ui . . 338

Lisfranc, M. on cancer . 74

Liston, Mr. on surgery . 37

- on restoring the columna

nasi . 165

Liver, hydatids of. Dr. Billing on. . 58

- - rupture of . . . i 394

London College of Medicine . 341

Hospital Reports from . 58

.532

INDEX.

Page

Long, St. John, Report of trial fox-

manslaughter . 248

Longevity in Russia . 430

Lungs, hydatids of . 58

Lying-in Hospitals, Dublin, Repts. of 12
Lyon, Mr. on spasm of the colon. 302

M’Dowell, Dr. cure of vesico-va--

ginal fistula, by cautery . 50

Mac Kibbin, Dr. on the Caesarean

operation . 42S

Malins, Dr. on peritonitis during

gestation . 52

- lecture on midwifery 317, 385

Manual of legal medicine, by Dr.

Sedillot . 442

Marshall, Mr. on vaccination . 216

Mayo, Dr. on temperament in dys¬
pepsia . 446

Medical Annual, Dr. Reece’s . 247

- - Reform, Mr. Green on . 468

Medicine, First Principles of, by Dr.

Billing . 39

- State of, in Turkey . 244

- - - Naval Improvement in . . 276

- Statistical * . 430

Medico-Botanical Society, Reports
of . ...77, 255 343

Medico-Chirurgical Transactions . . 122
Menorrhagia, Ergot of Rye in .... 428
Mercury and its salts poisoning by. . 414

- Effects of in neuralgia ... 511

Mental Derangement, Dr. Uwins on 344
Metallic Poisons account of, M.

Regnault on . 364

Midwifery, History of, by Dr. Malins 317

Mitchell, Mr. on hip-disease . 209

- ■ - on stricture of gall-

ducts and urethra . 398

Monstrosity, case of . 11

Mott, Dr. case of ligature on the

subclavian, by . . 518

Morbus Coxarius, remarks on .... 510
Natural Philosophy, Mr. E. Browne

on . 65

Nffivus, cure of by compression. ... 511
Neuralgia cubito-digital, Mr. Swift

on . 48

- -new cures for . 511

Nitrate of Potass, poisoning by ... 414

Nice, Mr. on Amaurosis . 496

Nose Cancer of, extirpation of . 74

- restoration of, by Mr. Liston. . 165

Nottingham Dispensary, disputes in 243

Old Dislocations, Dr. Laurie on... 513

- Critical strictures on .... 516

Oleum Crotonis Tiglii, remarks on .. 396

• O

Operation of physical causes on

health, &c . 508

Operative Surgery, by Mr. Hargrave 38

- Coster’s, by Dr. Fife .... 443

Ophthalmic Hospital (Westminster)

Report of . 489

Ophthalmia purulent, Mr. Foote Jun.
on . 489

- - leucorrhcea .... 491

- muco-purulent . 493

- pustular . 494

- - from lime . 495

O’Shaughnessy, Dr. on poisons ... 408
Otto, Dr. on congenital incontinence

of urine . 333

Outlines of physiology, by Dr. Alison 191

Paracentesis Cranii, by Dr. Conquest 255
Paralysis, Dr. Geddings on stry¬
chnia in . . . 426

Paris, Dr. Life of Sir H. Davy, by 199

- Hospital Reports of, 74, 75, 76

Pattison, Professor, defence of .... 428
Paxton, Mr. on human anatomy. . . 360

Pelvis views of . . 520

Percussion, discovery of tubercles

by . 509

Peritonitis fatal, by Dr. Malins ... 52

- Chronic, duration of. Editor

on . 55

— - Mr. Rees on . 213

Peruvian Bark, new species of .... 521

Pessaries, injuries 'caused by . 523

Pharmacopoeias, Mr. Gray on the.. . 81

- ■ Mr. Rennie . 83

- - Drs. Barker, and

Montgomeny on . 86

Phlegmasia Dolens, Mr. Lawrence

on . 123

Phthisis, in last stage, cure of .... 242

- Dr. Hastings on . 332

Physiology outlines of, by Dr.

Alison . 191

Physiology of the foetus, &c. Dr.

Holland on . 292 345

Pleuritis,hydro-thorax, stethoscope in 7

Pleuro-pneumonia, detected by per¬
cussion . 509

Potass fused and nitrate of, poison¬
ing by . 414

Pneumonia, cure of, by tartar-

Poisons, action of, on the economy.

Dr. Ryan on . . 402

Poisons, on the detection of, . 402

- irritant symptoms of . 403

mineral, symptoms of . 405

INDEX

533

Page

Poisons, autopsies by . 406

Poisoning by mineral acids and

‘ tests for . 407

- mercurial preparations and

tests for . 414

- - Compounds of arsenic . . 416

Pregnancy, phrenological sign of . . 524

- Chronic peritonitis in 213, 521

Preparations, anatomical mode of

preserving . . . 420

Productiveness, extraordinary case of 255
Prussic Acid, new process for pre¬
paring . 524

Pulmonary Apoplexy, Dr. J. C.

Fergusson on . 188

- Abscess, Dr. Gilroy on . . 425

Pulse, Dr. Burne on the . 505

Purulent Ophthalmia, Mr. Foote, Jun.

on . 489

Pustular Ophthalmia . 494

Quain, Jones, Dr. on Anatomy, &c. 197

Ramadge, Dr. Defence of Saint John

by . . .

expelled by the London

Long,

433

Medical Society
- reclamation of

526

511

150

520

247

213

468

364

Recamier, M. on Cancer .

Reclamation, of Mr. Searle . . .

Rectum valves in, discovery of .

Reece, Dr. Medical Annual, by
Rees, Mr. on chronic peritonitis
Reform Medical, Mr. Green on
Regnault, M. on mental alienation .

Remarks on morbus coxarius . 510

Rennie, Mr. on the pharmacopaeia. 83
Respiratory Organs, Diseases of . .
Richmond Hospital, Report of, bv

Mr. Swift . . ........ 48

Rivinus, Dr. on the operation of

physical causes . 508

Rose’s chemistry by Griffin ....... 300

Rupture of the liver, &c. by Dr.

Tuthill . 304

Russia, Longevity in . 430

Ryan, Dr. on infanticide . 59, 126

- the hydrostatic test . 63

• viability of new-born in¬
fants . 63

- on the autopsy of . 128

- on the violation of women 131

- signs of defloration . 132

- - purulent discharge from the

genitals of children . 135

- - - ■ ■ violation, whether

ever

followed by conception . 141

- on unnatural offences ... 141

Page

Ryan, Dr. on homicide . . . . . . 142

- - on wounds. See . 144

- -on the judiciary examina¬
tion of wounds . . 236

- - on homicide by asphyxia . 308

- - by poisoning, 401, 498

Scudamore, Sir C. on consumption. 33

Searle, Mr. reclamation . 150

- - - on cholera . 212

Sedillot, M. on state medicine . 442

Seton, use of in ununited fractures

122, 334

Short, Dr, on cholera in Russia ... 482
Society, Hunterian Prize Medal of. . 430
Somme, Dr. on ununited fracture . . 122
Spasm of the colon, Mr. Lyon on 302
Spleen, enlargement of, cured by

iodine . . . 49

Stafford, Mr. by operation for stric¬
ture . 424

Stays, effects of, in producing hernia 484
Stevens, Dr. on tying the internal

iliac . 31

Stethoscope, failure of . 509

Stirling, Mr. on the Caesarean opera¬
tion . . 44

Stomach found in the chest . . 11

Stricture, new cure for . 424

Strychnia in paralysis. Dr. Gedding

on . 426

- - amaurosis . 521

Sublimate corrosive of, poisoning by 415
Surgical Report of the Glasgow In¬
firmary . . 511

Swift, Mr. Report of the Richmond

Hospital . 48

- on cubito-digital neuralgia 48

- enlargement of the spleen 49

Syme, Mr. on excision of the elbow
joints . 335

- re-union of fractures . . . 422

' ■ urinary calculus ........ 422

Syphiloid gonorrhoea, case of . 51

Tartar-emetic in pneumonia .... 1, 507
Tartar-emetic in amaurosis, Mr.

Nice on . 496

Terebinth ol. in salivation . 329

Tetanus infantum. Dr. Hancock on 427
Thackrah, Mr. on health and lon-

Townsend, Dr. translation of An-

dral’s pathology, by . S6

Tracheotomy when a foreign body is

in rhe bronchus . 424

Trades and professions diseases caused
by . 266, 354, 472

534

INDEX.

Page

Tubero-carunculoid liver . . 509

Tuthill, Dr. on fractures of the

cranium . 41

■ ■ '■ on fungus-cerebri . 42

- on rupture of the liver, &c . 304

Typhus Fever at Warwick Bridge . . 254

U. V.

Urethra Strictures of, cure of •••• 398
Vaccination, Mr. Marshall on .... 216
Vaccine Establishment, annual re¬
port of . . . . 431

Velpeu, on lithotomy and lithotrity . 75

Violation Female, medico-legal
questions on . 132

Page

Walker, Dr. Life of, by Dr. Epps 280
West’s, Dr. translation of Andral’s

pathology . 86

Warden, of the London University,

resignation of . 431

Wounds, medico-legal questions

on . , . 142, 150

- — judiciary examination of,

by Dr. Ryan . 236

Utero-gestation, phrenological sign

of . . 524

University of London, proceedings of 528

THE END.

'• 'i,

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Full text of "The London medical and surgical journal : exhibiting a view of the improvements and discoveries in the various branches of medical science. Volume 6, January - July 1831."

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